Neurology India最新文献

Background: Previous studies have localized the origin of "generalized" spike-wave discharges of idiopathic generalized epilepsies to specific brain regions. Although there are studies in juvenile myoclonic epilepsy (JME) which have investigated the origin of spike-wave discharges, reports on the propagation of discharges are sparse.

Objective: The current study investigated the propagation of spike-wave discharges in JME, which was investigated by statistically comparing the electroencephalography (EEG)-derived cortical source activity during (a) various phases of spike-wave discharge versus background (eyes closed) activity, and (b) various phases of the first spike wave versus the corresponding phase of subsequent spike waves.

Material and methods: Fourteen patients with JME who had generalized spike/polyspike and slow wave discharges in interictal EEG were included in the study. A total of 179 spike waves (first discernible spike wave - 55; subsequent spike waves - 124) were selected for source localization. Source analysis was carried out using exact low-resolution electromagnetic tomography (eLORETA). Statistical analyses to estimate the probability distribution of differences in cortical activity between (a) eight phases of epileptic discharge versus background (eyes closed) activity and (b) phases of the first spike wave versus the corresponding phases of subsequent spike waves were performed by paired t-tests and corrected for multiple testing using LORETA-KEY software.

Results: Widespread activation of cortical voxels (more than 94%) was observed during all phases of epileptic discharge except the initial phase (pre-first spike) and terminal phase (post-peak of the subsequent wave). The parietal lobe, which was the most activated lobe during the pre-first spike, was found to be the least activated during the post-peak of first and subsequent waves. More than 93% of voxels in the sublobar region were consistently activated during all eight phases of discharge.

Conclusion: The study findings suggest that the activity generated from the restricted brain network involving parietal lobe could be propagated through sublobar structures to cause widespread cortical activation during the subsequent phases of the spike-wave cycle.

Pain is a common complaint among a spectrum of diseases. Although an ideal objective method of pain assessment is lacking, several validated tools are available for use in clinical research and practice. The tool considerations are based upon the parameters to be assessed and factors specific to patient, disease, and availability of instruments. This review classifies and brings the key aspects of currently available pain assessment tools on a single platform to ease the selection process for researchers/practitioners. The tools utilized for pain assessment were collected from articles available in PubMed and Google Scholar databases and classified into the following domains: unidimensional, multi-dimensional, investigation-based, and computerized algorithm-based tools. Their purpose of use and limitations are reviewed. The unidimensional scales are used to describe only the characteristics of pain, like intensity (e.g. numerical rating scale), type (e.g. neuropathic pain questionnaire), or pattern. In contrast, multi-dimensional tools, like Mc Gill Questionnaire, assess not only pain as an individual symptom but also its influence on physical functioning and general well-being. However, certain components like ethnicity, age, cognitive impairment, sedation, and emotion become a limiting factor in selecting the scale. In addition to these scales, a potential role of parameters such as biopotentials/markers has also been shown in pain assessment. Last, artificial intelligence is also being applied in evaluation of pain. Pain measurement is subjective in nature as assessed through questionnaires and observational tools. Currently, multi-dimensional approaches of pain assessment are available, which can lead to precision pain management.

The surgical treatment of pain has been an integral part of neurosurgery since the early 20th century when Harvey Cushing pioneered ganglionectomy for trigeminal neuralgia. Over the ensuing years, as anatomic and physiologic knowledge of pain systems grew, new techniques aimed at new targets were developed for various pain conditions. Our objective was to provide an informative and up-to-date summary of radiosurgery for chronic facial pain, emphasizing trigeminal neuralgia and discussing the advantages and challenges of this modality. A PubMed search with keywords ("trigeminal neuralgia" or "cluster headache" or "glossopharyngeal neuralgia") and ("radiosurgery") and ("systematic review" or "review") was conducted. Relevant publications in English published from January 2000 to May 2022 were screened manually for their title, abstract, and even full text to determine their relevance. References from the searched articles were also searched as other supplementary articles. We excluded original articles and personal series from the analysis and only considered systematic reviews to maintain the transparency in the record. A total of 19 studies for trigeminal neuralgia (n > 100), 52 cases of cluster headache, and 42 cases of glossopharyngeal neuralgia were found. Radiosurgery remains the safest among various treatment options with equitable pain control with other percutaneous procedures. MVD remains the gold standard for long-term pain control. There is no difference in efficacy or tolerance between patients treated with gamma knife, linear accelerator, or CyberKnife. The minimum recommended prescription dose was 70 Gy (level of evidence II), and the maximum dose was 90 Gy (level of evidence III) in a single fraction. Radiosurgery provides 5-year pain control in 50% of patients without medication (85% of patients with/without medication) with an average latency period of 1-3 months. Approximately 8-15% of patients will experience a recurrence of pain after an average period of 1 year. Prospective pain relief will be about 60% at 3 years, 40% at 7 years, and 37% in 10 years. The main complication was facial hypoesthesia occurring in 25-50% of patients within 6 months-3 years and disabling in 10% of cases. Cluster headache and glossopharyngeal neuralgia are emerging conditions for treatment with GKRS, although long-term efficacy remains to be studied. Having searched PubMed and other databases and summarized the application of radiosurgery for facial pain, we concluded that radiosurgery is undoubtedly a promising tool for chronic facial pain, but further studies are needed to realize its long-term efficiency and advanced applications of the same.

The vein of Galen arteriovenous malformation is a rare abnormality of the fetal cerebral vascular system. It is caused by the persistence of a cerebral arteriovenous fistula of the median prosencephalic vein. Due to the high mortality rate of the surgical option in its treatment, the approach with embolization and radiosurgery combinations continues to be popular. We present a 3-year-old child patient who was accidentally detected by vein of Galen malformations during a screening for headache complaints with known heart disease. In the treatment of this patient, we performed radiosurgery therapy alone, rather than a combination. Our case is the third case of a and the youngest example child who was treated with only radiosurgery without embolization. Gamma knife therapy, which is a more convenient and effective treatment plan, is a method that can be safely used instead of open surgery with a high mortality rate.

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis has been reported after severe acute respiratory disease coronavirus 2 (SARS-CoV-2) vaccination rarely. We report the second known case of anti-NMDAR encephalitis after receiving fourth dose of SARS-CoV-2 vaccine in a middle-aged male presenting with stroke-like symptoms, highlighting a rare potential neuroinflammatory complication of vaccination against SARS-CoV-2 that is currently being distributed worldwide. Despite the occurrence of such rare adverse events, the benefits of COVID-19 vaccination outweigh concerns over neurologic complications.