Summary
Although epilepsy is defined by the occurrence of spontaneous epileptic seizures, a large body of evidence indicates that epilepsy is linked to a spectrum of behavioral, psychiatric, and ...cognitive disorders as well as to sudden death. Explanations for these associations include the following: (1) The effects of structural lesions that may impair the functions subserved by the regions of the brain involved in the lesion. (2) The effects of seizure activity that may begin well before a clinical seizure occurs and may persist long after it is over, raising questions about what truly constitutes “interictal.” In addition, encephalopathic effects of epilepsy in infancy during critical periods in development may be particularly severe and potentially irreversible. (3) Shared mechanisms underlying seizures as well as these other disorders in the absence of structural lesions or separate diseases of the central nervous system (CNS). Epidemiologic and clinical studies demonstrate the elevated risk of cognitive, psychiatric, and behavioral disorders not just during but also prior to the onset of epilepsy (seizures) itself. These may outlast the active phase of epilepsy as well. The mounting evidence argues strongly for the recognition of epilepsy as part of a spectrum of disorders and against the notion that even uncomplicated epilepsy can a priori be considered benign.
This paper systematically reviews the scientific literature on the effects of individual and work-related factors on the Work Ability Index (WAI) Studies on work ability published from 1985 to 2006 ...were identified through a structured search in PubMed, and Web of Science. Studies were included if the WAI was used as measure of work ability and if quantitative information was presented on determinants of work ability. In total, 20 studies were included with 14 cross-sectional studies and six longitudinal studies. Factors associated with poor work ability, as defined by WAI, were lack of leisure-time vigorous physical activity, poor musculoskeletal capacity, older age, obesity, high mental work demands, lack of autonomy, poor physical work environment, and high physical work load. The WAI is associated with individual characteristics, lifestyle, demands at work, and physical condition. This multifactorial nature of work ability should be taken into account in health promotion programmes aimed at maintaining and promoting the participation of the labour force and improvement of the performance at work.
Abstract Electroencephalography (EEG) studies increasingly utilize more mobile experimental protocols, leading to more and stronger artifacts in the recorded data. Independent Component Analysis ...(ICA) is commonly used to remove these artifacts. It is standard practice to remove artifactual samples before ICA to improve the decomposition, for example using automatic tools such as the sample rejection option of the AMICA algorithm. However, the effects of movement intensity and the strength of automatic sample rejection on ICA decomposition have not been systematically evaluated. We conducted AMICA decompositions on eight open-access datasets with varying degrees of motion intensity using varying sample rejection criteria. We evaluated decomposition quality using mutual information of the components, the proportion of brain, muscle, and 'other' components, residual variance, and an exemplary signal-to-noise ratio. Within individual studies, increased movement significantly decreased decomposition quality, though this effect was not found across different studies. Cleaning strength significantly improved the decomposition, but the effect was smaller than expected. Our results suggest that the AMICA algorithm is robust even with limited data cleaning. Moderate cleaning, such as 5 to 10 iterations of the AMICA sample rejection, is likely to improve the decomposition of most datasets, regardless of motion intensity.
Purpose
To study the influence of gradient echo–based contrasts as input channels to a 3D patch‐based neural network trained for synthetic CT (sCT) generation in canine and human populations.
Methods
...Magnetic resonance images and CT scans of human and canine pelvic regions were acquired and paired using nonrigid registration. Magnitude MR images and Dixon reconstructed water, fat, in‐phase and opposed‐phase images were obtained from a single T1‐weighted multi‐echo gradient‐echo acquisition. From this set, 6 input configurations were defined, each containing 1 to 4 MR images regarded as input channels. For each configuration, a UNet‐derived deep learning model was trained for synthetic CT generation. Reconstructed Hounsfield unit maps were evaluated with peak SNR, mean absolute error, and mean error. Dice similarity coefficient and surface distance maps assessed the geometric fidelity of bones. Repeatability was estimated by replicating the training up to 10 times.
Results
Seventeen canines and 23 human subjects were included in the study. Performance and repeatability of single‐channel models were dependent on the TE‐related water–fat interference with variations of up to 17% in mean absolute error, and variations of up to 28% specifically in bones. Repeatability, Dice similarity coefficient, and mean absolute error were statistically significantly better in multichannel models with mean absolute error ranging from 33 to 40 Hounsfield units in humans and from 35 to 47 Hounsfield units in canines.
Conclusion
Significant differences in performance and robustness of deep learning models for synthetic CT generation were observed depending on the input. In‐phase images outperformed opposed‐phase images, and Dixon reconstructed multichannel inputs outperformed single‐channel inputs.
Objectives To establish standards for early, cost-effective and accurate diagnosis, optimal therapies for seizures, and recommendations for evaluation and management of comorbidities for children and ...adults with Dravet syndrome, using a modified Delphi process. Methods An Expert Panel was convened comprised of epileptologists with nationally recognized expertise in Dravet syndrome and parents of children with Dravet syndrome, whose experience and understanding was enhanced by their active roles in Dravet syndrome associations. Panelists were asked to base their responses to questions both on their clinical expertise as well as results of a literature review which was forwarded to each panelist. Three rounds of on-line questionnaires were conducted to identify areas of consensus and strength of that consensus, as well as areas of contention. Results The Panel consisted of 13 physicians and 5 family members. Strong consensus was reached regarding typical clinical presentation of Dravet syndrome, range of EEG and MRI findings, need for genetic testing, critical information which should be conveyed to families at diagnosis, priorities for seizure control and typical degree of control, seizure triggers and recommendations for avoidance, first and second-line therapies for seizures, requirement and indications for rescue therapy, specific recommendations for co-morbidity screening and need for family support. Consensus was not as strong regarding later therapies, including vagus nerve stimulation and callosotomy, and for specific therapies of associated co-morbidities. Beyond initial treatment with benzodiazepines and use of valproate, there was no consensus on the optimal in-hospital management of convulsive status epilepticus. Conclusions We were able to identify areas where there was strong consensus that we hope will (a) inform health care providers on optimal diagnosis and management of patients with Dravet syndrome, (b) support reimbursement from insurance companies for genetic testing and Dravet-specific therapies, and (c) improve quality of life for patients with Dravet syndrome and their families by avoidance of unnecessary testing and provision of an early accurate diagnosis allowing optimal selection of therapeutic strategies.
Summary
Objectives
Determine frequency of remissions, relapses, and pharmacoresistance over two decades. Develop a composite measure of seizure control over that time.
Methods
Community‐based cohort ...of children with newly diagnosed epilepsy prospectively followed for up to 21 years with frequent calls and periodic medical record review. Multiple periods of 1‐, 2‐, 3‐, and 5‐year remission with subsequent relapses were recorded. Other outcomes included pharmacoresistance (failure of two adequately used drugs), early remission and early pharmacoresistance by 2 years, and complete remission at last contact (CR‐LC, 5 years both seizure‐ and drug‐free at last contact). A composite summary of seizure course was created with eight categories ranging from early sustained remission and CR‐LC (best) to never achieving a 1‐year remission (worst).
Results
Five hundred sixteen of 613 participants were followed ≥10 years. An initial 1‐ 2‐, 3‐, and 5‐year remission occurred, respectively, in 95%, 92%, 89%, and 81%. Relapses followed in 52%, 41%, 29%, and 15%, respectively. Repeated remission after relapse was common. Up to seven 1‐year, five 2‐year and 3‐year, and two 5‐year remissions were recorded per participant. Pharmacoresistance at any time, early pharmacoresistance (<2 years), early remission, and CR‐LC occurred in 118 (22.9%), 70 (13.6%), 283 (54.8%), and 311 (60.3%). Composite outcomes were early sustained remission with CR‐LC (N = 172, 33%); later but then sustained remission with CR‐LC (N = 51, 10%); one (N = 61, 12%) or more (N = 27, 5%) remission‐relapse episodes but then CR‐LC; various non‐CR‐LC outcomes (N = 179, 35%); and never achieved 1‐year remission (N = 26, 5%). These patterns varied across groups defined by epilepsy type and presence of brain insults or neurodisability (p < 0.0001).
Significance
The seizure prognosis of pediatric epilepsies is highly variable. Most patients follow complex courses not easily summarized by remission status at the end of a period of follow‐up. These complexities may facilitate efforts to understand the impact epilepsy has on young people entering adulthood.
Summary
Concepts and terminology for classifying seizures and epilepsies have, until recently, rested on ideas developed nearly a century ago. In order for clinical epilepsy and practice to benefit ...fully from the major technological and scientific advances of the last several years, advances that are revolutionizing our understanding and treatment of the epilepsies, it is necessary to break with the older vocabulary and approaches to classifying epilepsies and seizures. The Commission on Classification and Terminology made specific recommendations to move this process along and ensure that classification will reflect the best knowledge, will not be arbitrary, and will ultimately serve the purpose of improving clinical practice as well as research on many levels. The recommendations include new terms and concepts for etiology and seizure types as well as abandoning the 1989 classification structure and replacing it instead with a flexible multidimensional approach in which the most relevant features for a specific purpose can be emphasized. This is not a finished product and will take yet more time to achieve. Waiting any longer, however, would be a disservice to patient care and will continue the longstanding frustrations with the earlier system which, at this point in time, can be viewed as both antiquated and arbitrary.
Summary
Psychiatric and behavioral disorders are important aspects of epilepsy and have received increasing attention in the last several years. The literature upon which most of the field relies ...contains some biases that must be carefully examined and resolved in future studies. First, in the pediatric epilepsy literature, many reports find that children with epilepsy have high levels of behavioral and psychiatric disorders when compared to appropriate controls. Most of these studies rely on parent‐proxy completed instruments to assess these behavioral endpoints. Parents’ reports are not objective but reflect parents’ reactions and emotions. Increasing evidence suggests inherent biases in proxy reports and highlights the need to assess children directly. Second, periictal phenomena may be mischaracterized as underlying mood disorders. Third, many studies report elevated levels of psychiatric morbidity before and after the diagnosis of epilepsy, suggesting an inherent relation between the two types of disorders. Psychogenic nonepileptic seizures, while widely recognized as posing a diagnostic dilemma in the clinic, may account for some of these research findings. Diagnostic errors between epilepsy and psychogenic nonepileptic seizures need careful consideration when evaluating studies demonstrating associations between psychiatric disorders and epilepsy or poorer seizure control in association with psychiatric disorders in people who have epilepsy. Mental health concerns are important for everyone. An accurate, undistorted understanding of the relation between mental health disorders and epilepsy is essential to ensure appropriate therapy and to avoid unnecessary and potentially harmful treatments and common misconceptions.
The use of valproic acid in the first trimester of pregnancy is associated with an increased risk of spina bifida, but data on the risks of other congenital malformations are limited.
We first ...combined data from eight published cohort studies (1565 pregnancies in which the women were exposed to valproic acid, among which 118 major malformations were observed) and identified 14 malformations that were significantly more common among the offspring of women who had received valproic acid during the first trimester. We then assessed the associations between use of valproic acid during the first trimester and these 14 malformations by performing a case-control study with the use of the European Surveillance of Congenital Anomalies (EUROCAT) antiepileptic-study database, which is derived from population-based congenital-anomaly registries. Registrations (i.e., pregnancy outcomes with malformations included in EUROCAT) with any of these 14 malformations were compared with two control groups, one consisting of infants with malformations not previously linked to valproic acid use (control group 1), and one consisting of infants with chromosomal abnormalities (control group 2). The data set included 98,075 live births, stillbirths, or terminations with malformations among 3.8 million births in 14 European countries from 1995 through 2005.
Exposure to valproic acid monotherapy was recorded for a total of 180 registrations, with 122 registrations in the case group, 45 in control group 1, and 13 in control group 2. As compared with no use of an antiepileptic drug during the first trimester (control group 1), use of valproic acid monotherapy was associated with significantly increased risks for 6 of the 14 malformations under consideration; the adjusted odds ratios were as follows: spina bifida, 12.7 (95% confidence interval CI, 7.7 to 20.7); atrial septal defect, 2.5 (95% CI, 1.4 to 4.4); cleft palate, 5.2 (95% CI, 2.8 to 9.9); hypospadias, 4.8 (95% CI, 2.9 to 8.1); polydactyly, 2.2 (95% CI, 1.0 to 4.5); and craniosynostosis, 6.8 (95% CI, 1.8 to 18.8). Results for exposure to valproic acid were similar to results for exposure to other antiepileptic drugs.
The use of valproic acid monotherapy in the first trimester was associated with significantly increased risks of several congenital malformations, as compared with no use of antiepileptic drugs or with use of other antiepileptic drugs.
We describe the execution and data reduction of the European Southern Observatory Large Programme “Quasars and their absorption lines: a legacy survey of the high-redshift Universe with ...VLT/X-shooter” (hereafter “XQ-100”). XQ-100 has produced and made publicly available a homogeneous and high-quality sample of echelle spectra of 100 quasars (QSOs) at redshifts z ≃ 3.5–4.5 observed with full spectral coverage from 315 to 2500 nm at a resolving power ranging from R ~ 4000 to 7000, depending on wavelength. The median signal-to-noise ratios are 33, 25 and 43, as measured at rest-frame wavelengths 1700, 3000 and 3600 Å, respectively. This paper provides future users of XQ-100 data with the basic statistics of the survey, along with details of target selection, data acquisition and data reduction. The paper accompanies the public release of all data products, including 100 reduced spectra. XQ-100 is the largest spectroscopic survey to date of high-redshift QSOs with simultaneous rest-frame UV/optical coverage, and as such enables a wide range of extragalactic research, from cosmology and galaxy evolution to AGN astrophysics.
PDF
