Summary:Purpose: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy.Methods: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ≥1 year during the follow-up period.Results: Sixty-six (75%) patients achieved complete seizure freedom for ≥1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n = 60), and in seven (12%) patients after discontinuation of AEDs (n = 38). The seizure recurrence rate was not different between the immediateand delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free ≥1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration.Conclusions: Our results suggest that seizure freedom without aura at ≥1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period. Key Words: Temporal lobe epilepsy-Epilepsy surgeryAntiepileptic drug discontinuation-Seizure recurrence.Temporal lobectomy (TL) is a well-recognized treatment modality for medically refractory temporal lobe epilepsy (TLE), which carries a wide range of seizurefree rates from 33 to 93% (median, 70%), according to a recent systematic review (1). Most outcome studies have adopted cross-sectional analysis methods, which have been problematic in understanding the longitudinal seizure outcome. From those studies, it is even more difficult to assess the surgical outcome related to alterations of antiepileptic drug (AED) therapy.The ultimate success of epilepsy surgery is to achieve a state of complete seizure freedom without AED treatment. However, trials of AED discontinuation for patients rendered seizure free by surgery is arduous for both paAccepted October 2, 2004. Address correspondence and ...

Sound vibration (SV), a mechanical stimulus, can trigger various molecular and physiological changes in plants like gene expression, hormonal modulation, induced antioxidant activity and calcium spiking. It also alters the seed germination and growth of plants. In this study, we investigated the effects of SV on the resistance of Arabidopsis thaliana against Botrytis cinerea infection. The microarray analysis was performed on infected Arabidopsis plants pre-exposed to SV of 1000 Hertz with 100 decibels. Broadly, the transcriptomic analysis revealed up-regulation of several defense and SA-responsive and/or signaling genes. Quantitative real-time PCR (qRT-PCR) analysis of selected genes also validated the induction of SA-mediated response in the infected Arabidopsis plants pre-exposed to SV. Corroboratively, hormonal analysis identified the increased concentration of salicylic acid (SA) in the SV-treated plants after pathogen inoculation. In contrast, jasmonic acid (JA) level in the SV-treated plants remained stable but lower than control plants during the infection. Based on these findings, we propose that SV treatment invigorates the plant defense system by regulating the SA-mediated priming effect, consequently promoting the SV-induced resistance in Arabidopsis against B. cinerea.

Bilaterality of the EEG findings correlated with BTH on 18F-FDG PET by the SPM method. Our results suggest that analysis of 18F-FDG PET by using SPM may have a role in predicting those patients with bitemporal excitability or bitemporal independent epileptogenicity, and these patients should be monitored carefully.

PurposeThe main purpose of this paper is to explore the challenges that Wal‐Mart may face as it expands into the Indian retail market. Wal‐Mart's failures in Germany and South Korea are analyzed to identify learnings that could be utilized in the Indian expansion.Design/methodology/approachDunning's eclectic theory as applied to international expansion is used to analyze Wal‐Mart's advantages and disadvantages in Germany and South Korea. The theory is then applied to India to understand the possible advantages and disadvantages for Wal‐Mart in entering the Indian retail market.FindingsThe key findings of the study are that Wal‐Mart faces many ownership as well as locational disadvantages while expanding in India. These significant challenges need to be well‐understood and suitably addressed for success in the Indian market.Originality/valueThis report makes a contribution towards understanding the challenges in entering an international market using a case study. The study helps analyze international experiences can be leveraged in future plans of international expansion.