The human 60 kDa and microbial 65 kDa heat shock proteins (HSP) have been implicated in the pathogenesis of chronic periodontitis (P) and coronary heart disease (CHD). We have studied four male non-smoking cohorts of 81 subjects, matched for age. Group (a) consisted of a healthy group with minimal gingivitis ( n = = = = 18), group (b) were patients with P ( n = = = = 23), group (c) patients with CHD and minimal gingivitis ( n = = = = 20) and group (d) patients with CHD and P ( n = = = = 20). T cells separated from peripheral blood were found to be primed to both microbial HSP65 and human HSP60 but significant CD4, human leucocyte antigen (HLA) class II-restricted proliferative responses were found only with the human HSP60 in patients with P ( P < < < < 0·001) and CHD without ( P < < < < 0·001) or with ( P < < < < 0·00001) periodontitis. Dose-dependent inhibition of T cell proliferative responses was carried out to determine the receptors involved in recognition of HSP60 and HSP65. Monoclonal antibodies to CD14 showed inhibition of T cell proliferation stimulated by both HSP60 and HSP65, consistent with the role of CD14 as a receptor for these HSPs in P and CHD. The toll-like receptor 2 (TLR-) and TLR-4 were then studied and these showed that TLR-4 was recognized by microbial HSP65, whereas TLR-2 was recognised by human HSP60 in both P and CHD. However, a dissociation was found in the HSP60 and TLR4 interaction, as TLR4 appeared to have been recognized by HSP60 in P but not in CHD. The results suggest an autoimmune or cross-reactive CD4 + + + + class IIrestricted T cell response to the human HSP60 in P and CHD. Further studies are required to determine if there is a common epitope within HSP60 that stimulates T cell proliferation in P and CHD.

Summary:We report a 28-year-old woman of normal intellect, who had three late-onset seizures with unusual ictal features and secondary generalization during prolonged and vigorous tooth brushing. Neurologic examination and brain magnetic resonance imaging (MRI) were normal, but interictal EEG showed left frontal epileptiform activity. Reasonable precautions (regular but briefer and less vigorous brushing of her teeth) combined with a moderate dose of carbamazepine effectively prevented seizure recurrence. This case may be an example of cryptogenic form of reflex epilepsy with seizures induced exclusively by tooth brushing.

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The human 60 kDa and microbial 65 kDa heat shock proteins (HSP) have been implicated in the pathogenesis of chronic periodontitis (CP) and coronary heart disease (CHD). We have studied 100 subjects: Group (