Risk of epilepsy in gonadal teratoma: a nationwide population-based study.

Epilepsy is a common neurological disease. Systemic tumors are associated with an increased risk of epileptic events. Paraneoplastic encephalitis related to gonadal teratoma is frequently accompanied by seizures and life-threatening status epilepticus (SE). However, the risk of epilepsy in gonadal teratoma has not been studied. This study aims to investigate the relationship between epileptic events and gonadal teratoma. This retrospective cohort study used the Korean National Health Insurance (KNHI) database. The study population was divided into two study arms (ovarian teratoma vs. control and testicular teratoma vs. control) with 1:2 age and gender-matched control groups without a history of gonadal teratoma or other malignancy. Participants with other malignancies, neurologic disorders, and metastatic brain lesions were excluded. We observed the occurrence of epileptic events during the observation period (2013-2018) and investigated the risk of epileptic events in each gonadal teratoma group compared to controls. In addition, the influence of malignancy and tumor removal was investigated. The final analysis included 94,203 women with ovarian teratoma, 2314 men with testicular teratoma, and controls. Ovarian teratoma is associated with a higher risk of epilepsy without SE (HR, 1.244; 95% CI 1.112-1.391) and epilepsy with SE (HR, 2.012; 95% CI 1.220-3.318) compared to the control group. The risk of epilepsy without SE was higher in malignant ovarian teratoma (HR, 1.661; 95% CI 1.358-2.033) than in benign (HR, 1.172; 95% CI 1.037-1.324). Testicular teratoma did not show significant relations with epileptic events. The risk of epileptic events showed a tendency to decrease after removing the ovarian teratoma. This study found that ovarian teratoma is associated with a higher risk of epileptic events, especially in malignant tumors, whereas testicular teratoma did not show significant differences in epileptic events compared to the control group. This study adds to the current understanding of the association between gonadal teratoma and epileptic events.

Premorbid cancer and motor reserve in patients with Parkinson's disease.

Decreased cancer risk has been reported in patients with Parkinson's disease (PD), and cancer prior to PD can have a protective effect on PD risk. We investigated cancer history prior to PD diagnosis to determine if such history can enhance motor reserve in PD by assessing the association between motor deficits and striatal subregional dopamine depletion. A total of 428 newly diagnosed, drug-naïve PD patients was included in the study. PD patients were categorized into three groups of no prior neoplasia, premorbid precancerous condition, and premorbid malignant cancer before PD diagnosis. Parkinsonian motor status was assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) motor score and modified Hoehn and Yahr stage score. All patients underwent positron emission tomography (PET) with 18F-N-(3-fluoropropyl)-2beta-carbon ethoxy-3beta-(4-iodophenyl) nortropane (18F-FP-CIT), and the regional standardized uptake value ratios (SUVRs) were analyzed with a volume-of-interest template among the groups. The UPDRS motor score negatively correlated with SUVRs in the posterior putamen for all patient groups. Groups with neoplasia, especially those with premorbid cancer, showed lower motor scores despite similar levels of dopamine depletion in the posterior putamen relative to those without neoplasia. These results suggest that premorbid cancer acts as a surrogate for motor reserve in patients with PD and provide imaging evidence that history of cancer has a protective effect on PD.

Delayed appearance of wing-beating tremor after liver transplantation in a patient with Wilson disease.

Orthotopic liver transplantation (OLT) is the sole etiological treatment for Wilson disease (WD), but several neurological complications after OLT have been reported. We report a WD patient who developed a unilateral wing-beating tremor 6years after OLT. New neurological symptoms develop immediately after OLT in most cases. In our patient, the onset of extrapyramidal symptoms was at a prolonged interval after OLT. To our knowledge this is the first patient with delayed extrapyramidal symptoms after OLT in WD where the pathophysiology of these late extrapyramidal symptoms is still unknown.

Cognitive improvement after long-term electrical stimulation of bilateral anterior thalamic nucleus in refractory epilepsy patients.

INTRODUCTION: The cognitive and behavioral effect of deep brain stimulation (DBS) administered to the deep cerebral nuclei for epilepsy treatment is unknown. We investigated the cognitive outcomes at least 12 months after DBS to the bilateral anterior thalamic nucleus (ATN) for controlling intractable epilepsy. METHODS: Nine patients with intractable epilepsy who were not candidates for resective surgery, but who were treated by bilateral ATN DBS underwent cognitive and behavioral assessments before implantation and more than 1 year after DBS surgery. Postoperative cognitive assessments were carried out under a continuous stimulation mode. RESULTS: The mean seizure-reduction rate of these patients after ATN DBS was 57.9% (35.6-90.4%). Cognitive testing showed favorable results for verbal fluency tasks (letter and category, p<0.05), and a significant improvement in delayed verbal memory was observed (p=0.017). However, we did not observe any significant changes in general abilities (IQ, MMSE), information processing (digit forward and backward, Trail A, and Digit Symbol), or executive function (Trail B and WCST). Interestingly, we did not observe any significant cognitive decline approximately 1 year (mean, 15.9 months) after ATN DBS surgery. CONCLUSIONS: We showed that ATN DBS not only resulted in promising clinical effects but was also associated with improvements in both verbal recall and oral information processing, which may be related to the bilateral activation of the fronto-limbic circuit following DBS surgery. Further controlled, long-term studies with larger populations are warranted for elucidating the clinical effects of ATN DBS.

Incidental unruptured intracranial aneurysms in patients with acute ischemic stroke.

BACKGROUND: The management and clinical prognosis of incidental intracranial aneurysms in acute ischemic stroke patients have been understudied. We investigated the clinical outcome of acute ischemic stroke subjects with incidentally found intracranial aneurysms. METHODS: We consecutively included acute ischemic stroke patients within 7 days of onset. Their demographics, risk factors, stroke subtypes, antithrombotics use and modified Rankin scale (mRS) at 3 months after stroke were obtained. CT or MR angiography was used to diagnose the intracranial aneurysms. The development of an aneurysmal rupture was checked during the following 3 months. RESULTS: Incidental intracranial aneurysms were found in 17 (6.6%) of the 258 patients. The female sex and old age were associated with the presence of incidental intracranial aneurysms (p = 0.001, 0.032). The most common site of aneurysm was at the distal internal carotid artery (n = 9), followed by the middle cerebral artery (n = 6). The diameters of the aneurysms ranged from 2.09 to 8.06 mm. All the participants except 1 who had cancer were taking antiplatelet agents. No aneurysmal rupture or subarachnoid hemorrhage happened until 3 months after stroke.There was no significant difference in excellent outcome (3-month mRS = 0, 1) between the patients with an aneurysm and those without (28.6 vs. 53.4%, p = 0.097). CONCLUSION: There was no rupture of the incidentally found aneurysms in the patients with acute ischemic stroke during their first 3 months. The 3-month mRS was not affected by the presence of incidental intracranial aneurysm. A large cohort study and long-term follow-up are required.