Interpretable surface-based detection of focal cortical dysplasias: a Multi-centre Epilepsy Lesion Detection study.

One outstanding challenge for machine learning in diagnostic biomedical imaging is algorithm interpretability. A key application is the identification of subtle epileptogenic focal cortical dysplasias (FCDs) from structural MRI. FCDs are difficult to visualize on structural MRI but are often amenable to surgical resection.

Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study.

Objective: Drug-resistant focal epilepsy is often caused by focal cortical dysplasias (FCDs). The distribution of these lesions across the cerebral cortex and the impact of lesion location on clinical presentation and surgical outcome are largely unknown. We created a neuroimaging cohort of patients with individually mapped FCDs to determine factors associated with lesion location and predictors of postsurgical outcome.

Quantitative EEG as a Prognostic Tool in Suspected Anti-N-Methyl- d -Aspartate Receptor Antibody Encephalitis.

Purpose: Anti-N-methyl- d -aspartate receptor (anti-NMDAR) encephalitis is a form of autoimmune encephalitis associated with EEG abnormalities. In view of the potentially severe outcomes, there is a need to develop prognostic tools to inform clinical management. The authors explored whether quantitative EEG was able to predict outcomes in patients with suspected anti-NMDAR encephalitis.

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures.

Objective: To assess factors associated with favorable outcome in refractory insular epilepsy treated by volume-based stereotactic radiofrequency thermocoagulation (RFTC).

Methods: We performed volume-based RFTC in 19 patients (11 males, 7-44 years old). The volume for thermocoagulation was identified by multimodal data including electroencephalography (EEG)-video, magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (PET) in all patients, and epileptogenic zone (EZ) was assessed by stereo-electroencephalography (SEEG) in 16.

Short-lasting retroorbital pain attacks as a form of ictal epileptic headache: Case report.

Background And Objectives: Ictal epileptic headache is a rare form of painful seizure, habitually consisting of migrainous or tension-type headache. We describe a case of a patient with short-lasting, severe retroorbital pain attacks caused by frontal lobe epilepsy.

Case Report: A 25-year-old male patient presented with recurrent attacks of paroxysmal, short-lasting, excruciating left periorbital and facial pain mainly occurring from sleep.

Cingulate gyrus epilepsy.

The cingulate gyrus is located above the corpus callosum and forms part of the limbic system. Cingulate gyrus epilepsy poses a diagnostic challenge, given its diverse and variable seizure semiology. We present two patients with seizures arising in the cingulate gyrus that highlight the electroclinical and imaging features of this rare form of epilepsy.

A prospective, multicenter study of cardiac-based seizure detection to activate vagus nerve stimulation.

Purpose: This study investigates the performance of a cardiac-based seizure detection algorithm (CBSDA) that automatically triggers VNS (NCT01325623).

Methods: Thirty-one patients with drug resistant epilepsy were evaluated in an epilepsy monitoring unit (EMU) to assess algorithm performance and near-term clinical benefit. Long-term efficacy and safety were evaluated with combined open and closed-loop VNS.

The histopathology of polymicrogyria: a series of 71 brain autopsy studies.

Aim: Polymicrogyria (PMG) is one of the most common forms of cortical malformation yet the mechanism of its development remains unknown. This study describes the histopathological aspects of PMG in a large series including a significant proportion of fetal cases.

Method: We have reviewed the neuropathology and medical records of 44 fetuses and 27 children and adults in whom the cortical architecture was focally or diffusely replaced by one or more festooning bands of neurons.

Prognostic value of intracranial seizure onset patterns for surgical outcome of the treatment of epilepsy.

Objective: To investigate if intracranial EEG patterns at seizure onset can predict surgical outcome.

Methods: Ictal onset patterns from intracranial EEG were analysed in 373 electro-clinical seizures and subclinical seizures from 69 patients. Seizure onset patterns were classified as: (a) Diffuse electrodecremental (DEE); (b) Focal fast activity (FA); (c) Simultaneous onset of fast activity and diffuse electrodecremental event (FA-DEE); (d) Spikes; (e) Spike-wave activity; (f) Sharp waves; (g) Alpha activity; (h) Delta activity.

Preoperative estimation of seizure control after resective surgery for the treatment of epilepsy.

Purpose: Predicting seizure control after epilepsy surgery is difficult. The objectives of this work are: (a) to estimate the value of surgical procedure, presence of neuroimaging abnormalities, need for intracranial recordings, resection lobe, pathology, durations of epilepsy and follow-up period to predict postsurgical seizure control after epilepsy surgery and (b) to provide empirical estimates of successful outcome after different combinations of the above factors in order to aid clinicians in advising patients presurgically about the likelihood of success under their patients' individual circumstances.

Methods: We report postsurgical seizure control from all 243 patients who underwent resective surgery for epilepsy at King's College Hospital between 1999 and 2011.

Centromedian thalamic nuclei deep brain stimulation in refractory status epilepticus.

Background: Refractory status epilepticus (RSE) is associated with high mortality. We report a potential treatment alternative.

Hypothesis: Deep brain stimulation (DBS) of the centromedian thalamic nuclei (CMN) can be effective in the treatment of RSE.

Diffuse form of dysembryoplastic neuroepithelial tumour: the histological and immunohistochemical features of a distinct entity showing transition to dysembryoplastic neuroepithelial tumour and ganglioglioma.

Aims: A diffuse variant of dysembryoplastic neuroepithelial tumour (dDNT) has previously been described, which although composed of oligodendroglia-like cells (OLC), astrocytes and mature neurones, lacks the multinodularity and 'specific component' of typical DNT. The dDNT poses a significant challenge to the neuropathologist. This study was undertaken to further characterize the histological and immunohistochemical features of dDNT.

Cingulate epileptogenesis in hypothalamic hamartoma.

Hypothalamic hamartoma (HH) is a relatively rare cause of epilepsy, mainly affecting children. Nearly all patients develop gelastic seizures, often followed by other focal seizure types. Our case illustrates the mechanisms of epileptogenesis in HH.

Pregabalin as adjunctive therapy for partial epilepsy: an audit study in 96 patients from the South East of England.

Introduction: Pregabalin (PGB) was licensed in the EU in 2004 as an adjunctive therapy in partial epilepsy. It is also licensed for neuropathic pain and generalised anxiety.

Aims: To identify the clinical usefulness and side effects of add-on PGB in out-patient epilepsy clinics.

Psychiatric comorbidity in adult patients with hypothalamic hamartoma.

The objective was to investigate the prevalence of psychiatric comorbidity in adults with hypothalamic hamartoma (HH). A standardized clinical interview and assessment scales were used to assess for depression, anxiety, personality, and sexual behavior, based on previous findings in the pediatric population. We found a high prevalence of mood and anxiety disorders, with Major Depressive Disorder and Social Anxiety Disorder being the most common.

Is it worth pursuing surgery for epilepsy in patients with normal neuroimaging?

Objective: To determine whether it is worth pursuing surgery for the treatment of epilepsy in patients with normal neuroimaging.

Methods: Two patient populations were studied: (1) 136 consecutive patients who were surgically treated; (2) 105 consecutive patients assessed with chronically implanted intracranial electrodes within the same period. Sixty patients belonged to both groups, and included all 21 patients who had normal neuroimaging.

Hypothalamic hamartoma in adults.

Epilepsy in adult patients with hypothalamic hamartoma has not been well studied. It is uncommon but merits recognition. In this paper, 14 adult patients with hypothalamic hamartoma and epilepsy, of whom three developed epilepsy only in adult life, are presented.

The clinical spectrum of epilepsy in children and adults with hypothalamic hamartoma.

Purpose: Hamartomas of the hypothalamus (HH) cause an uncommon and unusual epilepsy syndrome. The condition is recognized to affect children, but the presentation in adults is not well understood. We present 19 children and adult patients with HH, including three patients whose epilepsy began in adult life.

Alcoholic skeletal muscle myopathy: definitions, features, contribution of neuropathy, impact and diagnosis.

Alcohol misusers frequently have difficulties in gait, and various muscle symptoms such as cramps, local pain and reduced muscle mass. These symptoms are common in alcoholic patients and have previously been ascribed as neuropathological in origin. However, biochemical lesions and/or the presence of a defined myopathy occur in alcoholics as a direct consequence of alcohol misuse.

Intraoperative monitoring during surgery for acoustic neuroma: benefits of an extratympanic intrameatal electrode.

Objectives: To assess the utility of an extratympanic intrameatal electrode for intraoperative monitoring during acoustic neuroma and other cerebellopontine angle tumour surgery and to define the neurophysiological and surgical factors which influence hearing preservation.

Methods: Twenty two patients, 18 with acoustic neuromas and four with other cerebellopontine angle tumours, underwent intraoperative monitoring during tumour excision. The extratympanic intrameatal electrode (IME) was used to record the electrocochleogram (ECoG) and surface electrodes to record the brainstem auditory evoked response (ABR).

Chronic inflammatory demyelinating polyneuropathy : clinical, electrophysiological and morphological study.

Twelve patients (M:F 9:3) who fulfilled diagnostic criteria of chronic inflammatory demyelinating polyneuropathy (CIDP) were seen at NIMHANS over a period of three years (1987-1990). Their ages ranged from 20 yrs to 71 yrs and the mean duration of symptoms was 30 months (range 3 months to 6 yrs). Symptoms at the onset were dependent on the duration of disease.