Approximately 50 million people worldwide and one in every 100 South Africans, live with epilepsy. The challenges of epilepsy are not limited to the physical manifestations of the disease i.e. seizures. Public perceptions of epilepsy contribute significantly to an individual’s experience of living with epilepsy. Stigmatisation of epilepsy occurs worldwide and presents in varying forms. Enacted stigma refers to overt acts of discrimination against people with epilepsy and perceived (or “felt”) stigma is the feeling of shame and fear of being stigmatised as a person with epilepsy. Epilepsy stigma is considered to be one of the most important factors that have a negative influence on people with epilepsy. There is a noticeable difference in the nature of epilepsy stigma between developed and developing countries, and even between communities within the same country. This difference suggests that epilepsy stigma is shaped by differences in education, cultural values, access to healthcare, quality of care and legal rules. There is very little research on epilepsy-associated stigma emerging from South Africa. The aim of this study is to describe the lived experience of living with epilepsy and the associated stigma. Following qualitative methods, using an ethnographic approach, 10 semi-structured interviews with people with epilepsy were conducted. The complexity of studying the subjective experience of stigmatisation lends itself well to this approach. Participants were identified through the Western Cape branch of Epilepsy South Africa and recruited from various communities in Cape Town, South Africa. Data was analysed using Braun and Clarke’s (2006) principles of thematic analysis. The participants reported a broad range of subjective experiences and perspectives of living with epilepsy. Across all participants, the factors which played an impactful role on their lives was the social support they received, the public understanding of the community they lived in, the daily reminders of being “different” and living with the fear of not knowing when the next seizure will occur. By nature of this study’s design, the findings from this study cannot be generalised to South Africa. However, this study offers a glimpse into the subjective experience of living with epilepsy from individuals residing in different communities in Cape Town, South Africa. The findings show a broad range of experiences which are mediated by external influences. The findings suggest a need for further research into the challenges people with epilepsy face across communities within South Africa. / Psychology / M.A. (Psychology)

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Before 1994 criminal procedure was subject to the sovereignty of Parliament and the untrammelled law enforcement powers of the executive which resulted in the authoritarian and oppressive criminal justice system of the apartheid era. The Constitution, Act 108 of 1996 has since created a democratic state based on the values of the supremacy of the Constitution and the rule of law. The basic principles of criminal procedure are now constitutionalised in the Bill of Rights. The Bill of Rights protects the fundamental rights of individuals when they come into contact with organs of the state which includes the police. The Criminal Procedure Act 51 of 1977 authorises the police to search for and to seize articles, and has long provided the only legal basis for obtaining warrants to search for and to seize articles and for performing such actions without a warrant in certain circumstances. Generally the standard for these measures and actions taken under their purview has been one of reasonableness. Since the birth of the Constitution there has been additional constraints on search and seizure powers. Not only are there now constitutionalised standards by which such legal powers are to be measured, but there is also the possibility of excluding evidence obtained in course of a violation of a constitutional right. The provisions of the Criminal Procedure Act are now qualified by the Constitution. Where feasible a system of prior judicial authorisation in the form of a valid search warrant obtained on sworn information establishing reasonable grounds is a precondition for a valid search or seizure. Search and seizure without a warrant is permitted only in exceptional circumstances such as an immediate threat to person or property. By prohibiting unreasonable searches and seizures the Constitution places important limits on police efforts to detect and investigate crime. The Constitution appreciates the need for legitimate law enforcement activity. / Criminal and Procedural Law / LL.M.

The State as the representative of the victims of crime is expected to protect those vulnarable group of people with due regard to the rights of the perpetrators’s of crime. It is imperative that the law of general application which is aimed at protecting victims of crime, be sufficiently effective to protect the victims. The Criminal Procedure Act 51 of 1977 is aimed at assisting the police to conduct pre-trial criminal procedure in order to bring perpetrators of crime to book. Sections 36A, 36B, 36C and 37 (both previous and as amended) of the Criminal Procedure Act including chapter 5A of the South African Police Act, 1995 are explored in this dissertation. This dissertation examines the areas in the Criminal Procedure Act that make it problematic for the police to conduct efficient and effective crime detection through the ascertainment of bodily features of the suspected or accused person. The law in three foreign jurisdictions relating to this topic are investigated and compared in order to make recommendations and suggest possible solutions. / Criminal and Procedural Law / LL.M.

Monosialoganglioside (GM1) is a component of most cell membranes and is thought to play a role in development, recognition and cellular differentiation. Furthermore, GM1 is a neuroprotective agent that has been reported to scavenge free radicals generated during reperfusion and to protect receptors and enzymes from oxidative damage. In the present study we investigate the effect of GM1 on the catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities, on the spontaneous chemiluminescence and total radical-trapping potential (TRAP) in cortex of rats ex vivo and in vitro. Systemic GM1 administration (50 mg/kg, i.p.; twice) reduced spontaneous chemiluminescence and increased CAT activity ex vivo. On the other hand, GM1 (103-104 nM) reduced CAT activity in vitro. The other parameters were not affected by GM1 administration. These findings agree with the view that the antioxidant action of GM1 is not due to an intrinsic antioxidant activity of this glycolipid, but due to a secondary decrease of reactive species generation and/or increase of antioxidant defenses. Moreover, we evaluated whether GM1 could have a neuroprotective action on the experimental model of glutaric acidemia, an inherited metabolic disorder characterized by glutaric acid (GA) accumulation and neurological dysfunction, as striatal degeneration and convulsion. The systemic GM1 administration (50 mg/kg, i.p. twice) protected against the convulsions, oxidative damage markers increase (total protein carbonylation and thiobarbituric acid-reactive substances - TBARS) production and Na+,K+-ATPase activity inhibition induced by GA (4 mol/ 2 l) in striatum of rats. Furthermore, convulsive episodes induced by GA strongly correlated with Na+,K+-ATPase activity inhibition in the injected striatum, but not with oxidative stress marker measures. In addition, GM1 (50-200 M) protected against Na+,K+-ATPase inhibition induced by GA (6 mM), but not against oxidative damage in vitro. Intrastriatal administration of muscimol (46 pmol/striatum), a GABAA receptor agonist, but not glutamatergic receptor antagonists MK-801 (3 nmol/striatum) and DNQX (8 nmol/striatum), prevented GA-induced convulsions and inhibition of Na+,K+-ATPase activity. The protection of GM1 and muscimol against GA-induced seizures strongly correlated with Na+,K+-ATPase activity maintenance in the injected striatum with GA. Since GM1 and muscimol prevented neurotoxic effects induced by GA, we investigated the GM1 action after intrastriatal administration of pentylenetetrazole (PTZ), a GABAA receptor antagonist. GM1 treatment prevented seizures, Na+,K+-ATPase inhibition, and increase of TBARS and protein carbonyl induced by PTZ (1.8 mol/striatum) in the rats striatum. Furthermore, these data suggest that Na+,K+-ATPase and GABAA receptor-mediated mechanisms may play important roles in GA-induced seizures and in their prevention by GM1. / O monossialogangliosídeo (GM1) é um componente natural de membrana plasmática que está envolvido no crescimento, reconhecimento e diferenciação celular, além de proteger o SNC da ação dos radicais livres. No presente estudo investigou-se o efeito do GM1 sobre a atividade das enzimas antioxidantes catalase (CAT), superóxido dismutase (SOD) e glutationa peroxidase (GPx), assim como na quimiluminescência e capacidade antioxidante total (TRAP) em córtex cerebral de ratos machos adultos ex vivo e in vitro. A administração sistêmica de GM1 (50 mg/kg, i.p.; duas doses: 24 horas e 30 minutos antes do sacrifício) reduziu a quimiluminescência e aumentou significativamente a atividade da CAT ex vivo. A adição de GM1 (103-104 nM) ao meio de incubação diminuiu a atividade da CAT in vitro. Estes resultados sugerem que o efeito neuroprotetor do GM1 não é devido à ação antioxidante intrínseca deste glicoesfingolipídeo, mas devido ao aumento secundário das defesas antioxidantes e/ou uma redução da geração de radicais livres. Além disso, avaliamos se o GM1 tinha efeito neuroprotetor em um modelo experimental da acidemia glutárica, um erro inato do metabolismo caracterizado pelo acúmulo tecidual de ácido glutárico (GA) e alterações neurológicas, como degeneração estriatal e convulsões. A administração de GM1 preveniu as convulsões, o aumento da produção dos marcadores do dano oxidativo (carbonilação protéica total e substâncias reativas do ácido tiobarbitúrico - TBARS) e a inibição da atividade da Na+,K+-ATPase induzidas pelo GA (4 mol/2 µl) em estriado de ratos. Além disso, os episódios convulsivos induzidos por GA apresentaram uma correlação significativa com a inibição da atividade da Na+,K+-ATPase no estriado injetado, mas não com os níveis dos marcadores do estresse oxidativo. A adição de GM1 (50 200  ao meio de incubação preveniu a inibição da Na+,K+-ATPase, mas não reduziu o dano oxidativo induzido por GA (6 mM) in vitro. A administração intraestriatal de muscimol (46 pmol/0,5 l), um agonista de receptor GABAA, mas não dos antagonistas de receptores glutamatérgicos, MK-801 (3 nmol/0,5 l) e DNQX (8 nmol/0,5 l), preveniu as convulsões e a inibição da atividade da Na+,K+-ATPase induzidas por GA. A proteção do GM1 e muscimol contra as convulsões induzidas por GA apresentou uma correlação significativa com a manutenção da atividade da Na+,K+-ATPase no estriado injetado com GA. Desde que o GM1 e o muscimol preveniram os efeitos neurotóxicos induzidos pelo GA, investigou-se a ação do GM1 após a administração intraestriatal de pentilenotetrazol (PTZ), um antagonista de receptores GABAA. O tratamento com GM1 preveniu as convulsões, o dano oxidativo e a inibição da atividade da Na+,K+-ATPase induzidas por PTZ (1,8 µmol/2 µl). Esses dados sugerem que a atividade da Na+,K+-ATPase e mecanismos mediados pela ativação de receptores GABAérgicos podem ser de grande importância para a atividade convulsiva induzida por GA, bem como nos mecanismos de neuroproteção induzidos pelo GM1.

Crime has been around since the beginning of time. In an evolving society, and the methodology of crime also changes. The methodology of combating and preventing crime should aim to match the speed at which crime occurs. Criminal procedure deals with the powers of the police to investigate crimes.1 The Criminal Procedure Act 51 of 1977 (CPA) contains the principles of search and seizure in chapter 2. The promulgation of the CPA was during a period where the computer was a new phenomenon. At this time, it was inconceivable that technology would ever advance and become so ubiquitous, to the point that technology would infiltrate every aspect of our lives, and laws. There has since been many developments in our law, especially a new Constitutional dispensation.2 There have been developments and technological advancements that have had a direct and indirect bearing on the CPA. People use technology to communicate, transact, and unfortunately, to commit crime. These developments require there to be amendments in the CPA. There has been no specific amendments relating to search and seizure which are of significance in addressing technological advances. It is recommended that the amendments to the CPA include definitions and guidelines for procedural aspects of collection of electronic evidence. / Criminal and Procedural Law / LL. M. (Criminal and Procedural Law)

La spectroscopie proche infrarouge fonctionnelle (SPIRf) est une technique de neuro-imagerie noninvasive permettant de mesurer les changements de concentration d’hémoglobine oxygéné (Δ[HbO]) et désoxygéné (Δ[HbR]). Au cours des deux dernières décennies, notre groupe (et d’autres) ont combiné la SPIRf avec l'électroencéphalographie (EEG) pour effectuer des enregistrements chez des patients avec épilepsie réfractaire afin d’évaluer son potentiel comme 1) technique de cartographie cérébrale noninvasive (par exemple, localisation des aires impliquées dans le langage et localisation du foyer épileptique) et 2) comme approche noninvasive pour étudier le couplage neurovasculaire pendant les pointes épileptiques interictales ainsi que lors des crises épileptiques. Malgré des résultats prometteurs, de nombreux enjeux demeurent avant que la EEG-SPIRf puisse être implantée en pratique clinique. En effet, l’installation de l’équipement prend encore trop de temps, l’obtention de signaux de qualité nécessite encore une surveillance serrée et un certain inconfort apparaît au fur et à mesure que les enregistrements progressent dans le temps. C’est d’ailleurs pourquoi les enregistrements EEG-SPIRf ont, jusqu’à maintenant, été généralement de courte durée (c. à d. rarement plus de deux heures) avec une couverture limitée du cortex cérébral (c. à d. généralement une ou deux aires corticales) et dans un milieu contrôlé de recherche (plutôt qu’au chevet dans un milieu clinique). Compte tenu de son potentiel clinique, il y a lieu de poursuivre les efforts pour développer la EEG-SPIRf pour usage clinique. Notamment, un grand potentiel est pressenti pour la EEG-SPIRf aux soins intensifs neurologiques. D’une part, les patients qui y sont admis étant souvent comateux et/ou sous sédation, l’inconfort relié au port d’électrodes et d’optodes n’est plus en enjeu. D’autre part, ces patients présentent généralement des pathologies graves souvent associées à des anomalies épileptiformes fréquentes à l’EEG (décharges périodiques, crises subcliniques, état de mal non convulsif) dont l’impact hémodynamique sur cerveau tout comme leur prise en charge demeurent controversés. Les techniques actuellement utilisées aux soins intensifs (moniteur de pression intracrânienne, sonde de saturation veineuse jugulaire en oxygène, doppler transcrânien, EEG seul sans SPIRf) présentant des limitations, l’ajout d’une composante de SPIRf à l’EEG permettrait possiblement d’élucider l’impact de certaines de ces anomalies épileptiformes, guider leur traitement et en améliorer leur surveillance. Ainsi, cette thèse visait à 1) développer et valider un système d’EEG-SPIRf compact, sans fil et couvrant toute la tête, destinée à une surveillance à long terme de patients souffrant de divers troubles neurologiques; 2) évaluer la faisabilité et le potentiel d’une surveillance vidéo-EEG-SPIRf (vEEG-SPIRf) à long terme auprès de patients comateux admis aux soins intensifs neurologiques présentant des décharges périodiques, des crises ou un patron électrophysiologique de bouffées-suppression; et 3) étudier la dynamique neurovasculaire associée à l'état de mal épileptique non convulsif chez des patients comateux. La première et la deuxième partie du projet décrivent le développement et la validation d'un système EEG-SPIRf hybride et de "casques" EEG-SPIRf personnalisés destinés à surveiller l'hémodynamique corticale entière chez les patients neurologiques. Nous avons d'abord démontré sa performance globale chez des participants sains effectuant deux tâches cognitives spécifiques (c.-à-d. des tâches linguistiques et visuelles) en position assise (pour la première) et en pédalant sur une bicyclette (pour la seconde). Les mesures électrophysiologiques et hémodynamiques ont été validées à l'aide de deux systèmes commerciaux et ont montré, chez tous les participants, une sensibilité et une spécificité spatiotemporelle élevées. Nous avons ensuite démontré le potentiel clinique de notre système chez quatre patients souffrant de divers troubles neurologiques (par exemple, épilepsie réfractaire et maladies vasculaires cérébrales). Nous avons ainsi réalisé avec succès des enregistrements prolongés vEEG-SPIRf au chevet de tous ces patients et observé des changements hémodynamiques cliniquement pertinents et en concordance avec d’autres modalités de neuro-imagerie fonctionnelle. Une originalité particulière de ce projet réside dans sa capacité à "personnaliser" une technique d’imagerie fonctionnelle prometteuse à un environnement clinique (c.-à-d., à l’étage de neurologie et à l’unité de soins intensifs dans notre cas). Cette étude est la première à rapporter avec succès des changements hémodynamiques sur l’ensemble du cortex chez des patients neurologiques à l'aide d’une surveillance vEEG-SPIRf prolongée au chevet. Par la suite, nous avons évalué la faisabilité de la surveillance vEEG-SPIRf à long terme dans un environnement plus ardu : les soins intensifs neurologiques. Nous avons réalisé avec succès de multiples sessions de surveillance vEEG-SPIRf de très longue durée auprès de 11 patients comateux présentant différentes anomalies épileptiformes. Une augmentation significative de [HbO] et une diminution de [HbR] était présentes lors des crises. De plus, ces changements étaient relativement proportionnels à la durée des crises. Bien qu’elles étaient de moins grande amplitude, de similaires Δ[HbO] et de Δ[HbR] était présents durant les bouffées lors de patrons de bouffées-suppression et lors de décharges périodiques de basses fréquences (i.e., < 2Hz). Finalement, dans une étude subséquente, nous avons exploré l'hémodynamique corticale chez 11 patients comateux en état de mal épileptique non convulsif. Nous avons observé dans la majorité des cas, une augmentation de [HbO], du volume sanguin cérébral et du débit sanguin cérébral, mais avec des changements variables de [HbR] lors de courtes crises (inférieure à 100s). Cependant, lors de longues crises (plus de 100s), une augmentation de [HbR] était observée. Ces résultats préliminaires suggèrent que les mécanismes de couplage neurovasculaire pendant l’état de mal épileptique peuvent être dysfonctionnels chez certains patients et induire un état hypoxique, notamment lors de crises prolongées. En conclusion, les observations rapportées dans cette thèse confirment le potentiel clinique de la vEEG-SPIRf chez l'adulte, notamment pour la surveillance des patients admis aux soins intensifs neurologiques à haut risque de décharges épileptiformes. La poursuite de son développement pourrait éventuellement fournir aux neurologues et intensivistes un autre outil de surveillance neurologique. / Functional near-infrared spectroscopy (fNIRS) is a noninvasive neuroimaging technique that measures concentration changes in oxy- and deoxyhemoglobin (Δ[HbO] and Δ[HbR]) associated with brain activity. Over the past two decades, our group (and others) have combined fNIRS with electroencephalography (EEG) to record patients with refractory epilepsy and evaluate its potential as 1) a noninvasive brain mapping technique (e.g., language area localization and localization of epileptic foci) and 2) as a noninvasive approach to study neurovascular coupling during interictal spikes as well as during seizures. Despite promising results, many challenges remain before the EEG-fNIRS can be implemented in clinical practice. Indeed, installing the equipment still takes too much time, obtaining and maintaining good signal quality still requires close monitoring, and the appearance of discomfort as the recordings progress in time. For those reasons, EEG-fNIRS recordings to date have generally been of short duration (i.e., rarely more than two hours) with limited coverage of the cerebral cortex (i.e., typically one or two cortical areas) and in a controlled research setting (rather than at the bedside in a clinical setting). Given its clinical potential, there is a need for continued efforts to develop fNIRS-EEG for clinical use. In particular, fNIRS-EEG has great potential in neurological intensive care. On the one hand, since patients admitted to the ICU are often comatose and/or sedated, the discomfort of wearing electrodes and optodes is no longer an issue. On the other hand, these patients generally present serious pathologies often associated with frequent epileptiform abnormalities on the EEG (periodic discharges, nonconvulsive seizures and status) whose hemodynamic impact on the brain, as well as their management remain controversial. The techniques currently used in intensive care units (intracranial pressure monitor, jugular venous oxygen saturation probe, transcranial Doppler, EEG alone without fNIRS) have limitations. Adding an fNIRS component to the EEG could perhaps elucidate the impact of some of these epileptiform abnormalities, guide their treatment and improve their monitoring. Thus, this thesis aimed to 1) develop and validate a compact, wireless, whole-head EEG-fNIRS system for long-term monitoring of patients with various neurological disorders; 2) to evaluate the feasibility and potential of long-term video EEG-fNIRS (vEEG-fNIRS) monitoring of comatose patients admitted to the neurological intensive care unit with periodic discharges, seizures or an electrophysiological pattern of burst-suppression; and 3) to study the neurovascular dynamics associated with nonconvulsive status epilepticus in comatose patients. The first and second parts of the project describe the development and validation of a hybrid EEG-fNIRS system and personalized EEG-fNIRS "caps" to monitor whole cortical hemodynamics in neurological patients. We first demonstrated its overall performance in healthy participants performing two specific cognitive tasks (i.e., language and visual tasks) while sitting (for the former) and pedalling a bicycle (for the latter). Electrophysiological and hemodynamic measurements were validated using two commercial systems and showed, in all participants, high sensitivity and spatiotemporal specificity. We then demonstrated the clinical potential of our system in four patients suffering from various neurological disorders (e.g., refractory epilepsy and cerebrovascular diseases). We successfully performed prolonged vEEG-fNIRS recordings at the bedside of all these patients and observed clinically relevant hemodynamic changes* in agreement with other functional neuroimaging modalities. A particular originality of this project is its ability to "customize" a promising functional imaging technique specific clinical settings (i.e., neurology ward, epilepsy monitoring unit, and intensive care unit in our case). This study is the first to successfully report hemodynamic changes across the cortex in neurological patients using extended bedside vEEG-fNIRS monitoring. Subsequently, we evaluated the feasibility of long-term vEEG-fNIRS monitoring in a more challenging environment: the neurological intensive care unit. We successfully performed multiple sessions of very long-term vEEG-fNIRS monitoring in 11 comatose patients with different epileptiform abnormalities. During seizures, a significant increase in [HbO] and a decrease in [HbR] were present. Moreover, these changes were relatively proportional to the duration of the seizures. Although they were of lesser magnitude, similar changes in [HbO] and [HbR] were present during bursts in burst-suppression patterns and with low-frequency (i.e., < 2Hz) periodic discharges. Finally, in a subsequent study, we explored cortical hemodynamics in 11 comatose patients in nonconvulsive status epilepticus. We observed in the majority of cases an increase in [HbO], CBV and CBF, but with variable changes in [HbR] during short seizures (less than 100s). However, during prolonged seizures (more than 100s), an increase in [HbR] was seen. These preliminary results suggest that neurovascular coupling mechanisms during status epilepticus may be dysfunctional in some patients and induce a hypoxic state, especially during protracted seizures. In conclusion, the observations reported in this thesis confirm the clinical potential of vEEG-fNIRS in adults, especially for monitoring patients admitted to neurological intensive care units at high risk of epileptiform discharges. Further development could eventually provide neurologists and intensivists with another tool for neurological monitoring.