Summary:Purpose: To describe a new ictal sign in temporal lobe seizures-rhythmic ictal nonclonic hand (RINCH) motions and to determine its lateralizing significance and other ictal manifestations associated with it.Methods: We identified 15 patients with temporal lobe epilepsy who demonstrated RINCH motions and reviewed video-EEG recordings of all their seizures. We analyzed the epilepsy characteristics and all clinical features of recorded seizures, with particular attention to RINCH motions.Results: RINCH motions were unilateral, rhythmic, nonclonic, nontremor hand motions. RINCH motions were usually followed by posturing, sometimes with some overlap. They involved the hand contralateral to the temporal lobe of seizure onset in 14 of 15 patients.Conclusions: RINCH motions are a distinct ictal sign that could be considered a specific type of automatism. They appear to be a lateralizing contralateral sign and are associated with dystonic posturing in temporal lobe epilepsy. Key Words: Seizure semiology-Automatisms-Dystonic posturing-Temporal lobe epilepsy.Accurate localization of the epileptogenic zone is essential for successful epilepsy surgery. Although many tests contribute to the final localization, seizure semiology plays an important role in localization and lateralization (Kotagal et al., 1995;Kramer et al., 1997). The majority of patients seen for epilepsy surgery have temporal lobe epilepsy (TLE). In many patients with TLE, lateralization of the seizure focus is the major challenge, particularly when bilateral EEG abnormalities are in evidence. Dystonic posturing is one of the most reliable lateralizing signs in TLE, being contralateral to the hemisphere involved in the seizure activity. Manual automatisms have generally been regarded as lacking lateralizing significance, except when associated with dystonic posturing, which tends to inhibit or mask automatisms in the affected extremity (Serles et al., 1998;Kotagal, 1999). It is possible that the classification of automatisms so far has been too broad and that some movements classified as automatisms may be distinct in their characteristics.We observed distinctive nonclonic unilateral rhythmic hand (RINCH) motions during seizures in several patients with TLE undergoing seizure monitoring. We initially considered these rhythmic hand movements to be automatisms, but noted they were contralateral to the seizure focus. We studied these RINCH motions systematically in a consecutive series of patients. METHODSAfter our initial observation of RINCH motions, we identified 15 patients with epilepsy who demonstrated these motions and reviewed the video recordings of all their seizures. We recorded time of clinical and EEG onset, time and duration of the rhythmic motions, specific character and laterality of these motions, and association with other ictal signs. We recorded the proportion of seizures that involved RINCH activity. We reviewed the results of the presurgical evaluation and in particular recorded the localization and laterality of the seizure focus. ...

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Objective: To investigate the clinical efficacy of Serenity, an Australia Government listed Chinese herbal patent medicine, in the treatment of long-term insomnia. Methods: Adopting randomized double blind placebo controlled cross-over method, 19 volunteers participated were enrolled in this study for a period of 12 weeks. Each phase of the trial lasted for six weeks. No washout period was implemented. Assessment was based on the Vital Sign Test, Sleep Parameter Questionnaire, Leeds Sleep Evaluation Questionnaire and the Side Effects Questionnaire. Results: Serenity improved significantly the Overall Sleep Evaluation in the treated group, in comparing with that in the control group, P < 0.01. Therapeutic effect reached the peak at the end of the fourth week of the treatment period. Conclusion: Serenity, a Chinese herbal patent medicine, is effective for the clinical management of long-term insomnia.

The amino-terminal region of human GH (hGH), in particular the amino acid sequence Leu-Ser-Arg-Leu-Phe-Asp-Asn-Ala[hGH-(6-13)], has been implicated as a functional region for the regulation of energy metabolism by exerting an insulin-potentiating action on insulin-sensitive tissues. Recent structural studies have revealed that the cyclization of the aspartate (Asp11) residue to form the alpha-aminosuccinimide (Asu11) ring is essential for the biological action of peptides related to this hGH fragment. The pharmacological application of these hGH-(6-13) peptides has been hindered by the vulnerability of the alpha-aminosuccinimide to hydrolytic modification leading to the loss of biological action. We have succeeded in stabilizing the structure of the Asu11-hGH-(6-13) peptide by replacing the alpha-aminosuccinimide ring with compatible and less rapidly metabolized gamma-lactam structures. In the present paper we report the bioactivity profile of an analog of hGH-(6-13) containing a gamma-lactam at residue position 11 that mimics the stereoelectronic and conformational characteristics of the alpha-aminosuccinimide ring. In vitro, the gamma-lactam11-hGH-(6-13) peptide analog increased [14C]glucose incorporation into glycogen in muscles and conversion to lipid in adipose tissues. In vivo, the gamma-lactam11-hGH-(6-13) peptide enhanced hypoglycemia during iv insulin tolerance tests. The results demonstrate that the gamma-lactam11-hGH-(6-13) peptide analog has similar biological properties to the Asu11-hGH-(6-13) peptide fragment, but with improved molecular stability and bioavailability.

The amino-terminal region of human GH (hGH), in particular the amino acid sequence Leu-Ser-Arg-Leu-Phe-Asp-Asn-Ala[hGH-(6-13)], has been implicated as a functional region for the regulation of energy metabolism by exerting an insulin-potentiating action on insulin-sensitive tissues. Recent structural studies have revealed that the cyclization of the aspartate (Asp11) residue to form the alpha-aminosuccinimide (Asu11) ring is essential for the biological action of peptides related to this hGH fragment. The pharmacological application of these hGH-(6-13) peptides has been hindered by the vulnerability of the alpha-aminosuccinimide to hydrolytic modification leading to the loss of biological action. We have succeeded in stabilizing the structure of the Asu11-hGH-(6-13) peptide by replacing the alpha-aminosuccinimide ring with compatible and less rapidly metabolized gamma-lactam structures. In the present paper we report the bioactivity profile of an analog of hGH-(6-13) containing a gamma-lactam at residue position 11 that mimics the stereoelectronic and conformational characteristics of the alpha-aminosuccinimide ring. In vitro, the gamma-lactam11-hGH-(6-13) peptide analog increased [14C]glucose incorporation into glycogen in muscles and conversion to lipid in adipose tissues. In vivo, the gamma-lactam11-hGH-(6-13) peptide enhanced hypoglycemia during iv insulin tolerance tests. The results demonstrate that the gamma-lactam11-hGH-(6-13) peptide analog has similar biological properties to the Asu11-hGH-(6-13) peptide fragment, but with improved molecular stability and bioavailability.

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