Objective: In a previous proof of concept study, selective posterior callosotomy achieved similar degree of control of drop attacks as total callosotomy, while sparing prefrontal interconnectivity. The present study aims to confirm this finding in a larger cohort and to provide anatomical and prognostic data.
Methods: Fifty-one patients with refractory drop attacks had selective posterior callosotomy and prospective follow up for a mean of 6.4 years. Twenty-seven patients had post-operative magnetic resonance imaging (MRI) and 18 had tractography (DTI) of remaining callosal fibers. Pre and postoperative falls were quantified and correlated with demographic, clinical and imaging data.
Results: Mean monthly frequency of drop attacks had a 95 % reduction, from 297 before to 16 after the procedure. Forty- one patients (80 %) had either complete or greater than 90 % control of the epileptic falls. Age and duration of epilepsy at surgery correlated with outcome (p values, respectively, 0.042 and 0.005). Mean index of callosal section along the posterior-to-anterior axis was 53.5 %. Extending the posterior section anterior to the midbody of the corpus callosum did not correlate with seizure control (p 0.91), providing fibers interconnecting the primary motor (M1) and caudal supplementary motor areas (SMA) were sectioned. Only one patient had a notable surgical complication which resolved in two days.
Conclusions: This level III cohort study with objective outcome assessment confirms that selective posterior callosotomy is safe and effective to control epileptic falls. Younger patients with smaller duration of epilepsy have better results. A posterior section contemplating the splenium, isthmus and posterior half of the body (posterior midbody) seems sufficient to achieve complete or almost complete control of drop attacks.
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http://dx.doi.org/10.1016/j.eplepsyres.2020.106544 | DOI Listing |
Cureus
December 2024
Department of Community Medicine, College of Medicine, Gulf Medical University, Ajman, ARE.
Objectives: The purpose of this research was to assess the impact of exposure to heat on the physical, social, and mental health domains of adults residing in the United Arab Emirates (UAE), where the region faces great increases in temperature due to climate change. Previous research has focused mainly on physical health outcomes; this research addressed the expansive impacts of mental and social health, which remain understudied in the region.
Methods: A cross-sectional study surveyed 397 adults in the UAE using a structured questionnaire.
Front Cardiovasc Med
December 2024
Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China.
Background: Deceleration capacity (DC) and acceleration capacity (AC) are used to characterize autonomic regulation. The purpose of this study was to evaluate the autonomic nervous function in patients with vasovagal syncope (VVS) and to evaluate the diagnostic value of DC and AC for VVS.
Methods: A total of 94 consecutive patients with VVS [51.
Indian Pacing Electrophysiol J
December 2024
Intermountain Heart Institute - Utah Valley Hospital, Salt Lake City, Utah, USA.
Introduction: The advancement of medical technology has introduced leadless pacemakers (LPMs) as a significant innovation in cardiac pacing, offering potential advantages over traditional ventricular transvenous pacemakers. This report explores the application of LPMs in two patients with complex valvular histories, particularly those with mechanical tricuspid valves.
Case Reports: The first case involves a 60-year-old male with a history of rheumatic heart disease and triple valve replacement who developed a high-grade AV block.
Cureus
November 2024
Medicine, University of Central Florida College of Medicine, Orlando, USA.
Introduction SARS-CoV-2 infection (COVID-19) and the COVID-19 vaccine have been linked to the development of persistent symptoms, including orthostatic intolerance (OI) and postural orthostatic tachycardia syndrome (POTS), in both children and adults. POTS is characterized by excessive tachycardia and other symptoms upon standing, significantly impacting quality of life. This study aims to evaluate the clinical and laboratory findings in pediatric patients with post-COVID-19 or post-COVID-19 vaccine OI and POTS.
View Article and Find Full Text PDFIn Vivo
December 2024
Department of Health and Care Professions, Faculty of Health and Life Sciences, University of Exeter, Exeter, U.K.;
Background: Coronary artery disease (CAD), primarily caused by atherosclerosis, is a leading cause of death, presenting as angina or myocardial infarction. Advances in cardiac imaging, angiography, and procedures like percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery have improved early detection and management of this condition. This report presents the case of a man who experienced worsening exertional chest pain and discomfort while at rest.
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