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Lemus HN, Villamar MF, Roth J, Tobochnik S. Initiation of Antiseizure Medications by US Board-Certified Neurologists After a First Unprovoked Seizure Based on EEG Findings. Neurol Clin Pract 2024; 14:e200249. [PMID: 38204587 PMCID: PMC10775163 DOI: 10.1212/cpj.0000000000200249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
Background and Objectives To investigate neurologists' practice variability in antiseizure medication (ASM) initiation after a first unprovoked seizure based on reported EEG interpretations. Methods We developed a 15-question multiple-choice survey incorporating a standardized clinical case scenario of a patient with a first unprovoked seizure for whom different EEG reports were provided. The survey was distributed among board-certified neurologists practicing in the United States. Associations between categorical variables were evaluated using the Fisher Exact test. Multivariate analysis was performed using logistic regression. Results A total of 106 neurologists responded to the survey. Most responders (75%-95%) would start ASM for definite epileptiform features on EEG, with similar rates between subgroups differing in years of practice, presence of subspecialty EEG training, and self-reported confidence in EEG interpretation. There was greater variability in practice for nonspecific EEG abnormalities, with sharply contoured activity, sharp transients, and focal delta slowing associated with the highest variability and uncertainty. Neurologists with >5 years of practice experience (21% vs 44%, OR 0.35 [95% CI 0.13-0.89], p = 0.021), subspecialty EEG training (15% vs 50%, OR = 0.17 [95% CI 0.06-0.48], p < 0.001), and greater confidence in EEG interpretation (21% vs 52%, OR 0.24 [95% CI 0.09-0.62], p = 0.001) were less likely to start ASM for ≥2 nonspecific EEG abnormalities and reported greater uncertainty. In multivariate analysis, seniority (p = 0.039) and subspecialty EEG training (p = 0.032) were associated with decreased ASM initiation for nonspecific EEG features. Discussion There was substantial variability in ASM initiation practices between board-certified neurologists after a first unprovoked seizure with nonspecific EEG abnormalities. These findings clarify specific areas where EEG reporting may be optimized and reinforces the importance of implementing evidence-based practice guidelines.
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Affiliation(s)
- Hernan Nicolas Lemus
- Department of Neurology (HNL), The University of Alabama at Birmingham; Department of Neurology (MFV, JR), The Warren Alpert Medical School of Brown University, Providence, RI; and Department of Neurology (ST), Brigham and Women's Hospital, Boston, MA
| | - Mauricio F Villamar
- Department of Neurology (HNL), The University of Alabama at Birmingham; Department of Neurology (MFV, JR), The Warren Alpert Medical School of Brown University, Providence, RI; and Department of Neurology (ST), Brigham and Women's Hospital, Boston, MA
| | - Julie Roth
- Department of Neurology (HNL), The University of Alabama at Birmingham; Department of Neurology (MFV, JR), The Warren Alpert Medical School of Brown University, Providence, RI; and Department of Neurology (ST), Brigham and Women's Hospital, Boston, MA
| | - Steven Tobochnik
- Department of Neurology (HNL), The University of Alabama at Birmingham; Department of Neurology (MFV, JR), The Warren Alpert Medical School of Brown University, Providence, RI; and Department of Neurology (ST), Brigham and Women's Hospital, Boston, MA
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Beaulieu-Jones BK, Villamar MF, Scordis P, Bartmann AP, Ali W, Wissel BD, Alsentzer E, de Jong J, Patra A, Kohane I. Predicting seizure recurrence after an initial seizure-like episode from routine clinical notes using large language models: a retrospective cohort study. Lancet Digit Health 2023; 5:e882-e894. [PMID: 38000873 PMCID: PMC10695164 DOI: 10.1016/s2589-7500(23)00179-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/08/2023] [Accepted: 08/31/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The evaluation and management of first-time seizure-like events in children can be difficult because these episodes are not always directly observed and might be epileptic seizures or other conditions (seizure mimics). We aimed to evaluate whether machine learning models using real-world data could predict seizure recurrence after an initial seizure-like event. METHODS This retrospective cohort study compared models trained and evaluated on two separate datasets between Jan 1, 2010, and Jan 1, 2020: electronic medical records (EMRs) at Boston Children's Hospital and de-identified, patient-level, administrative claims data from the IBM MarketScan research database. The study population comprised patients with an initial diagnosis of either epilepsy or convulsions before the age of 21 years, based on International Classification of Diseases, Clinical Modification (ICD-CM) codes. We compared machine learning-based predictive modelling using structured data (logistic regression and XGBoost) with emerging techniques in natural language processing by use of large language models. FINDINGS The primary cohort comprised 14 021 patients at Boston Children's Hospital matching inclusion criteria with an initial seizure-like event and the comparison cohort comprised 15 062 patients within the IBM MarketScan research database. Seizure recurrence based on a composite expert-derived definition occurred in 57% of patients at Boston Children's Hospital and 63% of patients within IBM MarketScan. Large language models with additional domain-specific and location-specific pre-training on patients excluded from the study (F1-score 0·826 [95% CI 0·817-0·835], AUC 0·897 [95% CI 0·875-0·913]) performed best. All large language models, including the base model without additional pre-training (F1-score 0·739 [95% CI 0·738-0·741], AUROC 0·846 [95% CI 0·826-0·861]) outperformed models trained with structured data. With structured data only, XGBoost outperformed logistic regression and XGBoost models trained with the Boston Children's Hospital EMR (logistic regression: F1-score 0·650 [95% CI 0·643-0·657], AUC 0·694 [95% CI 0·685-0·705], XGBoost: F1-score 0·679 [0·676-0·683], AUC 0·725 [0·717-0·734]) performed similarly to models trained on the IBM MarketScan database (logistic regression: F1-score 0·596 [0·590-0·601], AUC 0·670 [0·664-0·675], XGBoost: F1-score 0·678 [0·668-0·687], AUC 0·710 [0·703-0·714]). INTERPRETATION Physician's clinical notes about an initial seizure-like event include substantial signals for prediction of seizure recurrence, and additional domain-specific and location-specific pre-training can significantly improve the performance of clinical large language models, even for specialised cohorts. FUNDING UCB, National Institute of Neurological Disorders and Stroke (US National Institutes of Health).
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Affiliation(s)
- Brett K Beaulieu-Jones
- Department of Medicine, University of Chicago, Chicago, IL, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
| | - Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Benjamin D Wissel
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily Alsentzer
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | | | | | - Isaac Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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Villamar MF, Ayub N, Koenig SJ. Automated Seizure Detection in Patients with Cardiac Arrest: A Retrospective Review of Ceribell™ Rapid-EEG Recordings. Neurocrit Care 2023; 39:505-513. [PMID: 36788179 DOI: 10.1007/s12028-023-01681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND In patients with cardiac arrest who remain comatose after return of spontaneous circulation, seizures and other abnormalities on electroencephalogram (EEG) are common. Thus, guidelines recommend urgent initiation of EEG for the evaluation of seizures in this population. Point-of-care EEG systems, such as Ceribell™ Rapid Response EEG (Rapid-EEG), allow for prompt initiation of EEG monitoring, albeit through a reduced-channel montage. Rapid-EEG incorporates an automated seizure detection software (Clarity™) to measure seizure burden in real time and alert clinicians at the bedside when a high seizure burden, consistent with possible status epilepticus, is identified. External validation of Clarity is still needed. Our goal was to evaluate the real-world performance of Clarity for the detection of seizures and status epilepticus in a sample of patients with cardiac arrest. METHODS This study was a retrospective review of Rapid-EEG recordings from all the patients who were admitted to the medical intensive care unit at Kent Hospital (Warwick, RI) between 6/1/2021 and 3/18/2022 for management after cardiac arrest and who underwent Rapid-EEG monitoring as part of their routine clinical care (n = 21). Board-certified epileptologists identified events that met criteria for seizures or status epilepticus, as per the 2021 American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology, and evaluated any seizure burden detections generated by Clarity. RESULTS In this study, 4 of 21 patients with cardiac arrest (19.0%) who underwent Rapid-EEG monitoring had multiple electrographic seizures, and 2 of those patients (9.5%) had electrographic status epilepticus within the first 24 h of the study. None of these ictal abnormalities were detected by the Clarity seizure detection system. Clarity showed 0% seizure burden throughout the entirety of all four Rapid-EEG recordings, including the EEG pages that showed definite seizures or status epilepticus. CONCLUSIONS The presence of frequent electrographic seizures and/or status epilepticus can go undetected by Clarity. Timely and careful review of all raw Rapid-EEG recordings by a qualified human EEG reader is necessary to guide clinical care, regardless of Clarity seizure burden measurements.
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Affiliation(s)
- Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Medicine, Kent Hospital, Warwick, RI, USA.
| | - Neishay Ayub
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Seth J Koenig
- Department of Medicine, Kent Hospital, Warwick, RI, USA
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Villamar MF, Ayub N, Koenig SJ. Response to "Gaining Clarity on the Claritɣ Algorithm". Neurocrit Care 2023; 39:541-542. [PMID: 37523111 DOI: 10.1007/s12028-023-01798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Mauricio F Villamar
- Department of Medicine, Kent Hospital, Warwick, RI, USA.
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Neishay Ayub
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Seth J Koenig
- Department of Medicine, Kent Hospital, Warwick, RI, USA
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Villamar MF, Roth JL. The value of neurology clerkship rotations at non-tertiary hospitals. J Neurol Sci 2023; 451:120736. [PMID: 37478795 DOI: 10.1016/j.jns.2023.120736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurology, Rhode Island Hospital, Providence, RI, USA; Department of Medicine, Kent Hospital, Warwick, RI, USA.
| | - Julie L Roth
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurology, Rhode Island Hospital, Providence, RI, USA
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Quon RJ, Sarangi S, Rogg JM, Villamar MF. Cranial Polyneuropathy from Multiple Myeloma with CNS Involvement. R I Med J (2013) 2023; 106:38-39. [PMID: 37195160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Affiliation(s)
- Robert J Quon
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sasmit Sarangi
- Department of Neurology, Rhode Island Hospital, Department of Neurology, Division of Neuro-Oncology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jeffrey M Rogg
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI
| | - Mauricio F Villamar
- Department of Neurology, Neurohospitalist Division, The Warren Alpert Medical School of Brown University, Providence, RI; Department of Medicine, Kent Hospital, Warwick, RI
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DeCarvalho SA, Ibanhes FH, Villamar MF. Potential Relationship Between Polysubstance Overdose, Hypoxia, and Increased Risk of Delayed Leukoencephalopathy. Neurohospitalist 2023; 13:212-213. [PMID: 37064935 PMCID: PMC10091432 DOI: 10.1177/19418744231153471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
| | | | - Mauricio F. Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown
University, Providence, RI, USA
- Department of Medicine, Kent Hospital, Warwick, RI, USA
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Clay JL, Villamar MF, Bensalem-Owen MK. Pharmacist involvement with antiepileptic therapy for status epilepticus in the emergency department. Am J Emerg Med 2023; 63:156-157. [PMID: 36192245 DOI: 10.1016/j.ajem.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jordan L Clay
- Department of Neurology, Comprehensive Epilepsy Program, University of Kentucky College of Medicine, J-401 Kentucky Clinic, 740 S Limestone, Lexington, KY 40536, USA.
| | - Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, 593 Eddy St, APC 5, Providence, RI 02903, USA.
| | - Meriem K Bensalem-Owen
- Department of Neurology, Comprehensive Epilepsy Program, University of Kentucky College of Medicine, J-401 Kentucky Clinic, 740 S Limestone, Lexington, KY 40536, USA.
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Abud AM, Rizvi S, Zainah H, O'Brien TC, Villamar MF. Aggressive MOGAD with bilateral corticospinal tract lesions following infection with Jamestown Canyon virus. J Neuroimmunol 2022; 373:577997. [PMID: 36403434 DOI: 10.1016/j.jneuroim.2022.577997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
We present a case of a rare viral encephalitis due to Jamestown Canyon virus precipitating a severe phenotype of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) with novel neuroimaging findings.
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Affiliation(s)
- Alexander M Abud
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Syed Rizvi
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hadeel Zainah
- Department of Medicine, Kent Hospital, Warwick, RI, USA
| | | | - Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, Kent Hospital, Warwick, RI, USA
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Ibanhes FH, O'Connell E, Villamar MF. Delayed Toxic-Hypoxic Leukoencephalopathy After Posterior Reversible Encephalopathy Syndrome. R I Med J (2013) 2022; 105:37-39. [PMID: 36300963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | | | - Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI; Department of Medicine, Kent Hospital, Warwick, RI
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Villamar MF, Taylor JA, Hamner JW, Voinescu PE. Author Response: Clinical Reasoning: A Young Man With Daily Episodes of Altered Awareness. Neurology 2022; 99:540. [PMID: 36123139 DOI: 10.1212/wnl.0000000000201214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Affiliation(s)
- Mauricio F. Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, Kent Hospital, Warwick, RI, USA
| | - Ana C. Albuja
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Batayneh O, Lin A, Abu-Jaradeh O, Wu P, Villamar MF, Sharma P. Symptomatic leptomeningeal carcinomatosis: a rare presentation of chronic lymphocytic leukaemia relapse. BMJ Case Rep 2022; 15:15/6/e249940. [DOI: 10.1136/bcr-2022-249940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Central nervous system (CNS) involvement in patients with chronic lymphocytic leukaemia (CLL) is very rare and, when present, it is frequently asymptomatic. Rather, CNS involvement is more common in other haematological malignancies such as mantle cell lymphoma or diffuse large B cell lymphoma. The paucity of literature on CNS involvement in CLL underscores the importance of increasing awareness about its presentation, diagnosis and optimal management. We describe a case of symptomatic leptomeningeal leukaemic involvement as an atypical presentation of CLL relapse. A favourable clinical response was observed following systemic monotherapy with venetoclax.
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Villamar MF, Sarkis RA, Pennell P, Kohane I, Beaulieu-Jones BK. Severity of Epilepsy and Response to Antiseizure Medications in Individuals with Multiple Sclerosis: Analysis of a Real-World Dataset. Neurol Clin Pract 2022; 12:e49-e57. [DOI: 10.1212/cpj.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
ABSTRACTBackground and objectives:Epilepsy is an important comorbidity that affects outcomes for people with multiple sclerosis (MS). However, it is unclear if seizure severity among individuals with coexistence of multiple sclerosis and epilepsy (MS+E) is higher than in those with other focal epilepsies. Our goal was to compare the overall severity of epilepsy in individuals with MS+E versus those with focal epilepsy without MS (E-MS) as defined by seizure-related healthcare utilization, frequency and duration of status epilepticus, and frequency of antiseizure medication (ASM) regimen changes.Methods:In this hypothesis-generating study, we analyzed a U.S. commercial nationwide de-identified claims dataset with > 86 million individuals between 1/1/2008 and 8/31/2019. Using validated algorithms, we identified adults with E-MS and those with MS+E. We compared the number and length of seizure-related hospital admissions, the number of claims and unique days with claims for status epilepticus, and the rates of ASM regimen changes between the MS+E and the E-MS groups.Results:During the study period, 66,708 individuals with E-MS and 537 with MS+E had ≥ 2 years of coverage after their initial diagnosis of epilepsy. There was no difference between the MS+E and E-MS groups in the percentage of individuals admitted for seizures and/or status epilepticus. However, MS+E with seizure-related admissions had more admissions and longer hospital stays than those with E-MS. MS+E who experienced status epilepticus had more unique days with status epilepticus claims compared to E-MS. MS+E were more likely to have ASM regimen changes in Year 2 after the initial diagnosis of epilepsy and had more ASM changes during Year 2 compared to E-MS. Among individuals with MS+E, there were no differences in our measures of seizure severity for those treated with sodium channel blockers/modulators versus other ASM classes.Discussion:This study supports the notion that individuals with MS+E can have more severe epilepsy than those with E-MS. Seizure severity among individuals with MS+E treated with sodium-channel blockers/modulators versus other ASM classes shows no significant differences.Classification of evidence:This study provides Class III evidence that individuals with MS+E can have more severe epilepsy than those with E-MS.
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Ibanhes FH, Villamar MF. Delayed Unilateral Facial Weakness in COVID-19-Associated Guillain-Barré Syndrome. R I Med J (2013) 2022; 105:49-50. [PMID: 35476738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | - Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI; Department of Medicine, Kent Hospital, Warwick, RI
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Robbins JO, Rothschild JH, Albuja AC, Villamar MF. A Young Woman With New-Onset Focal Seizures. J Acute Med 2022; 12:43-44. [PMID: 35619727 PMCID: PMC9096503 DOI: 10.6705/j.jacme.202203_12(1).0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/13/2021] [Indexed: 06/15/2023]
Affiliation(s)
- James O Robbins
- Providence The Warren Alpert Medical School of Brown University RI USA
| | | | - Ana C Albuja
- The Warren Alpert Medical School of Brown University Department of Pediatrics Providence, RI USA
- The Warren Alpert Medical School of Brown University Department of Neurology Providence, RI USA
| | - Mauricio F Villamar
- The Warren Alpert Medical School of Brown University Department of Neurology Providence, RI USA
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DeCarvalho SA, Villamar MF. Opioid-Associated Amnestic Syndrome. R I Med J (2013) 2022; 105:22-23. [PMID: 35211705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | - Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI; Department of Medicine, Kent Hospital, Warwick, RI
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Villamar MF, Albuja AC. Academic diversity programmes for non-US international medical graduates. Lancet Gastroenterol Hepatol 2022; 7:115. [DOI: 10.1016/s2468-1253(21)00461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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Abstract
Stretch syncope is a distinct entity characterized by transient alteration in awareness (TAA) induced by neck hyperextension during stretching. Few cases of stretch syncope have been reported in the literature. Nevertheless, this is a highly relevant diagnosis as it can be easily mistaken for epilepsy for a number of reasons. These include stereotypical motor activity associated with the events, development of ictal tachycardia, and presence of rhythmic/semirhythmic slowing on EEG in the context of transient cerebral hypoperfusion.We present the case of a young man who was referred to our comprehensive epilepsy center for frequent episodes of TAA. After careful evaluation, the episodes were initially considered to be epileptic. Given that he had negligible clinical response to antiseizure medications, he underwent an experimental protocol at a cardiovascular research laboratory that ultimately confirmed the diagnosis of stretch syncope.The present manuscript describes an approach to the evaluation of TAA and illustrates a typical case of stretch syncope. The importance of considering stretch syncope in the differential diagnosis of TAA is exemplified. Finally, our analyses help elucidate the pathophysiology of this rare entity.
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Villamar MF, Albuja AC. Waveform Window #50: A Novel Presentation of Deep Brain Stimulator (DBS) Artifact on Electroencephalogram (EEG) and Electrocardiogram (ECG). Neurodiagn J 2021; 61:104-109. [PMID: 34009102 DOI: 10.1080/21646821.2021.1909972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Kent Hospital, Warwick, Rhode Island
| | - Ana C Albuja
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Obretenova S, Villamar MF, Tobochnik S. Addition of Anterior Temporal EEG Electrodes to Improve Seizure Detection. Neurohospitalist 2021; 11:89-90. [PMID: 33868567 DOI: 10.1177/1941874420945888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Steven Tobochnik
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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Albuja AC, Bensalem-Owen MK, Villamar MF. Reader Response: Association of Guideline Publication and Delays to Treatment in Pediatric Status Epilepticus. Neurology 2021; 96:502-503. [PMID: 33686007 DOI: 10.1212/wnl.0000000000011561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Facial myokymia is a clinical sign that can occur as a manifestation of demyelinating lesions. As seen in our patient with multiple sclerosis, acute-onset continuous facial myokymia can be indicative of an active lesion and can have localizing value.
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Affiliation(s)
- Jordan L. Clay
- Department of NeurologyUniversity of Virginia Health SystemsCharlottesvilleVAUSA
| | - Mauricio F. Villamar
- Department of NeurologyWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
- Kent HospitalWarwickRIUSA
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Sokolov E, Abdoul Bachir DH, Sakadi F, Williams J, Vogel AC, Schaekermann M, Tassiou N, Bah AK, Khatri V, Hotan GC, Ayub N, Leung E, Fantaneanu TA, Patel A, Vyas M, Milligan T, Villamar MF, Hoch D, Purves S, Esmaeili B, Stanley M, Lehn-Schioler T, Tellez-Zenteno J, Gonzalez-Giraldo E, Tolokh I, Heidarian L, Worden L, Jadeja N, Fridinger S, Lee L, Law E, Fodé Abass C, Mateen FJ. Tablet-based electroencephalography diagnostics for patients with epilepsy in the West African Republic of Guinea. Eur J Neurol 2020; 27:1570-1577. [PMID: 32359218 DOI: 10.1111/ene.14291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Epilepsy is most common in lower-income settings where access to electroencephalography (EEG) is generally poor. A low-cost tablet-based EEG device may be valuable, but the quality and reproducibility of the EEG output are not established. METHODS Tablet-based EEG was deployed in a heterogeneous epilepsy cohort in the Republic of Guinea (2018-2019), consisting of a tablet wirelessly connected to a 14-electrode cap. Participants underwent EEG twice (EEG1 and EEG2), separated by a variable time interval. Recordings were scored remotely by experts in clinical neurophysiology as to data quality and clinical utility. RESULTS There were 149 participants (41% female; median age 17.9 years; 66.6% ≤21 years of age; mean seizures per month 5.7 ± SD 15.5). The mean duration of EEG1 was 53 ± 12.3 min and that of EEG2 was 29.6 ± 12.8 min. The mean quality scores of EEG1 and EEG2 were 6.4 [range, 1 (low) to 10 (high); both medians 7.0]. A total of 44 (29.5%) participants had epileptiform discharges (EDs) at EEG1 and 25 (16.8%) had EDs at EEG2. EDs were focal/multifocal (rather than generalized) in 70.1% of EEG1 and 72.5% of EEG2 interpretations. A total of 39 (26.2%) were recommended for neuroimaging after EEG1 and 22 (14.8%) after EEG2. Of participants without EDs at EEG1 (n = 53, 55.8%), seven (13.2%) had EDs at EEG2. Of participants with detectable EDs on EEG1 (n = 23, 24.2%), 12 (52.1%) did not have EDs at EEG2. CONCLUSIONS Tablet-based EEG had a reproducible quality level on repeat testing and was useful for the detection of EDs. The incremental yield of a second EEG in this setting was ~13%. The need for neuroimaging access was evident.
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Affiliation(s)
- E Sokolov
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - F Sakadi
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - J Williams
- Department of Neurology, Mater Misericordiae University Hospital and Dublin Neurological Institute, Dublin, Ireland
| | - A C Vogel
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - N Tassiou
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - A K Bah
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - V Khatri
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - G C Hotan
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Boston, MA, USA
| | - N Ayub
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - E Leung
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, USA.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, USA
| | - T A Fantaneanu
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - A Patel
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - M Vyas
- Division of Neurology, University of Toronto, Toronto, ON, USA
| | - T Milligan
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M F Villamar
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - D Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - S Purves
- University of British Columbia, Vancouver, BC, Canada
| | - B Esmaeili
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M Stanley
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - J Tellez-Zenteno
- University of Saskatchewan College of Medicine, Saskatoon, SK, Canada
| | | | - I Tolokh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - L Worden
- Children's Hospital of Philadelphia, PA, USA
| | - N Jadeja
- University of Massachusetts School of Medicine, Boston, MA, USA
| | - S Fridinger
- Children's Hospital of Philadelphia, PA, USA
| | - L Lee
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Law
- University of Waterloo, Waterloo, ON, Canada
| | - C Fodé Abass
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - F J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Villamar MF, Smith VD, Smith JH, Wilson D, Nuovo GJ. Rabies encephalitis presenting with new-onset refractory status epilepticus-Update. Neurol Clin Pract 2019; 10:e1-e4. [PMID: 32190425 DOI: 10.1212/cpj.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Mauricio F Villamar
- Department of Neurology (MFV), Brigham and Women's Hospital, Boston, MA; Department of Neurology (VDS, JHS), Mayo Clinic Arizona, Phoenix; Department of Pathology and Laboratory Medicine (DW), University of Kentucky, Lexington, KY; and The Ohio State University Comprehensive Cancer Center (GJN), Columbus
| | - Vanessa D Smith
- Department of Neurology (MFV), Brigham and Women's Hospital, Boston, MA; Department of Neurology (VDS, JHS), Mayo Clinic Arizona, Phoenix; Department of Pathology and Laboratory Medicine (DW), University of Kentucky, Lexington, KY; and The Ohio State University Comprehensive Cancer Center (GJN), Columbus
| | - Jonathan H Smith
- Department of Neurology (MFV), Brigham and Women's Hospital, Boston, MA; Department of Neurology (VDS, JHS), Mayo Clinic Arizona, Phoenix; Department of Pathology and Laboratory Medicine (DW), University of Kentucky, Lexington, KY; and The Ohio State University Comprehensive Cancer Center (GJN), Columbus
| | - Dianne Wilson
- Department of Neurology (MFV), Brigham and Women's Hospital, Boston, MA; Department of Neurology (VDS, JHS), Mayo Clinic Arizona, Phoenix; Department of Pathology and Laboratory Medicine (DW), University of Kentucky, Lexington, KY; and The Ohio State University Comprehensive Cancer Center (GJN), Columbus
| | - Gerard J Nuovo
- Department of Neurology (MFV), Brigham and Women's Hospital, Boston, MA; Department of Neurology (VDS, JHS), Mayo Clinic Arizona, Phoenix; Department of Pathology and Laboratory Medicine (DW), University of Kentucky, Lexington, KY; and The Ohio State University Comprehensive Cancer Center (GJN), Columbus
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Affiliation(s)
| | - Mauricio F Villamar
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - John L Villano
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Department of Medicine, University of Kentucky, Lexington, KY, USA.,Department of Neurology, University of Kentucky, Lexington, KY, USA.,Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
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27
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Villamar MF. Reply. Arq Neuropsiquiatr 2019; 77:217. [PMID: 30970137 DOI: 10.1590/0004-282x20190018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Mauricio F Villamar
- Harvard Medical School, Brigham and Women's Hospital, Department of Neurology, Massachusetts, USA
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28
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McCann MR, Albuja AC, Villamar MF, Lukins DE. Disseminated necrotizing leukoencephalopathy. Arq Neuropsiquiatr 2019; 76:858-859. [PMID: 30698212 DOI: 10.1590/0004-282x20180123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/08/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Matthew R McCann
- University of Kentucky, Department of Neurology, Lexington, KY, USA
| | - Ana C Albuja
- University of Kentucky, Department of Neurology, Lexington, KY, USA
| | | | - Douglas E Lukins
- University of Kentucky, Department of Radiology, Lexington, KY, USA
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Albuja AC, Villamar MF, Stewart AM, Lightner DD. Pediatric cardioembolic stroke in midaortic syndrome. Arq Neuropsiquiatr 2018; 76:800-801. [PMID: 30570027 DOI: 10.1590/0004-282x20180117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/29/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Ana C Albuja
- University of Kentucky, Department of Neurology, Lexington, KY, USA
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Al-Bakri AF, Villamar MF, Haddix C, Bensalem-Owen M, Sunderam S. Noninvasive seizure prediction using autonomic measurements in patients with refractory epilepsy. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:2422-2425. [PMID: 30440896 DOI: 10.1109/embc.2018.8512785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is resurgent interest in the role played by autonomic dysfunction in seizure generation. Advances in wearable sensors make it convenient to track many autonomic variables in patient populations. This study assesses peri-ictal changes in surrogate measures of autonomic activity for their predictive value in epilepsy patients. We simultaneously recorded fronto-central surface EEG and submental EMG to score vigilance state, intracranial EEG (iEEG) to compute several electrophysiological variables (EV), and measurements (heart rate, blood volume pulse, skin impedance, and skin temperature) relevant to autonomic function (AV) using a wrist-worn sensor from three patients. A naïve Bayes classifier was trained on these features and tested using five-fold cross- validation to determine whether preictal and interictal sleep (or wake) epochs could be distinguished from each other using either AV or EV features. Of 16 EV features, beta power, gamma power (30-45 Hz and 47-75 Hz), line length, and Teager energy showed significant differences for preictal versus interictal sleep (or wake) state in each patient (t test: $p<0.001$). At least one AV was significantly different in each patient for interictal and preictal sleep (or wake) segments ($p<0.001$). Using AV features, the classifier labeled preictal sleep epochs with 84% sensitivity, 79% specificity, and 64% kappa; and 78%, 80% and 55% respectively for preictal wake epochs. Using EV, the classifier labeled preictal sleep epochs with 69% sensitivity, 64% specificity, and 33% kappa; and 15%, 93% and 10% respectively for preictal wake epochs.
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Villamar MF, Khan GQ, Naranjo VI, Alhajeri A. Pediatric spinal perimedullary arteriovenous fistula. Arq Neuropsiquiatr 2018; 76:722-723. [PMID: 30427515 DOI: 10.1590/0004-282x20180092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/29/2018] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | - Abdulnasser Alhajeri
- University of Kentucky, Departments of Radiology and Neurosurgery, Lexington, KY, USA
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32
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Smith JH, Nuovo GJ, Villamar MF. Author Response: Rabies encephalitis presenting with new-onset refractory status epilepticus (NORSE). Neurol Clin Pract 2018; 8:371-372. [PMID: 30564487 DOI: 10.1212/cpj.0000000000000543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Villamar MF, Cook AM, Ke C, Xu Y, Clay JL, Dolbec KS, Ward-Mitchell R, Goldstein LB, Bensalem-Owen M. Status epilepticus alert reduces time to administration of second-line antiseizure medications. Neurol Clin Pract 2018; 8:486-491. [PMID: 30588378 DOI: 10.1212/cpj.0000000000000544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/17/2018] [Indexed: 11/15/2022]
Abstract
Background Status epilepticus (SE) is a neurologic emergency with high morbidity and mortality. Delays in SE treatment are common in clinical practice and can be associated with poorer outcomes. Our goal was to determine whether the implementation of an SE alert protocol improves time to administration of a second-line antiseizure medication (ASM) in hospitalized adults. Methods We developed and implemented an inpatient SE alert system. A quasiexperimental cohort study was performed. We analyzed all patients aged 18-85 years who were managed at the University of Kentucky Medical Center using the SE alert protocol between March 2015 and June 2017 (n = 19). Controls were the first 20 consecutive patients treated for SE over the same time period, but who were managed with usual care (i.e., without SE alert protocol). Results Time to administration of a second-line ASM was shorter with the use of the SE alert system (22.21 ± 3.44 minutes) compared to usual care (58.30 ± 6.72 minutes; p < 0.0001). Conclusion Implementation of an SE alert system led to a marked improvement in time to administration of a second-line ASM. Classification of evidence This study provides Class III evidence that for adult inpatients treated for SE, implementation of an SE alert protocol reduces time to administration of second-line ASM.
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Affiliation(s)
- Mauricio F Villamar
- Departments of Neurology (MFV, JLC, KSD, RW-M, LBG, MB-O) and Statistics (CK, YX), University of Kentucky, Lexington; Department of Neurology (MFV), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and UK HealthCare Pharmacy Services (AMC), Lexington, KY
| | - Aaron M Cook
- Departments of Neurology (MFV, JLC, KSD, RW-M, LBG, MB-O) and Statistics (CK, YX), University of Kentucky, Lexington; Department of Neurology (MFV), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and UK HealthCare Pharmacy Services (AMC), Lexington, KY
| | - Chenlu Ke
- Departments of Neurology (MFV, JLC, KSD, RW-M, LBG, MB-O) and Statistics (CK, YX), University of Kentucky, Lexington; Department of Neurology (MFV), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and UK HealthCare Pharmacy Services (AMC), Lexington, KY
| | - Yan Xu
- Departments of Neurology (MFV, JLC, KSD, RW-M, LBG, MB-O) and Statistics (CK, YX), University of Kentucky, Lexington; Department of Neurology (MFV), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and UK HealthCare Pharmacy Services (AMC), Lexington, KY
| | - Jordan L Clay
- Departments of Neurology (MFV, JLC, KSD, RW-M, LBG, MB-O) and Statistics (CK, YX), University of Kentucky, Lexington; Department of Neurology (MFV), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and UK HealthCare Pharmacy Services (AMC), Lexington, KY
| | - Katelyn S Dolbec
- Departments of Neurology (MFV, JLC, KSD, RW-M, LBG, MB-O) and Statistics (CK, YX), University of Kentucky, Lexington; Department of Neurology (MFV), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and UK HealthCare Pharmacy Services (AMC), Lexington, KY
| | - Rachel Ward-Mitchell
- Departments of Neurology (MFV, JLC, KSD, RW-M, LBG, MB-O) and Statistics (CK, YX), University of Kentucky, Lexington; Department of Neurology (MFV), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and UK HealthCare Pharmacy Services (AMC), Lexington, KY
| | - Larry B Goldstein
- Departments of Neurology (MFV, JLC, KSD, RW-M, LBG, MB-O) and Statistics (CK, YX), University of Kentucky, Lexington; Department of Neurology (MFV), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and UK HealthCare Pharmacy Services (AMC), Lexington, KY
| | - Meriem Bensalem-Owen
- Departments of Neurology (MFV, JLC, KSD, RW-M, LBG, MB-O) and Statistics (CK, YX), University of Kentucky, Lexington; Department of Neurology (MFV), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and UK HealthCare Pharmacy Services (AMC), Lexington, KY
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Affiliation(s)
- Matthew R McCann
- Department of Neurology, University of Kentucky, 740 South Limestone St., Kentucky Clinic - J464, Lexington, KY 40536-0284, United States
| | - Mauricio F Villamar
- Department of Neurology, University of Kentucky, 740 South Limestone St., Kentucky Clinic - J464, Lexington, KY 40536-0284, United States.
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Villamar MF, Gilliam FG. Dyshormia in focal epilepsy. Arq Neuropsiquiatr 2018; 76:495-496. [PMID: 30066803 DOI: 10.1590/0004-282x20180045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/25/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - Frank G Gilliam
- University of Kentucky Department of Neurology, Lexington, KY, USA
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Campos EM, Raslau FD, Salinas R, Di Capua D, Slevin JT, Villamar MF. Reversible manifestations of extraparenchymal neurocysticercosis. Clin Case Rep 2018; 6:1400-1401. [PMID: 29988662 PMCID: PMC6028409 DOI: 10.1002/ccr3.1602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/03/2018] [Indexed: 11/18/2022] Open
Abstract
Movement disorders are uncommon manifestations of neurocysticercosis. When present, most are secondary to parenchymal lesions in the basal ganglia. Rarely, movement disorders can occur in racemose/extraparenchymal neurocysticercosis, an aggressive variant frequently associated with cerebrospinal fluid outflow obstruction and hydrocephalus. Appropriate treatment can reverse neurological manifestations.
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Affiliation(s)
- Edison M. Campos
- Department of NeurologyHospital de Especialidades Eugenio EspejoQuitoEcuador
| | | | - Robert Salinas
- Department of NeurologyHospital de Especialidades Eugenio EspejoQuitoEcuador
| | - Daniela Di Capua
- Department of NeurologyHospital de Especialidades Eugenio EspejoQuitoEcuador
| | - John T. Slevin
- Department of NeurologyUniversity of KentuckyLexingtonKYUSA
| | - Mauricio F. Villamar
- Department of NeurologyHospital de Especialidades Eugenio EspejoQuitoEcuador
- Department of NeurologyUniversity of KentuckyLexingtonKYUSA
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Villamar MF, Mirza FA, Smith JH, Smith VD. Pearls & Oy-sters: Persistent elevation of serum carcinoembryonic antigen in secretory meningioma. Neurology 2018; 90:e538-e541. [PMID: 29438031 DOI: 10.1212/wnl.0000000000004934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mauricio F Villamar
- From the Departments of Neurology (M.F.V., J.H.S.), Neurosurgery (F.A.M.), and Pathology and Laboratory Medicine (V.D.S.), University of Kentucky, Lexington
| | - Farhan A Mirza
- From the Departments of Neurology (M.F.V., J.H.S.), Neurosurgery (F.A.M.), and Pathology and Laboratory Medicine (V.D.S.), University of Kentucky, Lexington
| | - Jonathan H Smith
- From the Departments of Neurology (M.F.V., J.H.S.), Neurosurgery (F.A.M.), and Pathology and Laboratory Medicine (V.D.S.), University of Kentucky, Lexington
| | - Vanessa D Smith
- From the Departments of Neurology (M.F.V., J.H.S.), Neurosurgery (F.A.M.), and Pathology and Laboratory Medicine (V.D.S.), University of Kentucky, Lexington.
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Grewal PK, Villamar MF, Raslau FD, Dobbs MR. Pearls & Oy-sters: An uncommon initial presentation of thyrotoxicosis. Neurology 2017; 89:e61-e63. [DOI: 10.1212/wnl.0000000000004213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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40
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Villamar MF, Smith JH, Wilson D, Smith VD. Rabies encephalitis presenting with new-onset refractory status epilepticus (NORSE). Neurol Clin Pract 2017; 7:421-424. [PMID: 29620067 DOI: 10.1212/cpj.0000000000000372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/17/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Mauricio F Villamar
- Departments of Neurology (MFV, JHS) and Pathology and Laboratory Medicine (DW, VDS), University of Kentucky, Lexington
| | - Jonathan H Smith
- Departments of Neurology (MFV, JHS) and Pathology and Laboratory Medicine (DW, VDS), University of Kentucky, Lexington
| | - Dianne Wilson
- Departments of Neurology (MFV, JHS) and Pathology and Laboratory Medicine (DW, VDS), University of Kentucky, Lexington
| | - Vanessa D Smith
- Departments of Neurology (MFV, JHS) and Pathology and Laboratory Medicine (DW, VDS), University of Kentucky, Lexington
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Villamar MF, Lee JD. Cerebral venous sinus thrombosis secondary to otomastoiditis. Postgrad Med J 2017; 93:569. [PMID: 28123002 DOI: 10.1136/postgradmedj-2016-134680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/22/2016] [Accepted: 01/05/2017] [Indexed: 11/03/2022]
Affiliation(s)
| | - Jessica D Lee
- Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
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Bravo GL, Poje AB, Perissinotti I, Marcondes BF, Villamar MF, Manzardo AM, Luque L, LePage JF, Stafford D, Fregni F, Butler MG. Transcranial direct current stimulation reduces food-craving and measures of hyperphagia behavior in participants with Prader-Willi syndrome. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:266-75. [PMID: 26590516 PMCID: PMC6668339 DOI: 10.1002/ajmg.b.32401] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/26/2015] [Indexed: 01/21/2023]
Abstract
Prader-Willi syndrome (PWS) is a neurodevelopmental genetic disorder characterized by intellectual disabilities and insatiable appetite with compulsive eating leading to severe obesity with detrimental health consequences. Transcranial direct current stimulation (tDCS) has been shown to modulate decision-making and cue-induced food craving in healthy adults. We conducted a pilot double blind, sham-controlled, multicenter study of tDCS modulation of food drive and craving in 10 adult PWS participants, 11 adult obese (OB) and 11 adult healthy-weight control (HWC) subjects. PWS and OB subjects received five consecutive daily sessions of active or sham tDCS over the right dorsolateral prefrontal cortex (DLPFC), while HWC received a single sham and active tDCS in a crossover design. Standardized psychometric instruments assessed food craving, drive and hyperphagia by self-report and caregiver assessment over 30 days. Robust baseline differences were observed in severity scores for the Three-Factor Eating Questionnaire (TFEQ) and Dykens Hyperphagia Questionnaire (DHQ) for PWS compared to HWC while obese participants were more similar to HWC. Active tDCS stimulation in PWS was associated with a significant change from baseline in TFEQ Disinhibition (Factor II) (Ƶ = 1.9, P < 0.05, 30 days) and Total Scores (Ƶ = 2.3, P < 0.02, 30 days), and participant ratings of the DHQ Severity (Ƶ = 1.8, P < 0.06, 5 days) and Total Scores (Ƶ = 1.9, P < 0.05, 15 days). These findings support sustained neuromodulatory effects and efficacy of tDCS to reduce food drive and behaviors impacting hyperphagia in PWS. Transcranial direct current stimulation may represent a straight-forward, low risk and low cost method to improve care, management and quality of life in PWS.
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Affiliation(s)
- Gabriela L. Bravo
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Albert B. Poje
- Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas
| | - Iago Perissinotti
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bianca F. Marcondes
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mauricio F. Villamar
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ann M. Manzardo
- Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas,Correspondence to: Ann M. Manzardo, Ph.D., Department of Psychiatry and Behavioral Sciences, Kansas University Medical Center, 3901 Rainbow Blvd, MS 4015, Kansas City, KS 66160.
| | - Laura Luque
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jean F. LePage
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Diane Stafford
- Division of Endocrinology, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Merlin G. Butler
- Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas,Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
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Hamner J, Villamar MF, Fregni F, Taylor JA. Transcranial direct current stimulation (tDCS) and the cardiovascular responses to acute pain in humans. Clin Neurophysiol 2015; 126:1039-46. [DOI: 10.1016/j.clinph.2014.08.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/29/2014] [Accepted: 08/14/2014] [Indexed: 11/24/2022]
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Villamar MF, Volz MS, Bikson M, Datta A, Dasilva AF, Fregni F. Technique and considerations in the use of 4x1 ring high-definition transcranial direct current stimulation (HD-tDCS). J Vis Exp 2013:e50309. [PMID: 23893039 PMCID: PMC3735368 DOI: 10.3791/50309] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
High-definition transcranial direct current stimulation (HD-tDCS) has recently been developed as a noninvasive brain stimulation approach that increases the accuracy of current delivery to the brain by using arrays of smaller "high-definition" electrodes, instead of the larger pad-electrodes of conventional tDCS. Targeting is achieved by energizing electrodes placed in predetermined configurations. One of these is the 4x1-ring configuration. In this approach, a center ring electrode (anode or cathode) overlying the target cortical region is surrounded by four return electrodes, which help circumscribe the area of stimulation. Delivery of 4x1-ring HD-tDCS is capable of inducing significant neurophysiological and clinical effects in both healthy subjects and patients. Furthermore, its tolerability is supported by studies using intensities as high as 2.0 milliamperes for up to twenty minutes. Even though 4x1 HD-tDCS is simple to perform, correct electrode positioning is important in order to accurately stimulate target cortical regions and exert its neuromodulatory effects. The use of electrodes and hardware that have specifically been tested for HD-tDCS is critical for safety and tolerability. Given that most published studies on 4x1 HD-tDCS have targeted the primary motor cortex (M1), particularly for pain-related outcomes, the purpose of this article is to systematically describe its use for M1 stimulation, as well as the considerations to be taken for safe and effective stimulation. However, the methods outlined here can be adapted for other HD-tDCS configurations and cortical targets.
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Affiliation(s)
- Mauricio F Villamar
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, USA
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Villamar MF, Fregni F. Response to the letter to the editor by Berger. J Rehabil Med 2013; 45:221-222. [PMID: 23495381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
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