Mental illness a growing concern on tennis tours

For Petra Kvitova, everything changed thanks to a single, simple text message. It was February, and the Czech tennis standout had just landed in Doha, Qatar, for the next stop on the hectic tennis circuit. Seven months after winning her second Wimbledon title and four months after clinching another Fed Cup, she ought to have been on a high. But something was wrong. She felt empty, listless and, most worrying of all, unable to explain why.

Kvitova was preparing for her second-round match against Serbia’s Jelena Jankovic when she checked her text messages. Among them was one from her longtime coach, David Kotyza.

Petra Kvitova said she was burned out, mentally, after playing so much tennis. AP PhotoTim Ireland

“I think it’s a good idea to take a break,” he said. “Otherwise, I don’t know how long you are going to keep on feeling this way.”

Taken aback by the message, the 25-year-old knew something had to be done. She thought it over “for four days and for four nights” until she realized Kotyza was right. The pair had discussed her feelings in January during a tournament in Sydney in a conversation that had Kvitova on the verge of tears. Mentally and physically, she was exhausted.

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The search for circulating epilepsy biomarkers.

by Hegde M1, Lowenstein DH.

1UCSF Epilepsy Center, Department of Neurology, University of California, San Francisco, 521 Parnassus Avenue C-440, San Francisco, CA 94143-0138, USA

Abstract

Few would experience greater benefit from the development of biomarkers than those who suffer from epilepsy. Both the timing of individual seizures and the overall course of the disease are highly unpredictable, and the associated morbidity is considerable. Thus, there is an urgent need to develop biomarkers that can predict the progression of epilepsy and treatment response. Doing so may also shed light on the mechanisms of epileptogenesis and pharmacoresistance, which remain elusive despite decades of study. However, recent advances suggest the possible identification of circulating epilepsy biomarkers – accessible in blood, cerebrospinal fluid or urine. In this review, we focus on advances in several areas: neuroimmunology and inflammation; neurological viral infection; exemplary pediatric syndromes; and the genetics of pharmacoresistance, as relevant to epilepsy. These are fertile areas of study with great potential to yield accessible epilepsy biomarkers.

Background
For decades, the care of epilepsy patients has been limited by a paucity of biomarkers. There have been few indicators of disease progression or remission, aside from the rates of seizures themselves. Even seizure frequency has proven suboptimal, as patients may be amnestic for their seizures, or seizure manifestations may be subclinical. In fact, until recently, the primary tool used for prognostication in newly diagnosed epilepsy has been the electroencephalogram – a venerable test first used clinically by the pioneering German neurophysiologist Hans Berger in 1924. Since then, advances in imaging have allowed identification of lesions that confer an increased risk of seizures, such as mesial temporal sclerosis, vascular malformations and focal cortical dysplasia. The advent of 3T MRI promises to improve our sensitivity in this arena even further. However, these advances are insufficient to meet the level of uncertainty that face both clinician and patient during counseling after a first unprovoked seizure.

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