A meta-analysis on progressive atrophy in intractable temporal lobe epilepsy Time is brain?

Objective: It remains unclear whether drug-resistant temporal lobe epilepsy (TLE) is associated with cumulative brain damage, with no expert consensus and no quantitative syntheses of the available evidence. Methods: We conducted a systematic review and meta-analysis of MRI studies on progressive atrophy, searching PubMed and Ovid MEDLINE databases for cross-sectional and longitudinal quantitative MRI studies on drug-resistant TLE. Results: We screened 2,976 records and assessed eligibility of 248 full-text articles. Forty-two articles met the inclusion criteria for quantitative evaluation. We observed a predominance of cross-sectional studies, use of different clinical indices of progression, and high heterogeneity in age-control procedures. Meta-analysis of 18/1 cross-sectional/longitudinal studies on hippocampal atrophy (n 5 979 patients) yielded a pooled effect size of r 5 20.42 for ipsilateral atrophy related to epilepsy duration (95% confidence interval [CI] 20.51 to 20.32; p , 0.0001; I 2 5 65.22%) and r 5 20.35 related to seizure frequency (95% CI 20.47 to 20.22; p , 0.0001; I 2 5 61.97%). Sensitivity analyses did not change the results. Narrative synthesis of 25/3 crosssectional/longitudinal studies on whole brain atrophy (n 5 1,504 patients) indicated that .80% of articles reported duration-related progression in extratemporal cortical and subcortical regions. Detailed analysis of study design features yielded low to moderate levels of evidence for progressive atrophy across studies, mainly due to dominance of cross-sectional over longitudinal investigations, use of diverse measures of seizure estimates, and absence of consistent age control procedures. Conclusions: While the neuroimaging literature is overall suggestive of progressive atrophy in drug-resistant TLE, published studies have employed rather weak designs to directly demonstrate it. Longitudinal multicohort studies are needed to unequivocally differentiate aging from disease progression

Progetto Terra più Sicura: i rischi geologici e la loro prevenzione spiegati agli studenti delle scuole secondarie di primo grado

L'associazione Geologia Senza Frontiere onlus (www.gsf.it) è nata nel 2003 dalla volontà di un gruppo di geologi, ambientalisti e naturalisti di dare una prospettiva comune alle competenze conseguite nell'ambito della ricerca universitaria, dell'attività professionale e della cooperazione. Durante l'anno scolastico 2013-2014 Geologia Senza Frontiere ha ideato e realizzato il progetto Terra più Sicura (TpS), volto all'insegnamento dei rischi geologici in scuole secondarie di primo grado di Lazio, Toscana e Veneto. Gli obiettivi del progetto sono stati in particolare l'avvicinamento di studenti ed insegnanti ai problemi della sicurezza del territorio, dei rischi in esso presenti, oltre a come prevenire ed affrontare in maniera consapevole e corretta le emergenze naturali

Preoperative language mapping using navigated TMS compared with extra-operative direct cortical stimulation using intracranial electrodes: A case report

Highlights 1. rTMS provides a non-invasive means of performing pre-operative language mapping. 2. Sensitivity and specificity in epilepsy patients is lower than reported in tumour surgery. 3. Future methodological improvements may improve this

Quantitative Susceptibility Mapping (QSM) is Sensitive to Hippocampal and Subcortical Gray Matter Changes in Temporal Lobe Epilepsy

Although temporal lobe epilepsy (TLE) results in widespread changes in MRI measures of tissue volume, diffusion and functional connectivity, changes in tissue composition in TLE have not been investigated with MRI. Quantitative susceptibility mapping (QSM) is sensitive to changes in tissue composition, in particular to iron and myelin. Here, we show for the first time that QSM is sensitive to gray matter abnormalities in 31patients with temporal lobe epilepsy (TLE) compared to 23 healthy controls, and showed significant susceptibility changes in the hippocampus in left TLE patients, and in the bilateral thalamus in both left and right TLE

Imaging Biomarkers of Anti-Epileptic Drug Action: Insights from Magnetic Resonance Imaging

Background: Approximately one third of patients with epilepsy are refractory to medical treatment. Adverse effects associated with Anti-Epileptic Drugs (AEDs) are considered to affect quality of life often more than seizures themselves. Neuroimaging techniques, particularly Magnetic Resonance Imaging (MRI), have proven instrumental in clinical decision making in relation to epilepsy surgery, but may also provide further insights into the mechanisms underlying treatment response and side effects associated with AEDs. Objective and Method: We searched PubMed and Scopus databases for original articles and reviews published in the last two decades, which addressed the effects of AEDs on structural MRI, functional MRI and Magnetic Resonance Spectroscopy (MRS) measures. Results: The majority of investigations implemented task-based fMRI, and probed the influence of widely used anti-epileptic drugs on tasks assessing language, executive functions and emotion recognition. Collectively, MRI allows detecting reproducible AED-related effects on regions and networks relevant to disease pathomechanisms, thus elucidating the anatomo-functional substrates of cognitive side effects. MRS analyses shed light on the molecular correlates of AED action, and may provide indicators of treatment response. Conclusion: MRI techniques have considerably improved our understanding of the effects of AEDs at a regional and network level, and provide biomarkers with potential to improve routine clinical decision making in epilepsy

Decoupling of functional and structural language networks in temporal lobe epilepsy

OBJECTIVE: To identify functional and structural alterations in language networks of people with temporal lobe epilepsy (TLE), who frequently present with naming and word-finding difficulties. METHODS: Fifty-five patients with unilateral TLE (29 left) and 16 controls were studied with auditory and picture naming functional magnetic resonance imaging (fMRI) tasks. Activation maxima in the left posterobasal temporal lobe were used as seed regions for whole-brain functional connectivity analyses (psychophysiological interaction). White matter language pathways were investigated using diffusion tensor imaging and neurite orientation dispersion and density imaging metrics extracted along fiber bundles starting from fMRI-guided seeds. Regression analyses were performed to investigate the correlation of functional connectivity with diffusion MRI metrics. RESULTS: In the whole group of patients and controls, weaker functional connectivity from the left posterobasal temporal lobe (1) to the bilateral anterior temporal lobe, precentral gyrus, and lingual gyrus during auditory naming and (2) to the bilateral occipital cortex and right fusiform gyrus during picture naming was associated with decreased neurite orientation dispersion and higher free water fraction of white matter tracts. Compared to controls, TLE patients exhibited fewer structural connections and an impaired coupling of functional and structural metrics. SIGNIFICANCE: TLE is associated with an impairment and decoupling of functional and structural language networks. White matter damage, as evidenced by diffusion abnormalities, may contribute to impaired functional connectivity and language dysfunction in TLE

Transparent Films Made of Highly Scattering Particles

Today, colloids are widely employed in various products from creams and coatings to electronics. The ability to control their chemical, optical, or electronic features by controlling their size and shape explains why these materials are so widely preferred. Nevertheless, altering some of these properties may also lead to some undesired side effects, one of which is an increase in optical scattering upon concentration. Here, we address this strong scattering issue in films made of binary colloidal suspensions. In particular, we focus on raspberry-type polymeric particles made of a spherical polystyrene core decorated by small hemispherical domains of acrylate with an overall positive charge, which display an unusual stability against aggregation in aqueous solutions. Their solid films display a brilliant red color due to Bragg scattering but appear completely white on account of strong scattering otherwise. To suppress the scattering and induce transparency, we prepared films by hybridizing them with oppositely charged PS particles with a size similar to that of the bumps on the raspberries. We report that the smaller PS particles prevent raspberry particle aggregation in solid films and suppress scattering by decreasing the spatial variation of the refractive index inside the film. We believe that the results presented here provide a simple strategy to suppress strong scattering of larger particles to be used in optical coatings

Naming fMRI predicts the effect of temporal lobe resection on language decline

Objective: To develop language functional MRI (fMRI) methods that accurately predict postsurgical naming decline in temporal lobe epilepsy (TLE). Methods: Forty‐six patients with TLE (25 left) and 19 controls underwent two overt fMRI paradigms (auditory naming and picture naming, both with active baseline conditions) and one covert task (verbal fluency). Clinical naming performance was assessed preoperatively and 4 months following anterior temporal lobe resection. Preoperative fMRI activations were correlated with postoperative naming decline. Individual laterality indices (LI) were calculated for temporal (auditory and picture naming) and frontal regions (verbal fluency) and were considered as predictors of naming decline in multiple regression models, along with other clinical variables (age at onset of seizures, preoperative naming scores, hippocampal volume, age). Results: In left TLE patients, activation of the left posterior inferior temporal gyrus during auditory naming and activation of left fusiform gyrus during picture naming were related to greater postoperative naming decline. Activation LI were the best individual predictors of naming decline in a multivariate regression model. For picture naming, an LI of higher than 0.34 gave 100% sensitivity and 92% specificity (positive predictive value (PPV) 91.6%). For auditory naming, a temporal lobe LI higher than 0.18 identified all patients with a clinically significant naming decline with 100% sensitivity and 58% specificity (PPV: 58.3%). No effect was seen for verbal fluency. Interpretation: Auditory and picture naming fMRI are clinically applicable to predict postoperative naming decline after left temporal lobe resection in individual patients, with picture naming being more specific