bluuebunny/crossref_metadata_2025 huggingface dataset:
The long‐term efficacy and safety of levetiracetam in a tertiary epilepsy centre
Authors: Kang Bong Su , Moon Hye Jin , Kim Young‐Soo , Lee Soon‐Tae , Jung Keun‐Hwa , Chu Kon , Lee Sang Kun
Published: August 2019

Aim

To evaluate the long‐term efficacy and safety of levetiracetam based on a large population of patients in a tertiary epilepsy centre.

Methods

All patients who received levetiracetam at the Seoul National University Hospital between January 2007 and March 2009 were evaluated. Patients who underwent brain surgery for seizure control or who had associated progressive disease were excluded from this study. The electronic medical records of these patients were reviewed retrospectively.

Results

A total of 568 patients were recruited, including 124 patients with generalised epilepsy. The mean duration of the follow‐up period was 29.3 months. The seizure‐free rate was 33.6% and was higher in patients with generalised epilepsy (51.6%) than patients with localisation‐related epilepsy (28.6%). There was a strong correlation between initial response and dose‐up response in 351 patients with increased dosage during the follow‐up period. A total of 486 adverse events developed in 316 patients. The most common adverse event (24.3%) was irritability, which was associated with a high rate of drug discontinuation. Previous history of mood disorder was the only factor related to the development of irritability in patients using this medication.

Conclusion

Levetiracetam was effective and safe as monotherapy and add‐on therapy for partial and generalised epilepsy. The initial response to levetiracetam may provide useful information for predicting the response to increased dose of levetiracetam. However, the use of this medication was associated with a rate of irritability that was higher than expected in patients with a history of mood disorders.
Adult tonic‐clonic convulsive status epilepticus over the last 11 years in a resource‐poor country: a tertiary referral centre study from southern Thailand
Authors: Phabphal Kanitpong , Geater Alan , Limapichart Kitti , Sathirapanya Pornchai , Setthawatcharawanich Suwanna
Published: August 2019

Status epilepticus is a common condition in patients admitted to hospital in resource‐poor countries and reports indicate that aetiology, factors of poor outcome, and treatment strategies are variable. To date, there is no report of a prospective study in Thai adults. Herein, we investigated the aetiology, clinical features, factors of predicted poor outcome, and treatment strategies in Thai adult patients who presented with convulsive status epilepticus. A total of 180 patients, whose ages ranged from 15 to 106 years, were included. Of these, 121 patients (67.2%) had acute symptomatic aetiology. The most common aetiology of status epilepticus was encephalitis (36.1%), followed by scarring of the cerebral hemisphere (15%). The median duration of status epilepticus before treatment was three hours. The rate of mortality in the study was 26.7%. Poor outcome was identified in 112 (62.2%) patients. For referral patients, all received only intravenous drugs before referral. The variables that correlated with poor outcome were aetiology and duration of status epilepticus. An approach to incorporate improved prevention of encephalitis, a more effective transportation system, and provision of the essential intravenous antiepileptic drugs would effectively increase the response to treatment.
Ictal swearing: a case series and review
Authors: Birca Veronica , Tayah Tania , Saint‐Hilaire Jean‐Marc , Nguyen Dang Khoa
Published: August 2019

Seizures can manifest with ictal swearing but few studies have investigated the localising value of this epileptic manifestation. In this case series and review of the literature, we attempted to determine whether ictal swearing could help localise the epileptic focus. We review two previously published cases and report eight additional epileptic patients with ictal swearing for whom the epileptic focus was determined based on clinical, structural, electrophysiological, and surgical outcome data. Results indicated that ictal swearing occurs more commonly in male subjects and lateralises to the non‐dominant hemisphere, but has poor localisation value, arising either from the frontal, parietal, temporal or occipital lobes in different patients. We discuss the significance of these findings. [Published with video sequences]
Self‐induction seizures in sunflower epilepsy: a video‐EEG report
Authors: Belcastro Vincenzo , Striano Pasquale
Published: August 2019

Seizures triggered by visual stimuli are the most common type of reflex seizure. Self‐induced seizures produced by stimulation of natural light are rare and self‐induction is a mode of seizure precipitation employed by either intellectually disabled or healthy photosensitive individuals. Absences and myoclonic jerks are the most common seizure types in self‐induction. We report on a girl with normal intelligence who self‐induced seizures by waving her outspread fingers in front of a bright light. This situation is called sunflower epilepsy. [Published with video sequences]
History of epilepsy: nosological concepts and classification
Authors: Wolf Peter
Published: August 2019

The purpose of this review is to provide insight into the development of the nosological views of the epilepsies, from prehistoric times to the present, and highlight how these views are reflected by terminology and classification. Even the earliest written documents reveal awareness that there are multiple forms of epilepsy, and it is surprising that they should be included under the same disease concept, perhaps because the generalised tonic‐clonic seizure served as a common denominator. The Hippocratic doctrine that the seat of epilepsy is in the brain may be rooted in earlier knowledge of traumatic seizures. Galenus differentiated cases where the brain was the primary site of origin from others where epilepsy was concomitant with illness in other parts of the body. This laid the fundament for the distinction between idiopathic and symptomatic epilepsies, the definition of which changed considerably over time. The description of the multiple seizure types as they are known at present started in the late 18th century. Attempts to classify seizure types began in the late 19th century, when Jackson formulated a comprehensive pathophysiological definition of epilepsy. Electroencephalography supported a second dichotomy, between seizures with localised onset and others with immediate involvement of both hemispheres which became known as “generalised”. In recent years, advanced methods of studying brain function in vivo, including the generation of both spontaneous and reflex epileptic seizures, have revolutionised our understanding of focal and “generalised” human ictogenesis. Both involve complex neuronal networks which are currently being investigated.
Effectiveness of multimodality treatment for autoimmune limbic epilepsy
Authors: Dubey Divyanshu , Konikkara John , Modur Pradeep N. , Agostini Mark , Gupta Puneet , Shu Francy , Vernino Steven
Published: August 2019

We evaluated the outcome of multimodality treatment in autoimmune limbic epilepsy in 3 consecutive patients (2 male and 1 female; age 33–55 years) presenting with a combination of focal non‐convulsive status epilepticus, memory impairment, and psychosis. MRI showed right or bitemporal T2 or FLAIR hyperintensity. Video‐EEG showed seizures of right temporo‐occipital or bitemporal independent onset. Extensive workup failed to reveal infectious aetiology or an underlying tumour. However, the autoantibody panel was positive for one or more of these antibodies: anti‐VGKC, anti‐GABAB, anti‐VGCC (P/Q, N types), and anti‐GAD65. All patients received: (1) conventional antiepileptic drugs including levetiracetam, lacosamide, phenobarbital, lamotrigine, and valproate; (2) immunomodulatory therapy including methylprednisolone, plasmapheresis, and intravenous immunoglobulin; and (3) rituximab. After a 4–6‐week in‐hospital course, the seizures resolved in all patients but 2 had persistent memory impairment. None had treatment‐related complications. At the time of last follow‐up, 2–3 months later, 2 patients remained seizure‐free while 2 had residual memory impairment. Our findings suggest that multimodality treatment with a combination of conventional AEDs, immunomodulatory therapy, and rituximab is effective and safe in autoimmune limbic epilepsy.
The response to ACTH is determined early in the treatment of infantile spasms
Authors: Mytinger John R , Weber Amanda , Heyer Geoffrey L
Published: August 2019

Although adrenocorticotropic hormone is the most commonly used treatment for infantile spasms in the United States, the optimal regimen for this indication is not known. The purpose of this study was to elucidate the optimal adrenocorticotropic hormone treatment duration. We conducted a retrospective chart review of response to adrenocorticotropic hormone among all patients with infantile spasms managed at our institution from January 2009 to September 2013. Treatment response was defined as clinical remission for greater than or equal to 28 days starting at any point within the adrenocorticotropic hormone course and remission of hypsarrhythmia (or definite EEG improvement if hypsarrhythmia was absent at baseline). For responders, the diagnostic and post‐treatment EEG tracings were reviewed. Electroclinical remission was achieved in 21 of 39 patients (54%) receiving adrenocorticotropic hormone, including 11/25 (44%) receiving a long course (typically 12 weeks) and 10/14 (71%) receiving a short course (typically four weeks). The mean time to clinical remission was 5.8 days (median: 5 days; range: 1–20 days). Only one patient responded beyond two weeks of treatment. This study provides Class IV evidence that among patients with infantile spasms, the response to adrenocorticotropic hormone is most often determined early in the treatment course. Given the importance of rapid remission, clinicians should consider adding or changing treatment if infantile spasms do not resolve within two weeks of adrenocorticotropic hormone initiation. Further study is needed to determine the optimal adrenocorticotropic hormone regimen for infantile spasms.
Possible induction of multiple seizure foci due to parietal tumour and anti‐NMDAR antibody
Authors: Matsumoto Riki , Mikuni Nobuhiro , Tanaka Keiko , Usami Kiyohide , Fukao Kenjiro , Kunieda Takeharu , Takahashi Yukitoshi , Miyamoto Susumu , Fukuyama Hidenao , Takahashi Ryosuke , Ikeda Akio
Published: August 2019

“Formes frustes” of encephalopathy associated with anti‐NMDAR antibody have been recently described in cases of chronic epilepsy. We report a young woman with a parietal lesion and anti‐NMDAR antibody who acquired bilateral, secondary epileptogenesis in the temporal lobes within a period as short as six years. Removal of the primary epileptogenic lesion of oligoastrocytoma in the right parietal lobe resulted in seizure freedom, disappearance of secondary foci, and substantial decrease of the antibody titre. Chronic exposure to anti‐NMDAR antibody, albeit at a low titre, may have resulted in a smoldering chronic course and relatively early acquisition of “reversible” secondary foci without development of a high degree of epileptogenicity and structural changes.
Long‐lasting seizure‐related anxiety in patients with temporal lobe epilepsy and comorbid psychiatric disorders
Authors: Boulogne Sebastien , Catenoix Hélène , Ryvlin Philippe , Rheims Sylvain
Published: August 2019

Ictal anxiety is a frequent epileptic symptom; it is usually brief, associated with objective clinical signs, and is not positively influenced by external factors, in contrast to psychiatric disorders. These criteria can, however, be misleading, especially in patients with psychiatric comorbidities. We report two patients with a history of drug‐resistant right temporal lobe epilepsy, who developed long‐lasting psychiatric symptoms, suggestive of exacerbation of their comorbid anxiety disorder. However, intracranial EEG data and [18F] FDG‐PET suggested that these symptoms were related to seizure activity, highlighting the difficulties in differentiating ictal symptoms from psychiatric episodes in some patients with epilepsy and comorbid psychiatric disorders. [Published with video sequence]
Antiepileptic drug withdrawal in medically and surgically treated patients: a meta‐analysis of seizure recurrence and systematic review of its predictors
Authors: Lamberink Herm J. , Otte Willem M. , Geleijns Karin , Braun Kees P.J.
Published: August 2019

Aim. Many seizure‐free patients consider withdrawal of antiepileptic drugs, both when seizure control is achieved by medication alone, or once they became seizure‐free following epilepsy surgery. The risk of recurrence is consequently of very important prognostic value. However, estimations of recurrence risks are outdated for both populations. In addition, although many publications have reported predictors of seizure relapse, no comprehensive overview of prognostic factors is available.

Methods. A systematic review of the databases of PubMed and EMBASE was conducted, identifying articles on antiepileptic drug withdrawal in patient cohorts. Recurrence risk meta‐analyses were performed for both populations at one, two, three to four, and five or more years of follow‐up. Within the selected articles, studies presenting multivariable analysis of predictors were identified; all studied predictors were listed, as well as all significant independent predictors. The quality of separate analyses of predictors was assessed.

Results. There was no significant difference of long‐term cumulative recurrence risk between surgical and medication‐only populations, with respectively 29% and 34% recurrences. In medication‐only treated patients, 25 factors have been reported as significant independent predictors; 12 have been reported in surgical cohorts. The quality of most analyses of predictors was low to moderate. No predictor was consistently found among all analyses, and for most predictors, study results were contradictory.

Conclusion. No consistent set of predictors could be identified because a large number of variables have been identified in the literature, many studies reported contradicting results, study populations varied considerably, and the quality of the original studies was often low. Meta‐analysis of individual participant data is necessary, because it allows for (1) correction for differences in follow‐up duration between subjects and studies, (2) a study of interaction effects, (3) calculation of more accurate estimates valid across several populations, and (4) the assessment of each predictor's effect size.
Adult‐onset photosensitivity: clinical significance and epilepsy syndromes including idiopathic (possibly genetic) photosensitive occipital epilepsy
Authors: Koutroumanidis Michalis , Tsirka Vasiliki , Panayiotopoulos Chrysostomos
Published: August 2019

To evaluate the clinical associations of adult‐onset photosensitivity, we studied the clinical and EEG data of patients who were referred due to a possible first seizure and who had a photoparoxysmal response on their EEG. Patients with clinical evidence of photosensitivity before the age of 20 were excluded. Of a total of 30 patients, four had acute symptomatic seizures, two had vasovagal syncope, and 24 were diagnosed with epilepsy. Nine of the 24 patients had idiopathic (genetic) generalized epilepsies and predominantly generalized photoparoxysmal response, but also rare photically‐induced seizures, while 15 had exclusively, or almost exclusively, reflex photically‐induced occipital seizures with frequent secondary generalization and posterior photoparoxysmal response. Other important differences included a significantly older age at seizure onset and paucity of spontaneous interictal epileptic discharges in patients with photically‐induced occipital seizures; only a quarter of these had occasional occipital spikes, in contrast to the idiopathic (genetic) generalized epilepsy patients with typically generalized epileptic discharges. On the other hand, both groups shared a positive family history of epilepsy, common seizure threshold modulators (such as tiredness and sleep deprivation), normal neurological examination and MRI, a generally benign course, and good response to valproic acid. We demonstrated that photosensitivity can first occur in adult life and manifest, either as idiopathic (possibly genetic) photosensitive occipital epilepsy with secondary generalization or as an EEG, and less often, a clinical/EEG feature of idiopathic (genetic) generalized epilepsies. Identification of idiopathic photosensitive occipital epilepsy fills a diagnostic gap in adult first‐seizure epileptology and is clinically important because of its good response to antiepileptic drug treatment and fair prognosis.
Interictal high‐frequency oscillations (HFOs) as predictors of high frequency and conventional seizure onset zones
Authors: Modur Pradeep , Miocinovic Svjetlana
Published: August 2019

We investigated the relationship between the interictal high‐frequency oscillations (HFOs) and the seizure onset zones (SOZs) defined by the ictal HFOs or conventional frequency activity (CFA), and evaluated the usefulness of the interictal HFOs as spatial markers of the SOZs. We analysed seizures showing discrete HFOs at onset on intracranial EEGs acquired at ≥1000‐Hz sampling rate in a training cohort of 10 patients with temporal and extratemporal epilepsy. We classified each ictal channel as: HFO+ (HFOs at onset with subsequent evolution), HFO‐ (HFOs at onset without evolution), CFA (1.6–70‐Hz activity at onset with evolution), or non‐ictal. We defined the SOZs as: hSOZ (HFO+ channels only), hfo+&‐SOZ (HFO+ and HFO‐ channels), and cSOZ (CFA channels). Using automated methods, we detected the interictal HFOs and extracted five features: density, connectivity, peak frequency, log power, and amplitude. We created logistic regression models using these features, and tested their performance in a separate replication cohort of three patients. The models containing the five interictal HFO features reliably differentiated the channels located inside the SOZ from those outside in the training cohort (p<0.001), reaching the highest accuracy for the classification of hSOZ. Log power and connectivity had the highest odds ratios, both being higher for the channels inside the SOZ compared with those outside the SOZ. In the replication cohort of novel patients, the same models differentiated the HFO+ from HFO‐ channels, and predicted the extents of the hSOZ and hfo+&‐SOZ (F1 measure >0.5) but not the cSOZ. Our study shows that the interictal HFOs are useful in defining the spatial extent of the SOZ, and predicting whether or not a given channel in a novel patient would be involved in the seizure. The findings support the existence of an abnormal network of tightly‐linked ictal and interictal HFOs in patients with intractable epilepsy.
Cerebrospinal fluid findings after epileptic seizures
Authors: Chatzikonstantinou Anastasios , Ebert Anne D. , Hennerici Michael G.
Published: August 2019

We aimed to evaluate ictally‐induced CSF parameter changes after seizures in adult patients without acute inflammatory diseases or infectious diseases associated with the central nervous system. In total, 151 patients were included in the study. All patients were admitted to our department of neurology following acute seizures and received an extensive work‐up including EEG, cerebral imaging, and CSF examinations. CSF protein elevation was found in most patients (92; 60.9%) and was significantly associated with older age, male sex, and generalized seizures. Abnormal CSF‐to‐serum glucose ratio was found in only nine patients (5.9%) and did not show any significant associations. CSF lactate was elevated in 34 patients (22.5%) and showed a significant association with focal seizures with impaired consciousness, status epilepticus, the presence of EEG abnormalities in general and epileptiform potentials in particular, as well as epileptogenic lesions on cerebral imaging. Our results indicate that non‐inflammatory CSF elevation of protein and lactate after epileptic seizures is relatively common, in contrast to changes in CSF‐to‐serum glucose ratio, and further suggest that these changes are caused by ictal activity and are related to seizure type and intensity. We found no indication that these changes may have further‐reaching pathological implications besides their postictal character.
Transcranial direct current stimulation improves seizure control in patients with Rasmussen encephalitis
Authors: Tekturk Pinar , Erdogan Ezgi Tuna , Kurt Adnan , Kocagoncu Ece , Kucuk Zeynep , Kinay Demet , Yapici Zuhal , Aksu Serkan , Baykan Betul , Karamursel Sacit
Published: August 2019

Aim. Rasmussen encephalitis is associated with severe seizures that are unresponsive to antiepileptic drugs, as well as immunosuppressants. Transcranial direct current stimulation (t‐DCS) is a non‐invasive and safe method tried mostly for focal epilepsies with different aetiologies. To date, there is only one published study with two case reports describing the effect of t‐DCS in Rasmussen encephalitis. Our aim was to investigate the effect of t‐DCS on seizures in Rasmussen encephalitis and to clarify its safety.

Methods. Five patients (mean age: 19; three females), diagnosed with Rasmussen encephalitis were included in this study. Patients received first cathodal, then anodal (2 mA for 30 minutes on three consecutive days for non‐sham stimulations), and finally sham stimulation with two‐month intervals, respectively. Three patients received classic (DC) cathodal t‐DCS whereas two patients received cathodal stimulation with amplitude modulation at 12 Hz. Afterwards, all patients received anodal stimulation with amplitude modulation at 12 Hz. In the last part of the trial, sham stimulation (a 60‐second stimulation with gradually decreasing amplitude to zero in the last 15 seconds) was applied to three patients. Maximum current density was 571 mA/m2 using 70 mm × 50 mm wet sponge electrodes with 2‐mA maximum, current controlled stimulator, and maximum charge density was 1028 C/m2 for a 30‐minute stimulation period.

Results. After cathodal stimulation, all but one patient had a greater than 50% decrease in seizure frequency. Two patients who received modulated cathodal t‐DCS had better results. The longest positive effect lasted for one month. A second trial with modulated anodal stimulation and a third with sham stimulation were not effective. No adverse effect was reported with all types of stimulations.

Conclusion. Both classic and modulated cathodal t‐DCS may be suitable alternative methods for improving seizure outcome in Rasmussen encephalitis patients.
Electrophysiological findings in Rasmussen's syndrome
Authors: Gündüz Ayşegül , Kızıltan Meral E. , Coşkun Tülin , Delil Şakir , Yeni Naz , Özkara Çiğdem
Published: August 2019

Background. Rasmussen syndrome is a rare, inflammatory and probably autoimmune disease presenting with epilepsia partialis continua which is generally in the form of myoclonic jerks and involves the upper extremities with or without head involvement. We sought to demonstrate the electrophysiological features in patients with Rasmussen syndrome.

Methods. We performed continuous electrophysiological recordings of involuntary movement, as well as recordings of startle responses and long latency reflex in three patients with a diagnosis of Rasmussen syndrome.

Results. Positive and negative myoclonus were recorded. Startle responses were found to be suppressed. However, long latency reflexes were high in amplitude and one patient even had a C reflex.

Conclusion. Stimulus‐sensitive positive and negative cortical myoclonus are typical in epilepsia partialis continua of Rasmussen syndrome and degeneration of brainstem and reticulospinal pathways may develop in Rasmussen syndrome.
Stimulation of the bilateral anterior nuclei of the thalamus in the treatment of refractory epilepsy: two cases of subcortical band heterotopia
Authors: Franco Ana , Pimentel José , Campos Alexandre Rainha , Morgado Carlos , Pinelo Sara , Ferreira António Gonçalves , Bentes Carla
Published: August 2019

Subcortical band heterotopia is a neuronal migration disorder that may cause refractory epilepsy. In these patients, resective surgery has yielded inadequate results. Deep brain stimulation of the anterior nuclei of the thalamus has been used for the treatment of refractory epilepsy with good results. We describe the first two patients with subcortical band heterotopia who were submitted to deep brain stimulation of the anterior nuclei of the thalamus, with evaluation of seizure outcome after 12 and 18 months of follow‐up. At these times, both showed a >50% decrease in seizure frequency and an increase in seizure freedom. Both patients had a depressive syndrome after surgery that responded fully to anti‐depressive medication in one patient and partly in the other. In both, deep brain stimulation of the anterior nuclei of the thalamus was associated with good seizure outcome. This procedure can therefore be considered in the treatment of patients with subcortical band heterotopia and refractory epilepsy. Depression may be a transient adverse event of the surgery or stimulation, however, its aetiology is probably multifactorial.
Outcome of vagus nerve stimulation for drug‐resistant epilepsy: the first three years of a prospective Japanese registry
Authors: Kawai Kensuke , Tanaka Tatsuya , Baba Hiroshi , Bunker Mark , Ikeda Akio , Inoue Yushi , Kameyama Shigeki , Kaneko Sunao , Kato Amami , Nozawa Taneyoshi , Maruoka Eiji , Osawa Makiko , Otsuki Taisuke , Tsuji Sadatoshi , Watanabe Eiju , Yamamoto Takamichi
Published: August 2019

Aims. Vagus nerve stimulation (VNS) is an established option of adjunctive treatment for patients with drug‐resistant epilepsy, however, evidence for long‐term efficacy is still limited. Studies on clinical outcomes of VNS in Asia are also limited. We report the overall outcome of a national, prospective registry that included all patients implanted in Japan.

Methods. The registry included patients of all ages with all seizure types who underwent VNS implantation for drug‐resistant epilepsy in the first three years after approval of VNS in 2010. The registry excluded patients who were expected to benefit from resective surgery. Efficacy analysis was assessed based on the change in frequency of all seizure types and the rate of responders. Changes in cognitive, behavioural and social status, quality of life (QOL), antiepileptic drug (AED) use, and overall AED burden were analysed as other efficacy indices.

Results. A total of 385 patients were initially registered. Efficacy analyses included data from 362 patients. Age range at the time of VNS implantation was 12 months to 72 years; 21.5% of patients were under 12 years of age and 49.7% had prior epilepsy surgery. Follow‐up rate was >90%, even at 36 months. Seizure control improved over time with median seizure reduction of 25.0%, 40.9%, 53.3%, 60.0%, and 66.2%, and responder rates of 38.9%, 46.8%, 55.8%, 57.7%, and 58.8% at three, six, 12, 24, and 36 months of VNS therapy, respectively. There were no substantial changes in other indices throughout the three years of the study, except for self/family‐accessed QOL which improved over time. No new safety issues were identified.

Conclusions. Although this was not a controlled comparative study, this prospective national registry of Japanese patients with drug‐resistant epilepsy, with >90% follow‐up rate, indicates long‐term efficacy of VNS therapy which increased over time, over a period of up to three years. The limits of such trials, in terms of AED modifications and during follow‐up and difficulties in seizure counting are also discussed.
Investigation of SLC2A1 gene variants in genetic generalized epilepsy patients with eyelid myoclonia
Authors: Altıokka‐Uzun Güneş , Özdemir Özkan , Uğur‐İşeri Sibel , Bebek Nerses , Gürses Candan , Özbek Uğur , Baykan Betül
Published: August 2019

Aims. In addition to a complex inheritance pattern in genetic generalized epilepsy (GGE) syndromes, some studies have recently identified SLC2A1 variants which lead to glucose transporter type 1 (GLUT1) defects, in patients diagnosed with GGE. Here, we investigated the possible role of SLC2A1 variants in GGE patients with eyelid myoclonia (EM) which is a rare generalized seizure type associated with drug resistance and cognitive dysfunction.

Methods. After polymerase chain reaction with designed primers, sequencing of all SLC2A1 exons was performed for 25 GGE‐EM patients, as well as a control group of 15 GGE patients with absence seizures.

Results. Although various single nucleotide polymorphisms clustered in the ninth exon were detected, no variant was found in the two groups with GGE.

Conclusions. Even though the patient number in this study is small, the data suggest that SLC2A1 variants do not play any causative role in GGE associated with EM.
Faciobrachial dystonic seizures expressed as epileptic spasms, followed by focal seizures in anti‐LGI1 encephalitis: a video‐polygraphic study
Authors: d’Orsi Giuseppe , Martino Tommaso , Lalla Alessandra , Claudio Maria Teresa Di , Carapelle Elena , Avolio Carlo
Published: August 2019

The origin of faciobrachial dystonic seizures in anti‐LGI1 encephalitis is controversial due to a lack of neurophysiological characterization. We report a 68‐year‐old man with subacute anterograde memory loss and involuntary faciobrachial movements. Video‐polygraphic recordings disclosed repetitive events characterized by sudden, short contraction of the upper limbs and ipsilateral hemiface. A focal contralateral EEG slow wave from frontal or central electrodes was accompanied by increased muscle activity, often with a diamond‐shaped configuration, on the orbicularis oris muscle, deltoid muscle, and extensor muscle of the hand. This EEG/EMG pattern (resembling a tonic epileptic spasm) was always followed by oral and gestural automatisms with dystonic posturing of the upper limbs, compatible with a temporal lobe seizure. Brain MRI showed hyperintensity in the bilateral mesial temporal lobes, while 18FDG‐PET revealed basal ganglia hypermetabolism with extensive cortical hypometabolism. Serum and CSF were both positive for anti‐LGI antibodies. The patient was treated with intravenous methylprednisolone (1 g/day for five days) with seizure freedom within four days after initiation of the immunotherapy. In this case, a video‐EEG/polygraphic study disclosed that faciobrachial dystonic seizures may resemble epileptic spasms, and the occurrence in close temporal association with focal seizures as a single ictal event is suggestive of a peculiar cortical‐subcortical interaction. [Published with video sequence onwww.epilepticdisorders.com]
Çocukların Sebze ve Meyve Tüketim Durumu: Anne ve Çocuk Görüşleri
Authors: DEMİRİZ Serap , ÖZGEN Leyla
Published: August 2019

Çalışmanın amacı, anne ve
çocuk görüşlerine göre çocuğun sebze ve meyve tüketim durumlarını
belirlemektir. Çalışma evreninde yer alan 48 - 72 ay grubu çocuk arasından uygun
örnekleme yöntemi ile 229 çocuk ve anneye ulaşılmıştır. Araştırmada, çocukların
besin grupları tercihinde; meyve grubunu daha çok sebze grubunu daha az tercih
ettikleri hem anne hem de çocuk görüşlerinde bildirilmiştir. Çocukların sebze
ve meyve tüketim durumunu belirlemek için; kereviz, enginar, brokoli,
karnabahar, pırasa, ıspanak, taze fasulye, domates, havuç, salatalık olmak
üzere on sebze ve portakal, üzüm, kavun, erik, şeftali, çilek, mandalina, muz,
karpuz, elma olmak üzere on meyve seçilmiştir. Anne ve çocuk görüşlerine göre, çocukların
sebzelerden daha çok enginar, kereviz, brokoli, pırasa, karnabaharı
tüketmedikleri, tüketmeme nedeni ise bunları hiç yememiş olması ve tadı olarak belirlenmiştir.
Meyvelerden ise, çocukların daha çok anne görüşlerine göre, portakal, üzüm,
kavun, eriği, çocuk görüşlerine göre ise, erik, kavun, şeftaliyi tüketmedikleri
saptanmıştır. Tüketmeme nedenleri daha çok tadı olarak belirtilmiştir. Eğitim kurumlarında ve evlerde çeşitli
etkinliklerle, farklı pişirme teknikleri ve ilginç sunumlarla çocukların
yemedikleri sebze ve meyvelerin tüketimleri arttırılabilir.
Terapia manual na recuperação funcional pós-entorse lateral de tornozelo: revisão sistemática
Authors: Oliveira Igor Macedo de , Sacramento Marvyn de Santana do , Oliveira Alice Miranda de , Cadidé Yasmin Pimenta , Morais Mariana Pereira Gottschalk , Barros Eulália Silva dos Santos Pinheiro
Published: August 2019

INTRODUÇÃO: O tornozelo é considerado uma das regiões do corpo mais propensa às lesões esportivas, sendo 70% dessas lesões entorses de tornozelo. A recidiva de entorses pode provocar um prejuízo crônico na função proprioceptiva e sensório-motora. Não existe um tratamento específico para as entorses, sendo utilizados protocolos como o PRICE, abordagem passiva, imobilização da articulação e terapia manual. OBJETIVO: Trazer informações mais consistentes que elucidem os efeitos da terapia manual na recuperação da funcionalidade do paciente. MATERIAIS E MÉTODOS: Trata-se de uma revisão sistemática baseada no PRISMA, com buscas realizadas nas bases de dados: PubMed, SciELO, LILACS e PEDro. Foram pesquisados apenas ensaios clínicos randomizados, com avaliação maior ou igual a 5/10 na escala PEDro, nos idioma português e inglês. Os estudos deveriam incluir população com idade entre 18 e 60 anos utilizando técnicas de terapia manual como: Mulligan, Maitland, mobilização neural, massoterapia, liberação miofascial, pompage e alongamento passivo. RESULTADOS: Foram incluídos 7 artigos com um total de 300 indivíduos. Os estudos incluídos investigaram a recuperação da funcionalidade de pacientes submetidos à terapia manual. Limitações: heterogeneidade no tempo de lesão. CONCLUSÃO: Os resultados evidenciaram melhora na capacidade física para correr, saltar, pousar e realizar movimentos de corte e laterais, melhora da cinemática, marcha, distribuição de descarga de peso e função global.
Lombalgia e alterações funcionais em feirantes: um estudo transversal
Authors: Rodrigues Roquenei da Purificação , Santos Kionna Oliveira Bernardes
Published: August 2019

INTRODUÇÃO: A dor lombar atinge níveis epidêmicos na população em geral, sendo uma das causas de incapacidade funcional e motivo mais comum para a consulta médica. Sua etiologia é multifatorial e os fatores mais comuns para esta sintomatologia envolvem os elementos biomecânicos, ocupacionais e as características individuais. OBJETIVO: investigar a ocorrência das lombalgias e as repercussões funcionais entre os feirantes do setor de hortifruti (varejo). MÉTODOS: Foi realizado um estudo quantitativo, de natureza descritiva, com desenho de estudo transversal. Para tanto, aplicou-se o formulário de incapacidades Oswestry (modificado) e para a  mensuração da dor,a Escala Visual Analógica. Os dados foram avaliados descritivamente, por meio de frequência absoluta e relativa. RESULTADOS: Foram entrevistados 100 feirantes, com a idade média de 43 anos. Destes, 73% apresentam alguma dor ou desconforto na região lombar e para minimizar tal ocorrência, 39,7% faziam uso de remédio oral/tópico sem orientação médica. Com relação às alterações funcionais, 14% apresentam incapacidade intensa. CONCLUSÃO: O estudo permitiu identificar,  que os indivíduos com lombalgia, possuíam algum grau de incapacidade que repercutiam no seu contexto de vida.
Making sense of subclinical cardiac alterations in patients with diabetes
Authors: Pareek Manan , Olsen Michael Hecht
Published: August 2019

Patients with diabetes are prone to develop a distinct primary myocardial condition, diabetic cardiomyopathy, placing them at an increased risk for heart failure (1-3). This occurs independently of hypertension, coronary artery disease, and other established causes of heart failure. Pertinent findings include increased mass, concentric changes, and diastolic dysfunction of the left ventricle (4,5). Such adverse remodeling is common among patients with diabetes and appears to be strongly associated with its duration, suggesting a role for persistent metabolic stress (6-8). However, which exact components of the diabetic syndrome determine these cardiac alterations is not clear. Moreover, most studies have investigated patients with type 2 diabetes, and it is uncertain whether patients with type 1 diabetes experience similar myocardial changes.

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Growing bacteria in Superbroth (“thick food”) v2
Authors: Riccio Cristian
Published: August 2019

This protocol shows you how to prepare "thick food" to grow C. elegans at higher densities.
Effects of Caloric Restriction Associated with Low-Impact Aerobics and Strength Training Exercises on Body Compositions and Metabolic Syndrome Components among Obese students v1
Authors: Ahmed Said Mohamed
Published: August 2019

Diet and physical activity are the most commonly recommended strategies for preventing and treating obesity and metabolic conditions. This study aims to examine the effectiveness of a weight reduction intervention based on caloric restriction, low-impact aerobics (LIA), and a resistance-training program in improving patients' anthropometric and biochemical indicators and the incidence of metabolic syndrome (MetS) among youth with obesity. In all, 64 participants were introduced to an enhanced lifestyle counseling and dieting program (the diet group, or DG) or to enhanced lifestyle counseling, dieting, and a supervised physical training program (the diet and training group, or DTG). Individuals diagnosed with MetS were analyzed in this study (DG: N = 09; DTG: N = 14). Before and after the intervention, the participants' anthropometric measures and cardiovascular disease (CVD) risk factors were assessed. Following the interventions, significant improvements were noted in all anthropometric variables among all participants (p ≤ 0.001 for all). Significant differences were noted between groups in terms of body weight (p ≤ 0.05), waist circumference (WC; p ≤ 0.01), body mass index (BMI; p ≤ 0.05), fat percentage (F%; p ≤ 0.05), and waist-to-hip ratio (WHR; p ≤ 0.05). All MetS components also improved in both groups, and the most significant improvements were observed among the training group in terms of fasting blood glucose (FBG) level (p ≤ 0.05), triglyceride (TG) level (p ≤ 0.001), overall cholesterol (OC; p ≤ 0.01), low-density lipoprotein cholesterol (LDL-c; p ≤ 0.05), and very low-density lipoprotein cholesterol (VLDL-c; p ≤ 0.001). Conclusion: A minor daily caloric restriction (of approximately 500 kcal) program could be an effective tool in combating MetS. Further, the introduction of three weekly aerobic and resistance-training sessions in a gymnasium to the caloric restriction program may deliver better outcomes, mainly in terms of reductions in body weight, WC, FBG level, TG level, OC, LDL-c, and VLDL-c.
"Isolating Specific Cell Subsets Directly from Whole Blood Without Columns or Magnets" v1
Authors: Technologies STEMCELL , Thunoe Maria
Published: August 2019

The following procedure provides guidelines for isolating cells from whole blood using RosetteSep™, an immunodensity cell separation platform that isolates specific cell subsets during density gradient centrifugation. RosetteSep™ first crosslinks unwanted cells to red blood cells (RBCs) present in the sample to form immunorosettes. When the sample is centrifuged over a density gradient medium (e.g. Lymphoprep™), the immunorosettes pellet, leaving highly purified cells at the interface between the plasma and the density gradient medium.
La organización de las acepciones en un diccionario histórico
Authors: García Pérez Rafael
Published: August 2019

La organización de las acepciones en un diccionario histórico.
La lematización de los pronombres en los diccionarios actuales
Authors: Porto Dapena José-Álvaro
Published: August 2019

La lematización de los pronombres en los diccionarios actuales.
Lexicografía y Lexicología en Europa y América: Homenaje a Günther Haensch en su 80 aniversario, Madrid, Gredos, 2003
Authors: Campos Souto Mar
Published: August 2019

Reseña: Lexicografía y Lexicología en Europa y América: Homenaje a Günther Haensch en su 80 aniversario, Madrid, Gredos, 2003.
ANÁLISE SOCIOECONÔMICA DA RELAÇÃO ENTRE O EMPREENDEDORISMO E O DESENVOLVIMENTO REGIONAL DO PLANALTO NORTE CATARINENSE
Authors: Buss Regiane De Jesus , Senff Carlos Otávio
Published: August 2019

São numeráveis as variáveis que impactam no desenvolvimento de uma região. Compreender essas relações é fator determinante no estabelecimento de políticas mais acertadas. O objetivo deste estudo é analisar a relação entre o empreendedorismo e o desenvolvimento regional na microrregião do Planalto Norte Catarinense. No quadro teórico foram discutidos os conceitos de empreendedorismo e de desenvolvimento, este, especificamente a partir de uma visão mais ampla do que puramente a questão econômica. Os aspectos metodológicos utilizados para relacionar estes dois indicadores, foi uma pesquisa descritiva quantitativa, ex-post-facto, do tipo transversal. Os dados secundários foram obtidos de fontes oficiais, sendo analisados por meio de estatística descritiva básica, correlação entre as variáveis e regressão linear múltipla. Considerando os 10 municípios analisados, os principais resultados evidenciam que os empreendedores se encontram em todos os níveis de instrução escolar. Com relação as classes sociais, constatou-se que existem associações positivas e significativas com as classes A2, B1 e B2 e associações negativas e significativas com as classes C2, D e E. Além disso, se verificaram associações positivas e significativas do índice de empreendedorismo com o consumo per capita, IDHM e com a população urbana das cidades pesquisadas. Dentre os previsores analisados que impactam na variável dependente desenvolvimento regional na análise de regressão linear múltipla, somente a variável consumo per capita apresentou-se significativa (p
ÁGUA E DESENVOLVIMENTO REGIONAL: O CASO DA MESORREGIÃO OESTE DE SANTA CATARINA
Authors: Marchesan Jairo , Comassetto Vilmar
Published: August 2019

Este artigo tem o propósito de apresentar e analisar algumas questões e preocupações em relação à agua e o desenvolvimento da Mesorregião Oeste de Santa Catarina (Brasil). Historicamente, no Brasil, devido à disponibilidade de água em algumas regiões, estabeleceu-se a cultura do uso associado à falta de cuidado e do desperdício deste bem natural. Problemas de escassez, associado à má qualidade têm sido cada vez mais frequentes. Nesta perspectiva, a abordagem proposta para este artigo é a de analisar a realidade socioambiental e econômica do Oeste de Santa Catarina e a importância da água para as atividades de maneira geral. O artigo estabelece algumas relações do uso da água nas atividades econômicas, principalmente, na agropecuária, nas bacias hidrográficas que compõem o território analisado. Apresenta dados de produção agropecuária e de energia hidroelétrica, de quantidade e qualidade de água, de níveis de precipitação anual e ocorrência de estiagens. Conclui com cenários futuros, associando o balanço qualiquantitativo com os desafios a serem superados, visando garantir o pleno desenvolvimento da mesorregião, onde a água ofertada ou disponível em regularidade, quantidade e qualidade é determinante para a manutenção das atividades econômicas produtivas regionais e para a qualidade de vida das pessoas.
Giant Aggressive Aneurismal Bone Cyst of the Proximal Humerus Unresponsive to Denosumab
Authors: MN Aytekin , C Alemdar , S Elci , S Akcaalan , M Dogan
Published: August 2019

Aneurysmal Bone Cyst (ABC) is a destructive lesion. The main treatment is curettage, local adjuvant and grafting. However, it is difficult to apply the optimal surgical procedure in aggressive lesions. In these cases, the use of denosumab prior to surgery has been shown to reduce bone destruction and facilitate surgical treatment. A 22-year-old woman was referred for limited shoulder movement and pain complaints. Physical examination and radiological findings were interpreted in favor of ABC. The biopsy was also found to be consistent with the ABC. Since the lesion was aggressive, denosumab was applied prior to surgery. The mass quickly became calcified and patient’s pain complaint decreased. After stopping denosumab treatment, lesion progressed rapidly and destructive character became dominant at every part of lesion. The patient underwent proximal humeral resection and prosthesis. A painless limb with limited shoulder movement was achieved. Although denosumab application prior to surgery was initially good in this case, after termination of treatment, lesion progressed rapidly and the gains associated with denosumab use was lost.
Ecological and Toxicological Examination of Soils in the Territory Polluted by Industrial Emissions of Mining and Metallurgical Enterprises
Authors: Ingiri A.A.
Published: August 2019

The monitoring studies of the ecological state of soils of agricultural lands in the area of operation of the mining and smelting enterprise OJSC MMC Pechenganikel, located in the North-Western part of the Kola Peninsula, are presented. Planning of the survey (creation of a digital cartographic base) was carried out in a GIS environment using raster archive data and Earth remote sensing data. The accuracy of soil sampling within the boundaries of the selected elementary areas and contours was ensured by the use of GPS navigators. A significant excess of the APC content of Cu, Ni, As in the studied samples was established. Based on the survey results, cartograms were compiled using the GIS software package.
nStudy: Software for Learning Analytics about Processes for Self-Regulated Learning
Authors: Winne Philip H , Teng Kenny , Chang Daniel , Lin Michael Pin-Chuan , Marzouk Zahia , Nesbit John C , Patzak Alexandra , Raković Mladen , Samadi Donya , Vytasek Jovita
Published: August 2019

Data used in learning analytics rarely provide strong and clear signals about how learners process content. As a result, learning as a process is not clearly described for learners or for learning scientists. Gašević, Dawson, and Siemens (2015) urged data be sought that more straightforwardly describe processes in terms of events within learning episodes. They recommended building on Winne’s (1982) characterization of traces — ambient data gathered as learners study that more clearly represent which operations learners apply to which information — and his COPES model of a learning event — conditions, operations, products, evaluations, standards (Winne, 1997). We designed and describe an open source, open access, scalable software system called nStudy that responds to their challenge. nStudy gathers data that trace cognition, metacognition, and motivation as processes that are operationally captured as learners operate on information using nStudy’s tools. nStudy can be configured to support learners’ evolving self-regulated learning, a process akin to personally focused, self-directed learning science.
Family Influence on Career Trajectories among High School Students in Midlands Province, Zimbabwe
Authors: Mtemeri Jeofrey
Published: August 2019

Abstract

The study was aimed at finding the parental influence on their childrenâ€™s career trajectories. The study was informed by the quantitative research approach. A survey design was used in the current study. Data was collected through questionnaires. Data was analysed using descriptive statistics. Results of the study revealed that parents had tremendous influence to their childrenâ€™s career trajectories. Parental influence was in the form of their direct and indirect involvement in their childrenâ€™s education. Results also revealed that siblings and other extended family members had also an influence to a lesser extent. The study recommended that schools involve parents in their career development activities as they were found to be an important factor in the childrenâ€™s careers. The study also recommended a similar study be carried out at national level to enable generalisation of the findings.