Multivariate assessments of activity-related skeletal changes: Interpreting Bell Beaker specialized male archery and social organization in Central Europe

Objectives

The Bell Beaker period witnessed the rise of individual inhumations with “wealthy” burial contexts containing archery-related grave goods, leading archaeologists to label the individuals in these tombs as “archers.” This study looks to (1) compare the skeletons from male “archer” burials with those from male “non-archer” burials—those not having archery-related grave goods—in order to assess a possible link between burial context and physical activity, and (2) apply a biomechanics profile to evaluate whether the individuals associated with these “archer” burials practiced specialized archer activity.

Materials and Methods

The corpus (males only) included 46 “archers” and 40 “non-archers” from Bell Beaker individual inhumations. Osteological data included measurements, scores of entheseal changes, and a diagnosis of certain pathologies. Data analyses involved visual observations, hypothesis tests, dimension reduction, and MANOVA, with approaches aimed at exploring the treatment of data missingness.

Results

Measurement data revealed no differences between the two groups. Evaluations of entheseal changes found that “non-archers” had consistently more instances of bone surface modifications than “archers.” Individual assessments of specialized archer occupation identified 11 possible specialized archers.

Discussion

These findings indicate a possible labor differentiation represented through the presence of a probably prestigious “archer” burial context. This suggests a link between grave good presence and labor, but not between a Bell Beaker archery occupation and an “archer” burial context. Data analyses support the application of biomechanics to osteological analyses in order to assess specialized activity on the skeleton.     

Neuronal activity controls the development of interneurons in the somatosensory cortex

BACKGROUND

Neuronal activity in cortical areas regulates neurodevelopment by interacting with defined genetic programs to shape the mature central nervous system. Electrical activity is conveyed to sensory cortical areas via intracortical and thalamocortical neurons, and includes oscillatory patterns that have been measured across cortical regions.

OBJECTIVE

In this work, we review the most recent findings about how electrical activity shapes the developmental assembly of functional circuitry in the somatosensory cortex, with an emphasis on interneuron maturation and integration. We include studies on the effect of various neurotransmitters and on the influence of thalamocortical afferent activity on circuit development. We additionally reviewed studies describing network activity patterns.

METHODS

We conducted an extensive literature search using both the PubMed and Google Scholar search engines. The following keywords were used in various iterations: “interneuron”, “somatosensory”, “development”, “activity”, “network patterns”, “thalamocortical”, “NMDA receptor”, “plasticity”. We additionally selected papers known to us from past reading, and those recommended to us by reviewers and members of our lab.

RESULTS

We reviewed a total of 132 articles that focused on the role of activity in interneuronal migration, maturation, and circuit development, as well as the source of electrical inputs and patterns of cortical activity in the somatosensory cortex. 79 of these papers included in this timely review were written between 2007 and 2016.

CONCLUSION

Neuronal activity shapes the developmental assembly of functional circuitry in the somatosensory cortical interneurons. This activity impacts nearly every aspect of development and acquisition of mature neuronal characteristics, and may contribute to changing phenotypes, altered transmitter expression, and plasticity in the adult. Progressively changing oscillatory network patterns contribute to this activity in the early postnatal period, although a direct requirement for specific patterns and origins of activity remains to be demonstrated.

     

ClinMine: Optimizing the Management of Patients in Hospital

Context

A better understanding of “patient pathway” thanks to data analysis can lead to better treatments for patients. The ClinMine project, supported by the French National Research Agency (ANR), aims at proposing, from various case studies, algorithmic and statistical models able to handle this type of pathway data, focusing primarily on hospital data.

A series of patients with purging type anorexia nervosa who do “tube vomiting”

Background

It is important for clinicians to assess their patients’ purging behavior. Various methods of purging, such as self-induced vomiting are well-known. Because patients do not always report their purging behavior, knowing the clinical signs that indicate the behavior is useful. However, we have experienced patients who did not have the reported physical signs of self-induced vomiting because they used hoses instead of their fingers to purge their stomach contents, which they call “tube vomiting”. No other previous studies have reported the use of hoses as a purging tool.

Case presentation

We present as our main case a 20-year-old Japanese woman with anorexia nervosa who engaged in “tube vomiting.” Although she recovered well under medical treatment in our hospital, she began to lose weight and blood potassium soon after discharge. We found that she used a garden hose instead of her fingers to perform self-induced vomiting,. She inserted the hose into her stomach and evacuated the stomach contents through it, without pain. She learned this technique through a blog about eating disorders. We also present two other similar cases. In fact, many patients discuss “tube vomiting” on the internet.

Conclusion

Our experience suggests that a sudden decrease in the weight and blood potassium level could indicate “tube vomiting”. In addition, because many information resources are available on the internet, medical practitioners should be aware of these sites.

     

The Chromatography of “Myosin B” Prepared from Minced Rabbit Muscle on Triethylaminoethylcellulose

The chromatography on Cellex D DEAE-SF (Bio-Rad Lab.) or TEAE-cellulose (Serva) equilibrated against 0.28 m KCl solution containing 0.02 m tris-HCl buffer at pH 8.0 was found to be suitable for the refinement of myosin B.

The ultraviolet absorption spectrum and ATPase activity of the eluted fractions showed that “myosin B” was fractionated and purified by this technique, especially by the preferential removal of the fraction suggested as ribonucleic acid related substance.

The chromatography may provide the effective way to investigate changes of “myosin B” during aging of meat.     

Diet composition and activity level of at risk and metabolically healthy obese american adults

Objective:

Obesity often clusters with other major cardiovascular disease risk factors, yet a subset of the obese appears to be protected from these risks. Two obesity phenotypes are described, (i) “metabolically healthy” obese, broadly defined as body mass index (BMI) ≥ 30 kg/m² and favorable levels of blood pressure, lipids, and glucose; and (ii) “at risk” obese, BMI ≥ 30 with unfavorable levels of these risk factors. More than 30% of obese American adults are metabolically healthy. Diet and activity determinants of obesity phenotypes are unclear. We hypothesized that metabolically healthy obese have more favorable behavioral factors, including less adverse diet composition and higher activity levels than at risk obese in the multi‐ethnic group of 775 obese American adults ages 40‐59 years from the International Population Study on Macro/Micronutrients and Blood Pressure (INTERMAP) cohort.

Design and Methods:

In gender‐stratified analyses, mean values for diet composition and activity behavior variables, adjusted for age, race, and education, were compared between metabolically healthy and at risk obese.

Results:

Nearly one in five (149/775 or 19%) of obese American INTERMAP participants were classified as metabolically healthy obese. Diet composition and most activity behaviors were similar between obesity phenotypes, although metabolically healthy obese women reported higher sleep duration than at risk obese women.

Conclusions:

These results do not support hypotheses that diet composition and/or physical activity account for the absence of cardiometabolic abnormalities in metabolically healthy obese.     

Launch of a new report: “Road testing organizational life cycle assessment around the world: applications,experiences and lessons learned”

Purpose

Organizational life cycle assessment (O-LCA) is still a rather young proposal, but moving towards becoming more broadly accepted as a scientifically mature and practical method. The UNEP/SETAC flagship project “LCA of organizations” concluded its “road-testing” phase and is glad to announce the publication of the final report “Road testing organizational life cycle assessment around the world: applications, experiences and lessons learned.” The full report can be accessed at http://www.lifecycleinitiative.org/download/6060. This article shortly summarizes the flagship project phases and main outcomes, particularly the report recently launched, and pinpoints future actions.

Methods

In 2015, the “Guidance on Organizational Life Cycle Assessment” was published. During the following 2 years, the flagship project accompanied 12 organizations in the road testing of that O-LCA Guidance. They represent four world regions, different sectors and sizes. The road testers’ case studies and their feedback are the basis of the Road-testing Report.

Results and discussion

The Road-testing Report aims to complement the O-LCA Guidance through the road testers’ experience, thus delivering advice for future practitioners and inspiration to method developers. It includes executive summaries of the O-LCA road testers’ case studies and the main results of a comprehensive survey through which the road testers share their experience, feedback, and lessons learned. The road testing confirmed the application potential of the O-LCA method and the positive outcomes of the road testing have shown that no immediate updates to the O-LCA Guidance are needed, but some priority actions were identified in order to further ease the application of O-LCA.

Conclusions

Three main tasks for the coming years are identified by the authors: firstly, the challenges highlighted during the road testing should be addressed in the future by the LCA community; specific methodological difficulties of certain kinds of organizations, like the service sector, should be targeted; and finally, the potential revealed by the organizational perspective can be deployed in adjacent LCA fields. The flagship project team hopes that this second publication, together with the great acceptance of the O-LCA Guidance and the contribution of third parties, will pave the way to make O-LCA a mainstream tool.

     

Threatening biomarkers in lupus pregnancy: Biochemistry and genetic challenges

Objective

Using genetic markers and miRs work strongly beside other sensitive biomarkers in lupus management during sensitive period of pregnancy.

Methods

PubMed and Google Scholar databases were searched from 2000 to 2017 using the terms “lupus,” “lupus pregnancy,” “biomarkers,” “micro-RNA,” “polymorphisms,” “anti-phospholipid antibodies,” and “cluster differentiation markers.”

Discussion

Complement is a valuable biomarker in lupus pregnancy. However, the complement profile has ambiguous meaning because decreased levels of C3 and C4 reflect inflammation and because they are also prognostic biomarkers for abortion. Furthermore, increased C3 and C4 levels indicate hepatic protein synthesis in hepatocytes. Anti-phospholipid (APL) antibodies are present in 25% to 50% of lupus patients, and can lead to thrombotic and obstetric complications in some pregnancies and increase the risk of abortion, especially in a pregnant woman in the active phase of lupus. Several studies have associated APL with HELLP syndrome. However, other pregnancy complications have not been associated with APL. Autoantibodies against the major vault protein and anti-double strand DNA antibodies are valuable biomarkers in evaluating lupus activity. The expression pattern of micro-RNAs (miRs) differs in various diseases. Current studies have demonstrated the potential of miRs as diagnostic and prognostic biomarkers in various diseases; for example, the level of miR-126 is higher in lupus.

Conclusion

Mir-223-3p and miR-451 are informative biomarkers in estimating disease activity. TWEAK, BAFF, and APOL1 genes, and their polymorphisms are informative in estimating disease activity, especially renal effects, and in monitoring higher-risk pregnant women. Further studies of these genes and their relevant polymorphisms are needed.

     

Identification of putative interactions between swine and human influenza A virus nucleoprotein and human host proteins

Background

Influenza A viruses (IAVs) are important pathogens that affect the health of humans and many additional animal species. IAVs are enveloped, negative single-stranded RNA viruses whose genome encodes at least ten proteins. The IAV nucleoprotein (NP) is a structural protein that associates with the viral RNA and is essential for virus replication. Understanding how IAVs interact with host proteins is essential for elucidating all of the required processes for viral replication, restrictions in species host range, and potential targets for antiviral therapies.

Methods

In this study, the NP from a swine IAV was cloned into a yeast two-hybrid “bait” vector for expression of a yeast Gal4 binding domain (BD)-NP fusion protein. This “bait” was used to screen a Y2H human HeLa cell “prey” library which consisted of human proteins fused to the Gal4 protein’s activation domain (AD). The interaction of “bait” and “prey” proteins resulted in activation of reporter genes.

Results

Seventeen positive bait-prey interactions were isolated in yeast. All of the “prey” isolated also interact in yeast with a NP “bait” cloned from a human IAV strain. Isolation and sequence analysis of the cDNAs encoding the human prey proteins revealed ten different human proteins. These host proteins are involved in various host cell processes and structures, including purine biosynthesis (PAICS), metabolism (ACOT13), proteasome (PA28B), DNA-binding (MSANTD3), cytoskeleton (CKAP5), potassium channel formation (KCTD9), zinc transporter function (SLC30A9), Na+/K+ ATPase function (ATP1B1), and RNA splicing (TRA2B).

Conclusions

Ten human proteins were identified as interacting with IAV NP in a Y2H screen. Some of these human proteins were reported in previous screens aimed at elucidating host proteins relevant to specific viral life cycle processes such as replication. This study extends previous findings by suggesting a mechanism by which these host proteins associate with the IAV, i.e., physical interaction with NP. Furthermore, this study revealed novel host protein-NP interactions in yeast.

     

Relationships between catastrophic thought,bodily sensations and physical symptoms

Background

Researchers have recently begun to seek cognitive explanations for physical symptoms with no obvious biological cause. Concepts such as somatization, somatosensory amplification, and somatosensory catastrophizing have been invoked to explain these phenomena. Somatosensory amplification occurs when these bodily sensations become stronger and more painful. Somatosensory catastrophizing is the tendency to attribute these bodily sensations to unbearable functional modulation or as signs of serious illness. This causes the sufferer to pay excessive attention to these physical sensations. However, there is no scale for evaluating somatosensory catastrophizing, and there are no standard diagnostic criteria. There were two objectives for this study: to develop a scale for evaluating somatosensory catastrophizing and to investigate relationships between somatosensory amplification, somatosensory catastrophizing, and physical symptoms.

Methods

In the first part of this study, in which we developed the scale, there were 231 student participants with an average age of 20.1 years. Of these, 57% of the participants were female. In the second part of the study, there were two groups of participants. The first group consisted of 158 non-patient subjects, 56% of whom were female, with an average age of 20.2 years. There were 33 outpatients receiving treatment for somatoform disorders in the second group. The average age of these participants, of whom 67% were female, was 48.8 years. The second part of the study was conducted using standardized self-rating questionnaires to assess somatosensory amplification and catastrophizing.

Results

We developed a 27-item scale, which we have called the Somatosensory catastrophizing scale (SSCS). The SSCS assesses five key areas, and our analysis confirmed it to be valid and highly reliable. The scale identified that the patient group from the second part of the study scored more highly than the control group for both somatosensory amplification and catastrophizing. Additionally, the results of covariance structure analyses revealed a significant causal relationship of the form “somatosensory amplifcation” via “somatosensory catastrophizing” to “physical symptoms”. This relationship held in both groups of participants. The key difference between the patient and non-patient groups was that somatosensory catastrophizing had a greater impact on the physical symptoms of the participants in the patient group.

Conclusions

In this study, we developed the SSCS, which enables us to measure somatosensory catastrophizing empirically. We then clarified the relationship between somatosensory amplification, somatosensory catastrophizing, and physical symptoms. In the future, we expect to be able to apply our new understanding to developing intervention techniques to mitigate the physical symptoms caused by somatosensory catastrophizing.

     

Adaptation of environmental data to national and sectorial context: application for reinforcing steel sold on the French market

Purpose

Environmental data for steel products are generally proposed at a continental or a global scale. The question we are tackling here is: does the fact that steel as a global market necessarily reduces the need for national data?

Methods

In this study, the environmental impact of reinforcing steel sold in France is evaluated. To do so, a specific environmental inventory is adapted from Ecoinvent database. CML method is used for impact calculation and both methods “recycled content” as well as “end of life recycling approach” are tested.

Results and discussion

This study shows that there is a specificity of reinforcing steel products sold in France compared to European value. It is due to the fact that reinforcing steel is mainly made with recycled steel as the market growth for construction product in France is limited allowing a very high recycled content. This result is not sensitive neither to the allocation method used for recycling (cut-off approach or system expansion) nor to transport distance and electricity country mix used.

Conclusions

The result of this study can be used with confidence in every construction site work located on the French territory. Furthermore, the present study advocates for an adaptation of global database to local context defined by a specific industrial sector and a geographic region even for product such as steel that may be considered as a first approximation as a global product.     

Metabolic interaction between purine nucleotide cycle and oxypurine cycle during skeletal muscle contraction of different intensities: a biochemical reappraisal

Background

A substrate cycle is a metabolic transformation in which a substrate A is phosphorylated to A?P at the expense of ATP (or another “high energy” compound), and A?P is converted back to A by a nucleotidase or a phosphatase. Many biochemists resisted the idea of such an ATP waste. Why a non-phosphorylated metabolite should be converted into a phosphorylated form, and converted back to its non-phosphorylated form through a “futile cycle”?

Aim of review

In this Review we aim at presenting our present knowledge on the biochemical features underlying the interrelation between the muscle purine nucleotide cycle and the oxypurine cycle, and on the metabolic responses of the two cycles to increasing intensities of muscle contraction.

Key scientific concepts of review

Nowadays it is widely accepted that the substrate cycles regulate many vital functions depending on the expense of large amounts of ATP, including skeletal muscle contraction, so that the expense of some extra ATP and “high energy” compounds, such as GTP and PRPP via substrate cycles, is not surprising. The Review emphasizes the strict metabolic interrelationship between the purine nucleotide cycle and the oxipurine cycle.

     

Two‐Year Changes in Child Weight Status,Diet, and Activity by Neighborhood Nutrition and Physical Activity Environment

Objective

The aim of this study was to examine 2‐year changes in weight status and behaviors among children living in neighborhoods differing on nutrition and activity environments.

Methods

A prospective observational study, the Neighborhood Impact on Kids study, was conducted in King County, Washington, and San Diego County, California. Children 6 to 12 years old and a parent or caregiver completed Time 1 (n = 681) and Time 2 (n = 618) assessments. Children lived in neighborhoods characterized as “high/favorable” or “low/unfavorable” in nutrition and activity environments, respectively (four neighborhood types). Child BMI z score and overweight or obesity status were primary outcomes, with diet and activity behaviors as behavioral outcomes.

Results

After adjusting for sociodemographics and Time 1 values, children living in two of the three less environmentally supportive neighborhoods had significantly less favorable BMI z score changes (+0.11, 95% CI: 0.01‐0.21; + 0.12, 95% CI: 0.03‐0.21), and all three less supportive neighborhoods had higher overweight or obesity (relative risks, 1.41‐1.49; 95% CI: 1.13‐1.80) compared with children in the most environmentally supportive neighborhoods. Changes in daily energy intake and sedentary behavior by neighborhood type were consistent with observed weight status changes, with unexpected findings for physical activity.

Conclusions

More walkable and recreation‐supportive environments with better nutrition access were associated with better child weight outcomes and related behavior changes.     

Global guidance principles for life cycle assessment databases: development of training material and other implementation activities on the publication

Purpose

The paper introduces the publication on “Global Guidance Principles for Life Cycle Assessment Databases”; it focuses on the development of training material and other implementation activities on the publication.

Methods

The document is the output of the “Shonan Guidance Principles” workshop. The publication provides guidance principles for life cycle assessment (LCA) databases; this includes how to collect raw data, how to develop datasets, and how to manage databases. The publication also addresses questions concerning data documentation and review, coordination among databases, capacity building, and future scenarios. As a next step, the publication is used to prepare training material and other implementation activities.

Results

The publication was launched at the LCM 2011 Conference. Since then outreach activities have been organized in particular in emerging economies. Further developments with regard to the guidance principles are foreseen as part of a flagship project within phase 3 of the Life Cycle Initiative. Training material is being developed that will include how to set up databases and develop datasets. The topic has been taken up by United Nations Environment Programme (UNEP) in its Rio?+?20 Voluntary Commitments: UNEP and Society of Environmental Toxicology and Chemistry (SETAC) through the UNEP/SETAC Life Cycle Initiative commit to facilitate improved access to good quality life cycle data and databases as well as expanded use of key environmental indicators that allows the measurement and monitoring of progress towards the environmental sustainability of selected product chains.

Conclusions

The adoption of the “Global Guidance Principles” publication as a de facto global standard is expected to facilitate the work of database teams, especially, in developing countries, and the collaboration in regional networks. These efforts are supported by the development of training material and other implementation activities.     

Disrupted montane forest recovery hinders biodiversity conservation in the tropical Andes

Aim

Andean montane forests are biodiversity hotspots and large carbon stores and they provide numerous ecosystem services. Following land abandonment after centuries of forest clearing for agriculture in the Andes, there is an opportunity for forest recovery. Field-based studies show that forests do not always recover. However, large-scale and long-term knowledge of recovery dynamics of Andean forests remains scarce. This paper analyses tropical montane forest recovery trajectories over a 15-year time frame at the landscape and tropical Andean scale to inform restoration planning.

Methods

We first detect “potential recovery” as areas that have experienced a forest transition between 2000 and 2005. Then, we use Landsat time series analysis of the normalized difference water index (NDWI) to classify four “realized recovery” trajectories (“ongoing”, “arrested”, “disrupted” and “no recovery”) based on a sequential pattern of 5-yearly Z-score anomalies for 2005–2020. We compare these results against an analysis of change in tree cover to validate against other datasets.

Results

Across the tropical Andes, we detected a potential recovery area of 274 km² over the period. Despite increases in tree cover, most areas of the Andes remained in early successional states (10–25% tree cover), and NDWI levelled out after 5–10 years. Of all potential forest recovery areas, 22% showed “ongoing recovery”, 61% showed either “disrupted” or “arrested recovery”, and 17% showed “no recovery”. Our method captured forest recovery dynamics in a Peruvian arrested succession context and in landscape-scale tree-planting efforts in Ecuador.

Main conclusions

Forest recovery across the Andes is mostly disrupted, arrested or unsuccessful, with consequences for biodiversity recovery and provision of ecosystem services. Low-recovery areas identified in this study might be good candidates for active restoration interventions in this UN Decade on Restoration. Future studies could determine restoration strategies and priorities and suggest management strategies at a local planning scale across key regions in the biodiversity hotspot.     

Cationic antimicrobial peptide: LL-37 and its role in periodontitis

Background

Periodontitis i.e. inflammation of the periodontium is a multifactorial disease. Antimicrobial peptides (AMPs) which demonstrate a broad-spectrum of activity against varied number of bacteria, fungi, viruses, and parasites, and cancerous cells have been linked to periodontitis. The AMPs even possess the caliber of immunomodulation, and are significantly responsive to innate immuno-stimulation and infections. LL-37 plays a salubrious role by preventing and in treatment of chronic forms of periodontitis.

Objective

In the present work we will review the role of antimicrobial peptide LL-37 in periodontitis.

Methods

A systematic search was carried out from the beginning till August, 2016 using the Pubmed search engine. The keywords included “LL-37,” “periodontitis,” “Papillon–Lefevre syndrome,” “Morbus Kostmann,” “Haim-Munk syndrome” along with use of Boolean operator “and.”

Results

The search resulted in identifying 67 articles which included articles linking LL-37 with periodontitis, articles on Papillon–Lefevre syndrome, Morbus Kostmann, Haim-Munk syndrome, LL-37 and periodontitis and articles on pathogenicity of periodontitis.

Conclusion

The literature search concluded that LL-37 plays a pivotal role in preventing and treatment of severe form of periodontitis.

     

Influenza-related mortality trends in Japanese and American seniors: evidence for the indirect mortality benefits of vaccinating schoolchildren

Background

The historical Japanese influenza vaccination program targeted at schoolchildren provides a unique opportunity to evaluate the indirect benefits of vaccinating high-transmitter groups to mitigate disease burden among seniors. Here we characterize the indirect mortality benefits of vaccinating schoolchildren based on data from Japan and the US.

Methods

We compared age-specific influenza-related excess mortality rates in Japanese seniors aged ≥65 years during the schoolchildren vaccination program (1978–1994) and after the program was discontinued (1995–2006). Indirect vaccine benefits were adjusted for demographic changes, socioeconomics and dominant influenza subtype; US mortality data were used as a control.

Results

We estimate that the schoolchildren vaccination program conferred a 36% adjusted mortality reduction among Japanese seniors (95%CI: 17–51%), corresponding to ∼1,000 senior deaths averted by vaccination annually (95%CI: 400–1,800). In contrast, influenza-related mortality did not change among US seniors, despite increasing vaccine coverage in this population.

Conclusions

The Japanese schoolchildren vaccination program was associated with substantial indirect mortality benefits in seniors.     

Characterization of human tactile pattern recognition performance at different ages

This study examined tactile pattern recognition performance in human observers (N = 44) in the context of a letter recognition task at the fingertip. Participants were recruited from three different age groups (youth, n = 17; young adults, n = 14; seniors, n = 13) to examine age-related differences in performance. The influence of gender (males vs females) and hand (right vs left) was also examined. Performance was characterized in terms of both response accuracy and associated response times (RTs). Patterns of confusion between letters were also examined. Results showed that age was the most important factor in determining the capacity of our participants to perform fast and accurate pattern recognition. In this respect, younger participants (i.e., youth and young adults) clearly outperformed seniors by showing not only better accuracy and less confusion but also 2–3 times faster RT. By comparison, the combined influence of “hand” and “gender” on recognition performance was only marginal. These results indicate that the ability to perform complex tactile pattern recognition is already well established in youth 10–14 years of age with only minor refinements occurring later in early adulthood. With advancing age, such ability becomes far less efficient, as judged by the drastic increase in RT observed in seniors, in spite of a relatively good accuracy. This suggests that alterations not only at the peripheral receptor level but also at the central processing level might play an important role in limiting the ability of seniors to perform fast and efficient pattern recognition at the fingertip.     

Clinical course and seizure outcome of idiopathic childhood epilepsy: determinants of early and long-term prognosis

Background

Idiopathic epilepsies and epileptic syndromes predominate childhood and adolescence epilepsy. The aim of the present study was to investigate the clinical course and outcome of idiopathic childhood epilepsy and identify variables determining both early and long-term prognosis.

Methods

We followed 303 children with newly diagnosed idiopathic epilepsy aged 1–14 years old, both prospectively and retrospectively. Outcome was defined at one, 2 and 4 years of follow-up, as well as at the end of the study period for all patients. Based on the data collected, patients were classified in four patterns of clinical course: “excellent”, “improving”, “relapsing” and “poor”. Variables defined at intake and after the initial year of treatment were analyzed for their prognostic relevance towards the clinical course and outcome of the patients.

Results

The mean age at seizure onset was 6,7 years and the mean duration of follow-up was 8,3 years (range 2,0-22,0,SD 4,24). During the initial year of treatment, 70,3% of patients were seizure-free. The course of epilepsy was “excellent” in 53,1% of the subjects, “improving” in 22,8%, “relapsing” in 22,1% whereas only 6 children with idiopathic epilepsy (2%) had a “poor” clinical course exhibiting drug-resistance. After multivariate analysis, variables predictive of a poor initial response to therapy were early seizure onset, multiple seizure types and history of status epilepticus. At the end of follow-up, early response to treatment was of significant positive predictive value, while the presence of multiple seizure types and the history of migraine had a negative impact on prognosis.

Conclusions

In the vast majority of children, the long-term prognosis of idiopathic epilepsy is favorable. More than half of the patients attain seizure freedom immediately and their clinical course is considered “excellent”. About one fifth exhibit either an improving or a fluctuating course. Early seizure onset, multiple seizure types and status epilepticus are predictive of an initial poor response to treatment in children with idiopathic epilepsy. Initial non-response to treatment, multiple seizure types and history of migraine are determinants of a less favorable final outcome after long-term follow-up.