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Sample records for cefazolin-induced status epilepticus

  1. Status epilepticus

    NARCIS (Netherlands)

    Hensiek, AE; Absalom, Anthony

    2006-01-01

    Status epilepticus is defined as epileptic activity that continues for more than 30 minutes as a single seizure or as recurrent seizures without inter-ictal return of consciousness. The seizure activity is usually classified as partial or generalized. Although status epilepticus is an uncommon

  2. Super Refractory Status Epilepticus

    African Journals Online (AJOL)

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    Background: Status Epilepticus (SE) is defined as more than five minutes of persistent seizure activity without full recovery of consciousness in between the seizures. If SE fails to respond to two antiepileptic drugs, it is called refractory status epilepticus (RSE) and if it continues or recurs 24 hours after anesthesia, it is called ...

  3. Refractory status epilepticus

    Directory of Open Access Journals (Sweden)

    Sanjay P Singh

    2014-01-01

    Full Text Available Refractory status epilepticus is a potentially life-threatening medical emergency. It requires early diagnosis and treatment. There is a lack of consensus upon its semantic definition of whether it is status epilepticus that continues despite treatment with benzodiazepine and one antiepileptic medication (AED, i.e., Lorazepam + phenytoin. Others regard refractory status epilepticus as failure of benzodiazepine and 2 antiepileptic medications, i.e., Lorazepam + phenytoin + phenobarb. Up to 30% patients in SE fail to respond to two antiepileptic drugs (AEDs and 15% continue to have seizure activity despite use of three drugs. Mechanisms that have made the treatment even more challenging are GABA-R that is internalized during status epilepticus and upregulation of multidrug transporter proteins. All patients of refractory status epilepticus require continuous EEG monitoring. There are three main agents used in the treatment of RSE. These include pentobarbital or thiopental, midazolam and propofol. RSE was shown to result in mortality in 35% cases, 39.13% of patients were left with severe neurological deficits, while another 13% had mild neurological deficits.

  4. Super Refractory Status Epilepticus

    African Journals Online (AJOL)

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    Mayer st et al did retrospective cohort study from 1 January st. 1994 to 31 March 1998 at Presbyterian Medical. Centre in Columbia, to determine the frequency, risk factors and impact on the outcome of RSE. They found out that 69% of seizures recurred after. Key Words: Super refractory status epilepticus, Zambia. Medical ...

  5. Lorazepam v. diazepam for pediatric status epilepticus.

    Science.gov (United States)

    Pinto, Rovina Fiona; Turnbull, Jennifer

    2016-05-01

    Clinical question Is intravenous (IV) lorazepam superior to IV diazepam in the treatment of pediatric status epilepticus? Article chosen Chamberlain JM, Okada P, Holsti M, et al. Lorazepam v. diazepam for pediatric status epilepticus: a randomized clinical trial. JAMA 2014;311(16):1652-60. To determine whether lorazepam has better efficacy and safety than diazepam for treating pediatric status epilepticus.

  6. Predicting outcome of status epilepticus.

    Science.gov (United States)

    Leitinger, M; Kalss, G; Rohracher, A; Pilz, G; Novak, H; Höfler, J; Deak, I; Kuchukhidze, G; Dobesberger, J; Wakonig, A; Trinka, E

    2015-08-01

    Status epilepticus (SE) is a frequent neurological emergency complicated by high mortality and often poor functional outcome in survivors. The aim of this study was to review available clinical scores to predict outcome. Literature review. PubMed Search terms were "score", "outcome", and "status epilepticus" (April 9th 2015). Publications with abstracts available in English, no other language restrictions, or any restrictions concerning investigated patients were included. Two scores were identified: "Status Epilepticus Severity Score--STESS" and "Epidemiology based Mortality score in SE--EMSE". A comprehensive comparison of test parameters concerning performance, options, and limitations was performed. Epidemiology based Mortality score in SE allows detailed individualization of risk factors and is significantly superior to STESS in a retrospective explorative study. In particular, EMSE is very good at detection of good and bad outcome, whereas STESS detecting bad outcome is limited by a ceiling effect and uncertainty of correct cutoff value. Epidemiology based Mortality score in SE can be adapted to different regions in the world and to advances in medicine, as new data emerge. In addition, we designed a reporting standard for status epilepticus to enhance acquisition and communication of outcome relevant data. A data acquisition sheet used from patient admission in emergency room, from the EEG lab to intensive care unit, is provided for optimized data collection. Status Epilepticus Severity Score is easy to perform and predicts bad outcome, but has a low predictive value for good outcomes. Epidemiology based Mortality score in SE is superior to STESS in predicting good or bad outcome but needs marginally more time to perform. Epidemiology based Mortality score in SE may prove very useful for risk stratification in interventional studies and is recommended for individual outcome prediction. Prospective validation in different cohorts is needed for EMSE, whereas

  7. Prognostic Factors for Refractory Status Epilepticus

    Directory of Open Access Journals (Sweden)

    J. Gordon Millichap

    2013-03-01

    Full Text Available Researchers at the Mayo Clinic, Rochester, MN studied the outcome and identified prognostic factors for refractory status epilepticus (RSE in 54 adult patients, median age 52 years [range 18-93].

  8. Twinkle Mutations and Refractory Status Epilepticus

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-07-01

    Full Text Available Severe epileptic encephalopathy and refractory status epilepticus are reported in a 20-year follow-up of 23 patients with recessive Twinkle mutations studied at Helsinki University Central Hospital, Finland.

  9. Nonconvulsive status epilepticus after electroconvulsive therapy

    DEFF Research Database (Denmark)

    Povlsen, Uffe Juul; Wildschiødtz, Gordon; Høgenhaven, Hans

    2003-01-01

    SUMMARY: We describe three cases of nonconvulsive status epilepticus induced by electroconvulsive therapy (ECT). Nonconvulsive status epilepticus is an important differential diagnosis in patients who develop prolonged confusion after ECT. The present cases exemplify the difficulty in defining...... the diagnosis on the basis of the clinical manifestations. The application of electroencephalography is recommended in monitoring patients with prolonged confusion following ECT. Concurrent drug therapy and ECT is discussed....

  10. [Electrical status epilepticus during sleep].

    Science.gov (United States)

    Ortega, J J; Belda, V J; Tripiana, J L; Gil, M; Salas, R; Orenga, J V; Serrano, A L

    1996-12-01

    Sleep electrical status epilepticus (SESE) is a rare entity whose diagnosis depends or showing spike and wave complexes on the EEG during more than 85% of the duration of NoREM sleep. Typically it presents in children, most of whom have subjacent epilepsy. It is currently accepted that SESE is asymptomatic, although its persistence may give rise to severe neuropsychological sequelae. There are no references to sleep disorders in these patients. We present the case of a seven year old girl with SESE, hypersomnia and secondary nocturnal enuresis. The seven year old patient had a past history of simple partial crises with motor symptoms. There was progressive hypersomnia and nocturnal enuresis. The polysomnogram showed SESE. The Test for Multiple Latencies in Sleep (TMLS) showed pathological diurnal somnolence. HLA DR2 typing was negative. Neuropsychological study showed severe alterations in the language area, with a normal intelligence quotient. The new findings presented suggested that SESE is an intrinsic sleep disorder and not merely an EEG pattern. Since it occurs in children, sometimes with neuropsychological deficits, systematic TMLS should be done. The association of hypersomnia, changes in immediate visual memory and autistic regression suggest involvement of the limbic system.

  11. Monitor for status epilepticus seizures

    Science.gov (United States)

    Johnson, Mark; Simkins, Thomas

    1994-01-01

    This paper describes the sensor technology and associated electronics of a monitor designed to detect the onset of a seizure disorder called status epilepticus. It is a condition that affects approximately 3-5 percent of those individuals suffering from epilepsy. This form of epilepsy does not follow the typical cycle of start-peak-end. The convulsions continue until medically interrupted and are life threatening. The mortality rate is high without prompt medical treatment at a suitable facility. The paper describes the details of a monitor design that provides an inexpensive solution to the needs of those responsible for the care of individuals afflicted with this disorder. The monitor has been designed as a cooperative research and development effort involving the United States Army Armament Research, Development, and Engineering Center's Benet Laboratories (Benet) and the Cerebral Palsy Center for the Disabled (Center), in association with the Department of Neurology at Albany Medical College (AMC). Benet has delivered a working prototype of the device for field testing, in collaboration with Albany Medical College. The Center has identified several children in need of special monitoring and has agreed to pursue commercialization of the device.

  12. [Management of pediatric status epilepticus].

    Science.gov (United States)

    Vargas L, Carmen Paz; Varela E, Ximena; Kleinsteuber S, Karin; Cortés Z, Rocío; Avaria B, María de Los Ángeles

    2016-01-01

    Pediatric Status Epilepticus (SE) is an emergency situation with high morbidity and mortality that requires early and aggressive management. The minimum time criterion to define SE was reduced from 30 to 5 minutes, defined as continuous seizure activity or rapidly recurrent seizures without resumption of consciousness for more than 5 minutes. This definition considers that seizures that persist for > 5 minutes are likely to do so for more than 30 min. Those that persist for more than 30 minutes are more difficult to treat. Refractory SE is the condition that extends beyond 60-120 minutes and requires anesthetic management. Super-refractory SE is the state of no response to anesthetic management or relapse during withdrawal of these drugs. The aim of this review is to provide and update on convulsive SE concepts, pathophysiology, etiology, available antiepileptic treatment and propose a rational management scheme. A literature search of articles published between January 1993 and January 2013, focused on pediatric population was performed. The evidence about management in children is limited, mostly corresponds to case series of patients grouped by diagnosis, mainly adults. These publications show treatment alternatives such as immunotherapy, ketogenic diet, surgery and hypothermia. A 35% mortality, 26% of neurological sequelae and 35% of recovery to baseline condition is described on patient’s evolution.

  13. Acute polyhydramnios after maternal status epilepticus

    OpenAIRE

    Shindo, Ryosuke; Aoki, Shigeru; Kasai, Michi; Takahashi, Tsuneo; Hirahara, Fumiki

    2015-01-01

    Key Clinical Message Maternal status epilepticus can cause fetal hypoxic ischemic encephalopathy that in turn results in acute polyhydramnios caused by fetal dysphagia; thus, acute polyhydramnios is a symptom that should lead to a suspicion of fetal dysphagia caused by hypoxic ischemic encephalopathy.

  14. Acute polyhydramnios after maternal status epilepticus

    Science.gov (United States)

    Shindo, Ryosuke; Aoki, Shigeru; Kasai, Michi; Takahashi, Tsuneo; Hirahara, Fumiki

    2015-01-01

    Key Clinical Message Maternal status epilepticus can cause fetal hypoxic ischemic encephalopathy that in turn results in acute polyhydramnios caused by fetal dysphagia; thus, acute polyhydramnios is a symptom that should lead to a suspicion of fetal dysphagia caused by hypoxic ischemic encephalopathy. PMID:26331018

  15. Capgras syndrome and unilateral spatial neglect in nonconvulsive status epilepticus.

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    Turtzo, L Christine; Kleinman, Jonathan T; Llinas, Rafael H

    2008-01-01

    Nonconvulsive status epilepticus can manifest as personality changes and psychosis. We report an 87-year-old right-handed male presenting with both Capgras syndrome and severe unilateral spatial neglect during nonconvulsive status epilepticus. After treatment of his seizures, his Capgras syndrome and hemispatial neglect resolved. This case illustrates a report of the confluence of Capgras syndrome and documented hemispatial neglect in nonconvulsive status epilepticus only reported once previously [1].

  16. Capgras Syndrome and Unilateral Spatial Neglect in Nonconvulsive Status Epilepticus

    Directory of Open Access Journals (Sweden)

    L. Christine Turtzo

    2008-01-01

    Full Text Available Nonconvulsive status epilepticus can manifest as personality changes and psychosis. We report an 87-year-old right-handed male presenting with both Capgras syndrome and severe unilateral spatial neglect during nonconvulsive status epilepticus. After treatment of his seizures, his Capgras syndrome and hemispatial neglect resolved. This case illustrates a report of the confluence of Capgras syndrome and documented hemispatial neglect in nonconvulsive status epilepticus only reported once previously [1].

  17. Endocannabinoids block status epilepticus in cultured hippocampal neurons

    Science.gov (United States)

    Deshpande, Laxmikant S.; Blair, Robert E.; Ziobro, Julie M.; Sombati, Sompong; Martin, Billy R.; DeLorenzo, Robert J.

    2008-01-01

    Status epilepticus is a serious neurological disorder associated with a significant morbidity and mortality. Antiepileptic drugs such as diazepam, phenobarbital and phenytoin are the mainstay of status epilepticus treatment. However, over 20% of status epilepticus cases are refractory to the initial treatment with two or more antiepileptic drugs. Endocannabinoids have been implicated as playing an important role in regulating seizure activity and seizure termination. This study evaluated the effects of the major endocannabinoids methanandamide and 2-arachidonylglycerol (2-AG) on status epilepticus in the low-Mg2+ hippocampal neuronal culture model. Status epilepticus in this model was resistant to treatment with phenobarbital and phenytoin. Methanandamide and 2-AG inhibited status epilepticus in a dose-dependent manner with an EC50 of 145±4.15 nM and 1.68±0.19 µM, respectively. In addition, the anti-status epilepticus effects of methanandamide and 2-AG were mediated by activation of the cannabinoid CB1 receptor since they were blocked by the cannabinoid CB1 receptor antagonist AM251. These results provide the first evidence that the endocannabinoids, methanandamide and 2-AG, are effective inhibitors of refractory status epilepticus in the hippocampal neuronal culture model and indicate that regulating the endocannabinoid system may provide a novel therapeutic approach for treating refractory status epilepticus. PMID:17174949

  18. Super Refractory Status Epilepticus: A Case Report from Livingstone ...

    African Journals Online (AJOL)

    Background: Status Epilepticus (SE) is defined as more than five minutes of persistent seizure activity without full recovery of consciousness in between the seizures. If SE fails to respond to two antiepileptic drugs, it is called refractory status epilepticus (RSE) and if it continues or recurs 24 hours after anesthesia, it is called ...

  19. Ketogenic diet in 3 cases of childhood refractory status epilepticus

    DEFF Research Database (Denmark)

    Sort, Rune; Born, Alfred P; Pedersen, Karen N.

    2013-01-01

    Refractory status epilepticus (RSE) in children is associated with a significant risk of death or neurological morbidity. Recently attention has been drawn to the ketogenic diet (KD) as an acute treatment, as it has shown promise in controlling seizures in otherwise refractory status epilepticus...

  20. Gender dysphoria "cured" by status epilepticus.

    Science.gov (United States)

    Parkinson, John

    2015-04-01

    A case is described pointing to the biological factors in gender identity and personality structure. The history is presented of a transsexual patient who experienced a change of gender identity and personality following an episode of status epilepticus. The patient presented as convincingly feminine and with features of Borderline Personality Disorder. She had an old brain injury. After a prolonged epileptic episode the Borderline features disappeared and the patient expressed a clearly male identity. The findings are equivocal: they may be seen both as reflecting a change in a neurologically structured identity and as a resetting of psychosocially acquired characteristics. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  1. Ketogenic diet treatment for pediatric super-refractory status epilepticus.

    Science.gov (United States)

    Appavu, Brian; Vanatta, Lisa; Condie, John; Kerrigan, John F; Jarrar, Randa

    2016-10-01

    We aimed to study whether ketogenic diet (KD) therapy leads to resolution of super-refractory status epilepticus in pediatric patients without significant harm. A retrospective review was performed at Phoenix Children's Hospital on patients with super-refractory status epilepticus undergoing ketogenic diet therapy from 2011 to 2015. Ten children with super-refractory status epilepticus, ages 2-16 years, were identified. 4/10 patients had immune mediated encephalitis, including Rasmussen encephalitis, anti-N-methyl-d-aspartate receptor encephalitis, and post-infectious mycoplasma encephalitis. Other etiologies included Lennox Gastaut Syndrome, non-ketotic hyperglycinemia, PCDH19 and GABRG2 genetic epilepsy, New Onset Refractory Status Epilepticus, and Febrile Infection-Related Epilepsy Syndrome. 4/10 patients' EEG features suggested focal with status epilepticus, and 6/10 suggested generalized with status epilepticus. Median hospital length was 61days and median ICU length was 27days. The median number of antiepileptic medications prior to diet initiation was 3.0 drugs, and the median after ketogenic diet treatment was 3.5 drugs. Median duration of status epilepticus prior to KD was 18days. 9/10 patients had resolution of super-refractory status epilepticus in a median of 7days after diet initiation. 8/9 patients were weaned off anesthesia within 15days of diet initiation, and within 1day of achieving ketonuria. 1/10 patients experienced side effects on the diet requiring supplementation. Most patients achieved resolution of status epilepticus on KD therapy, suggesting it could be an effective therapy that can be utilized early in the treatment of children with super refractory status epilepticus. Copyright © 2016. Published by Elsevier Ltd.

  2. New lessons: Classic treatments in convulsive status epilepticus.

    LENUS (Irish Health Repository)

    Renganathan, R

    2012-02-03

    Convulsive status epilepticus is a relatively common life-threatening illness requiring prompt intervention. There has been much debate about the appropriate protocol for management of convulsive status epilepticus. Published data on the management of this condition in Ireland is limited. Our aim was to establish if there was a structured, evidence-based or consensus-based protocol being implemented in the management of status epilepticus in our centre. We retrospectively audited all charts with a diagnosis of \\'Status Epilepticus\\' admitted to our hospital from January 1998 to December 2002. A total of 95 episodes of convulsive status epilepticus were recorded. 34 charts were reviewed. Benzodiazepines were the drug class of first choice in 96% of patients. However, the doses of benzodiazepines used varied widely. The most frequent dose of phenytoin used was 1 gram. No one received continuous EEG monitoring during treatment of refractory status epilepticus. Overall mortality was 18%. The results of this study show that there is no consistent protocol was being followed for the management of convulsive status epilepticus in our centre. The drugs of first choice varied between diazepam and lorazepam in most cases. Although phenytoin was used as second line drug, the dose used was frequently suboptimal. We have developed a protocol for the management for convulsive status in our centre.

  3. Prallethrin Poisoning Presenting as Status Epilepticus

    Directory of Open Access Journals (Sweden)

    D Vijayaraju

    2014-02-01

    Full Text Available Mosquito repellents contain pyrethroid derivatives, as the active ingredient. Data regarding human toxicity following oral intake is limited. This is a case report of an individual who presented with neurotoxicity following oral ingestion of prallethrin (2.4% w/w of a higher concentration present in formulations commercially available than previously. A 22 year old male presented to the emergency Room (ER in status epilepticus. He was managed in the Intensive Care Unit (ICU. No cause for his status could be determined after all laboratory investigations. A review of history with the patient revealed that he had ingested a bottle of liquid mosquito repellent (45 ml. The patient has had no further symptoms on follow up and has been off anti epileptics. Pyrethroid containing mosquito repellents act on neuronal sodium channels causing hyperexcitiability. With no known specific antidotes, symptomatic treatment is the main stay of management.

  4. De novo status epilepticus with isolated aphasia.

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    Flügel, Dominique; Kim, Olaf Chan-Hi; Felbecker, Ansgar; Tettenborn, Barbara

    2015-08-01

    Sudden onset of aphasia is usually due to stroke. Rapid diagnostic workup is necessary if reperfusion therapy is considered. Ictal aphasia is a rare condition but has to be excluded. Perfusion imaging may differentiate acute ischemia from other causes. In dubious cases, EEG is required but is time-consuming and laborious. We report a case where we considered de novo status epilepticus as a cause of aphasia without any lesion even at follow-up. A 62-year-old right-handed woman presented to the emergency department after nurses found her aphasic. She had undergone operative treatment of varicosis 3 days earlier. Apart from hypertension and obesity, no cardiovascular risk factors and no intake of medication other than paracetamol were reported. Neurological examination revealed global aphasia and right pronation in the upper extremity position test. Computed tomography with angiography and perfusion showed no abnormalities. Electroencephalogram performed after the CT scan showed left-sided slowing with high-voltage rhythmic 2/s delta waves but no clear ictal pattern. Intravenous lorazepam did improve EEG slightly, while aphasia did not change. Lumbar puncture was performed which likely excluded encephalitis. Magnetic resonance imaging showed cortical pathological diffusion imaging (restriction) and cortical hyperperfusion in the left parietal region. Intravenous anticonvulsant therapy under continuous EEG resolved neurological symptoms. The patient was kept on anticonvulsant therapy. Magnetic resonance imaging after 6 months showed no abnormalities along with no clinical abnormalities. Magnetic resonance imaging findings were only subtle, and EEG was without clear ictal pattern, so the diagnosis of aphasic status remains with some uncertainty. However, status epilepticus can mimic stroke symptoms and has to be considered in patients with aphasia even when no previous stroke or structural lesions are detectable and EEG shows no epileptic discharges. Epileptic origin is

  5. Clonazepam in the treatment of status epilepticus.

    Science.gov (United States)

    Shangguan, Yafei; Liao, Huan; Wang, Xuefeng

    2015-01-01

    Status epilepticus (SE) is a common and serious neurological disorder. The prognosis of SE may be improved by effectively treating the disorder as early as possible. Clonazepam (CZP) has rarely been included in treatment guidelines for SE; however, this drug has been widely used in the treatment of SE patients and has unique advantages. Here, we elaborate on the clinical application of CZP in the treatment of SE and provide an effective and alternative treatment method for this disorder. We review selected literature, summarize action mechanisms, pharmacokinetics and clinical applications of CZP in the treatment of SE. We found that the effects of CZP are rapid and reliable and that adverse reactions are mild and transient. We conclude that CZP may be safely used to treat SE.

  6. NMDA and AMPA receptors: development and status epilepticus

    Czech Academy of Sciences Publication Activity Database

    Szczurowska, Ewa; Mareš, Pavel

    2013-01-01

    Roč. 62, Suppl.1 (2013), S21-S38 ISSN 0862-8408 Institutional support: RVO:67985823 Keywords : glutamate ionotropic receptors * ontogeny * status epilepticus Subject RIV: FH - Neurology Impact factor: 1.487, year: 2013

  7. Ketogenic Diet in Super-Refractory Status Epilepticus

    OpenAIRE

    Smith, Garnett; Press, Craig A.

    2017-01-01

    Researchers from the Children’s National Health System in Washington, D.C. studied the feasibility, rate of complications, and effect on seizures of initiating the Ketogenic Diet (KD) in pediatric patients with Super-Refractory Status Epilepticus (SRSE).

  8. Primary Amoebic (Naegleria fowleri Meningoencephalitis Presenting as Status Epilepticus

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    A Sharma

    2011-04-01

    Full Text Available Primary amebic meningoencephalitis (PAM is a rare entity. Usual presenting features are fever, headache and seizures with meningeal signs and this disease carries high mortality rate. We present a case report of PAM presenting as status epilepticus.

  9. Google search behavior for status epilepticus.

    Science.gov (United States)

    Brigo, Francesco; Trinka, Eugen

    2015-08-01

    Millions of people surf the Internet every day as a source of health-care information looking for materials about symptoms, diagnosis, treatments and their possible adverse effects, or diagnostic procedures. Google is the most popular search engine and is used by patients and physicians to search for online health-related information. This study aimed to evaluate changes in Google search behavior occurring in English-speaking countries over time for the term "status epilepticus" (SE). Using Google Trends, data on global search queries for the term SE between the 1st of January 2004 and 31st of December 2014 were analyzed. Search volume numbers over time (downloaded as CSV datasets) were analyzed by applying the "health" category filter. The research trends for the term SE remained fairly constant over time. The greatest search volume for the term SE was reported in the United States, followed by India, Australia, the United Kingdom, Canada, the Netherlands, Thailand, and Germany. Most terms associated with the search queries were related to SE definition, symptoms, subtypes, and treatment. The volume of searches for some queries (nonconvulsive, focal, and refractory SE; SE definition; SE guidelines; SE symptoms; SE management; SE treatment) was enormously increased over time (search popularity has exceeded a 5000% growth since 2004). Most people use search engines to look for the term SE to obtain information on its definition, subtypes, and management. The greatest search volume occurred not only in developed countries but also in developing countries where raising awareness about SE still remains a challenging task and where there is reduced public knowledge of epilepsy. Health information seeking (the extent to which people search for health information online) reflects the health-related information needs of Internet users for a specific disease. Google Trends shows that Internet users have a great demand for information concerning some aspects of SE

  10. Differential DNA methylation patterns define status epilepticus and epileptic tolerance.

    Science.gov (United States)

    Miller-Delaney, Suzanne F C; Das, Sudipto; Sano, Takanori; Jimenez-Mateos, Eva M; Bryan, Kenneth; Buckley, Patrick G; Stallings, Raymond L; Henshall, David C

    2012-02-01

    Prolonged seizures (status epilepticus) produce pathophysiological changes in the hippocampus that are associated with large-scale, wide-ranging changes in gene expression. Epileptic tolerance is an endogenous program of cell protection that can be activated in the brain by previous exposure to a non-harmful seizure episode before status epilepticus. A major transcriptional feature of tolerance is gene downregulation. Here, through methylation analysis of 34,143 discrete loci representing all annotated CpG islands and promoter regions in the mouse genome, we report the genome-wide DNA methylation changes in the hippocampus after status epilepticus and epileptic tolerance in adult mice. A total of 321 genes showed altered DNA methylation after status epilepticus alone or status epilepticus that followed seizure preconditioning, with >90% of the promoters of these genes undergoing hypomethylation. These profiles included genes not previously associated with epilepsy, such as the polycomb gene Phc2. Differential methylation events generally occurred throughout the genome without bias for a particular chromosomal region, with the exception of a small region of chromosome 4, which was significantly overrepresented with genes hypomethylated after status epilepticus. Surprisingly, only few genes displayed differential hypermethylation in epileptic tolerance. Nevertheless, gene ontology analysis emphasized the majority of differential methylation events between the groups occurred in genes associated with nuclear functions, such as DNA binding and transcriptional regulation. The present study reports select, genome-wide DNA methylation changes after status epilepticus and in epileptic tolerance, which may contribute to regulating the gene expression environment of the seizure-damaged hippocampus.

  11. Status epilepticus: Why, what, and how

    Directory of Open Access Journals (Sweden)

    P P Nair

    2011-01-01

    Full Text Available Status epilepticus (SE is an important neurological emergency with high mortality and morbidity. The first official definition of SE was the product of 10 th Marseilles colloquium held in 1962 which was accepted by International League Against Epilepsy in 1964. There are as many types of SE as of seizures. SE is supposed to result from failure of normal mechanisms that terminate an isolated seizure. In half of the cases, there is no history of epilepsy and SE is precipitated by some intercurrent infection. In children, it is often infection, whereas in adults, the major causes are stroke, hypoxia, metabolic derangements, and alcohol intoxication or drug withdrawal. The treatment of SE aims at termination of SE, prevention of seizure recurrence, management of precipitating causes, and the management of complications. The extent of investigations done should be based on the clinical picture and cost benefit analysis. The first line antiepileptic drugs (AED for SE include benzodiazepines, phenytoin, phosphenytoin, and sodium valproate. Mortality of SE ranges between 7 and 39% and depends on underlying cause and response to AEDs.

  12. Intensive care management of status epilepticus

    Directory of Open Access Journals (Sweden)

    Nidhi Gupta

    2016-01-01

    Full Text Available Status epilepticus (SE is a life-threatening neurological emergency that requires prompt diagnosis and treatment. SE may be classified into convulsive and non-convulsive types, based on the presence of rhythmic jerking of the extremities. Clinically, tonic-clonic convulsive SE (CSE is divided into four subsequent stages: Early, established, refractory and super-refractory. Initial elements of resuscitation include airway protection, haemodynamic resuscitation and seizure control. Further treatment should then be guided by the diagnostic workup. Rapid treatment of early SE is achieved with intravenous (IV lorazepam or intramuscular midazolam. In established SE, IV antiepileptic drugs (AEDs (phenytoin/fosphenytoin, valproate, levetiracetam, phenobarbital are most commonly used, but there is no Class I evidence for choosing one over the other. Considered overall, cumulative data from the literature are consistent with valproate and levetiracetam, being a safe and effective therapeutic alternative to phenobarbital and phenytoin for treatment of established SE. Refractory SE (RSE and super-RSE are treated with anaesthetic medications (propofol, midazolam, thiopental/pentobarbital, ketamine, non-anaesthetic drugs (lidocaine, magnesium, pyridoxine, AEDs (levetiracetam, lacosamide, topiramate, lacosamide, pregabalin, gabapentin and other cause-directed treatments with low success rates. Potential non-pharmacologic interventions to be considered in super-RSE include hypothermia, electroconvulsive therapy, ketogenic diet, immunomodulatory treatments, emergency resective epilepsy surgery, cerebrospinal fluid drainage and vagal nerve or deep brain stimulation or transcranial magnetic stimulation. Diagnosis of non-CSE requires continuous electroencephalography and involves a high index of suspicion in all patients with an altered mental status of unclear cause or with a prolonged postictal state. Treatment options include addressing underlying causes and

  13. Status epilepticus in the elderly: differential diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Mauricio EA

    2011-03-01

    Full Text Available Elizabeth Ann Mauricio, William David FreemanMayo Clinic, Jacksonville, FL, USADate of Preparation 28th January 2011 Conflict of interest: None declaredAbstract: Seizures are not an uncommon occurrence in older adults, and the incidence of status epilepticus is much greater in the elderly than in younger populations. Status epilepticus is a neurologic emergency and requires prompt intervention to minimize morbidity and mortality. Treatment involves both supportive care as well as initiation of medications to stop all clinical and electrographic seizure activity. Benzodiazepines are used as first-line agents, followed by antiepileptic drugs when seizures persist. In refractory status epilepticus, urgent neurologic consultation is indicated for the titration of anesthetic agents to a level of appropriate background suppression on EEG. In light of our aging population, physician awareness and competence in the management of status epilepticus is imperative and should be recognized as a growing public health concern.Keywords: status epilepticus, convulsive, generalized, nonconvulsive, refractory, elderly, treatment 

  14. Cocaine-Associated Seizures and Incidence of Status Epilepticus

    Directory of Open Access Journals (Sweden)

    Majlesi, Nima DO

    2010-05-01

    Full Text Available Objectives: Acute complications from cocaine abuse are commonly treated in the emergency department (ED; one of the most consequential is status epilepticus. The incidence of this complication is not clearly defined in the prior literature on cocaine-associated sequelae. We evaluated the incidence of status epilepticus in patients with seizures secondary to suspected cocaine use.Methods: We performed a retrospective multi-center study of patients with seizures resulting from cocaine use. We identified study subjects at 15 hospitals by record review and conducted a computer-assisted records search to identify patients with seizures for each institution over a four-year period. We selected subjects from this group on the basis of cocaine use and determined the occurrence of status epilepticus among them. Data were collected on each subject using a standardized data collection form.Results: We evaluated 43 patients in the ED for cocaine-associated seizures. Their age range was 17 to 54, with a mean age was 31 years; 53% were male. Of 43 patients, 42 experienced a single tonic-clonic seizure and one developed status epilepticus. All patients had either a history of cocaine use or positive urine drug screen for cocaine.Conclusion: Despite reported cases of status epilepticus with cocaine-induced seizures, the incidence of this complication was unclear based on prior literature. This study shows that most cocaine-associated seizures are self-limited. [West J Emerg Med. 2010; 11(2:157-160.

  15. Chlorpromazine-induced status epilepticus: A case report

    Directory of Open Access Journals (Sweden)

    Momčilović-Kostadinović Dragana

    2013-01-01

    Full Text Available Introduction. It is largely known that some antipsychotic agents could have proconvulsive and proepileptogenic effects in some patients and could induce EEG abnormalities as well. However, the association of status epilepticus with certain antipsychotic drugs has been very rarely reported. Case Report. A case of an 18-year-old adolescent girl, with chlorpromazine therapy started for anxiety-phobic disorder was reported. Her personal history disclosed delayed psychomotor development. Shortly after the introduction of the neuroleptic chlorpromazine therapy in minimal daily dose (37.5 mg, she developed myoclonic status epilepticus, confirmed by the EEG records. Frequent, symmetrical bilateral myoclonic jerks and altered behavior were associated with bilateral epileptiform discharges of polyspikes and spike-wave complexes. This epileptic event lasted 3.5 hours and it was stopped by the parenteral administration of valproate and lorazepam; she was EEG monitored until stable remission. Status epilepticus as initial epileptic event induced by neuroleptic agent was not previously reported in our national literature. Conclusion. Introduction of chlorpromazine to a patient without history of seizures is associated with the evolution of an epileptic activity, including the occurrence of status epilepticus. Clinical evaluation of the risk factors possibly related to chlorpromazine-induced seizure is recommended in individual patients before administering this drug.

  16. Partial status epilepticus - rapid genetic diagnosis of Alpers' disease.

    LENUS (Irish Health Repository)

    McCoy, Bláthnaid

    2011-11-01

    We describe four children with a devastating encephalopathy characterised by refractory focal seizures and variable liver dysfunction. We describe their electroencephalographic, radiologic, genetic and pathologic findings. The correct diagnosis was established by rapid gene sequencing. POLG1 based Alpers\\' disease should be considered in any child presenting with partial status epilepticus.

  17. Study of Refractory Status Epilepticus from a Tertiary Care Center.

    Science.gov (United States)

    Kohli, Sahil; Pasangulapati, Suresh Babu; Yoganathan, Sangeetha; Rynjah, Gideon Lyngsyun; Prabhakar, A T; Aaron, Sanjith; Alexander, Mathew; Mathew, Vivek

    2017-01-01

    To determine the proportion of refractory status epilepticus (RSE) and super-RSE (SRSE) among patients with status epilepticus (SE) and to analyze RSE and non-RSE (NRSE) in terms of etiology and predictors for RSE. Patients were identified from discharge summaries database with keywords of SE and records of the portable electroencephalogram (EEG) machine from January 2011 to March 2016. Two hundred and eighteen events were included in the study with 114 (52.3%) males, bimodal age preponderance age <5 years 30%, and second peak in age 15-65 years 52.8%, preexisting seizures were present in 34.4% ( n = 75). Nearly 77.1% had NRSE ( n = 168) and 22.9% had RSE ( n = 50). This included 17 patients with SRSE ( n = 17, 7.8% of all SE). Central nervous system (CNS) infection was a single largest etiological group in SE (69/218, 31.7%). In RSE, autoimmune encephalitis (17/50) and CNS infection (13/50) were the largest groups. De novo seizures ( P = 0.007), low sensorium at admission ( P = 0.001), low albumin at admission ( P = 0.002), and first EEG being abnormal ( P = 0.001) were risk factors on bivariate analysis. An unfavorable status epilepticus severity score (STESS) was predictive for RSE ( P = 0.001). On multivariate analysis, de novo seizures ( P = 0.009) and abnormal EEG at admission ( P = 0.03) were predictive for RSE. Fifty patients had RSE (22.9%), of which 17 went on to become SRSE (7.8%). Unfavorable STESS score was predictive for RSE on bivariate analysis. On multivariate analysis, de novo seizures and abnormal initial EEG were predictors of RSE.

  18. Veiligheid en farmacokinetiek van levetiracetam intraveneus add-on bij status epilepticus

    NARCIS (Netherlands)

    Uges, Joris; Van Huizen, Marc; Engelsman, Jeroen; Wilms, Erik; Touw, Daan; Peeters, Els; Vecht, Charles

    2008-01-01

    Objective: To evaluate safety of intravenous levetiracetam added to the standard therapeutic regimen in adults with status epilepticus. and to assess a population pharmacokinetic model for intravenous levetiracetam in patients with status epilepticus. Design: Prospective, single-centre, single-arm,

  19. Refractory status epilepticus treated with vagal nerve stimulation: case report.

    Science.gov (United States)

    O'Neill, Brent R; Valeriano, James; Synowiec, Andrea; Thielmann, Daniel; Lane, Carole; Wilberger, Jack

    2011-11-01

    Status epilepticus (SE) refractory to medical treatment has a high mortality rate and few effective treatments. We describe the implantation of a vagal nerve stimulator to help terminate a case of refractory SE. A 23-year-old man was in SE for 3 weeks without being able to be weaned from intravenous anesthetic agents. After implantation of a vagal nerve stimulator, SE soon terminated, and the patient could be weaned from sedative agents and made a full recovery. Vagal nerve stimulator should be considered in cases of refractory SE.

  20. Successful management of super-refractory status epilepticus with thalamic deep brain stimulation.

    Science.gov (United States)

    Lehtimäki, Kai; Långsjö, Jaakko W; Ollikainen, Jyrki; Heinonen, Hanna; Möttönen, Timo; Tähtinen, Timo; Haapasalo, Joonas; Tenhunen, Jyrki; Katisko, Jani; Öhman, Juha; Peltola, Jukka

    2017-01-01

    Super-refractory status epilepticus is a condition characterized by recurrence of status epilepticus despite use of deep general anesthesia, and it has high morbidity and mortality rates. We report a case of a 17-year-old boy with a prolonged super-refractory status epilepticus that eventually resolved after commencing deep brain stimulation of the centromedian nucleus of the thalamus. Later attempt to reduce stimulation parameters resulted in immediate relapse of status epilepticus, suggesting a pivotal role of deep brain stimulation in the treatment response. Deep brain stimulation may be a treatment option in super-refractory status epilepticus when other treatment options have failed. ANN NEUROL 2017;81:142-146. © 2016 American Neurological Association.

  1. Electrographic status epilepticus and neurobehavioral outcomes in critically ill children.

    Science.gov (United States)

    Abend, Nicholas S; Wagenman, Katherine L; Blake, Taylor P; Schultheis, Maria T; Radcliffe, Jerilynn; Berg, Robert A; Topjian, Alexis A; Dlugos, Dennis J

    2015-08-01

    Electrographic seizures (ESs) and electrographic status epilepticus (ESE) are common in children with acute neurologic conditions in pediatric intensive care units (PICUs), and ESE is associated with worse functional and quality-of-life outcomes. As an exploratory study, we aimed to determine if ESE was associated with worse outcomes using more detailed neurobehavioral measures. Three hundred children with an acute neurologic condition and altered mental status underwent clinically indicated EEG monitoring and were enrolled in a prospective observational study. We obtained follow-up data from subjects who were neurodevelopmentally normal prior to PICU admission. We evaluated for associations between ESE and adaptive behavior (Adaptive Behavior Assessment System-II, ABAS-II), behavioral and emotional problems (Child Behavior Checklist, CBCL), and executive function (Behavior Rating Inventory of Executive Function, BRIEF) using linear regression analyses. A p-value of behavioral global composite scores. On multivariate analysis, when compared to subjects with no seizures, both ESs (coefficient: -28, p=0.014) and ESE (coefficient: -36, p = 0.003) were associated with worse adaptive behavioral global composite scores. Among previously neurodevelopmentally normal children with acute neurologic disorders, ESs and ESE were associated with worse adaptive behavior and trends toward worse behavioral-emotional and executive function problems. This was a small exploratory study, and the impact of ESs and ESE on these neurobehavioral measures may be clarified by subsequent larger studies. This article is part of a Special Issue entitled "Status Epilepticus". Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Celiac crisis presenting with status epilepticus and encephalopathy.

    Science.gov (United States)

    Hijaz, Nadia M; Bracken, Julia M; Chandratre, Sonal R

    2014-12-01

    Celiac crisis is a life-threatening presentation of celiac disease which is described in the context of classic gastrointestinal (GI) symptoms of diarrhea, leading to dehydration and electrolyte imbalance. Neurologic manifestations are atypical symptoms of celiac crisis. To the best of our knowledge, there is no published report on seizure or encephalopathy as the presenting manifestation of celiac crisis. We describe a 2-year-old boy presenting with acute status epilepticus and lethargy. Prior to presentation, he had mild abdominal distention and intermittent diarrhea. Laboratory analysis revealed hyponatremia, anemia, hypocalcemia, transaminitis, and hyperglycemia. Electroencephalography revealed severe diffuse encephalopathy, and complete infectious work-up was negative. Initial brain magnetic resonance imaging was normal; however, repeat imaging showed osmotic demyelination syndrome. Given the history of GI symptoms and hyperglycemia, celiac serology was obtained revealing elevated tissue transglutaminase, and a diagnosis was confirmed by Marsh 3c lesions in the duodenum. He significantly improved with steroid therapy in addition to adequate nutrition, fluids, and initiation of a gluten-free diet. We report herein on the first case of celiac crisis presenting with status epilepticus and encephalopathy in the absence of profound GI symptoms. Our case suggests that celiac crisis should be considered in the differential of seizures and encephalopathy in children.

  3. Hyperglycemia associated with seizure control in status epilepticus.

    Science.gov (United States)

    Chiewthanakul, Piyawan; Noppaklao, Parinya; Sawanyawisuth, Kittisak; Tiamkao, Somsak

    2015-08-01

    Status epilepticus (SE) is a serious neurological condition and has a high mortality rate. Factors associated with seizure control measures in nonneurointensive care units (non-NICU) are limited. Adult patients diagnosed with SE at Khon Kaen hospital, Thailand from October 1st, 2010 to September 30th, 2012 were enrolled. Patients were categorized as having controlled seizures and having uncontrolled seizures. Controlled seizures were defined as seizures that were aborted without any recurrence, while uncontrolled seizures were defined as unstoppable or recurrent seizures. Clinical factors were analyzed to find factors associated with uncontrolled SE. During the study period, there were 211 patients diagnosed with SE. Of those, 57 patients (27.01%) were in the group with controlled SE. Plasma glucose and serum albumin were two significant factors with adjusted ORs (95% CI) of 1.008 (1.001, 1.027) and 0.166 (0.059, 0.466) that differentiated patients with controlled seizures from patients with uncontrolled seizures. Central nervous system infections and cardiac arrests were also completely associated with the uncontrolled SE in the multivariate logistic analysis. In the etiology of SE, high plasma glucose and low serum albumin levels were associated with uncontrolled seizures in patients with SE in the non-NICU setting. This article is part of a Special Issue entitled "Status Epilepticus". Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Syndrome of Electrical Status Epilepticus During Sleep: Epileptic Encephalopathy Related to Brain Development.

    Science.gov (United States)

    Chen, Xiao-Qiao; Zhang, Wei-Na; Hu, Lin-Yan; Liu, Meng-Jia; Zou, Li-Ping

    2016-03-01

    Epileptic encephalopathy with electrical status epilepticus during sleep is an age-related and self-limited disorder. The present study analyzed the etiology, demographics, and pathogenesis of patients with electrical status epilepticus during sleep to provide information on the diagnosis and therapy of this syndrome. The etiologies of epileptic encephalopathy with electrical status epilepticus during sleep in patients admitted in Chinese People's Liberation Army General Hospital from 2009 to 2014 were retrospectively analyzed. Patients were classified into the genetic, structural-metabolic, and unknown groups according to the etiology. Demographics and clinical characteristics of all the patients were then analyzed and compared among groups. The etiologies of epileptic encephalopathy with electrical status epilepticus during sleep in 75 patients mainly included benign childhood epilepsy with centrotemporal spikes, Landau-Kleffner syndrome, polymicrogyria, and migration disorders. Age at onset of epilepsy did not show a specific pattern, but age at onset of epileptic encephalopathy with electrical status epilepticus during sleep was concentrated at age 6-9 years. The mean age at onset of epilepsy in the genetic group was significantly older than that in the structural-metabolic group (P epileptic encephalopathy with electrical status epilepticus during sleep did not significantly differ between the two groups. Electrical status epilepticus during sleep is an epileptic encephalopathy related to brain development and presents an age-dependent occurrence. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Generalized status epilepticus associated with massive pulmonary aspiration and transient central diabetes insipidus: case report

    Directory of Open Access Journals (Sweden)

    CARVALHO MAURICIO

    2000-01-01

    Full Text Available Status epilepticus causes significant morbidity and mortality. A case of generalized status epilepticus followed by massive pulmonary aspiration, acute respiratory failure and transient central diabetes insipidus is presented. Seizures were promptly controlled, but the patient required mechanical ventilation and correction of polyuria with desmopressin acetate. During hospitalization mental status improved, diabetes insipidus spontaneously remitted and he was discharged without neurologic sequelae. The clinical and pathophysiological features of this case are discussed.

  6. Ketamine use in the treatment of refractory status epilepticus.

    Science.gov (United States)

    Synowiec, Andrea S; Singh, Deepinder S; Yenugadhati, Vamsi; Valeriano, James P; Schramke, Carol J; Kelly, Kevin M

    2013-07-01

    Refractory status epilepticus (RSE) occurs when status epilepticus (SE) fails to respond to appropriate therapy with typical antiepileptic drugs (AEDs). Animal studies have shown ketamine to be a highly efficacious agent in this setting, but very few case reports describe use of ketamine in human SE or RSE. We report a retrospective review of 11 patients who were treated for RSE with ketamine infusion in addition to other standard AEDs over a nine-year period. Data collection included age, gender, history of epilepsy, etiology of RSE, daily dose of ketamine, co-therapeutic agents, duration of seizures, treatment response, and disposition. RSE was successfully terminated in all 11 patients treated with ketamine. Dosing ranged from 0.45 mg/kg/h to 2.1 mg/kg/h based upon the preference of the treating clinician and response to therapy, with maximal daily doses ranging from 1392 mg to 4200 mg. Ketamine was the last AED used prior to resolution of RSE in 7/11 (64%) cases. In the remaining four cases, one other AED was added after ketamine infusion had begun. Time from ketamine initiation to seizure cessation ranged from 4 to 28 days (mean=9.8, SD=8.9). In 7/11 patients, RSE was resolved within one week of starting therapy. Administration of ketamine was uniformly associated with improvement in hemodynamic stability. Six of the seven patients (85%) who required vasopressors during early treatment for RSE were able to be weaned from vasopressors during ketamine infusion. No acute adverse effects were noted. These findings suggest that ketamine may be a safe and efficacious adjunctive agent in the treatment of RSE. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Top 100 cited articles on epilepsy and status epilepticus: A bibliometric analysis.

    Science.gov (United States)

    Park, Kang Min; Kim, Sung Eun; Lee, Byung In; Kim, Hyung Chan; Yoon, Dae Young; Song, Hong Ki; Bae, Jong Seok

    2017-08-01

    The purpose of this study is to identify the top 100-cited articles dedicated to epilepsy and status epilepticus published in journals from January, 1950 through February, 2016 that have made key contributions in the field. We performed a search of journals and selected the top 100-cited articles on epilepsy and status epilepticus, respectively, by utilizing the Institute for Scientific Information database available under the banner of the Web of Science. The top-cited articles on epilepsy and status epilepticus were all published in 24 journals, respectively. In both fields of epilepsy and status epilepticus, the most frequently cited journal was Epilepsia (26 articles on epilepsy and 19 articles on status epilepticus). The 100 most-cited articles in the field of both epilepsy and status epilepticus mainly originated from institutions in the United States of America. The articles on epilepsy included 25 laboratory studies, 15 pharmacotherapy studies, 13 general review studies, 12 surgery studies, 11 neuroimaging studies, eight epidemiology studies, eight neuropsychiatry studies, six genetic studies, and two electrophysiology studies, whereas 41 laboratory studies, 21 epidemiology studies, 16 pharmacotherapy studies, nine electrophysiology studies, nine general review studies, and four neuroimaging studies were included in the field of status epilepticus. We demonstrate that neuroimaging, genetics, and surgery are emerging topics in the field of epilepsy over the past decades. Moreover, we found that the majority of top-cited articles on epilepsy and status epilepticus originated from institutions in the United States of America and most were published in Epilepsia. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Gyriform Infarction in Cerebral Air Embolism: Imaging Mimicker of Status Epilepticus.

    Science.gov (United States)

    Malhotra, Konark; Rayi, Appaji

    2017-01-01

    Cerebral air embolism (CAE) is a potentially fatal iatrogenic complication related to common procedures including central venous catheter (CVC) removal. We report an interesting case of CAE related to CVC removal that was further complicated with status epilepticus. Neuroimaging of CAE and status epilepticus could pose diagnostic dilemmas and require consideration of wide diagnostic differentials. We discuss the clinical presentation, mechanism, and diagnostic approach, especially neuroimaging to differentiate various etiologies in CAE patients.

  9. Status epilepticus as the only presentation of the neonatal Bartter syndrome

    Directory of Open Access Journals (Sweden)

    Soumya Patra

    2012-01-01

    Full Text Available Bartter syndrome is a rare hereditary (autosomal recessive salt-losing tubulopathy characterized by hypokalemia, hypochloremia, metabolic alkalosis, and normal blood pressure with hyperreninemia, The underlying renal abnormality results in excessive urinary losses of sodium, chloride, and potassium. We report a case of a four-month-old infant with neonatal Bartter syndrome, who presented only with status epilepticus. To the best of our present knowledge, there is no reported case of Bartter syndrome who presented with status epilepticus.

  10. Anti-N-methyl-D-aspartate receptor encephalitis with favorable outcome despite prolonged status epilepticus

    OpenAIRE

    Finné Lenoir, Xavier; Sindic, Christian; Van Pesch, Vincent; El Sankari, Souraya; de Tourtchaninoff, Marianne; Denays, Roger; Hantson, Philippe

    2013-01-01

    BACKGROUND: To describe a case of auto-immune encephalitis in an adolescent with favorable outcome despite prolonged status epilepticus. METHODS: A 17 year old Asian man without previous medical history developed alteration of consciousness and partial seizures. The diagnosis of anti-N-methyl-D-aspartate receptor encephalitis was confirmed by the detection of specific antibodies in both cerebrospinal fluid and serum. RESULTS: The clinical course was complicated by prolonged status epilepticus...

  11. Neuroimaging in status epilepticus secondary to paraneoplastic autoimmune encephalitis

    International Nuclear Information System (INIS)

    Sarria-Estrada, S.; Toledo, M.; Lorenzo-Bosquet, C.; Cuberas-Borrós, G.; Auger, C.; Siurana, S.; Rovira, À.

    2014-01-01

    Aim: To describe the characteristic magnetic resonance imaging (MRI) findings of paraneoplastic autoimmune encephalitis in patients with new-onset status epilepticus. Materials and methods: The neuroimaging and clinical data of five patients with paraneoplastic autoimmune encephalitis debuting as status epilepticus were retrospectively reviewed. All patients met the criteria for definite paraneoplastic syndrome and all underwent brain MRI during the status epilepticus episode or immediately after recovery. Results: All patients showed hyperintense lesions on T2-weighted imaging (WI) involving the limbic structures, specifically the hippocampus. Three of them showed additional extra-limbic areas of signal abnormalities. The areas of T2 hyperintensity were related to the electroclinical onset of the seizures. In three patients, various techniques were used to study cerebral perfusion, such as arterial spin labelling MRI, single photon-emission computed tomography (SPECT) and 2-[ 18 F]-fluoro-2-deoxy-D-glucose (FDG)-positron-emission tomography (PET). Arterial spin labelling showed hyperperfusion overlapping the inflammatory lesions, whereas PET and SPECT disclosed increased perfusion and increased metabolism. The subtraction SPECT co-registered to MRI (SISCOM) demonstrated hypermetabolism outside the areas of encephalitis. After clinical recovery, follow-up MRI revealed the development of atrophy in the initially affected hippocampus. Two patients who had recurrent paraneoplastic autoimmune encephalitis manifesting as status epilepticus showed new T2 lesions involving different structures. Conclusion: The presence of limbic and extra-limbic T2 signal abnormalities in new-onset status epilepticus should suggest the diagnosis of a paraneoplastic syndrome, especially when status epilepticus is refractory to treatment. The lesions are consistently seen as hyperintense on T2WI. - Highlights: • New onset status epilepticus can be caused by paraneoplastic encephalitis.

  12. Dexamethasone exacerbates cerebral edema and brain injury following lithium-pilocarpine induced status epilepticus.

    Science.gov (United States)

    Duffy, B A; Chun, K P; Ma, D; Lythgoe, M F; Scott, R C

    2014-03-01

    Anti-inflammatory therapies are the current most plausible drug candidates for anti-epileptogenesis and neuroprotection following prolonged seizures. Given that vasogenic edema is widely considered to be detrimental for outcome following status epilepticus, the anti-inflammatory agent dexamethasone is sometimes used in clinic for alleviating cerebral edema. In this study we perform longitudinal magnetic resonance imaging in order to assess the contribution of dexamethasone on cerebral edema and subsequent neuroprotection following status epilepticus. Lithium-pilocarpine was used to induce status epilepticus in rats. Following status epilepticus, rats were either post-treated with saline or with dexamethasone sodium phosphate (10mg/kg or 2mg/kg). Brain edema was assessed by means of magnetic resonance imaging (T2 relaxometry) and hippocampal volumetry was used as a marker of neuronal injury. T2 relaxometry was performed prior to, 48 h and 96 h following status epilepticus. Volume measurements were performed between 18 and 21 days after status epilepticus. Unexpectedly, cerebral edema was worse in rats that were treated with dexamethasone compared to controls. Furthermore, dexamethasone treated rats had lower hippocampal volumes compared to controls 3 weeks after the initial insult. The T2 measurements at 2 days and 4 days in the hippocampus correlated with hippocampal volumes at 3 weeks. Finally, the mortality rate in the first week following status epilepticus increased from 14% in untreated rats to 33% and 46% in rats treated with 2mg/kg and 10mg/kg dexamethasone respectively. These findings suggest that dexamethasone can exacerbate the acute cerebral edema and brain injury associated with status epilepticus. Copyright © 2013. Published by Elsevier Inc.

  13. Evolution of Cerebral Atrophy in a Patient with Super Refractory Status Epilepticus Treated with Barbiturate Coma

    Directory of Open Access Journals (Sweden)

    Christopher R. Newey

    2017-01-01

    Full Text Available Introduction. Status epilepticus is associated with neuronal breakdown. Radiological sequelae of status epilepticus include diffusion weighted abnormalities and T2/FLAIR cortical hyperintensities corresponding to the epileptogenic cortex. However, progressive generalized cerebral atrophy from status epilepticus is underrecognized and may be related to neuronal death. We present here a case of diffuse cerebral atrophy that developed during the course of super refractory status epilepticus management despite prolonged barbiturate coma. Methods. Case report and review of the literature. Case. A 19-year-old male with a prior history of epilepsy presented with focal clonic seizures. His seizures were refractory to multiple anticonvulsants and eventually required pentobarbital coma for 62 days and midazolam coma for 33 days. Serial brain magnetic resonance imaging (MRI showed development of cerebral atrophy at 31 days after admission to our facility and progression of the atrophy at 136 days after admission. Conclusion. This case highlights the development and progression of generalized cerebral atrophy in super refractory status epilepticus. The cerebral atrophy was noticeable at 31 days after admission at our facility which emphasizes the urgency of definitive treatment in patients who present with super refractory status epilepticus. Further research into direct effects of therapeutic coma is warranted.

  14. Hippocampal sclerosis and status epilepticus: cause or consequence? A MRI study; Esclerose hipocampal e status epilepticus: causa ou consequencia? Um estudo de RM

    Energy Technology Data Exchange (ETDEWEB)

    Kuster, Gustavo Wruck; Braga-Neto, Pedro; Santos-Neto, Denizart; Santana, Maria Teresa Garcia; Barsottini, Orlando Graziani [Universidade Federal de Sao Paulo (UNIFESP-EPM), Sao Paulo, SP (Brazil). Dept. of Neurology. Div. of General Neurology]. E-mail: gwkuster@hotmail.com; Maia Junior, Antonio Carlos Martins [Fleury Institute, Sao Paulo, SP (Brazil). Magnetic Resonance Imaging Unit

    2007-12-15

    Background: Transient imaging abnormalities, including changes on diffusion-weighted imaging (DWI), may be seen in status epilepticus. These abnormalities can be followed by hippocampal sclerosis. Case Report: We report a 15-year-old lady with focal non convulsive status epilepticus (NCSE) and focal slowing on EEG. DWI exhibited abnormal hyperintense signals in bilateral temporal and insular cortices. After 3 weeks, MRI performed a localized hippocampal atrophy. Conclusion: The MRI findings indicated vasogenic and cytotoxic edema during seizure activity and subsequent loss of brain parenchyma. (author)

  15. Scavenging reactive oxygen species inhibits status epilepticus-induced neuroinflammation.

    Science.gov (United States)

    McElroy, Pallavi B; Liang, Li-Ping; Day, Brian J; Patel, Manisha

    2017-12-01

    Inflammation has been identified as an important mediator of seizures and epileptogenesis. Understanding the mechanisms underlying seizure-induced neuroinflammation could lead to the development of novel therapies for the epilepsies. Reactive oxygen species (ROS) are recognized as mediators of seizure-induced neuronal damage and are known to increase in models of epilepsies. ROS are also known to contribute to inflammation in several disease states. We hypothesized that ROS are key modulators of neuroinflammation i.e. pro-inflammatory cytokine production and microglial activation in acquired epilepsy. The role of ROS in modulating seizure-induced neuroinflammation was investigated in the pilocarpine model of temporal lobe epilepsy (TLE). Pilocarpine-induced status epilepticus (SE) resulted in a time-dependent increase in pro-inflammatory cytokine production in the hippocampus and piriform cortex. Scavenging ROS with a small-molecule catalytic antioxidant decreased SE-induced pro-inflammatory cytokine production and microglial activation, suggesting that ROS contribute to SE-induced neuroinflammation. Scavenging ROS also attenuated phosphorylation of ribosomal protein S6, the downstream target of the mammalian target of rapamycin (mTOR) pathway indicating that this pathway might provide one mechanistic link between SE-induced ROS production and inflammation. Together, these results demonstrate that ROS contribute to SE-induced cytokine production and antioxidant treatment may offer a novel approach to control neuroinflammation in epilepsy. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Oxidative Stress Contributes to Status Epilepticus Associated Mortality.

    Science.gov (United States)

    Pearson-Smith, Jennifer N; Liang, Li-Ping; Rowley, Shane D; Day, Brian J; Patel, Manisha

    2017-07-01

    Status epilepticus is a common manifestation of nerve agent toxicity and represents a serious medical emergency with high rates of mortality and neurologic injury in those that survive. The aim of the current study was to determine if targeting oxidative stress with the catalytic antioxidant, AEOL10150, would reduce pilocarpine-induced mortality and attenuate neuronal death and neuroinflammation. We found that treatment with AEOL10150 in conjunction with scopolamine and diazepam following pilocarpine-induced SE was able to significantly reduce mortality compared to treatment with just scopolamine and diazepam. Mortality was further reduced when AEOL10150 was used in conjunction with atropine and diazepam which is considered the standard of care for nerve agent exposures. Both treatment paradigms offered significant protection against SE-induced oxidative stress. Additionally, treatment with scopolamine, AEOL10150 and diazepam attenuated SE-induced neuronal loss and neuroinflammation. Taken together, the data suggest that pharmacological targeting of oxidative stress can improve survival and attenuate secondary neurological damage following SE induced by the nerve agent surrogate pilocarpine.

  17. Continuous infusion pentobarbital for refractory status epilepticus in children.

    Science.gov (United States)

    Barberio, Michael; Reiter, Pamela D; Kaufman, Jon; Knupp, Kelly; Dobyns, Emily L

    2012-06-01

    The purpose of this retrospective medical chart review was to describe dosing regimens and outcomes in children who received continuous pentobarbital therapy for refractory status epilepticus. Thirty patients (age = 6.5 ± 5.1 years; 67% male) received a mean loading dose of 5.4 ± 2.8 mg/kg with an initial infusion of 1.1 ± 0.4 mg/kg/h. Maximum infusion dose was 4.8 ± 2 mg/kg/h. Thirty-three percent of patients achieved sustained burst suppression without relapse; 66.7% experienced relapse, but 60% of those (n = 12) eventually reachieved burst suppression. Children achieving burst suppression within 24 hours of pentobarbital initiation and those older than age 5 years were 1.5 times more likely to have a positive outcome. None of these variables, however, achieved significance (Fisher exact test). Ninety-three percent of patients required inotropes; 66% acquired an infection; 10% had metabolic acidosis; and 10% experienced pancreatitis. Poor outcomes (death, encephalopathy) were observed in 33% of patients.

  18. Status epilepticus in pregnant women with epilepsy after valproate adjustment: A case series.

    Science.gov (United States)

    Wu, Mengqian; Hao, Nanya; Yan, Bo; Chi, Xiaosa; Zhou, Dong

    2016-12-01

    Valproate is an effective wide-spectrum anti-epileptic drug that is also known to be teratogenic. Its administration in epileptic women remains controversial. This report aims to draw more attention to valproate adjustment before and during pregnancy. We collected medical records of pregnant women with epilepsy at West China Hospital in Chengdu, China who developed status epilepticus during pregnancy after valproate withdrawal or reduction in dose from January 2013 to July 2015. A total of 281 pregnancies in patients with epilepsy were examined; 6 episodes of status epilepticus occurred during these pregnancies. Four patients with status epilepticus took long-term valproate before pregnancy. Among them, 2 patients stopped taking valproate 3 months prior to pregnancy, and 2 patients discontinued valproate or reduced their valproate dose when pregnancy was confirmed. All 4 suffered from a convulsive status epilepticus; 3 experienced an increased frequency of seizures. One child was diagnosed with neonatal asphyxia, hypoxic-ischemic encephalopathy, and neonatal pneumonia. Valproate adjustment prior to or during pregnancy may result in deterioration of seizure control, which may include resultant status epilepticus. Valproate during pregnancy increases the risk of major congenital malformations, but the significance of maintaining seizure control in pregnant women should be also taken into consideration. Open and careful discussion with every pregnant woman with epilepsy should discuss the risk-benefit ratio of epilepsy medications. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  19. Status epilepticus in dogs and cats, part 1: etiopathogenesis, epidemiology, and diagnosis.

    Science.gov (United States)

    Blades Golubovic, Susan; Rossmeisl, John H

    2017-05-01

    To review current knowledge of the etiopathogenesis, diagnosis, and consequences of status epilepticus (SE) in veterinary patients. Human and veterinary literature, including clinical and laboratory research and reviews. Status epilepticus is a common emergency in dogs and cats, and may be the first manifestation of a seizure disorder. It results from the failure of termination of an isolated seizure. Multiple factors are involved in SE, including initiation and maintenance of neuronal excitability, neuronal network synchronization, and brain microenvironmental contributions to ictogenesis. Underlying etiologies of epilepsy and SE in dogs and cats are generally classified as genetic (idiopathic), structural-metabolic, or unknown. Diagnosis of convulsive SE is usually made based on historical information and the nature of the seizures. Patient specific variables, such as the history, age of seizure onset, and physical and interictal neurological examination findings can help hone the rule out list, and are used to guide selection and prioritization of diagnostic tests. Electroencephalographic monitoring is routinely used in people to diagnose SE and guide patient care decisions, but is infrequently performed in veterinary medicine. Nonconvulsive status epilepticus has been recognized in veterinary patients; routine electroencephalography would aid in the diagnosis of this phenomenon in dogs and cats. Status epilepticus is a medical emergency that can result in life-threatening complications involving the brain and systemic organs. Status epilepticus often requires comprehensive diagnostic testing, treatment with multiple anticonvulsant agents, and intensive supportive care. © Veterinary Emergency and Critical Care Society 2017.

  20. Status epilepticus: Role for etiology in determining response to benzodiazepines.

    Science.gov (United States)

    Joshi, Suchitra; Rajasekaran, Karthik; Hawk, Kyle M; Chester, Stephen J; Goodkin, Howard P

    2018-04-01

    Clinical factors contributing to benzodiazepine failure in treating status epilepticus (SE) include suboptimal dosing and seizure duration. As many benzodiazepine-refractory episodes of SE arise from acute etiologies, we sought to determine whether etiology impacts SE treatment. The potency of diazepam to terminate SE induced by lithium-pilocarpine (LiPilo-SE) or kainic acid (KA-SE) in 3-week-old rats was studied by video-electroencephalography. Synaptic γ-aminobutyric acid type A receptor (GABAR)-mediated currents were recorded from dentate granule cells using voltage-clamp electrophysiology. Surface expression of γ2 subunit-containing GABARs and Kv4.2 potassium channels in hippocampal slices was determined using a biotinylation assay. Expression of phosphorylated forms of β2/3 and γ2 subunits was determined using phosphospecific antibodies and Western blotting. Diazepam failed to terminate late SE in LiPilo-SE animals but was successful in terminating KA-SE of 1- and 3-hour duration. One hour after SE onset, GABAR-mediated synaptic inhibition and γ2 subunit-containing GABAR surface expression were reduced in LiPilo-SE animals. These were unchanged in KA-SE animals at 1 and 3 hours. Phosphorylation of γ2 subunit residue S327 was unchanged in both models, although GABAR β3 subunit S408/409 residues were dephosphorylated in the LiPilo-SE animals. Kv4.2 potassium channel surface expression was increased in LiPilo-SE animals but reduced in KA-SE animals. SE-model-dependent differences support a novel hypothesis that the development of benzodiazepine pharmacoresistance may be etiologically predetermined. Further studies are required to investigate the mechanisms that underlie such etiological differences during SE and whether etiology-dependent protocols for the treatment of SE need to be developed. Ann Neurol 2018;83:830-841. © 2018 American Neurological Association.

  1. Transient bradycardia induced by thiopentone sodium: a unique challenge in the management of refractory status epilepticus.

    Science.gov (United States)

    Sharma, Sushma; Nair, Pradeep P; Murgai, Aditya; Selvaraj, Raja J

    2013-10-15

    Thiopentone sodium is one of the important drugs in the armamentarium for terminating refractory status epilepticus, a neurological emergency. We report a case of thiopentone-related bradycardia during the management of the new onset refractory status epilepticus in a young man, which was circumvented by prophylactic insertion of temporary pacemaker while thiopentone infusion was continued. A systematic approach was employed to manage the status epilepticus, including infusion of thiamine and glucose followed by antiepileptic drugs. The patient was ventilated and infused with lorazepam, phenytoin, sodium valproate, levetiracetam and midazolam followed by thiopentone sodium. With the introduction of thiopentone the seizures could be controlled but the patient developed severe bradycardia and junctional rhythm. The bradycardia disappeared when thiopentone was withdrawn and reappeared when the drug was reintroduced. Propofol infusion was tried with no respite in seizures. Later thiopentone sodium was reintroduced after inserting temporary cardiac pacemaker. Seizure was controlled and patient was weaned off the ventilator.

  2. Epilepsy is associated with ventricular alterations following convulsive status epilepticus in children.

    Science.gov (United States)

    Ali, Wail; Bubolz, Beth A; Nguyen, Linh; Castro, Danny; Coss-Bu, Jorge; Quach, Michael M; Kennedy, Curtis E; Anderson, Anne E; Lai, Yi-Chen

    2017-12-01

    Convulsive status epilepticus can exert profound cardiovascular effects in adults including ventricular depolarization-repolarization abnormalities. Whether status epilepticus adversely affects ventricular electrical properties in children is less understood. Therefore, we sought to characterize ventricular alterations and the associated clinical factors in children following convulsive status epilepticus. We conducted a 2-year retrospective, case-control study. Children between 1 month and 21 years of age were included if they were admitted to the pediatric intensive care unit with primary diagnosis of convulsive status epilepticus and had 12-lead electrocardiogram (ECG) within 24 hours of admission. Children with heart disease, ion channelopathy, or on vasoactive medications were excluded. Age-matched control subjects had no history of seizures or epilepsy. The primary outcome was ventricular abnormalities represented by ST segment changes, abnormal T wave, QRS axis deviation, and corrected QT (QTc) interval prolongation. The secondary outcomes included QT/RR relationship, beat-to-beat QTc interval variability, ECG interval measurement between groups, and clinical factors associated with ECG abnormalities. Of 317 eligible children, 59 met the inclusion criteria. History of epilepsy was present in 31 children (epileptic) and absent in 28 children (non-epileptic). Compared with the control subjects (n = 31), the status epilepticus groups were more likely to have an abnormal ECG with overall odds ratio of 3.8 and 7.0 for the non-epileptic and the epileptic groups respectively. Simple linear regression analysis demonstrated that children with epilepsy exhibited impaired dependence and adaptation of the QT interval on heart rate. Beat-to-beat QTc interval variability, a marker of ventricular repolarization instability, was increased in children with epilepsy. Convulsive status epilepticus can adversely affect ventricular electrical properties and stability in children

  3. Intravenous ketogenic diet therapy for treatment of the acute stage of super-refractory status epilepticus in a pediatric patient.

    Science.gov (United States)

    Lin, Jainn-Jim; Lin, Kuang-Lin; Chan, Oi-Wa; Hsia, Shao-Hsuan; Wang, Huei-Shyong

    2015-04-01

    A ketogenic diet has been used successfully to treat intractable epilepsy. However, the role of early intravenous initiation of ketogenic diet in the acute phase of super-refractory status epilepticus is not well-described. An intravenous ketogenic diet was administered to a boy with super-refractory status epilepticus. At 24 hours after intravenous ketogenic diet, moderate ketosis appeared, and thiamylal was successfully weaned at 70 hours after admission. An intravenous ketogenic regimen led to subsequent ketosis and seizure control in a child with super-refractory status epilepticus. Early induction of ketosis may be a novel strategy to effectively treat super-refractory status epilepticus. Although there are few data regarding the early use of intravenous ketogenic diet in the treatment of super-refractory status epilepticus, it may be considered an alternative option. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Recovery from near drowning and postanoxic status epilepticus with controlled hypothermia.

    Science.gov (United States)

    de Pont, A C J M; de Jager, C P C; van den Bergh, W M; Schultz, M J

    2011-04-01

    A diver was resuscitated after cardiac arrest due to near drowning and was hypothermic on hospital arrival. During rewarming, status epilepticus occurred, previously identified as a predictor of poor outcome. The seizures responded well to treatment with antiepileptic drugs and controlled hypothermia. After six weeks, the patient had completely recovered. This case supports the hypothesis that hypothermia offers neuroprotection, even in the presence of status epilepticus. We recommend that near-drowning victims who are comatose after resuscitation for cardiac arrest be treated with controlled mild hypothermia for 12 to 24 hours.

  5. Hippocampal sclerosis and status epilepticus: cause or consequence? A MRI study

    International Nuclear Information System (INIS)

    Kuster, Gustavo Wruck; Braga-Neto, Pedro; Santos-Neto, Denizart; Santana, Maria Teresa Garcia; Barsottini, Orlando Graziani; Maia Junior, Antonio Carlos Martins

    2007-01-01

    Background: Transient imaging abnormalities, including changes on diffusion-weighted imaging (DWI), may be seen in status epilepticus. These abnormalities can be followed by hippocampal sclerosis. Case Report: We report a 15-year-old lady with focal non convulsive status epilepticus (NCSE) and focal slowing on EEG. DWI exhibited abnormal hyperintense signals in bilateral temporal and insular cortices. After 3 weeks, MRI performed a localized hippocampal atrophy. Conclusion: The MRI findings indicated vasogenic and cytotoxic edema during seizure activity and subsequent loss of brain parenchyma. (author)

  6. Thymoquinone attenuates brain injury via an antioxidative pathway in a status epilepticus rat model

    Directory of Open Access Journals (Sweden)

    Shao Yi-ye

    2017-03-01

    Full Text Available Status epilepticus (SE results in the generation of reactive oxygen species (ROS, which contribute to seizure-induced brain injury. It is well known that oxidative stress plays a pivotal role in status epilepticus (SE. Thymoquinone (TQ is a bioactive monomer extracted from black cumin (Nigella sativa seed oil that has anti-inflammatory, anti-cancer, and antioxidant activity in various diseases. This study evaluated the protective effects of TQ on brain injury in a lithium-pilocarpine rat model of SE and investigated the underlying mechanism related to antioxidative pathway.

  7. Febrile infection-related status epilepticus in a child after a common infection

    DEFF Research Database (Denmark)

    Andersen, Anne Helene; Hansen, Lars Kjærsgaard

    2014-01-01

    A 13-year-old boy developed seizures and intractable status epilepticus a week after having had a sore throat. Ketogenic diet possibly had some effect. Antibodies to calmodulin dependent protein kinase II were found and could possibly suggest an immunologic aetiology.......A 13-year-old boy developed seizures and intractable status epilepticus a week after having had a sore throat. Ketogenic diet possibly had some effect. Antibodies to calmodulin dependent protein kinase II were found and could possibly suggest an immunologic aetiology....

  8. Manuscript title: Super Refractory Status Epilepticus: The development of a paradigm for critical care management.

    Science.gov (United States)

    Turnbull, D; Singatullina, N

    2013-02-18

    Super Refractory status epilepticus (SRSE) is a sub category of status epilepticus recently defined as seizures that persist following 24 hours of critical care sedation. SRSE is associated with a high morbidity and mortality. Protocols for the management of SRSE have been proposed, but restricted clinical trial data compromises the ability to develop a comprehensive critical care treatment paradigm. The majority of the published literature relates to anecdotal reports, case series, reviews and opinion. The objective of this review is to consolidate the knowledge of the treatment of SRSE and develop a management paradigm providing a clear clinical guide to future clinical management and clinical trials.

  9. Comparison of Intravenous Anesthetic Agents for the Treatment of Refractory Status Epilepticus

    Directory of Open Access Journals (Sweden)

    Michael E. Reznik

    2016-05-01

    Full Text Available Status epilepticus that cannot be controlled with first- and second-line agents is called refractory status epilepticus (RSE, a condition that is associated with significant morbidity and mortality. Most experts agree that treatment of RSE necessitates the use of continuous infusion intravenous anesthetic drugs such as midazolam, propofol, pentobarbital, thiopental, and ketamine, each of which has its own unique characteristics. This review compares the various anesthetic agents while providing an approach to their use in adult patients, along with possible associated complications.

  10. Hemispherotomy in children with electrical status epilepticus of sleep.

    Science.gov (United States)

    Jeong, Anna; Strahle, Jennifer; Vellimana, Ananth K; Limbrick, David D; Smyth, Matthew D; Bertrand, Mary

    2017-01-01

    OBJECTIVE Electrical status epilepticus of sleep (ESES) is a rare electrographic pattern associated with global regression, which is often poorly responsive to traditional epilepsy treatments and can have a devastating and permanent neurocognitive outcome. The authors analyzed clinical, electroencephalographic, and neuropsychological outcomes in 9 patients with refractory ESES treated with functional hemispherotomy to illustrate the wide clinical spectrum associated with the disease and explore the role of hemispherotomy in its treatment. METHODS During the period between 2003 and 2015, 80 patients underwent hemispherotomy at the authors' institution. Video electroencephalography (EEG) reports were reviewed for ESES or continuous spikes and waves during sleep (CSWS). Patients with preoperative ESES (> 85% slow-wave sleep occupied by spike waves), a unilateral structural lesion amenable to surgery, and more than 6 months of follow-up data were included in the analysis. Clinical data, EEG recordings, neuropsychological testing, and parental and clinician reports were retrospectively reviewed. RESULTS Nine patients were eligible for study inclusion. Age at seizure onset ranged from birth to 4.2 years (mean 1.9 years), age at ESES diagnosis ranged from 3.5 to 8.8 years (mean 6.0 years), and age at hemispherotomy ranged from 3.7 to 11.5 years (mean 6.8 years). All patients had drug-resistant epilepsy. The duration of epilepsy prior to hemispherotomy ranged from 2.7 to 8.9 years (mean ± SD, 5.0 ± 2.2 years). Engel Class I seizure outcome was observed in all 9 children, with a mean follow-up of 3.0 years (range 0.5-6.1 years). Hemispherotomy terminated ESES in 6 of 6 patients with available postoperative sleep EEG. All children had preoperative neuropsychological impairments. Developmental regression was halted postoperatively, but none of the children returned to their original pre-ESES baseline. Four children demonstrated academic gains, 2 of whom transitioned to

  11. Status epilepticus ausência de novo: relato de caso "De novo" absence status: case report

    Directory of Open Access Journals (Sweden)

    Gloria M. Almeida Tedrus

    1997-09-01

    Full Text Available Existem poucos relatos na literatura de pacientes adultos com status epilepticus não convulsivo, do tipo ausência típica. Apresentamos o caso de paciente do sexo feminino de 53 anos de idade, diabética, que iniciou quadro de confusão mental após crise tônico-clônica generalizada. O eletrencefalograma mostrou descargas contínuas generalizadas caracterizadas por complexos ponta-onda irregulares. As descargas ao eletrencefalograma desapareceram após diazepan endovenoso. A tomografia computadorizada de crânio foi normal. Esse caso mostra que o reconhecimento dessa entidade clínico-eletrencefalográfica é essencial, devido à semelhança com distúrbio psiquiátrico e da pronta resposta ao tratamento medicamentoso.There are few descriptions about middle-aged patients who have nonconvulsive status epilepticus, absence status. We reported the clinical case of a woman, 52-year-old, diabetic, referred to the emergency room in a confusional state. Initial electroencephalogram showed continuous typical, bilateral, symmetric and synchronous spike-and-wave discharges. Clinical and electroencephalogram normalization occurred immediatelly following intravenous injection of benzodiazepine. Computerized axial tomography was normal. The recognition of this entity is essential because of its similarity to psychiatric disturbance and its prompt response to proper treatment.

  12. Safety and pharmacokinetics of intravenous levetiracetam infusion as add-on in status epilepticus

    NARCIS (Netherlands)

    Uges, Joris W F; van Huizen, Marc D; Engelsman, Jeroen; Wilms, Erik B; Touw, Daniel J; Peeters, Els; Vecht, Charles J

    PURPOSE: To evaluate the feasibility and safety of intravenous (iv) levetiracetam (LEV) added to the standard therapeutic regimen in adults with status epilepticus (SE), and as secondary objective to assess a population pharmacokinetic (PK) model for ivLEV in patients with SE. METHODS: In 12 adults

  13. Treatment of convulsive status epilepticus in the UMCG: A retrospective, observational study

    NARCIS (Netherlands)

    Vlaskamp, D.R.M.; Brouwer, O.F.; Callenbach, P.M.C.

    2013-01-01

    Objectives: Little is known about clinical practice with respect to the application of guidelines in the treatment of Convulsive Status Epilepticus (CSE). This retrospective, observational study evaluated treatment of episodes of CSE in children at the University Medical Centre Groningen (UMCG).

  14. Degenerative neuronal changes in the rat thalamus induced by status epilepticus at different developmental stages

    Czech Academy of Sciences Publication Activity Database

    Druga, Rastislav; Mareš, Pavel; Otáhal, Jakub; Kubová, Hana

    2005-01-01

    Roč. 63, č. 1 (2005), s. 43-65 ISSN 0920-1211 R&D Projects: GA ČR(CZ) GA309/01/0285 Institutional research plan: CEZ:AV0Z5011922 Keywords : status epilepticus * lithium pilocarpine * thalamus Subject RIV: FH - Neurology Impact factor: 2.663, year: 2005

  15. Panayiotopoulos syndrome presenting with status epilepticus and cardiorespiratory arrest: a case report.

    Science.gov (United States)

    Mujawar, Quais Mohammad; Sen, Santanu; Ali, Mir Dilshad; Balakrishnan, Pramod; Patil, Shekhar

    2011-08-01

    Panayiotopoulos syndrome is early-onset benign childhood epilepsy, now classified as an electroclinical syndrome. The original description in 1989 focused on the triad of nocturnal seizures, tonic eye deviation, and vomiting. With available data from the long-term studies, a wide variety of manifestations have been described, with recognition of autonomic features as being the most prominent aspect of this epilepsy. The presenting symptoms are usually focal seizures comprising autonomic symptoms and/or behavioral changes. Majority of these seizures are in sleep, with half of the seizures progressing to become secondarily generalized. Occasionally, these seizures can present with prominent autonomic features such as ictal vomiting, pallor, flushing/cyanosis, and tachycardia with prolonged thermoregulatory changes lasting for hours, constituting autonomic status epilepticus. Recovery from this autonomic status epilepticus is within hours and is always complete. Autonomic status epilepticus has been previously reported in this epilepsy syndrome, but ictal cardiorespiratory arrest is extremely rare, with only 4 cases being reported in literature. All 4 cases reported in literature recovered spontaneously and did not require resuscitation. Here we present a 3½-year-old male child with Panayiotopoulos syndrome who presented with status epilepticus and ictal cardiorespiratory arrest requiring cardiopulmonary resuscitation for revival.

  16. Recovery from near drowning and postanoxic status epilepticus with controlled hypothermia

    NARCIS (Netherlands)

    de Pont, A. C. J. M.; de Jager, C. P. C.; van den Bergh, W. M.; Schultz, M. J.

    2011-01-01

    A diver was resuscitated after cardiac arrest due to near drowning and was hypothermic on hospital arrival. During rewarming, status epilepticus occurred, previously identified as a predictor of poor outcome. The seizures responded well to treatment with antiepileptic drugs and controlled

  17. Recovery from near drowning and postanoxic status epilepticus with controlled hypothermia

    NARCIS (Netherlands)

    de Pont, A C J M; de Jager, C P C; van den Bergh, W M; Schultz, M J

    A diver was resuscitated after cardiac arrest due to near drowning and was hypothermic on hospital arrival. During rewarming, status epilepticus occurred, previously identified as a predictor of poor outcome. The seizures responded well to treatment with antiepileptic drugs and controlled

  18. Ten patients with refractory status epilepticus in an intensive care department

    NARCIS (Netherlands)

    ter Maaten, JC; van Schijndel, RJM; Heimans, JJ; Schreuder, WO

    1998-01-01

    Status epilepticus (SE) is a serious disease, associated with a high morbidity and mortality, particularly if refractory to initial therapy. We describe the clinical manifestations and outcome in ten cases with refractory SE admitted to our medical intensive care unit. Three of these selected group

  19. Outcome of status epilepticus in immature rats varies according to the paraldehyde treatment

    Czech Academy of Sciences Publication Activity Database

    Kubová, Hana; Rejchrtová, Jana; Redkozubova, Olga; Mareš, Pavel

    2005-01-01

    Roč. 46, Suppl. 5 (2005), s. 38-42 ISSN 0013-9580 R&D Projects: GA MZd(CZ) NF6474 Institutional research plan: CEZ:AV0Z5011922 Keywords : status epilepticus * paraldehyde * long-term consequences Subject RIV: ED - Physiology Impact factor: 3.227, year: 2005

  20. An animal model of nonconvulsive status epilepticus: a contribution to clinical controversies

    Czech Academy of Sciences Publication Activity Database

    Kršek, Pavel; Mikulecká, Anna; Druga, Rastislav; Hliňák, Zdeněk; Kubová, Hana; Mareš, Pavel

    2001-01-01

    Roč. 42, č. 2 (2001), s. 171-180 ISSN 0013-9580 R&D Projects: GA ČR GA309/97/0552; GA AV ČR IAA7011603 Institutional research plan: CEZ:AV0Z5011922 Keywords : complex partial status epilepticus * pilocarpine * epileptic brain damage Subject RIV: ED - Physiology Impact factor: 3.271, year: 2001

  1. Cortical interhemispheric responses to rhythmic stimulation are influenced by status epilepticus in developing rats

    Czech Academy of Sciences Publication Activity Database

    Tsenov, Grygoriy; Mareš, Pavel

    2005-01-01

    Roč. 46, č. S6 (2005), s. 209-210 ISSN 0013-9580. [International Epilepsy Congress /26./. 28.08.2005-01.09.2005, Paris] Institutional research plan: CEZ:AV0Z50110509 Keywords : status epilepticus * interhemispheric responses * developing rats Subject RIV: ED - Physiology

  2. Changes of cortical interhemispheric responses after status epilepticus in immature rats

    Czech Academy of Sciences Publication Activity Database

    Mareš, Pavel; Tsenov, Grygoriy; Aleksakhina, Katarina; Druga, Rastislav; Kubová, Hana

    2005-01-01

    Roč. 46, Suppl. 5 (2005), s. 31-37 ISSN 0013-9580 R&D Projects: GA ČR(CZ) GA309/03/0770 Institutional research plan: CEZ:AV0Z5011922 Keywords : status epilepticus * transcallosal responses * ontogeny Subject RIV: ED - Physiology Impact factor: 3.227, year: 2005

  3. Neuronal degeneration induced by status epilepticus in the nucleus accumens of immature rats

    Czech Academy of Sciences Publication Activity Database

    Druga, Rastislav; Mareš, Pavel; Kubová, Hana

    2007-01-01

    Roč. 48, s6 (2007), s. 19-20 ISSN 0013-9580. [Annual Meeting of the American Epilepsy Society. 31.112007-3.12.2007, Philadelphia] R&D Projects: GA ČR GA304/07/1137 Institutional research plan: CEZ:AV0Z50110509 Keywords : cpo1 * neuronal degeneration * status epilepticus * immature rat Subject RIV: FH - Neurology

  4. Progranulin and Its Related MicroRNAs after Status Epilepticus: Possible Mechanisms of Neuroprotection

    Directory of Open Access Journals (Sweden)

    Peter Körtvelyessy

    2017-02-01

    Full Text Available The current knowledge about neuroprotective mechanisms in humans after status epilepticus is scarce. One reason is the difficulty to measure possible mediators of these neuroprotective mechanisms. The dawn of microRNA detection in the cerebrospinal fluid (CSF and the recent advancements in measuring proteins in the CSF such as progranulin, which is, e.g., responsible for neurite outgrowth and limiting exceeding neuroinflammatory responses, have given us new insights into putative neuroprotective mechanisms following status epilepticus. This should complement the animal data. In this review, we cover what is known about the role of progranulin as well as the links between microRNA changes and the progranulin pathway following status epilepticus in humans and animals hypothesizing neuroprotective and neurorehabilitative effects. Progranulin has also been found to feature prominently in the neuroprotective processes under hypoxic conditions and initiating neurorehabilitative processes. These properties may be used therapeutically, e.g., through drugs that raise the progranulin levels and therefore the cerebral progranulin levels as well with the goal of improving the outcome after status epilepticus.

  5. Prevalence and Risk Factors of Stress Cardiomyopathy After Convulsive Status Epilepticus in ICU Patients.

    Science.gov (United States)

    Belcour, Dominique; Jabot, Julien; Grard, Benjamin; Roussiaux, Arnaud; Ferdynus, Cyril; Vandroux, David; Vignon, Philippe

    2015-10-01

    Although stress cardiomyopathy has been described in association with epilepsy, its frequency in patients with convulsive status epilepticus remains unknown. Accordingly, we sought to determine the prevalence and risk factors of stress cardiomyopathy in patients admitted to the ICU for convulsive status epilepticus. Prospective, descriptive, single-center study. Medical-surgical ICU of a teaching hospital. Thirty-two consecutive ventilated patients (21 men; age, 50 ± 18 yr; Simplified Acute Physiology Score II, 53 ± 15; Sequential Organ Failure Assessment, 6 ± 2) hospitalized in the ICU for convulsive status epilepticus. None. Hemodynamic parameters, transthoracic echocardiography, biological data, and electrocardiogram were obtained serially on ICU admission (H0), and after 6, 12, 24, and 48 hours of hospitalization (H6, H12, H24, and H48). Stress cardiomyopathy was defined as a 20% decrease in left ventricular ejection fraction between H0 or H6 and H48. Stress cardiomyopathy was diagnosed in 18 patients (56%; 95% CI, 38-74%). Mean left ventricular ejection fraction, left ventricular stroke index and cardiac index were initially (at H0 or H6 according to lowest individual values) significantly reduced in stress cardiomyopathy patients (45 ± 14% vs 61 ± 6%, p ICU for convulsive status epilepticus. Accordingly, these patients should be screened for stress cardiomyopathy and monitored if they present with hemodynamic compromise.

  6. Increasing Ketamine Use for Refractory Status Epilepticus in US Pediatric Hospitals.

    Science.gov (United States)

    Keros, Sotirios; Buraniqi, Ersida; Alex, Byron; Antonetty, Annalee; Fialho, Hugo; Hafeez, Baria; Jackson, Michele C; Jawahar, Rachel; Kjelleren, Stephanie; Stewart, Elizabeth; Morgan, Lindsey A; Wainwright, Mark S; Sogawa, Yoshimi; Patel, Anup D; Loddenkemper, Tobias; Grinspan, Zachary M

    2017-06-01

    Ketamine is an emerging therapy for pediatric refractory status epilepticus. The circumstances of its use, however, are understudied. The authors described pediatric refractory status epilepticus treated with ketamine from 2010 to 2014 at 45 centers using the Pediatric Hospital Inpatient System database. For comparison, they described children treated with pentobarbital. The authors estimated that 48 children received ketamine and pentobarbital for refractory status epilepticus, and 630 pentobarbital without ketamine. Those receiving only pentobarbital were median age 3 [interquartile range 0-10], and spent 30 [18-52] days in-hospital, including 17 [9-28] intensive care unit (ICU) days; 17% died. Median cost was $148 000 [81 000-241 000]. The pentobarbital-ketamine group was older (7 [2-11]) with longer hospital stays (51 [30-93]) and more ICU days (29 [20-56]); 29% died. Median cost was $298 000 [176 000-607 000]. For 71%, ketamine was given ≥1 day after pentobarbital. Ketamine cases per half-year increased from 2 to 9 ( P Ketamine is increasingly used for severe pediatric refractory status epilepticus, typically after pentobarbital. Research on its effectiveness is indicated.

  7. Landau-Kleffner Syndrome, Electrical Status Epilepticus in Slow Wave Sleep, and Language Regression in Children

    Science.gov (United States)

    McVicar, Kathryn A.; Shinnar, Shlomo

    2004-01-01

    The Landau-Kleffner syndrome (LKS) and electrical status epilepticus in slow wave sleep (ESES) are rare childhood-onset epileptic encephalopathies in which loss of language skills occurs in the context of an epileptiform EEG activated in sleep. Although in LKS the loss of function is limited to language, in ESES there is a wider spectrum of…

  8. Treatment of electrical status epilepticus in sleep : A pooled analysis of 575 cases

    NARCIS (Netherlands)

    Van Den Munckhof, Bart; Van Dee, Violet; Sagi, Liora; Caraballo, Roberto H.; Veggiotti, Pierangelo; Liukkonen, Elina; Loddenkemper, Tobias; Sánchez Fernández, Iván; Buzatu, Marga; Bulteau, Christine; Braun, Kees P J; Jansen, Floor E.

    2015-01-01

    Objective Epileptic encephalopathy with electrical status epilepticus in sleep (ESES) is a pediatric epilepsy syndrome with sleep-induced epileptic discharges and acquired impairment of cognition or behavior. Treatment of ESES is assumed to improve cognitive outcome. The aim of this study is to

  9. The mast cell stabilizer sodium cromoglycate reduces histamine release and status epilepticus-induced neuronal damage in the rat hippocampus.

    Science.gov (United States)

    Valle-Dorado, María Guadalupe; Santana-Gómez, César Emmanuel; Orozco-Suárez, Sandra Adela; Rocha, Luisa

    2015-05-01

    Experiments were designed to evaluate changes in the histamine release, mast cell number and neuronal damage in hippocampus induced by status epilepticus. We also evaluated if sodium cromoglycate, a stabilizer of mast cells with a possible stabilizing effect on the membrane of neurons, was able to prevent the release of histamine, γ-aminobutyric acid (GABA) and glutamate during the status epilepticus. During microdialysis experiments, rats were treated with saline (SS-SE) or sodium cromoglycate (CG-SE) and 30 min later received the administration of pilocarpine to induce status epilepticus. Twenty-four hours after the status epilepticus, the brains were used to determine the neuronal damage and the number of mast cells in hippocampus. During the status epilepticus, SS-SE group showed an enhanced release of histamine (138.5%, p = 0.005), GABA (331 ± 91%, p ≤ 0.001) and glutamate (467%, p ≤ 0.001), even after diazepam administration. One day after the status epilepticus, SS-SE group demonstrated increased number of mast cells in Stratum pyramidale of CA1 (88%, p histamine (but not GABA and glutamate) release, lower number of mast cells (p = 0.008) and reduced neuronal damage in hippocampus. Our data revealed that histamine, possibly from mast cells, is released in hippocampus during the status epilepticus. This effect may be involved in the subsequent neuronal damage and is diminished with sodium cromoglycate pretreatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Medical management with diazepam for electrical status epilepticus during slow wave sleep in children.

    Science.gov (United States)

    Francois, Densley; Roberts, Jessica; Hess, Stephany; Probst, Luke; Eksioglu, Yaman

    2014-03-01

    Oral diazepam, administered in varying doses, is among the few proposed treatment options for electrical status epilepticus during slow wave sleep in children. We sought to retrospectively evaluate the long-term efficacy of high-dose oral diazepam in reducing electrographic and clinical evidence of electrical status epilepticus during slow wave sleep in children. Additionally, we surveyed caregivers to assess safety and behavioral outcomes related to ongoing therapy. We collected demographic and clinical data on children treated for electrical status epilepticus during slow wave sleep between October 2010 and March 2013. We sought to identify the number of patients who achieved at least a 50% reduction in spike wave index on electroencephalograph after receiving high-dose oral diazepam. We also administered a questionnaire to caregivers to assess for behavioral problems and side effects. We identified 42 evaluable patients who received high-dose diazepam (range 0.23-2.02 mg/kg per day) to treat electrical status epilepticus during slow wave sleep. Twenty-six patients had spike reduction data and 18/26 (69.2%) children achieved a greater than 50% reduction in spike wave count from an average of 15.54 to 5.05 (P = 0.001). We received 28 responses to the questionnaire. Some patients experienced new onset of difficulties with problem-solving and speech and writing development. Sleep disturbances (50%) and irritability (57.1%) were the most frequent side effects reported. There did not appear to be a dose-related effect with electroencephalograph changes, behavioral effects, or side effects. High-dose oral diazepam significantly reduces the spike wave count on electroencephalograph in children with electrical status epilepticus during slow wave sleep. Although this therapy improves electroencephalograph-related findings, it can be associated with concerning neurological and behavioral side effects in some individuals, so further study is warranted. Copyright © 2014

  11. Differential diagnosis by EEG of dissociative status versus nonconvulsive status epilepticus.

    Science.gov (United States)

    Amo, Carlos; Elices, Nélida; Huertas, David

    2012-01-01

    Nonconvulsive status epilepticus (NCSE) has different clinical presentations, from minimal confusion to bizarre behavioral manifestations, psychosis or coma. As a result, patients can sometimes be misdiagnosed and labeled as psychiatric cases. The patient was alert and disoriented in time, with disconnection episodes, generalized slowness, slow mental response, faltering language and slow answers. A differential diagnosis between dissociative status and NCSE was proposed. The physical and neurological examinations were normal. The cranial CT scan findings were normal. Only the EEG provided the definitive diagnostic data, consisting of generalized spike and wave discharges of 2-3 Hz against a desynchronized background. Diagnosis of NCSE requires the availability of an EEG. Often patients are on the border between medical conditions and mental disorders. Observation of the disease evolution and an open-minded attitude of physicians are necessary for the correct diagnosis and treatment.

  12. Use of the EpiNet database for observational study of status epilepticus in Auckland, New Zealand.

    Science.gov (United States)

    Bergin, Peter; Jayabal, Jayaganth; Walker, Elizabeth; Davis, Suzanne; Jones, Peter; Dalziel, Stuart; Yates, Kim; Thornton, Vanessa; Bennett, Patricia; Wilson, Kaisa; Roberts, Lynair; Litchfield, Rhonda; Te Ao, Braden; Parmer, Priya; Feigin, Valery; Jost, Jeremy; Beghi, Ettore; Rossetti, Andrea O

    2015-08-01

    The EpiNet project has been established to facilitate investigator-initiated clinical research in epilepsy, to undertake epidemiological studies, and to simultaneously improve the care of patients who have records created within the EpiNet database. The EpiNet database has recently been adapted to collect detailed information regarding status epilepticus. An incidence study is now underway in Auckland, New Zealand in which the incidence of status epilepticus in the greater Auckland area (population: 1.5 million) will be calculated. The form that has been developed for this study can be used in the future to collect information for randomized controlled trials in status epilepticus. This article is part of a Special Issue entitled "Status Epilepticus". Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Harmful effect of kainic acid on brain ischemic damage is not related to duration of status epilepticus

    OpenAIRE

    Hasson, Henry; Malhotra, Samit; Giorgi, Filippo S.; Rosenbaum, Daniel M.; Moshé, Solomon L.

    2009-01-01

    Status epilepticus is common in infants and may have long-term consequences on the brain persisting into adulthood. Vascular ischemia is a common cause of stroke in adulthood. The extent of stroke in 15-day-old rats is larger when previously exposed to kainic acid-induced status epilepticus. In this paper, we assess whether shortening the duration of seizures modifies subsequent susceptibility to middle cerebral artery occlusion. We administered pentobarbital 50 mg/kg to abort seizures after ...

  14. Thyroid-stimulating hormone elevation misdiagnosed as subclinical hypothyroidism following non-convulsive status epilepticus: a case report

    Directory of Open Access Journals (Sweden)

    Kunii Yasuto

    2011-09-01

    Full Text Available Abstract Introduction Non-convulsive status epilepticus is a form of epileptic seizure that occurs without convulsions. Recent reviews suggest that the diagnosis of non-convulsive status epilepticus remains difficult. Here, we report the case of a patient with thyroid-stimulating hormone elevation misdiagnosed as subclinical hypothyroidism following non-convulsive status epilepticus. Case presentation Our patient was a 68-year-old Japanese woman. The results of endocrine testing after her first episode of non-convulsive status epilepticus suggested latent subclinical hypothyroidism: she had elevated thyroid-stimulating hormone with normal levels of free tri-iodothyronine and free thyroxine. On examination, a diagnosis of thyroid disorder was not supported by other test results and our patient remained untreated. A follow-up examination revealed that her thyroid-stimulating hormone levels had spontaneously normalized. When she consulted another doctor for confusion, the transient increase in thyroid-stimulating hormone levels following non-convulsive status epilepticus was mistaken for subclinical hypothyroidism, and unfortunately treated with levothyroxine. Our patient then experienced levothyroxine-induced non-convulsive status epilepticus. Conclusions In this report, we suggested possible mechanisms for latent hypothyroid-like hormone abnormality following epileptic seizures and the possibility of provoking epileptic seizures by administering levothyroxine for misdiagnosed subclinical hypothyroidism.

  15. Status Epilepticus as an Initial Manifestation of Neurosyphilis: A Case Report

    Directory of Open Access Journals (Sweden)

    Chien-Hsun Li

    2006-08-01

    Full Text Available Seizures and focal neurologic deficits may be the complications of neurosyphilis, but status epilepticus as a presenting picture of neurosyphilis is rare. We describe a 41-year-old man with an acute onset of expressive dysphasia, followed by persistent seizure state and severe complications of systemic medical problems. An extensive laboratory evaluation confirmed the diagnosis of neurosyphilis and diabetes mellitus. Brain magnetic resonance imaging showed edematous change in the left cingulate gyrus, left temporal lobe, and peri-Rolandic area, which suggested an inflammatory process. Due to varied clinical manifestations of neurosyphilis, we underscore the importance of considering neurosyphilis among the possible causes of status epilepticus and any central nervous system diseases.

  16. Dyke-Davidoff-Masson Syndrome. An unusual cause of status epilepticus.

    Science.gov (United States)

    Zawar, Ifrah; Khan, Ashfa A; Sultan, Tipu; Rathore, Ahsan W

    2015-10-01

    The Dyke-Davidoff-Masson Syndrome (DDMS) results from an insult to the growing brain in utero or early infancy, which lead to loss of neurons compromising the growth of the brain. Clinical presentation includes seizures, hemiparesis, facial asymmetry, and learning disability. Radiological findings include cerebral atrophy on one side. Here, we present a case with status epilepticus who had underlying DDMS. It is a rare syndrome and uncommon cause for status epilepticus. Infections of CNS, hypoxic ischemic encephalopathy, intracranial bleed, trauma, congenital vascular malformations are the common causes of this syndrome. Diagnosis is established after clinical history, examination, and MRI. Intractable seizures can be controlled with appropriate anticonvulsants. Subsequently, these children may require physiotherapy, speech therapy, and occupational therapy in addition to the anticonvulsant medication. Outcome is better if the seizures are controlled.

  17. Status Epilepticus in Immature Rats Is Associated with Oxidative Stress and Mitochondrial Dysfunction

    Czech Academy of Sciences Publication Activity Database

    Folbergrová, Jaroslava; Ješina, Pavel; Kubová, Hana; Druga, Rastislav; Otáhal, Jakub

    2016-01-01

    Roč. 10, May 26 (2016), s. 136 ISSN 1662-5102 R&D Projects: GA ČR(CZ) GBP304/12/G069; GA ČR(CZ) GAP303/10/0999; GA ČR(CZ) GA15-08565S Institutional support: RVO:67985823 Keywords : immature rats * status epilepticus * oxidative stress * mitochondrial dysfunction Subject RIV: FH - Neurology Impact factor: 4.555, year: 2016

  18. Recurrent Metabolic Acidosis during High-dose Midazolam Therapy for Refractory Status Epilepticus.

    Science.gov (United States)

    Singh, Shalendra; Khandelwal, Ankur; Datta, Rashmi; Kaushal, Ashutosh; Singh, Gyaninder Pal

    2018-02-01

    High-dose continuous midazolam therapy has been used successfully for control of refractory status epilepticus. However, normal anion gap (AG) metabolic acidosis, a deleterious complication of this therapy is underrecognized. Even though previously reported in an isolated case report in a pediatric patient, we observed similar complication in an adult patient. Stereotyped normal AG metabolic acidosis along with hypotension developed on two occasions during high-dose continuous midazolam hydrochloride infusion that reverted rapidly following cessation of the infusion.

  19. Encephalopathy with status epilepticus during sleep (ESES) induced by oxcarbazepine in idiopathic focal epilepsy in childhood

    DEFF Research Database (Denmark)

    Pavlidis, Elena; Rubboli, Guido; Nikanorova, Marina

    2015-01-01

    Encephalopathy with status epilepticus during sleep (ESES) is an age-related disorder characterized by neuropsychological regression, epilepsy and a typical EEG pattern of continuous epileptiform activity (> 85%) during NREM sleep. Cases of worsening or induction of ESES with phenytoin......, carbamazepine and phenobarbital have been reported. We describe a child with benign epilepsy with centrotemporal spikes (BECTS) in whom treatment with oxcarbazepine (OXC) induced ESES. The patient was studied through repeated clinical-neuropsychological evaluations and 24-hour EEG recordings. He was treated...

  20. Neuronal degeneration induced by status epilepticus in basal ganglia of immature rats

    Czech Academy of Sciences Publication Activity Database

    Druga, Rastislav; Kubová, Hana; Mareš, Pavel

    2005-01-01

    Roč. 46, č. S8 (2005), s. 98-99 ISSN 0013-9580. [Joint Annual Meeting of the American Epilepsy Society and American Clinical Neurophysiology Society. 02.12.2005-06.12.2005, Washington, DC] R&D Projects: GA ČR(CZ) GA304/04/0464 Institutional research plan: CEZ:AV0Z50110509 Keywords : status epilepticus * neurodegeneration * basal ganglia Subject RIV: ED - Physiology

  1. Treatment of experimental status epilepticus in immature rats: dissociation between anticonvulsant and antiepileptogenic effects

    Czech Academy of Sciences Publication Activity Database

    Suchomelová, Lucie; Baldwin, R. A.; Kubová, Hana; Thompson, K. W.; Sankar, R.; Wasterlain, C. G.

    2006-01-01

    Roč. 59, č. 2 (2006), s. 237-243 ISSN 0031-3998 Grant - others:ILAE(BE) Fellowship; Johnson&Johnson´s(US) Pharm. Res. Institute; NINDS(US) NS13515; NINDS(US) NS046516; NINDS(US) NS045911 Institutional research plan: CEZ:AV0Z50110509 Keywords : status epilepticus * treatment * immature rats Subject RIV: ED - Physiology Impact factor: 2.619, year: 2006

  2. Partial motor status epilepticus as a clinical manifestation of carotid stenosis

    Directory of Open Access Journals (Sweden)

    Ribacoba Renée

    2010-09-01

    Full Text Available Abstract Limb shaking (LS is often confused with focal motor seizures. Distinguishing between both is crucial, because LS may represent an indicator of severe carotid occlusive disease and patients are at high risk of stroke. We report the case of a patient with occlusive carotid stenosis without definite stroke who develops partial motor status epilepticus (SE. Clinical, neuroimaging and electroencephalographic findings are provided. We conclude that focal motor seizures should be distinguished from LS based on clinical and electroencephalographic findings.

  3. Are morphologic and functional consequences of status epilepticus in infant rats progressive?

    Czech Academy of Sciences Publication Activity Database

    Kubová, Hana; Mareš, Pavel

    2013-01-01

    Roč. 235, APR 3 (2013), s. 232-249 ISSN 0306-4522 R&D Projects: GA ČR(CZ) GAP302/10/0971; GA ČR(CZ) GBP304/12/G069; GA MŠk(CZ) ME08045 Institutional research plan: CEZ:AV0Z50110509 Institutional support: RVO:67985823 Keywords : status epilepticus * immature brain * brain atrophy * epilepsy * cognitive impairment Subject RIV: FH - Neurology Impact factor: 3.327, year: 2013

  4. Does status epilepticus induced at early postnatal period change excitability after cortical epileptic afterdischarges?

    Czech Academy of Sciences Publication Activity Database

    Mareš, Pavel; Kubová, Hana

    2016-01-01

    Roč. 57, č. 8 (2016), E183-E186 ISSN 0013-9580 R&D Projects: GA MŠk(CZ) LH11015; GA ČR(CZ) GBP304/12/G069; GA ČR(CZ) GAP302/10/0971; GA ČR(CZ) GA15-16605S Institutional support: RVO:67985823 Keywords : status epilepticus * cortical stimulation * epileptic afterdischarges * ontogeny * rat Subject RIV: FH - Neurology Impact factor: 5.295, year: 2016

  5. Refractory Status Epilepticus in Children: Intention to Treat With Continuous Infusions of Midazolam and Pentobarbital.

    Science.gov (United States)

    Tasker, Robert C; Goodkin, Howard P; Sánchez Fernández, Iván; Chapman, Kevin E; Abend, Nicholas S; Arya, Ravindra; Brenton, James N; Carpenter, Jessica L; Gaillard, William D; Glauser, Tracy A; Goldstein, Joshua; Helseth, Ashley R; Jackson, Michele C; Kapur, Kush; Mikati, Mohamad A; Peariso, Katrina; Wainwright, Mark S; Wilfong, Angus A; Williams, Korwyn; Loddenkemper, Tobias

    2016-10-01

    To describe pediatric patients with convulsive refractory status epilepticus in whom there is intention to use an IV anesthetic for seizure control. Two-year prospective observational study evaluating patients (age range, 1 mo to 21 yr) with refractory status epilepticus not responding to two antiepileptic drug classes and treated with continuous infusion of anesthetic agent. Nine pediatric hospitals in the United States. In a cohort of 111 patients with refractory status epilepticus (median age, 3.7 yr; 50% male), 54 (49%) underwent continuous infusion of anesthetic treatment. The median (interquartile range) ICU length of stay was 10 (3-20) days. Up to four "cycles" of serial anesthetic therapy were used, and seizure termination was achieved in 94% by the second cycle. Seizure duration in controlled patients was 5.9 (1.9-34) hours for the first cycle and longer when a second cycle was required (30 [4-120] hr; p = 0.048). Midazolam was the most frequent first-line anesthetic agent (78%); pentobarbital was the most frequently used second-line agent after midazolam failure (82%). An electroencephalographic endpoint was used in over half of the patients; higher midazolam dosing was used with a burst suppression endpoint. In midazolam nonresponders, transition to a second agent occurred after a median of 1 day. Most patients (94%) experienced seizure termination with these two therapies. Midazolam and pentobarbital remain the mainstay of continuous infusion therapy for refractory status epilepticus in the pediatric patient. The majority of patients experience seizure termination within a median of 30 hours. These data have implications for the design and feasibility of future intervention trials. That is, testing a new anesthetic anticonvulsant after failure of both midazolam and pentobarbital is unlikely to be feasible in a pediatric study, whereas a decision to test an alternative to pentobarbital, after midazolam failure, may be possible in a multicenter

  6. Comparison of Intranasal and Intravenous Diazepam on Status Epilepticus in Stroke Patients

    Science.gov (United States)

    Inokuchi, Ryota; Ohashi-Fukuda, Naoko; Nakamura, Kensuke; Wada, Tomoki; Gunshin, Masataka; Kitsuta, Yoichi; Nakajima, Susumu; Yahagi, Naoki

    2015-01-01

    Abstract Administering diazepam intravenously or rectally in an adult with status epilepticus can be difficult and time consuming. The aim of this study was to examine whether intranasal diazepam is an effective alternative to intravenous diazepam when treating status epilepticus. We undertook a retrospective cohort study based on the medical records of 19 stroke patients presenting with status epilepticus to our institution. We measured the time between arrival at the hospital, the intravenous or intranasal administration of diazepam, and the seizure termination. Intranasal diazepam was administered about 9 times faster than intravenous diazepam (1 vs 9.5 minutes, P = 0.001), resulting in about 3-fold reduction in the time to termination of seizure activity after arrival at the hospital (3 minutes compared with 9.5 minutes in the intravenous group, P = 0.030). No adverse effects of intranasal diazepam were evident from the medical records. Intranasal diazepam administration is safer, easier, and quicker than intravenous administration. PMID:25700327

  7. The role for ketogenic diets in epilepsy and status epilepticus in adults

    Directory of Open Access Journals (Sweden)

    Tanya J. Williams

    Full Text Available Ketogenic diet (KD therapies are high fat, low carbohydrate diets designed to mimic a fasting state. Although studies demonstrate KD’s success in reducing seizures stretching back nearly a century, the last 25 years have seen a resurgence in diet therapy for the management of drug-resistant epilepsy in children as well as adults. With ≥50% seizure reduction efficacy rates in adults of 22–55% for the classic KD and 12–67% for the modified Atkins diet, diet therapy may be in many instances comparable to a trial of an additional anti-epileptic medication and potentially with fewer side effects and other health benefits. Moreover, ketogenic diets offer promising new adjunctive strategies for the treatment of acute status epilepticus in the intensive care setting. Here, we review the efficacy and utility of ketogenic diets for the management of chronic epilepsy and refractory status epilepticus in adults and offer practical guidelines for diet implementation and maintenance. Keywords: Ketogenic diet, Modified Atkins diet, Epilepsy, Drug-resistant epilepsy, Refractory status epilepticus

  8. Refractory metabolic acidosis as a complication of high-dose midazolam infusion for pediatric status epilepticus.

    Science.gov (United States)

    Federman, Myke D; Kelly, Robert; Harrison, Rick E

    2009-01-01

    The use of midazolam for the treatment of status epilepticus in children has generally been shown to be well tolerated and safe. Furthermore, encouraging efficacy has been observed when pediatric patients with status epilepticus have received continuous intravenous infusions of midazolam. A 9-year-old girl was treated with high-dose, continuous intravenous infusion of midazolam for the management of refractory status epilepticus. The patient developed a severe hyperchloremic, non-anion gap metabolic acidosis and resultant hemodynamic compromise, necessitating significant inotropic support and the initiation of a vasopressor infusion. We speculate that this complication was due to the preparation of parenteral midazolam with hydrochloric acid. The midazolam infusion was stopped, and, in less than 5 hours, the patient's metabolic acidosis resolved. The patient's inotropic and vasopressor infusions could only be weaned after discontinuing the use of high-dose midazolam. Although this complication was observed in only 1 pediatric patient with cortical dysplasia, caution and close clinical and laboratory surveillance should be exercised when administering continuous intravenous infusions of midazolam to pediatric patients.

  9. The ketogenic diet in two paediatric patients with refractory myoclonic status epilepticus.

    Science.gov (United States)

    Caraballo, Roberto Horacio; Valenzuela, Gabriela Reyes; Armeno, Marisa; Fortini, Sebastian; Mestre, Graciela; Cresta, Araceli

    2015-12-01

    We describe two patients with refractory myoclonic status epilepticus treated with the ketogenic diet. Between May 1, 2014 and January 1, 2015, two patients who met the diagnostic criteria for refractory myoclonic status epilepticus, seen at our department, were placed on the ketogenic diet and followed for a minimum of six months. One patient with myoclonic epilepsy of unknown aetiology had a 75-90% seizure reduction, and the other with progressive encephalopathy associated with myoclonic epilepsy had a 50% seizure reduction. Both patients retained good tolerability for the diet. At the last control, one patient had isolated myoclonias and EEG showed occasional generalized spike-and-polyspike waves; the patient is now successfully attending kindergarten. The quality of life of the second patient improved significantly. In both cases, the number of antiepileptic drugs was reduced. The ketogenic diet is an effective and well-tolerated treatment option for patients with refractory myoclonic status epilepticus and should be considered earlier in the course of treatment.

  10. Adult nonconvulsive status epilepticus in a clinical setting: Semiology, aetiology, treatment and outcome.

    Science.gov (United States)

    Power, Kjersti Nesheim; Gramstad, Arne; Gilhus, Nils Erik; Engelsen, Bernt A

    2015-01-01

    Our objective was to study the semiology, aetiology, treatment and outcome of nonconvulsive status epilepticus (NCSE) in adults. All NCSE episodes in an unselected hospital cohort in the period 2004-2009 were identified, and the files reviewed. STESS (Status Epilepticus Severity Scale) was conducted retrospectively and correlated to outcome. Follow-up was undertaken after >2 years. 48 NCSEs in 39 patients, 22 men and 17 women, were found. Mean age was 63 years. 23/39 (59%) patients had established epilepsy. The underlying cause of NCSE was cerebrovascular disease in 17/39 (44%). 37/48 (77%) NCSEs were complex focal status epilepticus. 3/48 NCSEs (6.3%) lead to death, whereas 8.5% lead to severe sequelae. Cognitive sequelae were found after 14.9% of NCSEs. The outcome was worst in the group with no prior epilepsy (p=0.013). STESS had a negative predictive value of 96% (cut-off value of 3) for severe sequelae and death combined (p<0.002). NCSE has a potential for severe sequelae and represents an emergency in need of intensive treatment. The major determinant of outcome is the underlying cause. The outcome was worse in patients without epilepsy than in patients with epilepsy. STESS is of value in predicting outcome. Cognitive sequelae following NCSE can occur, but need further investigation with prospective, systematic studies. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  11. Klüver-Bucy Syndrome with Isolated Bilateral Hippocampal Atrophy Following Status Epilepticus

    Science.gov (United States)

    Park, Hong-Kyun; Kim, Kyeong-Joon; Moon, Hye-Jin; Kim, Seon-Jeong; Yun, Chang-Ho; Park, Seong-Ho

    2012-01-01

    Klüver-Bucy syndrome may result from affection of various location of brain. We report a case of Klüver-Bucy syndrome associated with isolated bilateral hippocampal atrophy without any abnormal lesion in other areas following status epilepticus. A 31-year-old man who had no significant medical history presented with status epilepticus after encephalitis of unknown etiology. He had been recovered from status epilepticus three weeks later, but afterwards he developed Klüver-Bucy syndrome: hyperphagia, hypersexuality, hypermetamorphosis, anterograde amnesia and dysosmia. Initial brain MRI showed T2 hyperintensity and swelling of isolated bilateral hippocampus, especially CA1 region without any abnormal lesion in other areas. One month later, follow-up brain MRI showed isolated bilateral hippocampal atrophy. This is a meaningful case report because this case differs from other reports of Klüver-Bucy syndrome in humans in that the anatomic abnormalities revealed by MRI were very selective. We report this case because this case is very educative for above reason. Moreover, this report would give us additional information of the relationship between human behavior and limbic system. PMID:24649454

  12. Management protocols for status epilepticus in the pediatric emergency room: systematic review article

    Directory of Open Access Journals (Sweden)

    Cheuk C. Au

    Full Text Available Abstract Objective: This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus. Sources: Systematic search of national or regional guidelines (January 2000 to February 2017 contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline. Summary of findings: 356 articles were retrieved and 13 were selected according to the inclusion criteria. In all six pre-hospital guidelines, the preferred route of medication administration was to use alternatives to the intravenous route: all recommended buccal and intranasal midazolam; three also recommended intramuscular midazolam, and five recommended using rectal diazepam. All 11 emergency department guidelines described three phases in therapy. Intravenous medication, by phase, was indicated as such: initial phase - ten/11 guidelines recommended lorazepam, and eight/11 recommended diazepam; second phase - most (ten/11 guidelines recommended phenytoin, but other options were phenobarbital (nine/11, valproic acid (six/11, and either fosphenytoin or levetiracetam (each four/11; third phase - four/11 guidelines included the choice of repeating second phase therapy, whereas the other guidelines recommended using a variety of intravenous anesthetic agents (thiopental, midazolam, propofol, and pentobarbital. Conclusions: All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery.

  13. Curcumin protects neuronal cells against status-epilepticus-induced hippocampal damage through induction of autophagy and inhibition of necroptosis.

    Science.gov (United States)

    Wang, Jin; Liu, Yuan; Li, Xiao-Hui; Zeng, Xiang-Chang; Li, Jian; Zhou, Jun; Xiao, Bo; Hu, Kai

    2017-05-01

    Status epilepticus, the most severe form of epilepsy, is characterized by progressive functional and structural damage in the hippocampus, ultimately leading to the development and clinical appearance of spontaneous, recurrent seizures. Although the pathogenesis underlying epileptogenesis processes remains unclear, a substantial body of evidence has shown that status epilepticus acts as an important initial factor in triggering epileptogenesis. Notably, besides classical cell death mechanisms such as apoptosis and necrosis, 2 novel regulators of cell fate known as necroptosis and autophagy, are demonstrated to be involved in neuronal damage in various neurodegenerative and neuropsychiatric disorders. However, whether necroptosis and autophagy play a role in post-status-epilepticus rat hippocampus and other epilepsy mechanisms deserves further research effort. In addition, research is needed to determine whether compounds from traditional Chinese herbs possess antiepileptic effects through the modulation of necroptosis and autophagy. In this study, we found that curcumin, a polyphenolic phytochemical extracted from the Curcuma longa plant, protects neuronal cells against status-epilepticus-induced hippocampal neuronal damage in the lithium-pilocarpine-induced status epilepticus rat model through induction of autophagy and inhibition of necroptosis.

  14. Efficacy and safety of intramuscular midazolam versus rectal diazepam in controlling status epilepticus in children.

    Science.gov (United States)

    Momen, Ali Akbar; Azizi Malamiri, Reza; Nikkhah, Ali; Jafari, Maryam; Fayezi, Abbas; Riahi, Kourosh; Maraghi, Elham

    2015-03-01

    The aim of this study was to evaluate the efficacy and safety of intramuscular midazolam in controlling convulsive status epilepticus in children, by comparing it with rectal diazepam. In this randomized trial, 100 children (50 in each group) with convulsive status epilepticus aged 1 month to 16 years were enrolled and randomly assigned into two groups to receive either 0.3 mg/kg intramuscular midazolam or 0.5 mg/kg rectal diazepam. Main outcome measure was stopping of all motor activity after drug administration. Another measures were times between patient's arrival to emergency department till drug administration, between drug administration to seizure cessation, and between patient's arrival to seizure cessation. Both medication were effective for seizure control and no significant difference was found between successful treatments after administering the medication (P = 0.061). In the midazolam group, in 96% (48/50) of cases treatment was successful and in the diazepam group, in 94% (47/50) of cases treatment was successful. Time from arrival to administering the medication was significantly shorter in midazolam group (P = 0.017). The majority of seizures in midazolam group were stopped in less than 66 s (median) compared to 130 s (median) for diazepam group, (P diazepam for controlling of status epilepticus in children. Midazolam via IM route could be one of the choices in children with convulsive status seizures who have difficult IV access. Copyright © 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  15. Management protocols for status epilepticus in the pediatric emergency room: systematic review article.

    Science.gov (United States)

    Au, Cheuk C; Branco, Ricardo G; Tasker, Robert C

    This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus. Systematic search of national or regional guidelines (January 2000 to February 2017) contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline. 356 articles were retrieved and 13 were selected according to the inclusion criteria. In all six pre-hospital guidelines, the preferred route of medication administration was to use alternatives to the intravenous route: all recommended buccal and intranasal midazolam; three also recommended intramuscular midazolam, and five recommended using rectal diazepam. All 11 emergency department guidelines described three phases in therapy. Intravenous medication, by phase, was indicated as such: initial phase - ten/11 guidelines recommended lorazepam, and eight/11 recommended diazepam; second phase - most (ten/11) guidelines recommended phenytoin, but other options were phenobarbital (nine/11), valproic acid (six/11), and either fosphenytoin or levetiracetam (each four/11); third phase - four/11 guidelines included the choice of repeating second phase therapy, whereas the other guidelines recommended using a variety of intravenous anesthetic agents (thiopental, midazolam, propofol, and pentobarbital). All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  16. The electroclinical spectrum, etiologies, treatment and outcome of nonconvulsive status epilepticus in the elderly.

    Science.gov (United States)

    Canas, Nuno; Delgado, Henrique; Silva, Vanessa; Pinto, Ana Rita; Sousa, Sandra; Simões, Rita; Inácio, Nuno; Vale, José

    2018-02-01

    Nonconvulsive status epilepticus (NCSE) in the elderly is particularly difficult to diagnose, mainly due to subtle clinical manifestations and associated comorbidities. The recently validated electroencephalography (EEG) diagnostic criteria for NCSE and the proposed operational classification of status epilepticus provide tools that can allow an earlier diagnosis and better management of NCSE in this age group, possibly contributing to reduce its high mortality. we used these tools to identify and characterize a cohort of elderly (>60year-old) patients admitted at our institution in a 3-year period; the video-EEG and clinical files of the patients fulfilling EEG diagnostic criteria for NCSE were reviewed, being in this study described their electroclinical spectrum, etiologies, treatment, inhospital mortality, and status epilepticus severity score (STESS). Fourty patients (23 women; mean age 76.6years) were identified. Although dyscognitive NCSE associated with >2.5Hz of epileptiform discharges (ED) was the most frequent electroclinical phenotype, this was quite heterogeneous, ranging from patients with aura continua to patients in coma, associated with frequent ED or rhythmic slow activities. Acute symptomatic (45%) and multifactorial (27.5%) etiologies were the most common, and associated with the worst prognosis. There was a trend to use newer antiepileptic drugs in the early steps of NCSE treatment. The inhospital mortality was high (22.5%) and predicted by STESS scores ≥3. In the elderly, NCSE has heterogeneous electroclinical phenotypes and etiologies. In spite of the treatment limitations conditioned by the comorbidities, more aggressive treatments could be justified to reduce mortality in patients with high STESS scores. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. The CNTF-derived peptide mimetic Cintrofin attenuates spatial-learning deficits in a rat post-status epilepticus model

    DEFF Research Database (Denmark)

    Russmann, Vera; Seeger, Natalie; Zellinger, Christina

    2013-01-01

    . Whereas status epilepticus caused a significant disturbance in spatial learning in reversed peptide-treated rats, the performance of Cintrofin-treated rats did not differ from controls. The study confirms that Cintrofin comprises an active sequence mimicking effects of its parent molecule. While the data......Ciliary neurotrophic growth factor is considered a potential therapeutic agent for central nervous system diseases. We report first in vivo data of the ciliary neurotrophic growth factor peptide mimetic Cintrofin in a rat post-status epilepticus model. Cintrofin prevented long-term alterations...... in the number of doublecortin-positive neuronal progenitor cells and attenuated the persistence of basal dendrites. In contrast, Cintrofin did neither affect acute status epilepticus-associated alterations in hippocampal cell proliferation and neurogenesis nor reveal any relevant effect on seizure activity...

  18. Does status epilepticus modify the effect of ifenprodil on cortical epileptic afterdischarges in immature rats?

    Czech Academy of Sciences Publication Activity Database

    Abbasova, Kenul; Kubová, Hana; Mareš, Pavel

    Roč. 70, č. 1 ( 2018 ), s. 126-132 ISSN 1734-1140 R&D Projects: GA ČR(CZ) GAP302/10/0971; GA ČR(CZ) GBP304/12/G069; GA ČR(CZ) GA15-16605S; GA MŠk(CZ) LC554; GA MŠk(CZ) LH15032 Institutional support: RVO:67985823 Keywords : status epilepticus * immature rats * ifenprodil * cortical stimulation * epileptic afterdischarges Subject RIV: FH - Neurology OBOR OECD: Neurosciences (including psychophysiology Impact factor: 2.587, year: 2016

  19. Nonconvulsive Status Epilepticus Complicating Epstein-Barr Virus Encephalitis in a Child

    Directory of Open Access Journals (Sweden)

    Filippo Greco

    2014-01-01

    Full Text Available Children with acute encephalopathy show prolonged electrographic seizure activity consistent with nonconvulsive status epilepticus (NCSE. Pediatric NCSE is a heterogeneous clinical entity with poor outcome and different etiologies, including central nervous system infection, stroke, toxic-metabolic syndrome, and epileptic syndrome. We report a 4-year-old girl with seizure and behavioral changes in whom the analysis of cerebrospinal fluid by polymerase chain reaction was positive for Epstein-Barr virus. We emphasize the importance of electroencephalography (EEG, and particularly, of continuous EEG monitoring for early recognition and appropriate treatment of this condition.

  20. A case of nonconvulsive status epilepticus presenting as ...

    African Journals Online (AJOL)

    The relationship between epilepsy and psychiatric disorders has generated interest since ancient times. In recent years, the recognition of psychiatric disorders has gained much importance in patients with epilepsy, and some psychiatric symptoms are found to be an expression of the seizure disorder.[1]. Traditionally, status ...

  1. Intranasal Midazolam versus Rectal Diazepam for the Management of Canine Status Epilepticus: A Multicenter Randomized Parallel-Group Clinical Trial.

    Science.gov (United States)

    Charalambous, M; Bhatti, S F M; Van Ham, L; Platt, S; Jeffery, N D; Tipold, A; Siedenburg, J; Volk, H A; Hasegawa, D; Gallucci, A; Gandini, G; Musteata, M; Ives, E; Vanhaesebrouck, A E

    2017-07-01

    Intranasal administration of benzodiazepines has shown superiority over rectal administration for terminating emergency epileptic seizures in human trials. No such clinical trials have been performed in dogs. To evaluate the clinical efficacy of intranasal midazolam (IN-MDZ), via a mucosal atomization device, as a first-line management option for canine status epilepticus and compare it to rectal administration of diazepam (R-DZP) for controlling status epilepticus before intravenous access is available. Client-owned dogs with idiopathic or structural epilepsy manifesting status epilepticus within a hospital environment were used. Dogs were randomly allocated to treatment with IN-MDZ (n = 20) or R-DZP (n = 15). Randomized parallel-group clinical trial. Seizure cessation time and adverse effects were recorded. For each dog, treatment was considered successful if the seizure ceased within 5 minutes and did not recur within 10 minutes after administration. The 95% confidence interval was used to detect the true population of dogs that were successfully treated. The Fisher's 2-tailed exact test was used to compare the 2 groups, and the results were considered statistically significant if P < .05. IN-MDZ and R-DZP terminated status epilepticus in 70% (14/20) and 20% (3/15) of cases, respectively (P = .0059). All dogs showed sedation and ataxia. IN-MDZ is a quick, safe and effective first-line medication for controlling status epilepticus in dogs and appears superior to R-DZP. IN-MDZ might be a valuable treatment option when intravenous access is not available and for treatment of status epilepticus in dogs at home. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  2. The ketogenic diet as broad-spectrum treatment for super-refractory pediatric status epilepticus: challenges in implementation in the pediatric and neonatal intensive care units.

    Science.gov (United States)

    Cobo, Nicole H; Sankar, Raman; Murata, Kristina K; Sewak, Sarika L; Kezele, Michele A; Matsumoto, Joyce H

    2015-02-01

    Refractory status epilepticus carries significant morbidity and mortality. Recent reports have promoted the use of the ketogenic diet as an effective treatment for refractory status epilepticus. We describe our recent experience with instituting the ketogenic diet for 4 critically ill children in refractory status epilepticus, ranging in age from 9 weeks to 13.5 years after failure of traditional treatment. The ketogenic diet allowed these patients to be weaned off continuous infusions of anesthetics without recurrence of status epilepticus, though delayed ketosis and persistently elevated glucose measurements posed special challenges to effective initiation, and none experienced complete seizure cessation. The ease of sustaining myocardial function with fatty acid energy substrates compares favorably over the myocardial toxicity posed by anesthetic doses of barbiturates and contributes to the safety profile of the ketogenic diet. The ketogenic diet can be implemented successfully and safely for the treatment of refractory status epilepticus in pediatric patients. © The Author(s) 2014.

  3. A national database of incidence and treatment outcomes of status epilepticus in Thailand.

    Science.gov (United States)

    Tiamkao, Somsak; Pranbul, Sineenard; Sawanyawisuth, Kittisak; Thepsuthammarat, Kaewjai

    2014-06-01

    Status epilepticus (SE) is a serious neurological condition. The national database of SE in Thailand and other developing countries is limited in terms of incidence and treatment outcomes. This study was conducted on the prevalence of status epilepticus (SE). The study group comprised of adult inpatients (over 18 years old) with SE throughout Thailand. SE patients were diagnosed and searched based on ICD 10 (G41) from the national database. The database used was from reimbursement documents submitted by the hospitals under the three health insurance systems, namely, the universal health coverage insurance, social security, and government health welfare system during the fiscal year 2010. We found 2190 SE patients receiving treatment at hospitals (5.10/100 000 population). The average age was 50.5 years and 1413 patients were males (64.5%). Mortality rate was 0.6 death/100 000 population or 11.96% of total patients. Significant factors associated with death or a nonimproved status at discharge were type of insurance, hospital level, chronic kidney disease, having pneumonia, having shock, on mechanical ventilator, and having cardiopulmonary resuscitation. In conclusion, the incidence of SE in Thailand was 5.10/100 000 population with mortality rate of 0.6/100 000 population.

  4. Enteral topiramate in a pediatric patient with refractory status epilepticus: a case report and review of the literature.

    Science.gov (United States)

    Shelton, Chasity M; Alford, Elizabeth L; Storgion, Stephanie; Wheless, James; Phelps, Stephanie J

    2014-01-01

    We describe the use of topiramate in a healthy 12-year-old (88-kg) male who developed refractory generalized convulsive status epilepticus. Seizures persisted despite aggressive use of benzodiazepines (intravenous lorazepam; oral clorazepate), barbiturates (i.e., phenobarbital, pentobarbital), and hydantoins. The child's seizures were controlled with nasogastrically administered topiramate in doses up to 500 mg twice daily (11.4 mg/kg/day). The patient did not display any clinical or laboratory signs of metabolic acidosis while receiving topiramate. Topiramate should be considered as a treatment option in refractory status epilepticus.

  5. Slow pseudoperiodic lateralized epileptiform discharges in nonconvulsive status epilepticus in a patient with cerebral palsy and a large central meningioma

    Directory of Open Access Journals (Sweden)

    Y.Z. Imam

    2014-01-01

    Full Text Available The presence of cerebral palsy and that of slow growing brain tumors are risk factors for convulsive and nonconvulsive status epilepticus. Nonconvulsive status epilepticus (NCSE needs electroencephalographic (EEG monitoring to be confirmed as it may be clinically subtle. Furthermore, it may present with a variety of ictal EEG morphologies. We report a case of a patient with cerebral palsy and a large central meningioma. Electroencephalogram showed a slow pattern of periodic lateralized epileptiform discharges (PLEDs (a pattern considered as being situated in the ictal–interictal continuum on an alpha background. The patient was treated for NCSE successfully with benzodiazepines followed by up-titration of his antiepileptic drug doses.

  6. Predictive value of the Status Epilepticus Severity Score (STESS) and its components for long-term survival

    DEFF Research Database (Denmark)

    Aukland, Preben; Lando, Martin; Vilholm, Ole

    2016-01-01

    BACKGROUND: The "Status Epilepticus Severity Score" (STESS) is the most important clinical score to predict in-hospital mortality of patients with status epilepticus (SE), but its prognostic relevance for long-term survival is unknown. This study therefore examined if STESS and its components...... retain their prognostic relevance beyond acute treatment. METHODS: One hundred twenty-five non-anoxic patients with SE were retrospectively identified in two hospitals between 2008 and 2014 (39.2 % refractory SE). Patients' treatment, demographic data, date of death, aetiology of SE, and the components...

  7. Latency to treatment of status epilepticus is associated with mortality and functional status.

    Science.gov (United States)

    Cheng, Jocelyn Y

    2016-11-15

    Status epilepticus (SE) is a life-threatening neurologic emergency. Despite advances in management, in-hospital mortality remains unchanged. This is partly due to the pharmacoresistance which develops the longer that seizures persist. Therefore, rapid antiseizure medication (ASM) administration may represent a beneficial treatment option. The purpose of this study was to determine: 1) whether in-hospital mortality is reduced with shorter latencies to initial treatment of SE with an ASM (LTSE); and 2) the critical time frame during which LTSE is associated with reduced in-hospital mortality. This was a retrospective, single-center study of adults diagnosed with SE between 1/1/2005 and 10/31/2012. Demographic characteristics included seizure history, etiology, semiology, and duration. Subjects were assigned to LTSE groups at the time frames of 5, 10, 30 and 60min. The primary outcome was in-hospital mortality, with poor functional status (mRS 3-6) as a secondary measure. Pearson's chi-square, Mann-Whitney-U, two-sample-t-tests, and binary logistic regression analysis were used as appropriate, with p30min demonstrated increased risk of mortality (OR 2.06, CI 1.01-4.17, p=0.046) and poor functional status (OR 2.48, CI 1.05-5.85, p=0.038) compared to LTSE≤30min. Increased mortality risk remained after adjusting for SE duration (OR 2.07, CI 1.01-4.26, p=0.047) and nonconvulsive seizures (OR 2.28, CI 1.08-4.80, p=0.03). Compared to subjects treated within 60min, those treated after 60min were at increased risk of poor functional status, regardless of the presence of nonconvulsive seizures (OR 2.96, CI 1.14-7.73, p=0.026). In addition, when acute symptomatic SE was stratified by cardiac versus non-cardiac etiologies, subjects with non-cardiac acute symptomatic SE demonstrated worse functional outcome when treated after 60min (OR 7.20, CI 1.13-46.07, p=0.037). Treatment of SE within 30min of onset is associated with reduced risk of in-hospital mortality and poor

  8. A Case Of Primary Central Nervous System Vasculitis Who Presented With Status Epilepticus

    Directory of Open Access Journals (Sweden)

    Sırma Geyik

    2014-12-01

    Full Text Available Primary central nervous system vasculitis (PCNV is limited with central nervous system and rare vasculitis that mostly seen in middle-aged men. PCNV vasculitis is usually presented that headache, dementia, stroke and multifocal common neurological symptoms. PCNV especially involves small medium-sized leptomeningeal and cortical arteries. 43 years old male patient who have been progressive forgetfulness and headache for 3 years. He applied with recurrent that before starting right focal and than sprawling whole body which generalized tonic-clonic seizures to us. During management that he was transfered to the intensive care unit due to status epilepticus (SE. Later than we found right hemiparesis, motor aphasia and right babinski positivity in neurologic examination. Diffusion restriction was revealed in left MCA territory in diffusion magnetic resonance imaging(MRI. EEG showed two types abnormality that a slow background ritm and epileptiform activity. Biochemistry of blood, complete blood count, blood sedimentation rate, CRP and markers of vasculitis were found in the normal range. Cerebral anjiography revealed that irregularities in the distal vascular areas and fusiform aneurysm at the top of basilar artery. He was consulted with rheumatology and diagnosed central nervous system vasculitis with the existing findings. Biopsy couldn't be taken from the brain to verify the diagnosis. Finally, we applied treatment that pulse steroid and cyclophosphamide to patient. This case has been presented due to emphasize that PCNV rarely may play a role in the etiology of recurrent stroke and status epilepticus.

  9. Glucose utilisation during status epilepticus in an epilepsy model induced by pilocarpine: a qualitative study

    Directory of Open Access Journals (Sweden)

    Scorza Fulvio Alexandre

    2002-01-01

    Full Text Available Status epilepticus (SE is a medical emergency and it is associated to brain damage. 2-deoxy-[14C] glucose (2-DG procedure has been used to measure the alterations in the functional activity of the brain induced by various pharmacological and toxicological agents. The aim of this study was to determine which changes occur in the seizure anatomic substrates during the SE induced by pilocarpine (PILO using [14C]-2 deoxyglucose functional mapping technique. Wistar male adult rats were submitted to SE PILO-induced for 6h and received [14C] 2-deoxyglucose injection via jugular vein 45 min before the 6th hour of SE. The control animals were submitted to all procedures but received saline and not pilocarpine. Brain sections were prepared and exposed X-ray film about seven days. The optical density of each region was obtained using a solid state digital analyser. The analysis revealed that 14C-2DG utilisation was pronounced in the SE rats on the areas corresponding to the hippocampal formation (+50.6%, caudate-putamen (+30.6%, frontoparietal cortex (+32.2%, amygdala (+31.7%, entorrinal cortex (+28.2%, thalamic nucleus (+93.5%, pre-tectal area (+50.1% and substantia nigra (+50.3% when compared to control. Our results suggest that the different activation levels of the distinct structures may be particularly important for understanding triggering and spreading mechanisms underlying epileptic activity during status epilepticus.

  10. Nonconvulsive status epilepticus and continuous spike and slow wave of sleep in children.

    Science.gov (United States)

    Akman, Cigdem Inan

    2010-09-01

    Nonconvulsive status epilepticus (NCSE) is a special epileptic state that can be more common than previously thought in children and adult patients. Currently, there is no universally accepted definition for NCSE. Early and accurate diagnosis depends on a high index of suspicion and rapid availability of electroencephalographic recording. The clinical presentation of NCSE can vary from a mild confusional state to a coma. The underlying etiology is also quite diverse. In critically ill patients, NCSE has been reported with convulsive status epilepticus (CSE), hypoxemia, acute ischemic or hemorrhagic stroke, encephalitis, or trauma. The estimated incidence of NCSE is 15% to 40% in post-CSE, 8% in subarachnoid hemorrhage, and 8% to 10% in coma. As seen in CSE, there is a bimodal distribution with NCSE in critically ill patients; children (age <1 year) and elderly appear to be at great risk. NCSE has also been reported in a number of epilepsy syndromes, such as childhood absence epilepsy, Panayiotopoulos syndrome, Lennox-Gastaut syndrome, and Dravet syndrome. However, it is difficult to determine the incidence of NCSE in an ambulatory setting because of the great variation in clinical presentation and underlying etiology. This review examines the clinical features, outcome, and treatment approach for NCSE in 2 different clinical settings, in ambulatory and critically ill patients. NCSE is reviewed in children and adults to distinguish similarities and differences in their clinical presentation. Copyright 2010 Elsevier Inc. All rights reserved.

  11. Analysis of factors influencing admission to intensive care following convulsive status epilepticus in children.

    LENUS (Irish Health Repository)

    Tirupathi, Sandya

    2012-02-01

    OBJECTIVES: To identify clinical features and therapeutic decisions that influence admission to the Intensive Care unit (ICU) in children presenting with convulsive status epilepticus (CSE). METHODS: We evaluated 47 admissions with status epilepticus to a tertiary paediatric hospital A&E over a three year period (2003-2006). Following initial management 23 episodes required admission to ICU and 24 were managed on a paediatric ward. We compared clinical, demographic data and compliance with our CSE protocol between the ICU and ward groups. RESULTS: Median age at presentation in the ICU group was 17 months (range 3 months-11 years) compared to 46 months in the ward group (range 3 months-10 years). Fifty per cent of patients in both groups had a previous history of seizures. Median duration of pre-hospital seizure activity was 30 min in both groups. More than two doses of benzodiazepines were given as first line medication in 62% of the ICU group and 33% of the ward group. Among children admitted to ICU with CSE, 26% had been managed according to the CSE protocol, compared to 66% of children who were admitted to a hospital ward. Febrile seizures were the most common aetiology in both groups. CONCLUSION: Younger age at presentation, administration of more than two doses of benzodiazepines and deviation from the CSE protocol appear to be factors which influence admission of children to ICU. Recognition of pre-hospital administration of benzodiazepines and adherence to therapeutic guidelines may reduce the need for ventilatory support in this group.

  12. Status Epilepticus due to Intraperitoneal Injection of Vehicle Containing Propylene Glycol in Sprague Dawley Rats

    Directory of Open Access Journals (Sweden)

    Evon S. Ereifej

    2017-01-01

    Full Text Available Published reports of status epilepticus due to intraperitoneal injection containing propylene glycol in rats are sparse. In fact, there are no reports specifying a maximum safe dose of propylene glycol through intraperitoneal administration. We report here a case of unexpected seizures in Sprague Dawley rats after receiving an intraperitoneal injection containing propylene glycol. Nine-week-old, 225–250 gram male rats were reported to experience tremor progressing to seizures within minutes after given injections of resveratrol (30 mg/kg dissolved in a 40 : 60 propylene glycol/corn oil vehicle solution by direct intraperitoneal (IP slow bolus injection or via a preplaced intraperitoneal catheter. The World Health Organization suggests a maximum dose of 25 mg/kg/day of propylene glycol taken orally and no more than 25 mg/dL in blood serum, whereas the animals used in our study got a calculated maximum 0.52 g/kg (25 times lower dose. Blood tests from the seizing rat support a diagnosis of hemolysis and lactic acidosis which may have led to the seizures, all of which appeared to be a consequence of the propylene glycol administration. These findings are consistent with oral and intravenous administration of propylene glycol toxicity as previously reported in other species, including humans. To our knowledge, this report represents the first published case of status epilepticus due to an IP injection containing propylene glycol.

  13. Status Epilepticus due to Intraperitoneal Injection of Vehicle Containing Propylene Glycol in Sprague Dawley Rats.

    Science.gov (United States)

    Ereifej, Evon S; Meade, Seth M; Smith, Cara S; Chen, Keying; Kleinman, Nanette; Capadona, Jeffrey R

    2017-01-01

    Published reports of status epilepticus due to intraperitoneal injection containing propylene glycol in rats are sparse. In fact, there are no reports specifying a maximum safe dose of propylene glycol through intraperitoneal administration. We report here a case of unexpected seizures in Sprague Dawley rats after receiving an intraperitoneal injection containing propylene glycol. Nine-week-old, 225-250 gram male rats were reported to experience tremor progressing to seizures within minutes after given injections of resveratrol (30 mg/kg) dissolved in a 40 : 60 propylene glycol/corn oil vehicle solution by direct intraperitoneal (IP) slow bolus injection or via a preplaced intraperitoneal catheter. The World Health Organization suggests a maximum dose of 25 mg/kg/day of propylene glycol taken orally and no more than 25 mg/dL in blood serum, whereas the animals used in our study got a calculated maximum 0.52 g/kg (25 times lower dose). Blood tests from the seizing rat support a diagnosis of hemolysis and lactic acidosis which may have led to the seizures, all of which appeared to be a consequence of the propylene glycol administration. These findings are consistent with oral and intravenous administration of propylene glycol toxicity as previously reported in other species, including humans. To our knowledge, this report represents the first published case of status epilepticus due to an IP injection containing propylene glycol.

  14. Rapidly progressive cognitive impairment with neuropsychiatric symptoms as the initial manifestation of status epilepticus

    Directory of Open Access Journals (Sweden)

    Jorge A. Mutis

    2017-01-01

    Full Text Available The purpose of this article is to describe the clinical and electroencephalographic features of patients diagnosed with non-convulsive status epilepticus (NCSE with uncommon cognitive and behavioral involvement. We present two cases with sub-acute cognitive impairment and neuropsychiatric disorders (including anxiety and transient behavioral changes as their first manifestation of NCSE. A neuropsychological profile demonstrated executive dysfunction. In addition, the neurological examination revealed automatisms and 24-hour video EEG showed epileptiform activity. Although neuroimaging studies showed frontotemporal abnormalities, both neurophysiological and cognitive improvement after specific antiseizure drug treatment confirmed the diagnosis of non-convulsive status. Theoretical considerations between mental status changes and focal epilepsy will be reviewed. Our cases raise awareness of the importance of considering NCSE, a treatable condition, in the differential diagnosis of rapidly-progressive cognitive impairment with neuropsychiatric symptoms.

  15. Effect of glycemic state in rats submitted to status epilepticus during development Efeito do estado glicêmico em ratos submetidos ao status epilepticus durante o desenvolvimento

    Directory of Open Access Journals (Sweden)

    Joselita F.C. Santiago

    2006-06-01

    Full Text Available The effect of glycemic state on status epilepticus (SE development was studied in animals of different ages, submitted to pilocarpine model of epilepsy. Groups: I- Rats with 9-day-old (P9: IA. Submitted to 1SE; IB. Saline-treated; IC. Induced- hyperglycemia; ID. Induced- hyperglycemia+SE; II- Rats submitted to three consecutive episodes of SE at P7, P8 and P9; III- Rats submitted to 1SE at P17; IV- Rats submitted to 1SE at P21. Hippocampal cell death and the expression of glucose transporter GLUT3 were analyzed in group I. The results demonstrated normoglycemia in the groups IA, IB and II, hypoglycemia in group III and hyperglycemia in group IV, showing that the glycemia during SE is age dependent. Induced hyperglycemia during SE in P9 protected the hippocampal neurons from death and both groups IC and ID presented increased GLUT3 expression, showing high glucose consumption by the hippocampus.O efeito do estado glicêmico sobre o desenvolvimento do status epilepticus (SE foi estudado em animais de diferentes idades, submetidos ao modelo de epilepsia por pilocarpina. Grupos: I- Ratos com nove dias (P9: IA- Submetidos a 1SE; IB- Tratados com salina; IC- Hiperglicemia induzida; ID- Hiperglicemia induzida+SE; II- Ratos submetidos a 3 episódios consecutivos de SE em P7, P8 e P9; III- Ratos submetidos a 1SE em P17; IV- Ratos submetidos a 1SE em P21. Foram analisados no grupo I a morte celular hipocampal e a expressão do transportador de glicose GLUT3. Os resultados mostraram haver normoglicemia nos grupos IA, IB e II, hipoglicemia no grupo III e hiperglicemia no grupo IV, sendo a glicemia durante o SE, idade dependente. A hiperglicemia induzida durante o SE em P9 protegeu neurônios hipocampais e os grupos IC e ID apresentaram expressão aumentada de GLUT3, mostrando aumento no consumo de glicose pelo hipocampo.

  16. A Comparison of Midazolam, Lorazepam, and Diazepam for the Treatment of Status Epilepticus in Children: A Network Meta-analysis.

    Science.gov (United States)

    Zhao, Zi-Yu; Wang, Hong-Ying; Wen, Bin; Yang, Zhi-Bo; Feng, Kang; Fan, Jing-Chun

    2016-08-01

    Midazolam, lorazepam, and diazepam were recommended as emergent initial therapy for status epilepticus. However, there are no current studies to confirm the best agent for pediatric status epilepticus. We compared the efficacy of midazolam, lorazepam, and diazepam in treating pediatric status epilepticus using a network meta-analysis method. In total, 16 randomized controlled trials containing 1821 patients were included. Nonintravenous midazolam, intravenous lorazepam, and intravenous diazepam were more successful in achieving seizure cessation when compared with nonintravenous diazepam (odds ratio = 2.23, 95% credibility interval: 1.62, 3.10; odds ratio = 2.71, 95% credibility interval: 1.25, 5.89; odds ratio = 2.65, 95% credibility interval: 1.12, 6.29; respectively). Among lorazepam, midazolam, and diazepam, midazolam had the highest probability (surface under the cumulative ranking area [SUCRA] = 0.792) of achieving seizure cessation, and lorazepam had the largest probability (surface under the cumulative ranking area = 0.4346) of being the best treatment in reduction of respiratory depression. In conclusion, nonintravenous midazolam and intravenous lorazepam were superior to intravenous or nonintravenous diazepam, and intravenous lorazepam was at least as effective as nonintravenous midazolam in treating pediatric status epilepticus. © The Author(s) 2016.

  17. Impact of the NCAM derived mimetic peptide plannexin on the acute cellular consequences of a status epilepticus

    DEFF Research Database (Denmark)

    Zellinger, Christina; Hadamitzky, Martin; Bock, Elisabeth

    2011-01-01

    Plannexin represents a NCAM-derived peptide mimicking trans-homophilic NCAM interaction, which proved to exert neuroprotective effects in vitro. The effect of plannexin was evaluated in a rat status epilepticus model. As expected, prolonged seizure activity resulted in a pronounced cell loss in h...

  18. Effect of diet with omega-3 in basal brain electrical activity and during status epilepticus in rats.

    Science.gov (United States)

    Pessoa, Daniella Tavares; da Silva, Eva Luana Almeida; Costa, Edbhergue Ventura Lola; Nogueira, Romildo Albuquerque

    2017-11-01

    Western diets are high in saturated fat and low in omega-3. Certain animals cannot produce omega-3 from their own lipids, making it necessary for it to be acquired from the diet. However, omega-3s are important components of the plasma membrane, and altering their proportions can promote physical and chemical alterations in the membranes, which may modify neuronal excitability. These alterations occur in healthy individuals, as well as in patients with epilepsy who are more sensitive to changes in brain electrical activity. This study evaluated the effect of a diet supplemented with omega-3 on the basal brain electrical activity both before and during status epilepticus in rats. To evaluate the brain electrical activity, we recorded electrocorticograms (ECoG) of animals both with and without omega-3 supplementation before and during status epilepticus induced by pilocarpine. Calculation of the average brain wave power by a power spectrum revealed that omega-3 supplementation reduced the average power of the delta wave by 20% and increased the average power of the beta wave by 45%. These effects were exacerbated when status epilepticus was induced in the animals supplemented with omega-3. The animals with and without omega-3 supplementation exhibited increases in basal brain electrical activities during status epilepticus. The two groups showed hyperactivity, but no significant difference between them was noted. Even though the brain activity levels observed during status epilepticus were similar between the two groups, neuron damage to the animals supplemented with omega-3 was more slight, revealing the neuroprotective effect of the omega-3. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Transcriptional response of polycomb group genes to status epilepticus in mice is modified by prior exposure to epileptic preconditioning

    Directory of Open Access Journals (Sweden)

    James eReynolds

    2015-03-01

    Full Text Available Exposure of the brain to brief, non-harmful seizures can activate protective mechanisms that temporarily generate a damage-refractory state. This process, termed epileptic tolerance, is associated with large-scale down-regulation of gene expression. Polycomb group proteins are master controllers of gene silencing during development that are re-activated by injury to the brain. Here we explored the transcriptional response of genes associated with polycomb repressor complex (PRC 1 (Ring1A and Ring1B and Bmi1 and PRC2 (Ezh1, Ezh2 and Suz12, as well as additional transcriptional regulators Sirt1, Yy1 and Yy2, in a mouse model of status epilepticus. Findings were contrasted to changes after status epilepticus in mice previously given brief seizures to evoke tolerance. Real-time quantitative PCR showed status epilepticus prompted an early (1 h increase in expression of several genes in PRC1 and PRC2 in the hippocampus, followed by down-regulation of many of the same genes at later times points (4 , 8 and 24 h. Spatio-temporal differences were found among PRC2 genes in epileptic tolerance, including increased expression of Ezh2, Suz12 and Yy2 relative to the normal injury response to status epilepticus. In contrast, PRC1 complex genes including Ring 1B and Bmi1 displayed differential down-regulation in epileptic tolerance. The present study characterizes polycomb group gene expression following status epilepticus and shows prior seizure exposure produces select changes to PRC1 and PRC2 composition that may influence differential gene expression in epileptic tolerance.

  20. Nonconvulsive status epilepticus associated with periodic lateralized epileptiform discharges in a patient with syphilis

    Directory of Open Access Journals (Sweden)

    Xin Yu

    2016-09-01

    Full Text Available Nonconvulsive status epilepticus (NCSE has been increasingly recognized as a cause of impaired level of consciousness in the ICU and emergency rooms. The confirmation of NCSE is largely based on the EEG, given the nonspecific and pleomorphic clinical manifestations. Debate remains over electroencephalograms (EEG criteria for NCSE. Periodic lateralized epileptiform discharges (PLEDs, have sparked controversy with regard to being part of the ictal vs. interictal spectrum. We report a case of a patient with syphilis who had cognitive decline and damaged consciousness with PLEDs and T2 hyperintensity at temporal and occipital lobe in MRI. After antiepileptic treatment only, his consciousness improved markedly together with the EEG in few days, while the change of MRI was still serious. In this case PLEDs is the sign of NCSE and change of MRI is limbic encephalitis (LE. This report discusses the association of PLEDs and NCSE, and supports the concept of PLEDs as an ictal pattern in some condition.

  1. A Case of Tyrosinemia Type III with Status Epilepticus and Mental Retardation.

    Science.gov (United States)

    Najafi, Reza; Mostofizadeh, Neda; Hashemipour, Mahin

    2018-01-01

    Tyrosinemia type III is an autosomal recessive disorder caused by the deficiency of 4- hydroxyphenylpyruvate dioxygenase (4-HPPD). It is characterized by elevated levels of blood tyrosine and massive excretion of its derivatives into the urine. Clinical findings of tyrosinemia type III include neurological symptoms and mental retardation. Only a few patients presenting with this disease have been described, and the clinical phenotype remains variable and unclear. We present a case, who was admitted to the hospital at the age of 4 months for recurrent seizures. Two months later, she was admitted again with status epilepticus. Laboratory data showed increased level of tyrosine in the blood. She was treated with a diet low in tyrosine and phenylalanine and anamix formula that leading to catch-up growth and improvement of her symptoms. Plasma tyrosine level dropped to normal values. In any child who presents with the neurologic symptom, some rare diagnosis like tyrosinemia type III should be considered.

  2. Remission of encephalopathy with status epilepticus (ESES) during sleep renormalizes regulation of slow wave sleep

    DEFF Research Database (Denmark)

    Bölsterli, Bigna K.; Gardella, Elena; Pavlidis, Elena

    2017-01-01

    Objective: In previous studies, we showed an altered overnight decrease of non–rapid-eye-movement (NREM) sleep slow waves in children with encephalopathy related to status epilepticus during sleep (ESES). Here, we test the hypothesis that these alterations renormalize after remission of ESES...... with idiopathic ESES. Automated slow wave detection and calculation of slope of slow waves during the first and last hour of NREM sleep were employed. Intraindividual comparisons were undertaken of the slope during active phase and after remission of ESES, and between patients after remission of ESES and healthy...... evidence that alterations of overnight changes of NREM-sleep slow waves during active ESES are reversible when ESES resolves, and that the severity of neuropsychological compromise might be related to the extent of slow wave impairment during ESES. Our findings suggest that analysis of slow waves might...

  3. Newer Antiepileptic Drugs for Status Epilepticus in Adults: What's the Evidence?

    Science.gov (United States)

    Beuchat, Isabelle; Novy, Jan; Rossetti, Andrea O

    2018-03-01

    Status epilepticus (SE) is one of the most frequent neurological emergencies. Despite this, understanding of its pathophysiology and evidence regarding its management is limited. Rapid, effective, and well-tolerated treatment to achieve seizure cessation is advocated to prevent brain damage or potentially lethal outcomes. The last two decades have witnessed an exponential increase in the number of available antiepileptic drugs (AEDs). These compounds, especially lacosamide and levetiracetam, in view of their intravenous formulation, have been increasingly prescribed in SE. These and other newer AEDs present a promising profile in terms of tolerability, with few centrally depressive effects, favorable pharmacokinetic properties, and fewer drug interactions than classical AEDs; conversely, they are more expensive. There is still no clear evidence to suggest a specific beneficial impact of newer AEDs on SE outcome, preventing any strong recommendation regarding their prescription in SE. Further comparative studies are urgently required to clarify their place and optimal use in the armamentarium of SE treatment.

  4. Impact of the erythropoietin-derived peptide mimetic Epotris on the histopathological consequences of status epilepticus

    DEFF Research Database (Denmark)

    Zellinger, Christina; Seeger, Natalie; Hadamitzky, Martin

    2011-01-01

    The design of peptide mimetics offers interesting opportunities to selectively include beneficial and exclude undesirable effects of a parent molecule. Epotris represents a novel erythropoietin mimetic, which lacks an erythropoietic activity. The present study evaluates the potential of this pept......The design of peptide mimetics offers interesting opportunities to selectively include beneficial and exclude undesirable effects of a parent molecule. Epotris represents a novel erythropoietin mimetic, which lacks an erythropoietic activity. The present study evaluates the potential...... exert limited in vivo effects on the cellular consequences of prolonged seizure activity. When considering further testing it should be taken in mind that Epotris administration only attenuated selected cellular consequences of status epilepticus and did not completely prevent cellular alterations....

  5. Short-term mortality and prognostic factors related to status epilepticus

    Directory of Open Access Journals (Sweden)

    Fernando Gustavo Stelzer

    2015-08-01

    Full Text Available Objective Status epilepticus (SE is associated with significant morbidity and mortality, and there is some controversy concerning predictive indicators of outcome. Our main goal was to determine mortality and to identify factors associated with SE prognosis. Method This prospective study in a tertiary-care university hospital, included 105 patients with epileptic seizures lasting more than 30 minutes. Mortality was defined as death during hospital admission. Results The case-fatality rate was 36.2%, which was higher than in previous studies. In univariate analysis, mortality was associated with age, previous epilepsy, complex focal seizures; etiology, recurrence, and refractoriness of SE; clinical complications, and focal SE. In multivariate analysis, mortality was associated only with presence of clinical complications. Conclusions Mortality associated with SE was higher than reported in previous studies, and was not related to age, specific etiology, or SE duration. In multivariate analysis, mortality was independently related to occurrence of medical complications.

  6. Opercular myoclonic-anarthric status epilepticus: A report of two cases

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    Janapareddy Vijaya Bhaskara Rao

    2013-01-01

    Full Text Available Opercular myoclonic-anarthric status epilepticus (OMASE is an uncommon disorder of diverse etiology. This condition is characterized by fluctuating cortical dysarthria associated with epileptic myoclonus involving glossopharyngeal musculature bilaterally. We report two cases of OMASE of vascular etiology in adults. In both patients, ictally clonic expression was consistent with epilepsia partialis continua and bilateral, symmetrical involvement of soft palate in one patient and tongue, lips, chin and inferior jaw in both patients due to bilateral projections of the inferior corticonuclear pathways. The inferior rolandic area of dominant and high frontal region in non-dominant hemispheres were involved by an epileptogenic lesion of vascular etiology, which was confirmed by magnetic resonance imaging of brain and single photon emission computerized tomography. Carotid Doppler study showed thrombosis of internal carotid artery in both patients, suggestive of an embolic origin. Early recognition of OMASE is important for early management of carotid occlusive disease.

  7. Infodemiology of status epilepticus: A systematic validation of the Google Trends-based search queries.

    Science.gov (United States)

    Bragazzi, Nicola Luigi; Bacigaluppi, Susanna; Robba, Chiara; Nardone, Raffaele; Trinka, Eugen; Brigo, Francesco

    2016-02-01

    People increasingly use Google looking for health-related information. We previously demonstrated that in English-speaking countries most people use this search engine to obtain information on status epilepticus (SE) definition, types/subtypes, and treatment. Now, we aimed at providing a quantitative analysis of SE-related web queries. This analysis represents an advancement, with respect to what was already previously discussed, in that the Google Trends (GT) algorithm has been further refined and correlational analyses have been carried out to validate the GT-based query volumes. Google Trends-based SE-related query volumes were well correlated with information concerning causes and pharmacological and nonpharmacological treatments. Google Trends can provide both researchers and clinicians with data on realities and contexts that are generally overlooked and underexplored by classic epidemiology. In this way, GT can foster new epidemiological studies in the field and can complement traditional epidemiological tools. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Epilepsy with electrical status epilepticus during slow-wave sleep with a focus on electroencephalographic criteria

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    K. Yu. Mukhin

    2017-01-01

    Full Text Available The authors present a detailed literature review, devoted to epilepsy with electrical status epilepticus during slow-wave sleep (ESES, as well as own data. The issues of classification, etiology, ESES diagnostic criteria, aproaches to therapy and prognosis are discussed in the article. Authors pay particular attention to the description of electroencephalographic abnormalities in patients with ESES including changes in electroencephalogram (EEG during seizures and in the intetictal period (first of all during sleep. EEG during sleep is crucial in case of ESES, it is necessary for diagnosis. 20 % of the patients have no epileptic seizures; the diagnosis is based on the EEG results and neuropsychological testing. Continuous spike-and- wave epileptiform activity on EEG during slow-wave sleep is a compulsory diagnostic criterion for ESES. This activity defines the clinical spectrum of cognitive and behavioral discorders in patients with this disease.

  9. Analysis on the factors associated with treatment failure of using anesthetics in refractory status epilepticus

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    Ying-ying SU

    2015-11-01

    Full Text Available Objective To analyze the related factors associated with immediate treatment failure of using anesthetics in refractory status epilepticus (RSE.  Methods Thirty patients derived from Neurocritical Care Unit of Xuanwu Hospital from January 2004 to December 2013 were divided into 2 groups (acute treatment failure group and acute treatment success group based on the treatment outcome 6 h after intravenous injection of anesthetics. Univariate and multivariate forward Logistic regression analyses were used to analyze and screen the risk factors associated with immediate treatment failure, and calculate the failure rate of final outcome.  Results According to the results of univariate and multivariate Logistic regression analyses, among influencing factors such as sex, age, etiology, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ, type of status epilepticus (SE, type of antiepileptic drugs (AEDs, total duration of primary treatment, duration of prehospital primary treatment, duration of posthospital primary treatment, type of RSE and primary choice of anesthetics, only total duration of primary treatment was the independent risk factor for immediate treatment failure (OR = 1.007, 95%CI: 1.000-1.014; P = 0.047. The rate of immediate treatment failure of RSE by using anesthetics was 50% (15/30, and the rate of final treatment failure was 43.33% (13/30. The ratio of final treatment failure was much higher in acute treatment failure group than that in acute treatment success group (10/15 vs 3/15, P = 0.025.  Conclusions The acute treatment result of RSE depends on the total duration of primary treatment, and determinates the final result of treatment. On the basis of treating primary disease, the therapy to terminate SE or RSE should be started as early as possible. DOI: 10.3969/j.issn.1672-6731.2015.11.008

  10. Which component of treatment is important for changes of cortical epileptic afterdischarges after status epilepticus in immature rats?

    Czech Academy of Sciences Publication Activity Database

    Tsenov, Grygoriy; Kubová, Hana; Mareš, Pavel

    2017-01-01

    Roč. 644, Mar 22 (2017), s. 1-4 ISSN 0304-3940 R&D Projects: GA ČR(CZ) GBP304/12/G069; GA ČR(CZ) GAP302/10/0971; GA ČR(CZ) GA15-16605S Institutional support: RVO:67985823 Keywords : status epilepticus * immature rats * pilocarpine * lithium chloride * paraldehyde * cortical epileptic afterdischarges Subject RIV: FH - Neurology OBOR OECD: Neuroscience s (including psychophysiology Impact factor: 2.180, year: 2016

  11. Enteral Topiramate in a Pediatric Patient with Refractory Status Epilepticus: A Case Report and Review of the Literature

    OpenAIRE

    Shelton, Chasity M.; Alford, Elizabeth L.; Storgion, Stephanie; Wheless, James; Phelps, Stephanie J.

    2014-01-01

    We describe the use of topiramate in a healthy 12-year-old (88-kg) male who developed refractory generalized convulsive status epilepticus. Seizures persisted despite aggressive use of benzodiazepines (intravenous lorazepam; oral clorazepate), barbiturates (i.e., phenobarbital, pentobarbital), and hydantoins. The child's seizures were controlled with nasogastrically administered topiramate in doses up to 500 mg twice daily (11.4 mg/kg/day). The patient did not display any clinical or laborato...

  12. Long-term changes of activity of cortical neurons after status epilepticus induced at early developmental stages in rats

    Czech Academy of Sciences Publication Activity Database

    Doczi, J.; Bernášková, Klára; Kubová, Hana; Détari, L.; Világi, I.; Druga, Rastislav; Mareš, Pavel

    2003-01-01

    Roč. 352, č. 2 (2003), s. 125-128 ISSN 0304-3940 R&D Projects: GA ČR GA309/00/1643; GA ČR GA309/03/0770 Institutional research plan: CEZ:AV0Z5011922 Keywords : cerebral cortex * unit activity * consequences of status epilepticus Subject RIV: FH - Neurology Impact factor: 1.967, year: 2003

  13. Free radical scavenger, N-tert-butyl-alfa-phenylnitrone, affects long-term outcome of status epilepticus in immature rats

    Czech Academy of Sciences Publication Activity Database

    Kubová, Hana; Rejchrtová, Jana; Folbergrová, Jaroslava; Mareš, Pavel

    2005-01-01

    Roč. 46, č. S8 (2005), s. 111-112 [Joint Annual Meeting of the American Epilepsy Society and American Clinical Neurophysiology Society. 02.12.2005-06.12.2005, Washington, DC] R&D Projects: GA ČR(CZ) GA304/05/2582 Institutional research plan: CEZ:AV0Z50110509 Keywords : status epilepticus * PBN * rat Subject RIV: ED - Physiology

  14. Nonconvulsive status epilepticus in the elderly associated with newer antidepressants used at therapeutic doses: A report of three cases

    OpenAIRE

    Go Taniguchi; Miho Miyajima; Masako Watanabe; Yoshiko Murata; Daichi Sone; Yutaka Watanabe; Mitsutoshi Okazaki; Motonori Kobayashi-Kimura; Masaaki Kato; Teiichi Onuma

    2015-01-01

    Classic antidepressants have been known to induce convulsive seizures and nonconvulsive status epilepticus (NCSE). On the other hand, many reports have emphasized the safety of novel antidepressants. However, we encountered three cases of NCSE in the elderly associated with the use of newer antidepressants at therapeutic doses. All three patients were male and were 73?years of age or older. One patient was recently diagnosed with temporal lobe epilepsy and treated with low-dose lamotrigine. I...

  15. New Onset Refractory Status Epilepticus in a Young Man with H1N1 Infection

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    Faisal Ibrahim

    2014-01-01

    Full Text Available Objective. To report a case of refractory status epilepticus (SE as an unusual early manifestation of H1N1 influenza infection. Introduction. H1N1 neurological complications have been reported and consist mainly of seizures or encephalopathy occurring in children. However, we only found a single report of an adult developing complex partial SE with H1N1 infection. Case Report. A 21-year-old previously healthy man was brought to the emergency room (ER after a witnessed generalized tonic clonic seizure (GTCS. He was fully alert and afebrile upon ER arrival, but a second GTCS prompted treatment with Lorazepam and Fosphenytoin. The initial EEG showed diffuse slowing, but a repeat one requested as the patient failed to regain consciousness revealed recurrent focal seizures of independent bihemispheric origin, fulfilling the criteria for nonconvulsive SE. Chest X-ray, followed by chest CT scan, showed a left upper lobe consolidation. H1N1 infection was confirmed with PCR on bronchoalveolar lavage material. Despite aggressive treatment with Midazolam, Propofol, and multiple high dose antiepileptic drugs, the electrographic seizures recurred at every attempt to reduce the intravenous sedative drugs. The patient died two weeks after his initial presentation. Conclusion. H1N1 should be added to the list of rare causes of refractory SE, regardless of the patient’s age.

  16. [Use of benzodiazepines in prolonged seizures and status epilepticus in the community].

    Science.gov (United States)

    Sánchez-Carpintero, R; Camino, R; Smeyers, P; Raspall-Chaure, M; Martínez-Bermejo, A; Ruiz-Falcó, M L; Verdú, A; Sanmarti, F X; Blanco, O; Santos Borbujo, J; Picó, G; Cebollero, M A

    2014-12-01

    Prolonged seizures and status epilepticus are common neurological medical emergencies. Early and appropriate treatment is essential to reduce morbidity and mortality. Most seizures occur in the community, so parents and caregivers must be prepared for their management. Benzodiazepines (BZD) are the first-line drugs used, with rectal diazepam (DZPr) being the most commonly used in pre-hospital treatment in Spain. In September 2011, the European Medicines Agency (EMA) authorized the use of oromucosal midazolam (MDZb) for the treatment of prolonged acute convulsive seizures in patients aged 3 months to <18 years. MDZb has a rapid onset, short duration of effect, and avoids first-pass hepatic metabolism. MDZb has shown to be at least as or more effective than DZPr to stop the seizures. Buccal administration is easier and more socially accepted, especially in adolescents and adults. It is a safe drug with similar effects to other BZD; MDZb improves the overall cost-effectiveness of seizures management. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  17. A combination of ketamine and diazepam synergistically controls refractory status epilepticus induced by cholinergic stimulation

    Science.gov (United States)

    Martin, Brandon S.; Kapur, Jaideep

    2010-01-01

    SUMMARY Purpose New treatments are needed for status epilepticus (SE) that is refractory to drugs modulating GABAA receptors, and NMDA receptor antagonists are candidate drugs. Methods Clinically available NMDA receptor antagonist ketamine was tested for effectiveness in terminating prolonged SE induced by a combination of lithium and pilocarpine. Animals were treated 10 min after first grade 5 behavioral seizure (Racine scoring scale) by intraperitoneal administration of ketamine, diazepam, or saline. Seizure termination was determined by electroencephalogram (EEG) recordings from the hippocampus and the cortex. Results Animals treated with normal saline or either 20 mg/kg diazepam, or 50 mg/kg ketamine continued in SE for the next 300 min. However, combined treatment with diazepam and ketamine rapidly terminated prolonged cholinergic stimulation-induced SE. Detailed study of dose response relationships demonstrated that diazepam enhanced efficacy and potency of ketamine in terminating SE. Discussion This study demonstrated synergistic action of diazepam and ketamine in terminating SE. It suggests that a ketamine–diazepam combination might be a clinically useful therapeutic option for the treatment of refractory SE. PMID:17941842

  18. Lorazepam or diazepam for convulsive status epilepticus: A meta-analysis.

    Science.gov (United States)

    Wu, Wei; Zhang, Liqun; Xue, Rong

    2016-07-01

    Convulsive status epilepticus (CSE) is a neurological emergency in adults and children. However, whether a particular benzodiazepine is of superior efficacy and safety in management of CSE is controversial. We performed a meta-analysis to compare the outcome of lorazepam and diazepam for treating CSE. We searched the PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases from 1966 to February 2014. No language restriction was applied. Reference lists of all the selected articles were hand-searched for any additional trials. Trial quality was assessed using the modified Jadad scale and the Consolidated Standards Of Reporting Trials (CONSORT) checklist. Two authors independently extracted data from all eligible studies, including study design, participants, interventions, and outcomes. The data was analyzed using fixed-effects or random-effects models with mean differences and risk ratios for continuous and dichotomous variables, respectively. A total of six studies involving 970 patients were included in this analysis. The majority of patients were children (n=574) and 396 patients were adults. Meta-analysis showed no significant difference between the two treatment groups regarding seizure control and adverse effects regardless of patient age. This meta-analysis demonstrates that diazepam and lorazepam have equal efficacy and side effects for treating CSE in adults and children, and either can be chosen as a reasonable first-line therapy. More high quality randomized controlled trials are needed to support this finding. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Creutzfeldt-Jakob Disease Presenting as Expressive Aphasia and Nonconvulsive Status Epilepticus

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    Hafiz B. Mahboob

    2018-01-01

    Full Text Available Creutzfeldt-Jakob disease (CJD, the most common form of human prion diseases, is a fatal condition with a mortality rate reaching 85% within one year of clinical presentation. CJD is characterized by rapidly progressive neurological deterioration in combination with typical electroencephalography (EEG and magnetic resonance imaging (MRI findings and positive cerebrospinal spinal fluid (CSF analysis for 14-3-3 proteins. Unfortunately, CJD can have atypical clinical and radiological presentation in approximately 10% of cases, thus making the diagnosis often challenging. We report a rare clinical presentation of sporadic CJD (sCJD with combination of both expressive aphasia and nonconvulsive status epilepticus. This patient presented with slurred speech, confusion, myoclonus, headaches, and vertigo and succumbed to his disease within ten weeks of initial onset of his symptoms. He had a normal initial diagnostic workup, but subsequent workup initiated due to persistent clinical deterioration revealed CJD with typical MRI, EEG, and CSF findings. Other causes of rapidly progressive dementia and encephalopathy were ruled out. Though a rare condition, we recommend consideration of CJD on patients with expressive aphasia, progressive unexplained neurocognitive decline, and refractory epileptiform activity seen on EEG. Frequent reimaging (MRI, video EEGs and CSF examination might help diagnose this fatal condition earlier.

  20. Mechanisms of levetiracetam in the control of status epilepticus and epilepsy

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    Laxmikant S Deshpande

    2014-01-01

    Full Text Available Status epilepticus (SE is a major clinical emergency that is associated with high mortality and morbidity. SE causes significant neuronal injury and survivors are at a greater risk of developing acquired epilepsy and other neurological morbidities, including depression and cognitive deficits. Benzodiazepines and some anticonvulsant agents are drugs of choice for initial SE management. Despite their effectiveness, over 40% of SE cases are refractory to the initial treatment with two or more medications. Thus there is an unmet need of developing newer anti-SE drugs. Levetiracetam (LEV is a widely prescribed anti-epileptic drug that has been reported to be used in SE cases, especially in benzodiazepine-resistant SE or where phenytoin cannot be used due to allergic side-effects. Levetiracetam’s non-classical antiepileptic mechanisms of action, favorable pharmacokinetic profile, general lack of central depressant effects and lower incidence of drug interactions contributes to its use in SE management. This review will focus on LEV’s unique mechanism of action that makes it a viable candidate for SE treatment.

  1. Topography of generalized periodic epileptiform discharges in postanoxic nonconvulsive status epilepticus.

    Science.gov (United States)

    Sakellariou, Dimitris Fotis; Kostopoulos, George Kostantinos; Richardson, Mark Philip; Koutroumanidis, Michalis

    2017-12-01

    We studied slow (≤2.5 Hz) nonevolving generalized periodic epileptiform discharges (GPEDs) in the electroencephalogram (EEG) of comatose patients after cardiac arrest (CA) in search of evidence that could assist early diagnosis of possible hypoxic nonconvulsive status epilepticus (NCSE) and its differentiation from terminal brain anoxia (BA), which can present with a similar EEG pattern. We investigated the topography of the GPEDs in the first post-CA EEGs of 13 patients, using voltage-mapping, and compared findings between two patients with NCSE and GPEDs > 2.5 Hz (group 1), and 11 with GPEDs ≤ 2 Hz, of whom six had possible NCSE (group 2) and five had terminal BA (group 3). Voltage mapping showed frontal maximum for the negative phase of the GPEDs in all patients of groups 1 and 2, but not in any of the patients of group 3, who invariably showed maximization of the negative phase posteriorly. Morphology, amplitude, and duration of the GPEDs varied across the groups, without distinctive features for possible NCSE. These findings provide evidence that, in hypoxic coma after CA with slow GPEDs, anterior topography of the maximum GPED negativity on voltage mapping may be a distinctive biomarker for possible NCSE contributing to the coma.

  2. Prospects of Cannabidiol for Easing Status Epilepticus-Induced Epileptogenesis and Related Comorbidities.

    Science.gov (United States)

    Upadhya, Dinesh; Castro, Olagide W; Upadhya, Raghavendra; Shetty, Ashok K

    2018-01-25

    The hippocampus is one of the most susceptible regions in the brain to be distraught with status epilepticus (SE) induced injury. SE can occur from numerous causes and is more frequent in children and the elderly population. Administration of a combination of antiepileptic drugs can abolish acute seizures in most instances of SE but cannot prevent the morbidity typically seen in survivors of SE such as cognitive and mood impairments and spontaneous recurrent seizures. This is primarily due to the inefficiency of antiepileptic drugs to modify the evolution of SE-induced initial precipitating injury into a series of epileptogenic changes followed by a state of chronic epilepsy. Chronic epilepsy is typified by spontaneous recurrent seizures, cognitive dysfunction, and depression, which are associated with persistent inflammation, significantly waned neurogenesis, and abnormal synaptic reorganization. Thus, alternative approaches that are efficient not only for curtailing SE-induced initial brain injury, neuroinflammation, aberrant neurogenesis, and abnormal synaptic reorganization but also for thwarting or restraining the progression of SE into a chronic epileptic state are needed. In this review, we confer the promise of cannabidiol, an active ingredient of Cannabis sativa, for preventing or easing SE-induced neurodegeneration, neuroinflammation, cognitive and mood impairments, and the spontaneous recurrent seizures.

  3. Intravenous immunoglobulins for refractory status epilepticus, part I: A scoping systematic review of the adult literature.

    Science.gov (United States)

    Zeiler, F A; Matuszczak, M; Teitelbaum, J; Kazina, C J; Gillman, L M

    2017-02-01

    Our goal was to perform a scoping systematic review of the literature on the use of intravenous immunoglobulins (IVIG) for refractory status epilepticus (RSE) in adults. Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Healthstar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to May 2016), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers. Twenty-four original articles were identified. A total of 33 adult patients were described as receiving IVIG for RSE. Seizure reduction/control with IVIG occurred in 15 of the 33 patients (45.4%), with 1 (3.0%) and 14 (42.4%) displaying partial and complete responses respectively. No adverse events were recorded. Oxford level 4, GRADE D evidence exists to suggest an unclear impact of IVIG therapy in adult RSE. Routine use of IVIG in adult RSE cannot be recommended at this time. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  4. Successful Phenobarbital Desensitization After DRESS Reaction in the Management of Refractory Status Epilepticus.

    Science.gov (United States)

    Witcher, Robert H; Ramirez, Michelle M

    2018-01-01

    Drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with antiepileptic drug use and is a rare but life-threatening side effect. We present a case of phenobarbital-induced DRESS in a patient who subsequently required phenobarbital and was successfully desensitized. A 5-year-old male presented with medically refractory status epilepticus (SE). He had been trialed on several antiepileptic medications without achieving burst suppression. Burst suppression was achieved with a pentobarbital infusion, and thus, phenobarbital was initiated as the pentobarbital was weaned. After five days of phenobarbital, the patient developed signs and symptoms concerning for DRESS; a punch biopsy confirmed the drug reaction. Two months later, he again developed SE unresponsive to antiepileptic infusions. Burst suppression was achieved with pentobarbital, and it was decided to transition the patient to phenobarbital. Due to concerns of phenobarbital-induced DRESS, the patient underwent a phenobarbital desensitization consisting of 6 doses sequentially administered in 10-fold increasing concentrations before achieving therapeutic dosing. Three days later, the patient achieved therapeutic phenobarbital levels, was weaned off of pentobarbital, and remained seizure-free without recurrence of DRESS. Graded desensitization may be an option to minimize recurrence of DRESS in patients where avoidance of the offending agent is not possible.

  5. Review article: Paediatric status epilepticus in the pre-hospital setting: An update.

    Science.gov (United States)

    Furyk, Jeremy; Watt, Kerriane; Emeto, Theophilus I; Dalziel, Stuart; Bodnar, Daniel; Riney, Kate; Babl, Franz E

    2017-08-01

    Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  6. Midazolam-Ketamine Dual Therapy Stops Cholinergic Status Epilepticus And Reduces Morris Water Maze Deficits

    Science.gov (United States)

    Niquet, Jerome; Baldwin, Roger; Norman, Keith; Suchomelova, Lucie; Lumley, Lucille; Wasterlain, Claude G.

    2016-01-01

    SUMMARY Objective Pharmacoresistance remains an unsolved therapeutic challenge in status epilepticus (SE) and in cholinergic SE induced by nerve agent intoxication. SE triggers a rapid internalization of synaptic GABAA receptors and externalization of NMDA receptors that may explain the loss of potency of standard anti-epileptic drugs (AED). We hypothesized that a drug combination aimed at correcting the consequences of receptor trafficking would reduce SE severity and its long-term consequences. Methods A severe model of SE was induced in adult Sprague-Dawley rats with a high dose of lithium and pilocarpine. The GABAA receptor agonist midazolam, the NMDA receptor antagonist ketamine and/or the AED valproate were injected 40 min after SE onset in combination or as monotherapy. Measures of SE severity were the primary outcome. Secondary outcomes were acute neuronal injury, spontaneous recurrent seizures (SRS), and Morris water maze (MWM) deficits. Results Midazolam-ketamine dual therapy was more efficient than double-dose midazolam or ketamine monotherapy or than valproate-midazolam or valproate-ketamine dual therapy in reducing several parameters of SE severity, suggesting a synergistic mechanism. In addition, midazolam-ketamine dual therapy reduced SE-induced acute neuronal injury, epileptogenesis and MWM deficits. Significance This study showed that a treatment aimed at correcting maladaptive GABAA receptor and NMDA receptor trafficking can stop SE and reduce its long-term consequences. Early Midazolam-ketamine dual therapy may be superior to monotherapy in the treatment of benzodiazepine-refractory SE. PMID:27500978

  7. Optogenetic delay of status epilepticus onset in an in vivo rodent epilepsy model.

    Directory of Open Access Journals (Sweden)

    Inna Sukhotinsky

    Full Text Available Epilepsy is a devastating disease, currently treated with medications, surgery or electrical stimulation. None of these approaches is totally effective and our ability to control seizures remains limited and complicated by frequent side effects. The emerging revolutionary technique of optogenetics enables manipulation of the activity of specific neuronal populations in vivo with exquisite spatiotemporal resolution using light. We used optogenetic approaches to test the role of hippocampal excitatory neurons in the lithium-pilocarpine model of acute elicited seizures in awake behaving rats. Hippocampal pyramidal neurons were transduced in vivo with a virus carrying an enhanced halorhodopsin (eNpHR, a yellow light activated chloride pump, and acute seizure progression was then monitored behaviorally and electrophysiologically in the presence and absence of illumination delivered via an optical fiber. Inhibition of those neurons with illumination prior to seizure onset significantly delayed electrographic and behavioral initiation of status epilepticus, and altered the dynamics of ictal activity development. These results reveal an essential role of hippocampal excitatory neurons in this model of ictogenesis and illustrate the power of optogenetic approaches for elucidation of seizure mechanisms. This early success in controlling seizures also suggests future therapeutic avenues.

  8. Status epilepticus during early development disrupts sexual behavior in adult female rats: recovery with sexual experience.

    Science.gov (United States)

    Coria-Avila, Genaro Alfonso; Paredes-Ramos, Pedro; Galán, Ricardo; Herrera-Covarrubias, Deissy; López-Meraz, Maria-Leonor

    2014-05-01

    Female sexual behavior is sensitive to stress and diseases. Some studies have shown that status epilepticus (SE) can affect sexual proceptivity and receptivity in female rats and also increases reject responses towards males. However, epidemiologic studies indicate that SE is more frequent in young individuals. Herein, we assessed the effects of SE in infant females on their sexual behavior during adulthood. Thirteen-day-old (P13) rat pups received intraperitoneal injections of lithium chloride (3 mEq/kg). Twenty hours later, at P14, SE was induced by subcutaneous injection of pilocarpine hydrochloride (100 mg/kg s.c.). Control animals were given an equal volume of saline subcutaneously. The animals were weaned at P21 and, later in adulthood, were ovariectomized and hormone-primed with estradiol+progesterone, and their sexual behavior assessed during 4 separate trials of 30 min each with a stud male. Our results indicate that proceptive behaviors (solicitations and hops and darts) were impaired during the first trial, but no alterations were observed for receptivity and attractivity. By trial 3, all SE females displayed normal proceptivity. These results indicate that SE in infancy readily affects proceptivity in a reversible manner. We discuss the role of sexual experience in recovery. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Focal hemodynamic patterns of status epilepticus detected by susceptibility weighted imaging (SWI)

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    Aellen, Jerome; Kottke, Raimund; Springer, Elisabeth; Weisstanner, Christian; El-Koussy, Marwan; Schroth, Gerhard; Wiest, Roland; Gralla, Jan; Verma, Rajeev K. [University of Bern, University Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern and Inselspital, Bern (Switzerland); Abela, Eugenio; Schindler, Kaspar [University of Bern, Department of Neurology, Inselspital, Bern (Switzerland); Buerki, Sarah E. [Inselspital, Department of Neuropaediatrics, University Children' s Hospital, Bern (Switzerland)

    2014-11-15

    To investigate pathological findings in the susceptibility weighted imaging (SWI) of patients experiencing convulsive (CSE) or non-convulsive status epilepticus (NCSE) with focal hyperperfusion in the acute setting. Twelve patients (six with NCSE confirmed by electroencephalogram (EEG) and six patients with CSE with seizure event clinically diagnosed) underwent MRI in this acute setting (mean time between onset of symptoms and MRI was 3 h 8 min), including SWI, dynamic susceptibility contrast MR imaging (DSC) and diffusion-weighted imaging (DWI). MRI sequences were retrospectively evaluated and compared with EEG findings (10/12 patients), and clinical symptoms. Twelve out of 12 (100 %) patients showed a focal parenchymal area with pseudo-narrowed cortical veins on SWI, associated with focal hyperperfused areas (increased cerebral blood flow (CBF) and mean transit time (MTT) shortening), and cortical DWI restriction in 6/12 patients (50 %). Additionally, these areas were associated with ictal or postical EEG patterns in 8/10 patients (80 %). Most frequent acute clinical findings were aphasia and/or hemiparesis in eight patients, and all of them showed pseudo-narrowed veins in those parenchymal areas responsible for these symptoms. In this study series with CSE and NCSE patients, SWI showed focally pseudo-narrowed cortical veins in hyperperfused and ictal parenchymal areas. Therefore, SWI might have the potential to identify an ictal region in CSE/NCSE. (orig.)

  10. Exposure to Mozart music reduces cognitive impairment in pilocarpine-induced status epilepticus rats.

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    Xing, Yingshou; Qin, Yi; Jing, Wei; Zhang, Yunxiang; Wang, Yanran; Guo, Daqing; Xia, Yang; Yao, Dezhong

    2016-02-01

    Patients with temporal lobe epilepsy (TLE) often display cognitive deficits. However, current epilepsy therapeutic interventions mainly aim at how to reduce the frequency and degree of epileptic seizures. Recovery of cognitive impairment is not attended enough, resulting in the lack of effective approaches in this respect. In the pilocarpine-induced temporal lobe epilepsy rat model, memory impairment has been classically reported. Here we evaluated spatial cognition changes at different epileptogenesis stages in rats of this model and explored the effects of long-term Mozart music exposure on the recovery of cognitive ability. Our results showed that pilocarpine rats suffered persisting cognitive impairment during epileptogenesis. Interestingly, we found that Mozart music exposure can significantly enhance cognitive ability in epileptic rats, and music intervention may be more effective for improving cognitive function during the early stages after Status epilepticus. These findings strongly suggest that Mozart music may help to promote the recovery of cognitive damage due to seizure activities, which provides a novel intervention strategy to diminish cognitive deficits in TLE patients.

  11. Clinical patterns and outcomes of status epilepticus in patients with tuberous sclerosis complex

    Science.gov (United States)

    Shehata, Hatem S; AbdelGhaffar, Hadeer Mahmoud; Nasreldin, Mohammed; Elmazny, Alaa; Abdelalim, Ahmed; Sabbah, Asmaa; Shalaby, Nevin M

    2017-01-01

    Introduction Refractory epilepsy is a common clinical manifestation in patients with tuberous sclerosis complex (TSC), which can be complicated by many life-threatening conditions, such as status epilepticus (SE). However, very few reports mention the patterns and semiology of SE in those patients. Objective To study the clinical characteristics and outcomes of SE in TSC patients. Materials and methods This observational, prospective study was carried out on 36 Egyptian children with definite TSC. Clinical history, general and neurological examination and psychometric evaluation by standard questionnaires were used to explore characteristics of epileptic manifestations and clinical patterns of SE. All included patients were required to have long-term video electroencephalograms (EEGs) and brain MRI performed. Results A total of 32 attacks of SE were recorded in 21 patients (58.3%) in our cohort during a follow-up period of 2.8±1.1 years; of those patients, 15 had convulsive status, 7 had non-convulsive SE, 6 had refractory/super-refractory SE and 14 patients had a history of infantile spasms (epileptic spasms). The duration of status ranged from 40 to 150 min (mean ± standard deviation: 90±15). Fourteen patients with SE had severe mental retardation, 9 had autistic spectrum disorder and 22 had severe epileptogenic EEG findings. Patients with SE had higher tuber numbers (mean: 9.6), 5 patients had subependymal giant cell astrocytomas and 2 patients had their SE after receiving everolimus. Conclusions The incidence of SE in our patient sample is high (>50%); severe mental retardation, autistic features, history of infantile spasm (epileptic spasms) and high tuber burden are risk factors for developing SE. PMID:28721058

  12. Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography

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    Brenner, Jay M.

    2015-05-01

    Full Text Available Introduction: Electroencephalography (EEG is indicated for diagnosing nonconvulsive status epilepticus (NCSE in a patient who has altered level of consciousness after a motor seizure. A study in a neonatal population found 94% sensitivity and 78% specificity for detection of seizure using a single-lead device. This study aims to show that a reduced montage EEG would detect 90% of seizures detected on standard EEG. Methods: A portable Brainmaster EEG device was available in the emergency department (ED at all times. Patients presenting to the ED with altered mental status and known history of seizure or a witnessed seizure having a standard EEG were eligible for this study. The emergency physician obtained informed consent from the legally authorized representative (LAR, while an ED technician attached the electrodes to the patient, and a research associate attached the electrodes to the wiring routing to the portable EEG module. A board-certified epileptologist interpreted the tracings via the Internet. Simultaneously, the emergency physician ordered a standard 23-lead EEG, which would be interpreted by the neurologist on call to read EEGs. We compared the epileptologist’s interpretation of the reduced montage EEG to the results of the 23-lead EEG, which was considered the gold standard for detecting seizures. Results: Twelve of 12 patients or 100% had the same findings on reduced-montage EEG as standard EEG. One of 12 patients or 8% had nonconvulsive seizure activity. Conclusion: The results are consistent with prior studies which have shown that 8-48% of patients who have had a motor seizure continue to have nonconvulsive seizure activity on EEG. This study suggests that a bedside reduced-montage EEG can be used to make the diagnosis of NCSE in the ED. Further study will be conducted to see if this technology can be applied to the inpatient neurological intensive care unit setting. [West J Emerg Med. 2015;16(3:442–446.

  13. Peri-ictal signal changes in seven patients with status epilepticus: interesting MRI observations

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    Goyal, Manoj K.; Sinha, Sanjib [National Institute of Mental Health and Neurosciences (NIMHANS), Department of Neurology, Bangalore, Karnataka (India); Ravishankar, Shivshankar; Shivshankar, Jai Jai [National Institute of Mental Health and Neurosciences (NIMHANS), Department of Neuroimaging and Interventional Radiology, Bangalore (India)

    2009-03-15

    Transient peri-ictal changes on imaging had been described following status epilepticus (SE), but its cause is not very well understood. We analyzed the magnetic resonance imaging (MRI) findings in SE patients in order to elucidate such changes including peri-ictal signal. This prospective study involved 34 patients (M/F 23:11, mean age 25.8 {+-} 17.2 years) who experienced SE. MRI was performed during or within 96 h of cessation of seizures. Twenty-five patients had generalized convulsive status epilectus (GCSE; ten secondary GCSE and 15 primary GCSE). Seven patients had epilepsia partialis continua and two patients non-convulsive SE. Eight patients had a history of seizures and three patients previous SE. The mean duration of SE prior to MRI was 89.2 {+-} 105.3 h (range 2-360 h). MRI provided diagnosis in 17 patients, and in 13 patients, no structural cause was identified. Peri-ictal focal signal changes with restricted diffusion on apparent diffusion coefficient maps were present in seven (20.6%) patients with SE (generalized convulsive, three; partial, three; non-convulsive, one). The changes were observed when MRI was performed during SE in 3/10 (30%) patients, or within 24 h in 1/7 (14.3%), 48 h in 1/5 (20%), 72 h in 1/6 (16.7%), or 96 h in 1/6 (16.7%) patients after cessation of seizures. Repeat MRI revealed disappearance of signal changes in two patients. Peri-ictal MR changes with restricted diffusion appear to be an effect rather than the cause of SE. (orig.)

  14. Status epilepticus in dogs and cats, part 2: treatment, monitoring, and prognosis.

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    Blades Golubovic, Susan; Rossmeisl, John H

    2017-05-01

    To discuss current anticonvulsant drug options and advances in treatment of status epilepticus (SE) and to review the prognosis associated with SE. When treating a patient with SE, the main goals are to halt seizure activity, prevent further seizures, identify the cause of the seizures, and manage any complications. The veterinary literature indicates that benzodiazepines are the most common class of drugs used for the initial treatment of SE. Although many anticonvulsant drugs are currently available for treatment of SE, there is a lack of evidence demonstrating clear benefit to the use of specific therapeutics for benzodiazepine-refractory SE. Several multicenter, randomized, and placebo-controlled clinical trials are currently investigating the efficacy of new drugs, such as fosphenytoin, for use in canine SE. Another active area of research is the investigation of nonpharmacologic methods of seizure treatment including percutaneous vagal nerve stimulation and transcranial ultrasonic neuromodulation. Electroencephalography (EEG) is underutilized in the management of veterinary seizure disorders. However, recent advances in EEG technology may allow for earlier and proactive therapeutic interventions in epileptic patients, provide objective data collection regarding treatment efficacy, and yield insight into the neurologic status of patients with SE. Most importantly, use of EEG in patients with SE will lead to increased recognition of nonconvulsive seizures and nonconvulsive SE. Mortality associated with SE is as high as 25% in dogs due to direct and indirect causes of death. Dogs with seizure disorders have a decreased lifespan compared to the general population, and epileptic dogs with SE have a significantly abbreviated lifespan compared to epileptics that do not experience SE. In people, nonconvulsive SE has a higher morbidity and mortality than convulsive SE, regardless of patient age or underlying diagnosis. © Veterinary Emergency and Critical Care Society

  15. Population Pharmacokinetics and Exploratory Pharmacodynamics of Lorazepam in Pediatric Status Epilepticus.

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    Gonzalez, Daniel; Chamberlain, James M; Guptill, Jeffrey T; Cohen-Wolkowiez, Michael; Harper, Barrie; Zhao, Jian; Capparelli, Edmund V

    2017-08-01

    Lorazepam is one of the preferred agents used for intravenous treatment of status epilepticus (SE). We combined data from two pediatric clinical trials to characterize the population pharmacokinetics of intravenous lorazepam in infants and children aged 3 months to 17 years with active SE or a history of SE. We developed a population pharmacokinetic model for lorazepam using the NONMEM software. We then assessed exploratory exposure-response relationships using the overall efficacy and safety study endpoints, and performed dosing simulations. A total of 145 patients contributed 439 pharmacokinetic samples. The median (range) age and dose were 5.4 years (0.3-17.8) and 0.10 mg/kg (0.02-0.18), respectively. A two-compartment pharmacokinetic model with allometric scaling described the data well. In addition to total body weight (WT), younger age was associated with slightly higher weight-normalized clearance (CL). The following relationships characterized the typical values for the central compartment volume (V1), CL, peripheral compartment volume (V2), and intercompartmental CL (Q), using individual subject WT (kg) and age (years): V1 (L) = 0.879*WT; CL (L/h) = 0.115*(Age/4.7) 0.133 *WT 0.75 ; V2 (L) = 0.542*V1; Q (L/h) = 1.45*WT 0.75 . No pharmacokinetic parameters were associated with clinical outcomes. Simulations suggest uniform pediatric dosing (0.1 mg/kg, to a maximum of 4 mg) can be used to achieve concentrations of 50-100 ng/mL in children with SE, which have been previously associated with effective seizure control. The population pharmacokinetics of lorazepam were successfully described using a sparse sampling approach and a two-compartment model in pediatric patients with active SE.

  16. Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy.

    Science.gov (United States)

    Kariuki, Symon M; Kakooza-Mwesige, Angelina; Wagner, Ryan G; Chengo, Eddie; White, Steven; Kamuyu, Gathoni; Ngugi, Anthony K; Sander, Josemir W; Neville, Brian G R; Newton, Charles R J

    2015-05-05

    We conducted a community survey to estimate the prevalence and describe the features, risk factors, and consequences of convulsive status epilepticus (CSE) among people with active convulsive epilepsy (ACE) identified in a multisite survey in Africa. We obtained clinical histories of CSE and neurologic examination data among 1,196 people with ACE identified from a population of 379,166 people in 3 sites: Agincourt, South Africa; Iganga-Mayuge, Uganda; and Kilifi, Kenya. We performed serologic assessment for the presence of antibodies to parasitic infections and HIV and determined adherence to antiepileptic drugs. Consequences of CSE were assessed using a questionnaire. Logistic regression was used to identify risk factors. The adjusted prevalence of CSE in ACE among the general population across the 3 sites was 2.3 per 1,000, and differed with site (p < 0.0001). Over half (55%) of CSE occurred in febrile illnesses and focal seizures were present in 61%. Risk factors for CSE in ACE were neurologic impairments, acute encephalopathy, previous hospitalization, and presence of antibody titers to falciparum malaria and HIV; these differed across sites. Burns (15%), lack of education (49%), being single (77%), and unemployment (78%) were common in CSE; these differed across the 3 sites. Nine percent with and 10% without CSE died. CSE is common in people with ACE in Africa; most occurs with febrile illnesses, is untreated, and has focal features suggesting preventable risk factors. Effective prevention and the management of infections and neurologic impairments may reduce the burden of CSE in ACE. © 2015 American Academy of Neurology.

  17. Cognitive dysfunction after generalized tonic-clonic status epilepticus in adults.

    Science.gov (United States)

    Power, K N; Gramstad, A; Gilhus, N E; Hufthammer, K O; Engelsen, B A

    2018-04-01

    Generalized tonic-clonic status epilepticus (GTC-SE) is considered a risk for cognitive impairment. Research with standardized tools is scarce and non-conclusive. We systematically assessed short-term and long-term cognitive function after GTC-SE. Thirty-three patients were tested after the clinical post-ictal phase of GTC-SE (timepoint 1) and again after 1 year (timepoint 2). Twenty controls were examined with the same tests. Tests from Cambridge Neuropsychological Test Automated Battery were used. Motor screening test (MOT) assessed motor speed, delayed matching to sample (DMS) and paired associates learning (PAL) assessed memory, and Stockings of Cambridge (SOC) assessed executive function. Estimated premorbid IQ and radiologically visible brain lesions were controlled for in adjusted results. Outcome measures were z-scores, the number of standard deviations a score deviates from the mean of a norm population. At timepoint 1, unadjusted patient results were significantly below both norm and control group performances on all subtests. Patient mean was 1.9 z-scores below controls (P < .001) on PAL total errors. Results remained significant for PAL and DMS after adjustments. Patient results improved at timepoint 2, but memory tests remained lower than norms and for controls. An executive dysfunction emerged on the most complex SOC stage (z-score difference -0.83; P = .008, adjusted difference -0.94; P = .02). Memory and learning impairment in the early phase after SE and late developing executive dysfunction remained significant after adjusting for estimated premorbid IQ and pre-SE brain lesions. Results suggest that GTC-SE poses a risk for cognitive impairment. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Long-lasting modification of intrinsic discharge properties in subicular neurons following status epilepticus.

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    Wellmer, Jörg; Su, Hailing; Beck, Heinz; Yaari, Yoel

    2002-07-01

    A single episode of status epilepticus (SE) induces neuropathological changes in the brain that may lead to the development of a permanent epileptic condition. Most studies of this plasticity have focused on the hippocampus, where both synaptic function and intrinsic neuronal excitability have been shown to be persistently modified by SE. However, many other brain structures are activated during SE and may also be involved in the subsequent epileptogenic process. Here we have investigated whether SE, induced in rats with pilocarpine and terminated after 40 min with diazepam, persistently modifies the intrinsic excitability of pyramidal neurons in the subiculum. Subicular slices were prepared from control and SE-experienced rats (2-5 weeks after SE). In the control group, only 4% of the neurons fired bursts in response to intrasomatic, threshold-straddling depolarizing current pulses (low-threshold bursters). The remaining neurons either fired bursts in response to strong (3x threshold) depolarizations (35%; high-threshold bursters) or fired in a completely regular mode (61%; nonbursters). In the SE-experienced group, the fractions of low- and high-threshold bursters markedly increased to 29% and 53%, respectively. This change in firing behaviour was associated with a marked increase in the size of the spike after depolarization, particularly in low-threshold bursters. Experimental suppression of Ca2+ currents selectively blocked low-threshold bursting but did not affect high-threshold bursting, suggesting that a dual Ca2+- dependent and Ca2+- independent mechanism controls bursting in these neurons. The persistent up-regulation of intrinsic bursting in the subiculum, in concert with similar changes in the hippocampus, undoubtedly contributes to epileptogenesis following pilocarpine-induced SE.

  19. Emergency electroencephalogram: Usefulness in the diagnosis of nonconvulsive status epilepticus by the on-call neurologist.

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    Máñez Miró, J U; Díaz de Terán, F J; Alonso Singer, P; Aguilar-Amat Prior, M J

    2018-03-01

    We aim to describe the use of emergency electroencephalogram (EmEEG) by the on-call neurologist when nonconvulsive status epilepticus (NCSE) is suspected, and in other indications, in a tertiary hospital. Observational retrospective cohort study of emergency EEG (EmEEG) recordings with 8-channel systems performed and analysed by the on-call neurologist in the emergency department and in-hospital wards between July 2013 and May 2015. Variables recorded were sex, age, symptoms, first diagnosis, previous seizure and cause, previous stroke, cancer, brain computed tomography, diagnosis after EEG, treatment, patient progress, routine control EEG (rEEG), and final diagnosis. We analysed frequency data, sensitivity, and specificity in the diagnosis of NCSE. The study included 135 EEG recordings performed in 129 patients; 51.4% were men and their median age was 69 years. In 112 cases (83%), doctors ruled out suspected NCSE because of altered level of consciousness in 42 (37.5%), behavioural abnormalities in 38 (33.9%), and aphasia in 32 (28.5%). The EmEEG diagnosis was NCSE in 37 patients (33%), and this was confirmed in 35 (94.6%) as the final diagnosis. In 3 other cases, NCSE was the diagnosis on discharge as confirmed by rEEG although the EmEEG missed this condition at first. EmEEG performed to rule out NCSE showed 92.1% sensitivity, 97.2% specificity, a positive predictive value of 94.6%, and a negative predictive value of 96%. Our experience finds that, in an appropriate clinical context, EmEEG performed by the on-call neurologist is a sensitive and specific tool for diagnosing NCSE. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Practice variability and efficacy of clonazepam, lorazepam, and midazolam in status epilepticus: A multicenter comparison.

    Science.gov (United States)

    Alvarez, Vincent; Lee, Jong Woo; Drislane, Frank W; Westover, M Brandon; Novy, Jan; Dworetzky, Barbara A; Rossetti, Andrea O

    2015-08-01

    Benzodiazepines (BZD) are recommended as first-line treatment for status epilepticus (SE), with lorazepam (LZP) and midazolam (MDZ) being the most widely used drugs and part of current treatment guidelines. Clonazepam (CLZ) is also utilized in many countries; however, there is no systematic comparison of these agents for treatment of SE to date. We identified all patients treated with CLZ, LZP, or MDZ as a first-line agent from a prospectively collected observational cohort of adult patients treated for SE in four tertiary care centers. Relative efficacies of CLZ, LZP, and MDZ were compared by assessing the risk of developing refractory SE and the number of antiseizure drugs (ASDs) required to control SE. Among 177 patients, 72 patients (40.62%) received CLZ, 82 patients (46.33%) LZP, and 23 (12.99%) MDZ; groups were similar in demographics and SE characteristics. Loading dose was considered insufficient in the majority of cases for LZP, with a similar rate (84%, 95%, and 87.5%) in the centers involved, and CLZ was used as recommended in 52% of patients. After adjustment for relevant variables, LZP was associated with an increased risk of refractoriness as compared to CLZ (odds ratio [OR] 6.4, 95% confidence interval [CI] 2.66-15.5) and with an increased number of ASDs needed for SE control (OR 4.35, 95% CI 1.8-10.49). CLZ seems to be an effective alternative to LZP and MDZ. LZP is frequently underdosed in this setting. These findings are highly relevant, since they may impact daily practice. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  1. Dexmedetomidine stops benzodiazepine-refractory nerve agent-induced status epilepticus.

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    McCarren, Hilary S; Arbutus, Julia A; Ardinger, Cherish; Dunn, Emily N; Jackson, Cecelia E; McDonough, John H

    2018-03-01

    Nerve agents are highly toxic chemicals that pose an imminent threat to soldiers and civilians alike. Nerve agent exposure leads to an increase in acetylcholine within the central nervous system, resulting in development of protracted seizures known as status epilepticus (SE). Currently, benzodiazepines are the standard of care for nerve agent-induced SE, but their efficacy quickly wanes as the time to treatment increases. Here, we examine the role of the α2-adrenoceptor in termination of nerve agent-induced SE using the highly specific agonist dexmedetomidine (DEX). Adult male rats were exposed to soman and entered SE as confirmed by electroencephalograph (EEG). We observed that administration of DEX in combination with the benzodiazepine midazolam (MDZ) 20 or 40 min after the onset of SE stopped seizures and returned processed EEG measurements to baseline levels. The protective effect of DEX was blocked by the α2-adrenoceptor antagonist atipamezole (ATI), but ATI failed to restore seizure activity after it was already halted by DEX in most cases, suggesting that α2-adrenoceptors may be involved in initiating SE cessation rather than merely suppressing seizure activity. Histologically, treatment with DEX + MDZ significantly reduced the number of dying neurons as measured by FluoroJade B in the amygdala, thalamus, and piriform cortex, but did not protect the hippocampus or parietal cortex even when SE was successfully halted. We conclude that DEX serves not just as a valuable potential addition to the anticonvulsant regimen for nerve agent exposure, but also as a tool for dissecting the neural circuitry that drives SE. Published by Elsevier B.V.

  2. Status Epilepticus Induced Spontaneous Dentate Gyrus Spikes: In Vivo Current Source Density Analysis.

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    Sean P Flynn

    Full Text Available The dentate gyrus is considered to function as an inhibitory gate limiting excitatory input to the hippocampus. Following status epilepticus (SE, this gating function is reduced and granule cells become hyper-excitable. Dentate spikes (DS are large amplitude potentials observed in the dentate gyrus (DG of normal animals. DS are associated with membrane depolarization of granule cells, increased activity of hilar interneurons and suppression of CA3 and CA1 pyramidal cell firing. Therefore, DS could act as an anti-excitatory mechanism. Because of the altered gating function of the dentate gyrus following SE, we sought to investigate how DS are affected following pilocarpine-induced SE. Two weeks following lithium-pilocarpine SE induction, hippocampal EEG was recorded in male Sprague-Dawley rats with 16-channel silicon probes under urethane anesthesia. Probes were placed dorso-ventrally to encompass either CA1-CA3 or CA1-DG layers. Large amplitude spikes were detected from EEG recordings and subject to current source density analysis. Probe placement was verified histologically to evaluate the anatomical localization of current sinks and the origin of DS. In 9 of 11 pilocarpine-treated animals and two controls, DS were confirmed with large current sinks in the molecular layer of the dentate gyrus. DS frequency was significantly increased in pilocarpine-treated animals compared to controls. Additionally, in pilocarpine-treated animals, DS displayed current sinks in the outer, middle and/or inner molecular layers. However, there was no difference in the frequency of events when comparing between layers. This suggests that following SE, DS can be generated by input from medial and lateral entorhinal cortex, or within the dentate gyrus. DS were associated with an increase in multiunit activity in the granule cell layer, but no change in CA1. These results suggest that following SE there is an increase in DS activity, potentially arising from

  3. From intravenous to enteral ketogenic diet in PICU: A potential treatment strategy for refractory status epilepticus.

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    Chiusolo, F; Diamanti, A; Bianchi, R; Fusco, L; Elia, M; Capriati, T; Vigevano, F; Picardo, S

    2016-11-01

    Ketogenic diet (KD) has been used to treat refractory status epilepticus (RSE). KD is a high-fat, restricted-carbohydrate regimen that may be administered with different fat to protein and carbohydrate ratios (3:1 and 4:1 fat to protein and carbohydrate ratios). Other ketogenic regimens have a lower fat and higher protein and carbohydrate ratio to improve taste and thus compliance to treatment. We describe a case of RSE treated with intravenous KD in the Pediatric Intensive Care Unit (PICU). An 8-year-old boy was referred to the PICU because of continuous tonic-clonic and myoclonic generalized seizures despite several antiepileptic treatments. After admission he was intubated and treated with intravenous thiopental followed by ketamine. Seizures continued with frequent myoclonic jerks localized on the face and upper arms. EEG showed seizure activity with spikes on rhythmic continuous waves. Thus we decided to begin KD. The concomitant ileus contraindicated KD by the enteral route and we therefore began IV KD. The ketogenic regimen consisted of conventional intravenous fat emulsion, plus dextrose and amino-acid hyperalimentation in a 2:1 then 3:1 fat to protein and carbohydrate ratio. Exclusive IV ketogenic treatment, well tolerated, was maintained for 3 days; peristalsis then reappeared so KD was continued by the enteral route at 3:1 ratio. Finally, after 8 days and no seizure improvement, KD was deemed unsuccessful and was discontinued. Our experience indicates that IV KD may be considered as a temporary "bridge" towards enteral KD in patients with partial or total intestinal failure who need to start KD. It allows a prompt initiation of KD, when indicated for the treatment of severe diseases such as RSE. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  4. Glibenclamide ameliorates cerebral edema and improves outcomes in a rat model of status epilepticus.

    Science.gov (United States)

    Lin, Zhenzhou; Huang, Hua; Gu, Yong; Huang, Kaibin; Hu, Yafang; Ji, Zhong; Wu, Yongming; Wang, Shengnan; Yang, Tingting; Pan, Suyue

    2017-07-15

    Glibenclamide (GBC), a sulfonylurea receptor 1 blocker, emerges recently as a promising neuron protectant in various neurological disorders. This study aimed to determine whether GBC improves survival and neurological outcome of status epilepticus (SE). Male Sprague-Dawley rats successfully undergoing SE for 2.5 h (n = 134) were randomly assigned to GBC or vehicle group. Rats in the GBC group received a loading dose of 10 μg/kg of GBC, followed by 1.2 μg/6 h for 3 days, while same dose of vehicle was used as control. The 28-day survival rate in the GBC group (11/23) was significantly higher than that in the vehicle group (8/36). In addition, the frequency and duration of spontaneous recurrent seizures in SE rats were profoundly reduced by GBC but not by vehicle treatment. Moreover, cognitive impairment was observed in the SE rats at day 28, which was reversed by GBC treatment. Meanwhile, cerebral edema, as well as neuronal loss, was decreased in several brain areas in the GBC group. Additionally, on the molecular basis, the subunits of sulfonylurea receptor 1/transient receptor potential M4 (SUR1-TRPM4) heterodimer were both strongly upregulated after SE but partly suppressed by GBC treatment. Furthermore, gene knockdown of Trpm4 in SE rats reduced BBB disruption and neuronal loss, similar to the inhibitory effects with GBC treatment. Taken together, GBC treatment markedly improved survival and neurologic outcomes after SE. The salutary effects of GBC were correlated to the alleviation of cerebral edema and reduction in neurological injury via down-regulation of SUR1-TRPM4 channel. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Neonatal thalamic hemorrhage is strongly associated with electrical status epilepticus in slow wave sleep.

    Science.gov (United States)

    Kersbergen, Karina J; de Vries, Linda S; Leijten, Frans S S; Braun, Kees P J; Nievelstein, Rutger A J; Groenendaal, Floris; Benders, Manon J N L; Jansen, Floor E

    2013-04-01

    Thalamic hemorrhage has been associated with neonatal cerebral sinovenous thrombosis (CSVT), especially when the straight sinus is involved, and often presents with neonatal seizures. Early thalamic injury has previously been shown to predispose to epilepsy and electrical status epilepticus in slow wave sleep (ESES). The objective of this study was to assess the prevalence of sleep-induced epileptic electroencephalography (EEG) abnormalities and postneonatal epilepsy after neonatal thalamic hemorrhage associated with CSVT, in the absence of more widespread cerebral damage. Between 2003 and 2008 15 neonates were diagnosed with a thalamic hemorrhage due to suspected or proven CSVT. Neurodevelopment and the history of seizures were assessed at follow-up in the outpatient clinic in all 14 survivors (age 2-9 years). Whole-night or sleep-deprived EEG recordings were obtained to assess the prevalence of interictal epileptiform activity (EA) and calculate a sleep-induced spike and wave index (SWI). Three children were diagnosed with classic ESES (SWI >85%). Two children had ESES spectrum disorder (SWI between 50% and 85%), and in two children significant sleep-induced epileptiform activity (SIEA) was noted (SWI between 25% and 50%). Two other children were diagnosed with focal epilepsy, in the absence of sleep-induced epileptiform EEG abnormalities. Five children (age 2-7 years) had normal EEG recordings at follow-up. Deficits in neurodevelopment were seen significantly more often in children with ESES, ESES spectrum, or SIEA. Neonates with thalamic hemorrhage associated with straight sinus thrombosis, without evidence of more widespread cerebral damage, are at high risk of developing ESES (spectrum) disorder (35%), SIEA (14%), or focal epilepsy (14%). Electrographic abnormalities may already be present prior to recognition of cognitive deficits. Early diagnosis may guide parents and caregivers, and subsequent treatment may improve neurodevelopmental outcome. Routine

  6. The efficacy of topiramate in adult refractory status epilepticus: experience of a tertiary care center.

    Science.gov (United States)

    Synowiec, Andrea S; Yandora, Kristin A; Yenugadhati, Vamsi; Valeriano, James P; Schramke, Carol J; Kelly, Kevin M

    2012-02-01

    Refractory status epilepticus (RSE) occurs in patients with SE when they fail to respond to traditional medical therapy. Because there are very few case reports of topiramate (TPM) treatment of RSE in adult patients, we examined our experience with TPM with regard to its safety and efficacy in seizure termination in RSE in an adult patient population. We report a retrospective review of 35 adult patients with RSE who were treated with TPM in addition to other antiepileptic drugs (AEDs) between 2003 and 2010. After failure of initial treatments of benzodiazepines and weight-based intravenous loading doses of standard AEDs, TPM tablets were crushed and administered via nasogastric tube. Data were collected on age, gender, history of epilepsy, etiology of RSE, daily dose of TPM, co-therapeutic agents, treatment response, and disposition. Following initiation of TPM use and discontinuation of continuous intravenous anesthetics with no additional AEDs administered, cumulative cessation of RSE in patients was 4/35 (11%) at one day, 10/35 (29%) at two days, and 14/35 (40%) at three days. However, when including all patients and comparing the two patient groups in which RSE was or was not terminated within three days of initiating TPM as the last or not last AED given, there was no significant difference. Time to TPM response was not associated with the type of seizures, etiology of SE, or whether there was a history of epilepsy. There were no documented side effects or complications of therapy with TPM. This study provides support for the use of TPM as an adjunctive agent in the treatment of RSE. Copyright © 2011 Elsevier B.V. All rights reserved.

  7. Autoimmune encephalitis: A potentially reversible cause of status epilepticus, epilepsy, and cognitive decline

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    Awadh Kishor Pandit

    2013-01-01

    Full Text Available Objectives: To review clinical characteristics and response to immunomodulation therapy in autoimmune encephalitis presenting with status epilepticus (SE, epilepsy, and cognitive decline. Design: Observational, prospective case series. Setting: All India Institute of Medical Sciences, New Delhi, India. Materials and Methods: Prospective analysis of 15 patients, who presented with SE, epilepsy, cognitive decline, and other neurological symptoms with positive autoantibodies. Demographic and clinical characteristics were recorded. Brain magnetic resonance imaging (MRI, cerebrospinal-fluid analysis (CSF, and tumor screening were done periodically. Treatment received and responses (categorized as per patients and treating doctor′s information were noted. Results: There were 15 (males = 10 patients of autoimmune encephalitis. The mean age of presentation was 24 years (range: 2-64 years. The most common onset was subacute (64% and four (29% patients presented as SE. Predominant clinical presentations were seizures (100% almost of every semiology. CSF was done in 10 patients; it was normal in 60%. Brain MRI was done in all patients, in six (40% it was normal, six (40% showed T2W and FLAIR hyperintensities in bilateral limbic areas. Antibodies found were the N-methyl-D-aspartate receptor antibody in seven (50%, voltage-gated potassium channel antibody in five (36%, two of antiglutamic acid decarboxylase, and one patient with double stranded DNA (dsDNA antibodies. None showed evidence of malignancy. Patients received immunotherapy, either steroids, intravenous immunoglobulin, or both. Follow-up showed significant improvement in majority of cases, neither further seizures nor relapse in nine (67% cases. One death occurred, due to delayed presentation. Conclusions: Uncommon but potentially reversible causes of SE, epilepsy, and cognitive decline may be immune-related and high index of suspicion will prevent missing the diagnosis.

  8. Early predictors of refractory status epilepticus: an international two-center study.

    Science.gov (United States)

    Sutter, R; Kaplan, P W; Marsch, S; Hammel, E M; Rüegg, S; Ziai, W C

    2015-01-01

    Status epilepticus (SE) refractory to first- and second-line antiepileptic drugs carries high mortality. Little is known on early prediction of refractory SE (RSE)—an essential tool for planning appropriate therapy. Our aim was to identify and validate independent early RSE predictors in adults. Clinical and laboratory data on consecutive intensive care unit patients with SE from two academic care centers (a derivation data set from a Swiss center and a validation data set from a US center) were assessed. Multivariable analysis was performed with the derivation set to identify RSE predictors at SE onset. Their external validity was evaluated with an independent validation set. Measures of calibration and discrimination were assessed. In all, 302 patients were analyzed (138 with and 164 without RSE), 171 in the derivation data set and 131 in the validation data set. Acute SE etiology, coma/stupor and serum albumin RSE in the derivation data set [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.01-4.07; OR 4.83, 95% CI 2.42-9.68; OR 2.45, 95% CI 1.16-5.16]. The prediction model showed good measures of calibration (Hosmer-Lemesow goodness-of-fit test P = 0.99) and discrimination (area under the receiver operating characteristic curve 0.8) on the derivation data set—results that were similar in the validation data set (Hosmer-Lemeshow P = 0.24; area under the receiver operating characteristic curve 0.73). This study confirms the independent prognostic value of readily available parameters for early RSE prediction. Prospective studies are needed to identify additional robust predictors, which could be added to the proposed model for further optimization towards a reliable prediction scoring system. © 2014 EAN.

  9. Memory impairment following status epilepticus in immature rats: time-course and environmental effects.

    Science.gov (United States)

    Rutten, Annemarieke; van Albada, Mirjam; Silveira, Diosely C; Cha, Byung Ho; Liu, Xianzeng; Hu, Yingchu N; Cilio, Maria Roberta; Holmes, Gregory L

    2002-08-01

    Status epilepticus (SE) has a high mortality and morbidity rate in children. Disturbances in learning and memory are frequently associated with SE although it is not clear when the cognitive deficits occur. If cognitive dysfunction occurs immediately following the seizure, the window of opportunity for therapeutic intervention is limited. The first goal of this study was to determine the timing of cognitive dysfunction following SE in weanling rats. As there is evidence that enriching the environment can improve cognitive and motor deficits following brain injury, our second goal was to determine whether environmental enrichment improves cognitive function following SE. Rats underwent lithium-pilocarpine-induced SE at postnatal (P) day 20 and were then tested for visual-spatial memory in the water maze at P22, P25, P30, or P50. Rats with SE performed significantly worse in the water maze than control rats at all time points. Once the time-courses of visual-spatial memory deficits were determined, a second group of P20 rats were subjected to SE and were then placed in an enriched environment (enriched group) or remained in standard cages in the vivarium (nonenriched group) for 28 days. Following environmental manipulation, the animals were tested in the water maze. Rats housed in an enriched environment following the SE performed substantially better in the water maze than rats housed in standard cages. However, no differences were found between the enriched and nonenriched groups in EEG or histological evaluation. Although SE results in cognitive impairment within days of the seizure, housing in an enriched environment after SE has a beneficial effect on cognitive performance in rats.

  10. Beneficial effects of enriched environment following status epilepticus in immature rats.

    Science.gov (United States)

    Faverjon, S; Silveira, D C; Fu, D D; Cha, B H; Akman, C; Hu, Y; Holmes, G L

    2002-11-12

    There is increasing evidence that enriching the environment can improve cognitive and motor deficits following a variety of brain injuries. Whether environmental enrichment can improve cognitive impairment following status epilepticus (SE) is not known. To determine whether the environment in which animals are raised influences cognitive function in normal rats and rats subjected to SE. Rats (n = 100) underwent lithium-pilocarpine-induced SE at postnatal (P) day 20 and were then placed in either an enriched environment consisting of a large play area with toys, climbing objects, and music, or in standard vivarium cages for 30 days. Control rats (n = 32) were handled similarly to the SE rats but received saline injections instead of lithium-pilocarpine. Rats were then tested in the water maze, a measure of visual-spatial memory. A subset of the rats were killed during exposure to the enriched or nonenriched environment and the brains examined for dentate granule cell neurogenesis using bromodeoxyuridine (BrdU) and phosphorylated cyclic AMP response element binding protein (pCREB) immunostaining, a brain transcription factor important in long-term memory. Both control and SE rats exposed to the enriched environment performed significantly better than the nonenriched group in the water maze. There was a significant increase in neurogenesis and pCREB immunostaining in the dentate gyrus in both control and SE animals exposed to the enriched environment compared to the nonenriched groups. Environmental enrichment resulted in no change in SE-induced histologic damage. Exposure to an enriched environment in weanling rats significantly improves visual-spatial learning. Even following SE, an enriched environment enhances cognitive function. An increase in neurogenesis and activation of transcription factors may contribute to this enhanced visual-spatial memory.

  11. Mastery of Status Epilepticus Management via Simulation-Based Learning for Pediatrics Residents

    Science.gov (United States)

    Malakooti, Marcelo R.; McBride, Mary E.; Mobley, Bonnie; Goldstein, Joshua L.; Adler, Mark D.; McGaghie, William C.

    2015-01-01

    Background Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes. Objective To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm for managing SE. Methods Thirty pediatrics interns were enrolled. Using the Angoff method, an expert panel developed the minimal passing score, which defined mastery. Scoring of simulated performance was done by 2 observers. Sessions were digitally recorded. After the pretest, participants were debriefed on the algorithm and required to repeat the simulation. If mastery (minimal passing score) was not achieved, debriefing and the simulation were repeated until mastery was met. Once mastery was met, participants graded their comfort level in managing SE. Results No participants achieved mastery at pretest. After debriefing and deliberate simulator training, all (n = 30) achieved mastery of the algorithm: 30% achieved mastery after 1 posttest, 63% after a second, and 6.7% after a third. The Krippendorff α was 0.94, indicating strong interrater agreement. Participants reported more self-efficacy in managing SE, a preference for simulation-based education for learning practice-based algorithms of critical conditions, and highly rated the educational intervention. Conclusions A simulation-based mastery learning program using deliberate practice dramatically improves pediatrics residents' execution of a SE management protocol. Participants enjoyed and benefited from simulation education. Future applications include improving adherence to other hospital protocols. PMID:26221431

  12. Refractory Status Epilepticus in Children: intention-to-treat with continuous infusions of midazolam and pentobarbital

    Science.gov (United States)

    Tasker, Robert C; Goodkin, Howard P; Fernández, Iván Sánchez; Chapman, Kevin E; Abend, Nicholas S; Arya, Ravindra; Brenton, James N; Carpenter, Jessica L; Gaillard, William D; Glauser, Tracy A; Goldstein, Joshua; Helseth, Ashley R; Jackson, Michele C; Kapur, Kush; Mikati, Mohamad A; Peariso, Katrina; Wainwright, Mark S; Wilfong, Angus A; Williams, Korwyn; Loddenkemper, Tobias

    2016-01-01

    Objective To describe pediatric patients with convulsive refractory status epilepticus (RSE) in whom there is intention-to-use an intravenous anesthetic for seizure control. Design Two-year prospective observational study evaluating patients (age range one month to 21 years) with RSE not responding to two antiepileptic drug classes and treated with continuous infusion of anesthetic agent. Setting Nine pediatric hospitals in the United States. Patients In a cohort of 111 patients with RSE (median age 3.7 years, 50% male), 54 (49%) underwent continuous infusion of anesthetic treatment. Main Results The median (interquartile range, IQR) intensive care unit length-of-stay was 10 (3–20) days. Up to four ‘cycles’ of serial anesthetic therapy were used and seizure termination was achieved in 94% by the second cycle. Seizure duration in controlled patients was 5.9 (1.9–34) hours for the first cycle, and longer when a second cycle was required (30 [4,−120] hours, p=0.048). Midazolam was the most frequent first-line anesthetic agent (78%); pentobarbital was the most frequently used second-line agent after midazolam failure (82%). An electroencephalographic endpoint was used in over half of the patients; higher midazolam dosing was used with a burst suppression endpoint. In midazolam non-responders, transition to a second agent occurred after a median of one day. Most patients (94%) experienced seizure termination with these two therapies. Conclusions Midazolam and pentobarbital remains the mainstay of continuous infusion therapy for RSE in the pediatric patient. The majority of patients experience seizure termination within a median of 30 hours. These data have implications for the design and feasibility of future intervention trials. That is, testing a new anesthetic anticonvulsant after failure of both midazolam and pentobarbital is unlikely to be feasible in a pediatric study, whereas a decision to test an alternative to pentobarbital, after midazolam failure

  13. Combinations of ketamine and atropine are neuroprotective and reduce neuroinflammation after a toxic status epilepticus in mice

    International Nuclear Information System (INIS)

    Dhote, Franck; Carpentier, Pierre; Barbier, Laure; Peinnequin, André; Baille, Valérie; Pernot, Fabien; Testylier, Guy; Beaup, Claire; Foquin, Annie

    2012-01-01

    Epileptic seizures and status epilepticus (SE) induced by the poisoning with organophosphorus nerve agents (OP), like soman, are accompanied by neuroinflammation whose role in seizure-related brain damage (SRBD) is not clear. Antagonists of the NMDA glutamate ionotropic receptors are currently among the few compounds able to arrest seizures and provide neuroprotection even during refractory status epilepticus (RSE). Racemic ketamine (KET), in combination with atropine sulfate (AS), was previously shown to counteract seizures and SRBD in soman-poisoned guinea-pigs. In a mouse model of severe soman-induced SE, we assessed the potentials of KET/AS combinations as a treatment for SE/RSE-induced SRBD and neuroinflammation. When starting 30 min after soman challenge, a protocol involving six injections of a sub-anesthetic dose of KET (25 mg/kg) was evaluated on body weight loss, brain damage, and neuroinflammation whereas during RSE, anesthetic protocols were considered (KET 100 mg/kg). After confirming that during RSE, KET injection was to be repeated despite some iatrogenic deaths, we used these proof-of-concept protocols to study the changes in mRNA and related protein contents of some inflammatory cytokines, chemokines and adhesion molecules in cortex and hippocampus 48 h post-challenge. In both cases, the KET/AS combinations showed important neuroprotective effects, suppressed neutrophil granulocyte infiltration and partially suppressed glial activation. KET/AS could also reduce the increase in mRNA and related pro-inflammatory proteins provoked by the poisoning. In conclusion, the present study confirms that KET/AS treatment has a strong potential for SE/RSE management following OP poisoning. The mechanisms involved in the reduction of central neuroinflammation remain to be studied. -- Highlights: ► During soman-induced status epilepticus, ketamine-atropine limit brain damage. ► Molecular neuroinflammatory response is strongly decreased. ► Glial activation is

  14. Efficacy of lacosamide in children and adolescents with drug-resistant epilepsy and refractory status epilepticus: A systematic review.

    Science.gov (United States)

    Ortiz de la Rosa, Johann Sebastián; Ladino, Lady Diana; Rodríguez, Paula Juliana; Rueda, María Camila; Polanía, Juan Pablo; Castañeda, Angie Catalina

    2018-02-07

    Lacosamide, is one of the newer antiepileptic drug approved for focal drug-resistant epilepsy as an add-on treatment in patients older than 16 years. However, there is growing evidence of its use, safety and efficacy in children. We aim to evaluate efficacy and tolerability of lacosamide in focal and generalized drug-resistant epilepsy and refractory status epilepticus in the pediatric population. We conducted a systematic review on MEDLINE, EMBASE, COCHRANE, Google Scholar and Scielo from January 2008 to January 2017. The primary outcome was the efficacy of lacosamide in children with drug-resistant epilepsy and refractory status epilepticus. Efficacy and adverse events attributed to lacosamide were extracted from each publication and systematically reported. We performed no meta-analyses due to limited available data. Of 175 abstracts identified by the search, 82 were reviewed as full-text. Twenty-six articles fulfilled eligibility criteria and described outcomes in 797 patients (57% male). The majority of studies were retrospective (69%) small series (84%). On average 51% of patients had 50% or greater seizure reduction. The mean seizure freedom rate was 24%. Adverse effects occurred in 18-59% of patients. The main events were dizziness, sedation, gastrointestinal upset, mood and behavioral changes. Half of the patients with Lennox Gastaut syndrome showed 50% or greater seizure reduction, 32% did not response to lacosamide and 17% suffered seizure aggravation. Current evidence shows lacosamide as a good option in pediatric patients with focal drug-resistant epilepsy and refractory status epilepticus as an add-on therapy given its efficacy on seizure control and safety profile. The use of lacosamide in Lennox-Gastaut syndrome shows conflicting data. Large randomized controlled studies in the pediatric population are necessary to substantiate these findings. Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  15. Combinations of ketamine and atropine are neuroprotective and reduce neuroinflammation after a toxic status epilepticus in mice

    Energy Technology Data Exchange (ETDEWEB)

    Dhote, Franck, E-mail: franck.dhote@irba.fr [Département de Toxicologie et risques chimiques, Institut de Recherche Biomédicale des armées – Centre de recherches du Service de santé des armées IRBA-CRSSA, 24 avenue des Maquis du Grésivaudan, B.P. 87, 38702 La Tronche cedex (France); Carpentier, Pierre; Barbier, Laure [Département de Toxicologie et risques chimiques, Institut de Recherche Biomédicale des armées – Centre de recherches du Service de santé des armées IRBA-CRSSA, 24 avenue des Maquis du Grésivaudan, B.P. 87, 38702 La Tronche cedex (France); Peinnequin, André [Département Effets biologiques des rayonnements, Institut de Recherche Biomédicale des armées – Centre de recherches du Service de santé des armées IRBA-CRSSA, 24 avenue des Maquis du Grésivaudan, B.P. 87, 38702 La Tronche cedex (France); Baille, Valérie; Pernot, Fabien; Testylier, Guy; Beaup, Claire; Foquin, Annie [Département de Toxicologie et risques chimiques, Institut de Recherche Biomédicale des armées – Centre de recherches du Service de santé des armées IRBA-CRSSA, 24 avenue des Maquis du Grésivaudan, B.P. 87, 38702 La Tronche cedex (France); and others

    2012-03-01

    Epileptic seizures and status epilepticus (SE) induced by the poisoning with organophosphorus nerve agents (OP), like soman, are accompanied by neuroinflammation whose role in seizure-related brain damage (SRBD) is not clear. Antagonists of the NMDA glutamate ionotropic receptors are currently among the few compounds able to arrest seizures and provide neuroprotection even during refractory status epilepticus (RSE). Racemic ketamine (KET), in combination with atropine sulfate (AS), was previously shown to counteract seizures and SRBD in soman-poisoned guinea-pigs. In a mouse model of severe soman-induced SE, we assessed the potentials of KET/AS combinations as a treatment for SE/RSE-induced SRBD and neuroinflammation. When starting 30 min after soman challenge, a protocol involving six injections of a sub-anesthetic dose of KET (25 mg/kg) was evaluated on body weight loss, brain damage, and neuroinflammation whereas during RSE, anesthetic protocols were considered (KET 100 mg/kg). After confirming that during RSE, KET injection was to be repeated despite some iatrogenic deaths, we used these proof-of-concept protocols to study the changes in mRNA and related protein contents of some inflammatory cytokines, chemokines and adhesion molecules in cortex and hippocampus 48 h post-challenge. In both cases, the KET/AS combinations showed important neuroprotective effects, suppressed neutrophil granulocyte infiltration and partially suppressed glial activation. KET/AS could also reduce the increase in mRNA and related pro-inflammatory proteins provoked by the poisoning. In conclusion, the present study confirms that KET/AS treatment has a strong potential for SE/RSE management following OP poisoning. The mechanisms involved in the reduction of central neuroinflammation remain to be studied. -- Highlights: ► During soman-induced status epilepticus, ketamine-atropine limit brain damage. ► Molecular neuroinflammatory response is strongly decreased. ► Glial activation is

  16. Risk factors associated with death in in-hospital pediatric convulsive status epilepticus.

    Directory of Open Access Journals (Sweden)

    Tobias Loddenkemper

    Full Text Available To evaluate in-patient mortality and predictors of death associated with convulsive status epilepticus (SE in a large, multi-center, pediatric cohort.We identified our cohort from the KID Inpatient Database for the years 1997, 2000, 2003 and 2006. We queried the database for convulsive SE, associated diagnoses, and for inpatient death. Univariate logistic testing was used to screen for potential risk factors. These risk factors were then entered into a stepwise backwards conditional multivariable logistic regression procedure. P-values less than 0.05 were taken as significant.We identified 12,365 (5,541 female patients with convulsive SE aged 0-20 years (mean age 6.2 years, standard deviation 5.5 years, median 5 years among 14,965,571 pediatric inpatients (0.08%. Of these, 117 died while in the hospital (0.9%. The most frequent additional admission ICD-9 code diagnoses in addition to SE were cerebral palsy, pneumonia, and respiratory failure. Independent risk factors for death in patients with SE, assessed by multivariate calculation, included near drowning (Odds ratio [OR] 43.2; Confidence Interval [CI] 4.4-426.8, hemorrhagic shock (OR 17.83; CI 6.5-49.1, sepsis (OR 10.14; CI 4.0-25.6, massive aspiration (OR 9.1; CI 1.8-47, mechanical ventilation >96 hours (OR9; 5.6-14.6, transfusion (OR 8.25; CI 4.3-15.8, structural brain lesion (OR7.0; CI 3.1-16, hypoglycemia (OR5.8; CI 1.75-19.2, sepsis with liver failure (OR 14.4; CI 5-41.9, and admission in December (OR3.4; CI 1.6-4.1. African American ethnicity (OR 0.4; CI 0.2-0.8 was associated with a decreased risk of death in SE.Pediatric convulsive SE occurs in up to 0.08% of pediatric inpatient admissions with a mortality of up to 1%. There appear to be several risk factors that can predict mortality. These may warrant additional monitoring and aggressive management.

  17. Cognitive function after status epilepticus versus after multiple generalized tonic-clonic seizures.

    Science.gov (United States)

    Power, Kjersti N; Gramstad, Arne; Gilhus, Nils Erik; Hufthammer, Karl Ove; Engelsen, Bernt A

    2018-02-01

    Status epilepticus (SE) is considered a risk for cognitive impairment. Studies have indicated that SE cause more cognitive decline than multiple lifetime generalized tonic clonic (GTC) seizures. The aim of the study was to investigate whether patients suffering from SE or from multiple lifetime GTC seizures have cognitive dysfunction, and if the disabilities differ between these groups. Patients suffering from SE were evaluated shortly after the clinical post-ictal phase and again after one year. Their follow-up results were compared to results from patients with ≥10 GTC seizures and a group of control subjects. Tests from Cambridge Neuropsychological Test Automated Battery (CANTAB) were used. Motor Screening Test (MOT) assessed motor speed, Delayed Matching to Sample (DMS) and Paired Associates Learning (PAL) assessed memory, and Stockings of Cambridge (SOC) assessed executive function. Estimated premorbid IQ and radiologically visible brain lesions were controlled for in adjusted results. Outcome measures were z-scores, the number of standard deviations a score deviates from the mean of a norm population. Negative z-scores indicate poor performance. After the clinical post-ictal phase, performances of SE patients were poor on all domains (n = 46). Mean z-scores with 95% confidence intervals were below zero for tests of psychomotor speed, executive thinking times and memory. Both SE patients at follow-up (n = 39) and patients with multiple GTC seizures (n = 24) performed poorer than controls (n = 20) on tests of memory. These group differences remained significant after covariate adjustments. SE patients at follow-up scored below patients with multiple GTC seizures on tests of psychomotor speed (mean difference -0.59, P = 0.020), but after adjusting for covariates this difference was no longer significant. Our data do not allow a firm conclusion as to whether SE is a more pronounced risk factor for cognitive dysfunction than repeated

  18. Brain-derived neurotrophic factor ameliorates brain stem cardiovascular dysregulation during experimental temporal lobe status epilepticus.

    Directory of Open Access Journals (Sweden)

    Ching-Yi Tsai

    Full Text Available BACKGROUND: Status epilepticus (SE is an acute, prolonged epileptic crisis with a mortality rate of 20-30%; the underlying mechanism is not completely understood. We assessed the hypothesis that brain stem cardiovascular dysregulation occurs during SE because of oxidative stress in rostral ventrolateral medulla (RVLM, a key nucleus of the baroreflex loop; to be ameliorated by brain-derived neurotrophic factor (BDNF via an antioxidant action. METHODOLOGY/PRINCIPAL FINDINGS: In a clinically relevant experimental model of temporal lobe SE (TLSE using Sprague-Dawley rats, sustained hippocampal seizure activity was accompanied by progressive hypotension that was preceded by a reduction in baroreflex-mediated sympathetic vasomotor tone; heart rate and baroreflex-mediated cardiac responses remained unaltered. Biochemical experiments further showed concurrent augmentation of superoxide anion, phosphorylated p47(phox subunit of NADPH oxidase and mRNA or protein levels of BDNF, tropomyosin receptor kinase B (TrkB, angiotensin AT1 receptor subtype (AT1R, nitric oxide synthase II (NOS II or peroxynitrite in RVLM. Whereas pretreatment by microinjection bilaterally into RVLM of a superoxide dismutase mimetic (tempol, a specific antagonist of NADPH oxidase (apocynin or an AT1R antagonist (losartan blunted significantly the augmented superoxide anion or phosphorylated p47(phox subunit in RVLM, hypotension and the reduced baroreflex-mediated sympathetic vasomotor tone during experimental TLSE, pretreatment with a recombinant human TrkB-Fc fusion protein or an antisense bdnf oligonucleotide significantly potentiated all those events, alongside peroxynitrite. However, none of the pretreatments affected the insignificant changes in heart rate and baroreflex-mediated cardiac responses. CONCLUSIONS/SIGNIFICANCE: We conclude that formation of peroxynitrite by a reaction between superoxide anion generated by NADPH oxidase in RVLM on activation by AT1R and NOS II

  19. Dynamic changes of status epilepticus-induced neuronal degeneration in the mediodorsal nucleus of the thalamus during postnatal development of the rat

    Czech Academy of Sciences Publication Activity Database

    Kubová, Hana; Druga, Rastislav; Haugvicová, Renata; Suchomelová, Lucie; Pitkanen, A.

    2002-01-01

    Roč. 43, Suppl. 5 (2002), s. 54-60 ISSN 0013-9580 R&D Projects: GA MZd NF6474; GA ČR GA309/01/0285 Institutional research plan: CEZ:AV0Z5011922 Keywords : status epilepticus Subject RIV: FH - Neurology Impact factor: 3.530, year: 2002

  20. Efficacy and safety of non-intravenous midazolam for the treatment of status epilepticus in children: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Yan LIN

    2016-02-01

    Full Text Available Objective To evaluate the clinical efficacy and safety of non-intravenous midazolam for treating status epilepticus (SE in children.  Methods Taking midazolam, status epilepticus and children both in Chinese and English as search terms, retrieve in databases such as PubMed, ScienceDirect, China National Knowledge Infrastructure (CNKI, VIP and Wanfang Data, assisted by manual searching and Google Scholar, in order to collect randomized controlled trials (RCTs about non-intravenous midazolam for treating SE in children from January 2000 to January 2015. Jadad Scale was used to evaluate the quality of literatures. Meta-analysis was performed by using RevMan 5.3 software. Results There were a total of 258 records after preliminary searching, and 6 RCTs involving 766 episodes were finally included after excluding duplicate ones and those which did not meet the inclusion criteria. The results were as follows: 1 midazolam via intranasal administration was as effective as intravenous diazepam in achieving seizure control in children (RD = -0.070, 95%CI: -0.200—0.060, P = 0.290. However, non-intravenous (intranasal or buccal midazolam showed better effects on seizure control than rectal diazepam (RD = 0.170, 95% CI: 0.030—0.320; P = 0.020. 2 The mean time from arrival at hospital to cessation was not significantly different between intranasal midazolam and intravenous diazepam (SMD = -1.570, 95%CI: -3.280—0.140; P = 0.070. 3 There was no statistical difference between intranasal midazolam and intravenous diazepam for the time from giving drug to cessation (SMD = 0.240, 95%CI: -0.110—0.590; P = 0.170. 4 There was no statistical difference on the occurrence rate of adverse drug reactions between non-intravenous midazolam and intravenous or non-intravenous diazepam (RD = -0.010, 95% CI: -0.030—0.200; P = 0.500.  Conclusions Non-intravenous midazolam is safe and effective in the treatment for status epilepticus in children. However, the

  1. Diagnosing Sporadic Creutzfeldt-Jakob Disease in a Patient with a Suspected Status Epilepticus in the Intensive Care Unit

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    Harm J. van der Horn

    2013-01-01

    Full Text Available Objective. Several tests are available in the diagnostics of sporadic Creutzfeldt-Jakob disease (sCJD; however, none of these is conclusive. We review the values of these tests, from an intensive care unit (ICU perspective. Methods. Case report and review of the literature. Results. A 53-year-old woman initially presenting with psychiatric symptoms developed myoclonus and was admitted 1 month later to the ICU with a suspected nonconvulsive status epilepticus and respiratory insufficiency, probably due to extensive antiepileptic drug therapy. Typical MRI and EEG findings and a positive 14-3-3 protein led to the diagnosis of sCJD. All treatments were terminated, and autopsy confirmed sCJD. Conclusions. Clinical signs combined with MRI, EEG, and 14-3-3 and/or tau protein determination might be sufficient to diagnose or exclude sCJD and may therefore prevent the application of unnecessary diagnostic tests.

  2. Alterations in hyperpolarization-activated cyclic nucleotidegated cation channel (HCN expression in the hippocampus following pilocarpine-induced status epilepticus

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    Yun-Jung Oh, Jongju Na, Ji-Heon Jeong, Dae-Kyoon Park, Kyung-Ho Park, Jeong-Sik Ko & Duk-Soo Kim*

    2012-11-01

    Full Text Available To understand the effects of HCN as potential mediators in thepathogenesis of epilepsy that evoke long-term impairedexcitability; the present study was designed to elucidate whetherthe alterations of HCN expression induced by status epilepticus(SE is responsible for epileptogenesis. Although HCN1 immunoreactivitywas observed in the hippocampus, its immunoreactivitieswere enhanced at 12 hrs following SE. Although, HCN1immunoreactivities were reduced in all the hippocampi at 2weeks, a re-increase in the expression at 2-3 months followingSE was observed. In contrast to HCN1, HCN 4 expressions wereun-changed, although HCN2 immunoreactive neurons exhibitedsome changes following SE. Taken together, our findings suggestthat altered expressions of HCN1 following SE may be mainlyinvolved in the imbalances of neurotransmissions to hippocampalcircuits; thus, it is proposed that HCN1 may play animportant role in the epileptogenic period as a compensatoryresponse.

  3. The role of perfusion CT in identifying stroke mimics in the emergency room: a case of status epilepticus presenting with perfusion CT alterations

    OpenAIRE

    Guerrero, Waldo R; Dababneh, Haitham; Eisenschenk, Stephan

    2012-01-01

    Emergency medicine physicians are often faced with the challenging task of differentiating true acute ischemic strokes from stroke mimics. We present a case that was initially diagnosed as acute stroke. However, perfusion CT and EEG eventually led to the final diagnosis of status epilepticus. This case further asserts the role of CT perfusion in the evaluation of patients with stroke mimics in the emergency room setting.

  4. Influence of early life status epilepticus on the developmental expression profile of the GluA2 subunit of AMPA receptors

    Czech Academy of Sciences Publication Activity Database

    Szczurowska, Ewa; Ergang, Peter; Kubová, Hana; Druga, Rastislav; Salaj, M.; Mareš, Pavel

    2016-01-01

    Roč. 283, Part A (2016), s. 97-109 ISSN 0014-4886 R&D Projects: GA ČR(CZ) GA15-16605S; GA ČR(CZ) GBP304/12/G069 Institutional support: RVO:67985823 Keywords : development * pilocarpine * status epilepticus * LiCl * AMPA * GluA2 * subunit * expression * GRIA2A Subject RIV: FH - Neurology Impact factor: 4.706, year: 2016

  5. Effects of LiCl/pilocarpine-induced status epilepticus on rat brain mu and benzodiazepine receptor binding: Regional and ontogenetic studies

    Czech Academy of Sciences Publication Activity Database

    Rocha, L.; Suchomelová, Lucie; Mareš, Pavel; Kubová, Hana

    2007-01-01

    Roč. 1181, - (2007), s. 104-117 ISSN 0006-8993 R&D Projects: GA MŠk(CZ) LC554; GA ČR GA304/05/2582 Grant - others: CONACyT (MX) 45943-M Institutional research plan: CEZ:AV0Z50110509 Keywords : benzodiazepine receptor * µ receptor binding * status epilepticus Subject RIV: ED - Physiology Impact factor: 2.218, year: 2007

  6. Evaluation of the efficacy of sodium valproate in convulsive status epilepticus following to ıschemic stroke

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    Hasan Hüseyin Özdemir

    2015-04-01

    Full Text Available Objective : Convulsive status epilepticus (CSE is very rarely observed after ischaemic stroke. Sodium valproate (SV is one of the agents used in the treatment of CSE, but its role still controversial, and its degree of efficacy in treating CSE that develops following stroke is unclear. Method : We evaluated 19 patients who were treated with intravenous (IV SV (20 mg/kg, 2 mg/kg/h-12h after diazepam. Patients’ modified Rankin scores (mRS, SE types, and changes in biochemical parameters after treatment were assessed. Results : CSE was successfully treated in 12 (63.15% patients. Side effects such as hypotension and allergic reactions were observed in two patients. Refractory SE development was observed in 5 (29.4% patients with high mRS (˃ 3. No significant deterioration in patients’ laboratory evaluations, conducted before and after status, was observed. Conclusion : SV may be safe and effective in the treatment of CSE observed after ischaemic stroke, especially in patients with low mRS.

  7. How large must an epileptic focus be to cause an electrographic status epilepticus--a case report.

    Science.gov (United States)

    Fauser, Susanne; Schulze-Bonhage, Andreas

    2004-10-01

    Based on experimental data from animal studies different theories regarding the size of an epileptic focus have been postulated which range from single pacemaker cells to extended neuronal networks. We report a case which gives further information about the size of a human epileptic focus which can trigger manifest epileptic seizures. We report a 22-year-old man with medically refractory temporal lobe epilepsy. This patient suffered from brief complex partial seizures and frequent epigastric auras. To differentiate a mesiotemporal from a temporolateral seizure origin the patient was implanted with a 10 contact depth electrode from a posterior approach into the right hippocampus, and additional temporobasal/temporolateral subdural strip electrodes. Depth recordings revealed an electrographic status with continuous rhythmic sharp wave activity (1 Hz), the field of which was confined to a diameter of less than 1 cm in the anterior hippocampus, whereas temporobasal subdural strip electrodes did not display this activity. Periodically, spread of this activity occurred to the amygdala, to the posterior part of the hippocampus, and less often to the temporobasal cortex. Most seizure patterns remained subclinical, few of them became symptomatic as partial seizures. This case demonstrates that a hippocampal epileptic focus causing electrographic focal status epilepticus may be limited to a volume of less than 1 cm in diameter. This observation is discussed with regard to implantation strategies and to possible superselective resective or modulatory approaches in the treatment of such limited epileptogenic areas.

  8. Kainic Acid-Induced Post-Status Epilepticus Models of Temporal Lobe Epilepsy with Diverging Seizure Phenotype and Neuropathology

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    Daniele Bertoglio

    2017-11-01

    Full Text Available The aim of epilepsy models is to investigate disease ontogenesis and therapeutic interventions in a consistent and prospective manner. The kainic acid-induced status epilepticus (KASE rat model is a widely used, well-validated model for temporal lobe epilepsy (TLE. As we noted significant variability within the model between labs potentially related to the rat strain used, we aimed to describe two variants of this model with diverging seizure phenotype and neuropathology. In addition, we evaluated two different protocols to induce status epilepticus (SE. Wistar Han (Charles River, France and Sprague-Dawley (Harlan, The Netherlands rats were subjected to KASE using the Hellier kainic acid (KA and a modified injection scheme. Duration of SE and latent phase were characterized by video-electroencephalography (vEEG in a subgroup of animals, while animals were sacrificed 1 week (subacute phase and 12 weeks (chronic phase post-SE. In the 12 weeks post-SE groups, seizures were monitored with vEEG. Neuronal loss (neuronal nuclei, microglial activation (OX-42 and translocator protein, and neurodegeneration (Fluorojade C were assessed. First, the Hellier protocol caused very high mortality in WH/CR rats compared to SD/H animals. The modified protocol resulted in a similar SE severity for WH/CR and SD/H rats, but effectively improved survival rates. The latent phase was significantly shorter (p < 0.0001 in SD/H (median 8.3 days animals compared to WH/CR (median 15.4 days. During the chronic phase, SD/H rats had more seizures/day compared to WH/CR animals (p < 0.01. However, neuronal degeneration and cell loss were overall more extensive in WH/CR than in SD/H rats; microglia activation was similar between the two strains 1 week post-SE, but higher in WH/CR rats 12 weeks post-SE. These neuropathological differences may be more related to the distinct neurotoxic effects of KA in the two rat strains than being the outcome of seizure

  9. Níveis dos neurotransmissores estriatais durante o estado epiléptico Striatal monoamines levels during status epilepticus

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    Rivelilson Mendes de Freitas

    2003-01-01

    Full Text Available O objetivo desse estudo foi verificar os níveis dos neurotransmissores estriatais de ratas adultas durante o estado epiléptico induzido pela pilocarpina. Ratas wistar foram tratadas com uma única dose de pilocarpina (400 mg/kg por via subcutânea (S.C.; P400 e os controles receberam salina. A concentração dos neurotransmissores foi determinada através do HPLC eletroquímico, no corpo estriado de ratas que no período de observação de 1 hora desencadearam estado epiléptico e que sobreviveram à fase aguda do quadro convulsivo. Foi observada redução nos níveis de dopamina, serotonina, ácido diidroxifenilacético e aumento na concentração do ácido 5-hidroxiindolacético. Nenhuma alteração foi observada no 4-hidroxi-3-metoxi-fenilacético. Os resultados sugerem que a ativação do sistema colinérgico pode interagir com os sistemas dopaminérgico e serotonérgico nos mecanismos referentes à fase aguda do processo convulsivo no corpo estriado de ratos desenvolvidos.The purpose of the present work to investigate the striatal neurotransmissors level in adult rats after status epilepticus induced by pilocarpine. Wistar rats were treated with a single dose of pilocarpine (400 mg/kg; s.c.; P400 and the controls received saline. Adult animals were closed observed for behavioural changes during 1h. In this period, the animals that developed status epilepticus and survive this acute phase of seizures had the brains removed and striatal neurotransmissors level determiden by HPLC. The concentration of dopamine, serotonine, dihydroxyphenylacetic acid was reduced and an concentration increase in 5-hydroxyindolacetic acid. Didn't observed alteration in 4-hydroxy-3-methoxy-phenylacetic acid. These results suggest that cholinergic activation can interage with dopaminergic and serotonergic systems in acute phase of the convulsive process in rat mature striatum.

  10. Interleukin-1 receptor is a target for adjunctive control of diazepam-refractory status epilepticus in mice.

    Science.gov (United States)

    Xu, Zheng-Hao; Wang, Yi; Tao, An-Feng; Yu, Jie; Wang, Xiao-Yu; Zu, Yun-Yun; Zhang, Shi-Hong; Chen, Zhong

    2016-07-22

    Proinflammatory cytokine interleukin-1 beta (IL-1β) may accumulate in the brain during status epilepticus, but whether it contributes to the progressive refractoriness of SE remains unclear. By using a kainic acid-induced SE mice model, we tested whether pharmacological blockade or knock-out of interleukin-1 receptor type 1 (IL-1R1) could influence the diazepam-refractory phenomenon of prolonged SE. We confirmed diazepam failed to terminate prolonged SE (allowed to continue for 40min before diazepam administration). The expression level of IL-1β in the hippocampus during prolonged SE was significantly higher than that of baseline. Interestingly, prolonged SE was not diazepam-refractory in IL-1R1 knock-out mice. Moreover, administration of interleukin-1 receptor antagonist (IL-1RA) combined with diazepam terminated established prolonged SE, while IL-1RA alone is not capable to terminate prolonged SE. On the contrary, administration of recombinant human IL-1β weakens the efficacy of diazepam by prolonging its latency to terminate non-prolonged SE. Thus, the present study provides direct evidence that accumulated IL-1β contributed to the diazepam refractoriness of prolonged SE, and suggests that interleukin-1 receptor is a target for adjunctive control of diazepam-refractory SE. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

  11. Morphological alterations in newly born dentate gyrus granule cells that emerge after status epilepticus contribute to make them less excitable.

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    Julián Tejada

    Full Text Available Computer simulations of external current stimulations of dentate gyrus granule cells of rats with Status Epilepticus induced by pilocarpine and control rats were used to evaluate whether morphological differences alone between these cells have an impact on their electrophysiological behavior. The cell models were constructed using morphological information from tridimensional reconstructions with Neurolucida software. To evaluate the effect of morphology differences alone, ion channel conductances, densities and distributions over the dendritic trees of dentate gyrus granule cells were the same for all models. External simulated currents were injected in randomly chosen dendrites belonging to one of three different areas of dentate gyrus granule cell molecular layer: inner molecular layer, medial molecular layer and outer molecular layer. Somatic membrane potentials were recorded to determine firing frequencies and inter-spike intervals. The results show that morphologically altered granule cells from pilocarpine-induced epileptic rats are less excitable than control cells, especially when they are stimulated in the inner molecular layer, which is the target area for mossy fibers that sprout after pilocarpine-induced cell degeneration. This suggests that morphological alterations may act as a protective mechanism to allow dentate gyrus granule cells to cope with the increase of stimulation caused by mossy fiber sprouting.

  12. Chaos theory and the treatment of refractory status epilepticus: Who benefits from prolonged anesthesia, and is there a better way?

    Science.gov (United States)

    Hutchinson, Michael; Swanson, Phillip D

    2007-01-01

    Refractory status epilepticus (SE) is a condition of continuous seizure activity in which there is a regular, rapid, succession of spike discharges in the brain. It is incompatible with normal consciousness and is associated with an extremely high morbidity and mortality. Prior to 1990, prevailing opinion held that a brief period of anesthesia (up to two weeks) was to be recommended, but that if SE persisted this was a sign of irreversible brain damage. Therefore support of the patient in SE was not recommended beyond two weeks. On the basis of the theoretical constructs of chaos theory we hypothesized that, for selected cases, anesthesia should be continued indefinitely until the SE resolved. This became the standard of care at the University of Washington and at other institutions. After several years, the accumulating evidence lends support for this hypothesis and we are now able to propose which patients will benefit from such therapy. It is hypothesized that only those patients for whom there is no underlying brain disease, beyond epilepsy, are likely to benefit. Secondly, chaos theory suggests that a strong perturbation will cause a rapid transition from the stable attractor of SE to the stable attractor representing normal consciousness. In certain ways, SE is analogous to ventricular tachycardia, where the cardiac muscle has an abnormally fast rhythm incompatible with proper cardiac function. Therefore the second hypothesis is that a brain perturbation, analogous to defibrillation, may be even more useful than anesthesia in refractory SE.

  13. Control of refractory status epilepticus precipitated by anticonvulsant withdrawal using left vagal nerve stimulation: a case report.

    Science.gov (United States)

    Patwardhan, Ravish V; Dellabadia, John; Rashidi, Mahmoud; Grier, Laurie; Nanda, Anil

    2005-08-01

    To describe a case of left vagal nerve stimulation (VNS) resulting in immediate cessation of status epilepticus (SE) with good neurological outcome. A 30-year-old man with medically intractable seizures including episodes of SE was successfully treated using left VNS. After requiring discontinuation of phenytoin, valproic acid, carbamazepine, and topiramate because of severe allergic reactions resembling Stevens-Johnson syndrome, the patient required pentobarbital coma along with phenobarbital, tiagabine, and levetiracetam for seizure frequency reduction. He underwent left vagal nerve stimulator placement after nearly 9 days of barbiturate-induced coma, with stimulation initiated in the operating room. On the following day, electroencephalography revealed resolution of previously observed periodic lateral epileptiform discharges and the patient was free of seizures. Prestimulation seizure frequency was recorded at 59 times a day, with some seizures enduring 45 minutes despite barbiturate coma. Poststimulation, the patient has been free of seizures for 19 days and is presently taking only levetiracetam and phenobarbital, from which he continues to be successfully weaned without seizures. He is awake, alert, and can recall events leading up to his seizures, with good long-term memory and residual left upper extremity and lower extremity weakness. This case illustrates the role of left vagal stimulation in the treatment of SE and otherwise medically intractable seizures caused by allergic reactions. To our knowledge, this is the first case in the world literature for adults reporting cessation of SE after VNS. Another case with a similar improvement has been reported in the pediatric population.

  14. Pathophysiology and long-term outcome of reversible tumor-like lesions induced by presenting status epilepticus.

    Science.gov (United States)

    Canas, Nuno; Soares, Pedro; Calado, Sofia; Pestana, Ricardo; Ribeiro, Constança; Vale, José

    2010-04-01

    Within the spectrum of reversible neuroimaging abnormalities induced by status epilepticus (SE) tumor-like lesions (TLL) have been rarely described. Their etiology, pathophysiology, and long-term outcome remain uncertain. These issues could be clarified by long-term magnetic resonance imaging (MRI) studies in TLL induced by presenting SE. Prospective multi-sequence MRI and clinical and electroencephalographic long-term (18 to 60 months) follow-up studies were performed in 3 patients with reversible TLL induced by presenting SE. In the peri-ictal MRI, TLL are hypointense in T1-weighted, hyperintense in T2-weighted, and fluid-attenuated inversion recovery images with a marked subcortical component and sulci effacement. The diffusion and MR-spectroscopy studies disclosed intermixed areas of increased/decreased diffusivity associated with a lactate peak and a decreased N-acetylaspartate. At long-term follow-up, none of the patients had seizure recurrence or electroencephalographic epileptiform abnormalities; MRI showed residual focal atrophy and gliosis associated with neuronal loss/dysfunction. SE per se may induce TLL. MRI multi-sequence studies disclosed that they are mainly formed by focal vasogenic and cytotoxic edema resulting from the hypermetabolism associated with seizure activity. In spite of a clinical favorable long-term outcome, the demonstration of irreversible brain damage argues in favor of immediate treatment of SE.

  15. P2X7 receptor-mediated PARP1 activity regulates astroglial death in the rat hippocampus following status epilepticus

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    Ji Yang eKim

    2015-09-01

    Full Text Available Poly(ADP-ribose polymerase-1 (PARP1 plays a regulatory role in apoptosis, necrosis, and other cellular processes after injury. Recently, we revealed that PARP1 regulates the differential neuronal/astroglial responses to pilocarpine-induced status epilepticus (SE in the distinct brain regions. In addition, P2X7 receptor (P2X7R, an ATP-gated ion channel, activation accelerates astroglial apoptosis, while it attenuates clasmatodendrosis (lysosome-derived autophagic astroglial death. Therefore, we investigated whether P2X7R regulates regional specific astroglial PARP1 expression/activation in response to SE. In the present study, P2X7R activation exacerbates SE-induced astroglial apoptosis, while P2X7R inhibition attenuates it accompanied by increasing PARP1 activity in the molecular layer of the dentate gyrus following SE. In the CA1 region, however, P2X7R inhibition deteriorates SE-induced clasmatodendrosis via PARP1 activation following SE. Taken together, our findings suggest that P2X7R function may affect SE-induced astroglial death by regulating PARP1 activation/expression in regional-specific manner. Therefore, the selective modulation of P2X7R-mediated PARP1 functions may be a considerable strategy for controls in various types of cell deaths.

  16. Increased histone H3 phosphorylation in neurons in specific brain structures after induction of status epilepticus in mice.

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    Tetsuji Mori

    Full Text Available Status epilepticus (SE induces pathological and morphological changes in the brain. Recently, it has become clear that excessive neuronal excitation, stress and drug abuse induce chromatin remodeling in neurons, thereby altering gene expression. Chromatin remodeling is a key mechanism of epigenetic gene regulation. Histone H3 phosphorylation is frequently used as a marker of chromatin remodeling and is closely related to the upregulation of mRNA transcription. In the present study, we analyzed H3 phosphorylation levels in vivo using immunohistochemistry in the brains of mice with pilocarpine-induced SE. A substantial increase in H3 phosphorylation was detected in neurons in specific brain structures. Increased H3 phosphorylation was dependent on neuronal excitation. In particular, a robust upregulation of H3 phosphorylation was detected in the caudate putamen, and there was a gradient of phosphorylated H3(+ (PH3(+ neurons along the medio-lateral axis. After unilateral ablation of dopaminergic neurons in the substantia nigra by injection of 6-hydroxydopamine, the distribution of PH3(+ neurons changed in the caudate putamen. Moreover, our histological analysis suggested that, in addition to the well-known MSK1 (mitogen and stress-activated kinase/H3 phosphorylation/c-fos pathway, other signaling pathways were also activated. Together, our findings suggest that a number of genes involved in the pathology of epileptogenesis are upregulated in PH3(+ brain regions, and that H3 phosphorylation is a suitable indicator of strong neuronal excitation.

  17. A Low Mortality, High Morbidity Reduced Intensity Status Epilepticus (RISE Model of Epilepsy and Epileptogenesis in the Rat.

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    Tamara Modebadze

    Full Text Available Animal models of acquired epilepsies aim to provide researchers with tools for use in understanding the processes underlying the acquisition, development and establishment of the disorder. Typically, following a systemic or local insult, vulnerable brain regions undergo a process leading to the development, over time, of spontaneous recurrent seizures. Many such models make use of a period of intense seizure activity or status epilepticus, and this may be associated with high mortality and/or global damage to large areas of the brain. These undesirable elements have driven improvements in the design of chronic epilepsy models, for example the lithium-pilocarpine epileptogenesis model. Here, we present an optimised model of chronic epilepsy that reduces mortality to 1% whilst retaining features of high epileptogenicity and development of spontaneous seizures. Using local field potential recordings from hippocampus in vitro as a probe, we show that the model does not result in significant loss of neuronal network function in area CA3 and, instead, subtle alterations in network dynamics appear during a process of epileptogenesis, which eventually leads to a chronic seizure state. The model's features of very low mortality and high morbidity in the absence of global neuronal damage offer the chance to explore the processes underlying epileptogenesis in detail, in a population of animals not defined by their resistance to seizures, whilst acknowledging and being driven by the 3Rs (Replacement, Refinement and Reduction of animal use in scientific procedures principles.

  18. Assessment of effect of ethanolic extract of Tephrosia purpurea (L. Pers., Fabaceae, activity on lithium-pilocarpine induced Status epilepticus and oxidative stress in Wistar rats Avaliação do efeito do extrato etanólico da Tephrosia purpurea (L. Pers., Fabaceae, sobre o status epilepticus induzido por lítio-pilocarpina e estresse oxidativo, em ratos Wistar

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    G Asuntha

    2010-11-01

    Full Text Available Tephrosia purpurea (L. Pers., Fabaceae, is claimed to be of use in the control and treatment of a variety of epileptic disorders in Indian system of medicine. The present study plans to systematically evaluate T. purpurea and to verify this claim. Status epilepticus was induced in male albino rats of Wistar strain by administration of pilocarpine (30 mg/kg, i.p. 24 h after lithium chloride (3 mEq/kg, i.p.. Different doses of the extract of T. purpurea were administered orally one hour before the injection of pilocarpine. The severity of status epilepticus was observed and recorded every 15 min till 90 min and thereafter every 30 min till 180 min, using the scoring system. The in vivo lipid peroxidation of rat brain tissue was measured. The in vitro NO free radical scavenging activity of plant extract was assessed. The interaction between plant extract and 2-diphenyl-2-picryl hydrazyl (DPPH was also observed for in vitro free radical scavenging activity. The severity of status epilepticus was reduced with the administration of ethanolic extract of T. purpurea. Ethanolic extract of the plant exhibited both in vivo and in vitro antioxidant activity. The ethanolic extract of T. purpurea was found to be useful to control lithium-pilocarpine induced status epilepticus in albino rats of Wistar strain.Tephrosia purpurea (L. Pers., Fabaceae, é conhecida pelo seu uso no controle e tratamento de uma variedade de distúrbios epilépticos no sistema indiano de medicina. O presente estudo pretende avaliar de forma sistemática T. purpurea e verificar essa alegação. Status epilepticus foi induzido em ratos albinos machos da linhagem Wistar pela administração de pilocarpina (30 mg/kg, i.p. 24 h após o cloreto de lítio (3 mEq/kg, i.p.. Diferentes doses do extrato de T. purpurea foram administrados por via oral uma hora antes da injeção de pilocarpina. A gravidade do status epilepticus foi observada e registrada a cada 15 min até 90 min e

  19. Predictors of Outcome in Children with Status Epilepticus during Resuscitation in Pediatric Emergency Department: A Retrospective Observational Study.

    Science.gov (United States)

    Santhanam, Indumathy; Yoganathan, Sangeetha; Sivakumar, V Akila; Ramakrishnamurugan, Rubini; Sathish, Sharada; Thandavarayan, Murali

    2017-01-01

    To study the clinical profile and predictors of outcome in children with status epilepticus (SE) during resuscitation in pediatric emergency department. This retrospective study was carried out in a tertiary care teaching hospital. Admission and resuscitation data of children, aged between 1 month and 12 years, treated for SE, between September 2013 and August 2014, were extracted using a standard data collection form. Our SE management protocol had employed a modified pediatric assessment triangle to recognize and treat acute respiratory failure, cardiovascular dysfunction (CD), and subtle SE until all parameters resolved. Continuous positive airway pressure, fluid boluses based on shock etiology, inotropes, and cardiac safe anticonvulsants were the other modifications. Risk factors predicting mortality during resuscitation were analyzed using univariate and penalized logistic regression. Among 610 who were enrolled, 582 (95.4%) survived and 28 (4.6%) succumbed. Grunt odds ratio (OR): 3.747 (95% confidence interval [CI]: 1.035-13.560), retractions OR: 2.429 (95% CI: 1.036-5.698), rales OR: 10.145 (95% CI: 4.027-25.560), prolonged capillary refill time OR: 3.352 (95% CI: 1.339-8.388), and shock requiring >60 mL/kg fluids OR: 2.439 (95% CI 1.040-5.721) were associated with 2-3 times rise in mortality. Inappropriate prehospital treatment and CD were the significant predictors of mortality OR: 7.82 (95% CI 2.10-29.06) and 738.71 (95% CI: 97.11-999), respectively. Resolution of CD was associated with improved survival OR: 0.02 (95% CI: 0.003-0.17). Appropriate prehospital management and treatment protocol targeting resolution of CD during resuscitation could reduce mortality in children with SE.

  20. A rare cause of status epilepticus; alpha lipoic acid intoxication, case report and review of the literature.

    Science.gov (United States)

    Tolunay, Orkun; Çelik, Tamer; Kömür, Mustafa; Gezgin, Ali Emre; Kaya, Musa Soner; Çelik, Ümit

    2015-11-01

    Alpha lipoic acid is a powerful antioxidant widely used for the supplementary treatment of diabetic neuropathy. Intoxication with alpha lipoic acid is very rare. There is no reported dose of safety in children. A 14-month-old previously healthy girl was referred to our hospital with the diagnosis of drug intoxication. She was admitted to the emergency department with lethargy and continuing involuntary movements for several hours after she had ingested an unknown amount of alpha lipoic acid. On admission she was lethargic and had myoclonic seizures involving all extremities. She had no fever and laboratory examinations were normal except for mild metabolic acidosis. The seizures were unresponsive to bolus midazolam, phenytoin infusion and levetiracetam infusion. She was taken to the pediatric intensive care unit with the diagnosis of status epilepticus. After failure of the treatment with midazolam infusion she was intubated and thiopental sodium infusion was started. Her myoclonic seizures were controlled with thiopental sodium infusion. After 48 h intubation and mechanical ventilation thiopental sodium was gradually reduced and then stopped. Following the withdraw of thiopental sodium, she was seizure free on her discharge on the 8th day. Alpha lipoic acid and derivatives cause side effects in children like refractory convulsions. They are frequently rendered as vitamins by diabetic patients and are left at places where children can easily access them. Therefore, when faced with refractory convulsions in children who have had no disease before, intoxication by medicaments with alpha lipoic acid should be taken into consideration. Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  1. Evaluation of the neuroprotective effect of taurine and green tea extract against oxidative stress induced by pilocarpine during status epilepticus

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    Neveen A. Noor

    2015-10-01

    Full Text Available Status epilepticus (SE has functional and structural consequences resulting in brain damage. The present study aims to investigate the role of taurine and green tea extract in the neuroprotection against oxidative stress and changes in acetylcholinesterase (AChE and Na+,K+-ATPase activities during SE induced by pilocarpine in the hippocampus of adult male rats. Animals received an oral administration of either taurine (100 mg/kg or green tea extract containing 100 mg/kg epigallocatechin gallate for 3 days before the induction of SE with pilocarpine (380 mg/kg, i.p. and were sacrificed 1 h after pilocarpine injection. Data indicated that a state of oxidative stress has evolved during SE as evident from the significant increase in lipid peroxidation level and significant decrease in reduced glutathione (GSH level. Significant decreases in AChE and Na+,K+-ATPase activities were also recorded. Pretreatment of rats with taurine exaggerated the increase in lipid peroxidation and failed to prevent the decrease in Na+,K+-ATPase activity resulting from pilocarpine. However, taurine pretreatment prevented the reduced activity of hippocampal AChE induced by pilocarpine during SE. Pretreatment of rats with green tea extract prevented the increase in lipid peroxidation occurring during SE. However, it failed to inhibit the decrease in Na+,K+-ATPase activity. In conclusion, taurine pretreatment failed to reduce the oxidative stress induced during SE. In contrast, pretreatment of rats with green tea extract ameliorated the oxidative stress induced by pilocarpine and this may assist in reducing the insults of hyperexcitability and excitotoxicity that occur during SE and thereby reduce neuronal damage.

  2. Modificação do metodo "kindling" para obtenção de status epilepticus experimental em ratos

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    Carlos J. Reis de Campos

    1980-03-01

    Full Text Available Foi utilizada em nova espécie animal (ratos, uma modificação do método "kindling", introduzida por Taber e col. (1977 para obtenção de status epilepticus experimental. Para isso foram implantados mediante cirurgia estereotáxica, eletrodos duplos, torcidos no hipocampo dorsal de 12 ratos machos albinos. Esses animais foram submetidos, após uma semana de pós-operatório, a 1 segundo de estimulação elétrica de baixa intensidade em forma intermitente, um estímulo por minuto durante 2 horas, desenvolvendo-se em prazo de 30 minutos um estado de epilepsia eletrográfica e comportamental duradoura. Vários padrões de descargas epilépticas eletrográficas foram observados bem como manifestações convulsivas tônico-clônicas. Os animais que foram submetidos a novas sessões de estimulação após 7 e 14 dias mostraram aumento de atividade epiléptica demonstrando uma modificação plástica do hipocampo do rato submetido a estimulação elétrica a qual perdura no tempo. O método permite a obtenção de "kindling" em tempo bem mais curto (horas, comparativamente às técnicas anteriormente descritas (dias, tornando-se um promissor modelo de epilepsia para testes de drogas anticonvulsivantes e para o estudo dos mecanismos fisiopatológicos e bioquímicos envolvidos na descarga epiléptica.

  3. Inhibition of monoacylglycerol lipase terminates diazepam-resistant status epilepticus in mice and its effects are potentiated by a ketogenic diet.

    Science.gov (United States)

    Terrone, Gaetano; Pauletti, Alberto; Salamone, Alessia; Rizzi, Massimo; Villa, Bianca R; Porcu, Luca; Sheehan, Mark J; Guilmette, Edward; Butler, Christopher R; Piro, Justin R; Samad, Tarek A; Vezzani, Annamaria

    2018-01-01

    Status epilepticus (SE) is a life-threatening and commonly drug-refractory condition. Novel therapies are needed to rapidly terminate seizures to prevent mortality and morbidity. Monoacylglycerol lipase (MAGL) is the key enzyme responsible for the hydrolysis of the endocannabinoid 2-arachidonoylglycerol (2-AG) and a major contributor to the brain pool of arachidonic acid (AA). Inhibiting of monoacylglycerol lipase modulates synaptic activity and neuroinflammation, 2 mediators of excessive neuronal activation underlying seizures. We studied the effect of a potent and selective irreversible MAGL inhibitor, CPD-4645, on SE that was refractory to diazepam, its neuropathologic sequelae, and the mechanism underlying the drug's effects. Diazepam-resistant SE was induced in adult mice fed with standard or ketogenic diet or in cannabinoid receptor type 1 (CB1) receptor knock-out mice. CPD-4645 (10 mg/kg, subcutaneously) or vehicle was dosed 1 and 7 h after status epilepticus onset in video-electroencephalography (EEG) recorded mice. At the end of SE, mice were examined in the novel object recognition test followed by neuronal cellloss analysis. CPD-4645 maximal plasma and brain concentrations were attained 0.5 h postinjection (half-life = 3.7 h) and elevated brain 2-AG levels by approximately 4-fold. CPD-4645 administered to standard diet-fed mice progressively reduced spike frequency during 3 h postinjection, thereby shortening SE duration by 47%. The drug immediately abrogated SE in ketogenic diet-fed mice. CPD-4645 rescued neuronal cell loss and cognitive deficit and reduced interleukin (IL)-1β and cyclooxygenase 2 (COX-2) brain expression resulting from SE. The CPD-4645 effect on SE was similar in mice lacking CB1 receptors. MAGL represents a novel therapeutic target for treating status epilepticus and improving its sequelae. CPD-4645 therapeutic effects appear to be predominantly mediated by modulation of neuroinflammation. Wiley Periodicals, Inc. © 2017

  4. Atividade fisica e neuroproteção em camundongos adultos após indução de status epilepticus por pilocarpina

    OpenAIRE

    Cesar Renato Sartori

    2005-01-01

    Resumo: O modelo de epilepsia induzida por pilocarpina em camundongos reproduz a Epilepsia do Lobo Temporal (ELT) em humanos. Animais submetidos à indução de status epilepticus apresentam alterações comportamentais, eletroencefalográficas e lesão neuronal compatíveis com esta condição. Estudos recentes relatam relevantes efeitos positivos da prática de atividade física sobre o sistema nervoso tanto em humanos como em modelos animais. Dentre estes efeitos figuram o aumento da sobrevivência neu...

  5. Making Sense of a Negative Clinical Trial Result: A Bayesian Analysis of a Clinical Trial of Lorazepam and Diazepam for Pediatric Status Epilepticus.

    Science.gov (United States)

    Chamberlain, Daniel B; Chamberlain, James M

    2017-01-01

    We demonstrate the application of a Bayesian approach to a recent negative clinical trial result. A Bayesian analysis of such a trial can provide a more useful interpretation of results and can incorporate previous evidence. This was a secondary analysis of the efficacy and safety results of the Pediatric Seizure Study, a randomized clinical trial of lorazepam versus diazepam for pediatric status epilepticus. We included the published results from the only prospective pediatric study of status in a Bayesian hierarchic model, and we performed sensitivity analyses on the amount of pooling between studies. We evaluated 3 summary analyses for the results: superiority, noninferiority (margin diazepam. There is a 95% probability that the true efficacy of lorazepam is in the range of 66% to 80%. For both the efficacy and safety outcomes, there was greater than 95% probability that lorazepam is noninferior to diazepam, and there was greater than 90% probability that the 2 medications are practically equivalent. The results were largely driven by the current study because of the sample sizes of our study (n=273) and the previous pediatric study (n=61). Because Bayesian analysis estimates the probability of one or more hypotheses, such an approach can provide more useful information about the meaning of the results of a negative trial outcome. In the case of pediatric status epilepticus, it is highly likely that lorazepam is noninferior and practically equivalent to diazepam. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  6. Interleukin-18 expression increases in response to neurovascular damage following soman-induced status epilepticus in rats.

    Science.gov (United States)

    Johnson, Erik A; Guignet, Michelle A; Dao, Thuy L; Hamilton, Tracey A; Kan, Robert K

    2015-01-01

    Status epilepticus (SE) can cause neuronal cell death and impaired behavioral function. Acute exposure to potent acetylcholinesterase inhibitors such as soman (GD) can cause prolonged SE activity, micro-hemorrhage and cell death in the hippocampus, thalamus and piriform cortex. Neuroinflammation is a prominent feature of brain injury with upregulation of multiple pro-inflammatory cytokines including those of the IL-1 family. The highly pleiotropic pro-inflammatory cytokine interleukin-18 (IL-18) belongs to the IL-1 family of cytokines and can propagate neuroinflammation by promoting immune cell infiltration, leukocyte and lymphocyte activation, and angiogenesis and helps facilitate the transition from the innate to the adaptive immune response. The purpose of this study is to characterize the regional and temporal expression of IL -18 and related factors in the brain following SE in a rat GD seizure model followed by localization of IL-18 to specific cell types. The protein levels of IL-18, vascular endothelial growth factor and interferon gamma was quantified in the lysates of injured brain regions up to 72 h following GD-induced SE onset using bead multiplex immunoassays. IL-18 was localized to various cell types using immunohistochemistry and transmission electron microscopy. In addition, macrophage appearance scoring and T-cell quantification was determined using immunohistochemistry. Micro-hemorrhages were identified using hematoxylin and eosin staining of brain sections. Significant increases in IL-18 occurred in the piriform cortex, hippocampus and thalamus following SE. IL-18 was primarily expressed by endothelial cells and astrocytes associated with the damaged neurovascular unit. The increase in IL-18 was not related to macrophage accumulation, neutrophil infiltration or T-cell appearance in the injured tissue. These data show that IL-18 is significantly upregulated following GD-induced SE and localized primarily to endothelial cells in damaged brain

  7. Interleukin-1β increases neuronal death in the hippocampal dentate gyrus associated with status epilepticus in the developing rat.

    Science.gov (United States)

    Rincón-López, C; Tlapa-Pale, A; Medel-Matus, J-S; Martínez-Quiroz, J; Rodríguez-Landa, J F; López-Meraz, M-L

    Interleukin-1β (IL-1β) increases necrotic neuronal cell death in the CA1 area after induced status epilepticus (SE) in developing rats. However, it remains uncertain whether IL-1β has a similar effect on the hippocampal dentate gyrus (DG). In this study, we analysed the effects of IL-1β on 14-day-old Wistar rats experiencing DG neuronal death induced by SE. SE was induced with lithium-pilocarpine. Six hours after SE onset, a group of pups was injected with IL-1β (at 0, 0.3, 3, 30, or 300ng/μL) in the right ventricle; another group was injected with IL-1β receptor (IL-1R1) antagonist (IL-1Ra, at 30ng/μL) of IL-1RI antagonist (IL-1Ra) alone, and additional group with 30ng/μL of IL-1Ra plus 3ng/μL of IL-1β. Twenty-four hours after SE onset, neuronal cell death in the dentate gyrus of the dorsal hippocampus was assessed using haematoxylin-eosin staining. Dead cells showed eosinophilic cytoplasm and condensed and fragmented nuclei. We observed an increased number of eosinophilic cells in the hippocampal DG ipsilateral to the site of injection of 3ng/μL and 300ng/μL of IL-1β in comparison with the vehicle group. A similar effect was observed in the hippocampal DG contralateral to the site of injection of 3ng/μL of IL-1β. Administration of both of IL-1β and IL-1Ra failed to prevent an increase in the number of eosinophilic cells. Our data suggest that IL-1β increases apoptotic neuronal cell death caused by SE in the hippocampal GD, which is a mechanism independent of IL-1RI activation. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Prehospital treatment with levetiracetam plus clonazepam or placebo plus clonazepam in status epilepticus (SAMUKeppra): a randomised, double-blind, phase 3 trial.

    Science.gov (United States)

    Navarro, Vincent; Dagron, Christelle; Elie, Caroline; Lamhaut, Lionel; Demeret, Sophie; Urien, Saïk; An, Kim; Bolgert, Francis; Tréluyer, Jean-Marc; Baulac, Michel; Carli, Pierre

    2016-01-01

    Generalised convulsive status epilepticus (GCSE) should be treated quickly. Benzodiazepines are the only drug treatment available so far that is effective before admission to hospital. We assessed whether addition of the antiepileptic drug levetiracetam to the benzodiazepine clonazepam would improve prehospital treatment of GCSE. We did a prehospital, randomised, double-blind, phase 3, placebo-controlled, superiority trial to determine the efficacy of adding intravenous levetiracetam (2.5 g) to clonazepam (1 mg) in treatment of GCSE in 13 emergency medical service centres and 26 hospital departments in France. Randomisation was done at the Paris Descartes Clinical Research Unit with a list of random numbers generated by computer. Adults with convulsions lasting longer than 5 min were randomly assigned (1:1) by prehospital physicians to receive levetiracetam or placebo in combination with clonazepam. All physicians and paramedics were masked to group assignments. If the status epilepticus lasted beyond 5 min after drug injection, a second dose of 1 mg clonazepam was given. The primary outcome was cessation of convulsions within 15 min of drug injection. We analysed the modified intention-to-treat population that had received at least one injection of clonazepam and levetiracetam or placebo, excluding patients without valid consent and those randomised more than once. The trial is registered at EudraCT, number 2007-005782-35. Between July 20, 2009, and Dec 15, 2012, 107 patients were randomly assigned to receive placebo and 96 were assigned to receive levetiracetam. The trial was discontinued on Dec 15, 2012 when interim analysis showed no evidence of a treatment difference, and 68 patients in each group were included in the modified intention-to-treat analysis. Convulsions stopped at 15 min of drug injection in 57 of 68 patients (84%) receiving clonazepam and placebo and in 50 of 68 patients (74%) receiving clonazepam and levetiracetam (percentage difference -10

  9. Is pentobarbital safe and efficacious in the treatment of super-refractory status epilepticus: a cohort study.

    Science.gov (United States)

    Pugin, Deborah; Foreman, Brandon; De Marchis, Gian Marco; Fernandez, Andres; Schmidt, J Michael; Czeisler, Barry M; Mayer, Stephan A; Agarwal, Sachin; Lesch, Christine; Lantigua, Hector; Claassen, Jan

    2014-05-21

    Seizures refractory to third-line therapy are also labeled super-refractory status epilepticus (SRSE). These seizures are extremely difficult to control and associated with poor outcome. We aimed to characterize efficacy and side-effects of continuous infusions of pentobarbital (cIV-PTB) treating SRSE. We retrospectively reviewed continuous electroencephalography (cEEG) reports for all adults with RSE treated with cIV-PTB between May 1997 and April 2010 at our institution. Patients with post-anoxic SE and those receiving cIV-PTB for reasons other than RSE were excluded. We collected baseline information, cEEG findings, side-effects and functional outcome at discharge and one year. Thirty one SRSE patients treated with cIV-PTB for RSE were identified. Mean age was 48 years old (interquartile range (IQR) 28,63), 26% (N = 8) had a history of epilepsy. Median SE duration was 6.5 days (IQR 4,11) and the mean duration of cIV-PTB was 6 days (IQR 3,14). 74% (N = 23) presented with convulsive SE. Underlying etiology was acute symptomatic seizures in 52% (N = 16; 12/16 with encephalitis), remote 30% (N = 10), and unknown 16% (N = 5). cIV-PTB controlled seizures in 90% (N = 28) of patients but seizures recurred in 48% (N = 15) while weaning cIV-PTB, despite the fact that suppression-burst was attained in 90% (N = 28) of patients and persisted >72 hours in 56% (N = 17). Weaning was successful after adding phenobarbital in 80% (12/15 of the patients with withdrawal seizures). Complications during or after cIV-PTB included pneumonia (32%, N = 10), hypotension requiring pressors (29%, N = 9), urinary tract infection (13%, N = 4), and one patient each with propylene glycol toxicity and cardiac arrest. One-third (35%, N = 11) had no identified new complication after starting cIV-PTB. At one year after discharge, 74% (N = 23) were dead or in a state of unresponsive wakefulness, 16% (N = 5) severely disabled, and 10% (N

  10. Comparisons of the mortality and clinical presentations of status epilepticus in private practice community and university hospital settings in Richmond, Virginia.

    Science.gov (United States)

    DeLorenzo, Robert J; Kirmani, Batool; Deshpande, Laxmikant S; Jakkampudi, Vamsy; Towne, Alan R; Waterhouse, Elizabeth; Garnett, Linda; Ramakrishnan, Viswanathan

    2009-07-01

    We prospectively compared the clinical course of 119 patients treated for status epilepticus (SE) in private practice community hospitals and 344 SE patients treated in the VCU university hospitals in Richmond, Virginia USA over a 2-year period to test the hypothesis that SE presents with the same mortality and clinical patterns in both clinical settings. Of the patients reviewed, the major etiologies for SE were cerebrovascular disease, decreased anti-epileptic drug levels in epileptic patients, anoxia-hypoxia, and remote symptomatic. The other etiologies included were alcohol related, trauma, central nervous system infections, tumors, systemic infection, metabolic disorders, idiopathic, and hemorrhage. These observations provide the first direct prospective comparison of SE present in university and private practice community hospital settings in the same geographic area. Mortality was the highest in the elderly population while the pediatric population had low mortality in both clinical settings. Etiology risk factors for outcome were similar for both the populations. The data also suggest that the higher degree of illness severity in university hospitals may be associated with a higher incidence of SE, but not with mortality or a different clinical presentation of the condition. The results of this study demonstrate that SE has the same mortality and is present in an essentially identical manner in university and private practice community hospitals and underscores the fact that mortality in SE is not just associated with tertiary care hospitals and the importance of recognizing the severity of SE in the private practice setting.

  11. Early life status epilepticus and stress have distinct and sex-specific effects on learning, subsequent seizure outcomes, including anticonvulsant response to phenobarbital.

    Science.gov (United States)

    Akman, Ozlem; Moshé, Solomon L; Galanopoulou, Aristea S

    2015-02-01

    Neonatal status epilepticus (SE) is often associated with adverse cognitive and epilepsy outcomes. We investigate the effects of three episodes of kainic acid-induced SE (3KA-SE) and maternal separation in immature rats on subsequent learning, seizure susceptibility, and consequences, and the anticonvulsant effects of phenobarbital, according to sex, type, and age at early life (EL) event. 3KA-SE or maternal separation was induced on postnatal days (PN) 4-6 or 14-16. Rats were tested on Barnes maze (PN16-19), or lithium-pilocarpine SE (PN19) or flurothyl seizures (PN32). The anticonvulsant effects of phenobarbital (20 or 40 mg/kg/rat, intraperitoneally) pretreatment were tested on flurothyl seizures. FluoroJadeB staining assessed hippocampal injury. 3KA-SE or separation on PN4-6 caused more transient learning delays in males and did not alter lithium-pilocarpine SE latencies, but aggravated its outcomes in females. Anticonvulsant effects of phenobarbital were preserved and potentiated in specific groups depending on sex, type, and age at EL event. Early life 3KA-SE and maternal separation cause more but transient cognitive deficits in males but aggravate the consequences of subsequent lithium-pilocarpine SE in females. In contrast, on flurothyl seizures, EL events showed either beneficial or no effect, depending on gender, type, and age at EL events. © 2014 John Wiley & Sons Ltd.

  12. Intranasal brain-targeted clonazepam polymeric micelles for immediate control of status epilepticus: in vitro optimization, ex vivo determination of cytotoxicity, in vivo biodistribution and pharmacodynamics studies.

    Science.gov (United States)

    Nour, Samia A; Abdelmalak, Nevine S; Naguib, Marianne J; Rashed, Hassan M; Ibrahim, Ahmed B

    2016-11-01

    Clonazepam (CZ) is an anti-epileptic drug used mainly in status epilepticus (SE). The drug belongs to Class II according to BCS classification with very limited solubility and high permeability and it suffers from extensive first-pass metabolism. The aim of the present study was to develop CZ-loaded polymeric micelles (PM) for direct brain delivery allowing immediate control of SE. PM were prepared via thin film hydration (TFH) technique adopting a central composite face-centered design (CCFD). The seventeen developed formulae were evaluated in terms of entrapment efficiency (EE), particle size (PS), polydispersity index (PDI), zeta potential (ZP), and in vitro release. For evaluating the in vivo behavior of the optimized formula, both biodistrbution using 99m Tc-radiolabeled CZ and pharmacodynamics studies were done in addition to ex vivo cytotoxicty. At a drug:Pluronic® P123:Pluronic® L121 ratio of 1:20:20 (PM7), a high EE, ZP, Q8h, and a low PDI was achieved. The biodistribution studies revealed that the optimized formula had significantly higher drug targeting efficiency (DTE = 242.3%), drug targeting index (DTI = 144.25), and nose-to-brain direct transport percentage (DTP = 99.30%) and a significant prolongation of protection from seizures in comparison to the intranasally administered solution with minor histopathological changes. The declared results reveal the ability of the developed PM to be a strong potential candidate for the emergency treatment of SE.

  13. [Efficacy of levetiracetam combined with short-term clonazepam in treatment of electrical status epilepticus during sleep in children with benign childhood epilepsy with centrotemporal spikes].

    Science.gov (United States)

    Su, Tang-Feng; Xu, San-Qing; Chen, Ling

    2014-08-01

    To study the efficacy of levetiracetam (LEV) combined with short-term clonazepam (CZP) in the treatment of electrical status epilepticus during sleep (ESES) in children with benign childhood epilepsy with centrotemporal spikes (BECCT). Fifteen children (9 boys and 6 girls) diagnosed with BECCT with ESES, who had continuous spike-and-wave accounting for over 85% of the non-rapid eye movement sleep as monitored by 24-hours ambulatory EEG or 3-hours video EEG, were enrolled. The clinical manifestations and EEG characteristics of patients were retrospectively analyzed. These children received two months of CZP treatment in addition to oral LEV [20-40 mg/(kg·d)]. All patients were followed up for 6-18 months. The 15 children were orally given LEV in the early stage, but showed no improvement when reexamined by EEG or had seizures during treatment. Then, they received LEV in combination with short-term CZP. Re-examinations at 1 and 6 months after treatment showed that 14 cases had significantly reduced discharge (only little discharge in the Rolandic area) or no discharge, as well as completely controlled seizure; one case had recurrent ESES and two epileptic seizures during follow-up. The recurrent case received the combination therapy again, and re-examinations 1 and 6 months later revealed normal EEG; no seizure occurred in the 8 months of follow-up. LEV combined with short-term CZP is effective and has few side effects in treating ESES syndrome among children with BECCT.

  14. Alleviation of Oxidative Damage and Involvement of Nrf2-ARE Pathway in Mesodopaminergic System and Hippocampus of Status Epilepticus Rats Pretreated by Intranasal Pentoxifylline

    Directory of Open Access Journals (Sweden)

    Yunxiao Kang

    2017-01-01

    Full Text Available The current studies were aimed at evaluating the efficacy of intranasal pentoxifylline (Ptx pretreatment in protecting mesodopaminergic system and hippocampus from oxidative damage of lithium-pilocarpine induced status epilepticus (SE and the involvement of nuclear factor erythroid 2-related factor 2- (Nrf2- antioxidant response elements pathway. Pentoxifylline was administered to rats intranasally or intraperitoneally 30 minutes before inducing SE. Our results showed the impaired visuospatial memory, the defected mesodopaminergic system, and the oxidative damage and the transient activation of Nrf2 in SE rats. The transient activation of Nrf2 in SE rats was enhanced by Ptx pretreatment, which was followed by the upregulation of heme oxygenase-1 and NAD(PH:quinone oxidoreductase-1. Ptx pretreatment to SE rats significantly suppressed the epileptic seizures, decreased the levels of lipid peroxide and malondialdehyde, and elevated the ratio of reduced glutathione/oxidized glutathione. Compared with intraperitoneal injection, intranasal Ptx delivery completely restored the visuospatial memory and the activity of mesodopaminergic system in SE rats. Intranasal administration of Ptx may hopefully become a noninvasive, painless, and easily administered option for epileptic patients.

  15. Co-administration of subtherapeutic diazepam enhances neuroprotective effect of COX-2 inhibitor, NS-398, after lithium pilocarpine-induced status epilepticus.

    Science.gov (United States)

    Trandafir, C C; Pouliot, W A; Dudek, F E; Ekstrand, J J

    2015-01-22

    Seizures during status epilepticus (SE) cause neuronal death and induce cyclooxygenase-2 (COX-2). Pilocarpine-induced SE was used to determine if COX-2 inhibition with NS-398, when administered alone or with diazepam, decreases the duration and/or intensity of SE and/or reduces neuronal injury in the rat hippocampus. Electroencephalogram (EEG) electrodes were implanted in male Sprague-Dawley rats. SE was induced with lithium-pilocarpine, and continuous EEG and video monitoring were performed for 24 h. Rats were divided into four groups (n=8-14 rats/group) and received NS-398, diazepam, NS-398 and diazepam, or vehicle 30 min after the first motor seizure. Six hours later, NS-398 injection was repeated in the NS-398 and in the NS-398+diazepam groups. The duration of SE (continuous spiking) and the EEG power in the γ-band were analyzed. FluoroJade B staining in the dorsal hippocampus at 24h after SE was analyzed semi-quantitatively in the CA1, CA3 and hilus. The duration and intensity of electrographic SE was not significantly different across the four groups. In rats treated with NS-398 alone, compared to vehicle-treated rats, neuronal damage was significantly lower compared to vehicle-treated rats in the CA3 (27%) and hilus (27%), but neuroprotection was not detected in the CA1. When NS-398 was administered with diazepam, decreased neuronal damage was further obtained in all areas investigated (CA1: 61%, CA3: 63%, hilus: 60%). NS-398, when administered 30 min after the onset of SE with a repeat dose at 6h, decreased neuronal damage in the hippocampus. Administration of diazepam with NS-398 potentiates the neuroprotective effect of the COX-2 inhibitor. These neuroprotective effects occurred with no detectable effect on electrographic SE. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

  16. Examining health service utilization, hospital treatment cost, and mortality of individuals with epilepsy and status epilepticus in New South Wales, Australia 2012-2016.

    Science.gov (United States)

    Mitchell, Rebecca J; Herkes, Geoffrey; Nikpour, Armin; Bleasel, Andrew; Shih, Patti; Vagholkar, Sanjyot; Rapport, Frances

    2018-02-01

    This study examined the health service utilization and hospital treatment cost of individuals with epilepsy by age group, mortality within 30days, and surgical outcomes for individuals with refractory epilepsy in New South Wales (NSW), Australia. A retrospective examination of linked hospitalization and mortality data for individuals hospitalized with a diagnosis of epilepsy during 2012-2016. Hospitalized incidence rates per 1000 population were calculated, and negative binomial regression was used to examine temporal trends. Mortality within 30days of hospitalization was identified, along with cause of death. There were 44,722 hospitalizations during the five-year period, with a hospitalization rate of 85.6 per 1000 population (95% confidence interval (CI): 84.7-86.4). Total hospital treatment costs were AUD$402.9 million. Children aged ≤17years accounted for 32.0% of hospitalizations. Just over half to two-thirds of hospitalizations for each age group were for a principal diagnosis of epilepsy, with 2976 hospitalizations of individuals for status epilepticus. The overall mean hospital length of stay (LOS) for epilepsy hospitalizations was 5.1days (standard deviation (SD)=9.0). Thirty-day mortality was highest for individuals aged ≥65years (6.7%), and epilepsy was identified as the underlying cause of death for 18.2% of deaths. This research has provided insight into the healthcare utilization profiles of individuals with epilepsy at different ages. Epilepsy hospitalizations constitute a substantial cost to the healthcare system, and better overall management of seizures and comorbid conditions is likely to lead to a reduction in the need for hospitalization. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Diffusion tensor MRI shows progressive changes in the hippocampus and dentate gyrus after status epilepticus in rat - histological validation with Fourier-based analysis.

    Science.gov (United States)

    Salo, Raimo A; Miettinen, Tuukka; Laitinen, Teemu; Gröhn, Olli; Sierra, Alejandra

    2017-05-15

    Imaging markers for monitoring disease progression, recovery, and treatment efficacy are a major unmet need for many neurological diseases, including epilepsy. Recent evidence suggests that diffusion tensor imaging (DTI) provides high microstructural contrast even outside major white matter tracts. We hypothesized that in vivo DTI could detect progressive microstructural changes in the dentate gyrus and the hippocampal CA3bc in the rat brain after status epilepticus (SE). To test this hypothesis, we induced SE with systemic kainic acid or pilocarpine in adult male Wistar rats and subsequently scanned them using in vivo DTI at five time-points: prior to SE, and 10, 20, 34, and 79 days post SE. In order to tie the DTI findings to changes in the tissue microstructure, myelin- and glial fibrillary acidic protein (GFAP)-stained sections from the same animals underwent Fourier analysis. We compared the Fourier analysis parameters, anisotropy index and angle of myelinated axons or astrocyte processes, to corresponding DTI parameters, fractional anisotropy (FA) and the orientation angle of the principal eigenvector. We found progressive detectable changes in DTI parameters in both the dentate gyrus (FA, axial diffusivity [D || ], linear anisotropy [CL] and spherical anisotropy [CS], pFourier analysis revealed that both myelinated axons and astrocyte processes played a role in the water diffusion anisotropy changes detected by DTI in individual portions of the dentate gyrus (suprapyramidal blade, mid-portion, and infrapyramidal blade). In the whole dentate gyrus, myelinated axons markedly contributed to the water diffusion changes. In CA3bc as well as in CA3b and CA3c, both myelinated axons and astrocyte processes contributed to water diffusion anisotropy and orientation. Our study revealed that DTI is a promising method for noninvasive detection of microstructural alterations in the hippocampus proper. These alterations may be potential imaging markers for epileptogenesis

  18. mTOR inhibitor reverses autistic-like social deficit behaviours in adult rats with both Tsc2 haploinsufficiency and developmental status epilepticus.

    Science.gov (United States)

    Schneider, Miriam; de Vries, Petrus J; Schönig, Kai; Rößner, Veit; Waltereit, Robert

    2017-08-01

    Epilepsy is a major risk factor for autism spectrum disorder (ASD) and complicates clinical manifestations and management of ASD significantly. Tuberous sclerosis complex (TSC), caused by TSC1 or TSC2 mutations, is one of the medical conditions most commonly associated with ASD and has become an important model to examine molecular pathways associated with ASD. Previous research showed reversal of autism-like social deficits in Tsc1 +/- and Tsc2 +/- mouse models by mammalian target of rapamycin (mTOR) inhibitors. However, at least 70 % of individuals with TSC also have epilepsy, known to complicate the severity and treatment responsiveness of the behavioural phenotype. No previous study has examined the impact of seizures on neurocognitive reversal by mTOR inhibitors. Adult Tsc2 +/- (Eker)-rats express social deficits similar to Tsc2 +/- mice, with additive social deficits from developmental status epilepticus (DSE). DSE was induced by intraperitoneal injection with kainic acid at post-natal days P7 and P14 (n = 12). The experimental group that modelled TSC pathology carried the Tsc2 +/- (Eker)-mutation and was challenged with DSE. The wild-type controls had not received DSE (n = 10). Four-month-old animals were analysed for social behaviour (T1), then treated three times during 1 week with 1 mg/kg everolimus and finally retested in the post-treatment behavioural analysis (T2). In the experimental group, both social interaction and social cognition were impaired at T1. After treatment at T2, behaviour in the experimental group was indistinguishable from controls. The mTOR inhibitor, everolimus, reversed social deficit behaviours in the Tsc2 haploinsufficiency plus DSE animal model to control levels.

  19. Inhibition of the prostaglandin E2 receptor EP2 prevents status epilepticus-induced deficits in the novel object recognition task in rats

    Science.gov (United States)

    Rojas, Asheebo; Ganesh, Thota; Manji, Zahra; O’neill, Theon; Dingledine, Raymond

    2016-01-01

    Survivors of exposure to an organophosphorus nerve agent may develop a number of complications including long-term cognitive deficits (Miyaki et al., 2005; Nishiwaki et al., 2001). We recently demonstrated that inhibition of the prostaglandin E2 receptor, EP2, attenuates neuroinflammation and neurodegeneration caused by status epilepticus (SE) induced by the soman analog, diisopropylfluorophosphate (DFP), which manifest within hours to days of the initial insult. Here, we tested the hypothesis that DFP exposure leads to a loss of cognitive function in rats that is blocked by early, transient EP2 inhibition. Adult male Sprague-Dawley rats were administered vehicle or the competitive EP2 antagonist, TG6-10-1, (ip) at various times relative to DFP-induced SE. DFP administration resulted in prolonged seizure activity as demonstrated by cortical electroencephalography (EEG). A single intraperitoneal injection of TG6-10-1 or vehicle 1 h prior to DFP did not alter the development of seizures, the latency to SE or the duration of SE. Rats administered six injections of TG6-10-1 starting 90 min after the onset of DFP-induced SE could discriminate between a novel and familiar object 6–12 weeks after SE, unlike vehicle treated rats which showed no preference for the novel object. By contrast, behavioral changes in the light-dark box and open field assays were not affected by TG6-10-1. Delayed mortality after DFP was also unaffected by TG6-10-1. Thus, selective inhibition of the EP2 receptor may prevent SE-induced memory impairment in rats caused by exposure to a high dose of DFP. PMID:27477533

  20. The M1 Muscarinic Receptor Antagonist VU0255035 Delays the Development of Status Epilepticus after Organophosphate Exposure and Prevents Hyperexcitability in the Basolateral Amygdala

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    Miller, Steven L.; Aroniadou-Anderjaska, Vassiliki; Pidoplichko, Volodymyr I.; Figueiredo, Taiza H.; Apland, James P.; Krishnan, Jishnu K. S.

    2017-01-01

    Exposure to organophosphorus toxins induces seizures that progress to status epilepticus (SE), which can cause brain damage or death. Seizures are generated by hyperstimulation of muscarinic receptors, subsequent to inhibition of acetylcholinesterase; this is followed by glutamatergic hyperactivity, which sustains and reinforces seizure activity. It has been unclear which muscarinic receptor subtypes are involved in seizure initiation and the development of SE in the early phases after exposure. Here, we show that pretreatment of rats with the selective M1 receptor antagonist, VU0255035 [N-(3-oxo-3-(4-(pyridine-4-yl)piperazin-1-yl)propyl)-benzo[c][1,2,5]thiadiazole-4 sulfonamide], significantly suppressed seizure severity and prevented the development of SE for about 40 minutes after exposure to paraoxon or soman, suggesting an important role of the M1 receptor in the early phases of seizure generation. In addition, in in vitro brain slices of the basolateral amygdala (a brain region that plays a key role in seizure initiation after nerve agent exposure), VU0255035 blocked the effects produced by bath application of paraoxon—namely, a brief barrage of spontaneous inhibitory postsynaptic currents, followed by a significant increase in the ratio of the total charge transferred by spontaneous excitatory postsynaptic currents over that of the inhibitory postsynaptic currents. Furthermore, paraoxon enhanced the hyperpolarization-activated cation current Ih in basolateral amygdala principal cells, which could be one of the mechanisms underlying the increased glutamatergic activity, an effect that was also blocked in the presence of VU0255035. Thus, selective M1 antagonists may be an efficacious pretreatment in contexts in which there is risk for exposure to organophosphates, as these antagonists will delay the development of SE long enough for medical assistance to arrive. PMID:27799295

  1. Response to adrenocorticotropic in attention deficit hyperactivity disorder-like symptoms in electrical status epilepticus in sleep syndrome is related to electroencephalographic improvement: A retrospective study.

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    Altunel, Attila; Altunel, Emine Özlem; Sever, Ali

    2017-09-01

    Encephalopathy with electrical status epilepticus in sleep (ESES) syndrome is a rare epilepsy syndrome of childhood that is characterized by sleep-induced epileptiform discharges and problems with cognition or behavior. The neuropsychiatric symptoms in ESES syndrome, among which the ADHD-like symptoms are prominent, bear a close resemblance to symptoms in various developmental disorders. Positive response to adrenocorticotropic hormone (ACTH) is associated with the normalization of the EEG and improvement of neuropsychiatric function. This study aimed to determine the improvement in ADHD-like symptoms in response to ACTH and establish a relationship between improvement in clinical symptoms and EEG parameters. Seventy-five patients with ESES syndrome, who had clinically displayed ADHD-like symptoms, had been treated with ACTH for ESES, and their medical records were retrospectively reviewed. Sleep EEGs were recorded at referral and follow-up visits, and short courses of ACTH were administered when spike-wave index (SWI) was ≥15%. The assessment of treatment effectiveness was based on reduction in SWI and the clinician-reported improvement in ADHD-like symptoms. Statistical analyses were conducted in order to investigate the relationship between the clinical and EEG parameters. Following treatment with ACTH, a reduction in SWI in all the patients was accompanied by a mean improvement of 67% in ADHD-like symptoms. Disappearance/reduction of foci and cessation/reduction of seizures were achieved in patients with formerly antiepileptic-resistant seizures. Multiple linear regressions established that pretreatment SWI and treatment delay predicted posttreatment SWI, while reduction in SWI, treatment delay, and the presence of foci predicted improvement in ADHD-like symptoms. Improvement in ADHD-like symptoms showed high correlation and was timely with the resolution of ESES. It is suggested that ESES and ADHD may be the two different expressions of a common

  2. Inhibition of P2X7 Receptor Ameliorates Nuclear Factor-Kappa B Mediated Neuroinflammation Induced by Status Epilepticus in Rat Hippocampus.

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    Huang, Cheng; Chi, Xiao-Sa; Li, Rui; Hu, Xin; Xu, Hai-Xia; Li, Jin-Mei; Zhou, Dong

    2017-10-01

    P2X7 receptor (P2X7R) has been reported participating in neuroinflammation in multiple neurological diseases. We explored the role of P2X7R in a rat status epilepticus (SE) model induced by coriaria lactone (CL) and its association with neuroinflammation. Thirty minutes after intracerebroventricular infusion with P2X7R antagonists Brilliant blue G (BBG), A-438079, A-740003, or agonists 2',3'-O-(4-benzoylbenzoyl)-adenosine 5'-triphosphate (BzATP), SE was induced by intramuscular injection of CL in Sprague-Dawley rats. Seizures severity was recorded according to the Racine scale and Morris water maze test was performed. P2X7R expression was measured by western blotting. Immunohistochemical staining was performed to assess pro-inflammation cytokines expression, neuronal loss, and astrocyte activation. The results showed P2X7R level began to increase at 1 day, peaked at 2 days, and gradually decreased to baseline by 2 weeks in rat hippocampus after SE. P2X7R activation induced NF-κB phosphorylation, along with increased IL-1β and IL-6 expression. Pretreatment with P2X7R antagonists ameliorated SE-induced neuroinflammation, neuronal damage, and astroglial and microglial activation to variable extent. In addition, these antagonists ameliorated seizure severity and improved cognitive function. These findings suggest P2X7R activation plays a critical role in epileptogenesis via regulation of neuroinflammation and blocking P2X7R may be a novel therapeutic strategy for epilepsy.

  3. Immediate Epileptogenesis after Kainate-Induced Status Epilepticus in C57BL/6J Mice: Evidence from Long Term Continuous Video-EEG Telemetry.

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    Sreekanth Puttachary

    Full Text Available The C57BL/6J mouse as a model of seizure/epilepsy is challenging due to high mortality and huge variability in response to kainate. We have recently demonstrated that repeated administration of a low dose of kainate by intraperitoneal route can induce severe status epilepticus (SE with 94% survival rate. In the present study, based on continuous video-EEG recording for 4-18 weeks from epidurally implanted electrodes on the cortex, we demonstrate that this method also induces immediate epileptogenesis (<1-5 days post-SE. This finding was based on identification of two types of spontaneous recurrent seizures; behavioral convulsive seizures (CS and electrographic nonconvulsive seizures (NCS. The identification of the spontaneous CS, stage 3-5 types, was based on the behaviors (video that were associated with the EEG characteristics (stage 3-5 epileptiform spikes, the power spectrum, and the activity counts. The electrographic NCS identification was based on the stage 1-2 epileptiform spike clusters on the EEG and their associated power spectrum. Severe SE induced immediate epileptogenesis in all the mice. The maximum numbers of spontaneous CS were observed during the first 4-6 weeks of the SE and they decreased thereafter. Mild SE also induced immediate epileptogenesis in some mice but the CS were less frequent. In both the severe and the mild SE groups, the spontaneous electrographic NCS persisted throughout the 18 weeks observation period, and therefore this could serve as a chronic model for complex seizures. However, unlike rat kainate models, the C57BL/6J mouse kainate model is a unique regressive CS model of epilepsy. Further studies are required to understand the mechanism of recovery from spontaneous CS in this model, which could reveal novel therapeutic targets for epilepsy.

  4. MicroRNA expression profile of the hippocampus in a rat model of temporal lobe epilepsy and miR-34a-targeted neuroprotection against hippocampal neurone cell apoptosis post-status epilepticus

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    Hu Kai

    2012-09-01

    Full Text Available Abstract Background The expression pattern and function of miRNAs in the rat model of temporal lobe epilepsy have not been well defined. Profiling miRNA expression in the rat model of temporal lobe epilepsy and investigating the function of specific miRNAs in epilepsy offers the prospect of a deeper understanding of the mechanisms of epilepsy. Methods The lithium-pilocarpine-induced status epilepticus model and the temporal lobe epilepsy model were established in Sprague–Dawley rats. Samples were analysed to detect deregulated miRNAs in the hippocampal temporal lobe, and several of these deregulated miRNAs were confirmed by qPCR. The expression of the pro-apoptotic miR-34a was detected at 1 day, 7 days and 2 weeks post-status epilepticus and at 2 months after temporal lobe epilepsy. The antagomir of miR-34a was then utilised. The expression of miR-34a after targeting and the expression change of activated caspase-3 protein were examined. The effects of altering the expression of miR-34a and activated caspase-3 protein on neuronal survival and neuronal death or apoptosis post-status epilepticus were assessed. Results The miRNA microarray detected 9 up-regulated miRNAs (miR-146a, -211, -203, -210, -152, -31, -23a, -34a, -27a and 15 down-regulated miRNAs (miR-138*, -301a, -136, -153, -19a, -135b, -325-5p, -380, -190, -542-3p, -33, -144, -542-5p, -543, -296*. Some of the deregulated miRNAs (miR-146a, miR-210, miR-27a, miR-135b and miR-33 were confirmed using qPCR. Furthermore, an increase in expression of the pro-apoptotic miR-34a was demonstrated in the post-status epilepticus rat hippocampus. miR-34a was significantly up-regulated at 1 day, 7 days and 2 weeks post-status epilepticus and at 2 months after temporal lobe epilepsy. Experiments with the miR-34a antagomir revealed that targeting miR-34a led to an inhibition of activated caspase-3 protein expression, which may contribute to increased neuronal survival and reduced

  5. Autonomic seizures and autonomic status epilepticus in early onset benign childhood occipital epilepsy (Panayiotopoulos syndrome Crises autonômicas e status epilepticus autonômico na epilepsia occipital benigna da infância de início precoce (síndrome de Panayiotopoulos

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    Gloria Maria Almeida Souza Tedrus

    2006-09-01

    Full Text Available To study clinical and EEG features of children with ictal vomiting and no underlying brain lesions (Panayiotopoulos syndrome. The subjects were 36 children aged 2-13 years. The onset of seizures occurred between 1 and 5 years of age. Fourteen children (38.8% had a single seizure. Fourteen children (38.8% had autonomic status epilepticus. Impairment of consciousness was reported in 30 (83.3% children, eye deviation in 10 (27.7% other autonomic symptoms and head deviation in 9, generalization in 8, visual symptoms in one child, and, speech arrest or hemifacial motor symptoms in 8 cases. The EEG showed occipital spikes or spike-wave complexes in 27 (75.0% children, blocked by opening of the eyes in 8 (22.2% cases. Nine patients (25% also had rolandic spikes and 3 had extraoccipital spikes. Six (16.6% patients had normal EEG. No clinical differences were observed between patients having occipital or extraoccipital spikes. In children only with autonomic seizures, the spikes are predominantly occipital but blockage by opening of the eyes is a less frequent feature. In some children there is an overlapping of different focal childhood idiopathic syndromes.Estudar aspectos clínico-eletrencefalográficos de crianças com vômito ictal e sem sinais de lesão cerebral (síndrome de Panayiotopoulos. Foram estudadas 36 crianças na faixa etária de 2-13 anos. O início das crises ocorreu entre 1 e 5 anos de idade. Quatorze crianças tiveram crise única. Status epilepticus foi observado em 14 (38,8% casos. Distúrbio da consciência foi relatado em 83,3% das crianças, desvio ocular em 27,7%, outros sintomas autonômicos e desvio da cabeça em 26,4%, generalização em 23,5%, bloqueio da fala ou sintomas motores da hemiface em 23,5% das crianças e sintomas visuais em um caso. O EEG mostrou pontas ou complexos de ponta-onda em 27 (75,0% casos, bloqueados pela abertura dos olhos em 8 (22,2% pacientes. Nove pacientes tiveram também pontas rolândicas e 3

  6. Lovastatin reduces neuronal cell death in hippocampal CA1 subfield after pilocarpine-induced status epilepticus: preliminary results Lovastatina reduz a lesão celular na região CA1 do hipocampo após o status epilepticus induzido pela pilocarpina: resultados preliminares

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    Pauline Rangel

    2005-12-01

    Full Text Available OBJECTIVE: To further characterize the capacity of lovastatin to prevent hippocampal neuronal loss after pilocarpine-induced status epilepticus (SE METHOD: Adult male Wistar rats were divided into four groups: (A control rats, received neither pilocarpine nor lovastatin (n=5; (B control rats, received just lovastatin (n=5; (C rats that received just pilocarpine (n=5; (D rats that received pilocarpine and lovastatin (n=5. After pilocarpine injection (350mg/kg, i.p., only rats that displayed continuous, convulsive seizure activity were included in our study. Seizure activity was monitored behaviorally and terminated with an injection of diazepam (10 mg/kg, i.p. after 4 h of convulsive SE. The rats treated with lovastatin received two doses of 20mg/kg via an oesophagic probe immediately and 24 hours after SE induction. Seven days after pilocarpine-induced SE, all the animals were perfused and their brains were processed for histological analysis through Nissl method. RESULTS: The cell counts in the Nissl-stained sections performed within the hippocampal formation showed a significant cell loss in rats that received pilocarpine and presented SE (CA1= 26.8 ± 13.67; CA3= 38.1 ± 7.2; hilus= 43.8 ± 3.95 when compared with control group animals (Group A: CA1= 53.2 ± 9.63; CA3= 63.5 ± 13.35; hilus= 59.08 ± 10.24; Group B: CA1= 74.3 ± 8.16; CA3= 70.1 ± 3.83; hilus= 70.6 ± 5.10. The average neuronal cell number of CA1 subfield of rats that present SE and received lovastatin (44.4 ± 17.88 was statically significant increased when compared with animals that just presented SE. CONCLUSION: Lovastatin exert a neuroprotective role in the attenuation of brain damage after SE.OBJETIVO: Capacidade da lovastatina em prevenir a perda de neurônios hipocampais após o status epilepticus (SE induzido pela pilocarpina. MÉTODO: Ratos adultos Wistar foram divididos em 4 grupos: (A ratos controles que não receberam pilocarpina nem lovastatina (n=5; (B ratos

  7. Socioeconomic Outcome and Quality of Life in Adults after Status Epilepticus: A Multicenter, Longitudinal, Matched Case–Control Analysis from Germany

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    Lena-Marie Kortland

    2017-09-01

    Full Text Available BackgroundThere is a lack of data concerning socioeconomic outcome and quality of life (QoL in patients after status epilepticus (SE in Germany.Patients and methodsAdult patients treated between 2011 and 2015 due to SE at the university hospitals in Frankfurt, Greifswald, and Marburg were asked to fill out a questionnaire regarding long-term outcome of at least 3 months after discharge. The SE cohort consisted of 25.9% patients with an acute symptomatic, 42% with a remote symptomatic and previous epilepsy, 22.2% with a new-onset remote symptomatic, and 9.9% with other or unknown etiology. A matched case–control analysis was applied for comparison with patients with drug refractory epilepsy and seizure remission, both not previously affected by SE.ResultsA total of 81 patients (mean age: 58.7 ± 18.0 years; 58% female participated. A non-refractory course was present in 59.3%, while 27.2% had a refractory SE (RSE and 13.6% had a superrefractory SE (SRSE. Before admission, a favorable modified Rankin Scale (mRS of 0–3 was found in 82.7% (67/81, deteriorating to 38.3% (31/81 (p = 0.003 at discharge. The majority returned home [51.9% (42/81], 32.1% entered a rehabilitation facility, while 12.3% were transferred to a nursing home and 3.7% to another hospital. The overall mRS at follow-up did not change; 61.8% (45/74 reached an mRS of 0–3. In RSE and SRSE, the proportion with a favorable mRS increased from 45.5% at discharge to 70% at follow-up, while QoL was comparable to a non-refractory SE course. Matched epilepsy controls in seizure remission were treated with a lower mean number of anticonvulsants (1.3 ± 0.7 compared to controls with drug refractory epilepsy (1.9 ± 0.8; p < 0.001 or SE (1.9 ± 1.1; p < 0.001. A major depression was found in 32.8% of patients with SE and in 36.8% of drug refractory epilepsy, but only in 20.3% of patients in seizure remission. QoL was reduced in all categories (QOLIE-31 in SE

  8. (R-[11C]Verapamil PET studies to assess changes in P-glycoprotein expression and functionality in rat blood-brain barrier after exposure to kainate-induced status epilepticus

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    Lammertsma Adriaan A

    2011-01-01

    Full Text Available Abstract Background Increased functionality of efflux transporters at the blood-brain barrier may contribute to decreased drug concentrations at the target site in CNS diseases like epilepsy. In the rat, pharmacoresistant epilepsy can be mimicked by inducing status epilepticus by intraperitoneal injection of kainate, which leads to development of spontaneous seizures after 3 weeks to 3 months. The aim of this study was to investigate potential changes in P-glycoprotein (P-gp expression and functionality at an early stage after induction of status epilepticus by kainate. Methods (R-[11C]verapamil, which is currently the most frequently used positron emission tomography (PET ligand for determining P-gp functionality at the blood-brain barrier, was used in kainate and saline (control treated rats, at 7 days after treatment. To investigate the effect of P-gp on (R-[11C]verapamil brain distribution, both groups were studied without or with co-administration of the P-gp inhibitor tariquidar. P-gp expression was determined using immunohistochemistry in post mortem brains. (R-[11C]verapamil kinetics were analyzed with approaches common in PET research (Logan analysis, and compartmental modelling of individual profiles as well as by population mixed effects modelling (NONMEM. Results All data analysis approaches indicated only modest differences in brain distribution of (R-[11C]verapamil between saline and kainate treated rats, while tariquidar treatment in both groups resulted in a more than 10-fold increase. NONMEM provided most precise parameter estimates. P-gp expression was found to be similar for kainate and saline treated rats. Conclusions P-gp expression and functionality does not seem to change at early stage after induction of anticipated pharmacoresistant epilepsy by kainate.

  9. Myocyte-specific enhancer binding factor 2C (MEF2C expression in the dentate gyrus during development and after pilocarpine-induced status epilepticus: a preliminary report Realce miócito específico ligado a expressão do fator 2C (MEF2C no giro denteado durante o desenvolvimento e após uso de pilocarpina induzindo status epilepticus: estudo preliminar

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    Carla Alessandra Scorza

    2008-01-01

    Full Text Available OBJECTIVE: As axon outgrowth and dentate granule cell neurogenesis are hallmarks of hippocampal development and are also the two morphologic changes in the structure of the dentate gyrus after status epilepticus (SE, we hypothesized that molecules involved in normal development may also play a role during epileptogenesis. METHOD: Using in situ hybridization, we have characterized mRNA expression of myocyte-specific enhancer binding factor 2C (MEF2C in the dentate gyrus during development (P0, P3, P7, P14 and P28 and at multiple time points following pilocarpine-induced SE (3, 7, 14, 28 days after SE. RESULTS: It was demonstrated that MEF2C is up-regulated during development (P0, P3, P7, P14 and P28 and in the adult rat dentate gyrus following SE (3, 7, 14, 28 days after SE. CONCLUSIONS: The molecules controlling cell-fate decisions in the developing dentate gyrus are also operative during epileptogenesis.OBJETIVO: Como o crescimento axonal e a neurogênese do giro denteado são características intrínsecas do hipocampo durante o processo de desenvolvimento, e também são duas alterações morfológicas na estrutura do giro denteado após o status epilepticus (SE, nós hipotetizamos que as moléculas envolvidas no processo normal do desenvolvimento hipocampal também podem participar do processo de epileptogênese. MÉTODO: Utilizando hibridização in situ, caracterizamos a expressão do RNAm do fator de transcrição myocyte-specific enhancer binding factor 2C (MEF2C no giro denteado durante o desenvolvimento (P0, P3, P7, P14 e P28 e em diferentes períodos após o SE (3, 7, 14, 28 dias após SE. RESULTADOS: Foi demonstrado um aumento da expressão de MEF2C no giro denteado durante o desenvolvimento e no giro denteado de animais adultos após o SE. CONCLUSÃO: As moléculas que controlam o destino celular durante o processo de desenvolvimento também estão operativas durante o processo de epileptogênese.

  10. Glucose utilization in the brain during acute seizure is a useful biomarker for the evaluation of anticonvulsants: effect of methyl ethyl ketone in lithium-pilocarpine status epilepticus rats

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    Yamada, Akifumi; Momosaki, Sotaro; Hosoi, Rie; Abe, Kohji; Yamaguchi, Masatoshi; Inoue, Osamu

    2009-01-01

    Enhancement of glucose utilization in the brain has been well known during acute seizure in various kinds of animal model of epilepsy. This enhancement of glucose utilization might be related to neural damage in these animal models. Recently, we found that methyl ethyl ketone (MEK) had both anticonvulsive and neuroprotective effects in lithium-pilocapine (Li-pilo) status epilepticus (SE) rat. In this article, we measured the uptake of [ 14 C]2-deoxyglucose ([ 14 C]DG) in the Li-pilo SE and Li-pilo SE with MEK rat brain in order to assess whether the glucose utilization was a useful biomarker for the detection of efficacy of anticonvulsive compounds. Significant increase of [ 14 C]DG uptake (45 min after the injection) in the cerebral cortex, hippocampus, amygdala and thalamus during acute seizure induced by Li-pilo were observed. On the other hand, the initial uptake of [ 14 C]DG (1 min after the injection) in the Li-pilo SE rats was not different from the control rats. Therefore, the enhancement of glucose metabolism during acute seizure was due to the facilitation of the rate of phosphorylation process of [ 14 C]DG in the brain. Pretreatment with MEK (8 mmol/kg) completely abolished the enhancement of glucose utilization in the Li-pilo SE rats. The present results indicated that glucose utilization in the brain during acute seizure might be a useful biomarker for the evaluation of efficacy of anticonvulsive compounds.

  11. Glucose utilization in the brain during acute seizure is a useful biomarker for the evaluation of anticonvulsants: effect of methyl ethyl ketone in lithium-pilocarpine status epilepticus rats

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    Yamada, Akifumi [Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, 565-0871 (Japan)], E-mail: yamaaki@sahs.med.osaka-u.ac.jp; Momosaki, Sotaro; Hosoi, Rie [Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, 565-0871 (Japan); Abe, Kohji [Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, 565-0871 (Japan); Developmental Research Laboratories, Shionogi and Co., Ltd., Toyonaka, Osaka, 561-0825 (Japan); Yamaguchi, Masatoshi [Faculty of Pharmaceutical Sciences, Fukuoka University, Johnan, Fukuoka 814-0180 (Japan); Inoue, Osamu [Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, 565-0871 (Japan)

    2009-11-15

    Enhancement of glucose utilization in the brain has been well known during acute seizure in various kinds of animal model of epilepsy. This enhancement of glucose utilization might be related to neural damage in these animal models. Recently, we found that methyl ethyl ketone (MEK) had both anticonvulsive and neuroprotective effects in lithium-pilocapine (Li-pilo) status epilepticus (SE) rat. In this article, we measured the uptake of [{sup 14}C]2-deoxyglucose ([{sup 14}C]DG) in the Li-pilo SE and Li-pilo SE with MEK rat brain in order to assess whether the glucose utilization was a useful biomarker for the detection of efficacy of anticonvulsive compounds. Significant increase of [{sup 14}C]DG uptake (45 min after the injection) in the cerebral cortex, hippocampus, amygdala and thalamus during acute seizure induced by Li-pilo were observed. On the other hand, the initial uptake of [{sup 14}C]DG (1 min after the injection) in the Li-pilo SE rats was not different from the control rats. Therefore, the enhancement of glucose metabolism during acute seizure was due to the facilitation of the rate of phosphorylation process of [{sup 14}C]DG in the brain. Pretreatment with MEK (8 mmol/kg) completely abolished the enhancement of glucose utilization in the Li-pilo SE rats. The present results indicated that glucose utilization in the brain during acute seizure might be a useful biomarker for the evaluation of efficacy of anticonvulsive compounds.

  12. Is intravenous lorazepam really more effective and safe than intravenous diazepam as first-line treatment for convulsive status epilepticus? A systematic review with meta-analysis of randomized controlled trials.

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    Brigo, Francesco; Bragazzi, Nicola Luigi; Bacigaluppi, Susanna; Nardone, Raffaele; Trinka, Eugen

    2016-11-01

    Some guidelines or expert consensus indicate that intravenous (IV) lorazepam (LZP) is preferable to IV diazepam (DZP) for initial treatment of convulsive status epilepticus (SE). We aimed to critically assess all the available data on efficacy and tolerability of IV LZP compared with IV DZP as first-line treatment of convulsive SE. Systematic search of the literature (MEDLINE, CENTRAL, EMBASE, ClinicalTrials.gov) to identify randomized controlled trials (RCTs) comparing IV LZP versus IV DZP used as first-line treatment for convulsive SE (generalized or focal). Inverse variance, Mantel-Haenszel meta-analysis to obtain risk ratio (RR) with 95% confidence intervals (CI) of following outcomes: seizure cessation after drug administration; continuation of SE requiring a different drug; seizure cessation after a single dose of medication; need for ventilator support; clinically relevant hypotension. Five RCTs were included, with a total of 656 patients, 320 randomly allocated to IV LZP and 336 to IV DZP. No statistically significant differences were found between IV LZP and IV DZP for clinical seizure cessation (RR 1.09; 95% CI 1.00 to 1.20), continuation of SE requiring a different drug (RR 0.76; 95% CI 0.57 to 1.02), seizure cessation after a single dose of medication (RR 0.96; 95% CI 0.85 to 1.08), need for ventilator support RR 0.93; 95% CI 0.61 to 1.43, and clinically relevant hypotension. Despite its favorable pharmacokinetic profile, a systematic appraisal of the literature does not provide evidence to strongly support the preferential use of IV LZP as first-line treatment of convulsive SE over IV DZP. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Tumor necrosis factor-α-mediated threonine 435 phosphorylation of p65 nuclear factor-κB subunit in endothelial cells induces vasogenic edema and neutrophil infiltration in the rat piriform cortex following status epilepticus

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    Kim Ji-Eun

    2012-01-01

    Full Text Available Abstract Background Status epilepticus (SE induces severe vasogenic edema in the piriform cortex (PC accompanied by neuronal and astroglial damages. To elucidate the mechanism of SE-induced vasogenic edema, we investigated the roles of tumor necrosis factor (TNF-α in blood-brain barrier (BBB disruption during vasogenic edema and its related events in rat epilepsy models provoked by pilocarpine-induced SE. Methods SE was induced by pilocarpine in rats that were intracerebroventricularly infused with saline-, and soluble TNF p55 receptor (sTNFp55R prior to SE induction. Thereafter, we performed Fluoro-Jade B staining and immunohistochemical studies for TNF-α and NF-κB subunits. Results Following SE, most activated microglia showed strong TNF-α immunoreactivity. In addition, TNF p75 receptor expression was detected in endothelial cells as well as astrocytes. In addition, only p65-Thr435 phosphorylation was increased in endothelial cells accompanied by SMI-71 expression (an endothelial barrier antigen. Neutralization of TNF-α by soluble TNF p55 receptor (sTNFp55R infusion attenuated SE-induced vasogenic edema and neuronal damages via inhibition of p65-Thr435 phosphorylation in endothelial cells. Furthermore, sTNFp55R infusion reduced SE-induced neutrophil infiltration in the PC. Conclusion These findings suggest that impairments of endothelial cell functions via TNF-α-mediated p65-Thr 485 NF-κB phosphorylation may be involved in SE-induced vasogenic edema. Subsequently, vasogenic edema results in extensive neutrophil infiltration and neuronal-astroglial loss.

  14. Increased expression of the chemokines CXCL1 and MIP-1α by resident brain cells precedes neutrophil infiltration in the brain following prolonged soman-induced status epilepticus in rats

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    Koemeter-Cox Andrew I

    2011-05-01

    Full Text Available Abstract Background Exposure to the nerve agent soman (GD causes neuronal cell death and impaired behavioral function dependent on the induction of status epilepticus (SE. Little is known about the maturation of this pathological process, though neuroinflammation and infiltration of neutrophils are prominent features. The purpose of this study is to quantify the regional and temporal progression of early chemotactic signals, describe the cellular expression of these factors and the relationship between expression and neutrophil infiltration in damaged brain using a rat GD seizure model. Methods Protein levels of 4 chemokines responsible for neutrophil infiltration and activation were quantified up to 72 hours in multiple brain regions (i.e. piriform cortex, hippocampus and thalamus following SE onset using multiplex bead immunoassays. Chemokines with significantly increased protein levels were localized to resident brain cells (i.e. neurons, astrocytes, microglia and endothelial cells. Lastly, neutrophil infiltration into these brain regions was quantified and correlated to the expression of these chemokines. Results We observed significant concentration increases for CXCL1 and MIP-1α after seizure onset. CXCL1 expression originated from neurons and endothelial cells while MIP-1α was expressed by neurons and microglia. Lastly, the expression of these chemokines directly preceded and positively correlated with significant neutrophil infiltration in the brain. These data suggest that following GD-induced SE, a strong chemotactic response originating from various brain cells, recruits circulating neutrophils to the injured brain. Conclusions A strong induction of neutrophil attractant chemokines occurs following GD-induced SE resulting in neutrophil influx into injured brain tissues. This process may play a key role in the progressive secondary brain pathology observed in this model though further study is warranted.

  15. α-Asarone Attenuates Cognitive Deficit in a Pilocarpine-Induced Status Epilepticus Rat Modelviaa Decrease in the Nuclear Factor-κB Activation and Reduction in Microglia Neuroinflammation.

    Science.gov (United States)

    Liu, Hui-Juan; Lai, Xin; Xu, Yan; Miao, Jing-Kun; Li, Chun; Liu, Jing-Ying; Hua, Yuan-Yuan; Ma, Qian; Chen, Qixiong

    2017-01-01

    Temporal lobe epilepsy (TLE) is one of the most drug-resistant types of epilepsy with about 80% of TLE patients falling into this category. Increasing evidence suggests that neuroinflammation, which has a critical role in the epileptogenesis of TLE, is associated with microglial activation. Therefore, agents that act toward the alleviation in microglial activation and the attenuation of neuroinflammation are promising candidates to treat TLE. α-Asarone is a major active ingredient of the Acori Graminei Rhizoma used in Traditional Chinese Medicine, which has been used to improve various disease conditions including stroke and convulsions. In addition, an increasing number of studies suggested that α-asarone can attenuate microglia-mediated neuroinflammation. Thus, we hypothesized that α-asarone is a promising neuroprotective agent for the treatment of the TLE. The present study evaluated the therapeutic effects of α-asarone on microglia-mediated neuroinflammation and neuroprotection in vitro and in vivo , using an untreated control group, a status epilepticus (SE)-induced group, and an SE-induced α-asarone pretreated group. A pilocarpine-induced rat model of TLE was established to investigate the neuroprotective effects of α-asarone in vivo . For the in vitro study, lipopolysaccharide (LPS)-stimulated primary cultured microglial cells were used. The results indicated that the brain microglial activation in the rats of the SE rat model led to important learning and memory deficit. Preventive treatment with α-asarone restrained microglial activation and reduced learning and memory deficit. In the in vitro studies, α-asarone significantly suppressed proinflammatory cytokine production in primary cultured microglial cells and attenuated the LPS-stimulated neuroinflammatory responses. Our mechanistic study revealed that α-asarone inhibited inflammatory processes by regulation the transcription levels of kappa-B, by blocking the degradation pathway of kappa B

  16. Behandlingsrefraktaert status epilepticus med letal rabdomyolyse

    DEFF Research Database (Denmark)

    Kreft, Andreas; Rasmussen, Niels; Hansen, Lars Kjaersgård

    2008-01-01

    We are reporting two cases of SE with lethal rhabdomyolysis. Both were treated according to the guidelines on antiepileptic drug management by the Danish Paediatric Society, with one and two hours' delay, respectively. Intubation and midazolam infusion were needed to control seizures. After...... approximately one day both developed severe rhabdomyolysis with progressive DIC and acute renal failure, causing death despite intensive care, including acute hemodialysis. The aim of this case report is to emphasise one of the rare but severe consequences of SE and also to suggest that patients with known...

  17. Alterações agudas dos níveis de neurotransmissores em corpo estriado de ratos jovens após estado epiléptico induzido por pilocarpina Acute alterations of neurotransmitters levels in striatum of young rat after pilocarpine-induced status epilepticus

    Directory of Open Access Journals (Sweden)

    Rivelilson Mendes de Freitas

    2003-06-01

    Full Text Available Altas doses de agonista colinérgico muscarínico, pilocarpina, produzem alterações comportamentais, convulsões e estado epiléptico em ratos. O objetivo desse estudo foi verificar as alterações nas concentrações dos neurotransmissores em corpo estriado de ratos em desenvolvimento após estado epiléptico induzido pela pilocarpina. Ratas Wistar foram tratadas com uma única dose de pilocarpina (400mg/Kg; s.c.. Controles receberam salina. A concentração dos neurotransmissores foi determinada através do HPLC, no corpo estriado de ratos que no período de observação de 1 e 24h desencadearam estado epiléptico e não sobreviveram à fase aguda do quadro convulsivo. Foi observada redução nos níveis de dopamina, serotonina, ácido dihidroxifenilacético, ácido 5-hidroxiindolacético, e aumento no ácido 4-hidroxi-3-metoxi-fenilacético. Os resultados mostraram que a ativação do sistema colinérgico pode interagir com os sistemas dopaminérgico e serotonérgico nos mecanismos referentes à fase aguda do processo convulsivo.High doses of the muscarinic cholinergic agonist, pilocarpine, result in behavioural changes, seizures and status epilepticus in rats. The purpose of the present work is to invetigate the striatal neurotransmissors level in young rats after status epilepticus induced by pilocarpine. Wistar rats were treated with a single dose of pilocarpine (400mg/Kg; s.c.. Controls received saline. Young animals were closed observed for behavioural changes during 1 and 24h. In these periods, the animals that developed status epilepticus and didn't survive this acute phase of seizures had the brains removed and striatal neurotransmissors level determined by HPLC. The concentration of dopamine, serotonine, dihydroxyphenylacetic acid, 5-hydroxyindolacetic acid was reduced and an increase in 4-hydroxy-3-methoxy-phenylacetic acid was observed. These results suggest that cholinergic activation can interage with dopaminergic and

  18. Identification and Characterization of Cefazolin-Induced Liver Injury.

    Science.gov (United States)

    Alqahtani, Saleh A; Kleiner, David E; Ghabril, Marwan; Gu, Jiezhun; Hoofnagle, Jay H; Rockey, Don C

    2015-07-01

    Cephalosporin antibiotics are popular because they have a broad spectrum of activity and are generally well tolerated; however, cephalosporin-induced liver injury is considered rare. We describe a new syndrome associated with a single intravenous dose of cefazolin and the clinical features of cephalosporin-induced liver injury. The Drug-Induced Liver Injury (DILI) Network collected detailed clinical data on 1212 patients with DILI between 2004 and 2012. We analyzed data from 41 patients in whom cephalosporins were implicated as primary agents of liver disease; 33 formally were adjudicated as having cephalosporin-induced DILI. Nineteen patients developed clinically apparent DILI after a single intravenous dose of cefazolin. All patients developed self-limited liver injury 3 to 23 days after receiving cefazolin during surgery-often during a minor outpatient procedure. The latency period was 20 days. Clinical features included itching, jaundice, nausea, fever, and rash. Laboratory abnormalities included a mixed or cholestatic pattern of serum enzyme increases. We identified 14 more patients with DILI attributed to other cephalosporins (5 first-generation, 2 second-generation, 6 third-generation, and 1 fourth-generation agent). Although latency and injury patterns were similar for cefazolin and other cephalosporins, the other cephalosporins were associated with more severe courses of injury, including 2 deaths from liver failure. DILI can develop after a single dose of cefazolin. It is characterized by a latency period of 1 to 3 weeks after exposure, a cholestatic biochemical pattern, and a self-limited moderate to severe clinical course. Other cephalosporins can cause a similar but more severe injury. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  19. A Viable Neuroprotection Strategy Following Soman-induced Status Epilepticus

    Science.gov (United States)

    2003-12-01

    diminishes when treatment is delayed for 40 minutes or more (e.g., Lipp, 1972, 1973; Shih, 1990; Shih et al., 1991; Capacio and Shih, 1991; Philippens ...following seizure induction (e.g., Lipp, 1972, 1973; Shih, 1990; Shih et al., 1991; Capacio and Shih, 1991; Philippens et al., 1992; Sparenborg et al...Bruijnzeel PL, Carpentier P, Kulig BM, Lallement G, Melchers BP, Philippens IH and van Huygevoort AH. Beneficial effects of TCP on soman intoxication in

  20. A case of nonconvulsive status epilepticus presenting as ...

    African Journals Online (AJOL)

    He also left home many times, and remembered nothing about the period he had been away after he returned. He was hospitalised with a preliminary diagnosis of dissociative fugue. He had recurrent episodes with dissociative symptoms during his stay in the hospital. An electroencephalogram (EEG) and a 24-hour video ...

  1. Status of memory loss.

    LENUS (Irish Health Repository)

    Iyer, Parameswaran Mahadeva

    2012-01-01

    A 72-year-old woman presented with first onset of seizure with no prior history of cognitive dysfunction. EEG revealed focal non-convulsive status epilepticus. MRI brain showed a left temporal non-enhancing lesion. Temporal pole biopsy showed acute neuronal necrosis and astrocyte hyperplasia together with extensive amyloid plaques and neurofibrillary tangles. Perivascular oligodendroglial hyperplasia was present. Postmortem examination revealed extensive plaque and tangle disease. Perivascular oligodendroglial hyperplasia was limited to the left temporal area. The presence of focal perivascular oligodendroglial hyperplasia in the left temporal cortex, combined with extensive plaque and tangle disease may have contributed to the focal status epilepticus in this patient. Although the presence of focal perivascular oligodendroglial hyperplasia has been reported in cases of temporal lobe epilepsy, it has not been reported as a cause of seizure in patients with Alzheimer\\'s disease previously. Further studies for clinical-pathologic correlation would be required to confirm this hypothesis.

  2. Nonconvulsive status epilepticus and Creutzfeldt–Jakob-like EEG changes in a case of lithium toxicity

    Directory of Open Access Journals (Sweden)

    B.K. Madhusudhan

    2014-01-01

    This case highlights the importance of therapeutic drug-level monitoring of lithium, especially where toxicity is suspected, and the important role electroencephalography plays in diagnosing NCSE and its management.

  3. Isoniazid-induced status epilepticus in a pediatric patient after inadequate pyridoxine therapy.

    Science.gov (United States)

    Minns, Alicia B; Ghafouri, Nazli; Clark, Richard F

    2010-05-01

    Isoniazid (INH) is an effective treatment for tuberculosis and among the most common causes of drug-induced seizures in the United States. Isoniazid intoxication produces a characteristic clinical syndrome including seizures, metabolic acidosis, and, in severe cases, respiratory depression and coma. A 10-month-old male infant was presented after being found with his father's INH. The patient was brought to a local hospital where he had a witnessed generalized seizure and was given 650 mg pyridoxine intravenously, which was based on a 70 mg/kg recommendation. Five hours after the time of ingestion, the patient developed recurrent generalized seizures. He was given diazepam and then loaded with phenobarbital 20 mg/kg, while awaiting more pyridoxine from the pharmacy. He received an additional 2 g pyridoxine for a suspected ingestion of approximately 2.7 g INH (290 mg/kg total dose), and his seizures subsequently resolved. Treatment of INH toxicity must address correction of gamma-aminobutyric acid deficiency with pyridoxine replacement and management of life-threatening events. For poisonings in which the amount of INH ingested is known, pyridoxine is dosed on a gram-for-gram basis. Several reference textbooks recommend pyridoxine dosing in children to be 70 mg/kg. This was the justification for the initial pyridoxine dose administered in our case. However, after review of the referenced literature, the rationale supporting this recommendation remains unclear. Benzodiazepines should also be given with pyridoxine as they have been shown to have a synergistic effect in terminating seizures in animal models. As soon as possible after INH overdose is suspected or diagnosed, pyridoxine should be administered in a dose approximately equal to the estimated amount of INH ingested regardless of the age of the patient.

  4. Hyperthermia aggravates status epilepticus-induced epileptogenesis and neuronal loss in immature rats

    Czech Academy of Sciences Publication Activity Database

    Suchomelová, L.; Lopes-Meraz, M. L.; Niquet, J.; Kubová, Hana; Wasterlain, C. G.

    2015-01-01

    Roč. 305, Oct 1 (2015), s. 209-224 ISSN 0306-4522 R&D Projects: GA ČR(CZ) GAP302/10/0971; GA MŠk(CZ) ME08045; GA MŠk(CZ) LC554 Institutional support: RVO:67985823 Keywords : neuronal injury * temperature * immature brain * lithium /pilocarpine model * EEG monitoring Subject RIV: FH - Neurology Impact factor: 3.231, year: 2015

  5. Interstrain differences in cognitive functions in rats in relation to status epilepticus

    Czech Academy of Sciences Publication Activity Database

    Hort, J.; Brožek, Gustav; Komárek, V.; Langmeier, M.; Mareš, Pavel

    2000-01-01

    Roč. 112, - (2000), s. 77-83 ISSN 0166-4328 R&D Projects: GA MZd IZ2904; GA MZd IZ3510; GA AV ČR KSK2011602 Grant - others:GA UK(XC) 25/1966 Subject RIV: ED - Physiology Impact factor: 2.263, year: 2000

  6. Status epilepticus in immature rats leads to behavioural and cognitive impairment and epileptogenesis

    Czech Academy of Sciences Publication Activity Database

    Kubová, Hana; Mareš, Pavel; Suchomelová, Lucie; Brožek, Gustav; Druga, Rastislav; Pitkanen, A.

    2004-01-01

    Roč. 19, č. 12 (2004), s. 3255-3265 ISSN 0953-816X R&D Projects: GA MZd NF6474; GA ČR GA309/01/0285 Institutional research plan: CEZ:AV0Z5011922 Keywords : epilepsy * elevated plus-maze * Morris water-maze Subject RIV: FH - Neurology Impact factor: 3.820, year: 2004

  7. Cannabidiol Regulates Long Term Potentiation Following Status Epilepticus: Mediation by Calcium Stores and Serotonin

    Directory of Open Access Journals (Sweden)

    Nicola Maggio

    2018-02-01

    Full Text Available Epilepsy is a devastating disease, with cognitive and emotional consequences that are not curable. In recent years, it became apparent that cannabinoids help patients to cope with epilepsy. We have studied the effects of cannabidiol (CBD on the ability to produce long term potentiation (LTP in stratum radiatum of CA1 region of the mouse hippocampus. Exposure to seizure-producing pilocarpine reduced the ability to generate LTP in the slice. Pre-exposure to CBD prevented this effect of pilocarpine. Furthermore, CBD caused a marked increase in ability to generate LTP, an effect that was blocked by calcium store antagonists as well as by a reduction in serotonin tone. Serotonin, possibly acting at a 5HT1A receptor, or fenfluramine (FFA, which causes release of serotonin from its native terminals, mimicked the effect of CBD. It is proposed that CBD enhances non-NMDA LTP in the slice by facilitating release of serotonin from terminals, consequently ameliorating the detrimental effects of pilocarpine.

  8. Cannabidiol Regulates Long Term Potentiation Following Status Epilepticus: Mediation by Calcium Stores and Serotonin.

    Science.gov (United States)

    Maggio, Nicola; Shavit Stein, Efrat; Segal, Menahem

    2018-01-01

    Epilepsy is a devastating disease, with cognitive and emotional consequences that are not curable. In recent years, it became apparent that cannabinoids help patients to cope with epilepsy. We have studied the effects of cannabidiol (CBD) on the ability to produce long term potentiation (LTP) in stratum radiatum of CA1 region of the mouse hippocampus. Exposure to seizure-producing pilocarpine reduced the ability to generate LTP in the slice. Pre-exposure to CBD prevented this effect of pilocarpine. Furthermore, CBD caused a marked increase in ability to generate LTP, an effect that was blocked by calcium store antagonists as well as by a reduction in serotonin tone. Serotonin, possibly acting at a 5HT1A receptor, or fenfluramine (FFA), which causes release of serotonin from its native terminals, mimicked the effect of CBD. It is proposed that CBD enhances non-NMDA LTP in the slice by facilitating release of serotonin from terminals, consequently ameliorating the detrimental effects of pilocarpine.

  9. Changes in cytochrome oxidase in the piriform cortex after status epilepticus in adult rats

    Czech Academy of Sciences Publication Activity Database

    Otáhal, Jakub; Suchomelová, Lucie; Druga, Rastislav; Kubová, Hana

    2005-01-01

    Roč. 46, Suppl. 5 (2005), s. 89-93 ISSN 0013-9580 R&D Projects: GA ČR(CZ) GA309/03/0770 Institutional research plan: CEZ:AV0Z5011922 Keywords : seizures * lithium-pilocarpine * piriform cortex Subject RIV: ED - Physiology Impact factor: 3.227, year: 2005

  10. The cannabinoid receptor agonist WIN55.212 reduces consequences of status epilepticus in rats

    NARCIS (Netherlands)

    Suleymanova, E.M.; Shangaraeva, V.A.; Rijn, C.M. van; Vinogradova, L.V.

    2016-01-01

    An acute brain insult can cause a spectrum of primary and secondary pathologies including increased risk for epilepsy, mortality and neurodegeneration. The endocannabinoid system, involved in protecting the brain against network hyperexcitability and excitotoxicity, is profoundly dysregulated by

  11. Rare presentation of a common disease: Idiopathic hypoparathyroidism presenting with extrapyramidal symptoms and status epilepticus

    Directory of Open Access Journals (Sweden)

    Kaushik Ghosh

    2012-01-01

    Full Text Available We report of an 18-year-old male who presented with an epileptiform disorder, features of hypocalcemia, and an extrapyramidal symptom in the form of choreoathetosis. On evaluation he had idiopathic hypoparathyroidism with extensive calcifications in the extrapyramidal system of the brain; basal ganglion, as well as in the cerebral cortex and cerebellum, which is a rare entity. We report the rare presentation of a common disorder, which requires to be considered in evaluating hypoparathyroidism.

  12. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus

    DEFF Research Database (Denmark)

    Leitinger, M.; Trinka, E.; Gardella, E.

    2016-01-01

    Hospital, Aarhus, Denmark; and Paracelsus Medical University, Salzburg, Austria). Participants were included from the Danish centres if they were aged 4 months or older, and from the Austrian centre if aged 18 years or older. Participants were sorted into two groups: consecutive patients under clinical...

  13. Brain metabolism and diffusion in the rat cerebral cortex during pilocarpine-induced status epilepticus

    Czech Academy of Sciences Publication Activity Database

    Šlais, Karel; Voříšek, Ivan; Zoremba, N.; Homola, Aleš; Dmytrenko, Lesia; Syková, Eva

    2008-01-01

    Roč. 209, č. 1 (2008), s. 145-154 ISSN 0014-4886 R&D Projects: GA MŠk 1M0538; GA MŠk(CZ) LC554 Grant - others:EU(DE) 512146 Institutional research plan: CEZ:AV0Z50390512; CEZ:AV0Z50390703 Source of funding: R - rámcový projekt EK Keywords : Diffusion * Microdialysis * Pilocarpine Subject RIV: FH - Neurology Impact factor: 3.974, year: 2008

  14. Nerve Agent Induced Status Epilepticus: From Seizure Onset to Long Lasting Pathology

    Science.gov (United States)

    2014-01-31

    mucosa (rhinorrhea), miosis, failure of accommodation ( ciliary muscle paralysis ), and abdominal cramps (26; 289). As symptoms progress, bronchorrhea...fasciculations, convulsions, and paralysis (skeletal muscles including diaphragm and intercostal muscles) (26). In the CNS, muscarinic and nicotinic symptoms...LL, Lowe JS, Woolley TW. 2004. Clonazepam for treatment of sleep disturbances associated with combat-related posttraumatic stress disorder. Ann

  15. Effect of the endocannabinoid receptor agonist Win-55 212-2 on early electrographic changes in a post-status model of epileptogenesis

    NARCIS (Netherlands)

    Suleymanova, E.M.; Blik, V.; Rijn, C.M. van; Vinogradova, L.V.

    2015-01-01

    Purpose: This study was performed to investigate whether stimulation of endocannabinoid system early after status epilepticus (SE) could prevent or modify the subsequent epileptogenesis. We studied the effect of an agonist of endocannabinoid receptors, WIN-55 212-2, on electrographic features during

  16. The Acute Phase Response and Soman-Induced Status Epilepticus: Temporal, Regional and Cellular Changes in Rat Brain Cytokine Concentrations

    Science.gov (United States)

    2010-07-22

    Deleterious effects of IL-9-activated mast cells and neuroprotection by antihistamine drugs in the developing mouse brain. Pediatr Res 2001, 50:222-230. 20...evidence. Epilepsia 2005, 46:1724-1743. 14. Wallenstein MC: Attenuation of penicillin models of epilepsy by nonsteroidal anti-inflammatory drugs . Exp

  17. Interleukin-18 Expression Increases in Response to Neurovascular Damage Following Soman-induced Status Epilepticus in Rats

    Science.gov (United States)

    2015-07-22

    CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit Johnson et al. Journal of Inflammation (2015) 12:43 Page 11 of 11

  18. Pathophysiological Alterations In The Basolateral Amygdala And Neurodegeneration Of Limbic Structures During Epileptogenesis Induced By Status Epilepticus

    Science.gov (United States)

    2009-02-05

    pedestal (MS363; Plastics ONE Inc., Roanoke, VA) and attached to the skull with dental acrylic cement . Anesthesia was reversed by i.p. injection of 1 mg/kg...Armentia M, Power J (2003) The amgydaloid complex: anatomy and physiology. Physiol Rev 83:803-34. Salazar AM, Jabbari B, Vance SC, Grafman J, Amin D

  19. Cognitive functions after pilocarpine-induced status epilepticus: changes during silent priod precede appearance of spontaneous recurrent seizures

    Czech Academy of Sciences Publication Activity Database

    Hort, J.; Brožek, Gustav; Mareš, Pavel; Langmeier, M.; Komárek, V.

    1999-01-01

    Roč. 40, č. 9 (1999), s. 1177-1183 ISSN 0013-9580 R&D Projects: GA ČR GA309/96/1592; GA MZd IZ2904; GA MZd IZ3510; GA AV ČR IAA7011603 Subject RIV: ED - Physiology Impact factor: 3.218, year: 1999

  20. Group II metabotropic glutamate receptor agonist may reduce behavioural deficit induced by early status epilepticus in adult rats

    Czech Academy of Sciences Publication Activity Database

    Alaverdashvili, Mariam; Kaminskij, Julij; Haugvicová, Renata; Folbergrová, Jaroslava

    2005-01-01

    Roč. 46, č. S6 (2005), s. 203-203 ISSN 0013-9580. [International Epilepsy Congress /26./. 28.08.2005-01.09.2005, Paris] R&D Projects: GA ČR(CZ) GA309/02/1238 Institutional research plan: CEZ:AV0Z50110509 Keywords : APDC * memory * cognitive functions Subject RIV: ED - Physiology

  1. Status epilepticus in 12 day old rats leads to temporal lobe neurodegeneration and volume reduction: A histologic and MRI study

    Czech Academy of Sciences Publication Activity Database

    Nairismägi, J.; Pitkänen, A.; Kettunen, M. I.; Kauppinen, R. A.; Kubová, Hana

    2006-01-01

    Roč. 47, č. 3 (2006), s. 479-488 ISSN 0013-9580 R&D Projects: GA ČR(CZ) GA304/05/2582 Institutional research plan: CEZ:AV0Z50110509 Keywords : amygdala * epileptogenesis * hippocampus Subject RIV: ED - Physiology Impact factor: 3.526, year: 2006

  2. Neuronal degeneration induced by status epilepticus in the thalami reuniens nucleus of immature rats. Are calcium binding proteins neuroprotective?

    Czech Academy of Sciences Publication Activity Database

    Druga, Rastislav; Kubová, Hana; Mareš, Pavel

    2006-01-01

    Roč. 47, č. S4 (2006), s. 302-302 ISSN 0013-9580. [Annual Meeting of the American Epilepsy Society and Canadian League against Epilepsy. 01.12.2006-05.12.2006, San Diego, CA] R&D Projects: GA ČR(CZ) GA304/04/0464 Institutional research plan: CEZ:AV0Z50110509 Keywords : pilocarpine * neurodegeneration * nucleus reuniens Subject RIV: ED - Physiology

  3. Nonconvulsive status epilepticus in the elderly associated with newer antidepressants used at therapeutic doses: A report of three cases

    Directory of Open Access Journals (Sweden)

    Go Taniguchi

    2015-01-01

    All three patients were male and were 73 years of age or older. One patient was recently diagnosed with temporal lobe epilepsy and treated with low-dose lamotrigine. In all patients, newer antidepressants were initiated because of depressive symptoms. After titrating to therapeutic doses (paroxetine 20 mg/day, sertraline 50 mg/day, and combination of sertraline 50 mg/day and mirtazapine 30 mg/day in one patient each, impaired consciousness appeared. Electroencephalography (EEG showed generalized slow waves with intermittent spike–slow-wave complexes. Intravenous injection of antiepileptic drugs improved EEG findings and clinical symptoms. After discontinuance of the abovementioned antidepressants, NCSE did not recur in any of patients. These reports raise the question of whether the newer antidepressants, like classic antidepressants, might also induce NCSE in the elderly, even when used at therapeutic doses. Physicians should consider monitoring for possible NCSE when using newer antidepressants in patients who may have low drug tolerability. Active continuous video-EEG monitoring is essential when behavioral and psychological symptoms or change in consciousness level is suspected.

  4. Tiagabine: efficacy and safety in partial seizures – current status

    Directory of Open Access Journals (Sweden)

    Jürgen Bauer

    2008-09-01

    Full Text Available Jürgen Bauer, Déirdre Cooper-MahkornDepartment of Epileptology, Bonn University Hospital, GermanyAbstract: Tiagabine hydrochloride (TGB is a selective gamma-aminobutyric acid (GABA reuptake inhibitor. TGB is effective as an add-on medication in adults and children 12 years and older in the treatment of partial seizures. Results of nonrandomized add-on trials with TGB show treatment success with seizure reduction of at least 50% in 33% to 46% of patients. In newly diagnosed patients with partial epilepsy, TGB monotherapy was as effective as carbamazepine. Comedication with TGB elevates the risk of nonconvulsive status (7.8% vs 2.7% without TGB. The most common side effects include dizziness/lightheadedness, asthenia/lack of energy and somnolence. TGB has no negative effects on cognition; it does not increase the risk of fractures or rash. TGB may interfere with color perception. TGB presents an intermediate risk for depression in patients with epilepsy (approximately 4%. Regarding the risk of overdose, 96–680 mg TGB (mean 224 mg caused seizures or coma. TGB is an antiepileptic drug exhibiting a specific anticonvulsive mechanism of action, the efficacy of which is relatively low when used in comedication. Critical side effects, such as the induction of nonconvulsive status epilepticus, further limit its use.Keywords: epilepsy, tiagabine, antiepileptic drugs, status epilepticus, pharmacotherapy

  5. Practice parameters in management of status epileptics

    Directory of Open Access Journals (Sweden)

    Usha Kant Misra

    2014-01-01

    Full Text Available Status epilepticus (SE is an emergency neurological problem, more common in the developing countries due to high incidence of infection, stroke and head injury. The protocol for management of SE is intravenous benzodiazepine, followed by phenytoin, valproate (VPA and phenobarbitone and if uncontrolled general anesthesia (GA. World Federation of Neurology recommends special guidelines for resource poor countries. Use of GA results in hypotension and respiratory depression needing intensive care management. There is a paucity of intensive care facilities hence the recommended antiepileptic drugs (AEDs which have inherent toxicity of hypotension and respiratory failure cannot be given safely. Under these situations AEDs such as VPA, levetiracetam and lacosamide may be evaluated in SE because of cardiovascular and respiratory safety profile. In this review, the limitations of existing guidelines in the developing countries have been discussed and a way forward has been suggested.

  6. Long-lasting increased excitability differs in dentate gyrus vs. CA1 in freely moving chronic epileptic rats after electrically induced status epilepticus

    NARCIS (Netherlands)

    Gorter, Jan A.; van Vliet, Erwin A.; Aronica, Eleonora; Lopes da Silva, Fernando H.

    2002-01-01

    A paired-pulse (PP) stimulation protocol was used to examine changes in field potentials (fEPSPs), locally evoked in CA1 via Schaffer/ commissural fiber stimulation and in the dentate gyrus (DG) through angular bundle stimulation, in freely moving epileptic rats. This epilepsy model is characterized

  7. N-w-Propyl-L-arginine (L-NPA) reduces status epilepticus and early epileptogenic events in a mouse model of epilepsy: behavioural, EEG and immunohistochemical analyses

    Czech Academy of Sciences Publication Activity Database

    Beamer, E.; Otáhal, Jakub; Sills, G.J.; Thippeswamy, T.

    2012-01-01

    Roč. 36, č. 9 (2012), s. 3194-3203 ISSN 0953-816X R&D Projects: GA ČR(CZ) GAP303/10/0999 Institutional research plan: CEZ:AV0Z50110509 Institutional support: RVO:67985823 Keywords : aberrant sprouting * gliosis * nitric oxide * seizure * telemetry Subject RIV: FH - Neurology Impact factor: 3.753, year: 2012

  8. The ketogenic diet in patients with myoclonic status in non-progressive encephalopathy.

    Science.gov (United States)

    Caraballo, Roberto; Darra, Francesca; Reyes, Gabriela; Armeno, Marisa; Cresta, Araceli; Mestre, Graciela; Bernardina, Bernardo Dalla

    2017-10-01

    Myoclonic status in non-progressive encephalopathy (MSNPE) is characterized by the recurrence of long-lasting atypical status epilepticus associated with attention impairment and continuous polymorphous jerks, mixed with other complex abnormal movements, in infants suffering from a non-progressive encephalopathy. The ketogenic diet (KD) has been used as an alternative to antiepileptic drugs (AEDs) for patients with refractory epileptic encephalopathies. In this study we assess the efficacy and tolerability of the KD in patients with MSNPE. Between March 1, 1980 and August 31, 2013, 99 patients who met the diagnostic criteria of MSNPE were seen (58 patients in Verona and 41 patients in Buenos Aires). Six of these 99 patients were placed on the KD using the Hopkins protocol and followed for a minimum period of 24 months. Twelve months after initiating the diet, three patients had a 75%-99% decrease in seizures, two had a 50%-74% decrease in seizures, and the remaining child had a less than 50% seizure reduction. In five patients with a seizure reduction of more than 50%, the myoclonic status epilepticus disappeared within 6 months after starting the diet. All patients had very good tolerability and no adverse events were identified. In most of the patients AEDs were reduced. The KD is a promising therapy for MSNPE, with most of our patients showing a more than 50% seizure reduction. In patients that responded well to the diet cognitive performance and quality of life also improved. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  9. Role of cranial imaging in epileptic status

    Energy Technology Data Exchange (ETDEWEB)

    Nair, Pradeep P.; Kalita, Jayantee [Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014 (India); Misra, Usha K. [Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014 (India)], E-mail: drukmisra@rediffmail.com

    2009-06-15

    Introduction: There is paucity of studies evaluating the role of cranial imaging in the management of status epilepticus (SE); therefore this study evaluates the role of imaging in predicting the outcome of SE. Methods: Consecutive patients with SE were prospectively evaluated. Clinical evaluation, blood counts, serum chemistry and cerebrospinal fluid (CSF) were carried out. Cranial CT scan was performed on a spiral CT and MRI on a 1.5 T scanner. Patients were treated with IV sodium valproate, phenytoin and benzodiazepines as per fixed protocol. Outcome was defined as seizure control at 1 h and mortality. Various clinical and radiological parameters were correlated. Results: There were 99 patients with SE whose mean age was 35 (1-78) years, 40 females and 17 were below 12 years of age. Fifty six patients had central nervous system (CNS) infections, 15 strokes, 13 metabolic encephalopathy, 5 drug default and in the remaining 10 patients various acute symptomatic causes were present. Cranial imaging was abnormal in 59% patients. CT was abnormal in 21 (47.7%) out of 44 patients whereas MRI was abnormal in 26 (63.4%) out of 41 patients. Both MRI and CT were carried out in 14 patients and 12 revealed abnormalities; 2 had abnormality only on MRI. Imaging revealed cortical lesions in 10, subcortical in 19 and both cortical as well as subcortical in 30 patients. One hour seizure control was achieved in 60, seizures recurred within 24 h in 38 and 27 patients died during hospital stay. Seizure type, duration of SE, seizure control at 1 h and mortality did not correlate with radiological abnormalities. Conclusion: Cranial imaging reveals structural abnormality in 59% patients with SE and was not related to SE control and mortality.

  10. Stock Status

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These data inform the public of the most recent stock status for all stocks (FSSI and non-FSSI) in the fishery management unit contained in a fishery managment plan....

  11. STATUS REPORT

    Indian Academy of Sciences (India)

    First page Back Continue Last page Graphics. STATUS REPORT. Raman scattering observed – 90, 135, 180 degrees and back scattering. Traditionally specific angle dependence to learn about polarization response. Learn molecular information from the surface or materials just below the surface (upto 12 mm depth) ...

  12. Compliance status

    International Nuclear Information System (INIS)

    Black, D.G.

    1995-01-01

    This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford's compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute

  13. Increased Expression of the Chemokines CXCL1 and MIP-1a by Resident Brain Cells Precedes Neutrophil Infiltration in the Brain Following Prolonged Soman-Induced Status Epilepticus in Rats

    Science.gov (United States)

    2011-05-01

    the neuroinflamma- tory response by inducing the synthesis of acute phase response cytokines interleukin (IL)-1, IL-6 and tumor necrosis factor-a in...References 1. Shih TM: Anticonvulsant effects of diazepam and MK-801 in soman poisoning. Epilepsy Res 1990, 7:105-116. 2. Lallement G, Pernot-Marino I...Yoshida Y: Effects of shear stress on glycosaminoglycan synthesis in vascular endothelial cells. Ann N Y Acad Sci 1995, 748:543-554. 53. Gallagher JT

  14. USCIS My Case Status

    Data.gov (United States)

    Department of Homeland Security — USCIS provide a way for the public who applied for U.S. citizenship to check the status of their application online. To view the status of a case, the application...

  15. Innovations, status, and networks

    NARCIS (Netherlands)

    P. Wang (Pengfei)

    2016-01-01

    markdownabstractTo obtain and maintain competitive advantage, firms need to implement appropriate innovation strategies (i.e. exploration or exploitation) and acquire status in external networks. In this dissertation, I investigate how innovation strategy, status, and network structure jointly

  16. Heuristic status polling

    Science.gov (United States)

    Archer, Charles J [Rochester, MN; Blocksome, Michael A [Rochester, MN; Heidelberger, Philip [Cortlandt Manor, NY; Kumar, Sameer [White Plains, NY; Parker, Jeffrey J [Rochester, MN; Ratterman, Joseph D [Rochester, MN

    2011-06-07

    Methods, compute nodes, and computer program products are provided for heuristic status polling of a component in a computing system. Embodiments include receiving, by a polling module from a requesting application, a status request requesting status of a component; determining, by the polling module, whether an activity history for the component satisfies heuristic polling criteria; polling, by the polling module, the component for status if the activity history for the component satisfies the heuristic polling criteria; and not polling, by the polling module, the component for status if the activity history for the component does not satisfy the heuristic criteria.

  17. Service Level Status

    CERN Multimedia

    Lopienski, S

    2007-01-01

    Nowadays, IT departments provide, and people use, computing services of an increasingly heterogeneous nature. There is thus a growing need for a status display that groups these different services and reports status and availability in a uniform way. The Service Level Status (SLS) system addresses these needs by providing a web-based display that dynamically shows availability, basic information and statistics about various IT services, as well as the dependencies between them.

  18. SIS - Status Determination

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Status Determination dataset within the Species Information System (SIS) contains information related to overfishing, overfished, and approaching overfished...

  19. Status of numerical relativity

    Indian Academy of Sciences (India)

    Abstract. I describe the current status of numerical relativity from my personal point of view. Here, I focus mainly on explaining the numerical implementations necessary for simulating general relativistic phenomena such as the merger of compact binaries and stellar collapse, emphasizing the well-developed current status of ...

  20. Morocco: Country Status Report.

    Science.gov (United States)

    McFerren, Margaret

    A survey of the status of language usage in Morocco begins with an overview of the distribution and usage of Arabic, the official language, the Berber dialects, and French, an unofficial second language. The continuing high status and widespread use of French despite arabization efforts is discussed. A matrix follows that rates these languages and…

  1. Status of numerical relativity

    Indian Academy of Sciences (India)

    I describe the current status of numerical relativity from my personal point of view. Here, I focus mainly on explaining the numerical implementations necessary for simulating general relativistic phenomena such as the merger of compact binaries and stellar collapse, emphasizing the well-developed current status of such ...

  2. STATUS GIZI DAN STATUS KESEHATAN SUKU BADUY

    Directory of Open Access Journals (Sweden)

    Faisal Anwar

    2012-03-01

    Full Text Available 800x600 Normal 0 false false false IN X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} The objectives of the study were: (1 To analyze the socio-economic and demographic characteristics of Baduy people; (2 To analyze the health status and nutritional status of Baduy people and its influential factors. This research is an explorative and descriptive study on the socio-cultural aspects of food system. The data were collected through a direct interview and discussion with respondents as well as a direct observation at the location of respondents. A sample size of 338 households was drawn from the population. To obtain the data on the cultural aspects, history and  socio aspect of food, in-depth interviews was conducted with 19 key persons. The study was last for 12 months. In Outer Baduy, the factors significantly related to nutritional status are age, number of household size, income, nutritional knowledge, and wife’s ability to read. In Moslem Baduy, only age and income are related to the nutritional status of children. In Moslem Baduy and the Outer Baduy, the correlation between age and W/A or W/H is similar: namely, the higher the age, the lower would the Z-score for the W/A or W/H. The income is significantly correlated to the child nutritional status according to Z-score for W/A with a high correlation coefficient, that is, 0.61. This means that the higher the income, the higher would be the Z-score value for the W/A.  The distribution of adults according to BMI classification in Outer Baduy it shows that 12.7% husbands and 17.6% wives are thin (wasted, while the

  3. Semantic Web status model

    CSIR Research Space (South Africa)

    Gerber, AJ

    2006-06-01

    Full Text Available by researchers and practitioners, spanning a vast landscape of different fields, technologies, concepts and application areas. Furthermore, there is confusion with regards to the current status of the enabling technologies envisioned to realise the Semantic Web...

  4. NAIP Status Maps Gallery

    Data.gov (United States)

    Farm Service Agency, Department of Agriculture — NAIP Status Maps Gallery. These maps illustrate what aerial imagery collection is planned, whats been collected, when it is available and how it is available. These...

  5. Micronutrient status in phenylketonuria

    NARCIS (Netherlands)

    Robert, M.; Rocha, J. C.; van Rijn, M.; Ahring, K.; Belanger-Quintana, A.; MacDonald, A.; Dokoupil, K.; Ozel, H. Gokmen; Lammardo, A. M.; Goyens, P.; Feillet, F.

    2013-01-01

    Patients with phenylketonuria (PKU) encompass an 'at risk' group for micronutrient imbalances. Optimal nutrient status is challenging particularly when a substantial proportion of nutrient intake is from non-natural sources. In PKU patients following dietary treatment supplementation with

  6. PRESENT STATUS IN INDIA

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. PRESENT STATUS IN INDIA. FIXED LINES – 36 MILLION. MOBILE CONNECTIONS – 14 MILLION. TELEDENSITY APPROXIMATELY 5. INTERNET CONNECTIONS – 5 MILLION. INTERNET USERS NEARLY – 25 MILLION.

  7. ANAIS status report

    Energy Technology Data Exchange (ETDEWEB)

    Amare, J; Borjabad, S; Cebrian, S; Cuesta, C; Fortuno, D; Garcia, E; Gomez, H; Morales, J; Ortigoza, Y; Ortiz de Solorzano, A; Pobes, C; Puimedon, J; Rodriguez, A; Sarsa, M L; Villar, J A, E-mail: cpobes@unizar.e [University of Zaragoza. C/Pedro Cerbuna 12, 50009. Zaragoza (Spain)

    2010-01-01

    We report the status of the ANAIS (Annual modulation with NAI Scintillators) experiment focusing on the developments towards the improvement of the background level of our detectors and the reduction of the energy threshold.

  8. Safety system status monitoring

    International Nuclear Information System (INIS)

    Lewis, J.R.; Morgenstern, M.H.; Rideout, T.H.; Cowley, P.J.

    1984-03-01

    The Pacific Northwest Laboratory has studied the safety aspects of monitoring the preoperational status of safety systems in nuclear power plants. The goals of the study were to assess for the NRC the effectiveness of current monitoring systems and procedures, to develop near-term guidelines for reducing human errors associated with monitoring safety system status, and to recommend a regulatory position on this issue. A review of safety system status monitoring practices indicated that current systems and procedures do not adequately aid control room operators in monitoring safety system status. This is true even of some systems and procedures installed to meet existing regulatory guidelines (Regulatory Guide 1.47). In consequence, this report suggests acceptance criteria for meeting the functional requirements of an adequate system for monitoring safety system status. Also suggested are near-term guidelines that could reduce the likelihood of human errors in specific, high-priority status monitoring tasks. It is recommended that (1) Regulatory Guide 1.47 be revised to address these acceptance criteria, and (2) the revised Regulatory Guide 1.47 be applied to all plants, including those built since the issuance of the original Regulatory Guide

  9. Safety system status monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, J.R.; Morgenstern, M.H.; Rideout, T.H.; Cowley, P.J.

    1984-03-01

    The Pacific Northwest Laboratory has studied the safety aspects of monitoring the preoperational status of safety systems in nuclear power plants. The goals of the study were to assess for the NRC the effectiveness of current monitoring systems and procedures, to develop near-term guidelines for reducing human errors associated with monitoring safety system status, and to recommend a regulatory position on this issue. A review of safety system status monitoring practices indicated that current systems and procedures do not adequately aid control room operators in monitoring safety system status. This is true even of some systems and procedures installed to meet existing regulatory guidelines (Regulatory Guide 1.47). In consequence, this report suggests acceptance criteria for meeting the functional requirements of an adequate system for monitoring safety system status. Also suggested are near-term guidelines that could reduce the likelihood of human errors in specific, high-priority status monitoring tasks. It is recommended that (1) Regulatory Guide 1.47 be revised to address these acceptance criteria, and (2) the revised Regulatory Guide 1.47 be applied to all plants, including those built since the issuance of the original Regulatory Guide.

  10. The influence of socioeconomic status on health resource utilization in pediatric epilepsy in a universal health insurance system.

    Science.gov (United States)

    Puka, Klajdi; Smith, Mary Lou; Moineddin, Rahim; Snead, O Carter; Widjaja, Elysa

    2016-03-01

    It is unknown if there is a disparity in health resource utilization (HRU) among children with epilepsy in a universal health insurance system. The aims of this study were to evaluate whether socioeconomic status (SES) influenced the pattern of HRU among children with epilepsy, and to determine if neurology visits were associated with emergency department (ED) visits and hospitalizations. Health administrative databases were used to identify HRU among children with epilepsy in Ontario, Canada. The frequency of neurology visits, ED visits, and hospitalizations were assessed for 1 year. SES was measured using dissemination area income and deprivation index. The association between SES and HRU was evaluated, adjusting for age, sex, residence, and comorbidities. Subsequently, we assessed whether neurology visits influenced ED visits and hospitalizations, adjusting for age, sex, residence, comorbidities, and SES. Deprivation index was a more sensitive measure of disparity in HRU than dissemination area income. Status epilepticus-related ED visits and hospitalizations were most expensive but accounted for a small proportion of total costs. Higher deprivation was associated with fewer neurology visits (relative risk [RR] 0.85-0.89), more frequent ED visits (RR 1.08-1.36), and hospitalizations (RR 1.27). Increased neurology visits were associated with more frequent ED visits (RR 1.10) and hospitalizations (RR 1.15). The associations between neurology visits and ED visits as well as hospitalizations varied by deprivation index, in that neurology visits were associated with increased ED visits and hospitalizations and the increase was higher in the most deprived relative to the least deprived (all p use that may require additional support to reduce ED visits and hospitalizations. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  11. 76 FR 34968 - Intent to Grant an Exclusive License of U.S. Government-Owned Inventions

    Science.gov (United States)

    2011-06-15

    ... Seizures Causing Status Epilepticus'', to Biomedisyn Corporation with its principal place of business at 12... FURTHER INFORMATION CONTACT: For licensing issues, Dr. Paul Mele, Office of Research & Technology...

  12. Fukushima Daiichi Status Report

    International Nuclear Information System (INIS)

    2012-01-01

    The IAEA issues regular status reports to the public on the current status of the Fukushima Daiichi Nuclear Power Plant, including information on environmental radiation monitoring, the status of workers, and current conditions on-site at the plant. The information cited in this report is compiled from official Japanese sources, including the Ministry of Economy, Trade and Industry (METI), the Nuclear and Industrial Safety Agency (NISA), the Ministry of Education, Culture, Sports, Science and Technology (MEXT), the Ministry of Land, Infrastructure, Transport and Tourism (MLIT), the Ministry of Health, Labour and Welfare (MHLW) and the Ministry of Foreign Affairs (MOFA) through the Japanese Permanent Mission in Vienna and the Cabinet's Office of the Prime Minister. Information is also provided by the Tokyo Electric Power Company (TEPCO), the operator of the Fukushima Daiichi Nuclear Power Plant.

  13. New Service Status Board

    CERN Multimedia

    2013-01-01

    On Monday 14 October, the Service Status Board for GS and IT will change. The new Status Board will be integrated with the CERN Service Portal and with the CERN Service Catalogue.   As of today, the SSB will display “Service Incidents”, “Planned Interventions” and “Service Changes”. References valid from 14 October: CERN SSB at https://cern.ch/ssb Computing SSB (previously IT SSB) at https://cern.ch/itssb   Nicole Cremel, IT and GS Service Management Support

  14. FRIB Cryogenic Plant Status

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, Kelly D. [Thomas Jefferson National Accelerator Facility (TJNAF), Newport News, VA (United States); Ganni, Venkatarao [Thomas Jefferson National Accelerator Facility (TJNAF), Newport News, VA (United States); Knudsen, Peter N. [Thomas Jefferson National Accelerator Facility (TJNAF), Newport News, VA (United States); Casagranda, Fabio [Michigan State Univ., East Lansing, MI (United States)

    2015-12-01

    After practical changes were approved to the initial conceptual design of the cryogenic system for MSU FRIB and an agreement was made with JLab in 2012 to lead the design effort of the cryogenic plant, many activities are in place leading toward a cool-down of the linacs prior to 2018. This is mostly due to using similar equipment used at CHLII for the 12 GeV upgrade at JLab and an aggressive schedule maintained by the MSU Conventional Facilities department. Reported here is an updated status of the cryogenic plant, including the equipment procurement status, plant layout, facility equipment and project schedule.

  15. Worldwide vitamin D status

    NARCIS (Netherlands)

    van Schoor, N.M.; Lips, P.T.A.M.

    2011-01-01

    The aim of the present study is to summarize existing literature on vitamin D levels in adults in different continents and different countries woldwide. The best determinant of vitamin D status is the serum concentration of 25-hydroxyvitamin D (25(OH)D). Most investigators agree that serum 25(OH)D

  16. Status, Numbers and Influence

    Science.gov (United States)

    Melamed, David; Savage, Scott V.

    2013-01-01

    We develop a theoretical model of social influence in n-person groups. We argue that disagreement between group members introduces uncertainty into the social situation, and this uncertainty motivates people to use status characteristics to evaluate the merits of a particular opinion. Our model takes the numerical distribution of opinions and the…

  17. Assessing intravascular fluid status

    African Journals Online (AJOL)

    perfusion such as urine output. or titration of fluid therapy with the goal of optimising haemodynamic status. Most practitioners agree that an underlying theme is ... their work is the understanding that at steady state venous return and cardiac output are equal, and that factors increasing venous return would enable a greater.

  18. Fusion safety status report

    International Nuclear Information System (INIS)

    1986-10-01

    This report includes information on a) tritium handling and safety; b) activation product generation and release; c) lithium safety; d) superconducting magnet safety; e) operational safety and shielding; f) environmental impact; g) recycling, decommissioning and waste management; and h) accident analysis. Recommendations for high priority research and development are presented, as well as the current status in each area

  19. Status and the brain.

    Directory of Open Access Journals (Sweden)

    Amanda V Utevsky

    2014-09-01

    Full Text Available Social hierarchy is a fact of life for many animals. Navigating social hierarchy requires understanding one's own status relative to others and behaving accordingly, while achieving higher status may call upon cunning and strategic thinking. The neural mechanisms mediating social status have become increasingly well understood in invertebrates and model organisms like fish and mice but until recently have remained more opaque in humans and other primates. In a new study in this issue, Noonan and colleagues explore the neural correlates of social rank in macaques. Using both structural and functional brain imaging, they found neural changes associated with individual monkeys' social status, including alterations in the amygdala, hypothalamus, and brainstem--areas previously implicated in dominance-related behavior in other vertebrates. A separate but related network in the temporal and prefrontal cortex appears to mediate more cognitive aspects of strategic social behavior. These findings begin to delineate the neural circuits that enable us to navigate our own social worlds. A major remaining challenge is identifying how these networks contribute functionally to our social lives, which may open new avenues for developing innovative treatments for social disorders.

  20. Experimental status of physics

    Indian Academy of Sciences (India)

    In a short period of time, we will have a large amount of results from -factories including ones on CP violation. In this talk, we briefly review the current experimental status of -physics. After a quick description of -facilities, we divide this vast field into two categories: (1) weak interaction and QCD, (2) unitarity triangle and ...

  1. Health status ofhostel dwellers

    African Journals Online (AJOL)

    1991-06-15

    Jun 15, 1991 ... Cape Town tuberculosis notification rates for the hostel dwellers of Langa and Guguletu emphasise the ... Department of Social Anthropology, University of Cape. Town. M. A. RAMPHELE, M.B. CH.B., D.C.H. ... health status of hostel dwellers in Langa, Nyanga and Guguletu. Health data were collected from ...

  2. Status of TRISTAN operation

    International Nuclear Information System (INIS)

    Satoh, Kotaro

    1990-01-01

    The present status of the TRISTAN operation is summarized mainly after the installation of superconducting cavities in the 1988 summer shutdown. The paper describes the initial experience of the superconducting cavity operation, the colliding operation at 30.4 GeV and the beam injection. Future improvement is also reported. (author)

  3. COMPASS Status Report 2010

    CERN Document Server

    COMPASS Collaboration

    2010-01-01

    This report gives an overview of the setup and the performance of the COMPASS experiment during the 2009 hadron beam run and describes the preparation and startup of the 2010 muon beam run with the polarised target. The status of analysis is presented both for the hadron and muon data with emphasis on the 2008/2009 hadron data.

  4. HIV status and tuberculosis

    African Journals Online (AJOL)

    User

    This hospital based study was done to estimate the magnitude of pulmonary and extra-pulmonary tuberculosis and to determine predictors of tuberculosis ..... Patient`s risk factors associated with increased risk of tuberculosis includes chronic cough, wasting, advanced age, HIV status, Diabetes Mellitus, Malnutrition etc ...

  5. Status of numerical relativity

    Indian Academy of Sciences (India)

    Keywords. Numerical relativity; gravitational waves; black hole; neutron star. Abstract. I describe the current status of numerical relativity from my personal point of view. Here, I focus mainly on explaining the numerical implementations necessary for simulating general relativistic phenomena such as the merger of compact ...

  6. NASA Armstrong Status

    Science.gov (United States)

    Jacobson, Steven R.

    2014-01-01

    Armstrong (formerly Dryden) Flight Research Center continues it's legacy of exciting work in the area of dynamics and control of advanced vehicle concepts. This status presentation highlights the research and technology development that Armstrong's Control and Dynamics branch is performing in the areas of Control of Flexible Structures and Automated Cooperative Trajectories.

  7. Angola: Country Status Report.

    Science.gov (United States)

    Bruhn, Thea C.

    A survey of the status of language usage in Angola begins with an overview of the usage and distribution of Portuguese as the official language, and the four most significant native languages and dialects spoken there: Umbundu, Kimbundu, Kikongo, and Lunda-Chokwe. The introduction of Spanish through Cuban trainers, teachers, and military advisors…

  8. HESYRL control system status

    International Nuclear Information System (INIS)

    Yao Chihyuan

    1992-01-01

    HESYRL synchrotron radiation storage ring was completed in 1989 and has been in commissioning since then. Now it has met its design specification and is ready for synchrotron light experiments. Control system of the project was completed in 1989 and some modifications were made during commissioning. This paper describes its present configuration, status and upgrading plan. (author)

  9. Assessment of Mental Status.

    Science.gov (United States)

    Finney, Glen R; Minagar, Alireza; Heilman, Kenneth M

    2016-02-01

    Assessing the mental status of patients with a neurobehavioral disorder is a critical element in the diagnosis and treatment of these patients. This assessment should always be performed after the patient's history it taken and a general physical as well as a neurologic examination is completed. The mental status examination commences with observing the patient's appearance and level of consciousness. The examiner should also pay attention to patient's social behavior, emotional state and mood. There are 3 major means of assessing a patient's mental status. One type attempts to determine if the patient is demented and the severity of the dementia as it pertains to their ability to perform activities of daily living as well as instrumental activities. A second type of assessment utilizes what may be termed as "screening tests" or "omnibus tests". These brief tests are performed independent of the patient's history and examination. The two most frequently used screening tests are the Mini-Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The third means of assessing a patient's mental status is by using specific neuropsychological tests that focus on specific domains of cognition, such as frontal executive functions, attention, episodic verbal and visuospatial memory, declarative knowledge such as language (speech, reading and writing) and arithmetical, as well as visuospatial and perceptual abilities. These neurobehavioral, neuropsychiatric and neuropsychological assessments of patients with a cognitive decline and behavioral abnormalities should often be accompanied by laboratory tests, and neuroimaging that can help determine the underlying pathologic process so that effective therapeutic and management approaches can be provided. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Status of MARS Code

    Energy Technology Data Exchange (ETDEWEB)

    N.V. Mokhov

    2003-04-09

    Status and recent developments of the MARS 14 Monte Carlo code system for simulation of hadronic and electromagnetic cascades in shielding, accelerator and detector components in the energy range from a fraction of an electronvolt up to 100 TeV are described. these include physics models both in strong and electromagnetic interaction sectors, variance reduction techniques, residual dose, geometry, tracking, histograming. MAD-MARS Beam Line Build and Graphical-User Interface.

  11. Status of fusion maintenance

    International Nuclear Information System (INIS)

    Fuller, G.M.

    1984-01-01

    Effective maintenance will be an essential ingredient in determining fusion system productivity. This level of productivity will result only after close attention is paid to the entire system as an entity and appropriate integration of the elements is made. The status of fusion maintenance is reviewed in the context of the entire system. While there are many challenging developmental tasks ahead in fusion maintenance, the required technologies are available in several high-technology industries, including nuclear fission

  12. Tritium monitoring : present status

    International Nuclear Information System (INIS)

    Rathnakaran, M.; Singh, A.N.

    1993-01-01

    The report summarizes the present status of techniques employed for the monitoring of tritium in water, air and other samples. A brief mention of the work done by numerous workers in the field, critical comments about the work and a fairly exhaustive list of references about the work done during the last 4 decades has been presented. On-line monitoring on real time basis in nuclear reactors is also discussed. (author). 83 refs., 10 refs., 2 tabs

  13. Status of gluonium searches

    International Nuclear Information System (INIS)

    Heusch, C.A.; California Univ., Santa Cruz, CA

    1991-01-01

    Quantum chromodynamics predicts the existence of quarkless mesons. The search for these hadrons has been ingenious and persevering. A review is presented of the current status of research that considers all model-dependent theoretical prejudice when searching for specific states. Early hints for candidate states have been investigated in the light of recent data, mostly from the Mark III Collaboration, in radiative charmonium decay. No 'smoking-gun' candidate stands out. (R.P.) 25 refs., 20 figs., 2 tabs

  14. Mental Representations of Social Status

    Science.gov (United States)

    Chiao, Joan Y.; Bordeaux, Andrew R.; Ambady, Nalni

    2004-01-01

    How do people think about social status? We investigated the nature of social status and number representations using a semantic distance latency test. In Study 1, 21 college students compared words connoting different social status as well as numbers, which served as a control task. Participants were faster at comparing occupations and numbers…

  15. Health status of hostel dwellers

    African Journals Online (AJOL)

    Assessment of nutritional status provides an inexpensive, quick and objective measure of the health status of children.I The nutritional status of children (0 - 5 years) in the Zones, an urban migrant hostel complex in Langa outside Cape Town,. Department of Social Anthropology, University of Cape. Town. M. A. RAMPHELE ...

  16. Status of APE projects

    CERN Document Server

    Alfieri, R; Onofri, E; Bartoloni, A; Battista, C; Cabibbo, Nicola; Cosimi, M; Lonardo, A; Michelotti, A; Proietti, B; Rapuano, F; Rossetti, D; Sacco, G; Tassa, S; Torelli, M; Vicini, P; Pène, O; Errico, W; Magazzù, G; Sartori, L; Schiiano, F; Tripiccione, R; De Riso, P; Petronzio, Roberto; Destri, C; Frezzotti, R; Marchesini, G; Gensch, Ulrich; Jansen, K; Kretzschmann, A; Leich, H; Paschedag, N; Pleiter, D; Schwendicke, U; Simma, H; Sommer, Rainer; Sulanke, K; Wegner, P; Fucci, A; Martin, B; Pech, J; Panizzi, E; Petricola, A

    2001-01-01

    This talk is divided in two parts. In the first part, we will summarize the status of the APEmille project that will be completed by the end of the year. We will then devote the rest of the talk to the description of a new project for a multi-TeraFlop machine, ape NEXT. The interested reader will find a much more detailed discussion of all the items touched upon here in the full proposal of the project that will shortly appear on hep-lat. (9 refs).

  17. Model Validation Status Review

    International Nuclear Information System (INIS)

    E.L. Hardin

    2001-01-01

    The primary objective for the Model Validation Status Review was to perform a one-time evaluation of model validation associated with the analysis/model reports (AMRs) containing model input to total-system performance assessment (TSPA) for the Yucca Mountain site recommendation (SR). This review was performed in response to Corrective Action Request BSC-01-C-01 (Clark 2001, Krisha 2001) pursuant to Quality Assurance review findings of an adverse trend in model validation deficiency. The review findings in this report provide the following information which defines the extent of model validation deficiency and the corrective action needed: (1) AMRs that contain or support models are identified, and conversely, for each model the supporting documentation is identified. (2) The use for each model is determined based on whether the output is used directly for TSPA-SR, or for screening (exclusion) of features, events, and processes (FEPs), and the nature of the model output. (3) Two approaches are used to evaluate the extent to which the validation for each model is compliant with AP-3.10Q (Analyses and Models). The approaches differ in regard to whether model validation is achieved within individual AMRs as originally intended, or whether model validation could be readily achieved by incorporating information from other sources. (4) Recommendations are presented for changes to the AMRs, and additional model development activities or data collection, that will remedy model validation review findings, in support of licensing activities. The Model Validation Status Review emphasized those AMRs that support TSPA-SR (CRWMS M and O 2000bl and 2000bm). A series of workshops and teleconferences was held to discuss and integrate the review findings. The review encompassed 125 AMRs (Table 1) plus certain other supporting documents and data needed to assess model validity. The AMRs were grouped in 21 model areas representing the modeling of processes affecting the natural and

  18. Model Validation Status Review

    Energy Technology Data Exchange (ETDEWEB)

    E.L. Hardin

    2001-11-28

    The primary objective for the Model Validation Status Review was to perform a one-time evaluation of model validation associated with the analysis/model reports (AMRs) containing model input to total-system performance assessment (TSPA) for the Yucca Mountain site recommendation (SR). This review was performed in response to Corrective Action Request BSC-01-C-01 (Clark 2001, Krisha 2001) pursuant to Quality Assurance review findings of an adverse trend in model validation deficiency. The review findings in this report provide the following information which defines the extent of model validation deficiency and the corrective action needed: (1) AMRs that contain or support models are identified, and conversely, for each model the supporting documentation is identified. (2) The use for each model is determined based on whether the output is used directly for TSPA-SR, or for screening (exclusion) of features, events, and processes (FEPs), and the nature of the model output. (3) Two approaches are used to evaluate the extent to which the validation for each model is compliant with AP-3.10Q (Analyses and Models). The approaches differ in regard to whether model validation is achieved within individual AMRs as originally intended, or whether model validation could be readily achieved by incorporating information from other sources. (4) Recommendations are presented for changes to the AMRs, and additional model development activities or data collection, that will remedy model validation review findings, in support of licensing activities. The Model Validation Status Review emphasized those AMRs that support TSPA-SR (CRWMS M&O 2000bl and 2000bm). A series of workshops and teleconferences was held to discuss and integrate the review findings. The review encompassed 125 AMRs (Table 1) plus certain other supporting documents and data needed to assess model validity. The AMRs were grouped in 21 model areas representing the modeling of processes affecting the natural and

  19. Status of Wheeler Reservoir

    Energy Technology Data Exchange (ETDEWEB)

    1990-09-01

    This is one in a series of status reports prepared by the Tennessee Valley Authority (TVA) for those interested in the conditions of TVA reservoirs. This overview of Wheeler Reservoir summarizes reservoir purposes and operation, reservoir and watershed characteristics, reservoir uses and use impairments, and water quality and aquatic biological conditions. The information presented here is from the most recent reports, publications, and original data available. If no recent data were available, historical data were summarized. If data were completely lacking, environmental professionals with special knowledge of the resource were interviewed. 12 refs., 2 figs.

  20. NESTOR: A status report

    CERN Document Server

    Anassontzis, E G; Barone, M; Foudas, C; Grammatikakis, G; Katsanevas, S; Kourkoumelis, C; Manousakis-Katsikakis, A; Resvanis, L K; Siotis, I; Sotiriou, S A; Voulgaris, G; Minkowski, P; Grieder, P K F; Ball, A E; Bottai, S; Cartacci, A M; Monteleoni, B; Naumov, Vadim A; Trasatti, L; Fahrun, E; Keusen, U; Koske, P; Rathlev, J; Schmidt, N P; Voight, G; Bezrukov, Leonid B; Butkevich, A V; Dedenko, L G; Karaevsky, S K; Mironovich, A A; Zakharov, L M; Zheleznykh, I M; Zhukov, V A; Demidova, T A; Deineko, A O; Eremeev, A P; Paka, V T; Permyakov, A A; Platonov, M N; Rukol, V Kh; Sheremet, N A; Surin, N M; Albul, V I; Ledenev, V V

    2000-01-01

    NESTOR is an underwater neutrino astrophysics laboratory to be located in the international waters of the southwest of Greece. The first phase of this experiment is the construction and deployment of one hexagonal tower consisting of 168 optical modules, with effective are of 20000m2 for E ⩾ TeV neutrinos. Over the past few years detailed studies of the site have been carried out while many tests have been performed. The current status of the preparation of the experiment and the future plans will be presented.

  1. The status of molecules

    International Nuclear Information System (INIS)

    Barnes, T.

    1994-01-01

    The experimental and theoretical status of hadronic molecules, which are weakly-bound states of two or more hadrons are summarized. A brief history of the subject is given, and a few good candidates are discussed. Some signatures for molecules which may be of interest in the classification of possible molecule states are studied. It is shown that a more general understanding of 2 → 2 hadron-hadron scattering amplitudes will be crucial for molecule searches. A few more recent molecule candidates which are not well established as molecules but satisfy some of the expected signatures are also discussed. (author). 50 refs

  2. Teleradiology - current status

    International Nuclear Information System (INIS)

    Baltadjiev, D.; Charakchiev

    2000-01-01

    Tele-radiology is a term becoming increasingly popular in the medical literature. Nevertheless, terminological definitions in this particular field are still rather vague. The scope of applications extend from simple image presenting via analogue telephone lines to transmission of 3-D medical images through a satellite. It is a matter of standards highly differing in terms of data transmission rates, safety, technical demands on the systems and the like. In this article new information technologies, technical aspects, as well as some major applications of tele-radiology are discussed. The current status of tele-medicine/tele-radiology in this country is likewise briefly outlined

  3. 1998 status report

    International Nuclear Information System (INIS)

    1998-01-01

    Since its creation in 1945, the activities of Cea have been centered on the study and development of the pacific use of nuclear energy and on assuring the credibility of nuclear deterrent. This status report presents the research programs led by Cea in 1998. The main topics are: the designing of reactor cores, fuel cycle, nuclear safety, radiation protection, the activities for defense, high technologies for industry, biology and fundamental sciences. The quality of research work is assured by an independent and regular assessment of the scientific activities. (A.C.)

  4. Age, relationship status, and the planning status of births

    Directory of Open Access Journals (Sweden)

    Sarah Hayford

    2010-08-01

    Full Text Available In the United States historically, births to older mothers have been more likely to be planned than births to younger mothers, and births to unmarried women have been less likely to be planned than births to married women. As the average age of mothers has increased and more births have occurred outside of marriage in the United States, the intersection of these trends may have weakened the traditional linkage between age and birth planning status. In this article, we examine differences by maternal age in planning status of births using The 2002 National Survey of Family Growth. We find that age is strongly associated with planning status, but the association is reduced in magnitude when controlling for relationship status and is stronger for first and second births than for higher-parity births. Further, the association between union status and the planning status of births varies by race-ethnicity.

  5. The status of molecules

    International Nuclear Information System (INIS)

    Barnes, T.; Oak Ridge National Lab., TN; Tennessee Univ., Knoxville, TN

    1994-06-01

    This report summarizes the experimental and theoretical status of hadronic molecules, which are weakly-bound states of two or more hadrons. We begin with a brief history of the subject and discuss a few good candidates, and then abstract some signatures for molecules which may be of interest in the classification of possible molecule states. Next we argue that a more general understanding of 2 → 2 hadron-hadron scattering amplitudes will be crucial for molecule searches, and discuss some of our recent work in this area. We conclude with a discussion of a few more recent molecule candidates (notably the f o (1710)) which are not well established as molecules but satisfy some of the expected signatures. (Author)

  6. Status report on GANIL

    International Nuclear Information System (INIS)

    Ferme, J.; Gouttefangeas, M.

    1982-01-01

    The parameters of the three accelerators Col, SSC1 and SSC2 of the GANIL system are recalled with a special emphasis on those which have been modified since the beginning of the construction; furthermore consequences of theoretical works which were made in order to obtain a beam with small energy dispersion δW/W are given. The current status of the project is then described: the Col injector is already in operation, as well as the first part of the line L1 (from Col to SSC1) which is used to analyze the beam coming from Col; magnets (with their trim-coils) and chamber (vacuum tested) of SSC1 are completely assembled; routine magnetic measurements are in progress whereas the first resonant accelerating cavity is on a special test bench; magnets and chamber of SSC2 are installed and vacuum tests are under way

  7. Status of Standardization Projects

    Science.gov (United States)

    1991-06-30

    STATUS CODES: A- 1, G- 0, Y- 0, Z- 0 1 1265 A009 MIL C XXX CMPTR SYS GUN CP 1317 GYK 29 CR F4 894 914 914 A N D 1265 AO1O MIL L 70846 LASER TUBE/MOD...ASSY 11749646 AR B4 903 904 904 A N C 1265 A011 NIL L 70847 LASER TUBE/PWB ASSY 11749644 AR B4 903 904 904 A N C 1265 A012 MIL L 70848 LASER TUBE/PWB...VIBRATOR, MOLD MB DM F4 A 881 891 914 A MD MS 03 U D 6520 2102 A-A-XXX STOP, ENDODONTIC MB DM F4 A 892 902 914 A MD MS 03 U D 6520 2104 A-A-XXX

  8. Status of legislation

    International Nuclear Information System (INIS)

    Warner, C.

    1982-01-01

    The status of the House legislation, the major differences between the House and Senate legislation and a preview of what is likely to take place during the lame duck session in December are presented. The House legislation provides: long-term program leading toward permanent disposal of nuclear waste; an interim program for storage and for expansion of storage space for spent fuel; provides an R and D component through what is called a test and evaluation facility; an alternative long-term storage program based on a proposal to be completed by the Department of Energy on what's called Monitored Retrievable Storage; full upfront financing of the program through user fees based on contracts between the government and the users of the nuclear waste disposal services

  9. PANIC: current status

    Science.gov (United States)

    Cárdenas, M. C.; Rodríguez Gómez, J.

    2011-11-01

    PANIC, the PAnoramic Near Infrared Camera, is a new instrument for Calar Alto Observatory (CAHA) is a wide-field infraredimager for the CAHA 2.2 m and 3.5 m telescopes. The optics is a folded single optical train, pure lens optics, with a pixel scale of 0.45 arcsec/pixel (18 microns) at the 2.2 m telescope and 0.23 arcsec/pixel at the 3.5 m. A mosaic of four Hawaii-2RG detectorsprovides a field of view (FOV) of 0.5x0.5 degrees and 0.25x0.25 degrees, respectively. It will cover the photometric bandsfrom Z to K_s (0.8 to 2.5 microns) with a low thermal background due to cold stops. Here we present the current status of the project.

  10. Orion Project Status Report

    Science.gov (United States)

    Stiewing, Albert; Hopkins, Jeffrey L.

    2015-05-01

    Originally started in 2012 as the Betelgeuse Project, interest in the other bright stars of Orion soon expanded the Project stars to include a total of six of the brightest stars in Orion. The name was then changed to the Orion Project. Orion is one of the most famous constellations. Its declination along the celestial equator is such that it is visible from most of northern and southern hemispheres. In addition, the stars of Orion are very bright and interesting. The Orion Project now includes the stars Betelgeuse, Rigel, Saiph and the three stars of Orion's belt, Mintaka, Alnilam and Alnitak. The projects objectives are both to help the observer produce quality photometric and spectroscopic data and to produce archival quality photometric (BVRIJH bands) and spectroscopy (low, mid and high-resolution) data. This paper is a summary of the Orion Project status.

  11. ARAC status report: 1985

    International Nuclear Information System (INIS)

    Dickerson, M.H.; Gudiksen, P.H.; Sullivan, T.J.; Greenly, G.D.

    1985-05-01

    The Atmospheric Release Advisory Capability is a real-time emergency-response service available to federal and state agencies for providing estimates of the environmental consequences of accidental releases of radioactivity into the atmosphere. This includes the estimation of radiation doses to nearby population centers and the levels and extent of surface contamination. The service is currently being expanded to support the emergency response plans at approximately 50 Department of Defense and Department of Energy facilities. This expansion consists of the installation of enhanced computational and data communications and processing systems, development of terrain and geographic data bases, improvements in modeling capabilities, as well as increased staff housing facilities. This report summarizes the current status of ARAC and the requirements to receive the service

  12. The CMS HF status

    CERN Document Server

    Rahmat, Rahmat

    2012-01-01

    The experiments at the Large Hadron Collider will have to deal with unprecedented radiation levels. The design of the CMS forward calorimetry detector (HF) is now finalized. The present design of CMS calls for the HF calorimeter to be based on quartz fiber technology. It consists of two modules, located symmetrically at about 11 meters from either side of interaction point. They cover the pseudorapidity range 3-5. The length along the beam is 1.65m or 10 nuclear interaction lenghts. Each calorimeter consists of a large steel block that serves as the absorber. Embedded quartz fibers in the steel absorber run parallel to the beam and constitute the active component of the detector. In order to optimize energy resolution for E and ET flows and forward jets, the calorimeter is effectively segmented longitudinally by using two different fiber lengths. The present status will be discussed.

  13. Status of Standardization Projects

    Science.gov (United States)

    1994-06-30

    DELINQUENT - I , STATUS CODES: A- 2 , G- 0 , Y - 0 . Z- 0 1650 0514 MIL-C-5500D CAP HIGH PRESSURE AIR VALUE 71 C2 934 954 954 A AV AS 99 N 1650 0515...AS 85 N 5920 A179 NIL A 49201 ARRESTER ELEC F1482 F1495 G CR 02 904 924 934 A CR U B 5920 A947 NIL M 49240A MULTIPLEXER TO 1235 P TTC CR Fl 923 924...ANESTHESIA SET MB H5 942 952 943 G MD MS 03 U 6515 5706 A-A-XXX TUBE INHALER MB DM F4 A 942 952 952 A MD MS 03 N 6515 5707 A-A-XXX TUBES, DRAINAGE MB DM

  14. Status of Standardization Projects

    Science.gov (United States)

    1992-12-31

    Z- 0 3770 0136 MIL-C-1161E 1 COLLAR DOG LEATHER 84 CS Fl 921 931 931 Y GL 99 U 3770 0138 MIL C 43390C CLIPPER HAIR & BLADE MB OM H5 922 932 924 G MD...OM H5 923 933 933 A MD MS 03 MB N 6505 5782 A-A-XXX METHYLPHENIDATE MB DM F4 A 923 933 931 G MD MS 03 MB U *6505 5783 A-A-XXX QUINIDlNE SULFATE MB OH...A MR AS 99 U B IS TOTAL- 244, DELNQT- 199. STATUS CODES: A- 241, G- 3, Y- 0, Z- 0 3770 0138 MIL C 43390C CLIPPER HAIR & BLADE MB DM H5 922 932 924 G

  15. Media Challenging Status Quo

    DEFF Research Database (Denmark)

    Sandvik, Kjetil

    and Libya creating headlines like “the Facebook revolution”. On the other hand, several scholars argue that it is naive to believe that social media in themselves create change: they may at the best facilitate already existing social and political movements (Downing 2008, Christakis & Fowler 2010...... and dystopian trends in contemporary culture (Turner 2006). On that note, this paper examines the Occupy Wall Street-movement as an example on how social media may rock the status quo of today’s global power structures putting to use its democratic potential and its modes of communication through network...... power of social network and how they shape our lives, New York, Boston and London: Backbay Books/Little, Brown and Company Downing, J. (2008). ”Social Movement Theories and Alternative Media: An Evaluation and Critique”, in: ICA: Communication, Culture & Critique 1 Morozov, J. (2011). The Net Delusion...

  16. Status of French reactors

    International Nuclear Information System (INIS)

    Ballagny, A.

    1997-01-01

    The status of French reactors is reviewed. The ORPHEE and RHF reactors can not be operated with a LEU fuel which would be limited to 4.8 g U/cm 3 . The OSIRIS reactor has already been converted to LEU. It will use U 3 Si 2 as soon as its present stock of UO 2 fuel is used up, at the end of 1994. The decision to close down the SILOE reactor in the near future is not propitious for the start of a conversion process. The REX 2000 reactor, which is expected to be commissioned in 2005, will use LEU (except if the fast neutrons core option is selected). Concerning the end of the HEU fuel cycle, the best option is reprocessing followed by conversion of the reprocessed uranium to LEU

  17. Biomarkers of Selenium Status

    Directory of Open Access Journals (Sweden)

    Gerald F. Combs, Jr.

    2015-03-01

    Full Text Available The essential trace element, selenium (Se, has multiple biological activities, which depend on the level of Se intake. Relatively low Se intakes determine the expression of selenoenzymes in which it serves as an essential constituent. Higher intakes have been shown to have anti-tumorigenic potential; and very high Se intakes can produce adverse effects. This hierarchy of biological activities calls for biomarkers informative at different levels of Se exposure. Some Se-biomarkers, such as the selenoproteins and particularly GPX3 and SEPP1, provide information about function directly and are of value in identifying nutritional Se deficiency and tracking responses of deficient individuals to Se-treatment. They are useful under conditions of Se intake within the range of regulated selenoprotein expression, e.g., for humans <55 μg/day and for animals <20 μg/kg diet. Other Se-biomarkers provide information indirectly through inferences based on Se levels of foods, tissues, urine or feces. They can indicate the likelihood of deficiency or adverse effects, but they do not provide direct evidence of either condition. Their value is in providing information about Se status over a wide range of Se intake, particularly from food forms. There is need for additional Se biomarkers particularly for assessing Se status in non-deficient individuals for whom the prospects of cancer risk reduction and adverse effects risk are the primary health considerations. This would include determining whether supranutritional intakes of Se may be required for maximal selenoprotein expression in immune surveillance cells. It would also include developing methods to determine low molecular weight Se-metabolites, i.e., selenoamino acids and methylated Se-metabolites, which to date have not been detectable in biological specimens. Recent analytical advances using tandem liquid chromatography-mass spectrometry suggest prospects for detecting these metabolites.

  18. Biosimilar drugs: Current status.

    Science.gov (United States)

    Kumar, Rajiv; Singh, Jagjit

    2014-07-01

    Biologic products are being developed over the past three decades. The expiry of patent protection for many biological medicines has led to the development of biosimilars in UK or follow on biologics in USA. This article reviews the literature on biosimilar drugs that covers the therapeutic status and regulatory guidelines. Appraisal of published articles from peer reviewed journals for English language publications, search from PubMed, and guidelines from European Medicines Agency, US Food Drug Administration (FDA) and India were used to identify data for review. Literature suggest that biosimilars are similar biological products, i.e., comparable but not identical to the reference product, are not generic version of innovator product and do not ensure therapeutic equivalence. Biosimilars present more challenges than conventional generics and marketing approval is also more complicated. To improve access, US Congress passed the Biologics Price Competition and Innovation act 2009 and US FDA allowed "abbreviated pathway" for their approval. U.S law has defined new standards and terms and EMA scientific guidelines have also set detailed approval standards. India being one of the most preferred manufacturing destinations of biosimilars, there is a need for stringent safety and regulatory guidelines. The New India Guidelines "Draft Guidelines on Similar Biologics were announced in June 2012, by Department of Biotechnology at Boston bio and available online.

  19. LIL laser performance status

    International Nuclear Information System (INIS)

    Julien, X.; Adolf, A.; Bar, E.; Beau, V.; Bordenave, E.; Chies, Th.; Courchinoux, R.; Feral, Ch.; Gendeau, P.; Graillot, H.; Grosset-Grange, C.; Henry, O.; Higonenq, V.; Journot, E.; Lacampagne, L.; Lafond, E.; Le Deroff, L.; Martinez, A.; Patissou, L.; Roques, A.; Thauvin, L.; Di-Nicola, J.M.; Thiell, G.

    2011-01-01

    The Laser Integration Line (LIL) was first designed as a prototype to validate the concepts and the laser architecture of the Laser MegaJoule (LMJ). The LIL facility is a 4-beam laser representing a quad structure of the LMJ. A set of test campaigns were conducted to safely ramp up laser performance. The main goal was to measure quad-specific features such as beam synchronization and focal spot (size, smoothing contrast ratio or irradiation nonuniformity) versus the LMJ requirements. Following the laser commissioning, the LIL has become a major instrument dedicated to the achievement of plasma physics experiments for the French Simulation Program and was also opened to the academic scientific community. One of the attributes of the LIL facility is to be very flexible to accommodate the requests of plasma physicists during campaigns. The LIL is constantly evolving to best meet the needs of target physicists. Changes made or planned are either to improve the quality of laser beams, or to increase the LIL Energy-Power operating space. To optimize preparation and design of shot campaigns, the LIL performance status has been elaborated. It gives information about the characteristics of the laser in terms of near field and far field, defines the steps to maintain performance, explains how the facility responds to the request, details settings (smoothing, shaping of the focal spot, energy, temporal pulse shaping, beam pointing) and gives the limits in energy and power. In this paper, an overview of the LIL performance is presented. (authors)

  20. Nanometals - Status and perspective

    International Nuclear Information System (INIS)

    Faester, S.; Hansen, N.; Huang, X.; Juul Jensen, D.; Ralph, B.

    2012-01-01

    Nanometals and nanotechnology have over the years been covered in papers, books and conferences - also in many Risoe International Symposia, where the 30th in 2009 dealt solely with nanostructured metals. Since then, rapid progress has been made in synthesis, characterization and modeling, and it is timely to discuss status and perspective also with a view on applications in an international forum such as the Risoe Symposium. Both keynote and contributed papers address important current problems illustrating global research and development in this field. Examples are the development of new synthesis techniques followed by characterization and modeling of microstructures both in 2D and 3D now starting to bridge the micrometer scales. The vital area of mechanical behavior is addressed by the development of new testing techniques and a broad effort to characterize and model mechanical properties of metals strengthened by dislocations and twins. This research has now led to new understanding of both strengthening mechanisms and strengh structure relationships based on experiments in combination with analytical and numerical modeling. The holistic approach to research on nanometals demonstrated by these proceedings can guide both scientists and technologists in their future work also with the aim of introducing into society this new group of advanced materials. Such an effort is important, as science and technology today is significantly affected by politics of governments and international institutions, and therefore a new initiative in the pressent is to include a discussion of research and development in the area of nanometals i USA, China and Japan. (Author)

  1. Biocatalysis: A Status Report.

    Science.gov (United States)

    Bommarius, Andreas S

    2015-01-01

    This review describes the status of the fields of biocatalysts and enzymes, as well as existing drawbacks, and recent advances in the areas deemed to represent drawbacks. Although biocatalysts are often highly active and extremely selective, there are still drawbacks associated with biocatalysis as a generally applicable technique: the lack of designability of biocatalysts; their limits of stability; and the insufficient number of well-characterized, ready-to-use biocatalysts. There has been significant progress on the following fronts: (a) novel protein engineering tools, both experimental and computational, have significantly enhanced the toolbox for biocatalyst development. (b) The deactivation of biocatalysts under various stresses can be described quantitatively via rational models. There are several cases of spectacular leaps of stabilization after accumulating all stabilizing mutations found in earlier rounds. The concept that stabilization against one type of stress commonly also stabilizes against other types of stress is now experimentally considerably better founded than a few years ago. (c) A host of developments of novel biocatalysts in the past few years, in part fueled by improved designability and improved methods of stabilization, has considerably broadened the toolbox for synthetic chemistry.

  2. Status of fusion technology

    International Nuclear Information System (INIS)

    Mohan, Ashok

    1978-01-01

    The current status of fusion technology is surveyed. Limited reserves of fossil fuel and dangers of proliferation from nuclear reactors have brought into focus the need to develop an optional energy source. Fusion is being looked upon as an optional energy source which is free from environmental hazards unlike fossil fuels and nuclear reactors. Investments in R and D of fusion energy have increased rapidly in USA, Japan, USSR and European countries. Out of the various fusion fuels known, a mixture of D and T is widely chosen. The main problem in fusion technology is the confinement of plasma for a time sufficient to start the fusion reaction. This can be done magnetically or inertially. The three approaches to magnetic confinement are : (1) tokamak, (2) mirror and (3) pinch. Inertial confinement makes use of lasers or electron beams or ion beams. Both the methods of confinement i.e. magnetic and inertial have problems which are identified and their nature is discussed. (M.G.B.)

  3. Health status of hostel dwellers

    African Journals Online (AJOL)

    1991-06-15

    Jun 15, 1991 ... Here a high infant mortality rate is examined against ... social situation. A screen for health status in a single survey provides an overview of health status. It provides an unusual opportunity for an additional level of analysis that goes beyond ..... diastolic blood pressure and a higher death rate from hyper-.

  4. Between Status and Contract?

    Directory of Open Access Journals (Sweden)

    Thorsten Keiser

    2013-01-01

    Full Text Available This contribution deals with unfree labour in Germany from the early modern age until the beginning of the 20th century. It presents the main conclusions of a book published in 2013 on this subject in German. Unfree labour is not identified in the first place with slavery or any other labour relationship based on status. Instead, this study aims at an analysis of freedom and coercion in contractual labour relationships. It will be argued that in Germany contractual labour relationships before 1800 were embedded in a legal system that strongly restricted contractual autonomy and aimed at the suppression of free labour markets. The scope of this legislation was to guarantee efficient labour performance, which was not only perceived as being in the personal interest of an employer, but as a fundamental element of the common good. After 1800 the system changed to more incentive-based legislation that established freedom of contract for labour relations. Nevertheless, coercion in order to perform the contractual duties of a work contract remained important for many groups of workers, especially farmhands and industrial workers. The last criminal sanctions for breaches of labour contracts were only abolished in the revolution of 1919. This development shows the difficulties German law had in extending the principles of private law to workers. When a system of free labour was fully established, the issue of unemployment and economic problems, especially in the Weimar Republic, required a new system of protective rules. The history of free market based labour contracts in Germany was therefore very short, with state intervention shi ing from control and coercion to social assistance.

  5. Status of thorium technology

    International Nuclear Information System (INIS)

    Garg, R.K.; Raghavan, R.V.; Karve, V.M.; Narayandas, G.R.

    1977-01-01

    Although a number of studies have been conducted in various countries to evolve reactor systems based on thorium fuel cycle, its use, so far, is limited to only a few reactors. However, for countries having large reserves of thorium, its utilization is of great significance for their nuclear power programmes. Reasonably assured world resources of thorium in the lower price range have been estimated at more than 500,000 tons of ThO 2 . While most of these resources are in placer deposits in various parts of the world, some vein deposits and uranium ores are other important sources of thorium. Monazite, the most important mineral of thorium, is found in the beach sand deposits along with other heavy minerals like ilmenite, rutile, zircon, and sillimanite etc. Mining of these deposits is usually carried out by suction dredging and separation of monazite from other minerals is effected by a combination of magnetic, electrostatic and gravity separation techniques. Chemical processing of monazite is carried out either by sulphuric acid or caustic treatment, followed by separation of the rare earths and thorium by partial precipitation or leaching. The thorium concentrate is further processed to obtain mantle grade thorium nitrate by chemical purification steps whereas solvent extraction using TBP is adopted for making nuclear-grade material. The purified thorium nitrate is converted to the oxide usually by precipitation as oxalate followed by calcination. The oxide is reduced directly with calcium or converted to the chloride or fluoride and then reduced by calcium or magnesium to obtain thorium metal. Various fuel designs based on the metal or its alloys, mixed oxides or carbides, and dispersed type fuel elements have been developed and accordingly, different fabrication techniques have been employed. Work on irradiation of thorium containing fuel elements and separation of U 233 is being carried out. This paper reviews the status of thorium technology in the world with

  6. Status of ITER

    International Nuclear Information System (INIS)

    Aymar, R.

    2002-01-01

    At the end of engineering design activities (EDA) in July 2001, all the essential elements became available to make a decision on construction of ITER. A sufficiently detailed and integrated engineering design now exists for a generic site, has been assessed for feasibility, and costed, and essential physics and technology R and D has been carried out to underpin the design choices. Formal negotiations have now begun between the current participants--Canada, Euratom, Japan, and the Russian Federation--on a Joint Implementation Agreement for ITER which also establishes the legal entity to run ITER. These negotiations are supported on technical aspects by Coordinated Technical Activities (CTA), which maintain the integrity of the project, for the good of all participants, and concentrate on preparing for procurement by industry of the longest lead items, and for formal application for a construction license with the host country. This paper highlights the main features of the ITER design. With cryogenically-cooled magnets close to neutron-generating plasma, the design of shielding with adequate access via port plugs for auxiliaries such as heating and diagnostics, and of remote replacement and refurbishing systems for in-vessel components, are particularly interesting nuclear technology challenges. Making a safety case for ITER to satisfy potential regulators and to demonstrate, as far as possible at this stage, the environmental attractiveness of fusion as an energy source, is also important. The paper gives illustrative details on this work, and an update on the progress of technical preparations for construction, as well as the status of the above negotiations

  7. Reducing status quo bias in choice experiments

    DEFF Research Database (Denmark)

    Bonnichsen, Ole; Ladenburg, Jacob

    2015-01-01

    to be superior, i.e. a status quo effect. However, in the stated preference literature, the tendency to choose the alternative representing the status quo situation seems to exceed real life status quo effects. Accordingly, status quo bias can be a problem. In the Choice Experiment literature, status quo bias...

  8. Sentinel-2 Mission status

    Science.gov (United States)

    Hoersch, Bianca; Colin, Olivier; Gascon, Ferran; Arino, Olivier; Spoto, Francois; Marchese, Franco; Krassenburg, Mike; Koetz, Benjamin

    2016-04-01

    Copernicus is a joint initiative of the European Commission (EC) and the European Space Agency (ESA), designed to establish a European capacity for the provision and use of operational monitoring information for environment and security applications. Within the Copernicus programme, ESA is responsible for the development of the Space Component, a fully operational space-based capability to supply earth-observation data to sustain environmental information Services in Europe. The Sentinel missions are Copernicus dedicated Earth Observation missions composing the essential elements of the Space Component. In the global Copernicus framework, they are complemented by other satellites made available by third-parties or by ESA and coordinated in the synergistic system through the Copernicus Data-Access system versus the Copernicus Services. The Copernicus Sentinel-2 mission provides continuity to services relying on multi-spectral high-resolution optical observations over global terrestrial surfaces. Sentinel-2 capitalizes on the technology and the vast experience acquired in Europe and the US to sustain the operational supply of data for services such as forest monitoring, land cover changes detection or natural disasters management. The Sentinel-2 mission offers an unprecedented combination of the following capabilities: ○ Systematic global coverage of land surfaces: from 56°South to 84°North, coastal waters and Mediterranean sea; ○ High revisit: every 5 days at equator under the same viewing conditions with 2 satellites; ○ High spatial resolution: 10m, 20m and 60m; ○ Multi-spectral information with 13 bands in the visible, near infra-red and short wave infra-red part of the spectrum; ○ Wide field of view: 290 km. The data from the Sentinel-2 mission are available openly and freely for all users with online easy access since December 2015. The presentation will give a status report on the Sentinel-2 mission, and outlook for the remaining ramp-up Phase, the

  9. Large block test status report

    International Nuclear Information System (INIS)

    Wilder, D.G.; Lin, W.; Blair, S.C.

    1997-01-01

    This report is intended to serve as a status report, which essentially transmits the data that have been collected to date on the Large Block Test (LBT). The analyses of data will be performed during FY98, and then a complete report will be prepared. This status report includes introductory material that is not needed merely to transmit data but is available at this time and therefore included. As such, this status report will serve as the template for the future report, and the information is thus preserved

  10. Current status of pulmonary metastasectomy

    DEFF Research Database (Denmark)

    Hornbech, Kåre; Ravn, Jesper; Steinbrüchel, Daniel Andreas

    2011-01-01

    for unresected patients. In this article, we discuss the current status on pulmonary metastasectomy. Preoperative assessment and selection of surgical candidates is covered. The different surgical strategies including surgical approach, unilateral versus bilateral exploration, lymph node dissection, and repeat...

  11. Refugee status determination: three challenges

    Directory of Open Access Journals (Sweden)

    Martin Jones

    2009-04-01

    Full Text Available Refugee status determination (RSD, which is vital to the protection of so many asylum seekers worldwide, is at best an imperfect, haphazard and challenging process. It merits greater attention and appropriate reform.

  12. Experimental status of quantum electrodynamics

    International Nuclear Information System (INIS)

    Drell, S.D.

    1978-10-01

    This review of the experimental status of quantum electrodynamics covers the fine structure constant, the muon g-2 value, the Lamb shift in hydrogen, the finite proton radius, progress in muonium, and positronium. 37 references

  13. Fusion technology status and requirements

    International Nuclear Information System (INIS)

    Thomassen, K.I.

    1982-01-01

    This paper summarizes the status of fusion technology and discusses the requirements to be met in order to build a demonstration fusion plant. Strategies and programmatic considerations in pursuing engineering feasibility are also outlined

  14. Status of time reversal invariance

    International Nuclear Information System (INIS)

    Henley, E.M.

    1989-01-01

    Time Reversal Invariance is introduced, and theories for its violation are reviewed. The present experimental and theoretical status of Time Reversal Invariance and tests thereof will be presented. Possible future tests will be discussed

  15. Fukushima Daiichi Status Report. 28 June 2012

    International Nuclear Information System (INIS)

    2012-01-01

    The IAEA issues regular status reports to the public on the current status of the Fukushima Daiichi Nuclear Power Plant, including information on environmental radiation monitoring, the status of workers, and current conditions on-site at the plant.

  16. Present status of CP violation

    International Nuclear Information System (INIS)

    Ng, J.N.

    1989-06-01

    A review of the status of CP violation in kaons is given. Status of our knowledge of quark mixing angles in the standard six quark model is presented. The role Β d o - Βd o transition plays in this study is examined. A comparison of the estimates of CP violation effects from models beyond the standard one is given. Other experiments that have the capability of testing different CP violation models are also discussed. (Author) 35 refs., 6 figs., tab

  17. The status of BAT detector

    Science.gov (United States)

    Lien, Amy; Markwardt, Craig B.; Krimm, Hans Albert; Barthelmy, Scott D.; Cenko, Bradley

    2018-01-01

    We will present the current status of the Swift/BAT detector. In particular, we will report the updated detector gain calibration, the number of enable detectors, and the global bad time intervals with potential calibration issues. We will also summarize the results of the yearly BAT calibration using the Crab nebula. Finally, we will discuss the effects on the BAT survey, such as the sensitivity, localization, and spectral analysis, due to the changes in detector status.

  18. Status report, canister fabrication

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, Claes-Goeran; Eriksson, Peter; Westman, Marika [Swedish Nuclear Fuel and Waste Management Co., Stockholm (Sweden); Emilsson, Goeran [CSM Materialteknik AB, Linkoeping (Sweden)

    2004-06-01

    The report gives an account of the development of material and fabrication technology for copper canisters with cast inserts during the period from 2000 until the start of 2004. The engineering design of the canister and the choice of materials in the constituent components described in previous status reports have not been significantly changed. In the reference canister, the thickness of the copper shell is 50 mm. Fabrication of individual components with a thinner copper thickness is done for the purpose of gaining experience and evaluating fabrication and inspection methods for such canisters. As a part of the development of cast inserts, computer simulations of the casting processes and techniques used at the foundries have been performed for the purpose of optimizing the material properties. These properties have been evaluated by extensive tensile testing and metallographic inspection of test material taken from discs cut at different points along the length of the inserts. The testing results exhibit a relatively large spread. Low elongation values in certain tensile test specimens are due to the presence of poorly formed graphite, porosities, slag or other casting defects. It is concluded in the report that it will not be possible to avoid some presence of observed defects in castings of this size. In the deep repository, the inserts will be exposed to compressive loading and the observed defects are not critical for strength. An analysis of the strength of the inserts and formulation of relevant material requirements must be based on a statistical approach with probabilistic calculations. This work has been initiated and will be concluded during 2004. An initial verifying compression test of a canister in an isostatic press has indicated considerable overstrength in the structure. Seamless copper tubes are fabricated by means of three methods: extrusion, pierce and draw processing, and forging. It can be concluded that extrusion tests have revealed a

  19. Conceptions of nuclear threshold status

    International Nuclear Information System (INIS)

    Quester, G.H.

    1991-01-01

    This paper reviews some alternative definitions of nuclear threshold status. Each of them is important, and major analytical confusions would result if one sense of the term is mistaken for another. The motives for nations entering into such threshold status are a blend of civilian and military gains, and of national interests versus parochial or bureaucratic interests. A portion of the rationale for threshold status emerges inevitably from the pursuit of economic goals, and another portion is made more attraction by the derives of the domestic political process. Yet the impact on international security cannot be dismissed, especially where conflicts among the states remain real. Among the military or national security motives are basic deterrence, psychological warfare, war-fighting and, more generally, national prestige. In the end, as the threshold phenomenon is assayed for lessons concerning the role of nuclear weapons more generally in international relations and security, one might conclude that threshold status and outright proliferation coverage to a degree in the motives for all of the states involved and in the advantages attained. As this paper has illustrated, nuclear threshold status is more subtle and more ambiguous than outright proliferation, and it takes considerable time to sort out the complexities. Yet the world has now had a substantial amount of time to deal with this ambiguous status, and this may tempt more states to exploit it

  20. Is Subjective Status Influenced by Psychosocial Factors?

    OpenAIRE

    Lundberg, Johanna; Kristenson, Margareta

    2008-01-01

    Objective Associations between subjective status and health are still relatively unexplored. This study aimed at testing whether subjective status is uniquely confounded by psychosocial factors compared to objective status, and what factors that may predict subjective status. Design A cross-sectional analysis of a population-based, random sample of 795 middle-aged men and women from the southeast of Sweden. Questionnaires included subjective status, objective measures of socioeconomic status,...

  1. Reducing status quo bias in choice experiments

    DEFF Research Database (Denmark)

    Bonnichsen, Ole; Ladenburg, Jacob

    In stated preference literature, the tendency to choose the alternative representing the status quo situation seems to exceed real life status quo effects. Accordingly, status quo bias can be a problem. In Choice Experiments, status quo bias is found to be strongly correlated with protest attitudes...

  2. Coagulation Status in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, Iben Marie; Johansen, Maria Egede; Mogensen, Ulla B

    2015-01-01

    performed a hospital- and population-based cross-sectional study investigating the coagulation status (thrombocytes, mean platelet volume [MPV], international normalized ratio [INR] and activated partial thromboplastin time [APTT]). RESULTS: 32 hospital HS subjects, 430 population HS subjects and 20.......3432). CONCLUSION: We did not find an association between HS and prothrombotic/hypercoagulable status. Thus, thrombocytes may not be activated in HS. Furthermore, INR may not be affected in HS, suggesting that intrinsic and vitamin K-dependent coagulation factors appear unaffected....

  3. ITA technical activities status report

    International Nuclear Information System (INIS)

    Shimomura, Y.

    2004-01-01

    This note summarizes the progress made in the technical work of the ITER Transitional Arrangements in the period between September 2003 and June 2004. It comprises design work, update of baseline documents, risk management plan, ITER baseline web site, preparation of technical specifications, task agreements, international team status, CAD and document management, codes and standards, common expenses, future network connectivity needs, travel support of members of the International Team, testing blanket working group, physics status, diagnostics, task agreements for large physics R and D

  4. Status of the Borexino experiment

    Energy Technology Data Exchange (ETDEWEB)

    Ianni, A

    2000-01-31

    The next generation of solar neutrino experiments will study mainly low energy solar neutrinos. In particular, Borexino among the new experiments aims to search for {sup 7}Be neutrinos by neutrino-electron elastic scattering in 300 tons of high purity scintillator. In this paper the detector design and the status of the Borexino experiment are briefly reviewed.

  5. Status of the Borexino experiment

    CERN Document Server

    Ianni, A

    2000-01-01

    The next generation of solar neutrino experiments will study mainly low energy solar neutrinos. In particular, Borexino among the new experiments aims to search for sup 7 Be neutrinos by neutrino-electron elastic scattering in 300 tons of high purity scintillator. In this paper the detector design and the status of the Borexino experiment are briefly reviewed.

  6. Ghana: Country Status Report (Revision).

    Science.gov (United States)

    McFerren, Margaret

    A survey of the status of language usage in Ghana begins with an overview of the distribution and usage of English, as the sole official language, and of the local languages Akan, Ewe, Adangme, Dagbani, Nzema, Ga, Dagaari, and Hausa. A matrix follows that rates these languages on: (1) their usage rating using State Department classifications; (2)…

  7. The status of 'standard' SUSY

    CERN Document Server

    Zwirner, F

    1992-01-01

    We summarize the present status of low-energy supersymmetry, exemplified by the Minimal Supersymmetric extension of the Standard Model (MSSM). We review the searches for Supersymmetric particles and supersymmetric Higgs bosons. We conclude with some comments on the open theoretical problems related to spontaneous supersymmetry breaking in the underlying fundamental theory.

  8. 2010 Chemical Working Group Status

    Science.gov (United States)

    Reid, Concha M.

    2010-01-01

    The Steering Group for the Interagency Advanced Power Group (IAPG) held their business meeting on November 30-December 1st in McLean, Virginia. Status reports were presented from each of the IAPG's Working Groups. These charts contain a brief summary of the IAPG Chemical Working Group's activities during 2010 and its plans for 2011.

  9. of nutritional status of women

    African Journals Online (AJOL)

    Ferro-Luzzi A, Saccini C, Taffesse S. Seasonal Energy deficiency in Ethiopian. Rural women. Eur. J.Clin.Nutr. 1990; 44. Supp. 1;7-18.' Taddess Zerihun et al.. Anthropometric status of Oromo women-in rural South- western Ethiopia. Ethiopian journal of health development. 1998;12(1);l -7. Demissie T. Dietary. craving and ...

  10. ATLAS Status and First Results

    CERN Document Server

    Lankford, AJ; The ATLAS collaboration

    2010-01-01

    The ATLAS Experiment at the CERN Large Hadron Collider will study a broad range of particle physics at the highest available laboratory energies, from measurements of the standard model to searches for new physics beyond the standard model. The status of ATLAS commissioning and the ATLAS physics program will be reported, and physics prospects for the 2010 LHC run will be discussed.

  11. Socioeconomic status and fertility decline

    DEFF Research Database (Denmark)

    Dribe, Martin; Breschi, Marco; Gagnon, Alain

    2017-01-01

    America to analyse the relationship between socio-economic status and fertility during the fertility transition. Using comparable analytical models and class schemes for each population, we examined the changing socio-economic differences in marital fertility and related these to common theories...

  12. Ethiopia: Country Status Report (Revision).

    Science.gov (United States)

    McFerren, Margaret

    A survey of the status of language usage in Ethiopia begins with an overview of the distribution of Amharic, the sole official language and medium of elementary instruction, and Tigrinya, Oromo, Wolayto, Somali, Sidamo, Hadiyya, and English, the medium of secondary and higher education instruction. The relationship of language usage patterns to…

  13. Economic Status of Academic Librarians

    Science.gov (United States)

    Perret, Robert; Young, Nancy J.

    2011-01-01

    This article examines some of the factors affecting the current economic status of academic librarians, as well as the history of changes in that economic picture. Issues discussed include the ranking of beginning academic librarian salaries in comparison to others in the profession, historical differences between academic librarian salaries and…

  14. Status of spallation neutron source

    Energy Technology Data Exchange (ETDEWEB)

    Oyama, Yukio [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    1997-03-01

    Existing and planned facilities using proton accelerator driven spallation neutron source are reviewed. These include new project of neutron science proposed from Japan Atomic Energy Research Institute. The present status of facility requirement and accelerator technology leads us to new era of neutron science such as neutron scattering research and nuclear transmutation study using very intense neutron source. (author)

  15. The Medicina Station Status Report

    Science.gov (United States)

    Orfei, Alessandro; Orlati, Andrea; Maccaferri, Giuseppe

    2013-01-01

    General information about the Medicina Radio Astronomy Station, the 32-m antenna status, and the staff in charge of the VLBI observations is provided. In 2012, the data from geodetic VLBI observations were acquired using the Mark 5A recording system with good results. Updates of the hardware were performed and are briefly described.

  16. Experimental Status of B Physics

    International Nuclear Information System (INIS)

    Stone, Sheldon

    2006-01-01

    A short summary is given of the current status of B physics. Reasons for physics beyond the Standard Model are discussed. Constraints on New Physics are given using measurements of B mixing, BS mixing, and CP violation, along with |Vub|. Future goals, and upcoming new experiments are also mentioned

  17. Status of the OPERA experiment

    International Nuclear Information System (INIS)

    Hamada, K.

    2011-01-01

    The OPERA hybrid apparatus consists of a large mass emulsion films/lead target complemented by electronic detectors. The OPERA experiment is currently in data taking and analysis, and the first ν τ candidate event was observed in 2010. In this report, the status of the OPERA experiment and statistical significance of the first candidate observed so far are presented.

  18. Research Status of Evaporative Condenser

    Science.gov (United States)

    Wang, Feifei; Yang, Yongan

    2018-02-01

    Reducing energy consumption, saving water resources, recycling cool water are main directions of China’s development. Evaporative condenser using latent heat reduces water resources waste, with energy-saving advantages. This paper reviews the research status of evaporative condenser at home and abroad, and introduces the principle, classification, various influencing factors of evaporative condenser, and puts forward the future research direction.

  19. Targeted Advertising and Social Status

    NARCIS (Netherlands)

    N. Vikander (Nick)

    2010-01-01

    textabstractThis paper shows how a firm can use non-targeted advertising to exploit consumers' desire for social status. A monopolist sells multiple varieties of a good to consumers who each care about what others believe about his wealth. Advertising allows consumers both to buy different varieties

  20. Present status of processing method

    Energy Technology Data Exchange (ETDEWEB)

    Kosako, Kazuaki [Sumitomo Atomic Energy Industries Ltd., Tokyo (Japan)

    1998-11-01

    Present status of processing method for a high-energy nuclear data file was examined. The NJOY94 code is the only one available to the processing. In Japan, present processing used NJOY94 is orienting toward the production of traditional cross section library, because a high-energy transport code using a high-energy cross section library is indistinct. (author)

  1. ANTIOXIDANT STATUS IN DIABETIC NEUROPATHY

    Directory of Open Access Journals (Sweden)

    Giriraja Vrushabaiah Kanakapura

    2017-09-01

    Full Text Available BACKGROUND Diabetic neuropathy, retinopathy and nephropathy are the chronic complications of diabetes mellitus. Neuropathy, retinopathy and nephropathy are microvascular complication of diabetes mellitus. Antioxidant status is reduced in DM-induced retinopathy and nephropathy. Present study is undertaken to evaluate the degree of oxidative stress in diabetic neuropathy patients. The aim of the study is to study on oxidative stress as measured by lipid peroxidation marker, malondialdehyde and antienzyme status in type II DM patients with neuropathy and compared them with a controlled nondiabetic group. MATERIALS AND METHODS The study included 100 subjects from Sapthagiri Medical College, Bangalore, from January 1, 2015, to December 31, 2015, of age group 50 to 70 yrs. out of which 50 patients were non-insulin-dependent DM with neuropathy and rest 50 age and sex matched apparently healthy individuals (control group. Antioxidant status was assessed by measuring superoxide dismutase (SOD, glutathione peroxidase (GPx, glutathione reductase (GR, Catalase and Reduced Glutathione (GSH. RESULTS It showed a significant increase p<0.001 in FBS, PPBS, TC, TG, LDL, VLDL, CAT, MDA, while HDL, GSH, GPX, GR and SOD were found to be decreased significantly (p 0.001. CONCLUSION MDA was significantly elevated in diabetic group, whereas antioxidant enzymes superoxide dismutase, glutathione peroxidase, glutathione reductase and reduced glutathione were significantly decreased, which might be helpful in risk assessment of various complications of DM. The data suggests that alteration in antioxidant status and MDA may help to predict the risk of diabetic neuropathy.

  2. The Epistemic Status of Intelligence

    DEFF Research Database (Denmark)

    Rønn, Kira Vrist; Høffding, Simon

    2012-01-01

    We argue that the majority of intelligence definitions fail to recognize that the normative epistemic status of intelligence is knowledge and not an inferior alternative. We refute the counter-arguments that intelligence ought not to be seen as knowledge because of 1) its action-oriented scope...... and robustness of claims to intelligence-knowledge can be assessed....

  3. DYMAC system: status and experience

    International Nuclear Information System (INIS)

    Malanify, J.J.

    1980-01-01

    The Dynamic Materials Accountability (DYMAC) system has been in operation at the Plutonium Processing Facility at the Los Alamos Scientific Laboratory since January 1978. The current status of this development and demonstration program, as well as the achieved operational experience, is reported

  4. The status of supersymmetry phenomenology

    Indian Academy of Sciences (India)

    The status of supersymmetry phenomenology. AMITAVA DATTA. Department of Physics, Jadavpur University, Calcutta 700 032, India. Present Address: Department of Physics, Visva Bharati, Santiniketan 731 235, India. Abstract. In this brief review the following topics are discussed: Direct searches for SUSY in mSUGRA: a ...

  5. Status of Japanese university reactors

    International Nuclear Information System (INIS)

    Fujita, Yoshiaki

    1999-01-01

    Status of Japanese university reactors, their role and value in research and education, and the spent fuel problem are presented. Some of the reactors are now faced by severe difficulties in continuing their operation services. The point of measures to solve the difficulties is suggested. (author)

  6. Gender, status, and psychiatric labels.

    Science.gov (United States)

    Kroska, Amy; Harkness, Sarah K; Brown, Ryan P; Thomas, Lauren S

    2015-11-01

    We examine a key modified labeling theory proposition-that a psychiatric label increases vulnerability to competence-based criticism and rejection-within task- and collectively oriented dyads comprised of same-sex individuals with equivalent education. Drawing on empirical work that approximates these conditions, we expect the proposition to hold only among men. We also expect education, operationalized with college class standing, to moderate the effects of gender by reducing men's and increasing women's criticism and rejection. But, we also expect the effect of education to weaken when men work with a psychiatric patient. As predicted, men reject suggestions from teammates with a psychiatric history more frequently than they reject suggestions from other teammates, while women's resistance to influence is unaffected by their teammate's psychiatric status. Men also rate psychiatric patient teammates as less powerful but no lower in status than other teammates, while women's teammate assessments are unaffected by their teammate's psychiatric status. Also as predicted, education reduces men's resistance to influence when their teammate has no psychiatric history. Education also increases men's ratings of their teammate's power, as predicted, but has no effect on women's resistance to influence or teammate ratings. We discuss the implications of these findings for the modified labeling theory of mental illness and status characteristics theory. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Standards development status. Summary report

    International Nuclear Information System (INIS)

    1981-12-01

    The Standards Development Status Summary Report is designed for scheduling, monitoring, and controlling the process by which Regulatory Standards, Guides, Reports, Petitions, and Environmental Statements are written. It is a summary of the current schedule plans for development of the above products

  8. Singleton status and childhood obesity: Investigating effects and mechanisms Status :

    OpenAIRE

    Maoyong Fan; Yanhong Jin

    2015-01-01

    Over the past four decades, paralleling the increasing prevalence of childhood obesity, the share of families with only one child has been rising steadily. Using three waves of the National Survey of Children's Health, we examine the effect of being the only child in a family on childhood obesity and the mechanisms through which singleton status might affect childhood obesity. We find gender-specific and age-dependent singleton effects. That is, singletons have a higher level of body mass ind...

  9. Distributed systems status and control

    Science.gov (United States)

    Kreidler, David; Vickers, David

    1990-01-01

    Concepts are investigated for an automated status and control system for a distributed processing environment. System characteristics, data requirements for health assessment, data acquisition methods, system diagnosis methods and control methods were investigated in an attempt to determine the high-level requirements for a system which can be used to assess the health of a distributed processing system and implement control procedures to maintain an accepted level of health for the system. A potential concept for automated status and control includes the use of expert system techniques to assess the health of the system, detect and diagnose faults, and initiate or recommend actions to correct the faults. Therefore, this research included the investigation of methods by which expert systems were developed for real-time environments and distributed systems. The focus is on the features required by real-time expert systems and the tools available to develop real-time expert systems.

  10. Digital radiography: Review, status, perspectives

    International Nuclear Information System (INIS)

    Pfeiler, M.; Marhoff, P.

    1989-01-01

    The contribution is intended as a status report, assessing current digital radiography from the angle of view of the year 1983, placing emphasis on digital imaging with the image enhancement and television equipment, discussing the luminescent foil technique in great detail. The article deals with the interpretation of the term resolution, necessary in connection with the digital technique, as well as with the possibility offered by the digital technique, to change standards for pulsed fluoroscopic, or stereo operation. The article explains the advantages of real-time image processing as against fluoroscopic operation. The control methods of digital radiography also are digital, as are the communication systems between the various system components (generators, central unit). The prospects of this imaging method are estimated in an extrpolation of the current status. (orig./MG) [de

  11. Sympathovagal imbalance in prehypertension status

    Directory of Open Access Journals (Sweden)

    Yi-Jhih Huang

    2016-01-01

    Full Text Available Background: Heart rate variability (HRV had been promoted for longer than half a century to monitor the activity of autonomic nerve systems. Previous studies have not clarified the relationship between HRV and prehypertension (pre-HTN status compared with the normal group. We aimed to figure out the optimal model or cutoff point for predicting the possible pre-HTN status. Patients and Methods: We retrospectively collected and reviewed 2586 Asian people who had joined annual physical examination in Tri-Service General Hospital at 2013. The patient profiles such as age, gender, body height, body weight, body weight index, waist circumferences, and serological biochemistry data were analyzed and correlated with HRV parameter. Results: A total number of 909 patients were enrolled in our study. The physical stress index (PSI owed a small but most significant Spearman's relation coefficient (r = 0.118, P58.4. Early intervention to these participants may decrease cardiovascular events in the coming future.

  12. HOMEOPATHY TODAY - EDUCATION AND STATUS

    Directory of Open Access Journals (Sweden)

    Snezana M Cupara

    2007-01-01

    Full Text Available Due to its encouaring results, classic homeopathy soon became very popular that a great number of homeopathic hospitals and educational institutions in Europe and America were founded at the end of the 19th century. However, historic events at the beinning of the 20th century diminished its use for the longer period of time. Since 1970, homoeopathy has been reviving in many countries of the world in different domains – educational institutions have appeared, it has been incorporated in many national health systems and there has been research development. Nowadays, homeopathy is recognised in all continents either as an independent or alternative (complementary medical system. Since status of homeopathy and possibilities for education have not been uniformed and standardized in the world, the aim of this article is to offer an abbreviated review on possibilities of education, status and history of homeopathy. The refer belong to developed countries, different continents and neighboring countries.

  13. 2016 Bioenergy Industry Status Report

    Energy Technology Data Exchange (ETDEWEB)

    Moriarty, Kristen L. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Milbrandt, Anelia R. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Warner, Ethan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Lewis, John E. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Schwab, Amy A. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2018-03-03

    This report provides a snapshot of the bioenergy industry status at the end of 2016. The report compliments other annual market reports from the U.S. Department of Energy’s (DOE’s) Office of Energy Efficiency and Renewable Energy offices and is supported by DOE’s Bioenergy Technologies Office (BETO). The 2016 Bioenergy Industry Status Report focuses on past year data covering multiple dimensions of the bioenergy industry and does not attempt to make future market projections. The report provides a balanced and unbiased assessment of the industry and associated markets. It is openly available to the public and is intended to compliment International Energy Agency and industry reports with a focus on DOE stakeholder needs.

  14. Status of the DIOS mission

    Science.gov (United States)

    Tawara, Y.; Sakurai, I.; Furuzawa, A.; Ohashi, T.; Ishisaki, Y.; Ezoe, Y.; Hoshino, A.; Akamatsu, H.; Ishikawa, K.; Mitsuda, K.; Yamasaki, N. Y.; Takei, Y.; Shinozaki, K.; Masui, K.; Yoshino, T.; Hagihara, T.; Kimura, S.; Yoshitake, H.

    2008-07-01

    We present the current status of a small X-ray mission DIOS (Diffuse Intergalactic Oxygen Surveyor), consisting of a 4-stage X-ray telescope and an array of TES microcalorimeters, cooled with mechanical coolers, with a total weight of about 400 kg. The mission will perform survey observations of warm-hot intergalactic medium using OVII and OVIII emission lines, with the energy coverage up to 1.5 keV. The wide field of view of about 50' diameter, superior energy resolution close to 2 eV FWHM, and very low background will together enable us a wide range of science for diffuse X-ray sources. We briefly describe the current status of the development of the satellite, and the subsystems.

  15. Health status of hostel dwellers

    African Journals Online (AJOL)

    1991-06-15

    Jun 15, 1991 ... Department of Social Anthropology, University of Cape. Town. M. A. RAMPHELE, M.B. CH.B., D.C.H. (S.A.). M. HEAP, M.A. (SOC. ANTHR.) Accepted 8 Aug 1990. Health status is measured on the basis of a number of criteria (see Appendix A), which vary for the different age and sex groupings of the hostel ...

  16. LHC: status and commissioning plans

    CERN Document Server

    Lamont, M.

    2009-01-01

    In 2008 the LHC saw a series of injection tests with beam and the start of full beam commissioning. Initial beam commissioning went well and circulating beam was quickly established. Progress was unfortunately curtailed by the sector 34 incident which caused extensive damage. The causes of the incident are recalled and the status of repairs and consolidation measures are presented. The schedule and luminosity targets for the 2009 - 2010 run are discussed.

  17. Photoprotection and vitamin D status.

    Science.gov (United States)

    Springbett, Peter; Buglass, Surhi; Young, Antony R

    2010-11-03

    The adverse effects of solar ultraviolet radiation on the skin are well documented, especially in fair-skinned people. These can be ameliorated by photoprotection strategies advocated by many public health bodies and typically include sun avoidance, sunscreen use and clothing. The UVB waveband which is the main cause of all adverse effects investigated in the laboratory to date is also the waveband for vitamin D photosynthesis which is the only established benefit of solar exposure. This is especially important because solar UVB is the main source of vitamin D for most people. There is increasing evidence that vitamin D plays a much greater role in human health than was previously thought. This has given rise to concerns that photoprotection, especially sunscreen use, could adversely affect vitamin D status and human health. Furthermore, it is stated that people with heavily pigmented skins often have poor vitamin D status because of photoprotection by melanin. In this paper we review the effect of photoprotection strategies and pigmentation on vitamin D status. Clothing can clearly be very effective at inhibiting vitamin D synthesis. Sunscreens are effective in theory and some limited human studies support this. However, most studies show little or no effect and the most likely reason for this is that sunscreens have not been applied in the manner that was used to determine their labelled index of protection against sunburn. This could change in the future if public health campaigns and the sunscreen industry are successful in encouraging the public to apply sunscreens more liberally and/or use much higher levels of labelled protection. The role of melanin on vitamin D status is not clear and requires further investigation. Copyright © 2010. Published by Elsevier B.V.

  18. The status of perturbative QCD

    International Nuclear Information System (INIS)

    Ellis, R.K.

    1988-10-01

    The advances in perturbative QCD are reviewed. The status of determinations of the coupling constant α/sub S/ and the parton distribution functions is presented. New theoretical results on the spin dependent structure functions of the proton are also reviewed. The theoretical description of the production of vector bosons, jets and heavy quarks is outlined with special emphasis on new results. Expected rates for top quark production at hadronic colliders are presented. 111 refs., 8 figs

  19. Happiness and Sexual Minority Status.

    Science.gov (United States)

    Thomeer, Mieke Beth; Reczek, Corinne

    2016-10-01

    We used logistic regression on nationally representative data (General Social Survey, N = 10,668 and N = 6680) to examine how sexual minority status related to happiness. We considered two central dimensions of sexual minority status-sexual behavior and sexual identity. We distinguished between same-sex, both-sex, and different-sex-oriented participants. Because individuals transition between sexual behavior categories over the life course (e.g., from both-sex partners to only same-sex partners) and changes in sexual minority status have theoretical associations with well-being, we also tested the associations of transitions with happiness. Results showed that identifying as bisexual, gay, or lesbian, having both male and female partners since age 18, or transitioning to only different-sex partners was negatively related to happiness. Those with only same-sex partners since age 18 or in the past 5 years had similar levels of happiness as those with only different-sex partners since age 18. Additional tests showed that the majority of these happiness differences became non-significant when economic and social resources were included, indicating that the lower happiness was a product of structural and societal forces. Our findings clearly and robustly underscored the importance of taking a multi-faceted approach to understanding sexuality and well-being, demonstrating that not all sexual minority groups experience disadvantaged happiness. Our study calls for more attention to positive aspects of well-being such as happiness in examinations of sexual minorities and suggests that positive psychology and other happiness subfields should consider the role of sexual minority status in shaping happiness.

  20. Status of the SOFIA Observatory

    Science.gov (United States)

    Roellig, Thomas L.

    2015-01-01

    The SOFIA observatory has been in routine science operations since returning in January from a 6 month-long heavy maintenance period for the aircraft and the telescope assembly. These operations include a successful 6 week deployment to the Southern hemisphere. This presentation will provide an update to the current operational status of the SOFIA observatory, concentrating on the improvements and upgrades that have been implemented since the heavy maintenance period.

  1. The WIMP Paradigm: Current Status

    International Nuclear Information System (INIS)

    Feng, Jonathan

    2011-01-01

    The WIMP paradigm is the glue that joins together much of the high energy and cosmic frontiers. It postulates that most of the matter in the Universe is made of weakly-interacting massive particles, with implications for a broad range of experiments and observations. I will review the WIMP paradigm's underlying motivations, its current status in view of rapid experimental progress on several fronts, and recent theoretical variations on the WIMP paradigm theme.

  2. Status report on mirror alternatives

    International Nuclear Information System (INIS)

    Condit, W.C.; Fowler, T.K.; Post, R.F.

    1976-01-01

    The present status of studies at Lawrence Livermore Laboratory (LLL) directed toward exploring variants on the basic magnetic mirror confinement concept is described. These studies have emphasized those ideas that could lead most directly to improvements in the scientific and economic viability of fusion reactors based on the mirror concept, within the general context of the extensive body of specialized physics and technology that has been developed in the course of the Mirror Program

  3. Status report on ILDG activities

    Energy Technology Data Exchange (ETDEWEB)

    Jansen, K. [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany). John von Neumann-Inst. fuer Computing NIC

    2006-09-15

    A status report about the International Lattice Data Grid (ILDG) is given. Different countries participating in the ILDG have created regional lattice data grid solutions that are implemented, working and used. The remaining task and the focus of present activities is the development of the interoperability of these regional grids. A first, successful step in this direction is a metadata catalogue service which is already working interoperable. (orig.)

  4. Status of 239Pu evaluations

    International Nuclear Information System (INIS)

    Kawano, Toshihiko; Talou, Patrick; Chadwick, Mark B.

    2014-01-01

    This paper summarises the current status of nuclear data evaluations for n+ 239 Pu. The nuclear data we address include fission, capture, scattering cross-sections, as well as the prompt fission neutron energy spectrum, which has large sensitivities to the criticality benchmark testing. The evaluated nuclear data files currently available for 239 Pu are compared, and the source of differences in the cross-sections are discussed. Some open questions on the statistical model calculations for deformed systems are also given. (authors)

  5. Marital status, health and mortality.

    Science.gov (United States)

    Robards, James; Evandrou, Maria; Falkingham, Jane; Vlachantoni, Athina

    2012-12-01

    Marital status and living arrangements, along with changes in these in mid-life and older ages, have implications for an individual's health and mortality. Literature on health and mortality by marital status has consistently identified that unmarried individuals generally report poorer health and have a higher mortality risk than their married counterparts, with men being particularly affected in this respect. With evidence of increasing changes in partnership and living arrangements in older ages, with rising divorce amongst younger cohorts offsetting the lower risk of widowhood, it is important to consider the implications of such changes for health in later life. Within research which has examined changes in marital status and living arrangements in later life a key distinction has been between work using cross-sectional data and that which has used longitudinal data. In this context, two key debates have been the focus of research; firstly, research pointing to a possible selection of less healthy individuals into singlehood, separation or divorce, while the second debate relates to the extent to which an individual's transitions earlier in the life course in terms of marital status and living arrangements have a differential impact on their health and mortality compared with transitions over shorter time periods. After reviewing the relevant literature, this paper argues that in order to fully account for changes in living arrangements as a determinant of health and mortality transitions, future research will increasingly need to consider a longer perspective and take into account transitions in living arrangements throughout an individual's life course rather than simply focussing at one stage of the life course. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. [Nutritional status in Alzheimer's disease].

    Science.gov (United States)

    Machado, Jacqueline; Caram, Carmen Lucia Barreto; Frank, Andrea Abdala; Soares, Eliane de Abreu; Laks, Jerson

    2009-01-01

    To describe the nutritional status of elderly subjects with mild to moderate Alzheimer's disease. Subjects of both genders (n=40) diagnosed with mild to moderate Alzheimer's disease according to NINCDS-ADRDA criteria, participated in the study. Socioeconomic status, activities of daily life, anthropometric, clinical and dietary profiles were surveyed. Of the total, 65% were female. More than 70% were capable of accomplishing daily activities by themselves. Subjects were eutrophic with a statistically significant difference of the arm circumference between the mild and moderate groups. As for illnesses secondary to Alzheimer's, 52% of the elderly presented hypertension, followed by arthrosis type alterations (17%). The mean consumption of energy and macronutrients in the elderly classified as mild dementia was of 1645 kcal, distributed in 53.7% of carbohydrate, 17.5% of proteins or 0.9 g/kg and 28.8% of lipids. For those classified as moderate dementia it was of 1482 kcal, distributed in 59.3% of carbohydrate, 16.1% of proteins and 24.6% of lipids. In this descriptive study of elderly outpatients with mild and moderate Alzheimer's disease, most presented a nutritional status of eutrophy, with adequate dietary intake of carbohydrates, proteins, lipids and vitamin C, but with low dietary intake of vitamin E.

  7. Renewables 2013. Global Status Report

    Energy Technology Data Exchange (ETDEWEB)

    Sawin, J.L. (ed.) [and others

    2013-07-01

    Renewable energy markets, industries, and policy frameworks have evolved rapidly in recent years. The Renewables Global Status Report provides a comprehensive and timely overview of renewable energy market, industry, investment, and policy developments worldwide. It relies on the most recent data available, provided by many contributors and researchers from around the world, all of which is brought together by a multi-disciplinary authoring team. The report covers recent developments, current status, and key trends; by design, it does not provide analysis or forecasts. This latest Renewables Global Status Report saw: a shift in investment patterns that led to a global decrease in clean energy investment; continuing growth in installed capacity due to significant technology cost reductions and increased investment in developing countries; renewables progressively supplementing established electricity systems, demonstrating that the implementation of suitable policies can enable the successful integration of higher shares of variable renewables; and the emergence of integrated policy approaches that link energy efficiency measures with the implementation of renewable energy technologies.

  8. Income Inequality, Status Seeking, and Consumption

    OpenAIRE

    Jin, Ye; Wu, Binzhen; Li, Hongbin

    2010-01-01

    Using the Chinese urban household survey data between 1997 and 2006, we find that income inequality has a negative (positive) impact on households’ consumption (savings), even after we control for family income. We argue that people save to improve their social status when social status is associated with pecuniary and non-pecuniary benefits. Rising income inequality can strengthen the incentives of status-seeking savings by increasing the benefit of improving status and enlarging the wealth ...

  9. The Retinal Readout System: a status report A Status Report

    CERN Document Server

    Litke, A M

    1999-01-01

    The 'Retinal Readout System' is being developed to study the language the eye uses to send information about the visual world to the brain. Its architecture is based on that of silicon microstrip detectors. An array of 512 microscopic electrodes picks up the signals generated by the output neurons of live retinal tissue in response to a dynamic image focused on the input neurons. These signals are amplified, filtered and multiplexed by a set of eight custom-designed VLSI readout chips, and digitized and recorded by a data acquisition system. This report describes the goals, design, and status of the system. (author)

  10. Status and the evaluation of workplace deviance.

    Science.gov (United States)

    Bowles, Hannah Riley; Gelfand, Michele

    2010-01-01

    Bias in the evaluation of workplace misbehavior is hotly debated in courts and corporations, but it has received little empirical attention. Classic sociological literature suggests that deviance by lower-status actors will be evaluated more harshly than deviance by higher-status actors. However, more recent psychological literature suggests that discrimination in the evaluation of misbehavior may be moderated by the relative status of the evaluator because status influences both rule observance and attitudes toward social hierarchy. In Study 1, the psychological experience of higher status decreased rule observance and increased preferences for social hierarchy, as we theorized. In three subsequent experiments, we tested the hypothesis that higher-status evaluators would be more discriminating in their evaluations of workplace misbehavior, evaluating fellow higher-status deviants more leniently than lower-status deviants. Results supported the hypothesized interactive effect of evaluator status and target status on the evaluation of workplace deviance, when both achieved status characteristics (Studies 2a and 2b) and ascribed status characteristics (i.e., race and gender in Study 3) were manipulated.

  11. ZEB Flexible Lab. Status ZEB-COM

    DEFF Research Database (Denmark)

    Førland-Larsen, Arne

    2017-01-01

    Dette notatet med vedlegg gir status for prosjektet ved målpris 2. Notat gir status i forhold til og nå ZEB-COM målsetningen for bygget, og herunder status og forutsetninger for: • Energibruk • Klimagassutslipp • Inneklima • Dagslys Resultatene er: Byggets energibruk og energiforsynings strategi ...

  12. 27 CFR 28.30 - Export status.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Export status. 28.30... Export status. (a) Distilled spirits and wines manufactured, produced, bottled in bottles packed in... such purposes are considered to be exported. Export status is not acquired until application on Form...

  13. 47 CFR 1.733 - Status conference.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Status conference. 1.733 Section 1.733..., and Reports Involving Common Carriers Formal Complaints § 1.733 Status conference. (a) In any... appear before it for a status conference. Unless otherwise ordered by the Commission, and with the...

  14. Nutritional status and liver transplantation.

    Science.gov (United States)

    Merli, Manuela; Giusto, Michela; Giannelli, Valerio; Lucidi, Cristina; Riggio, Oliviero

    2011-12-01

    Chronic liver disease has a profound effect on nutritional status and undernourishment is almost universally present in patients with end-stage liver disease undergoing liver transplantation. In the last decades, due to epidemiological changes, a trend showing an increase in patients with end-stage liver disease and associated obesity has also been reported in developed countries. Nutrition abnormalities may influence the outcome after transplantation therefore, the importance to carefully assess the nutritional status in the work-up of patients candidates for liver transplantation is widely accepted. More attention has been given to malnourished patients as they represent the greater number. The subjective global nutritional assessment and anthropometric measurements are recognized in current guidelines to be adequate in identifying those patients at risk of malnutrition. Cirrhotic patients with a depletion in lean body mass and fat deposits have an increased surgical risk and malnutrition may impact on morbidity, mortality and costs in the post-transplantation setting. For this reason an adequate calorie and protein intake should always be ensured to malnourished cirrhotic patient either through the diet, or using oral nutritional supplements or by enteral or parenteral nutrition although studies supporting the efficacy of nutritional supplementation in improving the clinical outcomes after transplantation are still scarce. When liver function is restored, an amelioration in the nutritional status is expected. After liver transplantation in fact dietary intake rapidly normalizes and fat mass is progressively regained while the recovery of muscle mass can be slower. In some patients unregulated weight gain may lead to over-nutrition and may favor metabolic disorders (hypertension, hyperglycemia, hyperlipidemia). This condition, defined as 'metabolic syndrome', may play a negative role on the overall survival of liver transplant patients. In this report we review

  15. Renewables 2007 - Global status report

    International Nuclear Information System (INIS)

    Martinot, Eric; Mastny, Lisa; Rosbotham, Lyle; Suding, Paul; Sonntag-O'Brien, Virginia; Lempp, Philippe

    2007-01-01

    In 2007, more than $100 billion was invested in new renewable energy capacity, manufacturing plants, and research and development-a true global milestone. Yet perceptions lag behind the reality of renewable energy because change has been so rapid in recent years. This report captures that reality and provides an overview of the status of renewable energy worldwide in 2007. The report covers trends in markets, investments, industries, policies, and rural (off-grid) renewable energy. (By design, the report does not provide analysis, discuss current issues, or forecast the future.) Many of the trends reflect increasing significance relative to conventional energy

  16. Status of the VIRGO experiment

    International Nuclear Information System (INIS)

    Yvert, M.

    1994-07-01

    The VIRGO experiment was approved in September 1993. The goal of the French-Italian collaboration is to detect Gravitational Waves using a 3 km arm-length Michelson interferometer. The construction of this detector, which will be installed in Pisa, is under way. The experiment is planned to take data, in a large bandwidth (10Hz-10kHz), at the beginning of year 2000 with nominal sensitivity close to h=3x10 -23 /√Hz. The motivations, detection principle, main sources of noise and status of the experiment are presented. (author). 14 refs., 4 figs

  17. Status of the BLAST experiment

    International Nuclear Information System (INIS)

    Hasell, D.K.

    2004-01-01

    The BLAST experiment is beginning operation at the MIT-Bates Linear Accelerator Laboratory. The experiment will study the spin dependent electro-magnetic interaction in few nucleon systems at momentum transfers between 0.1 and 1.0 GeV 2 . This will provide improved measurements of the nucleon form factors, particularly G E n , as well as study the structure of D and 3 He. Other reaction channels such as pion production and inclusive scattering will also be studied. The experiment, physics goals, and current status are described briefly. (orig.)

  18. Renewables 2005. Global status report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    This report provides an overview of the status of renewable energy worldwide in 2005. It covers markets, investments, industries, policies, and rural (off-grid) renewable energy in developing countries. By design, the report does not provide analysis, recommendations, or conclusions. An extensive research and review process over several months involving more than 100 researchers and contributors has kept inaccuracies to a minimum. REN21 sees this report as the beginning of an active exchange of views and information. This report reveals some surprising facts about renewable energy, many reflecting strong growth trends and increasing significance relative to conventional energy. (au)

  19. Renewables 2005 - Global status report

    International Nuclear Information System (INIS)

    Martinot, Eric

    2005-01-01

    This report provides an overview of the status of renewable energy worldwide in 2005. It covers markets, investments, industries, policies, and rural (off-grid) renewable energy in developing countries. By design, the report does not provide analysis, recommendations, or conclusions. An extensive research and review process over several months involving more than 100 researchers and contributors has kept inaccuracies to a minimum. REN21 sees this report as the beginning of an active exchange of views and information. This report reveals some surprising facts about renewable energy, many reflecting strong growth trends and increasing significance relative to conventional energy

  20. Renewables 2005. Global status report

    International Nuclear Information System (INIS)

    2005-01-01

    This report provides an overview of the status of renewable energy worldwide in 2005. It covers markets, investments, industries, policies, and rural (off-grid) renewable energy in developing countries. By design, the report does not provide analysis, recommendations, or conclusions. An extensive research and review process over several months involving more than 100 researchers and contributors has kept inaccuracies to a minimum. REN21 sees this report as the beginning of an active exchange of views and information. This report reveals some surprising facts about renewable energy, many reflecting strong growth trends and increasing significance relative to conventional energy. (au)

  1. Large Millimeter Telescope (LMT) status

    Science.gov (United States)

    Schloerb, F. Peter; Carrasco, Luis; Wilson, Grant W.

    2003-02-01

    We present a summary of the Large Millimeter Telescope Project and its present status. The Large Millimeter Telescope (LMT) is a joint project of the University of Massachusetts (UMass) in the USA and the Instituto Nacional de Astrofisica, Optica y Electronica (INAOE) in Mexico to build a 50m-diameter millimeter-wave telescope. The LMT is being built at an altitude of 4600 m atop Volcan Sierra Negra, an extinct volcanic peak in the state of Puebla, Mexico, approximately 100 km east of the city of Puebla. Construction of the antenna is now well underway, and it is expected to be completed in 2004.

  2. Status of LLNL granite projects

    Energy Technology Data Exchange (ETDEWEB)

    Ramspott, L.D.

    1980-12-31

    The status of LLNL Projects dealing with nuclear waste disposal in granitic rocks is reviewed. This review covers work done subsequent to the June 1979 Workshop on Thermomechanical Modeling for a Hardrock Waste Repository and is prepared for the July 1980 Workshop on Thermomechanical-Hydrochemical Modeling for a Hardrock Waste Repository. Topics reviewed include laboratory determination of thermal, mechanical, and transport properties of rocks at conditions simulating a deep geologic repository, and field testing at the Climax granitic stock at the USDOE Nevada Test Site.

  3. Status of LLNL granite projects

    International Nuclear Information System (INIS)

    Ramspott, L.D.

    1980-01-01

    The status of LLNL Projects dealing with nuclear waste disposal in granitic rocks is reviewed. This review covers work done subsequent to the June 1979 Workshop on Thermomechanical Modeling for a Hardrock Waste Repository and is prepared for the July 1980 Workshop on Thermomechanical-Hydrochemical Modeling for a Hardrock Waste Repository. Topics reviewed include laboratory determination of thermal, mechanical, and transport properties of rocks at conditions simulating a deep geologic repository, and field testing at the Climax granitic stock at the USDOE Nevada Test Site

  4. Status of the VIRGO experiment

    International Nuclear Information System (INIS)

    Caron, B.; Dominjon, A.; Marion, F.

    1995-01-01

    The VIRGO experiment was approved in September 1993. The goal of the French-Italian collaboration is to detect gravitational waves using a 3 km arm-length Michelson interferometer. The construction of this detector, which will be installed in Pisa, is under way. The experiment is planned to take data, in a large bandwidth (10 Hz-10 kHz), at the beginning of the year 2000 with nominal sensitivity close to h=3x10 -23 /√(Hz). The motivations, detection principle, main sources of noise and status of the experiment are presented. (orig.)

  5. Taxonomic status of Anastrepha fraterculus

    International Nuclear Information System (INIS)

    Steck, G.J.

    1999-01-01

    There has long been speculation that nominal Anastrepha fraterculus comprises more than a single biological species. Herein is a review of data supporting the hypothesis that multiple cryptic species are present. Evidence includes unusual variation in pest status, morphology, karyotypes, isozymes, mitochondrial DNA and cuticular hydrocarbon. The data strongly support the notion of multiple cryptic species. However, it is not yet possible to state how many species may be involved or to delineate them by diagnostic morphology, distribution, host plants or behavior. A combination of methodologies will be needed to resolve the complex. (author)

  6. Network management, status and directions

    International Nuclear Information System (INIS)

    Cottrell, R.L.A.; Streater, T.C.

    1992-09-01

    It has been said that the ''network is the system''. This implies providing levels of service, reliability, predictability and availability that are commensurate with or better than those that individual computers provide today. To provide this requires integrated network management for interconnected networks of heterogeneous devices covering both the local campus and across the world and spanning many administrative domains. This talk will review the status of existing tools to address management for networks. It draws on experience from both within and outside the HEP community

  7. State building energy codes status

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-09-01

    This document contains the State Building Energy Codes Status prepared by Pacific Northwest National Laboratory for the U.S. Department of Energy under Contract DE-AC06-76RL01830 and dated September 1996. The U.S. Department of Energy`s Office of Codes and Standards has developed this document to provide an information resource for individuals interested in energy efficiency of buildings and the relevant building energy codes in each state and U.S. territory. This is considered to be an evolving document and will be updated twice a year. In addition, special state updates will be issued as warranted.

  8. Renewables 2012. Global Status Report

    Energy Technology Data Exchange (ETDEWEB)

    Sawin, J.L. (ed.) [and others

    2012-08-15

    Renewable energy markets and policy frameworks have evolved rapidly in recent years. This report provides a comprehensive and timely overview of renewable energy market, industry, investment, and policy developments worldwide. It relies on the most recent data available, provided by a network of more than 400 contributors and researchers from around the world, all of which is brought together by a multi-disciplinary authoring team. The report covers recent developments, current status, and key trends; by design, it does not provide analysis or forecast the future.

  9. Status of food irradiation worldwide

    International Nuclear Information System (INIS)

    Loaharanu, P.

    1992-01-01

    The past four decades have witnessed the steady development of food irradiation technology - from laboratory-scale research to full-scale commercial application. The present status of this technology, approval for processing food items in 37 countries and commerical use of irradiated food in 24 countries, will be discussed. The trend in the use of irradiation to overcome certain trade barriers such as quarantine and hygiene will be presented. Emphasis will be made on the use of irradiation as an alternative to chemical treatments of food. (orig.) [de

  10. Status of the LHCb experiment

    International Nuclear Information System (INIS)

    Straumann, Ulrich D.

    2002-01-01

    LHCb is a second generation experiment on b physics which will run from the beginning of the LHC operation. The goals of the experiment are systematic measurements of CP violation and rare decays in the B-meson system with unprecedented precisions. By measuring CP violation in many different decay modes of B d and B s mesons and comparing the results with the predictions from the Standard Model, the experiment will search for new physics. This talk summarises the present status of the preparation and construction of the LHCb experiment. Details can be found in the technical design reports of the respective subsystems

  11. Status of the LHCb experiment

    CERN Document Server

    Straumann, U

    2001-01-01

    LHCb is a second generation experiment on b physics which runs from the beginning of the LHC operation. The goals of the experiment are systematic measurements of CP violation and rare decays in the B- meson system with unprecedented precisions. By measuring CP violation in many different decay modes of B/sub d/ and B/sub s/, mesons and comparing the results with the predictions from the standard model, the experiment searches for new physics. This talk summarises the present status of the preparation and construction of the LHCb experiment. Details are found in the technical design reports of the respective subsystems. (12 refs).

  12. Health status among elderly Hungarians and Americans.

    Science.gov (United States)

    Buss, T F; Beres, C; Hofstetter, C R; Pomidor, A

    1994-07-01

    Selected health status data for elderly populations from similar industrial cities-Youngstown, Ohio, USA, and Debrecen, Hungary-were compared. Because of their impoverished health care system, unregulated heavily industrialized society, and unhealthful life-styles Hungarians were hypothesized to have poorer health status than Americans, even after taking into account demographic mediating factors. The study provides a health status baseline for elderly Hungarians shortly after communism's fall in 1989-1990 and shows how great a gap exists between Hungarian health status and that in the West. Hungarians were in much poorer health as measured by functional status, symptomatology, medical condition, depression, and subjective health status. Distinctions persisted when controlling for gender, age, and education. Poverty-level (and income) did not explain health status differences. The paper concludes that Hungary should pay more attention to health promotion, prevention, and primary care, as well as to reforming patient management in hospitals, nursing homes, and home care programs.

  13. Status Configurations, Military Service and Higher Education.

    Science.gov (United States)

    Wang, Lin; Elder, Glen H; Spence, Naomi J

    2012-12-01

    The U.S. Armed Forces offer educational and training benefits as incentives for service. This study investigates the influence of status configurations on military enlistment and their link to greater educational opportunity. Three statuses (socioeconomic status of origin, cognitive ability and academic performance) have particular relevance for life course options. We hypothesize that young men with inconsistent statuses are more likely to enlist than men with consistent status profiles, and that military service improves access to college for certain configurations. Analyses of the National Longitudinal Study of Adolescent Health (Add Health) show (1. that several status configurations markedly increased the likelihood of military enlistment and (2. within status configurations, recruits were generally more likely to enroll in higher education than nonveterans, with associate degrees being more likely.

  14. Status Configurations, Military Service and Higher Education

    Science.gov (United States)

    Wang, Lin; Elder, Glen H.; Spence, Naomi J.

    2012-01-01

    The U.S. Armed Forces offer educational and training benefits as incentives for service. This study investigates the influence of status configurations on military enlistment and their link to greater educational opportunity. Three statuses (socioeconomic status of origin, cognitive ability and academic performance) have particular relevance for life course options. We hypothesize that young men with inconsistent statuses are more likely to enlist than men with consistent status profiles, and that military service improves access to college for certain configurations. Analyses of the National Longitudinal Study of Adolescent Health (Add Health) show (1. that several status configurations markedly increased the likelihood of military enlistment and (2. within status configurations, recruits were generally more likely to enroll in higher education than nonveterans, with associate degrees being more likely. PMID:24511161

  15. Repository development status in Spain

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez Beceiro, Alvaro; Zuloaga, Pablo [ENRESA (Spain)

    2009-06-15

    The paper describes the status of repository development for the different waste categories. Low and Intermediate Waste Disposal facility of El Cabril was commissioned in 1992 and is in normal operation. The major modifications and activities during the last years are the adaptation to waste streams not initially foreseen such as some decommissioning waste or waste from steel industry, and the improvement of its performance assessment, supported by a R and D and refined models. As part of this facility, a new disposal facility specifically intended for very low activity waste has been constructed and commissioned in July 2008. Its design is based on the European Directive for hazardous waste disposal. National policy for Nuclear Spent Fuel and High-Level waste is focused on the development of a centralized storage facility of the vault type, whose site location would be selected through a volunteering process. Meanwhile, with the aim of solving specific problems, three individual storage facilities are in different status at reactor sites. Research on final solution, including some repository aspects as well as separation and transmutation are being carried out in accordance to ENRESA's R and D program. ENRESA has developed conceptual designs for non site specific repositories, both in granite and clay, and has carried out their corresponding performance assessment exercises. (authors)

  16. Functional assessment of nutrition status.

    Science.gov (United States)

    Russell, Mary Krystofiak

    2015-04-01

    Functional status assessment has been recommended as a part of a complete nutrition assessment for decades, but the specific components of this assessment have eluded a consensus definition. The recent Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus criteria for identification of malnutrition include functional assessment determined by handgrip dynamometry, with the understanding that this technique is not practical for use in some patient populations. Other techniques for functional assessment include physical performance measures such as timed gait and chair stands, as well as activities of daily living tools such as the Katz Index, Lawton Scale, and Karnofsky Scale Index. Manual muscle testing and computed tomography scan assessment of lean tissue are other tools that show promise in correlating functional and nutrition assessments. Functional assessment parameters may be least well correlated with nutrition status in older individuals. Despite a number of scientific studies of a variety of tools for functional assessment, there is to date no definitive tool for use in all individuals in all settings. Nutrition scientists and clinicians must continue to collaborate with colleagues in physical and occupational therapy, geriatrics, and nursing to refine current functional assessment tools to more effectively correlate with nutrition and malnutrition assessment parameters. © 2015 American Society for Parenteral and Enteral Nutrition.

  17. Status of the CBM experiment

    Directory of Open Access Journals (Sweden)

    Heuser Johann M.

    2015-01-01

    Full Text Available The Compressed Baryonic Matter (CBM experiment at the Facility for Anti-Proton and Ion Research (FAIR will explore the phase diagram of strongly interacting matter at highest net baryon densities and moderate temperatures. The CBM physics program will be started with beams delivered by the SIS 100 synchrotron, providing energies from 2 to 11 GeV/nucleon for heavy nuclei, up to 14 GeV/nucleon for light nuclei, and 29 GeV for protons. The highest net baryon densities will be explored with ion beams up to 45 GeV/nucleon energy delivered by SIS 300 in the next stage of FAIR. Collision rates up to 107 per second are required to produce very rare probes with unprecedented statistics in this energy range. Their signatures are complex. These conditions call for detector systems designed to meet the extreme requirements in terms of rate capability, momentum and spatial resolution, and a novel DAQ and trigger concept which is not limited by latency but by throughput. The article discusses the development status of the CBM sub-systems for charged particle tracking, vertex detection, electron/muon identification, hadron/time-of-flight measurement, electromagnetic and zero-degree calorimetry, in terms of prototypes and expected physics performance. The concept and development status of CBM’s central detector, the Silicon Tracking System STS are presented in somewhat more detail.

  18. Vegetarian diets and bone status.

    Science.gov (United States)

    Tucker, Katherine L

    2014-07-01

    Osteoporosis is a common chronic condition associated with progressive loss of bone mineral density (BMD) and compromised bone strength, with increasing risk of fracture over time. Vegetarian diets have been shown to contain lower amounts of calcium, vitamin D, vitamin B-12, protein, and n-3 (ω-3) fatty acids, all of which have important roles in maintaining bone health. Although zinc intakes are not necessarily lower quantitatively, they are considerably less bioavailable in vegetarian diets, which suggests the need for even higher intakes to maintain adequate status. At the same time, healthy vegetarian diets tend to contain more of several protective nutrients, including magnesium, potassium, vitamin K, and antioxidant and anti-inflammatory phytonutrients. On balance, there is evidence that vegetarians, and particularly vegans, may be at greater risk of lower BMD and fracture. Attention to potential shortfall nutrients through the careful selection of foods or fortified foods or the use of supplements can help ensure healthy bone status to reduce fracture risk in individuals who adhere to vegetarian diets. © 2014 American Society for Nutrition.

  19. Glycemic Status in Organophosphorus Poisoning.

    Science.gov (United States)

    Panda, S; Nanda, R; Mangaraj, M; Rathod, P K; Mishra, P K

    2015-01-01

    Organophosphorus(OP) poisoning, in addition to its cholinergic manifestations shows metabolic derangements leading to hyperglycemia. Apart from inhibiting acetylcholinesterase it also induces oxidative stress to exhibit this manifestation. The present study aims to assess the glycemic status of OP poisoned patients and its association with various factors in OP poisoning like oxidative stress and dose of atropine. This is a prospective study which recruited 102 patients above 18 years of age with history of OP poisoning. They were categorized into 3 grades-mild, moderate and severe based on the Peradeniya Organophosphorus Poisining Scale. The routine biochemical parameters along with serum malondialdehyde (MDA) and cholinesterase were estimated in the study group. Hyperglycemia and glycosuria were observed, with majority cases of hyperglycemia (57%) noticed in the severe group. There was a rise in the random plasma glucose (RPG), serum malondialdehyde (MDA), total dose of atropine across the groups along with a fall in the serum cholinesterase with increase in severity of poisoning. The fall in plasma glucose at the time of discharge was significant in all three groups when compared to the admission random plasma glucose(RPG) level. This transient hyperglycemia exhibited a significant positive association with serum MDA and dose of atropine administered during treatment (p<0.05). Glycemic status in OP poisoning may play a role in identifying the severity of poisoning at the time of admission.

  20. renewables 2011 - Global status report

    International Nuclear Information System (INIS)

    Sawin, Janet L.; Martinot, Eric; Barnes, Douglas; Martinot, Eric; McCrone, Angus; Roussell, Jodie; Sawin, Janet L.; Sims, Ralph; Sonntag-O'Brien, Virginia; Adib, Rana; Skeen, Jonathan; Musolino, Evan; Riahi, Lily; Mastny, Lisa

    2011-01-01

    Changes in renewable energy markets, investments, industries, and policies have been so rapid in recent years that perceptions of the status of renewable energy can lag years behind the reality. This report captures that reality and provides a unique overview of renewable energy worldwide as of early 2011. The report covers both current status and key trends; by design, it does not provide analysis or forecast the future. Global energy consumption rebounded in 2010 after an overall downturn in 2009. Renewable energy, which experienced no downturn in 2009, continued to grow strongly in all end-use sectors - power, heat and transport - and supplied an estimated 16% of global final energy consumption. Renewable energy accounted for approximately half of the estimated 194 gigawatts (GW) of new electric capacity added globally during the year. Renewables delivered close to 20% of global electricity supply in 2010, and by early 2011 they comprised one quarter of global power capacity from all sources. In several countries, renewables represent a rapidly growing share of total energy supply, including heat and transport

  1. MENA Renewables Status Report 2013

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-15

    The MENA Renewables Status Report is an outcome of ADIREC, the Abu Dhabi International Renewable Energy Conference. The report provides a status overview of renewable energy markets, industry, policy and investment trends in the region, drawing on the most recent data available. It is produced in cooperation with over 50 contributors and researchers in the region and reveals massive growth in the renewable energy markets of the Middle East and North Africa (MENA). Regional investment topped US$2.9 billion in 2012, up 40% from 2011 and 650% from 2004. With over 100 projects under development, the region could see a 450% increase in non-hydro renewable energy generating capacity in the next few years. For the report, the 21 MENA countries were clustered into two sub-groups: Net Oil-Exporting Countries (NOEC) -- Algeria, Bahrain, Egypt, Iran, Iraq, Kuwait, Libya, Oman, Qatar, Saudi Arabia, Syria, United Arab Emirates, and Yemen; and Net Oil-Importing Countries (NOIC) -- Djibouti, Israel, Jordan, Lebanon, Malta, Morocco, Palestine, and Tunisia.

  2. Periodontal Status of Postmenopausal Women

    Directory of Open Access Journals (Sweden)

    Timur V. Melkumyan

    2014-06-01

    Full Text Available The objective of this study was to compare the periodontal status in postmenopausal women with osteopenia and osteoporosis. Material and Methods: We examined 43 postmenopausal women aged from 55 to 74 years. Material assessment of bones in every patient was performed by means of dual energy X-ray absorptiometry (DXA from two points on the skeleton – part of the femur neck and between the first and fourth lumbar vertebrae. A lipid blood test was done for patients of both groups. All patients were divided into two groups (the 1st with osteopenia, and the 2nd with osteoporosis. All patients were subjected to an oral clinical examination: the periodontal examination was composed of Plaque Index (PI, Pocket Score (PS, and Papillary Bleeding Index (PBI. X-ray analysis was performed for every patient. Results: The results of the clinical periodontal examination demonstrated that the mean PBI in patients in the 1st group had no significant differences from the PBI in patients in the 2nd group. PI value and PS findings in patients with general osteoporosis also had no statistical differences from the same parameters in patients with osteopenia. Conclusion: Under the circumstances of these patients’ characteristics and within the limits of the present study, we concluded that there is no significant difference in the periodontal status of postmenopausal women with systemic osteopenia and with osteoporosis.

  3. Occlusal status among Yemeni children

    Directory of Open Access Journals (Sweden)

    Nabil M Al-Zubair

    2014-01-01

    Full Text Available Objectives: The purpose of this study was to assess the occlusal status in schoolchildren in Yemen, and to compare the results with those of other studies. Materials and Methods: The sample for this epidemiological survey consisted of 3003 primary school students, half of whom were boys and the other half girls, aged 12 years. The subjects were randomly selected, and none had received previous orthodontic treatment. Variables examined included intra-arch irregularities and malalignment (crowding and spacing in the incisal segments of the arch and midline diastema and discrepancies in occlusal contact relationship (maxillary overjet, mandibular overjet, anterior openbite and antero-posterior molar relation. Results: The results showed that about 26.1% of the subjects were still in the late mixed dentition stage and 73.9% presented with a dentition in the early permanent stage. Normal overjet was found in 55% of the sample. Crowding was observed in 31.4% of the subjects and midline diastema in 14.2%. Conclusion: Occlusal status among Yemeni children was characterized by a relatively high frequency of dental crowding, as well as a relatively high frequency of anterior mandibular overjet (Class III malocclusions.

  4. Subjective social status and health.

    Science.gov (United States)

    Euteneuer, Frank

    2014-09-01

    Subjective social status (SSS) predicts health outcomes above and beyond traditional objective measures of social status, such as education, income and occupation. This review summarizes and integrates recent findings on SSS and health. Current studies corroborate associations between low SSS and poor health indicators by extending previous findings to further populations and biological risk factors, providing meta-analytic evidence for adolescents and by demonstrating that negative affect may not confound associations between SSS and self-rated health. Recent findings also highlight the relevance of SSS changes (e.g. SSS loss in immigrants) and the need to consider cultural/ethnical differences in psychological mediators and associations between SSS and health. SSS is a comprehensive measure of one's social position that is related to several poor health outcomes and risk factors for disease. Future investigation, particularly prospective studies, should extend research on SSS and health to further countries/ethnic groups, also considering additional psychological and biological mediators and dynamic aspects of SSS. Recently developed experimental approaches to manipulate SSS may also be promising.

  5. ORIGINAL .ARTICLES

    African Journals Online (AJOL)

    poor countries. J M Wilmshurst, Ronald van Toorn, C R J C Newton. Parenteral phenobarbitone is. an integral part of the management of status epilepticus, especially in the context of resource-poor countries. It is highly effective at controlling.

  6. Ketogenic Diet as Preferred Treatment of FIRES

    Directory of Open Access Journals (Sweden)

    John J Millichap

    2015-01-01

    Full Text Available Investigators from the University of Alabama, Birmingham, AL, and University of Michigan, Ann Arbor, MI, report 2 children who presented with FIRES and prolonged AED-resistant status epilepticus.

  7. American Epilepsy Society

    Science.gov (United States)

    ... for the AES Annual Meeting. More info here . Epilepsy Currents American Epilepsy Society Journal Impact Factor More ... P450 enzyme overexpression during spontaneous recurrent seizures More Epilepsy Professional News AES Status Epilepticus guideline for treatment ...

  8. Energy status 2010; Energistatus 2010

    Energy Technology Data Exchange (ETDEWEB)

    Skaansar, Ellen

    2011-07-01

    In the new report, Energy Status NVE provides a unified presentation of statistics and facts about the Norwegian energy system. It gives an overview of the production, transmission and consumption of electricity in the Norwegian society, and shows energy use for various purposes and the relationship between energy and the environment. Norway is the sixth largest hydropower producer in the world and, together with Iceland the highest portion of renewable electricity production of all countries in Europe. In comparison, is about 17 percent of all electricity in the EU based on renewable resources. In Sweden, renewable energy resources account for about half of all electricity production, while the corresponding share in Denmark is about 29 percent. The good supply of water power has contributed to the fact that Norway has a consumption pattern that differs from the countries around us. (AG)

  9. Upgrade programs. Status and prospective

    International Nuclear Information System (INIS)

    Loyer, F.

    1998-01-01

    Arguments for launching a renovation program for GANIL system, taking into account aging and wear, are analyzed. A statistics of failures related to vacuum systems, power supplies, electronics, cooling systems, beam dumps and other equipment is given. The renovation program is targeted to: replacement of obsolete components, introduction of advanced systems of failure diagnosis, augmentation of performances of the new regulating and control system and improvement in the performance characteristics of certain fundamental equipment. The first results and to date status of the program development is reported. Mentioned are the works related to control of HF cavities and the associated amplifiers, electronics, the system of cavity synchronization, power supply, RMN, system commutation grid, pumping equipment, etc. Also, improvements concerning the machine data acquisition and online processing are referred to as well as program cost estimations

  10. Hyper-X Program Status

    Science.gov (United States)

    McClinton, Charles R.; Reubush, David E.; Sitz, Joel; Reukauf, Paul

    2001-01-01

    This paper provides an overview of the objectives and status of the Hyper-X program, which is tailored to move hypersonic, airbreathing vehicle technology from the laboratory environment to the flight environment. The first Hyper-X research vehicle (HXRV), designated X-43, is being prepared at the Dryden Flight Research Center for flight at Mach 7. Extensive risk reduction activities for the first flight are completed, and non-recurring design activities for the Mach 10 X-43 (third flight) are nearing completion. The Mach 7 flight of the X-43, in the spring of 2001, will be the first flight of an airframe-integrated scramjet-powered vehicle. The Hyper-X program is continuing to plan follow-on activities to focus an orderly continuation of hypersonic technology development through flight research.

  11. ATLAS construction: A status report

    CERN Document Server

    Sfyrla, Anna

    2006-01-01

    ATLAS is a general purpose p-p collider detector being constructed for the CERN Large Hadron Collider (LHC). It is located in one of the two high luminosity bunch crossing points (peak luminosity of 1 0 3 4 c m - 2 s _ 1 ) of the LHC. It consists of 3 main sections. Located close to the beam axis, the tracking system employs pixel detectors, silicon microstrip modules and transition radiation straws, all within a 2 Tesla superconducting solenoid. The tracker is surrounded by the electromagnetic and hadronic calorimeters. In the outer part of the detector, 8 superconducting coils define an open toroidal magnetic field for muon detection. The construction status of the ATLAS detector towards being ready for the first collisions in 2007 will be presented, with particular emphasis on the construction and projected performance of the tracking system.

  12. AD status and consolidation plans

    CERN Document Server

    Eriksson, T; Arnaudon, L; Belochitskii, P; Bojtar, L; Calviani, M; Caspers, F; Federmann, S; Jørgensen, L; Louwerse, R; Oliveira, C; Tranquille, G

    2013-01-01

    The CERN Antiproton Decelerator (AD) has now completed its 12th year of supplying low-energy antiproton beams for the successful physics program. Most of the machine’s key components are in operation since more than 25 years and prompted by the approval of the ELENA project, a substantial consolidation program is now being launched to ensure continued reliable operation. Over the course of the next few years a progressive renovation of the AD-Target area and the AD-ring with all the associated systems will take place. Status and performance of the AD are presented along with an overview of planned and ongoing consolidation activities with emphasis on stochastic and electron beam cooling.

  13. Nuclear energy - status and outlook

    Energy Technology Data Exchange (ETDEWEB)

    Rogner, Hans-Holger; MacDonald, Alan

    2007-07-01

    Rising expectations best characterize the current prospects of nuclear power in a world that is confronted with a burgeoning demand for energy, higher energy prices, energy supply security concerns and growing environmental pressures. It appears that the inherent economic and environmental benefits of the technology and its excellent performance record over the last twenty years are beginning to tilt the balance of political opinion and public acceptance in favour of nuclear power. Nuclear power is a cost-effective supply-side technology for mitigating climate change and can make a substantial contribution to climate protection. This paper reviews the current status of nuclear power and its fuel cycle and provides an outlook on where nuclear power may be headed in the short-to-medium run (20 to 40 years from now). (auth)

  14. RTNS-II: present status

    International Nuclear Information System (INIS)

    Heikkinen, D.W.; Logan, C.M.

    1980-10-01

    The present status of the RTNS-II facility is described and typical operating parameters are given. A brief discussion is given of the methods used in production of the TiT 2 targets as well as their performance and tritium handling at RTNS-II. The various types of non-interactive beam diagnostics presently in use at the neutron sources are outlined. The on-line computer system which provides a time history of an irradiation and records target performance is described. Examples are listed of several representative experimental programs which have been carried out thus far at RTNS-II. These include both active and passive experiments. Finally, several of the major improvements to the facility made since the beginning of the experimental program are given

  15. Reactor pressure vessel status report

    International Nuclear Information System (INIS)

    Strosnider, J.; Wichman, K.; Elliot, B.

    1994-12-01

    This report gives a brief description of the reactor pressure vessel (RPV), followed by a discussion of the radiation embrittlement of RPV beltline materials and the two indicators for measuring embrittlement, the end-of-license (EOL) reference temperature and the EOL upper-shelf energy. It also summarizes the GL 92-01 effort and presents, for all 37 boiling water reactor plants and 74 pressurized water reactor plants in the United States, the current status of compliance with regulatory requirements related to ensuring RPV integrity. The staff has evaluated the material data needed to predict neutron embrittlement of the reactor vessel beltline materials. These data will be stored in a computer database entitled the reactor vessel integrity database (RVID). This database will be updated annually to reflect the changes made by the licensees in future submittals and will be used by the NRC staff to assess the issues related to vessel structural integrity

  16. Plant status monitor system description

    International Nuclear Information System (INIS)

    Prather, W.A.; Sly, G.A.

    1987-01-01

    In today's regulatory and financial environment, improving plant efficiency and safety are necessary elements of plant operations. Public utility commissions are making rate rulings based, in part, on plant availability performance; and the NRC is putting more emphasis on plant operational aspects. This comes at a time when operating, maintaining, and managing a plant are becoming increasingly complex; moreover, the desired number of experienced plant personnel are becoming more difficult to find. This situation can be partially resolved by using computer software tools to assist operations, maintenance, engineering, and management personnel. These software tools provide information and interpretations based on plant and equipment status. They support improved plant availability, technical specification compliance, and administrative functions. A key element or computerization is the ability to operate on integrated information

  17. Status of the Majorana Demonstrator

    Energy Technology Data Exchange (ETDEWEB)

    Cuesta, C.; Abgrall, N.; Arnquist, Isaac J.; Avignone, Frank T.; Barabash, Alexander S.; Bertrand, F.; Brudanin, V.; Busch, Matthew; Buuck, M.; Byram, D.; Caldwell, A. S.; Chan, Yuen-Dat; Christofferson, Cabot-Ann; Detwiler, Jason A.; Efremenko, Yuri; Ejiri, H.; Elliott, S. R.; Galindo-Uribarri, A.; Giovanetti, G. K.; Goett, J.; Green, M. P.; Gruszko, J.; Guinn, I.; Guiseppe, V. E.; Henning, R.; Hoppe, Eric W.; Howard, Stanley; Howe, M. A.; Jasinski, B. R.; Keeter, K.; Kidd, M. F.; Konovalov, S.; Kouzes, Richard T.; Laferriere, Brian D.; Leon, Jonathan D.; MacMullin, J.; Martin, R. D.; Meijer, S. J.; Mertens, S.; Orrell, John L.; O' Shaughnessy, C.; Overman, Nicole R.; Poon, Alan; Radford, D. C.; Rager, J.; Rielage, Keith; Robertson, R. G. H.; Romero-Romero, E.; Schmitt, C.; Shanks, B.; Shirchenko, M.; Snyder, N.; Suriano, Anne-Marie; Tedeschi, D.; Timkin, V.; Trimble, J. E.; Varner, R. L.; Vasilyev, Sergey; Vetter, Kai; Vorren, Kris R.; White, Brandon R.; Wilkerson, J. F.; Wiseman, C.; Xu, W.; Yakushev, E.; Yu, Chang-Hong; Yumatov, Vladimir

    2015-06-09

    The Majorana Collaboration is constructing the Majorana Demonstrator, an ultra-low background, 40-kg modular high purity Ge detector array to search for neutrinoless double-beta decay in 76Ge. In view of the next generation of tonne-scale Ge-based neutrinoless double-beta decay searches that will probe the neutrino mass scale in the inverted hierarchy region, a major goal of the Demonstrator is to demonstrate a path forward to achieving a background rate at or below 1 count/tonne/year in the 4 keV region of interest around the Q-value at 2039 keV. The current status of the Demonstrator is discussed, as are plans for its completion.

  18. Maternal folate status and lactation.

    Science.gov (United States)

    O'Connor, D L; Green, T; Picciano, M F

    1997-07-01

    Folate plays an essential role in DNA, RNA, and protein biosynthesis. For this reason, the physiological need for this vitamin is increased during periods of rapid anabolic activity such as pregnancy and lactation. Although the importance of folate and the consequences of suboptimal folate status during pregnancy, especially during the periconceptional period, are well appreciated, little is known about the value of folate during lactation. The limited number of studies available on folate intake during lactation suggest that many women do not consume an adequate amount of folate and that recommended target intakes may be too low. Although inadequate maternal folate intake does not affect milk folate concentration unless maternal deficiency is severe, potential consequences of suboptimal folate nutrition to both the mother and her future offspring should also be considered.

  19. Status report on radionuclide transfer

    International Nuclear Information System (INIS)

    1980-01-01

    At the suggestion of the Federal Minstry of the Interior, in June 1978, a group of scientists from several institutions who are active in the field of radionuclide transfer or are interested in these problems got together. During the discussions of the work team, especially the transfer soil/plants was emphasized. Then the work team set up a status report on the transfer of the radionuclides relevant in the sense of the radiation protection act. The nuclides H 3 and C14, the isotopes of the Sr, J, and Cs, Tc99, the so-called corrosion nuclides Mn54, Fe59, co-isotopes and Zn65, and isotopes of Pu, Am, and Cm were regarded as important for a possible radiation exposition. Recent investigations revealed that also the natural radionuclides Ra226, Po210, and Pb210 should be covered by the investigations. The goal of this status report is to present the level of knowledge on the transfer of these radionuclides to man in a brief form, giving hints at the most important literature. It was requested by the Federal Ministry of the Interior, as fas as possible, to indicate transfer factors which are necessary for the radio-occology act to be decreed according to Para. 45 of the radiation protection act. Another goal of the report was to show the gap in the knowledge on the radio nuclide transfer. This was thought to help to create a basis for the decisions of the Federal Ministry concerning the support of other investigation projects in the field of transfer of radionuclides. (orig./MG) [de

  20. Status of the DIRAC Project

    International Nuclear Information System (INIS)

    Casajus, A; Ciba, K; Fernandez, V; Graciani, R; Hamar, V; Mendez, V; Poss, S; Sapunov, M; Stagni, F; Tsaregorodtsev, A; Ubeda, M

    2012-01-01

    The DIRAC Project was initiated to provide a data processing system for the LHCb Experiment at CERN. It provides all the necessary functionality and performance to satisfy the current and projected future requirements of the LHCb Computing Model. A considerable restructuring of the DIRAC software was undertaken in order to turn it into a general purpose framework for building distributed computing systems that can be used by various user communities in High Energy Physics and other scientific application domains. The CLIC and ILC-SID detector projects started to use DIRAC for their data production system. The Belle Collaboration at KEK, Japan, has adopted the Computing Model based on the DIRAC system for its second phase starting in 2015. The CTA Collaboration uses DIRAC for the data analysis tasks. A large number of other experiments are starting to use DIRAC or are evaluating this solution for their data processing tasks. DIRAC services are included as part of the production infrastructure of the GISELA Latin America grid. Similar services are provided for the users of the France-Grilles and IBERGrid National Grid Initiatives in France and Spain respectively. The new communities using DIRAC started to provide important contributions to its functionality. Among recent additions can be mentioned the support of the Amazon EC2 computing resources as well as other Cloud management systems; a versatile File Replica Catalog with File Metadata capabilities; support for running MPI jobs in the pilot based Workload Management System. Integration with existing application Web Portals, like WS-PGRADE, is demonstrated. In this paper we will describe the current status of the DIRAC Project, recent developments of its framework and functionality as well as the status of the rapidly evolving community of the DIRAC users.

  1. Status of Forces and Criminal Jurisdiction

    OpenAIRE

    Voetelink, J.

    2013-01-01

    This article examines the legal status of armed forces present in friendly foreign territory with a special focus on criminal jurisdiction. Traditionally, this issue has been considered from the perspective of public international law in which immunities play an important role. However, this perspective does not fully cover the criminal jurisdiction provisions in the international agreements dealing with the status of visiting forces (Status of Forces Agreements). This article introduces mili...

  2. Renewables 2014. Global status report 2014

    International Nuclear Information System (INIS)

    Sawin, Janet L.; Sverrisson, Freyr; Chawla, Kanika; Lins, Christine; Adib, Rana; Hullin, Martin; Leitner, Sarah; Mazzaccaro, Stefano; Murdock, Hannah; Williamson, Laura E.; Wright, Glen; McCrone, Angus; Musolino, Evan; Mastny, Lisa; Lily Riahi; Sims, Ralph; Jonathan Skeen; Sverrisson, Freyr; Martinot, Eric

    2014-01-01

    The Renewables Global Status Report provides a comprehensive and timely overview of renewable energy market, industry, investment, and policy developments worldwide. It enables policy-makers, industry, investors, and civil society to make informed decisions. The report covers recent developments, current status, and key trends; by design, it does not provide analysis or forecast. The Renewables Global Status Report relies on up-to-date renewable energy data, provided by an international network of more than 500 contributors, researchers, and authors

  3. Tratamiento del estado epiléptico refractario con topiramato oral

    OpenAIRE

    Soler,Bernardita; Godoy,Jaime; Mellado,Patricio

    2009-01-01

    Refractory status epilepticus is a catastrophic illness of the central nervous system, with a mortality rate that reaches 50%. We report three patients admitted with refractory status epilepticus: a 24 year-old male that discontinued antiepileptic medications, a 46 year-old male with a focal epilepsy secondary to an encephalitis that discontinued medications due to gastrointestinal problems and a 59 year-old male with an ischemic encephalopathy AH were treated with topiramate, delivered throu...

  4. Nuclear status report for western Europe 1984

    International Nuclear Information System (INIS)

    Krejsa, P.; Laurent, L.; Lauridsen, K.

    1985-01-01

    The status report embraces the following countries: Austria, Belgium, Denmark, Finland, France, Federal Republic of Germany, Greece, Italy, The Netherlands, Spain, Sweden, Switzerland, United Kingdom, Yugoslavia

  5. Environmental Treaty Status Data Set, 2012 Release

    Data.gov (United States)

    National Aeronautics and Space Administration — The Environmental Treaty Status Data Set, 2012 Release contains comprehensive information on country participation in multilateral environmental agreements through...

  6. Anxiety, Depression, and Functional Status Are the Best Predictors of Health Status Patients With Heart Failure

    National Research Council Canada - National Science Library

    DeJong, Marla

    2004-01-01

    .... Therefore, health status is an increasingly important concept in the management of HF. In fact, most symptomatic patients are more concerned about their everyday health status than the length of their life...

  7. Micronutrient status and its relationship with nutritional status in preschool children in urban Sri Lanka.

    Science.gov (United States)

    Marasinghe, Eshani; Chackrewarthy, Sureka; Abeysena, Chrishantha; Rajindrajith, Shaman

    2015-01-01

    To assess the micronutrient status and its relationship with nutritional status in preschool children. In a cross sectional study, anthropometric data and fasting blood samples were obtained from 340 children attending preschool in urban Sri Lanka. Serum concentrations of vitamin D, parathyroid hormone, vitamin A, zinc and haemoglobin were measured. Z-scores of anthropometric indices of height-for-age, weight-for-age and weight-for-height were computed to evaluate the nutritional status. Prevalence of stunting, underweight, wasting and anaemia among children were 7.1%, 16.9%, 21.2% and 7.4%, respectively. Deficiencies of zinc and vitamin A occurred among 67% and 38% of children, respectively. Vitamin D deficiency (Nutritional status was significantly correlated (pnutritional status of the children was related to vitamin D status and with haemoglobin status. Zinc and vitamin A levels were low in children with severe stunting. Vitamins A, D and zinc levels were associated with haemoglobin status.

  8. Industry outreach a status report

    Energy Technology Data Exchange (ETDEWEB)

    Surek, D.; Sen, R. [R.K. Sen & Associates, Inc., Bethesda, MD (United States)

    1995-09-01

    The Outreach Project was initiated in October 1994 with the objective of developing a multi-year plan for the U.S. Department of Energy (DOE) for targeted outreach activities for stakeholders in industry and the general public. This status report summarizes the work on industry outreach that has been completed since the inception of the project in October 1994. A three-pronged approach was taken to ascertain issues related to industry outreach. First, there was a review of on-going and past industry outreach activities at DOE and NHA. Next, a series of meetings with industry decision makers was arranged to get a better understanding of industry interests and concerns, and to discuss how DOE and industry could work collaboratively to develop hydrogen energy systems. Third, a workshop is scheduled where representatives from industry, DOE and other federal agencies can identify issues that would enhance partnering between the federal government and industry in the development of hydrogen energy systems. At this tiny, the review of on-going and past activities has been completed. Industry interviews are in progress and a majority of meetings have been held. Analysis of the information gained is in progress. The preliminary analysis of this information indicates that for appropriate near-term demonstration-type projects, the level of interest for collaboration between DOE and industry is high. The data also identifies issues industry is concerned with which impact the commercialization of hydrogen energy systems.

  9. Status and prospects for CUORE

    Science.gov (United States)

    Canonica, L.; Alduino, C.; Alfonso, K.; Artusa, D. R.; Avignone, F. T., III.; Azzolini, O.; Banks, T. I.; Bari, G.; Beeman, J. W.; Bellini, F.; Bersani, A.; Biassoni, M.; Branca, A.; Brofferio, C.; Bucci, C.; Camacho, A.; Caminata, A.; Cao, X. G.; Capelli, S.; Cappelli, L.; Carbone, L.; Cardani, L.; Carniti, P.; Casali, N.; Cassina, L.; Chiesa, D.; Chott, N.; Clemenza, M.; Copello, S.; Cosmelli, C.; Cremonesi, O.; Creswick, R. J.; Cushman, J. S.; D'Addabbo, A.; Dafinei, I.; Davis, C. J.; Dell'Oro, S.; Deninno, M. M.; Di Domizio, S.; Di Vacri, M. L.; Drobizhev, A.; Fang, D. Q.; Faverzani, M.; Fernandes, G.; Ferri, E.; Ferroni, F.; Fiorini, E.; Franceschi, M. A.; Freedman, S. J.; Fujikawa, B. K.; Giachero, A.; Gironi, L.; Giuliani, A.; Gladstone, L.; Gorla, P.; Gotti, C.; Gutierrez, T. D.; Haller, E. E.; Han, K.; Hansen, E.; Heeger, K. M.; Hennings-Yeomans, R.; Hickerson, K. P.; Huang, H. Z.; Kadel, R.; Keppel, G.; Kolomensky, Yu G.; Leder, A.; Ligi, C.; Lim, K. E.; Liu, X.; Ma, Y. G.; Maino, M.; Marini, L.; Martinez, M.; Maruyama, R. H.; Mei, Y.; Moggi, N.; Morganti, S.; Mosteiro, P. J.; Napolitano, T.; Nones, C.; Norman, E. B.; Novati, V.; Nucciotti, A.; O'Donnell, T.; Orio, F.; Ouellet, J. L.; Pagliarone, C. E.; Pallavicini, M.; Palmieri, V.; Pattavina, L.; Pavan, M.; Pessina, G.; Pettinacci, V.; Piperno, G.; Pirro, S.; Pozzi, S.; Previtali, E.; Rosenfeld, C.; Rusconi, C.; Sangiorgio, S.; Santone, D.; Scielzo, N. D.; Singh, V.; Sisti, M.; Smith, A. R.; Taffarello, L.; Tenconi, M.; Terranova, F.; Tomei, C.; Trentalange, S.; Vignati, M.; Wagaarachchi, S. L.; Wang, B. S.; Wang, H. W.; Wilson, J.; Winslow, L. A.; Wise, T.; Woodcraft, A.; Zanotti, L.; Zhang, G. Q.; Zhu, B. X.; Zimmermann, S.; Zucchelli, S.

    2017-09-01

    CUORE is a cryogenic detector consisting of 988 TeO2 crystals, 750 g each, and will be operated at a temperature of ˜10 mK, to search for neutrinoless double beta decay (0νββ) of 130Te. The detector, in the final stages of construction at the Laboratori Nazionali del Gran Sasso (Italy), will start its operations in 2016. CUORE-0, its pilot experiment, has proven the feasibility of CUORE, demonstrating that the target background of 0.01 counts/keV/kg/y and the energy resolution of 5 keV are within reach. CUORE-0 also made the most precise measurement of the 2νββ decay. The expected sensitivity of CUORE to the 0νββ 130Te half-life is 9 ·1025y, for 5 years of data taking. Here, we report the most recent results of CUORE-0, their implications for CUORE, and the current status of the CUORE experiment.

  10. Current status of nuclear power

    International Nuclear Information System (INIS)

    Behnke, W.B.

    1984-01-01

    The decision to devote the 1984 conference to nuclear power is timely and appropriate. Illinois has a long, and distinguished history in the development of civilian nuclear power. The concept was born at the University of Chicago, developed at Argonne National Laboratory and demonstrated on the Commonwealth Edison system at our pioneer Dresden Nuclear Station. Today, Illinois ranks number one in the nation in nuclear generation. With over a quarter century of commercial operating experience, nuclear power has proven its worth and become a significant and growing component of electric power supply domestically and throughout the world. Despite its initial acceptance, however, the nuclear power industry in the U.S. is now in the midst of a difficult period of readjustment stemming largely from the economic and regulatory problems of the past decade. As a result, the costs of plants under construction have increased dramatically, causing serious financial difficulties for several projects and their owners. At the same time, the U.S. is facing hard choices concerning its future energy supplies. Conferences such as this have an important role in clarifying the issues and helping to find solutions to today's pressing energy problems. This paper summarizes the status of nuclear power both here and abroad, discussing the implications of current events in the context of national energy policy and economic development here in Illinois

  11. Caffeine, cognition, and socioeconomic status.

    Science.gov (United States)

    Kyle, Janet; Fox, Helen C; Whalley, Lawrence J

    2010-01-01

    There is interest in age-related cognitive decline and environmental risk factors for Alzheimer's disease (AD). This interest is focused on individual differences in exposure to agents that may harm or protect cognitive function. Caffeine is used as a short acting mental stimulant and may possess longer-term properties that protect against age-related decline and, possibly, AD. The current study aimed to: 1) examine current cognitive function in a narrow age range sample (n=351) without dementia (MMSE>25) who are, by reason of age, entering the period of increased risk of AD; and 2) link cognitive function to self-reported intake of caffeine and socioeconomic status (SES). Possible confounding by gender, childhood intelligence, education, and symptoms of anxiety and depression was introduced into the statistical model. There were significant differences between SES groups in caffeine intake (pcaffeine intake were associated with slower digit symbol speed (F =3.38, pcaffeine during cognitive testing and strong links between SES and cognitive performance. No evidence in support of cognitive enhancing effects of caffeine was found.

  12. Status of uranium in Brazil

    International Nuclear Information System (INIS)

    Majdalani, S.A.; Tavares, A.M.

    2001-01-01

    Uranium exploration in Brazil was started in 1952 by the Brazilian National Research Council. This led to the discovery of the first uranium deposits in Pocos de Caldas and Jacobina. These activities was later continued by the National Energy Commission/Comissao Nacional de Energia Nuclear (CNEN), formed in 1962. The founding of NUCLEBRAS at the end of 1974 marked the increasing effort of the country's uranium exploration programme. At this time only the Pocos de Caldas deposit was known with measurable resources. Due to the reorganization of the Brazilian nuclear programme in 1988, all uranium exploration in the country was stopped. By then, eight areas with uranium reserves has been identified. Brazil uranium resources in the RAR category at ≤ $80/kg U cost range are estimated to be 162,000 tonnes U, out of which 56,100 tonnes are in the ≤ $40/kg U cost range. Additional resources in the EAR-I category and the cost range ≤ 80/kg U are in the order of 100,200 tonnes U. The first production of uranium in Brazil, at the Osamu Utsumi mine (Pocos de Caldas deposit), started in 1982. Because of escalated costs and reduced demand, this activity was put on stand-by status between 1990 and 1992. The mine was restarted in 1993, but was stopped again in October 1995. The cumulative production of the mine to 1996 was 1241 tonnes U. The Lagoa Real deposit is currently being prepared as a new producing mine. (author)

  13. Current Status of RENO Experiment

    International Nuclear Information System (INIS)

    Kim, Soo-Bong

    2010-01-01

    The RENO (Reactor Experiment for Neutrino Oscillation) is under construction to measure the value of the smallest and unknown neutrino mixing angle θ 13 . The experiment will compare the measured fluxes of electron antineutrinos at two detectors located at 290 m and 1.4 km distances from the center of the Yonggwang nuclear reactors in Korea, with world-second largest thermal power output of 16.4 GW. Construction of experimental halls and access tunnels for both near and far detector sites was completed in early 2009. The detectors are near completion, and data-taking is planned to start in mid 2010. An expected number of observed antineutrino is roughly 510 and 80 per day in the near detector and far detector, respectively. An estimated systematic uncertainty associated with the measurement is less than 0.6%, and an expected statistical error is about 0.3%. With three years of data, the experiment will search for the mixing angle values of sin 2 (2θ 13 ) down to 0.02 in 90% C.L. limit. In this talk, the construction status will be presented. (author)

  14. MARS Validation Plan and Status

    International Nuclear Information System (INIS)

    Ahn, Seung-hoon; Cho, Yong-jin

    2008-01-01

    The KINS Reactor Thermal-hydraulic Analysis System (KINS-RETAS) under development is directed toward a realistic analysis approach of best-estimate (BE) codes and realistic assumptions. In this system, MARS is pivoted to provide the BE Thermal-Hydraulic (T-H) response in core and reactor coolant system to various operational transients and accidental conditions. As required for other BE codes, the qualification is essential to ensure reliable and reasonable accuracy for a targeted MARS application. Validation is a key element of the code qualification, and determines the capability of a computer code in predicting the major phenomena expected to occur. The MARS validation was made by its developer KAERI, on basic premise that its backbone code RELAP5/MOD3.2 is well qualified against analytical solutions, test or operational data. A screening was made to select the test data for MARS validation; some models transplanted from RELAP5, if already validated and found to be acceptable, were screened out from assessment. It seems to be reasonable, but does not demonstrate whether code adequacy complies with the software QA guidelines. Especially there may be much difficulty in validating the life-cycle products such as code updates or modifications. This paper presents the plan for MARS validation, and the current implementation status

  15. Status of the ARGOS project

    Science.gov (United States)

    Rabien, Sebastian; Barl, Lothar; Beckmann, Udo; Bonaglia, Marco; Borelli, José Luis; Brynnel, Joar; Buschkamp, Peter; Busoni, Lorenzo; Christou, Julian; Connot, Claus; Davies, Richard; Deysenroth, Matthias; Esposito, Simone; Gässler, Wolfgang; Gemperlein, Hans; Hart, Michael; Kulas, Martin; Lefebvre, Michael; Lehmitz, Michael; Mazzoni, Tommaso; Nussbaum, Edmund; Orban de Xivry, Gilles; Peter, Diethard; Quirrenbach, Andreas; Raab, Walfried; Rahmer, Gustavo; Storm, Jesper; Ziegleder, Julian

    2014-07-01

    ARGOS is the Laser Guide Star and Wavefront sensing facility for the Large Binocular Telescope. With first laser light on sky in 2013, the system is currently undergoing commissioning at the telescope. We present the overall status and design, as well as first results on sky. Aiming for a wide field ground layer correction, ARGOS is designed as a multi- Rayleigh beacon adaptive optics system. A total of six powerful pulsed lasers are creating the laser guide stars in constellations above each of the LBTs primary mirrors. With a range gated detection in the wavefront sensors, and the adaptive correction by the deformable secondary's, we expect ARGOS to enhance the image quality over a large range of seeing conditions. With the two wide field imaging and spectroscopic instruments LUCI1 and LUCI2 as receivers, a wide range of scientific programs will benefit from ARGOS. With an increased resolution, higher encircled energy, both imaging and MOS spectroscopy will be boosted in signal to noise by a large amount. Apart from the wide field correction ARGOS delivers in its ground layer mode, we already foresee the implementation of a hybrid Sodium with Rayleigh beacon combination for a diffraction limited AO performance.

  16. Renewables 2012 - Global status report

    International Nuclear Information System (INIS)

    Sawin, Janet L.; Bhattacharya, Sribas Chandra; Galan, Ernesto Macias; McCrone, Angus; Moomaw, William R.; Sims, Ralph; Sonntag-O'Brien, Virginia; Sverrisson, Freyr; Chawla, Kanika; Adib, Rana; Musolino, Evan; Mastny, Lisa; Skeen, Jonathan; Martinot, Eric; Hinrichs-Rahlwes, Rainer

    2012-01-01

    Renewable energy markets and policy frameworks have evolved rapidly in recent years. This report provides a comprehensive and timely overview of renewable energy market, industry, investment, and policy developments worldwide. It relies on the most recent data available, provided by a network of more than 400 contributors and researchers from around the world, all of which is brought together by a multi-disciplinary authoring team. The report covers recent developments, current status, and key trends; by design, it does not provide analysis or forecast the future. As such, this report and subsequent editions will serve as a benchmark for measuring global progress in the deployment of renewable energy, which is of particular interest in this International Year of Sustainable Energy for All. UN Secretary-General Ban Ki-moon has marked the occasion with a new global initiative, Sustainable Energy for All, which seeks to mobilise global action on three inter-linked objectives to be achieved by 2030: universal access to modern energy services, improved rates of energy efficiency, and expanded use of renewable energy sources

  17. Aging, Nutritional Status and Health

    Directory of Open Access Journals (Sweden)

    Wilma Leslie

    2015-07-01

    Full Text Available The older population is increasing worldwide and in many countries older people will outnumber younger people in the near future. This projected growth in the older population has the potential to place significant burdens on healthcare and support services. Meeting the diet and nutrition needs of older people is therefore crucial for the maintenance of health, functional independence and quality of life. While many older adults remain healthy and eat well those in poorer health may experience difficulties in meeting their nutritional needs. Malnutrition, encompassing both under and over nutrition increases health risks in the older population. More recently the increase in obesity, and in turn the incidence of chronic disease in older adults, now justifies weight management interventions in obese older adults. This growing population group is becoming increasingly diverse in their nutritional requirements. Micro-nutrient status may fluctuate and shortfalls in vitamin D, iron and a number of other nutrients are relatively common and can impact on well-being and quality of life. Aging presents a number of challenges for the maintenance of good nutritional health in older adults.

  18. Sinoprobe Datacenter Development: Current Status

    Science.gov (United States)

    Guan, Y.; Dong, S.; Chen, Z.; Chen, G.; Cheng, M.

    2011-12-01

    The project of the Sinoprobe datacenter development is to build new IT infrastructures needed to store, visualize and manage all the data acquired by SinoProbe program.The SinoProbe data center is designed using service-oriented architecture (SOA) principles. More specifically, service component architecture (SCA) is used to implement sinoprobe data services. It also uses various advanced technologies such as Java/JEE for the platform, PostgresSQL/PostGIS for the data storage, ApacheDS for LDAP, CoachDB for the medadata storage, GeoServer for the GIS services, ExtJs and OpenLayer for the Ajax framework, and Apache Shiro for the security framework. Through the integration and development of various technologies used, the major services of the datacenter system are implemented including the security infrastructure services (user authentication and authorization), metadata services, data warehouse stores, data services, GIS services, and web portal. There are also visualization components including the development of a virtual globe to replace the currently used Google Earth. This poster presents the current status of the SinoProbe data center development, and the detailed discussion of the system.

  19. Quantum flavordynamics: a status report

    International Nuclear Information System (INIS)

    Beg, M.A.B.

    1978-01-01

    The problems posed and the challenges offered by QFD, at this time, are analyzed and discussed. A convenient starting point is afforded by a comparison of the different circumstances of QFD and QCD. Some features of the conventional methodology of QFD, which may be deemed to be questionable, are underlined. The prospects of the standard model are examined in the light of recent experiments, and some theoretical deficiencies of the model are noted. Following a brief comment about the status of some recently proposed models, it is suggested that one search for new physical principles which may be governing the structure of weak interactions in a hitherto unperceived way. Manifest left-right symmetry and time-reversal invariance, realized as symmetries of the Nambu-Goldstone type, are mentioned as possible examples of such principles; additional motiviation for these symmetries emerges in a discussion of recent work on the problem of natural suppression of strong T-violation. The report concludes with a brief appraisal of the present state of QFD

  20. Status report on geochemical modelling

    International Nuclear Information System (INIS)

    Read, D.

    1991-12-01

    This report describes the findings of a review undertaken on behalf of the project management group of the programme 'Endlagersicherheit in der Nachbetriebsphase' based at GSF-IfT (Forschungszentrum fuer Umwelt und Gesundheit - Institut fuer Tieflagerung) to establish the current status of research into the simulation of geochemical processes relevant to radiological assessment. The review is intended to contribute to Stage 1 of a strategy formulated to enhance the use of geochemical models in Germany. Emphasis has been placed on processes deemed to be of greatest relevance to performance assessment for a HLW-repository in a salt dome principally, speciation-solubility in high salinity solutions, complexation by natural organics and generation-transport of colloids. For each of these and other topics covered, a summary is given of fundamental concepts, theoretical representations and their limitations, highlighting, where appropriate, the advantages and disadvantages of alternative approaches. The availability of data to quantify any given representation is addressed, taking into account the need for information at elevated temperatures and pressures. Mass transfer is considered in terms of aqueous, particulate and gas-mediated transport, respectively. (orig.) [de