IntroductionPatients with mental health problems (MHP) are known to have more physical comorbidities compared to the general population.In Malta, Mount Carmel hospital (MCH) which is the main psychiatric hospital (consisting of both acute and chronic wards), is separate from Mater Dei hospital (MDH) which is the general hospital at which medical and surgical care is provided.Such a division in healthcare may result in inadequate focus on physical health amongst patients of high demand in this regard. This subsequently puts an increased strain on the general hospital through repeated referrals.ObjectivesThe purpose of this study is to show that inpatients with MHP have a significant number of comorbidities and require multiple referrals to a general hospital for medical and surgical attention.MethodsThree hundred and ninety-three inpatients at acute and chronic wards of MCH (during the first week of December 2016) were enrolled in the study.Treatment charts and iSOFT (healthcare IT software used in Malta) were used to determine patient's diagnosed comorbidities, number and type of referrals to MDH outpatient clinics (OPC), casualty and admissions at MDH over 1 year.ResultsResults of the audit indicate that a significant number of inpatients at MCH have medical comorbidities and the majority have been referred to MDH for OPC and casualty over the past year.ConclusionsHaving medical and surgical liaison teams in psychiatric hospitals may enhance patient care and reduce the pressure exerted on general hospitals.Disclosure of interestThe authors have not supplied their declaration of competing interest.

OBJECTIVE:To demonstrate altered N-methyl-d-aspartate (NMDA) receptor availability in patients with focal epilepsies using positron emission tomography (PET) and [(18)F]GE-179, a ligand that selectively binds to the open NMDA receptor ion channel, which is thought to be overactive in epilepsy. METHODS:Eleven patients (median age 33 years, 6 males) with known frequent interictal epileptiform discharges had an [(18)F]GE-179 PET scan, in a cross-sectional study. MRI showed a focal lesion but discordant EEG changes in two, was non-localising with multifocal EEG abnormalities in two, and was normal in the remaining seven patients who all had multifocal EEG changes. Individual patient [(18)F]GE-179 volume-of-distribution (VT) images were compared between individual patients and a group of 10 healthy controls (47 years, 7 males) using Statistical Parametric Mapping. RESULTS:Individual analyses revealed a single cluster of focal VT increase in four patients; one with a single and one with multifocal MRI lesions, and two with normal MRIs. Post hoc analysis revealed that, relative to controls, patients not taking antidepressants had globally increased [(18)F]GE-179 VT (+28%; p<0.002), and the three patients taking an antidepressant drug had globally reduced [(18)F]GE-179 VT (-29%; p<0.002). There were no focal abnormalities common to the epilepsy group. CONCLUSIONS:In patients with focal epilepsies, we detected primarily global increases of [(18)F]GE-179 VT consistent with increased NMDA channel activation, but reduced availability in those taking antidepressant drugs, consistent with a possible mode of action of this class of drugs. [(18)F]GE-179 PET showed focal accentuations of NMDA binding in 4 out of 11 patients, with difficult to localise and treat focal epilepsy.

Approximately 20–30% of patients with focal epilepsy are medically refractory and may be candidates for curative surgery. Stereo EEG is the placement of multiple depth electrodes into the brain to record seizure activity and precisely identify the area to be resected. The two important criteria for electrode implantation are accurate navigation to the target area, and avoidance of critical structures such as blood vessels. In current practice neurosurgeons have no assistance in the planning of the electrode trajectories. To provide assistance a real-time solution was developed that first identifies the potential entry points by analysing the entry-angle, then computes the associated risks for trajectories starting from these locations. The entry angle, the total length of the trajectory and distances to critical structures are presented in an interactive way that is integrated with standard electrode placement planning tools and advanced visualisation. We show that this improves the planning of intracranial implantation, with safer trajectories in less time.

The increasing demand for clinical fMRI data has resulted in a need to translate research methods to clinical use. Referrals for language lateralization prior to epilepsy surgery are becoming more common, but time constraints make this unachievable in many busy neuroimaging departments. This study examines whether a single covert verbal fluency paradigm with real-time monitoring and online processing (BrainWave) could replace conventional offline processing (SPM) for the purpose of establishing expressive language dominance prior to epilepsy surgery. We analyzed language fMRI results of 30 patients (17 female; 24 right-handed; median age: 30.5) with temporal lobe epilepsy. Concordance between visual assessment of SPM and BrainWave was 92.8%. Lateralization indices correlated closely with visual assessments of lateralization with a concordance of 85.7%. BrainWave provided a real-time, fast and accurate display of language lateralization easily applied in a clinical setting using only online image processing.

BackgroundA third of patients with epilepsy are refractory to medical treatment and may be amenable to surgery. A major concern is to avoid causing new deficits. As conventional MR imaging does not delineate the optic radiation, the risk to vision from surgery cannot be predicted, nor can surgery be tailored to minimise the risk.MethodsConventional structural MRI and diffusion tensor imaging were acquired in 13 patients with medically refractory epilepsy due a lesion near the optic radiation and undergoing pre-surgical evaluation at the National Hospital for Neurology and Neurosurgery. The optic radiation was delineated and visualised in relation to the lesions on anatomical images and in 3D reconstructions. Pre- and post-operative visual fields were acquired by Goldmann perimetry.ResultsThe relationship between the epileptogenic lesion and the optic radiation was demonstrated in each patient provididing helpful additional information in deciding whether to proceed with surgery, and in planning the surgical procedure and approach. Prseoperative and postoperative imaging findings correlated with the visual field data.ConclusionThe optic radiation shows significant anatomical variability, but can be reliably delineated by tractography. As surgical disruption of the optic radiation has serious consequences for the patient, DTI tractography proves a useful technique in this population. Future integration with real-time neuronavigation will minimise the risks of neurosurgery.

Background Although conventional MRI (cMRI) has been reported to show specific abnormalities in parkinsonism, the diagnosis of the underlying pathology can be challenging. We report the radiological diagnostic accuracy, and the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of cMRI abnormalities in a pathologically confirmed cohort of Parkinson9s disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal degeneration (CBD). Method cMRI of donors to a neurological brain bank was reviewed by two experienced neuroradiologists blinded to clinical details. Images were systematically reviewed for the presence of specific reported abnormalities. Results 48 pathologically confirmed cases (23 PSP, 6 PD, 13 MSA and 6 CBD) and nine controls were studied. The final clinical diagnosis was supported in 68% and the radiological diagnosis in 60%. Using cMRI 55% of PSP, 67% of PD, and 77% of MSA were correctly identified. In this study the Hummingbird sign has 68% sensitivity, 100% specificity and PPV for PSP and the Hot Cross Bun has 62% sensitivity, 100% specificity and PPV for MSA. Conclusion The confirmation that using cMRI key diagnostic features with very high specificity and PPV have low sensitivity endorses the development of newer MR techniques (e.g., high field diffusion tensor imaging) as useful biomarkers early in disease.