Beyond the CA1 subfield: Local hippocampal shape changes in MRI-negative temporal lobe epilepsy.

OBJECTIVE: Hippocampal atrophy in temporal lobe epilepsy (TLE) can indicate mesial temporal sclerosis and predict surgical success. Yet many patients with TLE do not have significant atrophy (magnetic resonance imaging (MRI) negative), which presents a diagnostic challenge. We used a new variant of high-dimensional large-deformation mapping to assess whether patients with apparently normal hippocampi have local shape changes that mirror those of patients with significant hippocampal atrophy. METHODS: Forty-seven patients with unilateral TLE and 32 controls underwent structural brain MRI. High-dimensional large-deformation mapping provided hippocampal surface and volume estimates for each participant, dividing patients into low versus high hippocampal atrophy groups. A vertex-level generalized linear model compared local shape changes between groups. RESULTS: Patients with low-atrophy TLE (MRI negative) had significant local hippocampal shape changes compared to controls, similar to those in the contralateral hippocampus of high-atrophy patients. These changes primarily involved the subicular and hilar/dentate regions, instead of the classically affected CA1 region. Disease duration instead co-varied with lateral hippocampal atrophy, co-localizing with the CA1 subfield. SIGNIFICANCE: These findings show that patients with "MRI-negative" TLE have regions of hippocampal atrophy that cluster medially, sparing the lateral regions (CA1) involved in high-atrophy patients. This suggests an overall effect of temporal lobe seizures manifesting as bilateral medial hippocampal atrophy, and a more selective effect of hippocampal seizures leading to disease-proportional CA1 atrophy, potentially reflecting epileptogenesis.

Perceived stress of individuals with disabilities in the United States during COVID-19.

PURPOSE/OBJECTIVE: This study was conducted to better understand how COVID-19 has impacted the stress, resiliency, and quality of life of people with disabilities near the height of the first surge of the COVID-19 pandemic in the summer of 2020. RESEARCH METHOD/DESIGN: An online survey of 990 individuals who self-identified as having at least one disability in the United States was conducted. RESULTS: Quality of life, coping/resilience skills, number of identified disabilities, and age were all significantly related to perceived stress. While access to technology was not significantly related to perceived stress, increased use of technology since the pandemic was associated with increased reported stress, though the practical significance was small. CONCLUSIONS/IMPLICATIONS: There is a need for increased attention to dissemination of information to people with disabilities. Knowledge of medical rights was significantly associated with following social distancing practices and suggests that health knowledge does change behavior. Ensuring that people with disabilities are aware of coping skills and how to promote resilience is a needed area of focus for the field. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Direct Support Professionals: Stress and Resiliency Amidst the COVID-19 Pandemic.

This study reports on the results of an online survey of direct support professionals (DSPs) during the COVID-19 pandemic in June 2020 to measure their perceived quality of life, stressors, coping/resilience skills, and knowledge of health care rights directly related to the pandemic for the persons that they support. Specifically, we examined direct support workers' perceptions of their quality of life, levels of stress, and their self-reported resilience skills. We found that perceived stress was strongly correlated with both self-reported quality of life and resilience, but not with years of DSP experience. Moreover, while DSPs overwhelmingly knew and affirmed health care rights for people with disabilities, they were less knowledgeable about their legal rights during hospital stays.

Hippocampal surface deformation accuracy in T1-weighted volumetric MRI sequences in subjects with epilepsy.

BACKGROUND AND PURPOSE: To demonstrate the accuracy across different acquisition and analysis methods, we evaluated the variability in hippocampal volumetric and surface displacement measurements resulting from two different MRI (magnetic resonance imaging) acquisition protocols. METHODS: Nine epilepsy patients underwent two independent T1-weighted magnetization prepared spoiled gradient sequences during a single 3T MRI session. Using high-dimension mapping-large deformation (HDM-LD) segmentation, we calculated volumetric estimates and generated a vector-based 3-dimensional surface model of each subject's hippocampi, and evaluated volume and surface changes, the latter using a cluster-based noise estimation model. RESULTS: Mean hippocampal volumes and standard deviations for the left hippocampi were 2,750 (826) mm3 and 2,782 (859) mm3 (P = .13), and for the right hippocampi were 2,558 (750) mm3 and 2,547 (692) mm3 (P = .76), respectively for the MPR1 and MPR2 sequences. Average Dice coefficient comparing overlap for segmentations was 86%. There was no significant effect of MRI sequence on volume estimates and no significant hippocampal surface change between sequences. CONCLUSION: Statistical comparison of hippocampal volumes and statistically thresholded HDM-LD surfaces in TLE patients showed no differences between the segmentations obtained in the two MRI acquisition sequences. This validates the robustness across MRI sequences of the HDM-LD technique for estimating volume and surface changes in subjects with epilepsy.