Medical Specialties Commons^™

Plumbing And Wiring: Atherosclerosis In Epilepsy., Scott Mintzer, Md

Department of Neurology Faculty Papers

Over the long term, epilepsy is clearly associated with cognitive impairment. This has been demonstrated functionally, using neuropsychological testing, and reinforced by structural studies showing progressive atrophy in patients with chronic epilepsy ^1-3. The prevailing explanation for this, of course, has been the direct and cumulative effects of seizures on the brain. The basic science literature is chock full of studies showing impairment of neuronal function after seizures, both acutely and chronically. And for those of us who see patients, the progressive memory complaints and clear-cut decline in function seen in those with drug-resistant epilepsy — particularly temporal lobe …

Olfactory Acuity In Chronic Migraine: A Cross-Sectional Study., Alexander C Whiting, Michael J. Marmura, Sarah E Hegarty, Scott W. Keith

Department of Neurology Faculty Papers

OBJECTIVE/BACKGROUND: This study aims to measure olfactory acuity in chronic migraine subjects, at baseline and on migraine days, and compare to age- and sex-matched controls. Olfactory impairment is common in neurological disorders. While smell hypersensitivity has been established with chronic migraine, olfactory acuity has not been well studied.

METHODS: We recruited 50 subjects with chronic migraine from the Jefferson Headache Center and 50 age- and sex-matched controls. Using the University of Pennsylvania Smell Identification Test (UPSIT), a validated test of olfaction, olfactory acuity was measured at baseline and during a migraine for subjects, and compared to controls at baseline and …

Olfactory Function In Migraine Both During And Between Attacks., Michael J. Marmura, Teshamae S Monteith, Waseem Anjum, Richard L Doty, Sarah E Hegarty, Scott W Keith

Department of Neurology Faculty Papers

INTRODUCTION: People with migraine often report being osmophobic, both during and between acute migraine attacks. It is not clear, however, whether such reports are associated with changes in olfaction such as hyperosmia, as measured by psychophysical testing. In this case-control study we quantitatively assessed olfactory identification ability, which correlates with threshold tests of olfactory acuity, in patients with migraine at baseline (no headache), during migraine episodes, and after a treated attack and compared the test scores to those of matched control subjects.

METHODS: Fifty episodic migraine subjects and 50 and sex- and age-matched controls without headache were tested. All completed …

Theta And High-Frequency Activity Mark Spontaneous Recall Of Episodic Memories., John F Burke, Ashwini D Sharan, Michael R Sperling, Ashwin G Ramayya, James J. Evans, M Karl Healey, Erin N Beck, Kathryn A Davis, Timothy H Lucas, Michael J Kahana

Department of Neurology Faculty Papers

Humans possess the remarkable ability to search their memory, allowing specific past episodes to be re-experienced spontaneously. Here, we administered a free recall test to 114 neurosurgical patients and used intracranial theta and high-frequency activity (HFA) to identify the spatiotemporal pattern of neural activity underlying spontaneous episodic retrieval. We found that retrieval evolved in three electrophysiological stages composed of: (1) early theta oscillations in the right temporal cortex, (2) increased HFA in the left hemisphere including the medial temporal lobe (MTL), left inferior frontal gyrus, as well as the ventrolateral temporal cortex, and (3) motor/language activation during vocalization of the …

Regulation Of L1 Expression And Retrotransposition By Melatonin And Its Receptor: Implications For Cancer Risk Associated With Light Exposure At Night., Dawn Deharo, Kristine J Kines, Mark Sokolowski, Robert T Dauchy, Vincent A Streva, Steven M Hill, John P Hanifin, George Brainard, David E Blask, Victoria P Belancio

Department of Neurology Faculty Papers

Expression of long interspersed element-1 (L1) is upregulated in many human malignancies. L1 can introduce genomic instability via insertional mutagenesis and DNA double-strand breaks, both of which may promote cancer. Light exposure at night, a recently recognized carcinogen, is associated with an increased risk of cancer in shift workers. We report that melatonin receptor 1 inhibits mobilization of L1 in cultured cells through downregulation of L1 mRNA and ORF1 protein. The addition of melatonin receptor antagonists abolishes the MT1 effect on retrotransposition in a dose-dependent manner. Furthermore, melatonin-rich, but not melatonin-poor, human blood collected at different times during the circadian …

Use Of Antiepileptic Drugs And Lipid-Lowering Agents In The United States., Scott Mintzer, Vittorio Maio, Kathleen Foley

Department of Neurology Faculty Papers

INTRODUCTION: The extent to which enzyme-inducing antiepileptic drugs (EIAEDs) are used as first-line treatment in the United States remains unknown. Studies suggest that EIAEDs produce elevation of serum lipids, which could require additional treatment. We assessed the current use of EIAED in monotherapy for epilepsy in the U.S., as well as the correlation between the use of EIAEDs and subsequent new prescriptions for HMG-CoA reductase inhibitors ("statins") for hyperlipidemia.

METHODS: We queried the MarketScan® databases between July 2009 and January 2013, covering 66million patients with commercial or supplemental Medicare insurance. We identified individuals who had a diagnosis of seizures, continuous …

Current Pathophysiological Concepts In Cerebral Small Vessel Disease., Fred Rincon, Clinton B Wright

Department of Neurology Faculty Papers

The association between cerebral small vessel disease (SVD) - in the form of white matter lesions, infarctions, and hemorrhages - with vascular cognitive impairment (VCI), has mostly been deduced from observational studies. Pathological conditions affecting the small vessels of the brain and leading to SVD have suggested plausible molecular mechanisms involved in vascular damage and their impact on brain function. However, much still needs to be clarified in understanding the pathophysiology of VCI, the role of neurodegenerative processes such as Alzheimer's disease, and the impact of aging itself. In addition, both genetic predispositions and environmental exposures may potentiate the development …

Temporal Lobe Epilepsy And Surgery Selectively Alter The Dorsal, Not The Ventral, Default-Mode Network., Gaelle Eve Doucet, Christopher T Skidmore, James J. Evans, Ashwini Sharan Md, Michael R Sperling, Dorian Pustina, Joseph I Tracy

Department of Neurology Faculty Papers

The default-mode network (DMN) is a major resting-state network. It can be divided in two distinct networks: one is composed of dorsal and anterior regions [referred to as the dorsal DMN (dDMN)], while the other involves the more posterior regions [referred to as the ventral DMN (vDMN)]. To date, no studies have investigated the potentially distinct impact of temporal lobe epilepsy (TLE) on these networks. In this context, we explored the effect of TLE and anterior temporal lobectomy (ATL) on the dDMN and vDMN. We utilized two resting-state fMRI sessions from left, right TLE patients (pre-/post-surgery) and normal controls (sessions …

Novel Partial Anomalous Pulmonary Venous Connection Associated With Brain Abscess., Anish Koka, Md, Amit Sachdev, Md, Moussa F Yazbeck, Md, Rodney Bell, Md, Christopher Farrellc, Md

Department of Neurology Faculty Papers

BACKGROUND: Right-to-left vascular shunts are associated with brain abscess.

CASE REPORT: We present a 47-year-old female with a cryptogenic left thalamic abscess on which Streptococcus mitis grew upon aspiration. Computed tomography of the chest with contrast agent revealed an anomalous connection between the left superior pulmonary and brachiocephalic veins. A right-to-left shunt was confirmed in a transthoracic echocardiogram study in which bubbles were injected into the left arm; this shunt had not previously been noted upon right-arm injection.

CONCLUSIONS: We recommend aggressive evaluation for right-to-left shunts in patients who present with cryptogenic brain abscesses. In addition to imaging, this should …

Perception And Use Of Complementary And Alternative Medicine Among Children And Adults With Epilepsy: The Importance Of The Decision Makers., Ali A Asadi-Pooya, Mehrdad Emami

Department of Neurology Faculty Papers

The aim of the current study was to assess the extent to which complementary and alternative medicine (CAM) has been used in children and adults to treat seizures and to compare the perceptions and usage of CAM between adult patients who decides for themselves and adults who decide for their sick children.In this cross-sectional study, patients who have been treated for epilepsy for at least one year at the outpatient epilepsy clinic at the Shiraz University of Medical Sciences were interviewed from January 2012 through March 2012. The questionnaire collected specific information of CAM perceptions and usage among patients. Pearson …