Immediate Treatment of Seizure Clusters: A Conceptual Roadmap to Expedited Seizure Management.

Some patients with epilepsy continue to have seizures despite daily treatment with antiseizure medications. This includes seizure clusters (also known as acute repetitive seizures), which are an increase in seizure frequency that is different from the usual seizure pattern for that patient. In the literature, the term "rescue" is used for pharmacologic treatment for seizure clusters, but clarity regarding timing or whether a caregiver or patient should wait until a moment of life-threatening urgency before administering the medication is lacking. Additionally, the concept of waiting 5 minutes to identify and initiate treatment of status epilepticus has been carried over to the treatment of seizure clusters, as well as the idea of waiting owing to safety concerns, without reevaluation in the context of the reported safety profiles for currently available as-needed therapies when administered as prescribed. Delaying treatment of seizure clusters may have negative outcomes, including injury, emergency room use, hospitalization, and progression to status epilepticus. Additionally, increased time for administration of benzodiazepines, the cornerstone therapies for seizure clusters, may lower the potency and effectiveness once administration takes place, because of physiologic changes. Thus, clarifying the importance of timing in the treatment terminology may be of benefit in the acute context. The term "immediate-use seizure medication" (ISM), meaning treatment that is administered as quickly as possible once a seizure cluster is recognized, may help to clarify the timing of as-needed treatment. This review examines the recognition and definitions of seizure clusters, the physiologic rationale for ISM for seizure clusters, and the effectiveness and safety of early treatment. Remaining knowledge gaps are also discussed. The findings of this review suggest that it may be time to revisit the terminology of "rescue", which implies waiting to administer treatment for seizure clusters, as doing so is not supported by pathophysiologic, effectiveness, or safety data.

被引量：- 发表：1970

Impact of Altered Gut Microbiota on Ketamine-Induced Conditioned Place Preference in Mice.

被引量：- 发表：1970

Repetitive Transcranial Magnetic Stimulation Alleviates MPTP-Induced Parkinson's Disease Symptoms by Regulating CaMKII-CREB-BMAL1 Pathway in Mice Model.

被引量：- 发表：1970

The Face of Autism in Israel.

This article seeks to offer a comprehensive perspective on autism in Israel, aligning with global reports. It aims to serve as a foundational resource for policymakers in developing relevant support and point to unmet needs. The data was drawn from publications by Israeli government authorities and academic publications. In 2022, the prevalence of child and adolescent autism in Israel was approximately 1.13%, with a male-to-female ratio of 4:1, and an annual increase of 23%, particularly among young children. In Israel, the diagnosis of autism follows the DSM-5 guidelines and is conducted by a physician and a psychologist specializing in autism. Typically, diagnosis is at age 2. The autism intervention approaches prevalent in Israel are consistent with those that are globally accepted. Children with autism are entitled to special education services adapted to their needs and developmental levels. The legally established package of services for children with autism includes sessions with occupational therapists, speech-language pathologists (SLPs), physical therapists, psychologists, and social workers. Children and adults with autism are eligible for disability allowance along with support regarding residence, educational programs, and employment opportunities. Nonetheless, underdiagnosis and low accessibility to services are common in minority populations and rural areas. Furthermore, in recent years, services for autistic individuals have declined. This decline, particularly considering the ongoing rise in the prevalence of autism, pose significant challenges for Israeli government authorities in ensuring that autistic persons receive appropriate support.

被引量：- 发表：1970

Lack of Efficacy of Simvastatin Adjunctive Therapy for Patients with Schizophrenia: A Meta-Analysis of Randomized Controlled Trials.

The adjunctive therapeutic potential of simvastatin in schizophrenia treatment has generated interest due to its anti-inflammatory and neuroprotective properties. This meta-analysis aims to assess the efficacy of simvastatin as an adjunct treatment for schizophrenia, synthesizing results from various controlled trials. We performed a comprehensive search of databases including PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) evaluating the efficacy of simvastatin as an adjunct therapy in patients with schizophrenia. The primary outcome measures were improvements in the Positive and Negative Syndrome Scale (PANSS) scores. Secondary outcomes included changes in overall clinical condition and level of functioning. Data were pooled using random-effects models, and heterogeneity was assessed through I² statistics. The four RCTs included in the analysis represented 425 participants. The combined results demonstrated no significant advantage of simvastatin over placebo in reducing PANSS total scores with a pooled effect size (Standard Mean Difference, SMD) of -0.36 (95% Confidence Interval, CI: -0.82 to 0.11) at 1 month, and -1.80 (95% Confidence Interval, CI: -4.82 to 1.21) at 3 months, indicating minimal to no effect. Similarly, analyses of secondary outcomes showed no significant improvements in overall clinical condition and level of functioning. The studies exhibited low heterogeneity (I² = 0%). This meta-analysis provides evidence that simvastatin, used as adjunctive therapy, does not significantly improve the symptomatic outcomes of schizophrenia compared to placebo. Although simvastatin is well-tolerated, its role in enhancing antipsychotic treatment efficacy in patients with schizophrenia appears limited. These findings suggest that simvastatin should not be recommended as an adjunctive treatment in the clinical management of schizophrenia. Further research may explore the potential subgroups that could benefit from such treatment or identify the biological reasons for the lack of efficacy.

被引量：- 发表：1970