Highlights • High Frequency Oscillation were observed in epileptogenic zone in all patient with TSC. • Complete resection of high frequency oscillations (HFOs) led to the better surgical outcome. • ...Tuber types were not associated with either type of HFOs (fast ripple or ripple) or surgical outcome.
Tuberous sclerosis complex (TSC) with medically refractory epilepsy is characterized by multifocal brain abnormalities, traditionally indicating poor surgical candidacy. This single-center, ...retrospective study appraised seizurerelated, neuropsychological, and other outcomes of resective surgery in TSC patients with medically refractory epilepsy, and analyzed predictors for these outcomes.
Patients with multilesional TSC who underwent epilepsy surgery between 2007 and 2012 were identified from an electronic database. All patients underwent multimodality noninvasive and subsequent invasive evaluation. Seizure outcomes were classified using the International League Against Epilepsy (ILAE) scale. The primary outcome measure was complete seizure remission (ILAE Class 1). Secondary outcome measures included 50% responder rate, change in full-scale IQ, electroencephalography improvement, and reduction in antiepileptic drug (AED) burden.
A total of 37 patients with TSC underwent resective surgery during the study period. After a mean follow-up of 5.68 ± 3.67 years, 56.8% achieved complete seizure freedom (ILAE Class 1) and 86.5% had ILAE Class 4 outcomes or better. The full-scale IQ on follow-up was significantly higher in patients with ILAE Class 1 outcome (66.70 ± 12.36) compared with those with ILAE Class 2 or worse outcomes (56.00 ± 1.41, p = 0.025). In 62.5% of the patients with ILAE Class 2 or worse outcomes, the number of AEDs were found to be significantly reduced (p = 0.004).
This study substantiates the evidence for efficacy of resective epilepsy surgery in patients with bilateral multilesional TSC. More than half of the patients were completely seizure free. Additionally, a high proportion achieved clinically meaningful reduction in seizure burden and the number of AEDs.
Highlights • We have validated a novel method for language mapping using natural conversation. • We studied topography of natural conversation related ECoG high-γ power changes. • We compare ...spontaneous language mapping with electro-cortical response-inhibition. • This method was 89% sensitive and 96% negative predictive vs. cortical stimulation. • This methodology is safer and considerably less dependent on patient co-operation.
Highlights • 12/47 children with MRI-negative epilepsy were seizure-free 2.8 years after surgery. • 50% of children with single semiology and concordant ictal EEG were seizure free. • Clinical ...factors determine seizure outcomes in children with MRI-negative epilepsy. • Predictors: low seizure frequency, later age of onset, fewer pre-surgical AEDs. • ILAE type I-B cortical dysplasia was found in 17/47 patients.
Highlights • In pediatric patients undergoing epilepsy surgery, 60/124 had frequent spikes on post-resection ECoG. • Post-resection intraoperative ECoG directed additional resection in 30/124 ...patients. • Completeness of resection of spiking showed a trend toward predicting good outcome.
Abstract Patients with obsessive-compulsive disorder (OCD) often report sensory intolerances which may lead to significant functional impairment. This study used auditory evoked fields (AEFs) to ...address the question of whether neural correlates of sensory auditory information processing differ in youth with OCD compared with healthy comparison subjects (HCS). AEFs, recorded with a whole head 275-channel magnetoencephalography system, were elicited in response to binaural auditory stimuli from 10 pediatric subjects with OCD (ages 8–13, mean 11 years, 6 males) and 10 age- and gender-matched HCS. Three major neuromagnetic responses were studied: M70 (60–80 ms), M100 (90–120 ms), and M150 (130–190 ms). When compared with HCS, subjects with OCD demonstrated delayed latency of the M100 response. In subjects with OCD the amplitude of the M100 and M150 responses was significantly greater in the right hemisphere compared with the left hemisphere. Current results suggest that when compared with HCS, subjects with OCD have altered auditory information processing, evident from the delayed latency of the M100 response, which is thought to be associated with the encoding of physical stimulus characteristics. Interhemispheric asymmetry with increased M100 and M150 amplitudes over the right hemisphere compared with the left hemisphere was found in young OCD subjects. These results should be interpreted with caution due to the high variability rate of responses in both HCS and OCD subjects, as well as the possible effect of medication in OCD subjects.
A workshop on Antarctic Medical Research and Medicine 2006 was held at the National Institute of Polar Research (NIPR) on 26 August, 2006. Forty two participants from 27 institutes attended. The ...members consist of medical doctors with Antarctic experience, human biologists, research scientists in other fields, logistic staff members of the expedition and also medical doctors interested in Antarctica. The current resident doctor at Syowa Station joined the discussion through a telecommunication system. Doctors with Antarctic experience from China and Korea also participated in the workshop. They gave presentations on their Antarctic activities, followed by an active discussion session. Eighteen presentations were given on various topics, including the International Polar Year (IPY) 2007-2008 in medical research, space medicine, telemedicine, an international comparative study of medical operations, psychological surveys, Antarctic high-altitude medicine, Legionella surveillance and nutritional studies.
Recent studies in adults have found consistent contralateral high gamma activities in the sensorimotor cortex during unilateral finger movement. However, no study has reported on this same phenomenon ...in children. We hypothesized that contralateral high gamma activities also exist in children during unilateral finger movement. Sixty normal children (6-17 years old) were studied with a 275-channel MEG system combined with synthetic aperture magnetometry (SAM). Sixty participants displayed consistently contralateral event-related synchronization (C-ERS) within high gamma band (65-150 Hz) in the primary motor cortices (M1) of both hemispheres. Interestingly, nineteen younger children displayed ipsilateral event-related synchronization (I-ERS) within the high gamma band (65-150 Hz) just during their left finger movement. Both I-ERS and C-ERS were localized in M1. The incidence of I-ERS showed a significant decrease with age. Males had significantly higher odds of having ipsilateral activity compared to females. Noteworthy, high gamma C-ERS appeared consistently, while high gamma I-ERS changed with age. The asymmetrical patterns of neuromagnetic activities in the children's brain might represent the maturational lateralization and/or specialization of motor function. In conclusion, the present results have demonstrated that contralateral high-gamma neuromagnetic activities are potential biomarkers for the accurate localization of the primary motor cortex in children. In addition, the interesting finding of the ipsilateral high-gamma neuromagnetic activities opens a new window for us to understand the developmental changes of the hemispherical functional lateralization in the motor system.
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