The use of smartwatch electrocardiogram beyond arrhythmia detection.

The adoption of wearables in medicine has expanded worldwide with a rapidly growing number of consumers and new features capable of real-time monitoring of health parameters such as the ability to record and transmit a single-lead electrocardiogram (ECG). Smartwatch ECGs are increasingly used but current smartwatches only screen for atrial fibrillation (AF). Most of the literature has focused on analyzing the smartwatch ECG accuracy for the detection of AF or other tachycardias. As with the conventional ECG, this tool may be used for many more purposes than only detection of AF. The objectives of this review are to describe the published literature regarding the accuracy and clinical value of recording a smartwatch ECG in other situations than diagnosis of tachycardia and discuss possible techniques to optimize the diagnostic yield.

Couples and concealable chronic illness: Investigating couples' communication, coping, and relational well-being over time.

Couples managing chronic illnesses-the leading causes of death and disability in the United States-can experience challenges in their daily lives and relationships. Both couple members have reported lower satisfaction, greater burden, and communication difficulties. Many of these illnesses are nonvisible or concealable, increasing fear and uncertainty when sharing illness information, and reducing self-disclosure. These challenges can leave couples vulnerable to dissatisfaction and distress. In this longitudinal study, we integrated dyadic coping frameworks to examine how couples' communication and coping predicted relational well-being over time. Couples, where one partner was diagnosed with a concealable chronic illness, completed three online surveys 6 months apart (n = 242 couples at baseline, 146 couples at 6 months, and 123 couples at 12 months). Couples were recruited from university settings. Actor-partner interdependence mediation models using within-person multilevel dyadic path modeling tested the theoretical model. For patient and partner actor effects, at times when they saw the illness as shared and something that they could manage together, the more they talked about the illness and used dyadic coping strategies (p < .001). In turn, when using dyadic coping strategies more often, patients and partners felt more satisfied, close, and sexually satisfied than they typically felt that year (p < .001). For cross-partner effects, when patients talked about the illness more than usual, their partners also used dyadic coping strategies more often (p = .01). Patients' open communication may not only benefit themselves but also their partners. This multifaceted approach offers new insight into promoting relational well-being while managing concealable chronic illness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effect of Genetic and Environmental Factors on Twin Pregnancy in Primiparous Dairy Cows.

Twin pregnancies are highly undesirable in dairy cattle; they compromise the health and wellbeing of a cow and dramatically impair the farm economy. Recently, a genomic prediction for twin pregnancies has been developed. The objective of this study was to assess environmental and management risk factors affecting the incidence of twin pregnancies in high-producing dairy cows in their first lactation, with a special emphasis placed on the genomic prediction values of twin pregnancy. Our study population of primiparous cows proved valuable in identifying factors other than genomic predictive values that influence twin pregnancy rates. The odds ratio for twin pregnancies was 0.85 (p < 0.0001) for each unit of a prediction value increase, 3.5 (p = 0.023) for cows becoming pregnant during the negative photoperiod, and 0.33 (p = 0.016) for cows producing ≥42 kg of milk at AI, compared with the remaining cows who produced <42 kg of milk. As a general conclusion, the practical implication of our findings is that genomic prediction values can identify the risk of twin pregnancy at a herd level. Given the cumulative effect of genomic selection, selecting animals with a reduced genetic risk of twin pregnancies can contribute to reducing the incidence of twin pregnancies in dairy herds.

How Conversational Goals Predict Sexual Self-Disclosure Decisions.

Communicating verbally about sexual topics is one aspect of sexual communication, and romantic partners have to choose whether to disclose sexual information. The present study used conversational goals - what one hopes to accomplish in the conversation - to examine how people decide whether or not to engage in sexual self-disclosure. In an online survey, romantically involved participants (n = 428) provided data on four conversational goals (instrumental, impression management, identity, and relational), disclosure efficacy, disclosure anxiety, and likelihood to sexually self-disclose. Mediation model results indicated that the instrumental goal was directly associated with greater likelihood to disclose while the impression management goal was directly associated with less likelihood to disclose. The instrumental, impression management, and relational goals were indirectly connected with the likelihood to sexually self-disclose as mediated by disclosure efficacy and anxiety. The results highlight the importance of considering conversational goals perspectives when studying communication about taboo topics. Implications for future research are discussed.

Connectivity in deep brain stimulation for self-injurious behavior: multiple targets for a common network?

Self-injurious behavior (SIB) is associated with diverse psychiatric conditions. Sometimes (e.g., in patients with autism spectrum disorder or acquired brain injuries), SIB is the most dominant symptom, severely restricting the psychosocial functioning and quality of life of the patients and inhibiting appropriate patient care. In severe cases, it can lead to permanent physical injuries or even death. Primary therapy consists of medical treatment and if implementable, behavioral therapy. For patients with severe SIB refractory to conventional therapy, neuromodulation can be considered as a last recourse. In scientific literature, several successful lesioning and deep brain stimulation targets have been described that can indicate a common underlying neuronal pathway. The objectives of this study were to evaluate the short- and long-term clinical outcome of patients with severe, therapy refractory SIB who underwent DBS with diverse underlying psychiatric disorders and to correlate these outcomes with the activated connectivity networks. We retrospectively analyzed 10 patients with SIB who underwent DBS surgery with diverse psychiatric conditions including autism spectrum disorder, organic personality disorder after hypoxic or traumatic brain injury or Tourette syndrome. DBS targets were chosen according to the underlying disorder, patients were either stimulated in the nucleus accumbens, amygdala, posterior hypothalamus, medial thalamus or ventrolateral thalamus. Clinical outcome was measured 6 months after surgery and at long-term follow-up after 10 or more years using the Early Rehabilitation Barthel index (ERBI) and time of restraint. Connectivity patterns were analyzed using normative connectome. Based on previous literature the orbitofrontal cortex, superior frontal gyrus, the anterior cingulate cortex, the amygdala and the hippocampus were chosen as regions of interest. This analysis showed a significant improvement in the functionality of the patients with DBS in the short- and long-term follow-up. Good clinical outcome correlated with higher connectivity to the amygdala and hippocampus. These findings may suggest a common pathway, which can be relevant when planning a surgical procedure in patients with SIB.

Genomic Prediction for Abortion in Lactating Holstein Dairy Cows.

Abortion in dairy cattle causes great economic losses due to reduced animal health, increase in culling rates, reduction in calf production, and milk yield, among others. Although the etiology of abortions can be of various origins, previous research has shown a genetic component. The objectives of this study were to (1) describe the development of the genomic prediction for cow abortions in lactating Holstein dairy cattle based on producer-recorded data and ssGBLUP methodology and (2) evaluate the efficacy of genomic predictions for cow abortions in commercial herds of US Holstein cows using data from herds that do not contribute phenotypic information to the evaluation. We hypothesized that cows with greater genomic predictions for cow abortions (Z_Abort STA) would have a reduced incidence of abortion. Phenotypic data on abortions, pedigree, and genotypes were collected directly from commercial dairy producers upon obtaining their permission. Abortion was defined as the loss of a confirmed pregnancy after 42 and prior to 260 days of gestation, treated as a binary outcome (0, 1), and analyzed using a threshold model. Data from a different subset of animals were used to test the efficacy of the prediction. The additive genetic variance for the cow abortion trait (Z_Abort) was 0.1235 and heritability was 0.0773. For all animals with genotypes (n = 1,662,251), mean reliability was 42%, and genomic predicted transmitting abilities (gPTAs) ranged from −8.8 to 12.4. Z_Abort had a positive correlation with cow and calf health traits and reproductive traits, and a negative correlation with production traits. Z_Abort effectively identified cows with a greater or lesser risk of abortion (16.6% vs. 11.0% for the worst and best genomics groups, respectively; p < 0.0001). The inclusion of cow abortion genomic predictions in a multi-trait selection index would allow dairy producers and consultants to reduce the incidence of abortion and to select high-producing, healthier, and more profitable cows.

The impact of concealable chronic health conditions on college students' academic outcomes: A two-wave study.

College students (N = 125) with concealable chronic health conditions (CCHCs) completed online surveys at the beginning and end of the semester assessing stigma experiences and academic outcomes. Correlations showed stigma, alienation, and lack of campus fit were associated with greater illness-related academic interference (ps < 0.001), negative academic self-comparison (ps < 0.001), academic anxiety (ps < 0.001), academic dissatisfaction (ps < 0.001), and lower expected grades (except alienation; ps < 0.001-0.03) over time. Hierarchical multiple regressions identified a lack of campus fit as an important predictor across academic outcomes (ps < 0.001-0.019). Students with CCHCs face health- and stigma-related challenges that can interfere with academic performance.

Genomic Prediction for Twin Pregnancies.

Twinning is a multifactorial trait influenced by both genetic and environmental factors that can negatively impact animal welfare and economic sustainability on commercial dairy operations. To date, using genetic selection as a tool for reducing twinning rates on commercial dairies has been proposed, but not yet implemented. In response to this market need, Zoetis (Kalamazoo, MI, USA) has developed a genomic prediction for twin pregnancies, and included it in a comprehensive multitrait selection index. The objectives of this study were to (1) describe a genetic evaluation for twinning in Holstein cattle, (2) demonstrate the efficacy of the predictions, (3) propose strategies to reduce twin pregnancies using this information. Data were retrieved from commercial dairies and provided directly by producers upon obtaining their permission. The twin pregnancies trait (TWIN) was defined as a pregnancy resulting in birth or abortion of twin calves, classified as a binary (0,1) event, and analysed using a threshold animal model. Predictions for a subset of cows were compared to their on-farm twin records. The heritability for twin pregnancies was 0.088, and genomic predicted transmitting abilities ((g)PTAs) ranged from -7.45-20.79. Genetic correlations between TWIN and other traits were low, meaning that improvement for TWIN will not negatively impact improvement for other traits. TWIN was effectively demonstrated to identify cows most and least likely to experience a twin pregnancy in a given lactation, regardless of reproductive protocol used. Effective inclusion of the prediction in a multitrait selection index offers producers a comprehensive tool to inform selection and management decisions. When combined with sound management practices, this presents a compelling opportunity for dairy producers to proactively reduce the incidence of twin pregnancies on commercial dairy operations.

Off-Pump Coronary Artery Bypass Reduces Cardiac Death in Patients with Peripheral Arteriopathy.

OBJECTIVE: The aim of this study was to investigate whether the use of off-pump coronary artery bypass (OPCAB) may enhance early outcomes in subjects with peripheral artery disease (PAD) undergoing coronary artery bypass grafting (CABG). METHODS: We employed a propensity-score (PS) method to compare early postoperative results of OPCAB and on-pump CABG patients with associated PAD. The study population consisted of 1,961 patients: 284 in the OPCAB and 1,677 in the on-pump CABG group. The inverse probability of treatment weighting was used as PS method. RESULTS: The incidence of death (1.2% [95% confidence interval, CI: -0.9 to 3.3%], p = 0.262), stroke (2.2% [95% CI: -1.4 to 5.7%], p = 0.235), acute kidney disease (1.5% [95% CI: -3.8 to 6.8%], p = 0.586), limb ischemia (3.2% [95% CI: -0.6 to 7.0%], p = 0.315), and low output syndrome (1.2% [95% CI: -0.9 to 3.3%], p = 0.262) did not differ between the two groups. On the other hand, the rate of cardiac death (1.2% [95% CI: -0.1 to 2.3%], p = 0.038) was significantly higher in on-pump CABG group. CONCLUSIONS: The OPCAB procedure considerably reduced the occurrence of cardiac death after coronary revascularization. This finding might suggest that the OPCAB procedure should be considered as the first option in patients with higher cardiovascular risk scores. Further research is warranted.

A two-wave study on the health and relationship consequences of experienced stigma among individuals with concealable chronic health conditions.

Applying and extending the concealable stigmatized identity outcomes model, this two-wave study examined the psychological, behavioral, physical, and relational health consequences of experienced stigma among a sample of 124 individuals with concealable chronic health conditions. Path analyses revealed that chronic health condition-related experienced stigma was associated with greater chronic health condition-related stress, which in turn was linked to more physical health problems and, ultimately, poorer relational health 4 months later. These findings demonstrate that chronic health condition-related experienced stigma not only creates psychological, behavioral, and physical health consequences but also contributes to poor relational health over time among individuals with chronic health conditions.

The use of both internal thoracic arteries for coronary revascularization increases the estimate of post-operative lower limb ischemia in patients with peripheral artery disease.

BACKGROUND: Patients with a history of peripheral arterial disease (PAD) undergoing coronary artery bypass grafting (CABG) exhibit higher rates of complications. There are conflicting data on the survival benefits for bilateral thoracic artery (BITA) grafting compared with left internal thoracic artery (LITA) CABG in patients with PAD. The aim of the study was to explore the influence of the use of BITA grafts vs. LITA for CABG on post-operative acute lower limb ischemia (ALLI) and main post-operative complications in patients with concomitant PAD. METHODS: We used a propensity-score (PS) based analysis to compare outcomes between the two surgical procedures, BITA and LITA. The inverse probability of treatment weighting PS technique was applied to adjust for pre- and intra-operative confounders, and to get optimal balancing of the pre-operative data. The primary outcome was the estimate of postoperative ALLI. Secondary outcomes included overall death and death of cardiac causes within 30 days of surgery, stroke and acute kidney disease (AKD). RESULTS: The study population consisted of 1961 patients. The LITA procedure was performed in 1768 patients whereas 193 patients underwent a BITA technique. The estimate of ALLI was 14% higher in the BITA compared to the LITA (p < 0.001) group. Thirty-day mortality, cardiac death, occurrence of stroke and AKI did not differ significantly between the groups. CONCLUSIONS: The use of both ITAs led to a significant increase in ALLI. This result was most likely caused by the complete disruption of the ITA collateral providing additional blood supply to the lower extremities. Based on our data, BITA should be used with extreme caution in PAD patients. Further research on this topic is necessary to confirm our findings.

Validation of genomic predictions for a lifetime merit selection index for the US dairy industry.

Selection indices are a critical component of many breeding programs. A common purpose of a selection index is to predict an animal's genetic potential for total economic merit. The objective of this study was to evaluate retrospectively whether a specific selection index comprising genomically-enhanced predicted transmitting abilities had the ability to predict observed lifetime profit in US Holstein animals. The selection index evaluated was dairy wellness profit (DWP$). In total, 2,185 animals were included in this study. Index values were used to rank and assign animals to quartiles (genetic groups: worst 25%, 26-50%, 51-75%, and best 25%). Generalized linear mixed effects models were applied to estimate the associations between index quartile and defined economic outcomes. Similar analyses were conducted to estimate associations between index quartile and observed phenotype to characterize the extent to which profitability outcomes were driven by economically relevant production and health traits. Differences in lifetime profit and annuity value between the best and worst genetic groups for DWP$ were $811 (±297) and $232 (±88), respectively. Significant differences were also observed between top and bottom quartiles for milk production (8,077 kg), fat production (336 kg), protein production (264 kg), live calves (0.5), time spent in the lactating herd (6.6 mo), and cow mortality (8.4%). Additionally, differences in disease incidence were significant between the best and worst DWP$ quartiles for metritis (5.2%), mastitis (14.9%), and lameness (15.9%). The observed results of this study demonstrated the ability of DWP$ predictions to predict lifetime profitability of Holstein animals and its potential utility as a tool to guide selection and breeding programs. Improving DWP$ through genetic selection, when combined with good management practices, provides an opportunity for dairy producers to improve overall herd profitability.

Exploring a Contextual Model of Sexual Self-Disclosure and Sexual Satisfaction.

Sexual self-disclosure is a critical component of relationship and sexual satisfaction, yet little is known about the mechanisms that facilitate a person's engagement in sexual self-disclosure. Individuals (N = 265) involved in romantic relationships participated in an online study testing a contextual model of sexual self-disclosure across three contexts: relationship context, sexual self-disclosure context, and outcome of sexual self-disclosure. Results suggest that sexual satisfaction was predicted by a positive relationship context and a positive sexual self-disclosure context. In addition, the sexual self-disclosure context was predicted by the relationship context. These findings emphasize the importance of examining contextual influences that determine whether an individual will engage in or avoid sexual self-disclosure and the consequences of this engagement or avoidance on sexual satisfaction.

Aberration correction in coherence imaging microscopy using an image inverting interferometer.

We present an imaging method with the ability to correct even large optical phase aberrations in a purely numerical way. For this purpose, the complex coherence function in the pupil plane of the microscope objective is measured with the help of an image inverting interferometer. By means of a Fourier transform, it is possible to reconstruct the spatially incoherent object distribution. We demonstrate that aberrations symmetric to the optical axis do not impair the imaging quality of such a coherence imaging system. Furthermore, we show that it is possible to gain an almost complete correction of remaining aberrations with the help of a reference measurement. A mathematical derivation is given and experimentally verified. To demonstrate the ability of our method, randomly generated aberrations with peak-to-valley values of up to 8 λ are corrected.

Just-noticeable differences for wavefront aberrations obtained with a staircase procedure.

PURPOSE: To explore the magnitude of aberrations that alter the subjective visual quality measurably. The suitability of a staircase procedure for threshold determination was investigated. METHODS: Spectacle correction (correction A) was achieved in 28 healthy eyes by an adaptive optics set-up, and additional astigmatism, coma, or trefoil was induced (correction B). Subjects observed a radial test pattern with noncyclopleged eyes using an artificial 5-mm pupil. They compared corrections A and B and identified the subjectively better correction. The magnitude of the aberration for each presentation varied according to the "Best PEST" staircase procedure. Just-noticeable difference (JND) was found after 30 presentations. Participants were divided into three groups, and the experiment was repeated under the following conditions: without modifications (n = 9), with a letter chart (n = 10), and with full correction of all aberrations (n = 9). RESULTS: Median JND was 0.091 µm for astigmatism, 0.059 µm for coma, and 0.108 µm for trefoil, with a large interindividual spread. Repeatability coefficient across the three aberrations was 0.095 µm. A significant correlation was found between JNDs and the residual aberrations (without the generated aberration) in astigmatism and coma. Differences between radial test pattern and letter chart and between spectacle correction and full correction were not significant. CONCLUSIONS: JNDs were lower for coma than for astigmatism and trefoil, depending on the magnitude of other residual aberrations, and showed large variations among subjects. Thus, the decision to correct more pronounced aberrations (eg, by wavefront-guided LASIK) should not depend on wavefront measurement results alone. A staircase procedure for determination of JNDs provides repeatable results.

Increased membrane shedding--indicated by an elevation of CD133-enriched membrane particles--into the CSF in partial epilepsy.

PURPOSE: Recent analyses provided evidence that human adult cerebrospinal fluid (CSF) in addition to soluble proteins also contains membrane particles that moreover carry the somatic stem cell marker CD133. The significance of CD133 as a potential marker of cellular proliferation, including neurogenesis, remains unresolved. As adult neurogenesis has been implicated to be induced by epileptic seizures this study investigated whether patients with partial epilepsy show a varying amount of membrane-associated CD133 in CSF as compared to healthy adults. METHODS: CSF samples of 34 partial epilepsy patients were analyzed and compared to 61 healthy controls. Following sequential centrifugation up to 200,000 g quantitative immunoblotting was performed using a mouse monoclonal antibody. Antigen-antibody complexes were detected using enhanced chemiluminescence, and visualized and quantified digitally. RESULTS: The overall amount of membrane particle-associated CD133 was significantly increased in epilepsy patients compared to healthy controls (9.6±2.9 ng of bound CD133 antibody versus 7.4±3.8 ng; p<0.01). There were no differences according to etiology of epilepsy (cryptogenic, neoplasia, dysplasia, ammon's horn sclerosis, and others). Dichotomization of the patients according to temporal versus extratemporal foci revealed a significant increase of membrane particle-associated CD133 in patients with temporal lobe epilepsy (10.88±3.3 ng of bound CD133 antibody versus 8.35±3.48 ng; p<0.05). CONCLUSION: The increased amount of membrane particle-associated CD133 in the CSF of patients with partial epilepsy contributes to the ongoing debate of the source of these particles potentially emerging from subventricular zone astrocytes serving as neural stem cells. As neurogenesis in adults is related to the hippocampus, the significance of the increase of membrane particle-associated CD133 especially in temporal lobe epilepsy needs further clinical correlation.

Neuropathologic measurements in focal cortical dysplasias: validation of the ILAE 2011 classification system and diagnostic implications for MRI.

Focal cortical dysplasias (FCD) which represent a composite group of cortical malformations are increasingly recognized as morphological substrate for severe therapy-refractory epilepsy in children and young adults. However, presurgical evaluation remains challenging as not all FCD variants can be reliably detected by high-resolution magnetic resonance imaging (MRI). Here, we studied a cohort of 52 epilepsy patients with neuropathological evidence for FCD using the 2011 classification of the International League against Epilepsy (ILAE) and systematically analysed those histopathologic features applicable also for MRI diagnostics. Histopathologic parameters included quantitative measurements of cellular profiles, cortical thickness, heterotopic neurons in white matter, and myelination that were compared between FCD subtypes and age-/localization-matched controls (n = 36) using multivariate analysis. Dysmorphic neurons in both FCD Type II variants showed significantly increased diameter of their cell bodies and nuclei. Cortical thickness was also increased with a distinct loss of myelin content specifying FCD Type IIb from IIa. The data further suggested that myelination deficits in FCD Type IIb result from compromised oligodendroglial lineage differentiation and we concluded that the "transmantle sign" is a unique finding in FCD Type IIb. In contrast, FCD Type Ia was characterized by a smaller cortical ribbon and higher neuronal densities, but these parameters failed to reach statistical significance (considering age- and location-dependent variability in controls). All FCD variants showed abnormal grey-white matter boundaries with increased numbers of heterotopic neurons. Similar results were obtained also at deep white matter location. Thus, many FCD variants may indeed escape visual MRI inspection, but suspicious areas with increased or decreased cortical thickness as well as grey-white matter blurring may be uncovered using post-processing protocols of neuroimaging data. The systematic analysis of well-specified histopathological features could be helpful to improve sensitivity and specificity in MRI detection during pre-surgical work-up of patients with drug-resistant focal epilepsies.

Serologic response to Mannheimia haemolytica in calves concurrently inoculated with inactivated or modified-live preparations of M. haemolytica and viral combination vaccines containing modified-live bovine herpesvirus type 1.

OBJECTIVE: To assess the serologic response of calves to inactivated and modified-live (ML) Mannheimia haemolytica (MH) preparations given alone and concurrently with combination viral vaccines containing ML bovine herpesvirus type 1 (BHV-1). ANIMALS: 642 calves seronegative for BHV-1. PROCEDURES: In experiment 1, 192 calves received 1 of 3 MH preparations alone or concurrently received 1 of 3 MH preparations and 1 of 4 combination viral vaccines. In experiment 2, 450 calves received 1 of 4 MH preparations alone or concurrently received 1 of 4 MH preparations and 1 of 5 combination viral vaccines. Pretreatment and posttreatment blood samples were processed to obtain serum, which was analyzed to detect concentrations of antibodies against MH leukotoxin and BHV-1. RESULTS: In experiment 1, antibody titers against MH leukotoxin in calves receiving MH and ML virus vaccine appeared decreased, albeit nonsignificantly, compared with titers for calves receiving MH preparations alone. In experiment 2, all groups (except for 1) concurrently receiving an MH preparation and viral vaccine had a significant decrease in antibodies against MH leukotoxin. In both experiments, there was a significant decrease in the number of calves responding to MH leukotoxin when ML viral vaccine was coadministered. CONCLUSIONS AND CLINICAL RELEVANCE: Coadministration of ML BHV-1 and MH preparations interfered with the serologic response to MH leukotoxin in calves seronegative for BHV-1. Serologic response to MH leukotoxin may be substantially improved in seronegative calves when MH vaccination is delayed until after calves have received a dose of ML BHV-1 vaccine.

MEG in frontal lobe epilepsies: localization and postoperative outcome.

PURPOSE: This study aimed to analyze magnetoencephalography (MEG) localizations of epileptic clusters in different cortical regions of the frontal lobe and relate these findings to postoperative outcomes associated with frontal lobe epilepsy (FLE). METHODS: Thirty-nine patients from the Epilepsy Center of Erlangen-Nuremberg University with or without lesions on their magnetic resonance imaging (MRI) scans underwent MEG measurements and operation and were then analyzed retrospectively. MEG data were obtained using systems with either 74 or 248 channels. Single dipole analysis assuming a spherical head model was performed for localization. KEY FINDINGS: Epileptic clusters were detected by MEG in 30 patients, corresponding to a sensitivity of 76.9%; there was a sensitivity of 66.7% (20 of 30) in patients with monofocal activity (70% had an Engel class 1 outcome) and 33.3% (10 of 30) in patients with multifocal activity (20% had an Engel class 1 outcome). Of the patients who had isolated clusters, the distance between the MEG localizations and the respective lesions was equal to or <3 cm in 90% (18 of 20) of patients (13 of them had an Engel class 1 outcome) and >3 cm in 10% (2 of 20) of patients (one of them had an Engel class 1 outcome). A statistical difference was found between the outcomes of patients with a single focus and with multiple foci (p < 0.05). SIGNIFICANCE: Patients with a single focus had better postoperative outcomes compared with patients with multiple foci. MEG localizations close to the lesion marked the lesion or its surrounding network as epileptogenic. Therefore, source localization can provide important information for the presurgical evaluation of patients with FLE.

The correlation between ictal semiology and magnetoencephalographic localization in frontal lobe epilepsy.

OBJECTIVE: The aim of this study was to investigate the correlation of ictal semiology with localization and/or lateralization by magnetoencephalography (MEG). METHODS: Seven patients from the Neurology Department of the University Hospital Erlangen who underwent resective surgery for frontal lobe epilepsy (FLE) with an Engel 1a outcome were investigated retrospectively. MEG localizations were classified according to five compartments (separate or combined) of the frontal lobe: frontal basal (FB), frontal lateral (FL), frontal polar (FP), frontal mesial (FM), and frontal precentral (FPr). On the basis of previous studies that investigated the value of ictal semiology in localization and lateralization, we compared the experiential localization and/or lateralization of the epileptogenic region deduced from ictal semiology, that is, both seizure history and ictal video/EEG monitoring, with MEG localization. RESULTS: It is easier to determine lateralization than localization from ictal semiology because of the variety of signs and fast propagation in FLE. All of the patients had specific MEG localizations according to favorable postoperative outcome. Three patients had MEG foci associated with ictal semiology; in another four, the MEG localization was adjacent to the estimated area suggested by ictal semiology. Head version signs could be observed in all compartments of the frontal lobe: clonic in FB and FP areas; postural in FPr, FL, and FM areas; hypermotor in FB, FP, FPr, and FM areas; sensation aura in FB, FL, and FM areas; and automatisms in FP, FPr, and FL areas. All patients had concordant lateralizing and limited valuable locating information from ictal semiology, but no complete correlation with MEG foci. CONCLUSION: Ictal semiology may indicate the involvement of a symptomatogenic brain region during a seizure, but extent of seizure onset in central motor or sensorimotor area is not reliable enough to indicate the seizure onset zone and favorable postoperative outcome in FLE. MEG provided specific localization of epileptic activity in a FLE compartment, and indicated the relationship between epileptogenic region and lesion. MEG can complement ictal semiology in establishing a noninvasive focal localization hypothesis.