Real-world practices in reproductive health and counselling for women with epilepsy: A Canadian perspective.

Canadian women of reproductive potential living with epilepsy present unique care challenges due to the complex interplay of hormones, seizures, and medications. This study explores reproductive health practices and counselling for women with epilepsy. Through a questionnaire developed by the Canadian League Against Epilepsy women with epilepsy (WWE) workgroup, we are the first to report demographic and real-world practice characteristics of Canadian healthcare professionals providing care for WWE with specific focus on family planning, birth plans, and postpartum care counselling. Among respondents, 76.9% routinely reviewed contraception with patients and an intrauterine device (IUD) was the most popular recommended method (85.3%). With regards to preconception planning, 50% of respondents routinely had a preconception drug level prior to pregnancy. A significant proportion, 44.9%, reported not communicating a neurology-informed birth plan to obstetrical health practitioners. The majority recommended breastfeeding for WWE on anti-seizure medications (92.3%) and regularly provided safety counselling for women in the postpartum period (84.6%). Overall, our study demonstrates that Canadian practice patterns conform reasonably well to existing evidence and guidelines, although important gaps in care exist.

Food security and its association with socioeconomic status and dietary diversity in free living older people in Tehran, Iran.

BACKGROUND: Food security is a function of food access and dietary diversity. Older age is a period when adequate and diverse dietary intake is a challenge. This study aimed to investigate the association between food security on the one hand and dietary diversity and socioeconomic factors on the other hand among the free-living older people in the city of Tehran. METHODS: In this cross-sectional study, 583 older people, aged 60-80 years living in Tehran city, were selected through the systematic cluster sampling method. Food security was determined by the United States Household Food Security Survey Module (US-HFSSM (.Socioeconomic status (SES) and two 24-h recalls were obtained. Dietary Diversity Score (DDS) was calculated using the FAO 2010 guideline. Multinomial logistic regression was applied. RESULTS: The average age of participants was 67.87 ± 5.86 years. Based on US-HFSSM, 56.9% of older people were food secure; while 25.7%, 14.2% and 3.2% suffered from food insecurity (FI) without hunger, with moderate hunger, and with severe hunger, respectively. There was no association between FI and DDS, even after controlling for confounders. FI with mild hunger was associated with household income (OR = 2.744, 95% CI = 1.100-6.846), while FI with severe hunger was associated with Fars ethnicity (OR = 0.146, 95% CI = 0.051-0.424). CONCLUSIONS: Overall, socio-economic status and demographic characteristics were the predictors of FI among older people. The findings can have implication in design and targeting of interventions directed at older people.

Adherence to Mediterranean-Style Dietary Pattern and Risk of Bladder Cancer: A Case-Control Study in Iran.

Few dietary patterns are related to reduce the Bladder Cancer (BC) risk. One of the well-known dietary patterns is the Mediterranean diet (MD). This case-control study investigated the association between MD and the odds of BC among Iranian population. The present case-control study was performed on 103 eligible cases and 200 controls age 45 to 92 years. Diet of participants was assessed by a validated 168-item food frequency questionnaire (FFQ). Adherence to MD was measured by Mediterranean-Style Dietary Pattern Score (MSDPS). Multivariate logistic regression was used to estimate the relationship between MSDPS and risk of BC. After controlling for potential confounders, a negative association was observed between MSDPS and risk of BC (OR = 0.22; 95%CI = 0.09-0.52; p trend = 0.001). Furthermore, significant negative associations were observed for dairy, fish and other seafood, whole-grain, bread intake and risk of BC (p for trend < 0.05). In contrast, the risk of BC increased for high intake of poultry (OR = 1.09; 95%CI = 1.03-1.15; p trend = 0.003), sweets (OR = 1.24; 95%CI = 1.03-1.48; p trend = 0.018) and egg (p for trend = 0.01). Our results suggested that dietary habit in concordance with the principles of the Mediterranean dietary pattern may protect against BC.

Real-world practices for the care of women with epilepsy during pregnancy: A Canadian perspective.

OBJECTIVE: Approximately 150,000 Canadian women live with epilepsy, a population that presents with unique challenges. Our objective was to capture demographic and real-world practice characteristics of Canadian healthcare professionals providing care for women with epilepsy (WWE) with specific focus on reproductive considerations to identify potential gaps in knowledge and care. METHODS: A questionnaire developed by the Canadian League Against Epilepsy WWE workgroup was distributed to Canadian healthcare professionals from February 2021 to October 2022 to capture participant demographic characteristics and practice patterns in key areas of the reproductive cycle in WWE. RESULTS: A total of 156 participants completed the questionnaire, most being physicians (81.4%), epilepsy specialists (69.0%), and those who cared for adult patients (86.5%), with a significant proportion based at an academic center (65.4%). The majority of participants counselled on folic acid supplementation (89.7%). Participants selected lamotrigine and levetiracetam most frequently for either focal or generalized epilepsies during pregnancy. Additionally, 85.9% performed therapeutic drug monitoring during pregnancy. Almost all practitioners always or often counseled WWE on valproic acid on the benefits of switching to a less teratogenic medication (96.2%). Some geographic variability in practice patterns was noted with valproic acid being one of the top three medications selected for patients with generalized epilepsies in Western regions, although participants in Eastern regions had brivaracetam more commonly included as one of their top three agents for this population. SIGNIFICANCE: This is the first report of real-world Canadian practices in epilepsy care for women in pregnancy. Overall, our study reports that Canadian practice patterns conform well to current evidence and best-practice guidelines. Important variations in antiseizure medication selection across different regions were identified.

Association of Recommended and Non-Recommended Food Score and Risk of Bladder Cancer: A Case-Control Study.

Bladder cancer (BC) is the ninth most common cancer in the world. Dietary patterns and diet quality could reduce exposure to carcinogenic factors postulated to increase the risk of BC. The main objective of this study was to investigate the associations of Recommended Food Score (RFS) and Non-Recommended Food Score (n-RFS) with the risk of BC among Iranian adults.This is a hospital-based case-control study, conducted at three referral hospitals in Tehran, the capital of Iran. Cases consisted of 103 histologically confirmed BC patients, aged greater than 45 years. Age-matched controls (n = 200) were selected from the same hospital where cases were recruited. Controls were patients with non-neoplastic diseases that are not related to smoking, or long-term diet modification. Dietary intake was assessed by a 168-item Food Frequency Questionnaire (FFQ), which was validated in Iran. Logistic regression tests were used to estimate the relationship between RFS and n-RFS with BC.The risk of BC decreased by 69% (OR = 0.31; 95% CI:0.13-0.71) among participants belonging to the highest compared with the lowest quartile of RFS. After adjusting for age, sex, smoking, and total energy, a significant inverse trend was observed between the risk of BC and quartile of RFS. Regarding the n-RFS, also expressed as quartiles, subjects in the fourth quartile were at 2.7 times higher risk of having BC compared to participants in the first quartile (OR = 2.7; 95%CI: 1.07-6.78).The findings of this study suggested that, adherence to RFS decreased the risk of BC. Additionally, a higher score of n-RFS may lead to an increased risk of BC. These findings could be used to develop evidence-based recommendations for the prevention of BC in Iran.

Relationship between diet quality and depression among Iranian older adults in Tehran.

BACKGROUND: Depression is one of the prevalent mental disorders that is common in older ages. Evidence suggests that dietary intake status may potentially be associated with depression. However, this association has not been well studied in older adults, and the nature of the association remains unclear. This study aimed to investigate the association between diet quality and depression in free-living older adults living in Tehran city. METHODS: This cross-sectional study was conducted on 583 older adults (279 men and 304 women) aged 60 to 80 years living in Tehran city, selected by the systematic cluster sampling method. Individuals' dietary intake was determined by two non-consecutive 24-h dietary recalls, and diet quality was assessed calculating score of Healthy Eating Index-2015 (HEI-2015). The validated short form of the Geriatric Depression Scale (GDS-11) was used to assess depression status. A logistic regression model was used to assess the chance of depression across tertiles of HEI-2015 score. RESULTS: The point prevalence of depression was 22.5%, which was significantly higher in women (91 (69.5%) women vs. 40 (30.5%) men). A higher percentage of seniors at the higher tertile of HEI score were women, belonged to Fars ethnicity and had a higher score of activity of daily living (ADL). After adjustment for all potential confounders, the trend of depression chance was significantly decreased in those with higher HEI-2015 scores (p-for trend < 0.05). CONCLUSION: Higher quality of diet was associated with a lower possibility of depression in the studied participants. Further studies are required to investigate the possible causal relationship.

Association of Dietary Approaches to Stop Hypertension diet and risk of bladder cancer: A case-control study.

OBJECTIVE: The Dietary Approaches to Stop Hypertension (DASH) diet is rich in recommended foods that are inversely associated with bladder cancer (BC) risk. The main objective of this study was to investigate the association between adherence to DASH diet and the risk of BC among Iranian adults. METHOD: This study included 103 BC cases and 200 controls. The controls were patients who were hospitalised for acute non-neoplastic diseases. DASH scores were computed from dietary intake assessed by a previously validated food frequency questionnaire. RESULTS: After controlling for potential confounders, participants in the highest quintile of DASH (compared to the lowest quintile) had 84% lower BC risk (OR = 0.16; 95%CI: 0.05-0.45; p trend = 0.001). Among the DASH components, significant negative associations were observed between low fat dairy and whole grains intake with BC (p value < 0.05). A positive relation was observed for sodium, nuts and legumes, and sweetened beverages (p value < 0.05). CONCLUSION: The results of this study suggested that adherence to DASH might be associated with reduced risk of BC. These findings could be used to develop evidence-based recommendations for the prevention of BC.

Maternal dietary diversity and nutritional adequacy in relation with anthropometric measurements of newborns at birth: a cohort study in Tehran city.

BACKGROUND: Maternal dietary intake during pregnancy plays an important role in fetal development and birth outcomes. The aim of the present study was to determine maternal dietary diversity and Nutritional adequacy in relation with anthropometric measurements of newborn at birth as a cohort study in Tehran city. METHODS: This prospective cohort study, was conducted by participation of 585 pregnant women referred to public health centers and hospitals covered by Shahid Beheshti, Tehran and Iran Universities in Tehran City. Using face-to-face interviews, general characteristics were obtained by questionnaire. Pre-pregnancy dietary intake was measured by a 168-item semi-quantitative food frequency questionnaire at the first visit, and dietary intake during pregnancy was measured by 2 non-consecutive 24-h food recall (one holiday and one regular day) at 31-34 weeks. Maternal height and weight were measured using standard tools and protocol at the first visit, and maternal weight at the end of pregnancy and data related to neonatal anthropometric indices were collected from mothers and neonates health records in the Sib electrical system. By applying SPSS software (version 23) the association was analyzed by linear regression with adjusting for confounding factors. P-value< 0.05 was considered as significant. RESULTS: Mean ± standard deviation of body mass index (BMI) of pre-pregnancy, pregnancy weight gain, BMI for age z-score (BAZ) at birth of infants were 24.52 ± 4.12, 12.16 ± 6.85 kg and - 0.61 ± 1.48, respectively. Mean ± SD of the Dietary Diversity Score (DDS) and Mean Adequacy Ratio (MAR) before and during pregnancy were 5.31 ± 1.11, vs.5.23 ± 1.42 and 289.85 ± 113.12 vs. 371.07 ± 197.28, respectively. After adjusting for confounding factors DDS in the third trimester of pregnancy was inversely correlated with WAZ (B = -0.16, 95% CI = - 0.23_0.30) and BAZ (B = - 0.24, 95% CI = - 0.06_0. 42) at birth, MAR of pre-pregnancy (B = - 0.001, 95% CI = - 0.002_0.00) and in the third trimester of pregnancy (B = - 0.18, 95% CI = - 0.35_0.004) were negatively associated with WAZ at birth. CONCLUSION: The findings showed that maternal nutritional status (dietary diversity and nutritional adequacy) before and during pregnancy were correlated with neonatal anthropometric indices at birth.

Recommended Food Score and Healthy Nordic Food Index in Cancer: A Systematic Review.

Aim: Cancer is the second leading cause of death in the world. About one third of deaths from cancer are due to the five behavioral and dietary risk factors e.g., high body mass index, low fruit and vegetable consumption, lack of physical activity, tobacco use, and alcohol use. The aim of this study is to review systematically the association of Recommended Food Score (RFS) and the Healthy Nordic Food Index (HNFI) with cancer.Method: Literature search conducted using electronic database PubMed, Google scholar, Science direct for the period of 2011 until January 2020 also reference list of the included studies.Results: Nine studies were met inclusion criteria. Two studies that investigated about RFS showed no significant association between RFS and breast cancer and colorectal cancer survival. Two out of three studies aboutthe HNFI and colorectal cancer observed that adherence to the HNFI might decrease colorectal cancer incidence and improve colorectal cancer survival. In addition, two out of three studies showed adherence to the HNFI could decrease cancer mortality.Conclusion: Adherence to the HNFI might decrease the risk of colorectal cancer incidence. It is suggested more studies about between RFS and THE HNFI with other kind of cancers.

Designing a healthy, low-cost and environmentally sustainable food basket: an optimisation study.

OBJECTIVE: Sustainable diets are diets with low environmental impacts and high affordability which contribute to food and nutrition security. The present study aimed to develop a healthy, low-cost and environmental-friendly food basket for Iran based on current consumption. DESIGN: The Households Income and Expenditure Survey data were used. Linear Programming was utilised to obtain the optimal diets, separately, for each goal of the sustainable food basket: (1) Diet with maximum Nutrient Rich Food (NRF) index, (2) Diet with minimum cost, (3) Diet with the minimum water footprint and (4) Diet with the minimum carbon footprint. Goal Programming techniques were used to optimise the sustainable food basket by considering all goals simultaneously. SETTING: Iran. PARTICIPANTS: Households (n 100 500) in urban and rural areas of Iran, nationally representative. RESULTS: In the 'optimal model', compared with the usual consumption, the amount of the 'bread, cereal, rice, and pasta', 'meat, poultry, fish, eggs, legumes, and nuts' and 'fats, oils, sugars, and sweets' groups was decreased. Inside those food groups, cereals, poultry and vegetable oil subgroups were increased. Also, dairy, fruits and vegetable groups were increased. In this model, there was a 14 % reduction in the total water footprint, a 14 % decrease in the total carbon footprint, a 23 % decrease in the cost and a 7 % increase in NRF of diet compared with the usual consumption. CONCLUSIONS: Increasing the consumption of dairy, fruits and vegetables and reducing the consumption of bread, rice, pasta, meat, fish, eggs, legumes, nuts, hydrogenated fats and sugars are required to achieve a sustainable food basket.

De Novo Mutations in PPP3CA Cause Severe Neurodevelopmental Disease with Seizures.

Exome sequencing has readily enabled the discovery of the genetic mutations responsible for a wide range of diseases. This success has been particularly remarkable in the severe epilepsies and other neurodevelopmental diseases for which rare, often de novo, mutations play a significant role in disease risk. Despite significant progress, the high genetic heterogeneity of these disorders often requires large sample sizes to identify a critical mass of individuals with disease-causing mutations in a single gene. By pooling genetic findings across multiple studies, we have identified six individuals with severe developmental delay (6/6), refractory seizures (5/6), and similar dysmorphic features (3/6), each harboring a de novo mutation in PPP3CA. PPP3CA encodes the alpha isoform of a subunit of calcineurin. Calcineurin encodes a calcium- and calmodulin-dependent serine/threonine protein phosphatase that plays a role in a wide range of biological processes, including being a key regulator of synaptic vesicle recycling at nerve terminals. Five individuals with de novo PPP3CA mutations were identified among 4,760 trio probands with neurodevelopmental diseases; this is highly unlikely to occur by chance (p = 1.2 × 10-8) given the size and mutability of the gene. Additionally, a sixth individual with a de novo mutation in PPP3CA was connected to this study through GeneMatcher. Based on these findings, we securely implicate PPP3CA in early-onset refractory epilepsy and further support the emerging role for synaptic dysregulation in epilepsy.

Dietary Approaches to Stop Hypertension (DASH) diets and breast cancer among women: a case control study.

BACKGROUND: Studying entire dietary patterns is a promising alternative approach to overcome limitations of the single food or nutrient approach. We evaluated the relationship between the scores of 4 established Dietary Approaches to Stop Hypertension (DASH) diet indexes and breast cancer risk among Iranian women. METHODS: This case-control study was carried out on 408 eligible women (136 cases and 272 hospital-based controls). A validated 168 item semi-quantitative food frequency questionnaire was used for assessing usual dietary intakes. DASH index scores were generated based on predefined algorithms for each of the 4 previously described indexes (Dixon's, Mellen's, Fung's and Günther's DASH diet index). Unconditional logistic regression analysis was performed to estimate odds ratio (OR) and 95% confidence intervals (CIs) for score categories or quintiles of DASH diet indexes and breast cancer risk in multivariate adjusted models. RESULTS: Women in the highest categories of the Mellen's and Günther's scores had lower odds of breast cancer than those in the lowest quintiles (Mellen's OR:0.50; 95% CI:0.62-0.97; P-trend:0.02; Günther's OR:0.48; 95% CI:0.25-0.93; P-trend:0.05). However, no significant associations were found between Dixon's and Fung's DASH score and breast cancer risk. Modification by menopausal status revealed that breast cancer risk was only reduced in postmenopausal women with higher scores on Mellen's index (OR:0.24; 95% CI:0.08-0.68; P-trend:0.04). CONCLUSION: A greater adherence to 2 of the 4 DASH indexes (Mellen's and Günther's indexes) was associated with decreased risk of breast cancer.

STXBP1 encephalopathy is associated with awake bruxism.

Heterozygous mutations in syntaxin-binding protein 1 (STXBP1) gene are associated with early infantile epileptic encephalopathy 4 (EIEE4). This condition is characterized by epilepsy, developmental delay (DD), and various movement disorders. Herein, we will report 5 unrelated patients with different de novo mutations in STXBP1. In addition, we conducted an online survey through Facebook to identify the incidence of bruxism (BRX) in these patients. Four out of 5 patients (80%) presented with awake BRX (A-BRX). Bruxism was also reported in 81.4% (57/70) of the patients with STXBP1 encephalopathy through the online questionnaire. No consistent correlation was identified between the type of mutation and development of movement disorders or BRX. This is the first study to demonstrate A-BRX in patients with STXBP1 mutation. Given the role of STXBP1 in exocytosis of neurotransmitters and other manifestations of dopamine dysregulation in patients with STXBP1-EIEE4, we suggest that in patients with STXBP1 encephalopathy, A-BRX might be the result of the involvement of dopaminergic circuits.

Healthy diet: a step toward a sustainable diet by reducing water footprint.

BACKGROUND: This paper aims to assess different scenarios that reduce water use by following healthy diet recommendations. In this study, a food frequency questionnaire was used to assess the usual food intake of a sample of 723 individuals, aged 20-64 years, from Urmia, Iran. In order to calculate water use for production of food items, the water footprint method was applied. A linear programming technique was used to find a healthy diet with low blue water footprint in three scenarios. RESULTS: The biggest decline in water use compared with real intake (57%) was found in scenario 1, where the model-generated consider energy intake equal to usual energy intake. In scenario 2, in which the proportion of each food group was allowed to be in accordance with the Iranian food pyramid, the reduction in water use was less than for scenario 1 (47%). In scenario 3, where the Recommended Dietary Allowance values were also added to the set of model restrictions, the water usage was 51% of the real diet. CONCLUSION: A healthy diet with greater proportion of energy from fruit and dairy instead of a diet with high proportion of energy from 'meat-fish-poultry-eggs' and 'bread-cereal-rice-pasta' can supply all Recommended Dietary Allowances while reducing water use. © 2019 Society of Chemical Industry.

Nutrition and food security policy in the Islamic Republic of Iran: situation analysis and roadmap towards 2021.

BACKGROUND: All government policies and programmes for food and nutrition security should include providing healthy food, as well as providing economic and social availability for all people. AIM: This study aimed to analyse the current situation of Iranian food and nutrition security and establish a road map towards 2021. METHODS: The applied methods were situation analysis and a mixed qualitative-quantitative method. The conceptual method used for developing this national document encompassed three areas: sustainable food supply, food safety and nutrition. RESULTS: The outcomes of the Iranian food and nutrition security system in the past three decades include development of management infrastructure and improvement in food and nutrition security status. However, analysis of current programmes showed that there were some overlapping, intertwining and parallel works in the responsibilities of related organizations in the field of supervision of food safety (from production to supply). The national document produced as the outcome of this paper was communicated by the Iranian Ministry of Health in 2012 and has been running for 2 years. Selected ministries are responsible for implementation of 20 national programmes by the end of the 5th Economic, Social and Cultural Development Programme (2016-2011). The consensus of stakeholders by the end of the 6th Development Programme (2021) is to put all of the provinces in a safe or very safe situation in terms of food and nutrition security. CONCLUSION: The most important challenge in establishing national documents is to make them operational. This aim was achieved by an intersectoral nutrition and food security working group, which produced a general memorandum of understanding with the main organizations, the media, universities and private sector.

Major dietary patterns in relation to demographic and socio-economic status and food insecurity in two Iranian ethnic groups living in Urmia, Iran.

OBJECTIVE: To identify major dietary patterns and their association with socio-economic status (SES) and food insecurity in two major ethnic groups living in Urmia, north-west Iran. DESIGN: A cross-sectional study. SETTING: All four geographical zones of Urmia city. SUBJECTS: Participants (n 723; 427 women and 296 men), aged 20-64 years, from two ethnic groups (445 Azeri Turks and 278 Kurds). RESULTS: Three major dietary patterns were extracted: 'Traditional High SES' (THS), 'Traditional Low SES' (TLS) and 'Transitional'. After adjusting for confounders, the THS pattern was positively associated with education level and negatively associated with moderate or severe food insecurity in Azeri Turks; whereas, among Kurds, it was more common in women and positively associated with age. The TLS pattern was more common among men and negatively associated with educational level and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men, positively associated with being married and negatively associated with household income/capita. The 'Transitional' pattern was positively associated with being employed and negatively associated with age and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men and negatively associated with age, being married and physical activity level. CONCLUSIONS: Findings suggest that household SES and food insecurity are associated with detrimental dietary patterns and that this effect may be stronger than cultural and ethnic background. These patterns differ by age and gender. Therefore, such characteristics should be considered in planning and formulating diet-related policies and programmes.

Food insecurity, socio-economic factors and weight status in two Iranian ethnic groups.

OBJECTIVE: To study the association of weight status with food insecurity (FI) and socio-economic status (SES) in Azeri and Kurd ethnic groups living in Urmia city, North-Western Iran. DESIGN: In this cross-sectional study, 723 participants (427 women and 296 men) aged 20-64 years old, from two ethnic groups (445 Azeri and 278 Kurd), were selected through a combination of cluster, random and systematic sampling methods. Demographic and socio-economic characteristics were assessed by a valid questionnaire, and household food security status was analyzed using an adapted household food insecurity access scale through face-to-face interviews at homes. General and central obesities were measured and evaluated using standard methods. RESULTS: Based on the findings, moderate-to-severe FI, as well as low SES, was more dominant in Kurds, compared to Azeris. After adjusting for confounders, being female (OR = 4.33, CI 95%: 2.35-7.97) and moderate-to-severe FI (OR = 2.00, CI 95%: 1.01-3.97) in Azeris and being female (OR = 5.39, CI 95%: 2.28-12.23) and higher total cost of household/capita (OR = 1.005, CI 95%: 1.002-1.009) in Kurds were related to higher odds of general obesity while low (OR = 0.41, CI 95%: 0.18-0.91) and moderate (OR = 0.13, CI 95%: 0.02-0.60) education levels were linked to lower chance of general obesity. Furthermore, the chance of central obesity was lower in Azeris with high educational levels (OR = 0.64, CI 95%: 0.21-0.94), females (OR = 0.72, CI 95%: 0.34-0.86), home owners (OR = 0.56, CI 95%: 0.31-0.91) and females Kurds (OR = 0.60, CI 95%: 0.37-0.97) with moderate-to-severe FI and higher total income per capita. In contrast, the chance of central obesity increased in Kurds with increased age (OR = 1.06, CI 95%: 1.02-1.10) and total cost of household per capita (OR = 1.004, CI 95%: 1.000-1.008). CONCLUSION: These findings show that the association between moderate-to-severe FI and risk of general/central obesity varies in Azeris, compared to Kurds. However, better SES decreased the chance of general/central obesity in both ethnic groups.

Ipsilateral preictal alpha rhythm attenuation (IPARA): An EEG sign of side of seizure onset in temporal lobe epilepsy.

PURPOSE: Identification of the seizure onset zone is critically important for outlining the surgical plan in the treatment of pharmacoresistant focal epilepsy. In patients with temporal lobe epilepsy (TLE), bilateral ictal scalp EEG changes frequently occur and can make lateralization of the seizure onset zone difficult. We investigated the incidence and clinical utility of unilateral preictal alpha rhythm attenuation as a lateralizing sign of seizure onset in TLE. METHODS: Scalp EEG recordings of the seizures acquired during presurgical video-EEG monitoring of 57 consecutive patients with TLE were reviewed retrospectively. Included patients had interictal baseline recordings demonstrating symmetrical posterior alpha rhythm and seizures occurring during wakefulness. RESULTS: We identified a total of 649 seizures in the 57 patients, of which 448 seizures in 53 patients fulfilled the inclusion criteria. Among the 53 included patients, 7 patients (13.2%) exhibited a distinct attenuation of the posterior alpha rhythm prior to the first ictal EEG changes, in 26 of 112 (23.2%) included seizures. Preictal alpha rhythm attenuation in these seizures was ipsilateral to the ultimately determined side of seizure onset (based on video-EEG or intracranial EEG findings) in 22 (84.6%) of these seizures and bilateral in 4 (15.4%), and occurred on average 5.9 ± 2.6 s prior to ictal EEG onsets. CONCLUSION: Our findings suggest that in some patients with TLE lateralized preictal attenuation of the posterior alpha rhythm may be a useful indicator of side of seizure onset, presumably due to early disruption of thalamo-temporo-occipital network function, likely mediated through the thalamus.

Reliability, comparative validity and stability of dietary patterns derived from an FFQ in the Tehran Lipid and Glucose Study.

The aim of the present study was to assess the reliability, comparative validity and stability of dietary patterns defined by factor analysis for participants of the Tehran Lipid and Glucose Study. A total of 132 subjects, aged ≥ 20 years, completed a 168-item FFQ (FFQ1, FFQ2) twice, with a 14-month interval. Over this duration, twelve dietary recalls (DR) were collected each month. To assess the stability of the FFQ, participants completed the third FFQ (FFQ3) after 8 years. Following these, two dietary patterns--the 'Iranian Traditional' and the 'Western'--were derived from FFQ1 and FFQ2 and the mean of DR (mDR); and three dietary patterns were identified from FFQ3: the 'Iranian Traditional', the 'Western' and the 'Combined'. The reliability correlations between factor scores of the two FFQ were 0·72 for the Iranian Traditional and 0·80 for the Western pattern; corrected month-to-month variations of DR correlations between the FFQ2 and mDR were 0·48 for the first and 0·75 for the second pattern. The 95 % limits of agreement for the difference between factor scores obtained from FFQ2 and mDR lay between -1·58 and +1·58 for the Iranian Traditional and between -1·33 and +1·33 for the Western pattern. The intra-class correlations between FFQ2 and FFQ3 were -0·09 (P = 0·653) and 0·49 (P <0·001) for the 'Iranian Traditional' and the 'Western', respectively. These data indicate reasonable reliability and validity of the dietary patterns defined by factor analysis. Although the Western pattern was found to be fairly stable, the Iranian Traditional pattern was mostly unstable over the 8 years of the study period.