Neurology
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Multicenter Study
Worsening of quality of life after epilepsy surgery: effect of seizures and memory decline.
Surgery for intractable temporal lobe epilepsy usually controls seizures and improves health-related quality of life (HRQOL), but some patients experience continued seizures, memory decline, or both. The relative impact of these unfavorable outcomes on HRQOL has not been described. ⋯ After temporal resection, health-related quality of life (HRQOL) improves or remains stable in seizure-free patients despite memory decline, but HRQOL declines when persistent seizures are accompanied by memory decline. These results may be useful in presurgical counseling and identifying patients at risk for poor psychosocial outcome following surgery.
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MRI is the most important paraclinical measure for assessing and monitoring the pathologic changes implicated in the onset and progression of multiple sclerosis (MS). Conventional MRI sequences, such as T1-weighted gadolinium-enhanced and spin-echo T2-weighted imaging, are unable to provide full details about the degree of inflammation and underlying neurodegenerative changes. Newer nonconventional MRI techniques have the potential to detect clinical impairment, disease progression, accumulation of disability, and the neuroprotective effects of treatment. ⋯ High-resolution microautoradiography and new contrast agents are proving to be sensitive means for characterizing molecular markers of disease activity, such as activated microglia and macrophages. Optical coherence tomography, a new research technique, makes it possible to investigate relevant physiologic systems that provide accurate measures of tissue changes secondary to the MS disease process. Although detecting the status of neuronal integrity using MRI techniques continues to improve, a "gold standard" model remains to be established.