This fully revised and updated second edition of Pediatric Epilepsy Surgery, edited by internationally renowned pediatric neurosurgeons and epilepsy surgery experts Oğuz Çataltepe and George Jallo, fills a void in the literature, encompassing the full spectrum of topics related to the surgical treatment of intractable epilepsy and seizures in children. The prodigiously illustrated book and its accompanying videos feature contributions from distinguished specialists in several different countries across a wide range of disciplines.
From epidemiology, genetics, pathology, preoperative electrophysiological assessment and neuroimaging to state-of-the-art surgical approaches, this remarkable resource covers the full depth and breadth of surgical management of pediatric epilepsy. Topics include awake anesthesia, intracranial stimulation and mapping techniques, temporal and extratemporal epilepsy surgery techniques, insular, multilobar and hemispheric surgery approaches, and diverse disconnection, neuromodulation, and ablative procedures. Insights are provided on postoperative issues including seizure control, neuropsychological and psychosocial outcomes, surgical failure and re-operation, and much more.
A review of topographic anatomy of the cerebral cortex and white matter with numerous illustrations provides enhanced understanding of eloquent anatomy. Discussion of cutting-edge techniques such as stereo-electroencephalography, multi-modality imaging and tractography, endoscopic and laser ablation approaches in hypothalamic hamartomas, peri-insular quadrantotomy, and various hemispherotomy approaches. Overview of common cortical stimulation and mapping techniques including magnetic and electrical stimulation modalities, functional MRI, and the WADA test. 13 videos demonstrate seizure semiology, stimulation, awake surgery, hemispherotomy, amygdalohippocampectomy, and endoscopic corpus callosotomy. This state-of-the-art resource is a must-have for epilepsy surgeons and epileptologists. It will also greatly benefit neurosurgeons, neurologists, clinical neuropsychologists, electrophysiologists, neuroradiologists, residents, fellows, and medical students involved in the assessment and surgical management of epilepsy in pediatric patients.
Traumatic brain injury (TBI), also referred to as intracranialinjury, occurs due to trauma to the brain. It can cause a range of physical, cognitive, behavioral, social and emotional symptoms. Its outcome can vary from complete recovery to permanent disability or death. TBI can occur due to an accident, physical violence or a fall. Its diagnosis involves the use of techniques like magnetic resonance imaging (MRI) and computed tomography. Depending on the extent of the injury, confirmed through a diagnosis, treatment can be minimal or extensive involving medications, surgery and rehabilitation therapies. This book discusses the fundamental as well as modern approaches in the assessment and management of traumatic brain injury. The topics included in this book are of utmost significance and bound to provide incredible insights to readers. It will prove to be immensely beneficial to students and researchers in this domain.
Over the last 2 decades, sports related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004.
The purpose of a study of was to use the second edition of the Sport Concussion Assessment Tool (SCAT2) to profile a cohort of 60 healthy community volunteers who had not sustained a head injury. Participating volunteers underwent MRI scanning and were evaluated with the Hospital Anxiety and Depression Scale (HADS). Participants reported a median of 3 concussion-like symptoms and the 97.5 percentile score was found at 10.5 symptoms, out of a total of 22. The median severity score was 4.9 points, and 28.9 was the upper limit of the reference interval. Only 10 participants (16.7%) did not endorse any symptom. The most frequently endorsed symptom was feeling difficulty in concentrating, with 41.7% of the sample reporting it. Age, sex and general distress, anxiety and depressive symptoms were not associated with concussion-like symptoms.
This data yielded elevated cut-offs scores for both the number of symptoms and the symptom severity. In conclusion, postconcussive-like symptoms are frequent in the general non-concussed adult population and it should be taken into account in any future models developed for screening patients at risk of developing physical, cognitive, and psychological complaints following mild traumatic brain injury1).
Despite growing research on concussion, there is minimal evidence comparing the acute presentation of concussion between pediatric and adult patients. This cross-sectional study compares injury characteristics, symptoms, and neurologic examination in sport-related concussion based on age. Patients presenting to an outpatient sports neurology clinic for initial assessment of concussion within 7 days of injury were divided into 2 groups, 18 and older (n = 28) and 17 and younger (n = 107). There were no significant differences between pediatric and adult patients in any score of the Sport Concussion Assessment Tool-3rd Edition symptom scale, neurologic examination category, pertinent elements of past medical history, or characteristics of the concussion. The pediatric group had higher average hours of sleep (8.1 ± 0.3 vs 7.1 ± 0.58; P = .03) and were less likely to wake refreshed (36.3% vs 65%; P = .02). The initial presentation of concussion within 7 days of injury will likely not differ by age, specifically 18 and older versus 17 and younger 2).
Pediatric athletes diagnosed with migraine headaches reported higher baseline symptom provocation scores on the VOMS. Athletes with migraine headaches also performed worse on the K-D test, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated concussion assessment outcomes at baseline. Special consideration may be warranted for post-concussion assessment in athletes with migraine headaches 3).
Yengo-Kahn et al., conducted a systematic review of the SCAT and the evidence supporting its use to date.
English-language titles and abstracts published between 1995 and October 2015 were searched systematically across 4 electronic databases and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines adapted for the review of a heterogeneous collection of study designs. Peer-reviewed journal articles were included if they reported quantitative data on any iteration of the SCAT, Standardized Assessment of Concussion (SAC), or modified Balance Error Scoring System (mBESS) data at baseline or following concussion in an exclusively athlete population with any portion older than 13 years of age. Studies that included nonathletes, only children less than 13 years old, exclusively BESS data, exclusively symptom scale data, or a non-SCAT-related assessment were excluded. RESULTS The database search process yielded 549 abstracts, and 105 full-text articles were reviewed with 36 meeting criteria for inclusion. Nineteen studies were associated with the SAC, 1 was associated with the mBESS exclusively, and 16 studies were associated with a full iteration of the SCAT. The majority of these studies (56%) were prospective cohort studies. Male football players were the most common athletes studied. An analysis of the studies focused on baseline differences associated with age, sex, concussion history, and the ability to detect an SRC.
Looking toward the upcoming Concussion in Sport Group meeting in fall 2016, one may expect further revision to the SCAT3. However, based on this systematic review, the authors propose further, in-depth study of an already comprehensive concussion test, with acute, diagnostic, as well as long-term use 4).
Rădoi A, Poca MA, Gándara D, Castro L, Cevallos M, Pacios ME, Sahuquillo J. The Sport Concussion Assessment Tool (SCAT2) for evaluating civilian mild traumatic brain injury. A pilot normative study. PLoS One. 2019 Feb 20;14(2):e0212541. doi: 10.1371/journal.pone.0212541. eCollection 2019. PubMed PMID: 30785950.
Corti SJ, Pizzimenti NM, McCarthy MT, Essad KM, Kutcher JS. Comparing the Acute Presentation of Sport-Related Concussion in the Pediatric and Adult Populations. J Child Neurol. 2019 Jan 22:883073818825031. doi: 10.1177/0883073818825031. [Epub ahead of print] PubMed PMID: 30669942.
Moran RN, Covassin T, Wallace J. Premorbid migraine history as a risk factor for vestibular and oculomotor baseline concussion assessment in pediatric athletes. J Neurosurg Pediatr. 2019 Jan 11:1-6. doi: 10.3171/2018.10.PEDS18425. [Epub ahead of print] PubMed PMID: 30641840.