Compromised weight gain, milk intake, and feeding behavior in breastfed newborns of depressive mothers.

OBJECTIVE: To explore depressed mood in the breastfeeding dyad. METHOD: N = 50 mothers of 12-day-olds reported depressed mood (EPDS) and anxiety (STAI), then were videotaped while breastfeeding. Infants were weighed before and after breastfeeding. RESULTS: An ANCOVA on weight gain, which controlled for infant age and birth weight, found EPDS inversely related to weight gain. Following a significant MANCOVA on infant biobehavioral measures, ANCOVAs which controlled for birth weight, age, hunger at time of testing, and degree of exclusivity in breastfeeding, found EPDS inversely related to infants' milk intake and latch quality. Following a significant MANOVA on maternal behaviors, ANOVAs revealed EPDS inversely related to mothers' sensitive positioning and touch frequency. Contrastingly, anxiety was associated with increased touch. CONCLUSION: In the breastfed newborn, mothers' depressed mood is associated with lesser weight gain, lower milk intake, poorer latch to the breast, and receiving less frequent touch and less-sensitive positioning at the breast by mother.

Seizure prediction and recall.

Using separate generalized mixed-effects models, we assessed seizure recall and prediction, as well as contributing diagnostic variables, in 83 adult patients with epilepsy undergoing video/EEG monitoring. The model revealed that when participants predicted a seizure, probability equaled 0.320 (95% CI: 0.149-0.558), a significant (P<0.05) increase over negative predictions (0.151, 95% CI: 0.71-0.228]). With no seizure, the rate of remembering was approximately 0.130 (95% CI: 0.73-0.219), increasing significantly to 0.628 (95% CI: 0.439 to 0.784) when a seizure occurred (P<0.001). Of the variables analyzed, only inpatient seizure rate influenced predictability (P<0.001) or recollection (P<0.001). These models reveal that patients were highly aware of their seizures, and in many cases, were able to make accurate predictions, for which seizure rate may be an important factor.

Oxidation of glutathione and superoxide generation by inorganic and organic selenium compounds.

The carcinostatic activities of selenium (Se) compounds have been shown to be composition and concentration dependent. Several studies have indicated that the ratios between glutathione (GSH) and Se may play an important role in Se catalysis and toxicity. The present study examined the catalytic effect of three selenium compounds on GSH oxidation using lucigenin-dependent chemiluminescence (CL) as an indirect measure of superoxide generation. Various GSH:Se ratios were assayed for the glutathione oxidase activity of selenite, selenocystamine and diselenodipropionic acid. CL emitted from the reaction of selenite with GSH increased more rapidly and was greater than those from the diselenides, but the diselenide CL reactions were sustainable. Both selenite- and diselenide-induced CL were markedly suppressed by superoxide dismutase (SOD). Iodoacetic acid (IAc) effectively inhibited CL generated from selenite-, selenocystamine- and diselenodipropionic acid-catalyzed GSH oxidation. These results suggest that GSH oxidation catalyzed by selenite, and the diselenides selenocystamine and diselenodipropionic acid, generated the superoxide radical in which the CL was inhibited by SOD. Furthermore, CL inhibition by IAc suggests that the catalytic species producing superoxide were the GSSe(-) or RSe(-) anion. This redox chemistry may be responsible for selenite and organoselenium toxicity and apoptosis, making possible the design and synthesis of organoselenium-containing pharmaceuticals.

Auras are frequent in idiopathic generalized epilepsy.

The occurrence of an aura is often considered evidence of a partial rather than an idiopathic generalized epilepsy syndrome. The authors examined this hypothesis by prospectively recording reports of auras by patients being admitted for video-EEG monitoring. Auras were equally common (70%) among patients with idiopathic generalized epilepsy as they were among those with localization-related epilepsy. Presence of an aura is not a reliable indicator of localization-related epilepsy.

Brief report: newborn behavior differs with decosahexaenoic acid levels in breast milk.

OBJECTIVE: To assess whether natural variations in decosahexaenoic acid (DHA) levels in breast milk would relate to infant neurobehavioral outcomes at the newborn stage following equivocal findings on infant and toddler outcomes of exposure to DHA in formula and breast milk. METHODS: Breast milk samples from N = 20 mothers were collected 9 days after delivery, while the Brazelton Neonatal Behavioral Assessment Scale (NBAS) was administered on the infant. Milk samples were later analyzed for fatty acids, including DHA. RESULTS: Pearson correlations revealed a positive association between DHA concentrations in breast milk and infants' scores on the NBAS Range of State cluster score, suggesting that DHA is related to the infant's superior ability to maintain optimal arousal. CONCLUSIONS: These results suggest that breast milk DHA is beneficial to the neonate's neurobehavioral functioning and call for investigative attention to DHA's role in potentiating optimized intellectual functioning at later stages of development. The findings may also be interpreted as supporting formula supplementation with DHA.

Arsenic and selenium in human hair: a comparison of five countries with and without arsenicosis.

The selenium (Se) content of the diet and/or selenium supplements might have an ameliorating effect on arsenic (As) toxicity as recently shown by Wang et al., Yang et al., and as reviewed by Spallholz et al.. The underlying principles of the ameliorating effect is the complexation of Se with As forming the seleno-bis (S-glutathionyl) arsinium ion excreted in bile and the complexation of Se with As in tissues forming nontoxic insoluble selenides. Additional protection afforded by Se supplementation from arsenicosis could be the elevation of glutathione peroxidase activity reducing the oxidative stress induced by As. The present study assessed the status of Se and As in hair by neutron activation analysis (NAA). Human hair samples were collected from the United States, Canada, The People's Republic of China (PRC), Bangladesh, and Nepal, the latter two countries now engaged in a struggle to find relief from human arsenicosis resulting from extensive domestic groundwater contamination by As. No statistically significant differences were observed in the samples between the Se and As content of hair from, Lubbock, Texas (USA) or Winnipeg, Canada. The concentration of As in all hair samples analyzed correlated (r = 0.960, p < 0.001) with the amount of As in the drinking water. Selenium levels in hair were highest from Nepal. The results demonstrate the viability of hair as a noninvasive biomonitor in assessing aspects of dietary Se and environmental As exposure. The hair data confirmed the known low intake of Se in the Keshan disease area of the PRC, the very high accumulation in hair of As from subjects consuming contaminated groundwaters, and an adequate Se status in subjects from North America consuming municipal water of low As content. The high As content of hair from people in Bangladesh is the result of a high As consumption from contaminated water compounded by a less than desirable intake of Se. From Nepal, the As content of hair corresponded to the known low and high intake of As from contaminated groundwater. The very high Se content found in all hair samples from Nepal might be the result of the use of henna.

Environmental hypothesis: is poor dietary selenium intake an underlying factor for arsenicosis and cancer in Bangladesh and West Bengal, India?

To reduce the incidence of dysentery, cholera and other water-borne diseases and mortality of people drinking from surface contaminated sources of water, the World Bank and United Nations Children's Fund began to sink tube wells into the underlying aquifers of Bangladesh and West Bengal, India, in the 1970s. Many of the tube wells were drilled into underground aquifers that provided microbiologically clean water that was later determined to contain arsenic (As). As contamination of drinking water is a problem of natural occurrence throughout the world and domestic water often exceeds the World Health Organization limit of 50 microg As/l in the countries of Bangladesh, West Bengal, India and Nepal as well as other areas occupying much of the Ganges-Brahmaputra delta. It is estimated that as many as one-half of these tube wells discharge water with sufficient amounts of As to produce arsenicosis, i.e. As toxicity in the human population. Access to clean As free water is the priority of most organized relief efforts. Where As free domestic water cannot be provided, an improved diet and/or dietary supplements may ameliorate As toxicity or prevent its toxicity all together. The dietary status of the essential human trace element, selenium (Se) may be adversely affected by a chronic excessive ingestion of As. As added to animal diets has been known to counteract Se toxicity in animals since the 1930s. It is reasoned therefore, that high levels of chronic As ingestion from well water by people within the delta will accelerate the excretion of Se lowering the body's content of this essential trace element. Excessive Se excretion owing to Se/As complexation may add to the likelihood of As being more toxic and carcinogenic over time, due to the oxidative stress imposed by the excessive As and low Se ingestion. Because of the unique environment of the Ganges-Brahmaputra delta in which millions of people are presently exposed to As, we ask the question: are low dietary Se ingestion and accelerated Se depletion by As possible contributing factors to arsenicosis?

Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy.

BACKGROUND: The two-thirds of patients with epilepsy who become seizure-free have a quality of life (QOL) similar to the general population. The major treatment challenge is patients with refractory epilepsy. Whereas neurologists typically focus on seizure reduction in the treatment of these patients, results of studies relating seizure frequency to QOL are conflicting. As depression is associated with reduced QOL in epilepsy and antiepileptic medications (AEDs) can cause depression, it is important to determine the relative roles of depression and seizure frequency in QOL in refractory epilepsy. METHODS: Prospective evaluation was conducted of patients with refractory epilepsy being admitted to an inpatient video-EEG monitoring unit. The impact of clinical variables (age, sex, marital status, seizure frequency, duration and type of seizure disorder, seizure localization, number of AEDs, depression) on QOL was analyzed. RESULTS: Depression was a powerful predictor of QOL (n = 122, beta = -35.8, p < 0.0001). No other variable predicted QOL. Depression was common (54%), severe (19% with suicidal thoughts), underdiagnosed (37%), and largely untreated (17% on antidepressants). CONCLUSIONS: Treatment of depression may be inadequately prioritized in the management of intractable epilepsy.

Brief report: breast-fed one-week-olds demonstrate superior neurobehavioral organization.

OBJECTIVES: Following studies conducted during the immediate newborn stage, we investigated whether one-week-olds' neurobehavioral functioning was differentiated by feeding method. We also examined whether feeding-method effects differed among infants of adolescent mothers. METHOD: Participants were infants (N = 83) of breast-feeding (N = 41) and formula-feeding (N = 42) mothers. Approximately half of each group's participants had adolescent mothers and half were infants of adult mothers. Assessments on the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) were conducted on the infants when they were 8.95 days of age. RESULTS: Breast-fed infants surpassed formula-fed infants on items of the orientation, motor, range of state, and state regulation dimensions of the BNBAS. Breast-fed infants also exhibited fewer abnormal reflexes, signs of depression, and withdrawal. Infants of adolescent mothers did not differ from those of adult mothers, regardless of feeding method. CONCLUSION: These data provide compelling evidence that breast-feeding is advantageous to neonates' neurobehavioral organization.

Focal prefrontal seizures induced by bilateral ECT.

INTRODUCTION: It has been proposed that the greater efficacy of bilateral (BL) over right unilateral (RUL) electroconvulsive therapy (ECT) at low stimulus intensity is due to differences in site of seizure initiation. We hypothesized that focal prefrontal seizures are more common with BL than RUL administration. METHOD: Records were reviewed of the 1,007 ECT treatments of 84 consecutive patients randomized to RUL or BL electrode placement. RESULTS: Eight events were identified in which there was an electroencephalographic seizure without motor manifestation. All of these events occurred at titration sessions and with BL stimuli (p = 0.002). These events were more likely to occur later in the course of treatment. DISCUSSION: We suggest that BL ECT may induce focal seizures in prefrontal areas and that these seizures are more likely to occur later in the treatment course.

Repetitive transcranial magnetic stimulation to SMA worsens complex movements in Parkinson's disease.

OBJECTIVES: To evaluate the therapeutic potential of repetitive transcranial magnetic stimulation (rTMS) for Parkinson's disease (PD) by delivering stimulation at higher intensity and frequency over longer time than in previous research. Promising beneficial effects on movement during or after rTMS have been reported. METHODS: Ten patients with idiopathic PD were enrolled in a randomized crossover study comparing active versus sham rTMS to the supplementary motor area (SMA). Assessments included reaction and movement times (RT/MT), quantitative spiral analysis, timed motor performance tests, United Parkinson's Disease Rating Scale (UPDRS), patient self-report and guess as to stimulation condition. RESULTS: Two of 10 patients could not tolerate the protocol. Thirty to 45 min following stimulation, active rTMS as compared with sham stimulation worsened spiral drawing (P=0.001) and prolonged RT in the most affected limb (P=0.030). No other significant differences were detected. CONCLUSIONS: We sought clinically promising improvement in PD but found subclinical worsening of complex and preparatory movement following rTMS to SMA. These results raise safety concerns regarding the persistence of dysfunction induced by rTMS while supporting the value of rTMS as a research tool. Studies aimed at understanding basic mechanisms and timing of rTMS effects are needed.

Magnetoelectric brain stimulation in the assessment of brain physiology and pathophysiology.

OBJECTIVE: To review findings from transcranial magnetic stimulation (TMS)-induced motor evoked potentials in normal subjects, in various neurological diseases and with pharmacologic manipulation. METHODS: MEDLINE was searched to identify pertinent articles and articles referenced therein were also reviewed. RESULTS: TMS is a safe and non-invasive technique which has been used widely in the study of corticospinal and corticocortical connectivity as well as in the assessment of basal ganglia disorders, diffuse diseases, and neuropharmacology. CONCLUSIONS: TMS motor measures have utility in examination of brain structure and function within and beyond the corticospinal tract. These measures have both research and clinical applications.

Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors.

The electrical dosage of the ECT stimulus impacts on efficacy and cognitive side effects, yet seizure threshold (ST) may vary as much as 50-fold across patients. It would be desirable to predict ST on the basis of patient and treatment characteristics. In particular, concerns have been raised that benzodiazepine use and higher dosage of barbiturate anesthetics elevate ST. In a three-site study, ST was quantified at the first ECT session using an identical empirical titration procedure in 294 patients who met RDC and DSM-IIIR criteria for a major depressive episode. ST varied over a 35-fold range across patients treated with right unilateral (RUL) (n = 267) and bilateral (BL) (n = 27) ECT. Higher ST was associated with BL electrode placement (p = 0.001). Among patients treated with RUL ECT, univariate analyses indicated that higher ST was associated with advanced age (p < 0.001), male gender (p < 0.001), greater burden of medical illness (p < 0.001), weight (p < 0.01), duration of mood disorder (p < 0.01), and history of previous ECT (p < 0.05). Average lorazepam dose in the 48 hours prior to ECT was not associated with ST, but was associated with decreased seizure duration (p < 0.01). Absolute, but not weight-adjusted, methohexital dose was associated with ST (p < 0.01). Multivariate analyses in patients treated with unilateral ECT showed that only 27.6% of the variance in ST (p < 0.0001) could be predicted. In the multivariate analyses, only age (p = 0.0001), gender (p = 0.01), and methohexital dose (p = 0.0001) were independently related to ST. Low dosage of lorazepam and methohexital dosage below 1 mg/kg are unlikely to impact on ST. Given the limited capacity to predict ST, empirical titration remains the only accurate method to determine electrical dosage in RUL ECT.

Effect of dietary copper on selenium toxicity in Fischer 344 rats.

The purpose of this study was to investigate the ameliorating effects of dietary copper supplementation on selenium toxicity. Nine groups (n = 6) of weanling Fischer 344 female rats were randomly assigned to treatment groups and fed diets containing nontoxic levels of copper as CuCl2 and/or selenium as selenite or selenocystamine. Weight gain, liver and spleen weights, plasma lipid peroxidation, and liver selenium and copper content were analyzed after the 6-wk treatment period. Concentrations of up to 10 times the daily lethal dose of dietary selenium were well tolerated in rats supplemented with dietary copper. As the dietary level of selenium was increased, the ratio of selenium to copper measured in the liver decreased. In the groups of rats in which dietary copper supplementation was absent and dietary selenium was supplemented, copper stores in the liver remained unchanged from control values. Copper's protective effects from dietary selenium toxicity may come from the formation of a copper-selenide complex that renders both selenium and copper metabolically unavailable and nontoxic.