• Advanced Neuromodulation Systems / ANS
  • Epilepsy & Cyberonics
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• Integra LifeSciences
  • Epilepsy
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• Medtronic
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  • Multichannel electrode
  • Feedback control (1)
  • Myoclonic (7)
  • Refractory (4)
  • Vaccination
  • Lead poisoning

(A small sampling of results from a January 15, to January 28, 2007 MIB Abstract Alert search)

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DIGEST; [3 STAR , 0 Edition]

Houston Chronicle. Houston, Tex.: Jan 23, 2007. pg. 1

NANCY SARNOFF

HEALTH

Investor increases Cyberonics stake

Billionaire investor Carl Icahn boosted his stake in medical- device maker Cyberonics to 2.5 million shares, calling the shares undervalued.

Three investment funds controlled by Icahn added about 1.3 million shares between Jan. 10 and Monday for a total stake of 2.5 million purchased for $46.9 million, according to a Securities and Exchange Commission filing.

Icahn, the chairman of biotech company ImClone Systems, said in the filing he boosted his stake in Cyberonics, a Houston-based maker of devices to treat epilepsy and other disorders, to about 9.8 percent.

Proquest Identifier: 1200414921
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Cyberonics Sends Letter to Stockholders; Urges Stockholders to Reelect Board's Highly Qualified Nominees

PR Newswire. New York: Jan 24, 2007. pg. n/a

HOUSTON, Jan. 24 /PRNewswire-FirstCall/ -- Cyberonics, Inc. (Nasdaq: CYBX)today announced that it will send the following letter to stockholders urgingthem to vote to reelect the Board's highly qualified nominees, Stanley H.Appel, M.D., Tony Coelho, Guy C. Jackson, Kevin S. Moore, Hugh M. Morrison,Alan J. Olsen, Michael J. Strauss, M.D., M.P.H., and Reese S. Terry, Jr.

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Epilepsy; Study data from University of Toronto, Canada, shed light on epilepsy research

Pain & Central Nervous System Week. Atlanta: Jan 15, 2007. pg. 386

2007 JAN 15 - (NewsRx.com) -- Epilepsy research advances have been reported from University of Toronto, Canada.

Study 1: Current study results from the report, "Status epilepticus after electroconvulsive therapy in a pregnant patient," have been published. According to recent research from Canada, "Status epilepticus after electroconvulsive therapy is a rare complication, and its occurrence during pregnancy has not been reported previously. We discuss the case of a 31-year-old primigravida at 22 weeks of gestation, with a history of bipolar disorder, who underwent electroconvulsive therapy under general anesthesia."

"Following three treatments she developed status epilepticus, requiring large doses of benzodiazepines, thiopental, propofol and diphenylhydantoin to control the seizure activity. She remained intubated and ventilated for several days after treatment with a complicated course. As a consequence, the fetus died," wrote M. Balki and colleagues, University of Toronto, Department of Anesthesia.

The researchers concluded: "We discuss the possible causes and the management of status epilepticus after electroconvulsive therapy during pregnancy and its implications for maternal and fetal outcome."

Balki and colleagues published their study in International Journal of Obstetric Anesthesia (Status epilepticus after electroconvulsive therapy in a pregnant patient. International Journal of Obstetric Anesthesia, 2006;15(4):325-8).

For additional information, contact M. Balki, Mount Sinai Hospital, Dept. of Anesthesia, University of Toronto, Ontario, Canada.

Study 2: The role of magnetoencephalography in pediatric epilepsy surgery is reviewed.

According to a study from Canada, "Magnetoencephalography (MEG) is a new diagnostic imaging and brain mapping device that has been recently used in the context of pediatric epilepsy, epilepsy surgery, and neuronavigation. MEG allows for the placement of magnetic spike sources on a conventional magnetic resonance imaging scan, the so-called magnetic source imaging, so that the localization of epileptiform activity in a child can be determined."

R. Grondin and colleagues, University of Toronto, wrote, "Considerable effort is placed on analyzing the configuration and number of spike waves by MEG that relate to a primary epileptiform discharge. Such MEG spike clusters are corroborated now by intraoperative invasive subdural grid monitoring that show good correlation in the majority of cases. Another important role of MEG relates to the mapping of critical regions of brain function using known paradigms for speech, motor, sensory, visual, and auditory brain cortex."

They continued, "When linked to standard neuronavigation devices, MEG brain mapping can be extremely helpful to the neurosurgeon approaching nonlesional epilepsy cases or lesional cases where the safest and most direct route to the surgical disease can be selected."

The researchers concluded, "As paradigms for brain mapping improve and as MEG software upgrades become more sensitive to analyzing all types of spike sources, MEG will play an increasingly important role in pediatric neurosurgery, especially for the child with intractable epilepsy."

Grondin and colleagues published their review in the Childs Nervous System (The role of magnetoencephalography in pediatric epilepsy surgery. Childs Nerv Syst, 2006;22(8):779-785).

For additional information, contact J.T. Rutka, University of Toronto, Hospital for Sick Children, Division Neurosurgery, 555 University Avenue, Toronto, ON M5G 1X8, Canada.

Study 3: Vagal nerve stimulation (VNS) implantation can be a safe and effective alternative therapy for children with drug-resistant epilepsy who are not candidates for epilepsy surgery.

According to recent research from Canada, "The management of intractable epilepsy in children is a challenging problem. For those patients who do not respond to antiepileptic drugs and are not candidates for epilepsy surgery, VNS can be a viable alternative for reducing seizure frequency. We have reviewed the historical and clinical background of VNS treatment. We also include our experience at The Hospital for Sick Children in children who underwent VNS implantation."

M. Benifla and colleagues, University of Toronto, wrote, "Forty- one children underwent VNS implantation for epilepsy over 6 years. After a mean follow-up of 31 months, 15 (38%) patients had a seizure frequency reduction of more than 90%. Fifteen (38%) children failed to respond to the VNS treatment. The device was removed in five children: in one, due to late infection; the other four could not tolerate the side effects of chronic VNS therapy. Two patients required reimplantation due to electrode failure. The most common side effects in our series were cough and vocal disturbances."

The researchers concluded, "Our results show that VNS implantation can be a safe and effective alternative therapy for children with drug-resistant epilepsy who are not candidates for epilepsy surgery."

Benifla and colleagues published their study in the Childs Nervous System (Vagal nerve stimulation for refractory epilepsy in children: indications and experience at The Hospital for Sick Children. Childs Nerv Syst, 2006;22(8):1018-1026).

For additional information, contact E.J. Donner, University of Toronto, Hospital for Sick Children, Division Neurology, 555 University Avenue, Toronto, ON M5G 1X8, Canada.

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Epilepsy; Scientists at MS Ramaiah Medical College, Department of Physiology describe research in epilepsy

Pain & Central Nervous System Week. Atlanta: Jan 22, 2007. pg. 72

Full Text (450 words)
(c)Copyright 2007, Pain & Central Nervous System Week viaNewsRx.com
2007 JAN 22 - (NewsRx.com) -- Investigators publish new data in the report "Kindling & mossy fibre sprouting in the rat hippocampus following hot water induced hyperthermic seizures. & Hot water epilepsy (HWE) is well recognized reflex epilepsy with possible genetic susceptibility. Rat model and human experimentation had proven that HWE is a type of hyperthermic seizure with possible kindling on repeated stimulation in animals," investigators in Bangalore, India report.

"The present study was undertaken to investigate kindling associated with hyperthermic seizures induced by repeated hot water stimulation in the rat model and to prove hyperthermic kindling. Epileptic seizures were induced in 36 male Wistar albino rats by means of hot water sprays at 48 h time intervals. Progression of seizure activity was investigated by studying the behaviour, severity and duration of the seizure. Threshold of rectal temperatures and timed latency for seizure induction were studied. Seizure discharges (EEG) were recorded from ventral hippocampus in six of these rats. Timm's staining was used to study the neuronal sprouting as a consequence of kindling. Studying the seizure threshold, latency, duration of seizure discharge and behavioural seizure following a stimulus-free interval of 30 days tested permanence of kindling. Following 8-12 episodes of hot water stimulations there was progressive epileptic activity manifested in the form of lowering of rectal temperature thresholds from 41.5 to 40.0 degrees C, drop in latency for developing seizures from 185 to 118 sec, increase in duration of hippocampal seizure discharge from 15 to 140 sec, along with progressive increase in complexity of EEG after discharges, increase in behavioural seizure severity from Grade 1 to 5 in all the rats, and neuronal sprouting observed in supragranular molecular layer and in stratum lacunosum. INTERPRETATION & Our study covered all aspects of kindling and provided a useful animal model for human hot water epilepsy," wrote G.R. Ullal and colleagues, MS Ramaiah Medical College, Department of Physiology.

The researchers concluded: "Hyperthermic seizures induced by hot water in the rat model kindle as demonstrated by Timm's staining."

Ullal and colleagues published their study in The Indian Journal of Medical Research (Kindling & mossy fibre sprouting in the rat hippocampus following hot water induced hyperthermic seizures. The Indian Journal of Medical Research, 2006;124(3):331-42).

For additional information, contact G.R. Ullal, Molecular Epilepsy-Research Laboratory, Dept. of Physiology, MS Ramaiah Medical College, Bangalore, India.

The publisher of the The Indian Journal of Medical Research can be contacted at: Indian Council Medical Research, PO Box 4911 Ansari Nagar, New Delhi 110029, India.

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Brain-Computer-Interfaces(BCI): Communication and Restoration of Movement in Paralysis.

Full-Text Link

J Physiol. 2007 Jan 18; [Epub ahead of print]

Birbaumer N, Cohen LG.

University of Tuebingen.

The review describes the status of brain-computer- or brain-machine-interface research. We focus on non-invasive brain-computer-interfaces (BCIs) and their clinical utility for direct brain communication in paralysis and motor restoration in stroke. A large gap between the promises of invasive animal and invasive human BCI-preparations and the clinical reality characterises the literature: while intact monkeys learn to execute more or less complex upper limb movements with spike patterns from motor brain regions alone without concomitant peripheral motor activity usually after extensive training, clinical applications in human diseases such as Amyotrophic Lateral Sclerosis and Paralysis from stroke or spinal cord lesions shows only limited success with the exception of verbal communication in paralysed and locked-in patients: BCIs based on electroencephalographic potentials or oscillations are ready to undergo large clinical studies and commercial production as an adjunct or a major assisted communication device for paralysed and locked-in patients. However, attempts to train completely locked-in patients with BCI-communication after entering the complete locked-in state with no remaining eye-movement failed. We propose that a lack of contingencies between goal directed thoughts and intentions may be at the heart of this problem. Experiments with chronically curarised rats support our hypothesis, operant conditioning and voluntary control of autonomic physiological functions turned out to be impossible in this preparation. In addition to assisted communication BCIs consisting of operant learning of EEG slow cortical potentials and sensorimotor rhythm was demonstrated to be successful in drug resistant focal epilepsy and attention deficit disorder. First studies of non-invasive BCIs using sensorimotor rhythm of the EEG and MEG in restoration of paralysed hand movements in chronic stroke and single cases of high spinal cord lesions show some promise but need extensive evaluation in well-controlled experiments. Invasive BMIs based on neuronal spike patterns, local field potentials or electrocorticogram may constitute the strategy of choice in severe cases of stroke and spinal cord paralysis. Future directions of BCI research should include the regulation of brain metabolism and blood flow and electrical and magnetic stimulation of the human brain (invasive and non-invasive). A series of studies using BOLD-response regulation with functional magnetic resonance imaging (fMRI) and near infrared spectroscopy demonstrated a tight correlation between voluntary changes in brain metabolism and behaviour.

PreMedline Identifier: 17234696

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Researchers' data from University of California, U.S., highlight new research

Fitness & Wellness Business Week January 24, 2007

Researchers' data from University of California, U.S., highlight new research.

This trend article about University of California, U.S., is an immediate alert from NewsRx to identify developing directions of research.

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Antiepileptic effects of low-frequency repetitive transcranial magnetic stimulation by different stimulation durations and locations.

Clin Neurophysiol. 2007 Mar;118(3):702-8. Epub 2007 Jan 16.

Joo EY, Han SJ, Chung SH, Cho JW, Seo DW, Hong SB.

Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-gu, 135-710 Seoul, South Korea; Department of Neurology, College of Medicine, Ewha Womans University, Seoul, South Korea.

OBJECTIVE: To evaluate the antiepileptic effect of low-frequency rTMS (repetitive transcranial magnetic stimulation) in the patients with intractable epilepsy. METHODS: We enrolled 35 patients with localization-related epilepsy who had experienced at least one complex partial seizure or a secondarily generalized seizure per week on a constant antiepileptic drug regimen over an 8-week period. rTMS was administered using a Rapid(2) magnetic stimulator with an air-cooled coil at 0.5Hz for 5 consecutive days at 100% of rMT (resting motor threshold). Patients were divided into a focal stimulation group with a localized epileptic focus, or a non-focal stimulation group with a non-localized or multifocal epileptic focus. These two groups were then randomly subdivided into four subgroups depending on the total number of stimulations administered, i.e., 3000 pulse and 1500 pulse subgroups. Weekly seizure frequencies were determined for 8 weeks before and after rTMS. To compare the number of interictal spikes before and after rTMS, EEG was recorded twice before (1st day) and after rTMS (5th day). RESULTS: Mean weekly seizure frequency was non-significantly decreased after rTMS (8.4-->6.8/week, -13.9%). Longer stimulation subgroups (3000 pulses, -23.0%) tended to have fewer seizures than shorter stimulation subgroups (1500 pulses, -3.0%), without statistical significance. TMS stimulation site and structural brain lesions did not influence seizure outcome. However, interictal spikes significantly decreased (-54.9%, P=0.012) after rTMS and they totally disappeared in 6 patients (17.1%, 6/35). CONCLUSIONS: Low-frequency rTMS reduced interictal spikes, but its effect on seizure outcome was not significant. Focal stimulation for a longer duration tended to further reduce seizure frequency. SIGNIFICANCE: These findings may help clinicians to further investigate the therapeutic potential of the rTMS for patients with intractable epilepsy.

PreMedline Identifier: 17223384

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New data from Beth Israel Deaconess Medical Center, Boston, U.S., detailed

Health Risk Factor Week January 16, 2007

New data from Beth Israel Deaconess Medical Center, Boston, U.S., detailed.

This trend article about Beth Israel Deaconess Medical Center, Boston, U.S., is an immediate alert from NewsRx to identify developing directions of research.

Study 1: Data detailed in "A randomized clinical trial of repetitive transcranial magnetic stimulation in patients with refractory epilepsy" have been presented. In this recently published article, scientists in the United States conducted a study "To study the antiepileptic effects of rTMS in patients with refractory epilepsy and malformations of cortical development in a randomized, double-blind, sham-controlled trial. Twenty-one patients with malformations of cortical development and refractory epilepsy underwent five consecutive sessions of low-frequency rTMS, either sham or active (1Hz, 1,200 pulses), focally targeting the malformations of cortical development."

"The number of epileptiform discharges in the electroencephalogram and the number of clinical seizures were measured before (baseline), immediately after, as well as 30 and 60 days after rTMS treatment. rTMS significantly decreased the number of seizures in the active compared with sham rTMS group (p <0.0001), and this effect lasted for at least 2 months. Furthermore, there was a significant decrease in the number of epileptiform discharges immediately after (p=0.01) and at week 4 (p=0.03) in the active rTMS group only. There were few mild adverse effects equally distributed in both groups. The preliminary cognitive evaluation suggests improvement in some aspects of cognition in the active rTMS group only," wrote F. Fregni and colleagues, Beth Israel Deaconess Medical Center.

The researchers concluded: "Noninvasive brain stimulation for epilepsy may be an alternative treatment for pharmaco-resistant patients with clearly identifiable seizure foci in the cortical convexity and who are not eligible for surgical treatment."

Fregni and colleagues published their study in Annals of Neurology (A randomized clinical trial of repetitive transcranial magnetic stimulation in patients with refractory epilepsy. Annals of Neurology, 2006;60(4):447-55).

For more information, contact F. Fregni, Center for Non-invasive Brain Stimulation, Beth Israel Medical Center, Harvard Medical School, Boston, MA 02215 U.S.

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Human intracranially-recorded cortical responses evoked by painful electrical stimulation of the sural nerve.

Neuroimage. 2007 Jan 15;34(2):743-63. Epub 2006 Nov 9.

Dowman R, Darcey T, Barkan H, Thadani V, Roberts D.

Department of Psychology, Clarkson University, Potsdam, NY 13699-5825, USA. rdowman@clarkson.edu

Intracranial recordings were obtained from 5 epilepsy patients to help identify the generators of the scalp somatosensory evoked potential (SEP) components that appear to be involved in orienting attention towards a potentially threatening, painful sural nerve electrical stimulus. The intracranial recording data support, for the most part, the generators suggested by our scalp SEP studies. The generators of the central negativity at 70-110 ms post-stimulus and the contralateral temporal negativity at 100-180 ms are located in the somatosensory association areas in the medial wall of the parietal cortex and in the parietal operculum and insula, respectively. The negative potential at 130-200 ms recorded from over the fronto-central scalp appears to be generated in the medial prefrontal cortex and primary somatosensory cortex foot area. The intracranial recording data suggest that the positive scalp potential at 280-320 ms, which corresponds to the pain-related P2, has multiple generators, including the anterior cingulate cortex, inferior parietal cortex, and possibly the somatosensory association areas in the medial wall of the parietal cortex. Finally, the positive scalp potential at 320-400 ms has generators in brain areas that others have shown to generate the P3a, including the dorsolateral and medial prefrontal cortices, temporal parietal junction, and the posterior hippocampus, which supports our hypothesis that this potential is a pain-evoked P3a. The putative functional roles of the brain areas generating these components and the response properties of the intracranial peaks recorded from these brain areas are in most cases consistent with the attention- and pain-related properties of their corresponding scalp SEP components. The intracranial recordings also demonstrate that the source configuration underlying the SEP components are often more complex than was suggested from the scalp studies. This complexity implies that the dipole source localization analysis of these components will at best provide only a very crude estimate of source location and activity, and that caution must be used when interpreting a change in the scalp component amplitude.

PreMedline Identifier: 17097306

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Activity of ventral medial thalamic neurons during absence seizures and modulation of cortical paroxysms by the nigrothalamic pathway.

J Neurosci. 2007 Jan 24;27(4):929-41.

Paz JT, Chavez M, Saillet S, Deniau JM, Charpier S.

Institut National de la Sante et de la Recherche Medicale, Unite 667, College de France, F-75231 Paris, France. jeanne.paz@college-de-france.fr

Absence seizures are characterized by bilaterally synchronous spike-and-wave discharges (SWDs) in the electroencephalogram, which reflect abnormal oscillations in corticothalamic networks. Although it was suggested that basal ganglia could modulate, via their feedback circuits to the cerebral cortex, the occurrence of SWDs, the cellular and network mechanisms underlying such a subcortical control of absence seizures remain unknown. The GABAergic projections from substantia nigra pars reticulata (SNR) to thalamocortical neurons of the ventral medial (VM) thalamic nucleus provide a potent network for the control of absence seizures by basal ganglia. The present in vivo study provides the first description of the activity of VM thalamic neurons during seizures in the genetic absence epilepsy rats from Strasbourg, a well established model of absence epilepsy. Cortical paroxysms were accompanied in VM thalamic neurons by rhythmic bursts of action potentials. Pharmacological blockade of excitatory inputs of nigrothalamic neurons led to a transient interruption of SWDs, correlated with a change in the activity of thalamic cells, which was increased in frequency and converted into a sustained arrhythmic firing pattern. Simultaneously, cortical neurons exhibited a decrease in their firing rate that was associated with an increase in membrane polarization and a decrease in input resistance. These new findings demonstrate that an inhibition of SNR neurons changes the activity of their thalamic targets, which in turn could affect cortical neurons excitability and, consequently, the generation of cortical epileptic discharges. Thus, the nigro-thalamo-cortical pathway may provide an on-line system control of absence seizures.

PreMedline Identifier: 17251435

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[Myoclonus.]

Nervenarzt. 2007 Jan 16; [Epub ahead of print]

[Article in German]

Meinck HM.

Neurologische Universitatsklinik, Im Neuenheimerfeld 400, 69120 , Heidelberg, Deutschland, Hans-Michael.Meinck@med.uni-heidelberg.de.

Myoclonus, an involuntary movement disorder reveals itself with a wide variety of short muscle twitches or jerks, and may cause severe disability. From a clinical perspective, it is sometimes difficult to discriminate myoclonus from other central movement disorders. Moreover, myoclonus has a spectrum of causes including rare neurological syndromes and uncommon manifestations of systemic disease. Its pathogenesis is only partially understood. Neurophysiologic investigations suggest a close relationship between certain types of myoclonic jerking and epilepsy. The use of anticonvulsants for treatment of myoclonus has its basis in such observations and empirical evidence. Often high doses or a combination of drugs, or both are required, with, however, serious side effects.

PreMedline Identifier: 17226014

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Progressive myoclonic epilepsy: A clinical, electrophysiological and pathological study from South India.

J Neurol Sci. 2007 Jan 15;252(1):16-23. Epub 2006 Dec 12.

Sinha S, Satishchandra P, Gayathri N, Yasha TC, Shankar SK.

Department of Neurology, National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore, India. sanjib_sinha@nimhans.kar.nic.in

Progressive myoclonic epilepsy (PME) is a syndrome complex encompassing different diagnostic entities and often cause problems in diagnosis. We describe the clinical, electrophysiological and pathological features of 97 patients with the diagnosis of PME evaluated over 25 years. Case records of confirmed patients of Neuronal ceroid lipofuscinosis (NCL = 40), Lafora body disease (LBD = 38), Myoclonic epilepsy with ragged red fibers (MERRF = 10), and probable Unverricht-Lundberg disease (ULD = 9) were reviewed. The mean age at onset in patients with NCL (n = 40) was 5.9+/-9.1 years (M:F:: 28:12). Subtypes of NCL were: late infantile (n = 19), infantile (n = 8), juvenile (n = 11) and adult (n = 2) NCL. EEG (n = 37) showed varying degree of diffuse slowing of background activity in 94.6% and epileptiform discharges in 81.1% of patients. Slow frequency photic stimulation evoked photo-convulsive response in 5 patients only. Giant SSEP was demonstrated in 7 and VEP study revealed a prolonged P100 (2) and absent waveform (7). Electrophysiological features of neuropathy were present in 3 patients. Presence of PAS and Luxol Fast Blue (LFB) positive, auto fluorescent (AF) ceroid material in brain tissue (n = 12) and electron microscopy of brain (n = 5), skin (n = 28) and muscle (n = 1) samples showing curvilinear and lamellar bodies established the diagnosis. Patients of LBD (mean age of onset at 14.4+/-3.9 years, M:F:: 24:14) with triad of PME symptoms were evaluated. EEG (n = 37) showed variable slowing of background activity in 94.6% and epileptiform discharges in 97.4%. Photosensitivity with fast frequency was observed only in 5 patients. CT (n = 32) and MRI (n = 4) revealed diffuse cortical atrophy. Giant SSEP was demonstrated in 24 patients of LBD while VEP study revealed a prolonged P100 (4) and absent waveform (8). Electrophysiological features of neuropathy were present in one patient. Diagnosis was established by the presence of PAS positive diastase resistant, Lugol's Iodine labeled inclusions in sweat glands of axillary skin (n = 35), brain (n = 2) and liver (n = 1). Ten patients with MERRF (mean age at onset: 14.6+/-5.8 years; M: F:: 3:2) had triad of PME symptoms. Muscle biopsy revealed oxidative reaction product and classical ragged red fibers. In nine patients of PME without cognitive decline, probable diagnosis of ULD (mean age at onset: 13.8+/-9.5 years) was considered after biopsy of skin and/or muscle excluded other forms of PMEs. Neuronal ceroid lipofuscinosis and Lafora body diseases were the common causes of PME in the series from south India. This is one of the largest series from the Indian subcontinent to the best of our knowledge. Photosensitivity is notably less common in LBD/NCL in this series distinctly different from those reported in the literature. Further exploration is required to determine whether different genotype is responsible. Morphological changes were helpful in diagnosis and could be confirmed by biopsy of peripheral tissues like skin and muscle in majority (60%). Electron microscopy was helpful in the diagnosis NCL and MERRF.

PreMedline Identifier: 17166519

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Neuropsychological profile of patients with juvenile myoclonic epilepsy: A controlled study of 50 patients.

Epilepsy Behav. 2007 Jan 25; [Epub ahead of print]

Pascalicchio TF, de Araujo Filho GM, da Silva Noffs MH, Lin K, Caboclo LO, Vidal-Dourado M, Ferreira Guilhoto LM, Yacubian EM.

Department of Neurology, Escola Paulista de Medicina/UNIFESP, 740 Vila Clementino, Sao Paulo SP, Brazil.

The purpose of this study was to verify possible cognitive dysfunction in patients with juvenile myoclonic epilepsy (JME) and its relationship to factors related to epilepsy and schooling. Fifty subjects diagnosed with JME and 50 controls underwent neuropsychological assessment evaluating intellectual functions, attention, memory, executive functions, and language. The patients were further divided into two subgroups on the basis of educational level: 11 and >11 years of formal education. Participants diagnosed with JME scored significantly below age-, education-, and gender-matched controls on neuropsychological measures of attention, immediate verbal memory, mental flexibility, control of inhibition, working memory, processing speed, verbal delayed memory, visual delayed memory, naming, and verbal fluency. A positive correlation was observed between duration of epilepsy and cognitive decline. However, in the group of patients with >11 years of education, this correlation was not significant. In this series of patients with JME, neuropsychological evaluation suggests widespread cognitive dysfunction outside the limits of the frontal lobes. The duration of epilepsy correlated with cognitive decline, and patients with higher education manifested less progression of deficits.

PreMedline Identifier: 17258506

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Levetiracetam in three cases of progressive myoclonus epilepsy.

Pharm World Sci. 2007 Jan 23; [Epub ahead of print]

Papacostas S, Kkolou E, Papathanasiou E.

The Cyprus Institute of Neurology & Genetics, P.O. Box 23462, 1683, Nicosia, Cyprus, savvas@cing.ac.cy.

We present three unrelated cases of genetically confirmed progressive myoclonic epilepsy of the Unverricht-Lundborg type who were treated with Levetiracetam as adjunctive therapy for their myoclonus. All cases responded with decrease of their myoclonus and improvement of quality of life. Two were able to return to or continue their employment. Patients tolerated the drug well without side effects reported. Levetiracetam appears to be a useful antimyoclonic agent in cases of progressive myoclonic epilepsy and should be considered for adjunctive therapy.

PreMedline Identifier: 17242859

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MERRF syndrome without ragged-red fibers: The need for molecular diagnosis.

Pharm World Sci. 2007 Jan 23; [Epub ahead of print]

Mancuso M, Petrozzi L, Filosto M, Nesti C, Rocchi A, Choub A, Pistolesi S, Massetani R, Fontanini G, Siciliano G.

Department of Neuroscience, Neurological Clinic, University of Pisa, Via Roma 67, 56126 Pisa, Italy.

We report a patient with myoclonic epilepsy who underwent muscle biopsy for suspected mitochondrial disease (myoclonic epilepsy with ragged-red fibers, MERRF). In spite of normal histochemical studies and of the absence of a severe COX deficiency, the molecular analysis showed the common MERRF mutation (A8344G) in the tRNA(Lys) gene on mitochondrial DNA. The case serves to illustrate the importance of pursuing the proposed mitochondrial genetic abnormality, even in patients with normal biopsy findings.

PreMedline Identifier: 17275787

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Tiagabine-induced myoclonic status epilepticus in a nonepileptic patient.

Neurology. 2007 Jan 23;68(4):310.

Vollmar C, Noachtar S.

Department of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Christian.Vollmar@med.uni-muenchen.de

<<No Abstract Available>>

PreMedline Identifier: 17242344

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The correlation between neurological evaluations and neurological outcome in acute encephalitis: A hospital-based study.

Eur J Paediatr Neurol. 2007 Jan 18; [Epub ahead of print]

Wang IJ, Lee PI, Huang LM, Chen CJ, Chen CL, Lee WT.

Department of Pediatrics, Taipei Hospital, Department of Health, Taipei, Taiwan.

Acute encephalitis is a common CNS infectious disease in children. However, there are limited studies concerning about the correlation between the clinical evaluations and neurological outcome. To investigate the value of neurological evaluations, and the correlation between these evaluations and neurological outcomes of acute encephalitis, in the present study we retrospectively evaluated the neurological outcome of 0- to 16-year-old children with encephalitis or meningoencephalitis between 1999 and 2000. Of 101 children enrolled, 4 died and 25 had other neurological sequelae, including epilepsy, headache, developmental delay, and emotional or behavioral changes during the 5 years of follow-up. The causative organisms in patients with neurological sequelae were herpes virus (HSV) 2/2 (100%), influenza 2/3 (67%), mycoplasma 5/12 (42%), and enterovirus 71 2/7 (29%). The important predictors for adverse outcomes were focal neurological signs, multiple seizures or status epilepticus on admission, leukopenia, focal slow waves or continuous generalized delta waves in electroencephalography (EEG), and focal cortical parenchymal hyperintensity in the magnetic resonance imaging (MRI) (p<0.05). Patients with initial presentations of focal neurological signs, papilledema, myoclonic jerks, and status epilepticus tended to have higher incidence of abnormal findings in brain MRI, although not achieving statistic significances. In addition, children with focal spikes or continuous generalized delta waves in EEG also had higher incidence of MRI abnormalities. We conclude that brain MRI studies may be indicated in patients with focal neurological signs, intractable seizure, and focal spikes, focal delta waves, or continuous generalized delta waves in EEG. For those with MRI examinations, focal cortical hyperintensity suggests poorer neurological outcomes.

PreMedline Identifier: 17240177

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Major depression in temporal lobe epilepsy with hippocampal sclerosis: clinical and imaging correlates.

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J Neurol Neurosurg Psychiatry. 2007 Jan 26; [Epub ahead of print]

Briellmann RS, Hopwood MJ, Jackson GD.

Brain Research Institute, Australia.

Purpose: Refractory temporal lobe epilepsy (TLE) is often associated with hippocampal sclerosis (HS). Patients with Major Depression (MD) may also show structural abnormalities in the limbic system. Co- occurrence of TLE with HS and MD is not uncommon. We investigate clinical and morphological characteristics of TLE patients in relation to MD. METHODS: Thirty-four TLE patients with HS were assessed at a Comprehensive Epilepsy Program. All relevant clinical data were obtained, including the history of antecedent events to epilepsy. MD was diagnosed based on detailed psychiatric investigation. MRI was used to measure the volume and tissue signal (T2-relaxometry) of the hippocampus and amygdala. The imaging data were expressed as percentage of the values obtained in a series of 55 controls. RESULTS: A history of MD was present in 15 (44%) of the 34 patients. Patients with MD had a longer duration of their epilepsy (p<0.05), and a lower frequency of antecedent events (13% with MD, 58% without MD, p< 0.05). Both groups had a similar degree of ipsilateral HS (small hippocampal volume, increased hippocampal T2- relaxation time), and demonstrated bilateral amygdaloid atrophy. However, the contralateral amygdala showed lower signal in presence of MD (97 +/- 9 msec; no MD: 103 +/- 8 msec, ANCOVA, p<0.05). CONCLUSION: The integrity of the amygdala may influence mood disturbances in TLE patients with HS, as depression was associated with a relative preservation of the contralateral amygdala. In contrast, hippocampal abnormalities were not related to the presence of depression.

PreMedline Identifier: 17259350

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Retention rate of Levetiracetam in children with intractable epilepsy at 1 year.

Seizure. 2007 Mar;16(2):185-9. Epub 2007 Jan 26.

Peake D, Mordekar S, Gosalakkal J, Mukhtyar B, Buch S, Crane J, Wheway R, Rittey C, Donnelly J, Whitehouse WP, Philip S.

Department of Paediatric Neurology, Birmingham Children's Hospital, UK.

Levetiracetam (LEV) is a novel antiepileptic drug (AED) that has recently obtained marketing authorisation for use in children. The purpose of this study was to assess the efficacy, tolerability and retention rate of LEV in children with refractory epilepsies. It is a retrospective multicentre observational study reporting the use of LEV in 200 children, aged 0.3-19 years (median 9-years-old) over a 4-year period. All of the patients included in the study had refractory epilepsy with a median age of onset of epilepsy of 3 years (range 0-13 years). The 38% had failed and withdrawn 3 or more AEDs previously and 24% were taking at least 2 other AEDs in addition to LEV. The 47% had focal, and 58% had symptomatic epilepsies. The LEV dose ranged from 8 to 100mg/kg/day (mean 39mg/kg). The study comprised 215 person years of LEV exposure. RESULTS: LEV was well tolerated with a retention rate of 49% at 1 year. No serious adverse events were reported with possibly related adverse events reported in only 24% of patients (mainly emotional or behavioural changes). At more than 2, 6 and 12 months, worthwhile improvement (>50% seizure reduction) was noted in 60, 40 and 32%, including seizure freedom in 14, 14 and 5%, respectively. CONCLUSION: Our results confirm the efficacy and tolerability of LEV in children with refractory epilepsies and demonstrate good response and retention rates at 12 months. It represents the largest cohort of paediatric patients published so far on LEV with a 1-year follow-up.

PreMedline Identifier: 17258474

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Atypical presentation of Leber's hereditary optic neuropathy associated to mtDNA 11778G>A point mutation-A case report.

Eur J Paediatr Neurol. 2007 Mar;11(2):115-8. Epub 2007 Jan 24.

Grazina MM, Diogo LM, Garcia PC, Silva ED, Garcia TD, Robalo CB, Oliveira CR.

Biochemistry Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.

Leber's hereditary optic neuropathy (LHON) is a maternally inherited mitochondrial disorder characterized by bilateral loss of central vision, most frequently found in young adult males. In most patients there are no other neurological manifestations and cerebral neuroimaging is normal, but some rare cases of "LHON plus" have been described. Classical LHON is mainly associated to mitochondrial DNA (mtDNA) mutations 11778G>A, 3460G>A and 14484T>C, localized in the coding regions for ND4, ND1 and ND6 of the complex I subunits of mitochondrial respiratory chain (MRC), respectively. We report a 12-year-old girl who presented with reduced visual acuity secondary to optic atrophy at 8 months of age, which led to a clinical diagnosis of LHON. Psychomotor regression, refractory epilepsy and progressive neurological abnormalities developed subsequently. Skeletal muscle histology and biochemical MRC function were normal (evaluated by dual wavelength spectrophotometry). A 11778G>A mtDNA point mutation (investigated by standard PCR and automatic sequencing methods) was identified in lymphocytes isolated from peripheral blood, muscle biopsy and cultured skin fibroblasts. The mother and other maternal relatives are carriers for the same mutation. This case is unusual for age of onset, gender, associated neurological findings and evolution.

PreMedline Identifier: 17254817

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What is the significance of interictal water diffusion changes in frontal lobe epilepsies?

Neuroimage. 2007 Mar;35(1):28-37. Epub 2007 Jan 18.

Guye M, Ranjeva JP, Bartolomei F, Confort-Gouny S, McGonigal A, Regis J, Chauvel P, Cozzone PJ.

INSERM, U 751, Laboratoire de Neurophysiologie et Neuropsychologie, Marseille, France; CNRS, UMR 6612, Centre de Resonance Magnetique Biologique et Medicale (CRMBM), Marseille, France; Universite de la Mediterranee, Faculte de Medecine, Marseille, France; CHU Timone, Service de Neurophysiologie Clinique, Marseille, France.

The aim of this study was to better understand the significance of interictal changes in water molecule diffusivity defined by diffusion-weighted imaging (DWI) in frontal lobe epilepsy (FLE), as well as to test the accuracy of interictal DWI in the definition of the epileptogenic zone (EZ). DWI was carried out in 14 patients with refractory FLE (9 negative-MRI) as well as in 25 controls. Statistical mapping analysis (SPM2) of diffusivity maps was used to detect, for each subject, significant diffusivity alterations. We then studied the relationships between diffusion and depth recorded electrical abnormalities. Clinical correlates of the extent of diffusivity changes were also tested. We found areas of significantly increased diffusivity (SID) in 13 patients. Eight had SID in the EZ, 9 within the irritative zone (IZ) and 12 outside, mainly in connected areas. We found a correlation between the extent of SID and the duration of epilepsy (p corrected=0.026, R=0.621). In addition, SID was significantly less widespread in negative-MRI patients (p=0.028). However, we found no significant differences concerning either seizure frequency (p=0.302), seizure generalization (p=0.841), history of status (p=0.396), or surgical outcome (p=0.606). We suggest that SID in normal appearing areas is not a specific signature of epileptogenicity in FLE, and is more likely to reflect multifactorial and potentially evolving neuro-glial injuries.

PreMedline Identifier: 17239624

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Cyberonics Sends Letter to Stockholders; Urges Stockholders to Reelect Board's Highly Qualified Nominees

PR Newswire. New York: Jan 24, 2007. pg. n/a

HOUSTON, Jan. 24 /PRNewswire-FirstCall/ -- Cyberonics, Inc. (Nasdaq: CYBX)today announced that it will send the following letter to stockholders urgingthem to vote to reelect the Board's highly qualified nominees, Stanley H.Appel, M.D., Tony Coelho, Guy C. Jackson, Kevin S. Moore, Hugh M. Morrison,Alan J. Olsen, Michael J. Strauss, M.D., M.P.H., and Reese S. Terry, Jr.

**Click Here to return to abridged abstract**

January 24, 2007

Dear Fellow Cyberonics Stockholder,

Cyberonics' February 1st Annual Meeting of Stockholders is rapidly approaching, and your vote is important, no matter how many, or how few, shares you own. We urge you to support your Board of Directors by signing, dating and returning the enclosed WHITE proxy card today.

In advance of the Annual Meeting, members of our Board and management team have been meeting with stockholders to have open discussions about the future of our Company. We have appreciated the opportunity to exchange ideas and share our vision of Cyberonics' bright future. While we did not seek out this proxy contest -- and indeed, sought to avoid it -- we are grateful for the opportunity it has provided us to meet with you and benefit from your insights. We are resolutely focused on creating stockholder value, and we are actively executing on a strategy designed to make it happen.

YOUR BOARD HAS IMPLEMENTED STRONG

CORPORATE GOVERNANCE SAFEGUARDS

You should be aware that your Board has proactively addressed a number of governance issues over the past year, even before this proxy contest began. For example, the Company has adopted an option grants policy with underlying work instructions that are meant to ensure tight administrative accountability. The work instructions describe the process for initiating, approving, and documenting all equity grants and the persons responsible for each step of the process. Among the highlights of the policy are:

-- Officers and directors are not eligible to receive options. Equity

grants to officers and directors will be limited to restricted stock.

This codifies a practice adopted in 2004.

-- Restricted stock grants to officers and directors can be made only

once each year on the date of the annual meeting.

-- Equity grants to other employees can be made only once each quarter in

the 7th week of the fiscal quarter. All paperwork for these grants

(other than Compensation Committee approval) must be complete by the

4th week of the quarter.

VOTING ADVISORY FIRM ISS RECOGNIZES OUR STEADILY INCREASING REVENUES, COST

CUTTING EFFORTS, AND INCREASING GROSS PROFIT MARGINS

In addition to recognizing a number of improvements our Board is making, we are pleased that Institutional Shareholder Services (ISS), a leading independent voting advisory service, recommended that Cyberonics stockholders vote to re-elect Cyberonics' Chairman, Tony Coelho, to the Cyberonics Board of Directors. In its January 22, 2007 report, ISS stated:

-- "[O]perationally the company has been able to steadily increase its

revenues, expand into international markets, and as a result of an

internal cost structure review, has been able to increase its gross

profit margins."*

-- "The company is awaiting favorable coverage from the large national

and regional insurance payers which may require close relationships

with constituencies such as lawmakers, regulators, providers and major

payers which could be critical to the company's success. We believe

that the presence of Tony Coelho on the board could enhance this

process, particularly given his experience and his position as the

chairman of the Epilepsy Foundation. As such, we believe that Tony

Coelho should continue as a director."*

-- "[W]e believe that replacement of Tony Coelho could negatively impact

the execution of the company's business plan, in particular obtaining

broad-based national and regional coverage policy for treatment using

the VNS device."*

* Permission to use quotations from the ISS report was neither sought

nor obtained.

OUR BOARD AND MANAGEMENT HAVE IN PLACE A STRATEGIC PLAN

We've heard in our meetings with stockholders that you would like a clearer understanding of our plan to create value and of the key milestones on the path ahead. We're proud of the actions we have already taken to position Cyberonics for continued success. As a result of these efforts, Cyberonics is now a stronger company with less risk and uncertainty. Our focus is on obtaining broad-based national and regional coverage policy for Vagus Nerve Stimulation Therapy (VNS Therapy) in treatment-resistant depress (TRD) more quickly than we did for refractory epilepsy.

As you may know, we expect to receive a proposed national coverage determination for VNS Therapy in TRD from the Centers for Medicare & Medicaid Services (CMS) on February 7, 2007. If favorable, this will be an important step forward in the quest for TRD coverage. During the first public comment period for our TRD coverage request, CMS received 1,329 public comments, 99.5% of which favored coverage for TRD, including comments from 258 psychiatric thought leaders and psychiatrists, 50 neurologists, more than 100 other healthcare professionals, 645 patients and family members, 41 patient advocacy groups, and more than 20 members of Congress.

Given the body of clinical evidence that VNS Therapy in TRD is safe and effective, and the overwhelming support among physicians and patients, CMS should propose a favorable coverage policy for our life-altering product. Even if CMS proposes a favorable coverage policy, however, our quest for coverage among major private payers and the sales growth that will accompany increased coverage must continue anew. In this regard, continuity on your Board is critical as the current Board members have relationships with key constituencies that are critical to our success, in particular, key contacts with lawmakers, regulators, providers and major payors -- our most important constituencies.

WE URGE YOU NOT TO JEOPARDIZE THE CONSIDERABLE SUCCESS WE HAVE ALREADY

ACHIEVED

Your Board unanimously recommends that Cyberonics stockholders vote to reelect the following highly qualified individuals: Stanley H. Appel, M.D., Tony Coelho, Guy C. Jackson, Kevin S. Moore, Hugh M. Morrison, Alan J. Olsen, Michael J. Strauss, M.D., M.P.H., and Reese S. Terry, Jr. Each of these directors possesses extensive and relevant experience, and relationships with key constituencies that are critical to the Company's success.

TIME IS SHORT. Protect your investment in Cyberonics TODAY by voting your shares by phone, by using the internet, or by signing, dating and returning the enclosed WHITE proxy card.

On behalf of your Board of Directors, thank you for your continued support.

TONY COELHO REESE S. TERRY, JR.

Chairman of the Board of Directors Interim Chief Executive Officer

Proquest Identifier: 1201185931
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Researchers' data from University of California, U.S., highlight new research

Fitness & Wellness Business Week January 24, 2007

Researchers' data from University of California, U.S., highlight new research.

This trend article about University of California, U.S., is an immediate alert from NewsRx to identify developing directions of research.

**Click Here to return to abridged abstract**

The effects of TMS "on vagus nerve stimulation (VNS) are unknown. Understanding these effects is important before exposing individuals with an implanted VNS to TMS, as could occur in epilepsy or depression TMS research," neurologists in the United States explained.

"To explore this issue, the TMS-induced current in VNS leads and whether TMS has an effect on the VNS pulse generator" was evaluated, in a study conducted by L.M. Schrader and coauthors at the University of California-Los Angeles.

"Ex vivo measurement of current in VNS leads during single-pulse TMS and pulse generator function before, during, and after single-pulse TMS was assessed," the investigators said. "At the highest intensity and with the TMS coil held approximately 5 mm from the VNS wires, a 200 nA, 1.0 ms current was induced by TMS."

"This translates to an induced charge density of 3.3 nC/cm2/phase," published data indicated. "The function of the pulse generator was unaffected by single-pulse TMS, even when its case was directly stimulated by the coil."

"TMS-induced current in VNS electrodes was not only well outside of the range known to be injurious to peripheral nerve, but also below the activation threshold of nerve fibers," according to the study report.

"Using single-pulse TMS in individuals with VNS should not result in nerve stimulation or damage," the researchers concluded. "Furthermore, single-pulse TMS does not affect the VNS pulse generator's function."

Schrader and colleagues published their study in Clinical Neurophysiology (A lack of effect from transcranial magnetic stimulation (TMS) on the vagus nerve stimulator (VNS). Clin Neurophysiol, 2005;116(10):2501-2504).

For more information, contact L.M. Schrader, University of California-Los Angeles, Dept. of Neurology, Geffen School of Medicine, Reed Neurology Research Bldg., 710 Westwood Plaza, Room 1-19, Los Angeles, CA 90095, USA.

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