Dynamic interactions between anterior insula and anterior cingulate cortex link perceptual features and heart rate variability during movie viewing

AbstractThe dynamic integration of sensory and bodily signals is central to adaptive behaviour. Although the anterior cingulate cortex (ACC) and the anterior insular cortex (AIC) play key roles in this process, their context-dependent dynamic interactions remain unclear. Here, we studied the spectral features and interplay of these two brain regions using high-fidelity intracranial-EEG recordings from five patients (ACC: 13 contacts, AIC: 14 contacts) acquired during movie viewing with validation analyses performed on an independent resting intracranial-EEG dataset. ACC and AIC both showed a power peak and positive functional connectivity in the gamma (30–35 Hz) frequency while this power peak was absent in the resting data. We then used a neurobiologically informed computational model investigating dynamic effective connectivity asking how it linked to the movie’s perceptual (visual, audio) features and the viewer’s heart rate variability (HRV). Exteroceptive features related to effective connectivity of ACC highlighting its crucial role in processing ongoing sensory information. AIC connectivity was related to HRV and audio emphasising its core role in dynamically linking sensory and bodily signals. Our findings provide new evidence for complementary, yet dissociable, roles of neural dynamics between the ACC and the AIC in supporting brain-body interactions during an emotional experience

Buli dan Hubungannya Dengan Prestasi Akademik di Sekolah Berasrama Penuh di Kedah

The purpose of this study is to describe gangterism in relation to bullying behavior and determine its relationship with students' academic achievement in three residential schools (SBP) in Kedah. The dimensions of bullying studied are types of bullying behavior, types of bullies and victims, places where bullying frequently happened either direct or indirect bullying and bullies and victims emotions and feelings. It is also attempted to identify the relationship between dimensions of bullying behavior and students' academic achievement. The samples of study are students from Form One to Form Five of the three selected SBPs in Kedah. Descriptive analysis and Pearson Correlation (r) are used for data analysis. Results showed that bullying incidents occured mainly in the hostel, cafeteria and bathroom or toilet more frequently compared to other places. More boys and groups of boys were involved in bullying compared to girls and the occurrence is more of indirect bullying. However, there are responses indicating that direct physical bully do exist though at a low rate but this call for appropriate action before the incident is beyond the control of the authority. Result of correlation analysis showed academic achievement was not significantly related with bullying and victims of bullying. Nevertheless, a total of 77 percent of 396 respondents belong to the hogh achievers group compared to 23 percent who belong to the low achievers group

Intracranial EEG recording in autoimmune epilepsy dataset

The appearance of seizures in autoimmune epilepsy on intracranial recordings has not been previously demonstrated. The following data shows a multifocal epilepsy in a patient with seronegative autoimmune epilepsy (reported here; “Electroclinical Insights into Autoimmune Epilepsy”, Gillinder, 2019). Independent seizures were seen to arise from 5 separate foci. These all began with slow repetitive spiking in a highly restricted area. Only after many minutes would this activity spread to other regions. Despite arising from different locations, all foci affected the posterior insula resulting in clinical symptoms

Electroclinical insights into autoimmune epilepsy

Purpose: Chronic autoimmune epilepsy is an increasingly recognised entity however its clinical and electrographic features remain poorly understood. We present a case undergoing diagnostic Stereo-electro-encephalography implantation that was found to have a multifocal perisylvian epilepsy with unique electrographic features and is now seizure free with immunotherapy.Methods: The patient had antibody negative refractory perisylvian epilepsy and underwent implantation of the perisylvian-temporal networks. Immunomodulatory treatment was administered during SEEG.Results: SEEG demonstrated a multifocal perisylvian epilepsy with strong involvement of the posterior insula. There was almost continuous spiking seen interictally from multiple foci within the right hemisphere and independent seizures were generated from 5 locations. After treatment with intravenous methylprednisone and immunoglobulin during SEEG, spiking and seizures terminated while still off anti-seizure medications. The patient remains seizure free on immunotherapy.Conclusion: This case highlights the importance of considering autoimmunity in the differential diagnosis of refractory epilepsy, especially perisylvian epilepsy. It also highlights the need to define a clinical phenotype associated with autoantibodies in epilepsy, as there are likely many cases who are not positive for one of the commercially available tests. This case also provides insights into the possible features of an electroclinical syndrome associated with autoimmunity

Short burst Clobazam dosing at discharge from VEEG evaluation reduces re-presentation with seizures

Purpose: Recurrent seizures and status epilepticus after medication reduction for inpatient Video Electroencephalograph (VEEG) monitoring is a well-known complication of this investigation. In the literature this is reported to occur at a rate of approximately 3–7%. We review the use of short burst Clobazam dosing on discharge from the Epilepsy monitoring unit (EMU) to determine if this might reduce rates of representation with seizures. Methods: We performed a retrospective review of all cases admitted to the EMU. Their medication reduction, number of seizures, seizure severity and demographics were collected. Representations to hospital were considered if they occurred within 14 days of discharge from the unit. Results: 264 cases were included, and 146 patients received 5 days of Clobazam 10 mg PO BD upon discharge after VEEG and 118 did not. There were significantly fewer patients re-presenting to hospital for seizures in the 14 days following discharge in those who were administered short-burst Clobazam compared to those who were not (0% and 4.23% respectively). There was also a trend towards fewer re-admissions for non-seizure indications including mental health issues or non-epileptic seizures and AED side effects. There were no definite adverse reactions to Clobazam recorded. Conclusion: Short burst Clobazam appears to be a safe and effective means to reduce representation with seizures after medication reduction during VEEG recording. This obviously benefits patients but it may also be a cost-effective means to reduce unnecessary health expenditure

The cost-effectiveness of stereo-electroencephalography (SEEG) for people with refractory epilepsy: A decision model analysis

Objective Stereo-electroencephalography (SEEG) is a promising diagnostic technique that is able to localise the focal point of seizure activity in patients with refractory epilepsy who would otherwise not be eligible for surgery. The objective of this study was to determine the long term cost-effectiveness of SEEG. Methods A decision model was developed to compare the costs and health outcomes associated with SEEG, as compared to usual care with anti-epileptic drugs. Data on patient clinical outcomes was obtained from the Mater Advanced Epilespy Unit. A ten year time horizon was adopted and direct health care costs were valued from the perspective of the Australian health care system. Patient health benefits in terms of quality adjusted life years (QALYs). A probabilistic sensitivity analysis was conducted to determine the impacts of uncertainty in the model parameters. Lessons Learned The base case analysis produced an incremental cost-effectiveness ratio for SEEG of $22,925 per QALY, falling below the cost-effectiveness threshold of$28,000 per QALY. The probabilistic sensitivity analysis indicated there was a 79% chance of the technology being cost-effective once uncertainty in the data was taken into account. Implications In Australia, SEEG is not reimbursed under current public funding mechanisms and a large treatment gap exists. This study provides evidence to suggest that SEEG represents a high value use of health care resources when the long term costs and consequences of epilepsy are taken into account. This points to the need for a new DRG code to be created for this procedure

Treatment outcomes after the introduction of a new seizure management protocol

Background/Aim: The present study aims to determine qualitative outcomes of presentations with acute recurrent seizures or status epilepticus to the emergency department of our institution after the introduction of a new seizure management protocol.Methods: We performed a retrospective analysis on two cohorts of patients for all presentations to the emergency department of our institution. Presentations were reviewed from January to July pre-protocol introduction and the same period post-protocol. Patients were included if they were treated for acute recurrent seizures or status epilepticus. The protocol applied a strict treatment regimen and used levetiracetam, valproate and phenobarbitone in place of phenytoin.Results: A total of 77 patients was included from the pre-protocol cohort and 72 from the post-protocol group. There was a significant reduction in intensive care unit (ICU) admission (seven patients in cohort 1 and 0 patients in cohort 2) and adverse drug reactions (18 patients in cohort 1 and four patients in cohort 2). There was a trend towards fewer deaths.Conclusion: The introduction of the new seizure management protocol assessed in this study has resulted in fewer ICU admissions, adverse drug reactions and most importantly fewer patient deaths. This is likely attributable to a combination of improved efficacy of the newer antiepileptic agents and a clearly defined protocol directed therapy

Considerations in performing and analyzing the responses of cortico-cortical evoked potentials in stereo-EEG

This review aims to highlight key considerations when performing cortico-cortical evoked potentials (CCEPs) using stereo–electroencephalography (SEEG) for network mapping and show its clinical applicability to presurgical evaluations. The parameters for performing stimulation and safety aspects have been investigated in electrocorticography (ECoG) and deep brain stimulation (DBS), but not as extensively in SEEG. A review of current literature was performed, with an attempt made to emphasize practical insights from all modalities of intracranial stimulation. This paper reviews physical stimulation parameters, highlights safety limits, and considers the influence of changing common stimulation parameters. These factors are put into the context of CCEPs in SEEG. Given the paucity of direct research in this area, studies utilizing low frequency stimulation, DBS, and ECoG are incorporated along with the fundamental principles of electrical engineering. In addition, postprocessing considerations are reviewed, including electrode localization, application of digital filters, baseline selection, application of connectivity metrics, and higher order network analysis. The aim is to guide CCEP stimulation as well as to provide an understanding of the underlying principles of this technique. At present, there are few articles detailing the design of low-frequency stimulation paradigms, especially in the setting of SEEG. Providing a review of the fundamentals and postprocessing considerations when performing CCEPs in SEEG will increase the accessibility of this technique

Resource use and costs associated with epilepsy in the Queensland hospital system: Protocol for a population-based data linkage study

Introduction: Epilepsy places a large burden on health systems, with hospitalisations for seizures alone occurring more frequently than those related to diabetes. However, the cost of epilepsy to the Australian health system is not well understood. The primary aim of this study is to quantify the health service use and cost of epilepsy in Queensland, Australia. Secondary aims are to identify differences in health service use and cost across population and disease subgroups, and to explore the associations between health service use and common comorbidities. Methods and analysis: This project will use data linkage to identify the health service utilisation and costs associated with epilepsy. A base cohort of patients will be identified from the Queensland Hospital Admitted Patient Data Collection. We will select all patients admitted between 2014 and 2018 with a diagnosis classification related to epilepsy. Two comparison cohorts will also be identified. Retrospective hospital admissions data will be linked with emergency department presentations, clinical costing data, specialist outpatient and allied health occasions of service data and mortality data. The level of health service use in Queensland, and costs associated with this, will be quantified using descriptive statistics. Difference in health service costs between groups will be explored using logistic regression. Linear regression will be used to model the associations of interest. The analysis will adjust for confounders including age, sex, comorbidities, indigenous status, and remoteness. Ethics and dissemination: Ethical approval has been obtained through the QUT University Human Research Ethics Committee (1900000333). Permission to waive consent has been granted under the Public Health Act 2005, with approval provided by all relevant data custodians. Findings of the proposed research will be communicated through presentations at national and international conferences, presentations to key stakeholders and decision-makers, and publications in international peer-reviewed journals.</p

Refractory chronic epilepsy associated with neuronal auto-antibodies: could perisylvian semiology be a clue?

Aims. We report a case series of 10 patients with chronic medically refractory antibody-positive autoimmune epilepsy and assess their common clinical features. Immune-mediated seizures are most commonly reported in the context of encephalitis or encephalopathy, with few reports focusing on lone, chronic epilepsy in the outpatient setting. Our aim was to define the potential diagnostic clues that might be present in these cases, leading to consideration of an autoimmune cause of the epilepsy