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Objective Corpus callosotomy is an effective palliative treatment for drug-resistant Lennox-Gastaut syndrome (LGS). Laser interstitial thermal therapy has been increasingly used in the treatment of epilepsy. Here, we assess the safety and effectiveness of minimally invasive stereotactic laser anterior corpus callosotomy (SLACC) for drop attacks in LGS. Methods We reviewed sequential cases of patients with medically intractable LGS who underwent SLACC using a two-cannula technique between November 2014 and July 2019. Pre- and postoperative magnetic resonance imaging was used to measure the anteroposterior length of callosal ablation (contrast-enhancing lesion) and estimated disconnection (gap in tract projections on diffusion tensor imaging). Patients were followed longitudinally to assess clinical outcomes. Results Ten patients were included in this study. The median age was 33 (range = 11-52) years, median duration of epilepsy was 26 (range = 10-49) years, and median duration of postoperative follow-up was 19 (range = 6-40) months. In the anteroposterior direction, 53 ± 7% (mean ± SD) of the corpus callosum was ablated and 62 ± 19% of the corpus callosum was estimated to be disconnected. Six (60%) of 10 patients achieved >80% seizure reduction, two (20%) of whom became seizure-free. Eight (80%) patients had >80% reduction in drop attacks, five (50%) of whom became free of drop attacks. Three patients subsequently underwent laser posterior callosotomy with further improvement in drop attacks and/or overall seizure frequency. One patient had an asymptomatic intracerebral hemorrhage along the cannula tract. One patient developed significant aggression after becoming seizure-free. Significance Seizure outcomes following SLACC were comparable to previously reported outcomes of open callosotomy, with reasonable safety profile. SLACC appears to be an effective alternative to open anterior corpus callosotomy with minimal postoperative discomfort and a short recovery period.

Neurological dysfunction has been noted in up to 36% of patients hospitalized with COVID-19, and a variety of mechanisms of neurological injury are possible. Here we report the rapid development of PRES and acute seizures in a patient with COVID-19 infection and sickle cell disease. The combination of COVID and sickle cell disease may raise the risk of PRES and could contribute to the higher mortality rate of COVID in patients with sickle cell disease.

Acute symptomatic seizures have been reported in sporadic cases in patients with COVID-19.1 2 However, a recent large retrospective cohort study suggested that there was no increased risk of acute symptomatic seizures in these patients.3 As such, the association of seizures with COVID-19 has not been established. Admittedly, EEG studies have been significantly underused due to exposure concerns, and epileptiform activity has seldom been identified in this patient population. The aims of this study were to determine the prevalence of epileptiform activity and to assess the risk of seizures in patients with COVID-19. We retrospectively reviewed consecutive patients with COVID-19 from 1 March to 27 May 2020 in a single institution. Patients were included if they were (1) ≥18 years of age, (2) positive for nasal swab SARS-CoV-2 RNA qualitative PCR test and (3) underwent EEG monitoring. Patients with a prior active diagnosis of epilepsy were excluded. Patient data regarding demographics, medical history, neuroimaging, laboratory tests, complications, mortality, metabolic profiles and treatment were extracted from electronic medical records. COVID-19 disease severity was categorised according to WHO guideline into (1) non-severe: absence of viral pneumonia or hypoxia, or clinical signs of pneumonia but SpO2 of >90% on room air; (2) severe: clinical pneumonia, respiratory rate of >30 and SpO2 of

Background: Stroke burden is a leading cause of disability on developing countries. However, there are no studies assessing the impact of previous non-fatal strokes on all-cause mortality in rural areas of Latin America, where living conditions and health care access are different than in urban centers. Using a population-based prospective cohort study (The Atahualpa Project), we aimed to assess the influence of non-fatal stroke on all-cause mortality in community-dwelling older adults living in a remote rural setting. Methods: Individuals aged ≥60 years with a non-fatal stroke were detected during yearly door-to-door surveys by the use of validated questionnaires and corroborated by a certified neurologist. Deaths occurring during the follow-up were identified from annual surveys, death certificates review, and other overlapping sources. Univariate tests for equality of survivor functions were used to estimate differences between observed and expected deaths for the presence of a non-fatal stroke. Survival analyses were conducted by the use of the mortality incidence rate ratio (IRR) and by Cox proportional hazard models with subsequent estimation of Kaplan Meier survival curves. Results: Of 437 individuals aged ≥60 years enrolled during a 5-year period, follow-up was achieved in 417 (95%), contributing 1,776 years of follow-up (average 4.3±1.3 years). Forty-five (10.8%) individuals were stroke survivors. Fifty-one deaths were detected, for an overall cumulative 5-year mortality rate of 12.2% (95% C.I.: 8.9 - 15.6). According to log-rank analysis, the ratio of observed versus expected deaths among stroke survivors was 14/5.12 (p=0.0001). Having history of a non-fatal stroke was significantly related to mortality (IRR: 3.38; 95% C.I.: 1.69 - 6.41; p=0.0005). A fully adjusted Cox proportional hazard model showed that non-fatal strokes independently predicted mortality (hazard ratio: 2.18, SE: 0.75; 95% C.I.: 1.11 - 4.28; p=0.024). Conclusions: This study shows the importance of a previous non-fatal stroke on the risk of all-cause mortality in inhabitants of a remote rural village. Epidemiological studies assessing the impact of region-specific factors influencing mortality may prove cost-effective for developing preventive strategies.