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My Editorial and Review on Recent Trends in Brain Damage is next, in the mean time, this is the latest news about Traumatic Brain Injruy (TBI) and how Spreading Depolarization can be tapped using neuromonitoring and how that can be used to understand and interpret the brain damage without opening the skull, what I meant is without a neurosurgery?.
This particular video taken during the Lateral Lumbar Interbody Fusion procedure at UPMC by Dr.Kanter and his team is a treat to watch the intricacy of surgical steps during lateral Spine procedure, you might have been into the OR or probably done neuromonitoring for procedures including various lumbar level fusion procedures, but if there is no live camera equipped in the OR, it is often difficult to know where exactly is the surgeon is and what is he/she is doing at a particular stage of the procedure, it will be just a guess work and that is not acceptable in the medical/health care field (all the stakeholders inside the OR must know exactly about the procedure) and that is not how things can go inside the Operating Room. Every team member from Anesthesiologist to Neurophysiologist to nurses must know every step of the way what exactly the surgeon is doing in order to help or figure out if there is any issue arise during surgical procedure. Unfortunately, most ORs are not equipped with the video transmission inside the OR or if there is one they normally do not use it (but in most neurosurgery ORs they do use). Those professionals who work inside the OR must acquaint themselves with surgical steps of the surgeons, one way to do is watch it live or recorded one, or a demo before participating in such surgical procedure. It will provide a deeper understanding and realistic perception of how a particular procedure is done, with that knowledge handy, it will be more appropriate to provide feed back to the surgeon on neurophysiology or anesthesia or other relevant modalities to be monitored inside the OR. Even the X-Ray tech's must know the basics (most often that is not the case), ironically the cell saver and other tech's who come inside the OR have no clue about anything in the OR except that little machine collecting the blood?. Knowing exactly what the surgeon is doing every step of the way inside the OR provides a lot more close to a realistic perception than reading it from a book or listening someone describe it. For those graduates or tech's who have not seen the details of this procedure, this is a good one to watch. Thanks to Dr.Kanter and his colleagues from UPMC for presenting this procedure so well.
Nature Publishing Group (the owner and publisher of worlds popular "Nature") has just published a special issue, featuring the story of Epilepsy covering aspects why this disease is still not well understood and what do the worlds govt's and funding agencies must do, meaning why there is not much funding is allocated to Epilepsy research considering more than 50Million people world wide are affected by more than a dozen types of Epilepsy?. Yes, that is certainly a valid question and reasonable expectation from various govts and funding agencies. That is just the beginning of this special issue, named under the category "Outlook". To run this special issue and program, Nature has been awarded a special "Independent Education Grant by Sunovion Pharmaceuticals Inc.
There is also another recent Special issue on Neuroscience published somewhere in late 2013, about which I will write later. This Editorial is to provide some idea to researchers, clinicians and people who are working in the field of Epilepsy that this might be the best issue to update yourself about the field and the recent developments in Epilepsy. Ofcourse, those patients and relatives who can understand the science behind Epilepsy, who are wondering what is really going on and what are the possible treatments available, might be a good place to check.
Mike May, the contributing Editor has given a brief summary of the entire issue, a good place to start reading this issue: http://www.nature.com/nature/journal/v511/n7508_supp/full/511S1a.html
Note: This special is issue is only open to public or non subscribers upto October, so better read before it will be taken of the shelf or go get a copy of it.
Interesting research reports presented by the field's top scientists/researchers, clinicians and more. I will go through the entire issue pretty much cover to cover, but before I spend time, I thought to share this for those who may not have heard about this special issue. The first Chapter or section begins with the background information about the basics of Epilepsy the origin of Excitation or Excitement, and there are sections on genetic basis, drug treatment modalities as well as technologies that can detect the types and details of the epilepsy. Other sections regarding the Epidemiology and types of this disease, management and social issues including the misunderstanding and tabo's of epilepsy, sociology of it, and the issue ends with what is food got to do with Epilepsy or what food intake might be the best for people with seizure or epileptic episodes. Overall, seems like a great issue with a comprehensive knowledge about the disease, complexities and its future. I hope I can write a real Editorial with scientific temperament when I am done reading the whole issue.......
Epilepsy is a common neurological condition that affects 50
million people worldwide. For many patients, medication helps reduce
seizure frequency; for drug-resistant epilepsy, treatments include diet
therapy and neurosurgery. Although discussed and feared for millennia,
progress towards understanding epilepsy has been slow — even with help
from modern genetic and neurological analysis. Stigmatization of people
with epilepsy continues in certain parts of the world and though lack of
funding limits epilepsy research, new ways to treat and manage seizures
are on the horizon. Free full access
Cover Art: Nik Spencer
Updates!: One would expect more news or updates on this sealed off city in China, nothing came out after the initial news?...Whatever news came out on this issue was in the month of July?.
Image on the left: This Flea is a carrier of Plague Bacteria.
at the bottom is the image of the bacteria: Yersinia Pestis ------------------------------------------------------------------------------------------------
People
with the plague need immediate treatment. If treatment is not received
within 24 hours of when the first symptoms occur, death can result. Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague. Oxygen, intravenous fluids, and respiratory support usually are also needed. Patients
with pneumonic plague should be strictly isolated from caregivers and
other patients. People who have had contact with anyone infected by
pneumonic plague should be watched carefully and given antibiotics as a
preventive measure.
The following news piece is not related to our field of Neuromonitoring but to disease, medicine and general health care. The way this disease and a case of death has been dealt with a country as large as China is bit unusual and rather bizarre, why?.
What exactly is happening in Yumen City right now:
MSN News: The 30,000 people living in Yumen in the northwestern province of Gansu
are not being allowed to leave, and police at roadblocks on the
perimeter of the city are telling motorists to find alternative routes,
state broadcaster China Central Television (CCTV) said. The
38-year-old victim died last Wednesday, the report said, and had been
in contact with a dead marmot, a small furry animal which lives on
grasslands and is related to the squirrel. "The city has enough rice, flour and oil to supply all its residents for up to one month," the report added. "Local residents and those in quarantine are all in stable condition."
"Live Science" in its latest news report published a piece (news headline and link posted below) about single case of "Plague" death in a small city called Yumen in China. According to the news sources, there is only one Plague death and no other reported case of death or ill (or perhaps the China media or govt did not say so?). Why would a country like China which has good research and science facility and medical facility will take a rather unscientific and scary decision to seal off the town/city.
As per CDC and experts in the field, this is a treatable disease if the patient or victim is brought to the right treatment facility in the earlier stages of infection. Hope some Chinese experts in the field of infectious disease inform the authorities about this treatments.
If it is a Bubonic Plague and if there is treatment available, why did the man died?, and why the city authorities sealing off the city?. It seems the man who died of Plague was interacted with more than 100s of people in that town, that is still not a reason to seal off an entire town, especially the kind of plague infected the dead person was Bubonic Plague, a less infectious and not transferable form of plague. Unless, he had died of other variants of Plague that can be transferred from one human to another, why would such a extreme decision to seal off the city was taken. Or are there more infections that news is not yet out to the public?. This is exactly why I call this Bizzare, this kind of actions will scare the people and create a fear, that is not at all inevitable given the circumstances of this disease, infact the US authorities say every now and then they come across rare cases of plague right here in USA!!. We don't seal off a town or city here...the patient gets the attention of right type of experts and doctors to provide treatment.
On a second thought, I am inclined to think the China is taking every precaution they can because of their past history of plague that devastated the nations.
Note: This Editorial is not to blame China or say insensitive thing about the nation or its actions, it is finally left to them to deal with the situation as it is appropriate, but a thorough scientific approach is a must.
Looking at the EEG patterns periodically at certain time difference, could be week or month in between, Yamanashi and his colleague found that there is a repetitive high frequency EEG waveform abnormality that can be used to strategies for treatment?. Although, it is a brief study on small number of children's, EEG recordings and the abnormal waveform morphology is one of the or the only way to ascertain what to do with such epileptic patient, actually, while referring to the recent reviews in this field, I found this compelling review article by Dr.Markand, MD (see at the bottom after the Yamanashi's work).
What was their research model and study is about:
A total of ten children between the ages of three and ten with
recurrent seizures and 12 patients aged between four and seven years who
experienced isolated seizures were enrolled in the study, with seizure
recurrence and prolonged high-frequency EEG paroxysm data being
correlated by the scientists. Repeated EEG recordings were taken every three months, with clinical
and EEG follow-up performed for four or more years. It was discovered
that seizure recurrence and extended periods of high-frequency
paroxysmal EEG abnormalities for more than 6 months after onset were
significantly linked.
New study shows how EEG can aid rolandic epilepsy treatment
A new study from Japan has shed light on how electroencephalogram
(EEG) techniques can be useful in aiding the treatment of patients with
rolandic epilepsy.
This form of epilepsy is generally associated with favourable
outcomes, with a moderate proportion of cases characterised by isolated
seizure events, meaning continuous treatment need only be considered
only for those affected by frequent seizures.
As such, the new research from the University of Yamanashi aimed to
identify EEG criteria related to seizure recurrence in rolandic
epilepsy, in order to help guide treatment strategies for those in this
patient group.
---------------------------------------
The review article that I mentioned above:
a good read to get the background idea of how the neurophysiologist, neurologist or clinicians can discern the EEG patterns:
An EEG is the most common and most useful test performed in evaluating
patients suspected of epilepsy. There are many areas where an EEG has
unique contributions. The value of an EEG lies in the fact that it not
only shows specific ictal discharges during a clinical seizure but also
characteristic epileptiform abnormalities in a high proportion of
epileptic patients even in the interictal period. Furthermore, an EEG
may be the only test demonstrating focal abnormalities responsible for
the patient's epileptic seizures. Specific patterns in the EEG make it
possible to classify the seizure type, which is an essential
prerequisite to institute proper antiepileptic medication. An EEG is
indispensable for the diagnosis of nonconvulsive epileptic status
presenting as prolonged "twilight" state or a prolonged episode of
abnormal behavior. In a patient with bizarre motor activity, the
recording of an EEG during such an episode may be the only way to
establish whether the abnormal behavior is due to an epileptic seizure
or a nonepileptic event, physiologic or nonphysiologic. Finally, the EEG
is indispensable to localize the epileptogenic (seizure producing) zone
before resective surgery (excision of the epileptogenic zone) is
undertaken in a patient with medically refractory focal epilepsy.
Fig from-Link: Human Epilepsy Patterns, focal epilepsy,
The following two new research reports published in Epilepsia journal [quoted Epilepsy current]might be of interest to those Epilepsy doctors and professionals, ofcourse to Neurophysiologists and long term intraoperative monitoring field.
Quoted: Current Literature In Clinical Science Are HFOs Still UFOs? The Known and Unknown About High Frequency Oscillations in Epilepsy Surgery
High-Frequency Oscillations, Extent of Surgical Resection, and Surgical Outcome in Drug-Resistant Focal Epilepsy.
Haegelen C, Perucca P, Chatillon CE, Andrade-Valenca L, Zelmann R, Jacobs J, Collins DL, Dubeau F, Olivier A, Gotman J.
Epilepsia 2013;54:848–857.
PURPOSE: Removal of areas generating high-frequency oscillations (HFOs) recorded from the intracerebral electroencephalography (iEEG) of patients with medically intractable epilepsy has been found to be correlated with improved surgical outcome. However, whether differences exist according to the type of epilepsy is largely unknown. We performed a comparative assessment of the impact of removing HFO-generating tissue on surgical outcome between temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). We also assessed the relationship between the extent of surgical resectionand surgical outcome.
Read the full abstract at: http://www.aesnet.org/files/dmfile/epcu_13.6_273_ClinicalCommentary_Jobst.pdf#!
And the Full article at Epilesia journal.
Ripple Classification Helps to Localize the Seizure-Onset Zone in Neocortical Epilepsy.
Wang S, Wang IZ, Bulacio JC, Mosher JC, Gonzalez-Martinez J, Alexopoulos AV, Najm IM, So NK.
Epilepsia 2013;54:370–376.
PURPOSE: Fast ripples are reported to be highly localizing to the epileptogenic or seizure-onset zone (SOZ) but may not be readily found in neocortical epilepsy, whereas ripples are insufficiently localizing. Herein we classified interictal neocortical ripples by associated characteristics to identify a subtype that may help to localize the SOZ in neocortical epilepsy. We hypothesize that ripples associated with an interictal epileptiform discharge (IED) are more pathologic,since the IED is not a normal physiologic event.
For full abstract and article, refer as the previous.
