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2. 7T Epilepsy Task Force Consensus Recommendations on the Use of 7T MRI in Clinical Practice

Author

Opheim, G., Opheim, G., van der Kolk, A., Bloch, K.M., Colon, A.J., Davis, K.A., Henry, T.R., Jansen, J.F.A., Jones, S.E., Pan, J.W., Rossler, K., Stein, J.M., Strandberg, M.C., Trattnig, S., de Moortele, P.F.V., Vargas, M.I., Wang, I., Bartolomei, F., Bernasconi, N., Bernasconi, A., Bernhardt, B., Bjorkman-Burtscher, I., Cosottini, M., Das, S.R., Hertz-Pannier, L., Inati, S., Jurkiewicz, M.T., Khan, A.R., Liang, S.L., Ma, R.E., Mukundan, S., Pardoe, H., Pinborg, L.H., Polimeni, J.R., Ranjeva, J.P., Steijvers, E., Stufflebeam, S., Veersema, T.J., Vignaud, A., Voets, N., Vulliemoz, S., Wiggins, C.J., Xue, R., Guerrini, R., Guye, M., Opheim, G., Opheim, G., van der Kolk, A., Bloch, K.M., Colon, A.J., Davis, K.A., Henry, T.R., Jansen, J.F.A., Jones, S.E., Pan, J.W., Rossler, K., Stein, J.M., Strandberg, M.C., Trattnig, S., de Moortele, P.F.V., Vargas, M.I., Wang, I., Bartolomei, F., Bernasconi, N., Bernasconi, A., Bernhardt, B., Bjorkman-Burtscher, I., Cosottini, M., Das, S.R., Hertz-Pannier, L., Inati, S., Jurkiewicz, M.T., Khan, A.R., Liang, S.L., Ma, R.E., Mukundan, S., Pardoe, H., Pinborg, L.H., Polimeni, J.R., Ranjeva, J.P., Steijvers, E., Stufflebeam, S., Veersema, T.J., Vignaud, A., Voets, N., Vulliemoz, S., Wiggins, C.J., Xue, R., Guerrini, R., and Guye, M.

Abstract

Identifying a structural brain lesion on MRI has important implications in epilepsy and is the most important factor that correlates with seizure freedom after surgery in patients with drug-resistant focal onset epilepsy. However, at conventional magnetic field strengths (1.5 and 3T), only approximately 60%-85% of MRI examinations reveal such lesions. Over the last decade, studies have demonstrated the added value of 7T MRI in patients with and without known epileptogenic lesions from 1.5 and/or 3T. However, translation of 7T MRI to clinical practice is still challenging, particularly in centers new to 7T, and there is a need for practical recommendations on targeted use of 7T MRI in the clinical management of patients with epilepsy. The 7T Epilepsy Task Force-an international group representing 21 7T MRI centers with experience from scanning over 2,000 patients with epilepsy-would hereby like to share its experience with the neurology community regarding the appropriate clinical indications, patient selection and preparation, acquisition protocols and setup, technical challenges, and radiologic guidelines for 7T MRI in patients with epilepsy. This article mainly addresses structural imaging; in addition, it presents multiple nonstructural MRI techniques that benefit from 7T and hold promise as future directions in epilepsy. Answering to the increased availability of 7T MRI as an approved tool for diagnostic purposes, this article aims to provide guidance on clinical 7T MRI epilepsy management by giving recommendations on referral, suitable 7T MRI protocols, and image interpretation.

Published
2021

3. Neuropsychological functions and metabolic aspects in subclinical hypothyroidism: the effects of L-thyroxine.

Author

Baldini M, Colasanti A, Orsatti A, Airaghi L, Mauri MC, and Cappellini MD

Subjects
Adult, Aged, Energy Metabolism physiology, Female, Humans, Hypothyroidism drug therapy, Lipid Metabolism physiology, Middle Aged, Reaction Time drug effects, Reaction Time physiology, Stereoisomerism, Energy Metabolism drug effects, Hypothyroidism metabolism, Hypothyroidism psychology, Lipid Metabolism drug effects, Neuropsychological Tests, Thyroxine therapeutic use
Abstract

Thyroid hypofunction is a slowly progressing graded phenomenon [Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43(1):55-68]; subclinical forms (SCH) often represent a laboratory diagnosis in apparently asymptomatic patients. In the absence of adequate parameters for thyroid hormone action in tissues, the level of TSH increase corresponding to negative effects remains unsettled. We studied a wide range of physiological processes in a strictly selected population of 38 female patients (56.4+/-12.6 years) with minor forms of SCH (TSH 6.6+/-1.8 mIU/L), after exclusion of neurological, psychiatric and somatic disorders or confounding conditions. The investigations, performed at admission and after 6 months of l-thyroxine (LT4) treatment, included metabolic evaluation, health status perception and an extensive battery of neuropsychological tests and psychological rating scales. Lipid metabolism improved after LT4 (total cholesterol: 231.9+/-49.6 mg/dl pre- vs 221.0+/-40.0 mg/dl post-treatment; LDL cholesterol: 183.1+/-62.9 vs 162.7+/-53.7 mg/dl; apolipoprotein A1: 183.5+/-64.5 vs 160.9+/-50.3 mg/dl; p<0.05 for all comparisons), while glucose metabolism was unchanged. Health status perception was favourably influenced by the treatment (total SF-36 score 97.8+/-18.4 pre- vs 108.5+/-14.8 post-, p<0.0001); in a matched control group with euthyroid goiter, tested to examine the effects of medical care in the absence of treatment, no significant differences were found in the SF-36 scores at admission and after 6 months (109.3+/-15.1 vs 109+/-14.2, p=0.9). Attention performance improved after LT4; HRSD and HRSA scores did not significantly change, but negative correlations were found between FT3 levels and affective scores at admission, and between the post-treatment changes of affective scores and of FT3. In our study subtle disturbances of health status perception, attention and lipid metabolism associated to SCH of mildest degrees were reverted by LT4 replacement, reinforcing reports of unfavourable consequences of marginal thyroid disease.

Published
2009
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