Usefulness of perampanel with concomitant levetiracetam for patients with drug-resistant epilepsy

Purpose

The purpose was to evaluate the efficacy of treatment and the occurrence of aggression-related adverse events among children receiving perampanel (PER) with concomitant levetiracetam (LEV).

Alterations in contractile properties of tongue muscles in old rats

OBJECTIVES: Fatigue and weakness are well-known signs of aging that are related to sarcopenia, or loss of skeletal muscle mass, organization, and strength. Sarcopenia may affect swallowing. The tongue plays a vital role in swallowing, but there is limited knowledge regarding age-related changes in lingual muscle contractile properties. Our purpose was to determine whether alterations in tongue force, temporal features of tongue muscle contraction, and fatigability are manifested as a function of aging in old rats. METHODS: We evaluated tongue muscle contractile properties in young and old Fischer 344/Brown Norway rats. Contractions were elicited via bilateral electrical stimulation of the hypoglossal nerves. RESULTS: Maximum tongue forces and fatigability were not significantly altered in old animals, but aging was associated with significantly longer twitch contraction time and longer half-decay recovery time intervals (p < .01). CONCLUSIONS: The results indicated that old animals generated sufficient maximum tongue forces, but were slower in achieving these forces than young animals. These findings are consistent with reports of altered temporal parameters of tongue actions during swallowing in humans, and suggest that a disruption in the timing of muscle contraction onset and recovery may contribute to the altered tongue kinetics observed with aging.     

Discoordination of laryngeal and respiratory movements in aged rats

Voice and swallowing actions require the coordination of multiple motor systems, and this coordination may be impaired with aging. Although recent work has reported impairments in age-related laryngeal kinematics in rats, the temporal relationship of laryngeal excursions to the respiratory cycle is unknown. The goal of this study was to assess laryngeal-respiratory coordination by examining temporal interrelationships between change in laryngeal aperture and chest wall movement during quiet breathing in a rat model. Glottal images were recorded, digitized, and synchronized with respiratory signals, and temporal features were measured. In the young animals, glottal opening began before the onset of inspiration, and glottal and respiratory cycles were phasic and stereotypic. In old animals, however, inspiration often began during the glottal closing phase, and both respiratory signals were asymmetric. Discoordination of laryngeal and respiratory motor actions associated with aging may be caused by a generalized decline in sensorimotor cranial functions and may contribute to age-related swallowing and communication impairment.     

Non-cardiogenic pulmonary oedema induced by salazosulfapyridine

A 25-year-old woman received oral salazosulfapyridine, 4 g/day, for treatment of ulcerative colitis. At 10 days later, she presented with fever and respiratory symptoms. Based on physical, laboratory and radiological findings, bacterial pneumonia and non-cardiogenic pulmonary oedema was suspected. Salazosulfapyridine was immediately halted and antibiotic therapy started. Two days later, her symptoms and abnormal findings had improved rapidly. Bacteriological studies were negative. Salazosulfapyridine-induced non-cardiogenic pulmonary oedema was diagnosed. Non-cardiogenic pulmonary oedema should be considered as one of several salazosulfapyridine- induced pulmonary diseases in patients who are receiving salazosulfapyridine and who develop respiratory symptoms and an abnormal CXR.     

Incremental benefits of FDG positron emission tomography over CT alone for the preoperative staging of ovarian cancer

OBJECTIVE: The purpose of this study was to determine whether the addition of positron emission tomography (PET) with the radiotracer FDG to cross-sectional imaging, such as CT, increases accuracy in the detection of tumor spread. SUBJECTS AND METHODS. Fifteen patients who were thought to have ovarian cancer on the basis of the results of physical examination, sonography findings, and level of serum cancer antigen 125 were enrolled over an 11-month period. After screening, patients underwent two imaging examinations-abdominopelvic CT and whole-body FDG PET- within 2 weeks before surgery. Also before surgery, staging accuracy was assessed separately using CT with or without FDG PET (which was based on modifications of the International Federation of Gynecology and Obstetrics [FIGO] criteria). The results of the histology and surgery findings were used to assess the accuracy of the scanning findings. RESULTS: Staging revealed stage III disease in seven patients (IIIC, n = 6; IIIB, n = 1), stage II in three (IIC, n = 2; IIB, n = 1), and stage I in five (IC, n = 3; IA, n = 2), according to the FIGO criteria. Although CT staging correlated with postoperative staging in eight (53%) of 15 patients, consensus evaluation of CT with FDG PET staging improved correlation with postoperative staging in 13 (87%) of 15 patients. CONCLUSION: The addition of FDG PET to CT increases accuracy in staging of ovarian cancer.     

Impulse response function based on multivariate AR model can differentiate focal hemisphere in temporal lobe epilepsy

The purpose of this study is to propose and investigate a new approach for discriminating between focal and non-focal hemispheres in intractable temporal lobe epilepsy, based on applying multivariate time series analysis to the discharge-free background brain activity observed in nocturnal electrocorticogram (ECoG) time series. Five unilateral focal patients and one bilateral focal patient were studied. In order to detect the location of epileptic foci, linear multivariate autoregressive (MAR) models were fitted to the ECoG data; as a new approach for the purpose of summarizing these models in a single relevant parameter, the behavior of the corresponding impulse response functions was studied and described by an attenuation coefficient. In the majority of unilateral focal patients, the averaged attenuation coefficient was found to be almost always significantly larger in the focal hemisphere, as compared to the non-focal hemisphere. Also the amplitude of the fluctuations of the attenuation coefficient was significantly larger in the focal hemisphere. Moreover, in one patient showing a typical regular sleep cycle, the attenuation coefficient in the focal hemisphere tended to be larger during REM sleep and smaller during Non-REM sleep. In the bilateral focal patient, no statistically significant distinction between the hemispheres was found. This study provides encouraging results for new investigations of brain dynamics by multivariate parametric modeling. It opens up the possibility of relating diseases like epilepsy to the properties of inconspicuous background brain dynamics, without the need to record and analyze epileptic seizures or other evidently pathological waveforms.     

Isolated cranial neuropathy associated with anti-glycolipid antibodies

We describe seven patients with isolated cranial neuropathy in whom serum anti-glycolipid antibodies were detected. Trigeminal sensory neuropathy was found in four patients, who had exhibited symptoms for 2 months to 4 years. The other three patients showed facial nerve palsy with or without ophthalmoparesis. Temporal profile analysis of anti-glycolipid antibodies revealed that titers of anti-glycolipid IgM antibodies against GM2 and LM1 gradually decreased in patients having chronic trigeminal sensory neuropathy. In patients with acute trigeminal sensory neuropathy, elevation of anti-LM1 antibody titers continued over 12 months although anti-GalNAc-GD1a antibody disappeared. On the other hand, titers of anti-glycolipid antibodies rapidly decreased in patients with acute facial nerve palsy with or without ophthalmoparesis. We conclude that anti-glycolipid antibodies may play an important role in the development of isolated cranial neuropathy in some patients.