Epileptic monocular nystagmus and ictal diplopia as cortical and subcortical dysfunction

AbstractWe present the case of a patient with ictal monocular nystagmus and ictal diplopia who became seizure-free after resection of a right frontal focal cortical dysplasia (FCD), type 2B. Interictal neuroophthalmological examination showed several beats of a monocular nystagmus and a spasm of the contralateral eye. An exclusively ictal monocular epileptic nystagmus could be an argument for an exclusively cortical involvement in monocular eye movement control. The interictal findings in our patient, however, argue for an irregular ictal activation of both the cortical frontal eye field and the brainstem

Presentation of Graves' orbitopathy within European Group On Graves' Orbitopathy (EUGOGO) centres from 2012 to 2019 (PREGO III)

Background: Graves' orbitopathy (GO) is subject to epidemiological and care-related changes. Aim of the survey was to identify trends in presentation of GO to the European Group On Graves' Orbitopathy (EUGOGO) tertiary referral centres and initial management over time. Methods: Prospective observational multicentre study. All new referrals with diagnosis of GO within September-December 2019 were included. Clinical and demographic characteristics, referral timelines and initial therapeutic decisions were recorded. Data were compared with a similar EUGOGO survey performed in 2012. Results: Besides age (mean age: 50.5±13 years vs 47.7±14 years; p 0.007), demographic characteristics of 432 patients studied in 2019 were similar to those in 2012. In 2019, there was a decrease of severe cases (9.8% vs 14.9; p<0.001), but no significant change in proportion of active cases (41.3% vs 36.6%; p 0.217). After first diagnosis of GO, median referral time to an EUGOGO tertiary centre was shorter (2 (0-350) vs 6 (0-552) months; p<0.001) in 2019. At the time of first visit, more patients were already on antithyroid medications (80.2% vs 45.0%; p<0.001) or selenium (22.3% vs 3.0%; p<0.001). In 2019, the initial management plans for GO were similar to 2012, except for lid surgery (2.4% vs 13.9%; p<0.001) and prescription of selenium (28.5% vs 21.0%; p 0.027). Conclusion: GO patients are referred to tertiary EUGOGO centres in a less severe stage of the disease than before. We speculate that this might be linked to a broader awareness of the disease and faster and adequate delivered treatment

Clinical Congenital Anophthalmos and Microphthalmos—Experiences of Patients and Their Parents after More than 10 Years of Treatment

Congenital clinical anophthalmos and blind microphthalmos describe the absence of an eye or the presence of a small eye in the orbit. Between 1999 and 2013, 97 children with anophthalmos or microphthalmos were treated with self-inflating, hydrophilic gel expanders at the Rostock Eye Clinic. More than a decade later, this study investigated the perspective of patients and parents regarding the treatment, the surgical outcome, and the emotional and social well-being of the patients. A total of 22 families with 16 patients sighted in the other eye and six patients blind in both eyes participated. Questionnaires were developed, including items on physical, emotional, social, and medical aspects. The patients felt emotionally stable and integrated into their social environment, with no major limitations reported by the majority. These statements were confirmed by most of the parents. Parents (67%) indicated that the success of the operation was already apparent after the first intervention and that the current situation did not play a role in the patients’ social environment. The study provided new insights into the therapy results, the postoperative care, and the social and emotional stability of the prosthesis-wearing patients, indicating the chosen expander methods as promising in terms of positive postoperative care

Passive control of a swept-wing boundary layer using ring-type plasma actuators

Application of the ring-type plasma actuators for passive control of laminar- turbulent transition in a swept-wing boundary layer is investigated thorough direct numerical simulations. These actuators induce a wall-normal jet in the boundary layer and can act as virtual roughness elements. The flow configuration resembles experiments of Kim et al. (2016). The actuators are modelled by the volume forces computed from the experimentally measured induced velocity filed at the quiescent air condition. The natural surface roughness and unsteady perturbations are also included in the simulations. The interaction of generated vortices by the actuators with these perturbations is investigated in details. It is found that for a successful transition control the power of the actuator should be increased to generate a jet velocity one order of magnitude higher than that in the considered experiments. QC 20161125</p

Perimetry measures and EEG.

<p><b>(A)</b> Primary and secondary analyses of VF outcome between- and within-groups after rtACS and sham-stimulation bar charts of primary (first upper graph) and secondary parameters of VF diagnostics measured using HRP and standard-automated static and kinetic perimetry. Results are given as medians and 95%-CI. Between-group comparisons were performed according to a pre-defined hypothesis using a one-sided U-test. Within-group BASELINE vs. POST and BASELINE vs. FOLLOW-UP comparisons were calculated separately for each treatment arm using Wilcoxon matched-pairs signed rank tests. The respective p-values are reported with p<0.05 considered as significant. <b>(B)</b> Individual change in HRP VF charts at BASELINE and POST in the two best responding patients of both groups. By superimposing HRP computer campimetric VF charts of three repeated measurements, VF areas were categorized as intact (perfect stimulus detection at a given location, white spots), partially damaged/relative defect (inconsistent stimulus detection, grey spots), and absolutely impaired areas (no stimulus detected, black spots). Detection increases and decreases after intervention are shown in blue and red, respectively. The percentage improvement of the detection accuracy was comparable between the whole HRP VF 16x21.5° and the central 5° VF. <b>(C)</b> Power spectra before and after the first stimulation session. Left sub-figure: One session of tACS increased power of theta (Z = 3.583, p<0.001), alpha (t = 4.571, p<0.001) and beta bands (Z = 3.142, p = 0.002) recorded from electrode positions above the visual cortex. Middle sub-figure: After sham stimulation a significant power increase was observed for only the theta band (Z = 3.147, p = 0.002). Right sub-figure: Scatter plot showing the relation between change in alpha band coherence at the occipital area of interest and change in detection accuracy in total visual field (primary outcome measure).</p

Patients’ demographics and lesion characteristics.

<p>Patients’ demographics and lesion characteristics.</p

Clinical parameter changes after treatment and at follow-up.

<p>Clinical parameter changes after treatment and at follow-up.</p

Consort flow chart and study design.

<p><b>(A)</b> Patient flow for cases included in the primary outcome measure analysis. Of 98 eligible patients, 45 were treated with rtACS and 37 with sham-stimulation. Five subjects left the study between initial screening and BASELINE for different reasons and another five subjects were excluded due to violation of an inclusion criterion (unacceptable fluctuations between initial screening and BASELINE). During the treatment phase three subjects dropped out because of medical conditions that were unrelated to study participation. Three treated cases of legally blind subjects were excluded from subsequent analyses due to violation of inclusion criterion (no residual vision). <b>(B)</b> Study design with diagnostic and treatment visits. Randomization was done after BASELINE assessment. Stability of VF defects was ascertained by comparing VFs at BASELINE with those obtained during the screening visit 2 weeks earlier. Upon completion of the 10-day treatment, all initial diagnostic tests were repeated (POST). The FOLLOW-UP diagnostic assessment was conducted after a therapy-free interval of at least 2 months.</p

Visual field characteristics at BASELINE according to treatment arms.

<p>Visual field characteristics at BASELINE according to treatment arms.</p