Laser thermal ablation for mesiotemporal epilepsy: Analysis of ablation volumes and trajectories.

OBJECTIVE: To identify features of ablations and trajectories that correlate with optimal seizure control and minimize the risk of neurocognitive deficits in patients undergoing laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE). METHODS: Clinical and radiographic data were reviewed from a prospectively maintained database of all patients undergoing LiTT for the treatment of mTLE at the University of Miami Hospital. Standard preoperative and postoperative evaluations, including contrast-enhanced magnetic resonance imaging (MRI) and neuropsychological testing, were performed in all patients. Laser trajectory and ablation volumes were computed both by manual tracing of mesiotemporal structures and by nonrigid registration of ablation cavities to a common reference system based on 7T MRI data. RESULTS: Among 23 patients with at least 1-year follow-up, 15 (65%) were free of disabling seizures since the time of their surgery. Sparing of the mesial hippocampal head was significantly correlated with persistent disabling seizures (p = 0.01). A lateral trajectory through the hippocampus showed a trend for poor seizure outcome (p = 0.08). A comparison of baseline and postoperative neurocognitive testing revealed areas of both improvement and worsening, which were not associated with ablation volume or trajectory. SIGNIFICANCE: At 1-year follow-up, LiTT appears to be a safe and effective tool for the treatment of mTLE, although a longer follow-up period is necessary to confirm these observations. Better understanding of the impact of ablation volume and location could potentially fine-tune this technique to improve seizure-freedom rates and associated neurologic and cognitive changes.

[Indicators of depression symptoms in a sample of 12 to 17 year-old youths with diabetes mellitus type I]. / Indicadores de sintomas depresivos en una muestra de jóvenes de 12 a 17 años de edad con diabetes mellitus tipo I.

The purpose of this study was to find out what percent of a group of patients 12 to 17 years old and with a diagnosis of Diabetes Mellitus type I have depressive symptomatology. We also wanted to know if there were gender differences in regard to depressive symtomatology in this group. We used a revised and adapted spanish translation of the Beck Depression Inventory, the IDB-R. It was administered to a group of 49 patients ages 12 to 17 with Diabetes Mellitus type I. The mean score of the group at the IDR-R was 9.33, which according to the instrument represents absence of depressive symptomatology. We found that 36.7% of this group obtained a score greater than 10 in the IDB-R which according to this instrument, it means that depressive symptomatology was present. The symptoms most reported by the females were difficulties taking decisions and sleep problems. The symptom most reported by the males was change in appetite.