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Polycystic Ovary Syndrome (PCOS) is a common endocrinal disorder of uncertain etiology characterized by hyperandrogenism, anovulatory infertility, menstrual dysfunction, hirsutism, alopecia and acne. Periodontitis is a common chronic infection characterized by an exaggerated gingival inflammatory response against pathogenic bacterial microflora, resulting in alveolar bone and eventually tooth loss. The relationship of PCOS in periodontally compromised women are very distinctly studied.A cross-sectional survey study design was conducted with closed it's close ended questions. The question were self-prepared, validated and made reliable. Data collection done and analyzed using the SPSS software. Descriptive and inferential statistical analyses were determined.95 percent of the participants were aware of a condition called PCOS. A total of 71 percent of participants have expressed that they carry out routine screening in their clinical practice. However, only a total of 57% of the total participants were able to diagnose PCOS in their clinical practice. A total of 64% of the participants have expressed that intrigue knowledge on the oral manifestations of PCOS have helped diagnose PCOS in their patients. 63 percent of the total participants were aware of the medical specialty of choice to consult for patients diagnosed with PCOS of which only 28 percent of the total participants were aware of the clinical grading of PCOS.This survey helps conclude that even though knowledge of PCOS, clinical manifestations and oral manifestations of PCOS are aware for majority, only 10% achieve to diagnose it in daily practice. This study hopes to shed light on the relationship between Poly Cystic Ovarian Syndrome (PCOS) in periodontally compromised women to better enhance the diagnosis, treatment planning and the systemic corelation of the oral manifestations of the condition.

In active volcanic regions, ground displacement measurements can be used to detect signals of a changing magma source. This thesis presents ground displacement measurements at Okmok Volcano from both Interferometric Sythetic Aperture Radar (InSAR) and Global Positioning System (GPS) data from late 2010 through the present. Comparing the data sets illuminates complications that InSAR presents when applied to a region with high seasonal variability. Okmok is one of the most active volcanoes in the Aleutian island arc and recently erupted explosively in 2008. The data presented show that Okmok's ground surface has inflated over the data interval, indicating recharge of its magma storage. The radial symmetry of the inflation pattern on Okmok suggests that the magma source causing the inflation can be represented by a Mogi source model. Using our measurements of the volcano's surface deformation, we use the Mogi model to invert for for the magma chamber's best fit depth and volume change over time. Doing so results in an estimated magma chamber depth of ~3.6 kilometers and a time series of volume change that ends with ~0.05 cubic kilometers of cumulative growth.

Purpose Epileptiform activity limited to deep sources such as the hippocampus currently lacks reliable scalp correlates. Recent studies, however, have found that a subset of hippocampal interictal discharges may be associated with visible scalp signals, suggesting that some types of hippocampal activity may be monitored noninvasively. The purpose of this study is to characterize the relationship between these scalp waveforms and the underlying intracranial activity. Methods Paired intracranial and scalp EEG recordings obtained from 16 patients were used to identify hippocampal interictal discharges. Discharges were grouped by waveform shape, and spike-triggered averages of the intracranial and scalp signals were calculated for each group. Cross-correlation of intracranial and scalp spike-triggered averages was used to determine their temporal relationship, and topographic maps of the scalp were generated for each group. Results Cross-correlation of intracranial and scalp correlates resulted in two classes of scalp waveforms-those with and without time delays from the associated hippocampal discharges. Scalp signals with no delay showed topographies with a broad field with higher amplitudes on the side ipsilateral to the discharges and a left-right flip in polarity-observations consistent with the volume conduction of a single unilateral deep source. In contrast, scalp correlates with time lags showed rotational dynamics, suggesting synaptic propagation mechanisms. Conclusions The temporal relationship between the intracranial and scalp signals suggests that both volume conduction and synaptic propagation contribute to these scalp manifestations. Furthermore, the topographic evolution of these scalp waveforms may be used to distinguish spikes that are limited to the hippocampus from those that travel to or engage other brain areas.

Human accomplishments depend on learning, and effective learning depends on consolidation. Consolidation is the process whereby new memories are gradually stored in an enduring way in the brain so that they can be available when needed. For factual or event knowledge, consolidation is thought to progress during sleep as well as during waking states, and to be mediated by interactions between hippocampal and neocortical networks. However, consolidation is difficult to observe directly, but rather is inferred through behavioral observations. Here, we investigated overnight memory change by measuring electrical activity in and near the hippocampus. Electroencephalographic (EEG) recordings were made in five patients from electrodes implanted to determine whether a surgical treatment could relieve their seizure disorders. One night, while each patient slept in a hospital monitoring room, we recorded electrophysiological responses to 10-20 specific sounds that were presented very quietly, to avoid arousal. Half of the sounds had been associated with objects and their precise spatial locations that patients learned before sleep. After sleep, we found systematic improvements in spatial recall, replicating prior results. We assume that when the sounds were presented during sleep, they reactivated and strengthened corresponding spatial memories. Notably, the sounds also elicited oscillatory intracranial EEG activity, including increases in theta, sigma, and gamma EEG bands. Gamma responses, in particular, were consistently associated with the degree of improvement in spatial memory exhibited after sleep. We thus conclude that this electrophysiological activity in the hippocampus and adjacent medial temporal cortex reflects sleep-based enhancement of memory storage.Significance StatementSleep contributes to memory consolidation, we presume, because memories are replayed during sleep. Understanding this aspect of consolidation can help with optimizing normal learning in many contexts, and with treating memory disorders and other diseases. Here, we systematically manipulated sleep-based processing using targeted memory reactivation; brief sounds coupled with pre-sleep learning were quietly presented again during sleep, producing (a) recall improvements for specific spatial memories associated with those sounds, and (b) physiological responses in the sleep EEG. Neural activity in the hippocampus and adjacent medial temporal cortex was thus found in association with memory consolidation during sleep. These findings advance understanding of consolidation by linking beneficial memory changes during sleep to both memory reactivation and specific patterns of brain activity.

Background The mechanism of sudden unexpected death in epilepsy remains poorly understood. Seizure induced cardiac arrhythmia, central and obstructive apneas have been proposed as possible causes of death. Here we report a unique case of seizure related sudden unexpected death in a patient whose airway was fully protected by intubation and mechanic ventilation in the absence of fatal cardiac arrhythmia. Case presentation A 70-year-old woman was undergoing mechanical ventilation and video-electroencephalography (EEG) monitoring following two convulsive seizures with ictal hypoventilation and hypoxemia. Several hours after intubation, she suffered another generalized tonic clonic seizure lasted for 3 min and developed postictal generalized EEG suppression in the presence of stable vital signs with SpO2 > 90%. EEG suppression persisted throughout the postictal phase. There was a significant fluctuation of systolic blood pressure between 50 and 180 mmHg with several bouts of hypotension Conclusion Given the reliable periictal airway protection, neither seizure induced central apnea nor obstructive apnea appeared to be the direct cause of death in this unique case. In the absence of fatal cardiac arrhythmia, diffuse cerebral edema secondary to seizure-induced autonomic dysfunction, hypotension and hypoxemia might be the cause of death, highlighting the etiological heterogeneity of sudden unexpected death in epilepsy.

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.

Efforts to improve epilepsy surgery outcomes have led to increased interest in the study of electroencephalographic oscillations outside the conventional EEG bands. These include fast activity above the gamma band, known as high frequency oscillations (HFOs), and infraslow activity (ISA) below the delta band, sometimes referred to as direct current (DC) or ictal baseline shifts (IBS). HFOs in particular have been extensively studied as potential biomarkers for epileptogenic tissue in light of evidence showing that resection of brain tissue containing HFOs is associated with good surgical outcomes. Not all HFOs are conclusively pathological, however, as they can be recorded in nonepileptic tissue and induced by cognitive, visual, or motor tasks. Consequently, efforts to distinguish between pathological and physiological HFOs have identified several traits specific to pathological HFOs, such as coupling with interictal spikes, association with delta waves, and stereotypical morphologies. On the opposite end of the EEG spectrum, sub-delta oscillations have been shown to co-localize with the seizure onset zones (SOZ) and appear in a narrower spatial distribution than activity in the conventional EEG frequency bands. In this report, we review studies that implicate HFOs and ISA in ictogenesis and discuss current limitations such as inter-observer variability and poor standardization of recording techniques. Furthermore, we propose that HFOs and ISA should be analyzed in addition to activity in the conventional EEG band during intracranial presurgical EEG monitoring to identify the best possible surgical margin.

The objective of this study was to determine the effects of milk tube guidance setting and teat cup type on the dynamics of teat-end vacuum and vacuum fluctuations in quarter individual milking systems. In order to meet this objective, a series of wet tests was conducted in the laboratory. Different teat cups; AMS, BIO and RVS along with the milk tube guidance settings namely: direct tube, half-half tube and Y-piece tube system with varying tube inside diameters were tested at different water flow rates. The data obtained from the wet-test measurements were used to calculate the teat-end vacuum and vacuum fluctuation at the teat-old in b and d- phase. From the study conducted, it was found that the teat-end vacuum in BIO is always between the range of 32 and 42 kPa as recommended by DIN ISO 5707 (2010a) at any flow rate for all three types of connections. The teat-end vacuum for RVS was between 32-42 kPa range if the flow rate varies between 4 and 6 L min(-1) for both, the direct and the half-half connection. The Y-piece connection meets DIN ISO 5707 (2010a) requirements once the flow rate changes between 2 and 6 L min(-1). The findings about milk tube inside diameter indicated that the use of 14 or 16 mm milk tube diameter for BIO will provide better teat-end vacuum if the recommended value of 10 mm is used. On the other hand, the use of 16 mm milk tube diameter was found to be appropriate for AMS as recommended by the manufacturer. For the RVS, the appropriate milk tube diameter should be 14 mm when statistical differences in b and d-phase are examined from the point of teat-end vacuum and vacuum fluctuations.

Objective To determine the clinical implications of scalp ictal EEG pattern in patients with temporal lobe epilepsy (TLE). Methods Scalp EEG ictal patterns were retrospectively determined in 27 consecutive patients with medically refractory temporal lobe epilepsy who underwent phase-1 scalp video-EEG and phase-2 simultaneous scalp and intracranial video-EEG recordings for pre-surgical evaluation. Results Of the 192 temporal lobe seizures recorded during phase-1 and phase-2 scalp video-EEG studies, 124 (65%) seizures were associated with theta/alpha (5–9 Hz) ictal onset pattern, and 68 (35%) seizures were associated with delta (2–5 Hz) ictal onset pattern. Fourteen (52%) patients had exclusively theta/alpha ictal onset, 3 (11%) patients had exclusively delta ictal onset, and 10 (37%) patients had mixed theta/alpha and delta ictal onsets. MTLE was observed in 26 patients who had 124 seizures with theta/alpha ictal onset and 59 seizures with delta ictal onset. LTLE was observed in one patient who had 9 seizures with delta ictal onset. Scalp ictal EEG pattern was not significantly correlated with postsurgical seizure outcomes. Conclusions Both scalp delta and theta/alpha ictal onset patterns can be commonly found in patients with MTLE. Significance Scalp delta ictal onset is not a unique EEG pattern for LTLE as commonly believed.

Numerical simulations become an increasingly utilised tool for predicting soil behaviour in geotechnical engineering. However, these simulations require reliable soil parameters that have to be determined either by conducting laboratory experiments or by model parameter identification using in-situ measurements. To gain reliable and sufficiently informative measurement results for successful determination of the soil parameters while being still economic, an optimal experimental design is of crucial importance. This work presents a procedure of setting up a monitoring concept for a dike with uncertain material properties exposed to a rapid drawdown of the adjacent water level. The illustrative example is numerically modelled using a coupled hydro-mechanical analysis and the parameters that are most relevant for the dike stability are firstly identified via global sensitivity analysis. Subsequently, the global sensitivity analysis with respect to measurable outputs is employed to identify appropriate monitoring areas. Finally, bootstrapping is conducted to make possible to decide on the optimal observation sensor locations for reliable identification of the most influential soil parameters.

Purpose To determine the usefulness of the first-hour sleep EEG recording in identifying interictal epileptiform discharges (IEDs) during long-term video-EEG monitoring. Method We retrospectively reviewed 255 consecutive patients who underwent continuous long-term video-EEG monitoring in the adult epilepsy monitoring unit (EMU) at the University of Chicago. The complete video-EEG recording was reviewed, and the occurrence of IEDs was determined for each patient. We compared the occurrence of IEDs observed during the first-hour sleep EEG recordings with the occurrence of IEDs observed during the complete video-EEG recordings. Results Overall, IEDs were observed in 134 (53%) of 255 patients during the full long-term video-EEG recording with a mean duration of 4 days. IEDs were identified in the first-hour sleep EEG in 125 (49%) of 225 patients. Comparing to reviewing full records, the first hour sleep EEG identified IEDs in 125 (93%) of 134 patients. Of the IED subtypes, the first-hour sleep EEG identified 92 (94%) of 98 patients with temporal lobe IEDs, 11 (92%) of 12 patients with frontal lobe IEDs, 3 (100%) of 3 patients with parietal lobe IEDs, 1(50%) of the 2 patients with occipital lobe IEDs, 16 (94%) of 17 patients with generalized IEDs, and 2 (100%) 2 patients with multi-focal IEDs. Conclusions The first-hour sleep EEG reliably predicts the occurrence of IEDs during the long-term video-EEG recording, and therefore can be a time-efficient tool for identifying patients with IEDs during long-term video-EEG recording in the adult epilepsy monitoring unit.

Objective: To assess the seizure outcomes of stereotactic laser amygdalohippocampectomy (SLAH) in consecutive patients with mesial temporal lobe epilepsy (mTLE) in a single center and identify scalp EEG and imaging factors in the presurgical evaluation that correlate with post-surgical seizure recurrence.Methods: We retrospectively reviewed the medical and EEG records of 30 patients with drug-resistant mTLE who underwent SLAH and had at least 1 year of follow-up. Surgical outcomes were classified using the Engel scale. Univariate hazard ratios were used to evaluate the risk factors associated with seizure recurrence after SLAH.Results: The overall Engel class I outcome after SLAH was 13/30 (43%), with a mean postoperative follow-up of 48.9 ± 17.6 months. Scalp EEG findings of interictal regional slow activity (IRSA) on the side of surgery (HR = 4.05, p = 0.005) and non-lateralizing or contra-lateralizing seizure onset (HR = 4.31, p = 0.006) were negatively correlated with postsurgical seizure freedom. Scalp EEG with either one of the above features strongly predicted seizure recurrence after surgery (HR = 7.13, p < 0.001) with 100% sensitivity and 71% specificity.Significance: Understanding the factors associated with good or poor surgical outcomes can help choose the best candidates for SLAH. Of the variables assessed, scalp EEG findings were the most clearly associated with seizure outcomes after SLAH.

According to the socioecological model of female sociality, females living in environments with clumped resources should exhibit strong, linear dominance hierarchies and females in the upper part of these hierarchies should receive less aggression, gain better access to food and receive more grooming than their lower ranked counterparts. This dissertation investigates the predictions of this model using females in a group of bonnet macaques (Macaca radiata). It also investigates the effects of three food distributions (0.25 m², 1 m², and 4 m²) on female aggression. This group had a moderately linear dominance hierarchy (0.63 Modified Landau Index). Although aggressive behavior increased during the feeding experiments, the overall strength of the dominance hierarchy was not significantly affected by an increase in food clumping. Higher ranked females did not receive more grooming than lower ranked females. Females engaged in both reciprocal (12.6%) and non-reciprocal bouts (87.4 %) of grooming and reciprocal grooming was time matched. Although most grooming was not immediately reciprocated, females did not appear to be trading grooming for another commodity, except, potentially, for coalitionary support. Grooming was more reciprocal across bouts than within bouts showing increased grooming reciprocity between partners over time. This long-term reciprocity suggests that bonnet macaque females reciprocate grooming over long spans of time effectively increasing the proportion of reciprocal grooming and decreasing the amount traded in a biological market. Females showed different types of competition as the experimental food distribution was decreased. High ranking females consumed more than low ranking females in each distribution. The greatest rank asymmetry in feeding was found in the highly clumped condition due to the ability of dominant individuals to monopolize the feeding platform. However, the number of aggressive acts among females was significantly lower in both clumped distributions than in the dispersed condition. Usurpation, as measured by agonistic acts, was higher in the dispersed condition, but competition through monopolization was greatest in the highly clumped condition as expected by the socioecological model. Competition in the highly clumped condition could not be measured by quantity of agonistic behavior illustrating the importance of distinguishing between monopolizability and usurpability when analyzing levels of competition

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.

To identify scalp EEG correlates of hippocampal spikes in patients with mesial temporal lobe epilepsy (mTLE).We recorded scalp and intracranial EEG simultaneously in 20 consecutive surgical candidates with mTLE. Hippocampal spikes were identified from depth electrodes during the first hour of sleep on the first night of recording in the epilepsy monitoring unit, and their scalp EEG correlates were identified.Hippocampal spiking rates varied widely from 101 to 2187 (556 ± 672, mean ± SD) spikes per hour among the subjects. Of the 16,398 hippocampal spikes observed in this study, 492 (3.0%) of hippocampal spikes with extensive involvement of lateral temporal cortex were associated with scalp interictal epileptiform discharges (IEDs) including spikes and sharp waves; 198 (1.2%) of hippocampal spikes with limited involvement of lateral temporal cortex were associated with sharp transients or sharp slow waves, and 78 (0.05%)of hippocampal spikes with no lateral temporal involvement were associated with small sharp spikes (SSS). SSS were not correlated with independent temporal neocortical spikes.There are morphologically heterogeneous scalp EEG correlates of hippocampal spikes including SSS, sharp transients, sharp slow waves, spikes, and sharp waves. SSS correlate with hippocampal spikes and are likely an EEG marker for mTLE. These findings have important clinical implications for the diagnosis and localization of mTLE, and provide new perspectives on criteria for defining scalp IEDs.

To determine clinical and intracranial EEG correlates of rhythmic temporal theta bursts of drowsiness (RTTBD) and assess its clinical significance in patients with temporal lobe epilepsy (TLE). A retrospective review of simultaneous scalp and intracranial video-EEG recordings from 28 patients with TLE was evaluated for epilepsy surgery. Scalp RTTBD patterns were identified and their clinical and intracranial EEG correlates were then determined on video-EEG recording using depth and subdural electrodes. Thirty-one RTTBD patterns on scalp EEG were observed in six (21%) of the 28 patients. Five (16%) of the RTTBD patterns occurred during wakefulness and 26 (84%) occurred during drowsiness and light sleep. The mean duration of RTTBD was 10 seconds (range: 3-28 seconds). RTTDB consistently correlated with hippocampal ictal discharges and was time-locked to the hippocampal seizures in which the ictal discharges evolved into rhythmic theta frequency (4-7-Hz) range. Ictal automatisms were observed during five (16%) RTTBD patterns, while cognitive impairment was observed in four (13%) of the 31 RTTBD patterns. Our findings show that scalp EEG correlates of hippocampal ictal discharges can resemble RTTBD and may be associated with ictal symptoms and cognitive impairment, indicating that RTTBD may rarely be an ictal EEG pattern in patients with TLE.

The insertion of peripheral intravenous catheter is a common practice in hospitals. The present study isaimed to assess the incidence and factors associated with peripheral intravenous catheter failure. Theobjective were the estimation of the incidence of peripheral intravenous catheter failure among patientadmitted in tertiary care setting and to assess the factors associated with it. The design used for this studywas prospective survey. The data were collected from 294 participant with a semi structured interviewschedule and an observation checklist. The findings of the study revealed that the incidence of peripheralintravenous catheter failure were 50.3% and mean dwell time were 71.7 hours. The factors associated withPIVC failure was gender, type of ward, duration of hospital stay, purpose of PIVC insertion.

Objective To describe the spatio-temporal dynamics and interactions during linguistic and memory tasks. Methods Event-related electrocorticographic (ECoG) spectral patterns obtained during cognitive tasks from 26 epilepsy patients (aged: 9–60 y) were analyzed in order to examine the spatio-temporal patterns of activation of cortical language areas. ECoGs (1024 Hz/channel) were recorded from 1567 subdural electrodes and 510 depth electrodes chronically implanted over or within the frontal, parietal, occipital and/or temporal lobes as part of their surgical work-up for intractable seizures. Six language/memory tasks were performed, which required responding verbally to auditory or visual word stimuli. Detailed analysis of electrode locations allowed combining results across patients. Results Transient increases in induced ECoG gamma power (70–100 Hz) were observed in response to hearing words (central superior temporal gyrus), reading text and naming pictures (occipital and fusiform cortex) and speaking (pre-central, post-central and sub-central cortex). Conclusions Between these activations there was widespread spatial divergence followed by convergence of gamma activity that reliably identified cortical areas associated with task-specific processes. Significance The combined dataset supports the concept of functionally-specific locally parallel language networks that are widely distributed, partially interacting in succession to serve the cognitive and behavioral demands of the tasks.

Milking machine settings such as the machine vacuum, pulsation rate, and pulsation ratio influence teat tissue and teat condition, but there remains a lack of knowledge about the teat-liner interface and the pressure applied to the teat tissue by the teat cup liner during milking. The aim of the present study was to determine the influence of different milking settings on the teat-liner interface with the help of a pressure-indicating film. The Extreme Low Prescale film by Fujifilm and a hollow artificial teat made of silicone were used to measure the influence of different machine vacuum levels (30 kPa, 40 kPa, 50 kPa), different pulsation rates (40 cycles min−1, 60 cycles min−1, 80 cycles min−1), and different pulsation ratios (60:40, 65:35, 70:30) on the teat load caused by the collapsing liner. The response surface methodology with a central composite design was used to plan the experiment. The experiment was performed with a conventional milking cluster equipped with round silicone liners. The average pressure (AP), the maximum pressure (MP), and the load (L) were used to analyse the influence of different milking settings. Analysis of covariance was used to estimate the differences between measuring areas, machine vacuum levels, pulsation rates, and pulsation ratios. Machine vacuum levels, pulsation rates, and pulsation ratios had a significant influence on the measured teat load caused by liner collapse; the higher the machine vacuum and the pulsation rate, the higher the measured values of AP, MP, and L. MP values decreased with an increase of the pulsation ratio. The pulsation ratio affected L significantly depending on the machine vacuum. The liner applied more pressure to the end of the teat compared with the whole teat barrel. In conclusion, the results of the present investigation show that different adjustments to the machine vacuum, the pulsation rate, and the pulsation ratio can significantly influence the pressure applied to the whole teat by a collapsing liner.

Objective Mesial temporal lobe epilepsy (mTLE) is the most common type of focal epilepsy, but often lacks scalp EEG correlates. We ask if hippocampal epileptiform discharges that are characteristic of mTLE are associated with small sharp spikes (SSS) recorded on scalp EEG. SSS are considered benign waveforms, so are not currently used as markers of epilepsy. Methods To determine if there is a relationship between SSS and hippocampal discharges, simultaneous scalp and hippocampal depth electrode EEGs were recorded from 27 patients being evaluated for possible mTLE. Scalp EEG waveforms were assessed at the time of hippocampal discharges identified on intracranial hippocampal depth electrodes. Results 15 of 27 patients had SSS on scalp EEG that were time locked to hippocampal epileptiform discharges measured intracranially. These hippocampal spikes tended to have overlying high frequency oscillations and to co-localize with a seizure onset zone, suggesting that they were pathological discharges. Conclusions There is a tight coupling between a subset of pathological hippocampal discharges and SSS. Significance SSS can be scalp EEG markers of mTLE rather than normal EEG variants.

Glutamic acid decarboxylase (GAD) antibody-associated encephalitis causes both acute seizures and chronic epilepsy with predominantly temporal lobe onset. This condition is challenging in diagnosis and management, and the incidence of GAD antibody (Ab)-related epilepsy could be much higher than commonly believed. Imaging and CSF evidence of inflammation along with typical clinical presentations, such as adult onset temporal lobe epilepsy (TLE) with unexplained etiology, should prompt testing for the diagnostic antibodies. High serum GAD Ab titer (≥2000U/mL or ≥20nmol/L) and evidence of intrathecal anti-GAD Ab synthesis support the diagnosis. Unlike other immune-mediated epilepsies, antiglutamic acid decarboxylase 65 (GAD65) antibody-mediated epilepsy is often poorly responsive to antiepileptic drugs (AEDs) and only moderately responsive to immune therapy with steroids, intravenous immunoglobulin (IVIG), or plasma exchange (PLEX). Long-term treatment with more aggressive immunosuppressants such as rituximab (RTX) and/or cyclophosphamide is often necessary and may be more effective than current immunosuppressive approaches. The aim of this review is to review the physiology, pathology, clinical presentation, related ancillary tests, and management of GAD Ab-associated autoimmune epilepsy by searching the keywords and to promote the recognition and the initiation of proper therapy for this condition.

The objective of this study was to determine the association of sleep with sudden unexpected death in epilepsy (SUDEP).We conducted a systematic review and meta-analysis based on literature search from databases PubMed, Web of Science, and Scopus using keywords "SUDEP", or "sudden unexpected death in epilepsy", or "sudden unexplained death in epilepsy". Sudden unexpected death in epilepsy was considered to occur during sleep if the patient was found in bed, if the SUDEP cases were documented as in sleep, or if the patient was found at bedside on the bedroom floor.Circadian pattern was documented in 880 of the 1025 SUDEP cases in 67 studies meeting the inclusion and exclusion criteria. Of the 880 SUDEP cases, 69.3% occurred during sleep and 30.7% occurred during wakefulness. Sudden unexpected death in epilepsy was significantly associated with sleep as compared to wakefulness (P0.001). In the subgroup of 272 cases in which circadian pattern and age were documented, patients 40years old or younger were more likely to die in sleep than those older than 40years (OR: 2.0; 95% CI=1.0, 3.8; P=0.05). In the subgroup of 114 cases in which both circadian pattern and body position at the time of death were documented, 87.6% (95% CI=81.1%, 94.2%) of patients who died during sleep were in the prone position, whereas 52.9% (95% CI=24.7%, 81.1%) of patients who died during wakefulness were in the prone position. Patients with nocturnal seizures were 6.3 times more likely to die in a prone position than those with diurnal seizures (OR: 6.3; 95% CI=2.0, 19.5; P=0.002).There is a strong association of SUDEP with sleep, suggesting that sleep is a significant risk factor for SUDEP. Although the risks of SUDEP associated with sleep are unknown and likely multifactorial, the prone position might be an important contributory factor.

The aim of this study was to investigate the influence of a new type of milking system on the behaviour of cows during milking by comparing a conventional milking system (CON) with an individual quarter milking system (MUL), MultiLactor®. Sixty-eight dairy cows were observed during their milking times (32 cows in CON, 36 cows in MUL) using video recordings to analyse their behavioural traits. The udder preparation duration, milking duration and milk yield were also evaluated. No significant differences were found between the CON and the MUL regarding cows’ head posture (P=0.38), body posture (P=0.85), number of steps (P=0.08) and number of kicks (P=0.56). However, the milk yield was lower (P=0.02), just as the udder preparation duration (P

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

OBJECTIVEThe authors sought to perform a preliminary assessment of the safety and effectiveness of stereotactic laser interstitial thermal therapy (LITT) for patients with cerebral cavernous malformation (CCM)–related epilepsy.METHODSThe authors retrospectively analyzed 6 patients with CCM-related epilepsy who underwent LITT. Pre-, intra-, and postoperative brain MRI studies were used to characterize preoperative CCM volume, ablation volume, and postablation hemosiderin volume. Clinical outcomes were assessed postoperatively during clinic follow-up visits or phone interviews.RESULTSLITT was performed in 7 CCMs in 6 patients. Two patients had familial CCM disease with multifocal lesions. Four treated CCMs were extratemporal, and 3 were in or near the visual pathways. The median follow-up was 25 (range 12–39) months. Five of 6 (83%) patients achieved seizure freedom (Engel I classification), of whom 4 (67%) were Engel IA and 1 was Engel IC after a single seizure on postoperative day 4. The remaining patient had rare seizures (Engel II). One patient had a nondisabling visual field deficit. There were no hemorrhagic complications. All patients were discharged within 24 hours postablation. MRI 3–11 months after ablation demonstrated expected focal necrosis and trace hemosiderin-related T2 hypointensity measuring 9%–44% (median 24%) of the original lesion volume, with significant (p = 0.04) volume reduction.CONCLUSIONSLITT is a minimally invasive option for treating CCM-related epilepsy with seizure outcomes comparable to those achieved with open lesionectomy. The precision of LITT allows for the obliteration of eloquent, deep, small, and multifocal lesions with low complication rates, minimal postoperative discomfort, and short hospital stays. In this study the feasibility and benefits of this method were demonstrated in 2 patients with multifocal lesions.

Highlights • FFEVF associated with a higher (~50%) risk of medication resistant epilepsy. • Surgery in the familial epilepsies has been of benefit in some patients. • LITT can be an effective treatment for medically refractory NPRL3-related epilepsy., Introduction: NPRL3 gene mutations cause autosomal dominant familial focal epilepsy of variable foci (FFEVF) and is characterized by focal epilepsy arising from different brain regions including temporal, frontal, parietal and occipital lobes. About 50% of patients with NPRL3 related epilepsy are resistant to medical treatment. Method: We present a case of 27 years old man with NPRL3 related focal drug-resistant epilepsy. Stereotactic EEG showed two independent seizure foci, namely, left hippocampus and left orbitofrontal cortices. He underwent laser interstitial thermal therapy for ablating both foci in the same procedure that led to seizure cessation. Conclusion: laser interstitial thermal therapy can be an effective treatment for drug resistant NPRL3 related focal epilepsy with better tolerance and less morbidity as compared to open surgical resection, particularly in those with multiple seizure foci.

To determine the incidence and clinical significance of small sharp spikes (SSS) in the patient population of the adult Epilepsy Monitoring Unit (EMU).This is a retrospective study of EEG data and medical records from consecutive patients who underwent video-EEG recording in the adult EMU from March 2013 to February 2019. SSS, interictal epileptiform discharges (IEDs), and ictal patterns were identified.Of the 909 patients reviewed, SSS were observed in110 (12.1 %) patients. Epilepsy was present in 101 of the 110 (91.8 %) patients with SSS and in 441 of the 799 (55.2 %) patients without SSS. The incidence of epilepsy was significantly higher in patients with SSS than in those without SSS (OR = 9.1, 95 % CI: 4.5-18.3, P0.01). The sensitivity of SSS for epilepsy was 18.6 % and the specificity was 97.5 %. The incidence of SSS was strongly correlated with the frequency of IEDs (OR 1.89; 95 %CI: 1.60-2.24, P0.01). When both present, SSS and IEDs were co-lateralized in the same hemisphere.There is a statistically significant association between SSS and focal epilepsy. SSS have similar clinical implications to IEDs in the lateralization and localization of temporal lobe seizures. SSS can be an epileptiform EEG pattern for temporal lobe epilepsy.

Epilepsy can be a manifestation of paraneoplastic syndromes which are the consequence of an immune reaction to neuronal elements driven by an underlying malignancy affecting other organs and tissues. The antibodies commonly found in paraneoplastic encephalitis can be divided into two main groups depending on the target antigen: 1) antibodies against neuronal cell surface antigens, such as against neurotransmitter (N-methyl-d-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), gamma-aminobutyric acid (GABA)) receptors, ion channels (voltage-gated potassium channel (VGKC)), and channel-complex proteins (leucine rich, glioma inactivated-1 glycoprotein (LGI1) and contactin-associated protein-2 (CASPR2)) and 2) antibodies against intracellular neuronal antigens (Hu/antineuronal nuclear antibody-1 (ANNA-1), Ma2/Ta, glutamate decarboxylase 65 (GAD65), less frequently to CV2/collapsin response mediator protein 5 (CRMP5)). In this review, we provide a comprehensive survey of the current literature on paraneoplastic epilepsy indexed by the associated onconeuronal antibodies. While a range of seizure types can be seen with paraneoplastic syndromes, temporal lobe epilepsy is the most common because of the association with limbic encephalitis. Early treatment of the paraneoplastic syndrome with immune modulation/suppression may prevent the more serious potential consequences of paraneoplastic epilepsy.

Objective The objectives of this study were to determine the incidence of peri-ictal prone position in patients with generalized convulsive seizures (GCS) and to further assess the risk of sudden unexpected death in epilepsy (SUDEP) associated with the prone position. Method We retrospectively reviewed the video-EEG data of 308 GCS in 193 patients who underwent long-term video-EEG monitoring in two epilepsy centers. We determined the peri-ictal (preictal, ictal, and/or postictal) body positions. Results A peri-ictal prone position was observed in 12 (6.2%) of 193 patients and 13 (4.2%) of 308 GCS. In 5 (1.6%) of 308 GCS, patients in nonprone positions at seizure onset turned into the prone position during versive seizures. In 8 (2.6%) of 308 GCS, patients were sleeping prone at seizure onset. Peri-ictal intervention with body repositioning was provided in 11 of 12 patients and 12 of the 13 GCS. Repositioning was not provided during the remaining seizure; the patient died in the prone position. In the subset of 96 GCS without ictal intervention, patients in a supine position at seizure onset remained in the supine position at seizure termination in 57 (98.3%) of 58 GCS. Patients sleeping prone at seizure onset remained in the prone position at seizure termination in 4 (80%) of 5 GCS. Conclusion Our data suggest that the incidence of peri-ictal prone position in patients with GCS is low. Both prone sleeping and forced ictal version may result in postictal prone position. Although avoiding prone sleeping may reduce the SUDEP risk, influencing forced ictal version may be difficult in the absence of supervision.