Decreasing SUDEP incidence in a tertiary epilepsy center between 1981 and 2016: Effects of better patient supervision

OBJECTIVE

The objective of this study was to investigate the incidence of sudden unexpected death in epilepsy (SUDEP) in a tertiary epilepsy center in the years 1981-2016 with an emphasis on patient supervision and nursing intervention in different departments.

METHODS

We identified 14 SUDEP cases (probable, definite, definite plus). Patient-years (PY) and incidence were calculated for the periods of six years for the general epileptology wards (adults and children) and, in addition, for the epilepsy monitoring unit (EMU) since 1990.

RESULTS

The incidence of SUDEP showed a decreasing trend over time (r = -0.81; p = 0.053, two-sided; Pearson correlation coefficient). This is especially true in children (no SUDEP occurred in pediatric general epileptology since 1992). Additionally, in the EMU (314 PY since the start of 1990), no SUDEP occurred. Sudden unexpected death in epilepsy incidence was highest (6.8/1000 PY) in the early time periods (1981-1992) and lowest (1.7/1000 PY) in the later time periods (1999-2010). In the general epileptology wards (3579 PY), the overall incidence was 3.9 per 1000 PY (95% confidence interval (CI): 2.1-6.6).

CONCLUSIONS

We assume that the decreased SUDEP incidence is an effect of better supervision by the use of technical means (e.g., video cameras, pulse oximeters, seizure detection systems) and rooming-in of parents or family.

Waterborne and diet-related effects of inorganic and organic fungicides on the insect leaf shredder Chaetopteryx villosa (Trichoptera)

It is well-documented that fungicides can affect crustacean leaf shredders via two effect pathways, namely waterborne exposure and their diet (i.e., via dietary uptake of fungicides adsorbed to leaf material and an altered microorganism-mediated food quality). As a consequence of different life history strategies, the relevance of these effect pathways for aquatic shredders belonging to other taxonomic classes, for instance insects, remains unclear. Therefore, we investigated waterborne and diet-related effects in larvae of the caddisfly leaf shredder Chaetopteryx villosa (Insecta: Trichoptera) and compared our observations to previous reports on effects in adults of the crustacean leaf shredder Gammarus fossarum (Malacostraca: Amphipoda). We assessed acute waterborne effects of an organic fungicide mixture (OFM) and the inorganic fungicide copper (Cu) on the leaf consumption (n = 30) of the fourth-/fifth-instar larvae of C. villosa and their food choice (n = 49) when offered leaf material, which was either conditioned in presence or in absence of the respective fungicide(s). Moreover, the larval leaf consumption (n = 50) and physiological fitness (i.e., growth as well as lipid and protein content) were examined after subjecting C. villosa for 24 days towards the combination of both effect pathways at environmentally relevant concentrations. G. fossarum and C. villosa exhibited similar sensitivities and the same effect direction when exposed to the OFM (either waterborne or dietary pathways). Both shredders also showed the same effect direction when exposed to dietary Cu, while with regards to mortality and leaf consumption C. villosa was less sensitive to waterborne Cu than G. fossarum. Finally, as observed for G. fossarum, the combined exposure to OFM over 24 days negatively affected leaf consumption and the physiology (i.e., growth and lipid reserves) of C. villosa. While no combined Cu effects were observed for larval leaf consumption, contrasting to the observations for G. fossarum, the physiology of both shredders was negatively affected, despite partly differing effect sizes and directions. Our results suggest that C. villosa and G. fossarum are of comparable sensitivity towards waterborne and diet-related organic fungicide exposure, whereas the trichopteran is less sensitive to Cu-based waterborne fungicide exposure. However, when both pathways act jointly, organic and inorganic fungicides can affect the physiology of shredder species with completely different life history strategies. As caddisflies represent a subsidy for terrestrial consumers, these observations indicate that fungicide exposure might not only affect aquatic ecosystem functioning but also the flux of energy across ecosystem boundaries.

Parietofrontal network upregulation after motor stroke

Objective

Motor recovery after stroke shows a high inter-subject variability. The brain's potential to form new connections determines individual levels of recovery of motor function. Most of our daily activities require visuomotor integration, which engages parietal areas. Compared to the frontal motor system, less is known about the parietal motor system's reconfiguration related to stroke recovery. Here, we tested if functional connectivity among parietal and frontal motor areas undergoes plastic changes after stroke and assessed the behavioral relevance for motor function after stroke.

Methods

We investigated stroke lesion-induced changes in functional connectivity by measuring high-density electroencephalography (EEG) and assessing task-related changes in coherence during a visually guided grip task with the paretic hand in 30 chronic stroke patients with variable motor deficits and 19 healthy control subjects. Quantitative changes in task-related coherence in sensorimotor rhythms were compared to the residual motor deficit.

Results

Parietofrontal coupling was significantly stronger in patients compared to controls. Whereas motor network coupling generally increased during the task in both groups, the task-related coherence between the parietal and primary motor cortex in the stroke lesioned hemisphere showed increased connectivity across a broad range of sensorimotor rhythms. Particularly the parietofrontal task-induced coupling pattern was significantly and positively related to residual impairment in the Nine-Hole Peg Test performance and grip force.

Interpretation

These results demonstrate that parietofrontal motor system integration during visually guided movements is stronger in the stroke-lesioned brain. The correlation with the residual motor deficit could either indicate an unspecific marker of motor network damage or it might indicate that upregulated parietofrontal connectivity has some impact on post-stroke motor function.

The 67P/Churyumov-Gerasimenko observation campaign in support of the Rosetta mission

We present a summary of the campaign of remote observations that supported the European Space Agency's Rosetta mission. Telescopes across the globe (and in space) followed comet 67P/Churyumov-Gerasimenko from before Rosetta's arrival until nearly the end of the mission in September 2016. These provided essential data for mission planning, large-scale context information for the coma and tails beyond the spacecraft and a way to directly compare 67P with other comets. The observations revealed 67P to be a relatively 'well-behaved' comet, typical of Jupiter family comets and with activity patterns that repeat from orbit to orbit. Comparison between this large collection of telescopic observations and the in situ results from Rosetta will allow us to better understand comet coma chemistry and structure. This work is just beginning as the mission ends-in this paper, we present a summary of the ground-based observations and early results, and point to many questions that will be addressed in future studies.This article is part of the themed issue 'Cometary science after Rosetta'.