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Objective: To report long-term efficacy and safety results of the SANTE trial investigating deep brain stimulation of the anterior nucleus of the thalamus (ANT) for treatment of localization-related epilepsy. Methods: This long-term follow-up is a continuation of a previously reported trial of 5- vs 0-V ANT stimulation. Long-term follow-up began 13 months after device implantation with stimulation parameters adjusted at the investigators9 discretion. Seizure frequency was determined using daily seizure diaries. Results: The median percent seizure reduction from baseline at 1 year was 41%, and 69% at 5 years. The responder rate (≥50% reduction in seizure frequency) at 1 year was 43%, and 68% at 5 years. In the 5 years of follow-up, 16% of subjects were seizure-free for at least 6 months. There were no reported unanticipated adverse device effects or symptomatic intracranial hemorrhages. The Liverpool Seizure Severity Scale and 31-item Quality of Life in Epilepsy measure showed statistically significant improvement over baseline by 1 year and at 5 years ( p Conclusion: Long-term follow-up of ANT deep brain stimulation showed sustained efficacy and safety in a treatment-resistant population. Classification of evidence: This long-term follow-up provides Class IV evidence that for patients with drug-resistant partial epilepsy, anterior thalamic stimulation is associated with a 69% reduction in seizure frequency and a 34% serious device-related adverse event rate at 5 years.

We report a multicenter, double-blind, randomized trial of bilateral stimulation of the anterior nuclei of the thalamus for localization-related epilepsy.Participants were adults with medically refractory partial seizures, including secondarily generalized seizures. Half received stimulation and half no stimulation during a 3-month blinded phase; then all received unblinded stimulation.One hundred ten participants were randomized. Baseline monthly median seizure frequency was 19.5. In the last month of the blinded phase the stimulated group had a 29% greater reduction in seizures compared with the control group, as estimated by a generalized estimating equations (GEE) model (p = 0.002). Unadjusted median declines at the end of the blinded phase were 14.5% in the control group and 40.4% in the stimulated group. Complex partial and "most severe" seizures were significantly reduced by stimulation. By 2 years, there was a 56% median percent reduction in seizure frequency; 54% of patients had a seizure reduction of at least 50%, and 14 patients were seizure-free for at least 6 months. Five deaths occurred and none were from implantation or stimulation. No participant had symptomatic hemorrhage or brain infection. Two participants had acute, transient stimulation-associated seizures. Cognition and mood showed no group differences, but participants in the stimulated group were more likely to report depression or memory problems as adverse events.Bilateral stimulation of the anterior nuclei of the thalamus reduces seizures. Benefit persisted for 2 years of study. Complication rates were modest. Deep brain stimulation of the anterior thalamus is useful for some people with medically refractory partial and secondarily generalized seizures.

Mouthpieces for brass wind musical instruments are shaped so the physical length of a mouthpiece body ( 40, 50, 60, 70 , & 80 ) is inversely-proportional to the volumetric size of a corresponding cup-chamber ( 42, 52, 62, 72 , & 82 ). Methods for constructing separate sets of such mouthpieces for each kind of brass wind instrument are disclosed. Other embodiments include variations like multi-section components and alternative backbore shapes.

The Parlement of foules is a poem in three parts: the prelude before the dream, the scene in the garden of love, and the debate among the birds. Each part differs from the others in its sources, content, mode of treatment, and tone. Because of these differences many-critics have argued that the poem lacks unity. Such arguments would be more convincing if Chaucer seemed unaware of the differences and if the three parts of the poem did not, in some way, serve a common purpose. It is probable, however, that Chaucer created these differences deliberately, for he appears to have worked to heighten and exploit them. A conscious artistic purpose is behind the poem's variety. Moreover, this variety is the agent of the poem's unity; it both contains and creates the poem's ultimate meaning. To make this clear, we shall look first at some of the ways in which Chaucer sharpened the distinctions between the three parts. And then we shall consider the ways in which the parts are unified and the purpose which is served by the tripartite organization.

A patient had a large internal carotid artery aneurysm with extension to the base of the skull. Resection and reconstitution of flow was thought to be hazardous because of the difficulty in obtaining distal control. After assessment of collateral flow to the brain, placement of a Selverstone clamp resulted in gradual occlusion of the aneurysm. The aneurysm was subsequently resected.