The evolution of epilepsy surgery between 1991 and 2011 in nine major epilepsy centers across the United States, Germany, and Australia.

OBJECTIVE: Epilepsy surgery is the most effective treatment for select patients with drug-resistant epilepsy. In this article, we aim to provide an accurate understanding of the current epidemiologic characteristics of this intervention, as this knowledge is critical for guiding educational, academic, and resource priorities. METHODS: We profile the practice of epilepsy surgery between 1991 and 2011 in nine major epilepsy surgery centers in the United States, Germany, and Australia. Clinical, imaging, surgical, and histopathologic data were derived from the surgical databases at various centers. RESULTS: Although five of the centers performed their highest number of surgeries for mesial temporal sclerosis (MTS) in 1991, and three had their highest number of MTS surgeries in 2001, only one center achieved its peak number of MTS surgeries in 2011. The most productive year for MTS surgeries varied then by center; overall, the nine centers surveyed performed 48% (95% confidence interval [CI] -27.3% to -67.4%) fewer such surgeries in 2011 compared to either 1991 or 2001, whichever was higher. There was a parallel increase in the performance of surgery for nonlesional epilepsy. Further analysis of 5/9 centers showed a yearly increase of 0.6 ± 0.07% in the performance of invasive electroencephalography (EEG) without subsequent resections. Overall, although MTS was the main surgical substrate in 1991 and 2001 (proportion of total surgeries in study centers ranging from 33.3% to 70.2%); it occupied only 33.6% of all resections in 2011 in the context of an overall stable total surgical volume. SIGNIFICANCE: These findings highlight the major aspects of the evolution of epilepsy surgery across the past two decades in a sample of well-established epilepsy surgery centers, and the critical current challenges of this treatment option in addressing complex epilepsy cases requiring detailed evaluations. Possible causes and implications of these findings are discussed

Epidemiology of status epilepticus in adults: A population-based study on incidence, causes, and outcomes

In 2015, the International League Against Epilepsy (ILAE) proposed a new definition of status epilepticus (SE): 5 minutes of ongoing seizure activity to diagnose convulsive SE (CSE, ie, bilateral tonic-clonic SE) and 10 minutes for focal SE and absence SE, rather than the earlier criterion of 30 minutes. Based on semiology, several types of SE with prominent motor phenomena at any time (including CSE) were distinguished from those without (ie, nonconvulsive SE, NCSE). We present the first population-based incidence study applying the new 2015 ILAE definition and classification of SE and report the impact of the evolution of semiology and level of consciousness (LOC) on outcome

An interdisciplinary framework for evaluating 19th century landscape paintings for ecological research

As we contemplate the future of forest landscapes under changing climate conditions and land-use demands, there is increasing value in studying historic forest conditions and how these landscapes have changed following past disturbances. Historic landscape paintings are a potential source of data on preindustrial forests with highly detailed, full-color depictions of overstory and understory environments. They display key details about forest community composition, microhabitat features, and structural complexity from a time well before the advent of color photography. Despite these paintings’ potential, their scientific applications have been impeded by questions of validity. How truly accurate are the images portrayed in these paintings? How much of an image is an artist’s manipulation of a scene to best illustrate an allegory or romanticized view of nature? Following an established assessment model from historical ecology for evaluating resource validity, we demonstrate how scholarship on art history can be integrated with ecological understanding of forest landscapes to follow this model and address these questions of image veracity in 19th century American art. Further, to illustrate the potential use of these historic images in ecological studies, we present in a case study assessing microhabitat features of 10 different paintings. While this paper explores 19th century landscape art broadly, we focus our art historical review in particular on Asher Durand, a prolific and influential artist associated with the so-called “Hudson River School” in the mid-1800s. Durand left clear records about his perspectives on accurately depicting nature, and from a review of images and writings of Durand, we find support for the potential use of many of his paintings and sketches in historic forest ecology research. However, we also identify important caveats regarding potential ecological interpretations from these images. More broadly, because 19th century landscape paintings are not always directly transcriptive, and because regional art cultures differed in the 1800s, we cannot within this paper speak about landscape image veracity across all 19th century landscape art. However, in following established methods in historical ecology and integrating tools from art history research, we show that one can identify accurate historic landscape paintings for application in scientific studies

Centerscope

Centerscope, formerly Scope, was published by the Boston University Medical Center "to communicate the concern of the Medical Center for the development and maintenance of improved health care in contemporary society.

Differential Brain Development with Low and High IQ in Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) and intelligence (IQ) are both heritable phenotypes. Overlapping genetic effects have been suggested to influence both, with neuroimaging work suggesting similar overlap in terms of morphometric properties of the brain. Together, this evidence suggests that the brain changes characteristic of ADHD may vary as a function of IQ. This study investigated this hypothesis in a sample of 108 children with ADHD and 106 typically developing controls, who participated in a cross-sectional anatomical MRI study. A subgroup of 64 children also participated in a diffusion tensor imaging scan. Brain volumes, local cortical thickness and average cerebral white matter microstructure were analyzed in relation to diagnostic group and IQ. Dimensional analyses investigated possible group differences in the relationship between anatomical measures and IQ. Second, the groups were split into above and below median IQ subgroups to investigate possible differences in the trajectories of cortical development. Dimensionally, cerebral gray matter volume and cerebral white matter microstructure were positively associated with IQ for controls, but not for ADHD. In the analyses of the below and above median IQ subgroups, we found no differences from controls in cerebral gray matter volume in ADHD with below-median IQ, but a delay of cortical development in a number of regions, including prefrontal areas. Conversely, in ADHD with above-median IQ, there were significant reductions from controls in cerebral gray matter volume, but no local differences in the trajectories of cortical development

Neuroleptiques, allongement du QT et mort subite

ANGERS-BU Médecine-Pharmacie (490072105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF