Changes in Brain Activation Associated with Spontaneous Improvization and Figural Creativity After Design-Thinking-Based Training: A Longitudinal fMRI Study.

Creativity is widely recognized as an essential skill for entrepreneurial success and adaptation to daily-life demands. However, we know little about the neural changes associated with creative capacity enhancement. For the first time, using a prospective, randomized control design, we examined longitudinal changes in brain activity associated with participating in a five-week design-thinking-based Creative Capacity Building Program (CCBP), when compared with Language Capacity Building Program (LCBP). Creativity, an elusive and multifaceted construct, is loosely defined as an ability to produce useful/appropriate and novel outcomes. Here, we focus on one of the facets of creative thinking-spontaneous improvization. Participants were assessed pre- and post-intervention for spontaneous improvization skills using a game-like figural Pictionary-based fMRI task. Whole-brain group-by-time interaction revealed reduced task-related activity in CCBP participants (compared with LCBP participants) after training in the right dorsolateral prefrontal cortex, anterior/paracingulate gyrus, supplementary motor area, and parietal regions. Further, greater cerebellar-cerebral connectivity was observed in CCBP participants at post-intervention when compared with LCBP participants. In sum, our results suggest that improvization-based creative capacity enhancement is associated with reduced engagement of executive functioning regions and increased involvement of spontaneous implicit processing.

Dextromethorphan in the treatment of early myoclonic encephalopathy evolving into migrating partial seizures in infancy.

Epileptic encephalopathy with suppression-burst in electroencephalography (EEG) can evolve into a few types of epileptic syndromes. We present here an unusual case of early myoclonic encephalopathy that evolved into migrating partial seizures in infancy. A female neonate initially had erratic myoclonus movements, hiccups, and a suppression-burst pattern in EEG that was compatible with early myoclonic encephalopathy. The seizures were controlled with dextromethorphan (20 mg/kg), and a suppression-burst pattern in EEG was reverted to relatively normal background activity. However, at 72 days of age, alternating focal tonic seizures, compatible with migrating partial seizures in infancy, were demonstrated by the 24-hour EEG recording. The seizures responded poorly to dextromethorphan. To our knowledge, this is the first reported case of early myoclonic encephalopathy evolving into migrating partial seizure in infancy. Whether it represents another age-dependent epilepsy evolution needs more clinical observation.

Eye anomalies and neurological manifestations in patients with PAX6 mutations.

PURPOSE: Mutations in the paired box 6 (PAX6)gene cause a wide variety of eye anomalies, including aniridia. PAX6 mutations are not well described in the Chinese population so this study is aimed at exploring the role of PAX6 mutations in Taiwanese patients with congenital eye anomalies. METHODS: Seventeen patients with single or multiple congenital eye anomalies were enrolled. Genomic DNA was prepared from venous blood leukocytes, and the coding regions of PAX6 were analyzed by PCR and direct sequencing. Clinical manifestations of the patients were then correlated to PAX6 mutations. RESULTS: Five PAX6 mutations were identified in one case each. Three mutations c.317T>A (p.L106X), c.142-1G>T, and c.656del10 (p.Q219QfsX20) were novel and the other two, c.331delG (p.V111SfsX13) and c.949C>T (p.R317X), have been reported. All five cases had aniridia; three had other eye anomalies; and four had developmental delay. Only one case had other affected family members. In the ten cases that had no PAX6 mutation, only one had aniridia. CONCLUSIONS: Both novel and known PAX6 mutations were identified in the current study, and PAX6 mutations were closely associated with aniridia. Absence of a positive family history does not exclude PAX6 mutation. The frequent occurrence of developmental delay in patients with PAX6 mutation argues for a prompt diagnosis of the disease.

Acute disseminated encephalomyelitis in children: one medical center experience.

Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of the central nervous system. The experience in children is limited. We retrospectively reviewed our experience with 20 ADEM patients (10 females, 10 males) with age of onset before 18 years old in Taiwan to clarify the clinical manifestations, neuroimaging findings, and the relationship between ADEM and multiple sclerosis (MS). The age at onset ranged from 4 months to 15 years. Seventeen (85%) children had a recent infectious prodrome. Children presented most often with acute consciousness disturbance (70%) and motor deficits (55%). Seizures occurred in 10 (50%), but only one child developed epilepsy in follow-up. Brain magnetic resonance imaging (MRI) evaluations done in all patients revealed multifocal lesions, mainly in subcortical white matter (80%), brainstem (65%), basal ganglia (55%), cerebellum (45%), thalamus (40%), and periventricular white matter (35%). Spinal cord MRI was performed in 9 patients and all of them showed abnormal lesions. Eleven patients were treated with high-dose intravenous methylprednisolone pulse therapy, and only one had mild long-term neurological sequelae. Among the 20 patients, five had long-term neurological sequelae and one died. Three patients fit the criteria of multiphasic disseminated encephalomyelitis, in which two developed MS in follow-up. Another patient with ADEM turned out to be MS two years later. We concluded that seizures are not uncommon in ADEM, but the subsequent development of epilepsy is rare. Long-term prognosis of ADEM is generally good. Because recurrence of ADEM is not uncommon, long-term follow-up of those children with ADEM is needed to distinguish between ADEM and MS.

Pictionary-based fMRI paradigm to study the neural correlates of spontaneous improvisation and figural creativity.

A novel game-like and creativity-conducive fMRI paradigm is developed to assess the neural correlates of spontaneous improvisation and figural creativity in healthy adults. Participants were engaged in the word-guessing game of Pictionary(TM), using an MR-safe drawing tablet and no explicit instructions to be "creative". Using the primary contrast of drawing a given word versus drawing a control word (zigzag), we observed increased engagement of cerebellum, thalamus, left parietal cortex, right superior frontal, left prefrontal and paracingulate/cingulate regions, such that activation in the cingulate and left prefrontal cortices negatively influenced task performance. Further, using parametric fMRI analysis, increasing subjective difficulty ratings for drawing the word engaged higher activations in the left pre-frontal cortices, whereas higher expert-rated creative content in the drawings was associated with increased engagement of bilateral cerebellum. Altogether, our data suggest that cerebral-cerebellar interaction underlying implicit processing of mental representations has a facilitative effect on spontaneous improvisation and figural creativity.

Single-Incision laparoscopic surgery (SILS) for ventriculoperitoneal shunt placement.

BACKGROUND: Single-incision laparoscopic surgery (SILS) may facilitate safer shunt placement and lower distal obstruction rate than is seen in conventional surgery. OBJECTIVE: We reviewed our 2-year experience in SILS for ventriculoperitoneal shunt placement to evaluate its usefulness and safety.Materials and Methods In this retrospective study, we enrolled patients older than 18 years with dilated ventricle and syndromes of hydrocephalus. A total of 31 patients underwent 31 primary ventriculoperitoneal shunt placement surgery and two underwent revision surgery. All the procedures were performed by the SILS technique. RESULTS: The entire duration of ventriculoperitoneal shunt implantation ranged from 45 to 80 minutes, with mean operation time of 65 ± 15.3 minutes. No major laparoscopy-related complications were noted. Shunt infection, peritonitis, and distal catheter malfunction occurred in one case (3.2%), proximal malfunction in one case (3.2%), and subcutaneous emphysema occurred in two cases (6.4%). The emphysema resolved within 2 days. Cosmetic results were "very good to good" in 17 patients (54.8%) and "satisfactory" in 14 patients (45.2%). The abdominal scars in most cases were nearly invisible. CONCLUSION: SILS is a safe and effective technique for ventriculoperitoneal shunt placement and can be accomplished with no higher risk of shunt infection and distal malfunction. Without an additional port, SILS allows good visualization of the peritoneal cavity to avoid major intra-abdominal complications. Only one 6-mm incision at the umbilicus area is required and is almost invisible after wound healing.