Exploring behavioral systems of the reinforcement sensitivity theory in people with epilepsy: A cross-sectional study.

OBJECTIVES: Although epilepsy has previously been associated with behavioral changes, no previous study has utilized the behavioral models of the reinforcement sensitivity theory (RST) to investigate the impact of epilepsy on behavior. Therefore, the objective of this cross-sectional study is to examine the potential relationship between epilepsy and the neurobehavioral systems of the RST. METHODS: Using the Reinforcement Sensitivity Theory-Personality Questionnaire (RST-PQ), this cross-sectional study assessed the behavioral systems of the RST in a sample of 27 epilepsy patients and 27 age- and gender-matched healthy individuals. The RST-PQ was designed to assess the different behavioral systems of the RST. The behavioral approach system (BAS) is responsible of the approach behavior, in high values related to risk seeking and addictive behavior and in low values well related to depression. The behavioral inhibition system (BIS) is well related to anxiety in high levels, and the fight flight freeze system (FFFS) is responsible for the avoidance behavior. RESULTS: After adjusting for age, no significant differences were found in demographic information (gender and marital status) between the general population and epilepsy patients. Gender distribution was similar, with 55.6% females in both groups. Marital status also showed no significant difference, with 74% single in the control group and 63% in the epilepsy group. Significant differences were observed in the behavioral systems of the RST. The epilepsy group had higher scores compared with the control group in several areas. BAS reward activity had a median score of 23 in the epilepsy group and 21 in the control group (p = 0.001). BAS goal drive persistence (p = 0.04), BAS impulsivity (p = 0.014), FFFS (p = 0.002), and BIS (median score of 77 in the epilepsy group and 66 in the control group) also showed significant differences, with p = 0.001. These significant differences remained consistent before and after matching the control group, indicating their robustness. The only exception was BAS reward activity, which did not show a significant difference after matching, with p = 0.106 and p = 0.051 before and after matching, respectively. CONCLUSIONS: The study suggests a potential positive association between epilepsy and the BIS, potentially mediated by the hippocampus. The relationship between epilepsy and the BAS, as well as the FFFS, may also be influenced by the BIS. These findings have clinical implications, but further research is needed to confirm these relationships.

ABSENCE OF SEPTAL Q WAVES: An Important Predictor of Significant Coronary Artery Disease and Mainly Proximal Stenosis of the Left Anterior Descending Artery.

AIMS: Data concerning the correlation between the absence of septal q waves and significant stenosis of proximal left anterior descending (LAD) artery shows conflicting results. This retrospective study was conducted to show that absence of septal q waves in leads V5-V6 could be of value in predicting significant coronary artery disease (CAD) and mainly significant proximal LAD coronary artery stenosis. METHODS: Our study included 500 consecutive patients who had coronary angiography, retrospectively chosen, excluding patients with acute coronary syndromes, and patients with abnormal ECGs (abnormal QRS duration, pathological q waves and hemiblocks). ECG and angiography films were reviewed. For the 2x2 tables analysis, a chi-square test was used. RESULTS: Of the 500 patients, 386 had significant CAD defined as 70% luminal stenosis, and 260 had no septal q wave. Of the 386 patients with significant CAD, 233 (60%) did not have septal q waves. Of 260 who did not have septal q wave, 192 (73%) had significant stenosis of proximal LAD. Statistical analysis shows that significant CAD correlates with the absence of septal q waves, with a sensitivity of 60% and a specificity of 76%, and that stenosis of proximal LAD could be predicted by absence of septal q waves in leads V5-V6 with a sensitivity of 83% and a specificity of 74%. CONCLUSION: The absence of septal q waves in leads V5-V6 on the ECG correlates with the presence of significant CAD and is of highly predictive value in those with significant stenosis of proximal LAD (p < 0.0001).

Neurocardiogenic syncope and associated conditions: insight into autonomic nervous system dysfunction.

Neurocardiogenic syncope is known to be associated with autonomic nervous system dysfunction, although the mechanism has not been entirely elucidated. In this study, we sought to highlight the pathogenic role of the autonomic nervous system in neurocardiogenic syncope and to review the associated co-morbidities known to have a dysautonomic basis. Herein we discuss migraine, orthostatic hypotension, postural orthostatic tachycardia syndrome, endothelial dysfunction, chronic fatigue syndrome, and carotid sinus hypersensitivity with a focus on the pathogenic role of the autonomic nervous system and any consecutive clinical implications. Other conditions, such as pre-syncopal heart rate acceleration and/or instability and pre-syncopal breathing instability, which occur during a tilt test, are discussed in the same perspective.

Human poisoning after ingestion of puffer fish caught from Mediterranean Sea.

Puffer fish poisoning is due to a powerful neurotoxin produced by bacteria living in this kind of fish. Though the sea of Lebanon (Mediterranean) is not endemic of puffer fish and incidence of its serious poisoning is rare, yet occasional incidences do occur. The purpose of this presentation is to raise the awareness of fishermen, fish-restaurant frequenters, public health organizations and the Ministry of Health, of its serious symptomology and to seek medical help as soon as possible.

Encephalopathy induced by antihelminthic use of levamisole: report of two patients.

BACKGROUND: The antihelminthic Levamisole (LVM) is actually used as an immunomodulator in colon cancer. Its neurological toxicity is well known when used concomitantly with 5-Fluorouracil (5 FU) and, rarely when used solely at high doses. Antihelminthic imidazoles induced encephalopathy (AIIE), has been reported only in China. METHODS: We report two Lebanese patients with AIIE, with literature review concerning the pathophysiology, clinical presentation, laboratory, imaging and prognosis of this entity. RESULTS: AIIE supervenes after sensitization and re-exposure to the drug. It resembles the acute disseminated encephalomyelitis (ADEM) and the differentiation from multiple sclerosis is primarily based on the monophasic clinical and radiological (MRI) pattern of the disease. The treatment consists of steroids, and it has a good prognosis. The immunomodulatory role of Levamisole is evident but the pharmacokinetics remain unknown. CONCLUSION: This disease entity has to be considered anytime a patient, in an endemic area for helminthiasis, develops an encephalopathy, especially after a documented exposure to imidazoles, even at low doses and particularly after re-exposure to the drug that has to be prudent.