Frontiers in neurology
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Frontiers in neurology · Jan 2020
Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions?
Introduction: Differential diagnosis between disorders of arousal (DoA) and sleep-related hypermotor epilepsy (SHE) often represents a clinical challenge. The two conditions may be indistinguishable from a semiological point of view and the scalp video-polysomnography is often uninformative. Both disorders are associated with variable hypermotor manifestations ranging from major events to fragments of a hierarchical continuum of increasing intensity, complexity, and duration. ⋯ Given their clinical and epidemiological overlap, a common genetic background is also hypothesized. In such a perspective, we suggest that the consolidated dichotomy DoA vs. SHE should be reappraised.
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Frontiers in neurology · Jan 2020
Characterization of Post-exertional Malaise in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
Background: Myalgic encephalomyelitis/chronic fatigue syndrome is characterized by persistent and disabling fatigue, exercise intolerance, cognitive difficulty, and musculoskeletal/joint pain. Post-exertional malaise is a worsening of these symptoms after a physical or mental exertion and is considered a central feature of the illness. Scant observations in the available literature provide qualitative assessments of post-exertional malaise in patients with myalgic encephalomyelitis/chronic fatigue syndrome. ⋯ Patients described post-exertional malaise as interfering with their ability to lead a "normal" life. Conclusion: The experience of post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome varies greatly between individuals and leads to a diminished quality of life. myalgic encephalomyelitis/chronic fatigue syndrome patients describe post-exertional malaise as all-encompassing with symptoms affecting every part of the body, difficult to predict or manage, and requiring complete bedrest to fully or partially recover. Given the extensive variability in patients, further research identifying subtypes of post-exertional malaise could lead to better targeted therapeutic options.
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Frontiers in neurology · Jan 2020
Cerebral Near Infrared Spectroscopy Monitoring in Term Infants With Hypoxic Ischemic Encephalopathy-A Systematic Review.
Background: Neonatal hypoxic ischemic encephalopathy (HIE) remains a significant cause of mortality and morbidity worldwide. Cerebral near infrared spectroscopy (NIRS) can provide cot side continuous information about changes in brain hemodynamics, oxygenation and metabolism in real time. Objective: To perform a systematic review of cerebral NIRS monitoring in term and near-term infants with HIE. ⋯ Conclusion: Commercial NIRS cerebral oximeters can provide important information regarding changes in cerebral oxygenation and hemodynamics following HIE and can be particularly helpful when used in combination with other neuromonitoring tools. Optical measurements of brain metabolism using broadband NIRS and cerebral blood flow using diffuse correlation spectroscopy add additional pathophysiological information. Further randomized clinical trials and large observational studies are necessary with proper study design to assess the utility of NIRS in predicting neurodevelopmental outcome and guiding therapeutic interventions.
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Frontiers in neurology · Jan 2020
A Novel INCNS Score for Prediction of Mortality and Functional Outcome of Comatose Patients.
Objectives: The purpose of this study was to verify the veracity and reliability of the INCNS score for prediction of neurological ICU (NICU) mortality and 3-month functional outcome and mortality in comatose patients. Methods: In this prospective study, data of the patients admitted to NICU from January 2013 to January 2019 were collected for validation. The 3-month functional outcomes were evaluated using modified Rankin Scale (mRS). ⋯ The INCNS score exhibited a significantly better predictive performance of mortality and 3-month functional outcomes than FOUR and GCS. There was no significant difference in predicting NICU mortality and 3-month functional outcomes between INCNS and APACHE II, but INCNS had better predictive performance of 3-month mortality than APACHE II. Conclusions: The INCNS score could be used for predicting the functional outcomes and mortality rate of comatose patients.
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Frontiers in neurology · Jan 2020
Refining Planning for Stereoelectroencephalography: A Prospective Validation of Spatial Priors for Computer-Assisted Planning With Application of Dynamic Learning.
Objective: Stereoelectroencephalography (SEEG) is a procedure in which many electrodes are stereotactically implanted within different regions of the brain to estimate the epileptogenic zone in patients with drug-refractory focal epilepsy. Computer-assisted planning (CAP) improves risk scores, gray matter sampling, orthogonal drilling angles to the skull and intracerebral length in a fraction of the time required for manual planning. Due to differences in planning practices, such algorithms may not be generalizable between institutions. ⋯ Conclusions: We provide spatial priors for common SEEG trajectories that prospectively integrate clinically feasible trajectory planning practices from previous SEEG implantations. This allows institutional SEEG experience to be incorporated and used to guide future implantations. The deployment of a K-NN classifier may improve the generalisability of the algorithm by dynamically modifying the spatial priors in real-time as further implantations are performed.