Neurology
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To date, seizures in relation to arteriovenous malformations (AVM) have been a secondary target of most studies. The insufficient evaluation, in conjunction with the lack of consistent seizure outcome assessment, has made it been difficult to draw conclusions about seizure outcome after radiosurgery for AVM. This study aimed to determine the effect of radiosurgery on seizure outcome depending on AVM obliteration and on the development of new seizure in patients with AVM. ⋯ Although radiosurgery tends to cause seizures temporarily, the radiosurgery may improve seizure outcomes in patients with AVM-related seizures, especially in patients with AVM obliteration.
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To characterize clinically and genetically a family with autosomal dominant lateral temporal epilepsy (ADLTE) negative to LGI1 exon sequencing test. ⋯ This is the first microdeletion affecting LGI1 identified in ADLTE. Families with ADLTE in which no point mutations are revealed by direct exon sequencing should be screened for possible genomic deletion mutations by CNV analysis or other appropriate methods. Overall, CNV analysis of multiplex families may be useful for identifying microdeletions in novel disease genes.
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Multicenter Study Comparative Study
Migraine in cervical artery dissection and ischemic stroke patients.
Several small to medium-sized studies indicated a link between cervical artery dissection (CeAD) and migraine. Migrainous CeAD patients were suggested to have different clinical characteristics compared to nonmigraine CeAD patients. We tested these hypotheses in the large Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) population. ⋯ Migraine without aura is more common among CeAD(stroke) patients compared to non-CeAD IS patients. The mechanisms and possible causative link remain to be proved. Although CeAD is often complicated by stroke, our data do not support increased risk of stroke in migrainous CeAD patients.
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To examine national time trends of resective surgery for the treatment of medically refractory epilepsy before and after Class I evidence demonstrating its efficacy and subsequent practice guidelines recommending early surgical evaluation. ⋯ Despite Class I evidence and subsequent practice guidelines, the utilization of lobectomy has not increased from 1990 to 2008. Surgery continues to be heavily underutilized as a treatment for epilepsy, with significant disparities by race and insurance coverage. Patients who are medically refractory after failing 2 antiepileptic medications should be referred to a comprehensive epilepsy center for surgical evaluation.