Patient experiences of resection versus responsive neurostimulation for drug-resistant epilepsy.

This study explored illness experiences and decision-making among patients with epilepsy who underwent two different types of surgical interventions: resection versus implantation of the NeuroPace Responsive Neurostimulation System (RNS). We recruited 31 participants from a level four epilepsy center in an academic medical institution. We observed 22 patient clinic visits (resection: n = 10, RNS: n = 12) and conducted 18 in-depth patient interviews (resection: n = seven, RNS: n = 11); most visits and interviews included patient caregivers.

Maintaining Medical Student Motivation During Remote Clinical Learning.

Purpose: Remote clinical learning (RCL) may result in learner disengagement. The factors that influence medical student motivation during RCL remain poorly understood. The authors aimed to explore factors that affect medical student motivation during RCL and determine potential strategies to optimize student motivation during RCL.

Deep learning as a tool for neural data analysis: Speech classification and cross-frequency coupling in human sensorimotor cortex.

A fundamental challenge in neuroscience is to understand what structure in the world is represented in spatially distributed patterns of neural activity from multiple single-trial measurements. This is often accomplished by learning a simple, linear transformations between neural features and features of the sensory stimuli or motor task. While successful in some early sensory processing areas, linear mappings are unlikely to be ideal tools for elucidating nonlinear, hierarchical representations of higher-order brain areas during complex tasks, such as the production of speech by humans.

Seizure outcomes in nonresective epilepsy surgery: an update.

In approximately 30 % of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy.

Purification and Characterization of Progenitor and Mature Human Astrocytes Reveals Transcriptional and Functional Differences with Mouse.

The functional and molecular similarities and distinctions between human and murine astrocytes are poorly understood. Here, we report the development of an immunopanning method to acutely purify astrocytes from fetal, juvenile, and adult human brains and to maintain these cells in serum-free cultures. We found that human astrocytes have abilities similar to those of murine astrocytes in promoting neuronal survival, inducing functional synapse formation, and engulfing synaptosomes.

Phenotypic and imaging features of FLNA-negative patients with bilateral periventricular nodular heterotopia and epilepsy.

Purpose: Periventricular nodular heterotopia (PVNH) is a malformation of cortical development due to impaired neuronal migration resulting in the formation of nodular masses of neurons and glial cells in close proximity to the ventricular walls. We report the clinical characteristics of the largest case series of FLNA-negative patients with seizures and bilateral periventricular heterotopia.

Methods: Participants were recruited through the Epilepsy Phenome/Genome Project (EPGP), a multicenter collaborative effort to collect detailed phenotypic data and DNA on a large number of individuals with epilepsy, including a cohort with symptomatic epilepsy related to PVNH.

Transient aphasias after left hemisphere resective surgery.

Object: Transient aphasias are often observed in the first few days after a patient has undergone resection in the language-dominant hemisphere. The aims of this prospective study were to characterize the incidence and nature of these aphasias and to determine whether there are relationships between location of the surgical site and deficits in specific language domains.

Methods: One hundred ten patients undergoing resection to the language-dominant hemisphere participated in the study.

Control of spoken vowel acoustics and the influence of phonetic context in human speech sensorimotor cortex.

Speech production requires the precise control of vocal tract movements to generate individual speech sounds (phonemes) which, in turn, are rapidly organized into complex sequences. Multiple productions of the same phoneme can exhibit substantial variability, some of which is inherent to control of the vocal tract and its biomechanics, and some of which reflects the contextual effects of surrounding phonemes ("coarticulation"). The role of the CNS in these aspects of speech motor control is not well understood.

The search for circulating epilepsy biomarkers.

Few would experience greater benefit from the development of biomarkers than those who suffer from epilepsy. Both the timing of individual seizures and the overall course of the disease are highly unpredictable, and the associated morbidity is considerable. Thus, there is an urgent need to develop biomarkers that can predict the progression of epilepsy and treatment response.

Seizure types and frequency in patients who "fail" temporal lobectomy for intractable epilepsy.

Background: Temporal lobectomy can lead to favorable seizure outcomes in medically-refractory temporal lobe epilepsy (TLE). Although most studies focus on seizure freedom after temporal lobectomy, less is known about seizure semiology in patients who "fail" surgery. Morbidity differs between seizure types that impair or spare consciousness.

Effects of temporal lobectomy on consciousness-impairing and consciousness-sparing seizures in children.

Purpose: Most children with medically refractory temporal lobe epilepsy (TLE) become seizure free after temporal lobectomy, but some individuals continue to seize. As studies of temporal lobectomy typically focus on seizure freedom, the effect of surgery on seizure type and frequency among children with persistent seizures is poorly understood. Seizures which impair consciousness are associated with increased morbidity compared to consciousness-sparing seizures.

Epilepsy surgery trends in the United States, 1990-2008.

Objective: To examine national time trends of resective surgery for the treatment of medically refractory epilepsy before and after Class I evidence demonstrating its efficacy and subsequent practice guidelines recommending early surgical evaluation.

Methods: We performed a population-based cohort study with time trends of patients admitted to US hospitals for medically refractory focal epilepsy between 1990 and 2008 who did or did not undergo lobectomy, as reported in the Nationwide Inpatient Sample.

Results: Weighted data revealed 112,026 hospitalizations for medically refractory focal epilepsy and 6,653 resective surgeries (lobectomies and partial lobectomies) from 1990 to 2008.

Characteristics and treatment of seizures in patients with high-grade glioma: a review.

High-grade gliomas (HGGs), including anaplastic astrocytoma and glioblastoma multiforme, are the most common primary brain tumors, and are often associated with seizures. Seizure control is a critical but often underappreciated goal in the treatment of patients harboring these malignant lesions. Patients with HGG who also have medically intractable seizures should be considered for a palliative resection guided by electrocorticography and functional mapping.

Interictal MEG/MSI in intractable mesial temporal lobe epilepsy: spike yield and characterization.

Objective: To evaluate the ability of MEG to detect medial temporal spikes in patients with known medial temporal lobe epilepsy (MTLE) and to use magnetic source imaging (MSI) with equivalent current dipoles to examine localization and orientation of spikes and their relation to surgical outcome.

Methods: We prospectively obtained MSI on a total of 25 patients previously diagnosed with intractable MTLE. MEG was recorded with a 275 channel whole-head system with simultaneous 21-channel scalp EEG during inpatient admission one day prior to surgical resection.

The effects of epilepsy and its treatments on affect and emotion.

Epilepsy creates significant morbidity, disability, and loss of productivity worldwide. Although unpredictable seizures define epilepsy, the cognitive and emotional difficulties encountered by people with epilepsy may have an even greater impact on everyday function. Epilepsy is associated with lower quality of life (QOL); while this is partially attributable to ongoing seizures, QOL is independently affected by comorbid affective disorders like depression and anxiety.

Concordance between routine interictal magnetoencephalography and simultaneous scalp electroencephalography in a sample of patients with epilepsy.

Both electroencephalography (EEG) and magnetoencephalography (MEG) localize epileptiform activity but may yield different results. This discordance may arise from different detection capabilities or from different data collection and interpretation techniques. Comparisons of MEG and EEG have focused on detection of individual spikes.

Automated localization of magnetoencephalographic interictal spikes by adaptive spatial filtering.

Objective: Automated adaptive spatial filtering techniques can be applied to magnetoencephalographic (MEG) data collected from people with epilepsy. Source waveforms estimated by these methods have higher signal-to-noise ratio (SNR) than spontaneous MEG data, allowing identification and location of interictal spikes. The software tool SAM(g(2)) provides an adaptive spatial filtering algorithm for MEG data that yields source images of excess kurtosis and provides source time-courses in voxels exhibiting high excess kurtosis.

Social cognition and epilepsy surgery.

Human social behavior depends on a set of perceptive, mnemonic, and interpretive abilities that together may be termed social cognition. Lesion and functional imaging studies of social cognitive functions implicate the temporal lobes (in particular, the nondominant temporal lobe) and mesial temporal structures as critical at the front end of social cognitive processes. The frontal lobes, in turn, function to interpret and to modulate these processes via top-down control.

Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy.

Background: The intracarotid amobarbital (Wada) test can be used to evaluate hemispheric memory capacity before anterior temporal lobectomy (ATL). Most patients demonstrate better memory with injection ipsilateral to planned resection (expected asymmetry [EA]), but a substantial minority show better memory with contralateral injection (unexpected asymmetry [UA]). Both degree and direction of Wada memory asymmetry (WMA) have been associated with worse surgical outcome in small series.