Personality changes in patients suffering from drug-resistant epilepsy after surgical treatment : a 1-year follow-up study

Acord transformatiu CRUE-CSICObjective: To determine changes in dimensions of personality in a sample of patients suffering from drug-resistant epilepsy at the 1-year follow-up following surgery, compared to non-surgically treated controls. Methods: We conducted a prospective comparative controlled study, including drug-resistant epilepsy surgery candidates. Demographic, psychiatric, neurological, and psychological data were recorded. Presurgical and 12-months follow-up evaluations were performed. Personality dimensions were measured by the NEO Five-Factor Inventory, Revised version (NEO-FFI-R), anxiety and depression symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS: HADA-Anxiety and HADD-Depression), psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis-I disorders classification. Statistical analysis consisted of comparative tests, correlation analysis, and the stepwise multiple regression test (ANOVA). Results: A 1-year follow-up was completed by 70 out of 80 patients. Through the study, the surgical group decreased in neuroticism and increased in agreeableness. The controls increased in consciousness, and these changes were predicted by the earlier age of epilepsy onset and lesser score in HADD at the baseline. No personality changes were associated with seizure frequency. The presurgical evaluation concluded that both groups had no differences in demographic, psychiatric, or neurological variables with the only exception being for the number of seizures per month, which was higher in the surgical group. Psychiatric comorbidity in patients was associated with their higher degree of neuroticism and agreeableness at the baseline. Comparing control and surgical groups at the one-year follow-up, the agreeableness personality variable was higher in the surgical group, and as expected, HADS scores were higher in the control group, and seizure frequency was also higher in the control group. Significance: Higher agreeableness was the most relevant difference in personality dimensions in patients who underwent surgical treatment compared with the non-surgical treatment group. After surgery patients decreased in neuroticism and increased in agreeableness scores

Influence of personality profile in patients with drug-resistant epilepsy on quality of life following surgical treatment : A 1-year follow-up study

Acord transformatiu CRUE-CSICThe objectives of this study are to determine the influence of personality profile in patients with drug-resistant epilepsy on quality of life (QoL) after surgical treatment and compare the results with a non-surgical control group at the 1-year follow-up. We conducted a prospective, comparative, controlled study, including 70 patients suffering from drug-resistant epilepsy. Demographic, psychiatric, neurological, and psychological data were recorded at the baseline and at the 1-year follow-up. Assessment of personality dimensions was performed using the NEO-FFI-R questionnaire; severity of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS), and QoL was evaluated using the QOLIE-31. At the 1-year follow-up, comparing the control and the surgical groups, we detected differences in scores of most items of QoL, which were higher in those patients who had undergone surgery. High levels of Conscientiousness and Openness to experience at the baseline in patients who underwent surgery predicted better post-surgical outcomes in the QoL scores, whereas high neurotic patients showed worse QoL results. Postoperative changes in QoL in patients were associated with the personality profile at the baseline. QoL measures significantly improved in the surgical group compared with the non-surgical group but were not associated with baseline or postoperative seizure frequency at 1 year

Spanish version of the Satisfaction with Epilepsy Care questionnaire: Adaptation and psychometric properties

OBJECTIVE: The objective of this study was to perform a cross-cultural adaption and psychometric evaluation of the Spanish version of the Satisfaction with Epilepsy Care (SEC) questionnaire and analyze patient satisfaction with epilepsy care. METHODS: Transcultural adaptation and validation of the SEC were carried out using translation and back-translation with pilot testing and an expert panel. The SEC-E (Spanish) was analyzed in 213 patients with epilepsy to examine construct and criterion validity and internal consistency. RESULTS: The SEC-E achieved conceptual, semantic, and content equivalence with the original version. For content validity, one question was eliminated from the original questionnaire as it has little relevance in our cultural setting. Positive correlations for criterion validity were obtained using the gold standard measure (Satisfaction in Hospitalized Patients scale). Construct validity replicated the three dimensions of the original questionnaire. The scale showed adequate reliability through internal consistency (Cronbach's α of 0.94) and temporal stability on retest (n = 85). Patients scored (0 to 100) 77.5 [standard deviation (SD): 19.9] for satisfaction with communication, 76.9 (SD: 17) for organization, and 67.2 (SD: 22.1) for information. SIGNIFICANCE: The SEC-E is a valid and reliable tool for the assessment of educational interventions aiming to improve the quality of care in patients with epilepsy in Spanish clinical practice. The results showed a good level of patient satisfaction with epilepsy care

Interpretable surface-based detection of focal cortical dysplasias:a Multi-centre Epilepsy Lesion Detection study

One outstanding challenge for machine learning in diagnostic biomedical imaging is algorithm interpretability. A key application is the identification of subtle epileptogenic focal cortical dysplasias (FCDs) from structural MRI. FCDs are difficult to visualize on structural MRI but are often amenable to surgical resection. We aimed to develop an open-source, interpretable, surface-based machine-learning algorithm to automatically identify FCDs on heterogeneous structural MRI data from epilepsy surgery centres worldwide. The Multi-centre Epilepsy Lesion Detection (MELD) Project collated and harmonized a retrospective MRI cohort of 1015 participants, 618 patients with focal FCD-related epilepsy and 397 controls, from 22 epilepsy centres worldwide. We created a neural network for FCD detection based on 33 surface-based features. The network was trained and cross-validated on 50% of the total cohort and tested on the remaining 50% as well as on 2 independent test sites. Multidimensional feature analysis and integrated gradient saliencies were used to interrogate network performance. Our pipeline outputs individual patient reports, which identify the location of predicted lesions, alongside their imaging features and relative saliency to the classifier. On a restricted 'gold-standard' subcohort of seizure-free patients with FCD type IIB who had T1 and fluid-attenuated inversion recovery MRI data, the MELD FCD surface-based algorithm had a sensitivity of 85%. Across the entire withheld test cohort the sensitivity was 59% and specificity was 54%. After including a border zone around lesions, to account for uncertainty around the borders of manually delineated lesion masks, the sensitivity was 67%. This multicentre, multinational study with open access protocols and code has developed a robust and interpretable machine-learning algorithm for automated detection of focal cortical dysplasias, giving physicians greater confidence in the identification of subtle MRI lesions in individuals with epilepsy

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Neuroimagen avanzada en la identificación de cambios estructurales y funcionales de memoria en pacientes con epilepsia del lóbulo temporal como aproximación a la medicina de precisión.

[spa] La neuroimagen ha adquirido un papel determinante en la valoración diagnóstico-terapéutica de la epilepsia y más especialmente en los casos de farmacorresistencia. La resección temporal antero-medial (RTAM) es el tratamiento quirúrgico más establecido para la ELT refractaria a fármacos. El tratamiento quirúrgico en la epilepsia focal refractaria se ha asociado con un aumento de 5 años en la esperanza de vida. La predicción del deterioro cognitivo tras la RTAM es esencial para asesorar a los pacientes sobre el riesgo de afectación de funciones relevantes como la memoria verbal. Diversos estudios han valorado el uso de distintas técnicas de imagen para la evaluación cognitiva, pero no existe una técnica específica de análisis estructural ni tampoco ningún paradigma de memoria verbal estandarizado en la evaluación prequirúrgica de epilepsia. La epilepsia tiene distintas etiologías. En el caso de la esclerosis del hipocampo (EH), los cambios morfológicos específicos en las subregiones hipocámpicas podrían ser relevantes como marcador de su etiología y conllevar implicaciones clínicas importantes, ya que la ELT asociada a anticuerpos neuronales presenta mala respuesta al abordaje quirúrgico. Esta tesis doctoral pretende conocer en mayor detalle las alteraciones tanto estructurales como funcionales en la ELT y su relación con la disfunción cognitiva para para poder ahondar en técnicas que nos permitan disponer de marcadores no invasivos de uso clínico. Hemos planteado las siguientes hipótesis: 1) los cambios morfológicos del hipocampo difieren en pacientes con ELT mesial según la etiología, 2) las alteraciones morfológicas en la ELT no inmune ocurren a edades tempranas y esto permite una reorganización funcional preservando mejor la funcionalidad que en la etiología inmune por anticuerpos GAD65, 3) el uso de un paradigma de aprendizaje verbal basado en el test de aprendizaje verbal auditivo de Rey (AVLT), que es un test ampliamente usado en la evaluación neuropsicológica para valorar la función del hipocampo, permitiría lateralizar la memoria verbal y mostrarnos las diferencias funcionales de activación durante la tarea en el eje hipocámpico anteroposterior. Esto tendría una importante aplicación clínica en la evaluación prequirúrgica de epilepsia. Los dos primeros objetivos de esta tesis son la mejor caracterización de los cambios morfológicos del hipocampo observados en la resonancia magnética (RM) de pacientes con ELT por anticuerpos GAD65 en comparación con la ELT no inmune y controles sanos, así como su relación con los déficits cognitivos. Estos objetivos se abordan en el primer artículo donde se evalúan los cambios del hipocampo tanto volumétricos como de forma y su correlación con los déficits de memoria en los tres grupos. Los pacientes con ELT autoinmune por GAD65 mostraron una fuerte correlación entre la duración de la enfermedad y el análisis volumétrico, que sugiere que la atrofia puede ocurrir progresivamente a lo largo de los años, y también alteraciones de forma en comparación a los controles sanos, pero mucho menos extensos que las alteraciones observadas en los pacientes con ELT no autoinmune. La disfunción cognitiva fue similar en ambos grupos, pero los cambios volumétricos específicos de cada subregión hipocámpica podrían ser relevantes como marcador de la identidad patológica específica. El tercer objetivo pretende investigar la activación hipocámpica en los pacientes con ELT mediante RM funcional (RMf) con tarea de memoria. Se busca evaluar la eficiencia de la RMf con un paradigma clínico centrado en una tarea de memoria verbal para valorar la de lateralización de la activación y como potencial herramienta en la predicción de déficits mnésicos postquirúrgicos en la RTAM. Este objetivo se ha abordado en el segundo artículo que es un estudio trasversal en el que se ha empleado RMf mediante un paradigma de memoria verbal basado en una prueba de memoria establecida como es el AVLT para evaluar las diferencias en el índice de lateralidad (LI) de la memoria y su asociación con el deterioro neuropsicológico y el lenguaje. El paradigma adaptado al AVLT fue capaz de provocar la activación del hipocampo en el 100% de los controles sanos y en el 92% de los pacientes. Además, nuestros resultados sugieren una redistribución distintiva de los sistemas de memoria verbal y lenguaje en la ELT izquierdo.[eng] Neuroimaging has become a relevant tool in the diagnostic evaluation and therapeutic approach of focal epilepsy, especially in cases of drug resistance. MRI is used for etiological assessment and allows to precisely find structural abnormalities, but also for selecting the appropriate treatment approach after evaluating cognitive functions such as memory and language prior to a surgical approach to epilepsy. Antero-medial temporal resection (AMTR) is the most established surgical treatment for drug-refractory temporal lobe epilepsy (TLE). Surgery, when possible, has been associated with a 5-year increase in life expectancy. Prediction of cognitive impairment after AMTR is essential to properly counsel patients about potential decline in relevant functions such as verbal memory. Several studies have assessed the use of different imaging techniques for cognitive evaluation but there is neither any specific structural analysis technique nor standard verbal memory paradigm in presurgical assessment. TLE has different etiologies, and the specific morphological changes of each hippocampal subfield could be relevant as a marker of the specific etiology, which also has relevant clinical implications since TLE associated with neuronal antibodies has a poor response after surgical approach. This doctoral thesis aims to learn in greater detail the structural and functional alterations in temporal lobe epilepsy and its relationship with cognitive dysfunction to delve into techniques that allow us to have non-invasive markers for clinical use. We have thought of the following hypotheses: 1) hippocampal morphological changes differ in patients with TLE according to etiology, 2) temporal morphological alterations in non-immune TLE occur at early ages which would allow them a functional reorganization preserving better functionality than in immune etiology by anti-GAD65 antibodies 3) the use of a verbal learning paradigm based on the Rey auditory verbal test (AVLT), which is a test widely used in neuropsychological evaluation to assess hippocampal function, could assist in the lateralization of verbal memory at the hippocampus, and also showing specific differences of activation in the anteroposterior hippocampal axis according to the task phase. The first and second aims of this thesis are to better characterize the hippocampal morphological changes observed on MRI of patients with GAD-TLE compared to non-immune TLE and healthy controls, as well as their relationship to cognitive deficits. These objectives are addressed in the first article where both volumetric and shape hippocampal changes and their correlation with memory deficits are evaluated in each of the groups. Patients with autoimmune TLE by GAD65 showed a strong correlation between disease duration and volumetric analysis which suggests that atrophy may occur progressively over the years. Shape deformations were found compared with healthy controls, but much less extensive than the changes observed in patients with non-autoimmune TLE. Cognitive dysfunction was similar in both groups but volumetric changes specific to each hippocampal subregion could be relevant as a marker of their specific pathological identity. The third objective aims to investigate hippocampal activation by functional MRI with memory task to evaluate the radiological efficiency of a verbal clinical paradigm for clinical use as an MRI task, to assess the lateralization of activation for the prediction of postsurgical mnesic deficits in temporal epilepsy surgery. This objective has been addressed in the second article which is a cross-sectional study in which a verbal memory paradigm based on an established memory test such as the AVLT has been employed to assess differences in LI memory and its association with neuropsychological and language impairment. The AVLT-adapted paradigm was able to elicit hippocampal activation in 100% of healthy controls and 92% of patients. Our results suggest a distinct redistribution of verbal memory and language systems in the left TLE

Emergency implementation of telemedicine for epilepsy in Spain: Results of a survey during SARS-CoV-2 pandemic.

Teleneurology in Spain had not been implemented so far in clinical practice, except in urgent patients with stroke. Telemedicine was hardly used in epilepsy, and patients and neurologists usually preferred onsite visits. Our goal was to study impressions of adult and pediatric epileptologists about the use of telemedicine after emergent implementation during the new coronavirus 2019 (COVID-19) pandemic. An online survey was sent to the members of the Spanish Epilepsy Society and the members of the Epilepsy Study Group of the Catalan Neurological Society, inquiring about different aspects of telemedicine in epilepsy during the pandemic lockdown. A total of 66 neurologists responded, mostly adult neurologists (80.3%), the majority with a monographic epilepsy clinic (4 out of 5). Of all respondents, 59.1% reported to attend more than 20 patients with epilepsy (PWE) a week. During the pandemic, respondents handled their epilepsy clinics mainly with telephone calls (88%); only 4.5% used videoconference. Changes in antiseizure medications were performed less frequently than during onsite visits by 66.6% of the epileptologists. Scales were not administered during these visits, and certain types of information such as sudden expected unrelated death in epilepsy (SUDEP) were felt to be more appropriate to discuss in person. More than 4 out of 5 of the neurologists (84.8%) stated that they would be open to perform some telematic visits in the future. In Spain, emergent implantation of teleneurology has shown to be appropriate for the care of many PWE. Technical improvements, extended use of videoconference and patient selection may improve results and patient and physician satisfaction

Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study

OBJECTIVE: Drug-resistant focal epilepsy is often caused by focal cortical dysplasias (FCDs). The distribution of these lesions across the cerebral cortex and the impact of lesion location on clinical presentation and surgical outcome are largely unknown. We created a neuroimaging cohort of patients with individually mapped FCDs to determine factors associated with lesion location and predictors of postsurgical outcome. METHODS: The MELD (Multi-centre Epilepsy Lesion Detection) project collated a retrospective cohort of 580 patients with epilepsy attributed to FCD from 20 epilepsy centers worldwide. Magnetic resonance imaging-based maps of individual FCDs with accompanying demographic, clinical, and surgical information were collected. We mapped the distribution of FCDs, examined for associations between clinical factors and lesion location, and developed a predictive model of postsurgical seizure freedom. RESULTS: FCDs were nonuniformly distributed, concentrating in the superior frontal sulcus, frontal pole, and temporal pole. Epilepsy onset was typically before the age of 10 years. Earlier epilepsy onset was associated with lesions in primary sensory areas, whereas later epilepsy onset was associated with lesions in association cortices. Lesions in temporal and occipital lobes tended to be larger than frontal lobe lesions. Seizure freedom rates varied with FCD location, from around 30% in visual, motor, and premotor areas to 75% in superior temporal and frontal gyri. The predictive model of postsurgical seizure freedom had a positive predictive value of 70% and negative predictive value of 61%. SIGNIFICANCE: FCD location is an important determinant of its size, the age at epilepsy onset, and the likelihood of seizure freedom postsurgery. Our atlas of lesion locations can be used to guide the radiological search for subtle lesions in individual patients. Our atlas of regional seizure freedom rates and associated predictive model can be used to estimate individual likelihoods of postsurgical seizure freedom. Data-driven atlases and predictive models are essential for evidence-based, precision medicine and risk counseling in epilepsy