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Abstract Introduction Primary hyperparathyroidism is a common endocrine disorder characterized by elevated parathyroid hormone levels, which cause continuous osteoclastic bone resorption. Giant cell tumor of bone is an expansile osteolytic tumor that contains numerous osteoclast-like giant cells. There are many similarities in the radiological and histological features of giant cell tumor of bone and brown tumor. This is a rare benign focal osteolytic process most commonly caused by hyperparathyroidism. Case presentation We report the unusual case of a 40-year-old Caucasian woman in which primary hyperparathyroidism was diagnosed after surgical ablation of a costal mass. The mass was suspected of being neoplastic and histopathology was compatible with a giant cell tumor of bone. On the basis of the biochemical results (including serum calcium, phosphorous and intact parathyroid hormone levels) primary hyperparathyroidism was suspected and a brown tumor secondary to refractory hyperparathyroidism was diagnosed. Conclusions Since giant cell tumor is a bone neoplasm that has major implications for the patient, the standard laboratory tests in patients with bone lesions are important for a correct diagnosis.

Objective: Depressive disorders are common among about 50% of the patients with drug‐resistant temporal lobe epilepsy (TLE). The underlying etiology remains elusive, but hypothalamus‐pituitary‐adrenal (HPA) axis activation due to changes in glucocorticoid receptor (GR) protein expression could play an important role. Therefore, we set out to investigate expression of the GR in the hippocampus, an important brain region for HPA axis feedback, of patients with drug‐resistant TLE, with and without comorbid depression. Methods: GR expression was studied using immunohistochemistry on hippocampal sections from well‐characterized TLE patients with depression (TLE + D, n = 14) and without depression (TLE − D, n = 12) who underwent surgery for drug‐resistant epilepsy, as well as on hippocampal sections from autopsy control cases (n = 9). Video–electroencephalography (EEG), magnetic resonance imaging (MRI), and psychiatric and memory assessments were performed prior to surgery. Results: Abundant GR immunoreactivity was present in dentate gyrus granule cells and CA1 pyramidal cells of controls. In contrast, neuronal GR expression was lower in patients with TLE, particularly in the TLE + D group. Quantitative analysis showed a smaller GR+ area in TLE + D as compared to TLE − D patients and controls. Furthermore, the ratio between the number of GR+/NeuN+ cells was lower in patients with TLE + D as compared to TLE − D and correlated negatively with the depression severity based on psychiatric history. The expression of the GR was also lower in glial cells of TLE + D compared to TLE − D patients and correlated negatively to the severity of depression. Significance: Reduced hippocampal GR expression may be involved in the etiology of depression in patients with TLE and could constitute a biological marker of depression in these patients. [ABSTRACT FROM AUTHOR]

Purpose. Changes in calbindin (CB) expression have been reported in patients with temporal lobe epilepsy (TLE) with controversial implications on hippocampal functions. The aim of this study was to determine the CB immunoreactivity in hippocampal dentate gyrus of patients who underwent epilepsy surgery for drug-resistant TLE with and without comorbid depression and/or memory deficits. Methods. Selected hippocampal samples from patients with TLE who underwent epilepsy surgery were included. Clinical and complementary assessment: EEG, video-EEG, MRI, psychiatric assessment (structured clinical interview, DSM-IV), and memory assessment (Rey auditory verbal learning test, RAVLT; Rey-Osterrieth complex figure test, RCFT), were determined before surgery. Hippocampal sections were processed using immunoperoxidase with the anti-calbindin antibody. The semiquantitative analysis of CB immunoreactivity was determined in dentate gyrus by computerized image analysis (ImageJ). Results. Hippocampal sections of patients with TLE and HS (n=24) and postmortem controls (n=5) were included. A significant reduction of CB+ cells was found in patients with TLE (p<0.05, Student's t-test). Among TLE cases (n=24), depression (n=12) and memory deficit (n=17) were determined. Depression was associated with a higher % of cells with the CB dendritic expression (CB-sprouted cells) (F1,20=11.81, p=0.003, hp2=0.37), a higher CB+ area (μm2) (F1,20=5.33, p=0.032, hp2=0.21), and a higher optical density (F1,20=15.09, p=0.001, hp2=0.43) (two-way ANOVA). The GAF scale (general assessment of functioning) of DSM-IV inversely correlated with the % of CB-sprouted cells (r=−0.52, p=0.008) and with the CB+ area (r=−0.46, p=0.022). Conclusions. In this exploratory study, comorbid depression was associated with a differential pattern of CB cell loss in dentate gyrus combined with a higher CB sprouting. These changes may indicate granular cell dysmaturation associated to the epileptic hyperexcitability phenomena. Further investigations should be carried out to confirm these preliminary findings. [ABSTRACT FROM AUTHOR]

Body piercing of the genitalia and nipples, called intimate piercing (IP), is an increasingly popular practice. However, research on psychological effects of IP is still scarce. In the present study we assessed the assumption that IP may play a key role in coping with childhood abuse, psychological distress, and body image derogations. An IP sample consisting of 71 female and male participants with at least one genital and/or one nipple piercing was assessed with psychometric tests. Indeed, the IP sample included significantly more subjects with emotional, sexual, and physical childhood abuse as well as emotional and physical neglect experiences, than expected in the German general population. On the contrary, the IP sample did not yield psychological distress symptoms of clinical relevance and showed an average body image profile. The results are discussed in light of trauma-coping strategies. [ABSTRACT FROM AUTHOR]

Purpose:To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules. Materials and methods:Institutional review board approval was obtained, and patients’ consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57 ± 14 years) with LA and 152 (107 females, age 57 ± 14 years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12 months and complications were evaluated. Results:No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12 months was −67 ± 19% vs. −57 ± 21% (p < 0.001) − 70 ± 19% vs. −62 ± 22% (p= 0.001) in LA group and in RFA group, respectively. Nodules with volume >30 mL had significantly higher percentage volume reduction at 6 and 12 months (−69 ± 19 vs. −50 ± 21,p = 0.001) and (−73 ± 18 vs. −54 ± 23 8,p = 0.001) in the LA group than in the RFA group, respectively. In both groups, operator’s skills affected the results. Major complications occurred in 4 cases in each group (p = 0.116) Conclusions:LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator’s skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique. [ABSTRACT FROM PUBLISHER]

Background: The efficacy and safety of various modes of medical treatment for primary hyperparathyroidism in pregnancy are largely unknown.Case Presentation: We report the case of a 34-year-old white woman with primary hyperparathyroidism symptomatic for nephrolithiasis. Her serum calcium was 3.15 mmol/l and parathyroid hormone was 109.0 ng/L. Neck imaging found no pathological parathyroid tissue. Cinacalcet and cholecalciferol were started. She became pregnant 17 months later. The calcimimetic was stopped. During pregnancy, she was admitted for hydration administered intravenously two to three times per week. In her 24th week of pregnancy, cinacalcet was restarted. In her 32nd week, a cesarean section was carried out as planned.Conclusions: Only three cases of primary hyperparathyroidism in women on cinacalcet therapy in pregnancy have been published in the literature. In the present case, hydration was useful in controlling serum calcium. Cinacalcet therapy helped to control serum calcium. [ABSTRACT FROM AUTHOR]

The original Personality Styles and Disorder Inventory (PSDI) consists of 140 items capturing the non-pathological equivalents of 14 personality disorders (PDs) listed in DSM-II1-R, DSM-IV-TR. and ICD-10. Because the DSM-5 proposes only six PDs in its research section and completing the PSDI is very time-consuming, a questionnaire capturing these six PDs with a smaller number of items would be desirable. Therefore, the short version PSDI-6 measuring each of the six PDs with six items was developed. Methods: Items were selected by means of exploratory and confirmatory factor analysis (CFA), using a calibration sample of nonclinical pregnant women. Measurement invariance of the PSDI-6 was demonstrated by CFA of multisample models in two independent samples. The PSDI-6 demonstrated acceptable internal consistency, factorial validity, and factorial invariance. Correlations with perfectionism, anxiety, and depression provided preliminary evidence of convergent and discriminant validity. Because our sample was limited to pregnant women, further studies should investigate the PSDI-6 in other clinical contexts. [ABSTRACT FROM AUTHOR]

Depth intracranial electrodes (IEs) placement is one of the most used procedures to identify the epileptogenic zone (EZ) in surgical treatment of drug resistant epilepsy patients, about 20-30% of this population. IEs localization is therefore a critical issue defining the EZ and its relation with eloquent functional areas. That information is then used to target the resective surgery and has great potential to affect outcome. We designed a methodological procedure intended to avoid the need for highly specialized medical resources and reduce time to identify the anatomical location of IEs, during the first instances of intracranial EEG recordings. This workflow is based on established open source software; 3D Slicer and Freesurfer that uses MRI and Post-implant CT fusion for the localization of IEs and its relation with automatic labeled surrounding cortex. To test this hypothesis we assessed the time elapsed between the surgical implantation process and the final anatomical localization of IEs by means of our proposed method compared against traditional visual analysis of raw post-implant imaging in two groups of patients. All IEs were identified in the first 24 H (6-24 H) of implantation using our method in 4 patients of the first group. For the control group; all IEs were identified by experts with an overall time range of 36 h to 3 days using traditional visual analysis. It included (7 patients), 3 patients implanted with IEs and the same 4 patients from the first group. Time to localization was restrained in this group by the specialized personnel and the image quality available. To validate our method; we trained two inexperienced operators to assess the position of IEs contacts on four patients (5 IEs) using the proposed method. We quantified the discrepancies between operators and we also assessed the efficiency of our method to define the EZ comparing the findings against the results of traditional analysis. [ABSTRACT FROM AUTHOR]

The aim of the present study is to compare pre- and postsurgical neuropsychological outcome in individuals suffering from mesial temporal lobe epilepsy (mTLE), in order to evaluate prognosis. The selected thirty-five patients had medically mTLE and had undergone an anterior temporal lobectomy (ATL). Neuropsychological evaluation was performed in three different stages: before ATL, 6 months after resection, and a year afterwards. Neuropsychological protocol evaluated attention, verbal memory, visual memory, executive function, language, intelligence, and handedness. There was a significant improvement (P = 0.030) in the group with visual memory deficit after surgery, whereas no changes were observed across patients with verbal memory deficit. No changes were observed in language after surgery. Executive function showed significant improvement 6 months after surgery (P = 0.035). Postoperative outcome of cognitive impairments depends on baseline neuropsychological status of the patients with TLE. In our case series, deficits found in patients with mTLE after ATL did not result in a subjective complaint. [ABSTRACT FROM AUTHOR]

Background: Functional/dissociative seizures (FDS), also known as psychogenic non-epileptic seizures (PNES), are sudden, transient, and involuntary events that include motor, sensory, cognitive or autonomic function alterations. In this work we analyzed the psychopathological characteristics of a subgroup of women who suffer from FDS with the aim to analyze the role of psychological trauma, with special emphasis on trauma due to sexual abuse (SA). Methods: Forty-five women diagnosed with FDS were included in the study (age range 18 to 64 years, mean = 34.7, standard deviation (SD) = 13.1). Clinical and psychopathological characteristics were reviewed. All patients have completed the clinical interviews, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID II) and the Global Assessment of Functioning (GAF) according to a special protocol for mental health assessment. Also, the history of sexual abuse trauma, the history of other non-sexual traumas and absence of history of trauma were reviewed. Results: Eighty percent of the cases reported a history of trauma, and 40% reported a history of SA. Patients with a history of SA presented a significantly lower average age of seizure onset than patients with a history of other non-sexual traumas (p = 0.021). Significant associations were found between SA and post-traumatic stress disorder (PTSD) (p = 0.031), and SA and history of suicide attempts (p = 0.037). Conclusions: SA carries serious implications for the mental health of women suffering from FDS. Mental health professionals must consider the history of this type of trauma to provide the necessary care for this patient population. [ABSTRACT FROM AUTHOR]

Background: Functional/dissociative seizures (FDS), also known as psychogenic non-epileptic seizures (PNES), are sudden, transient, and involuntary events that include motor, sensory, cognitive or autonomic function alterations. In this work we analyzed the psychopathological characteristics of a subgroup of women who suffer from FDS with the aim to analyze the role of psychological trauma, with special emphasis on trauma due to sexual abuse (SA)., Methods: Forty-five women diagnosed with FDS were included in the study (age range 18 to 64 years, mean = 34.7, standard deviation (SD) = 13.1). Clinical and psychopathological characteristics were reviewed. All patients have completed the clinical interviews, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID II) and the Global Assessment of Functioning (GAF) according to a special protocol for mental health assessment. Also, the history of sexual abuse trauma, the history of other non-sexual traumas and absence of history of trauma were reviewed., Results: Eighty percent of the cases reported a history of trauma, and 40% reported a history of SA. Patients with a history of SA presented a significantly lower average age of seizure onset than patients with a history of other non-sexual traumas (p = 0.021). Significant associations were found between SA and post-traumatic stress disorder (PTSD) (p = 0.031), and SA and history of suicide attempts (p = 0.037)., Conclusions: SA carries serious implications for the mental health of women suffering from FDS. Mental health professionals must consider the history of this type of trauma to provide the necessary care for this patient population.

Objective: Temporal lobe epilepsy can disturb eloquent areas, affecting language. We applied a visually-mediated task to measure lateralization of language recognition in drug-resistant temporal lobe epilepsy., Method: Patients with left ( n = 26), right ( n = 28) temporal lobe epilepsy and controls ( n = 30) were administered the translingual lexical decision task. We performed repeated measures analyses of variance, with the visual half-field as an intrasubject factor and the group as an intersubject factor., Results: A main effect of visual half-field was found, showing the right visual field (left hemisphere) advantage for both accuracy and response time. A main effect of the group was found in accuracy, showing that both epilepsy groups performed less accurately than controls, and left temporal lobe epilepsy performed less accurately than right temporal lobe epilepsy. Also, the group-by-visual half-field interaction was significant. Post hoc t tests indicated the controls and right temporal lobe epilepsy performed better in the right visual field than in the left visual field, whereas no visual half-field effect was found in left temporal lobe epilepsy. For response times, the interaction was also significant. Post hoc t tests showed a significant right visual-field advantage for controls (two-tailed) and for the right temporal lobe epilepsy (one-tailed). Right visual-field advantage was absent in left temporal lobe epilepsy., Conclusions: The translingual lexical decision task can efficiently distinguish between left and right temporal lobe epilepsy. Compared to right temporal lobe epilepsy and controls, language lateralization is diminished in left temporal lobe epilepsy. The potential use of the translingual lexical decision task as an effective noninvasive presurgical language lateralization screening tool is highlighted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The loss of consciousness (LOC) during seizures is one of the most striking features that significantly impact the quality of life, even though the neuronal network involved is not fully comprehended. We analyzed the intracerebral patterns in patients with focal drug-resistant epilepsy, both with and without LOC. We assessed the localization, lateralization, stereo electroencephalography (SEEG) patterns, seizure duration, and the quantification of contacts exhibiting electrical discharge. The degree of LOC was quantified using the Consciousness Seizure Scale. Thirteen patients (40 seizures) with focal drug-resistant epilepsy underwent SEEG. In cases of temporal lobe epilepsy (TLE, 6 patients and 15 seizures), LOC occurred more frequently in seizures with mesial rather than lateral temporal lobe onset. On the other hand, in cases of frontal lobe epilepsy (7 patients; 25 seizures), LOC was associated with pre-frontal onset, a higher number of contacts with epileptic discharge compared to the onset count and longer seizure durations. Our study revealed distinct characteristics during LOC depending on the epileptogenic zone. For temporal lobe seizures, LOC was associated with mesial seizure onset, whereas in frontal lobe epilepsy, seizure with LOC has a significant increase in contact showing epileptiform discharge and a pre-frontal onset. This phenomenon may be correlated with the broad neural network required to maintain consciousness, which can be affected in different ways, resulting in LOC., Competing Interests: We declare we have no competing interests., (© The Author(s) 2024. Published by Oxford University Press.)

Ictal semiology is essential to identify the epileptogenic zone (EZ), especially in drug-resistant focal epilepsy (DRE), as its accurate identification determines the surgical prognosis. Dancing is highly unusual ictal semiology, and its underlying neural networks remain somehow unclear since both temporal and frontal lobe (FL) have been implicated in its generation. We present a 21-year-old male with DRE characterized by dancing seizures. Homemade videos were obtained. Through a non-invasive pre-surgical evaluation, the epileptogenic zone was localized within a gross lesion in the left FL. Using stereo electroencephalography (SEEG), we successfully identified the ictal-onset zone in the mesial middle, inferior, and orbito-frontal cortex, with rapid propagation of ictal activity extending backward and laterally to the precentral regions. Subsequently, a left frontal middle and inferior gyrectomy was performed, resulting in seizure freedom for the patient. Pathology results revealed a mild malformation of cortical development with oligodendroglial hyperplasia (MOGHE). Atypical seizure semiology, such as dancing, provides an interesting starting point for the analysis of the areas involved in the EZ. Further intracranial recordings are required to fully comprehend the underlying networks and interactions of cerebral areas during dancing seizures., (© 2023 International League Against Epilepsy.)

Purpose: To use computational modeling to provide a complete and logical description of the electrical and thermal behavior during stereoelectroencephalography-guided (SEEG) radiofrequency thermo-coagulation (RF-TC)., Methods: A coupled electrical-thermal model was used to obtain the temperature distributions in the tissue during RF-TC. The computer model was first validated by an ex vivo model based on liver fragments and later used to study the impact of three different factors on the coagulation zone size: 1) the difference in the tissue surrounding the electrode (gray/white matter), 2) the presence of a peri-electrode gap occupied by cerebrospinal fluid (CSF), and 3) the energy setting used (power-duration)., Results: The model built for the experimental validation was able to predict both the evolution of impedance and the short diameter of the coagulation zone (error < 0.01 mm) reasonably well but overestimated the long diameter by 2 - 3 mm. After adapting the model to clinical conditions, the simulation showed that: 1) Impedance roll-off limited the coagulation size but involved overheating (around 100 °C); 2) The type of tissue around the contacts (gray vs. white matter) had a moderate impact on the coagulation size (maximum difference 0.84 mm), and 3) the peri-electrode gap considerably altered the temperature distributions, avoided overheating, although the diameter of the coagulation zone was not very different from the no-gap case (<0.2 mm)., Conclusions: This study showed that computer modeling, especially subject- and scenario-specific modeling, can be used to estimate in advance the electrical and thermal performance of the RF-TC in brain tissue.

Introduction: Epilepsy is closely related to daily rhythms, such as the sleep-wake cycle. The objective of this study was to evaluate the relationship between drug-resistant temporal lobe epilepsy (TLE) and the parameters related to the sleep-wake cycle, seizure time and epilepsy laterality., Methods: Consecutive patients admitted to the video electroencephalogram unit with a diagnosis of TLE were enrolled. Patients were divided into two groups: those with left TLE (LTLE) and those with right TLE (RTLE). They then remained in the conditions of 12-hour light, 12-hour darkness. Demographic data, treatment, number and time of seizure occurrence, sleep diary, morningness-eveningness questionnaire, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were recorded., Results: In total, 74 patients with TLE, 43 with LTLE and 31 with RTLE, were studied. RTLE patients showed a significant preference for morningness. Patients treated with benzodiazepines showed worse sleep quality and greater daytime sleepiness. Patients who did not report any clear predominance and patients who reported seizures during wakefulness had significantly more seizures during wakefulness and patients who reported sleep predominance had more seizures during sleep (p>0.001). The LTLE group had a greater number of seizures from 8 to 16 hours, unlike the RTLE group, which had a uniform distribution (p=0.008)., Conclusions: This was a prospective study of patients with drug-resistant TLE performed in a controlled environment to study the impact of daily rhythms, seizure frequency and seizure distribution. Laterality seems to be a key factor in seizure distribution., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Primary hyperparathyroidism (PHPT) is an increasingly common endocrine disorder. Most patients with PHPT do not have disease-specific symptoms. The management of these patients has been widely debated. Recent studies have shown the importance of following up asymptomatic patients in order to reduce co-morbidity. However, there are conflicting opinions as to medical management. The aim of our study was to compare the outcome of PHPT patients on antiresorptive therapy vs. observation only., Material and Methods: We longitudinally evaluated 157 PHPT patients (126 females) aged 22-90 years. Patients who did not undergo surgery were divided into two groups: those on anti-resorptive therapy (N = 52), and those without any treatment (N = 37). Patients who were disease-free after surgery (N = 50) served as controls., Results: The values of serum calcium (S-Ca), parathyroid hormone (PTH) and indices of bone metabolism did not differ significantly among the three groups of subjects. No differences in 25(OH)-vitamin D levels were noted. Bone mineral density (BMD) was not significantly different at the spinal level. Finally, we found no evidence of an effect of medical treatment on quality of life (QoL). However, QoL significantly improved in the surgery group after parathyroidectomy (PTX)., Conclusions: This study provided up-to-date information in terms of biochemical progression on the natural history of PHPT patients. No significant differences emerged between anti-resorptive therapy and observation only. It is not yet possible to assess the effect of pharmacological treatments on QoL in statistical terms.

Introduction: Status epilepticus increases the production of new neurons (hippocampal neurogenesis) and promotes aberrant migration. However chronic experimental models of epilepsy and studies performed in human epilepsy showed controversial results suggesting a reduction in hippocampal neurogenesis in late stages of the disease. Doublecortin (DCX) has been validated to determine alterations in the production of new neurons in the human hippocampus., Objectives: Determine DCX expression in human hippocampal sclerosis (HS) from patients who underwent epilepsy surgery for refractory temporal lobe epilepsy (TLE)., Methods: Hippocampal sections of 9 patients with HS and TLE who underwent surgery, were processed using immunoperoxidase for DCX. Archival material from 5 normal post-mortem hippocampus were simultaneously processed., Results: Significantly lower staining intensity was observed in DCX-positive neurons localized in dentate gyrus (DG) and in CA1 of epileptic hippocampus; lower DCX reactive area was observed in pyramidal layers of CA1; and a reduced in the mean number of DCX-positive neurons were determined in DG compared to normal hippocampus (p<0.05)., Conclusions: This study found a decrease in DCX expression in hippocampus of patients with HS and chronic and refractory TLE suggesting alterations in NG and hippocampal synaptogenesis with potential cognitive and emotional repercussion., (Published by Elsevier Ltd.)

The issue of psychotic disorders in epilepsy has given rise to great controversy among professionals; however, there are not many studies in this area and the physiopathological mechanisms remain unknown. The aim of this study was to describe the spectrum of psychotic disorders in an Argentine population with refractory temporal lobe epilepsy (RTLE) and to determine the risk factors associated with psychotic disorders. Clinical variables of the epileptic syndrome were compared among a selected population with RTLE with and without psychotic disorders (DSM-IV/Ictal Classification of psychoses). Logistic regression was performed. Sixty-three patients with psychotic disorders (Psychotic Group, PG) and 60 controls (Control Group, CG) were included. The most frequent psychotic disorders were brief psychotic episodes (35%) (DSM-IV) and interictal psychosis (50%) (Ictal Classification). Risk factors for psychotic disorders were bilateral hippocampal sclerosis, history of status epilepticus, and duration of epilepsy greater than 20 years.