Systematic review and patient-level meta-analysis of radiofrequency ablation for medically refractory epilepsy: Implications for clinical practice and research.

BACKGROUND: Radiofrequency thermocoagulation (RF-TC) is a minimally invasive procedure for the treatment of epileptic foci. The aim of this study is to review available evidence on the safety and efficacy of RF-TC for medically refractory epilepsy. METHODS: A comprehensive literature search (Pubmed/Medline, EMBASE, Cochrane) was conducted for studies with patient-level data on RF-TC for medically refractory epilepsy. Seizure outcome (Engel classification) at last follow-up comprised the primary endpoint. New temporary or permanent post-procedural neurological deficits were the secondary endpoints. RESULTS: A total of 20 studies (360 patients) were analyzed. Median age at the time of intervention was 29 years (interquartile range (IQR): 21-37) and 57% were males. A lesional MRI was noted in 59% of patients. Median duration of postoperative follow-up was 24 months (IQR: 11-48). The median number of RF-TC lesions per patient was 11 (IQR: 6-19), with bipolar ablation (i.e. between two contiguous contacts) being the most common method (n = 244, 68%). The most common RF-TC location was the mesial temporal structures, without (34%) or with (7%) the temporal neocortex, followed by the insula (13%) and the frontal lobe (12%). Multilobar targets were lesioned in 11% of patients. New neurological deficits developed in 10% of patients (2% remained permanently), with the most common being motor deficits. Among patients with at least 12 months of follow-up (n = 267, 74% of overall cohort), a favorable seizure outcome (Engel I/II class) was achieved in 62% of cases. Patients with a favorable seizure outcome were significantly more likely to have a lesional MRI (71% vs 43% 51%, p < 0.001), have a higher number of RF ablations (15 [IQR 8-31] vs 9 [IQR 4-14], p < 0.001), and undergo monopolar RF-TC (50% vs 30%, p = 0.002). CONCLUSION: Current evidence supports the promising safety and efficacy profile of RF-TC for medically refractory epilepsy. Randomized controlled trial data are needed to further establish the role of this intervention in preoperative discussions with patients and their families.

Expression profiles of miR3181 and miR199a in plasma and placenta of virally suppressed HIV-1 infected Cameroonian pregnant women at delivery.

Human immunodeficiency virus (HIV)-1 infection during pregnancy reduces the transplacental transfer of protective maternal antibodies needed to confer immunity during early postnatal life. However, the mediation of MicroRNA in this dysregulation is not well understood MicroRNAs 3181 and 199a have been shown to mediate neonatal Fc receptor (FcRn)-like transmembrane antibody transfer and endocytosis respectively but their expression levels in the placenta and plasma in women living with HIV have not been extensively investigated. The objective of this study was to determine how the expression levels of miR-3181 and miR-199a in the placenta and plasma are affected in women chronically infected with HIV who are on antiretroviral therapy (ART) and are virally suppressed at delivery. In this pilot case-control study, plasma and placenta biopsies were obtained from 36 (18 HIV+ and 18 HIV-) Cameroonian women at delivery. MicroRNAs 3181 and 199a expression levels were measured using RT-qPCR, data was analyzed using SPSS22.0 and R 3.60, and p values below 0.05 were considered statistically significant. All the HIV-infected women were on known ART regimens and were virally suppressed. There was no significant difference in the levels of miR-3181 (p>0.05) in the placenta and plasma amongst HIV-infected and HIV uninfected women. The expression levels of miR-199a were significantly greater in the plasma compared to the placenta of HIV+ (p = 0.00005) and HIV- (p = 0.027) women. Moreover, there was a significantly higher (p = 0.02) level of miR-199a in the plasma of women with HIV and their uninfected counterparts. Linear regression models adjusted for systolic pressure showed no significant difference (p>0.05) in the levels of miR-199a and miR-3181 in both the placenta and plasma due to HIV infection. Our findings suggest that even though ART uptake and viral suppression might help in maintaining miR3181 and miR199a levels in the placenta of women with HIV at comparative levels to those of their HIV negative counterparts, the significantly higher levels of miR-199a in the plasma of women with HIV compared to the placenta might highlight lurking systemic dangers and requires further investigation.