Treatment of arteriovenous malformation of the brain – preliminary experience

With the availability of new techniques, such as intravascular embolisation and radiosurgery, the therapeutic approach to arteriovenous malformations (AVMs) of the brain has recently been modified. The present study reports the authors, experiences in treating AVMs over the past 13 years. Spetzler-Martin grading of AVMs was I and II in 19 cases, III in 12, IV in 5 and V in 1 case. Four therapeutic regimens were utilised: surgical resection alone, embolisation and resection, and radiosurgery alone or after surgical resection. Generally, for low-grade AVMs (Spetzler-Martin grades I, II and III), the therapeutic choice was surgical resection in 27 cases, in combination with pre-operative embolisation in two of these patients. Two cases received radiotherapy only and one case received radiosurgery after embolisation, while one case was treated conservatively. Of the five cases of grade IV, four required surgical treatment, whereas the fifth case was treated conservatively. Favourable results (good recovery and moderate disability) were obtained in 96% of the low-grade AVMs as compared with the high-grade AVMs (66%) that had a poor outcome (due to primary brain damage resulting from haemorrhage at the onset in three cases and due to postoperative re-bleeding in one case). This report summarises preliminary experience in treating intracranial AVMs by surgical resection, intravascular embolisation and radiotherapy. Good therapeutic results can be expected by combining these therapeutic modalities.     

Role of neuroimaging before reperfusion therapy. Part 1 – IV thrombolysis – Review

This review paper summarises the yield of the different imaging modalities in the evaluation of patients for IV thrombolysis. Non-contrast CT and CTA or brain MRI combined with MRA are the recommended sequences for the evaluation of patients within the 4.5 hours time window. Multimodal MRI (DWI/PWI), and more recently, CT perfusion, offer reliable surrogate of salvageable penumbra, the target mismatch, which is now currently used as selection criteria for revascularisation treatment in an extended time window. Those sequences may also help the physician for the management of other limited cases when the diagnosis of acute ischemic stroke is difficult. Another approach the DWI/FLAIR mismatch has been proposed to identify among wake-up stroke patients those who have been experiencing an acute ischemic stroke evolving from less than 4.5 hrs. Other biomarkers, such as the clot imaging on MRI and CT, help to predict the recanalisation rate after IVT, while the impact of the presence microbleeds on MRI remains to be determined.     

Validation of the Lebanese Childhood Autism Rating Scale – Second Edition – High Functioning Version

This paper presents the psychometric properties of the Lebanese version of the Childhood Autism Rating Scale Second Edition, High Functioning Version (CARS2-HF). The participants consisted of 30 children aged 6–18 years among which 24 had a clinical diagnosis of Asperger disorder or Pervasive Developmental Disorder-Not Otherwise Specified and 6 had a clinical diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). All participants were verbally fluent and had IQ estimates of 80 or higher, determined with the Wechsler Nonverbal Scale of Ability (WNV). Forward and backward translation of the CARS2-HF and the Childhood Autism Rating Scale Second Edition, Questionnaire for Parents or Caregivers (CARS2-QPC) was completed before the administration of the scales. The results of this study showed that the Lebanese CARS2-HF has a high degree of internal consistency (.92), inter-rater reliability (.97), and test–retest reliability (.99). Receiver Operating Characteristic (ROC) analysis determined that individuals with total raw scores below 26 are less likely – to be in the autism spectrum. This instrument can be used in screening and assessing for ASD in high-functioning Lebanese and Arab speaking individuals.     

Effect of simulated dawn on quality of sleep – a community-based trial

Background  

Morning light exposure administered as simulated dawn looks a promising method to treat Seasonal Affective Disorder, but it may moreover help with resetting the inaccurate organisation of body clock functions relative to sleep occurring in winter among people in general. Disturbances in sleep patterns are common and may compromise wellbeing even in the short term. Our hypothesis was that simulated dawn could improve the subjective quality of sleep during winter.     

Intraspinal neurenteric cysts – report of three paediatric cases

BACKGROUND: Neurenteric cysts are rare congenital lesions of the spine and are lined with entodermal epithelium. They result from anomalous endodermal-neuroectodermal adhesion in the 3rd week of embryonic life with persistence of canal of Kovalevsky. The nature of the eventual abnormality depends on the extent to which this adhesion subsequently disappears. Persistence of the entire tract results in the extreme form of combined anterior and posterior spina bifida with dorsal enteric fistula and persistence of only a part of the tract producing the isolated intraspinal cyst. The most common location is the cervico-dorsal region, and usually it lies ventral to the spinal cord. The lumbosacral location is uncommon. Associated vertebral anomalies, gut cysts, bowel duplication, the presence of keratin markers and mucin-secreting cuboidal or columnar intestinal epithelium in their walls confirm their entodermal origin. PATIENTS: We describe here three unusual cases of neurenteric cysts in patients aged 5-18 years who had already had symptoms for some time. One of these had a cyst sited predominantly in the sacral canal, another presented with a lumbar neurenteric cyst, and the third patient had an intradural extramedullary thoracic lesion. Two of these children had associated anomalies, the one with lumbar cyst also having a lipomeningomyelocele and spina bifida while the other also had deformed vertebrae. All three patients underwent laminectomy and gross excision of the cysts through a posterior approach. RESULTS AND CONCLUSION: The diagnosis of neurenteric cysts was confirmed by demonstrating mucin-producing cuboidal or columnar epithelium lining the cystic cavity.     

Moral Blindness – The Gift of the God Machine

The continuing debate between Persson and Savulescu and myself over moral enhancement concerns two dimensions of a very large question. The large question is: what exactly makes something a moral enhancement? This large question needs a book length study and this I provide in my How to be Good, Oxford 2016. (JH 2016). In their latest paper Moral Bioenhancement, Freedom and Reason take my book as their point of departure and the first dimension of the big question they address is one that emphasizes a distinction, not highlighted in their original 2008 paper, between a moral enhancement that will ensure an improvement in morality and one that will simply make people more motivated to be moral. The second issue concerns whether anything that would be a “moral enhancement” properly so called, could involve denying moral agents the very possibility of autonomously choosing to try to be good. In this response, although P&S cover a number of other related issues, I shall concentrate on these two points.     

Epidemiology of epilepsy in old age – English Version

Clinical Epileptology - Epilepsie ist eine häufige neurologische Erkrankung, die alle Altersgruppen betreffen kann. Symptomatische Epilepsien, u. a. auf dem Boden zerebrovaskulärer...     

The mechanisms of human ejaculation – a critical analysis

The current mechanism for human ejaculation is a two-part model consisting of a postulated “pressure chamber” created in the prostatic urethra by initial closure of both distal and proximal sphincters with secretions loaded in by adrenergic-mediated smooth muscle contractions of the vas deferens and capsules of the internal genital organs. The pressure build up is claimed then to “trigger” the intermittent relaxation/contraction of the distal sphincter and activate the contractions of the striated pelvic musculature, especially that of the bulbocavernosus, which forcefully expels the semen along the urethra by powerful, rhythmical spurts. A number of difficulties with this model are examined critically against experimental findings which indicate that the so-called pressure chamber is unlikely to be the valid trigger for ejaculation. The most recent finding of a specialised group of lumbar sacral neurons in the spinal cord of rat that function as the spinal ejaculation generator is more likely to be the “trigger” for ejaculation but confirmation that these cells also exist in the human cord is waiting.     

Neuroimaging of L-dopamine and dopamine agonist therapy – revisited

Treatment of Parkinson's disease (PD) is improving and we can choose a variety of drugs and surgical procedures for appropriate stages of the disease. However, we depend upon clinical signs and symptoms as well as patient reports to evaluate such issues. While neurochemical research into the etiological aspects of PD has been expanding, imaging is still under investigation. Here, I summarize the results of studies with regard to imaging of dopaminergic systems, and discuss the key points for imaging of PD with respect to treatment evaluation.     

Neuroeducation – A Critical Overview of An Emerging Field

In the present article, we provide a critical overview of the emerging field of ‘neuroeducation’ also frequently referred to as ‘mind, brain and education’ or ‘educational neuroscience’. We describe the growing energy behind linking education and neuroscience in an effort to improve learning and instruction. We explore reasons behind such drives for interdisciplinary research. Reviewing some of the key advances in neuroscientific studies that have come to bear on neuroeducation, we discuss recent evidence on the brain circuits underlying reading, mathematical abilities as well as the potential to use neuroscience to design training programs of neurocognitive functions, such as working memory, that are expected to have effects on overall brain function. Throughout this review we describe how such research can enrich our understanding of the acquisition of academic skills. Furthermore, we discuss the potential for modern brain imaging methods to serve as diagnostic tools as well as measures of the effects of educational interventions. Throughout this discussion, we draw attention to limitations of the available evidence and propose future avenues for research. We also discuss the challenges that face this growing discipline. Specifically, we draw attention to unrealistic expectations for the immediate impact of neuroscience on education, methodological difficulties, and lack of interdisciplinary training, which results in poor communication between educators and neuroscientists. We point out that there should be bi-directional and reciprocal interactions between both disciplines of neuroscience and education, in which research originating from each of these traditions is considered to be compelling in its own right. While there are many obstacles that lie in the way of a productive field of neuroeducation, we contend that there is much reason to be optimistic and that the groundwork has been laid to advance this field in earnest.     

A psychometric study of the Bayley Scales of Infant and Toddler Development – 3rd Edition for term and preterm Taiwanese infants

The Bayley Scales of Infant and Toddler Development – 3rd Edition (Bayley-III) was updated to enhance its usefulness for contemporary child developmental assessment. However, recent data in Western countries have implicated the overestimation of child development by the new instrument. This study aimed to investigate the psychometric features of the Bayley-III for term and preterm infants in Taiwan. Forty-seven term infants and 167 preterm infants were prospectively examined with the Bayley Scales of Infant Development – 2nd Edition (BSID-II) and the Bayley-III at 6, 12, 18, and 24 months of age (corrected for prematurity). The psychometric properties examined included reliability, construct validity, and known-group validity. The intra- and inter-rater reliabilities of the Bayley-III were good to excellent. The correlations between the BSID-II and Bayley-III raw scores were good to excellent for the cognitive and motor items and low to excellent for the language items. Term infants achieved higher composite scores than preterm infants on all of the Bayley-III scales (p < 0.05). However, their rates of developmental delay were lower than the previously established prevalence estimates. The Bayley-III cut-off composite score was adjusted 10–20, 1–13, and 12–24 points higher than 70 for optimal prediction of cognitive, language, and motor delay, respectively, as defined by the BSID-II index score < 70. The Bayley-III is a reliable instrument that extends its previous edition, especially in early language assessment. However, the upward adjustment of its cut-off score is recommended for the accurate identification of developmental delay in term and preterm Taiwanese infants.     

Prediction of seizure freedom after epilepsy surgery – Critical reappraisal of significance of intracranial EEG parameters

ObjectiveTo analyze the significance of intracranial electroencephalography (iEEG) parameters such as seizure onset patterns (SOP) and size of seizure onset zone (SOZ) with respect to prediction of seizure freedom after resective epilepsy surgery.MethodsAll patients who underwent iEEG with subdural electrodes between January 2006 and December 2015 in our epilepsy-center were included. Various iEEG parameters were retrospectively analyzed regarding their predictive value to post-operative seizure freedom. Furthermore, associations of specific SOPs with underlying histopathology and brain regions of the SOZ were examined.ResultsEighty-one patients (34 female) with 324 seizures were assessed. Low-voltage fast activity (37%) and sharp activity <13 Hz (30%) were the most frequent SOPs. Focal SOZ (≤2 cm) was the only iEEG parameter independently associated with 1-year post-operative seizure freedom (OR 4.1, 95% CI 1.433–11.679). While no SOP was linked to specific histopathologies, some associations between SOPs and anatomical regions of SOZ were found.ConclusionsA circumscribed SOZ, but no specific SOP was predictive for seizure freedom after epilepsy surgery.SignificanceIntracranial EEG may be helpful to predict post-operative seizure freedom. Multicenter studies with larger numbers of patients are required to reliably assess the significance of specific SOPs for successful resective epilepsy surgery.     

The development of the Chinese version of Impact of Event Scale – Revised (CIES-R)

Background: This is an exploratory study on the psychometric properties and normative data of the Chinese translation of the Impact of Event Scale – Revised (CIES-R). Methods: The original Impact of Event Scale – Revised was translated into Chinese and the comparability of content was verified through back-translation procedures. The study consisted of a sample of 116 patients from the Accident and Emergency Department. Results: The reliability of the Chinese version was verified. The validity of the Chinese version as a measure of psychological distress was supported by the positive correlations between the various subscale scores of CIES-R (i. e., Intrusion, Avoidance, and Hyperarousal) and General Health Questionnaire-20. However, the independence of the three subscales was not supported. Conclusions: The present result suggests that normative information for different age groups and clinical samples might be different. Further study with clinical sample and investigation of the relationship between CIES-R and other diagnostic measures of PTSD are discussed. Received: 22 August 2002 / Accepted: 13 September 2002 Correspondence to Kitty K. Wu     

Isolated thrombosis of cortical veins – Clinical and radiological correlation

Isolated cortical venous thrombosis (ICVT) is a relatively rare clinical entity with non-specific clinical presentations. Anatomical variations in cortical veins and the lack of a gold standard imaging feature make the diagnosis of ICVT challenging. Headache and seizures were the most common presentations. The Vein of Trolard followed by superficial middle cerebral vein (SMCV) were the most commonly involved. Susceptibility Weighted Imaging (SWI) cord sign was observed in 100% of the cases. CT cord sign and filling defects on contrast enhanced CT were evident in 46.7% and 10% of the cases, respectively. Notably, in the absence of filling defect visualized on contrast CT, MRI, replacement of flow void was the surrogate marker for the ICVT. A high index of clinical suspicion, a thorough understanding of neurovascular anatomy, multiparametric, multiplanar MRI protocol is required to diagnose this rare entity. A serpiginous blooming structure within the subarachnoid space identifiable in less than two contiguous sections on SWI in the vicinity of haemorrhagic infarction should alert the clinician to the imaging possibility of ICVT.     

Health anxiety – An indicator of higher interoceptive sensitivity?

Background and objectivesAccording to cognitive-behavioral models, health anxiety arises from the misattribution of normal bodily sensations as signs of a severe illness. Consequently, higher levels of interoceptive accuracy might be critically involved in the development of health anxiety.MethodsTo test this central assumption of cognitive behavioral models of health anxiety, we assessed interoceptive accuracy in a sample of college students (N = 100). Two interoceptive tasks (detection of one's own heartbeat using the Schandry paradigm and detection of nonspecific skin conductance fluctuations, NSCFs) were used.ResultsWe found no indication for a positive association between facets of health anxiety and a higher interoceptive accuracy in the two tasks. In fact, worse heartbeat perception was associated with higher health anxiety as measured by two questionnaires whereas perception of NSCFs was not significantly related to any facet of health anxiety. In addition, we found a bias to overestimate NSCFs in people with heightened health anxiety.LimitationsBecause a sample of college students served as participants, the generalization of the findings is limited and further studies in patients with the diagnosis of hypochondriasis are necessary.ConclusionsThe findings of both interoceptive paradigms suggest that health anxiety is not associated with better but rather with less accurate and biased interoceptive sensitivity. Probably, not a heightened interoceptive sensitivity but rather the bias in overestimating harmless somatic cues is more relevant for the maintenance of health anxiety. Our results are in line with recent research in other somatoform disorders.     

Clinical advantages of COMT inhibition with entacapone – a review

Two catechol- O-methyltransferase (COMT) inhibitors, entacapone and tolcapone, were developed during the 1990's to be used as adjuncts to levodopa (LD) - dopa decarboxylase (DDC) inhibitors in the treatment of Parkinson's disease (PD). Entacapone is currently in wide clinical use, while tolcapone can be used in restricted indications only, due to its hepatotoxicity. COMT inhibitors prolong the elimination of LD, while DDC inhibitors mainly increase its absorption; both mechanisms leading to increased bioavailability of LD. The pharmacokinetic properties of LD, carbidopa and entacapone are quite similar, and entacapone is administered concomitantly with LD plus carbidopa. Entacapone prolongs the clinical effect of each LD dose by 30 to 40 minutes; this effect is seen already after the first entacapone dose. When LD is administered in several frequent daily doses, addition of entacapone reduces the daily fluctuations of plasma LD by 30 to 40%.Based on studies with home diaries, entacapone increases the daily ON-time by an average of one to two hours, and reduces the daily OFF-time correspondingly in patients with PD with motor fluctuations. The daily LD dose has been reduced by 10 to 30%. These positive effects are sustained in long term use over several years. There is still scant information of the benefit of entacapone in patients without motor fluctuations.Entacapone can cause both dopaminergic and non-dopaminergic adverse events. Increased dyskinesias are most frequently recorded in patients with motor fluctuations. The dopaminergic adverse events can usually be diminished by reducing the LD dose. Non-dopaminergic adverse events are abdominal pain and diarrhea. Diarrhoea has led to discontinuation in 3 to 4% of the patients in clinical trials. Entacapone has not been connected to liver toxicity and there are no indications to follow laboratory safety during treatment. The benefit-risk ratio of entacapone is considered favorable.A triple LD/carbidopa/entacapone combination tablet has recently been developed. Three LD strengths (50, 100 and 150 mg) are available, each contains 200 mg of entacapone. The majority of the patients can be managed with these three LD strengths. Entacapone has today an established position in treatment of PD patients with motor fluctuations, either as a separate tablet or as the triple LD combination.     

A behavioural pattern analysis of hypoglutamatergic mice – effects of four different antipsychotic agents

In a hypoglutamatergic rodent model, we have observed certain behaviours that might have relevance for the cognitive impairments seen in autism and schizophrenia. Thus, hypoglutamatergic mice show defective habituation, impaired attention, a meagre behavioural repertoire and a general behavioural primitivization. The aim of the present study was to characterise and quantify changes in movement pattern in mice rendered hypoglutamatergic by means of MK-801 treatment, using an automated video tracking system. Further, the effects of four different antipsychotic drugs, the classical neuroleptic haloperidol, the atypical antipsychotic clozapine, the DA D2/5-HT2A antagonist risperidone and the selective 5-HT2A-receptor antagonist M100907, were compared with respect to effects on NMDA antagonist-induced movement pattern alterations. We found that each receptor antagonist had a unique effect on the MK-801-induced behavioural primitivization. Haloperidol was unable to affect the monotonous behaviour induced by MK-801, while risperidone, clozapine and M100907 produced movement patterns of high intricacy.