Allergic skin rash with lamotrigine and concomitant valproate therapy - Evidence for an increased risk

Cutaneous rash is one of the commonest adverse events associated with lamotrigine. We assessed whether the risk is increased in patients receiving concomitant valproate therapy in a population of 103 adult patients with intractable epilepsy, who had lamotrigine added to their treatment. Of the 33 patients taking valproate, 10 (30%) developed a rash, whilst of the 70 not taking valproate, only 6 (8%) developed a rash. This suggests a significantly higher risk of cutaneous rash when starting lamotrigine in patients already taking valproate (p<0.02)

Advanced neuroimaging techniques in epilepsy

PURPOSE OF REVIEW: We review significant advances in epilepsy imaging in recent years. RECENT FINDINGS: Structural MRI at 7T with optimization of acquisition and postacquisition image processing increases the diagnostic yield but artefactual findings remain a challenge. MRI analysis from multiple sites indicates different atrophy patterns and white matter diffusion abnormalities in temporal lobe and generalized epilepsies, with greater abnormalities close to the presumed seizure source. Structural and functional connectivity relate to seizure spread and generalization; longitudinal studies are needed to clarify the causal relationship of these associations. Diffusion MRI may help predict surgical outcome and network abnormalities extending beyond the epileptogenic zone. Three-dimensional multimodal imaging can increase the precision of epilepsy surgery, improve seizure outcome and reduce complications. Language and memory fMRI are useful predictors of postoperative deficits, and lead to risk minimization. FDG PET is useful for clinical studies and specific ligands probe the pathophysiology of neurochemical fluxes and receptor abnormalities. SUMMARY: Improved structural MRI increases detection of abnormalities that may underlie epilepsy. Diffusion, structural and functional MRI indicate the widespread associations of epilepsy syndromes. These can assist stratification of surgical outcome and minimize risk. PET has continued utility clinically and for research into the pathophysiology of epilepsies

Extensive hemicerebral damage after traumatic midterm amniocentesis

We present a 28-year-old right-handed male who, at 17 weeks' gestation, suffered a traumatic amniocentesis, and was subsequently born with extensive right-sided cerebral, cerebellar and brainstem damage. The initial amniocentesis was abandoned and repeated 2 weeks later, with normal results, subsequent prenatal ultrasound scans were normal. The patient had an uncomplicated delivery at term, however a complete right sided ptosis and marks on the right parietal region of the scalp were noted. By 4 months of age, a right sided third nerve palsy, a left sided hemiplegia and left visual field defect had been identified, and infantile spasms developed, which were treated successfully with ACTH. No further seizures occurred until habitual seizures began at 7 years of age, consisting of focal seizures with, and without, loss of awareness, with blank spells, abdominal discomfort, head turning, agitation and disorientation. Although initially controlled with antiseizure medication, seizures became refractory within 3 years, occurring several times per day despite extensive medications and vagal nerve stimulation. In recent months, atonic seizures developed, characterised by sudden weakness of the lower limbs causing collapse, not associated with loss of consciousness, with risk of injury and a significant effect on his quality of life. There have not been secondarily generalized tonic-clonic seizures. He achieved undergraduate level education and can walk despite a left hemiparesis

T2 mapping outperforms normalised FLAIR in identifying hippocampal sclerosis

Rationale Qualitatively, FLAIR MR imaging is sensitive to the detection of hippocampal sclerosis (HS). Quantitative analysis of T2 maps provides a useful objective measure and increased sensitivity over visual inspection of T2-weighted scans. We aimed to determine whether quantification of normalised FLAIR is as sensitive as T2 mapping in detection of HS. Method Dual echo T2 and FLAIR MR images were retrospectively analysed in 27 patients with histologically confirmed HS and increased T2 signal in ipsilateral hippocampus and 14 healthy controls. Regions of interest were manually segmented in all hippocampi aiming to avoid inclusion of CSF. Hippocampal T2 values and measures of normalised FLAIR Signal Intensity (nFSI) were compared in healthy and sclerotic hippocampi. Results HS was identified on T2 values with 100% sensitivity and 100% specificity. HS was identified on nFSI measures with 60% sensitivity and 93% specificity. Conclusion T2 mapping is superior to nFSI for identification of HS

Memory fMRI predicts verbal memory decline after anterior temporal lobe resection.

To develop a clinically applicable memory functional MRI (fMRI) method of predicting postsurgical memory outcome in individual patients

Neuroimaging in epilepsy

PURPOSE OF REVIEW: Epilepsy neuroimaging is important for detecting the seizure onset zone, predicting and preventing deficits from surgery and illuminating mechanisms of epileptogenesis. An aspiration is to integrate imaging and genetic biomarkers to enable personalized epilepsy treatments. RECENT FINDINGS: The ability to detect lesions, particularly focal cortical dysplasia and hippocampal sclerosis, is increased using ultra high-field imaging and postprocessing techniques such as automated volumetry, T2 relaxometry, voxel-based morphometry and surface-based techniques. Statistical analysis of PET and single photon emission computer tomography (STATISCOM) are superior to qualitative analysis alone in identifying focal abnormalities in MRI-negative patients. These methods have also been used to study mechanisms of epileptogenesis and pharmacoresistance. Recent language fMRI studies aim to localize, and also lateralize language functions. Memory fMRI has been recommended to lateralize mnemonic function and predict outcome after surgery in temporal lobe epilepsy. SUMMARY: Combinations of structural, functional and post-processing methods have been used in multimodal and machine learning models to improve the identification of the seizure onset zone and increase understanding of mechanisms underlying structural and functional aberrations in epilepsy

Land Use Changes within the Bogoso-Prestea Gold Concession, South West Ghana

Mining activities have existed in the Bogoso-Prestea area for over a century. The high demand for gold has led to intense mining activities in the area and has resulted in land use changes. This study evaluated a total area of 4 379.93 ha within the Bogoso-Prestea Gold Concession that has experienced land use change due to mining using estimation of areas and analysis of land use flows over a period of twenty years ie.1986 - 2006. Results from the study revealed that mining increased in land coverage from 4.69 ha in 1986 to 530.84 ha in 2006, an increase to 12.1% of the study area. Settlements increased to 4.95% in 2006 as compared to 0.41% in 1986, showing a significant rural migration primarily due to mining. Agricultural land use reduced from 97.8% in 1986 to 82.7% in 2006. The study also revealed that land use due to mining increased by only 0.67 % between 1996 and 2006 and if this trend continues, then land use due to mining under the prevailingconditions might not introduce any significant increment between 2006 and 2016

Automated hippocampal segmentation in patients with epilepsy: Available free online

Hippocampal sclerosis, a common cause of refractory focal epilepsy, requires hippocampal volumetry for accurate diagnosis and surgical planning. Manual segmentation is time-consuming and subject to interrater/intrarater variability. Automated algorithms perform poorly in patients with temporal lobe epilepsy. We validate and make freely available online a novel automated method

Neck atonia with a focal stimulation-induced seizure arising from the SMA: pathophysiological considerations.

A 28-year-old patient with pharmacoresistant non-lesional right frontal epilepsy underwent extra-operative intracranial EEG recordings and electrical cortical stimulation (ECS) to map eloquent cortex. Right supplementary motor area (SMA) ECS induced a brief seizure with habitual symptoms involving neck tingling followed by asymmetric tonic posturing. An additional feature was neck atonia. During atonia and sensory aura, discharges were seen in the mesial frontal electrodes and precentral gyrus. Besides motor signs, atonia, although rare and not described in the neck muscles, and sensations have been reported with SMA stimulation. The mechanisms underlying neck atonia in seizures arising from the SMA can be explained by supplementary negative motor area (SNMA) - though this was not mapped in electrodes overlying the ictal onset zone in our patient - or primary sensorimotor cortex activation through rapid propagation. Given the broad spectrum of signs elicited by SMA stimulation and rapid spread of seizures arising from the SMA, caution should be taken to not diagnose these as non-epileptic, as had previously occurred in this patient

Wearable EEG: what is it, why is it needed and what does it entail?

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