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A brother is as easily forgotten as an umbrella. James Joyce, Ulysses Recently having abandoned his RD Laing-influenced experiment in running a therapeutic community - the so-called Concept House in Willesden - maverick psychiatrist Zack Busner arrives at Friern Hospital, a vast Victorian mental asylum in North London, under a professional and a marital cloud. He has every intention of avoiding controversy, but then he encounters Audrey Dearth, a working-class girl from Fulham born in 1890 who has been immured in Friern for decades. A socialist, a feminist and a munitions worker at the Woolwich Arsenal, Audrey fell victim to the encephalitis lethargica sleeping sickness epidemic at the end of the First World War and, like one of the subjects in Oliver Sacks' Awakenings, has been in a coma ever since. Realising that Audrey is just one of a number of post-encephalitics scattered throughout the asylum, Busner becomes involved in an attempt to bring them back to life - with wholly unforeseen consequences.

Immune sera from volunteers vaccinated in a blinded Phase 3 clinical trial with JE-VAX ® and a new Japanese encephalitis virus (JEV) vaccine (IC51 or IXIARO), were tested for the ability to protect mice against lethal JEV challenge. Sera from IXIARO vaccinated subjects were pooled into four batches based on neutralizing antibody measured by plaque reduction neutralization test (PRNT 50 titer): high (∼200), medium (∼40–50), low (∼20) and negative (<10). Pooled sera from JE-VAX ® vaccinated subjects (PRNT 50 titer ∼ 55) and pooled JEV antibody negative pre-vaccination sera were used as controls. Groups of ten 6- to 7-week-old female ICR mice were injected intraperitoneally with 0.5 ml of each serum pool diluted 1:2 or 1:10, challenged approximately 18 h later with a lethal dose of either JEV strain SA14 (genotype III) or strain KE-093 (genotype I) and observed for 21 days. All mice in the non-immune serum groups developed clinical signs consistent with JEV infection or died, whereas high titer sera from both IXIARO and JE-VAX ® sera protected 90–100% of the animals. Statistical tests showed similar protection against both JEV strains SA14 and KE-093 and protection correlated with the anti-JEV antibody titer of IXIARO sera as measured by PRNT 50. Ex vivo neutralizing antibody titers showed that almost all mice with a titer of 10 or greater were fully protected. In a separate study, analysis of geometric mean titers (GMTs) of the groups of mice vaccinated with different doses of IXIARO and challenged with JEV SA14 provided additional evidence that titers ≥ 10 were protective.

\"In the aftermath of a shattering illness, Lonni Sue Johnson lives in a \"perpetual now,\" where she has almost no memories of the past and a nearly complete inability to form new ones. The Perpetual Now is the moving story of this exceptional woman, and the groundbreaking revelations about memory, learning, and consciousness her unique case has uncovered. Lonni Sue Johnson was a renowned artist who regularly produced covers for The New Yorker, a gifted musician, a skilled amateur pilot, and a joyful presence to all who knew her. But in late 2007, she contracted encephalitis. The disease burned through her hippocampus like wildfire, leaving her severely amnesic, living in a present that rarely progresses beyond ten to fifteen minutes. Remarkably, she still retains much of the intellect and artistic skills from her previous life, but it's not at all clear how closely her consciousness resembles yours or mine. As such, Lonni Sue's story has become part of a much larger scientific narrative--one that is currently challenging traditional wisdom about how human memory and awareness are stored in the brain. In this probing, compassionate, and illuminating book, award-winning science journalist Michael D. Lemonick uses the unique drama of Lonni Sue Johnson's day-to-day life to give us a nuanced and intimate understanding of the science that lies at the very heart of human nature\"-- Provided by publisher.

LGI1 encephalitis is one of the most common forms of autoimmune encephalitis and has been noted to have prominent psychiatric features. However, psychiatric phenotyping to date has relied on small studies and has lacked detail. This case series aimed to assess psychiatric symptoms and clinical course of patients with a confirmed diagnosis of LGI1 encephalitis identified by our centre. Our sample (n=31) had a mean (SD) age of 61 (14) years, 22/31 (71%) of whom were male. Mean (SD) time to diagnosis was 4.9 (5.8) months and mean follow-up (SD) time was 55.8 (36.7) months. 18/30 patients had documented hyponatraemia, and 22 were managed as inpatients at our centre. Psychiatric (22/31, 71%), cognitive (25/31, 81%) and other neurological (26/31, 84%) symptoms presented at similar rates, despite 30/31 (97%) patients coming from neurology referrals. Patients presented with a diverse range of seizures, including faciobrachial dystonic seizures. Of the 19 patients undergoing detailed psychometric analysis, impairments were noted in memory (19, 100%), executive function (12, 63%) and naming (9, 47%). 13 (42%) patients presented with psychotic symptoms, 12 (39%) with agitation/aggression, 11 (35%) with emotional lability, 8/31 (26%) with anxiety and 5/31 (16%) with cognitive-dysmnesic phenomena. Many patients had psychiatric sequalae which resolved after treatment, but a modest proportion of patients experienced ongoing apathy (2/31, 6%), disinhibition (4/31, 13%), OCD (3/31, 10%), cognitive-dysmnesic phenomena (4/31, 13%) and sleep disorders (9/31, 29%). Our findings show that cognitive impairment and/or psychopathology are rarely absent in LGI1 encephalitis. Future research should examine neuroimaging and EEG correlates of psychiatric and cognitive deficits.

In China, measles-rubella vaccine and live attenuated SA 14–14–2 Japanese encephalitis vaccine (LJEV) are recommended for simultaneous administration at 8 months of age, which is the youngest recommended age for these vaccines worldwide. We aimed to assess the effect of the co-administration of these vaccines at 8 months of age on the immunogenicity of measles-rubella vaccine. We did a multicentre, open-label, non-inferiority, two-group randomised controlled trial in eight counties or districts in China. We recruited healthy infants aged 8 months who had received all scheduled vaccinations according to the national immunisation recommendations and who lived in the county of the study site. Enrolled infants were randomly assigned (1:1) to receive either measles-rubella vaccine and LJEV simultaneously (measles-rubella plus LJEV group) or measles-rubella vaccine alone (measles-rubella group). The primary outcome was the proportion of infants with IgG antibody seroconversion for measles 6 weeks after vaccination, and a secondary outcome was the proportion of infants with IgG antibody seroconversion for rubella 6 weeks after vaccination. Analyses included all infants who completed the study. We used a 5% margin to establish non-inferiority. This trial was registered at ClinicalTrials.gov (NCT02643433). 1173 infants were assessed for eligibility between Aug 13, 2015, and June 10, 2016. Of 1093 (93%) enrolled infants, 545 were randomly assigned to the measles-rubella plus LJEV group and 548 to the measles-rubella group. Of the infants assigned to each group, 507 in the measles-rubella plus LJEV group and 506 in the measles-rubella group completed the study. Before vaccination, six (1%) of 507 infants in the measles-rubella plus LJEV group and one (<1%) of 506 in the measles-rubella group were seropositive for measles; eight (2%) infants in the measles-rubella plus LJEV group and two (<1%) in the measles-rubella group were seropositive for rubella. 6 weeks after vaccination, measles seroconversion in the measles-rubella plus LJEV group (496 [98%] of 507) was non-inferior to that in the measles-rubella group (499 [99%] of 506; difference −0·8% [90% CI −2·6 to 1·1]) and rubella seroconversion in the measles-rubella plus LJEV group (478 [94%] of 507) was non-inferior to that in the measles-rubella group (473 [94%] of 506 infants; difference 0·8% [90% CI −1·8 to 3·4]). There were no serious adverse events in either group and no evidence of a difference between the two groups in the prevalence of any local adverse event (redness, rashes, and pain) or systemic adverse event (fever, allergy, respiratory infections, diarrhoea, and vomiting). Fever was the most common adverse event (97 [19%] of 507 infants in the measles-rubella plus LJEV group; 108 [21%] of 506 infants in the measles-rubella group). The evidence of similar seroconversion and safety with co-administered LJEV and measles-rubella vaccines supports the co-administration of these vaccines to infants aged 8 months. These results will be important for measles and rubella elimination and the expansion of Japanese encephalitis vaccination in countries where it is endemic. US Centers for Disease Control and Prevention, US Department of Health and Human Services; China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases.

\"This book gives a rare, poignant and in depth understanding of what it is like to live with the severe after effects of brain damage caused by a viral infection of the brain. It tells the story of Claire, a survivor of encephalitis, who was left with an inability to recognise faces, also called prosopagnosia. It describes our current knowledge of the condition, and offers a unique report on daily living with a condition which many of us have, for too long, known too little about. Identity Unknown will be essential reading for professionals working in rehabilitation settings, and will also be of great interest to people who have sustained a brain injury and their families\"-- Provided by publisher.

Herpes simplex encephalitis can trigger autoimmune encephalitis that leads to neurological worsening. We aimed to assess the frequency, symptoms, risk factors, and outcomes of this complication. We did a prospective observational study and retrospective analysis. In the prospective observational part of this study, we included patients with herpes simplex encephalitis diagnosed by neurologists, paediatricians, or infectious disease specialists in 19 secondary and tertiary Spanish centres (Cohort A). Outpatient follow-up was at 2, 6, and 12 months from onset of herpes simplex encephalitis. We studied another group of patients retrospectively, when they developed autoimmune encephalitis after herpes simplex encephalitis (Cohort B). We compared demographics and clinical features of patients who developed autoimmune encephalitis with those who did not, and in patients who developed autoimmune encephalitis we compared these features by age group (patients ≤4 years compared with patients >4 years). We also used multivariable binary logistic regression models to assess risk factors for autoimmune encephalitis after herpes simplex encephalitis. Between Jan 1, 2014, and Oct 31, 2017, 54 patients with herpes simplex encephalitis were recruited to Cohort A, and 51 were included in the analysis (median age 50 years [IQR 5–68]). At onset of herpes simplex encephalitis, none of the 51 patients had antibodies to neuronal antigens; during follow-up, 14 (27%) patients developed autoimmune encephalitis and all 14 (100%) had neuronal antibodies (nine [64%] had NMDA receptor [NMDAR] antibodies and five [36%] had other antibodies) at or before onset of symptoms. The other 37 patients did not develop autoimmune encephalitis, although 11 (30%) developed antibodies (n=3 to NMDAR, n=8 to unknown antigens; p<0·001). Antibody detection within 3 weeks of herpes simplex encephalitis was a risk factor for autoimmune encephalitis (odds ratio [OR] 11·5, 95% CI 2·7–48·8; p<0·001). Between Oct 7, 2011, and Oct 31, 2017, there were 48 patients in Cohort B with new-onset or worsening neurological symptoms not caused by herpes simplex virus reactivation (median age 8·8 years [IQR 1·1–44·2]; n=27 male); 44 (92%) patients had antibody-confirmed autoimmune encephalitis (34 had NMDAR antibodies and ten had other antibodies). In both cohorts (n=58 patients with antibody-confirmed autoimmune encephalitis), patients older than 4 years frequently presented with psychosis (18 [58%] of 31; younger children not assessable). Compared with patients older than 4 years, patients aged 4 years or younger (n=27) were more likely to have shorter intervals between onset of herpes simplex encephalitis and onset of autoimmune encephalitis (median 26 days [IQR 24–32] vs 43 days [25–54]; p=0·0073), choreoathetosis (27 [100%] of 27 vs 0 of 31; p<0·001), decreased level of consciousness (26 [96%] of 27 vs seven [23%] of 31; p<0·001), NMDAR antibodies (24 [89%] of 27 vs 19 [61%] of 31; p=0·033), and worse outcome at 1 year (median modified Rankin Scale 4 [IQR 4–4] vs 2 [2–3]; p<0·0010; seizures 12 [63%] of 19 vs three [13%] of 23; p=0·001). The results of our prospective study show that autoimmune encephalitis occurred in 27% of patients with herpes simplex encephalitis. It was associated with development of neuronal antibodies and usually presented within 2 months after treatment of herpes simplex encephalitis; the symptoms were age-dependent, and the neurological outcome was worse in young children. Prompt diagnosis is important because patients, primarily those older than 4 years, can respond to immunotherapy. Mutua Madrileña Foundation, Fondation de l'Université de Lausanne et Centre Hospitalier Universitaire Vaudois, Instituto Carlos III, CIBERER, National Institutes of Health, Generalitat de Catalunya, Fundació CELLEX.

\"When twenty-four-year-old Susannah Cahalan woke up alone in a hospital room, strapped to her bed and unable to move or speak, she had no memory of how she'd gotten there. Days earlier, she had been on the threshold of a new, adult life: at the beginning of her first serious relationship and a promising career at a major New York newspaper. Now she was labeled violent, psychotic, a flight risk. What happened? In a swift and breathtaking narrative, [the author] tells the astonishing true story of her descent into madness, her family's inspiring faith in her, and the lifesaving diagnosis that nearly didnt happen\"--Amazon.com.