Citations

Background: The diagnostic issue of paroxysmal spells, including epileptic seizure (ES) mimics, is one that neurologists frequently encounter. This review provides an up-to-date overview of the most common causes of ES mimics encountered in the outpatient setting. Review Summary: Paroxysmal spells are characterized by changes in awareness, attention, perception, or abnormal movements. These can be broadly classified as ES and nonepileptic spells (NES). NES mimics ES but are distinguished by their symptomatology and lack of epileptiform activity on electroencephalography. NES may have psychological or physiological underpinnings. Psychogenic non-ES are the most common mimics of ES. Physiological causes of NES include syncope, cerebrovascular, movement, and sleep-related disorders. Conclusions: Distinguishing NES from ES at times may be challenging even to the most experienced clinicians. However, detailed history with an emphasis on the clinical clues, including taking a moment-by-moment history of the event from the patient and observers and physical examination, helps create an appropriate differential diagnosis to guide further diagnostic testing. An accurate diagnosis of NES prevents iatrogenic harm, including unnecessary exposure to antiseizure medications and overuse of health care resources. It also allows for the correct specialist referral and appropriate treatment.

While abnormalities of the hippocampus have been well characterized in temporal lobe epilepsy, various additional temporal lobe abnormalities have also been described. One poorly understood entity, the so-called temporal pole blurring (TPB), is one of the more frequently described neocortical abnormalities in TLE and is thought to represent dysmyelination and axonal loss due to chronic electrical perturbations in early age-onset temporal lobe epilepsy. In this study, we describe the first reported cases of TPB diagnosed by a recently described MRI sequence known as 3D Edge-Enhancing Gradient Echo (3D-EDGE), which has an effective “myelin weighting” making it exquisitely sensitive to this temporal pole dysmyelination. The value of detection of TPB lies in lateralizing seizure onset, as well as predicting a lower baseline neuropsychological performance compared to temporal lobe epilepsy without TPB. Additionally, it is critical to not mistake TPB for alternative diagnoses, such as focal cortical dysplasia or neoplasm.

ABSTRACTDespite advancements in the neurophysiology of language and presurgical evaluation for epilepsy surgery, there is a paucity of information in the literature regarding presurgical evaluation of multilingual patients. We present a case of a 52‐year‐old right‐handed woman with refractory epilepsy who was fluent in six languages and underwent subsequent trilingual presurgical evaluation which included neuropsychological testing, Wada testing, functional magnetic resonance imaging (fMRI), and electrocortical stimulation. These studies suggested a seizure focus in the left temporal lobe and language localization that was predominantly right‐hemispheric; she subsequently underwent left temporal laser interstitial thermal therapy without clinical disturbance in language function while remaining seizure‐free. A multidisciplinary effort was integral in providing an optimal outcome for this patient.

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

Background Anesthesia-focused short courses might be an effective and sustainable way to further the ongoing training and evidence-based practice skills of anesthesia professionals in low- and middle-income countries (LMICs). Instructional design, the process by which formalized learning theory is incorporated into education planning and delivery, is a tool that can strengthen learning in these short courses. As part of an ongoing multilateral project between the University of Minnesota (UMN) and Kabul University of Medical Sciences (KUMS), this project sought to identify the feasibility and potential educational impact of a newly designed postoperative analgesia short-course employing instructional design principles. The Afghan faculty learners’ subjective viewpoint of the short course experience was also investigated and is described in this article. Methods Afghan learners and United States based faculty met in Bangalore, India in August 2018 for this short course. During the 6-day course, learners participated in didactics and workshops discussing regional anesthesia techniques, multimodal analgesia, safety, pain assessment and management, and the influence of ethno-cultural context on pain control. Interactive games, model-based nerve block simulations, and flipped classroom approaches were educational strategies used in the course. The Afghan faculty also participated in instructional design workshops designed to strengthen their teaching skills for use with both students and faculty colleagues. Pretests, posttests, and opinion surveys were completed by the Afghan faculty learners. Results All learners completed the course with full participation. A median of 5 out of 10 technical questions were answered correctly by the learners on the pretest; this score improved to a median of 6.5 on the posttest. The number of learners who ranked their understanding of the role of regional anesthesia in their perioperative care practice as “very well” increased from 2 to 5 faculty. Likewise, the number of learners who described their understanding of postoperative pain and their ability to perform regional anesthesia as “not well at all” decreased from 2 to 0 in both categories. Further, the majority of the participants agreed that at the end of the course their ability to understand and apply instructional design concepts had improved. Conclusions The short course in postoperative pain management appeared to improve short-term knowledge among Afghan faculty participants. Afghan faculty had a favorable opinion of the course and increased confidence in their ability to use instructional design best practices. The results of this project suggest that short courses based in instructional design can be useful and effective for short-term knowledge gain in an LMIC setting such as Afghanistan.