Neurology

Marius Kløvgaard, Thomas Hadberg Lynge, Ioannis Tsiropoulos, Peter Vilhelm Uldall, Jytte Banner, Bo Gregers Winkel, Philippe Ryvlin, Jacob Tfelt-Hansen, Anne Sabers

doi : 10.1212/WNL.0000000000013068

vol. 98 no. 3 e213-e224

Mortality is increased in epilepsy, but the important issue is that a proportion of epilepsy-related death is potentially preventable by optimized therapy and therefore needs to be identified. A new systematic classification of epilepsy-related mortality has been suggested to identify these preventable deaths. We applied this classification to an analysis of premature mortality in persons with epilepsy who were <50 years of age.

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Development and Validation of Prediction Models for Developmental and Intellectual Outcome Following Pediatric Epilepsy Surgery

doi : 10.1212/WNL.0000000000013065

vol. 98 no. 3 e225-e235

To identify predictors of postoperative intelligence and developmental quotients (IQ/DQ) and develop and validate clinically applicable IQ/DQ prediction models.

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Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia

doi : 10.1212/WNL.0000000000013066

vol. 98 no. 3 e236-e248

Focal cortical dysplasia (FCD) has been associated with poorer postsurgical seizure outcomes compared to other pathologies. FCD surgical series have been assembled on the basis of a histologic diagnosis, including patients with abnormal and normal preoperative MRI. However, in clinical workflow, patient selection for surgery is based on preoperative findings, including MRI. We performed a systematic review and meta-analysis of the literature to determine the rate and predictors of favorable seizure outcome after surgery for MRI-detected FCD.

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Functional Connectivity as a Potential Mechanism for Language Plasticity

doi : 10.1212/WNL.0000000000013071

vol. 98 no. 3 e249-e259

Task fMRI is a clinical tool for language lateralization, but has limitations, and cannot provide information about network-level plasticity. Additional methods are needed to improve the precision of presurgical language mapping. We investigate language resting-state functional connectivity (RS fMRI; FC) in typically developing children (TD) and children with epilepsy. Our objectives were to (1) understand how FC components differ between TD children and those with epilepsy; (2) elucidate how the location of disease (frontal/temporal epilepsy foci) affects FC; and (3) investigate the relationship between age and FC.

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Causes of Death and End-of-Life Care in Patients With Intracranial High-Grade Gliomas

doi : 10.1212/WNL.0000000000013057

vol. 98 no. 3 e260-e266

To understand patterns of care and circumstances surrounding end of life in patients with intracranial gliomas.

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Association Between Time Spent Outdoors and Risk of Multiple Sclerosis

doi : 10.1212/WNL.0000000000013045

vol. 98 no. 3 e267-e278

This study aims to determine the contributions of sun exposure and ultraviolet radiation (UVR) exposure to risk of pediatric-onset multiple sclerosis (MS).

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Global, Regional, and National Burden of Ischemic Stroke, 1990–2019

doi : 10.1212/WNL.0000000000013115

vol. 98 no. 3 e279-e290

To the best of our knowledge, no comprehensive update of the descriptive epidemiology and trends of ischemic stroke has been released since Global Burden of Disease (GBD) 2017. Thus, our objective was to examine ischemic stroke burden at the global, regional, and national levels in terms of sex, age, and social development index (SDI).

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Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke

doi : 10.1212/WNL.0000000000013049

vol. 98 no. 3 e291-e301

To explore the association between blood pressure (BP) levels after endovascular thrombectomy (EVT) and the clinical outcomes of patients with acute ischemic stroke (AIS) patients with large vessel occlusion (LVO).

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Cerebral Microbleeds and Treatment Effect of Intravenous Thrombolysis in Acute Stroke

doi : 10.1212/WNL.0000000000013055

vol. 98 no. 3 e302-e314

Cerebral microbleeds (CMBs) are common in patients with acute ischemic stroke and are associated with increased risk of intracerebral hemorrhage (ICH) after intravenous thrombolysis. Whether CMBs modify the treatment effect of thrombolysis is unknown.

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Disorders of Consciousness Associated With COVID-19

doi : 10.1212/WNL.0000000000013067

vol. 98 no. 3 e315-e325

In patients with severe coronavirus disease 2019 (COVID-19), disorders of consciousness (DoC) have emerged as a serious complication. The prognosis and pathophysiology of COVID-DoC remain unclear, complicating decisions about continuing life-sustaining treatment. We describe the natural history of COVID-DoC and investigate its associated brain connectivity profile.

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Physiology and Clinical Relevance of Enlarged Perivascular Spaces in the Aging Brain

doi : 10.1212/WNL.0000000000013077

vol. 98 no. 3 107-117

Perivascular spaces (PVS) are fluid-filled compartments that are part of the cerebral blood vessel wall and represent the conduit for fluid transport in and out of the brain. PVS are considered pathologic when sufficiently enlarged to be visible on MRI. Recent studies have demonstrated that enlarged PVS (ePVS) may have clinical consequences related to cognition. Emerging literature points to arterial stiffening and abnormal protein aggregation in vessel walls as 2 possible mechanisms that drive ePVS formation. We describe the clinical consequences, anatomy, fluid dynamics, physiology, risk factors, and in vivo quantification methods of ePVS. Given competing views of PVS physiology, we detail the 2 most prominent theoretical views and review ePVS associations with other common small vessel disease markers. Because ePVS are a marker of small vessel disease and ePVS burden is higher in Alzheimer disease, a comprehensive understanding about ePVS is essential in developing prevention and treatment strategies.

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