Antiseizure medications for Lennox-Gastaut Syndrome: Comprehensive review and proposed consensus treatment algorithm.

Lennox-Gastaut syndrome (LGS) is a severe, childhood-onset developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, specific electroencephalogram (EEG) patterns, and significant cognitive and behavioral impairments. To date, eight anti-seizure medications (ASMs) have been specifically approved by the U.S.

We're in This Together: A Case Study of the Concurrent Delivery of Prolonged Exposure Therapy to Intimate Partners With PTSD.

Research on the links between intimate relationships and PTSD and the treatments for PTSD tend to be limited to couples in which only one partner within the dyad has PTSD. No investigations, to our knowledge, have empirically examined the simultaneous provision of evidence-based PTSD treatment to both partners in an intimate relationship diagnosed with PTSD. The current case study describes two partners in a different-sex relationship, both diagnosed with current PTSD, who received individual Prolonged Exposure (PE) therapy at the same time as part of a larger randomized clinical trial.

Effects of Tirzepatide on the Clinical Trajectory of Patients with Heart Failure, a Preserved Ejection Fraction, and Obesity.

Background: Patients with heart failure, a preserved ejection fraction (HFpEF), and obesity have significant disability and suffer frequent exacerbations of heart failure. We hypothesized that tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, would improve a comprehensive suite of clinical endpoints, including measures of health status, functional capacity, quality of life, exercise tolerance, patient well-being, and medication burden in these patients.

Methods: 731 patients in class II-IV heart failure, ejection fraction ≥50%, and body mass index ≥30 kg/m were randomized(double-blind) to tirzepatide(titrated up to 15mg subcutaneously weekly)(n=364) or placebo(n=367), added to background therapy for a median of 104 weeks (Q1=66, Q3=126 weeks).

Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity.

Background: Obesity increases the risk of heart failure with preserved ejection fraction. Tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, causes considerable weight loss, but data are lacking with respect to its effects on cardiovascular outcomes.

Methods: In this international, double-blind, randomized, placebo-controlled trial, we randomly assigned, in a 1:1 ratio, 731 patients with heart failure, an ejection fraction of at least 50%, and a body-mass index (the weight in kilograms divided by the square of the height in meters) of at least 30 to receive tirzepatide (up to 15 mg subcutaneously once per week) or placebo for at least 52 weeks.

Artifacts Deceive: The Electroretinogram in the Electroencephalogram of a teenager with cerebral anoxia.

Artifacts on an electroencephalogram (EEG) - whether physiologic or non-physiologic - can be common and are important to recognize to prevent errors in interpretation. One such EEG artifact is an electroretinogram (ERG) artifact which occurs during photic stimulation. Typically, of a low amplitude, its presence is usually obscured by normal EEG activity over the frontopolar channels but it can appear prominent in very suppressed or EEG recordings showing electrocerebral inactivity.

Mean Arterial Pressure and Neonatal Outcomes in Pregnancies Complicated by Mild Chronic Hypertension.

Objective: To estimate the association between mean arterial pressure during pregnancy and neonatal outcomes in participants with chronic hypertension using data from the CHAP (Chronic Hypertension and Pregnancy) trial.

Methods: A secondary analysis of the CHAP trial, an open-label, multicenter randomized trial of antihypertensive treatment in pregnancy, was conducted. The CHAP trial enrolled participants with mild chronic hypertension (blood pressure [BP] 140-159/90-104 mm Hg) and singleton pregnancies less than 23 weeks of gestation, randomizing them to active treatment (maintained on antihypertensive therapy with a goal BP below 140/90 mm Hg) or standard treatment (control; antihypertensives withheld unless BP reached 160 mm Hg systolic BP or higher or 105 mm Hg diastolic BP or higher).

"Oh My Sleeping Child" … Narcolepsy Type 1 in a 22-Month-Old Boy.

Pediatric narcolepsy is a complex disorder with unique diagnostic challenges. It is diagnosed with a combination of clinical presentation, polysomnogram with multiple sleep latency test (PSG with MSLT), and occasionally, hypocretin-1 (orexin) levels in the cerebrospinal fluid (CSF). This report describes a 22-month-old boy experiencing excessive daytime sleepiness (EDS) and frequent falls.

Transforming Neurology Care Delivery Through a Population Health Data Strategy.

Background: With more than 30% of global data originating from health care, deriving usable insights that improve health requires population health analytics. In neurology, data-driven approaches have grown in significance because of digital health records and advanced analytics. A vital aspect of this evolution is adopting a population health data strategy (PHDS).

Health and Healthcare Disparities in Pediatric Epilepsy in the United States: A Scoping Review.

Objectives: Health disparities impact epilepsy care in children. Previous efforts to summarize data in this population have been limited. This study sought to understand how this information exists in the literature and identify gaps in knowledge.

A quality improvement initiative standardizing the antibiotic treatment and feeding practices in patients with medical necrotizing enterocolitis.

Objective: Evaluate the impact of a multidisciplinary guideline standardizing antibiotic duration and enteral feeding practices following medical necrotizing enterocolitis (mNEC).

Study Design: For preterm infants with Bell Stage 2 A mNEC and negative blood culture, antibiotic treatment was standardized to 7 days. Trophic feeds of unfortified human milk began 72 h after resolution of pneumatosis.

Role of cosyntropin in the management of postpartum post-dural puncture headache: a two-center retrospective cohort study.

Background: Research suggests that postpartum post-dural puncture headache (PDPH) might be prevented or treated by administering intravenous cosyntropin.

Methods: In this retrospective cohort study, we questioned whether prophylactic (1 mg) and therapeutic (7 µg/kg) intravenous cosyntropin following unintentional dural puncture (UDP) was effective in decreasing the incidence of PDPH and therapeutic epidural blood patch (EBP) after birth. Two tertiary-care American university hospitals collected data from November 1999 to May 2017.

Regional contributions to impaired myocardial mechanical function in heart failure with preserved ejection fraction.

Aims: Hypertensive heart disease (HHD) is recognized as a key clinical precursor to heart failure with preserved ejection fraction (HFPEF). However, pathophysiological transition from HHD to HFPEF is not well understood. We sought determine whether regional differences in impaired myocardial function may underlie the greater mechanical dysfunction seen in HFPEF compared to HHD.

The Effect of Sacubitril/Valsartan on Left Ventricular Myocardial Deformation in Heart Failure with Preserved Ejection Fraction (PARAMOUNT trial).

Background: Global longitudinal strain (GLS) and global circumferential strain (GCS) have been shown to be impaired in heart failure with preserved ejection fraction. We sought to assess whether treating patients with heart failure with preserved ejection fraction with sacubitril/valsartan would significantly improve GLS and GCS compared with valsartan alone.

Methods And Results: PARAMOUNT (Prospective Comparison of ARNI With ARB on Management of Heart Failure With Preserved Ejection Fraction Trial) was a phase II, randomized, parallel-group, double-blind multicenter trial in 301 patients with New York Heart Association functional class II-III heart failure, a left ventricular ejection fraction of 45%, and an N-terminal pro-B-type natriuretic peptide of ≥400 pg/mL.

Functional Network Alterations Associated with Cognition in Pre-Clinical Alzheimer's Disease.

Accumulation of cerebral amyloid-β (Aβ) is a risk factor for cognitive decline and defining feature of Alzheimer's disease (AD). Aβ is implicated in brain network disruption, but the extent to which these changes correspond with observable cognitive deficits in pre-clinical AD has not been tested. This study utilized individual-specific functional parcellations to sensitively evaluate the relationship between network connectivity and cognition in adults with and without Aβ deposition.

High-Density (HD) Scalp EEG Findings in "Benign" Childhood Epilepsy with Centrotemporal Spikes (BCECTS).

Despite characteristic clinical and scalp EEG findings, BCECTS pathophysiology is unclear regarding involvement of large-scale neuronal networks. Higher number of scalp electrodes with HD-EEG may promote accurate localization of the cortical generators in BCECTS providing additional insight in those with neurocognitive problems. We aimed to determine the value of visual interpretation of topographical maps using 256 channels (when compared to standard 21 channel array) HD-EEG in BCECTS and attempted to source localize interictal discharges (IEDs) using Geosource 2 software.

Novel De Novo Heterozygous Variants in the Gene Causing ZTTK Syndrome: A Case Report of Two Patients and Review of Neurological Findings.

Zhu-Tokita-Takenouchi-Kim (ZTTK) syndrome is a newly described autosomal dominant multisystem developmental disorder resulting from a mutation of the SON gene located on chromosome region 21q22.11. It is characterized by heterogeneous features such as intellectual disability, facial dysmorphisms, poor feeding, vision abnormalities, musculoskeletal anomalies, congenital heart and genitourinary system defects, as well as several unique neurological findings including seizures, tone abnormalities, autism spectrum disorder and variable brain abnormalities noted on neuroimaging.

Intimate partner violence: Opening the door to a safer future.

These recommendations can help you to identify patients at risk of violence, create an environment where they feel comfortable disclosing their experiences, and help them plan for their safety.