New and Noteworthy Information—November 2015

HLA-DRB1*1501, adolescent summer sun habits, and BMI at the age of 20 independently affect age of multiple sclerosis (MS) onset, according to a study published online ahead of print October 7 in Neurology. This cross-sectional study included 1,161 Danish patients with MS. Lifestyle questionnaires and blood samples for genotyping were collected from all participants from 2009 to 2012. Information on age at onset was obtained from the Danish MS Treatment Registry. Younger age at onset was significantly associated with low exposure to summer sun in adolescence, higher BMI at age 20, and the HLA-DRB1*1501 risk allele in both univariate analyses and in a multivariable regression analysis. No association was found between age at onset and other single-nucleotide polymorphisms studied or vitamin D-associated environmental factors.

Treatment responses for autoimmune ataxia are more likely in patients with nonparaneoplastic disorders and those with exclusively plasma membrane protein (PMP) antibodies, according to a study published online ahead of print September 28 in JAMA Neurology. Investigators examined 118 patients with ataxia who were 18 or older, were seropositive for at least one neural autoantibody, had received at least one immunotherapy or cancer therapy, and had neurologist-reported outcomes documented from January 1, 1989, through December 31, 2013. Fifty-four patients had neurologic improvements. Kaplan-Meier analyses revealed that progression to wheelchair dependence occurred significantly faster among patients with neuronal nuclear or cytoplasmic antibody positivity only, although those with glutamic acid decarboxylase 65-kDa isoform autoimmunity progressed to wheelchair dependence at a rate similar to those with PMP autoimmunity.

Patients with celiac disease are not at increased risk for dementia overall, though they may be at increased risk for vascular dementia, according to a study published online ahead of print September 29 in Journal of Alzheimer’s Disease. Researchers compared the incidence of a subsequent dementia diagnosis among 8,846 older adults with celiac disease to that among 43,474 age- and gender-matched controls. The median age of the study population was 63, and 56% of participants were female. During a median follow-up time of 8.4 years, dementia was diagnosed in 4.3% of patients with celiac disease and 4.4% of controls. The researchers observed an increased risk of dementia in the first year following a diagnosis of celiac disease, but the increased risk was restricted to vascular dementia and was not present for Alzheimer’s dementia.

Infection may trigger childhood arterial ischemic stroke, while routine vaccinations appear to protect against it, according to a study published online ahead of print September 30 in Neurology. This international case–control study included 355 children with confirmed cases of arterial ischemic stroke and 354 controls without stroke. Median age was 7.6 for cases and 9.3 for controls. Infection in the week prior to stroke, or interview date for controls, was reported in 18% of cases versus 3% of controls. Infection thus conferred a 6.3-fold increased risk of arterial ischemic stroke. Children with some, few, or no routine vaccinations were at higher stroke risk than those receiving all or most vaccinations. Risk factors for arterial ischemic stroke included infection in the prior week, undervaccination, black race, and rural residence.

Amyloid PET and CSF biomarkers identify early Alzheimer’s disease with equal accuracy, according to a study published October 6 in Neurology. Researchers examined 122 healthy elderly people and 34 patients with mild cognitive impairment who developed Alzheimer’s disease dementia within three years (MCI-AD). They examined β-amyloid deposition in nine brain regions with [¹⁸F]-flutemetamol PET. CSF was analyzed with INNOTEST and EUROIMMUN ELISAs. CSF samples and PET scans each identified approximately 90% of patients who later received a diagnosis of Alzheimer’s disease. The best CSF measures for identifying MCI-AD were Aβ42/total tau and Aβ42/hyperphosphorylated tau, which performed better than CSF Aβ42 and Aβ42/40. CSF Aβ42/total tau had the highest accuracy of all CSF and PET biomarkers. The combination of CSF and PET was not better than either individual biomarker.

A combination of dextromethorphan and quinidine demonstrated clinically relevant efficacy for agitation in patients with probable Alzheimer’s disease and was generally well tolerated, according to a study published September 22 in JAMA. A total of 194 patients completed a preliminary 10-week phase II randomized clinical trial. In the sequential parallel comparison design, 152 patients received dextromethorphan–quinidine, and 127 received placebo. Analysis combining all patients and rerandomized placebo nonresponders showed significantly reduced agitation and aggression scores for dextromethorphan–quinidine versus placebo. Among all patients, mean agitation and aggression scores were reduced from 7.1 to 3.8 with dextromethorphan–quinidine and from 7.0 to 5.3 with placebo. Between-group treatment differences were significant. Among rerandomized placebo nonresponders, agitation and aggression scores were reduced from 5.8 to 3.8 with dextromethorphan–quinidine and from 6.7 to 5.8 with placebo.

The FDA has approved Betaconnect, an electronic autoinjector for the treatment of relapsing-remitting multiple sclerosis. Bayer HealthCare (Whippany, NJ) manufactures Betaconnect, which will be available to patients receiving Betaseron beginning in early 2016. The autoinjector, which was created based on feedback from patients and caregivers, offers customizable injection speed and depth settings that allow patients to administer injections quietly and precisely. Betaconnect also has an optional backup reminder function that tells patients the time of their next injection. In addition, the automatic needle insertion and retraction and a visual and audio end-of-dose indication tell patients when the injection is complete. Patients should speak with a healthcare provider before making any changes to injection depth or speed settings.

In patients with an intracranial pressure of more than 20 mmHg after traumatic brain injury (TBI), therapeutic hypothermia plus standard care to reduce intracranial pressure do not result in outcomes better than those associated with standard care alone, according to a study published online ahead of print October 7 in New England Journal of Medicine. Investigators enrolled 387 patients with TBI from November 2009 through October 2014 in a study. Barbiturates and decompressive craniectomy were required to control intracranial pressure in 54% of patients who received standard care and in 44% of patients who received hypothermia and standard care. The hypothermia group had worse outcomes in general than the standard-care group. A favorable outcome occurred in 26% of patients in the hypothermia group and in 37% of patients in the control group.

Differing manifestations of postconcussion symptoms on functional MRI (fMRI) between younger and older patients indicate that age influences the activation, modulation, and allocation of working memory processing resources after mild traumatic brain injury (MTBI), according to a study published online ahead of print October 6 in Radiology. Researchers performed fMRI exams on 13 young adults and 13 older adults with MTBI and 26 age- and gender-matched controls. Younger patients performing working-memory tasks had initial hyperactivation in the right precuneus and right inferior parietal gyrus, compared with younger controls. Older patients performing these tasks had hypoactivation in the right precuneus and right inferior frontal gyrus, compared with older controls. Younger patients, but not older patients, had partial recovery of activation pattern and decreased postconcussion symptoms at follow-up.

An immune system gene is associated with higher rates of amyloid plaque buildup in the brains of patients with Alzheimer’s disease and older adults at risk for the disease, according to a study published in the October issue of Brain. Investigators performed a genome-wide association study of longitudinal change in brain amyloid burden measured by ¹⁸F-florbetapir PET. They found that interleukin-1 receptor accessory protein (IL1RAP) was associated with higher rates of amyloid accumulation, independent of APOE ε4 status. This novel association was validated by deep sequencing. IL1RAP rs12053868-G carriers were more likely to progress from mild cognitive impairment to Alzheimer’s disease and exhibited greater longitudinal temporal cortex atrophy on MRI. In independent cohorts, rs12053868-G was associated with accelerated cognitive decline and lower cortical ¹¹C-PBR28 PET signal.

For children with tuberous sclerosis complex and medically intractable epilepsy, a greater extent of resection is associated with a greater probability of seizure freedom, according to a study published in the October issue of Neurosurgery. Seventy-four patients were included in this retrospective chart review, and their median age at the time of surgery was 120 months. Engel Class I outcome was achieved in 65% and in 50% of patients at the one- and two-year follow-up, respectively. On univariate analyses, younger age at seizure onset, larger size of predominant tuber, and resection larger than a tuberectomy were associated with a longer duration of seizure freedom. In multivariate analyses, resection larger than a tuberectomy was independently associated with a longer duration of seizure freedom.

A new imaging method that uses a 7-T magnet shows promise in locating hard-to-find epileptic foci by visualizing the neurotransmitter glutamate, according to a study published October 14 in Science Translational Medicine. In a pilot study, researchers applied glutamate chemical exchange saturation transfer (GluCEST) to patients with nonlesional temporal lobe epilepsy based on conventional MRI. GluCEST correctly lateralized the temporal lobe seizure focus on visual and quantitative analyses in all patients. Hippocampal volumes were not significantly different between hemispheres. GluCEST allowed high-resolution functional imaging of brain glutamate and has the potential to identify the epileptic focus in patients previously deemed nonlesional. This method may lead to improved clinical outcomes for temporal lobe epilepsy as well as other localization-related epilepsies, according to the researchers.

—Kimberly Williams

HLA-DRB1*1501, adolescent summer sun habits, and BMI at the age of 20 independently affect age of multiple sclerosis (MS) onset, according to a study published online ahead of print October 7 in Neurology. This cross-sectional study included 1,161 Danish patients with MS. Lifestyle questionnaires and blood samples for genotyping were collected from all participants from 2009 to 2012. Information on age at onset was obtained from the Danish MS Treatment Registry. Younger age at onset was significantly associated with low exposure to summer sun in adolescence, higher BMI at age 20, and the HLA-DRB1*1501 risk allele in both univariate analyses and in a multivariable regression analysis. No association was found between age at onset and other single-nucleotide polymorphisms studied or vitamin D-associated environmental factors.

Treatment responses for autoimmune ataxia are more likely in patients with nonparaneoplastic disorders and those with exclusively plasma membrane protein (PMP) antibodies, according to a study published online ahead of print September 28 in JAMA Neurology. Investigators examined 118 patients with ataxia who were 18 or older, were seropositive for at least one neural autoantibody, had received at least one immunotherapy or cancer therapy, and had neurologist-reported outcomes documented from January 1, 1989, through December 31, 2013. Fifty-four patients had neurologic improvements. Kaplan-Meier analyses revealed that progression to wheelchair dependence occurred significantly faster among patients with neuronal nuclear or cytoplasmic antibody positivity only, although those with glutamic acid decarboxylase 65-kDa isoform autoimmunity progressed to wheelchair dependence at a rate similar to those with PMP autoimmunity.

Patients with celiac disease are not at increased risk for dementia overall, though they may be at increased risk for vascular dementia, according to a study published online ahead of print September 29 in Journal of Alzheimer’s Disease. Researchers compared the incidence of a subsequent dementia diagnosis among 8,846 older adults with celiac disease to that among 43,474 age- and gender-matched controls. The median age of the study population was 63, and 56% of participants were female. During a median follow-up time of 8.4 years, dementia was diagnosed in 4.3% of patients with celiac disease and 4.4% of controls. The researchers observed an increased risk of dementia in the first year following a diagnosis of celiac disease, but the increased risk was restricted to vascular dementia and was not present for Alzheimer’s dementia.

Infection may trigger childhood arterial ischemic stroke, while routine vaccinations appear to protect against it, according to a study published online ahead of print September 30 in Neurology. This international case–control study included 355 children with confirmed cases of arterial ischemic stroke and 354 controls without stroke. Median age was 7.6 for cases and 9.3 for controls. Infection in the week prior to stroke, or interview date for controls, was reported in 18% of cases versus 3% of controls. Infection thus conferred a 6.3-fold increased risk of arterial ischemic stroke. Children with some, few, or no routine vaccinations were at higher stroke risk than those receiving all or most vaccinations. Risk factors for arterial ischemic stroke included infection in the prior week, undervaccination, black race, and rural residence.

Amyloid PET and CSF biomarkers identify early Alzheimer’s disease with equal accuracy, according to a study published October 6 in Neurology. Researchers examined 122 healthy elderly people and 34 patients with mild cognitive impairment who developed Alzheimer’s disease dementia within three years (MCI-AD). They examined β-amyloid deposition in nine brain regions with [¹⁸F]-flutemetamol PET. CSF was analyzed with INNOTEST and EUROIMMUN ELISAs. CSF samples and PET scans each identified approximately 90% of patients who later received a diagnosis of Alzheimer’s disease. The best CSF measures for identifying MCI-AD were Aβ42/total tau and Aβ42/hyperphosphorylated tau, which performed better than CSF Aβ42 and Aβ42/40. CSF Aβ42/total tau had the highest accuracy of all CSF and PET biomarkers. The combination of CSF and PET was not better than either individual biomarker.

A combination of dextromethorphan and quinidine demonstrated clinically relevant efficacy for agitation in patients with probable Alzheimer’s disease and was generally well tolerated, according to a study published September 22 in JAMA. A total of 194 patients completed a preliminary 10-week phase II randomized clinical trial. In the sequential parallel comparison design, 152 patients received dextromethorphan–quinidine, and 127 received placebo. Analysis combining all patients and rerandomized placebo nonresponders showed significantly reduced agitation and aggression scores for dextromethorphan–quinidine versus placebo. Among all patients, mean agitation and aggression scores were reduced from 7.1 to 3.8 with dextromethorphan–quinidine and from 7.0 to 5.3 with placebo. Between-group treatment differences were significant. Among rerandomized placebo nonresponders, agitation and aggression scores were reduced from 5.8 to 3.8 with dextromethorphan–quinidine and from 6.7 to 5.8 with placebo.

The FDA has approved Betaconnect, an electronic autoinjector for the treatment of relapsing-remitting multiple sclerosis. Bayer HealthCare (Whippany, NJ) manufactures Betaconnect, which will be available to patients receiving Betaseron beginning in early 2016. The autoinjector, which was created based on feedback from patients and caregivers, offers customizable injection speed and depth settings that allow patients to administer injections quietly and precisely. Betaconnect also has an optional backup reminder function that tells patients the time of their next injection. In addition, the automatic needle insertion and retraction and a visual and audio end-of-dose indication tell patients when the injection is complete. Patients should speak with a healthcare provider before making any changes to injection depth or speed settings.

In patients with an intracranial pressure of more than 20 mmHg after traumatic brain injury (TBI), therapeutic hypothermia plus standard care to reduce intracranial pressure do not result in outcomes better than those associated with standard care alone, according to a study published online ahead of print October 7 in New England Journal of Medicine. Investigators enrolled 387 patients with TBI from November 2009 through October 2014 in a study. Barbiturates and decompressive craniectomy were required to control intracranial pressure in 54% of patients who received standard care and in 44% of patients who received hypothermia and standard care. The hypothermia group had worse outcomes in general than the standard-care group. A favorable outcome occurred in 26% of patients in the hypothermia group and in 37% of patients in the control group.

Differing manifestations of postconcussion symptoms on functional MRI (fMRI) between younger and older patients indicate that age influences the activation, modulation, and allocation of working memory processing resources after mild traumatic brain injury (MTBI), according to a study published online ahead of print October 6 in Radiology. Researchers performed fMRI exams on 13 young adults and 13 older adults with MTBI and 26 age- and gender-matched controls. Younger patients performing working-memory tasks had initial hyperactivation in the right precuneus and right inferior parietal gyrus, compared with younger controls. Older patients performing these tasks had hypoactivation in the right precuneus and right inferior frontal gyrus, compared with older controls. Younger patients, but not older patients, had partial recovery of activation pattern and decreased postconcussion symptoms at follow-up.

An immune system gene is associated with higher rates of amyloid plaque buildup in the brains of patients with Alzheimer’s disease and older adults at risk for the disease, according to a study published in the October issue of Brain. Investigators performed a genome-wide association study of longitudinal change in brain amyloid burden measured by ¹⁸F-florbetapir PET. They found that interleukin-1 receptor accessory protein (IL1RAP) was associated with higher rates of amyloid accumulation, independent of APOE ε4 status. This novel association was validated by deep sequencing. IL1RAP rs12053868-G carriers were more likely to progress from mild cognitive impairment to Alzheimer’s disease and exhibited greater longitudinal temporal cortex atrophy on MRI. In independent cohorts, rs12053868-G was associated with accelerated cognitive decline and lower cortical ¹¹C-PBR28 PET signal.

For children with tuberous sclerosis complex and medically intractable epilepsy, a greater extent of resection is associated with a greater probability of seizure freedom, according to a study published in the October issue of Neurosurgery. Seventy-four patients were included in this retrospective chart review, and their median age at the time of surgery was 120 months. Engel Class I outcome was achieved in 65% and in 50% of patients at the one- and two-year follow-up, respectively. On univariate analyses, younger age at seizure onset, larger size of predominant tuber, and resection larger than a tuberectomy were associated with a longer duration of seizure freedom. In multivariate analyses, resection larger than a tuberectomy was independently associated with a longer duration of seizure freedom.

A new imaging method that uses a 7-T magnet shows promise in locating hard-to-find epileptic foci by visualizing the neurotransmitter glutamate, according to a study published October 14 in Science Translational Medicine. In a pilot study, researchers applied glutamate chemical exchange saturation transfer (GluCEST) to patients with nonlesional temporal lobe epilepsy based on conventional MRI. GluCEST correctly lateralized the temporal lobe seizure focus on visual and quantitative analyses in all patients. Hippocampal volumes were not significantly different between hemispheres. GluCEST allowed high-resolution functional imaging of brain glutamate and has the potential to identify the epileptic focus in patients previously deemed nonlesional. This method may lead to improved clinical outcomes for temporal lobe epilepsy as well as other localization-related epilepsies, according to the researchers.

—Kimberly Williams

HLA-DRB1*1501, adolescent summer sun habits, and BMI at the age of 20 independently affect age of multiple sclerosis (MS) onset, according to a study published online ahead of print October 7 in Neurology. This cross-sectional study included 1,161 Danish patients with MS. Lifestyle questionnaires and blood samples for genotyping were collected from all participants from 2009 to 2012. Information on age at onset was obtained from the Danish MS Treatment Registry. Younger age at onset was significantly associated with low exposure to summer sun in adolescence, higher BMI at age 20, and the HLA-DRB1*1501 risk allele in both univariate analyses and in a multivariable regression analysis. No association was found between age at onset and other single-nucleotide polymorphisms studied or vitamin D-associated environmental factors.

Treatment responses for autoimmune ataxia are more likely in patients with nonparaneoplastic disorders and those with exclusively plasma membrane protein (PMP) antibodies, according to a study published online ahead of print September 28 in JAMA Neurology. Investigators examined 118 patients with ataxia who were 18 or older, were seropositive for at least one neural autoantibody, had received at least one immunotherapy or cancer therapy, and had neurologist-reported outcomes documented from January 1, 1989, through December 31, 2013. Fifty-four patients had neurologic improvements. Kaplan-Meier analyses revealed that progression to wheelchair dependence occurred significantly faster among patients with neuronal nuclear or cytoplasmic antibody positivity only, although those with glutamic acid decarboxylase 65-kDa isoform autoimmunity progressed to wheelchair dependence at a rate similar to those with PMP autoimmunity.

Patients with celiac disease are not at increased risk for dementia overall, though they may be at increased risk for vascular dementia, according to a study published online ahead of print September 29 in Journal of Alzheimer’s Disease. Researchers compared the incidence of a subsequent dementia diagnosis among 8,846 older adults with celiac disease to that among 43,474 age- and gender-matched controls. The median age of the study population was 63, and 56% of participants were female. During a median follow-up time of 8.4 years, dementia was diagnosed in 4.3% of patients with celiac disease and 4.4% of controls. The researchers observed an increased risk of dementia in the first year following a diagnosis of celiac disease, but the increased risk was restricted to vascular dementia and was not present for Alzheimer’s dementia.

Infection may trigger childhood arterial ischemic stroke, while routine vaccinations appear to protect against it, according to a study published online ahead of print September 30 in Neurology. This international case–control study included 355 children with confirmed cases of arterial ischemic stroke and 354 controls without stroke. Median age was 7.6 for cases and 9.3 for controls. Infection in the week prior to stroke, or interview date for controls, was reported in 18% of cases versus 3% of controls. Infection thus conferred a 6.3-fold increased risk of arterial ischemic stroke. Children with some, few, or no routine vaccinations were at higher stroke risk than those receiving all or most vaccinations. Risk factors for arterial ischemic stroke included infection in the prior week, undervaccination, black race, and rural residence.

Amyloid PET and CSF biomarkers identify early Alzheimer’s disease with equal accuracy, according to a study published October 6 in Neurology. Researchers examined 122 healthy elderly people and 34 patients with mild cognitive impairment who developed Alzheimer’s disease dementia within three years (MCI-AD). They examined β-amyloid deposition in nine brain regions with [¹⁸F]-flutemetamol PET. CSF was analyzed with INNOTEST and EUROIMMUN ELISAs. CSF samples and PET scans each identified approximately 90% of patients who later received a diagnosis of Alzheimer’s disease. The best CSF measures for identifying MCI-AD were Aβ42/total tau and Aβ42/hyperphosphorylated tau, which performed better than CSF Aβ42 and Aβ42/40. CSF Aβ42/total tau had the highest accuracy of all CSF and PET biomarkers. The combination of CSF and PET was not better than either individual biomarker.

A combination of dextromethorphan and quinidine demonstrated clinically relevant efficacy for agitation in patients with probable Alzheimer’s disease and was generally well tolerated, according to a study published September 22 in JAMA. A total of 194 patients completed a preliminary 10-week phase II randomized clinical trial. In the sequential parallel comparison design, 152 patients received dextromethorphan–quinidine, and 127 received placebo. Analysis combining all patients and rerandomized placebo nonresponders showed significantly reduced agitation and aggression scores for dextromethorphan–quinidine versus placebo. Among all patients, mean agitation and aggression scores were reduced from 7.1 to 3.8 with dextromethorphan–quinidine and from 7.0 to 5.3 with placebo. Between-group treatment differences were significant. Among rerandomized placebo nonresponders, agitation and aggression scores were reduced from 5.8 to 3.8 with dextromethorphan–quinidine and from 6.7 to 5.8 with placebo.

The FDA has approved Betaconnect, an electronic autoinjector for the treatment of relapsing-remitting multiple sclerosis. Bayer HealthCare (Whippany, NJ) manufactures Betaconnect, which will be available to patients receiving Betaseron beginning in early 2016. The autoinjector, which was created based on feedback from patients and caregivers, offers customizable injection speed and depth settings that allow patients to administer injections quietly and precisely. Betaconnect also has an optional backup reminder function that tells patients the time of their next injection. In addition, the automatic needle insertion and retraction and a visual and audio end-of-dose indication tell patients when the injection is complete. Patients should speak with a healthcare provider before making any changes to injection depth or speed settings.

In patients with an intracranial pressure of more than 20 mmHg after traumatic brain injury (TBI), therapeutic hypothermia plus standard care to reduce intracranial pressure do not result in outcomes better than those associated with standard care alone, according to a study published online ahead of print October 7 in New England Journal of Medicine. Investigators enrolled 387 patients with TBI from November 2009 through October 2014 in a study. Barbiturates and decompressive craniectomy were required to control intracranial pressure in 54% of patients who received standard care and in 44% of patients who received hypothermia and standard care. The hypothermia group had worse outcomes in general than the standard-care group. A favorable outcome occurred in 26% of patients in the hypothermia group and in 37% of patients in the control group.

Differing manifestations of postconcussion symptoms on functional MRI (fMRI) between younger and older patients indicate that age influences the activation, modulation, and allocation of working memory processing resources after mild traumatic brain injury (MTBI), according to a study published online ahead of print October 6 in Radiology. Researchers performed fMRI exams on 13 young adults and 13 older adults with MTBI and 26 age- and gender-matched controls. Younger patients performing working-memory tasks had initial hyperactivation in the right precuneus and right inferior parietal gyrus, compared with younger controls. Older patients performing these tasks had hypoactivation in the right precuneus and right inferior frontal gyrus, compared with older controls. Younger patients, but not older patients, had partial recovery of activation pattern and decreased postconcussion symptoms at follow-up.

An immune system gene is associated with higher rates of amyloid plaque buildup in the brains of patients with Alzheimer’s disease and older adults at risk for the disease, according to a study published in the October issue of Brain. Investigators performed a genome-wide association study of longitudinal change in brain amyloid burden measured by ¹⁸F-florbetapir PET. They found that interleukin-1 receptor accessory protein (IL1RAP) was associated with higher rates of amyloid accumulation, independent of APOE ε4 status. This novel association was validated by deep sequencing. IL1RAP rs12053868-G carriers were more likely to progress from mild cognitive impairment to Alzheimer’s disease and exhibited greater longitudinal temporal cortex atrophy on MRI. In independent cohorts, rs12053868-G was associated with accelerated cognitive decline and lower cortical ¹¹C-PBR28 PET signal.

For children with tuberous sclerosis complex and medically intractable epilepsy, a greater extent of resection is associated with a greater probability of seizure freedom, according to a study published in the October issue of Neurosurgery. Seventy-four patients were included in this retrospective chart review, and their median age at the time of surgery was 120 months. Engel Class I outcome was achieved in 65% and in 50% of patients at the one- and two-year follow-up, respectively. On univariate analyses, younger age at seizure onset, larger size of predominant tuber, and resection larger than a tuberectomy were associated with a longer duration of seizure freedom. In multivariate analyses, resection larger than a tuberectomy was independently associated with a longer duration of seizure freedom.

A new imaging method that uses a 7-T magnet shows promise in locating hard-to-find epileptic foci by visualizing the neurotransmitter glutamate, according to a study published October 14 in Science Translational Medicine. In a pilot study, researchers applied glutamate chemical exchange saturation transfer (GluCEST) to patients with nonlesional temporal lobe epilepsy based on conventional MRI. GluCEST correctly lateralized the temporal lobe seizure focus on visual and quantitative analyses in all patients. Hippocampal volumes were not significantly different between hemispheres. GluCEST allowed high-resolution functional imaging of brain glutamate and has the potential to identify the epileptic focus in patients previously deemed nonlesional. This method may lead to improved clinical outcomes for temporal lobe epilepsy as well as other localization-related epilepsies, according to the researchers.

—Kimberly Williams