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This article, published in the journal Neuropediatrics, explores the connection between sleep and epilepsy in children. The researchers aimed to compare the sleep patterns of children with epilepsy to a healthy control group. They found that children with epilepsy had higher rates of sleep slow waves (SW) and increased coupling between SW and sleep spindles during non-rapid eye movement (NREM) sleep. These findings suggest that children with epilepsy may experience altered sleep macro- and microstructure, which could potentially contribute to cognitive impairment. Further research is needed to better understand the relationship between sleep and epilepsy in children. [Extracted from the article]

This article, published in the journal Neuropediatrics, discusses a study on the use of pulsatile corticoid therapy (PCT) in children with genetic drug-resistant epilepsy. The study aimed to compare the epileptic burden in children before and after PCT treatment using objective and subjective approaches. The results showed that PCT led to a significant reduction in spike burden in the electroencephalogram (EEG) and improved sleep physiology, specifically an increase in fast spindle rates. Additionally, seizure frequency improved in the majority of patients, and no severe adverse effects were reported. The study suggests that PCT may be an effective treatment option for children with genetic drug-resistant epilepsy, leading to a reduction in epileptic burden and improvement in cognitive functioning. [Extracted from the article]

This article, published in the journal Neuropediatrics, examines the prevalence of primary headache types and their impact on the quality of life in children with epilepsy. The study involved 119 children with epilepsy, and it found that 38.7% of them reported suffering from headaches. Of those with headaches, 34.8% had migraine, 19.6% had tension-type headache, and 45.7% had not classifiable headache. Female epilepsy patients were more likely to be affected by headaches than male patients. The study also found that patients with headaches had lower quality of life compared to those without headaches. Overall, the findings suggest that headache is common among children with epilepsy and can negatively impact their quality of life. [Extracted from the article]

Objective: Corticosteroids and adrenocorticotropic hormone (ACTH) are the therapy of choice to treat infantile spasms. However, systematic studies about their use in other types of childhood epilepsies remain rare and ACTH can have serious side effects. This study compares the interictal epileptic activity (IEA) burden (% of electroencephalography (EEG) time with IEDs) in children with genetic drug-resistant epilepsy before and after a standardized treatment with pulsatile corticoid therapy (PCT)., Methods: Children with drug-resistant epilepsy underwent a standardized protocol for PCT with cycles of high-dose dexamethasone (20 mg/m 2 body surface) intravenously. Patients were hospitalized for 3 days per PCT cycle and EEGs were obtained before initiation of treatment (baseline) and during the hospitalization around the time of every second cycle. EEG recordings during sleep and wakefulness were obtained. IEA burden was compared before and after PCT. Secondary outcome measures included the sleep spindle rate, the seizure frequency and subjective evaluation in a standardized interview., Results: In the cohort of 24 children (10 female, 6.2 ± 3.4 years), IEA burden was lower in the EEG after PCT compared to the baseline (baseline: 5.4% [0.7-97.3] vs. after PCT: 1.5% [0-96.9], p = 0.001, d = -0.41). Sleep physiology expressed by sleep spindles improved after PCT with enhanced fast spindle rates (0.8/min [0-2.2] vs. 1.5/min [0.2-3.4], p = 0.045, d = 0.36). Seizure frequency was decreased in 17 of the 24 patients (70.8%) with one patient achieving seizure freedom. The majority of patients improved in quality of life (79.2%), and sleep (81.3%). No serious adverse effects were documented., Significance: This study systematically assessed the effect of PCT in children with genetic / suspected genetic drug-resistant epilepsy. PCT was found to not only reduce the IEA burden but also increase sleep spindle rates, which are important for cognitive functioning., Plain Language Summary: In this study, children with a form of epilepsy, which is resistant against antiseizure medication, received a systematic treatment with corticosteroids over multiple cycles in the hospital. It was found that not only the epileptic activity was reduced but also the sleep of the patients was improved after the treatment. These findings could provide the basis for extending the use of corticosteroids in children with epilepsy., (© 2024 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Headache is a frequent comorbidity in patients with epilepsy. Data are sparse regarding the distribution of headache types in children with epilepsy (CWE). We aimed to assess the prevalence of primary headache types and their influence on health-related quality of life (QoL) in CWE. CWE filled out a validated headache questionnaire to assess migraine (MIG), tension-type headache (TTH), trigeminal-autonomic cephalalgia (TAC), or, if the criteria were not fulfilled, non-classifiable headache (NCH). QoL was measured using both patient and parent versions of a validated questionnaire. Of 119 CWE (59 female; 11.5 ± 3.1 y), headache was found in 46 (38.7%). Sixteen (34.8%) patients showed MIG, 9 (19.6%) patients TTH, and 21 (45.7%) patients described NCH. More girls reported headache ( χ 2 = 5.4, p = 0.02) when compared to boys. Overall, QoL was reduced in patients with headache from both the patients' and parents' points of view (70.8% [39.6; 87.5] vs. 77.0% [46.9; 95.8], p = 0.002; 71,9% [33.3; 87.5] vs. 78,1% [54.2; 95.8], p = 0.003). Headache is common among CWE with MIG as the most prevalent primary headache type and higher rates in female patients. Importantly, patients and their parents perceive a reduced overall QoL when suffering from headache.

Ketogenic diet (KD) and pulsatile dexamethasone therapy (PDT) are commonly used in the treatment of children with drug resistant epilepsy. Potential side effects of the KD are hypoglycemia, whereas PDT might lead to hyperglycemia. One practical option to measure glucose concentrations regularly is the flash glucose monitoring system (FGM). In this single-center study in Germany, two pediatric patients with epilepsy (age: 6.0 and 6.8 years) received FGM from the beginning of the KD over six months, in the year 2020, and one patient (9.8 years) was observed for one month on PDT and switched to the KD thereafter. Glucose concentrations were measured by using an FGM system and capillary blood measurement. Seizure frequency, changes in cognition, motor performance, social behavior, and sleep quality were evaluated. The mean hypoglycemia rate per day (65 mg/dL and lower) declined significantly in patient 1 and 2 after three months. Patient 3 showed in total seven hyperglycemic events during PDT. Patient 1 became seizure free. Improvement of attention and memory performance were reported. FGM during the KD as a treatment for drug resistant epilepsies in childhood is a practical option to explore and to avoid hypoglycemia during the KD and hyperglycemia during PDT.

We herein report the case of a 3-year-old girl with severe myoclonic epilepsy of infancy known as Dravet syndrome (DS) on a ketogenic diet (KD) whose glucose concentrations were controlled by using a flash glucose monitoring system. Two-hundred ninety-three events of moderate hypoglycemia with a minimum of 45 mg/dL, not related to day or night, were recorded during the observational period. Hypoglycemia rate declined from 24.5% of all measurements to 11.8% over time; one hypoglycemia-associated seizure and one seizure due to ketone concentrations below the therapeutic range were observed. In summary, this case report broadens our understanding of hypoglycemia risk in patients with DS on a KD. Especially in childhood, the painless and easy detection of low glucose concentrations might lead to improved cognitive performance, and the reduction of hypoglycemia-induced seizures., Competing Interests: The authors report no conflicts of interest., (Georg Thieme Verlag KG Stuttgart · New York.)

Four distinct integration/translocation routes into/across thylakoid membranes have recently been deduced for nuclear-encoded polypeptides of the photosynthetic membrane. Corresponding information for the plastid-encoded protein complement is lacking. We have investigated this aspect with in-organello assays employing chimeric constructs generated with codoncorrect cassettes for genes of plastid-encoded thylakoid proteins, and appropriate transit peptides from six nuclear genes, representing three targeting classes, as a strategy. The three major plastid-encoded components of the cytochrome b (6)f complex, namely pre-apocytochrome f, (including apocytochrome f, and pre-apocytochrome f lacking the C-terminal transmembrane segment), cytochrome b(6), and subunit IV, which differ in the number of their transmembrane segments, were studied. Import into chloroplasts could be observed in all instances but with relatively low efficiency. Thylakoid integration can occurr post-translationally, but only components with secretory/secretory pathway (SEC)-route-specific epitopes were correctly assembled with the cytochrome complex, or competed with this process. Inhibitor studies were consistent with these findings. Imported cytochrome b(6) and subunit IV operated with uncleaved targeting signals for thylakoid integration. The corresponding determinant for cytochrome f is its signal peptide; its C-terminal hydrophobic segment did not, or did not appreciably, contribute to this process. The N-termini of cytochrome b(6) and subunit IV appear to reside on the same (lumenal) side of the membrane, consistent with the currently favored four-helix model for the cytochrome, but in disagreement with the topography proposed for both components. The impact of the findings for protein routing, including for applied approaches such as compartment-alien transformation, is discussed.

This article deals with differences in work satisfaction, general state of well being, somatic complaints and work load of psychiatric student nurses and graduated nurses. Data were collected from a sample of 53 psychiatric student nurses and 145 graduated nurses. The graduated nurses reported an unexpectedly high job satisfaction of 70% compared to other working groups in hospitals. The student nurses were more content with their work and reported less somatic complaints. Furthermore the student nurses found in 20 cases certain duties less strenuous. In addition, the student nurses reported a more negative general state of well being.

In accordance with neuropsychological findings, that chronic alcohol abuse can lead to cognitive impairment, a multi-phased cognitive training program (MKT) developed by Sagstetter was conducted with a group of chronic alcoholic patients. In this article this program is introduced and evaluated with regard to chronic alcoholic patients and their improvement in certain cognitive functions. The study group consisted of 11 chronic alcoholics, who regularly took part in the program. The control group consisted of 11 patients who took part on a behavior therapy program offered by the clinic and had similar social and pathological histories to those of the study group. The two groups were compared with each other with the help of a follow-up study design after approximately seven weeks. The results reveal that this present cognitive training program promotes, above all, cognitive functions such as visual short-time memory, concentration, form perception as well as combination and organisation ability.