The long-term development of public attitudes towards people with epilepsy in the Czech Republic: 1981, 1984, 1998 and 2009 studies.

OBJECTIVE: The long-term development of public attitudes towards people with epilepsy (PWE) was studied. METHODS: Four questions (Q) used in Czech questionnaires for studies in 1981, 1984, 1998 and 2009 concerned: Q1, familiarity with the concept of epilepsy; Q2, tolerance towards children with epilepsy; Q3, whether epilepsy is considered to be a mental disease; and Q4, attitudes towards employment of PWE. RESULTS: The quality of information about epilepsy increased significantly between 1981 and 1998, 1981 and 2009, and 1998 and 2009. The 1981 and 1984 studies reflected a level of information inferior to the levels seen in Germany and the USA, and the difference had almost disappeared in 1998 and 2009. CONCLUSIONS: The long-term follow-up studies in Czech Republic displayed a permanent increase in knowledge about epilepsy. This may reflect the progress in the spread of information, the efforts of patient associations and specialists and perhaps also a change in general attitudes towards people with disabilities. The dramatic change of information levels in Czech surveys could also reflect the change of the political system in 1989. A question that remains to be answered is the extent to which the positive trend reflects positive attitudes in real life. The answers to questions concerning whether people would be willing to help a person having a seizure remain unsatisfactory. Greater efforts should be made to improve the situation of PWE and to minimize their stigmatization.

IT delivery of ChABC modulates NG2 and promotes GAP-43 axonal regrowth after spinal cord injury.

Chondroitin sulphate proteoglycans (CSPGs) with the major component NG2 have an inhibitory effect on regeneration of damaged axons after spinal cord injury. In this study, we investigate whether the digestion of CSPGs by chondroitinase ABC (ChABC) may decrease the NG2 expression and promote axon regrowth through the lesion site. Rats underwent spinal cord compression injury and were treated with ChABC or vehicle through an intrathecal catheter delivery at 2, 3, and 4 days after injury. In addition, animals were behaviorally scored using BBB test in weekly intervals after SCI. Based on immunocytochemical analyses, we have quantified distribution of NG2 glycoprotein and GAP-43 in spinal cord tissue in both experimental groups. Multiple injections of ChABC caused decrease of NG2 expression at lesion site at 5 and 7 days, but not at 14 and 28 days in comparison with vehicle-treated rats and significantly enhanced GAP-43 expression during the entire survival. The densitometry analysis showed significantly higher GAP-43 immunoreactivity (1.8-2.2-fold) in the regrowing axons and cell bodies within the central lesion cavity when compared with vehicle group. Longitudinally oriented and disorganized GAP-43-labeled axons were able to infiltrate and penetrate damaged tissue. The outgrowth of GAP-43 axons after CHABC delivery was significantly longer (≤0.457 mm) when compared with the length of axons in vehicle-treated rats (≤0.046 mm). Present findings suggest that degradation of NG2 with acute IT ChABC treatment may promote ongoing (long-lasting) axonal regenerative processes at late survival (14 and 28 days), but with no significant impact on the improvement of motor function.

Chondroitinase ABC treatment and the phenotype of neural progenitor cells isolated from injured rat spinal cord.

The aim of the present study was to investigate whether enzyme chondroitinase ABC (ChABC) treatment influences the phenotype of neural progenitor cells (NPCs) derived from injured rat spinal cord. Adult as well as fetal spinal cords contain a pool of endogenous neural progenitors cells, which play a key role in the neuroregenerative processes following spinal cord injury (SCI) and hold particular promise for therapeutic approaches in CNS injury or neurodegenerative disorders. In our study we used in vitro model to demonstrate the differentiation potential of NPCs isolated from adult rat spinal cord after SCI, treated with ChABC. The intrathecal delivery of ChABC (10 U/ml) was performed at day 1 and 2 after SCI. The present findings indicate that the impact of SCI resulted in a decrease of all NPCs phenotypes and the ChABC treatment, on the contrary, caused an opposite effect.

Long-term levetiracetam treatment in patients with epilepsy: 3-year follow up.

OBJECTIVES: To assess the long-term efficacy and tolerability of levetiracetam in routine clinical practice. MATERIALS AND METHODS: We retrospectively analysed 218 patients, mostly adults, presenting mostly with localisation-related epilepsy, treated with levetiracetam as adjunctive therapy or monotherapy for up to 36 months. The primary points evaluated were: long-term retention rate, reasons for discontinuing levetiracetam and the percentage of seizure-free patients. RESULTS: The retention rate at 6, 12, 24 and 36 months following the commencement of levetiracetam treatment was 91.7, 75.2, 60.1 and 53.7% respectively. Sixty-seven (30.7%) patients discontinued levetiracetam treatment. During the clinical audit evaluation period, surgical resection or implantation of VNS was performed in 31 (14.3%) patients. In 53 of the 67 patients (79.1%), the treatment was discontinued due to lack of efficacy; in 14 patients (20.9%) treatment was discontinued due to adverse events. In total, 24 of 218 patients (11.0%) were seizure-free for 36 months. CONCLUSIONS: Levetiracetam is an effective and well-tolerated option for long-term treatment of epilepsy in adults.

Enrichment of rat oligodendrocyte progenitor cells by magnetic cell sorting.

The embryonic, neonatal, as well as adult rat spinal cords harbor a pool of neural stem cells (NSCs), which may be easily isolated and used to replace neuronal cell loss or remyelinate damaged axons following various neurodegenerative disorders. In the present study we have used magnetic cell sorting (MACs) technology to generate enriched oligodendroglial cell populations from the embryonic (E16) rat spinal cord. Target cells were separated by positive selection, using specific A2B5 antibody-labeled MicroBeads achieving optimal recovery and high purity of pro-oligodendroglial cells. Based on immunocytochemical analyses for oligodendroglial developmental markers (A2B5, NG2, RIP and MBP) we were able to characterize and quantify oligodendroglial progenitors (OPCs) and mature oligodendroglial cells in: (i) unseparated heterogeneous population of NSCs, or in (ii) antigen-antibody separated NSCs. Our results showed that MACs technology enable us to gain enriched OPCs from heterogeneous population of spinal NSCs, resulting in a 58-61% of mature oligodendrocytes content (MBP+, RIP+) in comparison to 6-12% of oligodendroglial cells acquired from unseparated population. In addition, the enriched OPCs could be cultured in vitro for several >8 passages, giving rise to a high number of newly formed spheres, as well as high expansion potential. These experiments indicate that MACs technology provide a feasible approach for experimental cell enrichment of desired oligodendroglial progeny, which may be used in future trials for cell-based therapies to treat spinal cord injury.

Long-term levetiracetam treatment of epilepsy patients: clinical audit.

PURPOSE: The long-term efficacy and tolerability of levetiracetam (LEV) was analysed in 218 epilepsy patients. One hundred and ninety-nine patients were treated for at least 6 months. We evaluated LEV efficacy for all types of seizures together, and for simple partial, complex partial and secondary generalized seizures individually. RESULTS: A significant decrease in the number of seizures occurred after 6 months of treatment (p<0.001). Mean seizure frequency (irrespective of type) before LEV was 19.2 a month. The mean monthly frequency at 6, 12, 24 and 36 months dropped to 12.7, 10.5, 9.7 and 7.1 seizures a month, respectively. The mean percentage reduction in seizures at these times was 45.7, 52.1, 59.1 and 64.2% and the number of responding patients was 51.3, 54.2, 59.8 and 62.2%. The number of patients completely seizure free was 18.6, 16.7, 15.2 and 16.2%. We found similar results in the last three categories for partial simple, complex and secondary generalized seizures individually. Side effects in 18.3% of patients caused treatment discontinuation in 6.4%. The most frequent were somnolence, moodiness and dizziness. The retention rate at 6, 12, 24 and 36 months was 0.848, 0.72, 0.62 and 0.5, respectively. CONCLUSIONS: LEV is effective and well tolerated for long-term treatment of epilepsy.

The trend in public attitudes in the Czech Republic towards persons with epilepsy.

This study evaluates trends in public familiarity with and attitudes towards people with epilepsy over a 16-year time-period. A survey exploring the Czech public's attitudes towards and knowledge of epilepsy used a modified version of a questionnaire first used in the USA in 1949, and in the Federal Republic of Germany beginning in 1968. This survey was carried out for the first time in the Czech Republic (then Czechoslovakia) in 1981, and then again in 1984. There was no significant difference between the 1981 and 1984 responses. A slightly modified questionnaire was used in 1997-1998, with evaluable responses gathered from 235 people. In comparison with the 1981 study, people's acquaintance with epilepsy was significantly higher in 1997-1998. In 1997-1998, about 94% of the people surveyed had some information about epilepsy (78% in 1981). Intolerance towards children with epilepsy dropped from 29 to 13%. About 30% of the people surveyed considered epilepsy to be a mental disease (50% in 1981). Employment of people with epilepsy was recommended by 74% (42% in 1981). In contrast with the situation about 16 years earlier, there were fewer important differences from the results of similar surveys taken in other European countries. However, the answers concerning the willingness to help a person having a seizure show that, despite certain progress, the quality of information that the Czech population has is not fully satisfactory.