Epilepsy research
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The structural connection patterns of the human brain are the underlying bases for functional connectivity. Although abnormal functional connectivity has been uncovered in childhood absence epilepsy (CAE) in previous electroencephalography and functional magnetic resonance imaging studies, little is known regarding the structural connectivity in CAE. We hypothesized that the structural connectivity would be disrupted in response to the decreased brain function in CAE. ⋯ The present study demonstrated, for the first time, the disrupted topological organization of WM networks in CAE. The decreased connectivity and efficiency in the orbitofrontal and sub-cortical regions may serve as anatomical evidence to support the functional abnormalities related to the epileptic discharges observed in CAE. Moreover, the orbitofrontal sub-network may play a key role in CAE. These findings open up new avenues toward the understanding of absence epilepsy.
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Review Case Reports
Usefulness of Wada test in predicting seizure outcome following anterior temporal lobectomy.
To study the usefulness of the Wada test for predicting seizure outcome following anterior temporal lobectomy (ATL). ⋯ Wada test has limited usefulness for predicting seizure outcome following ATL.
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Mortality in people with epilepsy has not previously been estimated in Georgia. We identified a prevalent cohort of people with epilepsy from a tertiary referral centre in Tbilisi, Georgia and attempted to establish survivorship status for all. One-way sensitivity analysis estimating mortality rates in those lost to follow-up was also used. ⋯ One SUDEP was confirmed with a further 4 possible, but the cause of death was unknown in 47%. The overall SMR was 1.4, with much higher SMRs (up to 12) in young people. The sensitivity analysis suggested an SMR of 3.0.
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Since intracranial electrode implantation has limited spatial sampling and carries significant risk, placement has to be effective and efficient. Structural and functional imaging of several different modalities contributes to localising the seizure onset zone (SoZ) and eloquent cortex. There is a need to summarise and present this information throughout the pre/intra/post-surgical course. ⋯ We have demonstrated feasibility of the developed intraoperative M3N pipeline which serves as a prototype for clinical implementation. Further validity studies with larger sample groups are required to determine the utility of M3N in routine surgical practice.
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This retrospective study evaluates the impact of postoperative antiepileptic drug (AED) withdrawal on psychomotor speed in seizure-free children, operated for medically refractory epilepsy. Post-surgical medication policy and neuropsychological assessments (performed shortly before and 6, 12 and 24 months after surgery), were evaluated in 57 children (32 female, median age at surgery 13 years). Patients were divided into a withdrawal (n=29) and a no-withdrawal group (n=28). ⋯ At 24 months, the withdrawal group had improved significantly more than the no-withdrawal group on three of four tests; reaction time to light (p=0.031), reaction time to sound (p=0.045) and tapping (p=0.003). At 12 months, a non-significant tendency in the same direction was found for both reaction time tests. Drug withdrawal after surgery improves psychomotor speed and may unleash the potential for cognitive improvement.