- Email: [email protected]
Occipital epilepsies: identification of specific and newly recognized syndromes1
●
Occipital epilepsies: identification of specific and newly recognized syndromes. Taylor I, Scheffer IE, Berkovic SF.* Brain 2003;126:753–769.
O
CCIPITAL EPILEPSIES ARE DIFFICULT TO DIAGNOSE
and are under-recognized. Visual hallucinations are the key clinical symptoms indicating an occipital focus but may be difficult to elicit on history, especially from children, and are not always present. In this comprehensive review, the authors present the clinical and neuroimaging advances that have led to the recognition of many new occipital epilepsy syndromes, which generally present in childhood or adolescence. Major groups include malformations of cortical development (focal cortical dysplasia, periventricular heterotopia, subcortical band heterotopia, polymicrogyria), vascular (including epilepsy with bilateral occipital calcifications often associated with celiac disease), metabolic and the emerging idiopathic occipital epilepsies. The idiopathic occipital epilepsies now comprise three identifiable electroclinical syndromes of childhood and adolescence, the biological inter-relationships and overlap with idiopathic generalized epilepsies of which are discussed in this review. The authors emphasize the clues to recognition of specific occipital epilepsies, some of which now have specific treatments. When medical therapy is ineffective, occipital corticectomy may be considered. Emerging evidence suggests that some syndromes have a good surgical outcome, and the consequences to visual function may be less severe than anticipated.—Vale´ rie Biousse *Samuel F. Berkovic, Epilepsy Research Institute, Level 1, Neurosciences Building, University of Melbourne, Austin and Repatriation Medical Centre, Banksia Street, Heidelberg West, Victoria, 3081, Australia; e-mail: [email protected]
●
Comparison of efficacy and immunogenicity of original versus current botulinum toxin in cervical dystonia. Jankovic J,* Vuong KD, Ahsan J. Neurology 2003;60: 1186 –1188.
S
INCE ITS APPROVAL BY THE FOOD AND DRUG ADMINIS-
tration for the treatment of blepharospasm and other facial spasm in 1989, Botulinum toxin (BTX) type A has been used for a variety of diseases. The possibility of increasing immunoresistance due to the development of blocking antibodies has been raised in multiple studies. Some authors have suggested that up to 17% of patients treated repeatedly for cervical dystonia with BTX type A have such immunoresistance. However, these data were based on experience with the original preparation of BTX type A used before 1998. The authors compared 130 patients treated for cervical dystonia with the original botulinum toxin (BTX) type A (Botox; Allergan, Inc., Irvine, California, USA), 42 of whom were exposed only
VOL. 136, NO. 4
to the original BTX type A used before 1998 (25 ng protein/100 units), and 119 treated only with the current BTX type A (5 ng of protein/100 units). Blocking antibodies were detected in 4 of 42 (9.5%) patients treated only with original BTX type A but in none of the 119 patients treated exclusively with current BTX type A (P ⬍ .004). The current preparation decreased the risk of antibody formation by a factor of six. The authors conclude that the low risk of antibody formation after current BTX type A treatment is related to lower protein load.—Vale´ rie Biousse *Joseph Jankovic, MD, Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801. Houston, TX 77030; e-mail: josephj@ bcm.tmc.edu
● Role of a research ethics committee in follow-up and publication of results. Piche J, Carne´ X,* Arnaiz JA, Gomez B, Trilla A, Rodes J. Lancet 2003;361:1015–1016.
T
HE MAIN ROLE OF RESEARCH ETHICS COMMITTEES
(RECs) is to assess both the scientific and clinical aspects of submitted protocols. Research ethics committees are responsible not only for approval of the protocol and its amendments but also for follow-up and monitoring of the trial until its closure. However, follow-up of clinical trials is a commitment rarely fulfilled by research ethics committees. The authors assessed the output of clinical trials submitted in 1997 to their REC (in Barcelona, Spain) and talked to principal investigators, sponsors, contract research organizations, or a combination of these. During 1997, their REC reviewed 166 clinical trials and approved 158. The recruitment rate was lower than expected in 45% (64 of 143) of all initiated clinical trials; 64% (92 of 143) were finished in accordance with the protocol. Three years later, the results of only 21% (26 of 123) of finished clinical trials were published in peer-reviewed journals, rising to 31% (38 of 123) when in-press articles were included. The authors suggest that RECs should devote more effort and resources to assess public dissemination of results of clinical trials.—Vale´ rie Biousse See commentary by Antes G, Chalmers I. Underreporting of clinical trials is unethical. Lancet 2003;361: 978 –979. *Xavier Carne´ , MD, Clinical Pharmacology Unit, Hospital Clinic, Barcelona, Farmacologicia Clinica-UASP, Villarroel 170, 08036, Barcelona, Spain.
● Intraocular pressure-induced interlamellar keratitis after LASIK surgery. Davidson RS, Brandt JD, Mannis MJ.* J Glaucoma 2003;12:23–26.
ABSTRACTS
785
Occipital epilepsies: identification of specific and newly recognized syndromes. Taylor I, Scheffer IE, Berkovic SF.* Brain 2003;126:753–769.
O
CCIPITAL EPILEPSIES ARE DIFFICULT TO DIAGNOSE
and are under-recognized. Visual hallucinations are the key clinical symptoms indicating an occipital focus but may be difficult to elicit on history, especially from children, and are not always present. In this comprehensive review, the authors present the clinical and neuroimaging advances that have led to the recognition of many new occipital epilepsy syndromes, which generally present in childhood or adolescence. Major groups include malformations of cortical development (focal cortical dysplasia, periventricular heterotopia, subcortical band heterotopia, polymicrogyria), vascular (including epilepsy with bilateral occipital calcifications often associated with celiac disease), metabolic and the emerging idiopathic occipital epilepsies. The idiopathic occipital epilepsies now comprise three identifiable electroclinical syndromes of childhood and adolescence, the biological inter-relationships and overlap with idiopathic generalized epilepsies of which are discussed in this review. The authors emphasize the clues to recognition of specific occipital epilepsies, some of which now have specific treatments. When medical therapy is ineffective, occipital corticectomy may be considered. Emerging evidence suggests that some syndromes have a good surgical outcome, and the consequences to visual function may be less severe than anticipated.—Vale´ rie Biousse *Samuel F. Berkovic, Epilepsy Research Institute, Level 1, Neurosciences Building, University of Melbourne, Austin and Repatriation Medical Centre, Banksia Street, Heidelberg West, Victoria, 3081, Australia; e-mail: [email protected]
●
Comparison of efficacy and immunogenicity of original versus current botulinum toxin in cervical dystonia. Jankovic J,* Vuong KD, Ahsan J. Neurology 2003;60: 1186 –1188.
S
INCE ITS APPROVAL BY THE FOOD AND DRUG ADMINIS-
tration for the treatment of blepharospasm and other facial spasm in 1989, Botulinum toxin (BTX) type A has been used for a variety of diseases. The possibility of increasing immunoresistance due to the development of blocking antibodies has been raised in multiple studies. Some authors have suggested that up to 17% of patients treated repeatedly for cervical dystonia with BTX type A have such immunoresistance. However, these data were based on experience with the original preparation of BTX type A used before 1998. The authors compared 130 patients treated for cervical dystonia with the original botulinum toxin (BTX) type A (Botox; Allergan, Inc., Irvine, California, USA), 42 of whom were exposed only
VOL. 136, NO. 4
to the original BTX type A used before 1998 (25 ng protein/100 units), and 119 treated only with the current BTX type A (5 ng of protein/100 units). Blocking antibodies were detected in 4 of 42 (9.5%) patients treated only with original BTX type A but in none of the 119 patients treated exclusively with current BTX type A (P ⬍ .004). The current preparation decreased the risk of antibody formation by a factor of six. The authors conclude that the low risk of antibody formation after current BTX type A treatment is related to lower protein load.—Vale´ rie Biousse *Joseph Jankovic, MD, Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801. Houston, TX 77030; e-mail: josephj@ bcm.tmc.edu
● Role of a research ethics committee in follow-up and publication of results. Piche J, Carne´ X,* Arnaiz JA, Gomez B, Trilla A, Rodes J. Lancet 2003;361:1015–1016.
T
HE MAIN ROLE OF RESEARCH ETHICS COMMITTEES
(RECs) is to assess both the scientific and clinical aspects of submitted protocols. Research ethics committees are responsible not only for approval of the protocol and its amendments but also for follow-up and monitoring of the trial until its closure. However, follow-up of clinical trials is a commitment rarely fulfilled by research ethics committees. The authors assessed the output of clinical trials submitted in 1997 to their REC (in Barcelona, Spain) and talked to principal investigators, sponsors, contract research organizations, or a combination of these. During 1997, their REC reviewed 166 clinical trials and approved 158. The recruitment rate was lower than expected in 45% (64 of 143) of all initiated clinical trials; 64% (92 of 143) were finished in accordance with the protocol. Three years later, the results of only 21% (26 of 123) of finished clinical trials were published in peer-reviewed journals, rising to 31% (38 of 123) when in-press articles were included. The authors suggest that RECs should devote more effort and resources to assess public dissemination of results of clinical trials.—Vale´ rie Biousse See commentary by Antes G, Chalmers I. Underreporting of clinical trials is unethical. Lancet 2003;361: 978 –979. *Xavier Carne´ , MD, Clinical Pharmacology Unit, Hospital Clinic, Barcelona, Farmacologicia Clinica-UASP, Villarroel 170, 08036, Barcelona, Spain.
● Intraocular pressure-induced interlamellar keratitis after LASIK surgery. Davidson RS, Brandt JD, Mannis MJ.* J Glaucoma 2003;12:23–26.
ABSTRACTS
785