Publications by authors named "Lila Worden"
Purpose: The ketogenic diet (KD) is initiated emergently in the intensive care unit (ICU) for patients with super refractory status epilepticus (SRSE) and epileptic encephalopathies (EE). However, few data are available regarding safety, effectiveness, and long-term outcomes.
Methods: We performed a retrospective cohort study of consecutive patients with KD initiated in the ICU from 2010 to 2018 for SRSE and EE.
Objective: To compare pediatric migraine treatment efficacy in the emergency department before and after the implementation of a comprehensive migraine initiative, consisting of a standardized treatment protocol, provider educational series and standardized physician documentation template.
Background: Pediatric migraine is common, accounting for 1% of pediatric emergency department visits. Yet there is large variability in treatment practices, with few studies looking into measures of both clinical effectiveness and timeliness of treatment following implementation of standardized protocols.
Article Synopsis
- The study focused on the impact of monitoring indications, early EEG results, and clinical factors on seizure risk in neonates undergoing continuous EEG (cEEG).
- About 28% of the high-risk neonates experienced seizures, with significant variations in timing and risk based on the reason for monitoring and early EEG abnormalities.
- The findings suggest that early detection through cEEG is critical, as certain groups have a notably higher risk of seizures, emphasizing the need for ongoing monitoring beyond 24 hours after the last seizure.
Rationale: Implementation of electronic health records may improve the quality, accuracy, timeliness, and availability of documentation. Thus, our institution developed a system that integrated EEG ordering, scheduling, standardized reporting, and billing. Given the importance of user perceptions for successful implementation, we performed a quality improvement study to evaluate electroencephalographer satisfaction with the new EEG report system.
View Article and Find Full Text PDFNonconvulsive status epilepticus (NCSE) is present in multiple pediatric neurogenetic syndromes with epileptic encephalopathies. While intravenous (IV) medications are used inpatient for treatment of critical illness-related NCSE, there is no consensus on treatment of ambulatory NCSE. Up to 50% of patients with Angelman syndrome (AS) have NCSE with myoclonic or atypical absence status.
View Article and Find Full Text PDFHuman pluripotent stem cell (hPSC) lines exhibit repeated patterns of genetic variation, which can alter in vitro properties as well as suitability for clinical use. We examined associations between copy-number variations (CNVs) on chromosome 17 and hPSC mesodiencephalic dopaminergic (mDA) differentiation. Among 24 hPSC lines, two karyotypically normal lines, BG03 and CT3, and BG01V2, with trisomy 17, exhibited amplification of the WNT3/WNT9B region and rapid mDA differentiation.
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- The ideal weaning speed for the ketogenic diet and its impact on seizures remains uncertain, prompting a study of children who discontinued the diet between 2000 and 2010 at Johns Hopkins Hospital.
- Children with longer diet durations and lower seizure frequencies tended to wean off the diet more slowly, but the speed of discontinuation did not significantly affect seizure worsening rates overall.
- Notably, those with a 50-99% reduction in seizures who were taking more anticonvulsants faced a higher risk of worsening seizures, indicating that quick discontinuation of the diet is generally safe, especially when done over several weeks rather than months.
Article Synopsis
- Prenatal cocaine exposure leads to changes in the structure of the embryonic neocortex, affecting the development and migration of glutamate and GABA neurons.
- Cocaine was administered to pregnant rats during critical periods of brain development, resulting in a reduction of the neocortical area and altered neuron distribution.
- The study suggests that these changes may disrupt normal neuronal migration and development, potentially leading to adverse effects on cortical function.
Background: Stromal-Derived Inducing Activity (SDIA) is one of the most efficient methods of generating dopaminergic (DA) neurons from embryonic stem cells (ESC). DA neuron induction can be achieved by co-culturing ESC with the mouse stromal cell lines PA6 or MS5. The molecular nature of this effect, which has been termed "SDIA" is so far unknown.
View Article and Find Full Text PDFRationale: Brain dopamine (DA) participates in the modulation of instrumental behavior, including aspects of behavioral activation and effort-related choice behavior. Rats with impaired DA transmission reallocate their behavior away from food-seeking behaviors that have high response requirements, and instead select less effortful alternatives. Although accumbens DA is considered a critical component of the brain circuitry regulating effort-related choice behavior, emerging evidence demonstrates a role for adenosine A(2A) receptors.
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- Goal-directed actions are influenced by the effort required for work, with dopamine in the nucleus accumbens playing a key role in motivating behavior.
- Activation of adenosine A(2A) receptors in the nucleus accumbens impairs performance on tasks that require high effort but not on those needing less effort.
- Understanding how these receptors affect motivation and effort may provide insights into issues like depression-related fatigue and reduced motivation.
Intra-accumbens injections of the adenosine A2A agonist CGS 21680 affect effort-related choice behavior in rats.
Psychopharmacology (Berl)
September 2008
Rationale: Nucleus accumbens dopamine (DA) participates in the modulation of instrumental behavior, including aspects of behavioral activation and effort-related choice behavior. Rats with impaired accumbens DA transmission reallocate their behavior away from food-reinforced activities that have high response requirements and instead select less-effortful types of food-seeking behavior. Although accumbens DA is considered a critical component of the brain circuitry regulating effort-related processes, emerging evidence also implicates adenosine A(2A) receptors.
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