Highly flexible and self-adaptive dry adhesive end-effectors for precision robotics.

Many research groups have studied biomimetic functional surfaces for practical applications. Dry adhesives inspired by the gecko foot consist of hierarchical and numerous micro/nano hairs and can achieve pull-off strengths for vertical and shear adhesion of up to 20 N cm-2. However, when detachment of the nearly dry adhesive is carried out by peeling, the pull-off strength of the dry adhesive in the tilted state is remarkably reduced. In this study, an enhanced pull-off strength dry adhesive in the tilted state was fabricated by using a strategy that reduces the restoring force from the bending moment. An experiment with various column-type dry adhesives was implemented to find the relation between the pull-off strength in the tilted state and the bending resistance of the dry adhesive. The feasibility of using a dry adhesive in the tilted state was observed through a glass-lifting experiment. This strategy could be widely utilized in many practical applications, such as robotics.

Scalable and continuous fabrication of bio-inspired dry adhesives with a thermosetting polymer.

Many research groups have developed unique micro/nano-structured dry adhesives by mimicking the foot of the gecko with the use of molding methods. Through these previous works, polydimethylsiloxane (PDMS) has been developed and become the most commonly used material for making artificial dry adhesives. The material properties of PDMS are well suited for making dry adhesives, such as conformal contacts with almost zero preload, low elastic moduli for stickiness, and easy cleaning with low surface energy. From a performance point of view, dry adhesives made with PDMS can be highly advantageous but are limited by its low productivity, as production takes an average of approximately two hours. Given the low productivity of PDMS, some research groups have developed dry adhesives using UV-curable materials, which are capable of continuous roll-to-roll production processes. However, UV-curable materials were too rigid to produce good adhesion. Thus, we established a PDMS continuous-production system to achieve good productivity and adhesion performance. We designed a thermal roll-imprinting lithography (TRL) system for the continuous production of PDMS microstructures by shortening the curing time by controlling the curing temperature (the production speed is up to 150 mm min-1). Dry adhesives composed of PDMS were fabricated continuously via the TRL system.

Prediction of mortality and functional outcome from status epilepticus and independent external validation of STESS and EMSE scores.

BACKGROUND: Two clinical scoring systems, the status epilepticus severity score (STESS) and the epidemiology-based mortality score in status epilepticus (EMSE), are used to predict mortality in patients with status epilepticus (SE). The aim of this study was to compare the outcome-prediction function of the two scoring systems regarding in-hospital mortality using a multicenter large cohort of adult patients with SE. Moreover, we studied the potential role of these two scoring systems in predicting the functional outcome in patients with SE. METHODS: The SE cohort consisted of patients from the epilepsy centers of eight academic tertiary medical centers in South Korea. The clinical and electroencephalography data for all adult patients with SE from January 2013 to December 2014 were derived from a prospective SE database. The primary outcome variable was defined as in-hospital death. The secondary outcome variable was defined as a poor functional outcome, i.e., a score of 1-3 on the Glasgow Outcome Scale, at discharge. RESULTS: Among the 120 non-hypoxic patients with SE recruited into the study, 16 (13.3%) died in the hospital and 64 (53.3%) were discharged with a poor functional outcome. The receiver-operating characteristic (ROC) curve for prediction of in-hospital death based on the STESS had an area under the curve of 0.673 with an optimal cutoff value for discrimination (best match for both sensitivity (0.56) and specificity (0.70)) that was ≥ 4 points. The two combinations of elements of the EMSE system (EMSE-ALDEg and EMSE-ECLEg) predicted not only in-hospital mortality with the best match for sensitivity (more than 0.6) and specificity (more than 0.6), but also a poor functional outcome with the best match for both sensitivity (>0.7) and specificity (>0.6). STESS did not predict a poor functional outcome (area under the ROC, 0.581; P = 0.23). CONCLUSION: Although the EMSE is a clinical scoring system that focuses on individual mortality, we did not find differences between the EMSE and STESS in the prediction of in-hospital death. The EMSE was useful in predicting poor functional outcome, as it was significantly better than STESS.

The long-term efficacy and safety of levetiracetam in a tertiary epilepsy centre.

AIM: To evaluate the long-term efficacy and safety of levetiracetam based on a large population of patients in a tertiary epilepsy centre. METHODS: All patients who received levetiracetam at the Seoul National University Hospital between January 2007 and March 2009 were evaluated. Patients who underwent brain surgery for seizure control or who had associated progressive disease were excluded from this study. The electronic medical records of these patients were reviewed retrospectively. RESULTS: A total of 568 patients were recruited, including 124 patients with generalised epilepsy. The mean duration of the follow-up period was 29.3 months. The seizure-free rate was 33.6% and was higher in patients with generalised epilepsy (51.6%) than patients with localisation-related epilepsy (28.6%). There was a strong correlation between initial response and dose-up response in 351 patients with increased dosage during the follow-up period. A total of 486 adverse events developed in 316 patients. The most common adverse event (24.3%) was irritability, which was associated with a high rate of drug discontinuation. Previous history of mood disorder was the only factor related to the development of irritability in patients using this medication. CONCLUSION: Levetiracetam was effective and safe as monotherapy and add-on therapy for partial and generalised epilepsy. The initial response to levetiracetam may provide useful information for predicting the response to increased dose of levetiracetam. However, the use of this medication was associated with a rate of irritability that was higher than expected in patients with a history of mood disorders.

An assessment of a new navigatable percutaneous disc decompression device (l'DISQ) through histologic evaluation and thermo-mapping in human cadaveric discs.

STUDY DESIGN: This is an in vitro experimental study of the technical capability and safety study of a navigable percutaneous disc decompression device named L'DISQ. OBJECTIVES: The objectives of this study were to determine if L'DISQ could adequately reach certain target zones in the disc and to measure the distribution of rises in temperature in the surrounding tissue when the device was used to ablate the disc. METHODS: Placement of the wand of L'DISQ was attempted into the posterior annulus of the discs of four fresh human cadavers. During disc ablation, thermocouple probes were used to measure the temperature within the nucleus pulposus and annulus fibrosus, on the surface of the annulus, and on the posterior longitudinal ligament. Tissues harvested from around the disc were examined histologically. RESULTS: The tip of the wand could be successfully navigated to the posterolateral or posterocentral annulus at all levels above L5-S1 using a lateral approach. Rises in temperature did not exceed 13.25 ± 0.84°C within the disc, and did not exceed 1°C on the surface of the disc. Histology demonstrated no thermal damage to the surrounding neural tissues. CONCLUSION: L'DISQ can be successfully navigated to the target zones, and disc tissue ablated without thermal or structural damage to the adjacent neural tissues.

Magneto-Responsive Actuating Surfaces with Controlled Wettability and Optical Transmittance.

The wettability of surfaces can be manipulated using actuating micro/nanostructures, as in the manipulation of water droplets with magnetic forces. Controlling water droplets with magneto-responsive surfaces is limited to optical applications, however, because these surfaces are normally opaque. Herein, we introduce a magneto-responsive actuating surface that is capable of controlling not only the wettability but also the optical transmittance. The magneto-responsive actuating surface is fabricated using a composite of iron particles with polydimethylsiloxane (PDMS). Thanks to the elastic properties of PDMS, fabricated microstructures' bending is induced by applying magnetic force. Therefore, the static/dynamic water contact angle and the optical transmittance can be controlled. Furthermore, as a feasible application, a sliding angle control system that depends on the magnet location is implemented. On the basis of the interesting characteristics of not only wettability but also optical transmittance, this study is expected to be widely used in various fields such as optics, surface self-cleaning systems of solar cells, and smart windows.

Fabrication and Performance Evaluation of the Helmholtz Resonator Inspired Acoustic Absorber Using Various Materials.

A soundwave is transmitted by adjacent molecules in the medium, and depending on the type of sound, it exhibits various characteristics such as frequency, sound pressure, etc. If the acoustic wavelength of the soundwave is sufficiently long compared with the size of an acoustic element, physical analysis within the sound element could be simplified regardless of the shape of the acoustic element: this is called "long wavelength approximation". A Helmholtz resonator, a representative acoustic element which satisfies the "long wavelength theory", consists of a neck part and a cavity part. The Helmholtz resonators can absorb certain frequencies of sound through resonance. To exhibit attenuation properties at ultrasound range, the Helmholtz resonator should be made into a microscale since Helmholtz resonators should satisfy the "long wavelength approximation". In this study, Helmholtz resonator inspired acoustic elements were fabricated using MEMS technology, and acoustic attenuation experiments in a water bath were conducted using various shapes and materials. As a result, the fabricated samples showed admirable attenuation properties up to ~13 dB mm-1 at 1 MHz. The results were analyzed to derive the necessary conditions for the fabrication of acoustic elements with acoustic attenuation properties in ultrasound range.

Low level of low-density lipoprotein cholesterol increases hemorrhagic transformation in large artery atherothrombosis but not in cardioembolism.

BACKGROUND AND PURPOSE: Low cholesterol level is known to be associated with increased cerebral hemorrhage. However, the associations of hemorrhagic transformation (HTf) after acute ischemic stroke and the low levels of total cholesterol (TC) or low-density lipoprotein cholesterol (LDLC) are largely undiscovered. METHODS: Of the 1034 patients with acute ischemic stroke who were consecutively admitted to our hospital, 377 patients with stroke attributable to large artery atherothrombosis (LAA; n=210) or cardioembolism (n=167) were selected for this study. Demographic and clinical information was collected and HTf was evaluated through follow-up T2*-weighted gradient-echo MRI performed usually within 1 week after stroke. Measurement of lipid parameters included TC, LDLC, high-density lipoprotein cholesterol, and triglyceride. RESULTS: Of the 377 patients, HTf was noted in 74 patients (19.6%). When patients were divided into 4 groups according to their TC and LDLC levels, the incidence of HTf was significantly elevated in the lowest quartile of each TC (P<0.01) and LDLC (P<0.01) level in LAA subgroup, but not in cardioembolism. After adjusting covariates, a low level of LDLC (OR, 0.46 per 1 mmol/L-increase; 95% CI, 0.22-0.98) was independently associated with HTf in LAA, but not in cardioembolism. There was no significant association between low levels of TC (OR, 0.63 per 1 mmol/L-increase; 95% CI, 0.35-1.15) and HTf in LAA. CONCLUSIONS: Low levels of LDLC, and possibly TC, are associated with greater risk of hemorrhagic transformation after acute ischemic stroke attributable to LAA.

Inhibitory effects of the aqueous extract of Magnolia officinalis on the responses of human urinary bladder cancer 5637 cells in vitro and mouse urinary bladder tumors induced by N-Butyl-N-(4-hydroxybutyl) nitrosamine in vivo.

This study investigated the anticancer activity of Magnolia officinalis on urinary bladder cancer in vitro and in vivo, and elucidated the mechanism of its activity. An aqueous extract of M. officinalis inhibited cell viability and DNA synthesis in cultured human urinary bladder cancer 5637 cells. Inhibition of proliferation was the result of apoptotic induction, because FACS analyses of 5637 cells treated with M. officinalis showed a sub-G1 phase accumulation. M. officinalis extract also increased cytoplasmic DNA-histone complex dose-dependently. These inhibitory effects were associated with the upregulation of proapoptotic molecules Bax, cytochrome c and caspase 3. Treatment of 5637 cells with M. officinalis extract suppressed the expression of matrix metalloproteinase 2 (MMP-2) and MMP-9, as revealed by zymographic and immunoblot analyses. When M. officinalis extract was given to mice simultaneously with the carcinogen N-butyl-N-(4-hydroxybutyl) nitrosamine, which induces urinary bladder tumors, the size of the induced tumors was smaller. Finally, histological data indicated that the histological grade of carcinoma and the depth of invasion were dramatically decreased by treatment with M. officinalis extract in mice with N-butyl-N-(4-hydroxybutyl) nitrosamine-induced urinary bladder tumors. In conclusion, the findings showed that M. officinalis extract exhibited potential chemopreventive activity against urinary bladder tumor in vitro and in vivo.

Remora-Inspired Reversible Adhesive for Underwater Applications.

The remoras are marine species that can effectively move by clinging onto other marine species via a suction disk on their dorsal side, which is composed of complex structures. The inner suction disk could be divided into three large parts, namely, lip, lamella, and spinule. The lamella is deformed actively to generate pressure difference between the inside and outside of the suction disk, and the lip maintains the sealing. The spinule, which is composed of hairs with diameter of 300 µm or less hair, enhances the frictional force. In this study, we easily fabricated polymer-based adhesive inspired by the suction disk of the remora and conducted an experiment to determine its performance. The adhesive exhibited admirable performance with a 26.68 N cm-2 (266.8 kPa) pull-off strength and a 19.42 N cm-2 (194.2 kPa) shear strength in water. The durability test result indicated that the adhesion and friction characteristics of the adhesive were well maintained even after multiple uses.

Cancer gene therapy using adeno-associated virus vectors.

Gene therapy has offered highly possible promises for treatment of cancers, as many potential therapeutic genes involved in regulation of molecular processes may be introduced by gene transfer, which can arrest angiogenesis, tumor growth, invasion, metastasis, and/or can stimulate the immune response against tumors. Therefore, viral and non-viral gene delivery systems have been developed to establish an ideal delivery vector for cancer gene therapy over the past several years. Among the currently developed virus vectors, the adeno-associated virus (AAV) vector is considered as one of those that are closest to the ideal vector mainly for genetic diseases due to the following prominent features; the lack of pathogenicity and toxicity, ability to infect dividing and non-dividing cells of various tissue origins, a very low host immune response and long-term expression. Particularly, the most important attribute of AAV vectors is their safety profile in clinical trials ranging from CF to Parkinson's disease. Although adenovirus and several other oncolytic viruses have been more frequently used to develop cancer gene therapy, AAV also has many critical properties to be exploited for a cancer gene delivery vector. In this review, we will briefly summarize the basic biology of AAV and then mainly focus on recent progresses on AAV vector development and AAV-mediated therapeutic vectors for cancer gene therapy.

Transcriptional targeting of gene expression in breast cancer by the promoters of protein regulator of cytokinesis 1 and ribonuclease reductase 2.

For cancer gene therapy, cancer-specific over- expression of a therapeutic gene is required to reduce side effects derived from expression of the gene in normal cells. To develop such an expression vector, we searched for genes over-expressed and/or specifically expressed in cancer cells using bioinformatics and have selected genes coding for protein regulator of cytokinesis 1 (PRC1) and ribonuclease reductase 2 (RRM2) as candidates. Their cancer-specific expressions were confirmed in both breast cancer cell lines and patient tissues. We compared each promoter's cancer-specific activity in the breast normal and cancer cell lines using the luciferase gene as a reporter and confirmed cancer-specific expression of both PRC1 and RRM2 promoters. To test activities of these promoters in viral vectors, the promoters were also cloned into an adeno-associated viral (AAV) vector containing green fluorescence protein (GFP) as the reporter. The GFP expression levels by these promoters were various depending on cell lines tested and, in MDA-MB-231 cells, GFP activities derived from the PRC1 and RRM2 promoters were as strong as that from the cytomegalovirus (CMV) promoter. Our result showed that a vector containing the PRC1 or RRM2 promoter could be used for breast cancer specific overexpression in gene therapy.

Diabetes increases large artery diseases, but not small artery diseases in the brain.

BACKGROUND: It is established that diabetes causes various systemic micro- and macro-vascular complications. Little has been, however, studied on the differential effects of diabetes on the large artery diseases (LAD) or small artery disease (SAD) in the brain. The purpose of this study was to examine an association of diabetes on the incidence of underlying LAD versus SAD in ischemic stroke patients. METHODS: We prospectively collected 523 acute ischemic stroke patients without cardioembolic causes or other determined causes of stroke. Using brain MRI, the cerebral LAD (extracranial and intracranial arterial stenosis of 50 % or more) and the cerebral SAD (old lacunar infarction, microbleeds and leukoaraiosis) findings were assessed. Information regarding vascular risk factor was also collected. RESULTS: Among the patients (male, n = 342; diabetes, n = 200), diabetes was not associated with the presence of LADs or SADs in female subjects, but strongly with the presence of intracranial LAD in male subjects (p < 0.01). The association remained significant (OR 2.09, 95 %CI 1.25-3.51) after adjusting for major confounders. A similar association was also found in intracranial LAD and insulin resistance. There was, however, no significant association of diabetes with SAD in male nor in female patients. CONCLUSIONS: Our results showed that diabetes is associated with the frequency of intracranial LAD, especially in males. Out study may be regarded as evidence of differential biological effects of diabetes on cerebral vasculature.

Prognosis of symptomatic and asymptomatic middle cerebral artery occlusion.

BACKGROUND: The annual risk of stroke or cardiovascular events has been reported to be over 10% in middle cerebral artery stenosis. However, the prognosis of patients with middle cerebral artery occlusion (MCAO) remains unclear. We investigated the risk of cardiovascular events or death in patients with symptomatic or asymptomatic MCAO. METHODS: Consecutive patients with MCAO demonstrated by transcranial Doppler sonography and magnetic resonance angiography were enrolled. Medical records were reviewed during the follow-up period and a telephone interview was conducted using a preformed questionnaire, comparing asymptomatic and symptomatic patients who had a history of ischemic stroke or transient ischemic attack in the same vascular territory. The composite outcome of ipsilateral stroke, hemorrhagic stroke, overall stroke, myocardial infarction (MI), any vascular death and nonvascular death was evaluated during the follow-up period. RESULTS: Thirty-seven of the 48 patients were symptomatic and 11 were asymptomatic. During the mean follow-up period of 2.8 years, cardiovascular events or death occurred in a total of 13 patients: 1 from the asymptomatic group and 12 from the symptomatic group (overall stroke, 6; MI, 2; vascular death, 1; nonvascular death, 5). The annual rates of composite outcome (2.2 vs. 13.2%, p = 0.041) and overall stroke (0.0 vs. 6.6%, p = 0.048) were significantly lower in the asymptomatic group. CONCLUSION: These results suggest that the overall prognosis of MCAO is not worse than previously reported for patients with middle cerebral artery stenosis or internal carotid artery stenosis. Asymptomatic MCAO seems to be a benign condition associated with a low risk of subsequent stroke, MI or death under the optimal medical therapy.

A novel way of therapeutic angiogenesis using an adeno-associated virus-mediated angiogenin gene transfer.

To develop a novel therapeutic angiogenesis for the treatment of cardiovascular diseases, angiogenin (ANG1) was examined as a potential therapeutic gene. An adeno-associated virus (AAV)-mediated gene delivery system was used to measure the therapeutic efficacy of ANG1. Using a triple co-transfection technique, rAAV-ANG1-GFP, rAAV- VEGF-GFP and rAAV-GFP vectors were produced, which were then used to infect human umbilical vein endothelial cells (HUVECs) in order to evaluate in vitro angiogenic activities. Their protein expressions, tagged with green fluorescent protein (GFP), were monitored by confocal microscopy. The functional activities were measured using wound- healing HUVEC migration assays. The number of migrated cells stimulated by both the expressed ANG1 and the VEGF in rAAV-infected HUVECs increased almost twice the number observed in the expressed GFP control. In vivo angiogenic activities of the expressed ANG1 or VEGF were determined using mouse angiogenesis assays. The angiogenic activities of ANG1 or VEGF expressed in the injected mice were increased by 1.36 and 2.16 times, respectively, compared to those of the expressed GFP control. These results demonstrate that the expressed ANG1 derived from rAAV infection has in vitro and in vivo angiogenic activities and suggest that the rAAV-ANG1 vector is a potential strategy for therapeutic angiogenesis.

Stroke as the first manifestation of concealed cancer.

BACKGROUND AND PURPOSE: Trousseau's syndrome (TS) is defined as a malignancy-related thromboembolism occurring in patients with an underlying or undiagnosed malignancy. Stroke seldom occurs as the first manifestation of a cancer. We investigated the clinical and radiological features of patients with TS. METHODS: We reviewed the clinical, pathologic, and radiological records of consecutive stroke patients, whose cancers were diagnosed at stroke presentation. Cancer-related stroke was defined if no definite cause was confirmed and malignancy was detected within 6 months of first stroke onset without cancer-related treatment. All patients underwent brain diffusion-weighted MRI (DWI), MR angiography, and echocardiography. The sizes, numbers, and locations of all hyperintense lesions in the DWI were noted. RESULTS: Ten patients were finally analyzed. Histologically, cancers were often proven to adenocarcinomas (50%, 5/10) of advanced stage. Six of 10 patients tested (60%) had elevated D-dimer. Seven of the 10 patients (70%) showed bihemispheric anterior and posterior involvement. DWI features showed numerous small and medium or large lesions in multiple territories in 9 patients (90%). CONCLUSIONS: The authors emphasize that when presented with multiple bihemispheric infarctions on DWI and an unknown etiology, the neurologist must consider the existence of a concealed cancer.

Successful Use of Therapeutic Hypothermia for Refractory Nonconvulsive Status Epilepticus.

Therapeutic hypothermia (TH) has rarely been utilized as an adjunct to anticonvulsants in treating patients with refractory convulsive status epilepticus (CSE). However, determining the effectiveness of TH in CSE is difficult due to the unavoidable use of sedative drugs to manage hypothermia. Additionally, the effectiveness of TH has not been studied in patients with refractory non-convulsive status epilepticus (NCSE). Here, we report the successful use of TH without additional sedative drugs in a patient with temporal lobe epilepsy and refractory NCSE. A 46-year-old man was referred to the neurology department because of recurrent seizure attacks. Electroencephalography (EEG) after first-line status treatment showed continuous periodic discharges consistent with NCSE. He was started simultaneously on continuous EEG monitoring and TH, but was not administered any benzodiazepines to control shivering or maintain TH. During TH, EEG abnormalities gradually improved, and the patient regained consciousness in accordance with the improvement in EEG. The patient was alert and his EEG had normalized a few days after starting TH. To the best of our knowledge, this is the first report describing the successful treatment of refractory NCSE with TH. As no sedative drugs were used during the maintenance of hypothermia, NCSE control may have been achieved by TH alone.

CADASIL Initially Presented with a Seizure.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disease of the cerebral small blood vessels characterized by recurrent ischemic strokes, migraine, and progressive cognitive impairment. In patients with CADASIL, in whom subcortical white matter structures are typically involved, epileptic seizures have been rarely reported as an initial clinical symptom. We describe a patient genetically confirmed as having CADASIL who initially presented with a seizure.

Prognostic Value of Initial Standard EEG and MRI in Patients with Herpes Simplex Encephalitis.

BACKGROUND AND PURPOSE: Herpes simplex encephalitis (HSE) is the most common type of sporadic encephalitis worldwide, and it remains fatal even when optimal antiviral therapy is applied. There is only a weak consensus on the clinical outcomes and prognostic factors in patients with HSE. This study examined whether the radiological and electrophysiological findings have a prognostic value in patients with HSE. METHODS: We retrospectively analyzed patients who were diagnosed with HSE by applying the polymerase chain reaction to cerebrospinal fluid and who received intravenous acyclovir at our hospital from 2000 to 2014. We evaluated the clinical outcomes at 6 months after onset and their correlations with initial and clinical findings, including the volume of lesions on MRI, the severity of EEG findings, and the presence of epileptic seizures at the initial presentation. RESULTS: Twenty-nine patients were enrolled (18 men and 11 women). Univariate analysis revealed that the presence of severe EEG abnormality and epileptic seizures at the initial presentation were significant correlated with a poor clinical outcome at 6 months (p=0.005 and p=0.009, respectively). In multivariate analysis, the presence of severe EEG abnormality was the only independent predictor of a poor outcome at 6 months (p=0.006). CONCLUSIONS: In cases of HSE, the initial EEG severity and seizure presentation may be useful predictive factors for the outcome at 6 months after acyclovir treatment.

Change of Patient Selection Strategy and Improved Surgical Outcome in MRI-negative Neocortical Epilepsy.

BACKGROUND AND PURPOSE: It is crucial to make selection strategy to identify surgical candidates among medically refractory MRI-negative neocortical epilepsy patients. In our previous study, we suggested two or more concordance between noninvasive studies (EEG, ictal scalp EEG, interictal FDG-PET, and SPECT) as a new patient selection strategy for MRI-negative neocortical epilepsy surgery. The objective of this study was to evaluate the surgical outcomes of MRI-negative neocortical epilepsy patients before and after the implementation of a new selection strategy. METHODS: From 1995 to 2011, we included 153 consecutive MRI-negative neocortical epilepsy patients who received focal resection and had a follow-up period of at least 2 years. These patients were divided into two groups according to their date of surgery (before and after July 2002). The old group consisted of 89 patients and the new one consisted of 53 patients. Clinical characteristics, presurgical evaluations, and pathology were reviewed. RESULTS: The new patient selection strategy led to a significant increase in the concordance between two or more modalities. The improvement in surgical outcome after 2002 was significant (seizure-free outcome, 47.2% vs. 75.5%; p = 0.001). Concordance between two or more presurgical evaluations and localizing PET were related to a seizure-free outcome in a multivariate analysis. CONCLUSIONS: After a change in surgical strategy to select patients with two or more concordance between noninvasive studies, the seizure-free outcome improved up to 75.5%. MRI-negative neocortical epilepsy patients with two or more concordance between noninvasive studies seem to be good candidates for epilepsy surgery.