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ObjectiveTo evaluate efficacy and safety of lacosamide (up to 12 mg/kg/day or 400 mg/day) as adjunctive treatment for uncontrolled primary generalised tonic-clonic seizures (PGTCS) in patients (≥4 years) with idiopathic generalised epilepsy (IGE).MethodsPhase 3, double-blind, randomised, placebo-controlled trial (SP0982; NCT02408523) in patients with IGE and PGTCS taking 1–3 concomitant antiepileptic drugs. Primary outcome was time to second PGTCS during 24-week treatment.Results242 patients were randomised and received ≥1 dose of trial medication (lacosamide/placebo: n=121/n=121). Patients (mean age: 27.7 years; 58.7% female) had a history of generalised-onset seizures (tonic-clonic 99.6%; myoclonic 38.8%; absence 37.2%). Median treatment duration with lacosamide/placebo was 143/65 days. Risk of developing a second PGTCS during 24-week treatment was significantly lower with lacosamide than placebo (Kaplan-Meier survival estimates 55.27%/33.37%; HR 0.540, 95% CI 0.377 to 0.774; p<0.001; n=118/n=121). Median time to second PGTCS could not be estimated for lacosamide (>50% of patients did not experience a second PGTCS) and was 77.0 days for placebo. Kaplan-Meier estimated freedom from PGTCS at end of the 24-week treatment period (day 166) for lacosamide/placebo was 31.3%/17.2% (difference 14.1%; p=0.011). More patients on lacosamide than placebo had ≥50% (68.1%/46.3%) or ≥75% (57.1%/36.4%) reduction from baseline in PGTCS frequency/28 days, or observed freedom from PGTCS during treatment (27.5%/13.2%) (n=119/n=121). 96/121 (79.3%) patients on lacosamide had treatment-emergent adverse events (placebo 79/121 (65.3%)), most commonly dizziness (23.1%), somnolence (16.5%), headache (14.0%). No patients died during the trial.ConclusionsLacosamide was efficacious and generally safe as adjunctive treatment for uncontrolled PGTCS in patients with IGE.

Zespół nadpobudliwości psychoruchowej z deficytem uwagi (attention-deficit/hyperactivity disorder, ADHD) to przewlekłe zaburzenie polietiologiczne, najczęściej rozpoznawane w okresie dzieciństwa, ale występujące również w życiu dorosłym. Diagnostyka ADHD jest złożona – opiera się na wywiadzie i obserwacjach pochodzących z różnych źródeł. U pacjentów z zespołem nadpobudliwości częściej współwystępują zachowania antyspołeczne, uzależnienie od alkoholu i narkotyków oraz depresja, a także wzrasta ryzyko samobójstwa. Leczenie ADHD wymaga kompleksowego podejścia, które polega na stosowaniu psychoedukacji, terapii behawioralnej i farmakoterapii. Standardowe leczenie farmakologiczne oraz terapia psychologiczna są często niewystarczające. Leki stwarzają niebezpieczeństwo wystąpienia objawów niepożądanych, ponadto ich stosowanie jest limitowane z uwagi na ograniczenia refundacyjne. Do najpoważniejszych działań ubocznych należy zaliczyć możliwość uzależnienia się od środków psychostymulujących, hamowanie wzrostu, bezsenność, brak apetytu, dysforię, objawy cholinolityczne i pozapiramidowe. W badaniach dzieci z ADHD wykazano charakterystyczne nieprawidłowe formy zapisu elektroencefalograficznego w określonych lokalizacjach w mózgu. Jedną z niestandardowych metod leczenia zespołu nadpobudliwości, wykazującą podobieństwo do terapii behawioralnej, jest EEG-biofeedback. Jego istotą jest modelowanie zachowania poprzez wpływ na czynność bioelektryczną mózgu. W porównaniu z farmakoterapią jest to metoda relatywnie tania (nawet jeśli koszty terapii nie są refundowane), nieobciążająca pacjenta i bezpieczna. Nie ma jednak dobrze udokumentowanych badań jej skuteczności w ADHD, dlatego w dokonanym przeglądzie publikacji szczególną uwagę zwrócono na wybór zastosowanej metodologii, krytycznie odnosząc się do wyników, które nie pochodzą z badań kontrolowanych.

Attention-deficit/hyperactivity disorder (ADHD) is a chronic disorder of multifactorial aetiology, usually recognized in childhood but also occur in adulthood. Diagnostics of ADHD is complex and requires a comprehensive approach considering interview and observations from different sources. In patients with ADHD more frequently co-occur antisocial behaviour, addiction to alcohol and drugs, depression, and increased risk of suicide. Treatment of ADHD requires a comprehensive approach that involves the use of psychoeducation, behavioural therapy and pharmacotherapy. Standard pharmacological treatment and psychological therapy are often insufficient. The drugs increase the risk of side effects and their use is limited due to the limitations of the reimbursement. The most serious adverse effects include the possibility of psychostimulant drugs addiction, inhibition of growth, insomnia, lack of appetite, dysphoria, anticholinergic symptoms and extrapyramidal symptoms. Studies of children with ADHD have demonstrated characteristic abnormalities in EEG in specific locations of the brain. Neurofeedback, a type of behavioural therapy, is one of the non-standard treatment for ADHD. The essence of neurofeedback is modelling behaviour through effects on the bioelectric activity of the brain. In comparison with pharmacotherapy it is a relatively cheap method – even if the costs are not reimbursed – not overloading for the patient and safe (has few side effects). There is no, however, well-documented studies of effectiveness this method in ADHD so in the review we focused on the methodology, critically referring to results not derived from controlled trials.

[...]binge drinking and associated ills, such as alcohol poisoning, drunk driving and date rape, are significantly less prevalent per capita among 18 to 20-year-olds in countries with relaxed attitudes toward alcohol than to the United States.

The Ivory Coast is the world's largest producer with 40 percent of the trade, followed by Ghana at 30 percent, the Anti-Slavery Organization said. Because cocoa farmers earn less than $2 per day, to stay competitive they employ child laborers who are often forced to work with little or no pay, Food Is Power reported.

[...]of this policy, there has not been a waiting list for organ transplantation in Iran since 1999.

[...]in Hawai'i, cockfighting, sports betting, video gambling machines and backroom card games are available to locals and tourists willing to track them down.

To solve the problem of commuting, the city of Honolulu could have incentivized people using tax credits or subsidies to live closer to where they work or to work from home as telecommuters.

According to the Colorado Department of Revenue, the state earned over $7 million in tax revenue in August from recreational and medical marijuana sales.