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In der neuen S2k-Leitlinie „Erster epileptischer Anfall und Epilepsien im Erwachsenenalter“ werden Empfehlungen zu klinisch relevanten Fragestellungen in fünf großen Themenblöcken gegeben: Management erster epileptischer Anfall, Pharmakotherapie, Epilepsiechirurgie, komplementäre und supportive Therapieverfahren und psychosoziale Aspekte.

The new S2k guideline “First epileptic seizure and epilepsies in adulthood” provides recommendations on clinically relevant issues in five major topics: management of first epileptic seizures, pharmacotherapy, epilepsy surgery, complementary and supportive treatment, and psychosocial aspects.

Purpose: This paper aims to explore how historical context influences the content and selection of rhetorical legitimation strategies. Using case study method, this paper will focus on how insurance companies and labor tried to defend their legitimacy in the context of enactment of Medicare in the USA. What factors influenced the strategic (rhetorical) decisions made by insurance companies and labor unions in their institutional work? Design/methodology/approach: The study is empirically grounded in archival research, involving an analysis of over 9,000 pages of congressional hearings on Medicare covering the period 1958–1965. Findings: The authors show that rhetorical legitimation strategies depend significantly on the specific historical circumstances in which those strategies are used. The historical context lent credibility to certain arguments and organizations are forced to decide either to challenge widely held assumptions or take advantage of them. The authors show that organizations face strong incentives to pursue the latter option. Here, both the insurance companies and labor unions tried to show that their positions were consistent with classical liberal ideology, because of high respect of classical liberal principles among different stakeholders (policymakers, voters, etc.). Research limitations/implications: It is uncertain how much the results of the study could be generalized. More information about the organizations whose use of rhetorics the authors studied could have strengthened our conclusions. Practical implications: The practical relevancy of the revised paper is that the authors should not expect hegemony challenging rhetorics from organizations, which try to influence legislators (and perhaps the larger public). Perhaps (based on the findings), this kind of rhetorics is not even very effective. Social implications: The paper helps to understand better how organizations try to advance their interests and gain acceptance among the stakeholders. Originality/value: In this paper, the authors show how historical context in practice influence rhetorical arguments organizations select in public debates when their goal is to influence the decision-making of their audience. In particular, the authors show how dominant ideology (or ideologies) limit the options organizations face when they are choosing their strategies and arguments. In terms of the selection of rhetorical justification strategies, the most pressing question is not the “real” broad based support of certain ideologies. Insurance company and labor union representatives clearly believed that they must emphasize liberal values (or liberal ideology) if they wanted to gain legitimacy for their positions. In existing literature, it is often assumed that historical context influence the selection of rhetorical strategies but how this in fact happens is not usually specified. The paper shows how interpretations of historical contexts (including the ideological context) in practice influence the rhetorical strategies organizations choose.

Epitaxially grown self-assembled semiconductor quantum dots (QDs) with atom-like optical properties have emerged as the best choice for single-photon sources required for the development of quantum technology and quantum networks. Nondestructive selection of a single QD having desired structural, compositional, and optical characteristics is essential to obtain noise-free, fully indistinguishable single or entangled photons from single-photon emitters. Here, we show that the structural orientations and local compositional inhomogeneities within a single QD and the surrounding wet layer can be probed in a screening fashion by scanning X-ray diffraction microscopy and X-ray fluorescence with a few tens of nanometers-sized synchrotron radiation beam. The presented measurement protocol can be used to cull the best single QD from the enormous number of self-assembled dots grown simultaneously. The obtained results show that the elemental composition and resultant strain profiles of a QD are sensitive to in-plane crystallographic directions. We also observe that lattice expansion after a certain composition-limit introduces shear strain within a QD, enabling the possibility of controlled chiral-QD formation. Nanoscale chirality and compositional anisotropy, contradictory to common assumptions, need to be incorporated into existing theoretical models to predict the optical properties of single-photon sources and to further tune the epitaxial growth process of self-assembled quantum structures.

We report the case of a patient with nonlesional, pharmacoresistant epilepsy. Bilateral synchronous discharges as well as focal discharges were identified on electroencephalogram (EEG). After non-invasive and invasive presurgical evaluation, a probable epileptogenic zone was identified with concordant results of focal origin involvement of the left temporal pole. Resective epilepsy surgery provided seizure freedom (last follow-up at 12 months). The case nicely illustrates that bilateral synchronous discharges or/and a lack of lesions on neuroimaging are not contraindications to presurgical evaluation of epilepsy, which on the contrary should be offered to all patients with pharmacoresistant epilepsy. The case also illustrates the importance of combining electrophysiological, imaging, and neuropsychological information to guide intracranial EEG placement and improve postsurgical outcome.

Early detection of focal cortical dysplasia (FCD) using brain MRI in young children presenting with drug-resistant epilepsy may facilitate prompt surgical treatment, resulting in better control of seizures and decreased associated cognitive difficulties. Characteristics of FCD described in the literature are predominantly based on MRI findings in a fully myelinated brain; therefore, changes occurring during early brain maturation are not well known. In this case report, we describe distinct MRI features of a FCD visualized best before completion of myelination of the cortex and subcortical white matter. Specifically, this lesion exhibited increased visibility because of better delineation of the borders of the pathological area involved in the malformation compared with imaging obtained after completion of myelination. Although the pathophysiology of these imaging features necessitates further investigation, one hypothesis is that excessive neuronal input in young epileptic patients could trigger premature myelination of overstimulated fibers underlying the cortical epileptogenic focus. The aim of this case report was to raise awareness that seizures might induce local changes in brain myelination, which can be detected by MRI during the first year of life. Early identification of FCD may prompt surgical treatment in selected patients with drug-resistant epilepsy.

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Hintergrund: Nichtläsionelle Epilepsien haben derzeit ein schlechteres postoperatives Ergebnis als Epilepsien mit Läsionsnachweis. EEG- und MEG-Quellenrekonstruktion (ESI/MSI) leisten zu der präoperativen Eingrenzung des epileptogenen Fokus einen wichtigen Beitrag. Ziel der Arbeit: Ziel ist es, einen Überblick über den Status quo zu ESI und MSI bei nichtläsionellen Epilepsien zu geben und die Relevanz dieser Techniken in der präoperativen Diagnostik hervorzuheben. Material und Methoden: Nichtsystematisches Literaturreview. Ergebnisse und Schlussfolgerungen: Quellenrekonstruktion bei nichtläsionellen Epilepsien hat einen großen Nutzen bezüglich der Lokalisationspräzision des epileptogenen Fokus, was sich in einer Übereinstimmung der Resektionszone bzw. des intrakraniellen EEGs und der Quellenrekonstruktion bei postoperativ anfallsfreien Patienten*innen zeigt. Weiterhin enthält diese Technik nichtredundante Informationen, indem eine bis dahin unerkannte Läsion im Nachhinein identifiziert wurde. Jedoch wird ESI von nur 9, MSI von nur 7 von 25 europäischen Epilepsiezentren zur prächirurgischen Diagnostik eingesetzt. Semiautomatische Quellenrekonstruktion sowie Eingrenzung der Spike- und Elektrodenanzahl könnten helfen, die Praktikabilität und die Verbreitung dieser wichtigen Methoden in den Epilepsiezentren zu erhöhen.

This educational topical review and Task Force report aims to address learning objectives of the International League Against Epilepsy (ILAE) curriculum. We sought to extract detailed features involving semiology from video recordings and interpret semiological signs and symptoms that reflect the likely localization for focal seizures in patients with epilepsy. This glossary was developed by a working group of the ILAE Commission on Diagnostic Methods incorporating the EEG Task Force. This paper identifies commonly used terms to describe seizure semiology, provides definitions, signs and symptoms, and summarizes their clinical value in localizing and lateralizing focal seizures based on consensus in the published literature. Video‐EEG examples are included to illustrate important features of semiology in patients with epilepsy.

Restructuring of healthcare services during the COVID‐19 pandemic has led to lockdown of epilepsy monitoring units (EMUs) in many hospitals. The ad‐hoc taskforce of the International League Against Epilepsy (ILAE) and the International Federation of Clinical Neurophysiology (IFCN) highlights the detrimental effect of postponing video‐EEG monitoring of patients with epilepsy and other paroxysmal events. The taskforce calls for action for continued functioning of EMUs during emergency situations, such as the COVID‐19 pandemic. Long‐term video‐EEG monitoring is an essential diagnostic service. Access to video‐EEG monitoring of the patients in the EMUs must be given high priority. Patients should be screened for COVID‐19, before admission, according to the local regulations. Local policies for COVID‐19 infection control should be adhered to during the video‐EEG monitoring. In cases of differential diagnosis in which reduction of antiseizure medication is not required, home video‐EEG monitoring should be considered as an alternative in selected patients.

The self-assembly of nanoparticles into highly ordered crystals is largely influenced by variations in the size and shape of the constituent particles, with crystallization generally not observed if their polydispersity is too large. Here, we report on size selectivity in the self-assembly of rounded cubic maghemite nanoparticles into three-dimensional mesocrystals. Different X-ray scattering techniques are used to study and compare a nanoparticle dispersion that is used later for self-assembly, an ensemble of mesocrystals grown on a substrate, as well as an individual mesocrystal. The individual μm-sized mesocrystal is isolated using a focused-ion-beam-based technique and investigated by the diffraction of a micro-focused X-ray beam. Structural analysis reveals that individual mesocrystals have a drastically smaller size dispersity of nanoparticles than that in the initial dispersion, implying very strong size selectivity during self-assembly. The small size dispersity of the nanoparticles within individual mesocrystals is accompanied by a very narrow lattice parameter distribution. In contrast, the lattice parameter distribution within all mesocrystals of an ensemble is about four times wider than that of individual mesocrystals, indicating significant size fractionalization between mesocrystals during self-assembly. The small size dispersity within each mesocrystal has important implications for their physical properties.

Evoked potentials (EPs) are a powerful and cost-effective tool for evaluating the integrity and function of the central nervous system. Although imaging techniques, such as MRI, have recently become increasingly important in the diagnosis of neurological diseases, over the past 30 years, many neurologists have continued to employ EPs in specific clinical applications. This review presents an overview of the recent evolution of ‘classical’ clinical applications of EPs in terms of early diagnosis and disease monitoring and is an extension of a previous review published in this journal in 2005 by Walsh and collaborators. We also provide an update on emerging EPs based on gustatory, olfactory and pain stimulation that may be used as clinically relevant markers of neurodegenerative disorders such as Parkinson’s disease, Alzheimer’s disease and cortical or peripheral impaired pain perception. EPs based on multichannel electroencephalography recordings, known as high-density EPs, help to better differentiate between healthy subjects and patients and, moreover, they provide valuable spatial information regarding the site of the lesion. EPs are reliable disease-progression biomarkers of several neurological diseases, such as multiple sclerosis and other demyelinating disorders. Overall, EPs are excellent neurophysiological tools that will expand standard clinical practice in modern neurology.

Der Beitrag basiert auf Erfahrungen der Jugendarbeit des Bunds der Deutschen Katholischen Jugend mit minderjährigen Geflüchteten. Es wird deutlich, dass Angebote der Jugendarbeit zunächst das Willkommensein spiegeln sollten, auf Dauer allerdings durch die Öffnung der eigenen Struktur auf langfristige integrative Angebote umstellen müssen.

Aim. To describe the association between Alzheimer's disease and seizures by reviewing epidemiological data from available literature and to assess the putative pathophysiological links between neurodegeneration and altered cortical excitability. We also discuss specific antiepileptic treatment strategies in patients with Alzheimer's disease, as well as transient epileptic amnesia as a possible crossroads between degeneration and epilepsy. Methods. Regarding epidemiology, we searched publications in Pubmed, Medline, Scopus and Web of Science (until September 2015) using the keywords “incidence”, “prevalence” and “frequency”, as well as “Alzheimer's disease” and “seizures”. In addition, therapeutic aspects for seizures in Alzheimer's disease were searched using the key words “antiepileptic drugs”, “seizure treatment” and “Alzheimer”. Results. The prevalence and incidence rates of seizures were found to be increased 2 to 6‐fold in patients with Alzheimer's disease compared to age‐adjusted control patients. Treatment strategies have mainly been extrapolated from elderly patients without dementia, except for one single randomised trial, in which levetiracetam, lamotrigine and phenobarbital efficacy and tolerance were investigated in patients with Alzheimer's disease. Mouse models appear to show a major role of amyloid precursor protein and its cleavage products in the generation of cortical hyperexcitability. Conclusion. A link between Alzheimer's disease and epilepsy has long been described and recent cohort studies have more clearly delineated risk factors associated with the genesis of seizures, such as early onset and possibly severity of dementia. As genetic forms of Alzheimer's disease and experimental mouse models suggest, beta‐amyloid may play a prominent role in the propagation of synchronised abnormal discharges, perhaps more viaan excitatory mode than a direct neurodegenerative effect.

AbstractSurface sensitive X-ray scattering methods are mostly non-destructive tools which are frequently used to investigate the nature of thin films, interfaces and artificial near surface structures. Discussed here are diffraction based methods, namely reflectometry and the related techniques grazing incidence diffraction and crystal truncation rod measurements. For the experiment, an X-ray beam is diffracted from surface near structures of the sample and detected by adequate detectors. To analyze the data the according X-ray scattering theory has to be applied. The full theory of surface sensitive X-ray scattering is complex and based on general considerations from wave optics. However, instructive insights into the scattering processes are provided by the Born-approximation which in many cases yields sufficient results. The methods are applied to solve the structure of a mercury-electrolyte interface during a chemical reaction and to determine the strain distribution in surface near SiGe quantum dots.

X-ray reflectivity measurements of increasingly more complex interfaces involving silicon (001) substrates reveal the existence of a thin low-density layer intruding between the single-crystalline silicon and the amorphous native SiO2terminating it. The importance of accounting for this layer in modeling silicon/liquid interfaces and silicon-supported monolayers is demonstrated by comparing fits of the measured reflectivity curves by models including and excluding this layer. The inclusion of this layer, with 6–8 missing electrons per silicon unit cell area, consistent with one missing oxygen atom whose bonds remain hydrogen passivated, is found to be particularly important for an accurate and high-resolution determination of the surface normal density profile from reflectivities spanning extended momentum transfer ranges, now measurable at modern third-generation synchrotron sources.

Synchrotron based X-ray diffraction (XRD) and X-ray reflectivity (XRR) were used to study the structural and magnetic properties of ion beam sputtered Fe/Al multilayer sample (MLS) as a function of annealing temperature. The structural studies show substantial intermixing between the layers which results in multilayer of complicated structures i.e. formation of thin intermixed FeAl layer at the interface during deposition, the nucleation and precipitation of disordered FeAl layer, and its subsequent growth to Fe3Al at higher temperature. The results were also supported by TEM measurements. Magnetization decreases with increase in temperature and Curie temperature (Tc) is found to be much less than that of bulk bcc Fe.

Chronic epilepsy has rarely been reported after posterior reversible encephalopathy syndrome (PRES) and the association with hippocampal sclerosis has been suggested only once before. We report the case of a girl admitted at the age of 8 years with idiopathic nephrotic syndrome. On the second day of admission, she presented with focal complex seizures and cerebral MRI showed posterior encephalopathy and no hippocampal sclerosis. MRI after one month confirmed the diagnosis of PRES. The seizures recurred and the girl developed pharmacoresistant epilepsy and was admitted to our hospital for further investigation. Cerebral MRI three years after the diagnosis of PRES showed hippocampal sclerosis which was not present on the initial MRI. We conclude that there is a triggering role of PRES in the development of hippocampal sclerosis. Hippocampal sclerosis may have resulted from seizure-associated damage, alternatively, hypertensive encephalopathy may have led to hippocampal damage viaa vascular mechanism.

Chronic epilepsy has rarely been reported after posterior reversible encephalopathy syndrome (PRES) and the association with hippocampal sclerosis has been suggested only once before. We report the case of a girl admitted at the age of 8 years with idiopathic nephrotic syndrome. On the second day of admission, she presented with focal complex seizures and cerebral MRI showed posterior encephalopathy and no hippocampal sclerosis. MRI after one month confirmed the diagnosis of PRES. The seizures recurred and the girl developed pharmacoresistant epilepsy and was admitted to our hospital for further investigation. Cerebral MRI three years after the diagnosis of PRES showed hippocampal sclerosis which was not present on the initial MRI. We conclude that there is a triggering role of PRES in the development of hippocampal sclerosis. Hippocampal sclerosis may have resulted from seizure‐associated damage, alternatively, hypertensive encephalopathy may have led to hippocampal damage viaa vascular mechanism.

L’imagerie hybride par tomographie par émission de positons/imagerie par résonance magnétique (TEP/IRM) est une nouvelle modalité qui combine les informations moléculaires et métaboliques fournies par la TEP avec les données morphologiques et fonctionnelles fournies par l’IRM. Les tomographes TEP/IRM ont été conçus en analogie avec la technologie de TEP/tomodensitométrie (TEP/TDM) couramment utilisée, avec toutefois des caractéristiques spécifiques liées aux différences intrinsèques de l’imagerie IRM et TDM. Dans le domaine de la neuro-imagerie, l’IRM fournit un panel d’informations beaucoup plus vaste que la TDM. De plus, l’IRM est déjà systématiquement réalisée en neuro-imagerie et fusionnée à l’imagerie TEP, à l’aide de logiciels spécifiques, à des fins diagnostiques et de recherche. Nous résumons ici notre expérience avec le premier tomographe intégré TEP/IRM installé en Suisse, principalement dans trois domaines d’application : la caractérisation des tumeurs cérébrales, le diagnostic précoce et différentiel des démences neurodégénératives et le bilan préopératoire de l’épilepsie pharmaco-résistante. Avec ce tomographe séquentiel, nous avons pu combiner les séquences diagnostiques IRM (y compris l’imagerie du tenseur de diffusion, la tractographie, la spectroscopie et l’IRM fonctionnelle) avec l’imagerie TEP du métabolisme glucidique (par 18F-Fluorodéoxyglucose–18F-FDG) ou du transport des acides aminés (par 18F-Fluoroéthyltyrosine–18F-FET). Nous résumons ici les principaux résultats obtenus dans le domaine de la neuro-imagerie par les différentes équipes travaillant avec ces nouveaux tomographes intégrés. L’ensemble de ces données montre que la TEP/IRM, réalisée en une session unique, peut représenter la modalité de choix pour la neuro-imagerie.

Pre-operative assessment and surgical management of patients with non-lesional extratemporal epilepsy remain challenging due to a lack of precise localisation of the epileptic zone. In most cases, invasive recording with depth or subdural electrodes is required. Here, we describe the case of 6.5-year-old girl who underwent comprehensive non-invasive phase I video-EEG investigation for drug-resistant epilepsy, including electric source and nuclear imaging. Left operculo-insular epilepsy was diagnosed. Post-operatively, she developed aphasia which resolved within one year, corroborating the notion of enhanced language plasticity in children. The patient remained seizure-free for more than three years.