Prevalence of sleep-disordered breathing in Japanese medical students based on type-3 out-of-center sleep test

BackgroundSleep-disordered breathing (SDB), especially obstructive sleep apnea disorder (OSA), is thought to mainly affect men over the age of 40. Following findings that Asian people are more likely to experience severe OSA, regardless of obesity, we investigated the prevalence of SDB and OSA in a larger sample and in more younger age groups than those described in previous reports.MethodsBetween 2011 and 2016, 487 medical students (358 males, mean age 24.8 ± 1.9 years; 129 females: mean age 23.8 ± 1.6 years) underwent an out-of-center sleep test using a type-3 portable monitor. The results were analyzed visually.ResultsThe mean ± standard deviation of the respiratory event index (REI: events/hour of monitoring) was 5.4 ± 6.7 (6.7 ± 7.5 in male participants, 2.6 ± 2.1 in female participants). There were 170 participants (36.6%) with an REI ≥ 5, including 158 male participants (46.9%) and 12 female participants (9.1%). SDB or undefined OSA with low REI (15 > REI ≥ 5) was observed in 141 participants (30.4%), defined OSA with moderate REI (30 > REI ≥ 15) in 19 participants (4.1%), and defined OSA with high REI (REI ≥ 30) in 10 participants (2.2%). Among the male students, 129 had low REI (38.3%), 19 had moderate REI (5.6%), and 10 had high REI (3.0%). All female participants with OSA events (9.4%) had a low REI.ConclusionsThe prevalence of OSA in Japanese young adults, especially males under 30 years old, is similar or even higher than that in older age groups described previously. Thus, an aggressive sleep study for SDB might be necessary for the younger generation in the Asian population.     

Depressive symptoms predict the quality of sleep in patients with partial epilepsy — A combined retrospective and prospective study

IntroductionEpilepsy is one of the most common neurological diseases and has many detrimental effects on the patients' well-being as well as sleep quality. The aim of this study was to assess the subjective quality of sleep and influencing factors on subjective sleep quality in patients with partial epilepsy using a combined retrospective and prospective study design.MethodsWe conducted a combined retrospective and prospective study in patients with partial epilepsy and analyzed subjective ratings of sleep quality in 32 patients (17 female, 15 male; mean age: 40.41 ± 12.67 years, range: 20–64) with partial epilepsy (mean duration of epilepsy diagnosis: 18.31 ± 13.26 years) and 32 healthy gender-matched and age-matched controls. All patients filled out a seizure diary for 90 days, which included the number, duration, and type (partial vs. secondary generalized) of epileptic seizures and intake of antiepileptic and sleep medications. At baseline, all participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Beck's Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Poor sleepers were defined by a PSQI score of ≥5.ResultsTwenty-three patients (72%) reported 15.17 ± 25.54 seizures in the previous three months, and nine (28%) patients reported being seizure-free. During the 90-day diary period, twenty-two patients (69%) documented a total of 319 epileptic seizures, while ten patients (31%) reported that they were seizure-free.The mean PSQI score of all patients was 4.88 ± 2.92 (range: 1–14) and the mean ESS score was 5.25 ± 2.98 (range: 0–10). The mean PSQI score of the control group was 3.25 ± 1.57 (range: 1–6), and their mean ESS score was 6.72 ± 3.48 (range: 0–14). The comparison of the two groups showed a significantly higher PSQI score in the patient group (t = 2.778, p = 0.008), but no statistically significant difference regarding their ESS score (t = − 1.811, p = 0.075). Sixteen (50%) patients were poor sleepers. Good sleepers showed a significantly lower PSQI (2.69 ± 1.08 vs. 7.06 ± 2.49; p < 0.001) and BDI scores (2.38 ± 2.50 vs. 9.63 ± 7.63; p < 0.002) than poor sleepers. Linear regression analysis showed that the BDI score was the significant predictor for the PSQI score (estimate: 0.2019; p = 0.00819) and for the ESS score (estimate: 0.2251; p = 0.0321).ConclusionIn patients with partial epilepsy, a higher depression score was the best predictor for a poor subjective sleep quality and increased daytime sleepiness.     

Awareness,attitudes toward epilepsy,and first aid knowledge of seizures of hospital staff in Henan,China

AimThe aim of this study was to evaluate awareness of, attitudes toward, and first aid knowledge of seizures of hospital staff in Henan, China.MethodTwo hundred nineteen hospital staff, including doctors, nurses, medical technicians, logisticians, and executives working at tertiary hospitals in Henan, China, completed the survey from March to September in 2016. The data comprised the demographic data section, awareness of epilepsy section, attitude toward epilepsy section, and first aid knowledge of seizure attack section.ResultsThe participants obtained a mean score of 7.48 ± 1.705 on the awareness of epilepsy section, and a mean score of 5.32 ± 1.165 on the first aid knowledge of seizure attacks section. There were significant correlations between educational level (r = 0.187, P = 0.006), occupation (r = − 0.244, P = 0.000), and attitudes toward patients with epilepsy (r = 0.351, P = 0.000) with the awareness of epilepsy. There were significant correlations between age (r = 0.170, P = 0.014), educational status (r = 0.139, P = 0.040), and professional titles (r = 0.197, P = 0.004) with the first aid knowledge of seizures.ConclusionThe study showed that hospital staff had a moderate level of knowledge regarding epilepsy, and they generally displayed a positive attitude. It was also determined that as the awareness of epilepsy increased, they displayed more positive attitudes toward patients with epilepsy. The study also suggests that specialists working on epilepsy should provide more lectures and educational sessions to improve the knowledge of and attitude toward epilepsy and first aid knowledge of seizures among hospital staff.     

Clinical predictors for favorable outcomes from endovascular recanalization in wake-up stroke

Background and purposePatients who have acute stroke symptoms present on awakening are ineligible for standard intravenous thrombolysis due to the unclear onset time of symptoms. Some of these wake-up stroke (WUS) patients may benefit from endovascular recanalization. This study aimed to evaluate clinical predictors of outcomes from endovascular recanalization in WUS patients.MethodsForty-one WUS patients with internal carotid (ICA) or middle cerebral artery (MCA) occlusion treated with endovascular recanalization were reviewed. Regression analysis was performed to measure clinical predictors of outcomes from endovascular recanalization in WUS patients.ResultsThe mean initial NIHSS score was 16.41 ± 4.96 (5–24). The mean symptom recognition-to-door time (SRDT) was 108.85 ± 65.80 (19–230) min. Successful recanalization (TICI 2b-3) was achieved in 29 patients (70.7%). Thirty-four patients improved on NIHSS (amount 7.59 ± 4.84, range; 1–17) at 7 days after recanalization. At 90 days after recanalization, a mRS of ≤2 was achieved in 19 patients (46.3%) and a mRS of ≤3 was achieved in 24 patients (58.5%). No symptomatic intracerebral hemorrhage occurred. Multivariate regression analysis identified SRDT (P = 0.019), successful recanalization (P = 0.005), and hypertension (P = 0.013) were factors associated with an improvement of the NIHSS score. For a good functional outcome at 90 days, SRDT (P = 0.036) and initial NIHSS score (P = 0.016) were found to be significant predictors.ConclusionsThe results of this study suggest that the SRDT is an independent predictor of both an improvement of NIHSS score and a good functional outcome in endovascular recanalization for WUS patients.     

Stigmatisation des patients atteints d’un trouble mental par les internes de médecine générale : une enquête nationale

ObjectivesThe objective was to assess the level of stigmatisation of psychiatric patients by medical interns specialising in general practice (GP), and to assess the influencing factors of stigmatisation.MethodsA national survey was carried out among interns in general practice (GP) contacted through their local associations from December 10, 2019 to March 9, 2020. An online questionnaire was diffused. The validated French version of the Mental Illness Clinicians’ Attitudes (MICA) was used to measure stigmatising attitudes towards psychiatry and persons with psychiatric disorder by the interns. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness with scores ranging from 16 to 96 (the most stigmatizing). Several covariates were collected: socio-demographics, personal experiences with mental health, and mental health trainings during medical studies. All questionnaires were strictly anonymized. Comparative analyses of the MICA score by group were performed using Student's tests.ResultsA total of 389 interns responded. The majority of respondents were female (n = 277; 71%) and the mean age was 27 years [standard deviation (SD) ± 2.39]. The mean MICA rate was 40.64 (SD ± 8.09) for a neutral score of 56, reflecting low overall stigmatizing attitudes. MICA scores were significantly lower among female interns (40.11 vs. 41.95; P = 0.042), those who had benefited from personal psychological or psychiatric support (38.70 vs. 41.61; P = 0.001), and those who had completed a psychiatric externship (39.47 vs. 42.16; P = 0.001).ConclusionsGP interns had an attitude that is generally not very stigmatizing even if its improvement should still be sought. This is particularly verified among those who have completed a psychiatric internship during their externship. This suggested association should be supported by other studies. The stakes are high for the future management of patients since stigmatisation by a physician is strongly implied in the worse healthcare management of patients with psychiatric disorders, leading them to a shorter lifespan.     

Negative symptoms are associated with lower autonomous motivation towards physical activity in people with schizophrenia

ObjectiveThis cross-sectional study examined the association between psychiatric symptoms and motivation for physical activity within the self-determination theory (SDT) framework in people with schizophrenia.MethodOver a 4-month period, 55 (17♀) inpatients with a DSM-V diagnosis of schizophrenia were assessed with the Psychosis Evaluation tool for Common use by Caregivers (PECC) and the Behavioural Regulation in Exercise Questionnaire (BREQ-2), that provided separate scores for amotivation, external, introjected and autonomous regulation. Spearman correlation coefficients were examined between these motivation scores and symptom ratings.ResultsThe BREQ-2 score for autonomous regulations (2.6 ± 1.1) was significantly correlated with the PECC negative symptoms score (10.3 ± 4.1) (r = −0.34, p = 0.011). No other significant correlations between BREQ-2 and PECC scores were found. The BREQ-2 score for external regulations (0.7 ± 0.9) was associated with older age (35.2 ± 11.3 years) (r = −0.30, p = 0.024).ConclusionsThese findings provide evidence that negative symptoms are associated with lower autonomous motivation towards physical activity in inpatients with schizophrenia. Future longitudinal research should confirm the current findings. Such research will guide physical activity approaches aimed at facilitating enhanced physical and mental health outcomes in individuals with schizophrenia.     

A web-based survey of attitudes toward epilepsy in secondary and tertiary students in Malaysia,using the Public Attitudes Toward Epilepsy (PATE) scale

BackgroundStudents' attitudes toward epilepsy have been studied in several countries, but none of the studies used a quantitative scale. We aimed to determine the validity and reliability of the Public Attitudes Toward Epilepsy (PATE) scale in a homogenous population consisting of secondary and tertiary students in Malaysia and to quantify their attitudes toward epilepsy, using a web-based survey.ResultsA total of 227 respondents with a mean age of 19.6 ± 2.07 years, predominantly Chinese (85%), female (62%), and in a pre-university education level (71%) completed the web-based survey. Psychometric testing showed that the PATE is a valid and reliable scale to be applied in a homogenous population. The mean score in the personal domain was significantly higher than that in the general domain (2.73 ± 0.61 vs. 2.12 ± 0.60, respectively, p < 0.001). Compared with a study previously performed on a general population (Lim et al., 2012 [10]), the mean score in the general domain was significantly lower (p < 0.01), whereas there was no significant difference between the mean scores in the personal domain. The mean scores in the general domain were significantly lower for those with tertiary education (p < 0.001) but did not correlate with gender and ethnicity.ConclusionThe attitudes of secondary and tertiary students are more positive than those of the general population in the general domain but not in the personal domain.     

Effects of long-term use of clonazepam on nonrapid eye movement sleep patterns in rapid eye movement sleep behavior disorder

ObjectiveWe aim to analyze in detail the characteristics of nonrapid eye movement (NREM) sleep in drug-free patients with idiopathic rapid eye movement sleep behavior disorder (iRBD). We compare drug-free iRBD patients to both normal controls and drug-free patients with narcolepsy/RBD and evaluate the changes following the long-term use of bedtime clonazepam.Participants and methodsForty-six participants were recruited: 15 with iRBD (13 men, 2 women; mean age, 65.8 ± 4.39 years), 13 with narcolepsy/RBD (10 men, 3 women; mean age, 63.0 ± 6.73 years), and 18 normal controls (10 men, 8 women; mean age 69.4 ± 7.72 years). Sleep was video polysomnographically recorded and the RBD severity scale (RBDSS) was obtained. Chin electromyography (EMG) amplitude was quantitatively assessed and the atonia index was computed. Additionally, NREM sleep instability was evaluated using an automatic quantitative analysis. Participants with iRBD were re-evaluated after 2.75 ± 1.62 years of regular therapy with 0.5 to 1-mg clonazepam at bedtime.ResultsSlow transient electroencephalography (EEG) events were increased in iRBD and decreased in narcolepsy/RBD, while fast transient events decreased in iRBD and increased in narcolepsy/RBD. During rapid eye movement (REM) sleep the atonia index was reduced in both iRBD and narcolepsy/RBD groups and during NREM sleep atonia index was increased in iRBD participants, remaining low in narcolepsy/RBD participants. After long-term therapy with clonazepam, wakefulness after sleep onset was decreased together with an increase in both slow-wave sleep (SWS) and sleep stage 2, in which the latter reached statistical significance; sleep stages 1 and 2 instability significantly decreased and the duration of EEG transients also slightly but significantly decreased. Finally, chin tone was not modified by clonazepam.ConclusionsOur study confirms that clonazepam modifies some aspects of NREM sleep in iRBD participants with a decrease in its instability. Moreover, we also show that a complex modification of sleep chin atonia exists in these participants, which also involves NREM sleep; for iRBD more complex neuropathologic models encompassing REM sleep and NREM sleep mechanisms are needed.     

Effect of motivational interviewing on quality of life in patients with epilepsy

ObjectiveIn this study, the effect of motivational interviewing on quality of life was evaluated in patients with epilepsy.MethodsFifty-six patients with epilepsy in a clinical trial were randomly assigned to intervention and control groups. Motivational interviewing during 5 sessions was applied for the intervention group, and the control group received health-care services. Quality-of-life questionnaire in epilepsy (QOLIE-89) was applied as pre- and posttest for both groups. Before and two months after intervention, both groups were assessed. Data were analyzed by independent t-test, Chi-square test, and paired t-test.ResultsThe data analysis showed that mean score of the QOLIE-89 was 38.94 ± 8.55 and 70.90 ± 7.99 in the intervention group before and after the intervention, respectfully, and 44.59 ± 12.27 and 36.52 ± 7.16 in the control group sequentially. The intervention group showed a significant score increase in their quality of life (p < 0.001), whereas the control group had a score decrease (p < 0.001).ConclusionMotivational interviewing approach could be used as an effective intervention method for improving patients' quality of life.     

Quality of life and its determinants in essential tremor

IntroductionDespite Essential Tremor (ET) being the commonest movement disorder, there are few studies on the quality of life (QOL) in patients with ET, with most studies employing generic questionnaires.MethodsWe studied QOL in 50 patients with ET attending the outpatient of a hospital using the Quality of life in Essential Tremor (QUEST) questionnaire a disease specific QOL instrument. The severity of tremor was assessed using a modified Fahn Tolosa Marin tremor rating scale (mFTMRS), co morbid anxiety and depression were studied using the Hamilton Anxiety (HARS) and Depression (HDRS) rating scales respectively. We also analyzed the influence of gender, age at presentation, age of onset, duration of tremor, distribution of tremor, family history and use of medications on the QOL.ResultsThe mean age of onset of tremor was 32.2 ± 18.9 years, mean duration of tremor was 8.4 ± 10.0 years, mean QUEST summary index (QSI) was 24.2 ± 19.2; mean scores in each of the domains were as follows – physical 29.3 ± 26.7, psychosocial 36.4 ± 28.7, communication 23.9 ± 36.9, work & finance 23.5 ± 29.9, hobbies 6.8 ± 17.3. The QSI had significant positive correlation with the mFTMRS, HARS and HDRS. Gender, age at presentation, age of onset, duration of tremor, distribution of tremor, family history and use of medication did not influence the QOL.ConclusionPsychosocial aspects are important in determining the QOL in patients with ET. Tremor severity, co morbid anxiety and depression are associated with a lower QOL whereas tremor characteristics like age of onset, duration, distribution do not influence the QOL.     

Stigmatizing attitudes and social perception towards mental illness among Moroccan medical students

ObjectivesThis study aimed to explore medical students’ attitudes, social perception, and knowledge towards mental illness and identify the associated factors.MethodsA cross-sectional study was conducted in the Medical Faculty of Fez. A representative sample of 420 Moroccan students from the first to the seventh years was selected randomly during the academic year (2018/2019). They completed the Mental Illness Clinicians Attitudes scale (MICA) and a self-questionnaire exploring sociodemographic data, the university course, social perception and knowledge towards mental illness, and the potential consideration of psychiatry as a career.ResultsThe average age of participants was 21.73 years (SD ± 2.60), and 72.4% (n = 304) of respondents were female (M/F gender ratio = 0.39). The participants held stigmatizing attitudes and negative social perceptions towards mental illness, as indicated by the high score of the MICA scale (mean = 57.24; SD ± 9.95). Females (p = 0.02) and married students (p = 0.02) showed significantly more tolerant attitudes. The attitudes of students (p = 0.37) who completed the psychiatry clerkship were slightly more favorable (p = 0.15). There was no significant difference in attitudes according to the level of study (p = 0.06). Students with a lower socioeconomic level tended to be less stigmatizing (p = 0.08). The assessment of knowledge about mental illness among students objectified major gaps. A total of 17.9% (n = 75) considered psychiatry as a career.ConclusionThe attitudes of medical students in this study were stigmatizing, and this should without delay motivate Moroccan research, educational and health authorities to investigate further scientific research in this area to address these attitudes and remedies.     

Sleep disordered breathing in a cohort of patients with sporadic inclusion body myositis

ObjectiveThe aims of the study were: (1) to evaluate subjective sleep quality and daytime sleepiness in patients affected by sporadic inclusion-body myositis (IBM); (2) to define the sleep and sleep-related respiratory pattern in IBM patients.MethodsThirteen consecutive adult patients affected by definite IBM were enrolled, six women and seven men, mean age 66.2 ± 11.1 years (range: 50–80). Diagnosis was based on clinical and muscle biopsy studies. All patients underwent subjective sleep evaluation (Pittsburgh Sleep Quality Index, PSQI and Epworth Sleepiness Scale, ESS), oro-pharingo-esophageal scintigraphy, pulmonary function tests, psychometric measures, anatomic evaluation of upper airways, and laboratory-based polysomnography. Findings in IBM patients were compared to those obtained from a control group of 25 healthy subjects (13 men and 12 women, mean age 61.9 ± 8.6 years).ResultsDisease duration was >10 years in all. Mean IBM severity score was 28.8 ± 5.4 (range 18–36). Dysphagia was present in 10 patients. Nine patients had PSQI scores ? 5; patients had higher mean PSQI score (IBM: 7.2 ± 4.7, Controls: 2.76 ± 1.45, p = 0.005); one patient (and no controls) had EES > 9. Polysomnography showed that IBM patients, compared to controls, had lower sleep efficiency (IBM: 78.8 ± 12.0%, Controls: 94.0 ± 4.5%, p < 0.001), more awakenings (IBM: 11.9 ± 11.0, Controls: 5.2 ± 7.5, p = 0.009) and increased nocturnal time awake (IBM: 121.2 ± 82.0 min., Controls: 46.12 ± 28.8 min., p = 0.001). Seven Patients (and no controls) had polysomnographic findings consistent with sleep disordered breathing (SDB).ConclusionData suggest that sleep disruption, and in particular SDB, might be highly prevalent in IBM.SignificanceData indicate that IBM patients have poor sleep and high prevalence of SDB.     

Un programme court de TCCi en groupe par visioconférence dans l’insomnie modifie-t-il les croyances erronées ?

IntroductionThe Morphee Sleep network runs a short group CBT programme. During the pandemic, the programme was administered by videoconference. The programme focuses on behavioral modification. The objective of our study was to evaluate whether the videoconference programme produced changes in dysfunctional beliefs about sleep and whether these changes were linked to improvements in insomnia.MethodsObservational study of 3 × 90 minute sessions of group CBT by videoconference over one month delivered by experienced psychologists. The outcome measures : insomnia severity scale (ISI), dysfunctional beliefs and attitudes about sleep short version (DBAS 16), hospital anxiety and depression scale (subscales depression HADD and anxiety HADA), and epworth sleepiness scale (ESS) completed before session 1 and at the end of session 3. The effectiveness of the programme on insomnia was evaluated by the decrease in the ISI score : full response R+ (>7 points), partial response, R- (4 - 6 points) non response, NR (<3 points). The effect on dysfunctional beliefs and attitudes about sleep were measured by the decrease in the DBAS 16 with response CR (>9 points) and no response CNR (<9 points).ResultsThere were fifty-five participants, 64 % women with a mean age of 49.1 ± 16.1 years. The DBAS 16 was reduced by 6.12 ± 1.29 to 5.09 ± 1.57 (P< 0.0001) with 67 % of participants showing a response CR. The ISI score reduced from 17.7 ± 3.6 to 14.0 ± 4.9 (P< 0.0001) with 49 % showing at least a partial response (R+ and R-). A significant correlation (0.327, P = 0.015) between the CBT response and dysfunctional beliefs about sleep was observed with a significant reduction in the DBAS 16 between responders R+ and non-responders (R+ vs. NR 1.67 ± 1.3 vs. 0.57 ± 1.28 P = 0.012). Seventy-nine of R+ showed improvements in the DBAS 16 vs. 69 % of R- and 61 % of non-responders NR.ConclusionA short group CBT programme by videoconference focused on behavioral modification can reduce dysfunctional beliefs about sleep.     

Clinical and polysomnographic characteristics and response to continuous positive airway pressure therapy in obstructive sleep apnea patients with nightmares

ObjectiveTo assess the characteristics of obstructive sleep apnea (OSA) patients with nightmares and the effects of continuous positive airway pressure (CPAP) therapy on nightmares.MethodsConsecutive patients referred with a clinical suspicion of OSA underwent attended overnight sleep studies. OSA and nightmares were diagnosed according to the American Academy of Sleep Medicine (AASM) criteria, and CPAP titration was performed in accordance with the AASM guidelines. A follow-up visit was performed 3 months later, and the patients with nightmares were divided into two groups: group 1 used CPAP with good compliance, whereas group 2 refused CPAP treatment and did not use other alternative treatments for OSA.ResultsThe study included 99 patients who had been diagnosed with OSA with nightmares. Their mean age was 47.2 ± 11.2 years, and they had a mean apnea–hypopnea index (AHI) of 36.5 ± 34.3/h. Also included were 124 patients with OSA without nightmares. The mean age of these patients was 45.4 ± 13.9 years, and they had a mean AHI of 40.2 ± 35/h. The patients with nightmares had a significantly higher AHI during rapid eye movement sleep (REM) compared with the patients without nightmares (51.7 ± 28.1 vs 39.8 ± 31.9/h). Logistic regression analysis revealed that the REM-AHI and interrupted sleep at night were independent predictors of nightmares in the OSA patients. Nightmares disappeared in 91% of the patients who used CPAP compared with 36% of patients who refused to use CPAP (p < 0.001).ConclusionNightmares in OSA patients are associated with a higher REM-AHI. CPAP therapy results in a significant improvement in nightmare occurrence.     

The accuracy and reliability of 3D CT/MRI co-registration in planning epilepsy surgery

ObjectiveTo investigate the accuracy and reliability of 3D CT/MRI co-registration technique for the localization of implanted subdural electrodes in the routine epilepsy presurgical evaluation, in so doing assess its usefulness in planning the tailored resection of epileptic focus.MethodsFour external anatomic fiducial makers were used for co-registration of volumetric pre-implant brain MRI and post-implant head CT using Curry 5.0 software in 19 epilepsy presurgical candidates. The location of subdural electrodes derived from the co-registration was compared to that obtained by intra-operative digital photographs by using gyral/sulcal patterns and cortical vasculature as anatomic markers.ResultsThe mean localization error was 4.3 ± 2.5 mm in all 19 patients. However, the mean localization error was 3.1 ±  1.3 mm in 13 patients with all four reliable fiducial markers; whereas the mean localization error was 6.8 ± 2.4 mm in 6 patients with two or three reliable fiducial markers.ConclusionVisualization of subdural electrode positions on a patient’s cortex can be accurately performed in the routine clinical setting by 3D CT/MRI co-registration. However, the accuracy of co-registration is dependent upon having reliable surface fiducial markers. In practice, confirmation of location accuracy, such as with intra-operative digital photographs, is necessary for planning of tailored resective surgery.SignificanceThe combination of 3D CT/MRI co-registration and intra-operative digital photography techniques provides a practical and effective algorithm for the localization and validation of implanted subdural electrodes.     

C1 lateral mass screw insertion from the caudal–dorsal to the cranial–ventral direction as an alternate method for C1 fixation: A quantitative anatomical and morphometric evaluation

ObjectC1 lateral mass screw has been widely used for fixation of the upper cervical spine. However, traditional fixation methods are not without complication. Morphometric measurement of an alternative approach is conducted.MethodsThree-dimensional CT scans of the cervical spine obtained in 100 adults were evaluated, and key measurements were determined for screw entry points, trajectories, and screw lengths for placement of a C1 screw via this alternate approach. Additional measures were included to account for relevant anatomic variation, including the size of the dangerous lateral zone of the C1 entry point and depth of the atlantooccipital joint surface. Twenty dried atlantal specimens were evaluated to determine corresponding ex vivo measurements.ResultsThe mean maximum angle of medialization was 20.8° ± 2.8° (right) and 21.1° ± 2.8° (left), as measured in the axial CT images. Sagittal CT images show the mean maximum superior angulation was 24.7° ± 4.3° (right) and 24° ± 4.0° (left), and the mean minimum superior angulation was 13.6° ± 4.4° (right) and 13.6° ± 3.9° (left). The mean screw length within the lateral mass was 21.2 ± 1.9 mm (right) and 21.3 ± 2.0 mm (left). Given an additional 10–15 mm needed for rod adaptation, an ideal screw length of 30–35 mm was determined.ConclusionThe C1 insertion caudally from the C2 nerve root may become an alternate method. Preoperative consideration of the ideal screw insertion point, trajectory, and length are vital for safe and effective surgical intervention.