Altered amygdala volumes and microstructure in focal epilepsy patients with tonic-clonic seizures, ictal, and post-convulsive central apnea.

Objectives: Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death for patients with epilepsy; however, the pathophysiology remains unclear. Focal-to-bilateral tonic-clonic seizures (FBTCS) are a major risk factor, and centrally-mediated respiratory depression may increase the risk further. Here, we determined the volume and microstructure of the amygdala, a key structure that can trigger apnea in people with focal epilepsy, stratified by the presence or absence of FBTCS, ictal central apnea (ICA), and post-convulsive central apnea (PCCA).

Altered Amygdala Volumes and Microstructure in Focal Epilepsy Patients with Tonic-Clonic Seizures, Ictal and Post-Ictal Central Apnea.

Objectives: Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death for patients with epilepsy; however, the pathophysiology remains unclear. Focal-to-bilateral tonic-clonic seizures (FBTCS) are a major risk factor, and centrally-mediated respiratory depression may increase the risk further. Here, we determined volume and microstructure of the amygdala, a key structure that can trigger apnea in people with focal epilepsy, stratified by presence or absence of FBTCS, ictal central apnea (ICA) and post-ictal central apnea (PICA).

Diverging Temporal Trends in Stroke Incidence in Younger vs Older People: A Systematic Review and Meta-analysis.

Importance: Overall stroke incidence is falling in high-income countries, but data on time trends in incidence of young stroke (ie, stroke in individuals younger than 55 years) are conflicting. An age-specific divergence in incidence, with less favorable trends at younger vs older ages, might be a more consistent underlying finding across studies.

Objective: To compare temporal trends in incidence of stroke at younger vs older ages in high-income countries.

Association of Younger vs Older Ages With Changes in Incidence of Stroke and Other Vascular Events, 2002-2018.

Importance: Some studies have reported increasing stroke incidence at younger ages (<55 years) but have often relied only on administrative data, and more population-based studies of adjudicated stroke are required. An understanding of the drivers of any increase in incidence of young stroke also requires comparisons with stroke trends at older ages and with trends in incidence of other vascular events at younger ages.

Objective: To determine temporal changes in incidence of stroke and other major vascular events at younger vs older ages.

Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy.

To characterize regional brain metabolic differences in patients at high risk of sudden unexpected death in epilepsy (SUDEP), using fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET). We studied patients with refractory focal epilepsy at high ( = 56) and low ( = 69) risk of SUDEP who underwent interictal FDG-PET as part of their pre-surgical evaluation. Binary SUDEP risk was ascertained by thresholding frequency of focal to bilateral tonic-clonic seizures (FBTCS).

Peri-ictal hypoxia is related to extent of regional brain volume loss accompanying generalized tonic-clonic seizures.

Objectives: Hypoxia, or abnormally low blood-oxygen levels, often accompanies seizures and may elicit brain structural changes in people with epilepsy which contribute to central processes underlying sudden unexpected death in epilepsy (SUDEP). The extent to which hypoxia may be related to brain structural alterations in this patient group remains unexplored.

Methods: We analyzed high-resolution T1-weighted magnetic resonance imaging (MRI) to determine brain morphometric and volumetric alterations in people with generalized tonic-clonic seizures (GTCS) recorded during long-term video-electroencephalography (VEEG), recruited from two sites (n = 22), together with data from age- and sex-matched healthy controls (n = 43).

Trends in Stroke Incidence in High-Income Countries in the 21st Century: Population-Based Study and Systematic Review.

Background and Purpose- Population-based studies provide the most reliable data on stroke incidence. A previous systematic review of population-based studies suggested that stroke incidence in high-income countries decreased by 42% between the 1970s and early 2000s. However, it is uncertain whether this trend of steady decline has been maintained in more recent periods.

Dysfunctional Brain Networking among Autonomic Regulatory Structures in Temporal Lobe Epilepsy Patients at High Risk of Sudden Unexpected Death in Epilepsy.

Background: Sudden unexpected death in epilepsy (SUDEP) is common among young people with epilepsy. Individuals who are at high risk of SUDEP exhibit regional brain structural and functional connectivity (FC) alterations compared with low-risk patients. However, less is known about network-based FC differences among critical cortical and subcortical autonomic regulatory brain structures in temporal lobe epilepsy (TLE) patients at high risk of SUDEP.

The long-term course of temporal lobe epilepsy: From unilateral to bilateral interictal epileptiform discharges in repeated video-EEG monitorings.

Introduction: Bilateral interictal epileptiform discharges (IED) and ictal patterns are common in temporal lobe epilepsy (TLE) and have been associated with decreased chances of seizure freedom after epilepsy surgery. It is unclear whether secondary epileptogenesis, although demonstrated in experimental models, exists in humans and may account for progression of epilepsy.

Material And Methods: We reviewed consecutive video-EEG recordings from 1992 to 2014 repeated at least two years apart (mean interval 6.

Ictal EEG source imaging in frontal lobe epilepsy leads to improved lateralization compared with visual analysis.

Purpose: To investigate the utility of EEG source imaging to lateralize ictal patterns in frontal lobe epilepsy, which were nonlateralized by standard EEG analysis.

Methods: Prospective analysis of 17 seizures in 8 patients with unilateral frontal lobe epilepsy MRI lesions and nonlateralizing ictal scalp EEG. We applied four EEG source imaging techniques (phase maps, symmetric dipoles, low-resolution brain electromagnetic tomography analysis, and classical low-resolution brain electromagnetic tomography analysis recursively applied) to the averaged seizure pattern.

Clinical significance of nonhabitual seizures during intracranial EEG monitoring.

This study sought to determine the frequency and clinical significance of nonhabitual seizures in 101 consecutive patients undergoing presurgical intracranial electroencephalography intracranial (icEEG) recording. We compared clinical data, recording details, and postsurgical outcome in patients with nonhabitual seizures to those without nonhabitual seizures during icEEG. In patients with nonhabitual seizures we compared icEEG recordings of nonhabitual seizures to recordings of habitual seizures.

Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis.

Background: Resistance and aerobic exercises are both recommended as effective treatments for people with type 2 diabetes. However, the optimum type of exercise for the disease remains to be determined to inform clinical decision-making and facilitate personalized exercise prescription.

Objectives: Our objective was to investigate whether resistance exercise is comparable to aerobic exercise in terms of effectiveness and safety in people with type 2 diabetes.

Comparison of bipolar versus monopolar extraoperative electrical cortical stimulation mapping in patients with focal epilepsy.

Objective: Extraoperative cortical stimulation (CS) for mapping of eloquent cortex in patients prior to epilepsy surgery is not standardized across centres. Two different techniques are in use, referred to as bipolar and monopolar CS. We compared the ability of bipolar versus monopolar CS to identify eloquent cortex and their safety profile in patients undergoing subdural EEG recordings.

Incidence, risk factors, management, and outcomes of stroke in pregnancy.

Objective: To estimate the incidence of antenatal stroke in the United Kingdom and to describe risk factors associated with stroke during pregnancy, management, and outcomes.

Methods: A population-based (nationwide) cohort and nested case-control study was conducted using the UK Obstetric Surveillance System between October 2007 and March 2010. We investigated the potential factors associated with antenatal stroke using a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Management of lymphadenitis due to non-tuberculous mycobacterial infection in children.

Purpose: Non-tuberculous mycobacterial (NTM) infection is an important cause of cervico-facial lymph node enlargement in young children. The optimal treatment is thought to be early complete excision without chemotherapy. We compared management of patients referred to our centre to this "gold standard" and determined clinical outcomes by type of primary surgical intervention (complete excision vs.

Extraoperative electrical cortical stimulation: characteristics of motor responses and correlation with precentral gyrus.

Purpose: To characterize properties and stimulation thresholds of extraoperative cortical stimulation with respect to the anatomic area stimulated.

Methods: Analysis of 1,496 bipolar extraoperative cortical stimulations with respect to stimulation threshold, anatomic area stimulated, afterdischarges (ADs), and latencies to observe a clinical sign on video analysis.

Results: Cortical stimulation mapping stimulus thresholds to induce clinical motor responses are lower when compared with stimulus thresholds to induce nonmotor responses (P < 0.

Postictal increase in T-wave alternans after generalized tonic-clonic seizures.

Purpose: Sudden unexpected death in epilepsy (SUDEP) occurs most frequently in people with chronic uncontrolled epilepsy. Tonic-clonic seizures are a well-recognized risk factor for SUDEP. T-wave alternans (TWA) is a novel independent marker of risk of sudden cardiac death and cardiovascular mortality.

Postictal generalized electroencephalographic suppression is associated with generalized seizures.

Postictal generalized electroencephalographic suppression (PGES) may be involved in sudden unexpected death in epilepsy (SUDEP). We examined whether the occurrence of PGES depends on seizure type and whether PGES occurs more frequently in people with epilepsy who died suddenly. EEG recordings of people with pharmacoresistant focal epilepsies who died from SUDEP after presurgical video/EEG telemetry were compared with recordings of living controls.

Asymmetric hemispheric representation of periictal heart rate modulation is individually lateralised.

Asymmetric cortical representation of cardiac function is a matter of debate and large inter-individual variability of cortical autonomic networks and different study designs may contribute to this controversy. Lateralised seizure activity in individual patients may provide valuable insights into cortical regulation of cardiac function. We report two patients with focal epilepsy who had seizures arising from both hemispheres.

Enhanced QT shortening and persistent tachycardia after generalized seizures.

Objective: Generalized tonic-clonic seizures (GTCS) are a major risk factor for sudden unexpected death in epilepsy (SUDEP). We investigated whether ictal/postictal cardiac features were dependent on seizure type within individual patients.

Methods: ECG data from patients with medically refractory temporal lobe epilepsy (TLE) undergoing presurgical investigation who had both complex partial seizures and secondarily GTCS during video-EEG telemetry were retrospectively reviewed.

Pathologic cardiac repolarization in pharmacoresistant epilepsy and its potential role in sudden unexpected death in epilepsy: a case-control study.

Purpose: To determine whether abnormal cardiac repolarization and other electrocardiography (ECG) predictors for cardiac mortality occur in epilepsy patients and whether they are associated with an increased risk for sudden unexpected death in epilepsy (SUDEP).

Methods: In a matched-pair case-control study, recordings of adult patients with pharmacoresistant focal epilepsies who died from SUDEP and who had previously had presurgical video-EEG (electroencephalography) telemetry were reviewed. Living controls were matched for age, gender, and date of admission for video-EEG telemetry.

Do subclinical electrographic seizure patterns affect heart rate and its variability?

Purpose: Autonomic symptoms during seizures may provide information on seizure onset zone. We investigated whether changes in heart rate (HR) and HR variability (HRV) occur during subclinical electrographic seizure patterns, and whether these have a localising/lateralising value.

Methods: EEG and ECG recordings of pharmacoresistant epilepsy patients who underwent intracranial video-EEG telemetry were reviewed.

Peri-ictal atrioventricular conduction block in a patient with a lesion in the left insula: case report and review of the literature.

Seizure-induced syncope is uncommon and is usually due to peri-ictal bradycardia and asystole. In contrast, peri-ictal atrioventricular conduction block (AV block) has been reported only rarely. Here, we review the literature on peri-ictal AV block and describe a patient with recurrent episodes of epigastric auras that were occasionally followed by a sensation of dizziness and syncope because of transient third-degree AV block.