VIGABATRIN TOXICITY IN INFANCY IS ASSOCIATED WITH RETINAL DEFECT IN ADOLESCENCE: A Prospective Observational Study.

PURPOSE: The purpose was to determine whether vigabatrin (VGB) (Sabril)-attributed retinal toxicity defined by electroretinogram in early childhood is associated with visual system defect in adolescents after discontinuation of VGB. METHODS: This prospective cross-sectional study included 24 children previously treated with VGB and monitored in early childhood by electroretinogram for VGB-attributed retinal defects. Ten had been diagnosed with VGB-attributed retinal defect (Group I) and 14 had no VGB-attributed retinal defect (Group II). Outcome measures were extent of monocular visual fields using Goldmann kinetic perimetry and RNFL thickness at the optic nerve head, using optical coherence tomography. RESULTS: Of those able to complete testing (6 eyes Group I and 16 eyes Group II), Goldmann results revealed results of visual field loss in Group I and not in Group II. The optical coherence tomography results demonstrated attenuation of the RNFL in all 6 eyes of Group I participants and in only 1 eye of 10 Group II participants. Optical coherence tomography data were nonoverlapping between Group 1 and Group II eyes. CONCLUSION: The VGB-attributed retinal toxicity identified by means of electroretinogram in infancy was associated with visual field loss and RNFL attenuation of the retinal nerve when tested in adolescence.

Therapeutic Touch in the Management of Responsive Behavior in Patients With Dementia.

Patients with dementia experience various behavioral symptoms in the course of their illnesses, which greatly affect their quality of life. Current treatment modalities are not always effective, and, thus, nonpharmacological approaches are the preferred first-line therapy for managing such symptoms. They generally address the basic needs of the person with dementia and provide humane care, often producing noticeable improvements in symptoms. Thus, such therapies should precede pharmacological interventions. The following literature review of 5 publications from 2010 to 2015 evaluates the use of therapeutic touch (TT) in the management of responsive behavior in patients with dementia. The results of the review suggest that TT may be beneficial in reducing agitation in individuals with dementia; however, further research is needed to assess the use of TT.

Vigabatrin retinal toxicity in children with infantile spasms: An observational cohort study.

OBJECTIVES: To determine time to vigabatrin (VGB, Sabril; Lundbeck, Deerfield, IL) induced retinal damage in children with infantile spasms (IS) and to identify risk factors for VGB-induced retinal damage (VGB-RD). METHODS: Observational cohort study including 146 participants (68 female, 81 male) with IS, an age-specific epilepsy syndrome of early infancy, treated with VGB. Participants ranged from 3 to 34.9 months of age (median 7.6 months). The median duration of VGB treatment was 16 months (range 4.6-78.5 months). Electroretinograms (ERGs) were performed according to the Standards of the International Society for Clinical Electrophysiology of Vision. Inclusion required baseline (pre-VGB or within 4 weeks of starting VGB treatment) and at least 2 follow-up ERGs. Significant reduction from baseline of the 30-Hz ERG flicker amplitude on 2 consecutive visits identified VGB-RD. Kaplan-Meier survival analyses depicted the effect of duration of VGB on VGB-RD. RESULTS: These data represent the largest survival analysis of children treated with VGB who did not succumb to retinal toxicity during the study. Thirty of the 146 participants (21%) showed VGB-RD. The ERG amplitude reduced with duration of VGB treatment (p = 0.0004) with no recovery after VGB cessation. With 6 and 12 months of VGB treatment, 5.3% and 13.3%, respectively, developed VGB-RD. There was neither effect of age of initiation of VGB treatment nor sex of the child on survival statistics and no significant effect of cumulative dosage on the occurrence of VGB-RD. CONCLUSIONS: Minimizing VGB treatment to 6 months will reduce the prevalence of VGB-RD in patients with IS.

Detection of the spatiotemporal trends of mercury in Lake Erie fish communities: a Bayesian approach.

The temporal trends of total mercury (THg) in four fish species in Lake Erie were evaluated based on 35 years of fish contaminant data. Our Bayesian statistical approach consists of three steps aiming to address different questions. First, we used the exponential and mixed-order decay models to assess the declining rates in four intensively sampled fish species, i.e., walleye (Stizostedion vitreum), yellow perch (Perca flavescens), smallmouth bass (Micropterus dolomieui), and white bass (Morone chrysops). Because the two models postulate monotonic decrease of the THg levels, we included first- and second-order random walk terms in our statistical formulations to accommodate nonmonotonic patterns in the data time series. Our analysis identified a recent increase in the THg concentrations, particularly after the mid-1990s. In the second step, we used double exponential models to quantify the relative magnitude of the THg trends depending on the type of data used (skinless-boneless fillet versus whole fish data) and the fish species examined. The observed THg concentrations were significantly higher in skinless boneless fillet than in whole fish portions, while the whole fish portions of walleye exhibited faster decline rates and slower rates of increase relative to the skinless boneless fillet data. Our analysis also shows lower decline rates and higher rates of increase in walleye relative to the other three fish species examined. The food web structural shifts induced by the invasive species (dreissenid mussels and round goby) may be associated with the recent THg trends in Lake Erie fish.