Successful management of super-refractory status epilepticus with thalamic deep brain stimulation.

Super-refractory status epilepticus is a condition characterized by recurrence of status epilepticus despite use of deep general anesthesia, and it has high morbidity and mortality rates. We report a case of a 17-year-old boy with a prolonged super-refractory status epilepticus that eventually resolved after commencing deep brain stimulation of the centromedian nucleus of the thalamus. Later attempt to reduce stimulation parameters resulted in immediate relapse of status epilepticus, suggesting a pivotal role of deep brain stimulation in the treatment response. Deep brain stimulation may be a treatment option in super-refractory status epilepticus when other treatment options have failed. ANN NEUROL 2017;81:142-146.

Mismatch negativity abnormality in traumatic brain injury without macroscopic lesions on conventional MRI.

Traumatic brain injury (TBI) causes damage through complex pathophysiological mechanisms. Deficits related to traumatic axonal injury persist in a subset of patients with no macroscopic lesions on conventional MRI. We examined two event-related brain potentials, mismatch negativity (MMN) and P3a, to identify possible electrophysiological anomalies in this subset of TBI patients in comparison with TBI patients with focal abnormalities on MRI/computed tomography and healthy controls. Each group consisted of 10 individuals. A passive oddball paradigm, in which the individuals were instructed to ignore auditory stimuli while watching a silent movie, consisted of non-native speech sounds presented in a random order. Patients with no discernible lesions on conventional MRI showed a significantly augmented amplitude of the brain's involuntary change-detection response MMN, relative to that of the two other groups. In patients with focal neuroradiological abnormalities, this MMN anomaly was not found, whereas the subsequent orientation-related P3a response was significantly enlarged when compared with that of the controls. The present findings demonstrate that MMN is indicative of a functional abnormality in the mechanisms of involuntary attention in chronic TBI patients with normal conventional MRI findings, indexing their increased distractibility associated with the traumatically-induced loss of neural integrity.

Semantic processing in comatose patients with intact temporal lobes as reflected by the N400 event-related potential.

The present study aimed at determining whether the N400 effect (an ERP index of semantic processing) for spoken words occurs in comatose patients. The patients, treated in an intensive care unit, scored less than 8 points in the glasgow coma score at the time of the recording. Semantically related and unrelated spoken word pairs were delivered to patients through headphones at a rate of 1/3s. Patients with an intact temporal lobe exhibited differential N400-like responses for semantically related and unrelated word pairs, which suggests that word semantics can be processed even in the comatose state. In contrast, patients with an injured temporal lobe showed no such effect.