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Q4 Medicine Pub Date : 2020-04-01 DOI: 10.1055/s-0040-1716600
Dr. Sanjib Sinha
Let X = {X1, X2, ..., XN} be a random vector that follows multivariate Gaussian distribution, i.e., X ∼ N (μ,Σ). Directly sampling from the multivariate Gaussian distribution may be challenging. This challenge can be mitigated with the re-parameterization trick. Let Z be a random vector that follows the standard multivariate Gaussian distribution, i.e., Z ∼ N (0, I), where I is the identity covariance matrix. We can easily prove that x = Lz +μ, where L is the lower triangle matrix resulted from Cholesky decomposition of Σ, i.e., Σ = LL . As Z follows standard multivariate Gaussian distribution, we can sample each element of Z independently, yielding a sample zs, based on which we obtain the corresponding sample for X as xs = Lzs + μ.
设X={X1,X2,…,XN}是遵循多元高斯分布的随机向量,即X~N(μ,∑)。从多元高斯分布直接采样可能具有挑战性。这个挑战可以通过重新参数化技巧来缓解。设Z是遵循标准多变量高斯分布的随机向量,即Z~N(0,i),其中i是单位协方差矩阵。我们可以很容易地证明x=Lz+μ,其中L是∑的Cholesky分解得到的下三角矩阵,即∑=LL。由于Z遵循标准的多元高斯分布,我们可以独立地对Z的每个元素进行采样,从而产生样本zs,在此基础上,我们获得X的相应样本xs=Lzs+μ。
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引用次数: 0
Management of Refractory Epilepsy 难治性癫痫的治疗
Q4 Medicine Pub Date : 2020-04-01 DOI: 10.1055/s-0040-1712777
Rajveer Singh, K. Chakravarty, Jitupam Baishya, M. Goyal, P. Kharbanda
Abstract Drug refractory epilepsy, defined as a failure of adequate trials of two (or more) tolerated, appropriately chosen, and appropriately used antiepileptic drug (AED) regimens (whether administered as monotherapies or in combination) to achieve freedom from seizures, affects approximately 30% of patients with new-onset epilepsy. Persistent epileptic seizures in these patients, in addition to having deleterious effects on health, are also associated with psychosocial, behavioral, cognitive, and financial consequences. Despite availability of several new drugs, response to therapy remains poor in most of drug refractory cases. Also despite several ongoing treatment trials, ideal combination of AEDs remains to be identified. Careful attention to ruling out alternative diagnoses, optimal selection of AEDs, rational use of combination therapy, as well as attention to patient-specific factors, such as poor compliance and drug abuse, remain cornerstone of therapy. In view of poor response to polytherapy, if possible, surgical intervention should be contemplated early. In future, development of new drugs with better efficacy and tolerability and minimal drug interactions, as well as better nonpharmacological therapeutic techniques, will help in managing these patients better.
摘要药物难治性癫痫,定义为两种(或多种)耐受性、适当选择和适当使用的抗癫痫药物(AED)方案(无论是单药还是联合用药)的充分试验失败,以实现免于癫痫发作,影响约30%的新发癫痫患者。这些患者的持续癫痫发作除了对健康产生有害影响外,还与心理、行为、认知和经济后果有关。尽管有几种新药可用,但在大多数药物难治性病例中,对治疗的反应仍然很差。此外,尽管有几项正在进行的治疗试验,AED的理想组合仍有待确定。谨慎注意排除替代诊断、最佳选择AED、合理使用联合治疗,以及注意患者的特定因素,如依从性差和药物滥用,仍然是治疗的基石。鉴于对多种疗法反应不佳,如果可能的话,应尽早考虑手术干预。未来,开发具有更好疗效和耐受性、最小药物相互作用的新药,以及更好的非药物治疗技术,将有助于更好地管理这些患者。
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引用次数: 2
Management of Infantile Spasms: An Updated Review 婴儿痉挛的治疗:最新综述
Q4 Medicine Pub Date : 2020-04-01 DOI: 10.1055/s-0040-1708562
M. Iype, K. Koshy
Abstract Infantile spasms remain the most challenging of the epileptic encephalopathies of childhood. Infantile spasms are classified as an epileptic encephalopathy, as the adverse cognitive and behavioral burden of the condition is out of proportion to the burden one would expect from the underlying etiology or the accompanying magnetic resonance imaging. The ictal and interictal electroencephalographic (EEG) activity is presumed to contribute to the progressive cerebral dysfunction. In many of these children, the underlying etiology also contributes to the severe mental subnormality and autistic behavior. Though it is the syndromic approach that guides the pediatric epileptologist, it is best to keep in mind that one syndrome may evolve into another in infancy and early childhood. A baby with Ohtahara syndrome may, after 2 to 7 months, begin to have spasms. Lennox-Gastaut syndrome with its typical seizure types and EEG may evolve in a child with infantile spasms. The unique modalities used in the treatment of infantile spasms make early recognition important. It is, however, also of paramount importance to make an etiological diagnosis as the underlying etiology may be eminently treatable. The treating physician cannot abandon them as wholly “intractable” epilepsy. The excellent response to treatment in the few who just cannot be defined or accurately predicted drives the physician to exercise his brain. Use of the two well-accepted modalities of treatment; vigabatrin and adrenocorticotrophic hormone singly or in combination, oral steroids in high dose, ketogenic diet, the conventional antiepileptic medications, and strategies to target the basic cause have been tried out by various clinicians. Here, we have made an attempt to collate evidence and describe the progress in the management of infantile spasms.
婴儿痉挛仍然是儿童癫痫性脑病中最具挑战性的。婴儿痉挛被归类为癫痫性脑病,因为这种情况的不良认知和行为负担与人们从潜在病因或伴随的磁共振成像所期望的负担不成比例。发作期和间歇期脑电图(EEG)活动被认为是进行性脑功能障碍的原因之一。在这些儿童中,潜在的病因也会导致严重的精神异常和自闭症行为。虽然这是综合征的方法,指导儿科癫痫医生,最好记住,一种综合征可能演变成另一个在婴儿期和幼儿期。患有大田原综合征的婴儿可能在2至7个月后开始出现痉挛。lenox - gastaut综合征及其典型的癫痫发作类型和脑电图可能在婴儿痉挛患儿中发展。治疗婴儿痉挛的独特方式使得早期识别非常重要。然而,病原学诊断也是至关重要的,因为潜在的病因可能是可以治疗的。主治医生不能将其视为完全“难治性”癫痫而放弃。少数无法定义或准确预测的患者对治疗的良好反应促使医生锻炼他的大脑。使用两种广为接受的治疗方式;维加巴林和促肾上腺皮质激素单用或联用、大剂量口服类固醇、生酮饮食、常规抗癫痫药物以及针对根本原因的治疗策略已被不同的临床医生尝试过。在这里,我们试图整理证据并描述婴儿痉挛管理的进展。
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引用次数: 2
Screening of Antiseizure Activity of Aryl Acetic Acid Compounds in Wistar Albino Rats by using PTZ and MES Tests 应用PTZ和MES试验筛选白化大鼠芳基乙酸类化合物的抗癫痫活性
Q4 Medicine Pub Date : 2018-10-01 DOI: 10.1055/s-0039-1694877
C. D., Karamthoti B., Kurra B.
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引用次数: 0
Detection of Startle-Type Epileptic Seizures using Machine Learning Technique 利用机器学习技术检测首发型癫痫发作
Q4 Medicine Pub Date : 2018-10-01 DOI: 10.1055/s-0039-1693072
Pushpa Balakrishnan, S. Hemalatha, Dinesh Nayak Shroff Keshav
Abstract Background Epilepsy is a common neurological disorder characterized by seizures and can lead to life-threatening consequences. The electroencephalogram (EEG) is a diagnostic test used to analyze brain activity in various neurological conditions including epilepsy and interpreted by the clinician for appropriate diagnosis. However, the process of EEG analysis for diagnosis can be automated using machine learning algorithms (MLAs) to aid the clinician. The objective of the study was to test different algorithms that could be used for the detection of seizures. Materials and Methods Video EEG (vEEG) was collected from subjects diagnosed to have episodes of seizures. The epilepsy dataset thus obtained was subjected to empirical mode decomposition (EMD) and the signal was decomposed into intrinsic mode functions (IMFs). The first five levels of decomposition were considered for analysis as per the established protocol. Statistical features such as interquartile range (IQR), entropy, and mean absolute deviation (MAD) were extracted from these IMFs. Results In this study, different MLAs such as nearest neighbor (NN), naïve Bayes (NB), and support vector machines (SVMs) were used to distinguish between normal (interictal) and abnormal (ictal) states. The demonstrated accuracy rates were 97.32% for NN, 99.02% for NB, and 93.75% for SVM. Conclusion Based on this accuracy and sensitivity, it may be posited that the NB classifier provides significantly better results for the detection of abnormal signals indicating that MLA can detect the seizure with better accuracy.
背景癫痫是一种常见的以癫痫发作为特征的神经系统疾病,可导致危及生命的后果。脑电图(EEG)是一种诊断测试,用于分析包括癫痫在内的各种神经系统疾病的大脑活动,并由临床医生解释以进行适当的诊断。然而,脑电图分析的诊断过程可以使用机器学习算法(MLAs)自动化,以帮助临床医生。这项研究的目的是测试可用于检测癫痫发作的不同算法。材料与方法采集被诊断为癫痫发作的受试者的视频脑电图(vEEG)。将得到的癫痫数据集进行经验模态分解(EMD),并将信号分解为内禀模态函数(IMFs)。根据已建立的方案,考虑前五个分解层次进行分析。统计特征,如四分位数范围(IQR),熵和平均绝对偏差(MAD)从这些imf中提取。结果在本研究中,使用了最近邻(NN)、naïve贝叶斯(NB)和支持向量机(svm)等不同的mla来区分正常(间隔)和异常(间隔)状态。NN的准确率为97.32%,NB为99.02%,SVM为93.75%。结论基于此准确率和灵敏度,可以认为NB分类器对异常信号的检测效果明显更好,说明MLA检测癫痫发作的准确率更高。
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引用次数: 2
Three Staged Epidemiological Survey of Pediatric Epilepsy in a Rural Suburb of Pune 浦那郊区农村儿童癫痫三阶段流行病学调查
Q4 Medicine Pub Date : 2018-10-01 DOI: 10.1055/s-0039-1694857
E. Agarwal, S. Rajadhyaksha, K. Srivastava, V. Kulkarni
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引用次数: 0
Evaluation of Anticonvulsant Activity of Propranolol by using Electrically Induced Animal Models 电诱导动物模型评价心得安的抗惊厥作用
Q4 Medicine Pub Date : 2018-10-01 DOI: 10.1055/S-0039-1694876
C. D., Karamthoti B., Kurra B.
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引用次数: 0
De Novo Mutations in TUBB2A Cause Infantile-Onset Epilepsy and Mental Retardation and Literature Review TUBB2A基因的新生突变导致婴儿癫痫和智力低下及文献综述
Q4 Medicine Pub Date : 2018-10-01 DOI: 10.1055/S-0039-1694896
Shuying Cai, Jinliang Li, Ye Wu, Yuwu Jiang
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引用次数: 0
Peroxisome Proliferator Activated Receptor σ (pPARσ) Agonists and Their Role on Epilepsy-Induced Seizures: An Experimental Evaluative Study 过氧化物酶体增殖物激活受体(pPARσ)激动剂及其在癫痫诱导发作中的作用:一项实验评价研究
Q4 Medicine Pub Date : 2018-10-01 DOI: 10.1055/s-0039-1694878
C. D., Karamthoti B., Kurra B.
To evaluate the anticonvulsant activity of propranolol in Wistar albino rats by maximal electroshock (MES)-induced seizure model. study CPCSEA Healthy, adult Wistar albino rats of either sex 180 and 250 g were used for the study. The animals were procured from the central animal house and were acclimatized in the experimental laboratory for 7 days. The study consisted of three groups with six animals in each group. Group I: control (equivalent volume of normal saline, i.p.); group II: diphenylhydantoin (25 mg/kg BW, i.p.); group III: propranolol (i.p.). Anticonvulsant activity in Wistar albino rats was assessed by MES model. The data were expressed as median ± SE. Statistical significance among study groups was carried using Graph Pad Instat Software, by ANOVA test followed by Bonferroni’s post hoc test. Results: In group II (standard) all animals were pro-tected by absence of THLE when compared with group I (control). Group II also exhibited significant decline in scores when compared with control group. Administration of propranolol in groups III also showed significant percent decline in THLE as well as scores when compared with group I. Percent decline in THLE and scores in group III were comparable to the group II. Conclusion: anticonvulsant activity in MES in rats. and test independent variables— tests associates and complex factors impact of on adherence to antiepileptic drugs in in the Methods: The setting of the study was provided by community care trial of home-based care delivered by primary health care workers versus routine clinic-based care. We studied the association between monthly pill counts and self-reported adherence questionnaire score with age, gen-der, religion, ethnic origin, education, occupation, monthly family income, and socioeconomic class. In addition, we cre-ated a dummy variable, which represented baseline scores for each subject. Results: There was considerable inter individual varia-tions on pill count and SRMS score. Overall, lag SRMS, religion, ethnic origin, and monthly family income determined adherence status. A steady increase in the proportion of people with appropriate pill count was observed in the home-based care group but not in the clinic-based care group. Conclusion: adherence varies consider-ably between individuals and is influenced by individual behavior. However, repeated adherence reinforcement by primary health care workers may lead to improvement in adherence.
应用最大电休克(MES)致癫痫模型评价心得安对Wistar白化大鼠的抗惊厥作用。研究采用健康成年Wistar白化大鼠,雌雄各180和250 g。动物从中心动物舍采购,在实验室内驯化7 d。该研究分为三组,每组6只动物。第一组:对照组(等量生理盐水,每日1次);II组:二苯肼(25mg /kg BW, i.p.);第三组:心得安。采用MES模型评价Wistar白化大鼠抗惊厥活性。数据用中位数±SE表示。使用Graph Pad Instat软件对各研究组间进行统计学意义分析,采用方差分析后进行Bonferroni事后检验。结果:与ⅰ组(对照组)相比,ⅱ组(标准组)无THLE保护。与对照组相比,第二组的得分也有明显下降。与第一组相比,第三组服用心得安也显示THLE和评分显著下降。第三组THLE和评分下降的百分比与第二组相当。结论:MES大鼠具有抗惊厥活性。并检验自变量——检验相关因素和复杂因素对抗癫痫药物依从性的影响。方法:本研究的环境由社区护理试验提供,由初级卫生保健工作者提供家庭护理与常规临床护理。我们研究了每月服药次数和自我报告依从性问卷得分与年龄、性别、宗教、种族、教育程度、职业、家庭月收入和社会经济阶层之间的关系。此外,我们创建了一个虚拟变量,表示每个受试者的基线分数。结果:个体间在药片数和SRMS评分上存在较大差异。总体而言,滞后SRMS、宗教、种族和家庭月收入决定了依从性状况。在以家庭为基础的护理组中,观察到服用适当药片数量的人的比例稳步增加,而在以诊所为基础的护理组中则没有。结论:依从性在个体之间有很大差异,并受个体行为的影响。然而,初级卫生保健工作者反复加强依从性可能导致依从性的改善。
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引用次数: 0
Use of early childhood epilepsy severity scale (E-Chess) in classification and prognostication of children with west syndrome: A study from tertiary care pediatric neurology centre 应用早期儿童癫痫严重程度量表(E-Chess)对西综合征儿童进行分类和预测:来自三级儿科神经病学中心的研究
Q4 Medicine Pub Date : 2018-10-01 DOI: 10.1055/s-0039-1694895
S. Mishra, A. Mallick, G. Mohanty, N. Biswal
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引用次数: 0
期刊
International Journal of Epilepsy
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