Objective: To evaluate the efficacy and safety of brivaracetam (BRV) as an add-on therapy for people with drug-resistant epilepsy.Methods: Comprehensive literature search was done in PubMed, Cochrane Library and other databases for clinical trials (CTs) investigating the efficacy of BRV in the treatment of drug resistant epilepsy. 5 CTs having 12 dose groups including 2,187 patients comparing BRV (1212 patients) to placebo (975 patients) are pooled in the present analysis. Subgroup, sensitivity and meta-regression analysis are also performed.Results: The pooled RD in favour of BRV over placebo for >= 50% seizure frequency reduction was 13% and 3% for complete seizure freedom. The pooled RD for the proportion of patients withdrawn, withdrawn due to adverse events (AEs) and experienced with AEs was in favour of placebo over BRV 3%, 1% and 5%, respectively. Meta-regression analysis was demonstrated no significant linear relationship to dose, but significant linear relationship to treatment duration.Conclusion: Meta-analysis provides evidence supporting BRV effectiveness as an add-on treatment for drug-resistant epilepsy. However, results may not be generalizable due to the pooled trials were of relatively short duration, small sample size, heterogeneity and provide no evidence for the long-term efficacy of BRV.
"Tumour-to-tumour metastasis" (TTM) refers to the metastatic deposition from a primary neoplasm to another type of neoplasm within the same patient. While meningiomas have been reported to be the most common intracranial host of malignant metastases, breast and lung carcinomas have been the most frequently reported systemic donor tumours. In the relevant literature, some of the characteristics of meningiomas have been suggested to provide a favourable environment for the metastasis. Furthermore, some factors, such as immunological and hormonal factors, that are thought to make significant contribution to this event prompt research interest. Physiology-based neuroimaging methods, such as perfusion MRI (p-MRI) and proton spectroscopic MRI (proton s-MRI) could be efficient in differentiating TTM characterisation. The current case of this study, a primary breast carcinoma metastasising into two intracranial meningiomas, is presented with a list of pertinent cases reported to date, and literature is reviewed.
There are very close relationships among deglutition, taste sensations, and facial expressions in humans. However, the associations among mimicking, swallowing, and the suprahyoid/submental muscle group (SM) during deglutition events have yet to be investigated using electrophysiological techniques to elucidate taste sensation and facial expression further. Thus, this study used surface EMG to evaluate synchronous electromyography activity in the facial and swallowing muscles during the swallowing of water and sour boluses in 20 normal healthy adults. All participants were instructed to swallow four bolus volumes (5, 10, 15, and 20 ml) each of a water bolus and a sour bolus (lemon juice) in a neutral head position. EMG recordings were obtained from the orbicularis oculi (OC; a mimic muscle), orbicularis oris (OR; a mimic and swallowing muscle), and SM (deglutition muscles) to determine whether these muscles were synchronously activated during voluntary oropharyngeal swallowing. The mimic (OC and OR) and swallowing muscles (SM) were synchronously activated in more than 90% of participants during water swallowing. Swallowing lemon juice increased the number of spontaneous swallows after the first deglutition and significantly shortened the duration of a single swallowing apnea. The present findings indicate that both taste and the intraoral trigeminal afferents of water and sour boluses excite facial neurons via the nucleus tractus solitarius and/or a central pattern generator. Additionally, sour boluses produced stronger and safer oropharyngeal swallowing in conjunction with increases in facial expressions due to the activation of facial mimic muscles.
Curcumin Improves Chronic Stress Induced Potentiated Seizure Activity in Experimental Model of Epilepsy Haydeh HAGHIGHIZAD, Atefeh TOUHIDI, Ali POURMOTABBED, Farshad MORADPOUR, Seyed Ershad NEDAEI, Tayebeh POURMOTABBED Department of Physiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic Republic of University of Tennessee Health Science Center, Molecular Sciences, Memphis, USA
Objective (Background): To investigate whether experimental subarachnoid hemorrhage (SAH) could induce histopathologic changes and inflammatory response in the gastrointestinal system, and if this response may be attenuated by the potential effects of hyperbaric oxygen therapy (HBOT).Methods: Twenty rabbits were randomly divided into four groups. Group I was not subjected to SAH or sham operation. Group II were subjected to a sham operation. Group III were subjected to SAH and did not receive HBOT after SAH. Group IV were subjected to SAH and received five sessions of HBOT. Animals were euthanized through perfusion and fixation 72 h after the procedures. Four-millimeter tissue sections were obtained from the liver and terminal ileum and were examined microscopically. Arteriolar diameters were measured under light microscopy in five different examples taken randomly from each tissue. Statistical comparisons were performed using the Mann-Whitney U test.Results: Increased inflammation was seen in the liver and terminal ileum in the SAH group compared with the sham and control groups. Inflammation in the SAH group was high compared with the HBOT group, but it did not reach significance. There were no differences between groups regarding edema.Conclusions: We showed that HBOT performed after induced SAH was ineffective in the attenuation of inflammation in the liver and ileum tissues that occurred after SAH.
In Alzheimer's disease (AD), which is the most common cause of dementia, the accumulation of amyloid beta (AB) peptides has a causal role in the neurodegeneration process. AB peptides can induce synthesis of dehydroepiandrosterone (DHEA), which is a precursor of various steroids. Neurosteroids are modulators of neuronal survival and may have different effects depending on whether they are free or sulfa-conjugated.Nitrophenols can inhibit the aggregation of AB peptides at relatively low concentrations. 2,4-dichloro- 6-nitrophenol (DCNP) is a small water-soluble derivative of nitrophenols, and it is also known as the inhibitor of steroid sulfotransferase enzyme. However, the effects of DCNP on levels of distinct steroids and cell viability is not yet clearly known. This work aimed to investigate the effects of DCNP on various steroid levels and AB-induced cell death.SH-SY5Y cells were treated with DCNP (1 mu M) and aggregates of AB 1-42 peptides (10 mu M) for 72 hours. Cell viabilities were evaluated using MTT reduction and immune-fluorescence microscopy. The cellular changes of DHEA, DHEA sulfate, and sex steroids were determined using liquid chromatography-mass spectrometry (LC-MS/MS). The effect of DCNP on ultrastructure of AB aggregates was also examined with transmission electron microscopy.Seventy-two-hour treatment with DCNP significantly decreased DHEA sulfate and increased DHEA levels. Treatment with AB 1-42 aggregates decreased cell viability to approximately 50% and significantly changed DHEA and estradiol levels in SH-SY5Y cells. The ratio of cell death induced by AB 1-42 was reduced with DCNP treatment. When the AB aggregates were incubated in the aqueous solution with DCNP, the size of the aggregates became significantly smaller compared with the initial size. According to our literature knowledge, this is the first study to show the beneficial effects of DCNP on AB toxicity.
Objectives. Pituitary adenoma surgery can be challenging and residual tumor tissue avoids complete recovery. A few studies have explored preoperative tumor volume as a predictor of the presence of a residual tumor besides suprasellar and/or parasellar extension. We aimed to predict the existence of residual tumor by measuring preoperative tumor volume. Materials and Methods. This retrospective study was performed on 118 patients with pituitary macroadenomas who underwent trans-sphenoidal pituitary surgery in Kartal Lutfi Kirdar and Fatih Sultan Mehmet Research and Training Hospitals between January 2011 and August 2014. We explored the effectiveness and reliability of radiologic variables including preoperative tumor volume and cavernous sinus invasion (Knosp grading) on the presence of residual tumor (thus triggering a need for repeat resection). Results. The most significant correlation noted was between postoperative residual tumor volume and preoperative Knosp grading (r= 0.800, p < 0.001). Also, we recorded a highly significant positive correlation between postoperative residual tumor volume and preoperative tumor volume (r= 0.551, p < 0.001). The preoperative tumor cut-off volume for gross total resection was 3.4 cm(3). Conclusion. The most reliable factor predicting a postoperative residual mass was the existence of cavernous sinus invasion. The possibility of gross total resection decreased as the preoperative measured tumor mass exceeded 3.4 cm(3).
Alopecia areata and myasthenia gravis are two autoimmune diseases that are rarely associated with each other. We present a man aged 47 years who was newly diagnosed as having ocular myasthenia gravis but also had alopecia universalis, which started 15 years ago. His findings of negative decrement response, increased jitter values of the orbicularis oculi muscle in single fiber analysis, negative anti-acetylcholine receptor antibody test, and negative thorax computerized tomography scan for thymoma were all compatible with ocular myasthenia gravis. Pyridostigmine 60 mg 4x1 and methylprednisolone 16 mg 1x1 were administered and relief of the symptoms was observed. At the end of the first month, the patient reported improvement related with body hairs including eyebrows and scalp hairs, which were regrowing. Alopecia areata has been defined as a non-motor symptom of thymoma-associated myasthenia gravis, and usually starts after myasthenia gravis. Different from the alopecia areata, the alopecia universalis seen in this case was not related with the thymoma and started long before the ocular myasthenia gravis. The immunosuppressive treatment (steroid) used for ocular myasthenia gravis was also helpful for alopecia universalis in this case.
Urea cycle disorders are commonly seen in the newborn and paediatric population, however presenting cases in adults are uncommon and are usually misdiagnosed before a correct diagnosis is elicited. Several enzymes are involved in the urea cycle, and a defect in any of them can lead to specific laboratory abnormalities and variable clinical presentations. Deficiency of the enzyme ornithine transcarbamylase (OTC) is the most common inherited urea cycle disorder; however, other less common enzyme deficits have been described. In adults, manifestations range from severe encephalopathy to subtle psychiatric manifestations. Prompt diagnosis and recognition are essential to a successful outcome. In this article, we present the case of a 28-year-old female admitted to an A&E department with encephalopathy of unknown aetiology resulting in a diagnosis of carbomoyl synthetase 1 deficiency as well as an unfortunate outcome.
Introduction: Primary headaches impact substantially on daily activities of the sufferers leading to increased direct and indirect medical burden on its sufferers. It is a growing public health problem affecting an estimated 5.6% of Africans yet, among young Nigerians the disorder remains underestimated in scope and scale, under-recognized and under-treated. Methods: This was a questionnaire bases cross sectional study conducted in Enugu South East Nigeria. Frequency of headache and pain intensity were accessed questions (a) and (b) of the MIDAS questionnaire. Precipitating factors, drugs used, medical consultation and academic limitation were also assessed. Results: A total of 218 students were interviewed. The lifetime prevalence of primary headache was 74.3%. The corresponding prevalence of migraine and tension type headache were 7.8% and 32.6% respectively. Unlike migraine, tension type headache was significantly higher in females. Most headaches lasted 1-5 days (all primary headaches 24.7%, migraine 11.8% and TTH, 35.2%) similar in males and females. The proportion of students who worried over headache and attacks compared to those who did not: all primary headaches, 22.2%, who consulted a physician 16% and whose academic performance were often affected 26.5%. Limitation in academic performance was significantly higher among students that received medical consultation and students who worried over attacks. Conclusion: Primary headaches are common among secondary school children in Enugu, South East Nigeria, Nigeria. Most headaches last 1-5 days, frequently limit the academic activities of its sufferers and are sources of concern to the sufferers.
Acute ischemia of peripheral nerves generally results from occlusion of a main proximal limb artery or from occlusion of many distal arteries. The rareness of such neuropathies can be explained by the relative resistance of peripheral nerves to ischemia. Leriche syndrome is an aortoiliac occlusive disease that is known to cause neurologic complications such as ischemic neuropathy and spinal cord ischemia. Here, we present a man aged 55 years with bilateral lumbosacral plexopathy that presented as acute paraparesia due to thrombotic occlusion of an axillobifemoral graft, which was performed for the treatment of Leriche syndrome.
Objective: To investigate the assessment of cortical function changes and intrinsic circuitry in Amyotrophic Lateral Sclerosis (ALS) by transcranial magnetic stimulation (TMS). Methods: We studied 16 ALS and 11 healthy controls by single pulse TMS from abductor digiti minimi muscle (ADM). We evaluated cortical excitability parameters including, resting motor evoked potentials (MEPs) amplitude, resting MEPs threshold, central motor conduction time (CMCT), cortical silent period duration (CSPD) and cortical silent period threshold (CSPT) in ALS. Results: Resting MEPs threshold, CMCT, CSPT were increased in ALS patients compared to controls. CSPD was significantly shortened in ALS group. Conclusions: TMS findings reflect the cortical hyperexcitability in ALS.
