Use of the Personality Assessment Inventory as an efficacious and cost-effective diagnostic tool for nonepileptic seizures

Video electroencephalographic monitoring (VEEG) is considered the "gold standard" for making the differential diagnosis between epileptic seizures (ES) and nonepileptic seizures (NES), but is a costly, time-consuming procedure and not readily available in all communities. Of the various diagnostic techniques and measures that have been used, the Personality Assessment Inventory (PAI) has shown promise as an effective psychological screening tool to aid in the differential diagnosis of ES/NES. Using VEEG results as the outcome measure, this study examined the diagnostic effectiveness of the PAI in a group of adults with treatment-refractory seizures. Results indicated that, on psychological screening, patients with NES endorse significantly greater functional consequences of their seizure-like episodes than participants with ES. A "NES Indicator" score, calculated from the PAI Somatization subscales, provided a sensitivity of 84% and specificity of 73% for the diagnosis of NES versus ES. The PAI appears to be a useful screening tool prior to hospital admission for VEEG.     

A phase I trial of perillyl alcohol administered four times daily for 14 days out of 28 days

Purpose Perillyl alcohol (POH) has been shown to have both chemopreventative and chemotherapeutic activities in preclinical studies. The underlying mechanism(s) of action of POH have yet to be delineated but may involve effects on the transforming growth factor (TGF) and/or the Ras signaling pathways. A phase I study of POH for 14 days out of every 28 days in subjects with advanced malignancies was performed to evaluate dose escalation, toxicity, pharmacokinetics, and effects on TGF and Ras.Methods POH was administered orally (500 mg capsules containing 250 mg POH) to 20 patients four times a day on a continuous basis for 14 days followed by a 14-day rest period, for up to three courses. The starting dose was 1200 mg/m² per dose. A minimum of three patients were treated and evaluated at each escalating POH dose. Pharmacokinetic analysis was performed on days 1 and 14 of course 1 and day 1 of selected later courses. Plasma TGF levels were measured on days 1 and 14. Peripheral blood lymphocyte (PBLs) Ras levels were assayed on days 1 and 2 of the first course.Results The 20 patients, of whom 15 were evaluable, received doses between 1200 and 2000 mg/m² per dose for a total of 43 courses. The most common observed toxicities were nausea, gastrointestinal distress, and fatigue. Other toxicities included diarrhea or constipation, hypokalemia, and one incidence of acute pancreatitis. Due to these toxicities, four of the patients declined further treatment either during or after the second course. While POH was not detected in plasma, perillic acid (PA) and dihydroperillic acid (DHPA) were detected in plasma, and the peak levels at 2000 mg/m² per dose were approximately 600 M (PA) and 50 M (DHPA). There was some evidence for linearity in the peak plasma levels and area under the concentration–time curve of the metabolites from the starting dose to the highest dose. Metabolite pharmacokinetics were not significantly affected by ingestion in the fed or fasting state, or repeated exposure to POH. No evidence for an effect of POH on plasma TGF or PBL Ras protein was observed. No objective responses were observed.Conclusions In adults with advanced malignancies, an interrupted administration schedule of POH did not reveal significant advantages over continuous dosing schedules.     

A randomized pilot test of “moms on the move”: A physical activity intervention for WIC mothers

Background: Sedentary mothers are important to reach with physical activity promotion.Purpose: This study pilot tested “Moms on the Move” a Transtheoretical Model (TTM)-derived physical activity (PA) intervention for low-income mothers enrolled in the Women, Infants, and Children (WIC) program. Method: Sedentary mothers (N = 44) were randomized to (a) Moms on the Move (PA intervention) or (b) counseling on self-breast examination (control). Pre- and posttest measurement (baseline and 2 weeks after the 8-weekinterventions) included (a) stage of PA behavior change, (b) PA behavior, (c) selected TTM constructs, and (d) social support. Pre- and posidifference scores, chi-square, and one-way analyses of variance (ANOVAs) were used.Results: The experimental group progressed in stage of change more than control, x²(1, N = 44)=20.50, p < .001. The experimental group had greater PA behavior: weekly minutes of PA, F(l, 42) = 46.85, p< .001; daily energy expenditure (EE), F(1, 42) = 23.01,p < .001; and weekly moderate PA EE, F(1, 42) = 32.63, p < .001. Experimental subgroup (n = 11) step counts increased pre-post, t(l 0)=6.16,p7lt;. 001. AnANOVA showed that the experimental group had greater improvements in all TTM constructs and social support, ps < .001.Conclusions: WIC mothers are at risk for sedentary living and have not been targeted for PA behavior change using a provider-counseled approach. Although further testing is needed, Moms on the Move appears to be efficacious. This study was supported by a National Research Service Award, predoctoral fellowship, from the National Institutes of Health, National institute of Nursing Research, No. F31 NR07420-01A1. Nancy L. Fahrenwald acknowledges the support of South Dakota State University for doctoral education.