Gray Matter Changes Following Mild COVID-19: An MR Morphometric Study in Healthy Young People.

BACKGROUND: Although COVID-19 is primarily an acute respiratory infection, 5%-40% of patients develop late and prolonged symptoms with frequent neurological complaints, known as long COVID syndrome. The presentation of the disease suggests that COVID infection may cause functional and/or morphological central nervous system alterations, but studies published in the literature report contradictory findings. PURPOSE: To investigate the chronic effects of COVID-19 on cerebral grey matter in a group of young patients without comorbidities, with mild course of COVID infection and no medical complaints at the time of examination. STUDY TYPE: Prospective. POPULATION: Thirty-eight young (age = 26.6 ± 5.0 years; male/female = 14/24), adult participants who recovered from mild COVID infection without a history of clinical long COVID and 37 healthy control subjects (age = 25.9 ± 2.8 years; male/female = 14/23). FIELD STRENGTH/SEQUENCE: Three Tesla, 3D T1-weighted magnetization-prepared rapid gradient-echo, 2D T2-weighted turbo spin-echo. ASSESSMENT: MRI-based morphometry and volumetry along with neuropsychological testing and self-assessed questionnaire. STATISTICAL TESTS: Fisher's exact test, Mann-Whitney U-test, and multiple linear regression analyses were used to assess differences between COVID and healthy control groups. P < 0.05 was used as cutoff for significance. RESULTS: In the COVID group, significantly lower bilateral mean cortical thickness (left/right-hemisphere: 2.51 ± 0.06 mm vs. 2.56 ± 0.07 mm, η2 p = 0.102/2.50 ± 0.06 mm vs. 2.54 ± 0.07 mm, η2 p = 0.101), lower subcortical gray matter (57881 ± 3998 mm3 vs. 60470 ± 5211 mm3 , η2 p = 0.100) and lower right olfactory bulb volume (52.28 ± 13.55 mm3 vs. 60.98 ± 15.8 mm3 , η2 p = 0.078) were found. In patients with moderate to severe anosmia, cortical thickness was significantly lower bilaterally, as compared to patients without olfactory function loss (left/right-hemisphere: 2.50 ± 0.06 mm vs. 2.56 ± 0.05 mm, η2 = 0.173/2.49 ± 0.06 mm vs. 2.55 ± 0.05 mm, η2 = 0.189). Using further exploratory analysis, significantly reduced cortical thickness was detected locally in the right lateral orbitofrontal cortex in the COVID group (2.53 ± 0.10 mm vs. 2.60 ± 0.09 mm, η2 p = 0.112). DATA CONCLUSION: Even without any subjective or objective neurological complaints at the time of the MR scan, subjects in the COVID group showed gray matter alterations in cortical thickness and subcortical gray matter volume. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 3.

Basis Set Limit CCSD(T) Energies for Extended Molecules via a Reduced-Cost Explicitly Correlated Approach.

Several approximations are introduced and tested to reduce the computational expenses of the explicitly correlated coupled-cluster singles and doubles with perturbative triples [CCSD(T)] method for both closed and open-shell species. First, the well-established frozen natural orbital (FNO) technique is adapted to explicitly correlated CC approaches. Second, our natural auxiliary function (NAF) scheme is employed to reduce the size of the auxiliary basis required for the density fitting approximation regularly used in explicitly correlated calculations. Third, a new approach, termed the natural auxiliary basis (NAB) approximation, is proposed to decrease the size of the auxiliary basis needed for the expansion of the explicitly correlated geminals. The performance of the above approximations and that of the combined FNO-NAF-NAB approach are tested for atomization and reaction energies. Our results show that overall speedups of 7-, 5-, and 3-times can be achieved with double-, triple-, and quadruple-ζ basis sets, respectively, without any loss in accuracy. The new method can provide, e.g., reaction energies and barrier heights well within chemical accuracy for molecules with more than 40 atoms within a few days using a few dozen processor cores, and calculations with 50+ atoms are still feasible. These routinely affordable computations considerably extend the reach of explicitly correlated CCSD(T).

Language processing in Internet use disorder: Task-based fMRI study.

Internet use disorder (IUD) is generally conceptualized as a fast-growing behavioral addiction. Several structural and functional brain alterations have been revealed in this condition, but previous behavioral studies indicated that language systems may also be impaired. We used a silent word generation task to induce brain activation in Broca's area and other parts of the language system. Blood-oxygen-level-dependent activation analysis and psychophysiological interaction analysis were applied to assess functional brain changes. IUD was measured by the Problematic Internet Use Questionnaire and two additional questions concerning usage time and subjective rating of addiction. According to our key findings, areas strongly related to the default mode network were altered in IUD during the task. Moreover, Broca's area showed altered functional connectivity with other language network and occipital areas in IUD. These findings may address the neural background of decreased verbal fluency performance previously reported in the literature, and we emphasize that beside the brain's reward and inhibitory control systems, the language system is the next candidate to be involved in the pathogenesis of IUD.

Computer simulation investigation of the adsorption of acetamide on low density amorphous ice. An astrochemical perspective.

The adsorption of acetamide on low density amorphous (LDA) ice is investigated by grand canonical Monte Carlo computer simulations at the temperatures 50, 100, and 200 K, characteristic of certain domains of the interstellar medium (ISM). We found that the relative importance of the acetamide-acetamide H-bonds with respect to the acetamide-water ones increases with decreasing temperature. Thus, with decreasing temperature, the existence of the stable monolayer, characterizing the adsorption at 200 K, is gradually replaced by the occurrence of marked multilayer adsorption, preceding even the saturation of the first layer at 50 K. While isolated acetamide molecules prefer to lay parallel to the ice surface to maximize their H-bonding with the surface water molecules, this orientational preference undergoes a marked change upon saturation of the first layer due to increasing competition of the adsorbed molecules for H-bonds with water and to the possibility of their H-bond formation with each other. As a result, molecules stay preferentially perpendicular to the ice surface in the saturated monolayer. The chemical potential value corresponding to the point of condensation is found to decrease linearly with increasing temperature. We provide, in analogy with the Clausius-Clapeyron equation, a thermodynamic explanation of this behavior and estimate the molar entropy of condensed phase acetamide to be 34.0 J/mol K. For the surface concentration of the saturated monolayer, we obtain the value 9.1 ± 0.8 µmol/m2, while the heat of adsorption at infinitely low surface coverage is estimated to be -67.8 ± 3.0 kJ/mol. Our results indicate that the interstellar formation of peptide chains through acetamide molecules, occurring at the surface of LDA ice, might well be a plausible process in the cold (i.e., below 50 K) domains of the ISM; however, it is a rather unlikely scenario in its higher temperature (i.e., 100-200 K) domains.

Investigation of synapses in the cortical white matter in human temporal lobe epilepsy.

Temporal lobe epilepsy (TLE) is one of the most common focal pharmacotherapy-resistant epilepsy in adults. Previous studies have shown significantly higher numbers of neurons in the neocortical white matter in TLE patients than in controls. The aim of this work was to investigate whether white matter neurons are part of the neuronal circuitry. Therefore, we studied the distribution and density of synapses in surgically resected neocortical tissue of pharmacotherapy-resistant TLE patients. Neocortical white matter of temporal lobe from non-epileptic patients were used as controls. Synapses and neurons were visualized with immunohistochemistry using antibodies against synaptophysin and NeuN, respectively. The presence of synaptophysin in presynaptic terminals was verified by electron microscopy. Quantification of immunostaining was performed and the data of the patients' cognitive tests as well as clinical records were compared to the density of neurons and synapses. Synaptophysin density in the white matter of TLE patients was significantly higher than in controls. In TLE, a significant correlation was found between synaptophysin immunodensity and density of white matter neurons. Neuronal as well as synaptophysin density significantly correlated with scores of verbal memory of TLE patients. Neurosurgical outcome of TLE patients did not significantly correlate with histological data, although, higher neuronal and synaptophysin densities were observed in patients with favorable post-surgical outcome. Our results suggest that white matter neurons in TLE patients receive substantial synaptic input and indicate that white matter neurons may be integrated in epileptic neuronal networks responsible for the development or maintenance of seizures.

Epilepsy is overrepresented among young people who died from COVID-19: Analysis of nationwide mortality data in Hungary.

BACKGROUND: Studies examining epilepsy as a COVID-related death risk have come to conflicting conclusions. Our aim was to assess the prevalence of epilepsy among COVID-related deaths in Hungary. METHODS: Each COVID-19 infection case is required to be reported on a daily basis to the National Public Health Center of Hungary. This online report includes the beginning and end of the infection, as well as information on comorbidities. Death during infection is regarded as COVID-related. The anonymized data of each deceased patient are published on an information website (www.koronavirus.gov.hu) and provides up-to-date information on each patient with the date of death, the patient's sex, age, and chronic illness. RESULTS: There were 11,968 patients who died of COVID-19 in Hungary between 13 March 2020 and 23 January 2021. Among 11,686 patients with no missing values for comorbidities, 255 patients had epilepsy (2.2%). Epilepsy was much more common among those who died at a young age: 9.3% of those who died under the age of 50 had epilepsy, compared with only 1.3% in those over the age of 80. The younger an age group was, the higher was the prevalence of epilepsy. CONCLUSION: Patients who died of COVID-19 under the age of 50 were 10 to 20 times more likely to have epilepsy than what would have been expected from epidemiological data. Our results highlight the need for increased protection of young people with epilepsy from COVID-19 infection and the development of a vaccination strategy accordingly.

The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy.

BACKGROUND: When MRI fails to detect a potentially epileptogenic lesion, the chance of a favorable outcome after epilepsy surgery becomes significantly lower (from 60 to 90% to 20-65%). Hybrid FDG-PET/MRI may provide additional information for identifying the epileptogenic zone. We aimed to investigate the possible effect of the introduction of hybrid FDG-PET/MRI into the algorithm of the decision-making in both lesional and non-lesional drug-resistant epileptic patients. METHODS: In a prospective study of patients suffering from drug-resistant focal epilepsy, 30 nonlesional and 30 lesional cases with discordant presurgical results were evaluated using hybrid FDG-PET/MRI. RESULTS: The hybrid imaging revealed morphological lesion in 18 patients and glucose hypometabolism in 29 patients within the nonlesional group. In the MRI positive group, 4 patients were found to be nonlesional, and in 9 patients at least one more epileptogenic lesion was discovered, while in another 17 cases the original lesion was confirmed by means of hybrid FDG-PET/MRI. As to the therapeutic decision-making, these results helped to indicate resective surgery instead of intracranial EEG (iEEG) monitoring in 2 cases, to avoid any further invasive diagnostic procedures in 7 patients, and to refer 21 patients for iEEG in the nonlesional group. Hybrid FDG-PET/MRI has also significantly changed the original therapeutic plans in the lesional group. Prior to the hybrid imaging, a resective surgery was considered in 3 patients, and iEEG was planned in 27 patients. However, 3 patients became eligible for resective surgery, 6 patients proved to be inoperable instead of iEEG, and 18 cases remained candidates for iEEG due to the hybrid FDG-PET/MRI. Two patients remained candidates for resective surgery and one patient became not eligible for any further invasive intervention. CONCLUSIONS: The results of hybrid FDG-PET/MRI significantly altered the original plans in 19 of 60 cases. The introduction of hybrid FDG-PET/MRI into the presurgical evaluation process had a potential modifying effect on clinical decision-making. TRIAL REGISTRATION: Trial registry: Scientific Research Ethics Committee of the Medical Research Council of Hungary. TRIAL REGISTRATION NUMBER: 008899/2016/OTIG . Date of registration: 08 February 2016.

Size-consistent explicitly correlated triple excitation correction.

A new approach is proposed to reduce the basis set incompleteness error of the triple excitation correction in explicitly correlated coupled-cluster singles and doubles with perturbative triples calculations. Our method is similar to the intuitive triples correction approach of Knizia et al. [J. Chem. Phys. 130, 054104 (2009)] but, in contrast to the latter, is size-consistent. The new approximation is easy to implement, and its overhead is negligible with respect to the conventional (T) correction. The performance of the approach is assessed for atomization, reaction, and interaction energies as well as for bond lengths and harmonic vibrational frequencies. The advantages of its size consistency are also demonstrated.

Pregnancy and deep brain stimulation therapy for epilepsy.

Neuromodulation therapy -vagus nerve stimulation (VNS) and deep brain stimulation (DBS)- is one of the therapeutic options for drug-resistant epilepsy. With the increasing number of DBS implantations in women with epilepsy, it has become a burning issue whether DBS is safe in pregnancy. We report here two women with epilepsy who gave birth to healthy children with DBS therapy. We describe two cases, a 30-year-old woman and a 37-year-old woman. Both were implanted with DBS due to drug-resistant epilepsy. Both of our patients showed a significant improvement after DBS implantation and thereafter gave birth to a healthy child with DBS treatment. The severity and frequency of epileptic seizures did not change during pregnancy and after childbirth. Although a Caesarean section was performed in one case, pregnancies and births were essentially problem-free. At present, the two- and four-year-old children are healthy. Considering these cases, previously described VNS cases, and DBS cases with non-epileptic indications; we suggest that pregnancy and childbirth are safe in epilepsy patients with DBS, moreover, DBS treatment has probably no effect on foetal abnormalities or breastfeeding.

Multi-marker approach for the evaluation of environmental impacts of APACS 50WG on aquatic ecosystems.

Neonicotinoids are the most widely used synthetic insecticides in the world. These insecticides are widely distributed in the ecosystem, indicating that more attention should be paid to the potential risks regarding their use in agriculture. Due their intensive use, non-target species in the environment are also exposed to their putative effects. Within acute exposure trials, the time related effect of sublethal dose of the neonicotinoid preparation APACS 50 WG was investigated on swimming behaviour and the multi-xenobiotic resistance system (MXR) activity, as a first line defence pathway of adult Dikerogammarus villosus. Results showed that treated animals manifested an increased swimming activity. Exposed animals were monitored by the rhodamine B accumulation assay, and APACS 50 WG exerted distinct changes in the MXR activity as well. Our results suggested that application of neonicotinoid at a low concentration (3.9 ng/l) contributed to the activation of locomotor activity and at the same concentration range the transmembrane transport mechanisms was altered too.

Surface Affinity of Alkali and Halide Ions in Their Aqueous Solution: Insight from Intrinsic Density Analysis.

The surface tension of all aqueous alkali halide solutions is higher than that of pure water. According to the Gibbs adsorption equation, this indicates a net depletion of these ions in the interfacial region. However, simulations and experiments show that large, soft ions, such as I-, can accumulate at the liquid/vapor interface. The presence of a loose hydration shell is usually considered to be the reason for this behavior. In this work, we perform computer simulations to characterize the liquid-vapor interface of aqueous alkali chloride and sodium halide solutions systematically, considering all ions from Li+ to Cs+ and from F- to I-. Using computational methods for the removal of surface fluctuations, we analyze the structure of the interface at a dramatically enhanced resolution, showing that the positive excess originates in the very first molecular layer and that the next 3-4 layers account for the net negative excess. With the help of a fictitious system with charge-inverted ion pairs, we also show that it is not possible to rationalize the surface affinity of ions in solutions in terms of the properties of anions and cations separately. Moreover, the surface excess is generally dominated by the smaller of the two ions.

Status epilepticus 2020. / Status epilepticus 2020

Status epilepticus is the second most common neurological emergency with 15‒25% mortality rate. The principle of "time is brain" is also true for the treatment of status epilepticus: the earlier we start an adequate treatment, the more likely we are to stop progression. With treatment protocols based on high-level evidence, the progression of status epilepticus can be prevented in 75­90% of cases: we can avoid the induced coma or death. At the beginning of status epilepticus, parenteral benzodiazepine should be given immediately: intramuscular midazolam (0.2 mg/kg, max. 10 mg). In the case of easy veinous access, benzodiazepines can also be given intravenously. If the first benzodiazepine bolus does not stop the status epilepticus, we speak about established (benzodiazepine refractory) status epilepticus. In this case, a fast-acting non-benzodiazepine antiepileptic drug should be given: intravenous valproate (40 mg/kg, max. 3000 mg, within 10 minutes) or levetiracetam (60 mg/kg, max. 4500 mg, within 10 minutes). Refractory status epilepticus that persists for more than 1 hour and does not respond to either benzodiazepines or antiepileptics should be treated with general anesthesia (full narcosis). Induced coma can be achieved with fast-acting anesthetics, a combination of propofol with midazolam is the most frequently used one. Orv Hetil. 2020; 161(42): 1779­1786.

Identification, presence, and possible multifunctional regulatory role of invertebrate gonadotropin-releasing hormone/corazonin molecule in the great pond snail (Lymnaea stagnalis).

In the last years, our interpretation of the origin and function of the gonadotropin-releasing hormone (GnRH) neuropeptide superfamily has changed substantially. A main driver for these conceptual changes came from increased investigations into functions and evolutionary lineage of previously identified molluscan GnRH molecules. Emerging evidence suggests not only reproductive, but also diverse biological effects of these molecules and proposes they should most likely be called corazonin (CRZ). Clearly, a more global understanding requires further exploration of species-specific functions and structure of invGnRH/CRZ peptides. Towards this goal, we have identified the full-length cDNA of invGnRH/CRZ peptide in an invertebrate model species, the great pond snail Lymnaea stagnalis, termed ly-GnRH/CRZ, and characterized the transcript and peptide distribution in the central nervous system (CNS) and peripheral organs. Our results are consistent with previous data that molluscan GnRHs are more related to CRZs and serve diverse functions. Hence, our findings support the notion that peptides originally termed molluscan GnRH are multifunctional modulators and that nomenclature change should be taken into consideration.

Chemical-neuroanatomical organization of peripheral sensory-efferent systems in the pond snail (Lymnaea stagnalis).

Perception and processing of chemical cues are crucial for aquatic gastropods, for proper elaboration of adaptive behavior. The pond snail, Lymnaea stagnalis, is a model species of invertebrate neurobiology, in which peripheral sensory neurons with different morphology and transmitter content have partly been described, but we have little knowledge regarding their functional morphological organization, including their possible peripheral intercellular connections and networks. Therefore the aim of our study was to characterize the sensory system of the tentacles and the lip, as primary sensory regions, and the anterior foot of Lymnaea with special attention to the transmitter content of the sensory neurons, and their relationship to extrinsic elements of the central nervous system. Numerous bipolar sensory cells were demonstrated in the epithelial layer of the peripheral organs, displaying immunoreactivity to antibodies raised against tyrosine hydroxylase, histamine, glutamate and two molluscan type oligopeptides, FMRFamide and Mytilus inhibitory peptide. A subepithelial plexus was formed by extrinsic serotonin and FMRFamide immunoreactive fibers, whereas in deeper regions axon processess of different origin with various immunoreactivities formed networks, too. HPLC-MS assay confirmed the presence of the low molecular weight signal molecules in the three examined areas. Following double-labeling immunohistochemistry, close arrangements were observed, formed by sensory neurons and extrinsic serotonergic (and FMRFamidergic) fibers at axo-dendritic, axo-somatic and axo-axonic levels. Our results suggest the involvement of a much wider repertoire of signal molecules in peripheral sensory processes of Lymnaea, which can locally be modified by central input, hence influencing directly the responses to environmental cues.

Thermodynamics of mixing methanol with supercritical CO2 as seen from computer simulations and thermodynamic integration.

The changes in extensive thermodynamic quantities, such as volume, energy, Helmholtz free energy and entropy, occurring upon mixing liquid methanol with supercritical CO2, are calculated using Monte Carlo simulations and thermodynamic integration for all eight combinations of four methanol and two CO2 potential models in the entire composition range at 313 K. The obtained results are also compared with experimental data whenever possible. The transition of the system from liquid to a supercritical state is found to occur at this temperature around a CO2 mole fraction value of 0.95 with all model combinations considered. This liquid to supercritical transition is always accompanied by positive Helmholtz free energy of mixing values and, consequently, by the non-miscibility of the two components. Furthermore, both this non-miscibility around the liquid to supercritical transition and also the miscibility of the two components below this transition, in the liquid regime, are found to be primarily of the energetic rather than entropic origin; the entropy of mixing turns out to be very close to zero, and around the liquid to supercritical transition even its qualitative behaviour is strongly model dependent. Finally, it is found that the methanol expansion coefficient is not sensitive to the details of the potential models, and it is always in excellent agreement with the experimental data. On the other hand, both the volume and the energy of mixing depend strongly on the molar volume of neat CO2 in the model being used, and in this respect the TraPPE model of CO2 [J. J. Potoff and J. I. Siepmann, AIChE J., 2001, 47, 1676] performs considerably better than that of Zhang and Duan [Z. Zhang and Z. Duan, J. Chem. Phys., 2005, 122, 214507].

Internet addiction and functional brain networks: task-related fMRI study.

A common brain-related feature of addictions is the altered function of higher-order brain networks. Growing evidence suggests that Internet-related addictions are also associated with breakdown of functional brain networks. Taking into consideration the limited number of studies used in previous studies in Internet addiction (IA), our aim was to investigate the functional correlates of IA in the default mode network (DMN) and in the inhibitory control network (ICN). To observe these relationships, task-related fMRI responses to verbal Stroop and non-verbal Stroop-like tasks were measured in 60 healthy university students. The Problematic Internet Use Questionnaire (PIUQ) was used to assess IA. We found significant deactivations in areas related to the DMN (precuneus, posterior cingulate gyrus) and these areas were negatively correlated with PIUQ during incongruent stimuli. In Stroop task the incongruent_minus_congruent contrast showed positive correlation with PIUQ in areas related to the ICN (left inferior frontal gyrus, left frontal pole, left central opercular, left frontal opercular, left frontal orbital and left insular cortex). Altered DMN might explain some comorbid symptoms and might predict treatment outcomes, while altered ICN may be the reason for having difficulties in stopping and controlling overuse.

The allelochemical tannic acid affects the locomotion and feeding behaviour of the pond snail, Lymnaea stagnalis, by inhibiting peripheral pathways.

(1) The effect of tannic acid (TA), a dominant component of plant allelochemicals, was investigated on the locomotion and feeding of the pond snail, Lymnaea stagnalis. The effect of TA on the neuronal background underlying feeding activity was also analysed. (2) TA affected the spontaneous locomotion and of juvenile snails in a concentration-dependent way. Low (10 µM) TA concentration resulted in an increased (sliding or swimming) activity compared to the control; meanwhile, high (100 µM) TA concentration inhibited the locomotion of the animals. (3) Low (10 µM) TA concentration increased the frequency of sucrose-evoked feeding of intact animals, whereas high (100 µM) TA concentration resulted in significantly longer feeding latency and decreased feeding rate. The feeding changes proved to be partially irreversible, since after 48 h maintained in clear water, the animals tested in 100 µM TA previously still showed lower feeding rate in sucrose. (4) Electrophysiological experiments on semi-intact preparations showed that application of 100 µM TA to the lip area inhibited the fictive feeding pattern of central neurons, the cellular response to sucrose. (5) On isolated CNS preparation, 100 µM TA applied in the bathing solution, however, failed to inhibit the activation of the central feeding (CPG) interneurons following application of extracellular dopamine. Our results suggest that TA affects both afferent and efferent peripheral functions in Lymnaea. TA reduces feeding activity by primarily blocking feeding sensory pathways, and its negative effect on locomotion may imply sensory pathways and/or ciliary activity.

[Evaluation of resection margins following breast conserving surgery for breast cancer. A multicentric retrospective study]. / Emlorák miatti szervmegtartó mutétek reszekciós széleinek vizsgálata. Multicentrikus retrospektív elemzés.

Introduction: Breast conserving surgery for breast cancer requires the analysis of surgical margins. If the tumor is not removed completely, additional treatments (reoperation, boost irradiation) are generally recommended. Aim: To analyze the information content of histopathology reports on surgical margins in consecutive cases of breast conservation for invasive female breast cancer, to evaluate the frequency of incompletely removed tumors and to estimate the rate of further treatments after incomplete removal. Method: Analysis of margin related data of consecutive histopathology reports from 8 Hungarian pathology units with locoregional treatment related data in case of unsafe margins. Results: 386 reports were analyzed after exclusions. 200 and 32 cases were identified as having unsafe margins according to the previous (<5 mm) and the new (0 mm) definition of unclear margin, respectively. Unsafe margins were more common with lobular carcinomas. Specimens with clear margins weighed more. Reoperations for unsafe margins were performed in 43/180 and 12/22 cases according to the previous and the new definitions, respectively. Only 75/137 patients without reoperation received boost irradiation of the tumor bed; information on boost radiotherapy was often missing. Residual cancer was identified in 15/43 reoperated patients, of whom 9 had >0 mm margin distance. Conclusions: Some pathology reports lack information on surgical margins. Unsafe margin rates decreased with the new definition. Residual cancer may be left behind in case of clear margins with no ink on tumor. Neither reoperation, nor boost radiotherapy is given to some patients with unclear surgical margins. Orv Hetil. 2019; 160(26): 1036-1044.

[Postoperative outcome of surgical interventions for epilepsy between 2005 and 2016 at the Epilepsy Center of Pécs]. / Epilepsziasebészeti beavatkozások eredményei a Pécsi Epilepszia Centrumban 2005 és 2016 között.

INTRODUCTION: Epilepsy as a chronic, severe neurologic disease significantly influences the quality of life of the epileptic patients. In candidates well selected for surgery, the seizure freedom is realistically achievable, and the quality of life can be further improved with complex individual rehabilitation. AIM: We aimed to evaluate the postoperative outcome of patients who underwent epilepsy surgery between 2005 and 2016 at the Epilepsy Center at Pécs. METHOD: We evaluated seizure status at regular follow-up visits after surgery and the quality of life using questionnaires focusing on employment and social status. RESULTS: 76% of the 72 patients who underwent surgical resection for epilepsy were free from disabling seizures , and 10% had rare disabling seizures (almost seizure-free), 7% experienced worthwhile improvement and 7% had no worthwhile improvement. Comparing the employment status of patients free from disabling seizures to patients not free from disabling seizures, we found that the employment status is significantly influenced by seizure freedom (p<0.01, Fisher's exact test). While 67% of seizure-free patients were employed, only 19% of patients not free from disabling seizures were hired. CONCLUSION: Our results resemble the international tendencies and success rate, proving epilepsy surgery as an available, valid and effective treatment in well selected patients. Orv Hetil. 2019; 160(7): 270-278.

Ictal piloerection is associated with high-grade glioma and autoimmune encephalitis-Results from a systematic review.

PURPOSE: To comprehensively analyze ictal piloerection (IP) in a large number of subjects. METHODS: We performed a systematic review on case report studies of patients diagnosed with IP (1929-2017) with additional cases included from the Department of Neurology of University of Pécs, the National Institute of Clinical Neurosciences, and Odense University Hospital. Each included case was characterized regarding patient history, IP seizure characteristics, diagnostic work-up, and therapy. Comparative analyses were also carried out based on sex and pathology. RESULTS: Altogether, 109 cases were included. We observed a strong male predominance (p < 0.001). The mean age at onset of epilepsy was 39.5 ± 20.7 years (median: 38, IQR:24-57). The seizure onset zone was temporal (p < 0.001), and was lateralized to the ipsilateral hemisphere in unilateral localization (p = 0.001). The seizure was accompanied by cold shiver in 53%, and by other autonomic symptoms in 47% of cases. In 53% of patients, IP never progressed into complex partial or generalized tonic-clonic seizure; 16% of the patients reported occasional, and 31% regular generalization. Seizure frequency was higher among females (median:25/day, IQR:3-60) than among males (median:3/day, IQR:1-11) (p = 0.017). The two most common underlying pathologies were limbic encephalitis (23%) and astrocytoma (23%, among them 64% WHO III-IV astrocytoma). CONCLUSION: IP was particularly associated with autoimmune encephalitis and high-grade glioma, suggesting IP's particular clinical importance in directing diagnostic work-up.