Epileptology of the first-seizure presentation

Addy, D P

doi:10.1016/s0140-6736(05)79922-0

Cited by 2 publications

(1 citation statement)

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“…6 Moreover, most patients in the study of King et al were adults over 30 years old, so many had probably suffered a remote symptomatic partial seizure. [28][29][30] More recently, the CAROLE group also made a syndrome classification in patients with newly diagnosed epilepsy or only a single seizure. 2 In this study a panel made the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Interrater agreement of the diagnosis and classification of a first seizure in childhood. The Dutch Study of Epilepsy in Childhood

Stroink

Donselaar²,

Geerts³

et al. 2004

Journal of Neurology, Neurosurgery & Psychiatry

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Objective: To assess the interrater agreement of the diagnosis and the classification of a first paroxysmal event in childhood. Methods: The descriptions of 100 first paroxysmal events were submitted to two panels each consisting of three experienced paediatric neurologists. Each observer independently made a diagnosis based on clinical judgment and thereafter a diagnosis based on predefined descriptive criteria. Then, the observers discussed all patients within their panel. The agreement between the six individual observers was assessed before discussion within each panel and after that, between the two panels. Results: Using their clinical judgement, the individual observers reached only fair to moderate agreement on the diagnosis of a first seizure (mean (SE) kappa 0.41 (0.03)). With use of defined descriptive criteria the mean (SE) kappa was 0.45 (0.03). The kappa for agreement between both panels after intra-panel discussion increased to 0.60 (0.06). The mean (SE) kappa for the seizure classification by individual observers was 0.46 (0.02) for clinical judgment and 0.57 (0.03) with use of criteria. After discussion within each panel the kappa between the panels was 0.69 (0.06). In 24 out of 51 children considered to have had a seizure, agreement was reached between the panels on a syndrome diagnosis. However, the epileptic syndromes were in most cases only broadly defined. Conclusions: The interrater agreement on the diagnosis of a first seizure in childhood is just moderate. This phenomenon hampers the interpretation of studies on first seizures in which the diagnosis is only made by one observer. The use of a panel increased the interrater agreement considerably. This approach is recommended at least for research purposes. Classification into clinically relevant syndromes is possible only in a very small minority of children with a single seizure.

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Section: Discussionmentioning

confidence: 99%

Interrater agreement of the diagnosis and classification of a first seizure in childhood. The Dutch Study of Epilepsy in Childhood

Stroink

Donselaar²,

Geerts³

et al. 2004

Journal of Neurology, Neurosurgery & Psychiatry

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SecA2-dependent secretion of autolytic enzymes promotes Listeria monocytogenes pathogenesis

Lenz

Mohammadi

Geissler

et al. 2003

Proc. Natl. Acad. Sci. U.S.A.

253

355

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Pathogenic bacteria secrete proteins that promote invasion of host tissues and resistance to immune responses. However, secretion mechanisms that contribute to the enormous morbidity and mortality of Gram-positive bacteria are largely undefined. An auxiliary protein secretion system (SecA2) has recently emerged in Listeria monocytogenes and eight other Gram-positive pathogens. Here, a proteomics approach identified seventeen SecA2-dependent secreted and surface proteins of L. monocytogenes, the two most abundant of which [the p60 and N-acetylmuramidase (NamA) autolysins] hydrolyze bacterial peptidoglycan (PGN) and contribute to host colonization. SecA2-deficient (⌬SecA2) bacteria were rapidly cleared after systemic infection of murine hosts, and in cultured cells showed reduced cell-cell spread. p60 or NamA deficiencies (⌬p60 and ⌬NamA) caused intermediate reductions in bacterial virulence in vivo, yet showed no defect for infection of cultured cells. Restoration of virulence in ⌬p60 bacteria required full-length p60 with an intact catalytic domain, suggesting that PGN hydrolysis by p60 is crucial for L. monocytogenes virulence. Coordinated PGN hydrolysis by p60 and NamA activities is predicted to generate a muramyl glycopeptide, glucosaminylmuramyl dipeptide (GMDP), which is known to modify host inflammatory responses. Thus, SecA2-dependent secretion may promote release of muramyl peptides that subvert host pattern recognition.

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Epileptology of the first-seizure presentation

Cited by 2 publications

References 1 publication

Interrater agreement of the diagnosis and classification of a first seizure in childhood. The Dutch Study of Epilepsy in Childhood

Interrater agreement of the diagnosis and classification of a first seizure in childhood. The Dutch Study of Epilepsy in Childhood

SecA2-dependent secretion of autolytic enzymes promotes Listeria monocytogenes pathogenesis

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