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Background and ObjectivesWe conducted a multisite, pragmatic replication trial at 4 New England epilepsy centers to determine the effectiveness of Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) in a real-world setting and to assess feasibility of a virtual intervention.MethodsHOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QoL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in 4 states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3 months, and 6 months; intervention groups received long-term follow-up at 9 and 12 months.ResultsA total of 108 participants were recruited, of whom 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QoL score compared with controls (p< 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p< 0.001). There were no meaningful group differences in objective cognition or health care utilization at any time points and the treatment effect for QoL diminished by 6 months. The virtual intervention demonstrated feasibility but did not significantly improve outcomes compared with controls. Within-group analysis found improvements in QoL for both H-V and H-IP.DiscussionThis study replicated the effectiveness of the HOBSCOTCH program in improving QoL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect.Trial Registration InformationClinicalTrials.gov(NCT02394509).Classification of EvidenceThis study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.

In 2017, the International League Against Epilepsy (ILAE) Classification of Epilepsies described the “genetic generalized epilepsies” (GGEs), which contained the “idiopathic generalized epilepsies” (IGEs). The goal of this paper is to delineate the four syndromes comprising the IGEs, namely childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic–clonic seizures alone. We provide updated diagnostic criteria for these IGE syndromes determined by the expert consensus opinion of the ILAE’s Task Force on Nosology and Definitions (2017–2021) and international external experts outside our Task Force. We incorporate current knowledge from recent advances in genetic, imaging, and electroencephalographic studies, together with current terminology and classification of seizures and epilepsies. Patients that do not fulfill criteria for one of these syndromes, but that have one, or a combination, of the following generalized seizure types: absence, myoclonic, tonic‐clonic and myoclonic‐tonic‐clonic seizures, with 2.5–5.5 Hz generalized spike‐wave should be classified as having GGE. Recognizing these four IGE syndromes as a special grouping among the GGEs is helpful, as they carry prognostic and therapeutic implications.

Human neural networks important for singing have not been clearly elucidated. Here, we present a case of electrical brain stimulation of the right non-language dominant cingulate gyrus during brain surgery for epilepsy which resulted in involuntary singing of spoken language. We postulate that the current observation provides the strongest evidence as of yet that the cingulate gyrus is directly involved in voluntary motor control of singing. [Published with video sequence].

Aim There are limited data on psychological outcomes in older people with epilepsy (PWE). This analysis, from a large pooled dataset of clinical studies from the Managing Epilepsy Well (MEW) Network, examined clinical variables including depressive symptom severity, quality of life and epilepsy self-management competency among older (age 55+) vs younger (

Mathematical reasoning is central to everyday life. Lesion data and functional MRI studies suggest that even simple arithmetic involves the coordination of multiple spatially diverse brain regions, but to date, math processing has not been well characterized using direct brain recordings, especially outside of the parietal cortex. To address this, we utilized an unparalleled data set of 310 subjects implanted with intracranial electrodes to investigate the spatial and temporal dynamics of arithmetic reasoning. Our data support the importance of regions previously implicated in numerosity such as the superior parietal lobule and intraparietal sulcus. However, we also identify contributions to arithmetic processing from regions such as the entorhinal cortex and temporal pole. Using the excellent bihemispheric coverage afforded by our data set and the precise temporal resolution of intracranial recordings, we characterize in detail the spatial and temporal characteristics of an arithmetic processing network, quantifying subtle hemispheric differences for selected regions. We also examine how activity in these regions predicts arithmetic ability and look for gender differences in the pattern of network activation. Our findings further define the complex network of regions involved in human arithmetical reasoning.

In working memory tasks, stimulus presentation induces a resetting of intracranial temporal lobe oscillations in multiple frequency bands. To further understand the functional relevance of this phenomenon, we investigated whether working memory performance depends on the phase precision of ongoing oscillations in the hippocampus. We recorded intra-hippocampal local field potentials in individuals performing a working memory task. Two types of trials were administered. For high memory trials presentation of a list of four letters (“List”) was followed by a single letter memory probe (“Test”). Low memory load trials, consisting of four identical letters (AAAA) followed by a probe with the same letter (A), were interspersed. Significant phase locking of ongoing oscillations across trials, estimated by the Pairwise Phase Consistency Index (PPCI) was observed in delta (0.5–4 Hz), theta (5–7 Hz), and alpha (8–12 Hz) bands during stimulus presentation and recall but was increased in low memory load trials. Across patients however, higher delta PPCIs during recall in the left hippocampus were associated with faster reaction times. Because phase locking could also be interpreted as a consequence of a stimulus evoked potential, we performed event related potential analysis (ERP) and examined the relationship of ERP components with performance. We found that both amplitude and latency of late ERP components correlated with both reaction time and accuracy. We propose that, in the Sternberg task, phase locking of oscillations, or alternatively its ERP correlate, synchronizes networks within the hippocampus and connected structures that are involved in working memory.

Recently a quantum size effect was proposed to be responsible for the blue shift of optical absorption edge and photoluminescence peak wavelength as well as for the porous silicon (PS) formation itself. In the debate about the mechanism of light emission from PS a correlation between particle size and luminescence peak position would be a key test of the confinement approach. In this letter X-ray diffraction results of as-etched PS samples will be presented that indicate a decrease of particle size and an increase of stress in conjunction with a blueshift of photoluminescence wavelength and absorption edge.