Threat and safety reversal learning in social anxiety disorder – an fMRI study

Social anxiety disorder (SAD) has been linked to maladaptive forms of fear regulation, including flexibly distinguishing between learned threat and safety signals. Few studies have examined this in young, unmedicated SAD patients, including its neural basis. We aimed to characterize the neural, subjective, and autonomic correlates of reversal learning in patients with SAD and compare them to matched patients with major depressive disorder and to healthy control participants. All participants completed a threat-safety reversal learning task during functional magnetic resonance imaging. Successful threat-safety updating was associated with significant activation of primary regions of interest (anterior cingulate, insula and ventromedial prefrontal cortex), however, no significant differences were observed between them, consistent with subjective reports of task-evoked anxiety and affect. Contrary to expectations, we did not observe threat and safety reversal learning to be significantly impaired in young people with SAD.     

Executive functions in preschool children with cerebral palsy – Assessment and early intervention – A pilot study

Objective: To assess the level of executive functioning among preschool children with cerebral palsy (CP) and evaluate effects of the Program Intensified habilitation (PIH). Methods: In this non-randomized, prospective study, 15 preschool children with CP, and their parents attended the PIH for a 1-year period. Executive functions were evaluated using the Behavior Rating Inventory of Executive functions – Preschool version (BRIEF-P), filled out by parents and preschool teachers. Results: Before PIH, scores of executive function difficulties were close to the general population mean. After PIH, fathers and preschool teachers reported reduced levels of executive difficulties on, respectively, the Emergent Metacognition Index and the Flexibility Index on the BRIEF-P. Mothers reported no changes. Conclusion: The children in our sample showed age-appropriate levels of executive functions before attending PIH. Some aspects of executive skills difficulties were reduced after PIH. Using BRIEF-P contributed to the differentiation of cognitive strengths and weaknesses among the children.     

The use of EEG in Alzheimer’s disease,with and without scopolamine – A pilot study

ObjectiveTo use multivariate statistical analysis of EEG data in order to separate EEGs of patients with Alzheimer’s disease (AD) from controls. A group of individuals with mild cognitive impairment (MCI) was evaluated using the same methodology. Additionally, the effects of scopolamine on this separation are studied.MethodsStatistical pattern recognition (SPR) is used in conjunction with information extracted from EEGs before and after administration of scopolamine.ResultsThere was complete separation of the AD group and controls before administration of scopolamine. The separation increased after scopolamine had been given. Of the 10 MCI individuals, five seemed to belong to the AD group. Three of those progressed to AD within 1 year and one after 3 years.ConclusionsUsing SPR on EEG recordings it is possible to separate AD from controls. This separation can be increased by the use of scopolamine but the medication is not a prerequisite for classification. The results indicate that SPR is useful for predicting progress of MCI to AD.SignificanceEEG registration is a simple and noninvasive method. If these results are confirmed in other studies, this method could be more widely applied than the highly specialized methods used today in detection of early AD.     

Prevalence and factors of verbal learning and memory dysfunction in patients with epilepsy – A single centre study

The objective of this study is to determine prevalence and factors leading to verbal learning and memory dysfunction among patients with epilepsy.A total of 211 subjects were recruited. Their verbal memory was assessed by Rey’s Auditory Verbal Learning Test (RAVLT). This test was further subdivided into four major spheres for analysis, namely the verbal learning, interference list, immediate memory and delayed memory. All data collected were analyzed using Statistical Package for Social Sciences.Among the 211 patients, 55% (n = 116) had focal seizures and the remaining 45% (n = 95) had generalized seizures. Prevalence of verbal learning and memory impairment was high at 39.97% overall, and found most commonly in patients with focal impaired awareness seizures. Verbal learning and immediate memory dysfunction were significantly lower in focal impaired awareness group compared to others. Age more than 50 years, exposure to three or more antiepileptic drugs and use of carbamazepine more than 1000 mg a day were the predictors in poor verbal memory outcome. No statistical difference was observed in the mean RAVLT scores among the gender and hand dominance groups. Between patients with and without electroencephalogram changes as well as brain magnetic resonance imaging changes, the mean RAVLT scores showed no statistically significant difference.Verbal learning and memory impairment is prevalent among the epilepsy patients. The consequences of the memory impairment can be as debilitating as the seizure control. RAVLT is a reliable and practical test in the clinical setting.     

Evaluation of ultrashort echo-time (UTE) and fast-field-echo (FRACTURE) sequences for skull bone visualization and fracture detection – A postmortem study

Background and PurposeCT is considered the modality of choice in the assessment of the skull due to the fast and accurate depiction of bone structures. Nevertheless, MRI has evolved into a possible alternative due to optimal soft tissue contrast and recent advances with the ability to visualize tissues with shortest T2 times, such as osseous structures. In this study we compare skull bone visualization and fracture detection across two MRI sequences to CT as reference standard.Material and MethodsTwenty subjects underwent CT and MRI with less than 72 h between examination. The MRI protocol included a 2D ultrashort echo time (UTE) and a 3D multi-echo in-phase fast-field-echo (FRACTURE) sequence. Independent raters evaluated qualitative characteristics and fracture detectability in different skull subregions (skull vault, skull base and viscerocranium). Interrater and intermodality agreement was evaluated by calculating intraclass coefficients (ICC).ResultsFRACTURE ICC indicated a good agreement in all subregions (ICC = 0.83 – 0.88), whereas UTE had excellent results calculated in the skull vault and viscerocranium (ICC = 0.91 – 0.94). At the skull vault, both MRI sequences received an overall good rating (UTE: 2.63 ± 0.42 FRACTURE. 2.81 ± 0.32). Fracture detection using MRI sequences for the skull vault, was highest compared to other subregions.ConclusionsBoth MRI sequences may provide an alternative e.g. for surgical planning or follow up exams of the osseous neurocranium; although, at the skull base and viscerocranium bone visualization with MRI bone imaging sequences perform inferior to CT standard imaging.     

Identifying the most appropriate lumbar decompression patients for ambulatory surgery centers – A pilot study using inpatient and outpatient hospital data

IntroductionTo minimize healthcare related costs, ambulatory surgery centers (ASCs) have become increasingly favored venues for outpatient spine surgery. Using a national cohort of patients undergoing elective lumbar decompression (LD) in an inpatient or outpatient hospital setting, the current objectives were to: 1) outline specific factors that were associated with complications, and 2) describe potentially catastrophic complications.MethodsAdults who underwent LD between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Inclusion criteria were: principal procedure LD (CPT 63030), elective, neurologic/orthopaedic surgeons, length of stay (LOS) of 0/1 days, and discharged home. The primary outcome was presence of any complication. The secondary outcome was occurrence of potentially catastrophic complications. Univariate/multivariable logistic regression was performed.ResultsA total of 19,908 patients met the inclusion criteria. 564 (2.83%) patients experienced a complication. Cardiac intervention remained the only independent predictor of complications after multivariate testing (OR: 2.02, 95% CI: 1.00, 4.07, p = 0.049). Approximate comorbidity score cut-offs associated with <2% risk of complication were: ASA ≤ 3, CCI ≤ 5, mFI ≤ 0.182. A total of 96 (0.48%) patients experienced potentially catastrophic complications.ConclusionsWe utilized a national cohort of patients undergoing elective inpatient and outpatient LD in a hospital setting to identify preoperative risk factors for postoperative complications. Previous cardiac intervention was the sole independent predictor of complications. Although no patients treated at ASCs were studied, we believe these factors can aid in selecting patients most appropriate for ASCs and begin the process of selecting the best patients for an ambulatory setting.     

Predicting and reducing cranioplasty infections by clinical,radiographic and operative parameters – A historical cohort study

Cranioplasty is a relatively straightforward and common procedure, yet it carries a substantial rate of infection that causes major morbidity and mortality. The authors’ objective was to assess the effect of various variables on the risk of developing post-cranioplasty infections, and to enable the prediction and reduction of its incidence, contributing to an improved patient-selection. The medical records, microbiologic cultures, imaging studies and operative reports of patients who have undergone cranioplasty between the years 2008–2014 at Sheba Medical Center, a tertiary care teaching hospital in Tel-Hashomer, Israel, were reviewed and evaluated for potential predictive factors of infection. Cox regression was applied for uni- as well as multi-variate analyses, and a Kaplan–Meier curve and Log-Rank test were used to describe the association between neurological deficit prior to operation and occurrence of infection. Eighty-eight patients who had undergone cranioplasties using autologous as well as various artificial materials were included in the study. The overall rate of infection was 13.6%; median time to infection was 30.5 days (interquartile range: 17.35–43.5). Pre-operative degree of neurological disability was the strongest predictor for infection in both uni- and multi-variate analyses (Hazard ratio [HR] = 18.9, 95% confidence interval [CI]: 1.9–187 p = 0.014). Patients admitted due to trauma (HR = 7.04 CI: 0.9–54.6, p = 0.062) and autologous graft material (HR = 2.88, 95% CI: 0.92–9.09, p = 0.07) were associated with a trend toward a higher risk for infection. In conclusion, careful patient selection is a key concept in avoiding harmful post-cranioplasty infections. Modified Rankin Score yields a well-established tool that predicts the risk of infection.     

Cerebral creatine deficiency disorders – A clinical,genetic and follow up study from India

IntroductionCerebral creatine deficiency syndromes (CCDS) are a group of potentially treatable neurometabolic disorders. The clinical, genetic profile and follow up outcome of Indian CCDS patients is presented.Materials and methodsThis was a retrospective cohort of CCDS patients seen over six-years. Diagnosis was based either on low creatine peak on proton magnetic resonance spectroscopy (MRS) and/or genetic evaluation.ResultsThirteen patients were eligible [8 creatine transporter deficiency (CTD), 4 guanidinoacetate methyltransferase (GAMT) deficiency and 1 could not be classified]. The mean (±SD) age at diagnosis was 7.2(±5.0) years.Clinical manifestations included intellectual disability (ID) with significant expressive speech delay in all. Most had significant behavior issues (8/13) and/or autism (8/13). All had history of convulsive seizures (11/13 had epilepsy; 2 patients only had febrile seizures) and 2/13 had movement disorder. Constipation was the commonest non-neurological manifestation (5/13 patients).Cranial MRI was normal in all CTD patients but showed globus pallidus hyperintensity in all four with GAMT deficiency. MRS performed in 11/13 patients, revealed abnormally low creatine peak. A causative genetic variant (novel mutation in nine) was identified in 12 patients.Three GAMT deficiency and one CTD patient reported neurodevelopmental improvement and good seizure control after creatine supplementation.ConclusionIntellectual disability, disproportionate speech delay, autism, and epilepsy, were common in our CCDS patients. A normal structural neuroimaging with easily controlled febrile and/or afebrile seizures differentiated CTD from GAMT deficiency patients who had abnormal neuroimaging and often difficult to control epilepsy and movement disorder.     

Is there any difference in the effects of Qi therapy (external Qigong) with and without touching? A pilot study

The aim of this study was to evaluate differences in the effects of Qi therapy without touching or with touching on anxiety, mood, neurohormones, and cellular immune function. Twenty-four healthy male subjects were randomly assigned to either QTN (n = 12) or QTT (n = 12). They received Qi therapy (external Qigong) without touching (QTN) or with touching (QTT). Nonparametric statistical tests revealed no significant differences between the effects of QTN and QTT (all p > .05). Separate Wilcox signed rank tests for each intervention revealed significant effects on anxiety, alertness, depression, fatigue, tension, cortisol levels, and NK cell cytotoxicity for both QTN and QTT, and on neutrophil function for QTN only. These findings suggest that there are few differences between the effects of QTN and QTT. However, the reproducibility of the findings should be tested with multiple sessions, and long-term follow-up tests.     

Evaluating the effects of amantadin,modafinil and acetyl-l-carnitine on fatigue in multiple sclerosis – result of a pilot randomized,blind study

ObjectiveFatigue affects more than 60% of multiple sclerosis (MS) patients and is one of the most troublesome symptoms of the disease. Current treatment options for MS fatigue include amantadine, modafinil and acetyl-l-carnitine (ALCAR). The aim of our study was to compare efficacy of amantadine, modafinil and ALCAR with placebo in patients with MS.MethodsPatients with MS and a disability level ≤5.5 on the Kurtzke Expanded Disability Status Scale (EDSS) and fatigue were included in the study. Patients were assigned to a one month treatment with either amantadine 200 mg, ALCAR 2 g, modafinil 200 mg or placebo. Efficacy of the treatment was evaluated by using the modified fatigue impact scale (MFIS).ResultsSixty patients were included in the study (39 females). The mean age of patients was 38 ± 6.7 years and the mean disease duration was 6.6 ± 1.2 years. Contrast analysis showed significantly lower mean MFIS score after one month in patients on amantadine compared to placebo (mean difference = 17.3, p = 0.001). There was also a trend of a lower MFIS score in ALCAR group in comparison to placebo (mean difference = 12.4, p = 0.05, with Keppel-corrected alpha of 0.046). The quality of life measured as SF 36 – PCS and SF 36 – MCS proved to be significantly influenced by treatment.ConclusionOne month treatment with amantadine improved fatigue in patients with relapsing-remitting MS as evaluated by MFIS. No or only a trend of improvement was seen in patients treated with modafinil or ALCAR, respectively.     

Evaluation of postural balance control in patients with multiple sclerosis – effect of different sensory conditions and arithmetic task execution. A pilot study

Background and purposeThe purpose of this study was to investigate the effect of concomitant cognitive task execution and different sensory conditions on balance control in patients with multiple sclerosis (MS).Material and methodsThirty-two subjects with MS and 30 healthy age- and sex-matched control subjects were included in the study. Balance Performance Oriented Mobility Assessment was performed in all subjects. Their spontaneous sway characteristics while standing with different sensory conditions and during execution of a simple arithmetic task were analysed. Mean sway in the coronary and sagittal plane, as well as sway velocity, were measured.ResultsThe values of all evaluated variables obtained in all tests were significantly higher in the MS group than in controls. In the MS group, more pronounced progression of changes in response to increased difficulty of the test was also observed. Analysis of risk of falls in MS revealed a significant increase of sway velocity and mean sway in the mediolateral and anteroposterior plane in the majority of tests.ConclusionsPostural stability in patients with MS is significantly decreased in comparison with the control group in all evaluated conditions. Stability deficit is enhanced in response to more difficult conditions of evaluation. Increased risk of falls is related to the increased postural sway velocity and length of mean sway; this association is most pronounced in the coronary plane.     

Neuroinformatics Database (NiDB) – A Modular, Portable Database for the Storage, Analysis, and Sharing of Neuroimaging Data

We present a modular, high performance, open-source database system that incorporates popular neuroimaging database features with novel peer-to-peer sharing, and a simple installation. An increasing number of imaging centers have created a massive amount of neuroimaging data since fMRI became popular more than 20 years ago, with much of that data unshared. The Neuroinformatics Database (NiDB) provides a stable platform to store and manipulate neuroimaging data and addresses several of the impediments to data sharing presented by the INCF Task Force on Neuroimaging Datasharing, including 1) motivation to share data, 2) technical issues, and 3) standards development. NiDB solves these problems by 1) minimizing PHI use, providing a cost effective simple locally stored platform, 2) storing and associating all data (including genome) with a subject and creating a peer-to-peer sharing model, and 3) defining a sample, normalized definition of a data storage structure that is used in NiDB. NiDB not only simplifies the local storage and analysis of neuroimaging data, but also enables simple sharing of raw data and analysis methods, which may encourage further sharing.     

Effects of ethnicity on sub-clinical PTSD and depressive symptoms,following exposure to missile attacks in Israel—A pilot study

Abstract

Objective. The aim of this pilot study was to compare the occurrence of post-traumatic stress disorder (PTSD) symptoms, major depression disorder (MDD)-related symptoms, and negative mood regulation capacities among Israeli Jewish and Arab children and their parents, all of whom had been exposed to recurrent missiles attacks during the Second Lebanon War. Methods. Participants consisted of 28 Jewish and 14 Arab children (aged 4–18 years) and their parents. They were assessed by self-report instruments and a semi-structured interview (K-SADS-PL). Results. Among children, PTSD and depressive symptoms were found to be interrelated. Parents’ depression and mood regulation were found to be related to their children's PTSD and depressive responses. Both children's and parents’ negative mood regulation capacities were inversely related to children's depressive and PTSD symptoms. Both Jewish and Arab children's scores on the Children Depression Inventory (CDI) and on the PTSD Scale Symptoms Interview (PSS-I) showed significant levels of emotional distress following the missile attacks. However, Arab children reported significantly higher levels of PTSD and depressive symptoms in comparison to Jewish children. Conclusion. Ethnicity seems to be an important factor in children's responses to war-related events.     

Errorless (re)learning of everyday activities in patients with Korsakoff’s syndrome: A feasibility study

Errorless learning has proven to be an effective method for (re)learning tasks in several patient groups with amnesia. However, so far only a handful of studies have examined the effects of errorless learning in patients with Korsakoff’s syndrome. The aims of this feasibility study were to (a) examine the effects of errorless learning training on (re)learning tasks in a patient with Korsakoff’s syndrome, (b) examine the effects of the nature of the training on the execution of the tasks, and (c) examine characteristics that may mediate learning outcome. Professional caregivers, who were trained in errorless learning principles, taught 51 patients with Korsakoff’s syndrome two everyday tasks. Significant improvements in the performance were found after an errorless intervention for different types of trained tasks (activities of daily living, chores, mobility, housekeeping). Moreover, the results of this study suggest that all patients, despite of age, educational level, or level of cognitive functioning, may benefit from errorless learning. The results showed that, despite severe amnesia, patients with Korsakoff’s syndrome have the potential to (re)learn everyday skills. Errorless learning might be beneficial for memory rehabilitation in patients with Korsakoff’s syndrome in clinical practice. The results of this study are clinically relevant, as successfully learning tasks using errorless learning principles might improve autonomy and independence in the daily lives of patients with Korsakoff’s syndrome.