Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Dec 2012
ReviewLarge scale brain models of epilepsy: dynamics meets connectomics.
The brain is in a constant state of dynamic change, for example switching between cognitive and behavioural tasks, and between wakefulness and sleep. The brains of people with epilepsy have additional features to their dynamic repertoire, particularly the paroxysmal occurrence of seizures. Substantial effort over decades has produced a detailed description of many human epilepsies and of specific seizure types; in some instances there are known causes, sometimes highly specific such as single gene mutations, but the mechanisms of seizure onset and termination are not known. ⋯ These models are typically simplified, leaving a need to scale up these models to the large scale brain networks in which seizures become manifest. The emerging science of connectomics provides an approach to understanding the large scale brain networks in which normal and abnormal brain functions operate. The stage is now set to couple dynamics with connectomics, to reveal the abnormal dynamics of brain networks which allow seizures to occur.
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J. Neurol. Neurosurg. Psychiatr. · Dec 2012
A longitudinal MRI study of traumatic axonal injury in patients with moderate and severe traumatic brain injury.
To study the evolution of traumatic axonal injury (TAI) detected by structural MRI in patients with moderate and severe traumatic brain injury (TBI) during the first year and relate findings to outcome. ⋯ This is the first study to demonstrate and quantify attenuation of non-haemorrhagic TAI lesions on structural MRI during the first 3 months after TBI; most importantly, the disappearance of brainstem lesions. Haemorrhagic TAI lesions attenuate first after 3 months. Only early MRI findings predicted clinical outcome after adjustment for other prognostic factors. Hence valuable clinical information may be missed if MRI is performed too late after TBI.
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J. Neurol. Neurosurg. Psychiatr. · Dec 2012
Assessment of cerebral small vessel disease predicts individual stroke risk.
Despite several known risk factors it is still difficult to foresee who will develop a stroke and who will not. Vascular brain damage, visualised with MRI, reflects how the brain tolerates the effects of vascular risk factors and may therefore be relevant in predicting individual stroke risk. ⋯ Assessment of small vessel disease with MRI beyond the classic stroke risk factors improved the prediction of subsequent stroke, especially in women with an intermediate stroke risk. These findings support the use of MRI as a possible tool for better identifying people at high risk of stroke.
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J. Neurol. Neurosurg. Psychiatr. · Dec 2012
Cognitive and mood effects of phenobarbital treatment in people with epilepsy in rural China: a prospective study.
Phenobarbital is an effective treatment for epilepsy but concerns remain over its potential neurocognitive toxicity. This prospective study evaluated the effects of phenobarbital treatment on cognition and mood in people with epilepsy in rural China. ⋯ In this study, phenobarbital was not found to have a major negative impact on cognitive function of people with convulsive seizures and some cognitive gains were observed, possibly due to improved seizure control.