Exercise-induced central and peripheral sympathetic activity in a community-based group of epilepsy patients differ from healthy controls.

Ictal and interictal activity within the autonomic nervous system is characterized by a sympathetic overshoot in people with epilepsy. This autonomic dysfunction is assumed to be driven by alterations in the central autonomic network. In this study, exercise-induced changes of the interrelation of central and peripheral autonomic activity in patients with epilepsy was assessed. 21 patients with epilepsy (16 seizure-free), and 21 healthy matched controls performed an exhaustive bicycle ergometer test. Immediately before and after the exercise test, resting state electroencephalography measurements (Brain Products GmbH, 128-channel actiCHamp) of 5 min were carried out to investigate functional connectivity assessed by phase locking value in source space for whole brain, central autonomic network and visual network. Additionally, 1-lead ECG (Brain products GmbH) was performed to analyze parasympathetic (root mean square of successive differences (RMSSD) of the heart rate variability) and sympathetic activity (electrodermal activity (meanEDA)). MeanEDA increased (p < 0.001) and RMSSD decreased (p < 0.001) from pre to post-exercise in both groups. Correlation coefficients of meanEDA and central autonomic network functional connectivity differed significantly between the groups (p = 0.004) after exercise. Both patients with epilepsy and normal control subjects revealed the expected physiological peripheral autonomic responses to acute exhaustive exercise, but alterations of the correlation between central autonomic and peripheral sympathetic activity may indicate a different sympathetic reactivity after exercise in patients with epilepsy. The clinical relevance of this finding and its modulators (seizures, anti-seizure medication, etc.) still needs to be elucidated.

Glycemic response to meals with a high glycemic index differs between morning and evening: a randomized cross-over controlled trial among students with early or late chronotype.

PURPOSE: Glycemic response to the same meal depends on daytime and alignment of consumption with the inner clock, which has not been examined by individual chronotype yet. This study examined whether the 2-h postprandial and 24-h glycemic response to a meal with high glycemic index (GI) differ when consumed early or late in the day among students with early or late chronotype. METHODS: From a screening of 327 students aged 18-25 years, those with early (n = 22) or late (n = 23) chronotype participated in a 7-day randomized controlled cross-over intervention study. After a 3-day observational phase, standardized meals were provided on run-in/washout (days 4 and 6) and intervention (days 5 and 7), on which participants received a high GI meal (GI = 72) in the morning (7 a.m.) or in the evening (8 p.m.). All other meals had a medium GI. Continuous glucose monitoring was used to measure 2-h postprandial and 24-h glycemic responses and their variability. RESULTS: Among students with early chronotype 2-h postprandial glucose responses to the high GI meal were higher in the evening than in the morning (iAUC: 234 (± 92) vs. 195 (± 91) (mmol/L) × min, p = 0.042). Likewise, mean and lowest 2-h postprandial glucose values were higher when the high GI meal was consumed in the evening (p < 0.001; p = 0.017). 24-h glycemic responses were similar irrespective of meal time. Participants with late chronotype consuming a high GI meal in the morning or evening showed similar 2-h postprandial (iAUC: 211 (± 110) vs. 207 (± 95) (mmol/L) × min, p = 0.9) and 24-h glycemic responses at both daytimes. CONCLUSIONS: Diurnal differences in response to a high GI meal are confined to those young adults with early chronotype, whilst those with a late chronotype seem vulnerable to both very early and late high GI meals. Registered at clinicaltrials.gov (NCT04298645; 22/01/2020).

Training matters: Heading incidence and characteristics in children's and youth football (soccer) players.

OBJECTIVE: Concerns about short- and long-term consequences of repetitive heading contributed to heading restrictions in youth football in some countries. This prospective longitudinal cohort study aims to describe heading exposure in children's and youth football over two seasons using standardized video analysis. METHODS: All matches and training sessions of a male Under-11 (n = 29), Under-15 (n = 28), Under-19 (n = 38), and female Under-17 (n = 39) team were videotaped during the seasons 2019-2020 and 2020-2021. Heading frequencies and characteristics were analyzed. Individual heading exposure is presented as average incidence rates (IR) per 1000 match/training hours. RESULTS: In 275 matches and 673 training sessions, 22 921 headers were observed. Heading IR per player in matches was 1256 (Under-11 m), 1608 (Under-15 m), 1050 (Under-17 f), and 1966 (Under-19 m). In training sessions, IR per player was 739 (Under-11 m), 2206 (Under-15 m), 1661 (Under-17 f), and 1419 (Under-19 m). Five Under-15 males headed the ball five to eight times per training on average. Most headers were performed without heading duels. Flight distance was predominantly 5-20 m (54%) in matches and <5 m (65%) in training. While head impact location most frequently was at frontal areas, one-third of all headers in Under-11 in matches hit temporal, parietal, and occipital parts of the head. CONCLUSION: Heading incidence was low in the youngest age group, whereas (predominantly five) Under-15 males showed very high heading exposures in training. In assessment and regulation of heading burden, training sessions and individual heading behavior should specifically be addressed. Recommendations for heading the ball in practice should account for individual and age-related differences.

Cortical thickness and neurocognitive performance in former high-level female soccer and non-contact sport athletes.

BACKGROUND: Long-term effects of playing soccer (football) on the brain structure and function of the brain are vividly debated. While some studies showed differences in neurocognitive performance and structural brain changes in retired male players, data on female players are scarce. The present study compares cortical thickness and neurocognitive performance in former high-level female soccer (SOC) and non-contact sport athletes (CON). METHODS: 3 T T1-weighted 3D MPRAGE MRI was performed, and vertex-wise cortical thickness was analyzed using FreeSurfer (v. 6.0.0). Neurocognitive performance in seven domains of SOC and CON was assessed. A multivariate linear model was used to analyze interactions with respect to heading frequency and a history of concussion. RESULTS: SOC (n = 15, mean age 38.3 ± 5.1 years) and CON (n = 16, mean age 36.6 ± 5.8 years) had a similar cortical thickness and performed similarly in the neurocognitive tests except for verbal memory and psychomotor speed, where SOC performed significantly worse than CON. Moderate headers had a significantly larger cortical thickness than rare headers in the right inferior parietal region. Visual memory and cortical thickness were positively correlated in the group of frequent headers and negatively correlated in CON, but not in the other header groups. PERSPECTIVE: In contrast to previous reports in male soccer players, female players did not reveal cortical thinning in comparison with control athletes, whereas neurocognitive profiles of female soccer players might not significantly differ from male athletes. Small sample sizes, subjective header assessment, and the case-control study design require a cautious interpretation.

High revision arthroscopy rate after ACL reconstruction in men's professional team sports.

PURPOSE: The study analysed unique data on anterior cruciate ligament (ACL) injuries among German professional male team sports over five consecutive seasons with the aim of improving medical outcomes in the future. Sport-specific differences in injury occurrence, concomitant injuries, timing of ACL reconstruction, graft type selection and short-term complications were examined. METHODS: This retrospective study analysed trauma insurance data on all complete ACL tears from players with at least one competitive match appearance in the two highest divisions of German male basketball, ice hockey, football and handball. Each complete ACL tear registered by clubs or physicians between the 2014/15 and 2018/19 seasons with the German statutory accidental insurance for professional athletes (VBG) as part of occupational accident reporting was included. RESULTS: In total, 189 out of 7517 players (2.5%) sustained an ACL injury, mainly in handball (n = 82; 43.4%) and football (n = 72; 38.1%) followed by ice hockey (n = 20; 10.6%) and basketball (n = 15; 7.9%).Seventeen players (9.0%) also sustained a second ACL injury. Thus, 206 ACL injuries were included in the analysis. The overall match incidence of ACL injuries was 0.5 per 1000 h and was highest in handballs (1.1 injuries per 1000 h). A total of 70.4% of ACL injuries involved concomitant injury to other knee structures, and 29.6% were isolated ACL injuries. The highest rate of isolated ACL injuries was seen in ice hockey (42.9%). All ACL injuries, except for one career-ending injury, required surgery. In the four analysed team sports, hamstring tendons (71.4%) were the most commonly used grafts for ACL reconstruction; football had the highest percentage of alternative grafts (48.7%). During rehabilitation, 22.9% of all surgically treated ACL injuries (n = 205) required at least two surgical interventions, and 15.6% required revision arthroscopy. The main cause of revision arthroscopy (n = 32; 50.0%) was range-of-motion deficit due to arthrofibrosis or cyclops formation. CONCLUSION: The present study shows an overall high rate of revision arthroscopy after ACLR (15.6%), which should encourage surgeons and therapists to evaluate their treatment and rehabilitation strategies in this specific subpopulation. Hamstring tendon grafts are most commonly used for ACL reconstruction but have the highest revision and infection rates. Handball shows the highest ACL injury risk of the four evaluated professional team sports. Concomitant injuries occur in the majority of cases, with the highest share of isolated ACL injuries occurring in ice hockey. LEVEL OF EVIDENCE: Level III.

Home-Based Measurements of Nocturnal Cardiac Parasympathetic Activity in Athletes during Return to Sport after Sport-Related Concussion.

Sport-related concussions (SRC) are characterized by impaired autonomic control. Heart rate variability (HRV) offers easily obtainable diagnostic approaches to SRC-associated dysautonomia, but studies investigating HRV during sleep, a crucial time for post-traumatic cerebral regeneration, are relatively sparse. The aim of this study was to assess nocturnal HRV in athletes during their return to sports (RTS) after SRC in their home environment using wireless wrist sensors (E4, Empatica, Milan, Italy) and to explore possible relations with clinical concussion-associated sleep symptoms. Eighteen SRC athletes wore a wrist sensor obtaining photoplethysmographic data at night during RTS as well as one night after full clinical recovery post RTS (>3 weeks). Nocturnal heart rate and parasympathetic activity of HRV (RMSSD) were calculated and compared using the Mann-Whitney U Test to values of eighteen; matched by sex, age, sport, and expertise, control athletes underwent the identical protocol. During RTS, nocturnal RMSSD of SRC athletes (Mdn = 77.74 ms) showed a trend compared to controls (Mdn = 95.68 ms, p = 0.021, r = -0.382, p adjusted using false discovery rate = 0.126) and positively correlated to "drowsiness" (r = 0.523, p = 0.023, p adjusted = 0.046). Post RTS, no differences in RMSSD between groups were detected. The presented findings in nocturnal cardiac parasympathetic activity during nights of RTS in SRC athletes might be a result of concussion, although its relation to recovery still needs to be elucidated. Utilization of wireless sensors and wearable technologies in home-based settings offer a possibility to obtain helpful objective data in the management of SRC.

Fitness, performance, and cardiac autonomic responses to exercise in people with epilepsy.

People with epilepsy (PWE) are less fit and have an increased risk of sudden cardiac death. Imbalances within the autonomic nervous system (ANS) are believed to mediate some of those effects. However, results are mostly derived from patients whose seizures are refractory to medical therapy. In this study, an exhaustive bicycle ergometer test was delivered to 25 PWE (19 seizure free in the last 6 months) recruited in a community-based setting and 25 age-, sex-, and BMI-matched healthy controls. During the exercise test a 12-channel ECG was recorded and spirometry was carried out to determine the maximal oxygen uptake (VO2peak) as the gold standard to assess fitness. Before and after exercise, heart rate variability (HRV) and electrodermal activity (EDA) were measured along with an electroencephalogram (EEG). Blood samples were collected to determine anti-seizure drug (ASD) serum levels and physical activity of daily living was evaluated via the International Physical Activity Questionnaire (IPAQ). People with epilepsy and healthy controls were similarly fit and physically active. However, PWE had a lower maximum heart rate, a lower heart rate reserve, and a lower chronotropic index. The ratio between low- to high-frequency HRV changes (LF/HF ratio) was lower in PWE. Two patients with idiopathic genetic epilepsies revealed generalized interictal epileptiform discharges only after, but not before exercise. However, post-exercise EEG measurement was three times longer than pre-exercise and those patients did not report exercise induced seizures in the history. Besides epileptogenesis, anti-seizure medications may also contribute to those autonomic differences.

Twenty-four-hour patterns in electrodermal activity recordings of patients with and without epileptic seizures.

OBJECTIVE: Daytime and nighttime patterns affect the dynamic modulation of brain and body functions and influence the autonomic nervous system response to seizures. Therefore, we aimed to evaluate 24-hour patterns of electrodermal activity (EDA) in patients with and without seizures. METHODS: We included pediatric patients with (a) seizures (SZ), including focal impaired awareness seizures (FIAS) or generalized tonic-clonic seizures (GTCS), (b) no seizures and normal electroencephalography (NEEG), or (c) no seizures but epileptiform activity in the EEG (EA) during vEEG monitoring. Patients wore a device that continuously recorded EDA and temperature (TEMP). EDA levels, EDA spectral power, and TEMP levels were analyzed. To investigate 24-hour patterns, we performed a nonlinear mixed-effects model analysis. Relative mean pre-ictal (-30 min to seizure onset) and post-ictal (I: 30 min after seizure offset; II: 30 to 60 min after seizure offset) values were compared for SZ subgroups. RESULTS: We included 119 patients (40 SZ, 17 NEEG, 62 EA). EDA level and power group-specific models (SZ, NEEG, EA) (h = 1; P < .01) were superior to the all-patient cohort model. Fifty-nine seizures were analyzed. Pre-ictal EDA values were lower than respective 24-hour modulated SZ group values. Post hoc comparisons following the period-by-seizure type interaction (EDA level: χ2  = 18.50; P < .001, and power: χ2  = 6.73; P = .035) revealed that EDA levels were higher in the post-ictal period I for FIAS and GTCS and in post-ictal period II for GTCS only compared to the pre-ictal period. SIGNIFICANCE: Continuously monitored EDA shows a pattern of change over 24 hours. Curve amplitudes in patients with recorded seizures were lower as compared to patients who did not exhibit seizures during the recording period. Sympathetic skin responses were greater and more prolonged in GTCS compared to FIAS. EDA recordings from wearable devices offer a noninvasive tool to continuously monitor sympathetic activity with potential applications for seizure detection, prediction, and potentially sudden unexpected death in epilepsy (SUDEP) risk estimation.

Learning to play golf for elderly people with subjective memory complaints: feasibility of a single-blinded randomized pilot trial.

BACKGROUND: Subjective Memory Complaints (SMC) in elderly people due to preclinical Alzheimer's Disease may be associated with dysregulation of the Kynurenine Pathway (KP), with an increase in neurotoxic metabolites that affect cognition. Golf is a challenging sport with high demands on motor, sensory, and cognitive abilities, which might bear the potential to attenuate the pathological changes of preclinical AD. This trial investigated the feasibility of learning to play golf for elderly with cognitive problems and its effects on cognitive functions and the KP. METHODS: In a 22-week single-blinded randomized controlled trial, elderly people with SMC were allocated to the golf (n = 25, 180 min training/week) or control group (n = 21). Primary outcomes were feasibility (golf exam, adherence, adverse events) and general cognitive function (Alzheimer's Disease Assessment Scale). Secondary outcomes include specific cognitive functions (Response Inhibition, Corsi Block Tapping Test, Trail Making Test), KP metabolites and physical performance (6-Minute-Walk-Test). Baseline-adjusted Analysis-of-Covariance was conducted for each outcome. RESULTS: 42 participants were analyzed. All participants that underwent the golf exam after the intervention passed it (20/23). Attendance rate of the golf intervention was 75 %. No adverse events or drop-outs related to the intervention occurred. A significant time*group interaction (p = 0.012, F = 7.050, Cohen's d = 0.89) was found for correct responses on the Response Inhibition task, but not for ADAS-Cog. Moreover, a significant time*group interaction for Quinolinic acid to Tryptophan ratios (p = 0.022, F = 5.769, Cohen's d = 0.84) in favor of the golf group was observed. An uncorrected negative correlation between attendance rate and delta Quinolinic acid to Kynurenic acid ratios in the golf group (p = 0.039, r=-0.443) was found as well. CONCLUSIONS: The findings indicate that learning golf is feasible and safe for elderly people with cognitive problems. Preliminary results suggest positive effects on attention and the KP. To explore the whole potential of golfing and its effect on cognitive decline, a larger cohort should be studied over a longer period with higher cardiovascular demands. TRIAL REGISTRATION: The trial was retrospectively registered (2nd July 2018) at the German Clinical Trials Register ( DRKS00014921 ).

Generalized tonic-clonic seizures are accompanied by changes of interrelations within the autonomic nervous system.

PURPOSE: A seizure is a strong central stimulus that affects multiple subsystems of the autonomic nervous system (ANS), and results in different interactions across ANS modalities. Here, we aimed to evaluate whether multimodal peripheral ANS measures demonstrate interactions before and after seizures as compared to controls to provide the basis for seizure detection and forecasting based on peripheral ANS signals. METHODS: Continuous electrodermal activity (EDA), heart rate (HR), peripheral body temperature (TEMP), and respiratory rate (RR) calculated based on blood volume pulse were acquired by a wireless multi-sensor device. We selected 45 min of preictal and 60 min of postictal data and time-matched segments for controls. Data were analyzed over 15-min windows. For unimodal analysis, mean values over each time window were calculated for all modalities and analyzed by Friedman's two-way analysis of variance. RESULTS: Twenty-one children with recorded generalized tonic-clonic seizures (GTCS), and 21 age- and gender-matched controls were included. Unimodal results revealed no significant effect for RR and TEMP, but EDA (p = 0.002) and HR (p < 0.001) were elevated 0-15 min after seizures. The averaged bimodal correlation across all pairs of modalities changed for 15-min windows in patients with seizures. The highest correlations were observed immediately before (0.85) and the lowest correlation immediately after seizures. Overall, average correlations for controls were higher. SIGNIFICANCE: Multimodal ANS changes related to GTCS occur within and across autonomic nervous system modalities. While unimodal changes were most prominent during postictal segments, bimodal correlations increased before seizures and decreased postictally. This offers a promising avenue for further research on seizure detection, and potentially risk assessment for seizure recurrence and sudden unexplained death in epilepsy.

Evaluation of Open-Source and Pre-Trained Deep Convolutional Neural Networks Suitable for Player Detection and Motion Analysis in Squash.

In sport science, athlete tracking and motion analysis are essential for monitoring and optimizing training programs, with the goal of increasing success in competition and preventing injury. At present, contact-free, camera-based, multi-athlete detection and tracking have become a reality, mainly due to the advances in machine learning regarding computer vision and, specifically, advances in artificial convolutional neural networks (CNN), used for human pose estimation (HPE-CNN) in image sequences. Sport science in general, as well as coaches and athletes in particular, would greatly benefit from HPE-CNN-based tracking, but the sheer amount of HPE-CNNs available, as well as their complexity, pose a hurdle to the adoption of this new technology. It is unclear how many HPE-CNNs which are available at present are ready to use in out-of-the-box inference to squash, to what extent they allow motion analysis and if detections can easily be used to provide insight to coaches and athletes. Therefore, we conducted a systematic investigation of more than 250 HPE-CNNs. After applying our selection criteria of open-source, pre-trained, state-of-the-art and ready-to-use, five variants of three HPE-CNNs remained, and were evaluated in the context of motion analysis for the racket sport of squash. Specifically, we are interested in detecting player's feet in videos from a single camera and investigated the detection accuracy of all HPE-CNNs. To that end, we created a ground-truth dataset from publicly available squash videos by developing our own annotation tool and manually labeling frames and events. We present heatmaps, which depict the court floor using a color scale and highlight areas according to the relative time for which a player occupied that location during matchplay. These are used to provide insight into detections. Finally, we created a decision flow chart to help sport scientists, coaches and athletes to decide which HPE-CNN is best for player detection and tracking in a given application scenario.

Effects of force level and task difficulty on force control performance in elderly people.

As the proportion of people over 60 years of age rises continuously in westernized societies, it becomes increasingly important to better understand aging processes and how to maintain independence in old age. Fine motor tasks are essential in daily living and, therefore, necessary to maintain. This paper extends the existing literature on fine motor control by manipulating the difficulty of a force maintenance task to characterize performance optima for elderly. Thirty-seven elderly (M = 68.00, SD = 4.65) performed a force control task at dynamically varying force levels, i.e. randomly changing every 3 s between 10%, 20%, and 30% of the individual's maximum voluntary contraction (MVC). This task was performed alone or with one or two additional tasks to increase task difficulty. The force control characteristics accuracy, variability, and complexity were analyzed. Lowest variability was observed at 20%. Accuracy and complexity increased with increasing force level. Overall, increased task difficulty had a negative impact on task performance. Results support the assumption, that attention control has a major impact on force control performance in elderly people. We assume different parameters to have their optimum at different force levels, which remain comparably stable when additional tasks are performed. The study contributes to a better understanding of how force control is affected in real-life situations when it is performed simultaneously to other cognitive and sensory active and passive tasks.

Match Situations Leading to Head Injuries in Professional Male Football (Soccer)-A Video-Based Analysis Over 12 Years.

OBJECTIVE: To identify risk situations promoting head injuries in professional male football (soccer) and to investigate the impact of a rule change in 2006 punishing elbow-head contacts. DESIGN: Analysis of video sequences of head events leading to head injury. PARTICIPANTS: Professional football players of the first male German Bundesliga. MAIN OUTCOME MEASURES: Observational criteria of head impacts on video recordings (players' actions preceding head injuries, foul play-referee's decision and assessment of rater, ball possession, on-pitch medical treatment, and consequences of head impact). RESULTS: Three hundred thirty-four head injuries were reported in kicker Sportmagazin corresponding to an incidence rate of 2.25 (95% confidence interval 2.01-2.51) per 1000 player match hours. The injured player predominantly jumped (60%), headed the ball (36%), or ran forwards (20%); the noninjured players mainly jumped (64%), headed the ball (27%), or raised the elbow to the head (23%). Free ball situations (2 players challenge for the ball) caused most of the head injuries (81%). The players' action "raising the elbow" during a head injury seemed to be lower after the rule change. CONCLUSIONS: Jumping for the ball with the intention of heading is the predominant action associated with head injury risk. Head injuries occur most often when players challenge for the ball in a header duel. As head injuries bear the potential risk of long-term health sequelae, the identification of situational circumstances is essential to develop preventative means in the future.

Multimodal approach towards understanding the changes in the autonomic nervous system induced by an ultramarathon.

Purpose: Running an ultramarathon can be considered as a multifaceted, intense stressor inducing changes within the autonomic nervous system (ANS). The aim of this study was to examine changes within and across ANS modalities in response to an ultramarathon.Methods: Thirteen runners (44.3 ± 5.9 years) completed a 65 km run. Electrodermal activity (EDA), heart rate (HR), and skin temperature measured at wrist (Temp), were recorded before and after running. Three-minute intervals were analysed. Mean values were compared by t-tests for dependent samples. Joint principal component analysis-canonical correlation analysis (PCA-CCA) and multiset CCA techniques were employed to measure the interactions between either any two or among all modalities.Results: HR (p < 0.01) and EDA (p < 0.01) increased, while Temp decreased (p < 0.01). PCA-CCA revealed one significant component (p < 0.05) for each modality pair in pre and post measures. Component strength increased from pre (mean = 0.73) to post (mean = 0.92) test. Multiset CCA supported the assumption of increasing strength of correlations across modalities.Conclusion: Ultramarathon, an intense physical stressor, increases correlations across modalities pointing towards a reorganization of central ANS control to restore dynamic balance after physical load. This characterization of ANS-states might offer new avenues for training control.

Peripheral multimodal monitoring of ANS changes related to epilepsy.

The goal of this study was to evaluate and summarize the current literature on multimodal changes of the autonomic nervous system (ANS) in people with epilepsy (PWE). We included studies reporting ANS measures of at least two modalities and with a minimum of one group of people with epilepsy. We screened two hundred eighty-three abstracts and sixty-six full texts, of which twenty-two met our inclusion criteria. Eleven studies reported ictal and interictal cardiac and respiratory changes. Three studies investigated the correlation between cardiac and respiratory markers, whereby two found no correlation and one showed a relation. Six studies evaluated electrodermal and cardiac parameters and showed effects on both ANS subsystems that jointly indicate a shift toward increased sympathetic activity for people with epilepsy during rest and during activity. Two studies assessed three modalities and reveal epilepsy-related alterations within the ANS. In summary, there is a growing interest in multimodal monitoring approaches, such as combining at least two ANS modalities, to describe epilepsy-related changes in ANS activity and to test for the potential to use ANS markers for seizure detection and prediction. Most studies report multiple unimodal analyses while only few studies analyzed multimodal patterns. Patterns of changes depend on the type of epilepsy and differ on an individual level; therefore, a multimodal approach might offer an approach to more individualized monitoring and, ultimately, management.

Head injuries in professional male football (soccer) over 13 years: 29% lower incidence rates after a rule change (red card).

BACKGROUND: Absolute numbers of head injuries in football (soccer) are considerable because of its high popularity and the large number of players. In 2006 a rule was changed to reduce head injuries. Players were given a red card (sent off) for intentional elbow-head contact. AIMS: To describe the head injury mechanism and examine the effect of the rule change. METHODS: Based on continuously recorded data from the German football magazine "kicker", a database of all head injuries in the 1st German Male Bundesliga was generated comprising seasons 2000/01-2012/13. Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) as well as incidence rate ratios (IRR) to assess differences before and after the rule change were calculated. RESULTS: 356 head injuries were recorded (IR 2.22, 95% CI 2.00 to 2.46 per 1000 match hours). Contact with another player caused most head injuries, more specifically because of head-head (34%) or elbow-head (17%) contacts. After the rule change, head injuries were reduced by 29% (IRR 0.71, 95% CI 0.57 to 0.86, p=0.002). Lacerations/abrasions declined by 42% (95% CI 0.39 to 0.85), concussions by 29% (95% CI 0.46 to 1.09), contusions by 18% (95% CI 0.43 to 1.55) and facial fractures by 16% (95% CI 0.55 to 1.28). CONCLUSIONS: This rule change appeared to reduce the risk of head injuries in men's professional football.

VO2max Testing in Trail Runners: Is There a Specific Exercise Test Protocol?

Trail running places specific physiological demands on the human body due to its uphill and downhill running sections. We developed and investigated a more sport-specific trail exercise test protocol (inclination and speed incremental protocol), and compared it to two standard exercise test protocols (horizontal step and ramp protocol) in thirteen highly trained trail runners (age 31±6 years, height 179±6.4 cm, weight 69.2±7.9 kg, BMI 21.6±2.1 kg/m2). The maximum oxygen uptake (VO2max) measured during the trail test (62.5±5.9 ml·kg-1·min-1, [95% CI: 59.0-66.1]) was significantly higher compared to both the step test (60.1±5.3 ml·kg-1·min-1, [95% CI: 56.8-63.3], p=0.024) and the ramp test (59.7±5.5 ml·kg-1·min-1, [95% CI: 56.4-63.0], p=0.028). Time to task failure was significantly shorter in the trail test (557±73 s, [95% CI: 512-601]) compared to both the step test (1378±152 s, [95% CI: 1286-1470], p<0.001) and the ramp test (605±95, [95% CI: 547-662], p<0.001). Other physiological measurements obtained were similar. The trail test was the preferred choice in our group of trail runners. This study supports the implementation of the trail test in practice, and recommends that its validity be evaluated further.

Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors.

OBJECTIVE: New devices are needed for monitoring seizures, especially those associated with sudden unexpected death in epilepsy (SUDEP). They must be unobtrusive and automated, and provide false alarm rates (FARs) bearable in everyday life. This study quantifies the performance of new multimodal wrist-worn convulsive seizure detectors. METHODS: Hand-annotated video-electroencephalographic seizure events were collected from 69 patients at six clinical sites. Three different wristbands were used to record electrodermal activity (EDA) and accelerometer (ACM) signals, obtaining 5,928 h of data, including 55 convulsive epileptic seizures (six focal tonic-clonic seizures and 49 focal to bilateral tonic-clonic seizures) from 22 patients. Recordings were analyzed offline to train and test two new machine learning classifiers and a published classifier based on EDA and ACM. Moreover, wristband data were analyzed to estimate seizure-motion duration and autonomic responses. RESULTS: The two novel classifiers consistently outperformed the previous detector. The most efficient (Classifier III) yielded sensitivity of 94.55%, and an FAR of 0.2 events/day. No nocturnal seizures were missed. Most patients had <1 false alarm every 4 days, with an FAR below their seizure frequency. When increasing the sensitivity to 100% (no missed seizures), the FAR is up to 13 times lower than with the previous detector. Furthermore, all detections occurred before the seizure ended, providing reasonable latency (median = 29.3 s, range = 14.8-151 s). Automatically estimated seizure durations were correlated with true durations, enabling reliable annotations. Finally, EDA measurements confirmed the presence of postictal autonomic dysfunction, exhibiting a significant rise in 73% of the convulsive seizures. SIGNIFICANCE: The proposed multimodal wrist-worn convulsive seizure detectors provide seizure counts that are more accurate than previous automated detectors and typical patient self-reports, while maintaining a tolerable FAR for ambulatory monitoring. Furthermore, the multimodal system provides an objective description of motor behavior and autonomic dysfunction, aimed at enriching seizure characterization, with potential utility for SUDEP warning.

Altered structural connectome in temporal lobe epilepsy.

PURPOSE: To study differences in the whole-brain structural connectomes of patients with left temporal lobe epilepsy (TLE) and healthy control subjects. MATERIALS AND METHODS: This study was approved by the institutional review board, and all individuals gave signed informed consent. Sixty-direction diffusion-tensor imaging and magnetization-prepared rapid acquisition gradient-echo (MP-RAGE) magnetic resonance imaging volumes were analyzed in 24 patients with left TLE and in 24 healthy control subjects. MP-RAGE volumes were segmented into 1015 regions of interest (ROIs) spanning the entire brain. Deterministic white matter tractography was performed after voxelwise tensor calculation. Weighted structural connectivity matrices were generated by using the pairwise density of connecting fibers between ROIs. Graph theoretical measures of connectivity networks were compared between groups by using linear models with permutation testing. RESULTS: Patients with TLE had 22%-45% reduced (P < .01) distant connectivity in the medial orbitofrontal cortex, temporal cortex, posterior cingulate cortex, and precuneus, compared with that in healthy subjects. However, local connectivity, as measured by means of network efficiency, was increased by 85%-270% (P < .01) in the medial and lateral frontal cortices, insular cortex, posterior cingulate cortex, precuneus, and occipital cortex in patients with TLE as compared with healthy subjects. CONCLUSION: This study suggests that TLE involves altered structural connectivity in a network that reaches beyond the temporal lobe, especially in the default mode network.