Ion-Channel Antiepileptic Drugs: An Analytical Perspective on the Therapeutic Drug Monitoring (TDM) of Ezogabine, Lacosamide, and Zonisamide

The term seizures includes a wide array of different disorders with variable etiology, which currently represent one of the most important classes of neurological illnesses. As a consequence, many different antiepileptic drugs (AEDs) are currently available, exploiting different activity mechanisms and providing different levels of performance in terms of selectivity, safety, and efficacy. AEDs are currently among the psychoactive drugs most frequently involved in therapeutic drug monitoring (TDM) practices. Thus, the plasma levels of AEDs and their metabolites are monitored and correlated to administered doses, therapeutic efficacy, side effects, and toxic effects. As for any analytical endeavour, the quality of plasma concentration data is only as good as the analytical method allows. In this review, the main techniques and methods are described, suitable for the TDM of three AEDs belonging to the class of ion channel agents: ezogabine (or retigabine), lacosamide, and zonisamide. In addition to this analytical overview, data are provided, pertaining to two of the most important use cases for the TDM of antiepileptics: drug–drug interactions and neuroprotection activity studies. This review contains 146 references.

What Can We Learn About Art from People with Neurological Disease?

Investigation of people with neurological illnesses has been a central approach to understanding the neurobiology of cognitive systems like language, attention, emotions, and decision-making. Yet such lesion studies had not been applied to neuroaesthetics. In the article under discussion, the author reviewed the extant literature and found that artists were not spared the kind of visual-spatial deficits that others experience from brain damage. Rather, in their artwork, they gave eloquent expression of the nature of their deficits. The author was particularly interested in the paradoxical enhancement of some artists whose work seemed to get better following brain injury, and developed a scale, the Assessment of Art Attributes, by which to assess change in artistic style and content. Neuropsychological studies remain a relatively untapped source of information in probing the biology of aesthetic experiences and artistic production.

Clinico-etiological profile of first episode of seizure and its correlation with electroencephalogram in children aged 2 months to 18 years

Background: Seizure is one of the commonest neurological illnesses. About 4-10% of children experience at least one episode in the first 16 years of life. Approximately 30% of children who experience, first afebrile seizure later develop epilepsy. Risk is approximately 20% if neurological examination, electroencephalogram (EEG) and neuroimaging is normal. The objective of the study is to determine the age of onset, etiology of first episode of seizure in children between the age group of 2 months to 18 years and the pattern of EEG changes in the above group of children.Methods: In a prospective single centre observational study at Cheluvamba tertiary care hospital in Mysore, around 80 children who were admitted with first episode of afebrile seizure to our emergency department between October-2020 to July-2021 (10 months) were studied. Seizures defined using international league against epilepsy (ILAE) and EEG was done for all 80 children and their records were analysed.Results: A total of 80 children presenting with first episode of seizure were included in the study. Toddlers represented the major portion of our study with male gender predominance. Idiopathic seizure was the most common etiology identified (81.2%), followed by meningitis (7.5%). EEG abnormality was seen in 58.7% of the children which was statistically significant (p<0.05). MRI was done in 72.5% of the children, of which abnormality was seen in only 8.6% of the children.Conclusions: Seizure is mainly diagnosed clinically and EEG can be normal in many children. First episode of seizure is common in the age group of 1-3 years. Normal EEG at present may not indicate the non-recurrence in future. Though EEG interpretation is useful, treatment can be started based on clinical diagnosis and has to be individualized.

Next generation sequencing: A promising tool to explore the personalized medicine in understanding the neurodegenerative diseases

Despite the various advances made in the diagnosis and treatments, the incidence of the neurodegenerative diseases has increased manifold during the last few decades. The inadequate early diagnosis appears to be the main reason behind the significant increase in the number of neurodegenerative diseases and their poor prognosis. Next generation sequencing has been discovered as an effective and indicative tool, especially for chronic and severe neurological illnesses, such as Parkinson and Alzheimer. As a clinical apparatus, next generation sequencing will help in creating explicit hereditary focuses for the treatment of neurodegenerative diseases and finding new diagnostic biomarkers. Next-generation sequencing has been demonstrated to be increasingly productive, practical and utilizes molecular determination, which determines biomarkers and different targets quicker and efficiently than the other established diagnostic methods. There is a desperate requirement to change the current treatment and medication regimes in order to make better prognosis for the patients. This can be accomplished by utilizing customized drug to treat neurodegenerative diseases and using next generation sequencing with personal medicine as the method for specialized treatment of the patients suffering from neurodegenerative disorders.

205 - Holocaust survivors residence in Israel and nursing homes around the world during COVID-19 pandemic

Significant risk factors for Covid-19 infection include old age ,somatic illnesses as well as psychiatric and neurological illnesses such as dementia and schizophrenia .This lecture reviews the specific case of measures and considerations that were used to protect elderly holocaust survivors with severe mental illness or dementia, in Israel. We had to protect our residents from the virus, yet preserve certain autonomy.In addition this lecture reviews global aspects of nursing homes struggle during the pandemic as reflected in various periods (at beginning in march 2020, during various waves and after vaccinations). During the pandemic 100 holocaust survivors were monitored and protected in their long term residence at Lev-Hasharon mental health center, Israel with variety of measures such as recurrent PCR tests to inpatients and staff, isolation during fever and after emergency department visits etc. The features of caregivers visits changed in time. The safety measures that were taken in our nursing home and around the world is reviewed as well as the demand for preserving the autonomy and rights of the tenants.At the beginning families could not visit at all and virtual contacts were maintained in patients that could communicate. After the first wave a "drive in" method was carried out, families communicated with their relatives from a car.During the second wave of the virus in Israel (September 2020), an outbreak spread in our residence. 14 patients tested positive for COVID19, all suffering from dementia or schizophrenia. They were immediately placed in quarantine in Corona departments in other geriatric and general hospitals. All patients came back after recovering, small part of them regressed.As the pandemic continued we allowed visits with social distance and masks that were monitored by the staff. After vaccinations we allowed families to be with the elderly patients in the open yard without staff inspection. Four patients were infected during the third wave, although they were immunized.We had to consider every step of the way protection versus some autonomy to our patients and families and weigh creative ways to do this.

Comparative Assessment of Robotic versus Classical Physical Therapy Using Muscle Strength and Ranges of Motion Testing in Neurological Diseases

The use of robotic systems in physical rehabilitation protocols has become increasingly attractive and has been given more focus in the last decade as a result of the high prevalence of motor deficits in the population, which is linked to an overburdened healthcare system. In accordance with current trends, three robotic devices have been designed, called ParReEx Elbow, ParReEx Wrist, and ASPIRE, which were designed to improve upper-limb medical recovery (shoulder, elbow, forearm, and wrist). The three automated systems were tested in a hospital setting with 23 patients (12 men and 11 women) suffering from motor deficits caused by various neurological diseases such as stroke, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS). The patients were divided into three groups based on their pathology (vascular, extrapyramidal, and neuromuscular). Objective clinical measures, such as the Medical Research Council (MRC) scale, goniometry, and dynamometry, were used to compare pre- and post-rehabilitation assessments for both robotic-aided and manual physical rehabilitation therapy. The results of these tests showed that, with the exception of a few minor differences in muscular strength recovery, the robotic-assisted rehabilitation methods performed equally as well as the manual techniques, though only minor improvements were validated during short-term rehabilitation. The greatest achievements were obtained in the goniometric analysis where some rehabilitation amplitudes increased by over 40% in the vascular group, but the same analysis returned regressions in the neuromuscular group. The MRC scale analysis returned no significant differences, with most regressions occurring in the neuromuscular group. The dynamometric analysis mostly returned improvements, but the highest value evolution was 19.07%, which also in the vascular group. While the results were encouraging, more research is needed with a larger sample size and a longer study period in order to provide more information regarding the efficacy of both rehabilitation methods in neurological illnesses.

A Review of the Potential Use of Pinene and Linalool as Terpene-Based Medicines for Brain Health: Discovering Novel Therapeutics in the Flavours and Fragrances of Cannabis

“Medicinal cannabis” is defined as the use of cannabis-based products for the treatment of an illness. Investigations of cannabis compounds in psychiatric and neurological illnesses primarily focus on the major cannabinoids, cannabidiol (CBD) and Δ9-tetrahydrocannabinol (Δ9-THC), which are hypothesised to benefit multiple illnesses manifesting cognitive impairment, neurodegeneration and neuro-inflammation, as well as chronic pain, epilepsy and post-traumatic stress disorder, respectively. The cannabis plant contains &gt;500 compounds, including terpenes responsible for the flavour and fragrance profiles of plants. Recently, research has begun providing evidence on the potential use of certain plant-derived terpenes in modern medicine, demonstrating anti-oxidant, anti-inflammatory, and neuroprotective effects of these compounds. This review examined the effects of two key terpenes, pinene and linalool, on parameters relevant to neurological and psychiatric disorders, highlighting gaps in the literature and recommendations for future research into terpene therapeutics. Overall, evidence is mostly limited to preclinical studies and well-designed clinical trials are lacking. Nevertheless, existing data suggests that pinene and linalool are relevant candidates for further investigation as novel medicines for illnesses, including stroke, ischemia, inflammatory and neuropathic pain (including migraine), cognitive impairment (relevant to Alzheimer's disease and ageing), insomnia, anxiety, and depression. Linalool and pinene influence multiple neurotransmitter, inflammatory and neurotrophic signals as well as behaviour, demonstrating psycho-activity (albeit non-intoxicating). Optimising the phytochemical profile of cannabis chemovars to yield therapeutic levels of beneficial terpenes and cannabinoids, such as linalool, pinene and CBD, could present a unique opportunity to discover novel medicines to treat psychiatric and neurological illnesses; however, further research is needed.

A Case Study on the Effectiveness of Kabat Rehabilitation in a Patient with Bell’s Palsy

One of the most prevalent neurological illnesses affecting the VII cranial nerve is paralysis of facial nerve. The loss of sophisticated and multidimensional capabilities such as expression of emotions via facial mimicry, face identification, and communication is caused by nerve paralysis. Through stimulation of the proprioceptors, the Kabat rehabilitation therapy for facial paralysis can trigger or restore the neuromuscular circuit, restoring the normal functionality of nerve terminals in the muscles.This study aims to show how a patient can gain functional & aesthetic benefits through detailed clinical evaluation followed by kabat rehabilitation. Functionality evaluation of the facial nerve was based on the SFGS,FDI and H- B scales Patients who were treated with kabat rehabilitation method restored motor capacities of the paralysed hemifacia. Keywords: Kabat rehabilitation, facial nerve, facial palsy, proprioceptive facilitation, rehabilitation.

Review on various factors responsible for neurodegenerative disorders

Neurodegenerative disorders are nervous system disorders that result in the loss of neuronal structure and function. As shown in Alzheimer's and Parkinson's disease, these changes cause a loss of various capacities, including cognition and mobility. Several factors have been discovered to play a critical role in the etiology of common neurological illnesses, including oxidative stress and protein misfolding. It's still unclear if these factors cause or contribute to the progression of the illnesses. Despite efforts to understand the molecular and pathophysiological mechanisms behind these pathways, many aspects remain unknown. The goal of this review is to investigate the numerous factors linked to neurodegeneration.

Knowledge, attitudes, and impact of COVID-19 pandemic among neurology patients in Jordan: a cross-sectional study

Background The impacts of the COVID-19 pandemic on health services offered to patients with non-communicable diseases, including chronic neurological illnesses, are diverse and universal. We used a self-reported questionnaire to investigate these impacts on neurology patients in Jordan and assess their knowledge and attitudes towards the pandemic. Results Most respondents had positive attitudes towards the COVID-19 pandemic, with 96% reporting they believed in the seriousness of the pandemic and adhered to prevention measures. Nearly 97% resorted to the internet and media outlets for medical information about the pandemic. About one in five clinic visitors had their appointments delayed due to interruption of health services. A similar portion of patients with MS, epilepsy, and migraine or tension headache reported medication interruptions during the pandemic. One in two patients reported new events or worsening illness since the start of the pandemic, and sleep disturbances were reported by nearly one in three patients who had epilepsy or headache. Conclusion The COVID-19 pandemic’s impacts on patients with neurological illnesses in Jordan were deep and diverse. Meanwhile, the majority of surveyed neurology patients demonstrated a positive attitude towards the pandemic.