Publications by authors named "Chad Carlson"

99 Publications

You never forget your first? Impact of interview timing on institutional rank order.

Med Educ 2021 07 18;55(7):850-856. Epub 2021 Apr 18.

Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.

Objective: To analyze the impact of interview date on the applicant rank for Neurology residencies in the United States.

Methods: A multi-institutional retrospective review of interview dates and applicant rank list data for the National Resident Matching Program (NRMP) was conducted for five Neurology programs, totaling 1932 interviewed applicants over a combined total of 31 interview years. For each candidate, the interview date and applicant rank were abstracted along with the total number of interviews for that season. Statistical analyses were completed on the cumulative institution data set as well for each individual institution to assess for a possible relationship between interview date and applicant rank.

Results: The cumulative institutional analysis showed that the mean applicant rank decreased as the interview season progressed. Applicants who interviewed on the first day of the interview season were ranked 11.4% higher than those who interviewed on the last interview day. Additionally, applicants interviewed on the first interview day more likely to be ranked higher when compared to all other interview dates. Independent analysis of each program's data identified comparable, statistically significant, differences in mean applicant rank and interview position at three out of the five institutions.

Conclusions: This study evaluated the impact of interview order on the ranking of applicants by Neurology residency programs, noting a temporal relationship with applicant rank and interview date. The primacy bias appreciated in our data merits further evaluation in other medical specialties. Strategies to minimize the impact of this bias should be employed by residency programs who use medical matching services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/medu.14535DOI Listing
July 2021

Temporal lobe regions essential for preserved picture naming after left temporal epilepsy surgery.

Epilepsia 2020 09 11;61(9):1939-1948. Epub 2020 Aug 11.

Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Objective: To define left temporal lobe regions where surgical resection produces a persistent postoperative decline in naming visual objects.

Methods: Pre- and postoperative brain magnetic resonance imaging data and picture naming (Boston Naming Test) scores were obtained prospectively from 59 people with drug-resistant left temporal lobe epilepsy. All patients had left hemisphere language dominance at baseline and underwent surgical resection or ablation in the left temporal lobe. Postoperative naming assessment occurred approximately 7 months after surgery. Surgical lesions were mapped to a standard template, and the relationship between presence or absence of a lesion and the degree of naming decline was tested at each template voxel while controlling for effects of overall lesion size.

Results: Patients declined by an average of 15% in their naming score, with wide variation across individuals. Decline was significantly related to damage in a cluster of voxels in the ventral temporal lobe, located mainly in the fusiform gyrus approximately 4-6 cm posterior to the temporal tip. Extent of damage to this region explained roughly 50% of the variance in outcome. Picture naming decline was not related to hippocampal or temporal pole damage.

Significance: The results provide the first statistical map relating lesion location in left temporal lobe epilepsy surgery to picture naming decline, and they support previous observations of transient naming deficits from electrical stimulation in the basal temporal cortex. The critical lesion is relatively posterior and could be avoided in many patients undergoing left temporal lobe surgery for intractable epilepsy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/epi.16643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722029PMC
September 2020

Anti-myelin oligodendrocyte glycoprotein (MOG) associated disease masquerading as prolonged intractable nausea and vomiting.

Mult Scler Relat Disord 2020 Sep 16;44:102308. Epub 2020 Jun 16.

Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee 53226, WI, USA. Electronic address:

The clinical and radiological spectrum of myelin oligodendrocyte glycoprotein (MOG) antibody associated disease continues to expand. Here, we describe a case of prolonged, relapsing, intractable nausea and vomiting misdiagnosed as a functional disorder for more than one year. The patient did not receive a neurological workup until clear neurological signs developed. This case exemplifies the delay in diagnosis when neurological disease presents with seemingly non-neurological symptoms and illustrates brainstem and upper spinal cord radiological findings that can help guide the treating physician to test for MOG antibodies and provide the appropriate treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.msard.2020.102308DOI Listing
September 2020

Sexual violence in sport: American Medical Society for Sports Medicine Position Statement.

Br J Sports Med 2021 Feb 18;55(3):132-134. Epub 2020 Jun 18.

Department of Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the Task Force used an iterative process and expert consensus to finalise the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2020-102226DOI Listing
February 2021

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

Clin J Sport Med 2020 07;30(4):291-292

Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSM.0000000000000855DOI Listing
July 2020

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

Curr Sports Med Rep 2020 Jun;19(6):232-234

Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1249/JSR.0000000000000722DOI Listing
June 2020

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

Sports Health 2020 Jul/Aug;12(4):352-354. Epub 2020 Jun 8.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1941738120929946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787563PMC
July 2020

Active Learning in Psychiatry Education: Current Practices and Future Perspectives.

Front Psychiatry 2020 23;11:211. Epub 2020 Apr 23.

A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN, United States.

Over the past few decades, medical education has seen increased interest in the use of active learning formats to engage learners and promote knowledge application over knowledge acquisition. The field of psychiatry, in particular, has pioneered a host of novel active learning paradigms. These have contributed to our understanding of the role of andragogy along the continuum of medical education, from undergraduate to continuing medical education. In an effort to frame the successes and failures of various attempts at integrating active learning into healthcare curricula, a group of educators from the A. B. Baker Section on Neurological Education from the American Academy of Neurology reviewed the state of the field in its partner field of medical neuroscience. Herein we provide a narrative review of the literature, outlining the basis for implementing active learning, the novel formats that have been used, and the lessons learned from qualitative and quantitative analysis of the research that has been done to date. While preparation time seems to present the greatest obstacle to acceptance from learners and educators, there is generally positive reception to the new educational formats. Additionally, most assessments of trainee performance have suggested non-inferiority (if not superiority). However, occasional mixed findings point to a need for better assessments of the type of learning that these new formats engender: knowledge application rather than acquisition. Moreover, this field is relatively nascent and, in order to ascertain how best to integrate active learning into psychiatry education, a framework for quantitative outcome assessments is needed going forward.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyt.2020.00211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190786PMC
April 2020

Changes in description naming for common and proper nouns after left anterior temporal lobectomy.

Epilepsy Behav 2020 05 13;106:106912. Epub 2020 Mar 13.

Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States of America.

Numerous studies have shown that surgical resection of the left anterior temporal lobe (ATL) is associated with a decline in object naming ability (Hermann et al., 1999). In contrast, few studies have examined the effects of left ATL surgery on auditory description naming (ADN) or category-specific naming. Compared with object naming, which loads heavily on visual recognition processes, ADN provides a more specific measure of concept retrieval. The present study examined ADN declines in a large group of patients who were tested before and after left ATL surgery, using a 2 × 2 × 2 factorial manipulation of uniqueness (common vs. proper nouns), taxonomic category (living vs. nonliving things), and time (pre- vs. postsurgery). Significant declines occurred across all categories but were substantially larger for proper living (PL) concepts, i.e., famous individuals. The disproportionate decline in PL noun naming relative to other conditions is consistent with the notion that the left ATL is specialized not only for retrieval of unique entity concepts, but also plays a role in processing social concepts and person-specific features.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yebeh.2020.106912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195239PMC
May 2020

Strategic Considerations for Applying the Flipped Classroom to Neurology Education.

Ann Neurol 2020 01 21;87(1):4-9. Epub 2019 Nov 21.

A. B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, MN.

Nowadays, the "flipped classroom" approach is taking the center stage within medical education. However, very few reports on the implementation of the flipped classroom in neurology have been published to date, and this educational model still represents a challenge for students and educators alike. In this article, neurology educators from the American Academy of Neurology's A. B. Baker Section on Neurological Education analyze reports of flipped classroom in other medical/surgical subspecialties, review the current implementation in neurology, and discuss future strategies to flip the neurology curriculum through contextualization of the benefits and the consequences. ANN NEUROL 2020;87:4-9.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ana.25609DOI Listing
January 2020

Education Research: Flipped classroom in neurology: Principles, practices, and perspectives.

Neurology 2019 07;93(1):e106-e111

From the A.B. Baker Section on Neurological Education (S.S., J.V.B., C.C., J.C., N.D., A.F., J.K., J.W.M.O., G.P., H.S., D.W., L.D.S.), American Academy of Neurology, Minneapolis, MN; Imperial College London (S.S.), UK; University of Michigan (J.V.B.), Ann Arbor; Medical College of Wisconsin (C.C.), Milwaukee; Ohio State University (J.C.), Columbus; Weill Cornell Medicine (N.D., H.S.), New York, NY; Lebanon VA Medical Center (A.F.), PA; Tulane University School of Medicine (J.K.), New Orleans, LA; University of Washington (J.W.M.O.), Seattle; Oakland University William Beaumont School of Medicine (G.P.), Auburn Hills, MI; St. Louis University (D.W.), MO; and Stanford University (L.D.S.), CA.

How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000007730DOI Listing
July 2019

Treat the Patient, Not the Test When a Hospitalized Patient in Status Epilepticus Transitions to Comfort-Focused Goals of Care.

J Palliat Med 2018 08 29;21(8):1195-1198. Epub 2018 Jun 29.

3 Department of Neurology, Medical College of Wisconsin , Milwaukee, Wisconsin.

Status epilepticus is a common and under-recognized cause of unconsciousness among hospitalized patients. It can clinically mimic delirium and other causes of acute mental status change, especially when clinically relevant seizure activity is not appreciated on physical examination. While the successful treatment of status epilepticus may require anesthetic dosing of antiepileptics such as barbiturates, these seemingly drastic therapeutic measures are justified when goals of care are life prolonging as they may allow a patient to regain consciousness and meaningfully interact with loved ones. However, medical burden from electroencephalogram (EEG) monitoring and other care associated with its diagnosis and treatment can contribute to distress for patients who may be dying from a comorbid illness. Furthermore, when goals of care transition to comfort, care challenges can result regarding the ongoing management of barbiturates or other sedatives, previously prescribed to treat the status epilepticus. In this case study, the lack of clinically significant seizure activity led us to conclude that the discontinuation of a barbiturate infusion and the EEG monitoring was the clinically appropriate approach for a dying patient with comfort goals of care and nonconvulsive status epilepticus.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jpm.2018.0119DOI Listing
August 2018

Structural brain abnormalities in the common epilepsies assessed in a worldwide ENIGMA study.

Brain 2018 02;141(2):391-408

Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, USA.

Progressive functional decline in the epilepsies is largely unexplained. We formed the ENIGMA-Epilepsy consortium to understand factors that influence brain measures in epilepsy, pooling data from 24 research centres in 14 countries across Europe, North and South America, Asia, and Australia. Structural brain measures were extracted from MRI brain scans across 2149 individuals with epilepsy, divided into four epilepsy subgroups including idiopathic generalized epilepsies (n =367), mesial temporal lobe epilepsies with hippocampal sclerosis (MTLE; left, n = 415; right, n = 339), and all other epilepsies in aggregate (n = 1026), and compared to 1727 matched healthy controls. We ranked brain structures in order of greatest differences between patients and controls, by meta-analysing effect sizes across 16 subcortical and 68 cortical brain regions. We also tested effects of duration of disease, age at onset, and age-by-diagnosis interactions on structural measures. We observed widespread patterns of altered subcortical volume and reduced cortical grey matter thickness. Compared to controls, all epilepsy groups showed lower volume in the right thalamus (Cohen's d = -0.24 to -0.73; P < 1.49 × 10-4), and lower thickness in the precentral gyri bilaterally (d = -0.34 to -0.52; P < 4.31 × 10-6). Both MTLE subgroups showed profound volume reduction in the ipsilateral hippocampus (d = -1.73 to -1.91, P < 1.4 × 10-19), and lower thickness in extrahippocampal cortical regions, including the precentral and paracentral gyri, compared to controls (d = -0.36 to -0.52; P < 1.49 × 10-4). Thickness differences of the ipsilateral temporopolar, parahippocampal, entorhinal, and fusiform gyri, contralateral pars triangularis, and bilateral precuneus, superior frontal and caudal middle frontal gyri were observed in left, but not right, MTLE (d = -0.29 to -0.54; P < 1.49 × 10-4). Contrastingly, thickness differences of the ipsilateral pars opercularis, and contralateral transverse temporal gyrus, were observed in right, but not left, MTLE (d = -0.27 to -0.51; P < 1.49 × 10-4). Lower subcortical volume and cortical thickness associated with a longer duration of epilepsy in the all-epilepsies, all-other-epilepsies, and right MTLE groups (beta, b < -0.0018; P < 1.49 × 10-4). In the largest neuroimaging study of epilepsy to date, we provide information on the common epilepsies that could not be realistically acquired in any other way. Our study provides a robust ranking of brain measures that can be further targeted for study in genetic and neuropathological studies. This worldwide initiative identifies patterns of shared grey matter reduction across epilepsy syndromes, and distinctive abnormalities between epilepsy syndromes, which inform our understanding of epilepsy as a network disorder, and indicate that certain epilepsy syndromes involve more widespread structural compromise than previously assumed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/brain/awx341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837616PMC
February 2018

MEG language lateralization in partial epilepsy using dSPM of auditory event-related fields.

Epilepsy Behav 2017 08 26;73:247-255. Epub 2017 Jun 26.

Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.

Objective: Methods employed to determine hemispheric language dominance using magnetoencephalography (MEG) have differed significantly across studies in the choice of language-task, the nature of the physiological response studied, recording hardware, and source modeling methods. Our goal was to determine whether an analysis based on distributed source modeling can replicate the results of prior studies that have used dipole-modeling of event-related fields (ERFs) generated by an auditory word-recognition task to determine language dominance in patients with epilepsy.

Methods: We analyzed data from 45 adult patients with drug-resistant partial epilepsy who performed an auditory word-recognition task during MEG recording and also completed a language fMRI study as part of their evaluation for epilepsy surgery. Source imaging of auditory ERFs was performed using dynamic statistical parametric mapping (dSPM). Language laterality indices (LIs) were calculated for four regions of interest (ROIs) by counting above-threshold activations within a 300-600ms time window after stimulus onset. Language laterality (LL) classifications based on these LIs were compared to the results from fMRI.

Results: The most lateralized MEG responses to language stimuli were observed in a parietal region that included the angular and supramarginal gyri (AngSmg). In this region, using a half-maximal threshold, source activations were left dominant in 32 (71%) patients, right dominant in 8 (18%), and symmetric in 5 patients (11%). The best agreement between MEG and fMRI on the ternary classification of regional language dominance into left, right, or symmetric groups was also found at the AngSmg ROI (69%). This was followed by the whole-hemisphere and temporal ROIs (both 62%). The frontal ROI showed the least agreement with fMRI (51%). Gross discordances between MEG and FMRI findings were disproportionately of the type where MEG favored atypical right-hemispheric language in a patient with right-hemispheric seizure origin (p<0.05 at three of the four ROIs).

Significance: In a parietal region that includes the angular and supramarginal gyri, language laterality estimates based on dSPM of ERFs during auditory word-recognition shows a degree of MEG-fMRI concordance that is comparable to previously published estimates for MEG-Wada concordance using dipole counting methods and the same task. Our data also suggest that MEG language laterality estimates based on this task may be influenced by the laterality of epileptic networks in some patients. This has not been reported previously and deserves further study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yebeh.2017.06.002DOI Listing
August 2017

Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug-resistant focal epilepsy.

Epilepsia 2017 05 4;58(5):792-800. Epub 2017 Apr 4.

Department of Neurology, New York University Langone Medical Center, New York, New York, U.S.A.

Objective: Presently, there is no simple method at initial presentation for identifying a patient's likelihood of progressing to surgery and a favorable outcome. The Epilepsy Surgery Grading Scale (ESGS) is a three-tier empirically derived mathematical scale with five categories: magnetic resonance imaging (MRI), electroencephalography (EEG), concordance (between MRI and EEG), semiology, and IQ designed to stratify patients with drug-resistant focal epilepsy based on their likelihood of proceeding to resective epilepsy surgery and achieving seizure freedom.

Methods: In this cross-sectional study, we abstracted data from the charts of all patients admitted to the New York University Langone Medical Center (NYULMC) for presurgical evaluation or presented in surgical multidisciplinary conference (MDC) at the NYU Comprehensive Epilepsy Center (CEC) from 1/1/2007 to 7/31/2008 with focal epilepsy, who met minimal criteria for treatment resistance. We classified patients into ESGS Grade 1 (most favorable), Grade 2 (intermediate), and Grade 3 (least favorable candidates). Three cohorts were evaluated: all patients, patients presented in MDC, and patients who had resective surgery. The primary outcome measure was proceeding to surgery and seizure freedom.

Results: Four hundred seven patients met eligibility criteria; 200 (49.1%) were presented in MDC and 113 (27.8%) underwent surgery. A significant difference was observed between Grades 1 and 3, Grades 1 and 2, and Grades 2 and 3 for all presurgical patients, and those presented in MDC, with Grade 1 patients having the highest likelihood of both having surgery and becoming seizure-free. There was no difference between Grades 1 and 2 among patients who had resective surgery.

Significance: These results demonstrate that by systematically using basic information available during initial assessment, patients with drug-resistant epilepsy may be successfully stratified into clinically meaningful groups with varied prognosis. The ESGS may improve communication, facilitate decision making and early referral to a CEC, and allow patients and physicians to better manage expectations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/epi.13730DOI Listing
May 2017

The Value of Diagnostic Bilateral Intracranial Electroencephalography in Treatment-Resistant Focal Epilepsy.

World Neurosurg 2017 Jul 7;103:1-10. Epub 2017 Feb 7.

Department of Neurosurgery, New York University School of Medicine, New York, New York, USA. Electronic address:

Objectives: We assessed the efficacy and risks of diagnostic bilateral intracranial electroencephalography (bICEEG) in patients with treatment-resistant epilepsy (TRE) with poorly lateralized epileptogenic zone on noninvasive studies as reflected by progress to resection, Engel outcome, and complication rate.

Methods: This is a retrospective chart review of 199 patients with TRE who had diagnostic bICEEG at New York University Medical Center between 1994 and 2013. Study end points were progress to resection, surgical outcome, and perioperative complications. Univariate analysis was performed with analysis of variance, t test, or Fisher exact test; multivariable analysis was performed using discriminant function analysis.

Results: bICEEG lateralized the epileptogenic zone and the patient had resection in 60.3% of cases. The number of depth electrodes used was positively correlated with resection, and surgical complications during bICEEG negatively correlated. Vagal nerve stimulators were implanted in 58.2% of patients who did not undergo resection and 20.7% of those who did. Among the 87 patients who progressed to resection and had more than 1-year follow-up, 47.1% were seizure free compared with 12.7% of the 55 who did not. Male sex correlated with good postoperative seizure control. The most common complication was infection requiring debridement, occurring in 3.1% of admissions (9 of 290).

Conclusions: At our center, 60% of patients undergoing bICEEG progress to resection and 57% of these had more than 90% reduction in seizures. We conclude that bICEEG allows the benefits of epilepsy surgery to be extended to patients with poorly lateralized and localized TRE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2017.01.093DOI Listing
July 2017

Functional differences among stimulation-identified cortical naming sites in the temporal region.

Epilepsy Behav 2016 07 17;60:124-129. Epub 2016 May 17.

Department of Neurology, Columbia University Medical Center, New York, NY, United States.

To preserve postoperative language, electrical stimulation mapping is often conducted prior to surgery involving the language-dominant hemisphere. Object naming is the task most widely used to identify language cortex, and sites where stimulation elicits naming difficulty are typically spared from resection. In clinical practice, sites classified as positive undergo no further testing regarding the underlying cause of naming failure. Word production is a complex function involving multiple mechanisms that culminate in the identification of the target word. Two main mechanisms, i.e., semantic and phonological, underlie the retrieval of stored information regarding word meaning and word sounds, and naming can be hampered by disrupting either of these. These two mechanisms are likely mediated by different brain areas, and therefore, stimulation-identified naming sites might not be functionally equivalent. We investigated whether further testing at stimulation-identified naming sites would reveal an anatomical dissociation between these two mechanisms. In 16 patients with refractory temporal lobe epilepsy (TLE) with implanted subdural electrodes, we tested whether, despite inability to produce an item name, patients could reliably access semantic or phonological information regarding objects during cortical stimulation. We found that stimulation at naming sites in superior temporal cortex tended to impair phonological processing yet spared access to semantic information. By contrast, stimulation of inferior temporal naming sites revealed a greater proportion of sites where semantic access was impaired and a dissociation between sites where stimulation spared or disrupted semantic or phonological processing. These functional-anatomical dissociations reveal the more specific contribution to naming provided by these cortical areas and shed light on the often profound, interictal word-finding deficit observed in temporal lobe epilepsy. Additionally, these techniques potentially lay the groundwork for future studies to determine whether particular naming sites that fall within the margins of the desired clinical resection might be resected without significant risk of decline.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yebeh.2016.04.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912888PMC
July 2016

Epilepsy monitoring unit length of stay.

Epilepsy Behav 2016 05 9;58:102-5. Epub 2016 Apr 9.

New York University Langone Medical Center, USA; Medical College of Wisconsin, USA.

With an increasing focus on quality metrics, hospital length of stay (LOS) in the U.S. has garnered significant scrutiny. To help establish evidence-based benchmarks for epilepsy monitoring unit (EMU) metrics, we evaluated the impact of multiple variables on LOS through a retrospective analysis of 905 consecutive inpatient adult EMU admissions. The most common reasons for admission were event characterization (n=494), medication adjustment (n=189), and presurgical evaluation (n=96). Presurgical evaluations experienced a longer average LOS (aLOS) of 7.1days versus patients admitted for other indications (p<0.001). Patients with symptomatic generalized epilepsy (n=22) had a longer aLOS (6.9days) than patients with other types of epilepsy/events (p<0.001). Patients admitted on two or fewer antiepileptic drugs (AEDs) had a shorter aLOS than patients admitted on three or more AEDs (4.3days vs 6.3days, respectively; p<0.001). A history of previous invasive epilepsy management was associated with a longer aLOS than those without (6.2days vs 4.7days, respectively; p<0.0001). Epilepsy monitoring unit aLOS is influenced by admission indication, epilepsy classification, medication burden, and having had prior invasive management. Multiple variables should be considered when analyzing LOS EMU metrics, arguing against a "one size fits all" approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yebeh.2016.02.031DOI Listing
May 2016

Special Issues in Epilepsy: The Elderly, the Immunocompromised, and Bone Health.

Continuum (Minneap Minn) 2016 Feb;22(1 Epilepsy):246-61

Purpose Of Review: This article discusses targeted special issues in epilepsy, including epilepsy in the elderly and immuncompromised populations and bone health in epilepsy. Although this is a broad and diverse set of topics, common themes can be identified by focusing on elderly patients and patients who are immunocompromised that provide a valuable framework for other groups.

Recent Findings: An increasing incidence of epilepsy has been reported in patients 65 years of age and older. As people age, physiologic changes can alter antiepileptic drug metabolism, which can significantly impact dosing requirements and tolerability. Side effects of antiepileptic drugs may pose a significant challenge given the relatively high frequency of comorbid illnesses. When evaluating and treating immunocompromised patients, a broad range of potential etiologies for new-onset or worsening seizures must be considered. When choosing an antiepileptic drug, drug-drug interactions, the potential for increased side effects, and the overall impact of treatments on the underlying illness must be considered. The most recent findings and recommendations pertaining to bone health assessment and maintenance in various populations with epilepsy are summarized.

Summary: Treating epilepsy and seizures in special populations requires taking a broad view of patients' overall health status, including potentially complex treatment regimens and a unique predisposition to adverse events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/CON.0000000000000273DOI Listing
February 2016

The evolution of epilepsy surgery between 1991 and 2011 in nine major epilepsy centers across the United States, Germany, and Australia.

Epilepsia 2015 Oct 7;56(10):1526-33. Epub 2015 Aug 7.

Department of Neurology, New York University, New York, New York, U.S.A.

Objective: Epilepsy surgery is the most effective treatment for select patients with drug-resistant epilepsy. In this article, we aim to provide an accurate understanding of the current epidemiologic characteristics of this intervention, as this knowledge is critical for guiding educational, academic, and resource priorities.

Methods: We profile the practice of epilepsy surgery between 1991 and 2011 in nine major epilepsy surgery centers in the United States, Germany, and Australia. Clinical, imaging, surgical, and histopathologic data were derived from the surgical databases at various centers.

Results: Although five of the centers performed their highest number of surgeries for mesial temporal sclerosis (MTS) in 1991, and three had their highest number of MTS surgeries in 2001, only one center achieved its peak number of MTS surgeries in 2011. The most productive year for MTS surgeries varied then by center; overall, the nine centers surveyed performed 48% (95% confidence interval [CI] -27.3% to -67.4%) fewer such surgeries in 2011 compared to either 1991 or 2001, whichever was higher. There was a parallel increase in the performance of surgery for nonlesional epilepsy. Further analysis of 5/9 centers showed a yearly increase of 0.6 ± 0.07% in the performance of invasive electroencephalography (EEG) without subsequent resections. Overall, although MTS was the main surgical substrate in 1991 and 2001 (proportion of total surgeries in study centers ranging from 33.3% to 70.2%); it occupied only 33.6% of all resections in 2011 in the context of an overall stable total surgical volume.

Significance: These findings highlight the major aspects of the evolution of epilepsy surgery across the past two decades in a sample of well-established epilepsy surgery centers, and the critical current challenges of this treatment option in addressing complex epilepsy cases requiring detailed evaluations. Possible causes and implications of these findings are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082694PMC
http://dx.doi.org/10.1111/epi.13116DOI Listing
October 2015

Cortical feature analysis and machine learning improves detection of "MRI-negative" focal cortical dysplasia.

Epilepsy Behav 2015 Jul 31;48:21-8. Epub 2015 May 31.

Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, New York University, New York, USA; Department of Radiology, School of Medicine, New York University, New York, USA. Electronic address:

Focal cortical dysplasia (FCD) is the most common cause of pediatric epilepsy and the third most common lesion in adults with treatment-resistant epilepsy. Advances in MRI have revolutionized the diagnosis of FCD, resulting in higher success rates for resective epilepsy surgery. However, many patients with histologically confirmed FCD have normal presurgical MRI studies ('MRI-negative'), making presurgical diagnosis difficult. The purpose of this study was to test whether a novel MRI postprocessing method successfully detects histopathologically verified FCD in a sample of patients without visually appreciable lesions. We applied an automated quantitative morphometry approach which computed five surface-based MRI features and combined them in a machine learning model to classify lesional and nonlesional vertices. Accuracy was defined by classifying contiguous vertices as "lesional" when they fell within the surgical resection region. Our multivariate method correctly detected the lesion in 6 of 7 MRI-positive patients, which is comparable with the detection rates that have been reported in univariate vertex-based morphometry studies. More significantly, in patients that were MRI-negative, machine learning correctly identified 14 out of 24 FCD lesions (58%). This was achieved after separating abnormal thickness and thinness into distinct classifiers, as well as separating sulcal and gyral regions. Results demonstrate that MRI-negative images contain sufficient information to aid in the in vivo detection of visually elusive FCD lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yebeh.2015.04.055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500682PMC
July 2015

The relationship between seizure onset zone and ictal tachycardia: An intracranial EEG study.

Clin Neurophysiol 2015 Dec 14;126(12):2255-60. Epub 2015 Feb 14.

New York University, Comprehensive Epilepsy Center, New York, NY, USA.

Objectives: Seizures are often accompanied by ictal tachycardia, which, when pronounced, is one of the cardiac arrhythmias associated with sudden unexpected death in epilepsy (SUDEP). We examined the relationship between the lateralization and localization of seizure onset and development of ictal tachycardia.

Methods: We identified patients who underwent bi-hemispheric intracranial EEG recording over a period of 18 months. Two to four consecutive seizures were reviewed for each patient.

Results: Fifty-seizures from 19 consecutive patients were analyzed. Forty seizures (80%) developed tachycardia (>20% increase from baseline), but laterality at seizure onset did not predict its occurrence (p=0.168). Bi-laterality at ictal onset was associated with early ictal tachycardia (<10s) (p=0.0208). Seizures out of sleep developed tachycardia faster (mean 19.7s vs. 68.2s, p=0.0067), but the state of alertness was not predictive of the development of tachycardia within 10s of seizure onset. Temporal and/or orbito-frontal lobe involvement was associated with tachycardia when compared to any other lobar combinations at ictal onset (p=0.0073).

Conclusion: Laterality at seizure onset does not predict the occurrence of ictal tachycardia. Involvement of the temporal and orbito-frontal cortex, spread to the contralateral hemisphere and state of alertness, may define the degree and rate of autonomic changes.

Significance: Our results help clarify the autonomic control during seizures and offer potential use for future studies in SUDEP risk and automatic seizure detection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinph.2015.01.020DOI Listing
December 2015

Stay, Hit, or Fold? What Do You Do If the Treatment May Be as Bad as the Problem-Results of a Q-PULSE Survey.

Authors:
Chad Carlson

Epilepsy Curr 2014 Nov-Dec;14(6):358-60

Associate Professor of Neurology, Medical College of Wisconsin, Milwaukee, WI.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5698/1535-7597-14.6.358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325590PMC
February 2015

Sex differences in seizure types and symptoms.

Epilepsy Behav 2014 Dec 14;41:103-8. Epub 2014 Oct 14.

Department of Neurology, New York University School of Medicine, New York, NY, USA.

Background: Despite the increasing interest in sex differences in disease manifestations and responses to treatment, very few data are available on sex differences in seizure types and semiology. The Epilepsy Phenome/Genome Project (EPGP) is a large-scale, multi-institutional, collaborative study that aims to create a comprehensive repository of detailed clinical information and DNA samples from a large cohort of people with epilepsy. We used this well-characterized cohort to explore differences in seizure types as well as focal seizure symptoms between males and females.

Methods: We reviewed the EPGP database and identified individuals with generalized epilepsy of unknown etiology (GE) (n = 760; female: 446, male: 314), nonacquired focal epilepsy (NAFE) (n = 476; female: 245, male: 231), or both (n = 64; female: 33, male: 31). Demographic data along with characterization of seizure type and focal seizure semiologies were examined.

Results: In GE, males reported atonic seizures more frequently than females (6.5% vs. 1.7%; p < 0.001). No differences were observed in other generalized seizure types. In NAFE, no sex differences were seen for seizure types with or without alteration of consciousness or progression to secondary generalization. Autonomic (16.4% vs. 26.6%; p = 0.005), psychic (26.7% vs. 40.3%; p = 0.001), and visual (10.3% vs. 19.9%; p = 0.002) symptoms were more frequently reported in females than males. Specifically, of psychic symptoms, more females than males endorsed déjà vu (p = 0.001) but not forced thoughts, derealization/depersonalization, jamais vu, or fear. With corrections for multiple comparisons, there were no significant differences in aphasic, motor, somatosensory, gustatory, olfactory, auditory, vertiginous, or ictal headache symptoms between sexes.

Conclusions: Significant differences between the sexes were observed in the reporting of atonic seizures, which were more common in males with GE, and for autonomic, visual, and psychic symptoms associated with NAFE, which were more common in females.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yebeh.2014.09.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267158PMC
December 2014

Functional neuroimaging abnormalities in idiopathic generalized epilepsy.

Neuroimage Clin 2014 24;6:455-62. Epub 2014 Oct 24.

Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, NY 10016, USA.

Magnetic resonance imaging (MRI) techniques have been used to quantitatively assess focal and network abnormalities. Idiopathic generalized epilepsy (IGE) is characterized by bilateral synchronous spike-wave discharges on electroencephalography (EEG) but normal clinical MRI. Dysfunctions involving the neocortex, particularly the prefrontal cortex, and thalamus likely contribute to seizure activity. To identify possible morphometric and functional differences in the brains of IGE patients and normal controls, we employed measures of thalamic volumes, cortical thickness, gray-white blurring, fractional anisotropy (FA) measures from diffusion tensor imaging (DTI) and fractional amplitude of low frequency fluctuations (fALFF) in thalamic subregions from resting state functional MRI. Data from 27 patients with IGE and 27 age- and sex-matched controls showed similar thalamic volumes, cortical thickness and gray-white contrast. There were no differences in FA values on DTI in tracts connecting the thalamus and prefrontal cortex. Functional analysis revealed decreased fALFF in the prefrontal cortex (PFC) subregion of the thalamus in patients with IGE. We provide minimum detectable effect sizes for each measure used in the study. Our analysis indicates that fMRI-based methods are more sensitive than quantitative structural techniques for characterizing brain abnormalities in IGE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.nicl.2014.10.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221627PMC
July 2015