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ASO Visual Abstract: Recurrence and Survival Outcomes in Patients with Primary Merkel Cell Carcinoma with Positive, Negative or Not Performed Sentinel Lymph Node Biopsy.
No full textAccurate and automated multi-center TCD velocity analysis using natural language processing
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Independent component analysis of resting-state fMRI identifies regions associated with seizure freedom after laser interstitial thermal therapy for temporal lobe epilepsy.
No full textOBJECTIVE: Temporal lobe epilepsy (TLE) is a common form of drug-resistant epilepsy often treated with surgical interventions, including laser interstitial thermal therapy (LITT). However, patient-specific factors influencing LITT outcomes remain unclear. This retrospective study aimed to identify pre-operative resting-state functional MRI (rs-fMRI) patterns associated with seizure freedom following LITT in mesial TLE.
METHODS: We analyzed rs-fMRI data from 28 patients with mesial TLE who underwent LITT, classifying them into seizure-free (SF) and not seizure-free (NSF) groups based on 12-month post-operative outcomes. Independent component analysis (ICA) was used to identify subject-specific brain networks, and generalized linear models (GLM) were employed to assess associations between pre-operative spatial patterns of ICA-derived functional connectivity (FC) and surgical outcomes, controlling for clinical variables.
RESULTS: Significant differences in brain ICA-derived FC patterns were observed between SF and NSF groups, with SF exhibiting more locally distributed ICA-derived FC patterns around the mesial temporal lobe, including the posterior orbitofrontal cortex (OFC) and anterior parahippocampal gyrus (PHG). In contrast, NSF demonstrated more diffusely distributed ICA-derived FC patterns encompassing the insula and thalami.
SIGNIFICANCE: These findings highlight the potential of pre-operative rs-fMRI as a prognostic tool for identifying TLE patients more likely to benefit from LITT. Further validation in larger cohorts is warranted to confirm these results and optimize patient selection for surgical interventions
ACMT Highlights Episode 68: Harm Reduction - Rapid Inpatient Methadone Initiations in the Fentanyl Era
No full textChromatin Disruption After Prenatal Hypoxia Predicts Lasting Neuron Deficits.
No full textPrenatal exposure to transient hypoxia can result in various developmental disabilities presumably by disrupting normal neurodevelopmental processes, even in milder injuries without detectable cell death or structural damag
Electrode Type and Long-Term Clinical Response to Responsive Neurostimulation: A Single-Center Cohort With 5-Year Follow-up.
No full textBACKGROUND AND OBJECTIVES: Responsive neurostimulation (RNS) is a neuromodulatory treatment of medically refractory epilepsy involving the implantation of either subdural or depth electrodes and a neurostimulator. Previous studies suggest improved outcomes associated with subdural electrodes, although this relationship is incompletely elucidated. We aimed to measure long-term response to RNS including the role of lead type and baseline patient characteristics.
METHODS: We performed a retrospective chart review of 57 patients who underwent RNS implantation. Data collected included lead configuration, previous surgeries, unilateral vs bilateral RNS leads, seizure localization, epilepsy etiology, auras, and demographics. The primary outcomes assessed were responder rate (≥50% reduction from preoperative baseline), and super-responder rate (≥90% reduction) at each annual timepoint postimplantation using generalized estimating equations.
RESULTS: The mean duration of follow-up was 4.35 years and at 5 years, we observed an 81.4% responder rate and 55.8% super-responder rate. Responder (P = .016) and super-responder rates (P \u3c .001) improved over time. Longitudinal response rate was higher in patients with at least 1 subdural electrode in place compared with those with 2 depths (subdural/Subdural P = .011; Subdural/Depth P = .028). The super-responder rate was also improved, although only in patients with 2 subdural electrodes in place (P = .014). None of the other variables measured correlated with differences in clinical response.
CONCLUSION: We report longitudinal clinical benefit to RNS in support of multicenter trial findings, expanding on findings that electrode type correlates with clinical response. One subdural electrode may be sufficient to realize benefit over depth electrodes alone. The five-year response to RNS was improved with at least 1 subdural electrode over depth electrodes alone, with further benefit in the rate of super-response when 2 subdural electrodes were implanted. When evaluating patients for RNS therapy, these data support the use of subdural over depth electrodes when appropriate
