Persistent frequent subclinical seizures and memory impairment after clinical remission in smoldering limbic encephalitis.

Aim. To delineate a possible correlation between clinical course and EEG abnormalities in non-infectious “smoldering” limbic encephalitis. Methods. Long-term clinical data, including video-EEG monitoring records, were analysed in two patients. Results. The two patients were positive for anti-voltage-gated potassium channel complex antibody and unspecified antineuronal antibody, respectively. The latter patient had small cell lung carcinoma. Both patients had memory impairment and clinical seizures. EEG showed frequent subclinical seizure patterns in the bilateral temporal regions. Subclinical seizure patterns and memory impairment persisted over one to two years after clinical seizure remission. Therapy (prednisolone and chemoradiation in the two patients, respectively) resulted in decreased occurrence of subclinical seizure patterns and memory improvement. Conclusions. EEG seizure patterns may persist years after clinical seizure remission in “smoldering” limbic encephalitis and lead to memory impairment

Ictal direct current shifts contribute to defining the core ictal focus in epilepsy surgery

難治てんかん焦点の新しいバイオマーカー「発作時DC電位」 --国内5施設の共同研究での世界初の成果--. 京都大学プレスリリース. 2022-09-05.Identifying the minimal and optimal epileptogenic area to resect and cure is the goal of epilepsy surgery. To achieve this, EEG analysis is recognized as the most direct way to detect epileptogenic lesions from spatiotemporal perspectives. Although ictal direct-current shifts (icDCs; below 1 Hz) and ictal high-frequency oscillations (icHFOs; above 80 Hz) have received increasing attention as good indicators that can add more specific information to the conventionally defined seizure-onset zone, large cohort studies on postoperative outcomes are still lacking. This work aimed to clarify whether this additional information, particularly icDCs which is assumed to reflect extracellular potassium concentration, really improve postoperative outcomes. To assess the usefulness in epilepsy surgery, we collected unique EEG datasets recorded with a longer time constant of 10 sec using an alternate current amplifier. 61 patients [15 with mesial temporal lobe epilepsy and 46 with neocortical epilepsy] who had undergone invasive presurgical evaluation for medically refractory seizures at five institutes in Japan, were retrospectively enrolled in this study. Among intracranially implanted electrodes, the two core electrodes of both icDCs and icHFOs were independently identified by board-certified clinicians based on unified methods. The occurrence patterns, such as their onset time, duration, and amplitude (power) were evaluated to extract the features of both icDCs and icHFOs. Additionally, we examined whether the resection ratio of the core electrodes of icDCs and icHFOs independently correlated with favorable outcomes. A total of 53 patients with 327 seizures were analyzed for wide-band EEG analysis, and 49 patients were analyzed for outcome analysis. icDCs were detected in the seizure-onset zone more frequently than icHFOs among both patients (92% vs. 71%) and seizures (86% vs. 62%). Additionally, icDCs significantly preceded icHFOs in patients exhibiting both biomarkers, and icDCs occurred more frequently in neocortical epilepsy patients than in mesial temporal lobe epilepsy patients. Finally, although a low corresponding rate was observed for icDCs and icHFOs (39%) at the electrode level, complete resection of the core area of icDCs significantly correlated with favorable outcomes, similar to icHFO outcomes. Our results provide a proof of concept that the independent significance of icDCs from icHFOs should be considered as reliable biomarkers to achieve favorable outcomes in epilepsy surgery. Moreover, the different distribution of the core areas of icDCs and icHFOs may provide new insights into the underlying mechanisms of epilepsy, in which not only neurons but also glial cells may be actively involved via extracellular potassium levels

ヒトの難治てんかんの頭蓋内記録で、発作時直流電位は高周波数律動より先行する

京都大学0048新制・課程博士博士(医学)甲第18644号医博第3943号新制||医||1006(附属図書館)31558京都大学大学院医学研究科医学専攻(主査)教授 河野 憲二, 教授 福山 秀直, 教授 渡邉 大学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDFA

A New Liberal Class in Japan : Based on Latent Class Analysis

Presently, in Japanese politics, the majority of people opt to vote for conservative parties, with anti-conservatives and old liberals losing power and representation in the government. This study explores the emerging middle-class who may potentially lead to an alternative liberal politics in Japan. Using responses to an Internet survey conducted in 2018 as our data, we articulate features of a new liberal class by constructing a theory of class articulation and combining that theory with latent class analysis to compare the new liberals to old liberals and conservatives. This is the first attempt to apply latent class analysis to figure out differences in political orientations among possible social classes. We analyze some personality traits of the new liberals using our original 18 personality categories. We also analyze their social attitudes by comparing their questionnaire responses to those of old liberals. Although our analysis shows that new liberals are not experiencing upward social mobility, their personalities as defined by our study constitute a new political class, that is particularly sensitive to the environmental issues, and prefer the nature and minimal consumption. We discovered that these new liberals are in their sixties, graduates of university or graduate school, professionals, and low-income people. We have also discovered that although these new liberals are a coherent political class, they have no representations in our political party system. However, further research based on mail survey especially for elderly people should be conducted in order to conceive more precise features of new liberals