Diazepam induced sleep spindle increase correlates with cognitive recovery in a child with epileptic encephalopathy

BACKGROUND

Continuous spike and wave of sleep with encephalopathy (CSWS) is a rare and severe developmental electroclinical epileptic encephalopathy characterized by seizures, abundant sleep activated interictal epileptiform discharges, and cognitive regression or deceleration of expected cognitive growth. The cause of the cognitive symptoms is unknown, and efforts to link epileptiform activity to cognitive function have been unrevealing. Converging lines of evidence implicate thalamocortical circuits in these disorders. Sleep spindles are generated and propagated by the same thalamocortical circuits that can generate spikes and, in healthy sleep, support memory consolidation. As such, sleep spindle deficits may provide a physiologically relevant mechanistic biomarker for cognitive dysfunction in epileptic encephalopathies.

CASE PRESENTATION

We describe the longitudinal course of a child with CSWS with initial cognitive regression followed by dramatic cognitive improvement after treatment. Using validated automated detection algorithms, we analyzed electroencephalograms for epileptiform discharges and sleep spindles alongside contemporaneous neuropsychological evaluations over the course of the patient's disease. We found that sleep spindles increased dramatically with high-dose diazepam treatment, corresponding with marked improvements in cognitive performance. We also found that the sleep spindle rate was anticorrelated to spike rate, consistent with a competitively shared underlying thalamocortical circuitry.

CONCLUSIONS

Epileptic encephalopathies are challenging electroclinical syndromes characterized by combined seizures and a deceleration or regression in cognitive skills over childhood. This report identifies thalamocortical circuit dysfunction in a case of epileptic encephalopathy and motivates future investigations of sleep spindles as a biomarker of cognitive function and a potential therapeutic target in this challenging disease.

Demographics and anthropometrics impact benefits of health intervention: data from the Reduce Obesity and Diabetes Project

OBJECTIVE

To determine the efficacy of a 4-month school-based health, nutrition and exercise intervention on body fatness and examine possible effects of demographic and anthropometric covariates.

METHODS

Height, weight, waist circumference and body composition were measured in a diverse population of 644 NYC middle school students (mean ± SD age 12.7 ± 0.9 years; 46% male; 38% Hispanic, 17% East Asian, 15% South Asian, 13.5% African American, 8.5% Caucasian, 8% other) during the fall and spring semesters. Year 1 participants (n = 322) were controls. Experimental participants (year 2, n = 469) received a 12-session classroom-based health and nutrition educational programme with an optional exercise intervention.

RESULTS

Groups were demographically and anthropometrically similar. The intervention resulted in significant reductions in indices of adiposity (ΔBMI z-scores [-0.035 ± 0.014; p = 0.01], Δ% body fat [-0.5 ± 0.2; p < 0.0001] and Δwaist circumference [-0.73 ± 0.30 cm; p < 0.0001]). Intervention effects were greater (p = 0.01) in men (ΔBMI z-score = -0.052 ± 0.015) versus women (0.022 ± 0.018), participants who were obese (ΔBMI z-score -0.083 ± 0.022 kg m-2) versus lean (-0.0097 ± 0.020 kg m-2) and South Asians (Δ% body fat -1.03 ± 0.35) versus total (-0.49 ± 0.20%) participants (p = 0.005).

CONCLUSION

A 4-month school-based health intervention was effective in decreasing measures of adiposity in middle school students, particularly in men, participants who were obese and South Asians.

Macrothrombocytic Thrombopathia. Clinical, Coagulation and Hereditary Aspects

Macrothrombocytic thrombopathia (la dystrophie thrombocytaire hémorragipare congénitale) has been diagnosed in two sisters (10 and 12 years old) born of a consanguineous marriage. A short description of the clinical course in both patients is given. Microscopic examinations of stained blood smears revealed an abnormal size of platelets, the diameter of 80 per cent of platelets was greater than 4.3 ì. The platelet count in both children was normal except the period of haemorrhagic crises. The prolongation of bleeding time and defective prothrombin consumption were the only abnormalities found by means of routine coagulation study. Plasma clotting factors were normal. Platelets were lacking factor 1 and 3 but platelets agglutination, viscous metamorphosis and clot retraction were normal. Two forms of macrothrombocytic thrombopathia were ascertained in the patients family (17 members) by means of microscopic and coagulation studies. The first form (homozygous state) is a platelet anomaly associated with defective prothrombin consumption and bleeding tendency. The second one (heterozygous state) consists in platelet anomaly only. The authors suggest that macrothrombocytic thrombopathia is transmitted as an autosomic and incompletely recessive trait, some abnormalities being detected in heterozygotes. It was suggested that the microscopic examination of platelets in stained blood smears offers the possibilty for detection of heterozygotes.

The pathogenesis and the mechanism of hemostatic defect of macrothrombocytic thrombopathia is briefly discussed.

Infusion of donor leukocytes to induce tolerance in organ allograft recipients

To further enhance chimerism, 229 primary allograft recipients have received perioperative intravenous infusion of a single dose of 3 to 6 X 10(8) unmodified donor bone marrow (BM) cells/kg body weight. In addition, 42 patients have been accrued in a concurrent protocol involving multiple (up to three) sequential perioperative infusions of 2 x 10(8) BM cells/kg/day from day 0-2 posttransplantation (PTx). Organ recipients (n = 133) for whom BM was not available were monitored as controls. The infusion of BM was safe and except for 50 (18%), all study patients have optimal graft function. Of the control patients, allografts in 30 (23%) have been lost during the course of follow-up. The cumulative risk of acute cellular rejection (ACR) was statistically lower in the study patients compared with that of controls. It is interesting that, 62% of BM-augmented heart recipients were free of ACR (Grade > or = 3A) in the first 6 months PTx compared to controls. The incidence of obliterative bronchiolitis was also statistically lower in study lung recipients (3.8%) compared with the contemporaneously acquired controls (31%). The levels of donor cell chimerism were at least a log higher in the peripheral blood of majority of the study patients compared with that of controls. The incidence of donor-specific hyporeactivity, as determined by one-way mixed leukocyte reaction, was also higher in those BM-augmented liver, kidney, and lung recipients that could be evaluated compared to controls.

[A case of pregnancy with polycystic kidneys]

The authors described a course of pregnancy and delivery of pregnant women who was admitted to the hospital in the third trimester with symptoms of sepsis in course of the pyelonephritis. Signs of a kidney insufficiency and pulmonary oedema were observed. During hospitalization ultrasound examination showed polycystic kidneys.