Transcutaneous Vagus Nerve Stimulation in Patients With Severe Traumatic Brain Injury: A Feasibility Trial.

OBJECTIVES: Preclinical studies have shown that surgically implanted vagus nerve stimulation (VNS) promotes recovery of consciousness and cognitive function following experimental traumatic brain injury (TBI). The aim of this study is to report the feasibility and safety of a noninvasive transcutaneous vagus nerve stimulation (tVNS) in patients with persistent impairment of consciousness following severe TBI. MATERIALS AND METHODS: The feasibility of tVNS was evaluated in five patients presenting with diffuse axonal injury and reduced dominant EEG activity one month following severe TBI. tVNS was applied to the left cymba conchae of the external ear using a skin electrode four hours daily for eight weeks. Possible effects of tVNS on physiological parameters and general side effects were recorded. In addition, we report the rate of recovery using coma recovery scale revised (CRS-R). RESULTS: The tVNS regime of four hours daily for eight weeks was feasible and well tolerated with little side effects and no clinically relevant effects on physiological parameters. Three patients showed improvements (>3 points) in the CRS-R following eight weeks tVNS. CONCLUSION: We demonstrated that tVNS is a feasible and safe VNS strategy for patients following severe TBI. Controlled studies are needed to clarify whether tVNS has a potential to promote recovery of consciousness following severe TBI.

Forest law compliance and enforcement: the case of on-farm timber extraction in Ghana.

The paper investigates law compliance in case of on-farm timber extraction in Ghana. It empirically investigates compliance with rules that (i) require timber operators to obtain prior and informed consent from the farmers, (ii) require timber operators to pay appropriate and timely compensation for crop damage caused by timber extraction and (iii) ban chainsaw lumbering. The study documents a low level of compliance in all three domains. Subsequently, the paper discusses the underlying causes for the observed low compliance. The low compliance level is attributed to a legislation, and enforcement, that provides huge financial incentives for non-compliance for both farmers and timber operators, and in the latter case both with and without legal permits. At the same time the regulation is perceived to violate their moral values. The paper underlines the interests of the political elite as decisive in shaping the current regulation and the way it is implemented on the ground. It asserts that eliciting compliance requires consideration of both the instrumental and normative perspectives; else it becomes illusive. The study thus challenges the typical response of governments in developing countries, who, supported by donor agencies, attempt to elicit compliance through enhanced law enforcement efforts. The results presented on the Ghana case suggest that such an approach is unlikely to elicit compliance.

Truncation of the Down syndrome candidate gene DYRK1A in two unrelated patients with microcephaly.

We have identified and characterized two unrelated patients with prenatal onset of microcephaly, intrauterine growth retardation, feeding problems, developmental delay, and febrile seizures/epilepsy who both carry a de novo balanced translocation that truncates the DYRK1A gene at chromosome 21q22.2. DYRK1A belongs to the dual-specificity tyrosine phosphorylation-regulated kinase (DYRK) family, which is highly conserved throughout evolution. Given its localization in both the Down syndrome critical region and in the minimal region for partial monosomy 21, the gene has been studied intensively in animals and in humans, and DYRK1A has been proposed to be involved in the neurodevelopmental alterations associated with these syndromes. In the present study, we show that truncating mutations of DYRK1A result in a clinical phenotype including microcephaly.

Balanced translocation in a patient with severe myoclonic epilepsy of infancy disrupts the sodium channel gene SCN1A.

In a patient with severe myoclonic epilepsy of infancy (SMEI), we identified a de novo balanced translocation, t(2;5)(q24.3,q34). The breakpoint on chromosome 2q24.3 truncated the SCN1A gene and the 5q34 breakpoint was within a highly conserved genomic region. Point mutations or microdeletions of SCN1A have previously been identified in SMEI patients, but this is the first report of a balanced translocation disrupting the SCN1A gene in an epilepsy patient. We therefore recommend that SMEI patients without SCN1A microdeletions or point mutations should be investigated for chromosomal rearrangements.