Neuromodulation Strategies in Lennox-Gastaut Syndrome: Practical Clinical Guidance from the Pediatric Epilepsy Research Consortium.

Lennox-Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, cognitive impairment, and distinctive electroencephalographic patterns. Neuromodulation techniques, including vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS), have emerged as important treatment options for patients with LGS who do not respond adequately to antiseizure medications. This review, developed with input from the Pediatric Epilepsy Research Consortium (PERC) LGS Special Interest Group, provides practical guidance for clinicians on the use of these neuromodulation approaches in patients with LGS.

On the rheological and sensory properties of a novel natural salivary substitute.

The prevalence of xerostomia, the sensation of dry mouth, is estimated at 20 % in the general population and up to 50 % in older adults. Saliva plays different roles during bolus formation: lubrication, mixing, coating, hydration, dissolution, and comminution of food particles. This study proposes and tests artificial saliva formulations mimicking human saliva rheological and sensory perceptions.

Role of optically pumped magnetometers in presurgical epilepsy evaluation: Commentary of the American Clinical Magnetoencephalography Society.

One of the major challenges of modern epileptology is the underutilization of epilepsy surgery for treatment of patients with focal, medication resistant epilepsy (MRE). Aggravating this distressing failure to deliver optimum care to these patients is the underuse of proven localizing tools, such as magnetoencephalography (MEG), a clinically validated, non-invasive, neurophysiological method used to directly measure and localize brain activity. A sizable mass of published evidence indicates that MEG can improve identification of surgical candidates and guide pre-surgical planning, increasing the yield of SEEG and improving operative outcomes.

pKpQIL-like plasmid contributes to the dissemination of and plasmid mediated quinolone resistance determinants among multi drug resistant in Assiut university hospital, Egypt.

Background And Objectives: Concomitant carriage of and plasmid mediated quinolone resistance determinants (PMQRs) by multi drug resistant (MDR) has increased globally, often related to their presence on transmissible plasmids. In this study, we hypothesized the presence of and PMQRs on a single conjugative plasmid that circulates among strains isolated from Assiut University Hospital.

Materials And Methods: Twenty-two clinical MDR strains harboring both and PMQRs were genotyped using pulsed field gel electrophoresis.

Cognitive outcome in children with infantile spasms using a standardized treatment protocol. A five-year longitudinal study.

Aim: To evaluate the long-term developmental trajectory of children with infantile spasms (IS) and identify the clinical protective and risk factors associated with their cognitive outcome.

Methods: We analyzed the five-year follow-up results of 41 children (13 female) from the previously published cohort (n = 68) recruited in a multicenter randomized controlled trial for 2-years, examining the effect of an adjunctive therapy (Flunarizine) on standardized IS treatment. The children were subsequently monitored in an open-label study for additional 3 years.

Relative contribution of individual versus combined functional imaging studies in predicting seizure freedom in pediatric epilepsy surgery: an area under the curve analysis.

Objective: The goal of this study was to evaluate the predictive value and relative contribution of noninvasive presurgical functional imaging modalities based on the authors' institutional experience in pursuing seizure-free surgical outcomes in children with medically refractory epilepsy.

Methods: This was a retrospective, single-institution, observational cohort study of pediatric patients who underwent evaluation and surgical treatment for medically refractory partial epilepsy between December 2003 and June 2016. During this interval, 108 children with medically refractory partial epilepsy underwent evaluation for localization and resective epilepsy surgery.

Utility of magnetic source imaging in nonlesional focal epilepsy: a prospective study.

Objective: For patients with nonlesional refractory focal epilepsy (NLRFE), localization of the epileptogenic zone may be more arduous than for other types of epilepsy and frequently requires information from multiple noninvasive presurgical modalities and intracranial EEG (icEEG). In this prospective, blinded study, the authors assessed the clinical added value of magnetic source imaging (MSI) in the presurgical evaluation of patients with NLRFE.

Methods: This study prospectively included 57 consecutive patients with NLRFE who were considered for epilepsy surgery.

The clinical impact of integration of magnetoencephalography in the presurgical workup for refractory nonlesional epilepsy.

Objective: For patients with nonlesional refractory focal epilepsy (NLRFE), localization of the epileptogenic zone is more arduous, and intracranial electroencephalography (EEG) (icEEG) is frequently required. Planning for icEEG is dependent on combined data from multiple noninvasive modalities. We report the negative impact of lack of integration of magnetoencephalography (MEG) in the presurgical workup in NLRFE.

The impact of hypsarrhythmia on infantile spasms treatment response: Observational cohort study from the National Infantile Spasms Consortium.

Objective: The multicenter National Infantile Spasms Consortium prospective cohort was used to compare outcomes and phenotypic features of patients with infantile spasms with and without hypsarrhythmia.

Methods: Patients aged 2 months to 2 years were enrolled prospectively with new-onset infantile spasms. Treatment choice and categorization of hypsarrhythmia were determined clinically at each site.

Cost-utility analysis of magnetoencephalography used to inform intracranial electrode placement in patients with drug resistant epilepsy: a model based analysis.

Objectives: We estimated the cost-effectiveness of adding magnetoencephalography to a standard assessment for epilepsy surgery consisting of neuropsychology, magnetic resonance imagining, scalp electroencephalography, video electroencephalography and intracranial electroencephalography, in the capacity of informing intracranial electroencephalography electrode placement.

Methods: We used Microsoft Excel (2007) to construct a decision model. Discounted costs and quality adjusted life years are aggregated to calculate incremental cost-effectiveness ratios.

Recruitment of the left precentral gyrus in reading epilepsy: A multimodal neuroimaging study.

Purpose: In a previous study, we investigated a 42-year-old male patient with primary reading epilepsy using continuous video-electroencephalography (EEG). Reading tasks induced left parasagittal spikes with a higher spike frequency when the phonological reading pathway was recruited compared to the lexical one. Here, we seek to localize the epileptogenic focus in the same patient as a function of reading pathway using multimodal neuroimaging.

Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms?

Objective: Infantile spasms (IS) are a severe form of childhood epilepsy associated with autism spectrum disorders (ASD) in up to 35% of cases. The objective of this post hoc analysis of our randomized control trial was to determine whether rapid diagnosis and treatment of IS could limit the incidence of ASD while identifying risk factors related to ASD outcome.

Methods: Patients with IS were randomized in a standardized diagnostic and treatment protocol.

What do patients and families want from a child neurology consultation?

Understanding what patients and their parents want is essential to plan appropriate patient-centered care. Questionnaires were distributed to 500 consecutive children and parents seen for their first pediatric neurology consultation. Both patients and their families answered questions about their expectations of the consultation, their level of worry, and the Penn State Worry Questionnaire.

The utility of magnetoencephalography in the presurgical evaluation of refractory insular epilepsy.

Purpose: To study the utility of magnetoencephalography (MEG) in patients with refractory insular epilepsy. Covered by highly functional temporal, frontal, and parietal opercula, insular-onset seizures can manifest a variety of ictal symptoms falsely leading to a diagnosis of temporal, frontal, or parietal lobe seizures. Lack of recognition of insular seizures may be responsible for some epilepsy surgery failures.

Magnetoencephalography (MEG) and other neurophysiological investigations.

Cortical generators of epileptic and certain physiological activity can be localized noninvasively by magnetoencephalography (MEG). MEG detects weak magnetic fields produced by the postsynaptic currents of pyramidal cortical cells in sulcal walls. Unlike EEG, MEG signals are not distorted by edema or bone defects, and unlike fMRI, abnormal hemodynamics do not alter the MEG.

Source localization of interictal spike-locked neuromagnetic oscillations in pediatric neocortical epilepsy.

Objective: To evaluate the utility of an event-related beamforming (ERB) algorithm in source localization of interictal discharges.

Methods: We analyzed interictal magnetoencephalography data in 35 children with intractable neocortical epilepsy. We used a spatiotemporal beamforming method to estimate the spatial distribution of source power in individual interictal spikes.

A randomized controlled trial of flunarizine as add-on therapy and effect on cognitive outcome in children with infantile spasms.

Purpose: Cognitive impairment is observed commonly in children with a history of infantile spasms (IS). The goal of this study was to prospectively examine the effect on cognitive outcome of a neuroprotective agent used as adjunctive therapy during treatment of the spasms.

Methods: In a randomized controlled trial, patients received a standardized therapy plus flunarizine or placebo.

Neuromagnetic cerebellar activation during seizures arising from the motor cortex.

We utilized the high temporal resolution, whole head coverage and novel analysis methodology of magnetoencephalography (MEG) to record the dynamics of cerebellar activation during focal motor seizures. We analyzed ictal MEG data from a four-year old using an event-related beamformer to localize and display ictal changes over the motor cortex and cerebellum. Contralateral activation of the cerebellum was seen 14s after MEG ictal onset over the motor cortex.

Changing ictal-onset EEG patterns in children with cortical dysplasia.

Purpose: Cortical dysplasia (CD) is intrinsically epileptogenic. We hypothesize that CDs clinically emerging in the early developing brain tend to extend into multifocal or larger epileptic networks to pronounce intractability in contrast to CDs which clinically emerge at a later age.

Methods: We evaluated the spatial and temporal profiles of ictal-onset EEG patterns in children with histopathologically confirmed CD.

Somatosensory-evoked fields on magnetoencephalography for epilepsy infants younger than 4 years with total intravenous anesthesia.

Objective: Patients must remain immobile for magnetoencephalography (MEG) and MRI recordings to allow precise localization of brain function for pre-surgical functional mapping. In young children with epilepsy, this is accomplished with recordings during sleep or with anesthesia. This paper demonstrates that MEG can detect, characterize and localize somatosensory-evoked fields (SEF) in infants younger than 4 years of age with or without total intravenous anesthesia (TIVA).