Psychogenic Nonepileptic Seizures-High Mortality Rate Is a 'Wake-Up Call'.

Patients with epilepsy have an elevated mortality rate compared to the general population and now studies are showing a comparable death ratio in patients diagnosed with psychogenic nonepileptic seizures. The latter is a top differential diagnosis for epilepsy and the unexpected mortality rate in these patients underscores the importance of an accurate diagnosis. Experts have called for more studies to elucidate this finding but the explanation is already available, embedded in the existing data. To illustrate, a review of the diagnostic practice in epilepsy monitoring units, of the studies examining mortality in PNES and epilepsy patients, and of the general clinical literature on the two populations was conducted. The analysis reveals that the scalp EEG test result, which distinguishes a psychogenic from an epileptic seizure, is highly fallible; that the clinical profiles of the PNES and epilepsy patient populations are virtually identical; and that both are dying of natural and non-natural causes including sudden unexpected death associated with confirmed or suspected seizure activity. The recent data showing a similar mortality rate simply constitutes more confirmatory evidence that the PNES population consists largely of patients with drug-resistant scalp EEG-negative epileptic seizures. To reduce the morbidity and mortality in these patients, they must be given access to treatments for epilepsy.

Sensor for fluorene based on the incorporation of an environmentally sensitive fluorophore proximal to a molecularly imprinted binding site.

A fluorescence-based chemical sensor for fluorene was created by molecularly imprinting a sol-gel comprising the bridged silsesquioxane, bis(trimethoxysilylethyl)benzene. The template was covalently bound to the sol-gel matrix using a fluorene analogue functionalized silane. After chemical removal of template via cleavage of a carbamate linkage, an amine group was left that provided an attachment site for the environmentally sensitive fluorescent probe 7-nitrobenz-2-oxa-1,3-diazole (NBD). Fluorene binding was detected by a change in NBD fluorescence intensity induced by a difference in the local polarity around the probe when the recognition site is filled. Such an approach eliminated response to nonspecific binding to the matrix. Sensing films deposited on glass slides were shown to have response times of <60 s and detection limits below 10 parts-per-trillion. Binding experiments demonstrated that the materials had good selectivity for fluorene over close structural analogues including naphthalene, fluoranthene, and anthracene. However, the sensing design is limited by a lack of reversibility following fluorene binding.

Development and characterization of molecularly imprinted sol-gel materials for the selective detection of DDT.

Molecularly imprinting sol-gel materials for DDT using both a noncovalent and a covalent approach was examined. A nonpolar porous sol-gel network was created through the use of the bridged polysilsesquioxane, bis-(trimethoxysilylethyl)benzene (BTEB), as the principal sol-gel component. Noncovalent molecular imprinting was deemed unsuccessful, presumably because of the lack of strong intermolecular interactions that can be established between the DDT and the sol-gel precursor. A covalent imprinting strategy was employed by generating a sacrificial spacer through the reaction of two 3-isocyanatopropyltriethoxysilanes with one of two different template molecules: 4,4'-ethylenedianiline (EDA) or 4,4'-ethylidenebisphenol (EBP). After formation of the sol-gel, the bonds linking the spacer template to the matrix were cleaved in a manner that generated a pocket of the appropriate size bordered by amine groups that could aid in the binding of DDT through weak hydrogen bonding interactions. Experiments indicated that DDT could be bound selectively by such an approch. To generate a sensor, an environmentally sensitive fluorescent probe, 7-nitrobenz-2-oxa-1,3-diazole, (NBD) located adjacent to the DDT binding site was used to transduce the binding of analyte. EDA-imprinted sol-gels, deposited as films on glass microscope slides, were shown to quantitatively detect DDT in water to a limit-of-detection of 50 ppt with a response time of <60 s. Repeat measurements could be made with the same sensing films after rinsing with acetone between each measurement. The EDA sensing material was selective for DDT and other structurally similar molecules. However, the sensing film design was limited by the relatively minor changes in fluorescence intensity upon binding DDT. This situation may be remedied by an alternative methodology that can facilitate attachment of the NBD fluorophore in an optimal position proximal to the binding pocket.