SUMMARYObjective: The Global Assessment of Severity of Epilepsy (GASE) Scale is a singleitem, 7-point global rating scale designed for neurologist-report of overall severity of epilepsy in children. Building on previous preliminary evidence of its validity and reliability for research and clinical use, this study evaluated the GASE Scale's construct validity, reliability, and responsiveness to changes in severity of epilepsy. Methods: Data used for the study arose from the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES), a 2-year multicenter prospective cohort study (n = 374) with observations taken at baseline, and 6, 12, and 24 months after diagnosis. Construct validity and reliability were quantified using Spearman's correlation and intraclass correlation coefficient (ICC). Responsiveness was assessed using both distribution-based and anchor-based indices. Results: The GASE Scale was at least moderately correlated (r ≥ 0.30) with several key clinical aspects and most strongly correlated with frequency and intensity of seizures and interference of epilepsy or drugs with daily activities (r > 0.30). Total variation in GASE Scale scores explained by seven core clinical aspects of epilepsy increased over time (R 2 = 28% at baseline to R 2 = 70% at 24 months). The GASE Scale had modest test-retest reliability (ICC range: 0.52-0.64) and was responsive to changes in clinical criteria (standardized response mean range: 0.49-0.68; probability of change range: 0.69-0.75; Guyatt's responsiveness statistic range: 0.56-0.84). The GASE Scale showed potential to discriminate "stable" and "changed" patients according to select criteria and to a composite score (area under the receiver operating characteristic [ROC] curve range: 0.50-0.67). Significance: Results offer additional evidence in support of the GASE Scale's validity, reliability, as well as responsiveness to changes in severity of epilepsy in children. We conclude that the GASE Scale is a potentially useful tool for assessing the severity of epilepsy in both clinical and research settings.

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Precursors of mature natural killer (pre-mNK) cells, initially called IFN-producing killer dendritic cells, have been recently characterized as a novel intermediate in NK cell differentiation. Typified by a unique B220+NK1.1+CD11c+MHCII+ phenotype, pre-mNK cells exhibit prolific anti-tumor cytotoxicity while retaining the ability to present antigens thereby activating neighbouring T cells. Invariant NKT (iNKT) cells are another population highlighted for their potential in anti-cancer immunity. They are activated very early and play an important role in transactivating downstream effectors, such as NK cells. The extent to which iNKT cells can activate pre-mNK cells is unknown. We hypothesized that iNKT cells are able to activate pre-mNK cells and potentiate their anti-tumor properties. Wildtype C57BL/6 mice were injected i.p. with the iNKT cell superagonist, α-galactosylceramide (αGC), and various lymphoid tissues were harvested after 5 days for phenotyping or cytotoxicity assays. We have shown, for the first time that iNKT cell activation via αGC results in robust expansion of pre-mNK cells in the spleen, lung and most notably, in the liver. These cells exhibited cytotoxic activity against YAC-1 thymoma and B16 melanoma cancer cells via the granule exocytosis pathway and significantly contributed to overall NK cytotoxic activity in vivo. The anti-cancer responses due to αGC activation have been well documented; however, the contribution of pre-mNK cells in these responses have never been shown. Our findings demonstrate that pre-mNK cells rapidly expand due to iNKT activation while retaining their capacity to kill tumor targets. This may suggest a novel mechanism of targeting pre-mNK cells in anti-cancer therapies.