EPITRANS. Quality assessment of the epilepsy transition process

OBJECTIVE

To analyze the differences in clinical management during the epilepsy transition process from pediatric to adult care and to determine the quality of life and degree of satisfaction of patients and caregivers during the transition.

METHODS

This is a longitudinal study including patients with epilepsy transferred from pediatric to adult epilepsy care between 2013 and 2017. Patients had a minimum follow-up of 3 years before the transition visit and at least 3 years consulting in the adults section. Clinical characteristics were retrieved from the medical chart. Quality of life and satisfaction questionnaires were administered by online access to patients and caregivers at the end of the adult follow-up period.

RESULTS

99 patients (50.5 % women, mean transition age 16.5 ± 1 years old) were included. Before the transition visit, 90 % of patients received a transition discussion and 88 % had a formal clinical report. In the pediatric period, patients were visited more frequently, had more EEGs and genetic studies, and were seen by the same neuropediatrician (P<0.05). In the adult period, patients underwent a larger number of prolonged video EEGs and were prescribed polytherapy more often (P<0.05). Quality of life remained steady during the entire transition, but satisfaction with the care received was significantly higher during the pediatric period.

CONCLUSIONS

Significant differences were seen in epilepsy care during transition from pediatric to adult management, and this had an impact on the degree of satisfaction reported by patients and caregivers. Our results provide evidence of the potential value of development and early implementation of a protocolled transition program.

Implications of starting antiepileptic treatment prior to electroencephalography in first epileptic seizures

INTRODUCTION

This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure.

METHODS

We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence.

RESULTS

We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63).

CONCLUSIONS

Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.

Odor emission assessment of different WWTPs with Extended Aeration Activated Sludge and Rotating Biological Contactor technologies in the province of Cordoba (Spain)

In this study, five urban WWTPs (Wastewater Treatment Plant) with different biological treatment (Extended Aeration Activated Sludge - EAAS; Rotating Biological Contactor - RBC), wastewater type (Urban; Industrial) and size, were jointly evaluated. The aim was twofold: (1) to analyze and compare their odor emissions, and (2) to identify the main causes of its generation from the relationships between physico-chemical, respirometric and olfactometric variables. The results showed that facilities with EAAS technology were more efficient than RBC, with elimination yields of organic matter higher than 90%. In olfactometric terms, sludge managements facilities (SMFs) were found to be the critical odor source in all WWTPs compared to the Inlet point (I) or Post primary treatment (PP), and for seasonal periods with ambient temperature higher than 25 °C. Moreover, the global odor emissions quantified in all SMFs revealed that facilities with EAAS (C-WWTP, V-WWTP and Z-WWTP) had a lower odor contribution (19,345, 14,800 and 11,029 ou_E/s·m², respectively) than for those with RBC technology (P-WWTP and NC-WWTP) which accounted for 19,747 ou_E/s·m² and 80,061 ou_E/s·m², respectively. In addition, chemometric analysis helped to find groupings and differences between the WWTPs considering the wastewater (71.27% of total variance explained) and sludge management (64.52% of total variance explained) lines independently. Finally, odor emissions were adequately predicted from the physico-chemical and respirometric variables in the wastewater (r² = 0.8738) and sludge (r² = 0.9373) lines, being pH, volatile acidity and temperature (wastewater line), and pH, moisture, temperature, SOUR (Specific Oxygen Uptake Rate) and OD₂₀ (Cumulative Oxygen Demand at 20 h) (sludge line) the most influential variables.

Efecto de la pérdida de cobertura natural sobre la flora endémica del Área Tropical Importante para Plantas (TIPA) Concepción (Santa Cruz, Bolivia)

En el presente estudio se inventarió la riqueza de taxones endémicos que habitan en el Área Tropical Importante para Plantas (TIPA) Concepción, así como el efecto de la pérdida de la cobertura natural sobre estos atributos florísticos. El inventario fue realizado mediante fuentes de datos primarios (prospecciones de campo) y secundarios (bases de datos y especímenes de herbarios). La pérdida de la cobertura vegetal fue determinada mediante el análisis multitemporal de imágenes satelitales de tres periodos de tiempo (1990-2000, 2001-2010, 2011-2020). Basados en los registros históricos e inventarios de campo, un total de 28 taxones endémicos fueron inventariados (dos son nuevas especies para la ciencia). El endemismo que resguardan los hábitats que conforman el paisaje del área de estudio resultó distinto cuando comparados unos con otros (<30% de similaridad). Hasta el 2020, la cobertura natural se redujo progresivamente al 72.6%, bajo una tasa de pérdida anual de 0,88% ± 0,27%. Como consecuencia de la pérdida de la cobertura vegetal, ocho de los 28 taxones endémicos han desaparecido en la TIPA Concepción, ya que los hábitats donde fueron registrados se sustituyeron por áreas de producción agropecuaria. Por lo cual, los taxones remanentes enfrentan un alto riesgo de extinción local.

Overnight switch from levetiracetam to brivaracetam. Safety and tolerability

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Brivaracetam has a more selective action to SV2A binding site than levetiracetam.

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Neuropsychological adverse events improved in 76% of patients that switched.

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An overnight switch is well-tolerated in our relatively small Spanish sample.

Brivaracetam is a newer antiseizure medication than levetiracetam. It has a more selective action on the synaptic vesicle glycoprotein 2A binding site, and it seems to provide a more favorable neuropsychiatric profile. The aim of this study was to assess the safety and tolerability of an overnight switch from levetiracetam to brivaracetam.

This was a retrospective descriptive study including patients with epilepsy treated with levetiracetam, who switched due to inefficacy or previous adverse events (AEs). In total, forty-one patients were included (mean age 40.9 ± 17.8 years, women 48.8%). Focal epilepsy represented 75.6% (n = 31) of patients (structural cause [n = 25], unknown cause [n = 6]). Four patients had idiopathic generalized epilepsy, two had developmental and epileptic encephalopathy and four patients were unclassified. The reason to start brivaracetam was inefficacy in 53.7% (n = 22), AEs in 65.9% (25/27 neuropsychiatric) and both in 19.5% (n = 8). Brivaracetam-related AEs were reported in 24.4%. Neuropsychological AEs associated with the previous use of levetiracetam improved in 76% of patients. Treatment was discontinued in 19.5% patients. Patients’ reported seizure frequency improved, worsened and remained stable in 26.8%, 12.2%, and 61.0% of the cases, respectively.

An overnight switching to brivaracetam is safe and well tolerated. This treatment can improve levetiracetam-related neuropsychiatric AEs.

Functional recovery of secondary tropical forests

One-third of all Neotropical forests are secondary forests that regrow naturally after agricultural use through secondary succession. We need to understand better how and why succession varies across environmental gradients and broad geographic scales. Here, we analyze functional recovery using community data on seven plant characteristics (traits) of 1,016 forest plots from 30 chronosequence sites across the Neotropics. By analyzing communities in terms of their traits, we enhance understanding of the mechanisms of succession, assess ecosystem recovery, and use these insights to propose successful forest restoration strategies. Wet and dry forests diverged markedly for several traits that increase growth rate in wet forests but come at the expense of reduced drought tolerance, delay, or avoidance, which is important in seasonally dry forests. Dry and wet forests showed different successional pathways for several traits. In dry forests, species turnover is driven by drought tolerance traits that are important early in succession and in wet forests by shade tolerance traits that are important later in succession. In both forests, deciduous and compound-leaved trees decreased with forest age, probably because microclimatic conditions became less hot and dry. Our results suggest that climatic water availability drives functional recovery by influencing the start and trajectory of succession, resulting in a convergence of community trait values with forest age when vegetation cover builds up. Within plots, the range in functional trait values increased with age. Based on the observed successional trait changes, we indicate the consequences for carbon and nutrient cycling and propose an ecologically sound strategy to improve forest restoration success.

SIGUIENDO LOS PASOS DE LAS SEMILLAS: UTILIZACIÓN DEL SISTEMA DE INFORMACIÓN GEOGRÁFICA PARA GEORREFERENCIAR HUERTAS VINCULADAS A LA AGENCIA INTA RÍO CUARTO

The Pro-Huerta program delivers the autumn-winter and spring-summer seasonal seed kits free of charge to all INTA agencies. Each seed kit removed from the agency by the beneficiary, is registered in a form with the information of the address where the vegetable garden will be and a contact number. Using the data and a geographic information system (GIS), it was possible to georeference the potential vegetable gardens in the city of Río Cuarto, becoming a tool for intervention and territorial accompaniment of the extension agency in order to plan the survey and monitoring of activities productive of them.

Study of the Tagus River and Entrepeñas reservoir ecosystem around the Trillo nuclear power plant using chemometric analysis: Influence on water, sediments, algae and fish

The fluvial and aquatic ecosystem of the Tagus River and Entrepeñas reservoir located in the surrounding of the Trillo nuclear power plant (NPP) was evaluated from 1992 to 2008, considering the physical-chemical characteristics, metal content and radiological activity of the water, sediments, algae and fish. The water of both basins demonstrated pH, conductivity, COD, NO₃^- and DO values within a range considered as good quality and the water quality index (WQI) was found to be within a range of 71-90. Chemometric analysis revealed a shift in the river water (from upstream to downstream) affected by the concentration of salts and metals of natural origin, such as Fe and Al, and slight variations in temperature and radiological activity were detected due to the discharges from the NPP. The hydric conditions contributed to increase or decrease the metal concentration of the river water, the reservoir sediments, algae and fish. Fe and Al were found in higher concentration during drought periods and accumulated in sediments, algae and fish along the river course (from SP1 to SP3). Natural and artificial radionuclides found were ⁴⁰K with an average of 245 Bq/kg in river sediments, 499 Bq/kg in reservoir sediments and 121 Bq/kg in fish, and ⁹⁰Sr with a concentration between 0.40 and 1.30 Bq/kg in sediments. Contamination of the aquatic ecosystem with metals and radionuclides was low according to European legislation. In conclusion, this study provides additional elements aimed at understanding the dynamics of fluvial and lentic ecosystems under the influence of different disturbances.

Status epilepticus without impairment of consciousness: Long-term outcomes according to duration

OBJECTIVE

The point after which non-convulsive status epilepticus (NCSE) can cause permanent damage remains to be elucidated. The aim of this study was to analyze the association between time to resolution and long-term outcomes in NCSE.

METHODS

We performed a retrospective study of all patients with focal NCSE without consciousness impairment at two tertiary care hospitals in Spain. All the data were registered prospectively and the study period was December 2014-May 2018. We collected information on demographics, SE etiology, time to administration of different lines of treatment, time to NCSE resolution, and outcomes at discharge, 1 year, and 4 years. Clinical outcome was prospectively categorized as good (return to baseline function) or poor (new disability and death).

RESULTS

Seventy-four patients with a mean (±SD) age of 63.4 ± 17.5 years and a mean follow-up time of 2.4 ± 2.2 years were studied. A poor outcome at discharge was associated with a potentially fatal etiology (p < 0.001), EMSE score (Epidemiology-based Mortality Score in Status Epilepticus) (p = 0.012), lateral periodic discharges on EEG (p = 0.034), and occurrence of major complications during hospitalization (p = 0.007). An SE duration of >100 h was clearly associated with a worse outcome (p < 0.001). In the multiple regression analysis, the only independent predictors of a poor outcome at discharge were an SE duration of >+100 hours (p = 0.001), a potentially fatal etiology (p = 0.001), and complications during hospitalization (p = 0.010). An SE duration of >100 hours retained its value as the optimal cutoff point for predicting poor outcomes at both 1 year (p = 0.037) and 4 years (p = 0.05). Other predictors of poor long-term outcomes were a potentially fatal etiology (p < 0.001) and EMSE score (p = 0.034) at 1 year, and progressive symptomatic etiology at 4 years (p = 0.025).

SIGNIFICANCE

In patients with focal NCSE without consciousness impairment, a potentially fatal etiology and an SE duration of >100 h were associated with poor short-term and long-term outcomes.

Implications of initiating antiseizure drugs prior to the performance of EEG in first epileptic seizures

INTRODUCTION

This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure.

METHOD

We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72hours after the seizure, and the factors related with seizure recurrence.

RESULTS

We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63).

CONCLUSIONS

Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.

[Quality of life in adult patients with idiopathic generalised epilepsy. The EPILAK study]

INTRODUCTION

Quality of life (QoL) is an important aspect in the treatment of patients with epilepsy.

AIM

To analyse the QoL using the Quality of Life in Epilepsy Inventory-10 (QOLIE-10) in adults with idiopathic generalised epilepsy and to study factors associated with a worse QoL.

PATIENTS AND METHODS

A cross-sectional, multicentre, observational study conducted by 141 neurologists in all the autonomous communities of Spain. Each researcher analysed the QOLIE-10 of two males and two females over 18 years of age with idiopathic generalised epilepsy seen consecutively in public or private practice. The results were standardised: 0 was the worst QoL and 100 was the best.

RESULTS

A total of 546 patients were analysed. Women: 51.1% (n = 279). Mean age: 36 ± 15.3 years old (18-87). Childhood absence seizures: 7.5% (n = 41); juvenile absence seizures: 9.2% (n = 50); juvenile myoclonic seizures: 29.8% (n = 163); only tonic-clonic seizures: 53.5% (n = 292). Monotherapy: 63.2% (n = 345). Seizure-free in the last year: 53.1% (n = 290). Psychiatric comorbidity: anxiety: 28.4% (n = 155); depression: 14.1% (n = 77); attention deficit: 10.1% (n = 55). Employment status: in active employment: 47.2% (n = 258); student: 20% (n = 109); housewife/husband: 7.3% (n = 40); pensioner: 10.2% (n = 56); unemployed: 14.3% (n = 78). Marital status: married or in a relationship: 49.1% (n = 268); single: 43.7% (n = 239). Mean score on the QOLIE-10: 71.4 ± 19.1. Being female (p = 0.006), greater frequency of seizures (p < 0.001), polytherapy (p < 0.001), psychiatric comorbidity (p < 0.001) and unemployment (p < 0.001) were significantly associated with a worse QoL.

CONCLUSIONS

The QoL of patients with idiopathic/genetic generalised epilepsy is affected by poor seizure control, psychiatric comorbidity and unemployment, and women are more affected than men.

Tree mode of death and mortality risk factors across Amazon forests

The carbon sink capacity of tropical forests is substantially affected by tree mortality. However, the main drivers of tropical tree death remain largely unknown. Here we present a pan-Amazonian assessment of how and why trees die, analysing over 120,000 trees representing > 3800 species from 189 long-term RAINFOR forest plots. While tree mortality rates vary greatly Amazon-wide, on average trees are as likely to die standing as they are broken or uprooted-modes of death with different ecological consequences. Species-level growth rate is the single most important predictor of tree death in Amazonia, with faster-growing species being at higher risk. Within species, however, the slowest-growing trees are at greatest risk while the effect of tree size varies across the basin. In the driest Amazonian region species-level bioclimatic distributional patterns also predict the risk of death, suggesting that these forests are experiencing climatic conditions beyond their adaptative limits. These results provide not only a holistic pan-Amazonian picture of tree death but large-scale evidence for the overarching importance of the growth-survival trade-off in driving tropical tree mortality.

Biofiltration of butyric acid: Monitoring odor abatement and microbial communities

The objective of this study is to evaluate comparatively the odor removal efficacy of two biofilters operated under different conditions and to identify taxonomically the microbial communities responsible for butyric acid degradation. Both biofiltration systems, which were filled with non-inoculated wood chips and exposed to gas streams containing butyric acid, were evaluated under different operational conditions (gas airflow and temperature) from the physical-chemical, microbiological and olfactometric points of view. The physical-chemical characterization showed the acidification of the packing material and the accumulation of butyric acid during the biofiltration process (<60 days). The removal efficacy was found to be 98-100% during the first 20 days of operation, even at high odor concentration. Changes in the operational temperature increased the odor load factor from 400 to 1400 ou_E/m²·s, which led to the reduction of microbiota in the packing material, and a drastic drop of the odor removal efficacy. However, the progressive increase in gas airflow improved the biodegradation efficacy of butyric acid up to 88% with odor loadings as high as 33,000 ou_E/m³, while a linear relationship between odor inlet load and removal capacity was also found. The analysis of the microbial community showed that Proteobacteria was the most abundant phylum along the biofiltration time (58-92%) and regardless of the operational conditions. Finally, principal component analysis applied to the physical-chemical and microbiological data set revealed significant differences between the two biofilters under study.

How soon should urgent EEG be performed following a first epileptic seizure?

PURPOSE

Patients with a first unprovoked epileptic seizure are often seen in emergency services. Electroencephalography (EEG) is indicated for diagnosing epilepsy, but the optimal time to perform this test has not been defined. This study aimed to determine the time interval following a seizure within which EEG has the greatest diagnostic yield.

METHODS

We conducted a retrospective study of all adult patients with a first unprovoked seizure who had undergone emergency EEG (July 2014-December 2019). Data collection included demographics, seizure type, time interval to EEG study, EEG pattern identified, and the prescription after emergency assessment. An optimal cut-off point for time to EEG was obtained, and an adjusted regression model was performed to establish associations with the presence of epileptiform abnormalities.

RESULTS

A total of 170 patients were included (mean age: 50.7 years, 40.6% women). Epileptiform discharges were identified in 34.1% of recordings, nonepileptiform abnormalities in 46.5%, and normal findings in 19.4%. A lower latency from seizure to EEG was associated with a higher probability of finding epileptiform discharges (median: 12.7 in the epileptiform EEGs vs. 20 h in the nonepileptiform EEGs, p < 0.001). The time interval associated with the highest probability of detecting an epileptiform EEG pattern was within the first 16 h after seizure onset: 52.1% of recordings performed before the 16-h cut-off showed these abnormal patterns compared with 20.2% performed after (p < 0.001). These findings were not related to the presence of an epileptogenic lesion in neuroimaging or to other clinical variables. The finding of epileptiform abnormalities was followed by a greater prescription of antiseizure drugs (96.4% vs. 66% in nonepileptiform patterns, p < 0.001).

CONCLUSION

The diagnostic yield of EEG following a first unprovoked epileptic seizure is highest when this test is performed within the first 16 h after onset of the event.

Environmental performance of an industrial biofilter: Relationship between photochemical oxidation and odorous impacts

Biological techniques are widely used to treat gaseous streams derived from waste treatment plants. The generation of volatile organic compounds (VOCs) is one of the principal pollution sources in composting facilities from which nuisance odours are released. In addition, the generation of photochemical smog with other gases such as NO_X can produce ozone at ground level due to their photochemical ozone creation potential (POCP). In this work, the performance of an industrial biofilter was evaluated from an environmental point of view. Specifically, this study evaluated the potential impact in terms of photochemical oxidation and odour emission derived from composting in a vessel under four different aeration conditions. Gas chromatography-time-of-flight mass spectrometry (GC-TOFMS) was used to perform the chemical characterisation of the gaseous streams, while dynamic olfactometry was used to carry out the sensorial analysis. A total of 95 compounds belonging to 12 different families of VOCs were selected. Principal component analysis revealed the influence of each VOC family on each impact category and explained 88% of the total variance. Multivariate regression was used to study the correlation between photochemical oxidation and odour impact, which has never been reported before. The correlations obtained (r ≥ 0.97) evidenced the direct relationship between these two impacts. Photochemical oxidation and odour emission were proven to be important environmental impacts derived from composting facilities, whose abatement might be carried out by biofiltration systems.

The Forest Observation System, building a global reference dataset for remote sensing of forest biomass

Forest biomass is an essential indicator for monitoring the Earth's ecosystems and climate. It is a critical input to greenhouse gas accounting, estimation of carbon losses and forest degradation, assessment of renewable energy potential, and for developing climate change mitigation policies such as REDD+, among others. Wall-to-wall mapping of aboveground biomass (AGB) is now possible with satellite remote sensing (RS). However, RS methods require extant, up-to-date, reliable, representative and comparable in situ data for calibration and validation. Here, we present the Forest Observation System (FOS) initiative, an international cooperation to establish and maintain a global in situ forest biomass database. AGB and canopy height estimates with their associated uncertainties are derived at a 0.25 ha scale from field measurements made in permanent research plots across the world's forests. All plot estimates are geolocated and have a size that allows for direct comparison with many RS measurements. The FOS offers the potential to improve the accuracy of RS-based biomass products while developing new synergies between the RS and ground-based ecosystem research communities.

Sewage sludge composting under semi-permeable film at full-scale: Evaluation of odour emissions and relationships between microbiological activities and physico-chemical variables

In the present study, physico-chemical characteristics, heavy metals content, odour emissions, microbial enumeration and enzymatic activities were analysed during industrial scale composting of sewage sludge partially pre-treated to evaluate the effect of a combined system of semi-permeable film and aeration on these parameters. The results related to physico-chemical parameters showed a decrease in total organic carbon (TOC), organic matter (OM), total carbon (TC) along the process. Volatile solids (VS) were also reduced, reaching 36% at 120 days, which is above the limit according to the current legislation. Similarly, metal content was found to be an important variable in the evolution of enzymatic activity, while lead (Pb), zinc (Zn), and nickel (Ni) were the most influential. Moreover, heavy metals were found below the limit of type B compost quality or European class 2 at the end of the process, which is suitable for agriculture soil. The odorous impact generated during the hydrolytic stage was reduced to an average value of 4 ou_E/s. This suggests that, covered stage with the semi-permeable film, could be a viable solution to mitigate odour emissions. The highest temperature was reached at 10 days and it was favoured by semi-permeable film. Temperature promoted the presence of thermophilic bacteria and fungi and indicated an early biodegradation process mediated by microorganisms. Statistical analyses revealed a high correlation of physico-chemical variables with microbial activity. Thus, samples from the first 14 days were highly correlated with enzymatic activities such as β-glucosidase (Ac-βGlu), protease (Ac-Pr), and dehydrogenase (Ac-De), which have usually been involved in the hydrolysis of organic matter.

Co-composting of sewage sludge and eggplant waste at full scale: Feasibility study to valorize eggplant waste and minimize the odoriferous impact of sewage sludge

Sewage sludge and bulking agent with small proportions of eggplant waste (EP) (4.7 and 8.6%) were co-composted at full scale to evaluate the feasibility of their joint valorization and to reduce the odorous impact during composting. In this sense, physico-chemical, respirometric and olfactometric variables were monitored throughout the co-composting process. The physico-chemical variables studied were related to each other to evaluate their effect on the quality of the final product and the odoriferous impact. It was observed that the reduction in nitrogen concentration was not parallel to the removal of organic matter, which influenced the odor concentration emitted. Furthermore, during the hydrolytic stage of the co-composting process, the odor concentration was lower when the agricultural waste content was highest (8.6% EP: 6317 and 8192 ou_E/m³) in comparison with the lowest concentration of EP (4.7% EP: 9214 and 14720 ou_E/m³) or without the addition of EP (reference composting pile: 10200 and 22500 ou_E/m³). Although sewage sludge is more biodegradable than eggplant waste, the co-composting process was carried out under suitable conditions. Approximately 90 days were required to obtain a stabilized compost. Consequently, co-composting might be a suitable alternative to valorize EP and reduce the odoriferous impact of sewage sludge, with the consequent economic, social and environmental benefits.

Biodiversity recovery of Neotropical secondary forests

Old-growth tropical forests harbor an immense diversity of tree species but are rapidly being cleared, while secondary forests that regrow on abandoned agricultural lands increase in extent. We assess how tree species richness and composition recover during secondary succession across gradients in environmental conditions and anthropogenic disturbance in an unprecedented multisite analysis for the Neotropics. Secondary forests recover remarkably fast in species richness but slowly in species composition. Secondary forests take a median time of five decades to recover the species richness of old-growth forest (80% recovery after 20 years) based on rarefaction analysis. Full recovery of species composition takes centuries (only 34% recovery after 20 years). A dual strategy that maintains both old-growth forests and species-rich secondary forests is therefore crucial for biodiversity conservation in human-modified tropical landscapes.

Compositional response of Amazon forests to climate change

Most of the planet's diversity is concentrated in the tropics, which includes many regions undergoing rapid climate change. Yet, while climate-induced biodiversity changes are widely documented elsewhere, few studies have addressed this issue for lowland tropical ecosystems. Here we investigate whether the floristic and functional composition of intact lowland Amazonian forests have been changing by evaluating records from 106 long-term inventory plots spanning 30 years. We analyse three traits that have been hypothesized to respond to different environmental drivers (increase in moisture stress and atmospheric CO₂ concentrations): maximum tree size, biogeographic water-deficit affiliation and wood density. Tree communities have become increasingly dominated by large-statured taxa, but to date there has been no detectable change in mean wood density or water deficit affiliation at the community level, despite most forest plots having experienced an intensification of the dry season. However, among newly recruited trees, dry-affiliated genera have become more abundant, while the mortality of wet-affiliated genera has increased in those plots where the dry season has intensified most. Thus, a slow shift to a more dry-affiliated Amazonia is underway, with changes in compositional dynamics (recruits and mortality) consistent with climate-change drivers, but yet to significantly impact whole-community composition. The Amazon observational record suggests that the increase in atmospheric CO₂ is driving a shift within tree communities to large-statured species and that climate changes to date will impact forest composition, but long generation times of tropical trees mean that biodiversity change is lagging behind climate change.

[«Apuntes en Neurologia» (Notes in Neurology): a synthesis of the evidence on common paroxysmal neurological disorders and on neurodegenerative disorders]

«Apuntes en Neurologia» is an initiative in which prominent national and international leaders, with broad academic recognition, came together to synthesise the most outstanding clinical aspects within their area of interest and to discuss the latest developments in a more accessible language. Understanding the factors that affect the onset and progression of any neurological disease through a review is important to be able to develop strategies to reduce the burden of these diseases. Moreover, knowledge of the clinical aspects is essential to solve the problems of daily clinical practice. The data collected here reflect the weight of evidence and some of them anticipate a promising future in the treatment of these diseases. This first edition focuses on common paroxysmal neurological disorders such as migraine, epilepsy and sleep disorders, as well as neurodegenerative disorders such as Parkinson's disease and cognitive impairment. These are clearly different pathologies, although some of them such as migraine and epilepsy, may share clinical symptoms. Sleep disorders, however, are important manifestations of neurodegenerative diseases that are sometimes clinically apparent long before the onset of other neurological symptoms. After recalling pathophysiology and diagnosis, the current review focuses on bringing together the main advances in five of the major neurological diseases.

Full-scale composting of sewage sludge and market waste: Stability monitoring and odor dispersion modeling

The aim of this study was to assess the odor immission derived from full-scale composting of different abundant and highly pollutant organic waste: sewage sludge with bulking agent (SL), sewage sludge pretreated through anaerobic digestion and supplemented with bulking agent (SL-AD), and market waste with olive leaves (MW-OL). The combination of dynamic olfactometry and Gaussian dispersion modeling allowed both the quantification of odor emissions from each waste and the evaluation of their global odorous impact in nearby urban areas. Wind speed, summer and winter seasons, and atmospheric conditions were considered in the dispersion model. The results revealed that high wind speed (2.6 m/s) increases the global odor immission in summer season, independently of atmospheric stability. However, the maximum odor immission concentration recommended for composting process was not exceeded in any case, which depends on each country/region. The experimental results also enable to evaluate the influence of several physico-chemical variables on odor emissions derived from composting. The removal of nitrogen and volatile solids was the main cause for odor generation. Moreover, the microbiological activity of each substrate was monitored throughout the process and different percentages of biodegradability were quantified depending on the type of substrate and pretreatment applied.

Lacosamide monotherapy in clinical practice: A retrospective chart review

OBJECTIVE

To assess effectiveness and tolerability of first-line and conversion to lacosamide monotherapy for focal seizures.

MATERIALS AND METHODS

Retrospective, non-interventional chart review of lacosamide monotherapy patients aged ≥16 years in Europe. Outcomes included retention rate at observational point (OP) 3 (12 ± 3 months), seizure freedom rates at OP2 (6 ± 3 months) and OP3 and adverse drug reactions (ADRs).

RESULTS

A total of 439 patients were included (98 first-line and 341 conversion to monotherapy; 128 aged ≥65 years [25 first-line and 103 conversion to monotherapy]). First-line and conversion to monotherapy retention rates were 60.2% (59/98; 95% confidence interval [CI] 49.8%-70.0%) and 62.5% (213/341; 57.1%-67.6%), respectively. Kaplan-Meier estimates of 12-month retention rates were 81.2% and 91.4% for first-line and conversion to monotherapy, respectively. First-line and conversion to monotherapy retention rates in patients aged ≥65 years were 60.0% (38.7%-78.9%) and 68.9% (59.1%-77.7%), respectively. At OP2, 66.3% of first-line and 63.0% of conversion to monotherapy patients were seizure free. At OP3, 60.2% of first-line and 52.5% of conversion to monotherapy patients were seizure free. In the ≥65 years subgroup, seizure freedom rates at OP2 were 72.0% and 68.0% for first-line and converted to monotherapy, respectively, and at OP3, 68.0% and 56.3%, respectively. Overall, 52 of 439 (11.8%) patients reported ADRs (16.4% in ≥65 years subgroup), most commonly dizziness (5.0%), headache (2.1%) and somnolence (1.6%).

CONCLUSIONS

Lacosamide was effective and well tolerated as first-line or conversion to monotherapy in a clinical setting in adult and elderly patients with focal seizures.

Multivariate analysis and biodegradability test to evaluate different organic wastes for biological treatments: Anaerobic co-digestion and co-composting

This study proposes the combination of statistical analysis and a biodegradability test to complement the composition of different wastes in order to find the optimal balance of nutrients for their joint bioconversion. Due to the need to determine the adequate balance of nutrients, the use of alternative techniques to experimental procedures could significantly reduce the cost and time of the process. With this aim, fifteen organic wastes (nine solid and six liquid wastes) were selected and different statistical analyses were performed on the physico-chemical characterization and respirometric variables. Liquid and solid wastes were analyzed separately using principal components analysis (PCA) (PC1 + PC2: 67% of total variance explained for solid substrates and PC1 + PC2: 85% of total variance explained for liquid substrates). The analysis provided considerable information about the predominant chemical composition of each substrate as well as their similarities and deficiencies to identify possible mixtures. In addition to PCA, cluster analyses (CA) were performed to group the substrates and identify the most significant differences between them. The joint evaluation of PCA and CA permitted identifying the optimal waste mixtures (i.e., glycerol-strawberry-fish waste) by correlating the loadings and scores plot, the cluster analysis dendograms and the COD/TKN ratio from the physico-chemical characterization. Moreover, multivariate regression was found to be an appropriate tool for predicting microbiological activity, as well as the soluble available biodegradable organic matter of each substrate. Inorganic carbon (C_IC) and total organic carbon (C_TOC) were found to be the most influential parameters in the prediction correlation of oxygen consumption and oxygen uptake rate.

Monitoring of the composting process of different agroindustrial waste: Influence of the operational variables on the odorous impact

Composting is a conventional but economical and environmentally friendly way to transform organic waste into a valuable, organic soil amendment. However, the physico-chemical characterization required to monitor the process involves considerable investment in terms of cost and time. In this study, 52 samples of four compostable substrates were collected randomly during the composting process and analyzed physico-chemically. The physico-chemical characterization was evaluated and reduced by principal component analysis (PCA) (PC1 + PC2: 70% variance). Moreover, a study of the relationship between odor and the raw material and odor and the operational variables was carried out at pilot scale using PCA and multivariate regression. The substrates were grouped by PCA (PC1 + PC2: 87% variance). The odor emission rate (OER) and dynamic respirometric index (DRI) were found to be the most influential variables in the sample variance, being relevant to identify the different emission sources. Dynamic respirometry and multivariate regression could be suitable tools to predict these odor emissions for the majority of compostable substrates, identifying successfully the emission source.

[Social cognition and cognitive functions in patients with epilepsy treated with eslicarbazepine acetate]

INTRODUCTION

Epilepsy is accompanied by cognitive disorders, frequently aggravated by the use of antiepileptic drugs, which can affect social empathy.

AIM

To analyse the impact of treatment with eslicarbazepine acetate (ESL) on social cognition and prefrontal cognitive functions in adults with focal epilepsy.

PATIENTS AND METHODS

We conducted a prospective single-centre study with patients aged between 18 and 65 years with focal seizures treated with ESL. The patients were evaluated in their baseline visit and at six months after starting ESL treatment by means of tasks designed for theory of mind, executive and attentional functions, auditory-verbal memory, quality of life, and anxiety and depression.

RESULTS

Forty-one patients were treated with ESL, and 30 completed the follow-up. A significant improvement was observed in the theory of mind tasks. In the analysis stratified by sex, the men showed greater improvement. A cognitive improvement was observed in the Wisconsin Card Sorting Test, Symbol Digit, Backward Digit Span and Stroop tests. No differences were found in the Quality of Life in Epilepsy-31 Inventory or in the Hospital Anxiety and Depression Scale. These results were independent of the reduction in the number of seizures and the ESL dosage.

CONCLUSION

Treatment with ESL could improve some aspects of theory of mind in patients with epilepsy, especially in men and independently of the control of seizures, with no changes in quality of life, anxiety or depression.

Prognosis of status epilepticus in elderly patients

PURPOSE

To evaluate the clinical features and prognosis of status epilepticus (SE) in patients above 70 years old.

METHODS

Retrospective analysis of all patients ≥70 years old with SE registered prospectively during 4 years. Follow-up after discharge was performed.

RESULTS

Ninety patients were evaluated. Acute symptomatic etiology was the most prevalent. The mean number of antiepileptic drugs (AEDs) used was 2.7 ± 1.2, and 21% of the patients required sedation. A poor outcome was considered when death (31.1%) or developing of new neurological impairment at discharge (32.2%) occurred. After multivariate analysis, four variables predicted a poor outcome: acute symptomatic etiology (OR: 6.320; 95% CI: 1.976-20.217; P = .002), focal motor SE type (OR: 9.089; 95% CI: 2.482-33.283; P = .001), level of consciousness (OR: 4.596; 95% CI: 1.903-11.098; P = .001), and SE duration >12 hours (OR: 3.763; 95% CI: 1.130-12.530; P = .031). Independent predictive factors of mortality were SE duration >12 hours (OR: 4.306; 95% CI: 1.044-17.757; P = .043), modified Status Epilepticus Severity Score (mSTESS) (OR: 2.216; 95% CI: 1.313-3.740; P = .003), and development of complications (OR: 3.334; 95% CI: 1.004-11.070, P = .049). Considering long-term mortality, age (HR 1.036; 95% CI 1.001-1.071; P = .044), a potentially fatal underlying cause (HR 2.609; 95% CI 1.497- 4.548; P = .001), and mSTESS score >4 (HR 1.485; 95% CI 1.158-1.903; P = .002) remained as predictive factors. There was no association between sedation and the number of AEDs used with outcome at discharge or long-term mortality (P > .05).

CONCLUSIONS

SE above 70 years old has a high morbimortality. Prognosis is not related to treatment aggressiveness.

Outcome of cancer-related seizures in patients treated with lacosamide

OBJECTIVES

Lacosamide is an antiepileptic drug (AED), which has proven to be effective to control seizures, including acute conditions such as status epilepticus. The aim of this study is to describe the clinical experience with lacosamide in neuro-oncological patients.

MATERIALS AND METHODS

Multicenter retrospective study in patients with cancer-related seizures, who received lacosamide as an add-on therapy.

RESULTS

Forty-eight patients with benign and malignant tumors, including primary brain tumors, lymphomas, systemic cancer with central nervous system involvement, or paraneoplastic encephalitis, were included. Lacosamide was effective in the control of chronic seizures in patients with either benign or malignant tumors. The success rate was greater in malignant tumors, and drug-resistant epilepsies were more likely associated with benign tumors. Adverse events occurred in nearly 70% of patients, particularly in acute conditions and associated with the concomitant use of radio-/chemotherapy. Lacosamide-related adverse events were more likely somnolence and dizziness, which usually resolved after dose adjustment. After starting lacosamide, nearly half of the patients discontinued one of the baseline AEDs and decreased or discontinued dexamethasone. Fifteen patients with status epilepticus were treated with intravenous lacosamide, and 73% of them had their condition resolved without serious drug-related adverse events.

CONCLUSION

Lacosamide is an AED to consider in cases of cancer-related seizures. Lacosamide pharmacodynamics and pharmacokinetics allow the achievement of responder rates over 50% with no serious adverse effects, amelioration of side effects from other AEDs or radio-/chemotherapy, and no significant drug interactions. Furthermore, the intravenous formulation shows clear benefits in acute conditions such as status epilepticus.

EARLY-ESLI study: Long-term experience with eslicarbazepine acetate after first monotherapy failure

PURPOSE

Evaluate real-life experience with eslicarbazepine acetate (ESL) after first monotherapy failure in a large series of patients with focal epilepsy.

METHOD

Multicentre, retrospective, 1-year, observational study in patients older than 18 years, with focal epilepsy, who had failed first antiepileptic drug monotherapy and who received ESL. Data from clinical records were analysed at baseline, 3, 6 and 12 months to assess effectiveness and tolerability.

RESULTS

Eslicarbazepine acetate was initiated in 253 patients. The 1-year retention rate was 92.9%, and the final median dose of ESL was 800 mg. At 12 months, 62.3% of patients had been seizure free for 6 months; 37.3% had been seizure free for 1 year. During follow-up, 31.6% of the patients reported ESL-related adverse events (AEs), most commonly somnolence (8.7%) and dizziness (5.1%), and 3.6% discontinued due to AEs. Hyponatraemia was observed in seven patients (2.8%). After starting ESL, 137 patients (54.2%) withdrew the prior monotherapy and converted to ESL monotherapy; 75.9% were seizure free, 87.6% were responders, 4.4% worsened, and 23.4% reported ESL-related AEs.

CONCLUSION

Use of ESL after first monotherapy failure was associated with an optimal seizure control and tolerability profile. Over half of patients were converted to ESL monotherapy during follow-up.

[Classification of idiopathic generalised epilepsies in patients over 16 years of age]

INTRODUCTION

Idiopathic generalised epilepsies (IGE) are a set of electroclinical syndromes with different phenotypes. Our aim is to analyse those phenotypes in patients over 16 years of age.

PATIENTS AND METHODS

We conducted a retrospective analysis of a series of patients with IGE. They were classified as childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), epilepsy with tonic-clonic seizures only (TCSE), epilepsy with eyelid myoclonias and absences (EMA) and pure photogenic epilepsy (PE).

RESULTS

We included 308 patients, the majority females (56.8%), in our study. JME was the most prevalent (40.9%), followed by TCSE (30%), JAE (10%), EMA (8.7%), CAE (7.7%) and PE (1.6%). The types of seizures presented by the most patients were tonic-clonic (89.6%), myoclonic (45.4%), absence (31.4%), reflex seizures (13.3%), eyelid myoclonias (12.6%), non-epileptic psychogenic seizures (3.6%) and status epilepticus (1.9%). They all had generalised spike-and-wave discharges in the electroencephalogram (EEG). 19.2% presented asymmetrical discharges and 28.2% showed a photoparoxysmal response. We observed differences between syndromes in polytherapy (p < 0.0001), withdrawal of therapy (p = 0.01) and being seizure-free beyond the age of 50 (p = 0.004).

CONCLUSIONS

JME was the most frequent. Generalised tonic-clonic seizures were the type of seizures presented by the most patients, followed by myoclonic, absent and reflex seizures. The EEG showed a photoparoxysmal response in over a quarter of the patients, and one in five displayed asymmetrical anomalies. Differences were observed according to the syndrome in polytherapy, persistence of seizures and withdrawal of treatment.

Rufinamide in children and adults in routine clinical practice

OBJECTIVE

To explore the long-term effectiveness of rufinamide in managing Lennox-Gastaut Syndrome (LGS), other epileptic encephalopathies, and intractable focal epilepsies in adults and children in routine clinical practice.

METHODS

A multicentre, retrospective chart review of patients prescribed adjunctive rufinamide at seven Spanish epilepsy centres, with assessments at six and 12 months.

RESULTS

We evaluated data from 58 patients (40 male, age range 7-57 years), 25 of whom were diagnosed with LGS, 12 with other epileptic encephalopathies and 21 of whom were diagnosed with focal epilepsies, mainly frontal lobe. The mean daily rufinamide dose was 32.0 mg/kg (range 12.5-66.7 mg/kg) in children and 24.7 mg/kg (range 5.0-47.0 mg/kg) in adults, and the most commonly used concomitant antiepileptic drugs were levetiracetam and valproate. Rufinamide was discontinued in 25 patients (43.1%) during the 1-year follow-up, and the most common reason was lack of effectiveness (n = 12, 20.7% of total). The frequency of generalized tonic-clonic seizures was significantly reduced from baseline at 6 and 12 months (P = 0.001), both in patients with generalized epilepsies and in patients with focal epilepsies. Significant seizure frequency reduction from baseline was observed at 12 months (P = 0.01) for tonic/atonic seizures and at 6 months (P = 0.001) for focal seizures. Side effects were reported in 21 patients (36.2%): nausea, vomiting and weight loss were most frequent.

CONCLUSIONS

Rufinamide was well tolerated and was effective in reducing frequency of generalized tonic-clonic, tonic/atonic and focal seizures in both children and adults with severe refractory epilepsies, primarily LGS.

Variation in stem mortality rates determines patterns of above-ground biomass in Amazonian forests: implications for dynamic global vegetation models

Understanding the processes that determine above-ground biomass (AGB) in Amazonian forests is important for predicting the sensitivity of these ecosystems to environmental change and for designing and evaluating dynamic global vegetation models (DGVMs). AGB is determined by inputs from woody productivity [woody net primary productivity (NPP)] and the rate at which carbon is lost through tree mortality. Here, we test whether two direct metrics of tree mortality (the absolute rate of woody biomass loss and the rate of stem mortality) and/or woody NPP, control variation in AGB among 167 plots in intact forest across Amazonia. We then compare these relationships and the observed variation in AGB and woody NPP with the predictions of four DGVMs. The observations show that stem mortality rates, rather than absolute rates of woody biomass loss, are the most important predictor of AGB, which is consistent with the importance of stand size structure for determining spatial variation in AGB. The relationship between stem mortality rates and AGB varies among different regions of Amazonia, indicating that variation in wood density and height/diameter relationships also influences AGB. In contrast to previous findings, we find that woody NPP is not correlated with stem mortality rates and is weakly positively correlated with AGB. Across the four models, basin-wide average AGB is similar to the mean of the observations. However, the models consistently overestimate woody NPP and poorly represent the spatial patterns of both AGB and woody NPP estimated using plot data. In marked contrast to the observations, DGVMs typically show strong positive relationships between woody NPP and AGB. Resolving these differences will require incorporating forest size structure, mechanistic models of stem mortality and variation in functional composition in DGVMs.

Variation in stem mortality rates determines patterns of above-ground biomass in Amazonian forests: implications for dynamic global vegetation models

Understanding the processes that determine above-ground biomass (AGB) in Amazonian forests is important for predicting the sensitivity of these ecosystems to environmental change and for designing and evaluating dynamic global vegetation models (DGVMs). AGB is determined by inputs from woody productivity [woody net primary productivity (NPP)] and the rate at which carbon is lost through tree mortality. Here, we test whether two direct metrics of tree mortality (the absolute rate of woody biomass loss and the rate of stem mortality) and/or woody NPP, control variation in AGB among 167 plots in intact forest across Amazonia. We then compare these relationships and the observed variation in AGB and woody NPP with the predictions of four DGVMs. The observations show that stem mortality rates, rather than absolute rates of woody biomass loss, are the most important predictor of AGB, which is consistent with the importance of stand size structure for determining spatial variation in AGB. The relationship between stem mortality rates and AGB varies among different regions of Amazonia, indicating that variation in wood density and height/diameter relationships also influences AGB. In contrast to previous findings, we find that woody NPP is not correlated with stem mortality rates and is weakly positively correlated with AGB. Across the four models, basin-wide average AGB is similar to the mean of the observations. However, the models consistently overestimate woody NPP and poorly represent the spatial patterns of both AGB and woody NPP estimated using plot data. In marked contrast to the observations, DGVMs typically show strong positive relationships between woody NPP and AGB. Resolving these differences will require incorporating forest size structure, mechanistic models of stem mortality and variation in functional composition in DGVMs.