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© 2022 International Federation of Clinical NeurophysiologyObjective: The significance of ictal magnetoencephalography (MEG) is not well appreciated. We evaluated the relationships between ictal MEG, MRI, intracranial electroencephalography (ICEEG), surgery and postoperative seizure outcome. Methods: A total of 45 patients (46 cases) with ictal MEG who underwent epilepsy surgery was included. We examined the localization of each modality, surgical resection area and seizure freedom after surgery. Results: Twenty-one (45.7%) out of 46 cases were seizure-free at more than 6 months follow-up. Median duration of postoperative follow-up was 16.5 months. The patients in whom ictal, interictal single equivalent current dipole (SECD) and MRI lesion localization were completely included in the resection had a higher chance of being seizure-free significantly (p < 0.05). Concordance between ictal and interictal SECD localizations was significantly associated with seizure-freedom. Concordance between MRI lesion and ictal SECD, concordance between ictal ICEEG and ictal and interictal SECD, as well as concordance between ictal ICEEG and MRI lesion were significantly associated with seizure freedom. Conclusions: Ictal MEG can contribute useful information for delineating the resection area in epilepsy surgery. Significance: Resection should include ictal, interictal SECDs and MRI lesion localization, when feasible. Concordant ictal and interictal SECDs on MEG can be a favorable predictor of seizure freedom.

Supplemental material, JCB902742 Supplemental Material for Visualizing prolonged hyperperfusion in post-stroke epilepsy using postictal subtraction SPECT by Kazuki Fukuma, Katsufumi Kajimoto, Tomotaka Tanaka, Shigetoshi Takaya, Katsuya Kobayashi, Akihiro Shimotake, Riki Matsumoto, Akio Ikeda, Kazunori Toyoda and Masafumi Ihara in Journal of Cerebral Blood Flow & Metabolism

We build a multiple hierarchical model of a representative democracy in which, for instance, voters elect county representatives, county representatives elect district representatives, district representatives elect state representatives, and state representatives elect a prime minister. We use our model to show that the policy determined by the final representative can become more extreme as the number of hierarchical levels increases because of increased opportunities for gerrymandering. Thus, a sufficiently large number of voters gives a district maker an advantage, enabling her to implement her favorite policy. We also show that the range of implementable policies increases with the depth of the hierarchical system. Consequently, districting by a candidate in a hierarchical legislative system can be viewed as a type of policy implementation device.

We build a multiple hierarchical model of a representative democracy in which, for instance, voters elect county representatives, county representatives elect district representatives, district representatives elect state representatives, and state representatives elect a prime minister. We use our model to show that the policy determined by the final representative can become more extreme as the number of hierarchical levels increases because of increased opportunities for gerrymandering. Thus, a sufficiently large number of voters gives a district maker an advantage, enabling her to implement her favorite policy. We also show that the range of implementable policies increases with the depth of the hierarchical system. Consequently, districting by a candidate in a hierarchical legislative system can be viewed as a type of policy implementation device.

Multiple hierarchical models of representative democracies in which, for instance, voters elect county representatives, county representatives elect district representatives, district representatives elect state representatives and state representatives a president, reduces the number of electors a representative is answerable for, and therefore, considering each level separately, these models could come closer to direct democracy. In this paper we show that worst case policy bias increases with the number of hierarchical levels. This also means that the opportunities of a gerrymanderer increase in the number of hierarchical levels.