No abstract

Landau-Kleffner syndrome (LKS) is a rare childhood neurological condition that causes developmental regression, loss of language skills and abnormal electroencephalogram (EEG) patterns. Its etiology is unknown. This report describes a case of a 13-year-old boy who at 3.5 years of age was bitten by a tick. Two months thereafter, he began losing previously acquired developmental and language skills, and developed seizures. The seizures subsided with valproic acid treatment, but the developmental delays persisted. Family history and disease progression reports obtained from the patient's father revealed that the patient displayed repetitive behaviors prior to the age of three. Clinical observation also showed the patient having numerous repetitive vocalizations and movements along with difficulty with switching sets. His developmental age at the time of presentation was determined to be 3 to 4 years of age. During the course of diagnostic testing, we were able to rule out tick-borne encephalitis (TBE) and rule in LKS in a premorbidly autistic child. This case describes the similarities between the three conditions and the diagnostic investigations used to arrive at a final diagnosis.

BackgroundWe examined the impact of race on the maximum tolerated doses (MTD) and final approved doses (FAD) of single-agent molecular-targeted agents (MTA) in North America/Europe (NA/EU) and Asia.MethodsWe searched PubMed and regulatory databases to identify targeted drugs approved globally and compared their FAD and MTD in corresponding phase I/II studies conducted separately in NA/EU and Asia. To evaluate this further, we conducted parallel, prospective, first-in-human studies of DS-7423, a dual PI3K/mTOR inhibitor, in patients with advanced solid tumours in the US and Japan. We pooled and compared the pharmacokinetics (PK), pharmacodynamics (PD), toxicity, and efficacy between these populations.Results17 MTA were approved in NA/EU and Asia from 2001 to 2015. Recommended phase 2 doses (RP2D) were identical across races in 14 of 17 (80%) studies and differences were not clinically meaningful. FAD were identical across all regions. 42 and 27 patients from US and Japan, respectively, were enrolled in the phase I studies of DS-7423. Despite differences in race, body weight, and body mass index, the RP2D were 240 mg/day with no differences in toxicities, PK, PD, or efficacy.ConclusionsConducting separate clinical trials of single-agent MTA in Caucasian and Asian populations may be redundant.

To raise awareness of attention-deficit/hyperactivity disorder (ADHD) as an underdiagnosed, undertreated disorder in adult patients with comorbid substance use disorder (SUD) who are misdiagnosed with other common psychiatric illnesses and to reduce fear and hesitancy in prescribing stimulants as treatment in such a patient population. ADHD diagnosis is easier in the child and adolescent population than the adults due to comorbidities of other psychiatric illnesses and SUD. However, diagnosing ADHD appropriately in an increasing number of adult patients presents challenges. Even if they get diagnosed appropriately, the stigma of substance use disorder holds the providers prescribing stimulant medications for such patient populations due to the high comorbidity of ADHD with SUD. Accurate diagnosis of ADHD in adults is a worthwhile endeavor as this diagnosis is comorbidly present in many mood and substance use disorders patients. Treating ADHD in this population can improve clinical symptoms and overall quality of life.