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Fitzsimmons Daniels posted an update 2 days, 4 hours ago
Moyamoya disease (MMD) is a complex and incompletely-understood cerebrovascular pathological entity that requires thorough clinical and imaging evaluation. Moyamoya is rare, thereby making the establishment of an effective, thorough and interdisciplinary patient evaluation protocol challenging, even within specialized referral centers. Nevertheless, implementation of such a protocol is crucial in order to provide the best possible evaluation and treatment for MMD patients. Here, we describe our institution’s implementation of, rationale for, and experience with a comprehensive multidisciplinary collaboration and evaluation strategy for adult patients with moyamoya. This evaluation course consists of, first of all, a thorough clinical and laboratory evaluation with a vascular neurologist. This is followed by a comprehensive imaging assessment which evaluates angiographic and parenchymal features, in addition to cerebrovascular functionality. Finally, appropriate referrals are made to consulting services as indicated, which includes vascular neurosurgery. These steps are described in detail herein.Chronic migraine (CM) is often complicated by medication overuse headache (MOH) and psychiatric comorbidities that may influence the clinical outcome. This study aimed to investigate the relationship between psychiatric comorbidities and the effect of transcranial direct current stimulation (tDCS) in patients with CM with or without MOH. We recruited 16 consecutive CM patients who had an unsatisfactory response to at least three pharmacological preventive therapies. They were treated with anodal right-prefrontal and cathodal occipital tDCS (intensity 2 mA, time 20 min) three times per week for 4 weeks. All patients underwent a psychopathological assessment before and after treatment, and five of them were diagnosed with bipolar disorder (BD). After treatment, all the patients showed a significant decrease of severe and overall headache days per month. Despite having a higher migraine burden at baseline, patients with CM and BD showed a significantly greater reduction of severe headaches and psychiatric symptoms. Overall, tDCS seems to be effective in the treatment of CM patients with a poor response to different classes of pharmacological therapies, whereas BD status positively influences the response of migraineurs to tDCS.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. TOSLAB 829227 Scalp EEG with either one of the above features strongly predicted seizure recurrence after surgery (HR = 7.13, p less then 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.The coronavirus disease 19 (COVID-19) can cause neurological, psychiatric, psychological, and psychosocial impairments. Literature regarding cognitive impact of COVID-19 is still limited. The aim of this study was to evaluate cognitive deficits and emotional distress among COVID-19 and post-COVID-19 patients who required functional rehabilitation. Specifically, this study explored and compared cognitive and psychological status of patients in the subacute phase of the disease (COVID-19 group) and patients in the postillness period (post-COVID-19 group). Forty patients admitted to rehabilitation units were enrolled in the study and divided into two groups according to the phase of the disease (a) COVID-19 group (n = 20) and (b) post-COVID-19 group (n = 20). All patients underwent a neuropsychological assessment including Mini-Mental State Evaluation (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Rating Scale for Depression, and Impact of Event Scale-Revised (IES-R). A larger part of the COVID group showed neuropsychological deficits in the total MMSE (35%) compared to the post-COVID group (5%), whereas the majority of both groups (75-70%) reported cognitive impairments in the total MoCA. The post-COVID group reported significantly higher score in MMSE subtests of language (p = 0.02) and in MoCA subtests of executive functions (p = 0.05), language (p = 0.01), and abstraction (p = 0.02) compared to the COVID group. Regarding emotional disturbances, ~40% of patients presented with mild to moderate depression (57.9-60%). The post-COVID-19 group reported significantly higher levels of distress at the IES-R compared to the COVID group (p = 0.02). These findings highlight the gravity of neuropsychological and psychological symptoms that can be induced by COVID-19 infection and the need for tailored rehabilitation, including cognitive training and psychological support.Various cognitive disorders have been reported for mild traumatic brain injury (mTBI) patients during the acute stage. This acute stage provides an opportunity for clinicians to optimize treatment protocols, which are based on the evaluation of brain structural connectivity. So far, most brain functional magnetic resonance imaging studies are focused on moderate to severe traumatic brain injuries (TBIs). In this study, we prospectively collected resting state data on 50 mTBI within 3 days of injury and 50 healthy volunteers and analyzed them using Amplitude of low-frequency fluctuation (ALFF), Regional Homogeneity (ReHo), graph theory methods and behavior measure, to explore the dysfunctional brain regions in acute mTBI. In our study, a total of 50 patients suffering less then 3 days mTBI and 50 healthy subjects were tested in rs-fMRI, as well as under neuropsychological examinations including the Wechsler Intelligence Scale and Stroop Color and Word Test. The correlation analysis was conducted between graph theoretic parameters and neuropsychological results.