bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modulation of Calcium Channels by Group I and Group II Metabotropic Glutamate Receptors in Dentate Gyrus Neurons from Patients with Temporal Lobe Epilepsy
Authors: Schumacher T. B. , Beck H. , Steffens R. , Blümcke I. , Schramm J. , Elger C. E. , Steinhäuser C. 
Published: November 2007

Summary Purpose: Metabotropic glutamate receptors (raGluRs) might be promising new drug targets for the treatment of epilepsy because the expression of certain mGluRs is regulated in epilepsy and because activation of mGluRs results in distinctive anti‐ and proconvulsant effects. Therefore, we examined how mGluR activation modulates high‐voltage‐activated (HVA) Ca2+ channels. Methods: Whole‐cell patch‐clamp recordings were obtained from granule cells and interneuron‐like cells acutely isolated from the dentate gyrus of patients with pharmacoresistent temporal lobe epilepsy. Results: Agonists selective for either group I or group II mGluRs rapidly and reversibly reduced HVA currents in most dentate gyrus cells. These modulatory effects were inhibited by the respective group I and group IT mGluR antagonists. The specific Ca2+ channel antagonists nifedipine and w‐conotoxin GVLA potently occluded the effects of group I and II mGluR agonists, respectively, indicating that group I mGluRs acted on L‐type channels and group II mGluRs affected N‐type channels. About two thirds of the responsive neurons were sensitive either to group I or group II mGluRs, whereas a minority of cells showed effects to agonists of both groups, indicating a variable mGluR expression pattern. Conclusions: Group I and group II mGluRs are expressed in human dentate gyrus neurons and modulate L‐ and N‐type HVA channels, respectively. The data shed light on the possible cellular sequelae of the mGluRl upregulation observed in human epileptic dentate gyrus as well as on possible mGluR‐mediated anticonvulsant mechanisms.
How Well Can Epilepsy Syndromes Be Identified at Diagnosis? A Reassessment 2 Years After Initial Diagnosis
Authors: Berg Anne T. , Shinnar Shlorao , Levy Susan R. , Testa Francine M. , Smith‐Rapaport Susan , Beckerman Barbara 
Published: November 2007

Summary Purpose: Epilepsy syndromes can be identified very early in the course of a seizure disorder. It is unclear how accurate and resilient such early classifications are. We compared the classification of epilepsy syndromes made previously on the basis of information available at diagnosis with those made 2 years later in a cohort of children with newly diagnosed epilepsy. Methods: Children (n = 613) were prospectively identified at me time of initial diagnosis by participating physicians in Connecticut between 1993 and 1997. Classification of epilepsy syndrome according to International League Against Epilepsy guidelines was made previously based on all relevant information available at diagnosis. All cases were reclassified again after 2 years of additional evidence had accumulated. The distributions of syndromes at diagnosis and at 2 years are compared and reasons for changes examined. Results: After 2 years, syndromes remained the same in 86.3% of the cohort and changes occurred in 13.7% (n = 84). Evolution of the syndrome occurred in 24 children (3.9%), and rectification to the initial diagnosis occurred in 60 children (9.8%). The most common scenario for evolution of a syndrome was from West syndrome (n = 5), undetermined (n = 4), or symptomatic localization‐related epilepsy (n = 3) to the Lennox‐Gastaut syndrome. The most common rectification of initial classifications involved incompletely classified syndromes (cryptogenic localization‐related and undetermined syndromes; n = 36). In a few instances, a fully specified syndrome was reclassified to another apparently unrelated syndrome. In these cases, initial information at diagnosis had been difficult to interpret. Conclusions: Epilepsy syndromes can, for the most part, be identified at the time of initial diagnosis. Two years later, rectifications were made in only 9.8% of cases, and most of these involved syndromes that represented incomplete classifications in the first place. Significant changes were rare. The International League Against Epilepsy classification of the epilepsies can be meaningfully applied in epidemiological studies of newly diagnosed pediatric epilepsy.
Sulthiame as Monotherapy in Children with Benign Childhood Epilepsy with Centrotemporal Spikes: A 6‐Month Randomized, Double‐Blind, Placebo‐Controlled Study
Authors: Rating Dietz , Wolf Christian , Bast Thomas 
Published: November 2007

Summary Purpose: To evaluate the efficacy and tolerability of sulthiame (STM) as monotherapy in children with benign childhood epilepsy with centrotemporal spikes (BECTS). Methods: Sixty‐six BECTS patients entered a 6‐month double‐blind trial and were randomized to receive either STM (5 mg/kg/day) or a placebo. All patients had had two or more seizures during the 6 months preceding the trial and were aged 3–11 years. Seizures were recorded by parents in a diary. STM plasma levels and electroencephalograms (EEGs) were overseen by patient‐blinded observers. The primary effectiveness variable was the rate of treatment failure events (TFEs) per group. TFEs consisted of a first seizure after a 7‐day run‐in period, intolerable adverse events (AEs), development of another epileptic syndrome, or termination of the trial by parents or patient. Results: Twenty‐five of the 31 STM‐treated patients (81%) and 10 of the 35 placebo‐treated patients (29%) completed the trial without any TFEs (p = 0.00002). Most TFEs were seizures (n = 4 for the STM patients, n = 21 for the placebo group). Parents requested termination for two placebo‐treated patients. Four patients were terminated for administrative reasons. No patient was withdrawn for AEs. While all patients displayed at least one specific focus in either the awake or asleep EEG initially, 11 STM‐treated patients had a normal awake EEG and 10 had a normal asleep one after 6 months. Conclusions: STM was remarkably effective in preventing seizures in patients with BECTS. Patients suffering from ≥2 seizures during the past 6 months had a high risk of early recidivism. STM was well tolerated and should be considered for children with BECTS who are in need of treatment.
Gabapentin Versus Vigabatrin as First Add‐On for Patients with Partial Seizures That Failed to Respond to Monotherapy: A Randomized, Double‐Blind, Dose Titration Study
Authors: Lindberger Martin , Alenius Martin , Frisén Lars , Johannessen Svein I. , Larsson Sirkku , Malmgren Kristina , Torason Torbjorn 
Published: November 2007

Summary Purpose: Our objective was to compare the efficacy and safety of gabapentin and vigabatrin as first‐line addon treatment in patients with partial epilepsy. Methods: This was a multicenter, double‐blind, randomized dose titration study. After baseline assessment and randomization, the dose could be increased if seizures persisted and reduced if side effects occurred. Health‐related quality of life was assessed at baseline and at the end of the study. By a protocol amendment post hoc, all randomized patients were offered a standardized perimetry examination at the end of the study. Improvement rate was the proportion of patients with a reduction of seizure frequency of at least 50% during an 8‐week period without any adverse events causing withdrawal. Results: One hundred two patients were randomized and analyzed on an intent‐to‐treat basis. The improvement rate was 48% in the gabapentin group and 56% in the vigabatrin group. The improvement rate, when per protocol criteria were fulfilled, was 57% in the gabapentin group and 59% in the vigabatrin group. The proportion of seizure‐free patients was 31 % in the gabapentin group and 39% in the vigabatrin group. There was no difference in quality‐of‐life scores between the groups. Perimetry after termination of the study on 64 patients showed abnormal results in 3 of 32 patients in the vigabatrin group. Conclusion: Approximately one third of the patients in both groups became seizure‐free. Although no major differences were seen in terms of the improvement rate between the groups, equivalence between the two drugs was not found.
Epilepsy and Antiepileptic Drug Therapy in Juvenile Neuronal Ceroid Lipofuscinosis
Authors: Åberg L. E. , Bäckman M. , Kirveskari E. , Santavuori P. 
Published: November 2007

Summary Purpose: To survey the characteristics of epilepsy in patients with juvenile neuronal ceroid lipofuscinosis (JNCL) and determine the antiepileptic drug (AED) treatment most suitable for these patients. Methods: The study included 60 patients with JNCL; their mean age was 16.5 years (range 5–33). The age at onset of epilepsy, type of seizures, effect of the first AED on seizures, and the current seizure frequency and AED therapy were studied. The side effects of the AEDs were also clarified. Results: Fifty of the 60 patients had epilepsy. Patients' first epileptic seizure occurred at a mean age of 10.0 years (range 5–16), the most common type being generalized seizures. As the first AED tried, valproate (VPA) and lamotrigine (LTG) appeared equally effective, with 80% of the patients responding to these AEDs. During the study year, the median seizure frequency was four seizures a year (range 0–120), and 72% of the patients had good or satisfactory seizure control (0–6 seizures a year). In the different AED therapy groups, the proportion of patients with good or satisfactory seizure control ranged from 25% to 100%. LTG in monotherapy or in combination with clonazepam (CZP) was superior to other AEDs or combinations, but VPA also seemed effective. Adverse effects leading to the discontinuation of an AED were observed in 25% of the patients, most frequently in patients receiving phenobarbital (PB). No patient receiving LTG had to discontinue the drug due to adverse effects. Conclusion: Epilepsy in JNCL can usually be successfully treated with the current AEDs. In Finnish patients with JNCL, treatment is based on LTG, or, secondarily, VPA. In combination therapy, CZP seems a valuable add‐on AED.
Significance of Cerebellar Atrophy in Intractable Temporal Lobe Epilepsy: A Quantitative MRI Study
Authors: Sandok Evan K. , O'Brien Terence J. , Jack Clifford R. , So Elson L. 
Published: November 2007

Summary Purpose: To determine the incidence of cerebellar atrophy (CA) in patients with intractable temporal lobe epilepsy, whether any clinical factors are significantly associated with CA, whether CA is unilateral or asymmetric and whether this feature has any relationship to the side of epileptogenicity, and whether the presence of CA is related to epilepsy surgery outcome. Methods: We developed a magnetic resonance imaging method of measuring the presurgical volumes of the cerebellar hemispheres of 185 patients who underwent temporal lobectomy for intractable epilepsy and of 80 control subjects. In addition, cerebellar volumes were normalized to the total brain volumes. CA was determined as being present when the measured volume was smaller than two standard deviations from the mean value found in control subjects. Results: Both absolute and normalized cerebellar volumes were found to be significantly reduced in the epilepsy patients compared with the control subjects. Without normalization of the cerebellar volumes, CA was present in 25.9% of the epilepsy patients; with normalization, it was present in only 16.2%. The atrophy was symmetric between the cerebellar hemispheres, and there was no significant difference in volume between the hemisphere ipsilateral and the hemisphere contralateral to the side of the temporal lobectomy. The duration of epilepsy was significantly longer and the age at onset of epilepsy was younger in patients with CA than in those without CA. The presence of CA was not associated with the outcome of temporal lobectomy. Conclusions: CA is symmetric and common in patients with intractable temporal lobe epilepsy. However, the results suggest that the atrophy in one third of patients with CA also proportionately affects the cerebral hemispheres. The duration of epilepsy and the age at onset of epilepsy are associated with the occurrence of CA. Seizure control after temporal lobectomy is not influenced by the presence of CA.
Estimated Functional Capacity Predicts Mortality in Older Adults
Authors: Sui Xuemei , Laditka James N. , Hardin James W. , Blair Steven N. 
Published: November 2007

OBJECTIVES: To examine associations between functional capacity estimated from cardiorespiratory fitness (CRF) and mortality risks in adults aged 60 and older.DESIGN: Prospective study, averaging 13.6 years follow‐up.SETTING: Preventive medical clinic.PARTICIPANTS: Four thousand sixty adults who completed preventive medical examinations between 1971 and 2001; 24.7% women, mean age±standard deviation 64.6±4.9, body mass index (BMI) 25.9±3.8 kg/m2.MEASUREMENTS: CRF was quantified as metabolic equivalents (METs) achieved during maximal treadmill exercise. The lowest 20% of the age‐ and sex‐specific MET distribution was defined as having low CRF, the middle 40% moderate CRF, and the upper 40% high CRF. Cox regression was used to estimate death rates (per 1,000 person‐years), hazard ratios (HRs), and their 95% confidence intervals (CIs).RESULTS: Nine hundred eighty‐nine deaths occurred during follow‐up. Death rates adjusted for age, sex, and examination year were 30.9, 18.3, and 13.4 for all causes (P<.001); 15.9, 8.6, and 5.4 for cardiovascular disease (CVD) (P<.001); and 6.1, 4.9, and 4.2 for cancer (P=.04) for subjects with low, moderate, and high CRF, respectively. After adjusting for smoking, abnormal electrocardiograms at rest or while exercising, percentage of age‐predicted maximal heart rate achieved during exercise testing, baseline medical conditions, BMI, hypercholesterolemia, and family CVD and cancer history, subjects with high CRF had notably lower mortality risk than those with low CRF from all causes (HR=0.59, 95% CI=0.47–0.74) and from CVD (HR=0.57, 95% CI=0.41–0.80).CONCLUSION: CRF is an important independent predictor of death in older adults. The results add to the existing evidence that promoting physical activity in older adults provides substantial health benefits, even in the oldest old.
Geriatric Patients' Preferences for Treatment of Urinary Incontinence: A Study of Hospitalized, Cognitively Competent Adults Aged 80 and Older
Authors: Pfisterer Mathias H.‐D. , Johnson Theodore M. , Jenetzky Ekkehart , Hauer Klaus , Oster Peter 
Published: November 2007

OBJECTIVES: To elicit preferences for different urinary incontinence (UI) treatments of geriatric patients, to contrast these answers with answers from potential health proxies and providers, and to understand how select demographic factors might explain differences in patients' preferences.DESIGN: Cross‐sectional, descriptive.SETTING: German geriatric hospital.PARTICIPANTS: Medical inpatients aged 80 and older in a geriatric hospital, their physicians and nurses, and their family members.MEASURES: Six forced‐choice paired comparisons of four UI treatments were measured on an 11‐point visual analog scale, with verbal anchors.RESULTS: One hundred seventeen patients (mean age 84.6; 43% with UI), 72 staff members, and 71 family members participated. Although some preferred even “unpopular” management strategies, most respondents preferred diapers (79%), medications (78%), and scheduled toileting (79%) to urinary catheters; 64% preferred scheduled toileting to diapers. When choosing between diapers and medication, equal proportions preferred each option. In regression models, sex, activity of daily living score, and past treatment experience were significantly associated with expressed preferences. Proxies expressed greater preference for scheduled toileting than for diapers than patients did (P<.001). Intraclass correlation coefficients indicated at most only slight to fair agreement between patients and most other groups; spouses showed moderate to almost perfect agreement with patients.CONCLUSION: Preferences of cognitively competent geriatric patients for treatment of UI differed from those of their potential proxies (other than spouses), which emphasizes the need for focused communication to properly elicit patient preferences to achieve appropriate treatment decisions.
Comparison of Stress Experienced by Family Members of Patients Treated in Hospital at Home with That of Those Receiving Traditional Acute Hospital Care
Authors: Leff Bruce , Burton Lynda , Mader Scott L. , Naughton Bruce , Burl Jeffrey , Koehn Debbie , Clark Rebecca , Greenough William B. , Guido Susan , Steinwachs Donald , Burton John R. 
Published: November 2007

OBJECTIVES: To compare differences in the stress experienced by family members of patients cared for in a physician‐led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care.DESIGN: Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model.SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center.PARTICIPANTS: Two hundred fourteen community‐dwelling elderly patients who required acute hospital admission for community‐acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis.INTERVENTION: Treatment in a substitutive HaH model.MEASUREMENTS: Fifteen‐question survey questionnaire asking family members whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care.RESULTS: The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean ± standard deviation 1.7 ± 1.8 vs 4.3 ± 3.1, P<.001; median 1 vs 4, P<.001). HaH care was associated with lower odds of developing mean levels of family member stress (adjusted odds ratio=0.12, 95% confidence interval=0.05–0.30).CONCLUSION: HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members.
Occupational airborne allergic contact dermatitis from methacrylates in a dental nurse
Authors: Isaksson Marléne , Zimerson Erik , Svedman Cecilia 
Published: November 2007

Background:  There are very few reports of airborne allergic contact dermatitis from methacrylates.Objectives:  To report a dental nurse with facial eczema supposedly caused by airborne methacrylates present in the work environment.Methods:  Patch testing with serial dilutions of several methacrylates and work provocations in environments containing methacrylates was performed.Results:  Patch testing with serial dilutions of several methacrylates disclosed a high patch test reactivity. Repeated provocations when working with methacrylates resulted in facial eczema that resolved out of work. Attempts to collect the sensitizers using air pumps for the collection of vapors and filters for the collection of air‐born aerosols failed.Conclusions:  The clinical presentation was that of a facial dermatitis due to airborne exposure to methacrylates. It seems likely that 1 or several of these allergens caused the dermatitis.
Effect of coaching on psychological adjustment in patients with spinocerebellar degeneration: a pilot study
Authors: Izumi Shin-Ichi , Ando Kiyoshi , Ono Masafumi , Suzukamo Yoshimi , Michimata Akira , Fukuhara Shunichi 
Published: November 2007

Objective: To examine effect of coaching intervention on psychological adjustment to illness and health-related QOL (HRQOL) in patients with spinocerebellar degeneration. Design: Randomized controlled trial. Subjects: Twelve independently living patients with spinocerebellar degeneration aged 20—65 years old, without cognitive impairment or psychiatric disorder received coaching intervention, which was postponed in another 12 (control). Interventions: Three physician coaches telephoned assigned patients for 15—30 minutes in each of 10 weekly coaching sessions over three months. Main outcome measures: Primary endpoints were HRQOL (SF-36) and psychological adjustment to illness (Nottingham Adjustment Scale, Japanese version; NAS-J). Results: Two-way analysis of variance (group × time) showed statistically significant main effects of time for vitality (F = 5.00; P = 0.036), anxiety/depression (F = 5.15; P = 0.033), and locus of control (F = 5.58; P = 0.027), indicating improvement of scores over time in both coaching and control groups. No main effect of group or interaction was seen. However analysis of covariance with baseline scores as the covariate showed the coaching group to have better self-efficacy scores than controls at follow-up (least-square mean, experimental group, 65.1; control group, 52.7; P = 0.037). Conclusion: Carefully structured telephone coaching can improve self-efficacy in patients with spinocerebellar degeneration.
Group physical activity for demented older adults — feasibility and effectiveness
Authors: Netz Yael , Axelrad Salit , Argov Ester 
Published: November 2007

Objectives: (1) To examine the feasibility of group physical activity in a day-care routine. (2) To assess the impact of this programme on functional fitness. Design: Ten-week observational period, followed by 12 weeks of intervention in randomized controlled design, followed by 12 weeks of intervention only. Setting: A day-care centre for demented older individuals. Participants: Twenty-nine demented (Mini-Mental State Exam score 13.3 ± 5.83) day-care attendees, mean ± SD age 76.9 ± 6.72. Intervention: Group physical activity vs. social activity, followed by increased-intensity physical activity for both groups. Measurements: Performance rate (PR) in physical activity sessions, Timed Get Up and Go (TGUG), Sit-to-Stand (STS) and Functional Reach (FR). Results: Approximately 60% of the participants performed almost all movements or repetitions in both intervention phases. No improvements were observed following the first phase of physical activity. A reduction of 3.2 seconds (±1.2 SE) was noted in the time needed to perform the TGUG following the increased-intensity physical activity. Conclusion: A carefully tailored group physical activity, conducted twice weekly with a group of 12—15 participants in a medium size room, and led by a physical activity teacher assisted by a staff aide, is feasible. Although physical activity performed mainly while sitting is ineffective, it can be effective to a meaningful degree when performed while standing or walking.