We have previously devised a semiquantitative grading system for hippocampal sclerosis (HS) in specimens resected for intractable temporal lobe epilepsy. The grades range from zero to four based on the amount and distribution of neuronal loss and gliosis. In the present study hippocampal sections from 25 patients who had temporal lobe epilepsy and had previously been assigned a grade were examined with synaptophysin immunohistochemistry, and the synaptic content in specific hippocampal fields was correlated with the results of the HS grading system. There was evidence of both significant synaptic loss and increased synaptic density in different fields of the hippocampus with increasing HS. A marked decrement of synaptic immunostaining was present in fields CA1 and CA4 that were highly correlated with HS grade. Sector CA4 seemed to respond in a more graded or continuous way to the pathological insults occurring in temporal lobe epilepsy than did CA1, which appeared to exhibit an all or nothing response. Also, while the width of the outer part of the molecular layer of the dentate (mld) gyrus decreased with increasing HS grade, the inner part of the mld became wider and showed an increased synaptic density so that the overall width of the mld was increased in the high-grade group. We conclude that quantitative measurement of synaptic loss in CA1 and CA4 using synaptophysin immunohistochemistry is a sensitive method for detecting HS and correlates well with the empirically derived HS grading scale, with CA4 exhibiting a more graded response than CA1. In addition, a plasticity response in the inner part of the mld in patients with high-grade HS has been confirmed and quantitated.

No description available.

No description available.

No description available.

No description available.

No description available.

This legal research study identified Supreme Court cases relating to search and seizure generally, and Supreme Court, federal and state court cases relating specifically to search and seizure in education. The purpose of this study was to identify those concepts, doctrines and principles of law governing searches and seizures in order to inform administrators of their legal responsibilities. Concepts, doctrines and principles of law governing searches and seizures are summarized in the following statements: (1) Students have a right to privacy, but this right must be balanced against the school's interests and the rights of others. (2) Searches must be reasonably related to a legitimate school purpose. General, exploratory, blanket and indiscriminate searches will not be sustained by courts. (3) School officials have an affirmative obligation to maintain order and discipline for the health and safety of students. (4) Searches must be based on concrete, articulable facts. Mere suspicion is not acceptable to the courts. (5) Elementary and secondary school officials, acting in loco parentis, are generally held to the lesser standard of reasonable cause to believe. However, the more intrusive the search, the higher the standard to be applied. (6) Colleges and universities cannot condition attendance upon a waiver of a student's constitutional rights. (7) Police initiated searches are subject to the higher standard of probable cause. (8) In cases where exigent circumstances existed, such as the destruction of evidence or harm to another, administrative officials have an affirmative obligation to act immediately and they are not subject to the warIant requirement (9) Contraband seen in plain view is subject to seizure without a warrant. / Ed. D.

The prevalence of epilepsy in society is general knowledge; however the impact on social activity as well as other daily factors are not always fully recognised. Epilepsy frequently poses a problem with regard to work–related activities (Heaney, 1999:44). Moran et al. (2004:425) indicated that the major impacts of epilepsy on life were work and school difficulties, driving prohibition, psychological and social life of which restriction of work or schooling has the greatest impact on epileptic’s life. In all cases the type, severity, and frequency of the seizures as well as the age would be relevant. Davis et al. (2008:451) established that 39% of all epileptics were not adherent to their therapy and in patients over 65 this was even higher at 43 %. Non–adherence with antiepileptic medicine appears to be related to increased health care utilisation and costs and may also lead to an increased probable accidents or injuries The general objective was to investigate anti–epileptic medicine prescribing patterns and treatment cost in a section of the private health care sector by using a medicine claims database. A retrospective drug utilisation study was done on the data claims from a pharmacy benefit management company for the study period 1 January 2005 to 31 December 2008. Firstly epilepsy was investigated in order to understand the disease and to determine the prevalence and treatment thereof. It was found that epilepsy is still one of the most common neurological conditions and according to the findings, 2 out of every hundred patients were using anti–epileptic medicine in this section of the private health care sector. To make this condition socially more acceptable and understandable, public education for special target groups concerning the disorder must be conducted as well as employment training programmes for people with epilepsy themselves. The utilisation patterns of anti–epileptic drugs were reviewed, analysed and interpreted. It was determined that anti–epileptic medicine items are relatively expensive with regards to other medicine items on the total database. With regard to gender, more females are using anti–epileptic medicine than males on the database. The largest age group of patients using anti–epileptic medicine, is between > 40 years and <= 64 years of age. It was also clear that prevalence increase as age increase. With regard to the different prescribers, the number of items prescribed by a general practitioner was almost double that of the other prescribers. It was further established that newer anti–epileptic medicines are more expensive than older anti–epileptic medicine according to the cost per tablet in this section of the private health care sector. Carbamazepine and valproate were the two active ingredients that were most frequently prescribed as a single item on a prescription. After a cost–minimisation analysis was done, R134 685.66 could have been saved when generic substitution was implemented. The refill–adherence rate decreased as age increased. Only 30.46% of the trade names was refilled according to acceptable refill–adherence rates. The refill–adherence rate according to active ingredient showed that medicine items containing, phenobarbitone/vit B or gabapentin had the lowest unacceptable refill–adherence rate. The limitations for this study was stipulated and recommendations for further research regarding anti–epileptic medicine were also made. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

The prevalence of epilepsy in society is general knowledge; however the impact on social activity as well as other daily factors are not always fully recognised. Epilepsy frequently poses a problem with regard to work–related activities (Heaney, 1999:44). Moran et al. (2004:425) indicated that the major impacts of epilepsy on life were work and school difficulties, driving prohibition, psychological and social life of which restriction of work or schooling has the greatest impact on epileptic’s life. In all cases the type, severity, and frequency of the seizures as well as the age would be relevant. Davis et al. (2008:451) established that 39% of all epileptics were not adherent to their therapy and in patients over 65 this was even higher at 43 %. Non–adherence with antiepileptic medicine appears to be related to increased health care utilisation and costs and may also lead to an increased probable accidents or injuries The general objective was to investigate anti–epileptic medicine prescribing patterns and treatment cost in a section of the private health care sector by using a medicine claims database. A retrospective drug utilisation study was done on the data claims from a pharmacy benefit management company for the study period 1 January 2005 to 31 December 2008. Firstly epilepsy was investigated in order to understand the disease and to determine the prevalence and treatment thereof. It was found that epilepsy is still one of the most common neurological conditions and according to the findings, 2 out of every hundred patients were using anti–epileptic medicine in this section of the private health care sector. To make this condition socially more acceptable and understandable, public education for special target groups concerning the disorder must be conducted as well as employment training programmes for people with epilepsy themselves. The utilisation patterns of anti–epileptic drugs were reviewed, analysed and interpreted. It was determined that anti–epileptic medicine items are relatively expensive with regards to other medicine items on the total database. With regard to gender, more females are using anti–epileptic medicine than males on the database. The largest age group of patients using anti–epileptic medicine, is between > 40 years and <= 64 years of age. It was also clear that prevalence increase as age increase. With regard to the different prescribers, the number of items prescribed by a general practitioner was almost double that of the other prescribers. It was further established that newer anti–epileptic medicines are more expensive than older anti–epileptic medicine according to the cost per tablet in this section of the private health care sector. Carbamazepine and valproate were the two active ingredients that were most frequently prescribed as a single item on a prescription. After a cost–minimisation analysis was done, R134 685.66 could have been saved when generic substitution was implemented. The refill–adherence rate decreased as age increased. Only 30.46% of the trade names was refilled according to acceptable refill–adherence rates. The refill–adherence rate according to active ingredient showed that medicine items containing, phenobarbitone/vit B or gabapentin had the lowest unacceptable refill–adherence rate. The limitations for this study was stipulated and recommendations for further research regarding anti–epileptic medicine were also made. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Base teórica: O Acidente Vascular Cerebral (AVC) é a causa mais comum de novos diagnósticos de epilepsia no idoso. Embora a epilepsia pós-AVC seja um fenômeno clínico reconhecido há muito tempo, seguem muitas questões não resolvidas. Além disso, nas últimas duas décadas, o tratamento do AVC isquêmico sofreu mudanças radicais com a introdução da trombólise e da hemicraniectomia descompressiva (HD) para o tratamento do infarto maligno de artéria cerebral média (ACM). As consequências destas duas novas abordagens terapêuticas nas características da epilepsia pós-AVC ainda são pouco exploradas. Objetivo: Estudar as características e estimar fatores de risco para as crises epilépticas ou a epilepsia pós-AVC em pacientes submetidos ao tratamento agudo (Estudo 1) ou HD para infarto maligno de ACM (Estudo 2). Métodos: O estudo 1 é uma coorte de 153 pacientes submetidos a trombólise. Variáveis estudadas incluiram fatores de risco para o AVC e variáveis associadas ao AVC isquêmico agudo e trombólise. Utilizamos a análise de regressão de Cox para o estudo das variáveis que se associaram de forma independente com crises epilépticas, epilepsia pós-AVC e o desfecho do AVC. O estudo 2 é também uma coorte que retrospectivamente avaliou 36 pacientes com infarto maligno de ACM tratados com HD. Tempo, incidência e fatores de risco para crises epilépticas e desenvolvimento de epilepsia foram analisados. Resultados: Estudo 1: 74 pacientes (48,4%) eram mulheres; média de idade foi 67,2 anos (DP=13,1). Média do NIHSS na chegada foi 10,95 (DP=6,25) e 2,09 (DP=3,55) após 3 meses. Transformação hemorrágica ocorreu em 22 (14,4%) dos pacientes. Foi considerado desfecho bom classificação na escala modificada de Rankin (mRS) 0-1, sendo encontrado em 87 (56,9%) dos pacientes. Vinte e um pacientes (13,7%) tiveram crises epilépticas e 15 (9,8%) desenvolveram epilepsia após a trombólise. Crises epilépticas foram associadas de forma independente com transformação hemorrágica e desfecho não favorável (mRS ≥ 2) em três meses após o AVC. Transformação hemorrágica e mRS ≥ 2 avaliados em 3 meses, associaram-se de forma independente com epilepsia pós-AVC. Crises epilépticas surgiram como um fator de risco independente para desfecho pobre. Estudo 2. A média de seguimento dos pacientes foi de 1.086 (DP= 1.172) dias. Nove pacientes morreram antes de receberem alta hospitalar e no período de um ano, 11 pacientes haviam morrido. Quase 60% alcançaram mRS ≤ 4. Treze pacientes desenvolveram crises dentro da primeira semana após o AVC. No total, crises epilépticas ocorreram em 22 (61%) dos 36 pacientes. Dezenove pacientes (56%) dos 34, sobreviveram ao período agudo e desenvolveram epilepsia após infarto da ACM e HD. Questionamos aos pacientes ou responsáveis se eles se arrependeram de terem autorizado a HD no momento do AVC. Também foi perguntado se eles autorizariam a HD novamente. Trinta e dois (89%) não se arrependeram de ter autorizado a HD no momento do infarto agudo da ACM, e autorizaria novamente em retrospecto. Conclusão: Confirmamos que as frequências de crises ou epilepsia pós-AVC e trombolítico são comparáveis com as frequências das décadas da era pré-trombólise e confirmamos a alta incidência de crises epilépticas e epilepsia após infartos malignos de ACM submetidos a HD. Em nosso estudo, as crises epilépticas associaram-se de forma independente com pior prognóstico após terapia trombolítica. / Background: The most common cause of newly diagnosed epilepsies in the elderly is stroke. Although post-stroke epilepsy is a well-studied stroke complication, many questions remain unsolved. In addition, during the past two decades, the treatment of stroke has changed dramatically with the introduction of thrombolysis for treatment of acute ischemic stroke (AIS) and decompressive hemicraniectomy (DHC) for malignant middle cerebral artery infarction (MCA). The consequences of these two new therapeutic approaches for characteristics of post-stroke epilepsy remains poorly explored. Objective: To study characteristics and estimate risk factors for acute seizures or post-stroke epilepsy in patients submitted to thrombolysis for treatment of acute stroke (Study 1) or DHC for malignant MCA infarction. Methods: Study 1 is a cohort study of 153 patients submitted to thrombolysis. Variables studied included risk factors for stroke, and variables related to acute stroke and thrombolysis. Variables independently associated with seizures, pos-stroke epilepsy or stroke outcome were defined using Cox regression analysis. Study 2 is also a cohort study that retrospectively assessed 36 patients with malignant stroke of the MCA submitted to DHC. Timing, incidence and plausible risk factors for seizure and epilepsy development were analyzed in these patients. Results: Study 1. Seventy-four patients (48.4%) were female; mean age of patients was 67.2 years-old (SD=13.1). Initial NIHSS mean score was 10.95 (SD=6.25) and 2.09 (SD=3.55) after three months. Hemorrhagic transformation occurred in 22 (14.4%) patients. A good outcome, as defined by a modified Rankin Scale (mRS) of 0-1, was observed in 87 (56.9%) patients. Twenty one (13.7%) patients had seizures and 15 (9.8%) patients developed epilepsy after thrombolysis. Seizures were independently associated with hemorrhagic transformation and with mRS ≥ 2 three months after stroke. Hemorrhagic transformation and unfavorable outcome, as measured by mRS ≥ 2 after three months, were variables independently associated with post-stroke epilepsy. Seizures emerged as an independent factor for poor outcome in stroke thrombolysis. Study 2. Mean patient follow-up time was of 1.086 (SD=1.172) days. Nine patients died before being discharged and after one year eleven patients died. Almost 60% had the modified Rankin score ≤ 4. Thirteen patients developed seizures within the first week after stroke. In total, seizures occurred in 22 (61%) of 36 patients. Nineteen patients (56%) out of 34 patients who survived the acute period developed epilepsy after MCA infarcts and DHC. Also, we asked patients or the person responsible for them whether they regretted, in retrospect, having authorized DHC at the time of the stroke. It was also asked whether they would authorize DHC again. Thirty- two (89%) did not regret having authorized DHC at the time of acute MCA infarct, and would authorize DHC again in retrospect. Conclusion: We confirm that seizures or post-stroke epilepsy rates after thrombolysis are comparable with rates from pre-thrombolysis decades and a high incidence of seizures and epilepsy after malignant MCA infarcts submitted to DHC. In our study, seizures were an independent risk factor associated with worst outcome after thrombolysis therapy.