Hyper-Acute Stroke Systems of Care and Workflow.

Purpose Of Review: Recent stroke treatment advances have necessitated agile, broad-scale healthcare system redesign, to achieve optimal patient outcomes and access equity. Optimised hyperacute stroke care requires integrated pre-hospital, emergency department, stroke specialist, radiology, neurosurgical and endovascular neurointervention services, guided by a population-wide needs analysis. In this review, we survey system integration efforts, providing case studies, and identify common elements of successful initiatives.

Common experiences of patients following suboptimal treatment outcomes: implications for epilepsy surgery.

Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals.

Azo dyes and the blood-brain barrier: Robert Aird's novel concept in chronic neurological disease (1903-2000).

The well-established medical involvement of derivatives of the azo dye industry lent credibility to the 1935 announcement by Stanley Cobb of the use of vital brilliant red dye as an anticonvulsant. Although in the fullness of time clinical experience would discard this concept, nevertheless it was to give rise to Robert Aird who posited that the mechanism of action of this dye was due to its ability to decrease the permeability of the blood-brain barrier. In a very prolonged exploration of this concept, Aird concluded that blood-brain barrier permeability underlay the causation of a long list of chronic neurological conditions--a concept that was eventually abandoned.

Pioneering concepts in epileptology: the cerebral dysrhythmia of Frederic Gibbs (1903-92) and William Lennox (1884-1960).

The development of the electroencephalogram and its use in the study of epilepsy supplied the research team of William Lennox and Frederic (Frederick) Gibbs at Harvard University with an entirely new method of studying the epileptic activity of the brain. The abnormal activity, thought to be a "dysrhythmia", seemed to indicate a central role for inheritance in this condition, and there seemed a more considerable penetration of inheritable epileptic tendency in the community than at first thought. Lennox, who had a long-held interest in eugenics, felt that further study was needed and this he undertook in his famous "Twin Series" exploring epilepsy in identical and non-identical twin pairs.

The idea of epilepsy as a disease per se.

In the 1850s Delasiauve and Russell Reynolds independently introduced the idea that the previously more inclusive concept of "epilepsy" should be restricted to that of an idiopathic disease manifesting epileptic seizures not caused by detectable brain pathology. This idea was rather widely accepted, though with some modification, over much of the next century. However there was increasing opposition to the idea from those, including John Hughlings Jackson, who perceived that all epileptic seizures must be symptoms of underlying brain disease.

The threshold of the new epileptology: Dr Lennox at the London Congress, 1935.

By the time that Dr William Lennox presented his discovery of the diagnostic electrical signature of brain electrical activity in epileptic seizures at the 2nd International Neurology Congress, held in London in 1935, research in epileptology had become mired in conceptual confusion. Not only had the vain quest for extracerebral seizure triggers resulted in decades of negative research, but outré theories such as autointoxication and psychoanalysis had severely damaged and confused the conceptual approach to this condition. Lennox and the Harvard team, in applying the novel technology of electroencephalography helped to clear up this confusion radically.

Profiles of psychosocial outcome after epilepsy surgery: the role of personality.

Purpose: We have previously found that the developmental time frame of epilepsy onset influences adult personality traits and subsequent adjustment to intractable seizures. In the same cohort of patients we now investigate the influence of these factors on psychosocial outcome after surgical treatment.

Methods: Fifty-seven adult patients with focal epilepsy were prospectively assessed before and after surgery.

Hippocampal volume and depression: insights from epilepsy surgery.

Background: Major depression is common after epilepsy surgery. It has previously been suggested that surgical removal of limbic system structures such as the hippocampus may contribute to this comorbidity. Recent magnetic resonance imaging studies have found smaller hippocampal volumes in depressed patients in comparison with controls.

Personality development in the context of intractable epilepsy.

Objectives: To investigate the developmental time frame of epilepsy onset on adult personality traits of neuroticism and extraversion and to consider their role in adjustment to intractable epilepsy.

Design: Prospective, preoperative and postoperative survey of the psychological and psychosocial effects of intractable epilepsy and its surgical treatment. Data from the preoperative phase are reported.

Julius Althaus (1833--1900). Neurologist and cultural polymath; founder of Maida Vale Hospital.

Born, educated and trained in Germany, Julius Althaus migrated to London at the start of a long career in neurological medicine. He was a voluminous writer on a wide range of topics in both general medicine and neurology, especially electrotherapy. In addition, his textbooks form a snapshot of current concepts of great historical interest in areas such as epilepsy and cerebrovascular disease.

Edward Henry Sieveking and the demise of essential epilepsy.

Edward Henry Sieveking, eminent London physician of Victorian times, is best known as the speaker at the historic meeting at which the chairman, Sir Charles Locock, seem to overshadow him in announcing the introduction of bromide--the first effective anti-convulsant. But in fact Sieveking had announced a most important conceptual advance in epileptology--the demise of "essential epilepsy". In addition his book, published soon after and based upon his lecture, is an important historical resumé of Victorian era concepts and management of epilepsy.

The burden of normality: a framework for rehabilitation after epilepsy surgery.

This paper describes a conceptual framework that generates a modus operandi for rehabilitation after epilepsy surgery derived from regular longitudinal and prospective follow-up of patients and families. The framework focuses on patient experiences of undergoing surgery placed within the context of the family and broader community. It adopts a holistic view of patient care to understand the complex interactions between neurobiological and psychosocial factors that determine surgical outcome in the eyes of the patient, family, and clinical team.

Psychosocial adjustment following relief of chronic narcolepsy.

Background And Purpose: No previous research has examined the psychosocial adjustment of chronic narcolepsy patients following efficacious pharmacotherapy. In contrast, considerable research has examined the process of psychosocial adjustment following surgical relief of chronic epilepsy. This process can manifest as a clinical syndrome, the 'burden of normality', comprising psychological, behavioural, affective and sociological features.

Neurological control of human sexual behaviour: insights from lesion studies.

We review the human literature examining the effects of neurological insult on human sexual behaviour. We provide a synthesis of the findings to date, and identify key brain regions associated with specific aspects of human sexual behaviour. These include subcortical and cortical regions, with the mesial temporal lobe and the amygdala in particular being a crucial structure in the mediation of human sexual drive.

W. Grey Walter, pioneer in the electroencephalogram, robotics, cybernetics, artificial intelligence.

With the announcement by William Lennox at the 1935 London International Neurology Congress of the use of electroencephalography in the study of epilepsy, it became evident that a new and powerful technique for the investigation of seizures had been discovered. William Grey Walter, a young researcher finishing his post-graduate studies at Cambridge, was selected to construct and study the EEG in clinical neurology at the Maudsley Hospital, London. His hugely productive pioneering career in the use of EEG would eventually lead to groundbreaking work in other fields --the emerging sciences of robotics, cybernetics, and early work in artificial intelligence.

"The Epilepsies": Kinnier Wilson's landmark epileptology.

Kinnier Wilson, better known for his eponymous disease, in fact devoted much of his career to the study of epilepsy. In his long campaign to alter the general perception of epilepsy, he spent much time and effort decrying the use of "epilepsy" as a single disease, pleading for individual consideration for its sufferers. In addition, he undertook an extensive reconsideration of many of the basic principles of his mentor and friend the great John Hughlings Jackson.

Increased serotonin receptor availability in human sleep: evidence from an [18F]MPPF PET study in narcolepsy.

Data from animal studies suggest that serotonin release promotes wakefulness and suppresses REM sleep, but there are dangers in extrapolating these findings to humans. Binding of the radioligand [18F]MPPF to 5HT1A receptors is sensitive to levels of endogenous serotonin. In this study, we aimed to demonstrate changes in serotonin receptor availability in the human brain in wakefulness and sleep using [18F]MPPF and positron emission tomography.

Characterizing psychosocial outcome trajectories following seizure surgery.

Purpose: We have developed a new approach to characterizing psychosocial outcome after seizure surgery that allows us to identify diverse individual trajectories as well as subgroups of patients with similar outcomes.

Methods: Eighty-nine anterior temporal lobectomy (ATL) patients were recruited through our Seizure Surgery Follow-up and Rehabilitation Program. The Austin CEP Interview was used to measure psychosocial adjustment presurgery, at discharge, and 1, 3, 6, 12, and 24 months postsurgery.

Murray Alexander Falconer and the Guy's-Maudsley Hospital seizure surgery program.

The 1949 appointment of Murray Falconer to the neurosurgical post of Guy's Hospital, London, resulted in the creation of an extremely productive seizure surgery program, in the early days of this discipline. In association with the Institute of Psychiatry at the Maudsley Hospital, his program produced in-depth research on the neuropsychiatry, the neuropathology and the psychosocial follow-up of temporal lobe epilepsy treated by surgical ablation. These results constitute a very significant landmark in the history of the early days of the neurosurgical attack on refractory epilepsy.

Mood disturbance before and after seizure surgery: a comparison of temporal and extratemporal resections.

Purpose: Mood disturbance is a common comorbid condition of temporal lobe epilepsy before and after seizure surgery. Few studies have examined mood disturbance in patients undergoing resections outside the temporal lobe (extratemporal resections). This study aimed to compare the early, postoperative evolution of mood disturbance in temporal and extratemporal lobe epilepsy patients to examine the effect of site of surgical resection on mood outcome.

Paradoxical results in the cure of chronic illness: the "burden of normality" as exemplified following seizure surgery.

Little has been written about processes of recovery following life-changing medical interventions for chronic illness. This article reviews our research with chronic epilepsy patients undergoing neurosurgery for the relief of intractable partial seizures. This research has given rise to a new conceptualization of adjustment and outcome following effective treatment of chronic illness, representing the first, detailed characterization of this process from a psychological and psychosocial perspective.

The amygdala and sexual drive: insights from temporal lobe epilepsy surgery.

The aim of this study was to explore the relationship between the amygdala and human sex drive. We compared amygdalar volume in groups of patients with or without sexual changes after temporal lobe resection and in age-matched neurologically normal subjects. Forty-five patients with intractable temporal lobe epilepsy who underwent surgical resection in the Comprehensive Epilepsy Program at the Austin and Repatriation Medical Centre completed a semistructured interview and questionnaire relating to sexual outcome after surgery.

Status epilepticus, the grim reaper of the mental health system in early Victoria.

In an era when patients with refractory epilepsy were managed in mental asylums in the colonial days of Victoria, Australia, the opinion of the administration was that such patients seemed to have a benign prognosis. However the decision to collect all female epileptics in the colony and manage them in the Ballarat Mental Hospital, effected in 1901, allowed scrutiny of the progress of a cohort of 96 patients over the first seventeen years of the twentieth century, thereby revealing that under asylum conditions no less than a third of their number died as the result of status epilepticus. The results of this survey and the reasons for such an outcome are discussed.