Organic mental disorders (other than memory disorders, depression and psychosis) after temporal lobe epilepsy surgery

Epilepsy is one of the commonest neurological diseases (Hauser & Kurland 1975). Despite medical advances in treatment, 30% of focal epilepsies remain intractable to anti-epileptic drugs (Spencer 2008). The resective surgical alternative in patients with temporal lobe epilepsy (TLE) offers a good rate of long-term seizure freedom (Shorvon 2005) but is also often the source of postsurgical psychiatric and behavioural disturbance. The great majority of studies in this area have focused on depression, anxiety and psychosis, and memory disturbance. The occurrence of other organic mental disorders (OMDs) is often ignored. These disorders are generally underdiagnosed. This is because, pre-operative and post-operative psychiatric assessment is often overlooked, because of the lack of standardised classification (and hence vocabulary to describe these conditions) and a lack of sensitive psychological instruments to detect these conditions. Two main instruments are widely used in psychiatry for the classification of OMDs (LM, DSM-IV, and ICD-10). None is specific to epilepsy and epilepsy surgery. A third classification - the Lindqvist- Malmgren (LM) - has been proposed and is beginning to be used particularly in epilepsy circles. Aims: This thesis has 4 main aims -to describe the LM diagnostic system for organic psychiatry and contrast it with DSM-IV and ICD-10 (Aim 1) to review the occurrence and type of OMDs after TLES in the literature (Aim 2) to define the existence of an 'ideal' classification for use in studying the OMDs due to TLES (Aim 3) and to outline the structure of a pilot questionnaire for use in the evaluation of the range and extent of OMDs that occur following TLES and the design of a future research project to use in such evaluations (Aim 4). Methods: the information for this thesis was extracted from a database search of the literature of the last 40 years and from a scrutiny of the reference lists of all the relevant papers. It also relies on the interview of Professors Helge and Kristina Malmgren conducted in Sweden as part of data-gathering. Results and discussion: Aim 1: The LM scheme is poorly documented in the English literature. It is based on an etiologically neutral approach and individualises 6 main OMDs, the most important being the Astheno-Emotional Disorder. Several of its important categories have no equivalent in the DSM-IV and ICD-10 (including Astheno-Emotional Disorder, Emotional-Motivational Blunting Disorder, and Hallucination-Coenestopathy-Depersonalisation Disorder) and the categorization differs in terms of diagnostic criteria and the specification of individualised disorders. Aim 2: OMDs are rarely assessed in the course of TLES and there is a surprising dearth of cases documented in the literature, in spite of their frequent occurrence and potential importance. Where they have been reported in the literature, the diagnostic scheme used has varied (or indeed is often not specified). The reported cases from the literature review can be divided into 8 main categories: Astheno-Emotional and Emotional Motivational Blunting Disorder, interictal dysphoric disorder, mood disorders, obsessive-compulsive disorders, personality disorders, behavioural disorders, sexual disturbances, suicide and suicide attempts. Aim 3: None of the currently available classifications is considered 'ideal' in the study of the occurrence and range of OMDs following TLES. However, a modification of the LM scheme is the most likely to fulfill this condition. The suggested modifications can be amended to the existing classes of OMDs or integrated as new disorders and should include, for instance, the interictal dysphoric disorder, personality disorders and the Bear and Fedio traits (Bear & Fedio 1977). Aim 4: A suggested pilot questionnaire is proposed which explores the previously mentioned 8 OMDs categories individualised by the review of the literature as being consequences of TLES. A prospective longitudinal controlled study is the most powerful design for the assessment of the occurrence and range of OMDs after TLES. This is designed to proceed in two stages. In the first, the questionnaire should be finalized and validated. The second stage will incorporate the pilot questionnaire administered during semi-structured psychiatric interviews for both TLES candidates and a non-operated control group examined on 4 occasions (in the operated group, pre-operatively and 6, 12 and 24 months after surgery). The results will then be compared within the same patient pre- and postoperatively, and in the control group based on serial prospective scores

Introduction to the themed section: ‘Commoning the Future’: Sustaining and Contesting the Public Good in North Africa

Middle Eastern Studie

Characterizing the impact of urban emissions on regional aerosol particles: airborne measurements during the MEGAPOLI experiment

The MEGAPOLI (Megacities: Emissions, urban, regional and Global Atmospheric POLlution and climate effects, and Integrated tools for assessment and mitigation) experiment took place in July 2009. The aim of this campaign was to study the aging and reactions of aerosol and gas-phase emissions in the city of Paris. Three ground-based measurement sites and several mobile platforms including instrument equipped vehicles and the ATR-42 aircraft were involved. We present here the variations in particle- and gas-phase species over the city of Paris, using a combination of high-time resolution measurements aboard the ATR-42 aircraft. Particle chemical composition was measured using a compact time-of-flight aerosol mass spectrometer (C-ToF-AMS), giving detailed information on the non-refractory submicron aerosol species. The mass concentration of black carbon (BC), measured by a particle absorption soot photometer (PSAP), was used as a marker to identify the urban pollution plume boundaries. Aerosol mass concentrations and composition were affected by air-mass history, with air masses that spent longest time over land having highest fractions of organic aerosol and higher total mass concentrations. The Paris plume is mainly composed of organic aerosol (OA), BC, and nitrate aerosol, as well as high concentrations of anthropogenic gas-phase species such as toluene, benzene, and NO_x. Using BC and CO as tracers for air-mass dilution, we observe the ratio of ΔOA / ΔBC and ΔOA / ΔCO increase with increasing photochemical age (−log(NO_x / NO_y)). Plotting the equivalent ratios of different organic aerosol species (LV-OOA, SV-OOA, and HOA) illustrate that the increase in OA is a result of secondary organic aerosol (SOA) formation. Within Paris the changes in the ΔOA / ΔCO are similar to those observed during other studies in London, Mexico City, and in New England, USA. Using the measured SOA volatile organic compounds (VOCs) species together with organic aerosol formation yields, we were able to predict ~50% of the measured organics. These airborne measurements during the MEGAPOLI experiment show that urban emissions contribute to the formation of OA and have an impact on aerosol composition on a regional scale

Intracranial stimulation for children with epilepsy

OBJECTIVES: To evaluate the efficacy of intracranial stimulation to treat refractory epilepsy in children. METHODS: This is a retrospective analysis of a pilot study on all 8 children who had intracranial electrical stimulation for the investigation and treatment of refractory epilepsy at King's College Hospital between 2014 and 2015. Five children (one with temporal lobe epilepsy and four with frontal lobe epilepsy) had subacute cortical stimulation (SCS) for a period of 20-161 h during intracranial video-telemetry. Efficacy of stimulation was evaluated by counting interictal discharges and seizures. Two children had thalamic deep brain stimulation (DBS) of the centromedian nucleus (one with idiopathic generalized epilepsy, one with presumed symptomatic generalized epilepsy), and one child on the anterior nucleus (right fronto-temporal epilepsy). The incidence of interictal discharges was evaluated visually and quantified automatically. RESULTS: Among the three children with DBS, two had >60% improvement in seizure frequency and severity and one had no improvement. Among the five children with SCS, four showed improvement in seizure frequency (>50%) and one chid did not show improvement. Procedures were well tolerated by children. CONCLUSION: Cortical and thalamic stimulation appear to be effective and well tolerated in children with refractory epilepsy. SCS can be used to identify the focus and predict the effects of resective surgery or chronic cortical stimulation. Further larger studies are necessary

Pediatric colloid cysts: a multinational, multicenter study. An IFNE-ISPN-ESPN collaboration

OBJECTIVE Colloid cysts (CCs) are rare at all ages, and particularly among children. The current literature on pediatric CC is limited, and often included in mixed adult/pediatric series. The goal of this multinational, multicenter study was to combine forces among centers and investigate the clinical course of pediatric CCs. METHODS A multinational, multicenter retrospective study was performed to attain a large sample size, focusing on CC diagnosis in patients younger than 18 years of age. Collected data included clinical presentation, radiological characteristics, treatment, and outcome. RESULTS One hundred thirty-four children with CCs were included. Patient age at diagnosis ranged from 2.4 to 18 years (mean 12.8 ± 3.4 years, median 13.2 years, interquartile range 10.3–15.4 years; 22% were \u3c 10 years of age). Twenty-two cases (16%) were diagnosed incidentally, including 48% of those younger than 10 years of age. Most of the other patients had symptoms related to increased intracranial pressure and hydrocephalus. The average follow-up duration for the entire group was 49.5 ± 45.8 months. Fifty-nine patients were initially followed, of whom 28 were eventually operated on at a mean of 19 ± 32 months later due to cyst growth, increasing hydrocephalus, and/or new symptoms. There was a clear correlation between larger cysts and symptomatology, acuteness of symptoms, hydrocephalus, and need for surgery. Older age was also associated with the need for surgery. One hundred three children (77%) underwent cyst resection, 60% using a purely endoscopic approach. There was 1 death related to acute hydrocephalus at presentation. Ten percent of operated patients had some form of complication, and 7.7% of operated cases required a shunt at some point during follow-up. Functional outcome was good; however, the need for immediate surgery was associated with educational limitations. Twenty operated cases (20%) experienced a recurrence of their CC at a mean of 38 ± 46 months after the primary surgery. The CC recurrence rate was 24% following endoscopic resection and 15% following open resections (p = 0.28). CONCLUSIONS CCs may present in all pediatric age groups, although most that are symptomatic present after the age of 10 years. Incidentally discovered cysts should be closely followed, as many may grow, leading to hydrocephalus and other new symptoms. Presentation of CC may be acute and may cause life-threatening conditions related to hydrocephalus, necessitating urgent treatment. The outcome of treated children with CCs is favorable

Switching the uniaxial magnetic anisotropy by ion irradiation induced compensation

In the present work, the uniaxial magnetic anisotropy of GaMnAsP is modified by helium ion irradiation. According to the micro-magnetic parameters, e.g. resonance fields and anisotropy constants deduced from ferromagnetic resonance measurements, a rotation of the magnetic easy axis from out-of-plane [001] to in-plane [100] direction is achieved. From the application point of view, our work presents a novel avenue in modifying the uniaxial magnetic anisotropy in GaMnAsP with the possibility of lateral patterning by using lithography or focused ion beam

CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) — Part 2:Impact of COVID-19

Background During the pandemic, there has been a concern about the increased risk of perioperative mortality for patients with COVID-19, and the transmission risk to healthcare workers, particularly during endonasal neurosurgical operations. The Pituitary Society produced recommendations to guide management during this era. We sought to assess contemporary neurosurgical practice and the impact of COVID-19. Methods A multicentre, prospective, observational cohort study was conducted at twelve tertiary neurosurgical units (UK and Ireland). Data were collected from March 23rd-July 31st, 2020 inclusive. Data points collected were patient demographics, pre-operative COVID-19 testing, intra-operative operative modifications, and 30-day COVID infection rates. Results 124 patients were included. 116 patients (n=116/124, 94%) underwent COVID-19 testing pre-operatively (TSA: 97/105, 92%; EEA: 19/19, 100%). One patient (n=1/115, 1%) tested positively for COVID-19 pre-operatively, requiring a delay of operation until the infection was confirmed as resolved. Asides from transient diabetes insipidus; no other complications were reported for this case. All theatre staff wore at least level 2 PPE. Adaptations to surgical techniques included minimising drilling, draping modifications, and using nasal iodine wash. At 30 days postoperatively, there was no evidence of COVID infection (symptoms or on formal testing) in our cohort, and no mortality. Conclusions Preoperative screening protocols and operative modifications have facilitated endonasal neurosurgery during the COVID-19 pandemic, with Pituitary Society guidelines followed for the majority of these operations. There was no evidence of COVID infection in our cohort, and no mortality, supporting the use of risk mitigation strategies to continue endonasal neurosurgery in subsequent pandemic waves

CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study

Background: CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective, multicentre observational study seeking to determine: (1) the scope of skull base repair methods used; and (2) corresponding rates of postoperative CSF rhinorrhoea in endonasal transsphenoidal (TSA) expanded endonasal approaches (EEA) for skull base tumours. We sought to pilot the project - assessing the feasibility and acceptability by gathering preliminary data. / Methods: A prospective, observational cohort pilot study was carried out at twelve tertiary UK neurosurgical units. Feedback regarding project positives and challenges were qualitatively analysed. / Results: 187 cases were included, 159 TSA (85%) and 28 EEA (15%). The most common pathologies included: pituitary adenomas (n=141/187), craniopharyngiomas (n=13/187) and skull-base meningiomas (n=4/187). The most common skull base repair techniques used were tissue glues (n=132/187, most commonly Tisseel®), grafts (n=94/187, most commonly fat autograft or Spongostan™) and vascularised flaps (n=51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n=125/187) and lumbar drains (n=22/187). Biochemically-confirmed CSF rhinorrhoea occurred in 6/159 (3.8%) TSA and 2/28 (7.1%) EEA. Four TSA (3%) and two EEA (7%) cases required operative management for CSF rhinorrhoea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included: user-friendly and efficient data collection, strong support from senior team members) demonstrating acceptability. / Conclusions: Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicentre dissemination of this project, in order to establish a benchmark of contemporary skull base neurosurgery practice, particularly with respect to EEA cases

Altimetry for the future: Building on 25 years of progress

In 2018 we celebrated 25 years of development of radar altimetry, and the progress achieved by this methodology in the fields of global and coastal oceanography, hydrology, geodesy and cryospheric sciences. Many symbolic major events have celebrated these developments, e.g., in Venice, Italy, the 15th (2006) and 20th (2012) years of progress and more recently, in 2018, in Ponta Delgada, Portugal, 25 Years of Progress in Radar Altimetry. On this latter occasion it was decided to collect contributions of scientists, engineers and managers involved in the worldwide altimetry community to depict the state of altimetry and propose recommendations for the altimetry of the future. This paper summarizes contributions and recommendations that were collected and provides guidance for future mission design, research activities, and sustainable operational radar altimetry data exploitation. Recommendations provided are fundamental for optimizing further scientific and operational advances of oceanographic observations by altimetry, including requirements for spatial and temporal resolution of altimetric measurements, their accuracy and continuity. There are also new challenges and new openings mentioned in the paper that are particularly crucial for observations at higher latitudes, for coastal oceanography, for cryospheric studies and for hydrology. The paper starts with a general introduction followed by a section on Earth System Science including Ocean Dynamics, Sea Level, the Coastal Ocean, Hydrology, the Cryosphere and Polar Oceans and the “Green” Ocean, extending the frontier from biogeochemistry to marine ecology. Applications are described in a subsequent section, which covers Operational Oceanography, Weather, Hurricane Wave and Wind Forecasting, Climate projection. Instruments’ development and satellite missions’ evolutions are described in a fourth section. A fifth section covers the key observations that altimeters provide and their potential complements, from other Earth observation measurements to in situ data. Section 6 identifies the data and methods and provides some accuracy and resolution requirements for the wet tropospheric correction, the orbit and other geodetic requirements, the Mean Sea Surface, Geoid and Mean Dynamic Topography, Calibration and Validation, data accuracy, data access and handling (including the DUACS system). Section 7 brings a transversal view on scales, integration, artificial intelligence, and capacity building (education and training). Section 8 reviews the programmatic issues followed by a conclusion