Drug Dosing in Patients Undergoing Therapeutic Plasma Exchange.

Therapeutic plasma exchange (TPE) is an extracorporeal process in which a large volume of whole blood is taken from the patient's vein. Plasma is then separated from the other cellular components of the blood and discarded while the remaining blood components may then be returned to the patient. Replacement fluids such as albumin or fresh-frozen plasma may or may not be used. TPE has been used clinically for the removal of pathologic targets in the plasma in a variety of conditions, such as pathogenic antibodies in autoimmune disorders. TPE is becoming more common in the neurointensive care space as autoimmunity has been shown to play an etiological role in many acute neurological disorders. It is important to note that not only does TPE removes pathologic elements from the plasma, but may also remove drugs, which may be an intended or unintended consequence. The objective of the current review is to provide an up-to-date summary of the available evidence pertaining to drug removal via TPE and provide relevant clinical suggestions where applicable. This review also aims to provide an easy-to-follow clinical tool in order to determine the possibility of a drug removal via TPE given the procedure-specific and pharmacokinetic drug properties.

Systematic review of ketogenic diet use in adult patients with status epilepticus.

Status epilepticus (SE) is a medical emergency that is associated with a significant morbidity and mortality. Recently, there has been significant interest in the use of ketogenic diets (KD) in the management of SE. KD is a high-fat, low-carbohydrate, and adequate protein diet that has been shown to be a safe and effective adjuvant to present SE management in patients with refractory epilepsy. Many case reports and case series have demonstrated the potential safety and effectiveness of KD for the acute treatment of SE; however, quality studies remain scarce on this topic. The purpose of this systematic review is to summarize the available evidence for the safety and effectiveness of KD in adults with SE. A literature search was performed in MEDLINE, EMBASE, Cochrane Library, and CINAHL (September 14, 2018). The search was repeated on March 27, 2019, to include any studies published since the original search. Keywords related to KD and SE were used. Studies were selected based on the reported use of the KD in SE. The search resulted in a total of 954 records. After screening and full-text review, 17 articles were included in this review: four observational studies, 10 case reports, and 3 case series. Based on the observational studies, a total of 38 Patients with SE have been reported. KD was successful in achieving cessation of SE in 31 Patients (82%). The most common adverse effects reported were metabolic acidosis, hyperlipidemia, and hypoglycemia. The current limited evidence suggests that KD might be considered as an option for adult patients with SE. Although promising, the results need to be interpreted with caution due to the inherent bias, confounding and small sample size of the included studies. A randomized controlled trial is recommended to establish role of KD in the management of SE in adults.

Neural Processes Associated with Vocabulary and Vowel-Length Differences in a Dialect: An ERP Study in Pre-literate Children.

Although familiarity with a language impacts how phonology and semantics are processed at the neural level, little is known how these processes are affected by familiarity with a dialect. By measuring event-related potentials (ERPs) in kindergarten children we investigated neural processing related to familiarity with dialect-specific pronunciation and lexicality of spoken words before literacy acquisition in school. Children speaking one of two German dialects were presented with spoken word-picture pairings, in which congruity (or the lack thereof) was defined by dialect familiarity with pronunciation or vocabulary. In a dialect-independent control contrast, congruity was defined by audio-visual semantic (mis)match. Congruity effects and congruity-by-dialect group interactions in the ERPs were tested by data-driven topographic analyses of variance (TANOVA) and theory-driven focal analyses. Converging results revealed similar congruity effects in the N400 and late-positive-complex (LPC) in the control contrast for both dialect groups. In the dialect-specific vocabulary contrast, topographies of the N400- and LPC-effects were reversed depending on familiarity with the presented dialect words. In the dialect-specific pronunciation contrast, again a topography reversal was found depending on dialect familiarity, however, only for the LPC. Our data suggest that neural processing of unfamiliar words, but not pronunciation variants, is characterized by semantic processing (increased N400-effect). However, both unfamiliar words and pronunciation variants seem to engage congruity judgment, as indicated by the LPC-effect. Thus, semantic processing of pronunciation in dialect words seems to be rather robust against slight alterations in pronunciation, like changes in vowel duration, while such alterations may still trigger subsequent control processes.