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PurposeTo extend the MR MultiTasking-based Multidimensional Assessment of Cardiovascular System (MT-MACS) technique with larger spatial coverage and water-fat separation for comprehensive aortocardiac assessment.MethodsMT-MACS adopts a low-rank tensor image model for 7D imaging, with three spatial dimensions for volumetric imaging, one cardiac motion dimension for cine imaging, one respiratory motion dimension for free-breathing imaging, one T2-prepared inversion recovery time dimension for multi-contrast assessment, and one T2*-decay time dimension for water-fat separation. Nine healthy subjects were recruited for the 3T study. Overall image quality was scored on bright-blood (BB), dark-blood (DB), and gray-blood (GB) contrasts using a 4-point scale (0-poor to 3-excellent) by two independent readers, and their interreader agreement was evaluated. Myocardial wall thickness and left ventricular ejection fraction (LVEF) were quantified on DB and BB contrasts, respectively. The agreement in these metrics between MT-MACS and conventional breath-held, electrocardiography-triggered 2D sequences were evaluated.ResultsMT-MACS provides both water-only and fat-only images with excellent image quality (average score = 3.725/3.780/3.835/3.890 for BB/DB/GB/fat-only images) and moderate to high interreader agreement (weighted Cohen's kappa value = 0.727/0.668/1.000/1.000 for BB/DB/GB/fat-only images). There were good to excellent agreements in myocardial wall thickness measurements (intraclass correlation coefficients [ICC] = 0.781/0.929/0.680/0.878 for left atria/left ventricle/right atria/right ventricle) and LVEF quantification (ICC = 0.716) between MT-MACS and 2D references. All measurements were within the literature range of healthy subjects.ConclusionThe refined MT-MACS technique provides multi-contrast, phase-resolved, and water-fat imaging of the aortocardiac systems and allows evaluation of anatomy and function. Clinical validation is warranted.

Introduction: Neuropsychological assessment forms an integral part of the presurgical evaluation for patients with medically refractory focal epilepsy. Our understanding of cognitive impairment in epilepsy is based on seminal lesional studies that have demonstrated important structure-function relationships within the brain. However, a growing body of literature demonstrating heterogeneity in the cognitive profiles of patients with focal epilepsy (e.g., temporal lobe epilepsy; TLE) has led researchers to speculate that cognition may be impacted by regions outside the seizure onset zone, such as those involved in the interictal or “irritative” network. Methods: Neuropsychological data from 48 patients who underwent stereoelectroencephalography (SEEG) monitoring between 2012 and 2023 were reviewed. Patients were categorized based on the site of seizure onset, as well as their irritative network, to determine the impact of wider network activity on cognition. Neuropsychological data were compared with normative standards (i.e., z = 0), and between groups. Results: There were very few distinguishing cognitive features between patients when categorized based purely on the seizure onset zone (i.e., frontal lobe vs. temporal lobe epilepsy). In contrast, patients with localized irritative networks (i.e., frontal or temporal interictal epileptiform discharges [IEDs]) demonstrated more circumscribed profiles of impairment compared with those demonstrating wider irritative networks (i.e., frontotemporal IEDs). Furthermore, the directionality of propagation within the irritative network was found to influence the manifestations of cognitive impairment. Discussion: The findings suggest that neuropsychological assessment is sensitive to network activity beyond the site of seizure onset. As such, an overly focal interpretation may not accurately reflect the distribution of the underlying pathology. This has important implications for presurgical work-up in epilepsy, as well as subsequent surgical outcomes. [ABSTRACT FROM AUTHOR]

We present two cases with focal seizures where scalp electroencephalography (EEG) had prominent features of a developmental and epileptic encephalopathy (DEE): Case 1: a 17-year-old male with complex motor seizures whose EEG demonstrated a slow spike-and-wave pattern and generalized paroxysmal fast activity (GPFA). Case 2: a 12-year-old male with startle-induced asymmetric tonic seizures whose EEG also had a slow spike-and-wave pattern. Both patients had intracranial EEG assessment, and focal cortical resections resulted in long-term seizure freedom and resolution of generalized findings. These cases exemplify patients with focal epilepsy with networks that share similarities to generalized epilepsies, and importantly, these features did not preclude curative epilepsy surgery. [ABSTRACT FROM AUTHOR]

Objective: Determination of the real‐world performance of a health care system in the treatment of status epilepticus (SE). Methods: Prospective, multicenter population‐based study of SE in Auckland, New Zealand (NZ) over 1 year, with data recorded in the EpiNet database. Focus on treatment patterns and determinants of SE duration and 30‐day mortality. The incidence, etiology, ethnic discrepancies, and seizure characteristics of this cohort have been published previously. Results: A total of 365 patients were included in this treatment cohort; 326 patients (89.3%) were brought to hospital because of SE, whereas 39 patients (10.7%) developed SE during a hospital admission for another reason. Overall, 190 (52.1%) had a known history of epilepsy and 254 (70.0%) presented with SE with prominent motor activity. The mean Status Epilepticus Severity Score (STESS) was 2.15 and the mean SE duration of all patients was 44 min. SE self‐terminated without any treatment in 84 patients (22.7%). Earlier administration of appropriately dosed benzodiazepine in the pre‐hospital setting was a major determinant of SE duration. Univariate analysis demonstrated that mortality was significantly higher in older patients, patients with longer durations of SE, higher STESS, and patients who developed SE in hospital, but these did not maintain significance with multivariate analysis. There was no difference in the performance of the health care system in the treatment of SE across ethnic groups. Significance: When SE was defined as 10 continuous minutes of seizure, overall mortality was lower than expected and many patients had self‐limited presentations for which no treatment was required. Although there were disparities in the incidence of SE across ethnic groups there was no difference in treatment or outcome. The finding highlights the benefit of a health care system designed to deliver universal health care. [ABSTRACT FROM AUTHOR]

Eur J Paediatr Neurol. 2020; 24: 40 - 2. 44 Helmstaedter C, Beeres K, Elger CE, Kuczaty S, Schrm J, Hoppe C. Cognitive outcome of pediatric epilepsy surgery across ages and different types of surgeries: a monocentric 1-year follow-up study in 306 patients of school age. A systematic approach to the adaption of existing ERAS guidelines, using a model such as that proposed by Fervers and colleagues (i.e., ADAPTE),[11] could be applied to epilepsy surgery in much the same way the International League Against Epilepsy recently did for approaches to the management of depression in epilepsy.[12] START WITH THE PATIENT'S GOALS Improving postsurgical outcomes starts with understanding an individual patient's goals for surgery and the patient-specific barriers that may prevent their achievement. Keywords: burden of normality; enhanced recovery; epilepsy surgery; rehabilitation; surgical outcome EN burden of normality enhanced recovery epilepsy surgery rehabilitation surgical outcome 1785 1790 6 07/14/23 20230701 NES 230701 Key points Despite great advances in epilepsy surgery, there remains no consensus regarding best practice in postoperative rehabilitation, which can vary widely between surgical centers Preparing patients for surgery and supporting them through the process of adjustment that follows requires a patient-centered approach We advocate a holistic framework for recovery and rehabilitation after epilepsy surgery, where advice and interventions are tailored to each patient's goals It has long been established that social and emotional functioning can remain impaired in adults with drug-resistant epilepsy (DRE) who become seizure-free after epilepsy surgery.[1] The "burden of normality" is apparent, where identity associated with states of illness and dependence often remains a major limiting factor.[2] Epilepsy surgery is a life-defining event and can be a daunting prospect for patients. [Extracted from the article]

Background: Intra‐aortic balloon pumps (IABP) are used to bridge select end‐stage heart disease patients to heart transplant (HT). IABP use and exception requests both increased dramatically after the UNOS policy change (PC). The purpose of this study was to evaluate the effect of PC and exception status requests on waitlist and post‐transplant outcomes in patients bridged to HT with IABP support. Methods: We analyzed adult, first‐time, single‐organ HT recipients from the UNOS Registry either on IABP at the time of registration for HT or at the time of HT. We compared waitlist and post‐HT outcomes between patients from the PRE (October 18, 2016 to May 30, 2018) and POST (October 18, 2018 to May 30, 2020) eras using Kaplan‐Meier curves and time‐to‐event analyses. Results: A total of 1267 patients underwent HT from IABP (261 pre‐policy/1006 post‐policy). On multivariate analysis, PC was associated with an increase in HT (sub‐distribution hazard ratio (sdHR): 2.15, p <.001) and decrease in death/deterioration (sdHR: 0.55, p =.011) on the waitlist with no effect on 1‐year post‐HT survival (p =.8). The exception status of patients undergoing HT was predominantly seen in the POST era (29%, 293/1006); only four patients in the PRE era. Exception requests in the POST era did not alter patient outcomes. Conclusions: In patients bridged to heart transplant with an IABP, policy change is associated with decreased rates of death/deterioration and increased rates of heart transplantation on the waitlist without affecting 1‐year post‐transplant survival. While exception status use has markedly increased post‐PC, it is not associated with patient outcomes. [ABSTRACT FROM AUTHOR]