Stereoelectroencephalography for Epilepsy Presurgical Assessment

Optimized stereoelectroencephalography-guided thermocoagulation versus anterior temporal lobectomy in mesial temporal epilepsy: A pilot randomized controlled study.

Trigeminal neuralgia (TN) is known to be an excruciating disease. It leads to a reduced quality of life and psychological distress, often even to suicide. Patients who are intractable to pharmacotherapy should receive a percutaneous treatment, such as a trigeminal nerve block (TB) or radiofrequency thermocoagulation (RFT) of the trigeminal ganglion. The primary endpoint of this study was to compare the clinical outcome of TB alone with TB and RFT of the trigeminal ganglion. Retrospective study. The pain clinic of a tertiary university hospital. Patients with TN received an ultrasound-guided supraorbital, infraorbital, or mental nerve block twice depending on the affected division. They were divided into TB only group (n = 42) and TBRF group (n = 60) depending on the result of the nerve block. The TBRF group, which had an unresponsive result to the initial nerve block, then received radiofrequency thermocoagulation (RFT) at the trigeminal ganglion. The Numeric Rating Scale (NRS-11), measured at 2 and 4 weeks post the initial nerve block, was significantly lower in the TB group than the TBRF group (P < 0.001). However, when RFT was performed in the TBRF group, the NRS-11 score became similar between the 2 groups (2.4 vs 2.05). Patients with a Barrow Neurological Institute (BNI) Pain Intensity Scale score of I or II, had a successful outcome: 45 patients in the TBRF group (45/60, 75%). Whereas, patients with a BNI score of IV or V, had an unsuccessful outcome: 6 patients (6/60, 10%) in the TBRF group. The time to recurrence in the TB and TBRF groups was 11.2 ± 1.6 and 19.4 ± 2.8 months, respectively (P = 0.01). The total recurrence rate at the 3-year follow-up in the TB and TBRF groups was 57% (24/42) and 23% (14/60), respectively (P = 0.001). Facial hypoesthesia is an important sign of successful destruction of the trigeminal ganglion. However, we did not analyze the BNI score according to the degree of facial hypoesthesia. When patients with TN were unsuccessful with trigeminal nerve block alone, combining RFT at the trigeminal ganglion demonstrated a successful NRS-11 score reduction with a lower recurrence rate and a longer time to recurrence than trigeminal nerve block alone.

Objective: To evaluate the efficacy and safety of stereotactic electroencephalography (SEEG)-guided 3D radiofrequency thermocoagulation (RF-TC) in the treatment of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS). Methods: This study was a randomized controlled trial. The patients with drug-resistant mTLE-HS recruited from Xuanwu Hospital, Capital Medical University between August 2019 and October 2022 were prospectively enrolled. The patients were randomly assigned to receive either anterior temporal lobectomy (ATL) or RF-TC treatment using a variable block randomization method. All patients were assessed both preoperatively and 1 year postoperatively. The postoperative outcomes in terms of epileptic seizure results, visual field defects, and surgery-related complications were compared between the two groups. Results: A total of 38 patients were included, 19 males and 19 females, with an average age of (28.3±6.9) years. There were 20 cases in the ATL group and 18 cases in the RF-TC group. There was no statistically significant difference in age [(28.5±5.7) vs (28.2±8.1), P=0.848] or gender distribution (7/20 vs 12/18, P=0.103) between the both groups. At the 1-year follow-up post-surgery, there was no statistically significant difference in the proportion of patients achieving Engel Class Ⅰfor epileptic seizure results between the ATL group and the RF-TC group (17/20 vs 13/18, P=0.438). The proportion of patients in the ATL group who developed visual field defects was higher than that in the RF-TC group (15/20 vs 3/18, P<0.010). No severe adverse events were observed in both groups. Conclusion: The epilepsy control efficacy of SEEG-guided 3D RF-TC is comparable to that of traditional surgery, while offering superior outcomes in visual field preservation.

Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-RFTC) has emerged as a safe and effective minimally invasive treatment for children with drug-resistant focal epilepsy. Although evidence from real-world studies remains limited, numerous pediatric cases have demonstrated promising outcomes. This retrospective study aimed to evaluate the seizure outcomes of SEEG-RFTC in pediatric patients and identify predictive factors associated with seizure freedom. A retrospective observational study was conducted across two epilepsy centers, including 111 children with drug-resistant epilepsy who underwent SEEG-RFTC. Postoperative outcomes were assessed primarily by the rate of seizure freedom at the last follow-up (minimum 1 year). Potential predictive factors were analyzed through comparisons of clinical, neuroimaging, electrophysiological, and etiological variables. All patients were followed for at least 1 year post-procedure, with 73 (65.8%) achieving seizure freedom. Among 46 patients with focal cortical dysplasia, the seizure-free rate was 80.4%. In 10 patients with hippocampus sclerosis, 6 (60%) were seizure-free at the final follow-up. Statistical analysis identified the course of illness (p < 0.01) and positron emission tomography (PET) findings (p = 0.01) as significant predictors of seizure freedom. SEEG-RFTC is a safe procedure that yields favorable outcomes in a substantial proportion of pediatric patients with drug-resistant focal epilepsy. The duration of epilepsy and PET characteristics are significantly associated with the likelihood of achieving seizure freedom. These findings highlight the potential of SEEG-RFTC as a valuable therapeutic option in this population.

PurposeIndividuals with drug-resistant epilepsy may benefit from epilepsy surgery. In nonlesional cases, where no epileptogenic lesion can be detected on structural magnetic resonance imaging, multimodal neuroimaging studies are required. Breath-hold-triggered BOLD fMRI (bh-fMRI) was developed to measure cerebrovascular reactivity in stroke or angiopathy and highlights regional network dysfunction by visualizing focal impaired flow increase after vasodilatory stimulus. This regional dysfunction may correlate with the epileptogenic zone. In this prospective single-center single-blind pilot study, we aimed to establish the feasibility and safety of bh-fMRI in individuals with drug-resistant non-lesional focal epilepsy undergoing presurgical evaluation.MethodsIn this prospective study, 10 consecutive individuals undergoing presurgical evaluation for drug-resistant focal epilepsy were recruited after case review at a multidisciplinary patient management conference. Electroclinical findings and results of other neuroimaging were used to establish the epileptogenic zone hypothesis. To calculate significant differences in cerebrovascular reactivity in comparison to the normal population, bh-fMRIs of 16 healthy volunteers were analyzed. The relative flow change of each volume of interest (VOI) of the atlas was then calculated compared to the flow change of the whole brain resulting in an atlas of normal cerebral reactivity. Consequently, the mean flow change of every VOI of each patient was tested against the healthy volunteers group. Areas with significant impairment of cerebrovascular reactivity had decreased flow change and were compared to the epileptogenic zone localization hypothesis in a single-blind design.ResultsAcquisition of bh-fMRI was feasible in 9/10 cases, with one patient excluded due to noncompliance with breathing maneuvers. No adverse events were observed, and breath-hold for intermittent hypercapnia was well tolerated. On blinded review, we observed full or partial concordance of the local network dysfunction seen on bh-fMRI with the electroclinical hypothesis in 6/9 cases, including cases with extratemporal lobe epilepsy and those with nonlocalizing 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).ConclusionThis represents the first report of bh-fMRI in individuals with epilepsy undergoing presurgical evaluation. We found bh-fMRI to be feasible and safe, with a promising agreement to electroclinical findings. Thus, bh-fMRI may represent a potential modality in the presurgical evaluation of epilepsy. Further studies are needed to establish clinical utility.Supplementary InformationThe online version of this article (10.1007/s00062-023-01363-2) contains supplementary material, which is available to authorized users.

BackgroundOwing to migration, female genital mutilation or cutting (FGM/C) has become a growing concern in host countries in which FGM/C is not familiar. There is a need for reliable estimates of FGM/C prevalence to inform medical and public health policy. We aimed to advance methodology for estimating the prevalence of FGM/C in diaspora by determining the prevalence of FGM/C among women giving birth in the Netherlands.MethodsTwo methods were applied to estimate the prevalence of FGM/C in women giving birth: (I) direct estimation of FGM/C was performed through a nationwide survey of all midwifery practices in the Netherlands and (II) the extrapolation model was adopted for indirect estimation of FGM/C, by applying population-based-survey data on FGM/C in country of origin to migrant women who gave birth in 2018 in the Netherlands.ResultsA nationwide survey among primary care midwifery practices that provided care for 57.5% of all deliveries in 2018 in the Netherlands, reported 523 cases of FGM/C, constituting FGM/C prevalence of 0.54%. The indirect estimation of FGM/C in an extrapolation-model resulted in an estimated prevalence of 1.55%. Possible reasons for the difference in FGM/C prevalence between direct- and indirect estimation include that the midwives were not being able to recognize, record or classify FGM/C, referral to an obstetrician before assessing FGM/C status of women and selective responding to the survey. Also, migrants might differ from people in their country of origin in terms of acculturation toward discontinuation of the practice. This may have contributed to the higher indirect-estimation of FGM/C compared to direct estimation of FGM/C.ConclusionsThe current study has provided insight into direct estimation of FGM/C through a survey of midwifery practices in the Netherlands. Evidence based on midwifery practices data can be regarded as a minimum benchmark for actual prevalence among the subpopulation of women who gave birth in a given year.

This study aimed to investigate the prevalence of guidelines and routines used nationwide when children with autism spectrum disorder (ASD) are taken care of and examined in a radiology department during a peri-radiographic process. A nationwide survey was compiled and distributed to 94 radiology departments throughout Sweden, i.e. those performing more than 100 000 radiographic examinations annually. The survey was designed as a web questionnaire with seven questions on possible guidelines and/or routines for the departments when preparing and taking care of children with ASD in conjunction with a radiographic procedure. The data were scrutinized, using descriptive statistics. In total, 86 radiology departments responded to the survey (response rate 92%). Of those departments, 40 did not examine children with ASD. None of the departments included in the study had existing guidelines underpinning the routines when preparing and performing radiographic examinations for children diagnosed with ASD. A few departments (n = 8) would set aside more time for the procedure if it were known in advance that the child to be examined had been diagnosed with ASD. Also, some departments (n = 7) had radiographers who were more experienced in the care of children who would be appointed to perform examinations for children with ASD. It is suggested that guidelines should be developed in order to increase interaction in a supportive way and decrease anxiety during the peri-radiographic process with children with ASD.

A survey of software testing practices in Canada

Left Atrial Thrombus Formation After Successful Left Atrial Appendage Ligation: Case Series From a Nationwide Survey

Background The COVID-19 pandemic caused significant global social and economic disruption, highlighting the challenges of emerging infectious diseases. It also pushed modern medicine and healthcare systems to the wall.The mode of transmission of the SARS-CoV-2 infection is by aerosolized upper respiratory tract secretions. The otorhinolaryngology specialty seems to be among the riskiest for contracting airborne infections. This is because of the close face-to-face contact with the patients during routine examinations and many specific procedures. This study aimed to evaluate otolaryngologists' self-assessment of their comparative infection risk and the impact of the COVID-19 pandemic on their clinical practice, financial stability, and psychological well-being. Methodology A national cross-sectional survey was conducted among otorhinolaryngologists in Bulgaria by a research team from the Medical University of Varna. The study assessed infection risk perception, changes in practice, psychological stress, and financial effects. Data were collected via Survs.com and analyzed using descriptive statistics, cross-tabulations, and chi-squared tests, with significance set at 0.05 in Jamovi version 2.3.28. Results Of the 241 invited participants, 120 (49.8%) completed the survey. In total, 61 (50.8%) perceived their infection risk as similar to emergency healthcare workers, while 91 (75.8%) likened their exposure to that of dentists. Workplace exposure was identified as the main infection source by 95 (79.1%), with 71 (59.1%) considering outpatient clinics the highest-risk setting. Financially, 47 (39.1%) reported no income change, 31 (25.8%) experienced reductions, and 42 (35.0%) saw increased earnings. A chi-square test revealed a significant association between financial impact and workplace setting (χ² (3) = 11.68, p = 0.0086). Hospital-based otolaryngologists were more frequently affected by income reductions, with 65 (54.2%) reporting financial losses compared to 22 (18.3%) in outpatient settings. The psychological toll was substantial, with 44 (36.6%) reporting high stress, 34 (28.3%) very high stress, and only 3 (2.5%) stating no effect. Significant associations were found between stress levels and workplace setting (χ² (4) = 12.4, p = 0.015) and work experience (χ² (12) = 22.9, p = 0.029). Conclusions The COVID-19 pandemic profoundly affected otorhinolaryngologists' financial stability, work environments, infection risk perception, and mental health. Hospital-based specialists faced greater financial challenges, while stress levels were significantly linked to workplace setting and experience. These findings highlight critical areas for long-term changes in otorhinolaryngological practice.

Neoadjuvant chemotherapy in breast cancer is used to downstage locally advanced and inoperable tumors. Expanded benefits of neoadjuvant chemotherapy include downstaging of tumors to allow breast-conserving surgery (BCS) and assessment of in vivo tumor response. We sought to identify patterns and predictors of neoadjuvant chemotherapy use to determine if this has translated into population-level clinical practice. All patients undergoing surgery for invasive breast cancer between January 2012 and June 2014 were identified from our provincial synoptic operating room database. Data regarding patient demographics, hospital, operating surgeon, preoperative tumor characteristics, neoadjuvant treatment, and type of surgery performed were collected. Descriptive statistics and multivariable analysis were used to identify predictors of neoadjuvant chemotherapy. A total of 4186 patients were identified, 363 (8.53%) of whom underwent neoadjuvant chemotherapy. A significant increase was seen in the use of neoadjuvant chemotherapy over time. In multivariable analysis, neoadjuvant chemotherapy was associated with prechemotherapy tumor size, multicentricity, lymph node positivity, and decreasing patient age. In addition, there was significant variability in neoadjuvant chemotherapy use between operating surgeons. Of those patients who underwent neoadjuvant chemotherapy, 68.9% were not pretreatment candidates for BCS. At the time of definitive surgery, 72.1% had mastectomy, with 18.7% opting for contralateral prophylactic mastectomy. As reported, this was due to the tumor being advanced/too large (50.4%), patient preference (12.6%), multicentricity (8.8%) and margins, genetics, and previous radiotherapy (4%). A significant increase in the use of neoadjuvant chemotherapy over time was identified, and treatment with mastectomy as definitive surgical management remained high. There was significant variability in neoadjuvant chemotherapy use by the operating surgeons, in addition to factors generally associated with more locally advanced/aggressive tumors.

The purpose of this study was to assess the opinions, via a nationwide survey, of 109 teachers of students with behavioral disorders about substance-use prevention. The major finding from the study is that little is being done to provide students with behavioral disorders programming in this area. Teachers were not in agreement in their assignment of priority to the area of substance-use prevention instruction in relation to the other subjects they teach (about a third assigned it highest priority; about a third assigned it lowest priority). Additionally, teachers reported that parents of students with behavioral disorders were virtually absent from prevention program efforts. Lack of time, of curriculum materials, and of adequate funding were noted as the greatest impediments to prevention programming. To enhance substance-use prevention efforts, careful attention to a variety of issues that affect its implementation must be systematically conducted.

Reliability is one of the most discussed topics in the power industry today. Although many questions are being asked about the quality of service across the US nation, presently there are no standardized ways to track reliability between electric utilities. The same utilities are using the EEI/IEEE approved indices, but most have different ways of calculating the data. This paper provides the results of two nationwide surveys on reliability indices and practices and point out some of the pitfalls associated with comparing reliability indices between electric utilities.

There are potential benefits associated with advance care planning (ACP), and general practitioners (GPs) are well placed to coordinate ACP initiatives with their patients. Few studies have reported on the uptake of different forms of advance care plan conducted by GPs and how this affects patients' place of death. The primary aims of the study were to examine uptake of verbal (conversations regarding care preferences) and written (documented care preferences) advance care plans and their associated factors from the perspective of Australian GPs. The secondary aim was to determine the impact of different types of advance care plans on place of death. Sixty-one GPs from three Australian states used a validated clinic-based data collection process to report on care provided for decedents in the last year of life, including provision of services, place of death, and uptake of ACP. We found that 58 (27.9%), 91 (43.7%) and 59 (28.4%) reported decedents had no advance care plans, verbal plans or written plans, respectively. There were increased uptake of both verbal plans (relative risk ratio [RRR]=13.10, 95% confidence interval [CI]: 2.18-77.34) and written plans (RRR=10.61, 95% CI: 1.72-65.57) if GPs foresaw the death for >90days versus <7days. Palliative care training history for GPs predicted uptake of verbal plans (RRR=5.83, 95% CI: 1.46-31.93). Patients with verbal plans versus no plans were more likely to die at a private residence (odds ratio=4.97, 95% CI: 1.32-18.63). Our findings suggest that expectation of death for at least three months prior to the event (where clinically possible) and palliative care training for GPs improve the uptake of ACP in general practice. Larger pragmatic trials are required to determine the impact of ACP on patients' place of death.

BackgroundHIV prevalence among prisoners is over eight times higher than that of the general in Iran. Considering that sexually transmitted infections (STIs) increase the susceptibility to HIV infection, this study...