Management of psychogenic non-epileptic seizures: a multidisciplinary approach.

The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non-epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management. A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: diagnosis; ethical issues; psychiatric comorbidities; psychological treatment; and pharmacological treatment. After a systematic review of the literature, the board met in a consensus conference in Catanzaro (Italy). Further consultations using a model of Delphi panel were held. The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizure induction was considered ethical, preferring the least invasive techniques. The board recommended looking carefully for mood disturbances, personality disorders and psychic trauma in persons with PNES and considering cognitive-behavioural therapy as a first-line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. Psychogenic non-epileptic seizure management should be multidisciplinary. High-quality long-term studies are needed to standardize PNES management.

Spectral dependence of photoemission in multiphoton ionization of NO2 by femtosecond pulses in the 375-430 nm range.

We investigate the multiphoton ionization of NO2 using tunable (430-375 nm) femtosecond pulses and photoelectron-photoion coincidence momentum spectroscopy. In order to understand the complex electronic and nuclear photodynamics at play following absorption of three to five photons, we also report extended photoionization calculations using correlated targets and coupled channels. Exploring the multiphoton dissociative ionization (MPDI) and multiphoton ionization (MPI) processes over such a broad energy range enables us to lend further support to our work carried out around 400 nm of a femtosecond laser [S. Marggi Poullain et al., J. Phys. B: At., Mol. Opt. Phys., 2014, 47, 124024]. Two excitation energy regions are identified and discussed in terms of the proposed reaction pathways, highlighting the significant role of Rydberg states, such as the [R*(6a1)-1, 3pσ] Rydberg state, in the NO2 multiphoton excitation and photoionization. These new results support our previous assumption that different bent and linear geometries of the NO2+(X1Σg) ionic state contribute to the MPDI and MPI, consistent with the reported calculations which reveal an important vibronic coupling characterizing the photoemission. Remarkably, the strong anisotropy of the recoil frame photoelectron angular distribution (RFPAD) previously observed at 400 nm appears as a fingerprint across the whole explored photon energy range.

Psychiatric disorders in patients suffering from an acute cerebrovascular accident or traumatic injury, and their effects on rehabilitation: an observational study.

BACKGROUND: The presence of a post-traumatic psychiatric disorder in patients with acute injuries may have adverse effects on outcomes. AIM: In this study our aims were: (1) to assess the frequency of psychiatric disorders after a cerebrovascular accident or traumatic injury requiring rehabilitation; (2) to examine whether there was any correlation between psychiatric disorders and patients' baseline demographic and clinical variables. DESIGN: The study consisted of two phases: the first was cross-sectional and the second prospective with a 12-month follow-up. The period of recruitment was two years. The results of the first phase are presented here. SETTING: The study sample consisted of a consecutive series of patients admitted to hospital because of an acute cerebrovascular accident or a traumatic injury and referred for a rehabilitation program. Two inpatient Rehabilitation Hospitals were involved in the study. POPULATION: The sample consisted of 230 consecutive patients with a recent cerebrovascular accident or trauma included in a rehabilitation program. METHODS: The sample included: 89 men (39%) and 141 women (61%) aged 20-97 years. Psychiatric disorders and motor disabilities were assessed through psychiatric interview and the mini-international neuropsychiatric interview plus (MINI Plus) and, respectively, with the functional independent measure (FIM). In case of post-traumatic stress disorder (PTSD), severity was assessed through the Davidson's Trauma scale. Psychiatric disorders were correlated to demographic and clinical variables through univariate and multivariate analyses, the latter with logistic regression models. RESULTS: The most frequent entry diagnoses were traumatic fracture (41.3%) and stroke (37.0%). Ninety-three patients (40.4%) had one or more psychiatric disturbances at study entry, the commonest being depression (56 cases, 24.7%) and anxiety (23 cases, 10.0%). PTSD was present in 8 cases (3.5%). A history of psychiatric disorder was reported by 55 patients (24.2%) Compared to the rest of the study population, these subjects had more psychopathologic complaints (P<0.001). Mean total FIM score was 54.4 (SD=17.8) and 61.2 (SD=19.6) in patients with and without psychopathology (P<0.01) Independent predictors of psychopathology included past psychiatric history, lower total FIM scores, and limb amputation. Depression was predicted by history of psychiatric disorders and lack of partner. CONCLUSION: History of psychiatric disorders is the most relevant factor associated with psychopathology in patients with an acute cerebrovascular accident or traumatic injury, followed by lower total FIM scores, and type of pathologic event. CLINICAL REHABILITATION IMPACT: The presence of psychiatric disorders may potentially influence the rehabilitation process and outcomes; thus their recognition and management are key factors during a rehabilitation program.

Single-shot, high-dynamic-range measurement of sub-15 fs pulses by self-referenced spectral interferometry.

We explore theoretically and numerically the temporal contrast limitation of a self-referenced spectral interferometry measurement. An experimental confirmation is given by characterization and fine compression of hollow-core fiber generated sub-15 fs pulses, yielding an accurately measured coherent contrast of 50 dB on a ±400 fs time range.

Ion pair formation in multiphoton excitation of NO(2) using linearly and circularly polarized femtosecond light pulses: kinetic energy distribution and fragment recoil anisotropy.

The NO(2) ion pair photodissociation dynamics leading to NO(+)(X(1)Sigma(+),v) + O(-)((2)P(3/2) or (2)P(1/2)), induced by a 1 kHz femtosecond laser with wavelengths near 400 nm, has been characterized using the coincidence vector correlation method. The ion pair production after four-photon absorption reaches more than 15% of the primary ionization. The kinetic energy release of the fragments demonstrates a significant vibrational excitation of the NO(+)(X(1)Sigma(+),v) molecular fragment. Recoil ion fragment emission is strongly aligned along the polarization axis of linearly polarized light or preferentially emitted in the plane perpendicular to the propagation axis of circularly polarized light. The formalism describing the recoil anisotropy for bound-to-bound n-photon transition inducing prompt axial recoil dissociation of a nonlinear molecule has been developed to interpret the measured anisotropies in terms of excitation pathways via near-resonant intermediate states of specific symmetries. Possible reaction pathways are discussed that are consistent with the data and supported by calculations of potential energy surfaces and transition moments.

Clinical and genetic evaluation of a family showing both autism and epilepsy.

Autism is a strong genetic disorder, with an estimated heritability greater than 90%. Nonetheless, its specific genetic aetiology remains largely unknown. Autism is associated with epilepsy in early childhood and epilepsy occurs in 10-30% of individuals with autism. Here we report the case of a woman affected by a severe epileptic disorder with an onset at 14 years old. She is affected by a cryptogenetic focal epilepsy with complex partial (psychomotor) and secondarily generalized tonic-clonic seizures, which are drug resistant. The woman is married to a healthy man and has six children: two girls are healthy, a girl and two boys are affected by autism while one boy shows partial seizures. The three children with autism show moderate mental retardation and an EEG with no epileptiform alterations. The child with epileptic seizures shows an asymmetric EEG that is not necessarily pathological. In this family, no chromosomal rearrangements were detected by means of classical cytogenetic analyses. The presence of FRAXA alterations and of microdeletions of the 15q11-q13 chromosome region were also excluded. A genome-wide linkage analysis using microsatellite markers revealed several chromosome regions as possible susceptibility loci.

Laser-intensity dependent vibrational excitation and alignment of molecular ions in the ultrafast multiphoton regime.

H2 molecules were ionized in the ultrafast (approximately 150 fs) multiphoton regime (263 nm, approximately 10(13) W cm(-2)). Earlier experiments investigated the kinetic energies of electrons or ions only. Using a unique experiment, we show that the vibrational excitation of molecular ions contains essential information about the dynamics of the process. In addition, we prove some earlier interpretations wrong. A realistic model based on vibronically excited intermediates, Stark shifting into resonance, reproduces the measurements, demonstrating that resonances continue to be important in the femtosecond regime. This eventually enables ultrafast control of the vibrational excitation of molecular ions, which is relevant to the whole field of molecular physics and physical chemistry.

Intense-laser-field ionization of molecular hydrogen in the tunneling regime and its effect on the vibrational excitation of H2+.

H2 molecules were ionized by Ti:sapphire (45 fs, 800 nm) and Nd-doped yttrium aluminum garnet lasers (6 ns, 1064 nm). The relative populations of the vibrational levels of the H+2 ions were determined and found to be concentrated in the lowest vibrational levels. Tunneling ionization calculations with exact field-modified potential curves reproduce the experimental results. The reason for the departure from conventional Franck-Condon-like distributions is the rapid variation of the ionization rate with internuclear distance.

Direct costs of schizophrenia in Italian community psychiatric services.

OBJECTIVE: To estimate resource utilisation and direct costs of treatment for patients with schizophrenia in Italian Community Mental Health Centers (CMHCs). DESIGN: Multicentre, retrospective observational study. CMHCs recruited all patients who attended a follow-up consultation during the period September to December 1998. At enrollment, psychiatrists completed a questionnaire on consumption of resources in the 2 months before recruitment. SETTING: 14 CMHCs. PERSPECTIVE: Italian National Health Service (INHS). PATIENTS: 702 patients with a diagnosis of schizophrenia or other psychotic disorders, defined according to the Diagnostic and Statistical Manual of Mental Disorders-fourth edition. These patients had been followed by the CMHCs for at least 2 years and attended a follow-up consultation either during the period September to December 1998 or on randomly selected days during this period. Patients were classified into seven groups according to their diagnosis. RESULTS: The mean direct cost of patients with schizophrenia in the 2-month observation period was 2,234,475 Italian lire [L] (1154.01 Euro; EUR); direct costs ranged from L.1,545,818 to L.2,775,658 (EUR798.35 to EUR1433.51) by prognostic group. There was wide variability for prognostic groups in the impact of most cost components on total cost. Admissions accounted for between 11.4 and 56.3% of the total cost, daycare centre days for between 11.3 and 35.5%, home visits for 7.8 to 16.4%, and day-hospital days for 5.4 to 32.8%. Antipsychotics and anxiolytics were the most prescribed drugs and also the most costly. CONCLUSION: Despite the limitations of the study related to the short period considered, we believe this study offers some interesting information on the burden of schizophrenia, a disease for which its cost has received limited attention so far in Italy.

Experimental evidence of excited multicharged atomic fragments coming from laser-induced coulomb explosion of molecules

Direct experimental evidence is presented for the production of excited multicharged atomic fragments in the laser-induced Coulomb explosion of molecules. The comparison of the fluorescence signals of several atomic and molecular species shows that the excited fragments come from transient excited multicharged molecules. The atomic fluorescence spectra recorded with NH3, N2, and N2O, in the 50-120 nm wavelength range, show that the excitation increases noticeably from NH3 to N2O. This effect is interpreted in terms of the initial electronic configuration, which favors a stronger excitation when the electronic density is more delocalized on the molecular nuclear structure.

Hydrodynamic description of laser-induced coulomb explosion for small molecules

We have performed extensive numerical studies of Coulomb explosion of small molecules such as CO2 and N2O with the help of a hydrodynamic model, which allows one to deal with many-electron systems in intense laser fields. The predicted kinetic energy releases of the fragmentation channels are in good agreement with the measured energies, using realistic molecular and laser excitation condition parameters.

Epilepsy and everyday life risks. A case-referent study: rationale, study design, and preliminary results. Risk in Epilepsy Study Group.

Despite its favorable outcome in up to 90% of patients, epilepsy is still considered to carry a higher than normal risk of morbidity and accidents. Knowledge of the everyday life risks (illnesses, accidents) in patients with epilepsy is mostly anecdotal. For these reasons, a multinational cohort study has been started in 9 European countries to investigate the incidence and number of medical events and accidents in children and adults with unprovoked epilepsy (diagnosed in the recruiting centers in the previous 10 years) and in age- and sex-matched controls (relatives or friends). The 2 groups are being followed for at least 12 months. Using patients' diaries, data are being collected regarding the number and type of illnesses and accidents, the number of medical contacts and the actions taken, the number of hospital admissions, and the total number of days off work/school. In a preliminary report on 833 patients and 833 controls, the cases reported slightly less illnesses, medical contacts, and actions taken by doctors. Accidents and related events occurred in similar proportions in the 2 groups. Based on the results of the pilot study, idiopathic, cryptogenic and remote symptomatic epilepsy may be compatible with an at least fairly normal social life.