Interictal cardiac autonomic dysfunction in temporal lobe epilepsy demonstrated by [(123)I]metaiodobenzylguanidine-SPECT

We studied the post-ganglionic cardiac sympathetic innervation in patients with chronic temporal lobe epilepsy (TLE) by means of [(123)I]metaiodobenzylguanidine-single photon computed tomography (MIBG-SPECT) and evaluated the effects of carbamazepine on cardiac sympathetic innervation. TLE is frequently associated with dysfunction of the autonomic nervous system. Autonomic dysregulation might contribute to unexplained sudden death in epilepsy. Anticonvulsive medication, particularly with carbamazepine, might also influence autonomic cardiovascular modulation. MIBG-SPECT allows the quantification of post-ganglionic cardiac sympathetic innervation, whereas measuring the variability of the heart rate provides only functional parameters of autonomic modulation. Antiepileptic drugs, especially carbamazepine (CBZ), can affect cardiovascular modulation. We determined the index of cardiac MIBG uptake (heart/mediastinum ratio) and heart rate variability (HRV) using time and frequency domain parameters of sympathetic and parasympathetic modulation in 12 women and 10 men (median age 34.5 years) with a history of TLE for 7-41 years (median 20 years). Myocardial perfusion scintigrams were examined to rule out deficiencies of MIBG uptake due to myocardial ischaemia. To assess the possible effects of CBZ on autonomic function, we compared MIBG uptake and HRV in 11 patients who had taken CBZ and 11 patients who had not taken CBZ, and in 16 healthy controls. In order to identify MIBG uptake defects due to myocardial ischaemia, all patients had a perfusion scintigram. Cardiac MIBG uptake was significantly less in the TLE patients (1.75) than in the controls (2.14; P = 0.001), but did not differ between subgroups with and without CBZ treatment. The perfusion scintigram was normal in all patients. Time domain analysis of HRV parameters suggested the predominance of parasympathetic cardiac activity in the TLE patients, but less parasympathetic modulation in the patients treated with CBZ than in those not treated with CBZ (P < 0.05), whereas frequency domain parameters showed no significant difference between the subgroups of patients or between patients and controls. MIBG-SPECT demonstrates altered post-ganglionic cardiac sympathetic innervation. This dysfunction might carry an increased risk of cardiac abnormalities.

Prevalence and clinical importance of Entamoeba histolytica in two high-risk groups: travelers returning from the tropics and male homosexuals

This study was undertaken to learn the prevalence of amebiasis and to assess the clinical importance of Entamoeba histolytica in two high-risk groups: 2700 travelers returning from the tropics and 320 male homosexuals. Some 16.3% of the homosexual men and 4.0% of the travelers had E. histolytica infections. Only five travelers showed a pathogenic zymodeme of E. histolytica, which correlated closely with invasive amebiasis with positive amebic serology and clinical symptoms with diarrhea. The homosexual group had neither a pathogenic isoenzyme pattern nor positive amebic serology. Currently, travelers to the tropics have a risk of 0.3% (1:340) of acquiring invasive amebiasis; 92.5% of all E. histolytica infections in travelers remain asymptomatic and are confirmed by serology and zymodeme status. No homosexual presented with invasive amebiasis.

The Wada test in Austrian, Dutch, German, and Swiss epilepsy centers from 2000 to 2005: a review of 1421 procedures

Twenty-six Austrian, Dutch, German, and Swiss epilepsy centers were asked to report on use of the Wada test (intracarotid amobarbital procedure, IAP) from 2000 to 2005 and to give their opinion regarding its role in the presurgical diagnosis of epilepsy. Sixteen of the 23 centers providing information had performed 1421 Wada tests, predominantly the classic bilateral procedure (73%). A slight nonsignificant decrease over time in Wada test frequency, despite slightly increasing numbers of resective procedures, could be observed. Complication rates were relatively low (1.09%; 0.36% with permanent deficit). Test protocols were similar even though no universal standard protocol exists. Clinicians rated the Wada test as having good reliability and validity for language determination, whereas they questioned its reliability and validity for memory lateralization. Several noninvasive functional imaging techniques are already in use. However, clinicians currently do not want to rely solely on noninvasive functional imaging in all patients.

A case-control study on scrapie in Norwegian sheep flocks

Scrapie first was detected in indigenous sheep in Norway in 1981, and from 1995 to 1997 an increase in the number of flocks with scrapie cases was recorded. These flocks were mainly in one geographical region. A study to identify risk factors for scrapie was conducted. The study had three frequency-matched controls selected for every case within the same Veterinary District. A questionnaire was submitted to 176 sheep flocks (42 had been scrapie flocks). The data obtained by the questionnaire were linked to data collected from governmental and industry registers. After imputing missing data using single random imputation, the statistical analysis was performed using multivariable conditional logistic regression. Purchase of female sheep from scrapie flocks, sharing of rams, or sharing of pastures between different flocks were the risk factors associated with the occurrence of scrapie. Of factors potentially sustaining and promoting the infection in the flock, number of winter-fed sheep, number of buildings for housing sheep, rams and ewes shared room during mating period and increase in the flock size were associated with scrapie. We interpret these findings to show that factors involving transfer of sheep between flocks or direct contact between sheep of different flocks are important for the spread of scrapie. Management factors are important for the development of scrapie. However, it was not possible to discriminate between the different management factors in this study at the flock level. Also, factors indicating awareness and interest of the farmer (as well as willingness to contact a veterinarian for diseased sheep) were related to the detection of scrapie in the flock.

Magnetic resonance spectroscopy and histopathological findings in temporal lobe epilepsy

PURPOSE

In some patients with temporal lobe epilepsy, histopathological evaluation of resected brain tissue after surgical treatment may reveal several features indicative of discrete cortical malformations. We sought to determine whether these histopathological features were accompanied by hippocampal changes detectable preoperatively by proton magnetic resonance (MR) spectroscopy and to evaluate their relationship with postoperative outcome.

METHODS

In 25 consecutive temporal lobe epilepsy patients who were scheduled for surgical treatment, MR spectroscopy was performed, and resected brain tissue was analyzed histopathologically for the presence of discrete cortical malformations (e.g., microdysgenesis). Outcome was assessed in all patients with an average postoperative period of 26 months.

RESULTS

In 13 patients, we found subtle, histopathologically detectable signs of cortical malformation: 6 of them with concomitant hippocampal sclerosis (dual pathology) and 7 without. The latter subgroup had a worse surgical outcome and showed enhanced bilateral and/or contralateral pathological changes in the hippocampal formation when investigated by MR spectroscopy.

CONCLUSIONS

These data suggest that by showing contralaterally or bilaterally abnormal spectra, MR spectroscopy might be able to indicate pathological changes in subtle developmental disorders that are possibly more widespread over the brain. This observation may improve noninvasive diagnosis in presurgical evaluation and the neurobiological understanding of cortical malformations in pharmacoresistant temporal lobe epilepsy.

The significance of bilateral CSI changes for the postoperative outcome in temporal lobe epilepsy

PURPOSE

In a prospective study, we evaluated the significance of preoperative bilateral chemical shift spectroscopy imaging (CSI) changes for the prognosis of postoperative seizure outcome in the surgical treatment of patients with temporal lobe epilepsy (TLE).

METHOD

CSI using multivoxel spectroscopy was performed. Twenty-six consecutive TLE patients scheduled for epilepsy surgery were included. To evaluate the value of the CSI with respect to postoperative seizure outcome, discriminant analysis with ipsilateral and contralateral CSI was performed.

RESULTS

The discriminant analysis showed that the contralateral metabolic changes alone are able to predict seizure outcome whereby 92.3% of cases were correctly classified. Upon comparison of the two groups of seizure-free and non-seizure-free patients with respect to contralateral metabolic changes, the difference proved to be highly significant (paired t test: t = -6.3, df = 24, p < 0.001).

CONCLUSION

Bilateral metabolic CSI changes have a predictive value for the postoperative outcome in patients with TLE. In patients with severe bilateral metabolic changes, poor seizure outcome is a likely result.

Therapeutic intensive seizure analysis (TISA) in presurgical evaluation of Losigamone

OBJECTIVE

The new method TISA was used to evaluate Losigamone efficacy.

METHODS

Sixteen patients with pharmacoresistant partial seizures undergoing presurgical evaluation were randomized in this double-blind, placebo-controlled, parallel-group Losigamone monotherapy study under continuous video-EEG monitoring. Duration (in s, of each seizure and each ictal sign), intensity (grade zero to three), N/24h (number of seizures and ictal signs per 24 h), D/24h (seconds per 24 h covered by seizures and ictal signs) and seizure free intervals were recorded.

RESULTS

A total of 246 seizures were intensively analyzed. The duration and intensity of all seizures improved more in the active treatment group than in the placebo group. There was a statistically significant superiority in the duration of the seizure free interval in the Losigamone group. Ictal signs such as oro-alimentary automatisms and fumbling were improved during Losigamone treatment.

CONCLUSION

Losigamone has a preferred inhibitory effect on propagated epileptic activity. TISA is a sensitive method for evaluation of the selective effects of AEDs.

[MRI spectroscopy, T2 relaxometry, and postoperative prognosis in cryptogenic temporal lobe epilepsy]

The preoperative localization of pharmaco-resistant focal epilepsies before surgery and the prognosis concerning seizure outcome are both of importance. In addition to conventional MRI diagnostics for the detection of small epileptogenic lesions, proton magnetic resonance spectroscopic imaging (HMR spectroscopy) can be useful for assessing the bilaterality of pathological changes in cryptogenic temporal lobe epilepsies. The technique and findings of HMR spectroscopy are reported in patients with cryptogenic temporal lobe epilepsies. The findings indicate that chemical shift imaging (CSI) investigations of the ipsilateral and contralateral hemispheres provide important information for the prediction of seizure outcome after epilepsy surgery.

[Diagnostic imaging in refractory temporal lobe epilepsy. A comparison of MR volumetry and multivoxel-MR-spectroscopy for assessment of postoperative prognosis]

While the importance of magnetic resonance (MR) spectroscopy, volumetry, and T2-relaxometry for preoperative localization has already been verified, the question arises as to what extent the individual techniques are useful for assessing postoperative prognosis with respect to seizures and neuropsychological outcome. In a prospective comparative study, 26 patients were examined preoperatively with a 1.5 T whole-body scanner. The MR spectroscopy was taken by high resolution 1 H proton spectroscopy, the volumetry with MP rage technique. The postoperative outcome was laid down using Engel's classification. Our results show that the metabolic changes can be divided into three groups using MR spectroscopy: unilateral, slightly bilateral, and severely bilateral to contralateral. In case of bilateral changes, the severity of metabolic changes in the nonoperated, contralateral side was decisive for postoperative outcome. The results from volumetry did not correlate with postoperative outcome.

A Living Lab approach to understanding dairy farmers' technology and data needs to improve herd health: Focus groups from 6 European countries

For successful development and adoption of technology on dairy farms, farmers need to be included in the innovation process. However, the design of agricultural technologies usually takes a top-down approach with little involvement of end-users at the early stages. Living Labs offer a methodology that involve end-users throughout the development process and emphasize the importance of understanding users' needs. Currently, exploration of dairy farmers' technology needs has been limited to specific types of technology (e.g., smartphone apps) and adult cattle. The aim of this study was to use a Living Lab approach to identify dairy farmers' data and technology needs to improve herd health and inform innovation development. We conducted 18 focus groups with a total of 80 dairy farmers from Belgium, Ireland, the Netherlands, Norway, Sweden, and the United Kingdom. Data were analyzed using Template Analysis, and 6 themes were generated representing the fundamental needs of autonomy, comfort, competence, community and relatedness, purpose, and security. Farmers favored technologies that provided them with convenience, facilitated their knowledge and understanding of problems on farm, and allowed them to be self-reliant. Issues with data sharing and accessibility and usability of software were barriers to technology use. Furthermore, farmers were facing problems around recruitment and management of labor and needed ways to reduce stress. Controlling aspects of the barn environment, such as air quality, hygiene, and stocking density, were particular concerns in relation to youngstock management. Overall, the findings suggest that developers of farm technologies may want to include farmers in the design process to ensure a positive user experience and improve accessibility. The needs identified in this study can be used as a framework when designing farm technologies to strengthen need satisfaction and reduce any potential harm toward needs.