Publications by authors named "Jay Harvey"

18 Publications

  • Page 1 of 1

Emergent Admissions to the Epilepsy Monitoring Unit in the Setting of COVID-19 Pandemic-related, State-mandated Restrictions: Clinical Decision Making and Outcomes.

Neurodiagn J 2021 Jun 10;61(2):95-103. Epub 2021 Jun 10.

Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the state of Texas-limited elective procedures to conserve beds and personal protective equipment (PPE); therefore, between March 22 and May 18, 2020, admission to the epilepsy monitoring unit (EMU) was limited only to urgent and emergent cases. We evaluated clinical characteristics and outcomes of these patients who were admitted to the EMU. Nineteen patients were admitted (one patient twice) with average age of 36.26 years (11 female) and average length of stay 3 days (range: 2-9 days). At least one event was captured on continuous EEG (cEEG) and video monitoring in all 20 admissions (atypical in one). One patient had both epileptic (ES) and psychogenic non-epileptic seizures (PNES) while 10 had PNES and 9 had ES. In 8 of 9 patients with ES, medications were changed, while in 5 patients with PNES, anti-epileptic drugs (AED) were stopped; the remaining 5 were not on medications. Of the 14 patients who had seen an epileptologist pre-admission, 13 (or 93%) had their diagnosis confirmed by EMU stay; a statistically significant finding. While typically an elective admission, in the setting of the COVID-19 pandemic, urgent and emergent EMU admissions were required for increased seizure or event frequency. In the vast majority of patients (13 of 19), admission lead to medication changes to either better control seizures or to change therapeutics as appropriate when PNES was identified.
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http://dx.doi.org/10.1080/21646821.2021.1918512DOI Listing
June 2021

Non-lesional mesial temporal lobe epilepsy requires bilateral invasive evaluation.

Epilepsy Behav Rep 2021 27;15:100441. Epub 2021 Mar 27.

Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA.

Purpose: Mesial temporal lobe epilepsy (MTLE) usually responds well to surgical treatment, although in non-lesional cases up to 50% of patients experience seizure relapse. The possibility of bilateral independent seizure onset should be considered as a reason for epilepsy surgery failure.

Methods: In a cohort of 177 patients who underwent invasive presurgical evaluation with stereo-tactically placed electrodes in two level four epilepsy centers, 29 had non-lesional MTLE. Invasive evaluation results are described.

Results: Among 29 patients with non-lesional MRI and mesial temporal lobe seizure onset recorded during stereo-EEG (SEEG) evaluation, four patients with unilateral preimplantation hypothesis had independent bilateral mesial temporal seizures on SEEG despite of unilateral non-invasive evaluation data. Three of these patients were treated with bitemporal responsive neurostimulator system (RNS). Independent bilateral mesial temporal seizures have been confirmed on RNS ECoG (electrocorticography). The fourth patient underwent right anterior temporal lobectomy.

Conclusion: We propose that patients with non-lesional mesial temporal lobe epilepsy would benefit from bilateral invasive evaluation of mesial temporal structures to predict those patients who would be at most risk for surgical failure. Neurostimulaiton could be an initial treatment option for patients with independent bitemporal seizure onset.
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http://dx.doi.org/10.1016/j.ebr.2021.100441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058515PMC
March 2021

Personalized EEG Feature Selection for Low-Complexity Seizure Monitoring.

Int J Neural Syst 2021 Mar 22:2150018. Epub 2021 Mar 22.

Department of Neurology and Neurotherapeutic, The University of Texas Southwestern Medical Center, Dallas 75230, USA.

Approximately, one third of patients with epilepsy are refractory to medical therapy and thus can be at high risk of injuries and sudden unexpected death. A low-complexity electroencephalography (EEG)-based seizure monitoring algorithm is critically important for daily use, especially for wearable monitoring platforms. This paper presents a personalized EEG feature selection approach, which is the key to achieve a reliable seizure monitoring with a low computational cost. We advocate a two-step, personalized feature selection strategy to enhance monitoring performances for each patient. In the first step, linear discriminant analysis (LDA) is applied to find a few seizure-indicative channels. Then in the second step, least absolute shrinkage and selection operator (LASSO) method is employed to select a discriminative subset of both frequency and time domain features (spectral powers and entropy). A personalization strategy is further customized to find the best settings (number of channels and features) that yield the highest classification scores for each subject. Experimental results of analyzing [Formula: see text] subjects in CHB-MIT database are quite promising. We have achieved an average F-1 score of [Formula: see text] with excellent sensitivity and specificity using not more than [Formula: see text] features extracted from at most [Formula: see text] channels.
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http://dx.doi.org/10.1142/S0129065721500180DOI Listing
March 2021

Feature Selection Using F-statistic Values for EEG Signal Analysis.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:5963-5966

Electroencephalography (EEG) is a highly complex and non-stationary signal that reflects the cortical electric activity. Feature selection and analysis of EEG for various purposes, such as epileptic seizure detection, are highly in demand. This paper presents an approach to enhance classification performance by selecting discriminative features from a combined feature set consisting of frequency domain and entropy based features. For each EEG channel, nine different features are extracted, including six sub-band spectral powers and three entropy values (sample, permutation and spectral entropy). Features are then ranked across all channels using F-statistic values and selected for SVM classification. Experimentation using CHB-MIT dataset shows that our method achieves average sensitivity, specificity and F-1 score of 92.63%, 99.72% and 91.21%, respectively.
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http://dx.doi.org/10.1109/EMBC44109.2020.9176434DOI Listing
July 2020

Postoperative oxygenation in healthy dogs following mechanical ventilation with fractions of inspired oxygen of 0.4 or >0.9.

Vet Anaesth Analg 2020 May 25;47(3):295-300. Epub 2020 Jan 25.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.

Objective: To evaluate arterial oxygenation during the first 4 postoperative hours in dogs administered different fractions of inspired oxygen (FiO) during general anesthesia with mechanical ventilation.

Study Design: Prospective, randomized clinical trial.

Animals: A total of 20 healthy female dogs, weighing >15 kg and body condition scores 3-7/9, admitted for ovariohysterectomy.

Methods: Dogs were randomized to breathe an FiO >0.9 or 0.4 during isoflurane anesthesia with intermittent positive pressure ventilation. The intraoperative PaO:FiO ratio was recorded during closure of the linea alba. Arterial blood was obtained 5, 60 and 240 minutes after extubation for measurement of PaO and PaCO (FiO = 0.21). Demographic characteristics, duration of anesthesia, PaO:FiO ratio and anesthetic agents were compared between groups with Wilcoxon tests. The postoperative PaO, PaCO, rectal temperature, a visual sedation score and events of hypoxemia (PaO < 80 mmHg) were compared between groups with mixed-effects models or generalized linear mixed models.

Results: Groups were indistinguishable by demographic characteristics, duration of anesthesia, anesthetic agents administered and intraoperative PaO:FiO ratio (all p > 0.08). Postoperative PaO, PaCO, rectal temperature or sedation score were not different between groups (all p > 0.07). During the first 4 postoperative hours, hypoxemia occurred in three and seven dogs that breathed FiO >0.9 or 0.4 during anesthesia, respectively (p = 0.04).

Conclusions And Clinical Relevance: The results identified no advantage to decreasing FiO to 0.4 during anesthesia with mechanical ventilation with respect to postoperative oxygenation. Moreover, the incidence of hypoxemia in the first 4 hours after anesthesia was higher in these dogs than in dogs breathing FiO >0.9.
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http://dx.doi.org/10.1016/j.vaa.2020.01.002DOI Listing
May 2020

Cannabis and Epilepsy.

J Dual Diagn 2020 Jan-Mar;16(1):75-82. Epub 2019 Aug 6.

Department of Neurology, UTSW Epilepsy Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

In recent years, the use of cannabidiol in the treatment of refractory epilepsy has been increasingly investigated and has been gaining public support as a novel way to treat these disorders. Marijuana has been used for medical purposes for thousands of years, and a lot of research has been conducted over the last several decades into the chemistry and pharmacology of marijuana and its many compounds, including cannabidiol. Using PubMed, we performed a review of the literature regarding the history of cannabinoid use in treating epilepsy. There are historical and recent scientific developments that support the use of cannabidiol in rare severe epilepsy syndromes.
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http://dx.doi.org/10.1080/15504263.2019.1645372DOI Listing
May 2021

Efficacy and safety of eslicarbazepine acetate monotherapy in patients converting from carbamazepine.

Epilepsia 2018 03 16;59(3):704-714. Epub 2018 Feb 16.

Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.

Objective: To evaluate the influence of prior use of carbamazepine (CBZ) and other antiepileptic drugs (AEDs) with a putatively similar mechanism of action (inhibition of voltage-gated sodium channels; VGSCs) on seizure outcomes and tolerability when converting to eslicarbazepine acetate (ESL), using data pooled from 2 controlled conversion-to-ESL monotherapy trials (studies: 093-045, 093-046).

Methods: Adults with treatment-resistant focal (partial-onset) seizures were randomized 2:1 to ESL 1600 or 1200 mg once daily. The primary efficacy endpoint was study exit (meeting predefined exit criteria related to worsening seizure control) versus an historical control group. Other endpoints included change in seizure frequency, responder rate, and tolerability. Endpoints were analyzed for subgroups of patients who received CBZ (or any VGSC inhibitor [VGSCi]) during baseline versus those who received other AEDs.

Results: Of 365 patients in the studies, 332 were evaluable for efficacy. The higher risk of study exit in the subgroups that received CBZ (or any VGSCi) during baseline, versus other AEDs, was not statistically significant (hazard ratios were 1.49 for +CBZ vs -CBZ [P = .10] and 1.27 for +VGSCi vs. -VGSCi [P = .33]). Reductions in seizure frequency and responder rates were lower in patients who converted from CBZ or other VGSCi compared with those who converted from other AEDs. There were no notable differences in overall tolerability between subgroups, but the incidence of some adverse events (eg, dizziness, somnolence, nausea) differed between subgroups and/or between treatment periods.

Significance: Baseline use of CBZ or other major putative VGSC inhibitors did not appear to significantly increase the risk of study exit due to worsening seizure control, or to increase the frequency of side effects when converting to ESL monotherapy. However, bigger improvements in efficacy may be possible in patients converting to ESL monotherapy from an AED regimen that does not include a VGSC inhibitor.
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http://dx.doi.org/10.1111/epi.14014DOI Listing
March 2018

Effects of two fractions of inspired oxygen during anesthesia on early postanesthesia oxygenation in healthy dogs.

Am J Vet Res 2018 Feb;79(2):147-153

OBJECTIVE To evaluate the effects of 2 fractions of inspired oxygen (Fios) during anesthesia on postanesthesia Pao and other measures of oxygen exchange. ANIMALS 22 healthy adult sexually intact female dogs undergoing ovariohysterectomy by ventral midline celiotomy. PROCEDURES Dogs were randomly assigned to receive either oxygen (Fio > 0.9 [100% oxygen]; n = 11; control group) or a mixture of nitrogen and oxygen (Fio = 0.4; 11; 40% oxygen group) as the carrier gas for isoflurane while anesthetized. All dogs were allowed to breathe spontaneously while anesthetized. For each dog, the Pao, Paco, other indices of oxygenation, and extent of sedation were monitored at predetermined times during and for 1 hour after anesthesia. Measured variables were compared between the 2 treatment groups and over time within each treatment group. RESULTS None of the measured variables differed significantly between the control and 40% oxygen groups at any time during the postanesthesia period. Within each treatment group, the Paco and extent of sedation decreased over time during the postanesthesia period. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that indices of oxygenation did not differ significantly between healthy dogs in which the Fio was maintained at > 0.9 and those in which the Fio was maintained at 0.4 while anesthetized for ovariohysterectomy. Thus, the addition of nitrogen to the carrier gas for an inhalant anesthetic conferred neither an advantage nor disadvantage in regard to oxygenation during the first hour of anesthesia recovery.
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http://dx.doi.org/10.2460/ajvr.79.2.147DOI Listing
February 2018

Influence of titration schedule and maintenance dose on the tolerability of adjunctive eslicarbazepine acetate: An integrated analysis of three randomized placebo-controlled trials.

Epilepsy Res 2018 01 4;139:1-8. Epub 2017 Nov 4.

Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA 01752, USA. Electronic address:

Objective: To examine the influence of titration schedule and maintenance dose on the incidence and type of treatment-emergent adverse events (TEAEs) associated with adjunctive eslicarbazepine acetate (ESL).

Methods: Data from three randomized, double-blind, placebo-controlled trials were analyzed. Patients with refractory partial-onset seizures were randomized to maintenance doses of ESL 400, 800, or 1200mg QD (dosing was initiated at 400 or 800mg QD) or placebo. The incidence of TEAEs was analyzed during the double-blind period (2-week titration phase; 12-week maintenance phase), according to the randomized maintenance dose and the titration schedule.

Results: 1447 patients were included in the analysis. During the first week of treatment, 62% of patients taking ESL 800mg QD had ≥1 TEAE, vs 35% of those taking 400mg QD and 32% of the placebo group; dizziness, somnolence, nausea, and headache were numerically more frequent in patients taking ESL 800mg than those taking ESL 400mg QD. During the double-blind period, the incidences of common TEAEs were lower in patients who initiated ESL at 400mg vs 800mg QD. For the 800 and 1200mg QD maintenance doses, rates of TEAEs leading to discontinuation were lower in patients who began treatment with 400mg than in those who began taking ESL 800mg QD.

Conclusions: Initiation of ESL at 800mg QD is feasible. However, initiating treatment with ESL 400mg QD for 1 or 2 weeks is recommended, being associated with a lower incidence of TEAEs, and related discontinuations. For some patients, treatment may be initiated at 800mg QD, if the need for more immediate seizure reduction outweighs concerns about increased risk of adverse reactions during initiation.
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http://dx.doi.org/10.1016/j.eplepsyres.2017.10.021DOI Listing
January 2018

Detection of generalized tonic-clonic seizures using surface electromyographic monitoring.

Epilepsia 2017 11 5;58(11):1861-1869. Epub 2017 Oct 5.

Brain Sentinel, San Antonio, Texas, U.S.A.

Objective: A prospective multicenter phase III trial was undertaken to evaluate the performance and tolerability in the epilepsy monitoring unit (EMU) of an investigational wearable surface electromyographic (sEMG) monitoring system for the detection of generalized tonic-clonic seizures (GTCSs).

Methods: One hundred ninety-nine patients with a history of GTCSs who were admitted to the EMU in 11 level IV epilepsy centers for clinically indicated video-electroencephalographic monitoring also received sEMG monitoring with a wearable device that was worn on the arm over the biceps muscle. All recorded sEMG data were processed at a central site using a previously developed detection algorithm. Detected GTCSs were compared to events verified by a majority of three expert reviewers.

Results: For all subjects, the detection algorithm detected 35 of 46 (76%, 95% confidence interval [CI] = 0.61-0.87) of the GTCSs, with a positive predictive value (PPV) of 0.03 and a mean false alarm rate (FAR) of 2.52 per 24 h. For data recorded while the device was placed over the midline of the biceps muscle, the system detected 29 of 29 GTCSs (100%, 95% CI = 0.88-1.00), with a detection delay averaging 7.70 s, a PPV of 6.2%, and a mean FAR of 1.44 per 24 h. Mild to moderate adverse events were reported in 28% (55 of 199) of subjects and led to study withdrawal in 9% (17 of 199). These adverse events consisted mostly of skin irritation caused by the electrode patch that resolved without treatment. No serious adverse events were reported.

Significance: Detection of GTCSs using an sEMG monitoring device on the biceps is feasible. Proper positioning of this device is important for accuracy, and for some patients, minimizing the number of false positives may be challenging.
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http://dx.doi.org/10.1111/epi.13897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698770PMC
November 2017

Faciobrachial dystonic spells: Presenting feature of autoimmune encephalopathy.

Neurol India 2017 Sep-Oct;65(5):1149-1151

Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas, USA.

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http://dx.doi.org/10.4103/neuroindia.NI_452_16DOI Listing
July 2019

Automated seizure detection using limited-channel EEG and non-linear dimension reduction.

Comput Biol Med 2017 03 25;82:49-58. Epub 2017 Jan 25.

Texas Epilepsy Group, 12221 Merit Drive, Suite 350, Dallas, TX 75230, USA. Electronic address:

Electroencephalography (EEG) is an essential component in evaluation of epilepsy. However, full-channel EEG signals recorded from 18 to 23 electrodes on the scalp is neither wearable nor computationally effective. This paper presents advantages of both channel selection and nonlinear dimension reduction for accurate automatic seizure detection. We first extract the frequency domain features from the full-channel EEG signals. Then, we use a random forest algorithm to determine which channels contribute the most in discriminating seizure from non-seizure events. Next, we apply a non-linear dimension reduction technique to capture the relationship among data elements and map them in low dimension. Finally, we apply a KNN classifier technique to discriminate between seizure and non-seizure events. The experimental results for 23 patients show that our proposed approach outperforms other techniques in terms of accuracy. It also visualizes long-term data in 2D to enhance physician cognition of occurrence and disease progression.
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http://dx.doi.org/10.1016/j.compbiomed.2017.01.011DOI Listing
March 2017

Multi-Biosignal Analysis for Epileptic Seizure Monitoring.

Int J Neural Syst 2017 Feb 7;27(1):1650031. Epub 2016 Apr 7.

2 Neurology Consultants of Dallas, PA, 12221 Merit Drive, Suite 350, Dallas, TX 75230, USA.

Persons who suffer from intractable seizures are safer if attended when seizures strike. Consequently, there is a need for wearable devices capable of detecting both convulsive and nonconvulsive seizures in everyday life. We have developed a three-stage seizure detection methodology based on 339 h of data (26 seizures) collected from 10 patients in an epilepsy monitoring unit. Our intent is to develop a wearable system that will detect seizures, alert a caregiver and record the time of seizure in an electronic diary for the patient's physician. Stage I looks for concurrent activity in heart rate, arterial oxygenation and electrodermal activity, all of which can be monitored by a wrist-worn device and which in combination produce a very low false positive rate. Stage II looks for a specific pattern created by these three biosignals. For the patients whose seizures cannot be detected by Stage II, Stage III detects seizures using limited-channel electroencephalogram (EEG) monitoring with at most three electrodes. Out of 10 patients, Stage I recognized all 11 seizures from seven patients, Stage II detected all 10 seizures from six patients and Stage III detected all of the seizures of two out of the three patients it analyzed.
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http://dx.doi.org/10.1142/S0129065716500313DOI Listing
February 2017

Idiopathic Canine Laryngeal Paralysis as One Sign of a Diffuse Polyneuropathy: An Observational Study of 90 Cases (2007-2013).

Vet Surg 2016 Feb 12;45(2):254-60. Epub 2016 Jan 12.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York.

Objective: To determine survival and incidence of complications in dogs with idiopathic laryngeal paralysis (ILP) and concurrent neurologic signs.

Study Design: Observational study.

Animals: Dogs (n = 90) with ILP.

Methods: Medical records (January 2007-June 2013) of dogs with ILP were reviewed. Neurologic comorbidities, including pelvic limb neurologic abnormalities and esophageal abnormalities were identified. Using medical record information and client interviews, the relationship between these comorbidities and postoperative survival (primary outcome measure) and postoperative complications (secondary outcome measure) was identified.

Results: Dogs that had surgical correction of ILP had a 2.6-fold reduction in the hazard of death throughout the study period (HR = 2.6; 95% CI: 1.34-4.84, P = .006). Owner assessed patient quality of life (10-point scale) increased by an average of 4.1 ± 1.4 units immediately postoperatively, and 4.9 ± 0.9 units until death or followup compared with preoperative values. Thirty-five of 72 dogs available for followup had evidence of diffuse neurologic comorbidities. Overall complication rate for dogs with neurologic comorbidities was 74%, compared with 32% for dogs without neurologic comorbidities. Presence of any neurologic comorbidity was associated with a significantly greater odds of any complication (OR = 4.04; 95% CI: 1.25-13.90, P = .019) as well as recurring complications (OR = 8.00; 95% CI: 1.49-54.38; P = .015).

Conclusion: Surgical correction of ILP was positively associated with survival, and dogs with neurologic comorbidities were at greater risk for developing postoperative complications.
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http://dx.doi.org/10.1111/vsu.12444DOI Listing
February 2016

Efficacy and safety of conversion to monotherapy with eslicarbazepine acetate in adults with uncontrolled partial-onset seizures: a randomized historical-control phase III study based in North America.

Epilepsia 2015 Apr 16;56(4):546-55. Epub 2015 Feb 16.

Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.

Objective: To assess the efficacy and safety of eslicarbazepine acetate (ESL) as monotherapy in North American patients with partial-onset seizures (POS).

Methods: This multicenter, randomized, double-blind "withdrawal to monotherapy" study used historical control data as the comparator. Adults with POS medically uncontrolled by one to two antiepileptic drugs gradually converted to ESL monotherapy. Following an 8-week baseline period, patients were randomized 2:1 to receive ESL 1,600 mg (n = 128) or 1,200 mg QD (n = 65) for 18 weeks. The primary end point was the proportion of patients meeting predefined exit criteria (signifying worsening seizure control). Treatment was considered effective if the 95% upper confidence limit (UCL) for the Kaplan-Meier estimated exit rate was lower than the exit rate threshold calculated from the historical control (65.3%).

Results: Kaplan-Meier estimated exit rates were: ESL 1,600 mg, 28.7% (95% CI 21.2-38.1%) and 1,200 mg, 44.4% (32.5-58.3%). The difference between doses was not significant (p = 0.07). For both doses, the 95% UCLs for the exit rate were ˂ 65.3%; ESL monotherapy was considered superior to the historical control. There was no statistically significant increase in the risk of study exit related to carbamazepine use. Nine (7.6%) and five patients (8.3%) remained seizure-free during the 10-week monotherapy period, while taking ESL 1,600 and 1,200 mg, respectively. The reductions in median standardized seizure frequency (seizures per 28 days) between baseline and the 18-week treatment period were: ESL 1,600 mg, 42% and 1,200 mg, 31%. Treatment-emergent adverse events (TEAEs) occurring in ≥ 10% of patients were dizziness, headache, fatigue, somnolence, nausea, and nasopharyngitis. The TEAE most frequently leading to discontinuation was hyponatremia (2.1%).

Significance: ESL was efficacious and well tolerated as monotherapy in North American patients, and led to a reduction in seizure frequency. Exit rates for ESL 1,600 and 1,200 mg QD were superior to the historical control; the difference in exit rates between doses was not statistically significant.
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http://dx.doi.org/10.1111/epi.12934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016771PMC
April 2015

Eslicarbazepine acetate as adjunctive therapy in patients with uncontrolled partial-onset seizures: Results of a phase III, double-blind, randomized, placebo-controlled trial.

Epilepsia 2015 Feb 22;56(2):244-53. Epub 2014 Dec 22.

Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.

Objective: To evaluate the efficacy and safety of adjunctive eslicarbazepine acetate (ESL) in patients with refractory partial-onset seizures.

Methods: This randomized, placebo-controlled, double-blind, parallel-group, phase III study was conducted at 173 centers in 19 countries, including the United States and Canada. Eligible patients were aged ≥16 years and had uncontrolled partial-onset seizures despite treatment with 1-2 antiepileptic drugs (AEDs). After an 8-week baseline period, patients were randomized to once-daily placebo (n = 226), ESL 800 mg (n = 216), or ESL 1,200 mg (n = 211). Following a 2-week titration period, patients received ESL 800 or 1,200 mg once-daily for 12 weeks. Seizure data were captured and documented using event-entry or daily entry diaries.

Results: Standardized seizure frequency (SSF) during the maintenance period (primary end point) was reduced with ESL 1,200 mg (p = 0.004), and there was a trend toward improvement with ESL 800 mg (p = 0.06), compared with placebo. When data for titration and maintenance periods were combined, ESL 800 mg (p = 0.001) and 1,200 mg (p < 0.001) both reduced SSF. There were no statistically significant interactions between treatment response and geographical region (p = 0.38) or diary version (p = 0.76). Responder rate (≥50% reduction in SSF) was significantly higher with ESL 1,200 mg (42.6%, p < 0.001) but not ESL 800 mg (30.5%, p = 0.07) than placebo (23.1%). Incidence of treatment-emergent adverse events (TEAEs) and TEAEs leading to discontinuation increased with ESL dose. The most common TEAEs were dizziness, somnolence, nausea, headache, and diplopia.

Significance: Adjunctive ESL 1,200 mg once-daily was more efficacious than placebo in adult patients with refractory partial-onset seizures. The once-daily 800 mg dose showed a marginal effect on SSF, but did not reach statistical significance. Both doses were well tolerated. Efficacy assessment was not affected by diary format used.
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http://dx.doi.org/10.1111/epi.12894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354260PMC
February 2015

Gallbladder disease in Shetland Sheepdogs: 38 cases (1995-2005).

J Am Vet Med Assoc 2007 Jul;231(1):79-88

Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.

Objective: To determine risk, clinical features, and treatment responses for gallbladder disorders in Shetland Sheepdogs.

Design: Retrospective case-control study.

Animals: 38 Shetland Sheepdogs with gallbladder disease.

Procedures: Medical records were reviewed for signalment, history, physical findings, laboratory results, imaging features, coexistent illnesses, histologic findings, treatments, and survival rates.

Results: Mature dogs with gastrointestinal signs were predisposed (odds ratio, 7.2) to gallbladder disorders. Gallbladder mucocele was confirmed in 25 dogs. Concurrent problems included pancreatitis, hyperlipidemia, corticosteroid excess, hypothyroidism, protein-losing nephropathy, diabetes mellitus, cholelithiasis, and gallbladder dysmotility. Mortality rate was 68% with and 32% without bile peritonitis. Nonsurvivors had high WBC and neutrophil count and low potassium concentration. Although preprandial hypercholesterolemia, hypertriglyceridemia, and high serum liver enzyme activities were common, gallbladder disease was serendipitously discovered in 11 of 38 dogs. Histologic examination (n=20 dogs) revealed gallbladder cystic mucosal hyperplasia in 20 dogs, cholecystitis in 16, periportal hepatitis in 9, and vacuolar hepatopathy in 7. Surgery included cholecystectomy (n=17) and cholecystoenterostomy (4). In 1 hyperlipidemic dog without clinical signs, gallbladder mucocele resolved 6 months after beginning use of a fat-restricted diet and ursodeoxycholic acid.

Conclusions And Clinical Relevance: Shetland Sheepdogs are predisposed to gallbladder disorders, with mucoceles and concurrent dyslipidemia or dysmotility in many affected dogs. Most dogs were without clinical signs during mucocele development. Low survival rate after cholecystectomy in clinically affected dogs suggested that preemptive surgical interventions may be a more appropriate treatment strategy.
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http://dx.doi.org/10.2460/javma.231.1.79DOI Listing
July 2007

Use of recombinant tissue-plasminogen activator in a dog with chylothorax secondary to catheter-associated thrombosis of the cranial vena cava.

J Am Anim Hosp Assoc 2002 Sep-Oct;38(5):431-5

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York 14850, USA.

A 4-year-old, castrated male Maltese developed cranial vena caval thrombosis and chylothorax following central venous catheterization for treatment of postoperative sepsis. Vena caval thrombolysis was attempted using recombinant human tissue-plasminogen activator (t-PA). Thrombolytic therapy led to an acute reduction in the size of the caval thrombus and was followed by prompt resolution of the chylothorax. Hemorrhage at the entry sites of a jugular catheter and esophagostomy tube placed at the time of treatment was a dose-limiting complication of t-PA therapy in this dog.
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http://dx.doi.org/10.5326/0380431DOI Listing
October 2002
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