Digestive cancer management in Asia: position statements: a report on GI Oncology Summit in 2011.

BACKGROUND AND AIM: With the rising incidence of digestive cancers in the Asia Pacific region and the advancement in diagnosis, management and palliation in these conditions, the clinical burden on oncologists is ever increasing. This Summit meeting was called to discuss the optimal management of digestive cancers and the role of Gastroenterologists. METHOD: Experts from Asia Pacific countries in the fields of medical, oncologic, surgical and endoscopic management of cancers in the esophagus, stomach, colon/rectum and the liver reviewed the literature and their practice. 18 position statements were drafted, debated and voted. RESULTS: It was agreed that the burden on GI cancer is increasing. More research will be warranted on chemotherapy, chemoprevention, cost-effectiveness of treatment and nutrition. Cancer management guidelines should be developed in this region when more clinical data are available. In order to improve care to patients, a multi-disciplinary team coordinated by a "cancer therapist" is proposed. This cancer therapist can be a gastroenterologist, a surgeon or any related discipline who have acquired core competence training. This training should include an attachment in a center-of-excellence in cancer management for no less than 12 months. CONCLUSION: The management of GI cancer should be an integrated multi-disciplinary approach and training for GI cancer therapists should be provided for.

Posttraumatic epilepsy in Operation Enduring Freedom/Operation Iraqi Freedom veterans.

Penetrating traumatic brain injury (TBI) is a well-established risk factor for post-traumatic epilepsy (PTE). However, many veterans in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) who suffer from TBI do so from blast injury, and its consequences are not fully known. Two neurologists performed a chart review to describe patterns of injury and health care among all 16 OEF/OIF veterans at the VA Greater Los Angeles Healthcare System who were assigned an outpatient diagnosis of both epilepsy and TBI in 2008-2009. All Veterans were male, and the mean age was 30 years. Blast exposure was the most common mechanism of TBI (81%). Although all Veterans were assigned a diagnosis code of seizures, the diagnosis of PTE was clinically confirmed in only 3 veterans. On the other hand, the diagnosis of post-traumatic stress disorder was confirmed in 81% of the sample and a diagnosis of nonepileptic seizures was suspected in 44% of the sample. Researchers who study PTE among the OEF/OIF population using administrative data also should perform chart reviews to account for the prevalence of psychogenic nonepileptic seizures.

Quantification and localization of EEG interictal spike activity in patients with surgically removed epileptogenic foci.

OBJECTIVE: To demonstrate if interictal spike activity was localized within the resected area in surgically treated epilepsy patients; and if there is correspondence between the degree of localization and improvement after surgery. METHODS: We analyzed long-term EEGs from 34 patients. Interictal spikes were grouped in clusters and averaged according to morphology and topography. The relative contribution of each cluster to the total number of spikes in each patient was estimated. Dipole and distributed EEG source localization of each cluster was made. The percentage of spike activity localized within the site of resection (SR) during the onset was estimated. The relationship between the percentage of activity within SR and the surgery outcome was assessed. RESULTS: Fourteen patients had 90-100% of spikes within SR, 9 had 50-89%. Most patients with more than 50% of activity localized within SR were seizure free, while the 5 patients who had all activity localized outside SR were not seizure free. CONCLUSIONS: Localization of clusters containing the largest quantity of interictal spikes during onset generally corresponded to the likely location of the epileptogenic cortex. SIGNIFICANCE: Computer-assisted EEG source localization with our methodology can be a useful adjunct for the evaluation of candidates for epilepsy surgery.

Successful treatment of refractory simple motor status epilepticus with lacosamide and levetiracetam.

Lacosamide has been reported to have been successfully used for non-convulsive status epilepticus after benzodiazepine failure, and convulsive status epilepticus after benzodiazepine and levetiracetam failure. We report a case of simple motor status epilepticus refractory to benzodiazepines and multiple anti-epileptic medications (AEDs) over 4 days. The addition of lacosamide in combination with existing levetiracetam aborted the continuous seizure with maintenance of seizure freedom through the most recent follow-up at 4 weeks.