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Measure thrice, cut twice: On the benefit of reoperation for failed pediatric epilepsy surgery.

测量三次,切割两次: 对失败的小儿癫痫手术再次手术的益处。

  • 影响因子:2.36
  • DOI:10.1016/j.eplepsyres.2020.106289
  • 作者列表:"Cohen NT","Ziobro JM","Depositario-Cabacar DF","Havens K","Kao A","Schreiber JM","Tsuchida TN","Zelleke TG","Oluigbo CO","Gaillard WD
  • 发表时间:2020-02-11
Abstract

OBJECTIVE:To determine whether clinical outcomes are improved after repeat surgery for medically refractory epilepsy in children. METHODS:This is a single-center retrospective cohort analysis of all patients who received repeat resective surgery for ongoing seizures from 2000-2017. From a total of 251 consecutive individual epilepsy surgical patients for focal resection, 53 patients met study inclusion criteria and had adequate follow-up documented. RESULTS:Median age of seizure-onset was 2.0-years-old (IQR 0.3-5.5 years). The median age at first epilepsy surgery was 6.3-years-old (IQR 2.9-9.2 years) and at second epilepsy surgery was 8.4-years-old (IQR 4.7-12.6 years). Overall, 53 % (n = 28) of this series achieved Engel Class I (seizure freedom); with improved seizure control (Engel Class I-II) in 83 % (n = 44) of the cohort. 64 % (n = 34) had one reoperation; 26 % (n = 14) had two; and 9% (n = 5) had three. Pathology: 58 % (n = 31) had focal cortical dysplasia; 13 % (n = 10) tumor; 9% (n = 5) encephalitis; 6% (n = 3) gliosis; 4% (n = 2) mesial temporal sclerosis; and 2% (n = 1) hemimegalencephaly. Tumor pathology was associated with increased chance (p = 0.01) for seizure freedom (90 % of tumor patients had Engel Class I outcome). MTS had worse outcome with both patients having ongoing seizures (Engel II-IV). There were 6 patients who developed post-operative hemiparesis; one was unplanned but resolved. SIGNIFICANCE:Reoperation for pediatric epilepsy surgery can lead to seizure freedom in many cases and improved seizure control in most cases. Reoperation for brain tumor pathology is associated with a high rate of seizure freedom.

摘要

目的: 确定儿童药物难治性癫痫重复手术后临床结局是否得到改善。 方法: 这是一项单中心回顾性队列分析,分析了 2000-2017 例因持续癫痫发作接受重复切除手术的所有患者。从总共 251 例连续的个体癫痫手术患者中,53 例患者符合研究纳入标准,并有足够的随访记录。 结果: 癫痫发作的中位年龄为 2.0 岁 (IQR 0.3-5.5 岁)。首次癫痫手术的中位年龄为 6.3 岁 (IQR 2.9-9.2 岁),第二次癫痫手术的中位年龄为 8.4 岁 (IQR 4.7-12.6 岁)。总体而言,该系列中的 53% (n = 28) 实现了 Engel I 级 (癫痫自由发作); 在 83% (n = 44) 中改善了癫痫发作控制 (Engel I-II 级) 的队列。64% (n = 34) 有一次再次手术; 26% (n = 14) 有两次; 9% (n = 5) 有三次。病理: 局灶性皮质发育不良 58% (n = 31); 肿瘤 13% (n = 10); 脑炎 9% (n = 5); 胶质增生 6% (n = 3); 4% (n = 2) 颞叶内侧硬化; 2% (n = 1) 半侧巨脑畸形。肿瘤病理与癫痫发作自由机会增加 (p = 0.01) 相关 (90% 的肿瘤患者有 Engel I 级结局)。MTS 的结局更差,两个患者都有持续癫痫发作 (Engel II-IV)。有 6 例患者发生术后轻偏瘫; 1 例计划外但已解决。 意义: 小儿癫痫手术再次手术在许多情况下可导致发作自由,在大多数情况下可改善发作控制。脑肿瘤病理的再次手术与高癫痫发作自由率相关。

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影响因子:2.53
发表时间:2020-01-29
DOI:10.1007/s11011-020-00536-z
作者列表:["Garabadu D","Singh D"]

METHODS::Multiple sclerosis (MS) is a chronic neurodegenerative disorder with clinical symptoms of neuroinflammation and demyelination in the central nervous system. Recently, herbal medicines are clinically effective against MS as the current disease-modifying drugs have limited effectiveness. Hence, the present study evaluated the therapeutic potential of Ocimum basilicum essential oil (OB) in ethidium bromide (EB)-induced cognitive deficits in the male rats. Further, the effect of OB (50, 100 and 200 μL/kg) was evaluated on EB-induced neuroinflammation, astrogliosis and mitochondrial dysfunction in the pre-frontal cortex (PFC) of the animals. The EB was injected through bilateral intracerebroventricular route into hippocampus to induce MS-like manifestations in the rats. OB (100 and 200 μL/kg) and Ursolic acid (UA) significantly reduced the EB-induced cognitive deficits in Morris water maze and Y-maze test paradigms. OB (100 and 200 μL/kg) and UA significantly attenuated the EB-induced neuroinflammation in terms of increase in the levels of pro-inflammatory cytokines (TNF-alpha and IL-6) in the rat PFC. Further, OB (100 and 200 μL/kg) and UA significantly attenuated the EB-induced astrogliosis in terms of increase in the levels of GFAP (Glial fibrillary acidic protein) and Iba-1 (Ionized calcium binding adaptor molecule-1) in the rat PFC. In addition, OB (100 and 200 μL/kg) and UA significantly attenuated the EB-induced decrease in the mitochondrial function, integrity, respiratory control rate and ADP/O in the PFC of the rodents. Moreover, OB (100 and 200 μL/kg) and UA significantly reduced the EB-induced mitochondria-dependent apoptosis in the PFC of the rat. Hence, it can be presumed that OB could be a potential alternative drug candidate in the pharmacotherapy of MS.

影响因子:4.30
发表时间:2020-01-24
来源期刊:Experimental neurology
DOI:10.1016/j.expneurol.2020.113212
作者列表:["Bertrand SJ","Zhang Z","Patel R","O'Ferrell C","Punjabi NM","Kudchadkar SR","Kannan S"]

METHODS::Sleep fragmentation is an increase in sleep-wake transitions without an overall decrease in total sleep time. Sleep fragmentation is well documented during acute and chronic hospitalization and can result in delirium and memory problems in children. Sleep fragmentation is also often noted in neurodevelopmental disorders. However, it is unclear how sleep fragmentation independent of disease affects brain development and function. We hypothesized that acute sleep fragmentation during the neonatal period in otherwise healthy animals would result in neuroinflammation and would be associated with abnormalities in cognitive development. The orbital shaker method was used to fragment sleep for 72 h in postnatal day 3 New Zealand white rabbit kits (fragmentation group). To control for maternal separation, the sham group was separated from the dam and maintained in the same conditions without undergoing sleep fragmentation. A naïve control group remained with the dam. Kits underwent behavioral testing with novel object recognition and spontaneous alternation T-maze tests at 2-3 weeks post-fragmentation and were sacrificed 3-50 days after fragmentation. Sleep fragmentation resulted in acute and chronic changes in microglial morphology in the hippocampus and cortex, and regional differences in mRNA expression of pro- and anti-inflammatory cytokines at 3, 7 and 50 days post-fragmentation. Impaired novel object recognition and a longer latency in T-maze task completion were noted in the fragmented kits. This was in spite of normalization of sleep architecture noted at 2 months of age in these kits. The results indicate that transient neonatal sleep fragmentation results in short-term and long-term immune alterations in the brain, along with diminished performance in cognitive tasks long-term.

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影响因子:1.52
发表时间:2020-01-27
来源期刊:World neurosurgery
DOI:10.1016/j.wneu.2020.01.108
作者列表:["Middlebrooks EH","Lin C","Okromelidze L","Lu CQ","Tatum WO","Wharen RE Jr","Grewal SS"]

METHODS:BACKGROUND:Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a recently approved therapy for patients with drug-resistant epilepsy. To date, there is a poor understanding of the mechanism of action and lack of in vivo biomarkers. We propose a method for investigating the in vivo stimulation effects using blood-oxygen-level dependent (BOLD) MRI and present the brain activation pattern associated with ANT DBS. METHODS:Two patients undergoing ANT DBS for epilepsy underwent BOLD MRI using a block design after the DBS was programmed to alternate ON/OFF in 30 second blocks. The scanner was triggered utilizing surface electrophysiological recording to detect the DBS cycle. Nine total runs were obtained and were analyzed using a general linear model. RESULTS:Active ANT stimulation produced activation within several areas of the brain, including the thalamus, bilateral anterior cingulate and posterior cingulate cortex, precuneus, medial prefrontal cortex, amygdala, ventral tegmental area, hippocampus, striatum, and right angular gyrus. CONCLUSIONS:Utilizing block-design BOLD MRI, we were able to show widespread activation resulting from ANT DBS. Overlap with multiple areas of both the default mode and limbic networks was shown suggesting that these nodes may modulate the effect of seizure control with ANT DBS.

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