Milk production of cows grazing pasture supplemented with grain mixes containing canola meal or corn grain or both over the first 100 days of lactation.

Grain mixes varying in proportions of wheat grain, barley grain, canola meal, and corn grain were fed to grazing dairy cows in early lactation to determine the contribution of canola meal and corn grain to milk yield, BW, BCS, eating behavior, and blood serum metabolite concentrations. The experiment used 80 multiparous, seasonally calving Holstein-Friesian dairy cows during the first 100 d of lactation, the treatment period, and over the subsequent carryover period of 100 d, during which all cows were fed a common diet. Cows were divided into 4 cohorts (blocks) based on calving date and within each cohort, 5 cows were randomly allocated to each of the 4 treatments. Dietary treatments included disc-milled grain mixes comprising (on a DM basis) (1) a control treatment of wheat (25%) and barley (75%); (2) wheat (25%), barley (50%), and canola meal (25%); (3) wheat (25%), barley (50%), and corn (25%), and (4) wheat (25%), barley (25%), canola meal (25%), and corn (25%). Treatment diets were introduced at 19 DIM ± 4.7 d, which included a 7-d adaptation period and were applied up until 100 DIM. Each grain mix was fed at 9 kg of DM/cow per day, offered twice daily, in equal proportions in the parlor at milking times. In addition to the grain mix, all cows grazed perennial ryegrass pasture at a daily allowance of ∼35 kg of DM/cow per day (measured to ground level). Results were analyzed in terms of corn and canola presence or absence in the diet. Including canola meal in grain mixes increased grain intake and pasture intake by 0.6 and 2.1 kg of DM/cow per day, respectively, resulting in an increased milk yield of 2.6 kg/cow per day during the first 100 d of lactation. Including canola meal also increased yields of milk fat and protein, and concentrations of milk fat, as well as increasing mean BW and BCS over the 100 d. The inclusion of canola meal in the grain mixes also resulted in greater blood serum BHB and urea concentrations, compared with feeding grain mixes that did not contain canola meal. The inclusion of corn grain provided no milk production benefits and did not change BW, BCS, or any feeding behavior variables. There were no carryover effects on milk production from either canola meal or corn grain after the treatment period. In summary, the results demonstrate that the provision of canola meal in grain mixes can improve milk production and increase mean BCS. Further, there are no benefits to milk yield when a proportion of barley is substituted for corn, in a wheat and barley grain mix fed to grazing dairy cows in early lactation. However, these results are dependent on the level of inclusion and the feeding system employed.

Influence of proportion of wheat in a pasture-based diet on milk yield, methane emissions, methane yield, and ruminal protozoa of dairy cows.

Wheat is the most common concentrate fed to grazing dairy cows in Australia, but no studies have examined the effects of wheat proportion in a pasture-based diet on milk production and methane emissions. In this 47-d experiment, 32 Holstein dairy cows were offered 1 of 4 diets during d 1 to 36. Cows in each of the dietary treatment groups were individually offered no wheat (W0) or wheat at 3 kg of dry matter (DM)/d (W3), 6 kg of DM/d (W6), or 9 kg of DM/d (W9). The remainder of the diet was 2.2 kg of DM of concentrate mix and freshly harvested perennial ryegrass (Lolium perenne) such that all individual cows were offered a total diet of approximately 20.2 kg of DM/d. From d 37 to 47 the diets of cows receiving treatments W0 and W3 remained unchanged, but cows in treatments W6 and W9 received the W3 diet. Individual cow feed intakes, milk yields, milk compositions, and methane emissions were measured for d 31 to 35 (period 1) and d 45 to 47 (period 2). During period 1, the mean intakes of cows offered the W0, W3, W6, and W9 diets were 19.2, 20.4, 20.2, and 19.8 kg of DM/d. Diet caused differences in energy-corrected milk, and means for W0, W3, W6, and W9 were 29.5, 32.4, 33.0, and 32.9 kg/d, respectively. Milk fat percentage differed with respective means of 3.93, 3.94, 3.69, and 3.17. Diets also caused differences in methane emissions, with means for W0, W3, W6, and W9 of 440, 431, 414, and 319 g/d. During period 1, the cows fed the W9 diet produced less methane and had lower methane yields (g/kg of DMI) and intensities (g/kg of energy-corrected milk) than cows fed the W3 diet. However, in period 2 when the wheat intake of cows in the W9 treatment was reduced to the same level as in the W3 treatment, their methane emissions, yields, and intensities were similar to those offered the W3 treatment, yet protozoa numbers in ruminal fluid were still much lower than those in cows offered the W3 treatment. Our research shows that for diets based on perennial ryegrass and crushed wheat, only the diet containing more than 30% crushed wheat resulted in substantially depressed milk fat concentration and reduced methane emissions, methane yield, and methane intensity. Thus, although feeding a diet with a high proportion of wheat can cause substantial methane mitigation, it can come at the cost of depression in milk fat concentration.

Effect of dietary fat supplementation on methane emissions from dairy cows fed wheat or corn.

Diets that contain high proportions of either wheat or supplementary fat have been individually reported to reduce enteric methane production. The objective of this research was to determine the effect of dietary fat supplementation on methane emissions and milk yield from cows fed diets containing either corn or wheat grains. It was hypothesized that cows fed a diet containing wheat would produce less methane and have lower methane yield (methane per kg of dry matter intake; MY) than cows fed a diet containing corn and that methane mitigation from fat supplementation would occur irrespective of the type of grain in the basal diet. The experiment involved 32 Holstein-Friesian dairy cows allocated to 1 of 4 treatment groups (n = 8) and individually fed different diets restricted to approximately 90% of their mean ad libitum intake measured during a covariate period. All animals were offered 11.5 kg of dry matter/d of alfalfa hay, 1.8 kg of dry matter/d of solvent-extracted canola meal, and 1 of 4 dietary supplements. Dietary supplements were 8 kg of dry matter/d of either corn or wheat, or these same treatments with the addition of 0.8 kg of canola oil. In this 5-wk experiment, d 1 to 7 served as the covariate period, d 8 to 14 as the transition period, d 15 to 28 as the adaptation period, and d 29 to 35 as the experimental period. Cows were fed their full treatment diets from d 15 to 35 during which time milk production and feed intake were measured daily. During d 29 to 35, methane production was measured for individual cows daily using the sulfur hexafluoride tracer method. The resulting averages for milk production and feed intake were analyzed by analysis of covariance with factorial grain by fat as treatment structure, animal as the unit within blocks, and the corresponding milk production or feed intake covariate averages as principal covariate. Data on milk fatty acids, ruminal fluid data on pH, ammonia, volatile fatty acids, protozoa, and methane were analyzed by ANOVA using the same treatment and blocking structures excluding the principal covariate. Cows fed a diet containing wheat had greater MY than cows fed a diet containing corn. Irrespective of the type of grain in the diet, increasing the fat concentration from 2 to 6% dry matter reduced MY. It is concluded that the grain component in the basal diet does not affect the mitigating effects of dietary fat supplements on MY.

Influence of feeding supplements of almond hulls and ensiled citrus pulp on the milk production, milk composition, and methane emissions of dairy cows.

Almond hulls and citrus pulp have been fed to dairy cows with variable responses for milk production, but no information exists on their effect on enteric methane emissions. This experiment examined the effects of dietary supplementation with either almond hulls or ensiled citrus pulp on the milk yield, milk composition, and enteric methane emissions of dairy cows. Thirty-two Holstein dairy cows in mid lactation were offered 1 of 3 diets over a 28-d experiment. Twelve cows received a control (CON) diet, 10 cows a diet containing almond hulls (ALH), and 10 cows a diet containing ensiled citrus pulp (CIT). All cows were offered 6.0 kg of dry matter (DM)/d of crushed corn, 2.0 kg of DM/d of cold-pressed canola, and 0.2 kg of DM/d of a mineral mix. In addition, cows fed the CON diet were offered 14.5 kg of DM/d of alfalfa cubes; cows fed the ALH diet were offered 10.5 kg of DM/d of alfalfa cubes and 4.0 kg of DM/d of almond hulls; and cows on the CIT diet were offered 11.5 kg of DM/d of alfalfa cubes and 3.0 kg of DM/d of ensiled citrus pulp. Milk yield was measured daily and milk composition was measured on 4 d of each week. Individual cow methane emissions were measured by a sulfur hexafluoride tracer technique on d 24 to 28 of the experiment. The mean milk yield of cows fed the CON diet (27.4 kg/d) was greater than the mean milk yield of cows fed the ALH diet (24.6 kg/cow per day), whereas the mean milk yield of cows fed the CIT diet (26.2 kg/cow per day) was not different from the mean milk yield from cows fed the other 2 diets. Dietary treatment did not influence the concentrations of milk fat, protein, and lactose or fat yields, but the mean protein yield from cows fed the CON diet (0.87 kg/d) was greater than that from cows fed the ALH diet (0.78 kg/d) but not different to those fed the CIT diet (0.85 kg/d). In general, we found no differences in the proportion of individual fatty acids in milk. The mean pH of ruminal fluid from cows offered the CON diet was not different to the pH in the ruminal fluids of cows offered the ALH or the CIT diets. The mean methane emissions (g/d) and yields (g/kg of DM intake) were not influenced by dietary treatment. These findings indicate that, although almond hulls and ensiled citrus pulp can be used as a low-cost feed supplement, almond hulls did negatively affect milk production and neither inhibited enteric methane emissions.

Adaptation responses in milk fat yield and methane emissions of dairy cows when wheat was included in their diet for 16 weeks.

Short-term studies have shown that feeding dairy cows diets containing a high proportion (>40%) of wheat may result in reduced milk fat concentration and reduced CH4 emissions (g of CH4/cow per d), but no long-term studies have been done on these responses. This study compared the milk production and CH4 responses when 24 dairy cows were fed diets containing high proportions of either wheat or corn over 16 wk. Cows were assigned to 2 groups and offered a diet (CRN) containing 10.0 kg of dry matter/d of crushed corn grain, 1.8 kg of dry matter/d of canola meal, 0.2 kg of dry matter/d of minerals, and 11.0 kg of dry matter/d of chopped alfalfa hay or a similar diet (WHT) in which wheat replaced the corn. Dry matter intake and milk yields of individual cows were measured daily. Methane emissions from individual cows were measured using controlled climate respiration chambers over 2 consecutive days during each of wk 4, 10, and 16. Milk composition was measured on the 2 d when cows were in chambers during wk 4, 10, and 16. Over the 16-wk experimental period, total dry matter intake remained relatively constant and similar for the 2 dietary treatment groups. At wk 4, CH4 emission, CH4 yield (g of CH4/kg of dry matter intake), milk fat yield, and milk fat concentration were substantially less in cows fed the WHT diet compared with the same metrics in cows fed the CRN diet; but these differences were not apparent at wk 10 and 16. The responses over time in these metrics were not similar in all cows. In 4 cows fed the WHT diet, CH4 yield, milk fat concentration, and milk fat yield remained relatively constant from wk 4 to 16, whereas for 5 fed the WHT diet, their CH4 emissions, milk fat yields, and milk fat concentrations almost doubled between wk 4 and 16. In the short term (4 wk), the inclusion of approximately 45% wheat instead of corn in the diet of cows resulted in reductions of 39% in CH4 yield, 35% in milk fat concentration, and 40% in milk fat yield. However, these reductions did not persist to wk 10 or beyond. Our data indicate that cows do not all respond in the same way with some "adaptive" cows showing a marked increase in CH4 yield, milk fat concentration, and milk fat yield after wk 4, whereas in other "nonadaptive" cows, these metrics were persistently inhibited to 16 wk. This research shows that short-term studies on dietary interventions to mitigate enteric CH4 emissions may not always predict the long-term effects of such interventions.

Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus Nerve Stimulation Study Group E01-E05.

OBJECTIVE: To perform an open-label, long-term efficacy and safety/tolerability study of vagus nerve stimulation (VNS) of 454 patients with refractory epilepsy. METHODS: Subjects were enrolled from five clinical trials of VNS between 1988 and 1995 after undergoing an implantation of a pulse generator in the chest and a left cervical vagus nerve-stimulating lead coil. Patients were assessed at 6-month intervals until device approval. Seizure frequencies, medication treatment, and adverse events (AEs) were recorded and entered into a database. RESULTS: A total of 454 patients were implanted, and 440 patients yielded assessable data. A > or =50% seizure reduction postimplantation occurred in 36.8% of patients at 1 year, in 43.2% at 2 years, and in 42.7% at 3 years. Median seizure reductions compared with baseline were 35% at 1 year, 44.3% at 2 years, and 44.1% at 3 years. Most common AEs postimplantation at 1 year were hoarseness (28%) and paraesthesias (12%), at 2 years were hoarseness (19.8%) and headache (4.5%), and at 3 years was shortness of breath (3.2%). Continuation rates were 96.7% at 1 year, 84.7% at 2 years, and 72.1% at 3 years. CONCLUSION: Long-term, open-label vagus nerve stimulation (VNS) provided seizure reduction similar to or greater than acute studies, for median reductions and for those reaching a > or =50% seizure reduction. VNS remained safe and well tolerated, with nearly three-quarters of the patients choosing to continue therapy.

Fulminant progression of demyelinating disease after valproate-induced encephalopathy.

We report the clinical, radiologic, and pathologic features of a patient who had fulminant demyelinating disease and who experienced acute progression of his disease after an episode of valproate-induced hyperammonemic encephalopathy. The role hyperammonemia played in the progression of the demyelination is uncertain. This case raises concern of a possible risk with the use of valproic acid in the subset of patients with fulminant demyelinating disease.

Side of seizure focus predicts left medial temporal lobe activation during verbal encoding.

OBJECTIVE: Functional MRI (FMRI) was used to investigate the effect of medial temporal lobe (MTL) pathology on activation of language encoding areas in patients with temporal lobe epilepsy (TLE). METHODS: Whole-brain FMRI was obtained. Twenty-eight patients with either left TLE (LTLE) or right TLE (RTLE) performed a semantic decision task alternating with an auditory perceptual task. RESULTS: Activation of language areas in the frontal and parietal lobes was similar in both groups, with no group differences in the total number of active voxels. However, the RTLE group showed much stronger activation of the left MTL, including the hippocampus, parahippocampal gyrus, and collateral sulcus, than did the LTLE group. CONCLUSIONS: Activation of the left MTL during semantic encoding discriminates patients with RTLE and LTLE. This FMRI technique may potentially be of use in determining memory lateralization and for predicting the side of seizure focus in TLE.

Functional magnetic resonance imaging of complex human movements.

Functional magnetic resonance imaging (FMRI) is a new, noninvasive imaging tool thought to measure changes related to regional cerebral blood flow (rCBF). Previous FMRI studies have demonstrated functional changes within the primary cerebral cortex in response to simple activation tasks, but it is unknown whether FMRI can also detect changes within the nonprimary cortex in response to complex mental activities. We therefore scanned six right-handed healthy subjects while they performed self-paced simple and complex finger movements with the right and left hands. Some subjects also performed the tasks at a fixed rate (2 Hz) or imagined performing the complex task. Functional changes occurred (1) in the contralateral primary motor cortex during simple, self-paced movements; (2) in the contralateral (and occasionally ipsilateral) primary motor cortex, the supplementary motor area (SMA), the premotor cortex of both hemispheres, and the contralateral somatosensory cortex during complex, self-paced movements; (3) with less intensity during paced movements, presumably due to the slower movement rates associated with the paced (relative to self-paced) condition; and (4) in the SMA and, to a lesser degree, the premotor cortex during imagined complex movements. These preliminary results are consistent with hierarchical models of voluntary motor control.

Determination of language dominance using functional MRI: a comparison with the Wada test.

We performed functional MRI (FMRI) in 22 consecutive epilepsy patients undergoing intracarotid amobarbital (Wada) testing and compared language lateralization measures obtained with the two procedures. FMRI used a single-word semantic decision task previously shown to activate lateralized language areas in normal adults. Correlation between the two tests was highly significant (r = 0.96; 95% CIs 0.90 to 0.98; p < 0.0001). These results validate the FMRI technique and suggest that "active" areas observed with this semantic processing task correspond to those underlying hemispheric dominance for language. This strong correlation observed supports the view that language lateralization is a continuous rather than a dichotomous variable. In addition to lateralization information, FMRI consistently demonstrated focal regions of activity in lateral frontal and temporo-parieto-occipital cortex. These functional maps may be helpful in defining the boundaries of surgical excisions.

Oxcarbazepine: double-blind, randomized, placebo-control, monotherapy trial for partial seizures.

OBJECTIVE: To evaluate the efficacy and safety of oxcarbazepine in a placebo-control trial. METHODS: A multicenter, double-blind, randomized, placebo-control, two-arm parallel group, monotherapy design was used to compare oxcarbazepine administered 1,200 mg twice daily to placebo in hospitalized patients with refractory partial seizures, including simple and complex partial seizures and partial seizures evolving to secondarily generalized seizures. Patients exited the trial after completing the 10-day double-blind treatment phase or after experiencing four partial seizures, two new-onset secondarily generalized seizures, serial seizures, or status epilepticus, whichever came first. RESULTS: Analysis of the primary efficacy variable--time to meeting one of the exit criteria--showed a statistically significant effect in favor of oxcarbazepine (p = 0.0001). The secondary efficacy variables--percentage of patients who met one of the exit criteria (p = 0.0001) and total partial seizure frequency per 9 days during the double-blind treatment (p = 0.0001)--were also statistically significant in favor of oxcarbazepine. CONCLUSION: These results demonstrate that oxcarbazepine given as monotherapy is effective and safe for the treatment of partial seizures in this paradigm.

Vagus nerve stimulation therapy for epilepsy in older adults.

The authors assessed the efficacy, safety, and tolerability of vagus nerve stimulation (VNS) for refractory epilepsy in 45 adults 50 years of age and older. They determined seizure frequency, adverse effects, and quality of life. At 3 months, 12 patients had a >50% decrease in seizure frequency; at 1 year, 21 of 31 studied individuals had a >50% seizure decrease. Side effects were mild and transient. Quality of life scores improved significantly with time.

Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial.

OBJECTIVE: The purpose of this multicenter, add-on, double-blind, randomized, active-control study was to compare the efficacy and safety of presumably therapeutic (high) vagus nerve stimulation with less (low) stimulation. BACKGROUND: Chronic intermittent left vagus nerve stimulation has been shown in animal models and in preliminary clinical trials to suppress the occurrence of seizures. METHODS: Patients had at least six partial-onset seizures over 30 days involving complex partial or secondarily generalized seizures. Concurrent antiepileptic drugs were unaltered. After a 3-month baseline, patients were surgically implanted with stimulating leads coiled around the left vagus nerve and connected to an infraclavicular subcutaneous programmable pacemaker-like generator. After randomization, device initiation, and a 2-week ramp-up period, patients were assessed for seizure counts and safety over 3 months. The primary efficacy variable was the percentage change in total seizure frequency compared with baseline. RESULTS: Patients receiving high stimulation (94 patients, ages 13 to 54 years) had an average 28% reduction in total seizure frequency compared with a 15% reduction in the low stimulation group (102 patients, ages 15 to 60 year; p = 0.04). The high-stimulation group also had greater improvements on global evaluation scores, as rated by a blinded interviewer and the patient. High stimulation was associated with more voice alteration and dyspnea. No changes in physiologic indicators of gastric, cardiac, or pulmonary functions occurred. CONCLUSIONS: Vagus nerve stimulation is an effective and safe adjunctive treatment for patients with refractory partial-onset seizures. It represents the advent of a new, nonpharmacologic treatment for epilepsy.

Efficacy and tolerability of gabapentin in clinical practice.

The efficacy and tolerability of gabapentin therapy for seizures in patients in clinical practice were retrospectively evaluated. Demographics, seizure type and history, prior anticonvulsant therapy, concomitant anticonvulsant medications, gabapentin dosing, side effects, seizure response, and tolerability data were obtained from 100 consecutive clinical practice patients (47 men and 53 women) treated with gabapentin. All patients had been previously treated with a mean of 2.9 anticonvulsant drugs and were currently taking a mean of 1.75 anticonvulsant drugs. Seventy-two patients experienced a greater than 50% reduction in seizures, and 23 of these patients experienced a greater than 75% reduction; 57 patients continued gabapentin treatment, 5 of whom remain seizure free and side effect free with gabapentin monotherapy. Of the 42 patients discontinuing treatment, 17 had no seizure reduction, 17 had side effects, and 8 had both. One additional patient died. The mean daily dosage for all 100 patients was 2107 mg, and the mean daily dosage for patients who continued gabapentin treatment was 2270 mg. No linear relationship was found between dosage and patient weight. Fifty-two patients had the dosage of at least 1 concomitant anticonvulsant medication reduced, 31 had at least 1 concomitant anticonvulsant medication removed from the regimen, and 9 required a dosage increase of at least 1 anticonvulsant medication. Twenty patients experienced fatigue, which was usually transient after treatment initiation; in 13 patients fatigue was associated with carbamazepine therapy. In addition, 7 patients experienced ataxia (6 of whom were taking concomitant carbamazepine), and 2 experienced weight gain. Patients experiencing side effects resulting in discontinuation were taking a mean daily dose of gabapentin of 1182 mg. The maximum effective and tolerable daily dosage under clinical practice conditions appears to exceed dosages established in clinical trials. The results of our study suggest broader treatment parameters for gabapentin than initially determined in the more restrictive clinical trials conducted during the drug's development.

Anomalies of neuroepithelial cell associations in the Splotch mutant embryo.

Neuroepithelial development in Splotch mutant mouse embryos was examined using SEM and TEM. Unlike unaffected littermates, Sp/Sp embryos exhibited extensive neural tube closure defects, disorganization and misalignment of neuroepithelial cells in regions with open defects. Neuroepithelial cell processes often made lateral progress in these areas rather than maintaining their normal contact with the luminal surface. In addition, intercellular space was considerably increased and there were many ectopic cell processes in basal regions of affected areas. The role of altered cell-cell interactions in neurulation is considered.

Functional MR activation correlated with intraoperative cortical mapping.

PURPOSE: To evaluate the spatial specificity of functional MR imaging by comparing it with intraoperative electrocortical mapping. METHODS: Functional MR imaging was performed in 28 patients before awake craniotomy and intraoperative electrocortical mapping. Activation was mapped for finger movement, lip movement, tongue movement, word generation, and counting paradigms. During surgery, finger movement, lip movement, tongue movement, counting, and/or speaking were mapped. The functional images and the photographic recordings of the brain functions mapped during surgery were converted to bit maps and coregistered by a computer program. The distance between the intraoperatively mapped function site and the MR activation site for a comparable function was measured. RESULTS: Forty-six functions were recorded on MR images and intraoperative maps. In 100% of correlations, the intraoperative site and the MR activation site were within 20 mm; in 87% of correlations they were within 10 mm. For each paradigm, 67% or more of the intraoperative stimulation maps correlated within 10 mm of the MR activation site. CONCLUSIONS: For the tasks used in this study, the activation site on functional MR images correlated well with the site at which intraoperative stimulation identified function.

A comparison of functional MR activation patterns during silent and audible language tasks.

PURPOSE: To compare word generation tasks performed silently and aloud as paradigms for functional MR. METHODS: Images were obtained at 1.5 T, with echoplanar acquisition in nine subjects performing word generation aloud or silently. Functional images created from the echoplanar images by means of cross-correlation techniques were superimposed on anatomic reference images. The location of activation from the two tasks was tabulated; the number of activated pixels in each region from the two tasks was compared. RESULTS: Both silent and aloud word generation produced activation in the inferior frontal lobes, sensorimotor cortex regions, supplementary motor areas, and anterior cingulate gyri, predominantly in the dominant hemisphere. Significantly more activated pixels and fewer artifacts were detected with silent word generation than with word generation aloud. CONCLUSION: Word generation silently or aloud produce activation in the brain. Greater activation can be detected in the left frontal lobe with silent word generation, although the subject's performance of the task cannot be monitored independently during silent word generation.

Hemispheric language dominance studied with functional MR: preliminary study in healthy volunteers and patients with epilepsy.

PURPOSE: We used functional MR imaging to compare hemispheric language dominance in healthy volunteers and in patients with epilepsy. METHODS: We retrospectively reviewed the functional MR images of 23 healthy volunteers and 16 patients with epilepsy obtained by using an echo-planar technique designed for whole-brain imaging. The activation paradigm used was a silent word generation task. Hemispheric language dominance was assessed as the percentage of activated pixels in the left hemisphere minus the percentage of activated pixels in the right hemisphere x 100. RESULTS: We found no significant difference in language lateralization between right-handed male and right-handed female volunteers. However, a statistically significant difference in language distribution was found between left- and right-handed female volunteers. The left-handed female volunteers showed a more bilateral hemispheric language lateralization. Language lateralization in right-handed male epilepsy patients with early age at seizure onset and seizure locus in the left temporal lobe was not significantly different from that of healthy right-handed male volunteers. Similarly, we found no difference in language lateralization between right-handed female volunteers and right-handed female epilepsy patients with late age at seizure onset and seizures in the left temporal lobe. CONCLUSION: Handedness has a significant influence on hemispheric language dominance in healthy volunteers. Sex has no influence on hemispheric language dominance, regardless of the task used to assess such dominance, nor does age at seizure onset influence language lateralization in patients with left temporal lobe epilepsy. Therefore, hemispheric language dominance can be assessed and compared effectively with functional MR imaging.

Single-voxel proton MR spectroscopy of nonneoplastic brain lesions suggestive of a neoplasm.

BACKGROUND AND PURPOSE: MR spectroscopy is used to characterize biochemical components of normal and abnormal brain tissue. We sought to evaluate common histologic findings in a diverse group of nonneoplastic diseases in patients with in vivo MR spectroscopic profiles suggestive of a CNS neoplasm. METHODS: During a 2-year period, 241 patients with suspected neoplastic CNS lesions detected on MR images were studied with MR spectroscopy. Of these, five patients with a nonneoplastic diagnosis were identified retrospectively; a sixth patient without tissue diagnosis was added. MR spectroscopic findings consistent with a neoplasm included elevated choline and decreased N-acetylaspartate and creatine, with or without detectable mobile lipid and lactate peaks. RESULTS: The histologic specimens in all five patients for whom tissue diagnoses were available showed significant WBC infiltrates, with both interstitial and perivascular accumulations of lymphocytes, macrophages, histiocytes, and (in one case) plasma cells. Reactive astrogliosis was also prominent in most tissue samples. This cellular immune response was an integral component of the underlying disorder in these patients, including fulminant demyelination in two patients, human herpesvirus 6 encephalitis in one patient, organizing hematoma from a small arteriovenous malformation in one patient, and inflammatory pseudotumor in one patient. Although no histologic data were available in the sixth patient, neoplasm was considered unlikely on the basis of ongoing clinical and neuroradiologic improvement without specific therapy. CONCLUSION: Nonneoplastic disease processes in the CNS may elicit a reactive proliferation of cellular elements of the immune system and of glial tissue that is associated with MR spectroscopic profiles indistinguishable from CNS neoplasms with current in vivo MR spectroscopic techniques. Such false-positive findings substantiate the need for histologic examination of tissue as the standard of reference for the diagnosis of intracranial mass lesions.

Functional magnetic resonance imaging mapping of the sensorimotor cortex with tactile stimulation.

The purpose of this study is to compare tactile stimulation of the palm with voluntary movement of the fingers as paradigms for mapping the sensorimotor cortex in functional magnetic resonance imaging. In 22 subjects, 24 sets of functional magnetic resonance images were obtained with echoplanar acquisitions and cross-correlation image processing techniques. Two tasks were employed: a motor task in which subjects moved the thumb and index finger of one hand and a sensory task in which the palm was scratched by another person. The activation from the two tasks coincided entirely in 20 sets and partially in 3 sets. In one case, no activation was seen with the motor task. The study suggests that tactile stimulation of the palm is useful and reliable for mapping the sensorimotor cortex.