Development and prospective clinical validation of a convolutional neural network for automated detection and segmentation of focal cortical dysplasias.

Purpose: Focal cortical dysplasias (FCDs) are a leading cause of drug-resistant epilepsy. Early detection and resection of FCDs have favorable prognostic implications for postoperative seizure freedom. Despite advancements in imaging methods, FCD detection remains challenging.

Aberrant fast spiking interneuronal activity precedes seizure transitions in humans.

There is active debate regarding how GABAergic function changes during seizure initiation and propagation, and whether interneuronal activity drives or impedes the pathophysiology. Here, we track cell-type specific firing during spontaneous human seizures to identify neocortical mechanisms of inhibitory failure. Fast-spiking interneuron activity was maximal over 1 second before equivalent excitatory increases, and showed transitions to out-of-phase firing prior to local tissue becoming incorporated into the seizure-driving territory.

Disease-Related Protein Variants of the Highly Conserved Enzyme PAPSS2 Show Marginal Stability and Aggregation in Cells.

Cellular sulfation pathways rely on the activated sulfate 3'-phosphoadenosine-5'-phosphosulfate (PAPS). In humans, PAPS is exclusively provided by the two PAPS synthases PAPSS1 and PAPSS2. Mutations found in the PAPSS2 gene result in severe disease states such as bone dysplasia, androgen excess and polycystic ovary syndrome.

Human interictal epileptiform discharges are bidirectional traveling waves echoing ictal discharges.

Interictal epileptiform discharges (IEDs), also known as interictal spikes, are large intermittent electrophysiological events observed between seizures in patients with epilepsy. Although they occur far more often than seizures, IEDs are less studied, and their relationship to seizures remains unclear. To better understand this relationship, we examined multi-day recordings of microelectrode arrays implanted in human epilepsy patients, allowing us to precisely observe the spatiotemporal propagation of IEDs, spontaneous seizures, and how they relate.

Predicting the Outcome of Epilepsy Surgery by Covariance Pattern Analysis of Ictal Perfusion SPECT.

Previous studies on the utility of specific perfusion patterns in ictal brain perfusion SPECT for predicting the outcome of temporal lobe epilepsy surgery used qualitative visual pattern classification, semiquantitative region-of-interest analysis, or conventional univariate voxel-based testing, which are limited by intra- and interrater variability or low sensitivity to capture functional interactions among brain regions. The present study performed covariance pattern analysis of ictal perfusion SPECT using the scaled subprofile model for unbiased identification of predictive covariance patterns. The study retrospectively included 18 responders to temporal lobe epilepsy surgery (Engel I-A at 12 mo follow-up) and 18 nonresponders (≥Engel I-B).

No Evidence to Favor 99mTc-HMPAO or 99mTc-ECD for Ictal Brain Perfusion SPECT for Identification of the Seizure Onset Zone.

Purpose: Ictal brain perfusion SPECT with the tracer 99mTc-HMPAO or 99mTc-ECD is widely used for identification of the epileptic seizure onset zone (SOZ) in presurgical evaluation if standard pointers are uncertain or inconsistent. For both tracers, there are theoretical arguments to favor it over the other for this task. The aim of this study was to compare the performance of ictal brain perfusion SPECT between 99mTc-HMPAO and 99mTc-ECD in a rather large patient sample.

Stalkers: Specialists Versus Generalists.

AbstractIt is known that many domestic violence (DV) offenders also commit violent and nonviolent offences that are not domestic in nature. Stalking frequently evolves from DV contexts. The present study used police data to explore (i) the extent to which stalking offenders in Western Australia specialize in stalking, (ii) the frequency of involvement in DV offending by stalking offenders, and (iii) the types of offences that co-occur with stalking offences.

Automated detection and segmentation of focal cortical dysplasias (FCDs) with artificial intelligence: Presentation of a novel convolutional neural network and its prospective clinical validation.

Purpose: Focal cortical dysplasias (FCDs) represent one of the most frequent causes of pharmaco-resistant focal epilepsies. Despite improved clinical imaging methods over the past years, FCD detection remains challenging, as FCDs vary in location, size, and shape and commonly blend into surrounding tissues without clear definable boundaries. We developed a novel convolutional neural network for FCD detection and segmentation and validated it prospectively on daily-routine MRIs.

Evaluation of procalcitonin as a contribution to antimicrobial stewardship in SARS-CoV-2 infection: a retrospective cohort study.

It can be a diagnostic challenge to identify patients with coronavirus disease 2019 in whom antibiotics can be safely withheld. This study evaluated the effectiveness of a guideline implemented at Sheffield Teaching Hospitals NHS Foundation Trust that recommends withholding antibiotics in patients with low serum procalcitonin (PCT), defined as ≤0.25 ng/mL.

Neuronal Firing and Waveform Alterations through Ictal Recruitment in Humans.

Analyzing neuronal activity during human seizures is pivotal to understanding mechanisms of seizure onset and propagation. These analyses, however, invariably using extracellular recordings, are greatly hindered by various phenomena that are well established in animal studies: changes in local ionic concentration, changes in ionic conductance, and intense, hypersynchronous firing. The first two alter the action potential waveform, whereas the third increases the "noise"; all three factors confound attempts to detect and classify single neurons.

Recurrent Optic Disc Hemorrhage and Its Association with Visual Field Deterioration in Glaucoma.

Purpose: To investigate the association among optic disc hemorrhage (ODH) recurrence, location, and visual field (VF) progression.

Design: Prospective, observational study.

Participants: Patients with bilateral glaucoma or unilateral glaucoma with a fellow glaucoma suspect eye were enrolled.

Subthalamic nucleus deep brain stimulation with a multiple independent constant current-controlled device in Parkinson's disease (INTREPID): a multicentre, double-blind, randomised, sham-controlled study.

Background: Deep brain stimulation (DBS) of the subthalamic nucleus is an established therapeutic option for managing motor symptoms of Parkinson's disease. We conducted a double-blind, sham-controlled, randomised controlled trial to assess subthalamic nucleus DBS, with a novel multiple independent contact current-controlled (MICC) device, in patients with Parkinson's disease.

Methods: This trial took place at 23 implanting centres in the USA.

Influence of stiripentol on perampanel serum levels.

Stiripentol is an orphan drug successfully used in combination with valproate and clobazam in the treatment of Dravet syndrome. Perampanel has also been added by experts. In this retrospective study, we investigated the influence of stiripentol on perampanel serum levels by using the doses and corresponding perampanel serum levels of 10 patients.

Breath tests in Western Australia: Examining the economic dividends and effectiveness of general deterrence.

In this paper, we examine the relationship between traffic enforcement (in the form of roadside breath testing for alcohol) and traffic outcomes (alcohol-related traffic crashes) to identify an optimal point of traffic enforcement. In Western Australia (WA), Police are authorised to stop any driver and measure their blood alcohol concentration via a sample of their breath. Using a metric employed by Ferris et al.

Use of the mixed reality tool "VSI Patient Education" for more comprehensible and imaginable patient educations before epilepsy surgery and stereotactic implantation of DBS or stereo-EEG electrodes.

Purpose: It is unknown which patient education strategy before epilepsy surgery or stereotactic electrode implantation is best for patients. This prospective and randomized clinical study investigates whether the use of the mixed reality tool "VSI Patient Education" (VSI PE) running on HoloLens® glasses is superior to the use of a rubber brain model as a 3-dimensional tool for patient education before epilepsy surgery and stereotactic electrode implantation.

Material And Methods: 17 patients with indication for epilepsy surgery or stereotactic electrode implantation were included in the study and randomized into two groups.

Interleaved deep brain stimulation for dyskinesia management in Parkinson's disease.

Background: In patients with Parkinson's disease, stimulation above the subthalamic nucleus (STN) may engage the pallidofugal fibers and directly suppress dyskinesia.

Objectives: The objective of this study was to evaluate the effect of interleaving stimulation through a dorsal deep brain stimulation contact above the STN in a cohort of PD patients and to define the volume of tissue activated with antidyskinesia effects.

Methods: We analyzed the Core Assessment Program for Surgical Interventional Therapies dyskinesia scale, Unified Parkinson's Disease Rating Scale parts III and IV, and other endpoints in 20 patients with interleaving stimulation for management of dyskinesia.

Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness.

Medically induced loss of consciousness (mLOC) during anesthesia is associated with a macroscale breakdown of brain connectivity, yet the neural microcircuit correlates of mLOC remain unknown. To explore this, we applied different analytical approaches (t-SNE/watershed segmentation, affinity propagation clustering, PCA, and LZW complexity) to two-photon calcium imaging of neocortical and hippocampal microcircuit activity and local field potential (LFP) measurements across different anesthetic depths in mice, and to micro-electrode array recordings in human subjects. We find that in both cases, mLOC disrupts population activity patterns by generating (1) fewer discriminable network microstates and (2) fewer neuronal ensembles.

Association between focal lamina cribrosa defects and optic disc haemorrhage in glaucoma.

Background/aims: To explore the relationship between focal lamina defect (LD) size and optic disc haemorrhages (DH) in glaucomatous eyes.

Methods: Radial B-scan images at 15° intervals obtained using enhanced depth imaging (EDI) spectral-domain optical coherence tomography (OCT) were performed on a group of subjects previously assessed for DH every 3 months over a period of 5 years. EDI-OCT scans were assessed for the presence of focal lamina cribrosa defects by a single observer.

Complex sexual behaviors during sleep as a manifestation of epilepsy: a case series.

Study Objectives: Complex sexual behavior during sleep (CSBS) is a well described clinical entity in nonrapid eye movement (NREM) sleep parasomnias (i.e. sexsomnia).

Electrical Stimulation of the Anterior Thalamus for Epilepsy: Clinical Outcome and Analysis of Efficient Target.

Objective: Deep brain stimulation (DBS) of the anterior thalamic complex (ANT) is an adjunctive therapy for pharmacoresistant epilepsy. To define the most efficient target in DBS for epilepsy, we investigate clinical data, position of leads, usability of atlas data compared to electric field modeling based on programming parameters.

Methods: Data from ten consecutive patients who underwent ANT-DBS were analyzed.

Delayed high-frequency suppression after automated single-pulse electrical stimulation identifies the seizure onset zone in patients with refractory epilepsy.

Objective: Single-pulse electrical stimulation (SPES) of intracranial electrodes evokes responses that may help identify the seizure onset zone (SOZ); however, lack of automation and response variability has limited clinical adoption of this technique. We evaluated whether automated delivery of low-current SPES could evoke delayed high-frequency suppression (DHFS) of ongoing electrocorticography (ECoG) signals that, when combined with objective analytic techniques, may provide a reliable marker of this zone.

Methods: Low-current SPES (1-ms, 3.