The aim of this study was to study the effect of transcranial stimulation with photobiomodulation (tPBM) in patients suffering from chemobrain. Patients referred to a consultation dedicated to the management of post-chemotherapy cognitive impairment were included. The FACT-Cog (overall score and subscale) French version was used to assess perceived cognitive impairment and impact on quality of life for each patient before and at the end of tPBM treatment. All patients included were treated for chemobrain using transcranial stimulation by PBM for a minimum of 10 weeks (10 sessions, 1 session per week). The PBM consisted of transcranial stimulation delivered using a Vielight Neuro Duo 4® PBM device (in Gamma mode) for 20 min. Differences between pre- and post-treatment proportions were assessed with the McNemar test for paired data. Differences between FACT-Cog scores (total score and subscale) were assessed by the Wilcoxon signed-rank test. Thirty-one women were included (mean age 52.1 ± 9.0 years). Mean total FACT-Cog score prior to tPBM was 63.3 ± 19.8. After the course of tPBM sessions, the mean total FACT-Cog score was 101.2 ± 20.1 (p < 0.001). Twenty-nine patients improved cognitive performance and, in 9 patients (29.0
BACKGROUND:Functional/dissociative seizure (FDS) disorder presents diagnostic challenges due to its complex semiology and the lack of positive diagnostic biomarkers. Current evidence suggests that specific patterns of brain activity and distinct dynamics in the brain network may underlie the neurobiological mechanisms of FDS. METHODS:We retrospectively analyzed ictal EEG recordings from 46 patients with FDS, in three different conditions: during resting wakefulness (RW), during resting while having eyes closed (EC), and during functional/dissociative seizures of variable semiology (FDS). The occipital EEG in the alpha band (8-13 Hz) was assessed in terms of power and functional connectivity, quantified by debiased weighted phase lag index (dwPLI). Heart rate was also analyzed across conditions. Statistical comparisons were performed via paired permutation testing with Benjamini-Hochberg correction for multiple comparisons, complemented by Bayes factors for the key FDS-EC comparisons. RESULTS:EEG during FDS exhibited significantly higher occipital alpha power than RW (p = 0.0003) and levels not significantly different from EC, with moderate Bayesian evidence for the absence of a difference (BF01 = 6.1). Alpha power was elevated across all FDS subtypes and was, paradoxically, numerically highest in hypermotor seizures, although subtype differences did not survive correction for multiple comparisons. Control analyses showed that the alpha power did not significantly differ across video-rated states of eyes during FDS (open, intermittently closed, closed), including when conditions were matched for eye state. Functional whole-brain connectivity in the alpha band was intermediate between the two resting conditions, being higher during FDS than during RW but lower than during EC. Heart rate was highest during FDS, with a non-significant tendency toward higher rates in hypermotor than atonic FDS. No significant correlation was found between occipital alpha power and heart rate during FDS. CONCLUSION:Our findings suggest that FDS are characterized by a paradoxical hypersynchronization in the EEG alpha band, similar to EC, despite concurrent motor activity. Increased functional alpha connectivity, simultaneous with elevated heart rate during FDS, suggests that FDSs involve altered brain network dynamics rather than simple alpha power suppression by voluntary motor activity. These findings may aid in developing positive biomarkers for FDS diagnosis.
OBJECTIVE:Invasive presurgical evaluation plays a key role in pediatric epilepsy surgery, particularly in magnetic resonance imaging (MRI)-negative cases, by guiding resective, disconnective, or ablative procedures. This International League Against Epilepsy (ILAE) Pediatric Epilepsy Surgery Taskforce study provides an updated global overview of current invasive evaluation practices. METHODS:Group-level data were collected from 61 epilepsy surgery programs (49 pediatric-only) in 29 countries across six continents. Included were children and adolescents who underwent presurgical evaluation and epilepsy surgery in 2023. The study was designed to enable comparison with the similar ILAE survey conducted in 2004. RESULTS:A total of 2427 patients were included. Invasive evaluations were performed in 21.1% of cases, most frequently in North America (33.7%, higher than Europe: 18.0%, p = .003). Among invasive cases, 32.3% had no detectable MRI abnormalities. The main indication for invasive evaluation was seizure onset localization (88.1%), followed by motor or sensory mapping (17.2%) and language mapping (14.2%). Stereoelectroencephalography (SEEG) was the predominant technique (19.8% overall, 93.6% of invasive cases), more common in North America (30.0%, p = .021) and less common in South America (7.4%, p < .001). Subdural electrodes were used in only 3.2% of invasive cases, and combined depth and subdural approaches in 3.2%. SEEG-guided radiofrequency thermocoagulation (RF-TC) was performed in 40.9% of SEEG cases, most commonly in Asia (63.8%). In 16.2% of invasive evaluations, patients did not proceed to resection, disconnection, or ablation, with the highest rate in Europe (28.5%). SIGNIFICANCE:This global survey provides the first broad overview of invasive evaluation practices in pediatric epilepsy surgery across participating centers worldwide. It highlights the widespread adoption of SEEG, declining use of subdural electrodes, and increasing application of SEEG-guided RF-TC. The high proportion of MRI-negative cases and the considerable proportion of patients not proceeding to resection, disconnection, or ablation underscore the complexity of contemporary surgical candidates and the need for further refinement of selection strategies.
Interruptions to the flow of oxygenated blood to the fetal brain during labor can lead to hypoxic-ischemic encephalopathy (HIE). Timely interventions for suspected hypoxemia are crucial to prevent neurological injury. Prior cardiotocography (CTG) based prediction systems have focused only on the end of labor, when preventive measures are unlikely to be effective. We previously demonstrated that accounting for proximity to birth improved the association between CTG features and outcome. Since proximity to birth cannot be known prospectively, other time-surrogate variables (TSVs) may be more clinically appropriate. We analyzed intrapartum data from 174,186 births (152,761 vaginal, 21,425 Caesarean): 171,246 healthy, 2,636 with perinatal acidosis, and 304 with confirmed HIE. Classical and novel CTG features were extracted across labor durations up to 72 hours. This dataset represents one of the largest cohorts of intrapartum CTG data to date by participant count and signal length. We evaluated four candidate TSVs alongside the reference proximity to birth to evaluate their ability to enhance the association of CTG features and the development of HIE. To do so, we applied information-theoretic methods to quantify their contribution to the association of fetal outcomes with CTG features. Incorporating TSVs significantly increased the normalized mutual information (NMI) between CTG features and outcomes, improving NMI by over 20% for the ten most informative baseline features. Cumulative contraction time (CCT) and the time from labor onset (TLO) were the most effective TSVs in both vaginal and Caesarean delivery cohorts, which demonstrates their robustness regardless of delivery mode. However, it is more practical to track TLO in clinical settings than to continuously monitor contractions. To conclude, TLO is the most suitable TSV for prospective intrapartum CTG evaluation. Incorporating it may substantially enhance the performance of automated systems for early detection of intrapartum HIE.
The emergence of a dominant poultry-associated strain of Campylobacter jejuni in New Zealand coincided with a multi-year epidemic of human campylobacteriosis. This was characterised by an increase in cases to 2006, when one of the highest national case-rates in the world was recorded, followed by a rapid decline attributed to interventions in the poultry industry. The strain belonged to an internationally rare multilocus sequence type, ST474 - a member of Clonal Complex (CC) 48 - that was highly prevalent in both poultry and human cases in New Zealand but was also identified in other samples. ST474 isolates from humans, animal reservoirs and environmental water samples were collected between 2005 and 2019 and whole genome sequenced (N=443). Isolates from a 2018/9 case-control study of campylobacteriosis in New Zealand were included for genomic comparisons with other sequence types and CCs. This presented an opportunity to examine the genomic epidemiology of a single, relatively recently emerged lineage of C. jejuni, and improve our understanding of drivers of emergence and persistence in a relatively isolated ecosystem. Six subpopulations (clades) of ST474 were identified and these varied in terms of their host association, persistence, patterns of homologous recombination, and complement of mobile genetic elements, including plasmids and chromosomally integrated elements. Clade E was associated with a single poultry supplier in the initial epidemic phase and accounted for 34.5% of human cases. Clade F emerged from a declining Clade E after the peak in human cases and was also associated with poultry. The emergence of Clade F was accompanied by the loss of integrated element CJIE5 and the acquisition of multiple blocks of recombination, likely from diverse ancestral C. jejuni lineages, and the loss of the methionine biosynthesis operon metAB. In contrast, Clades A-D were detected at low frequencies in human cases over the 14-year period of surveillance and were associated with multiple hosts. This longitudinal study sheds light on the evolutionary processes that result in strain emergence and differentiation, highlighting the role of horizontal gene transfer in the evolution and adaptation of this pathogen to new niches, and the subsequent impact on public health. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of Multi-Region, New Zealand, gave ethical approval for this work (campylobacteriosis sentinel site). Ethics Committee of Northern B Health and Disabilities Ethics Committee gave ethical approval for this work (source assigned case control study). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. All ST474 raw reads and assemblies generated for this analysis are available from NCBI (Bioproject ID: PRJNA1538059). Biotechnology and Biological Sciences Research Council, BB/X011011/1, BB/V018221/1
