Citations

Understanding the evolution of clinical tools and models of care is fundamental to advancing the field of epilepsy. The 2025 American Epilepsy Society Annual Course examined the expanding spectrum of epilepsy care through the integration of multispecialty collaboration, innovative diagnostic modalities, and surgical and nonsurgical therapeutic interventions. The course underscored significant global advancements in epilepsy research and practice. This comprehensive review synthesizes key educational insights from the program, offering a critical perspective on the ongoing transformation of epilepsy care.

Hearing loss is a highly prevalent disease state affecting almost 1 in 5 individuals globally. Growing research shows that untreated or undertreated hearing loss carries significant long-term sequelae, including increased risk of social isolation, depression, and cognitive decline, among other ramifications. Limited awareness and common misperceptions among the general US adult population and primary care providers contribute to low rates of referral to hearing specialty clinics and underutilization of hearing aids, cochlear implants, and other rehabilitative devices. Comprised of diverse membership, the Hearing Health Collaborative (HHC) was formed in May 2021 to identify and overcome challenges impacting good health care practices and public policy on hearing care in connection with healthy aging. This editorial documents a recent outcome of the HHC derived from a structured A3 process. Specifically, initiative 2, a proposal to develop a simple, clinically anchored staging system primarily for use by frontline providers and patients, is presented. Unlike other common disorders that harbor long-term health sequelae, a corresponding pragmatic clinical staging system—leveraging precedent disease staging convention, based on clinically meaningful outcomes and prognosis for acquired hearing loss—does not exist. The development of this staging system will potentially allow for improved communication across providers and patients, facilitate referral pathways, and ultimately enable patient access to timely and appropriate care.

This study proposes a novel two-dimensional Empirical Mode Decomposition (2D EMD)-based deep learning framework to enhance model performance in multi-class image classification tasks and potential early detection of diseases in healthcare using medical imaging. To validate this approach, we apply it to gastrointestinal (GI) endoscopic image classification using the publicly available Kvasir dataset, which contains eight GI image classes with 1000 images each. The proposed 2D EMD-based design procedure decomposes images into a full set of intrinsic mode functions (IMFs) to enhance image features beneficial for AI model development. Integrating 2D EMD into a deep learning pipeline, we evaluate its impact on four popular models (ResNet152, VGG19bn, MobileNetV3L, and SwinTransformerV2S). The results demonstrate that subtracting IMFs from the original image consistently improves accuracy, F1-score, and AUC for all models. The study reveals a notable enhancement in model performance, with an approximately 9% increase in accuracy compared to counterparts without EMD integration for ResNet152. Similarly, there is an increase of around 18% for VGG19L, 3% for MobileNetV3L, and 8% for SwinTransformerV2. Additionally, explainable AI (XAI) techniques, such as Grad-CAM, illustrate that the model focuses on GI regions for predictions. This study highlights the efficacy of 2D EMD in enhancing deep learning model performance for GI image classification, with potential applications in other domains.

Cisplatin is an imperative drug in the treatment of a wide range of cancers. However, it has various side effects including ototoxicity causing bilateral sensorineural hearing loss. Despite lacking a clearly defined mechanism, Reactive Oxygen Species (ROS) production and damage to Outer Hair Cells (OHCs) have been implicated as possible culprits. The ideal otoprotective drug would target inflammation and oxidative stress without compromising cisplatin’s efficacy. This study aimed to scrutinize whether intratympanic Epigallocatechin-3-Gallate (EGCG) exhibits a protective effect against cisplatin-related ototoxicity. Twenty-four adult male Wistar rats (8–10 weeks, 200–250 g) were randomly divided into four groups (n=6 per group): Cisplatin, EGCG, Cisplatin+EGCG, and Control. Cisplatin (15 mg/kg) was administered intraperitoneally, and/or EGCG (10 mg/mL, 200 μL) was injected transtympanically into the right ear, depending on group assignment. Control rats received intratympanic distilled water. After 72 h, auditory function was assessed by Auditory Brain Response (ABR), followed by histopathological and Signal Transducer and Activator of Transcription-1 (STAT1) immunohistochemistry evaluation of cochlear sections. All animals underwent baseline otoscopy and ABR to rule out pre-existing hearing impairment. Data were analyzed using repeated measures of Analysis of Variance (ANOVA) and paired t-tests for ABR thresholds, and Kruskal–Wallis/Mann–Whitney tests for histopathological and Immunohistochemistry (IHC) scoring. Statistical significance was defined as p <0.05. EGCG injections failed to prevent hearing threshold increases in the Cisplatin group. According to histopathologic and STAT-1 IHC evaluation in the treatment group, reduced OHC damage, apoptosis, and cochlear hyperemia were observed. Administration of EGCG alleviated apoptosis and prevented OHCs damage in animals. However, it could not prevent hearing loss significantly.

Abstract Women remain underrepresented in physical medicine and rehabilitation, comprising only 36%–39% of residents despite evidence that diverse teams improve patient outcomes. Limited early exposure and systemic barriers may contribute to this disparity. In this cross-sectional study, we surveyed 1101 US premedical students from 198 colleges across 40 states and territories to assess perceptions of physical medicine and rehabilitation and identify effective early intervention strategies. While respondents included all gender identities, the analysis focused on the 870 female-identifying students (78.8%) due to the study’s primary aim of addressing gender equity in physical medicine and rehabilitation. Only 30.6% were familiar with physical medicine and rehabilitation, with exposure primarily through social media (42.6%) and personal connections (31.1%); just 9.0% had shadowed a physical medicine and rehabilitation physician. Financial concerns were prevalent, with 68.6% citing medical education costs and 66.4% citing application fees as deterrents. Despite these barriers, 60.6% expressed interest in learning more about physical medicine and rehabilitation. Preferred engagement strategies included shadowing (81.8%), interactive workshops (76.6%), mentorship programs (60.1%), and gender-specific events such as “Women in PM&R” (62.8%). These findings underscore the need for targeted, early outreach initiatives that address both informational and financial barriers, aiming to foster greater awareness and representation of women in physical medicine and rehabilitation and ultimately support a more inclusive physician workforce.

Abstract Introduction Periacetabular osteotomy (PAO) is a complex reconstructive procedure performed to address acetabular dysplasia. Postoperative pain management is challenging due to surgical invasiveness and the need to limit opioid use. Regional and local anesthesia are commonly used but may be short-lived, increasing opioid requirements. However, methadone is a long-acting analgesic that may offset these limitations. This is the first study to evaluate methadone use in PAO with arthroscopy, comparing efficacy and opioid consumption of three different anesthetic regimens: (1) lumbar plexus catheter with a single shot intrathecal hydromorphone (LP+HM) (2) locally administered intraoperative soft tissue periarticular injection with ropivacaine, epinephrine, and ketorolac (arthroplasty block [AP]), and (3) AP with intraoperative methadone (AP+M). Methods We retrospectively reviewed PAO with arthroscopy cases from 2022 to 2025 at a single tertiary center. All cases were performed by the same surgeon and anesthesia team and managed on the same postoperative floor. Patients were categorized into three groups: (1) LP+HM, (2) AP, and (3) AP+M. Primary outcomes were 48-hour morphine milligram equivalents (MME) and total inpatient opioid consumption. Length of stay (LoS), operative time, VAS pain scores at 24h and 48h, and antiemetic use were also collected. Results Fifty PAO procedures were identified. The mean age was 16.0±2.3 years, 96% were female, and mean BMI was 22.8±4.4 kg/m2. No significant differences were seen between groups. The addition of methadone to the arthroplasty block regimen (AP+M) resulted in significantly lower 48-h MME compared to AP alone (55.9 mg vs 83.3 mg, p=0.030), but did not differ significantly from LP+HM (39.0mg, p=0.593). Total inpatient opioid consumption was also significantly reduced in the AP+M (69.3 mg) and LP+HM (66.7 mg) groups compared to AP (110.5 mg, p=0.012). Similarly, 24-hour pain scores were significantly lower in the AP+M (3.6±1.9) and LP+HM (3.7±2.1) groups compared to AP (6.4±1.6, p=0.041). Length of stay was comparable across groups (p=0.39). Conclusion Intraoperative methadone added to the arthroplasty block provided comparable analgesia and reduced total opioid use compared to arthroplasty block alone. These findings support methadone as an adjunct to periarticular anesthesia for improving pain control and reducing opioid use in hip preservation surgery.

Abstract Introduction The utilization of total hip arthroplasty (THA) in skeletally immature patients remains controversial, with an open triradiate cartilage traditionally perceived as a relative contraindication due to concerns of acetabular fixation and component loosening. Early evidence suggests that THA may be a feasible option in this patient population yielding favorable short-term outcomes, however larger series and mid-term data are lacking. This study presents the largest series of THA in patients with open triradiate cartilage to date with mid-term clinical, radiographic, and patient-reported outcomes. Methods A retrospective review of our institutional Total Joint Registry identified 19 patients (22 hips) who underwent THA while having an open triradiate cartilage growth plate between the year 2000 and 2024. Skeletal maturity was assessed utilizing the modified Oxford bone age and all patients had a score of “1” or “2” on the triradiate cartilage stage of maturation. Demographics, surgical characteristics, implant data, radiographic parameters, and clinical outcomes were collected. Functional hip scores were assessed via the Harris Hip Score (HHS). Kaplan-Meier analysis was performed to analyze reoperation rates. Results The average age at surgery was 14 years (SD=1.68), the average BMI was 24 (SD=7.1) and 64% were male. Mean follow-up was 6.05 years (range 1-15). The mean modified Oxford bone age for this cohort was 23 (SD=1.4). The most common indications for THA were avascular necrosis (64%), degenerative joint disease (27%), and neoplasia (9%). Preoperatively, 54.5% of patients utilized gait aids. Postoperatively, all patients reported independent ambulation without assistive devices with an average HHS of 91.65 (SD=11.42). Ninety-six percent of implants were stable at final radiographic follow up. Both reported complications involved acetabular cup loosening, requiring revision of the acetabular component. Conclusion This study presents the largest cohort in the literature of patients who underwent THA with open triradiate cartilage. Our results highlight high patient reported outcomes and low revision rates at mid-term follow up. All patients had excellent implant fixation without radiographic signs of loosening at final radiographic follow up. These results support the use of THA in skeletally immature patients without the need to delay THA for closure of the triradiate cartilage.

Abstract Introduction Periacetabular osteotomy (PAO) is performed in the setting of hip dysplasia to increase acetabular coverage of the femoral head and improve joint biomechanics and longevity. PAO fixation is generally achieved with two or three 4.5 mm screws, as compared to the generally more substantial plate and screw constructs used in the setting of acetabular fractures or pelvic ring injuries. The purpose of this study was to evaluate postoperative changes in hip joint center medialization and lateral acetabular coverage following PAO, understanding that these radiographic measures are generally used to guide intra-operative assessment of correction. Methods A retrospective chart review of 100 consecutive PAOs during 2021-2023 at a single academic institution by four surgeons was performed. Perioperative radiographs and fluoroscopy images were evaluated to measure lateral center edge angle (LCEA), Tönnis angle, and medialization of the hip joint center. The hip joint center was measured at one-third of the diameter of the femoral head from inferior to superior, to the ilioischial line, as previously validated by Fowler and colleagues. Results One hundred PAOs in 87 patients (87% female, mean age: 23.0 years) were included. Average preoperative radiographic parameters were 19.9° for LCEA, 12.5° for Tönnis angle, and 12.6 mm for distance from the femoral head to ilioischial line. Ninety-four cases (94%) used three screws, and 6 cases (6%) used two screws for unstable fragment fixation. On immediate postoperative films, average correction was to 28.3° for LCEA, 4.9° for Tönnis angle, and 1.9 mm of pre- to postoperative femoral head medialization (p≤0.001). Patients were radiographically followed for an average of 13.3 months, with an average time to radiographic union of 7.1 months. During the course of follow-up, LCEA increased to 29.3°, Tönnis angle remained to 5.0° (p=0.47), and medialization increased to 2.7 mm (p≤0.02), suggesting further significant but clinically modest increases in lateral coverage and femoral head medialization. Conclusion While the majority of lateral acetabular coverage and femoral head medialization occurs intra-operatively at the time of PAO, patients undergo modest but statistically significant postoperative increases in lateral coverage and medialization prior to radiographic union.

Abstract Purpose Acetabular overcoverage (pincer morphology) has been suggested to be both a source of pain and dysfunction as well as potentially protective against osteoarthritic change. The purpose of this study was to compare minimum 5-year clinical outcomes of patients undergoing primary hip arthroscopic labral repair with a lateral center edge angle (LCEA) of ≥ 40° as compared to non-dysplastic controls with an LCEA of 25-40°. Methods We identified all patients that underwent primary hip arthroscopy with labral repair between 2009-2019 at a single academic institution. Patients with LCEA ≥ 40° (pincer) were propensity matched to non-dysplastic controls with LCEA 25-40° on a 1:2 basis by sex, age, body mass index (BMI), and year of surgery. Patient-reported outcome measures (PROMs) including Visual Analog Scale (VAS) for pain, Tegner activity score, modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and Hip Outcome Score (HOS) were analyzed, as were reoperations and conversions to total hip arthroplasty (THA). Results Fifty-five patients with pincer morphology (mean preoperative LCEA: 41.9°, Tonnis angle: -7.3°, alpha angle: 58.8°) were matched to 110 non-dysplastic controls (LCEA: 31.2°, Tonnis angle: 2.2°, alpha angle: 58.9°), resulting in a total of 165 hips in 163 patients (67% females, mean age: 37.7 years, BMI: 26.8 kg/m2). Pincer patients were corrected to a mean postoperative LCEA of 38.7° (p&lt;0.0001), with 22 pincer patients having residual overcoverage, namely a postoperative LCEA ≥ 40° (range: 40.0-45.8°). At mean 7.8 years follow-up (range: 5.1-13.2), there was no difference in any postoperative PROMs between pincers and controls (p&gt;0.15) and no difference in PROMs between patients with residual overcoverage and pincer patients with a postoperatively normalized LCEA (p&gt;0.25). At final follow-up, 4 patients in the pincer cohort (7%) and 21 controls (19%) had converted to THA (p=0.046). Conclusion Patients with lateral acetabular overcoverage demonstrated similar and satisfactory postoperative PROMs at a minimum of 5-year follow-up compared to propensity-matched non-dysplastic controls, regardless of if the LCEA was corrected to &lt;40°. Of note, non-dysplastic controls demonstrated an increased rate of conversion to THA, supporting the potentially chondroprotective role of acetabular overcoverage.

Abstract Background Some studies have reported more severe chondral pathology and less successful hip arthroscopic outcomes in patients with acetabular subchondral cysts. Purpose The purpose of this study is to report multicenter arthroscopic outcomes of patients with and without acetabular bone cysts. Methods A multicenter matched-pair study was performed with data from a large prospectively collected database. Inclusion criteria were adult patients that had undergone primary unilateral hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The study group was defined by the presence of a superolateral acetabular subchondral cyst on preoperative imaging with &gt; 2mm minimum joint width. 1:1 matching on age, gender, Body Mass Index (BMI), lateral center-edge angle (LCEA), Alpha angle, and rendered arthroscopic treatments of femoroplasty, acetabuloplasty, and labral treatment (i.e., repair, reconstruction, or debridement). Beck chondral grade and minimum 2-year outcomes utilizing VAS for pain, iHOT-12, MCID, SBC, and PASS scores were compared. Results There were 82 patients. The study group had a mean age of 42.16 ± 11.26 years with 48.78% women and a mean BMI of 26.51 ± 4.31 kg/m2. Mean Beck chondral grade was 2.59 ± 1.27 in the study group and 2.70 ± 0.95 in the matched control group (p=0.72). Two-year mean postoperative iHOT-12 scores for the study and control groups were 69.49 ± 24.51 and 73.24 ± 25.16 (p=0.38), while mean postoperative pain VAS were 18.84 ± 18.17 and 20.74 ± 21.39 (p=0.70) The study group reached MCID in 82.93%, SBC in 58.54%, and PASS in 65.85%. The control group reached MCID in 78.05%, SBC in 65.85%, and PASS in 73.17%, with no significant difference between the cohorts (p=0.57, p=0.49, p=0.47, respectively). Discussion/Conclusion Acetabular subchondral cysts are not associated with more chondral pathology than strictly matched controls and may not be a contraindication to hip arthroscopy in patients with FAIS that would otherwise be indicated for this surgery. This finding has pragmatic value in that a significant subset of patients that would otherwise have been denied elective hip arthroscopy may now be potential arthroscopic candidates.