Setting up EEG Source Imaging in Practice.

SUMMARY: Adding EEG source imaging to a clinical practice has clear advantages over visual inspection of EEG. This article offers insight on incorporating EEG source imaging into an EEG laboratory and the best practices for producing optimal source analysis results.

Top Ten Tips Palliative Care Clinicians Should Know About Providing Care for People With Disabilities.

Palliative care (PC) clinicians are well poised to help people with disabilities (PWD) live well in the context of serious illness. PC prioritizes person-centered care with a focus on function, autonomy, and quality of life. This approach aligns with principles of high-quality care for PWD. An understanding of the unique experiences and needs of PWD can advance the delivery of comprehensive, equitable PC for this population. In this article, we provide 10 tips to help PC clinicians develop an informed disability lens in their approach to care.

Excluding People With Disabilities From Clinical Research: Eligibility Criteria Lack Clarity And Justification.

The exclusion of people with disabilities from clinical research without appropriate justification is discriminatory, is counter to federal regulations and research guidelines, and limits study generalizability. This matter is understudied, and data on the disability status of trial participants are rarely collected or reported. We analyzed ninety-seven recent interventional protocols in four therapeutic areas registered on ClinicalTrials.gov. Eighty-five percent of protocols allowed broad investigator discretion to determine eligibility, whereas only 18 percent explicitly permitted people with disabilities to use forms of support (such as supported decision making or assistive devices) to facilitate study participation. Eligibility criteria affecting people with disabilities included exclusions for psychiatric (68 percent), substance use (62 percent), HIV or hepatitis (53 percent), cognitive or intellectual (42 percent), visual (34 percent), hearing (10 percent), mobility (9 percent), long-term care (6 percent), and speech and communication (3 percent) disability-related domains. Documented justification was provided for only 24 percent of these exclusions. We recommend greater scrutiny of study eligibility criteria, scientific or ethical justification of exclusions, and accessible study design.

Magnetoencephalography and New Imaging Modalities in Epilepsy.

The success of epilepsy surgery is highly dependent on correctly identifying the entire epileptogenic region. Current state-of-the-art for localizing the extent of surgically amenable areas involves combining high resolution three-dimensional magnetic resonance imaging (MRI) with electroencephalography (EEG) and magnetoencephalography (MEG) source modeling of interictal epileptiform activity. Coupling these techniques with newer quantitative structural MRI techniques, such as cortical thickness measurements, however, may improve the extent to which the abnormal epileptogenic region can be visualized. In this review we assess the utility of EEG, MEG and quantitative structural MRI methods for the evaluation of patients with epilepsy and introduce a novel method for the co-localization of a structural MRI measurement to MEG and EEG source modeling. When combined, these techniques may better identify the extent of abnormal structural and functional areas in patients with medically intractable epilepsy.

A Case of Polyarticular Pasteurella multocida Septic Arthritis.

A 76-year-old man with a history of osteoarthritis presents with right leg erythema and inability to weight-bear and pain in his right shoulder. Synovial fluid cell count of the knee and shoulder showed abundant neutrophils, and cultures of the knee showed growth of Pasteurella multocida. The patient owned four cats with which he had frequent contact, but history and physical examination elicited no evidence of scratches or bites. This case highlights the invasive potential of Pasteurella multocida in an immunocompetent individual and its capacity to cause septic arthritis in the setting of frequent animal contact.

The Texting Rhythm: A Novel EEG Waveform Using Smartphones.

INTRODUCTION: We report a unique EEG phenomenon in patients with paroxysmal neurological events undergoing video EEG monitoring. METHODS: Two epilepsy centers analyzed the interictal scalp EEG in patients using personal electronic devices during epilepsy monitoring. The texting rhythm (TR) was defined as a reproducible, stimulus-evoked, generalized frontocentral monomorphic burst of 5-6 Hz theta consistently induced by active text messaging. An independent prospective and retrospective cohort was analyzed and compared from two sites in Florida and Illinois. We assessed age, gender, diagnosis, epilepsy classification, MRI, and EEG to compare patients with a TR. Analysis was performed with statistical significance set at P < 0.05. RESULTS: We identified 24 of 98 evaluable patients with a TR in a prospective arm at one center and 7 of 31 patients in a retrospective arm at another totaling 31/129 (24.0%). The waveform prevalence was similar at both centers independent of location. TR was highly specific to active texting. A similar waveform during independent cognitive, speech or language, motor activation and audio cellular telephone use was absent (P < 0.0001). It appeared to be increased in patients with epilepsy in one cohort (P = 0.03) and generalized seizures in the other (P = 0.025). Age, gender, epilepsy type, MRI results, and EEG lateralization in patients with focal epileptic seizures did not bear a relationship to the presence of a TR in either arm of the study (P = NS). CONCLUSIONS: The TR is a novel waveform time-locked to text messaging and associated with active use of smartphones. Electroencephalographers should be aware of the TR to separate it from an abnormality in patients undergoing video EEG monitoring. Larger sample sizes and additional research may help define the significance of this unique cognitive-visual-cognitive-motor network that is technology-related and task-specific with implications in communication research and transportation safety.

Predicting white matter targets for direct neurostimulation therapy.

A novel depth electrode placement planning strategy is presented for propagating current to distant epileptic tissue during direct neurostimulation therapy. Its goal is to predict optimal lead placement in cortical white matter for influencing the maximal extent of the epileptic circuit. The workflow consists of three fundamental techniques to determine responsive neurostimulation depth lead placement in a patient with bilaterally independent temporal lobe epileptogenic regions. (1) Pre-implantation finite element modeling was used to predict the volume of cortical activation (VOCA). This model estimated the electric field and neural tissue influenced surrounding two adjacent active depth contacts prior to implantation. The calculations included anticipated stimulation parameters. (2) Propagation of stimulation therapy was simulated pre-implantation using the VOCA model positioned in the subject's diffusion tensor imaging (DTI) determined 8h post-ictally compared to an interictal DTI. (3) Validation of the predicted stimulated anatomical targets was determined 4.3 months post-implantation using subtracted activated SPECT (SAS). Presurgically, the modeling system predicted white matter connectivity and visual side-effects to stimulation. Post-implantation, SAS validated focal blood flow changes in ipsilateral occipital and frontal regions, and contralateral temporal lobe. This workflow demonstrates the feasibility of planning white matter-electrode placement with individual specificity to predict propagation of electrical current throughout an epileptic circuit.

Management of newly diagnosed epilepsy: a practical guide to monotherapy.

With the emergence of several new antiepileptic drugs (AEDs) in recent years, choosing an agent to initiate monotherapy in newly diagnosed epilepsy has become increasingly complicated. We provide a succinct guide intended for general clinicians to assist in this clinical situation. General features of AEDs, differences between first- and second-generation drugs, and characteristics specific to each medication are discussed. The emphasis is on tailoring treatment to the individual patient with epilepsy because each case has specific features that must be accounted for, including the type of seizure and epilepsy, medication-specific characteristics, co-morbid conditions, drug-drug interactions, patient drug tolerance, and special population factors, all of which must be balanced and optimized when choosing initial therapy in this setting. Finally, this information is conveniently summarized in a set of tables and illustrated by way of case scenarios.