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Objective: High-frequency oscillations (HFOs) have emerged as a promising clinical biomarker for presurgical evaluation in childhood epilepsy. HFOs are commonly classified in stereo-encephalography as ripples (80–200 Hz) and fast ripples (200–500 Hz). Ripples are less specific and not so directly associated with epileptogenic activity because of their physiological and pathological origin. The aim of this paper is to distinguish HFOs in the ripple band and to improve the evaluation of the epileptogenic zone (EZ). Approach: This study constitutes a novel modeling approach evaluated in ten patients from Sant Joan de Deu Pediatric Hospital (Barcelona, Spain), with clearly-defined seizure onset zones (SOZ) during presurgical evaluation. A subject-by-subject basis analysis is proposed: a probabilistic Gaussian mixture model (GMM) based on the combination of specific ripple features is applied for estimating physiological and pathological ripple subpopulations. Main Results: Clear pathological and physiological ripples are identified. Features differ considerably among patients showing within-subject variability, suggesting that individual models are more appropriate than a traditional whole-population approach. The difference in rates inside and outside the SOZ for pathological ripples is significantly higher than when considering all the ripples. These significant differences also appear in signal segments without epileptiform activity. Pathological ripple rates show a sharp decline from SOZ to non-SOZ contacts and a gradual decrease with distance. Significance: This novel individual GMM approach improves ripple classification and helps to refine the delineation of the EZ, as well as being appropriate to investigate the interaction of epileptogenic and propagation networks., This work was supported by Ministry of Science and Innovation (MICIIN), Spain, under Contract PID2020-117751RB-I00., Peer Reviewed, Postprint (published version)

La epilepsia es una enfermedad que afecta anualmente a 2,4 millones de personas en todo el mundo, de entre las cuales, un 30-40% no responde al tratamiento farmacológico, lo que se conoce como epilepsia farmacorresistente. En estos casos, se procede al estudio detallado del paciente, por medio de técnicas híbridas de imagen: Tomografía Computarizada por Emisión de Fotones Simples (SPECT), Tomografía por Emisión de Positrones (PET) y Resonancia Magnética Nuclear (RMN), con el objetivo de practicar una neurocirugía para extirpar el inicio de la lesión, el foco epileptógeno (FE). Actualmente, la práctica clínica utiliza la técnica SISCOM (Substracción de la SPECT interictal e ictal y corregistro con RMN) para la localización del FE. Por otro lado, la investigación clínica está trabajando en una nueva técnica, la PISCOM (Substracción de la PET interictal y SPECT ictal y corregistro con RMN), que utiliza una PET interictal en lugar de una SPECT, introduciendo nueva información como el consumo cerebral de glucosa. El objetivo principal de este proyecto es obtener una aplicación para la implementación de la técnica PISCOM en pacientes con epilepsia farmacorresistente. Para ello se propone el desarrollo de un sistema que permite la integración de la aplicación en una única plataforma y un nuevo método de procesado de la imagen PET interictal, consiguiendo una imagen PET degradada comparable con la SPECT ictal. Se han estudiado 10 pacientes adultos y 9 pacientes pediátricos con las técnicas SISCOM, PISCOM y la nueva aplicación propuesta para la PISCOM, comparando los resultados obtenidos visualmente, y con la localización exacta del FE extirpado mediante neurocirugía. Se comprobó que los resultados obtenidos con la aplicación diseñada para la PISCOM eran similares a los obtenidos con los métodos anteriores, tanto en pacientes adultos como en pediátricos. Además, este nuevo proceso permite una mejor localización del FE, lo que podría contribuir a una mejora en la práctica clí

Doctor of Philosophy in Psychology, Prolonged, uncontrolled epilepsy, at times resulting in hundreds of seizures per day, severely affects one's quality of life. While cerebral hemispherectomy (CHE) is a radical procedure, it has become a viable treatment option for children with medically intractable seizures. Research on functional outcomes following CHE, however, has been lacking. In the current study, functional outcomes were assessed across language, motor, vocational, social, and behavioral domains. A novel approach utilizing an estimated age at brain injury, as identified by the pediatric neurosurgeon, was utilized to help provide better predictive value than the phenotypical presentation of seizures or factors such as age at seizure onset, seizure etiology, and underlying brain pathology. Additionally, a novel functional outcome score that consists of five domains: seizure control, antiepileptic drug use, language skills, attention, academic skills, and motor skills, was utilized to assess outcome following CHE. Findings indicated that those with earlier estimated age at brain injury had better seizure control than those with later estimated age at brain injury. There was an estimated age at brain injury and side of CHE effect, as those with earlier estimated age at brain injury and left CHE had more stable seizure control, less antiepileptic drug (AED) use after surgery, and better attentional control. However, more behavior problems were noted in this younger group. The predictive value of the estimated age at brain injury and outcome as measured by the functional outcome score is discussed.

The present study attempted to identify valid predictors of the level and pattern of Wechsler intelligence test performance in children with lateralized temporal lobe epilepsy of unknown etiology. Six seizure-related variables (seizure type, seizure frequency, number of different types of anti-convulsant medication required to control the seizures, types of EEG abnormality, age of onset of the seizure disorder, and lateralization of the epileptiform activity) were evaluated as predictors of Full-scale IQ. Three variables (lateralization, age on onset, and severity of cerebral pathology) were evaluated as predictors of the relative magnitudes of Verbal IQ and Performance IQ. The number of anti-convulsants required to control seizures was significantly related to Full-scale IQ scores. Seizure type, seizure frequency, types of EEG abnormality, age of onset, and lateralization did not contribute significantly to the amount of explained variability in Full-scale IQ. There was a nonsignificant trend towards a relationship between the lateralization of epileptiform activity and the relative magnitudes of Verbal IQ and Performance IQ. Differences between the left and right temporal groups were in the expected direction on all but one of the Verbal and Performance IQ and subtest measures. No association was found between either the age of onset or severity of cerebral pathology and the relative magnitudes of Verbal IQ and Performance IQ. Methodological problems were considered in a discussion of these results. Most of the children in the study were not significantly impaired intellectually, as evidence by the fact that only four subjects in the total sample ([lowercase underlined n]=26) demonstrated Full-scale IQ scores which were below the Average range. In the left temporal group, nine of the twelve subjects demonstrated a lower Verbal IQ while, in the right temporal group, seven subjects demonstrated a lower Verbal IQ and seven subjects demonstrated a lower Performance IQ, Bibliography: leaves 73-82.

John J. Cronin writes in response to President Roosevelt's criticism of his article in the Review of Reviews , especially Roosevelt's assertion that he has a depraved moral character. He discusses the size of American families, especially poor families. Cronin argues that children are behind in school because of physical defects like epilepsy and that the "better class" should observe this and "preserve their stock."

We described the health resource utilisation (HRU) and associated direct medical costs of managing epilepsy in children and young people (CYP) using population-level data from the United Kingdom. The study cohort were CYP born between 1988 and 2004 who were newly diagnosed with epilepsy and identified using a nationally representative primary care database from the United Kingdom. Reference unit costs were applied to each element of HRU to calculate annual direct medical costs per child. We assessed whether HRU and costs differed by time from diagnosis, age, sex and socioeconomic deprivation. Of 798 CYP newly diagnosed with epilepsy, 56% were male and the mean age at diagnosis was 5.6 years. The highest burden of HRU was in the first year following diagnosis with a mean annual cost of £930 (95% confidence interval (CI) £839–1022) per child in this first year. This decreased to £461 (95%CI 368–551) in the second year which remained fairly constant each subsequent year (£413 (95% CI 282–540) in the 8th year). The highest contribution to the annual medical costs was from inpatient hospital admissions followed by the costs of AEDs. Mean annual medical costs were significantly higher in children under 6 years of age compared with older children (p < 0.01), but were similar across socioeconomic groups (p = 0.62). The direct medical costs of HRU in CYP with epilepsy are higher in the first year after diagnosis compared to subsequent years, reflecting HRU related to the diagnostic process in the first year. Medical costs did not vary substantially by sex or socioeconomic deprivation indicating a similar level of consultation and care across these groups.

We described the health resource utilisation (HRU) and associated direct medical costs of managing epilepsy in children and young people (CYP) using population-level data from the United Kingdom. The study cohort were CYP born between 1988 and 2004 who were newly diagnosed with epilepsy and identified using a nationally representative primary care database from the United Kingdom. Reference unit costs were applied to each element of HRU to calculate annual direct medical costs per child. We assessed whether HRU and costs differed by time from diagnosis, age, sex and socioeconomic deprivation. Of 798 CYP newly diagnosed with epilepsy, 56% were male and the mean age at diagnosis was 5.6 years. The highest burden of HRU was in the first year following diagnosis with a mean annual cost of £930 (95% confidence interval (CI) £839–1022) per child in this first year. This decreased to £461 (95%CI 368–551) in the second year which remained fairly constant each subsequent year (£413 (95% CI 282–540) in the 8th year). The highest contribution to the annual medical costs was from inpatient hospital admissions followed by the costs of AEDs. Mean annual medical costs were significantly higher in children under 6 years of age compared with older children (p < 0.01), but were similar across socioeconomic groups (p = 0.62). The direct medical costs of HRU in CYP with epilepsy are higher in the first year after diagnosis compared to subsequent years, reflecting HRU related to the diagnostic process in the first year. Medical costs did not vary substantially by sex or socioeconomic deprivation indicating a similar level of consultation and care across these groups.

We described the health resource utilisation (HRU) and associated direct medical costs of managing epilepsy in children and young people (CYP) using population-level data from the United Kingdom. The study cohort were CYP born between 1988 and 2004 who were newly diagnosed with epilepsy and identified using a nationally representative primary care database from the United Kingdom. Reference unit costs were applied to each element of HRU to calculate annual direct medical costs per child. We assessed whether HRU and costs differed by time from diagnosis, age, sex and socioeconomic deprivation. Of 798 CYP newly diagnosed with epilepsy, 56% were male and the mean age at diagnosis was 5.6 years. The highest burden of HRU was in the first year following diagnosis with a mean annual cost of £930 (95% confidence interval (CI) £839–1022) per child in this first year. This decreased to £461 (95%CI 368–551) in the second year which remained fairly constant each subsequent year (£413 (95% CI 282–540) in the 8th year). The highest contribution to the annual medical costs was from inpatient hospital admissions followed by the costs of AEDs. Mean annual medical costs were significantly higher in children under 6 years of age compared with older children (p < 0.01), but were similar across socioeconomic groups (p = 0.62). The direct medical costs of HRU in CYP with epilepsy are higher in the first year after diagnosis compared to subsequent years, reflecting HRU related to the diagnostic process in the first year. Medical costs did not vary substantially by sex or socioeconomic deprivation indicating a similar level of consultation and care across these groups.