Antenatal care access and concerns of pregnant women during pandemic: a population-based study

Background

The COVID-19 pandemic continues to burden the health of vulnerable populations such as pregnant women. It has been estimated that antenatal care coverage has been decreased with workforce, supplies, demand, and access reductions during the outbreak in some countries. The study aimed to investigate the health care access and concerns of pregnant women during the pandemic.

Methods

This cross-sectional study was conducted among 331 pregnant women in one district of Istanbul (Üsküdar) and a random sampling method was applied. The data was collected between November 22nd and December 18th 2020 by telephone interview after verbal consents were taken from the participants. Chi-square and multiple logistic regression analyses were performed. The study was approved by the Bahcesehir University Institutional Ethics Board.

Results

The median age of the participants was 30 years, the median gestational age was 24 weeks. Among the participants 9.6% were previously diagnosed with COVID-19, 15.8% had a chronic disease, 48.2% were nulliparous and 18.6% had a high-risk pregnancy. The frequency of having concern for their own health was 70.7%, for their children's health was 73,0%, for going to visits in healthcare facilities was 81.0% and for giving birth during the pandemic was 83.0%. Also, 17.1% did not go to antenatal visits because of the COVID-19 concerns. According to the logistic regression analysis, women who had chronic disease had higher concerns about their own health; women who had chosen to go to hospitals for antenatal care visits had higher concerns about children's health and giving birth, and women who had concerns about going to health facilities during the COVID-19 pandemic were less likely to go to family health centers.

Conclusions

Our results suggest that the concerns related to the pandemic among pregnant women are at significant levels. Measures should be taken to ensure that antenatal care services are not interrupted throughout the current pandemic.

Key messages

Significant concern levels were detected among pregnant women in our sample.

Measures should be taken to ensure to maintain uninterrupted antenatal care services.

Pre-participation screening of the athletes in Turkey: approach of primary care physicians

Background

The pre-participation screening is crucial as the risk of sudden death for competitive athletes is higher than that of non-athletes. In Turkey, screening could be performed at the primary health care setting both by family medicine specialists (FMSs) and by general practitioners (GPs). Although there is a guideline, there is no legal regulation for the process. The aim of this study is to evaluate the approach of primary care physicians in pre-participation screening.

Methods

An online questionnaire based on the Turkish Medical Association (TMA) guideline, and the 14-item Screening Guideline of the American Heart Association (AHA) was delivered to primary care physicians. Knowledge, experience and approach of the physicians were assessed. Self-confidence, application of AHA criteria, accurate referral ratios and further test requests were taken as outcome measures. Descriptive and inferential analyzes were performed and p < 0.05 was considered significant.

Results

Of 214 participants, 39.3% were women, the average age was 44.9 years, the average work experience was 7.9 years. 89.7% of the participants were aware of their authorization, 90.2% had previously given this report, but only 6.5% feels confident. Only 13.1% knows the presence of TMA guideline, and only 23.8% states being educated on the subject at any part of their career. More than 60% of the participants consider further testing necessary in addition to medical history and physical examination. Blood and urine test requests were significantly more for GPs compared to FMSs (p = 0.026, p = 0.011). Accurate referral decision ratio was only 59.3% with no difference between FMSs and GPs (p = 0.216). Work experience had no effect on any of the outcomes.

Conclusions

As the legal regulations and awareness of the guideline are insufficient, pre-participation screening is not standardized, and this increases tendency for further testing or referral.

Key messages

The pre-participation screening of athletes in Turkey is not standardized among primary care physicians. Further testing request ratio is high and accurate referral ratio is low.

A novel fuzzy logic-based image steganography method to ensure medical data security

This study aims to secure medical data by combining them into one file format using steganographic methods. The electroencephalogram (EEG) is selected as hidden data, and magnetic resonance (MR) images are also used as the cover image. In addition to the EEG, the message is composed of the doctor׳s comments and patient information in the file header of images. Two new image steganography methods that are based on fuzzy-logic and similarity are proposed to select the non-sequential least significant bits (LSB) of image pixels. The similarity values of the gray levels in the pixels are used to hide the message. The message is secured to prevent attacks by using lossless compression and symmetric encryption algorithms. The performance of stego image quality is measured by mean square of error (MSE), peak signal-to-noise ratio (PSNR), structural similarity measure (SSIM), universal quality index (UQI), and correlation coefficient (R). According to the obtained result, the proposed method ensures the confidentiality of the patient information, and increases data repository and transmission capacity of both MR images and EEG signals.

Secondary Corpus Callosum Abnormalities Associated with Antiepileptic Drugs in Temporal Lobe Epilepsy

Epilepsy is more than a grey-matter disorder affecting large white matter connections of the brain with seizure generation and propagation. The mechanism for such changes remains unclear. The purpose of this study was to investigate the microstructural changes in the corpus callosum in temporal lobe epilepsy (TLE) patients and whether these abnormalities are related to antiepileptic drug (AED) therapy. Ten TLE patients receiving AED therapy, ten TLE patients with no therapy and ten controls were included in the study. The regions of interest in the corpus callosum were outlined to each Witelson region (WR). Fractional anisotrophy (FA), apparent diffusion coefficient (ADC), three main diffusivity values (λ1, λ2, λ3) and tractography were acquired from each WR. DTI indices of these tracts and each WR were compared between the three subject groups and correlates examined with clinical variables that included duration of epilepsy, gender, AED type and AED therapy exposure. In TLE subjects with receiving AED therapy significantly (p<0.05) decreased FA and increased ADC values of corpus callosum were obtained when compared to the other groups. There was no significant relationship between AED type and DTI indices. Analysis of eigen values in the splenium of corpus callosum (WR7) showed λ1 values were significantly decreased in relation to AED medication duration (p<0.05). FA values of rostrum and corpus showed a reduction with duration of epilepsy. TLE is associated with abnormal integrity of corpus callosum white matter tracts. AED therapy may cause additional damage on secondary degeneration and medication time effects especially on the splenium of corpus callosum.

The role of event related potentials in evaluation of subclinical cognitive dysfunction in epileptic patients

BACKGROUND/AIM

Cognitive dysfunction in epileptic patients may develop due to the neurophysiological changes related to seizures or antiepileptic drugs. The aim of this study was to evaluate the cognitive dysfunction in epileptic patients under antiepileptic drug therapy by the aid of event related potentials.

METHOD

P300 latencies were obtained from Fz, Cz and Pz electrod positions from both epileptic patients (n=40) and age and sex matched control group (n=40). Epileptic patients were classified either idiopathic primary generalized (IPGE) (n=9) or secondary generalized epilepsy (SGE) (n=31) based on the ILAE classification. The effect of epilepsy type, treatment types (monotherapy/polytherapy), daily dosages and serum levels of antiepileptic drugs, age at onset and EEG abnormalities on P300 latencies were studied.

RESULTS

P300 latencies were longer in the epileptics when compared to controls (P < 0.05). Besides, our results pointed out that P300 latencies were longer in IPGE when compared to SGE (P < 0.05). No statistically significant difference was determined between ERP parameters neither in monotherapy nor in polytherapy groups (p > 0.05). Antiepileptic drug subgroups revealed variable effects on ERP latencies.

CONCLUSION

We believe P300 latencies may have an important role in the evaluation of subclinical cognitive dysfunction in epileptic patients treated with antiepileptic drugs.

Surgery in temporal lobe epilepsy patients without cranial MRI lateralization

High resolution MRI is very important in the evaluations of patients with intractable temporal lobe epilepsy in preoperative investigations. Morphologic abnormalities on cranial MRI usually indicate the epileptogenic focus. Intractable TLE patients who have normal cranial MRI or bilateral hippocampal atrophy may have a chance for surgery if a certain epileptogenic focus is determined. We evaluated the patients who were monitorized in Gazi University Medical Faculty Epilepsy Center from October 1997 to April 2004. Seventy three patients, who had a temporal epileptogenic focus, underwent anterior temporal lobectomy at Ankara University Medical Faculty Department of Neurosurgery. Twelve of them (16, 4%), did not have any localizing structural lesion on cranial MRI. Of the 12 patients examined 6 had normal findings and 6 had bilateral hippocampal atrophy. Of these 12 patients, 6 (50%) were women and 6 (50%) were men. The ages of patients ranged from 7 to 37 (mean: 24.5). Preoperatively long-term scalp video-EEG monitoring, cranial MRI, neuropsychological tests, and Wada test were applied in all patients. Five patients, whose investigations resulted in conflicting data, underwent invasive monitoring by the use of subdural strips. The seizure outcome of patients were classified according to Engel with postsurgical follow-up ranging from 11 to 52 (median: 35.7) months. Nine patients (75%) were classified into Engel's Class I and the other 3 patients (25%) were placed into Engel's Class II. One patient who was classified into Engel's Class II had additional psychiatric problems. The other patient had two different epileptogenic foci independent from each other in her ictal EEG. One of them localized in the right anterior temporal area, the other was in the right frontal lobe. She was classified in Engel's Class II and had no seizure originating from temporal epileptic focus, but few seizures originating from the frontal region continued after the surgery. In conclusion, surgery was successful in all 12 patients. We think that patients with no MRI lateralizing or localizing lesion should undergo epilepsy surgery after detailed presurgical evaluations, including invasive monitoring.

Detection of EEG background abnormalities in epilepsy by a new spectral index

OBJECTIVE

In epileptic disorders, EEG background activity is disorganized in or near the epileptogenic focus and spectral EEG analysis (SEA) can provide useful information about the focus. We tried to develop a new spectral index from basic spectral parameters to detect the epileptic abnormalities at EEG background activity.

METHODS

A new spectral EEG index, epileptic abnormality index (EAI), was constructed from frequency band power and power asymmetry parameters. Within the index, parameters were weighted due to both conventional EEG knowledge and their power in discrimination healthy subjects from patients. EEG background activity from 99 epileptic patients and 146 healthy subjects was examined both by EAI and by a conventional SEA method, by using z-scoring statistic. Each test results were compared with visual EEG interpretation of subjects.

RESULTS

In patient groups, EAI was most successful in lateralization of epileptic abnormalities. It was also helpful in discrimination of epileptic patients from normals in the case where visual EEG interpretation was 'normal'.

CONCLUSIONS

EAI depends on basic spectral parameters and it combines statistical methods and clinical knowledge about EEG. It increases the analysis capacity of SEA in evaluation of EEG background activity.

SIGNIFICANCE

EAI is a new and useful approach in detection of EEG background abnormalities in epilepsy and its logical base can also be used in the detection of brain electrical activity abnormalities other than epileptic disorders.

Inorganic compounds have dual effect on recombinant protein production: influence of anions and cations on serine alkaline protease production

AIMS

Investigation of concerted effects of cations, i.e. Mg2+ and Mn2+, in combination with their anions, i.e. sulphate, chloride and acetate (Ac), on the physiology of Bacillus licheniformis carrying pHV1431::subC to improve the fermentation medium for serine alkaline protease (SAP) production, whereupon, determination of the acid that can be used in pH control.

METHODS AND RESULTS

The cell concentrations increased with the increase in MnSO4 and Mn(Ac)2 concentrations, and the highest values were obtained at Co(MnSO4) = 0.20 mmol l-1 and Co(Mn(CH3COO)2) = 4.0 mmol l-1, as 2.3 and 2.2 g l-1, respectively. However, Co(MnCl2) did not influence biomass concentration. SAP production was inhibited with MnCl2 after Co(MnCl2) = 0.60 mmol l-1, but with MnSO4 SAP production was inhibited drastically. Whereas, at high concentrations of Mn(Ac)2 SAP production increased and the highest activity was obtained as ASAP = 1285 U ml-1 at t = 65 h. With the Mg compounds, cell concentrations increased with the increase in the concentrations of MgSO4, MgCl2 and Mg(Ac)2; and the anions did not show any influence on the cell growth. Similar to the results of Mn compounds, the glucose consumption rate increased with the increase in MgSO4 and MgCl2 concentrations; contrariwise, decreased with the increase in Mg(Ac)2 concentrations, due to the use of acetate as the second carbon source. Co(MgSO4) = 0.40 mmol l-1, Co(MgCl2) = 1.60 mmol l-1 and Co(Mg(Ac)2) = 0.40 mmol l-1 were the optimum concentrations separately, and the highest SAP activity was obtained with Mg(Ac)2 as ASAP = 1338 U ml-1 at t = 47 h. Consequently, ion acetate and its acid HAc appear, respectively, as the superior anion for the essential cations and the control agent for pH control in the bioreactor. Finally, optimum initial concentrations and the concerted effects of Mg(Ac)2 and Mn(Ac)2 were investigated, and the optimum concentrations were found respectively as 0.40 and 0.80 mmol l-1, while the maximum activity was obtained as ASAP = 1010 U ml-1 at a shortened cultivation time of t = 39 h.

CONCLUSIONS

Mn(Ac)2 and Mg(Ac)2 together enhanced the cell formation and SAP synthesis rates, moreover, SAP synthesis started at an earlier cultivation time.

SIGNIFICANCE AND IMPACT OF THE STUDY

Each inorganic compound with its cation and anion has dual effect on the metabolism. Mg2+ and Mn2+ at their specific concentrations influence the regulation of the pathways that might cause better coupling of supply and demand for the amino acids on the basis of the amino acid composition of the enzyme molecule.

Bilateral hippocampal atrophy: consequences to verbal memory following temporal lobectomy

BACKGROUND

Bilateral hippocampal damage is a risk factor for memory decline after anterior temporal lobectomy (ATL).

OBJECTIVE

To investigate verbal memory outcome in patients with temporal lobe epilepsy (TLE) with either unilateral or bilateral hippocampal atrophy as measured by MRI.

METHODS

The authors selected 60 patients with TLE who had undergone ATL (left = 31, right = 29). They determined normalized MRI hippocampal volumes by cursor tracing 1.5-mm slices from three-dimensional MRI acquisition. Hippocampal volumes were defined as atrophic if the volumes were below 2 SD for control subjects. Bilateral hippocampal atrophy was present in 10 patients with left TLE and 11 patients with right TLE. The authors assessed acquisition, retrieval, and recognition components of verbal memory both before and after ATL.

RESULTS

Groups did not differ across age, education, intelligence, age at seizure onset, or seizure duration. Seizure-free rates after ATL were 70% or higher for all groups. Before surgery, patients with left TLE displayed worse verbal acquisition performance compared with patients with right TLE. Patients with left TLE with bilateral hippocampal volume loss displayed the lowest performance across all three memory components. After surgery, both groups of patients with left TLE exhibited worse verbal memory outcome compared with patients with right TLE. Bilateral hippocampal atrophy did not worsen outcome in the patients with right TLE. A higher proportion of patients with left TLE with bilateral hippocampal atrophy experienced memory decline compared with the other TLE groups.

CONCLUSION

Bilateral hippocampal atrophy in the presence of left TLE is associated with worse verbal memory before and after ATL compared with patients with unilateral hippocampal volume loss or right TLE with bilateral hippocampal volume loss.

Complex partial seizure mimicking psychotic reaction in an adolescent

A previously healthy 15-year-old boy initially diagnosed to have acute psychotic reaction had a history of a single generalized seizure and prolonged amnestic states of varying intensity and duration. An ictal electroencephalogram (EEG) showed bitemporal ictal discharges starting from the left side. Carbamazepine was started. A magnetic resonance imaging (MRI) obtained on the 10th day of the antiepileptic therapy showed increased signal intensity on the T2 weighted images. The patient's memory function markedly improved during 10 months' follow-up with antiepileptic treatment, although he described brief attacks of dizziness. A repeat MRI examination showed normal findings. The amnesticstates were thought to be due to frequent complex partial seizures, and transient MRI changes to hippocampal edema. This case illustrates the importance of epileptic disorders in the differential diagnosis of psychiatric conditions.

Effects of spring-loaded posterior bite-block appliance on masticatory muscles

The effects of spring-loaded posterior bite-blocks on masticatory muscles were investigated to evaluate the correlation between masticatory muscles and craniofacial form in long-faced children. The appliance was used in 10 subjects (6 girls and 4 boys) with a chronological mean age of 10.40 +/- 1.12 years for the treatment of skeletal anterior open bite. Electromyographic activity of the anterior and posterior temporal and masseter muscles was recorded before and after treatment during postural position, maximal biting, chewing, swallowing, postural position with the appliance in the mouth, and maximal biting with the appliance in the mouth. After treatment, increases in SNB and overbite (P <.05, P <.001, respectively) and decreases in ANB, SNGoAr, and overjet parameters were found to be statistically significant (P <.05, P <.01). When the measurements related to muscle activity were examined, increases in anterior temporal postural (P <.05), anterior temporal chewing (P <.01), masseter chewing (P <.05), posterior temporal chewing (P <. 05), and masseter swallowing (P <.01) were found to be statistically significant. A positive correlation was found between ANB and anterior temporal postural and a negative correlation between SNGoAr and masseter swallowing. The increase in muscle activities was considered to occur as a result of the appliance used.

Predictive value of MRI-identified mesial temporal sclerosis for surgical outcome in temporal lobe epilepsy: an intent-to-treat analysis

PURPOSE

Magnetic resonance imaging (MRI) accurately identifies mesial temporal sclerosis (MTS), but prediction of successful surgical outcome ranges from 62% to 96% in published studies. Prior investigations only used patients who had received anterior temporal lobectomy (ATL), potentially overestimating the predictive value of MRI-identified MTS (MRI-MTS).

METHODS

The authors performed an intent-to-treat analysis of 90 consecutive patients assessed for possible ATL, including 13 who did not undergo ATL because of inconclusive intracranial ictal EEG. Four (31%) of these 13 patients had unilateral mesial temporal abnormalities on their MRIs.

RESULTS

The positive predictive value of MRI-MTS for seizure cessation decreased from 0.69 to 0.63 after adjustment for these additional false positive results. Four previous studies had revealed a positive predictive value of 0.75 (0.72 after similar adjustment).

CONCLUSIONS

The authors conclude that the predictive value of MRI-MTS for outcome from ATL may be overestimated by small retrospective studies of highly selected postoperative patients.

Effects of an activator on the masseter and anterior temporal muscle activities in Class II malocclusions

Effects of an activator on the temporal and masseter muscles activities were investigated in subjects with an Angle Class II division 1 malocclusions in this study. The measurements were done on 21 subjects. Twelve of these subjects were in the treatment group and 9 were in the control group. Average ages of treatment group was 11.42 +/- 0.29 years and average ages of control group was 10.68 +/- 0.52 years. Muscle activities were investigated at the beginning and at the end of this research, both with and without the activator. The increase of activities in the rest position and decrease of activities in maximum biting of both muscles with activator were found to be statistically significant at the beginning of the treatment. Activities of both muscles with the activator decreased in the rest position at the end of treatment when compared to the beginning of the treatment. No change has been observed between the activities of masseter and temporal muscles recorded at the beginning and at the end of this investigation without the activator.

MRI extrahippocampal volumes and visual memory: correlations independent of MRI hippocampal volumes in temporal lobe epilepsy patients

Limbic system atrophy and memory dysfunction are common in patients with temporal lobe epilepsy (TLE). However, the relationship between extrahippocampal limbic structures and memory functioning within TLE has received little attention. The present study examined associations of MRI volumetric measurements of the mammillary body, fornix, amygdala, and hippocampus to measures of episodic verbal and visual memory. The Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale were administered to 47 unilateral TLE patients (25 right, 22 left). Normalized right and left MRI volumes were determined for each patient by cursor tracing 1.5 mm slices from 3D-MRI. Significant associations were found between left hippocampal volume and the immediate, delayed, and percent retention scores of the Logical Memory Test; between the left mammillary body volume and the Logical Memory Test delayed and percent retention scores; immediate Visual Reproduction performance was significantly related to the right and left amygdala volumes, and right mammillary body volume; only the right amygdala and right mammillary body volume were associated with the delayed Visual Reproduction trial. However, neither right nor left hippocampal volumes were related to visual memory performance. Multiple limbic system structural volumes were independently associated with verbal and nonverbal memory performance. Results suggest that visual memory, as measured by the Visual Reproduction Test, may be uniquely associated with extrahippocampal volumes in patients with TLE.

Quantitative MRI in temporal lobe epilepsy: evidence for fornix atrophy

OBJECTIVE

To investigate whether the fornix and mamillary bodies, being part of the limbic system, are abnormal in patients with mesial temporal lobe epilepsy (MTLE).

BACKGROUND

The limbic system comprises the hippocampal formation, fornix, mamillary bodies, thalamus, and other integrated structures. This system is implicated in complex functions, including memory and emotion, and in diseases such as MTLE.

METHODS

The authors performed volumetric measurements of hippocampus, amygdala, fornix, and mamillary bodies in 50 patients with MTLE and compared the results with normal controls and patients with extratemporal lobe epilepsy.

RESULTS

Control (n = 17) measurements of the amygdala, hippocampus, and fornix revealed larger volumes of the right hemisphere structures (p < 0.001). Normalized fornix volumes revealed atrophy in 86% of studies concordant with hippocampal atrophy in all cases but one. Similarly, the mean hippocampal and fornix volumes for the group discriminated the epileptogenic temporal lobe (p < 0.001). Limbic volumes were normal in all patients with extratemporal lobe epilepsy.

CONCLUSIONS

Quantitative MRI findings support the concept that MTLE is not a process limited to the hippocampus but also involves other interrelated limbic system structures, in particular, the fornix.

Significance of interictal temporal lobe delta activity for localization of the primary epileptogenic region

Because interictal temporal lobe delta activity (TLDA) has been described in 30 to 90% of patients with temporal lobe epilepsy (TLE) but has not been investigated in patients with extratemporal epilepsy, we sought to determine the localizing significance of TLDA. We compared the presurgical interictal scalp EEG results of 47 consecutive patients who received extratemporal resection (40 frontal and 7 parietal-occipital) for intractable epilepsy with 43 consecutive patients who received anterior temporal lobectomy. We defined lateralized TLDA as runs of lower than 4-Hz waveforms that were easily distinguished from the background rhythms and were maximal at electrodes T4, F8, and T6 or T3, F7, and T5. The lateralized TLDA was subcategorized as temporal intermittent rhythmic delta activity (TIRDA) or temporal intermittent polymorphic delta activity (TIPDA). A chi-square test was used to determine the association of the lobe of the epileptogenic zone with TIRDA and TIPDA. We found TIRDA in 12 (28%) and TIPDA in 8 (19%) patients in the temporal lobe group, and TIRDA in 2 (4%) and TIPDA in 9 (19%) patients in the extratemporal group. TIRDA was strongly associated with TLE (p < 0.003), whereas TIPDA occurred at an equal rate in both groups. Similar to anterior temporal epilepsy, lateralized TIPDA is present in up to 20% of patients with extratemporal epilepsy. The presence of TIRDA strongly suggests TLE but may infrequently occur in extratemporal epilepsy. Caution should be used when using lateralized TLDA as a presurgical localizing finding.

Amygdala atrophy and seizure outcome after temporal lobe epilepsy surgery

Surgical outcome in hippocampal atrophy (n = 44) and amygdalohippocampal atrophy (n = 14) were compared. Hippocampal atrophy had better seizure-free outcome than amygdalohippocampal atrophy (80% versus 50%, p = 0.043). Severity of hippocampal atrophy correlated with duration of epilepsy in patients with hippocampal atrophy (r = 0.4, p = 0.007), but not in those with amygdalohippocampal atrophy, suggesting that these two groups may have a different pathogenesis.

Relative utility of 1H spectroscopic imaging and hippocampal volumetry in the lateralization of mesial temporal lobe epilepsy

OBJECTIVES

To determine the relative utility of 1H MRSI and hippocampal volumetry for the lateralization of mesial temporal lobe epilepsy (MTLE) in patients with intractable epilepsy.

BACKGROUND

MTLE is the most common partial-onset seizure disorder in patients undergoing temporal lobe epilepsy surgery. MR volumetry and spectroscopy are reliable preoperative imaging techniques for the lateralization of MTLE.

METHODS

We analyzed the 1H MRSI and hippocampal formation volumes preoperatively in 30 consecutive patients who had undergone temporal lobectomy.

RESULTS

Volumetry correctly lateralized the side of surgery in 93% of patients and 1H MRSI did so in 97% of patients. Incorrect lateralization occurred by volumetry in two patients and by 1H MRSI in one patient. Concordance between all MRI modalities was 73%. Pearson's analysis revealed no correlation between the degree of hippocampal volume loss and the creatine-to-N-acetylated-compounds ratio.

CONCLUSIONS

Volumetry and 1H MRSI correctly lateralized most patients with MTLE and complement each other in final lateralization. The lack of correlation between the severity of volume loss and the degree of metabolic disturbance suggests that the techniques examine distinct pathophysiologic processes in MTLE.

Volumetric MRI of the limbic system: anatomic determinants

The limbic system comprises the hippocampal formation, fornix, mamillary bodies, thalamus, and other integrated structures. It is involved in complex functions including memory and emotion and in diseases such as temporal lobe epilepsy. Volume measurements of the amygdala and hippocampus have been used reliably to study patients with temporal lobe epilepsy but have not extended to other limbic structures. We performed volume measurements of hippocampus, amygdala, fornix and mamillary bodies in healthy individuals. Measurements of the amygdala, hippocampus, fornix and mamillary bodies revealed significant differences in volume between right and left sides (P < 0.001). The intraclass coefficient of variation for measurements was high for all structures except the mamillary bodies. Qualitative image assessment of the same structures revealed no asymmetries between the hemispheres. This technique can be applied to the study of disorders affecting the limbic system.

Association of combined MRI, interictal EEG, and ictal EEG results with outcome and pathology after temporal lobectomy

PURPOSE

Magnetic resonance imaging, interictal scalp EEG, and ictal scalp EEG each have been shown to localize the primary epileptic region in most patients with mesial-basal temporal lobe epilepsy (MBTLE), but the association of surgical outcome and pathology with each combination of these test results is not known.

METHODS

We reviewed the MRI, interictal scalp EEG, and ictal scalp EEG results of 90 consecutive patients with MBTLE. Twelve patients were excluded from the analysis because inconclusive bitemporal intracranial EEG results precluded anterior temporal lobectomy (ATL); none had concordant MRI and interictal scalp EEG results. We compared all combinations of presurgical MRI, interictal EEG, and ictal EEG results to seizure outcome and tissue pathology in the 78 patients who underwent an ATL.

RESULTS

Forty-eight (61%) patients had concordant lateralized MRI and interictal EEG temporal lobe abnormalities, with no discordant ictal EEG results; 77% of these patients were seizure-free after ATL. Concordance of MRI and interictal EEG abnormalities correlated with seizure cessation (p < 0.05), compared to all combinations with discordant or nonlateralizing MRI and interictal EEG results. Mesial temporal sclerosis (MTS) was confirmed pathologically in about 80% of both groups (p = 0.5). Outcome in patients with concordant MRI and ictal EEG with nonlateralizing interictal EEG was significantly worse than combinations with concordant MRI and interictal EEG (p < 0.02).

CONCLUSIONS

Compared to other combinations of test results, concordance of MRI and interictal EEG is most closely associated with surgical outcome in MBTLE. However, most selected patients have pathologic confirmation of MTS regardless of test results or outcome. This information may be useful for planning the presurgical evaluation of patients with medically intractable MBTLE.

Multimodality MRI in mesial temporal sclerosis: relative sensitivity and specificity

Our objectives were to determine the relative sensitivity and specificity of different MRI sequences and analysis techniques for the detection of mesial temporal sclerosis (MTS). Mesial temporal sclerosis is the most common pathologic finding in patients undergoing temporal lobe epilepsy surgery. Magnetic resonance imaging is the most reliable preoperative imaging technique for the detection of MTS. We analyzed the abnormalities in preoperative MRIs of 44 consecutive patients who had undergone temporal lobectomy and who had pathologic confirmation of MTS. Techniques included inversion recovery (IR); T1-weighted, volume-acquired images; hippocampal T2 relaxometry (HT2); volumetric assessment; and visual analysis. Sensitivity was 86% with IR, 90% with T1-weighted qualitative visual analysis, and 97% with quantitative volumetry. Pathologic prolongation of HT2 (> 2 SD of normal) was present in 79%. Analysis of variance showed statistically significant differences in sensitivity between HT2, volumetric measurements (p < 0.01), and qualitative visual atrophy (p < 0.05). Concordance between all MRI modalities was 68%. Inversion recovery and qualitative analysis lateralized the side of surgery in 93%. The combination of IR and T1-weighted images correctly identify MTS in most patients. Hippocampal volumetry provided localization in an additional small number of patients.

Qualitative MRI segmentation in mesial temporal sclerosis: clinical correlations

Magnetic resonance imaging (MRI) is reliable and sensitive in the detection of mesial temporal atrophy in patients with temporal lobe epilepsy. We investigated the MRI patterns of atrophy in 47 patients with histologically confirmed hippocampal sclerosis and correlated the imaging findings to the clinical features and surgical outcome. One hundred percent of patients had hippocampal body atrophy, 70% had hippocampal tail atrophy, 23% had amygdala atrophy, and 10% had focal hippocampal body atrophy without other segmental involvement. Correlative analysis of the segmented MRI findings with other clinical variables, including a previous history of childhood febrile convulsions, showed no significant associations except for younger age of seizure onset associated with hippocampal tail atrophy (p <0.03). No associations between surgical outcome and the patterns of mesial temporal atrophy were detected. Our results demonstrate that variable patterns of atrophy exist in mesial temporal atrophy, but invariably atrophy involves the hippocampal body segment. Segmental MRI analysis in mesial temporal atrophy provides added useful diagnostic information.

Co-incidence of Guillain-Barré syndrome and spinal cord compression in non-Hodgkin lymphoma

Extradural, radicular and spinal cord compressions are severe neurological complications of lymphomas. Less frequently, involvement of the peripheral nervous system, polymyositis, myasthenia gravis and Guillain-Barré syndrome (GBS) occur. We report a patient with GBS along with a lymphoma of the spinal extradural space where at the beginning the features of GBS outweighed the symptomatology of the extradural spinal mass.

Perineural pethidine: effects of different doses on nerve conduction

Forty healthy young volunteers were divided randomly into four equal groups. 2 ml of solutions of pethidine (meperidine) in concentrations of 0.5%, 1% and 1.5% were given to three groups of 10 subjects: a fourth group received saline. Sensory evoked responses obtained via surface electrodes from both sural nerves simultaneously in the pethidine groups and unilaterally in the control group, were evaluated for latency, conduction velocity and amplitude. Sensory changes at the innervation zone were monitored by means of a pinprick. All recordings were obtained prior to injection and at 5 min intervals for 30 min. Concentrations of 1% and 1.5% pethidine were associated with significantly lower amplitudes and with hypoalgesia. Other parameters did not change.