1,721,093 research outputs found
Cardiac autonomic changes in epilepsy
No full textThe term "Epilepsy" encompasses a broad spectrum of medical and social disorders that affect about 65 million people worldwide and is commonly defined as a tendency to suffer recurrent seizures. In patients with epilepsy, ictal discharges that occur in (or propagate to) the anterior cingulate, insular, posterior orbito-frontal, and the pre-frontal cortices, along with the amygdala and hypothalamus play a key role in influencing the autonomic nervous system (ANS) at the cortical level. In turn, this can result in cardiac effects which are widespread and range from subtle changes in heart rate variability (HRV) to ictal sinus arrest, and from QT-interval shortening to atrial fibrillation. In addition, cardiac events are the main hypothesized mechanisms underlying sudden unexpected death in epilepsy (SUDEP), which occurs in absence of a known structural cause. Patients with epilepsy also experience long-lasting changes in the regulation of the ANS and target organs. Heart rate (HR) and HRV can be easily measured/estimated when compared to other biomarkers that are commonly associated with seizures (i.e., long-term EEG), and are therefore potentially valuable biomarkers when it comes to characterizing seizures. In this context, a number of linear and nonlinear analysis techniques have been applied in order to detect and characterize epilepsy-related ANS changes. While the physiological and clinical applicability of nonlinear analyses like fractal and complexity measures of HR dynamics are not yet completely understood, in view of recent experimental findings it is reasonable to assume that such indices highlight abnormal patterns of RR interval behaviour that are not easily detected by commonly used moment statistics of HR variation. These findings may provide new insight regarding physiological and seizure- induced states of the complex brain-heart network underlying epilepsy and related autonomic modifications. A better understanding of the autonomic manifestations of seizures would provide practical added value to clinical epileptologists dealing with differential diagnosis of epilepsy and related disorders, as well as aiding in designing more sensitive seizure detection and prediction algorithms
Folic acid supplements during pregnancy in specific clinical settings: What dowe know about epilepsy?
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L-dopa-induced excessive daytime sleepiness in PD: a placebo-controlled case with MSLT assessment.
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Profile of pitolisant in the management of narcolepsy: Design, development, and place in therapy
No full textNarcolepsy is a rare sleep disorder characterized by excessive daytime sleepiness and rapid eye movement sleep dysregulation, manifesting as cataplexy and sleep paralysis, as well as hypnagogic and hypnopompic hallucinations. Disease onset may occur at any age, although adolescents and young adults are mainly affected. Currently, the diagnosis delay ranges from 8 to 10 years and drug therapy may only attenuate symptoms. Pitolisant is a first-in-class new drug currently authorized by the European Medicines Agency to treat narcolepsy with or without cataplexy in adults and with an expanded evaluation for the treatment of neurologic diseases such as Parkinson's disease and epilepsy. This article reviews the pharmacokinetic and pharmacodynamic profile of pitolisant, highlighting its effectiveness and safety in patients with narcolepsy. We performed a systematic review of the literature using PubMed, Embase, and Google Scholar. We report on the efficacy and safety data of pitolisant in narcoleptic patients regarding cataplexy episodes and subjective and objective daytime sleepiness. The development program of pitolisant was characterized by eight Phase II/III studies. One proof-of-concept study followed by two pivotal studies, three randomized controlled trials, and two open studies were evaluated. Our review confirmed the effectiveness of pitolisant in treating major clinically relevant narcolepsy symptoms, including cataplexy, as compared to placebo. In addition, pitolisant revealed a safe profile when compared with placebo and active comparators. Headache, insomnia, and nausea were the prominent side effects. Further long-term randomized controlled trials comparing the efficacy of pitolisant with active comparators (ie, modafinil and sodium oxybate) may clarify its real place in therapy and its possible use as a first-line agent on the basis of its safety and tolerability
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Effect of antiepileptic drugs on sleep
No full textThe interactions between sleep and epilepsy are well known. A nodal point of the relationship between sleep and epilepsy is represented by pharmacological treatment. Sleep disturbances such as drowsiness are among the most frequent side effects of treatment with antiepileptic drugs, since they can deeply modify both sleep architecture and the sleep-wake cycle. Severe daytime somnolence affects patients' activities and it may facilitate the occurrence of seizures. These considerations underline the importance of antiepileptic drugs having anticonvulsant properties that do not negatively influence sleep and daytime somnolence. In this paper we review some relevant aspects of the effects of antiepileptic drugs on sleep
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