"Wearing-off" efficacy of CGRP monoclonal antibodies for migraine prevention: A meta-analysis of randomized controlled trials.

BACKGROUND: A new migraine prevention, CGRP monoclonal antibodies (mAbs), is injectable on a monthly or quarterly basis. In clinical practice, some patients reported that drug effectiveness does not last until the upcoming scheduled injection, a so-called "wearing-off" effect. We aimed to evaluate the wearing-off effect of the CGRP mAbs for migraine prevention in patients with different monthly migraine days. METHODS: We conducted a literature search for studies that reported migraine frequency after CGRP monoclonal antibody administration from MEDLINE, SCOPUS, Web of Science, and Cochrane Database from inception through February 2022. A meta-analysis, random-effects model was applied to assess the difference in migraine frequency between early and later weeks after medication to assess the presence of a wearing-off effect. Risk ratio was calculated to report the pooled treatment effect. RESULTS: Four studies were entered for the analysis, comprising 2409 patients in randomized controlled trials. There was no association between CGRP mAbs and wearing-off effect in patients with galcanezumab with a pooled risk ratio of 1.29 (95% CI 0.73 to 2.28) compared to placebo group. However, there was an association between galcanezumab and wearing-off effect in patients with chronic migraine with a pooled risk ratio of 1.91 (95% CI 1.11 to 3.28) compared to placebo group. CONCLUSION: In this meta-analysis, there was a wearing-off efficacy of galcanezumab but only in a small percentage of patients with chronic migraine in randomized controlled trials.

Potential risk factors for psychiatric disorders in patients with headache.

BACKGROUND: Psychiatric comorbidities are common among patients with headache. These can compromise the quality of life of patients and may affect the result of treatment. No available systematic study concerning this problem has been conducted in Thailand. OBJECTIVE: The study aimed to determine the prevalence and risk factors of psychiatric disorders in patients with headache in tertiary care facility. METHODS: The study was conducted at the Headache Clinic, King Chulalongkorn Memorial Hospital in Bangkok, Thailand. One hundred and thirteen patients were enrolled. Diagnosis of headache was made based on International Classification of Headache Disorders II system. Mental disorders were assessed using Primary Care Evaluation of Mental Disorders. Other possible risk factors were extracted using significant physical symptoms count and accumulated risk for mental disorder. RESULTS: Of the 113 samples analyzed, the prevalence of depression, anxiety, and somatoform disorder was found to be 29.2%, 9.7%, and 27.4%, respectively. No definite relationship between headache types and mental disorders was observed. High number of significant physical complaints and health concerns significantly increased the risk for depression (OR = 4.6, 95% CI = 1.6 to 13.5) while the level of possible risk for mental disorder was associated with an increased risk for somatoform disorder (OR = 1.6, 95% CI = 1.2 to 2.2). CONCLUSION: The study confirmed high prevalence of psychiatric comorbidities in patients with headache. The results of this study will raise the awareness of physicians to possible underlying mental disorders in patients with headache and facilitate appropriate treatment or psychiatric referral.

The low prevalence of primary restless legs syndrome in Thai Parkinson's disease patients at Chulalongkorn University Hospital.

OBJECTIVE: There have been many studies of the prevalence of restless legs syndrome (RLS) in Parkinson's disease (PD). Some studies found a lower prevalence than in comparable groups in the general population while others reported more RLS. The present study was designed to determine the prevalence of primary RLS in Thai PD patients. MATERIAL AND METHOD: PD patients were interviewed for RLS symptoms and were excluded if they had a malignancy, endstage renal disease, neuropathy, a history of spinal cord diseases or were pregnant. Serum ferritin levels were measured. RESULTS: Three out of 183 patients interviewed (1.6%) had symptoms consistent with RLS. When one patient who had a serum ferritin level of 31.9 ng/ml is excluded, the prevalence falls to 0.98%. None of the following variables were significantly different in patients with and without RLS: age, gender age at onset of PD, duration of PD, Hoehn and Yahr stage, serum ferritin level and dose and duration of dopaminergic medication. None of the patients who have had subthalamic nucleus deep brain stimulation (n = 5) had RLS. CONCLUSION: The prevalence of RLS in Thai PD patients was found to be much lower than in most of the previous studies, especially those conducted in Europe and America.

Preventive treatment response associated with migraine aura subtypes in a Thai population.

Introduction: Some studies indicate a different response to treatment between migraine patients with and without aura. Objectives: To determine whether aura, or simple or complex aura subtypes, are clinical markers predicting response to preventive treatment. Methods: Conducted a retrospective cohort study at a headache clinic in a tertiary referral hospital. We included data from patients registered from 1 November 2014, to 30 June 2022, having migraine with or without aura, or with simple or complex aura, and who had received migraine preventive treatments with at least 3 months follow-up. The primary outcome was a response to preventive treatment defined as at least a 50% reduction from a baseline of monthly migraine or headache days (MMDs/MHDs). Secondary outcomes were improvement in quality of life and disability scores. Results: For migraine patients with (45) and without (123) aura who took a migraine preventive with at least 3 months follow-up; except for median age, which was older for patients without aura, baseline sex, comorbidity, and migraine data were without significant difference including median history of migraine, chronic migraine subtype, chronic migraine with medication-overuse headache, median or mean MMDs/MHDs, number of preventive medications used, or migraine preventive medication inhibiting spreading depolarizations. Treatment outcomes at 3 and 6 months follow-up were not significantly different between migraine patients with and without aura, or with simple and complex aura, but tended to be greater in those with aura and those with complex aura. After adjustment for baseline comorbidity, migraine subtypes, aura subtypes, the number of preventives used, history of migraine, and MMDs/MHDs, we found no significant differences in 30% and 50% reduction from baseline of MMDs/MHDs in 3 or 6 months or most recent follow-up. Conclusions: Preventive treatment response tended to be associated with migraine aura subtypes. We found preventive treatment response tended to have more favorable outcomes in those with aura, especially those with complex aura.

The impact of phosphate lowering agents on clinical and laboratory outcomes in chronic kidney disease patients: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Besides reducing hyperphosphatemia in chronic kidney disease (CKD) patients, phosphate lowering agents might provide beneficial effects on clinical and laboratory parameters. This meta-analysis was conducted to comprehensively examine the impact of all phosphate lowering agents on various aspects of clinical and laboratory outcomes in CKD patients. METHOD: A systematic literature search was performed in MEDLINE, Scopus, and the Cochrane Register of Controlled Trials until July 2020 to identify randomized controlled trials (RCTs) which compared the effects of each phosphate lowering agent with controls, comprising placebo and all other phosphate lowering agents. Various clinical and laboratory outcomes were analyzed. Random effects model was used to compute the standardized mean difference for continuous variables and the risk ratio (RR) for binary variables. RESULTS: This meta-analysis included 127 RCTs with 20,215 patients. Sevelamer and lanthanum significantly reduced all-cause mortality (RR 0.610, 95% CI 0.401-0.929 and 0.467, 95% CI 0.337-0.647, respectively) but not cardiovascular (CV) mortality or CV events. Hospitalization rates were significantly diminished by sevelamer (RR 0.527; 95% CI 0.308-0.902). Certain phosphate lowering agents improved biochemical parameters including serum phosphate, calcium, coronary artery calcium scores, fibroblast growth factor-23, bone biomarkers, and lipid profiles. Intact parathyroid hormone and bone mineral density were not significantly changed. CONCLUSIONS: In addition to decreasing serum phosphate levels, various beneficial effects on clinical and laboratory parameters of phosphate lowering agents might play potential roles in diminishing morbidity and mortality in CKD patients.

A national registry to determine the distribution and prevalence of Parkinson's disease in Thailand: implications of urbanization and pesticides as risk factors for Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) occurs worldwide but prior to this review of data from the Thailand Parkinson's Disease Registry there had been no nationwide PD registry reported globally. OBJECTIVE: To determine the distribution and prevalence of PD in Thailand and related risk factors in order to more adequately develop and allocate prevention and treatment resources where they are most needed and to ascertain risk factors that are specific to the Thai population. DESIGN: The Thailand Parkinson's Disease Registry is a new resource, and data collection began in March 2008. Data is collected by the Registry from physicians, and a mechanism is also provided for patients to self-report. This data was further analyzed by the capture-recapture methodology (CRM) to assess reporting biases. METHODS: The three main sources of data input to the Registry, i.e. (1) public hospitals, (2) private hospitals and (3) self-registration, require checking for duplicates and also allow estimation of completeness of recording (the degree of underreporting) in this disease registry. There is underreporting because of poor record keeping and administrative procedures in some facilities, and there is an unknown number of persons with PD who are not properly diagnosed because of inadequate facilities and staffing in some areas. Since our data sources should be overlapping in some way, and assuming that the likelihood of being detected in one system is independent of the others, we estimated these data sources' actual coverage and the expected total number of patients utilizing the 'capture-recapture' statistical technique. RESULTS: As of March 2011, the Thailand PD Registry had identified 40,049 PD patients. Employing log-linear modeling, the CRM analysis based on the three data sets estimated underreporting of 20,516 cases. The revised estimated total is thus 60,565 cases, resulting in a crude and age-adjusted prevalence of 95.34 and 424.57 PD cases/100,000 population, respectively. The prevalence of PD was 126.83/100,000 in urban areas and 90.82/100,000 in rural areas (p < 0.001). Preliminary regional comparisons revealed a higher prevalence of PD in residents of the central plain valley of Thailand, an area with a large amount of pesticide use. CONCLUSIONS: The combination of a passive registry and the CRM technique allowed us to derive population prevalence estimates for PD in Thailand. Thai PD prevalence estimates were similar to previous ones published for Asian countries; in addition, they suggested that urbanization and exposure to pesticides may both be risk factors for PD in the Thai population.

Factors Associated with the Incidence and Mortality of Coronavirus Disease 2019 (COVID-19) after 126-million Cases: A Meta-analysis.

OBJECTIVES: This meta-analysis was conducted to investigate the current global incidence and mortality of COVID-19 and also explored the associated factors including geographic variations, transmission scenarios, country economic status, and healthcare performance. METHODS: The search was conducted in online databases based on reports from national authorities by March 28, 2021. Random-effects model meta-analyses and meta-regression analyses were used to generate summary estimates and explored sources of heterogeneity. RESULTS: The cumulative number of confirmed COVID-19 cases was 125,704,789 reported by 216 countries. The pooled Daily Cumulative Index (DCI) was 1423.87 cases/day which was highest in South America (2759.15 cases/day) followed by North America (2252.49 cases/day), Europe (1858.44 cases/day), Asia (1484.84 cases/day), Africa (193.09 cases/day), and Australia/Oceania (18.55 cases/day). The overall pooled mortality rate of COVID-19 was 1.53%. Higher income countries and countries with community transmission had higher DCI. By meta-regression, country total health expenditure per capita, percentage of universal health coverage, and total number of tests were associated with higher DCI. On the contrary, country Gross Domestic Product (GDP) per capita were negatively correlated with mortality rate. CONCLUSION: To date, 216 countries around the world are affected by COVID-19. Higher income, GDP, and countries' investments on heath are associated with higher DCI while higher GDP correlates with lower mortality. Community transmission route have more impact on the incidence and mortality of COVID-19.

Thai-version Migraine Disability Assessment (MIDAS) questionnaire: concurrent validity, test-retest reliability, internal consistency, and factors predictive for migraine-related disability.

Background: A Thai-version of the Migraine Specific Quality of Life Questionnaire (MSQ 2.1) is available, but a qualified questionnaire used specifically for disability assessment was not available. The most relevant practical disability assessment tested during this study was the Migraine Disability Assessment (MIDAS) Questionnaire. Objectives: To test the concurrent validity, test-retest reliability, and internal consistency of a Thai-version MIDAS questionnaire, and factors to predict disability in people with migraine. Methods: We conducted the present prospective study at a tertiary care teaching hospital in Bangkok. The original English MIDAS Questionnaire was translated into Thai with back-translation into English and the language equivalence was assessed. The Thai-version MIDAS Questionnaire was tested for concurrent validity, test-retest reliability, and internal consistency, and factors including duration of migraine history, migraine characteristics, and comorbidity were assessed for the ability to predict migraine-related disability of migraineurs. Results: Of the 58 participants, 31 were eligible to be included. The validity of the Thai-version questionnaire between the MIDAS total score and the mean headache severity (question B), the mean pain duration per attack, and the mean pain numerical rating scale (NRS) score were moderately correlated with a Spearman correlation coefficient range 0.42-0.58. The test-retest reliability of MIDAS grade had a weighted κ of 0.66, and for individual questions of the MIDAS total score, questions A and B assessed by intraclass correlation coefficients ranged 0.89-0.98. The internal consistency had a Cronbach α of 0.98. The mean pain NRS score in the past 3 months was an independent predictive factor for migraine-related disability. Conclusion: The Thai-version MIDAS Questionnaire has moderate concurrent validity, acceptable internal consistency, and excellent test-retest reliability. It would be helpful to assess clinical outcomes. Future study with a standardized translation process for the Thai-version questionnaire and a larger sample size is warranted to confirm internal consistency and determine all probable predictive factors for migraine-related disability.

Reliability of the Thai Version of the Motion Sickness Susceptibility Questionnaire Short-Form.

INTRODUCTION: Motion sickness is a feeling of unwellness and introduces a significant safety risk. If a specific questionnaire to screen for motion sickness susceptibility is available, it would have benefit for susceptible people. This aimed at examining test-retest reliability and internal consistency of the Thai, non-English version Motion Sickness Susceptibility Questionnaire Short-Form (MSSQ-Short).METHODS: The original English-version MSSQ-Short was translated into Thai and then had a backward translation into English. The process of forward and backward translation was repeated until fulfillment of content and language equivalence between the backward translation and the original questionnaire. The Thai-version MSSQ-Short then was applied to people with history of motion sickness for two occasions with a 2-wk interval. The two questionnaires were examined for test-retest reliability and the first occasion was examined for internal consistency. MSSQ total raw score and percentile score between the first and second occasions were tested for correlation.RESULTS: The questionnaires were completed by 30 subjects. The weighted kappa values between the two occasions for the 18 subitems of the MSSQ ranged from 0.38 to 0.86, with most being in the higher range. The Pearson's correlation coefficient of the MSSQ raw score between the two occasions was 0.94. The internal consistency was 0.80.CONCLUSION: The Thai, non-English version MSSQ-Short had an acceptable value for reliability. Further studies should be conducted with a larger sample size and with other populations.Asawavichienjinda T, Patarapak S. Reliability of the Thai version of the Motion Sickness Susceptibility Questionnaire Short-Form. Aerosp Med Hum Perform. 2019; 90(1):26-31.

A randomized controlled study of intravenous fluid in acute ischemic stroke.

OBJECTIVE: To compare the outcome of patients with acute ischemic stroke who received or did not receive intravenous fluid. PATIENTS AND METHODS: This study was a prospective, multicenter, randomized, open-label trial with blinded outcome assessment. We enrolled acute ischemic stroke patients without dehydration aged between 18 and 85 years with NIH Stroke Scale score (NIHSS) score from 1 to 18 who presented within 72h after onset. Patients were randomly assigned to receive 0.9% NaCl solution 100ml/h for 3days or no intravenous fluid. RESULTS: On the interim unblinded analysis of the safety data, significant excess early neurological deterioration was observed among patients in the non-intravenous fluid group. Therefore, the study was prematurely discontinued after enrollment of 120 patients, mean age 60 years, 56.6% male. Early neurological deterioration (increased NIHSS ≥3 over 72h) not of metabolic or hemorrhagic origin was observed in 15% of the non-IV fluid group and 3.3% of the IV fluid group (p=0.02). Predictors of neurological deterioration were higher NIHSS score, higher plasma glucose, and increased pulse rate. There was no difference in the primary efficacy outcome, NIHSS≤4 at day 7, 83.3% vs 86.7%, p=0.61 or secondary efficacy outcomes. CONCLUSION: Administration of 0.9% NaCl 100ml/h for 72h in patients with acute ischemic stroke is safe and may be associated with a reduced risk of neurological deterioration. These study findings support the use of intravenous fluid in acute ischemic stroke patients with NIHSS less than 18 who have no contraindications.

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors.

OBJECTIVE: The aim of this subgroup analysis was to identify the risk factors associated with the development of various movement disorder phenotypes. METHODS: Eighty-three non-Wilsonian cirrhotic patients with abnormal movements were allocated into the following groups: intention tremor, bradykinesia, Parkinsonism, and abnormal ocular movements. These movement types were considered the primary outcomes as there was a sufficient sample size. Researchers took into consideration the gender, etiologies of cirrhosis, cirrhosis-related complications, hepatic encephalopathy, medical illness, and some neurological deficits as potential factors associated with these movement disorders. RESULTS: The male gender (p = 0.002) and alcoholic cirrhosis (p = 0.005) were significant factors for the prevalence of intention tremors. In bradykinesia, hepatic encephalopathy was highly statistically significant (p < 0.001), and females more commonly developed bradykinesia (p = 0.04). The Parkinsonism features in this study were confounded by hyperlipidemia (p = 0.04) and motor or sensory deficits (p = 0.02). Jerky pursuits and a horizontal nystagmus were detected. Jerky pursuits were significantly related to hepatic encephalopathy (p = 0.003) and bradykinesia, but there were no factors associated with the prevalence of nystagmus other than an intention tremor. CONCLUSIONS: The association of alcoholic cirrhosis with the development of intention tremor indicates that the persistent cerebellar malfunction in cirrhotic patients is due to alcohol toxicity. The slowness of finger tapping and jerky pursuit eye movements are significantly associated with hepatic encephalopathy. Thus, further studies are needed to evaluate the diagnostic value of these two signs for an early detection of mild hepatic encephalopathy.

Movement Disorders in Non-Wilsonian Cirrhotic Patients: A Report of the Prevalence and Risk Factors from a Study Done in a Medical School in an Agricultural-Based Community.

OBJECTIVE: Parkinsonism and other movement disorders have previously been reported in the acquired hepatocerebral degeneration associated with portosystemic shunting. However, there is no study to date about their prevalence as has been noted in general practice. METHODS: One hundred and forty-three patients with hepatic cirrhosis from the gastroenterology clinic and internal medicine wards were enrolled. Liver data included the diagnoses, etiologies, assessments of complications, and treatments for cirrhosis. Hepatic encephalopathy was classified with regard to the West Haven criteria for semi-quantitative grading for mental status. Neurological examination results and abnormal involuntary movements were recorded as primary outcomes. Neuro-radiology was used for the detection of severe brain lesions. RESULTS: Alcoholism was the most common cause of liver cirrhosis. Eighty-three patients (58%) presented with movement disorders. Asterixis was found in one of the cases. The most common movement disorder seen was an intentional tremor at 37.1%, which was followed by bradykinesia, Parkinsonism, and postural tremors at 29.4%, 10.5%, and 6.3%, respectively. The prevalence of movement disorders simultaneously increased with a high Child-Turcotte-Pugh score. The hepatic encephalopathy was grade 1 and 2. With the inclusion of age-range adjustments, we found that alcoholic cirrhosis and hepatic encephalopathy are statistically significant factors [p < 0.05, odds ratio (OR) = 6.41, 95% confidence interval (CI) 1.38-29.71 and p < 0.001, OR = 13.65, 95% CI 4.71-39.54] for the development of movement disorders in non-Wilsonian cirrhotic patients. CONCLUSIONS: Intentional tremor is a common abnormal movement. Alcoholic cirrhosis and hepatic encephalopathy are significant risk factors in the development of movement disorders in non-Wilsonian cirrhotic patients.

The Thai version of the quality-of-life in epilepsy inventory (QOLIE-31-Thai version): translation, validity and reliability.

OBJECTIVE: To assess the validity and reliability of the QOLIE-31-Thai Version. MATERIAL AND METHOD: The original questionnaire of the QOLIE-31 was first translated into Thai and, then, item comprehension was assessed. Back translation into English and cross-cultural modification were conducted. Its reliability was assessed using a sample of consenting epileptics aged 18-65 years visiting community hospitals in Nakhon Ratchasima Province, Thailand. RESULTS: One hundred and sixty one epileptics completed the questionnaire. The internal consistency of each scale of the QOLIE-31 was above the accepted standard of 0.7, except for Cognitive Functioning, Medication Effect and Social Functioning. CONCLUSION: The QOLIE-31-Thai Version is reliable for use in Thai rural epileptics even for low educated epileptics but interviews might have to be used instead.

Compliance with treatment of adult epileptics in a rural district of Thailand.

BACKGROUND: Epilepsy, a disease when seizures can occur from antiepileptic drug withdrawal, requires regular drug taking. Non-compliance, therefore, is a major factor contributing to sub-optimal control of the seizures. PURPOSE: To determine the factors associated with noncompliance in epileptics in rural Thailand. METHOD: All epileptics, registered in the Pak Thong Chai District and their caregivers were invited to be interviewed and examined by a neurologist in their village. RESULTS: Of a total of 93 epileptics registered, 83 with their caregivers were interviewed and examined by the neurologist (T.A.) and of those 72 were adults. Of the 72 adult epileptics, 41 (56.9%) were 100 per cent compliant and factors found to be significantly associated with compliance were gender, household income and patient's health insurance (p-value < 0.05). The major reasons for non-compliance were misunderstanding (48.4%), forgetfulness (16.1%) and economic problem (12.9%). CONCLUSION: To improve patient-compliance, the real factors for non-compliance, which are unique to patients in a specific area, need to be identified.

Prevalence of epilepsy in rural Thailand: a population-based study.

BACKGROUND: A study of the community-based burden of illness based upon prevalence is needed to plan intervention strategy. PURPOSE: To determine the prevalence of epilepsy in a rural population in Thailand. METHOD: From January to June, 2000, all of the people in Talardkav sub-district were invited to be interviewed and examined by a neurologist who visited their village. RESULTS: Of the 2,069 people in 553 households who gave information (72.2% of the total households), 43 had a history of seizure and of the 43, 15 were epileptics. The prevalence of epilepsy was estimated at 7.2 per 1,000 population. The highest two peaks were in the age groups of 5-9 and 25-34 years (17.0, 17.4/1,000, respectively). CONCLUSION: The prevalence of epilepsy in rural Thailand is low, although probably underestimated, but it is the best to date for rural Thailand.

Prevalence of neuroleptic-induced restless legs syndrome in patients taking neuroleptic drugs.

Dopamine deficiency or dopamine dysfunction has been implicated as one of the factors involved in the pathophysiology of restless legs syndrome (RLS). Our objective is to determine the prevalence of primary RLS in patients taking neuroleptic drugs. One hundred patients taking neuroleptic drugs and 100 healthy age- and sex-matched controls were interviewed with the Cambridge-Hopkins diagnostic questionnaire for RLS. Patients with malignancy, end-stage renal disease, neuropathy, history of spinal cord diseases, pregnancy and Parkinson's disease were excluded. Only one patient had symptoms consistent with RLS (1%), similar to one patient in the control group. She was a 40 years old female with a diagnosis of depression. She started having RLS symptoms approximately four years after starting perphenazine. The symptoms persisted after the medications were discontinued but decreased in severity and frequency. Her serum ferritin level was 90.3 ng/ml. The prevalence of primary RLS is low in patients attending the out-patient clinic who are taking neuroleptic drugs. Other factors apart from dopaminergic dysfunction are likely to be involved in the pathogenesis of RLS.

Diagnostic utility of NMO/AQP4-IgG in evaluating CNS inflammatory disease in Thai patients.

Epidemiological studies in Thailand have reported that inflammatory demyelinating diseases (IDDs) commonly affect the optic nerve and spinal cord. We investigated the diagnostic utility of aquaporin (AQP)-4-IgG testing in 31 consecutive patients evaluated for CNS IDDs in 3 academic Thai hospital neurology clinics between February 2008 and January 2009. Patients were classified into 3 clinical diagnostic groups: Neuromyelitis optica (NMO, n=10) multiple sclerosis (MS, n=5) and unclassified IDD (n=16). All sera were tested blindly by cell binding (Euroimmun) assay (CBA). Sera were also tested by indirect immunofluorescence assay (IFA) and ELISA (RSR/Kronus). After initial screening by CBA, AQP4-IgG was detected in 6 NMO patients (60%); 3 of the 4 seronegative cases were receiving immunosuppressants. AQP4-IgG was detected in 13 unclassified IDD cases (81%), but in no MS cases. Cell binding assay and ELISA were more sensitive than IFA (p=0.0004). The 81% seropositivity rate in "unclassified" patients suggests that AQP4 autoimmunity accounts for a significant proportion of Thai CNS inflammatory demyelinating disease, especially those with optic neuritis or transverse myelitis, with or without abnormal brain MRI, in whom a specific diagnosis or clear-cut treatment approach is unclear.

A preliminary study of chemo- and cytokine responses in rabies vaccine recipients of intradermal and intramuscular regimens.

Plasma from 10 patients who had received rabies vaccine either intradermally (ID) or intramuscularly (IM) was examined for 20 chemo- and cytokines. Plasma samples were withdrawn on days 0, 3 and 7 after vaccination. These chemo- and cytokines and sampling days were chosen based on data collected from a protein array analysis of 122 cytokines conducted on one recipient of vaccine administered IM and one recipient of vaccine administered ID. Although eotaxin, interleukin (IL)-5 in the ID and IL-1 beta in the IM group were the only chemo- and cytokines that reached statistical significance (p<0.05), the overall trends may suggest bias on Th1 or Th2 according to vaccination routes. IL-1 alpha, -2, and -6, hemofiltrate cysteine-cysteine chemokine (HCC-4), glucocorticoid induced tumor necrosis factor receptor (GITR), tumor necrosis factor (TNF) related apoptosis inducing ligand-receptor (TRAIL-R3) had some degree of elevation in the ID group. TNF-alpha, gamma-interferon, granulocytes/macrophages - colony stimulating factor (GM-CSF), transforming growth factor (TGF)-beta, lymphotactin and pulmonary and activation-regulated chemokine (PARC) were elevated, although not to a significant level, in the IM group. IL-12, interferon-inducible T cell alpha chemoattractrant (I-TAC) and sertoli cell factor (SCF) were not significantly elevated in both groups whereas IL-4 and -10 were unchanged. Further studies are required to determine whether the presence of specific chemokines, such as eotaxin, is responsible for the production of high levels of rabies virus neutralizing antibody after administration of the dose-sparing ID regimen.

Predictive risk factors of seizure-related injury in persons with epilepsy.

OBJECTIVE: The clinical risk factors for seizure-related injuries (SRI) in adult persons with epilepsy (PWE) were studied and analyzed to develop a predictive model. METHODS: We enrolled 300 consecutive cases from three epilepsy clinics in Northeast, Thailand. Subjects were eligible if reported to have at least one seizure attack during the past 12 months. Face-to-face questionnaire was used to evaluate SRI, baseline characteristics and other seizure-related variables. RESULTS: There were 247 and 91 PWE who met a criterion and had SRI, respectively. By multivariate logistic regression method, GTC seizure type, having history of seizure attacks at least 12 times/year, and daytime seizure were significant risk factors of having SRI with odds ratio of 2.376, 2.460, and 3.562, respectively. We developed the predictive model for having SRI in PWE and it gave 90.3% sensitivity and 46.7% specificity on the occurrence of SRI. The estimated probability of SRI can be found online at http://sribykku.webs.com/. CONCLUSIONS: The significant predictive factors for SRI in PWE were the occurrence of GTCs, seizures at least 12 times/year or daytime seizures. Clinicians or PWE can easily evaluate the risk of having SRI in individuals by the online predictive model.