Introducing the Concept of Sanctuary Sites in Ischemic Stroke.

BACKGROUND: The topography of arterial territories has been defined using digital maps of supratentorial infarcts. Regions with a high probability of infarction (Pi) exist in the deep compartment due to a paucity of collaterals. However, less attention has been given to regions with a low Pi. METHODS: Using published digital maps, patients with cortical stroke and documented vessel occlusion were included. Infarcts from T2-weighted magnetic resonance images were segmented and registered onto a standard brain template (Montreal Neurological Institute 152). Segmented magnetic resonance images were averaged to yield the Pi at a voxel level. The overall Pi for the combined arterial territories was calculated to ensure that Pi was in the range of 0 to 1. Sanctuary sites were identified as regions with Pi <0.1. RESULTS: There were 154 patients (63% men; median age, 69 years; and interquartile range, 57-78 years). The magnetic resonance imaging scan used for segmentation was performed at a median interval of 35 (interquartile range, 3-66) days after stroke onset. Sanctuary sites were present in the frontal (gyrus rectus, the paracentral lobule, and orbitofrontal and precentral gyrus), parietal (postcentral, supramarginal, and angular gyrus, superior and inferior parietal lobule, and precuneus and posterior cingulate), and occipital cortex (cuneus, middle, and superior occipital gyrus). CONCLUSIONS: We propose that following vessel occlusion, there are cortical regions with a low Pi, which we termed sanctuary sites. The anatomic basis for this observation is the compensatory capacity of leptomeningeal collaterals.

Measures of Subjective Memory for People with Epilepsy: A Systematic Review of Measurement Properties.

People with epilepsy frequently express concern about the burden of memory problems in their everyday lives. Self-report memory questionnaires may provide valuable insight into individuals' perceptions of their everyday memory performance and changes over time. Yet, despite their potential utility, the measurement properties of self-report memory questionnaires have not been evaluated in epilepsy. This systematic review aimed to provide a critical appraisal of the measurement properties of self-report memory questionnaires for adults with epilepsy. Following protocol registration (PROSPERO CRD42020210967), a systematic search of PubMed, EMBASE, Web of Science, CINAHL, and PsychInfo from database inception until 27 May 2021 was conducted. Eligible studies were published in English-language peer-reviewed journals, recruited adults with epilepsy, and reported on the development or evaluation of the measurement properties of a self-report memory questionnaire. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology was used to evaluate each study of a measurement property, and results were qualitatively synthesised. In total, 80 articles and one test manual were located containing 153 studies of measurement properties pertinent to 23 self-report memory questionnaires. Overall, no scale could be recommended outright for the evaluation of subjective memory symptoms in adults with epilepsy. This was due to the near absence of dedicated content validation studies relevant to this population and shortcomings in the methodology and scientific reporting of available studies of structural validity. Recommendations to support the advancement and psychometric validation of self-report memory questionnaires for people with epilepsy are provided.

Towards automated in vivo parcellation of the human cerebral cortex using supervised classification of magnetic resonance fingerprinting residuals.

BACKGROUND: Accurate parcellation of the cerebral cortex in an individual is a guide to its underlying organization. The most promising in vivo quantitative magnetic resonance (MR)-based microstructural cortical mapping methods are yet to achieve a level of parcellation accuracy comparable to quantitative histology. METHODS: We scanned 6 participants using a 3D echo-planar imaging MR fingerprinting (EPI-MRF) sequence on a 7T Siemens scanner. After projecting MRF signals to the individual-specific inflated model of the cortical surface, normalized autocorrelations of MRF residuals of vertices of 8 microstructurally distinct areas (BA1, BA2, BA4a, BA6, BA44, BA45, BA17, and BA18) from 3 cortical regions were used as feature vector inputs into linear support vector machine (SVM), radial basis function SVM (RBF-SVM), random forest, and k-nearest neighbors supervised classification algorithms. The algorithms' prediction performance was compared using: (i) features from each vertex or (ii) features from neighboring vertices. RESULTS: The neighborhood-based RBF-SVM classifier achieved the highest prediction score of 0.85 for classification of MRF residuals in the central region from a held-out participant. CONCLUSIONS: We developed an automated method of cortical parcellation using a combination of MR fingerprinting residual analysis and machine learning classification. Our findings provide the basis for employing unsupervised learning algorithms for whole-cortex structural parcellation in individuals.

Improved dynamic distortion correction for fMRI using single-echo EPI and a readout-reversed first image (REFILL).

The boundaries between tissues with different magnetic susceptibilities generate inhomogeneities in the main magnetic field which change over time due to motion, respiration and system instabilities. The dynamically changing field can be measured from the phase of the fMRI data and corrected. However, methods for doing so need multi-echo data, time-consuming reference scans and/or involve error-prone processing steps, such as phase unwrapping, which are difficult to implement robustly on the MRI host. The improved dynamic distortion correction method we propose is based on the phase of the single-echo EPI data acquired for fMRI, phase offsets calculated from a triple-echo, bipolar reference scan of circa 3-10 s duration using a method which avoids the need for phase unwrapping and an additional correction derived from one EPI volume in which the readout direction is reversed. This Reverse-Encoded First Image and Low resoLution reference scan (REFILL) approach is shown to accurately measure B0 as it changes due to shim, motion and respiration, even with large dynamic changes to the field at 7 T, where it led to a > 20% increase in time-series signal to noise ratio compared to data corrected with the classic static approach. fMRI results from REFILL-corrected data were free of stimulus-correlated distortion artefacts seen when data were corrected with static field mapping. The method is insensitive to shim changes and eddy current differences between the reference scan and the fMRI time series, and employs calculation steps that are simple and robust, allowing most data processing to be performed in real time on the scanner image reconstruction computer. These improvements make it feasible to routinely perform dynamic distortion correction in fMRI.

Social Cognition in Temporal and Frontal Lobe Epilepsy: Systematic Review, Meta-analysis, and Clinical Recommendations.

OBJECTIVE: Despite the importance of social cognitive functions to mental health and social adjustment, examination of these functions is absent in routine assessment of epilepsy patients. Thus, this review aims to provide a comprehensive overview of the literature on four major aspects of social cognition among temporal and frontal lobe epilepsy, which is a critical step toward designing new interventions. METHOD: Papers from 1990 to 2021 were reviewed and examined for inclusion in this study. After the deduplication process, a systematic review and meta-analysis of 44 and 40 articles, respectively, involving 113 people with frontal lobe epilepsy and 1482 people with temporal lobe epilepsy were conducted. RESULTS: Our results indicated that while patients with frontal or temporal lobe epilepsy have difficulties in all aspects of social cognition relative to nonclinical controls, the effect sizes were larger for theory of mind (g = .95), than for emotion recognition (g = .69) among temporal lobe epilepsy group. The frontal lobe epilepsy group exhibited significantly greater impairment in emotion recognition compared to temporal lobe. Additionally, people with right temporal lobe epilepsy (g =  1.10) performed more poorly than those with a left-sided (g = .90) seizure focus, specifically in the theory of mind domain. CONCLUSIONS: These data point to a potentially important difference in the severity of deficits within the emotion recognition and theory of mind abilities depending on the laterlization of seizure side. We also suggest a guide for the assessment of impairments in social cognition that can be integrated into multidisciplinary clinical evaluation for people with epilepsy.

Usefulness and yield of routine electroencephalogram: a retrospective study.

BACKGROUND: The electroencephalogram (EEG) is a common diagnostic tool used to investigate patients for various indications including seizure disorders. AIMS: To investigate factors that predict the presence of epileptiform abnormalities on EEG and review the common indications for ordering an EEG. METHODS: We retrospectively reviewed all routine adult EEG performed in a hospital over a 6-month period. Data collated included patient demographics, clinical indication for EEG, setting in which EEG was performed, activation procedures utilised, history of epilepsy, and whether the patient was on antiepileptic medication. Our primary objective was to evaluate the factors that were predictive of an EEG with epileptiform abnormalities. RESULTS: Two hundred and thirty-nine routine EEG were included with indications, including first seizure (25.9%), known epilepsy (25.1%), cognitive change (15.9%), syncope (15.0%), movement disorder (6.7%), psychogenic non-epileptic events (5.4%), unresponsiveness/intensive care unit (4.6%) and psychiatric presentation (1.3%). Most (48.1%) EEG were normal; 8.9% of the EEG demonstrated epileptiform abnormalities. Using multivariate logistic regression, three variables proved significant in predicting an EEG with epileptiform abnormalities. Any seizure as an indication (first seizure or seizure in known epileptic), increasing patient age, and EEG conducted in an inpatient setting and within 48 h of seizure event were all statistically more likely to yield epileptiform abnormalities on EEG. CONCLUSIONS: Our findings suggest that careful selection of patients based on appropriate indications for EEG referral would likely improve the yield of an EEG. Depending on the indication, a normal EEG result can be of similar usefulness to an abnormal EEG demonstrating epileptiform abnormalities.

Generalisation of continuous time random walk to anomalous diffusion MRI models with an age-related evaluation of human corpus callosum.

Diffusion MRI measures of the human brain provide key insight into microstructural variations across individuals and into the impact of central nervous system diseases and disorders. One approach to extract information from diffusion signals has been to use biologically relevant analytical models to link millimetre scale diffusion MRI measures with microscale influences. The other approach has been to represent diffusion as an anomalous transport process and infer microstructural information from the different anomalous diffusion equation parameters. In this study, we investigated how parameters of various anomalous diffusion models vary with age in the human brain white matter, particularly focusing on the corpus callosum. We first unified several established anomalous diffusion models (the super-diffusion, sub-diffusion, quasi-diffusion and fractional Bloch-Torrey models) under the continuous time random walk modelling framework. This unification allows a consistent parameter fitting strategy to be applied from which meaningful model parameter comparisons can be made. We then provided a novel way to derive the diffusional kurtosis imaging (DKI) model, which is shown to be a degree two approximation of the sub-diffusion model. This link between the DKI and sub-diffusion models led to a new robust technique for generating maps of kurtosis and diffusivity using the sub-diffusion parameters ßSUB and DSUB. Superior tissue contrast is achieved in kurtosis maps based on the sub-diffusion model. 7T diffusion weighted MRI data for 65 healthy participants in the age range 19-78 years was used in this study. Results revealed that anomalous diffusion model parameters α and ß have shown consistent positive correlation with age in the corpus callosum, indicating α and ß are sensitive to tissue microstructural changes in ageing.

Salience and default-mode network connectivity during threat and safety processing in older adults.

The appropriate assessment of threat and safety is important for decision-making but might be altered in old age due to neurobiological changes. The literature on threat and safety processing in older adults is sparse and it is unclear how healthy ageing affects the brain's functional networks associated with affective processing. We measured skin conductance responses as an indicator of sympathetic arousal and used functional magnetic resonance imaging and independent component analysis to compare young and older adults' functional connectivity in the default mode (DMN) and salience networks (SN) during a threat conditioning and extinction task. While our results provided evidence for differential threat processing in both groups, they also showed that functional connectivity within the SN - but not the DMN - was weaker during threat processing in older compared to young adults. This reduction of within-network connectivity was accompanied by an age-related decrease in low frequency spectral power in the SN and a reduction in inter-network connectivity between the SN and DMN during threat and safety processing. Similarly, we found that skin conductance responses were generally lower in older compared to young adults. Our results are the first to demonstrate age-related changes in brain activation during aversive conditioning and suggest that the ability to adaptively filter affective information is reduced in older adults.

Synthesis, isolation and characterisation of fluorinated-benzimidazoisoquinoline regioisomers.

A pair of novel fluorinated-benzimidazoisoquinoline regioisomers was synthesised and isolated. Initial structural characterisation and identification employed 1D proton, 1D carbon, correlated spectroscopy (COSY), heteronuclear single quantum coherence (HSQC), and heteronuclear multiple bond correlation (HMBC) nuclear magnetic resonance spectroscopy and mass spectrometry. However, the fluorinated regioisomers could not be differentiated using nuclear magnetic resonance (NMR) alone. Density functional theory calculations and single-crystal X-ray diffraction experiments were used to completely characterise and identify the compounds.

Increased maternal body mass index is associated with prolonged anaesthetic and surgical times for caesarean delivery but is partially offset by clinician seniority and established epidural analgesia.

BACKGROUND: Obesity is associated with higher surgical and anaesthetic morbidity and difficulties. AIMS: We aimed to investigate associations between maternal body mass index (BMI) and the in-theatre time taken to produce an anaesthetised state or to perform surgery for caesarean delivery. MATERIALS AND METHODS: Using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we identified all women who underwent caesarean section at a single institution (2009-2015). The prospectively collected data arising from antenatal and peripartum care were analysed. Generalised linear regression was used to examine associations between maternal BMI and the time taken to anaesthetise the mother and the duration of surgery. RESULTS: Of a total of 24 761 caesarean deliveries, 5607 (22.7%) women were obese at antenatal registration. In-theatre anaesthetic preparation (18 vs 32 min, P < 0.001) and surgical duration (38 vs 52 min, P < 0.001) were longer in women with BMI ≥50 kg/m2 (BMI-50) than those with normal BMI (BMI-N). This difference remained significant after controlling for antenatal, intra-operative and immediate postoperative variables. Modifiable variables were identified that may mitigate the effects of severe obesity. Senior obstetric and anaesthetic care were both independently associated with a significant reduction in mean in-theatre anaesthetic preparation time and surgical duration, by 11 and three minutes respectively (P < 0.001), while epidural top-up significantly lessened mean anaesthetic in-theatre preparation duration by seven minutes (P < 0.001). CONCLUSIONS: Obese women had greater anaesthesia and surgery time, but the effect may potentially be mitigated by provision of care by experienced staff and prior establishment of epidural analgesia.

Investigation on the impact of three different quaternary methyl ammonium cartridges on the radiosynthetic yields of [18 F]fluoromethyl tosylate.

Our recent investigations for the radiosynthesis of [18 F]fluoromethyl tosylate have highlighted that choice of quaternary methyl ammonium (QMA) cartridge used during the radiosynthesis can significantly impact the radiochemical yields. Often the details of the QMA cartridge used in fluourine-18 syntheses are not fully described. However, our studies demonstrate that the type, the size, and nature (method by which it has been conditioned) of the QMA cartridge used during the radiosynthesis can make a significant impact in the labelling efficiency. This paper investigates the use of three QMA cartridges and demonstrates that radiochemical yield (decay corrected) of [18 F]fluoromethyl tosylate can increase from 46% to 60% by simply changing the QMA cartridge (and leaving all other reagents and labelling conditions exactly the same). These learnings may be applied to improve the radiochemical yields of a number of [18 F]-fluorinated tracers (and synthons), where the labelling step is base-sensitive to increase the radiochemical yield, thereby significantly benefiting the radiochemistry and nuclear medicine community. This paper also highlights the necessity of the radiochemistry community to ensure the details of QMA cartridges used in fluorine-18 chemistry are fully and accurately described, since this will improve the translation of radiochemical methods from one laboratory to another.

Synthesis of 18 F-radiolabeled diphenyl gallium dithiosemicarbazone using a novel halogen exchange method and in vivo biodistribution.

18 F-radiolabeled diphenyl gallium thiosemicarbazone was prepared by [18 F] fluoride exchange of a nitrato anion under mild conditions. The diphenyl gallium thiosemicarbazone chloride is easily prepared in gram quantities and can be used at room temperature in the presence of oxygen. The corresponding nitrate complex is prepared using silver nitrate in methanol solvent and can be stored under nitrogen for weeks before radiolabeling. The biodistribution of this new tracer was studied in mice using positron emission tomography (PET).

Can anomalous diffusion models in magnetic resonance imaging be used to characterise white matter tissue microstructure?

PURPOSE: During the time window of diffusion weighted magnetic resonance imaging experiments (DW-MRI), water diffusion in tissue appears to be anomalous as a transient effect, with a mean squared displacement that is not a linear function of time. A number of statistical models have been proposed to describe water diffusion in tissue, and parameters describing anomalous as well as Gaussian diffusion have previously been related to measures of tissue microstructure such as mean axon radius. We analysed the relationship between white matter tissue characteristics and parameters of existing statistical diffusion models. METHODS: A white matter tissue model (ActiveAx) was used to generate multiple b-value diffusion-weighted magnetic resonance imaging signals. The following models were evaluated to fit the diffusion signal: 1) Gaussian models - 1a) mono-exponential decay and 1b) bi-exponential decay; 2) Anomalous diffusion models - 2a) stretched exponential, 2b) continuous time random walk and 2c) space fractional Bloch-Torrey equation. We identified the best candidate model based on the relationship between the diffusion-derived parameters and mean axon radius and axial diffusivity, and applied it to the in vivo DW-MRI data acquired at 7.0 T from five healthy participants to estimate the same selected tissue characteristics. Differences between simulation parameters and fitted parameters were used to assess accuracy and in vivo findings were compared to previously reported observations. RESULTS: The space fractional Bloch-Torrey model was found to be the best candidate in characterising white matter on the base of the ActiveAx simulated DW-MRI data. Moreover, parameters of the space fractional Bloch-Torrey model were sensitive to mean axon radius and axial diffusivity and exhibited low noise sensitivity based on simulations. We also found spatial variations in the model parameter ß to reflect changes in mean axon radius across the mid-sagittal plane of the corpus callosum. CONCLUSION: Simulations have been used to define how the parameters of the most common statistical magnetic resonance imaging diffusion models relate to axon radius and diffusivity. The space fractional Bloch-Torrey equation was identified as the best model for the characterisation of axon radius and diffusivity. This model allows changes in mean axon radius and diffusivity to be inferred from spatially resolved maps of model parameters.

Evidence for a functional specialization of ventral anterior temporal lobe for language.

The controlled semantic cognition framework proposes that the ventral anterior temporal lobes (vATL) in the left and right hemisphere function as an integrated hub region supporting transmodal semantic representations. The clinical evidence for the transmodal function of vATL is largely based on studies of semantic dementia patients with severe anomia, who also show impaired performance on nonverbal tasks that involve the retrieval of knowledge about objects and their prototypical use, such as the production of tool use pantomimes. Yet, evidence from patients with apraxia and functional neuroimaging studies in healthy adults does not implicate vATL in pantomime production. We, therefore, compared semantic retrieval of object-action associations for overt verb and pantomime production from picture and word stimuli. Our results show that, independent of stimulus modality, the retrieval of object-action associations for verb, but not pantomime, production is related to activity in bilateral vATL. Bilateral vATL activation was also observed for meaningless verbal responses that did not require the retrieval of object-action associations. Taken together, our results suggest that bilateral vATL is not engaged in the retrieval of object-action associations per se, but rather supports semantic representations that are functionally specialized for language. These findings have implications for the semantic cognition framework and our understanding of the dependence of conceptual knowledge on language.

Signal compartments in ultra-high field multi-echo gradient echo MRI reflect underlying tissue microstructure in the brain.

Gradient recalled echo magnetic resonance imaging (GRE-MRI) at ultra-high field holds great promise for new contrast mechanisms and delineation of putative tissue compartments that contribute to the multi-echo GRE-MRI signal may aid structural characterization. Several studies have adopted the three water-pool compartment model to study white matter brain regions, associating individual compartments with myelin, axonal and extracellular water. However, the number and identifiability of GRE-MRI signal compartments has not been fully explored. We undertook this task for human brain imaging data. Multiple echo time GRE-MRI data were acquired in five healthy participants, specific anatomical structures were segmented in each dataset (substantia nigra, caudate, insula, putamen, thalamus, fornix, internal capsule, corpus callosum and cerebrospinal fluid), and the signal fitted with models comprising one to six signal compartments using a complex-valued plane wave formulation. Information criteria and cluster analysis methods were used to ascertain the number of distinct compartments within the signal from each structure and to determine their respective frequency shifts. We identified five principal signal compartments with different relative contributions to each structure's signal. Voxel-based maps of the volume fraction of each of these compartments were generated and demonstrated spatial correlation with brain anatomy.

Presurgical language fMRI: Technical practices in epilepsy surgical planning.

Little is known about how language functional MRI (fMRI) is executed in clinical practice in spite of its widespread use. Here we comprehensively documented its execution in surgical planning in epilepsy. A questionnaire focusing on cognitive design, image acquisition, analysis and interpretation, and practical considerations was developed. Individuals responsible for collecting, analyzing, and interpreting clinical language fMRI data at 63 epilepsy surgical programs responded. The central finding was of marked heterogeneity in all aspects of fMRI. Most programs use multiple tasks, with a fifth routinely using 2, 3, 4, or 5 tasks with a modal run duration of 5 min. Variants of over 15 protocols are in routine use with forms of noun-verb generation, verbal fluency, and semantic decision-making used most often. Nearly all aspects of data acquisition and analysis vary markedly. Neither of the two best-validated protocols was used by more than 10% of respondents. Preprocessing steps are broadly consistent across sites, language-related blood flow is most often identified using general linear modeling (76% of respondents), and statistical thresholding typically varies by patient (79%). The software SPM is most often used. fMRI programs inconsistently include input from experts with all required skills (imaging, cognitive assessment, MR physics, statistical analysis, and brain-behavior relationships). These data highlight marked gaps between the evidence supporting fMRI and its clinical application. Teams performing language fMRI may benefit from evaluating practice with reference to the best-validated protocols to date and ensuring individuals trained in all aspects of fMRI are involved to optimize patient care.

Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning.

The goal of this study was to document current clinical practice and report patient outcomes in presurgical language functional MRI (fMRI) for epilepsy surgery. Epilepsy surgical programs worldwide were surveyed as to the utility, implementation, and efficacy of language fMRI in the clinic; 82 programs responded. Respondents were predominantly US (61%) academic programs (85%), and evaluated adults (44%), adults and children (40%), or children only (16%). Nearly all (96%) reported using language fMRI. Surprisingly, fMRI is used to guide surgical margins (44% of programs) as well as lateralize language (100%). Sites using fMRI for localization most often use a distance margin around activation of 10mm. While considered useful, 56% of programs reported at least one instance of disagreement with other measures. Direct brain stimulation typically confirmed fMRI findings (74%) when guiding margins, but instances of unpredicted decline were reported by 17% of programs and 54% reported unexpected preservation of function. Programs reporting unexpected decline did not clearly differ from those which did not. Clinicians using fMRI to guide surgical margins do not typically map known language-critical areas beyond Broca's and Wernicke's. This initial data shows many clinical teams are confident using fMRI not only for language lateralization but also to guide surgical margins. Reported cases of unexpected language preservation when fMRI activation is resected, and cases of language decline when it is not, emphasize a critical need for further validation. Comprehensive studies comparing commonly-used fMRI paradigms to predict stimulation mapping and post-surgical language decline remain of high importance.

The challenge of bias-free coil combination for quantitative susceptibility mapping at ultra-high field.

PURPOSE: Quantitative susceptibility mapping is a technique to estimate the magnetic property of tissue with particularly high sensitivity at ultra-high field. However, a key challenge at ultra-high field is the combination of phase data acquired using phased array receive coils. Several methods for combining phase data have been proposed, but the influence of coil combination choices on susceptibility quantitation has not been studied systematically. METHODS: We combined phase data using COMPOSER (COMbining Phase data using a Short Echo-time Reference scan) and a reference-free channel-by-channel method. We investigated the effect of the chosen combination method on susceptibility results in a group of 28 participants at 7 Tesla. RESULTS: Our results show that reference scans can bias susceptibility values. Although the proposed reference-free channel-by-channel method cannot remove transmit field phase, it shows comparable results to the COMPOSER method in which a high-resolution ultrashort echo-time reference scan was used. CONCLUSIONS: We conclude that ultrashort echo-time reference scans reduce quantitation bias and remove the transmit field phase when using COMPOSER to combine phase data, and not combining the phase data before susceptibility processing avoids this bias, resulting in comparable results. Magn Reson Med 79:97-107, 2018. © 2017 InternationalSociety for Magnetic Resonance in Medicine.

Utility of gradient recalled echo magnetic resonance imaging for the study of myelination in cuprizone mice treated with fingolimod.

The availability of high-field-strength magnetic resonance imaging (MRI) systems has brought about the development of techniques that aim to map myelination via the exploitation of various contrast mechanisms. Myelin mapping techniques have the potential to provide tools for the diagnosis and treatment of diseases, such as multiple sclerosis. In this study, we evaluated the sensitivity of T2 *, frequency shift and susceptibility measures to myelin levels in a cuprizone mouse model of demyelination. The model was supplemented with two different dosages of fingolimod, a drug known to positively affect demyelination. A decrease in grey-white matter contrast with the cuprizone diet was observed for T2 *, frequency shift and susceptibility measures, together with myelin basic protein antibody findings. These results indicate that T2 *, frequency shift and susceptibility measures have the potential to act as biomarkers for myelination. Susceptibility was found to be the most sensitive measure to changes in grey-white matter contrast. In addition, fingolimod treatment was found to reduce the level of demyelination, with a larger dosage exhibiting a greater reduction in demyelination for the in vivo MRI results. Overall, susceptibility mapping appears to be a more promising tool than T2 * or frequency shift mapping for the early diagnosis and treatment of diseases in which myelination is implicated.

Postural change in convulsive seizures: a retrospective review of video-electroencephalographic recordings.

BACKGROUND: Prone position has been identified as an important risk factor for sudden unexpected death in epilepsy raising the possibility of avoidance of this posture in sleep as a preventative measure. AIMS: To evaluate the potential utility of prone posture position, we studied patterns of postural change during generalised tonic clonic seizures. METHODS: Video-electroencephalographic recordings of patients undergoing investigations at the Royal Brisbane and Women's Hospital between 2005 and 2013 were reviewed independently by two raters. Head and truncal positions (left and right lateral, supine, sitting, prone) at seizure onset and offset, before and after nurse interventions were recorded. Post-ictal postural changes and evidence of stertorous respirations were also recorded. RESULTS: Thirty-one seizures from 27 patients were included in the study. One seizure began with the patient asleep in the prone position. One patient became prone during a seizure, having previously been asleep in the left lateral position. Nine patients changed position during a seizure. Seven of these patients were sitting or in a lateral position at the time of seizure onset, two patients were supine at seizure onset. No patient rolled by more than 90° during a seizure. Post-ictal stertorous respirations were observed in 14 patients, one of whom was prone. CONCLUSION: The incidence of patients attaining a prone position during a seizure was low. Given that no patient rolled more than 90°, patients are least likely to attain a prone position if they are supine at the beginning of a seizure.