Geographic variation of epilepsy for older Americans: How close to the geographic variation of stroke?

Purpose: Given the strong association of stroke and epilepsy in older persons, and the existence of a Stroke Belt in the United States, we hypothesized that geographic variation in epilepsy prevalence would follow geographic patterns similar to stroke. Methods: We used a 2005 5% random sample of Medicare beneficiaries 65 and older in 48 U.S. contiguous states. Epilepsy was identified from claims for physician visits, hospitalizations, and outpatient procedures. Prevalence was obtained by state and county. Logistic regressions determined the independent association of the likelihood of epilepsy (prevalent or new case) and residence in Stroke Belt states, controlling for residence in highest epilepsy prevalence states, demographics (race, age, gender), comorbid conditions, cerebrovascular disease, dementia, and county characteristics. Key Findings: Of 1,212,015 beneficiaries, 11.9 per 1,000 had prevalent and 2.9 new cases of epilepsy. Nine of 11 Stroke Belt states were among the 20 states with the highest epilepsy prevalence. Counties in the 10 highest epilepsy prevalence states were more likely to be large urban counties with a higher number of neurologists or neurosurgeons per capita. The higher likelihood of prevalent epilepsy cases associated with Stroke Belt residence was explained by beneficiaries’ race; that associated with residence in high epilepsy prevalence states was not. The likelihood of new epilepsy cases was negatively associated with Stroke Belt residence when controlling for covariates. Significance: The geographic variation in epilepsy prevalence is not explained by variations in known risk factors. Further research should investigate why eastern U.S. states have higher frequency of epilepsy.     

Sufentanil versus Fentanyl: Efficacy and Patient Satisfaction with Intrathecal Pain Management

Objectives: This study compared fentanyl vs. sufentanil in intrathecal pain pumps. H1: both reduce patient subjective pain ratings. H2: sufentanil is more effective than fentanyl. H3: overall satisfaction with pain control is greater with sufentanil. Materials/Method: This is an archival study of patients in tertiary pain management (N= 97, mean age = 58.77, standard deviation = 14.88). Pain was measured using the subjective units of discomfort scale. Satisfaction with pain control/relief was measured by asking patients each visit if they are satisfied with pain management and is recorded in a “yes”/ “no” manner. Pain ratings were analyzed with repeated measures analysis of variance and satisfaction was analyzed with chi square. Results/Discussion: Sufentanil was found to be marginally more effective, but both medications controlled a significant degree of variance in pain reduction over time. A significantly greater number of patients maintained on sufentanil were satisfied with care than patients on fentanyl.     

Spontaneous regression of a terminal myelocystocele and associated syringomyelia: a case report

Introduction  

Terminal myelocystocele is a rare form of spinal dysraphism characterised by cystic dilatation of the central canal of a low-lying terminal cord. Typical presentation is a skin-covered dorsal mass; early surgical repair has been recommended.     

WISC-III index growth curve characteristics following traumatic brain injury. Wechsler Intelligence Scale for Children--Third Edition.

Previous studies have replicated the four-factor structure of the WISC-III in children with traumatic brain injury (TBI) and demonstrated the sensitivity of WISC-III indexes to severity of injury. This archival study examined the growth curve characteristics of the indexes following traumatic brain injury. The primary hypothesis was that there is systematic variability in the components (e.g., slope) of the curves. Subjects included 40 children with documented loss of consciousness, age at injury 9.3 years (SD = 2.6), 68% severe TBI, evaluated with a full WISC-III a minimum of three times post-injury. Growth curve analyses with hierarchical linear modeling, conducted with factor scores recalculated as non-age-standardized z scores, indicated that although the intercept was reliable and could be predicted by injury characteristics, there was little systematic variation in index growth rates. Findings suggest that WISC-III indexes are of limited utility as repeated measures of recovery following TBI.     

The clinical value of laryngeal electromyography in laryngeal immobility

Although laryngeal electromyography (LEMG) is commonly performed, there are no data confirming its efficacy. We evaluated 40 patients with a laryngoscopic diagnosis of unilateral vocal-fold immobility who underwent LEMG of the thyroarytenoid (TA) and cricothyroid (CT) muscle, with the immobile side of each muscle being compared to the normal side. The immobile side compared to the normal side showed more fibrillation potentials and positive sharp waves for the TA (p = 0.04), longer MUAP duration for the TA (p = 0.04) and CT (p = 0.01), more polyphasic potentials for the TA (p = 0.002), and more frequent decreased recruitment for the TA (p < 0.01) and CT (p = 0.008). Specificity and positive predictive value were around 90%. Sensitivity, negative predictive value and accuracy were around 50%. These results suggest that altered LEMG findings are reliable and they can be used to determine the innervation status of an immobile muscle. Conversely, when the LEMG is normal, the results should be reviewed.     

Association of breast cancer risk loci with breast cancer survival

The survival of breast cancer patients is largely influenced by tumor characteristics, such as TNM stage, tumor grade and hormone receptor status. However, there is growing evidence that inherited genetic variation might affect the disease prognosis and response to treatment. Several lines of evidence suggest that alleles influencing breast cancer risk might also be associated with breast cancer survival. We examined the associations between 35 breast cancer susceptibility loci and the disease over‐all survival (OS) in 10,255 breast cancer patients from the National Cancer Institute Breast and Prostate Cancer Cohort Consortium (BPC3) of which 1,379 died, including 754 of breast cancer. We also conducted a meta‐analysis of almost 35,000 patients and 5,000 deaths, combining results from BPC3 and the Breast Cancer Association Consortium (BCAC) and performed in silico analyses of SNPs with significant associations. In BPC3, the C allele of LSP1‐rs3817198 was significantly associated with improved OS (HR_per‐allele=0.70; 95% CI: 0.58–0.85; p_trend = 2.84 × 10^?4; HR_{heterozygotes} = 0.71; 95% CI: 0.55–0.92; HR_homozygotes = 0.48; 95% CI: 0.31–0.76; p_2DF = 1.45 × 10^?3). In silico, the C allele of LSP1‐rs3817198 was predicted to increase expression of the tumor suppressor cyclin‐dependent kinase inhibitor 1C (CDKN1C). In the meta‐analysis, TNRC9‐rs3803662 was significantly associated with increased death hazard (HR_META =1.09; 95% CI: 1.04–1.15; p_trend = 6.6 × 10^?4; HR_{heterozygotes} = 0.96 95% CI: 0.90–1.03; HR_homozygotes = 1.21; 95% CI: 1.09–1.35; p_2DF=1.25 × 10^?4). In conclusion, we show that there is little overlap between the breast cancer risk single nucleotide polymorphisms (SNPs) identified so far and the SNPs associated with breast cancer prognosis, with the possible exceptions of LSP1‐rs3817198 and TNRC9‐rs3803662.