Autoimmune Epilepsy Clinical Characteristics and Response to Immunotherapy

This is a very interesting article about patients treated with immunotherapy for autoimmune epilepsy.

• Online Features  This Article  • Full text  • PDF  • Author Interview  • eTables and eFigure  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Neurology  • Epilepsy  • Prognosis/ Outcomes  • Drug Therapy  • Immunologic Disorders  • Immunology, Other  • Alert me on articles by topic  Social Bookmarking          What's this? ONLINE FIRST Autoimmune EpilepsyClinical Characteristics and Response to Immunotherapy Amy M. L. Quek, MBBS; Jeffrey W. Britton, MD; Andrew McKeon, MD; Elson So, MD; Vanda A. Lennon, MD, PhD; Cheolsu Shin, MD; Christopher J. Klein, MD;Robert E. Watson Jr, MD, PhD; Amy L. Kotsenas, MD; Terrence D. Lagerlund, MD; Gregory D. Cascino, MD; Gregory A. Worrell, MD, PhD; Elaine C. Wirrell, MD;Katherine C. Nickels, MD; Allen J. Aksamit, MD; Katherine H. Noe, MD; Sean J. Pittock, MD  Arch Neurol. Published online March 26, 2012. doi:10.1001/archneurol.2011.2985 Objective  To describe clinical characteristics and immunotherapy responses in patients with autoimmune epilepsy. Design  Observational, retrospective case series. Setting  Mayo Clinic Health System. Patients  Thirty-two patients with an exclusive (n = 11) or predominant (n = 21) seizure presentation in whom an autoimmune etiology was suspected (on the basis of neural autoantibody [91%], inflammatory cerebrospinal fluid [31%], or magnetic resonance imaging suggesting inflammation [63%]) were studied. All had partial seizures: 81% had failed treatment with 2 or more antiepileptic drugs and had daily seizures and 38% had seizure semiologies that were multifocal or changed with time. Head magnetic resonance imaging was normal in 15 (47%) at onset.  Electroencephalogram abnormalities included interictal epileptiform discharges in 20; electrographic seizures in 15; and focal slowing in 13. Neural autoantibodies included voltage-gated potassium channel complex in 56% (leucine-rich, glioma-inactivated 1 specific, 14; contactin-associated proteinlike 2 specific, 1); glutamic acid decarboxylase 65 in 22%; collapsin response-mediator protein 5 in 6%; and Ma2, N-methyl-D-aspartate receptor, and ganglionic acetylcholine receptor in 1 patient each. Intervention  Immunotherapy with intravenous methylprednisolone; intravenous immune globulin; and combinations of intravenous methylprednisolone, intravenous immune globulin, plasmapheresis, or cyclophosphamide. Main Outcome Measure  Seizure frequency. Results  After a median interval of 17 months (range, 3-72 months), 22 of 27 (81%) reported improvement postimmunotherapy; 18 were seizure free. The median time from seizure onset to initiating immunotherapy was 4 months for responders and 22 months for nonresponders (P < .05). All voltage-gated potassium channel complex antibody–positive patients reported initial or lasting benefit (P < .05). One voltage-gated potassium channel complex antibody–positive patient was seizure free after thyroid cancer resection; another responded to antiepileptic drug change alone. Conclusion  When clinical and serological clues suggest an autoimmune basis for medically intractable epilepsy, early-initiated immunotherapy may improve seizure outcome. Author Affiliations: Departments of Laboratory Medicine and Pathology (Drs Quek, McKeon, Lennon, Klein, and Pittock), Neurology (Drs Britton, McKeon, So, Lennon, Shin, Klein, Lagerlund, Cascino, Worrell, Wirrell, Nickels, Aksamit, and Pittock), Immunology (Dr Lennon), and Radiology (Drs Watson and Kotsenas), Mayo Clinic, College of Medicine, Rochester, Minnesota; and Department of Neurology, Mayo Clinic, College of Medicine, Scottsdale, Arizona (Dr Noe). Abstract here

Sexual function in female patients with obstructive sleep apnea.

(Finally, some good science! - JR)

• Obstructive Sleep Apnea;
• Sexual Distress;
• Sexual Difficulties;
• Sexual Dysfunction;
• Females

Sexual Function in Female Patients with Obstructive Sleep Apnea

Keywords:

ABSTRACT

Introduction.  Obstructive sleep apnea is defined as repetitive (≥5/hour) partial or complete cessation of breathing during sleep. Whereas obstructive sleep apnea is often considered to be associated with sexual problems in men, studies concerning effects of obstructive sleep apnea on female sexual function and distress are sparse.

Aim.  To investigate sexual dysfunction and sexual distress in female patients with obstructive sleep apnea and to determine which factors are of importance for their sexual function.

Methods.  We investigated 80 female patients (ages 28–64) admitted to a sleep laboratory and who after investigation received a diagnosis of obstructive sleep apnea. All subjects answered questions drawn from three self-administered questionnaires on sexuality. The results were compared with a population sample (N = 240).

Main Outcome Measure.  Data from nocturnal respiratory recordings. Female Sexual Function Index, Female Sexual Distress Scale and four questions from Life Satisfaction-11 (Lisat-11).

Results.  Female Sexual Function Index indicated that obstructive sleep apnea patients were at a higher risk for having sexual difficulties. Female Sexual Distress Scale showed significantly more sexual distress in the obstructive sleep apnea group. Manifest Female Sexual Dysfunction (combined data from Female Sexual Function Index and Female Sexual Distress Scale) showed that female patients with obstructive sleep apnea also had more sexual dysfunction. Severity of sleep apnea was, however, not related to any of these indices but consumption of psychopharmaca was. In Lisat-11, we found that obstructive sleep apnea females scored lower than women in the population sample regarding life as a whole but not regarding domains of closeness.

Conclusions.  This study indicates that sexuality of women with untreated obstructive sleep apnea is negatively affected compared with a female population sample. This was not related to severity of obstructive sleep apnea, whereas psychopharmaca may act as an important confounder. Petersen M, Kristensen E, Berg S, Giraldi A, and Midgren B. Sexual function in female patients with obstructive sleep apnea. J Sex Med 2011;8:2560–2568.

What causes epilepsy in newborn babies?

Epilepsy in newborn babies

• What causes epilepsy in newborn babies?
• Types of seizures
• Diagnosis
• Treatment
• Outlook

What causes epilepsy in newborn babies?

There are many different causes of seizures in newborn babies and in the first six months of life. In very premature babies, the most common causes are a reduced blood and oxygen flow to the brain, and bleeding into the brain. Other causes include infections such as meningitis, low blood sugar or calcium, poor development of the brain and rarely, problems with the metabolism. In some cases, the seizures may be due to a faulty gene or chromosome. In other cases no cause can be found.

See also: What is epilepsy? 

Types of seizures

Seizures in newborn babies are often difficult to recognise. This is because the immature brain of a very young child is unable to produce the more obvious seizures that can be seen in older children. In a newborn baby seizures may be very subtle and consist simply of changes in breathing patterns, movements of the eyelids or lips or bicycling movements of the limbs. They may also consist of brief jerks or episodes of stiffening of the body and limbs. The jerks are called myoclonic or clonic seizures and the episodes of stiffening are called tonic seizures, or, sometimes, spasms.

More information about different types of seizures

Diagnosis

It is important that any baby who is suspected of having seizures is referred to a specialist, who may arrange for diagnostic tests. One of the most commonly performed tests is the electroencephalogram (EEG). While the EEG is not a conclusive test for epilepsy, it can be very useful in detecting subtle seizures, and can also provide information about specific seizure types. It is important that the EEG of a newborn baby is interpreted by someone who specialises in this age group. This is because the brainwave patterns and seizures are often very different to those in older children and adults. 

Treatment

There is a large range of anti-epileptic medication currently available and new ones continue to be developed. However, one of the older drugs, phenobarbital, seems to be particularly useful in treating seizures in babies; other drugs such as carbamazepine or phenytoin may also be effective. Ultimately, the choice of medication will depend on the child’s seizure type, the age when the epilepsy began, the cause of the epilepsy, if known, and the likely outcome of that particular type of epilepsy.

Outlook

Many parents become frustrated as they feel that doctors give them little information about how their child will develop and whether the epilepsy will ever go away. This frustration is understandable, but the lack of information may simply be due to the fact that the doctors themselves do not always know what will happen in the future.

One of the things parents may worry about is whether their child’s intellectual abilities will be affected by epilepsy. Many children with epilepsy will develop with the same range of intellectual abilities as children without the condition. However, where the epilepsy is caused by damage to the brain, this damage can, in some cases, also cause learning disabilities.

In the newborn period it is not always possible to predict what the outcome for each child will be. In some cases it is only when particular development milestones are reached, or not reached, that the doctors can try to predict what the future may hold for that child. Ultimately, the outlook for the future, both in terms of general development and future epilepsy, depends on the nature and, most importantly, on the underlying cause of the child’s epilepsy.

Epilepsy Action has fact sheets about some types of childhood epilepsy. Please contact the Epilepsy Helpline, freephone 0808 800 5050 (UK), orhelpline@epilepsy.org.uk

For the less common types of epilepsy the UK organisation Contact a Familymay be able to provide information on self-help groups for children with specific conditions.

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Study Claims Two-Thirds of Kids With Autism Have Been Bullied

Nearly two-thirds of American children with autism have been bullied at some point in their lives, and these kids are bullied three times more often than their siblings without autism, a new survey finds.

Bullying occurs in every grade but is worst in grades five through eight, with 42 percent to 49 percent of autistic children in those grades bullied, according to the survey of nearly 1,200 parents of autistic children ages 6 to 15.

The Interactive Autism Network (IAN), a project of the Kennedy Krieger Institute, conducted the survey.

"These survey results show the urgent need to increase awareness, influence school policies and provide families and children with effective strategies for dealing with bullying," Paul Law, director of the IAN Project, said in an institute news release.

Children with autism, a developmental disorder, usually have delayed language development and difficulty with social interaction.

"Children with [autism] are already vulnerable. To experience teasing, taunts, ostracism or other forms of spite may make a child who was already struggling to cope become completely unable to function," Law said. "The issue is complex and we plan to carefully analyze the data and publish peer-reviewed findings that will serve to advance policy and care for individuals with [autism]."

Overall, 63 percent of kids with an autism spectrum disorder have been bullied at some time, the survey found.

Children with autism in public schools are bullied nearly 50 percent more often than those in private schools or special-education schools, the researchers found.

Types of bullying experienced by autistic children include: being teased, picked on or made fun of (73 percent); being ignored or left out of things on purpose (51 percent); being called bad names (47 percent); and being pushed, shoved, hit, slapped or kicked (30 percent).

Bullying is experienced by 57 percent of children with autism who want to interact with others but have difficulty making friends, compared with 25 percent of those who prefer to play alone and 34 percent of those who will play with others only if approached.

Fifty-two percent of the parents said their child had been taunted by other children in order to trigger a meltdown or aggressive outburst.

Kids with Asperger's syndrome, a high-functioning type of autism, were nearly twice as likely as children with another autism disorder to be bullied, perhaps because of different school placements, the researchers said.

Read more here

Study: Sleep Apnea Raises Risk For Depression And Other Serious Health Problems

Sleep apnea, a condition that causes sleepers to stop breathing and gasp for air, may be linked to depression, according to a new study. Men with sleep apnea are twice as likely to be depressed and the emotional impact for women is even greater. Female sleep apnea sufferers are five times as likely to show signs of depression compared to normal sleepers, researchers reported.

Sleep apnea often persists undiagnosed. Researchers relied on self reporting and more than 80 percent of people who reported classic sleep apnea symptoms such as snorting or gasping for breath in their sleep were never officially diagnosed.

People who reported sleep apnea symptoms without an official diagnosis were three times more likely to exhibit symptoms of depression, such as hopelessness, feeling like a failure and poor appetite, according to the study.

"Mental health professionals often ask about certain sleep problems such as unrefreshing sleep and insomnia, but likely do not realize that [sleep apnea] may have an impact on their patients' mental health." the researchers, led by Dr. Anne Wheaton, an epidemiologist with the Centers for Disease Control and Prevention, wrote in the study.

Over 100 million people worldwide have sleep apnea, many of whom remain undiagnosed according to theWorld Health Organization. Undiagnosed sleep apnea adds $3.4 billion a year to medical costs, according to a 1999 study.

More research is needed to determine whether treating sleep apnea will alleviate depression symptoms, the researchers wrote.

Sleep apnea is most commonly treated with a continuous positive airway pressure, also known as CPAP, machine. The machine fits over the users face like a mask and blows air into the throat to keep the airway open, allowing the user to sleep without having to wake up to breath. Surgery can also be performed to increase the size of the airway, but is very painful, requires months of recovery and slightly changes facial appearance.

The journal Sleep will publish the study in April.

This study underscores the seriousness of sleep apnea, a condition that is already linked to a multitude of other health issues.

People with severe sleep apnea are at a higher risk of stroke, according to research presented at the American Stroke Association's International Stroke Conference in February. Researchers conducted a sleep study on 61 patients who suffered a stroke without any symptoms, known as a silent stroke, and found 91 percent of them had sleep apnea.

"We found a surprisingly high frequency of sleep apnea in patients with stroke that underlines its clinical relevance as a stroke risk factor," Jessica Kepplinger, lead researcher and research fellow at the Dresden University Stroke Center's Department of Neurology, said in a statement.

Sleep apnea may also be a risk factor for dementia in women, according to a study published in the Journal of the American Medical Association. Researchers studied 105 women with an average age of 82 who were diagnosed with sleep apnea but otherwise healthy. Five years later, 45 percent of the women with sleep apnea had developed some form of dementia. After adjusting for factors such as age, race and smoking status, researchers concluded that people with sleep apnea are 85 percent more likely to develop dementia.

Sleep apnea can also put a damper on your sex life. Researchers compared 80 women with sleep apnea to 240 women without the condition and found women with sleep apnea had a lower libido and more instances of sexual dysfunction, according to a study published in the Journal of Sexual Medicine.

Gasping for air can cause erectile dysfunction as well, according to a study published in the American Journal of Respiratory and Critical Care Medicine. Mice that underwent intermittent periods with a lack of oxygen, much like people with sleep apnea do, had a lower libido and developed erectile dysfunction. The mice did not fully recover six months after the study concluded, leading researchers to conclude sleep apnea can cause long-term damage even once it is treated.

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