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BACKGROUND AND OBJECTIVES: Epilepsy is associated with an increased risk of cardiovascular disease and premature mortality, including sudden unexpected death in epilepsy (SUDEP). Serious cardiac arrythmias might go undetected in routine epilepsy and cardiac investigations. METHOD(S): This prospective cohort study aimed to detect cardiac arrhythmias in patients with chronic drug-resistant epilepsy (>=5 years duration) using subcutaneous cardiac monitors for a minimum follow-up duration of 12 months. Participants with known cardiovascular disease or those with abnormal 12-lead ECGs were excluded. The device was programmed to automatically record episodes of tachycardia >=140 beats per minute (bpm), bradycardia <=40 bpm for >=3 seconds, or asystole >=3 seconds. FINDINGS: Thirty-one patients underwent subcutaneous cardiac monitoring for a median recording duration of 2.2 years (range 0.5-4.2). During this time, 28 patients (90.3%) had episodes of sustained (>=30 seconds) sinus tachycardia, 8/31 (25.8%) had sinus bradycardia, and 3 (9.7%) had asystole. Three patients (9.7%) had serious cardiac arrhythmias requiring additional cardiac interventions. Among them, 2 patients had prolonged sinus arrest and ventricular asystole (>6 seconds), leading to pacemaker insertion in one, and another patient with epileptic encephalopathy had multiple episodes of recurrent nonsustained polymorphic ventricular tachycardia and bundle branch conduction abnormalities. The time to first detection of a clinically significant cardiac arrhythmia ranged between 1.2 and 26.9 months following cardiac monitor insertion. DISCUSSION: Implantable cardiac monitors detected a high incidence of clinically significant cardiac arrhythmias in patients with chronic drug-resistant epilepsy, which may contribute to the incidence of premature mortality, including SUDEP.Copyright © 2022 American Academy of Neurology.

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Introduction Stroke is a common cause of epilepsy that may be mediated via glutamate dysregulation. There is currently no evidence to support the use of antiseizure medications as primary prevention against poststroke epilepsy. Perampanel has a unique antiglutamatergic mechanism of action and may have antiepileptogenic properties. This study aims to evaluate the efficacy and safety of perampanel as an antiepileptogenic treatment in patients at high risk of poststroke epilepsy. Methods and analysis Up to 328 patients with cortical ischaemic stroke or lobar haemorrhage will be enrolled, and receive their first treatment within 7 days of stroke onset. Patients will be randomised (1:1) to receive perampanel (titrated to 6 mg daily over 4 weeks) or matching placebo, stratified by stroke subtype (ischaemic or haemorrhagic). Treatment will be continued for 12 weeks after titration. 7T MRI will be performed at baseline for quantification of cerebral glutamate by magnetic resonance spectroscopy and glutamate chemical exchange saturation transfer imaging. Blood will be collected for measurement of plasma glutamate levels. Participants will be followed up for 52 weeks after randomisation. The primary study outcome will be the proportion of participants in each group free of late (more than 7 days after stroke onset) poststroke seizures by the end of the 12-month study period, analysed by Fisher's exact test. Secondary outcomes will include time to first seizure, time to treatment withdrawal and 3-month modified Rankin Scale score. Quality of life, cognitive function, mood and adverse events will be assessed by standardised questionnaires. Exploratory outcomes will include correlation between cerebral and plasma glutamate concentration and stroke and seizure outcomes. Ethics and dissemination This study was approved by the Alfred Health Human Research Ethics Committee (HREC No 44366, Reference 287/18). Trial registration number ACTRN12618001984280; Pre-results.Copyright © 2021

Objective: To examine the prognostic value of CSF abnormalities in seropositive autoimmune encephalitis (AE). Method(s): We retrospectively studied 57 cases of seropositive AE. Primary outcomes were mortality and modified Rankin Scale, while secondary outcomes were first line treatment failure, ICU admission and relapse. Regression analysis was performed. Result(s): CSF white cell count (WCC) was higher in the NMDAR group, while elevated protein was more common amongst other subtypes. We found an association between WCC >5 cells/mm3 and treatment failure (OR 16.0, p = 0.006)), and between WCC >20 cells/mm3 and ICU admission (OR 19.3, p = 0.026). Conclusion(s): Different subsets of AE have characteristic CSF abnormalities, which may aid recognition during early evaluation. CSF WCC had prognostic significance in our study.Copyright © 2021

Objective: To examine the utility of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) as biomarkers of prognosis in seropositive autoimmune encephalitis (AE). Method(s): In this multicenter study, we retrospectively analyzed 57 cases of seropositive AE with hospital admissions between January 2008 and June 2019. The initial full blood examination was used to determine each patients' NLR and MLR. The modified Rankin Scale (mRS) was utilized to assess the patients' follow-up disability at 12 months and then at final follow-up. Primary outcomes were mortality and mRS, while secondary outcomes were failure of first line treatment, ICU admission, and clinical relapse. Univariate and multivariable regression analysis was performed. Result(s): During initial hospital admission 44.7% of patients had unsuccessful first line treatment. After a median follow-up of 700 days, 82.7% had good functional outcome (mRS <=2) while five patients had died. On multivariable analysis, high NLR was associated with higher odds of first line treatment failure (OR 1.32, 95% CI 1.03-1.69, p = 0.029). Increased MLR was not associated with any short or long-term outcome. Conclusion(s): NLR on initial hospital admission blood tests may be provide important prognostic information for cases of seropositive AE. This study demonstrates the potential use of NLR as a prognostic marker in the clinical evaluation of patients with seropositive AE.© Copyright © 2021 Broadley, Wesselingh, Seneviratne, Kyndt, Beech, Buzzard, Nesbitt, D'Souza, Brodtmann, Kalincik, Butzkueven, O'Brien, Monif and Australian Autoimmune Encephalitis Consortium.

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ObjectiveTo identify clinical and EEG biomarkers of drug resistance in adults with idiopathic generalized epilepsy.MethodsWe conducted a case-control study consisting of a discovery cohort and a replication cohort independently assessed at 2 different centers. In each center, patients with the idiopathic generalized epilepsy phenotype and generalized spike-wave discharges on EEG were classified as drug-resistant or drug-responsive. EEG changes were classified into predefined patterns and compared between the 2 groups in the discovery cohort. Factors associated with drug resistance in multivariable analysis were tested in the replication cohort.ResultsThe discovery cohort included 85 patients (29% drug-resistant and 71% drug-responsive). Their median age at assessment was 32 years and 50.6% were female. Multivariable analysis showed that higher number of seizure types ever experienced (3 vs 1: odds ratio [OR] = 31.1, 95% confidence interval [CI]: 4.5-214, p < 0.001; 3 vs 2: OR = 14.6, 95% CI: 2.3-93.1, p = 0.004) and generalized polyspike train (burst of generalized rhythmic spikes lasting less than 1 second) during sleep were associated with drug resistance (OR = 10.8, 95% CI: 2.4-49.4, p = 0.002). When these factors were tested in the replication cohort of 80 patients (27.5% drug-resistant and 72.5% drug-responsive; 71.3% female; median age 27.5 years), the proportion of patients with generalized polyspike train during sleep was also higher in the drug-resistant group (OR = 4.0, 95% CI: 1.35-11.8, p = 0.012).ConclusionGeneralized polyspike train during sleep may be an EEG biomarker for drug resistance in adults with idiopathic generalized epilepsy.Copyright © 2018 American Academy of Neurology.

The accretion of hydrogen onto a white dwarf star ignites a classical nova eruption(1,2)-a thermonuclear runaway in the accumulated envelope of gas, leading to luminosities up to a million times that of the Sun and a high-velocity mass ejection that produces a remnant shell (mainly consisting of insterstellar medium). Close to the upper mass limit of a white dwarf(3) (1.4 solar masses), rapid accretion of hydrogen (about 10(-7) solar masses per year) from a stellar companion leads to frequent eruptions on timescales of years(4,5) to decades(6). Such binary systems are known as recurrent novae. The ejecta of recurrent novae, initially moving at velocities of up to 10,000 kilometres per second(7), must 'sweep up' the surrounding interstellar medium, creating cavities in space around the nova binary. No remnant larger than one parsec across from any single classical or recurrent nova eruption is known(8-10), but thousands of successive recurrent nova eruptions should be capable of generating shells hundreds of parsecs across. Here we report that the most frequently recurring nova, M31N 2008-12a in the Andromeda galaxy (Messier 31 or NGC 224), which erupts annually(11), is indeed surrounded by such a super-remnant with a projected size of at least 134 by 90 parsecs. Larger than almost all known remnants of even supernova explosions(12), the existence of this shell demonstrates that the nova M31N 2008-12a has erupted with high frequency for millions of years.

Item does not contain fulltext, The non-competitive N-methyl d-aspartate glutamate receptor (NMDAR) antagonist ketamine elicits a brain state resembling high-risk states for developing psychosis and early stages of schizophrenia characterized by sensory and cognitive deficits and aberrant ongoing gamma (30-80 Hz) oscillations in cortical and subcortical structures, including the thalamus. The underlying mechanisms are unknown. The goal of the present study was to determine whether a ketamine-induced psychotic-relevant state disturbs the functional state of the corticothalamic (CT) pathway. Multisite field recordings were performed in the somatosensory CT system of the sedated rat. Baseline activity was challenged by activation of vibrissa-related prethalamic inputs. The sensory-evoked thalamic response was characterized by a short-latency ( approximately 4 ms) prethalamic-mediated negative sharp potential and a longer latency ( approximately 10 ms) CT-mediated negative potential. Following a single subcutaneous injection of ketamine (2.5 mg/kg), spontaneously occurring and sensory-evoked thalamic gamma oscillations increased and decreased in power, respectively. The power of the sensory-related gamma oscillations was positively correlated with both the amplitude and the area under the curve of the corresponding CT potential but not with the prethalamic potential. The present results show that the layer VI CT pathway significantly contributes in thalamic gamma oscillations, and they support the hypothesis that reduced NMDAR activation disturbs the functional state of CT and corticocortical networks.

We present an analysis of optical and infrared spectra of the recurrent nova RS Oph obtained during between 2006 and 2009. The best fit to the optical spectrum for 2006 September 28 gives Teff = 3900 K for log g = 2.0, while for log g = 0.0 we find Teff = 4700 K, and a comparison with template stellar spectra provides Teff ~ 4500 K. The observed spectral energy distribution (SED), and the intensities of the emission lines, vary on short (≲1 d) time-scales, due to disc variability. We invoke a simple one-component model for the accretion disc, and a model with a hot boundary layer, with high (~3.9 × 10-6M⊙ yr-1) and low (~2 × 10-8M⊙ yr-1) accretion rates, respectively. Fits to the accretion disc-extracted infrared spectrum (2008 July 15) yield effective temperatures for the red giant of Teff = 3800 ± 100 K (log g = 2.0) and Teff = 3700 ± 100 K (log g = 0.0). Furthermore, using a more sophisticated approach, we reproduced the optical and infrared SEDs of the red giant in the RS Oph system with a twocomponent model atmosphere, in which 90 per cent of the surface has Teff = 3600 K and 10 per cent has Teff = 5000 K. Such structure could be due to irradiation of the red giant by the white dwarf. © 2015 The Authors.

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AASKA14 : Advancing Astrophysics with the Square Kilometre Array June 9-13, 2014 Giardini Naxos, Italy, Contains fulltext : 150818.pdf (publisher's version ) (Open Access)

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Melasma of the forearms seems to be a relatively common sign which is, to our knowledge, not reported in the literature. It seems that it may be more common in older patients and especially in postmenopausal women on supplementary oestrogen. The pigmentary change is macular and may be confluent or speckled. Like facial chloasma there is a sharp line of demarcation at the margins. In some, there seems to be an element of erythema.

Purpose: Approximately 30% of patients admitted for video-EEG monitoring have psychogenic nonepileptic seizures (PNES). Differentiation of "convulsive" PNES from convulsive seizures can be difficult. The EEG often displays rhythmic movement artifact that may resemble seizure activity and confound the interpretation. We sought to determine whether time-frequency mapping of the rhythmic EEG artifact during "convulsive" PNES reveals a pattern that differs from that of epileptic seizures. Method(s): EEGs from 15 consecutive patients with "convulsive" PNESs were studied with time-frequency mapping by using NEUROSCAN and compared with 15 patients with convulsive epileptic seizures. Fast Fourier transforms (FFTs) were performed to determine the dominant frequency for 1- to 2-s windows every 2 s through the seizures. Result(s): The dominant frequency remained stable within a narrow range for the duration of the PNES, whereas in the epileptic seizures, it evolved through a wide range. The coefficient of variation of the frequency during the seizures was considerably less for patients without epilepsy (median, 15.0%; range, 7.2-23.7% vs. median, 58.0%; range, 34.8-92.1%; p < 0.001). The median frequency did not differ significantly between groups (4.2 vs. 4.6 Hz; p = 0.290). Conclusion(s): "Convulsive" PNES display a characteristic pattern on time-frequency mapping of the EEG artifact, with a stable, nonevolving frequency that is different from the evolving pattern seen during an epileptic seizure.

Background: Computer-assisted-telephone-interviewing (CATI), widely used in market research, could be a useful alternative for conducting diagnostic interviews in epilepsy epidemiology. Method(s): We administered a diagnostic seizure questionnaire by CATI, interpreting the responses with standardized classification guidelines, compared against an epilepsy specialist's assessment, for agreement [Kappa statistic (kappa)], sensitivity, specificity, positive predictive value, negative predictive value and Youden's Index (YI). Result(s): 99 outpatients with 382 lifetime events participated: 22 generalized-onset epilepsy [16 Idiopathic Generalized Epilepsy (IGE)], 59 partial-onset epilepsy, 12 non-epileptic and 6 uncertain. We observed almost perfect agreement in diagnosing epilepsy (kappa=0.94), seizure-onset types (kappa=0.84), simple or complex partial seizures (kappa=0.87), any generalized non-convulsive seizure (kappa=0.82), and IGE (kappa=0.82). Although substantial, agreement was not as close for secondarily generalized seizures (kappa=0.74), and generalized tonic-clonic seizures (kappa=0.79). This related more to under-recognition of individual generalized non-convulsive seizures rather than misinterpretation of partial seizures. Discussion(s): Epilepsy diagnostic questionnaires administered by CATI and interpreted with standardized diagnostic guidelines can effectively classify epilepsy, most seizure types and IGE in outpatients with suspected seizures. Applying this diagnostic method in 'field' settings will allow firmer conclusions to be drawn on its wider epidemiological utility. © 2010 Elsevier B.V.