Atrophy computation in the spinal cord using the Boundary Shift Integral

In this work, we introduce a new pipeline based on the latest iteration of the BSI for computing atrophy in the SC and compare its results with the most popular atrophy measurements for this region, mean CSA. We demonstrated for the first time the use of BSI in the SC, as a sensitive, quantitative and objective measure of longitudinal tissue volume change. The BSI pipeline presented in this work is repeatable, reproducible and standardises a pipeline for computing SC atrophy

Fully automated grey and white matter segmentation of the cervical cord in vivo

We propose and validate a new fully automated spinal cord (SC) segmentation technique that incorporates two different multi-atlas segmentation propagation and fusion techniques: Optimized PatchMatch Label fusion (OPAL) and Similarity and Truth Estimation for Propagated Segmentations (STEPS). We collaboratively join the advantages of each method to obtain the most accurate SC segmentation. The new method reaches the inter-rater variability, providing automatic segmentations equivalents to inter-rater segmentations in terms of DSC 0.97 for whole cord for any subject

Fully automated grey and white matter spinal cord segmentation

Axonal loss in the spinal cord is one of the main contributing factors to irreversible clinical disability in multiple sclerosis (MS). In vivo axonal loss can be assessed indirectly by estimating a reduction in the cervical cross-sectional area (CSA) of the spinal cord over time, which is indicative of spinal cord atrophy, and such a measure may be obtained by means of image segmentation using magnetic resonance imaging (MRI). In this work, we propose a new fully automated spinal cord segmentation technique that incorporates two different multi-atlas segmentation propagation and fusion techniques: The Optimized PatchMatch Label fusion (OPAL) algorithm for localising and approximately segmenting the spinal cord, and the Similarity and Truth Estimation for Propagated Segmentations (STEPS) algorithm for segmenting white and grey matter simultaneously. In a retrospective analysis of MRI data, the proposed method facilitated CSA measurements with accuracy equivalent to the inter-rater variability, with a Dice score (DSC) of 0.967 at C2/C3 level. The segmentation performance for grey matter at C2/C3 level was close to inter-rater variability, reaching an accuracy (DSC) of 0.826 for healthy subjects and 0.835 people with clinically isolated syndrome MS

Is low antiepileptic drug dose effective in long-term seizure-free patients?

Objective: To investigate the value of leaving seizure-free patients on low-dose medication. Method: This was an exploratory prospective randomized study conducted at our University Hospital. We evaluated the frequency of seizure recurrence and its risk factors following complete or partial antiepileptic drug (AED) withdrawal in seizure free patients for at least two years with focal, secondarily generalized and undetermined generalized epilepsies. For this reason, patients were divided into two groups: Group 1 (complete AED withdrawal), and Group 2 (partial AED withdrawal). Partial AED withdrawal was established as a reduction of 50% of the initial dose. Medication was tapered off slowly on both groups. Follow-up period was 24 months. Results: Ninety-four patients were followed up: 45 were assigned to complete (Group 1) AED withdrawal and 49 to partial (Group 2) AED withdrawal. Seizure recurrence frequency after two years follow-up were 34.04% in group 1 and 32.69% in Group 2. Survival analysis showed that the probability of remaining seizure free at 6, 12, 18 and 24 months after randomization did not differ between the two groups (p = 0.8). Group 1: 0.89, 0.80, 0.71 and 0.69; group 2: 0.86, 0.82, 0.75 and 0.71. The analysis of risk factors for seizure recurrence showed that more than 10 seizures prior to seizure control was a significant predictive factor for recurrence after AED withdrawal (hazard ratio = 2.73). Conclusion: Leaving seizure free patients on low AED dose did not reduce the risk for seizure recurrence. That is, once the decision of AED withdrawal has been established, it should be complete.613A56657

Cysticidal therapy - Impact on seizure control in epilepsy associated with neurocysticercosis

Objective: To evaluate the clinical features and seizure control of epilepsy related to neurocysticercosis. Method: 18 patients with partial epilepsy and neurocysticercosis were treated with albendazol or praziquantel and followed from 3 months to 12 years. We analyzed results from the CSF exam, interictal electroencephalogram (EEG), head computerized tomography and/or magnetic resonance imaging. Results: The patients' mean age was 36.4 years. The mean duration of epilepsy was 16 years, 83% patients had simple partial seizures; 17% had complex partial seizures. All patients underwent routine EEGs; 62% had abnormalities and 38% were normal. A relationship was observed between focal EEG abnormality and the location of cyst in 28% of the patients. The CSF exams showed pleocytosis in 33% of the patients, and 28% had elevated protein levels. Only 22% of patients had positive titer for cysticercosis in the CSF. In all patients who had somatosensory and special sensory seizures there was a relationship between location of the cysts and seizure semiology (n = 11). After cysticidal therapy, 83% patients had a significant improvement in controlling seizures. Conclusion: In this group, we found a predominance of simple partial seizures and a relationship between somatosensory and special sensory seizures and the location of the cysts. Cysticidal therapy was effective in controlling seizures in these patients and should be considered for patients with partial seizures and semiology related to cyst location.5841014102