Antimicrobial susceptibilities in dairy herds that differ in dry cow therapy usage.

Intramammary infusion of antimicrobials at the end of lactation (dry cow therapy; DCT) is a central part of mastitis control programs and is one of the major indications for antimicrobial use in dairy cows. However, with increasing focus on prudent use of antimicrobials and concerns about emergence of antimicrobial resistance, the practice of treating every cow at the end of lactation with DCT is in question. This cross-sectional, observational study determined the minimum inhibitory concentrations (MIC) of 10 antimicrobials for coagulase-negative staphylococci (CNS), Staphylococcus aureus, Streptococcus dysgalactiae, and Streptococcus uberis isolates from milk samples from dairy cows with somatic cell counts >200,000 cells/mL in herds that had been organic for >3 yr (n = 7), or had used either ampicillin-cloxacillin DCT (n = 11) or cephalonium DCT (n = 8) in the preceding 3 yr. The organic herds were certified under the United States Department of Agriculture National Organic Program, meaning that there was no blanket DCT, and minimal use of antimicrobials in general, with a loss of organic status of the animal if treated with antimicrobials. Breakpoints (where available) were used to categorize isolates as resistant, intermediate, or susceptible to antimicrobials. The MIC distributions of isolates from different herd types were compared using binomial or multinomial logistic regression. Of 240 CNS isolates, 12.9, 0.8, 7.1, 32.6, and 1.2%, were intermediate or resistant to ampicillin, cephalothin, erythromycin, penicillin, and tetracycline, respectively. Of 320 Staph. aureus isolates, 29.0, 2.5, 1.2, and 34.9% were intermediately resistant or resistant to ampicillin, penicillin, erythromycin, and oxacillin, respectively. Of 184 Strep. uberis isolates, 1.1, 25.0, 1.6, and 1.6% were intermediately resistant or resistant to erythromycin, penicillin, pirlimycin, and tetracycline, respectively. Generally, the MIC of CNS and streptococcal isolates from organic herds were lower than isolates from herds using DCT. However, the differences in MIC distributions occurred at MIC below clinical breakpoints, so that the bacteriological cure rates may not differ between isolates of differing MIC. Bimodal distributions of MIC for ampicillin and penicillin were found in Staph. aureus isolates from organic herds, suggesting that isolates with a higher MIC are a natural part of the bacterial population of the bovine mammary gland, or that isolates with higher MIC have persisted within these organic herds from a time when antimicrobials had been used. Given these observations, further work is required to determine if exposure to DCT is causally associated with the risk of elevated MIC, and whether reduction or removal of DCT from herds would reduce the risk of elevated MIC of mastitis pathogens.

Association of quarter milking measurements and cow-level factors in an automatic milking system.

The primary aim of this observational study, in a single herd milked using multiple automatic milking system units, was to describe associations of quarter milk yield variability and quarter peak milk flow rate with cow-level factors. Information from the current lactation of 1,549 primiparous and multiparous cows was collected from January to December 2015. Data from each individual milking used in the analysis included quarter milk yield (QMY), udder milk yield, quarter peak milk flow rate (QPMF), quarter average milk flow rate (QAMF), quarter milking time, and milking interval. Milking interval and milk yield were used to calculate milk production rate (kg/h) at the quarter and udder levels. We investigated associations between QPMF and milking interval, QPMF and days in milk, and QMY and QAMF. A strong association between QPMF and both QAMF and milking interval was observed. A moderate association was found between QPMF and stage of lactation. However, QMY was not a useful indicator of QPMF because of the weak association observed between these variables. In this study, rear quarter QPMF was significantly increased by 3% compared with front quarter QPMF (1.45 vs 1.41 kg/min). Quarter milk yield was calculated as a percentage contribution of total udder milk yield per 10-d in milk window and ranked from lowest to highest contribution. Quarter contribution to udder milk yield showed a high level of variability, with 39% of animals having all 4 quarters change contribution rank at least once during part of or the whole lactation. Only 14% of cows were observed to have no change in quarter rank. When quarter contribution was assessed, irrespective of physical position of quarter within the udder, the percent of highest to lowest contribution across the lactation was relatively stable. The standard deviation of quarter milk production rate for each cow was regressed against the same cow's peak udder milk production rate, within a lactation, to ascertain whether quarter milk production rate variance could be used to predict peak udder milk production rate. Knowledge of the intra-udder quarter milk production rate standard deviation for an individual cow is not useful in predicting peak udder milk production rate. Quarter milking time appears to be a useful indicator to predict the optimal order of teatcup attachment. Analysis from this large, single-herd population indicates that QPMF is associated with the cow-level factors milking interval and days in milk, and that intra-udder QMY is highly variable.

A method for assessing teatcup liner performance during the peak milk flow period.

The objective of this study was to develop a method to quantify the milking conditions under which circulatory impairment of teat tissues occurs during the peak flow period of milking. A secondary objective was to quantify the effect of the same milking conditions on milk flow rate during the peak flow rate period of milking. Additionally, the observed milk flow rate was a necessary input to the calculation of canal area, our quantitative measure of circulatory impairment. A central composite experimental design was used with 5 levels of each of 2 explanatory variables (system vacuum and pulsator ratio), creating 9 treatments including the center point. Ten liners, representing a wide range of liner compression (as indicated by overpressure), were assessed, with treatments applied using a novel quarter-milking device. Eight cows (32 cow-quarters) were used across 10 separate evening milkings, with quarter being the experimental unit. The 9 treatments, with the exception of a repeated center point, were randomly applied to all quarters within each individual milking. Analysis was confined to the peak milk flow period. Milk flow rate (MFR) and teat canal cross sectional area (CA) were normalized by dividing individual MFR, or CA, values by their within-quarter average value across all treatments. A multiple explanatory variable regression model was developed for normalized MFR and normalized CA. The methods presented in this paper provided sufficient precision to estimate the effects of vacuum (both at teat-end and in the liner mouthpiece), pulsation, and liner compression on CA, as an indicator of teat-end congestion, during the peak flow period of milking. Liner compression (as indicated by overpressure), teat-end vacuum, vacuum in the liner mouthpiece, milk-phase time, and their interactions are all important predictors of MFR and teat-end congestion during the peak milk flow period of milking. Increasing teat-end vacuum and milk-phase time increases MFR and reduces CA (indicative of increased teat-end congestion). Increasing vacuum in the liner mouthpiece also acts to reduce CA and MFR. Increasing liner compression reduces the effects of teat-end congestion, resulting in increased MFR and increased CA at high levels of teat-end vacuum and milk-phase time. These results provide a better understanding of the balance between milking speed and milking gentleness.

Association of milking interval and milk production rate in an automatic milking system.

The primary aim of this research was to describe the association between milking interval (MI) and milk production rate (MPR) at the quarter level in a large commercial farm using an automatic milking system. A secondary aim was to determine whether a 2-h decrease in MI would increase MPR at the cow level in midlactation multiparous cows. Six months of data from 1,280 cows were used to assess the association between MI (h) and quarter MPR (kg/h). Increasing MI was associated with decreased MPR for early, mid, and late lactation, both primiparous and multiparous cows, and all 4 quarter positions and across time. The decrease in MPR is approximately 2%/h of increasing MI for multiparous cows and 1.5%/h for primiparous cows. Regardless of quarter, multiparous cows had a greater MPR than primiparous cows, and rear quarters had greater MPR than front quarters. An experiment to test the causal relationship between changing MI and cow-level MPR was conducted using 26 animal pairs matched on MI, days in milk, and milk yield. During the 21-d treatment period, the average MI of treatment cows was decreased by 2.4 h compared with control cows. In both the 21-d treatment and 42-d posttreatment periods, no significant difference was found in cow-level MPR between the treatment and control groups. Despite the negative association between increasing MI and MPR being consistent across all assessed days in milk windows and all quarters, results from this experiment suggest that intervention to decrease MI might require an MI change greater than 2 h or be applied in early lactation to significantly increase MPR.

Short communication: Cow- and quarter-level milking indicators and their associations with clinical mastitis in an automatic milking system.

The aim of this study was to assess associations of cow-, udder-, and quarter-level factors with the risk of clinical mastitis (CM) in cows managed using an automatic milking system. The primary hypothesis was that quarter peak milk flow rate (QPMF) is associated with increased risk of CM. A retrospective, case-control study was undertaken using data from a 1,549 cow farm using 20 automatic milking system units. All data from cows milked during March to December 2015 was available for analysis. Cases (n = 82) were defined as cows diagnosed with their first case of CM between 24 and 300 d in milk in the current lactation. Healthy control cows (n = 6/case) were randomly matched based on identical parity, existence of milk records during the day in milk period corresponding to the 15-d window before case diagnosis, average conductivity of <5.5 mS/cm in that window, and no history of CM in the current lactation. Logistic regression was used to estimate effects of parity, quarter position, day in milk at diagnosis of CM, average of QPMF 15 d before CM diagnosis, udder milk yield, and milking interval on the probability of CM. Of the 6 predictor variables included in the model, only milking interval was significantly associated with the increased risk of quarter CM. We concluded that in a high-production, freestall-housed North American herd using automatic milking system, milking interval, but not QPMF, was associated with risk of CM.

Effect of incomplete milking on milk production rate and composition with 2 daily milkings.

The primary aim of this study was to assess the effects of incomplete milking on milk secretion and milk composition at the quarter level. Twelve cows were enrolled beginning at 5 d in milk and remained on study through 47 d in milk. Half of each contralateral udder was incompletely milked (treatment), detaching the teat cup early to leave approximately 30% of the total milk yield behind. This target milk remaining in the gland was based on weekly calibration milking measurements of quarter total milk yield. Control quarters were milked completely until milk flow had decreased to 0 kg/min based on visual assessment. Harvested milk yield was measured twice daily at each milking, and milk components (fat, protein, lactose, solids nonfat, milk urea nitrogen) and somatic cell count, were measured twice weekly at the quarter level. The experimental unit in this design was the half-udder, and a mixed-model approach was used to assess the main and interactive effects of experiment week and treatment on milk production rate, milk remaining in the gland, and milk composition. The effect of treatment on milk production rate was significant, with the average control half-udder producing 0.97 kg/h and the treatment half-udder 0.73 kg/h. The effect of week on milk production rate and the interaction of week × treatment were also significant. The effect of treatment on milk remaining in the gland was significant, illustrating that an increase in milk remaining in the cisternal compartment had been achieved. We detected a significant decrease in milk lactose percentage in treatment half-udders, and a significant increase in somatic cell count (log10). The increase was relatively small, from a geometric mean of 26,300 cells/mL in control quarters to 48,300 cells/mL in treatment quarters. The decrease in milk production rate in treatment half-udders supports current knowledge about how mammary epithelial cell secretion, proliferation, and apoptosis are modulated by autocrine-paracrine factors.

Estimating teat canal cross-sectional area to determine the effects of teat-end and mouthpiece chamber vacuum on teat congestion.

The primary objective of this experiment was to assess the effect of mouthpiece chamber vacuum on teat-end congestion. The secondary objective was to assess the interactive effects of mouthpiece chamber vacuum with teat-end vacuum and pulsation setting on teat-end congestion. The influence of system vacuum, pulsation settings, mouthpiece chamber vacuum, and teat-end vacuum on teat-end congestion were tested in a 2×2 factorial design. The low-risk conditions for teat-end congestion (TEL) were 40 kPa system vacuum (Vs) and 400-ms pulsation b-phase. The high-risk conditions for teat-end congestion (TEH) were 49 kPa Vs and 700-ms b-phase. The low-risk condition for teat-barrel congestion (TBL) was created by venting the liner mouthpiece chamber to atmosphere. In the high-risk condition for teat-barrel congestion (TBH) the mouthpiece chamber was connected to short milk tube vacuum. Eight cows (32 quarters) were used in the experiment conducted during 0400 h milkings. All cows received all treatments over the entire experimental period. Teatcups were removed after 150 s for all treatments to standardize the exposure period. Calculated teat canal cross-sectional area (CA) was used to assess congestion of teat tissue. The main effect of the teat-end treatment was a reduction in CA of 9.9% between TEL and TEH conditions, for both levels of teat-barrel congestion risk. The main effect of the teat-barrel treatment was remarkably similar, with a decrease of 9.7% in CA between TBL and TBH conditions for both levels of teat-end congestion risk. No interaction between treatments was detected, hence the main effects are additive. The most aggressive of the 4 treatment combinations (TEH plus TBH) had a CA estimate 20% smaller than for the most gentle treatment combination (TEL plus TBL). The conditions designed to impair circulation in the teat barrel also had a deleterious effect on circulation at the teat end. This experiment highlights the importance of elevated mouthpiece chamber vacuum on teat-end congestion and resultant decreases in CA.

Assessing liner performance using on-farm milk meters.

The primary objective of this study was to quantify and compare the interactive effects of liner compression, milking vacuum level, and pulsation settings on average milk flow rates for liners representing the range of liner compression of commercial liners. A secondary objective was to evaluate a methodology for assessing liner performance that can be applied on commercial dairy farms. Eight different liner types were assessed using 9 different combinations of milking system vacuum and pulsation settings applied to a herd of 80 cows with vacuum and pulsation conditions changed daily for 36d using a central composite experimental design. Liner response surfaces were created for explanatory variables milking system vacuum (Vsystem) and pulsator ratio (PR) and response variable average milk flow rate (AMF=total yield/total cups-on time) expressed as a fraction of the within-cow average flow rate for all treatments (average milk flow rate fraction, AMFf). Response surfaces were also created for between-liner comparisons for standardized conditions of claw vacuum and milk ratio (fraction of pulsation cycle during which milk is flowing). The highest AMFf was observed at the highest levels of Vsystem, PR, and overpressure. All liners showed an increase in AMF as milking conditions were changed from low to high standardized conditions of claw vacuum and milk ratio. Differences in AMF between liners were smallest at the most gentle milking conditions (low Vsystem and low milk ratio), and these between-liner differences in AMF increased as liner overpressure increased. Differences were noted with vacuum drop between Vsystem and claw vacuum depending on the liner venting system, with short milk tube vented liners having the greater vacuum drop than mouthpiece chamber vented liners. The accuracy of liner performance assessment in commercial parlors fitted with milk meters can be improved by using a central composite experimental design with a repeated center point treatment, rotating different clusters to different stalls (milk meters), and adjusting performance estimates for similar claw vacuum and pulsation conditions.

Effect of pulsation rest phase duration on teat end congestion.

The objective of this study was to quantify the effect of d-phase (rest phase) duration of pulsation on the teat canal cross-sectional area during the period of peak milk flow from bovine teats. A secondary objective was to test if the effect of d-phase duration on teat canal cross-sectional area was influenced by milking system vacuum level, milking phase (b-phase) duration, and liner overpressure. During the d-phase of the pulsation cycle, liner compression facilitates venous flow and removal of fluids accumulated in teat-end tissues. It was hypothesized that a short-duration d-phase would result in congestion of teat-end tissue and a corresponding reduction in the cross-sectional area of the teat canal. A quarter milking device, designed and built at the Milking Research and Instruction Laboratory at the University of Wisconsin-Madison, was used to implement an experiment to test this hypothesis. Pulsator rate and ratios were adjusted to achieve 7 levels of d-phase duration: 50, 100, 150, 175, 200, 250, and 300ms. These 7 d-phase durations were applied during one milking session and were repeated for 2 vacuum levels (40 and 50kPa), 2 milking phase durations (575 and 775ms), and 2 levels of liner overpressure (9.8 and 18kPa). We observed a significant reduction in the estimated cross-sectional area of the teat canal with d-phase durations of 50 and 100ms when compared with d-phase durations of 150, 175, 225, 250, and 300ms. No significant difference was found in the estimated cross-sectional area of the teat canal for d-phase durations from 150 to 300ms. No significant interaction was observed between the effect of d-phase and b-phase durations, vacuum level, or liner overpressure.

Methods of estimating liner compression.

The aim of this study was to compare 2 methods of measuring overpressure (OP) using a new test device designed to make OP measurements more quickly and accurately. Overpressure was measured with no pulsation (OP np) and with limited pulsation (OP lp) repeatedly on the same cow during a single milking. Each of the 6 liners (3 round liners and 3 triangular liners) used in this study were tested on the same 6 experimental cows. Both OP np and OP lp were measured on all 4 teats of each experimental cow twice for each liner. The order of OP np and OP lp alternated sequentially for each cow test. The OP results for the 6 liners were also compared with liner compression estimated on the same liners with a novel artificial teat sensor (ATS). The OP lp method showed small but significantly higher values than the OP np method (13.9 vs. 13.4 kPa). The OP lp method is recommended as the preferred method as it more closely approximates normal milking condition. Overpressure values decreased significantly between the first and the following measurements, (from 15.0 to 12.4 kPa). We recommend performing the OP test at a consistent time, 1 min after attaching the teatcup to a well-stimulated teat, to reduce the variability produced by OP changing during the peak flow period. The new test device had several advantages over previously published methods of measuring OP. A high correlation between OP and liner compression estimated by the ATS was found, but difficulties were noted when using the ATS with triangular liners.

Developing new veterinary services in milk quality: a review of a recent mastitis risk management co-development in Australia.

A new veterinary service to promote ongoing, incremental improvements in the risk management of mastitis and milk quality was developed between 2005 and 2008. This was designed to enhance the relationship between the farmer and advisor, as an extension of the Countdown Downunder programme, Australia's national mastitis and milk quality programme. This service was co-developed between the Countdown Downunder programme team and a core development group of veterinarians involved with trialling the service, and farmers and social researchers. The service, known as Countdown MAX, involved advisory input at the planning stage, a written risk management plan, multiple engagements between the farm team and advisor for tracking and re-planning, and a service fee. Risk management resources (modules) were developed to be employed at the drying-off and calving periods, and during lactation. During the development and implementation phase eight veterinary practices conducted Countdown MAX consultations on 55 farms. Eighty-eight Countdown MAX modules were delivered in total, with 55% of farms completing more than one module but only 38% of modules reviewed successfully. A social research project examined the implementation of the Countdown MAX service in participating veterinary practices during the development phase. Findings of the project were that the successful uptake of a new mastitis service into a veterinary practice was enhanced through uptake by practice owners of the concept, the formation of a written practice plan, adequate communication and explanation of the new service to all staff, logistical support for the service within the practice, and transfer of mastitis expertise within the practice.

A national programme for mastitis control in Australia: Countdown Downunder.

In 1998, Countdown Downunder, Australia's national mastitis and cell count control programme, was created. With funding from the country's leading dairy organisation, Dairy Australia, this programme was originally intended to run for three years but is now in its tenth year. As it was the first time Australia had attempted a national approach to mastitis control on the farm, the first three years of the programme were largely concerned with the development of resources to be used by farmers and service providers. The second three years were devoted to training with both groups. Since that time, Countdown Downunder has entered into a second resource development phase. The goal of the programme was to achieve a reduction in the bulk milk somatic cell count from the Australian dairy herd. To achieve this, the programme had to develop resources with clear and consistent messages around mastitis and somatic cell count control on farms. It was determined that progress toward the goals would be made more rapidly if service providers were trained in the use of these resources prior to farmers. This paper reviews the Countdown Downunder programme from 1998 to 2007.

Formation of a stable heterodimer between Smad2 and Smad4.

Smad proteins mediate transforming growth factor beta signaling from the cell membrane to the nucleus. Upon phosphorylation by the activated receptor kinases, the receptor-regulated Smad, such as Smad2, forms a heterocomplex with the co-mediator Smad, Smad4. This heterocomplex is then translocated into the nucleus, where it associates with other transcription factors and regulates expression of ligand-responsive genes. The stoichiometry between receptor-regulated Smad and co-mediator Smad is important for understanding the molecular mechanisms of the signaling process. Using purified recombinant proteins, we demonstrate that Smad2 and Smad4 form a stable heterodimer and that the Smad4 activation domain is important for the formation of this complex. Many tumor-derived missense mutations disrupt the formation of this heterocomplex in in vitro interaction assays. Mapping these mutations onto the structures of Smad4 and Smad2 identifies a symmetric interface between these two Smad proteins. Importantly, two previous models on the formation of a heterocomplex are incompatible with our observations and other reported evidence.

Topiramate placebo-controlled dose-ranging trial in refractory partial epilepsy using 600-, 800-, and 1,000-mg daily dosages. Topiramate YE Study Group.

We conducted a multicenter, double-blind, randomized, parallel, placebo-controlled trial in 190 patients to evaluate the safety and efficacy of three dosages of topiramate (600, 800, and 1,000 mg/day) as adjunctive therapy for patients with refractory partial epilepsy. During an 18-week double-blind treatment period, median percent reductions from baseline in average monthly seizure rates were 1% for placebo, 41% for topiramate 600 mg/day and topiramate 800 mg/day, and 38% for topiramate 1,000 mg/day. There was a 50% or greater reduction from baseline in seizure frequency in 9% of patients in the placebo group and in 44% for topiramate 600 mg/day, 40% for topiramate 800 mg/day, and 38% for topiramate 1,000 mg/day. No placebo patients were improved by 75 to 100% in seizure frequency, whereas 20% of the topiramate patients were improved to this degree. All intent-to-treat drug-placebo comparisons including seizure reduction, percent responders, and investigator and patient global evaluations significantly (p < or = 0.02) favored topiramate. Treatment-emergent adverse events consisted mainly of neurologic symptoms commonly observed during antiepileptic drug (AED) therapy. Sixteen percent of patients on topiramate discontinued therapy due to adverse events. Results of this study indicate that topiramate is a highly efficacious and generally well tolerated new AED. When large groups of patients are compared, incremental efficacy in the add-on setting is not observed at topiramate dosages above 600 mg/day; however, higher doses may prove beneficial to individual patients who tolerate them.

Choreiform movements associated with the use of valproate.

OBJECTIVE: To describe the association of choreiform movements with the use of valproic acid. DESIGN: Case series. PATIENTS: Three patients who developed chorea during long-term treatment with valproic acid. All patients had severe brain damage; one had a preexisting unilateral vascular lesion in the caudate nucleus. At the time chorea developed, two patients were also receiving phenytoin sodium. RESULTS: Chorea developed between 30 minutes and 3 hours after ingestion of valproic acid, and the duration of the episodes varied between 30 minutes and 8 hours. The episodes of chorea occurred frequently for several days followed by asymptomatic periods lasting several weeks. Choreic movements involved the head, mouth, tongue, trunk, and limbs bilaterally in two cases and contralaterally in the patient with the caudate lesion. In one case, it was necessary to withdraw valproic acid treatment, while in the other two cases, replacement of valproic acid by divalproex sodium sprinkles presumably decreased peak concentrations and resulted in resolution with no recurrence of the chorea. CONCLUSIONS: Valproic acid-associated chorea occurred in patients with severe epilepsy and brain damage. It may occur after several years of valproic acid use and may be more likely to develop if valproic acid is taken together with phenytoin. Because valproic acid-associated chorea seemed to be dose related, avoiding excessive fluctuations of serum levels by the use of divalproex sodium sprinkles may be an effective solution in these cases.

Predictive value of induction of psychogenic seizures by suggestion.

Induction by suggestion has previously been reported to be effective in the diagnosis of psychogenic seizures (PS). However, the sensitivity and specificity of this procedure has not previously been studied. Results of induction of PS by suggestion were analyzed in 93 patients with purely PS. The diagnosis of PS was based on the recording of a clinical event on video-electroencephalography, the absence of clinical or electroencephalography the absence of clinical or electroencephalographic evidence of epilepsy, and the subsequent followup and withdrawal of anticonvulsants supporting the diagnosis of PS. A control-group was composed of 20 patients with epilepsy in which induction was tried. Both groups were comparable for age, sex, and educational level. Induction was performed following a standardized protocol. The test was carried out placing a colored patch on the neck. The test was considered positive when the induced clinical events were typical, according to a witness familiar with the patient's seizures. Induction was positive in 72 of 93 cases with PS and in none with epilepsy. Sensitivity of this test for the diagnosis of PS was 77.4%, specificity 100%, positive predictive value 100%, and negative predictive value 48.7%.

Clinical and EEG asymmetries in juvenile myoclonic epilepsy.

We reviewed records of 85 patients with juvenile myoclonic epilepsy (JME) for significant asymmetries in clinical seizures or the EEG. We noted asymmetries in 26 of 85 patients (30.6%). Only 2 patients had both clinical and EEG asymmetries; 12 had clinical asymmetries and 12 had EEG asymmetries exclusively. Analysis of patients with and without asymmetries showed no statistically significant differences in comparisons of sex, age at seizure onset, family history of epilepsy, seizure type, or response to treatment. The delay in diagnosis was greater in JME patients with asymmetries (9.5 years) than in JME patients with no asymmetries (7.5 years), but this difference was not statistically significant. Fourteen of the 26 patients with asymmetries (53.8%) were initially misdiagnosed as having partial seizures. Asymmetries in JME patients are not only common, but are also a frequent cause of misdiagnosis.

Psychogenic seizures in adults: a longitudinal analysis.

The clinical characteristics, psychosocial background, neuropsychological testing, clinical and social outcome were analysed in 93 adults with psychogenic seizures (PS). Thirteen (14%) were males and 80 (86%) were females. Mean age was 31.7 years (range 16 to 55 years). Lack of responsiveness associated with motor activity was the most common finding. Neuropsychological testing done in 46 cases revealed hysteroid traits and coping mechanisms and depression to be the most prevalent underlying problems. History of sexual abuse was evident in 10 (10.7%) cases. Social impact analysis revealed that of 62 patients who were working at the onset of PS, 34 were not working at the time of the diagnosis of PS. In 25 cases, PS were the reason for not working. After a mean follow-up of 60.7 months done in 63 patients, 16 (25.4%) patients were seizure-free. There were no obvious significant predictors of poor prognosis.