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The subthalamic nucleus (STN) and globus pallidus internus (GPi) targets for deep brain stimulation (DBS) can be defined by atlas coordinates or direct visualisation of the target on MRI. The aim of this study was to evaluate geometric differences between atlas-based targeting and MRI-guided direct targeting. One-hundred-nine Parkinson's disease or dystonia patients records who underwent DBS surgery between 2005 and 2016 were prospectively reviewed. MRI-guided direct targeting coordinates was used to implant 205 STN and 64 GPi electrodes and compared with atlas-based coordinates. The directly targeted coordinates (mean, SD, range) for STN were x: [9.9 ± 1.1 (7.1 − 13.2)], y: [−0.8 ± 1.1 (−4.2 − 2)] and z: [−4.7 ± 0.53 (−5.9 – −3.2)]. The mean value for the STN was 2.1 mm more medial (p < 0.0001), 1.2 mm more anterior (p < 0.0001) and 0.7 mm more ventral (p < 0.0001) than the atlas target. The targeted coordinates for GPi were x: [22.3 ± 2.0 (17.8 − 26.1)], y: [−0.2 ± 2.2 (−4.5 − 3.4)], z: [−4.3 ± 0.8 (−6.2 – −2.3)]. The mean value for the GPi was 2.2 mm (p < 0.001) more posterior and 0.3 mm (p < 0.01) more ventral than the atlas-based coordinates. MRI-guided targeting may be more accurate than atlas-based targeting due to individual variations in anatomy. [ABSTRACT FROM AUTHOR]

In recent years, there has been a rise in the number of people who are able to speak two or more languages. This has been paralleled by an increase in research related to bilingualism. Despite this, much of the neuroanatomical consequences and pathological implications of bilingualism are still subject to discussion. This review aims to evaluate the neuroanatomical structures related to language and to the acquisition of a second language as well as exploring how learning a second language can alter one's susceptibility to and the progression of certain cerebral pathologies. A literature search was conducted on the Medline, Embase, and Web of Science databases. A total of 137 articles regarding the neuroanatomical or pathological implications of bilingualism were included for review. Following analysis of the included papers, this review finds that bilingualism induces significant gray and white matter cerebral changes, particularly in the frontal lobes, anterior cingulate cortex, left inferior parietal lobule and subcortical areas, and that native language and acquired language largely recruit the same neuroanatomical structures with however, subtle functional and anatomical differences dependent on proficiency and age of language acquisition. There is adequate evidence to suggest that bilingualism offsets the symptoms and diagnosis of dementia, and that it is protective against both pathological and age‐related cognitive decline. While many of the neuroanatomical changes are known, more remains to be elucidated and the relationship between bilingualism and other neurological pathologies remains unclear. [ABSTRACT FROM AUTHOR]

Objectives: A pilot study evaluating the efficacy of intracranial stimulation at treating medically refractory epielpsy in children. Methods: A retrospective analysis of eight children who underwent intracranial electrical stimulation for the investigation and treatment of their refractory epilepsy at King's College Hospital between 2014 and 2015. Five had subacute cortical stimulation (SCS) during intracranial video-telemetry with efficacy of stimulation evaluated by counting interictal discharges and seizures (both clinical and subclinical). Three other children underwent deep brain stimulaton (DBS) of the centromedian (two patients) or anterior (one patient) thalamic nuclei. The incidence of interictal discharges was evaluated visually and quantified automatically. Results: Three patients had thalamic DBS (one with idiopathic generalized epilepsy, one with presumed symptomatic generalized epilepsy and one with right fronto-temporal epilepsy) and 5 patients had SCS (one with temporal lobe epilepsy and four with frontal lobe epilepsy). Among the three children with DBS, two had >60% improvement in seizure frequency and severity and one had no improvement. Among the five children undergoing SCS, four showed improvement in seizure frequency (>50%), severity of seizures and interictal epileptiform discharges (>75%) while one chid did not show improvement. Procedures were well tolerated by all children. Conclusion: Cortical and thalamic stimulation appear to be effective and well tolerated in children with refractory epilepsy. Subacute cortical stimulation can be used to identify the focus and predict the effects of resective surgery. Further larger studies are necessary. [ABSTRACT FROM AUTHOR]

Introduction: Subthalamic nucleus (STN) and globus pallidus (GPi) targets for deep brain stimulation (DBS) can be defined by reference to atlas coordinates or direct visualisation of the target on MRI. The aim of this study was to evaluate the difference between atlas-based targeting and direct MRI guided targeting. Methods: We reviewed prospectively collected records of adult patients who underwent DBS surgery from 2007 to 2016. MRI guided targeting was used to implant 206 STN electrodes and 62 GPi electrodes in 139 patients with Parkinson disease or dystonia. Surgery was performed using a Leksell G frame and targeting performed on 2mm thick T2 weighted MRI (for STN) and proton density (for GPi) scans acquired preoperatively. The Cartesian STN and GPi coordinates were normalised to the AC-PC plane and compared with atlas coordinates. Atlas STN coordinates were 12mm lateral (x), 2mm posterior (y) and 4 mm ventral (z); atlas GPi coordinates were 22mm lateral (x), 2 mm anterior (y), and 4 mm ventral (z) in relation to the AC- PC plane (y=distance from midpoint of AC-PC line). Results: The directly targeted coordinates (mean, SD, range) for STN were: x (9.9 ± 1.1 (7.1 - 13.2)), y (-0.8 ±1.1 (-4.2 - 2)), z (-4.7 ± 0.59 (-5.9 - -1.5)) and for GPi were: x (22.3 ± 2.0 (17.8 - 26.1)), y (-0.2 ± 2.1 (-4.5 - 3.4)), z (-4.3 ± 0.8 (-6.1 - -2.3)). The mean of the directly visualised STN was 2.1mm more medial (4.9 to -1.2, p < 0.0001), 0.2mm more anterior (-2.2 to -6, p < 0.0001) and 0.7mm more ventral (-1.9 to 2.5, p < 0.0001) than the atlas target. The mean of the directly visualised GPi target was 0.3mm (-4.2 to 4.1) more medial (not significant) 2.2mm (-6.5 to 1.4, p < 0.001) more posterior and 0.3mm (-2.1 to 1.7, p=0.009) more ventral than atlas coordinates. Conclusion: MRI guided direct targeting may be more accurate than atlas based targeting due to individual variations in anatomy. [ABSTRACT FROM AUTHOR]

Objectives: To prospectively assess the long-term outcome of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with Parkinson's disease and any relationship with patients' expectations and satisfaction. Design: STN stimulation is well-established in the treatment of patients with advanced Parkinson's disease. It produces objective improvements in motor symptoms and health-related quality of life. Patient satisfaction with surgical intervention, however, is variable and may be influenced by their individual expectations. Methods: Nineteen consecutive patients undergoing STN DBS completed a modified 39-item Parkinson's disease questionnaire (PDQ-39) before surgery and at early (6 months) and late (mean 6 years, 4-7) follow-up. A satisfaction questionnaire was included in the post-operative assessment. Results: At 6 months, most patients expressed satisfaction and felt that surgery had fulfilled their expectations (mean scores of 75.3 ± 17.8 and 73.3 ± 25.3 on a visual analogue scale from 0 to 100) despite a significant difference between expected and actual change (median PDQ-39 summary scores of 24.0, interquartile range 15.0, and 14.0, interquartile range 22.5, respectively, p = 0.008). This was sustained over time with 14 long-term responders declaring their expectations fulfilled (mean score of 85.4 ± 14/5). The main predictor of sustained satisfaction was younger patient age (p = 0.02). The mean patient age was 59.8 years with a median disease duration of 11 years. 2 patients had developed advanced dementia at long-term follow-up. Conclusion: Patient satisfaction correlated with fulfilment of their expectations (r = 0.910, p < 0.001) rather than quantitative changes in the PDQ-39 scores. This suggests that managing patient's expectations both pre- and post-operatively may be crucial in determining the overall outcome of STN stimulation in Parkinson's disease. Time does not appear to adversely affect patient satisfaction with STN stimulation and its impact on their quality of life. [ABSTRACT FROM AUTHOR]