Search

Objective: Determination of the real‐world performance of a health care system in the treatment of status epilepticus (SE). Methods: Prospective, multicenter population‐based study of SE in Auckland, New Zealand (NZ) over 1 year, with data recorded in the EpiNet database. Focus on treatment patterns and determinants of SE duration and 30‐day mortality. The incidence, etiology, ethnic discrepancies, and seizure characteristics of this cohort have been published previously. Results: A total of 365 patients were included in this treatment cohort; 326 patients (89.3%) were brought to hospital because of SE, whereas 39 patients (10.7%) developed SE during a hospital admission for another reason. Overall, 190 (52.1%) had a known history of epilepsy and 254 (70.0%) presented with SE with prominent motor activity. The mean Status Epilepticus Severity Score (STESS) was 2.15 and the mean SE duration of all patients was 44 min. SE self‐terminated without any treatment in 84 patients (22.7%). Earlier administration of appropriately dosed benzodiazepine in the pre‐hospital setting was a major determinant of SE duration. Univariate analysis demonstrated that mortality was significantly higher in older patients, patients with longer durations of SE, higher STESS, and patients who developed SE in hospital, but these did not maintain significance with multivariate analysis. There was no difference in the performance of the health care system in the treatment of SE across ethnic groups. Significance: When SE was defined as 10 continuous minutes of seizure, overall mortality was lower than expected and many patients had self‐limited presentations for which no treatment was required. Although there were disparities in the incidence of SE across ethnic groups there was no difference in treatment or outcome. The finding highlights the benefit of a health care system designed to deliver universal health care. [ABSTRACT FROM AUTHOR]

The discovery, in 1998, that the adult human brain contains at least two populations of progenitor cells and that progenitor cells are upregulated in response to a range of degenerative brain diseases has raised hopes for their use in replacing dying brain cells. Since these early findings, the race has been on to understand the biology of progenitor cells in the human brain, and they have now been isolated and studied in many major neurodegenerative diseases. Before these cells can be exploited for cell replacement purposes, it is important to understand how to (1) locate them, (2) label them, (3) determine what receptors they express, (4) isolate them, and (5) examine their electrophysiological properties when differentiated. In this chapter we have described the methods we use for studying progenitor cells in the adult human brain and in particular the tissue processing, immunohistochemistry, autoradiography, progenitor cell culture, and electrophysiology on brain cells. The Neurological Foundation of New Zealand Human Brain Bank has been receiving human tissue for approximately 25 years during which time we have developed a number of unique ways to examine and isolate progenitor cells from resected surgical specimens as well as from postmortem brain tissue. There are ethical and technical considerations that are unique to working with human brain tissue, and these, as well as the processing of this tissue and the culturing of it for the purpose of studying progenitor cells, are the topic of this chapter., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator-led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet-First trials., Methods: Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet-First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false-positive errors and could make only one error regarding seizure classification., Results: Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet-First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70., Significance: We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet-accredited and to participate in these investigator-led clinical trials.

The discovery, in 1998, that the adult human brain contains at least two populations of progenitor cells and that progenitor cells are upregulated in response to a range of degenerative brain diseases has raised hopes for their use in replacing dying brain cells. Since these early findings the race has been on to understand the biology of progenitor cells in the human brain and they have now been isolated and studied in many major neurodegenerative diseases. Before these cells can be exploited for cell replacement purposes it is important to understand how to: (1) find them, (2) label them, (3) determine what receptors they express, (4) isolate them, and (5) examine their electrophysiological properties when differentiated. In this chapter we have described the methods we use for studying progenitor cells in the adult human brain and in particular the tissue processing, immunohistochemistry, autoradiography, progenitor cell culture, and electrophysiology on brain cells. The Neurological Foundation of New Zealand Human Brain Bank has been receiving human tissue for approximately 20 years during which time we have developed a number of unique ways to examine and isolate progenitor cells from resected surgical specimens as well as from postmortem brain tissue. There are ethical and technical considerations that are unique to working with human brain tissue and these, as well as the processing of this tissue and the culturing of it for the purpose of studying progenitor cells, are the topic of this chapter.

Aims: To analyse the long-term outcome of patients who underwent temporal lobe resection for intractable temporal lobe epilepsy at Auckland Hospital., Methods: We performed a retrospective analysis of 176 patients who underwent temporal lobe resection at Auckland Hospital, New Zealand between 1987 and 2007. We had at least 1 year of follow-up on 174 patients., Results: Overall 98/174 (56%) individuals were seizure-free at 1 year (Engel Class 1) with a marked improvement in quality of life. A further 61/174 (35%) had rare seizures or had significant improvement in seizure frequency (Engel Classes II or III). At last follow up (mean 4.3 years) 95/174 (55%) were seizure-free (Engel Class 1). Hippocampal sclerosis was the pathological finding in 129 patients. Surgical complications included 2 (1.1%) deaths, while 6 (3.4%) patients had symptomatic visual field defects, and 8 (4.5%) had other permanent neurological problems. A further 18 (10.3%) patients had temporary complications including infection, pulmonary embolus, and aseptic meningitis. New psychological symptoms occurred during the first year after surgery in 52% of 114 patients for whom we had detailed psychiatric assessments., Conclusion: Temporal lobe resection is effective in controlling medically intractable seizures, but there are potentially serious complications that need to be considered when counselling patients for such a procedure.

Epilepsy is a common neurological disorder. Most patients with epilepsy have seizures that are relatively easily controlled, but a significant minority of patients have seizures that are resistant to standard anti-epileptic drugs. The New Zealand chapter of the International League against epilepsy (NZLAE) has recently been formed to improve the care of patients with epilepsy in New Zealand. NZLAE intends to work with the lay group, Epilepsy New Zealand to help raise the profile of epilepsy within the general community, and to improve access to some of the newer drugs that are not currently available here. NZLAE is also keen to promote research into epilepsy in New Zealand, and members have recently started recruiting patients for several research projects.