Early childhood myoclonic epilepsy: An independent genetic generalized epilepsy with myoclonic seizures as the main seizure type

Publication date: Available online 6 July 2017
Source:Clinical Neurophysiology
Author(s): Zhixian Yang, Jiao Xue, Hui Li, Ping Qian, Xiaoyan Liu, Yuwu Jiang, Yuehua Zhang
ObjectiveTo elucidate the characteristics of the myoclonic seizures alone, or predominant myoclonus combined with generalized tonic-clonic seizures (GTCS) and/or absences, in early childhood, and discuss its classification.MethodsForty-two children were retrospectively recruited between January 2006 and June 2015.ResultsThe mean age of seizure onset was 40.5 months. They were divided into 4 groups: myoclonic seizures alone; predominant myoclonus combined with GTCS; predominant myoclonus combined with absences; predominant myoclonus combined with both GTCS and absences. Interictal EEG showed generalized spike- or polyspike-wave discharges at 2-4 Hz. Seizures were controlled in 22 patients at a mean age of 60.5 months. The psychomotor development was normal (30/37) or mildly delayed (7/37).ConclusionsWe reported a cohort of patients with early childhood myoclonic epilepsy (ECME), with the following characteristics: Seizures started below 5 years old in otherwise normal children; Seizure types included myoclonic seizures alone or combined with GTCS and/or absences; Febrile or afebrile GTCS might appear firstly; Interictal EEG showed generalized spike- or polyspike-wave; Seizures usually were in remission before adolescence with normal development or mild cognitive or behavioral deficits in most.SignificanceECME might be an independent epileptic syndrome not established by International League Against Epilepsy (ILAE) previously.



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Guidelines for low intensity transcranial electrical stimulation – an overdue step in a fairly uncontrolled field.

Publication date: Available online 6 July 2017
Source:Clinical Neurophysiology
Author(s): Reinhard Dengler




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The impact of accelerated high frequency rTMS on brain neurochemicals in treatment-resistant depression: Insights from 1H MR spectroscopy

Publication date: Available online 6 July 2017
Source:Clinical Neurophysiology
Author(s): Chris Baeken, Jean-Pascal Lefaucheur, Peter Van Schuerbeek
ObjectiveAlthough accelerated repetitive transcranial magnetic stimulation (rTMS) designs seem to be able to alleviate mood over a relatively short period of time, no studies yet examined the cellular effects on neurochemicals with regard to working mechanisms, safety and neural integrity.MethodsEighteen right-handed antidepressant-free unipolar treatment resistant depressed (TRD) patients participated in this sham-controlled accelerated high frequency (aHF)-rTMS ¹H MR spectroscopy study applied to the left dorsolateral prefrontal cortex (DLPFC). Baseline measurements were compared to eighteen age- and gender-matched healthy controls. We explicitly focused on neurochemical concentrations in the bilateral DLPFC and rostral anterior cingulate cortex (rACC).ResultsCompared to healthy individuals, TRD patients displayed significantly lower baseline glutamatergic (sum absolute concentrations glutamate and glutamine) concentrations in the left DLPFC. aHF-rTMS does not significantly alter neurochemical concentrations in the three predefined brain regions. Clinical improvement was related to significant GABA concentration increases in the left DLPFC.ConclusionsAccelerated HF-rTMS treatment did not affect neural integrity in the examined regions. The observed GABA concentration increases suggest that the immediate therapeutic effects of aHF-rTMS could be mediated through a locally increased GABAergic inhibitory neurotransmission.SignificanceAlthough more statistical power is needed for reaching firm conclusions, aHF-rTMS does not appear to negatively influence neural integrity.



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The microbiota and autoimmunity: Their role in thyroid autoimmune diseases

Publication date: Available online 6 July 2017
Source:Clinical Immunology
Author(s): Hedda L. Köhling, Sue F. Plummer, Julian R. Marchesi, Kelly S. Davidge, Marian Ludgate
Since the 1970s, the role of infectious diseases in the pathogenesis of Graves' disease (GD) has been an object of intensive research. The last decade has witnessed many studies on Yersinia enterocolitica, Helicobacter pylori and other bacterial organisms and their potential impact on GD. Retrospective, prospective and molecular binding studies have been performed with contrary outcomes. Until now it is not clear whether bacterial infections can trigger autoimmune thyroid disease. Common risk factors for GD (gender, smoking, stress, and pregnancy) reveal profound changes in the bacterial communities of the gut compared to that of healthy controls but a pathogenetic link between GD and dysbiosis has not yet been fully elucidated. Conventional bacterial culture, in vitro models, next generation and high-throughput DNA sequencing are applicable methods to assess the impact of bacteria in disease onset and development. Further studies on the involvement of bacteria in GD are needed and may contribute to the understanding of pathogenetic processes. This review will examine available evidence on the subject.



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Patient non-adherence to guideline-recommended care in acute low back pain

Publication date: Available online 6 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jasper D. Bier, Steven J. Kamper, Arianne P. Verhagen, Christopher G. Maher, Christopher M. Williams
ObjectiveTo describe the magnitude of patient reported non-adherence with guideline-recommended care for acute low back pain.DesignSecondary analysis of data from participants enrolled in the PACE trial, a randomised controlled trial evaluating the effectiveness of paracetamol for acute low back pain.ParticipantsData from 1643 participants with acute low back pain.InterventionsGuideline recommendend care including; reassurance, simple analgesia, and the advice to stay active and avoid bed rest. Also advice against additional treatments and referral for imaging.Main Outcome MeasuresProportion of non-adherence with guideline-recommended care. Non-adherence was defined as 1) failure to consume the advised paracetamol dose, or 2) receipt of additional healthcare, tests, or medication during the trial treatment period (4 weeks). Multivariable logistic regression analysis was preformed to determine the factors associated with non-adherence.ResultsIn the first week of treatment, 39.7% of the participants were classified as non-adherent. Over the 4-week treatment period 70.0% were non-adherent, 57.5% did not consume the advised paracetamol dose. Higher perceived risk of persistent pain, lower level of disability and not claiming workers' compensation were associated with non-adherence with odds ratios ranging from 0.46 to 1.05.ConclusionsAdherence to guideline-recommended care for acute low back pain was poor. Most participants do not take the advised paracetamol dose. Higher perceived risk of persistence of complaints, lower baseline disability and participants not claiming workers' compensation were independently associated with non-adherence.



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Infection and apoptosis associated with inflammation in periodontitis: an immunohistologic study

Abstract

Objective

Evidence of increased apoptosis is observed in periodontitis, and may be associated with destruction of the periodontal tissue caused by the increased cell death, with the release of danger signals and subsequent stimulation of the proinflammatory processes. However, the exact mechanisms associated with these processes remain unclear. This study aimed to investigate the presence of the periodontal pathogen Treponema denticola, apoptosis, High Mobility Group Box1 as a damage-associated molecular pattern and several inflammatory markers in periodontitis and gingivitis subjects.

Materials and methods

Soft tissue specimens from gingival tissues of periodontitis and gingivitis patients were used for immunohistochemical and immunofluorescence staining of Treponema denticola chymotrypsin-like proteinase (CTLP), apoptosis markers, High Mobility Group Box1, Toll-like receptor 4, inflammatory cell markers and proinflammatory cytokines.

Results

Treponema denticola was detected in all periodontitis-affected tissues. This was associated with a significant increase in the number of apoptotic cells, including macrophages, alterations in the expression of High Mobility Group Box1 and its receptor, and increased levels of proinflammatory cytokines compared with gingivitis.

Conclusions

In summary, the presence of Treponema denticola (especially its CTLP), apoptosis, High Mobility Group Box1, and inflammatory markers suggest their potential involvement in the pathogenesis of periodontitis.

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Using the Systems-Practice Framework to Understand Food Allergen Management Practices at College Catering Operations: A Qualitative Study

Publication date: Available online 6 July 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Jennie Verstappen, Miranda Mirosa, Carla Thomson
BackgroundThe number of individuals with food allergies or intolerances attending catered university residential colleges is increasing, and safe dining options are required to minimize the risk of allergic reactions and food-induced death.ObjectiveThis qualitative research study sought to advance professional knowledge of the factors affecting allergen management practices, particularly pertaining to college foodservices.DesignThree catered residential colleges affiliated with a major university in New Zealand were selected as research sites. The study used an ethnographic approach and systems-practice theory as a framework for data collection and organizing results. Data collection techniques included document analyses (3 hours per site), observations (6 to 8 hours per site), focus groups with foodservice workers (30 to 45 minutes per site, n=16), and interviews with foodservice managers (45 to 90 minutes per interview, n=5). Notes and transcripts were coded through the process of thematic analysis using NVivo for Mac software, version 11.1.1, to identify factors affecting allergen management practices.ResultsThe main factors affecting allergen management practices at college foodservices included information provided by residents about dietary requirements; communication between residents and foodservice staff; systems for allergen management; attitude of foodservice staff; and college size.ConclusionsDetailed dietary information, effective communication with residents, sufficient resources, clarification of responsibilities, and thorough systems are required for staff to perform safe allergen management practices. Ultimately, successful implementation was predominantly determined by staff attitude. Foodservice managers are advised to identify motivators and address barriers of staff attitudes toward allergen management practices to promote successful implementation.



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