Disruption of Rolandic Gamma-Band Functional Connectivity by Seizures is Associated with Motor Impairments in Children with Epilepsy

Although children with epilepsy exhibit numerous neurological and cognitive deficits, the mechanisms underlying these impairments remain unclear. Synchronization of oscillatory neural activity in the gamma frequency range (>30 Hz) is purported to be a mechanism mediating functional integration within neuronal networks supporting cognition, perception and action. Here, we tested the hypothesis that seizure-induced alterations in gamma synchronization are associated with functional deficits. By calculating synchrony among electrodes and performing graph theoretical analysis, we assessed functional connectivity and local network structure of the hand motor area of children with focal epilepsy from intracranial electroencephalographic recordings. A local decrease in inter-electrode phase synchrony in the gamma bands during ictal periods, relative to interictal periods, within the motor cortex was strongly associated with clinical motor weakness. Gamma-band ictal desychronization was a stronger predictor of deficits than the presence of the seizure-onset zone or lesion within the motor cortex. There was a positive correlation between the magnitude of ictal desychronization and impairment of motor dexterity in the contralateral, but not ipsilateral hand. There was no association between ictal desynchronization within the hand motor area and non-motor deficits. This study uniquely demonstrates that seizure-induced disturbances in cortical functional connectivity are associated with network-specific neurological deficits

Hepatobiliary and pancreatic imaging in children—techniques and an overview of non-neoplastic disease entities

Imaging plays a major role in the diagnostic work-up of children with hepatobiliary or pancreatic diseases. It consists mainly of US, CT and MRI, with US and MRI being the preferred imaging modalities because of the lack of ionizing radiation. In this review the technique of US, CT and MRI in children will be addressed, followed by a comprehensive overview of the imaging characteristics of several hepatobiliary and pancreatic disease entities most common in the paediatric age group

Uterine artery velocity waveforms as predictors of pregnancy outcome in patients with antiphospholipid syndrome: a review.

In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk for preeclampsia, fetal intrauterine growth restriction, and other complications related to uteroplacental insufficiency. In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, as the likely consequence of the physiologic change of spiral arteries into low-resistance vessels. The presence of antiphospholipid antibodies can impair this vascular adaptation, resulting in a reduced placental perfusion. Doppler investigation provides a noninvasive method for the study of uteroplacental blood flow. Several studies were performed to detect the predictive role of uterine artery Doppler velocimetry in relation to pregnancy outcome in APS patients. In some studies, a high resistance index in the uterine arteries strongly predicted the subsequent development of obstetric complications. In other studies, persistent bilateral uterine artery notches identified the risk of preeclampsia and fetal intrauterine growth restriction. To date, the uterine artery Doppler velocimetry resulted to be a useful tool for identifying APS pregnancies at risk for adverse pregnancy outcome. These findings might have important implications for the management of these patients

Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex. Clinical article.

OBJECT: The authors undertook this study to review their experience with cortical resections in the rolandic region in children with intractable epilepsy. METHODS: The authors retrospectively reviewed the medical records obtained in 22 children with intractable epilepsy arising from the rolandic region. All patients underwent preoperative electroencephalography (EEG), MR imaging, prolonged video-EEG recordings, functional MR imaging, magnetoencephalography, and in some instances PET/SPECT studies. In 21 patients invasive subdural grid and depth electrode monitoring was performed. Resection of the epileptogenic zones in the rolandic region was undertaken in all cases. Seizure outcome was graded according to the Engel classification. Functional outcome was determined using validated outcome scores. RESULTS: There were 10 girls and 12 boys, whose mean age at seizure onset was 3.2 years. The mean age at surgery was 10 years. Seizure duration prior to surgery was a mean of 7.4 years. Nine patients had preoperative hemiparesis. Neuropsychological testing revealed impairment in some domains in 19 patients in whom evaluation was possible. Magnetic resonance imaging abnormalities were identified in 19 patients. Magnetoencephalography was performed in all patients and showed perirolandic spike clusters on the affected side in 20 patients. The mean duration of invasive monitoring was 4.2 days. The mean number of seizures during the period of invasive monitoring was 17. All patients underwent resection that involved primary motor and/or sensory cortex. The most common pathological entity encountered was cortical dysplasia, in 13 children. Immediately postoperatively, 20 patients had differing degrees of hemiparesis, from mild to severe. The hemiparesis improved in all affected patients by 3-6 months postoperatively. With a mean follow-up of 4.1 years (minimum 2 years), seizure outcome in 14 children (64%) was Engel Class I and seizure outcome in 4 (18%) was Engel Class II. In this series, seizure outcome following perirolandic resection was intimately related to the child's age at the time of surgery. By univariate logistic regression analysis, age at surgery was a statistically significant factor predicting seizure outcome (p < 0.024). CONCLUSIONS: Resection of rolandic cortex for intractable epilepsy is possible with expected morbidity. Accurate mapping of regions of functional cortex and epileptogenic zones may lead to improved seizure outcome in children with intractable rolandic epilepsy. It is important to counsel patients and families preoperatively to prepare them for possible worsened functional outcome involving motor, sensory and/or language pathways

Proceedings of the First Annual Meeting of the International Fetoscopic Myelomeningocele Repair Consortium

Made available in DSpace on 2019-09-12T16:53:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2019[Cortes, M. Sanz; Belfort, M.] Texas Childrens Hosp, Baylor Coll Med, Dept Obstet & Gynecol, 6621 Fannin St, Houston, TX 77030 USA[Lapa, D. A.] Hosp Israelita Albert Einstein, Fetal Therapy Program, Sao Paulo, Brazil[Acacio, G. L.] Universidade de Taubaté (Unitau), Dept Obstet, Sao Paulo, Brazil[Belfort, M.] Texas Childrens Hosp, Baylor Coll Med, Dept Neurosurg, Houston, TX 77030 USA[Carreras, E.; Maiz, N.] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Obstet & Gynecol, Barcelona, Spain[Peiro, J. L.; Lim, F. Y.] Cincinnati Childrens Hosp Med Ctr, Dept Pediat Surg, Cincinnati, OH 45229 USA[Miller, J.; Baschat, A.] Johns Hopkins Ctr Fetal Therapy, Dept Gynecol & Obstet, Baltimore, MD USA[Sepulveda, G.; Davila, I.] Hosp Christus Muguerza Alta Especialidad, Med Perinatal Alta Especialidad, Monterrey, NL, Mexico[Gielchinsky, Y.] Hadassah Hebrew Univ, Med Ctr, Dept Obstet & Gynecol, Jerusalem, Israel[Gielchinsky, Y.] Rabin Med Ctr, Dept Obstet & Gynecol, Petah Tiqwa, Israel[Benifla, M.] Rambam Hlth Care Campus, Pediat Neurosurg Unit, Haifa, Israel[Stirnemann, J.; Ville, Y.] Necker Enfants Malades Hosp, Dept Obstet & Gynecol, Paris, France[Yamamoto, M.; Figueroa, H.] Univ Los Andes, Santiago, Chile[Simpson, L.] Columbia Univ, New York Presbyterian Hosp, Med Ctr, Dept Obstet & Gynecol, New York, NY USA[Nicolaides, K. H.] Fetal Med Fdn, London, Englan