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Although the treatment of epilepsy primarily focuses on prevention, recurrent seizures are unfortunately an ongoing reality, particularly in people with epilepsy who live with chronic refractory seizures. Rescue medications are agents which can be administered in urgent/emergent seizure episodes such as seizure clusters or prolonged seizures with the goal of terminating seizure activity, preventing morbidity, and decreasing the risk of further seizures.This review first discusses clinical opportunities for rescue medications, with particular attention focused on seizure clusters and prolonged seizures, including their epidemiology, risk factors, and associated morbidity. Current rescue medications, their indications, efficacy, and adverse effects are discussed. We then discuss rescue medications and formulations which are currently under development, concentrating on practical aspects relevant for clinical care.Rescue medications should be considered for all people with epilepsy with ongoing seizures. Recent rescue medications including intranasal formulations provide considerable advantages. New rescue medications are being developed which may expand opportunities for effective treatment. In the future, combining rescue medications with seizure detection and seizure prediction technologies should further expand opportunities for use and should reduce the morbidity of seizures and provide increased comfort, control, and quality of life for people living with epilepsy.

Background In critical care settings, electroencephalography (EEG) with reduced number of electrodes (reduced montage EEG, rm-EEG) might be a timely alternative to the conventional full montage EEG (fm-EEG). However, past studies have reported variable accuracies for detecting seizures using rm-EEG. We hypothesized that the past studies did not distinguish between differences in sensitivity from differences in classification of EEG patterns by different readers. The goal of the present study was to revisit the diagnostic value of rm-EEG when confounding issues are accounted for. Methods We retrospectively collected 212 adult EEGs recorded at Massachusetts General Hospital and reviewed by two epileptologists with access to clinical, trending, and video information. In Phase I of the study, we re-configured the first 4 h of the EEGs in lateral circumferential montage with ten electrodes and asked new readers to interpret the EEGs without access to any other ancillary information. We compared their rating to the reading of hospital clinicians with access to ancillary information. In Phase II, we measured the accuracy of the same raters reading representative samples of the discordant EEGs in full and reduced configurations presented randomly by comparing their performance to majority consensus as the gold standard. Results Of the 95 EEGs without seizures in the selected fm-EEG, readers of rm-EEG identified 92 cases (97%) as having no seizure activity. Of 117 EEGs with “seizures” identified in the selected fm-EEG, none of the cases was labeled as normal on rm-EEG. Readers of rm-EEG reported pathological activity in 100% of cases, but labeled them as seizures (N = 77), rhythmic or periodic patterns (N = 24), epileptiform spikes (N = 7), or burst suppression (N = 6). When the same raters read representative epochs of the discordant EEG cases (N = 43) in both fm-EEG and rm-EEG configurations, we found high concordance (95%) and intra-rater agreement (93%) between fm-EEG and rm-EEG diagnoses. Conclusions Reduced EEG with ten electrodes in circumferential configuration preserves key features of the traditional EEG system. Discrepancies between rm-EEG and fm-EEG as reported in some of the past studies can be in part due to methodological factors such as choice of gold standard diagnosis, asymmetric access to ancillary clinical information, and inter-rater variability rather than detection failure of rm-EEG as a result of electrode reduction per se.

Neurocysticercosis is one of the most common causes of acquired epilepsy worldwide. Caused by Taenia solium, the infection uses pigs as an intermediate host and thus is often associated with proximity to and consumption of pigs.This review explores the epidemiology of neurocysticercosis in endemic regions across Africa, Asia, and Latin America and examines common risk factors in these areas.A literature review was conducted using pubmed to search for articles with key words including neurocysticercosis, Taenia, solium, epidemiology, and the names of countries and continents in the regions of interest.Multiple risk factors for neurocysticercosis were identified, including inadequate regulation of pig farms and food safety, poor sanitation, and water contamination. In addition, additional barriers to appropriate diagnosis and management were found, including resource limitations and poor health literacy.Despite its global prevalence, effective limitation of neurocysticercosis is still achievable through projects which address common risk factors.

Background: Ice hockey has significant workload demands. Research of other sports has suggested that decreased rest between games as well as an increased workload may increase the risk of injuries. Purpose: To evaluate whether condensed game schedules increase the frequency and severity of injuries in the National Hockey League (NHL). Study Design: Descriptive epidemiology study. Methods: Data were obtained from publicly available online sources on game schedules and injuries for all NHL teams for the 2005-2006 through 2018-2019 seasons. Injury rates (per team per game) and the proportion of severe and nonsevere injuries were determined. The game-spacing analysis assessed the risk of injuries in relation to the number of days between games played (range, 0-≥6 days). The game-density analysis assessed the risk of injuries in relation to the number of games played within 7 days (range, 1-5 games). Results were assessed by analysis of variance, the post hoc Tukey test, and the chi-square test of distribution. Results: The game-spacing analysis included 33,170 games and 7224 injuries, and a significant group difference was found ( P = 1.44×10–5), with the post hoc test demonstrating an increased risk of injuries when games were spaced with –48), demonstrating an increased risk of injuries with an increased number of games in all conditions except for the comparison between 4 versus 5 games in 7 days. There was also a significant difference in injury severity ( P = .008), indicating that the least dense condition had a higher ratio of severe to nonsevere injuries compared with the other game-density conditions. Finally, the game-density analysis was repeated after excluding games played with –46), with significant differences between all groups except for the comparison between 1 versus 2 games in 7 days. Conclusion: We found that a condensed schedule and

Objective:Bipolar disorder is associated with high risk for suicidal behavior that often develops in adolescence and young adulthood. Elucidation of involved neural systems is critical for prevention. This study of adolescents and young adults with bipolar disorder with and without a history of suicide attempts combines structural, diffusion tensor, and functional MR imaging methods to investigate implicated abnormalities in the morphology and structural and functional connectivity within frontolimbic systems.Method:The study had 26 participants with bipolar disorder who had a prior suicide attempt (the attempter group) and 42 participants with bipolar disorder without a suicide attempt (the nonattempter group). Regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli were compared between groups, and differences were explored for relationships between imaging modalities and associations with suicide-related symptoms and behaviors.Results:Comp...

Epilepsy impairs quality of life in physical, psychological, cognitive, social, and occupational domains. In people who are not seizure free, depression and adverse medication effects have a predominant role in determining quality of life. The assessment of these factors and other comorbidities is essential for maximizing quality of life in epilepsy. There are multiple tools available to assess medication effects and quality of life in a structured format. Such tools can provide superior assessments and allow clinicians to have a greater impact on their patients' quality of life.

Blond BN, Fredericks CA, Blumberg HP. Functional neuroanatomy of bipolar disorder: structure, function, and connectivity in an amygdala–anterior paralimbic neural system. Bipolar Disord 2012: 14: 340–355. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objectives: In past decades, neuroimaging research in bipolar disorder has demonstrated a convergence of findings in an amygdala–anterior paralimbic cortex neural system. This paper reviews behavioral neurology literature that first suggested a central role for this neural system in the disorder and the neuroimaging evidence that supports it. Methods: Relevant articles are reviewed to provide an amygdala–anterior paralimbic cortex neural system model of bipolar disorder, including articles from the fields of behavioral neurology and neuroanatomy, and neuroimaging. Results: The literature is highly supportive of key roles for the amygdala, anterior paralimbic cortices, and connections among these structures in the emotional dysregulation of bipolar disorder. The functions subserved by their more widely distributed connection sites suggest that broader system dysfunction could account for the range of functions—from neurovegetative to cognitive—disrupted in the disorder. Abnormalities in some components of this neural system are apparent by adolescence, while others, such as those in rostral prefrontal regions, appear to progress over adolescence and young adulthood, suggesting a neurodevelopmental model of the disorder. However, some findings conflict, which may reflect the small sample sizes of some studies, and clinical heterogeneity and methodological differences across studies. Conclusions: Consistent with models derived from early behavioral neurology studies, neuroimaging studies support a central role for an amygdala–anterior paralimbic neural system in bipolar disorder, and implicate abnormalities in the development of this system in the disorder. This system will be an important focus of future studies on the developmental pathophysiology, detection, treatment, and prevention of the disorder.

Over the past several decades, functional neuroimaging research has contributed to significant advances in understanding neural system abnormalities that underlie bipolar disorder (BD). Findings have converged to support dysfunction in a neural system that subserves emotional processing and regulation, which includes anterior paralimbic cortices and their subcortical connections sites, including amygdala and ventral striatum, as well as more rostral and lateral prefrontal cortices (1). Studies that focused on elevated, depressed, or euthymic mood states of the disorder suggest that some abnormalities are present only in individuals experiencing acute mood episodes of the disorder; whereas other abnormalities reflect the BD trait in that they are also present in euthymia. However, there are few studies that concurrently examined individuals in elevated, depressed, and euthymic mood states to clarify mood-state- and trait-related features. Such clarification may provide information important to understanding neural system features associated with vulnerability to, and recovery from, acute mood episodes and may suggest treatments to prevent or treat episodes of a particular valence, as well as markers of treatment response. Neural system findings associated with acute mood states of BD have primarily been in anterior paralimbic and more rostral and lateral cortices, including ventral anterior cingulate cortex (VACC), orbitofrontal cortex (OFC), rostral PFC (RPFC), and dorsolateral PFC (DLPFC). In comparison to healthy individuals, individuals with BD experiencing elevated mood episodes (including manic, mixed, or hypomanic episodes) have shown alterations in activation in these prefrontal regions at rest and in responses to activation tasks (2–7) that have tended to be decreases in the right hemisphere. These findings are consistent with lesions studies in which disinhibited manic-type states have been observed in association with frontal lesions, particularly when they occur in the right hemisphere (8–10). In individuals with BD experiencing depressive episodes, differences have tended to be in the left hemisphere and have tended to be activation increases (4, 11, 12), which may be elicited especially in response to negative emotional stimuli. For example, in one study in which faces of varying emotional expressions were presented, fearful face processing was associated with increases in left ventrolateral PFC activation (11). Recent functional neuroimaging investigations demonstrating dysfunction in VACC, OFC and RPFC during euthymia suggest dysfunction in these regions may be a trait feature of BD (4, 13–18), which is particularly elicited by emotional challenge and stimuli that may be of positive as well as negative valence (17, 19). Some studies have suggested that subcortical abnormalities may also be present across mood states of BD. Amygdala increases have been reported in manic, depressed, and euthymic mood states of BD, suggesting amygdala dysfunction may not be dependent on the valence of the mood state (11, 12, 20–33). However, there are some recent studies that suggest subcortical findings may be influenced by mood state, as there are reports of negative findings in euthymia and of abnormally increased amygdala activity that has been particularly associated with the depressed state in BD (17, 20, 34). The ventral striatum is highly implicated in BD because of its role in motivated behaviors, which are characteristically disrupted in acute mood episodes, such as in the disinhibited pursuit of motivationally-charged situations in mania and amotivated behavior in depression. The ventral striatum has less often been a focus in neuroimaging studies of BD although ventral striatal abnormalities have been reported in adults and adolescents with BD (11, 28, 35, 36). There are few neuroimaging studies that include individuals with BD in elevated, depressed, and euthymic mood states. A functional magnetic resonance imaging (fMRI) study in which individuals performed a color-word Stroop task showed decreased right OFC responses in association with elevated mood states, increased left OFC responses in association with depression, as well as an area of decreased left medial RPFC that was present across mood states (4). There were some consistencies between these findings and those of another fMRI study of the three mood states of BD during emotional processing. In that study, 12 manic, 12 depressed, and 18 euthymic individuals with BD, and 18 healthy individuals, were scanned while processing blocks of face stimuli depicting happy, fearful, or neutral expressions. Compared with healthy subjects, activation was reduced in OFC in individuals with BD across mood states and activation was also decreased in right DLPFC. No influence of the valence of the facial expression of the stimuli was detected (37). However, these findings were identified in an analysis that focused on specific regions of interest, and ventromedial PFC and RPFC regions were not assessed. The aim of the current study was to use an event-related fMRI design performed during implicit processing of positive, negative, and neutral faces by individuals with BD in elevated, depressed, and euthymic mood states to identify trait- and state-related abnormalities in neural system patterns of responses to the stimuli. We hypothesized ventral PFC decreases in responses would be present across mood states of BD, consistent with those decreases being trait features of the disorder. We further hypothesized that additional right PFC decreases would be associated with elevated mood states and that left PFC increases would be associated with depression. We anticipated amygdala and ventral striatal abnormalities (1, 24). We also explored wholebrain to assess whether there might be differences in other regions not hypothesized.

Functional neuroimaging techniques have been important research tools in the study of bipolar disorder (BPD). These methods provide measures of regional brain functioning that reflect the mental state at the time of scanning and have helped to elucidate both state and trait features of BPD. This chapter will review converging functional neuroimaging evidence implicating state and trait dysfunction in a ventral prefrontal cortex-amygdala neural system in BPD. Emerging evidence that suggests a developmental progression in dysfunction in this neural system over the course of adolescence will be considered. Finally, new research approaches that have begun to reveal the contribution of specific genetic mechanisms to regional dysfunction in the disorder, potential salutary effects of medications, and structure-function relationships will be discussed.

In past decades, neuroimaging research in bipolar disorder has demonstrated a convergence of findings in an amygdala-anterior paralimbic cortex neural system. This paper reviews behavioral neurology literature that first suggested a central role for this neural system in the disorder and the neuroimaging evidence that supports it.Relevant articles are reviewed to provide an amygdala-anterior paralimbic cortex neural system model of bipolar disorder, including articles from the fields of behavioral neurology and neuroanatomy, and neuroimaging.The literature is highly supportive of key roles for the amygdala, anterior paralimbic cortices, and connections among these structures in the emotional dysregulation of bipolar disorder. The functions subserved by their more widely distributed connection sites suggest that broader system dysfunction could account for the range of functions-from neurovegetative to cognitive-disrupted in the disorder. Abnormalities in some components of this neural system are apparent by adolescence, while others, such as those in rostral prefrontal regions, appear to progress over adolescence and young adulthood, suggesting a neurodevelopmental model of the disorder. However, some findings conflict, which may reflect the small sample sizes of some studies, and clinical heterogeneity and methodological differences across studies.Consistent with models derived from early behavioral neurology studies, neuroimaging studies support a central role for an amygdala-anterior paralimbic neural system in bipolar disorder, and implicate abnormalities in the development of this system in the disorder. This system will be an important focus of future studies on the developmental pathophysiology, detection, treatment, and prevention of the disorder.

Functional neuroimaging techniques have been important research tools in the study of bipolar disorder (BPD). These methods provide measures of regional brain functioning that reflect the mental state at the time of scanning and have helped to elucidate both state and trait features of BPD. This chapter will review converging functional neuroimaging evidence implicating state and trait dysfunction in a ventral prefrontal cortex–amygdala neural system in BPD. Emerging evidence that suggests a developmental progression in dysfunction in this neural system over the course of adolescence will be considered. Finally, new research approaches that have begun to reveal the contribution of specific genetic mechanisms to regional dysfunction in the disorder, potential salutary effects of medications, and structure–function relationships will be discussed.