Chad Carlson, M.D.

Volume of the human septal forebrain region is a predictor of source memory accuracy
Butler, Tracy; Blackmon, Karen; Zaborszky, Laszlo; Wang, Xiuyuan; Dubois, Jonathan; Carlson, Chad; Barr, William B; French, Jacqueline; Devinsky, Orrin; Kuzniecky, Ruben; Halgren, Eric; Thesen, Thomas
2012 Jan;18(1):157-161, Journal of the International Neuropsychological Society
Septal nuclei, components of basal forebrain, are strongly and reciprocally connected with hippocampus, and have been shown in animals to play a critical role in memory. In humans, the septal forebrain has received little attention. To examine the role of human septal forebrain in memory, we acquired high-resolution magnetic resonance imaging scans from 25 healthy subjects and calculated septal forebrain volume using recently developed probabilistic cytoarchitectonic maps. We indexed memory with the California Verbal Learning Test-II. Linear regression showed that bilateral septal forebrain volume was a significant positive predictor of recognition memory accuracy. More specifically, larger septal forebrain volume was associated with the ability to recall item source/context accuracy. Results indicate specific involvement of septal forebrain in human source memory, and recall the need for additional research into the role of septal nuclei in memory and other impairments associated with human diseases. (JINS, 2012, 18, 157-161)
— id: 147692, year: 2012, vol: 18, page: 157, stat: Journal Article,

Spasms in a child
Menzer, Kimberly; Carlson, Chad; Singh, Anuradha
Case-based neurology New York : Demos Medical, c2012,
— id: 5949, year: 2012, vol: , page: 351, stat: Chapter,

Epilepsy control following intracranial monitoring without resection in young children
Roth J; Olasunkanmi A; Ma TS; Carlson C; Devinsky O; Harter DH; Weiner HL
2012 Feb;53(2):334-41 L, Epilepsia
Purpose: Intracranial monitoring (IM) is a key diagnostic procedure for select patients with treatment-resistant epilepsy (TRE). Seizure focus resection may improve seizure control in both lesional and nonlesional TRE. IM itself is not considered to have therapeutic potential. We describe a cohort of patients with improved seizure control following IM without resective surgery. Methods: Over 12.5 years, 161 children underwent 496 surgeries including intracranial monitoring. We retrospectively reviewed the patients' charts, operative reports, and radiologic scans, under an institutional review board-approved protocol. Key Findings: Seventeen patients underwent only IM, without additional resective surgery, and seven had a dramatic improvement in their epilepsy; six of the seven patients are seizure-free (Engel class I), and one rarely has seizures (Engel class II). All seven patients had frequent seizures that led to IM: either daily (five patients) or 1-2 per week (two patients). The mean age (+/- standard deviation, SD) at seizure onset was 1.6 +/- 1.3 years (range 0.5-4 years). Etiologies were tuberous sclerosis (3 patients), trauma (1 patient), and unknown (3 patients). Mean age at surgery (+/- SD) was 4.1 +/- 2 years (range 1-7 years), and duration of epilepsy 2.5 +/- 1.1 years (range 0.5-4 years). Duration of IM was 11.7 +/- 5.6 days (5-19 days). Six patients had bilateral and one unilateral invasive electrodes. At last follow-up, four patients required fewer antiepileptic drugs (AEDs), one had the same medication but a higher dose, and two patients were taking additional AEDs. Follow-up was 30.6 +/- 9.5 months (range 19-41 months). Significance: Although uncommon, patients with TRE may improve after IM alone. The explanation for this observation remains unclear; however, perioperative medications including steroids, direct cortical manipulation, or other factors may influence the epileptogenic network
— id: 149914, year: 2012, vol: 53, page: 334, stat: Journal Article,

Structural evidence for involvement of a left amygdala-orbitofrontal network in subclinical anxiety
Blackmon K; Barr WB; Carlson C; Devinsky O; Dubois J; Pogash D; Quinn BT; Kuzniecky R; Halgren E; Thesen T
2011 Dec 30;194(3):296-303, Psychiatry research
Functional neuroimaging implicates hyperactivity of amygdala-orbitofrontal circuitry as a common neurobiological mechanism underlying the development of anxiety. Less is known about anxiety-related structural differences in this network. In this study, a sample of healthy adults with no history of anxiety disorders completed a 3T MRI scan and self-report mood inventories. Post-processing quantitative MRI image analysis included segmentation and volume estimation of subcortical structures, which were regressed on anxiety inventory scores, with depression scores used to establish discriminant validity. We then used a quantitative vertex-based post-processing method to correlate (1) anxiety scores and (2) left amygdala volumes with cortical thickness across the whole cortical mantle. Left amygdala volumes predicted anxiety, with decreased amygdala volume associated with higher anxiety on both state and trait anxiety measures. A negative correlation between left amygdala volume and cortical thickness overlapped with a positive correlation between anxiety and cortical thickness in left lateral orbitofrontal cortex. These results suggest a structural anxiety network that corresponds with a large body of evidence from functional neuroimaging. Such findings raise the possibility that structural abnormalities may result in a greater vulnerability to anxiety or conversely that elevated anxiety symptoms may result in focal structural changes
— id: 139495, year: 2011, vol: 194, page: 296, stat: Journal Article,

Structural evidence for involvement of a left amygdala-orbitofrontal network in subclinical anxiety
Blackmon, Karen; Barr, William B.; Carlson, Chad; Devinsky, Orrin; DuBois, Jonathan; Pogash, Daniel; Quinn, Brian T.; Kuzniecky, Ruben; Halgren, Eric; Thesen, Thomas (thomas.thesen@med.nyu.edu)
2011 DEC 30 ;194(3):296-303, Psychiatry Research Neuroimaging
Functional neuroimaging implicates hyperactivity of amygdala-orbitofrontal circuitry as a common neurobiological mechanism underlying the development of anxiety. Less is known about anxiety-related structural differences in this network. In this study, a sample of healthy adults with no history of anxiety disorders completed a 3T MRI scan and self-report mood inventories. Post-processing quantitative MRI image analysis included segmentation and volume estimation of subcortical structures, which were regressed on anxiety inventory scores, with depression scores used to establish discriminant validity. We then used a quantitative vertex-based post-processing method to correlate (1) anxiety scores and (2) left amygdala volumes with cortical thickness across the whole cortical mantle. Left amygdala volumes predicted anxiety, with decreased amygdala volume associated with higher anxiety on both state and trait anxiety measures. A negative correlation between left amygdala volume and cortical thickness overlapped with a positive correlation between anxiety and cortical thickness in left lateral orbitofrontal cortex. These results suggest a structural anxiety network that corresponds with a large body of evidence from functional neuroimaging. Such findings raise the possibility that structural abnormalities may result in a greater vulnerability to anxiety or conversely that elevated anxiety symptoms may result in focal structural changes. (C) 2011 Elsevier Ireland Ltd. All rights reserved. C1 Thesen, Thomas; NYU, Dept Neurol, Comprehens Epilepsy Ctr, 223 E 34th St, New York, NY 10016 USA
— id: 150857, year: 2011, vol: 194, page: 296, stat: Journal Article,

Individual differences in verbal abilities associated with regional blurring of the left gray and white matter boundary
Blackmon, Karen; Halgren, Eric; Barr, William B; Carlson, Chad; Devinsky, Orrin; Dubois, Jonathan; Quinn, Brian T; French, Jacqueline; Kuzniecky, Ruben; Thesen, Thomas
2011 Oct 26;31(43):15257-15263, Journal of neuroscience
Blurring of the cortical gray and white matter border on MRI is associated with normal aging, pathological aging, and the presence of focal cortical dysplasia. However, it remains unclear whether normal variations in signal intensity contrast at the gray and white matter junction reflect the functional integrity of subjacent tissue. This study explores the relationship between verbal abilities and gray and white matter contrast (GWC) in healthy human adults. Participants were scanned at 3 T MRI and administered standardized measures of verbal expression and verbal working memory. GWC was estimated by calculating the non-normalized T1 image intensity contrast above and below the cortical gray/white matter interface. Spherical averaging and whole-brain correlational analyses were performed. Sulcal regions exhibited higher contrast compared to gyral regions. We found a strongly lateralized and regionally specific profile with reduced verbal expression abilities associated with blurring in left hemisphere inferior frontal cortex and temporal pole. Reduced verbal working memory was associated with blurring in widespread left frontal and temporal cortices. Such lateralized and focal results provide support for GWC as a measure of regional functional integrity and highlight its potential role in probing the neuroanatomical substrates of cognition in healthy and diseased populations
— id: 139752, year: 2011, vol: 31, page: 15257, stat: Journal Article,

Cortical thickness abnormalities associated with depressive symptoms in temporal lobe epilepsy
Butler T; Blackmon K; McDonald CR; Carlson C; Barr WB; Devinsky O; Kuzniecky R; Dubois J; French J; Halgren E; Thesen T
2011 Jan;23(1):64-67, Epilepsy & behavior
Depression in patients with temporal lobe epilepsy (TLE) is highly prevalent and carries significant morbidity and mortality. Its neural basis is poorly understood. We used quantitative, surface-based MRI analysis to correlate brain morphometry with severity of depressive symptoms in 38 patients with TLE and 45 controls. Increasing severity of depressive symptoms was associated with orbitofrontal cortex (OFC) thinning in controls, but with OFC thickening in TLE patients. These results demonstrate distinct neuroanatomical substrates for depression with and without TLE, and suggest a unique role for OFC, a limbic region for emotional processing strongly interconnected with medial temporal structures, in TLE-related depressive symptoms
— id: 141935, year: 2011, vol: 23, page: 64, stat: Journal Article,

Generalized Postictal EEG Background Suppression: A Marker of SUDEP Risk
Carlson, Chad
2011 May;11(3):86-87, Epilepsy currents
— id: 149916, year: 2011, vol: 11, page: 86, stat: Journal Article,

Bilateral invasive electroencephalography in patients with tuberous sclerosis complex: a path to surgery?
Carlson, Chad; Teutonico, Federica; Elliott, Robert E; Moshel, Yaron A; LaJoie, Josiane; Miles, Daniel; Devinsky, Orrin; Weiner, Howard L
2011 Apr;7(4):421-430, Journal of Neurosurgery: Pediatrics
OBJECT: Many children with epilepsy and tuberous sclerosis complex (TSC) have multiple tubers on MR imaging and poorly localized/lateralized video electroencephalography (EEG) findings. Given the long-term risks associated with frequent seizures and multiple antiepileptic drugs, along with improved success in identifying focal epileptogenic zones in patients with multifocal lesions, the authors used bilateral intracranial EEG to lateralize the epileptogenic zone in patients with nonlateralizable noninvasive preoperative evaluations. METHODS: A retrospective analysis from January 1, 1998, to June 30, 2008, identified 62 children with TSC who were presented at a surgical conference. Of the 52 patients undergoing diagnostic or therapeutic procedures during the study period, 20 underwent bilateral intracranial EEG. The presurgical testing results, intracranial EEG findings, surgical interventions, and outcomes were reviewed. RESULTS: Fourteen of 20 patients had intracranial EEG findings consistent with a resectable epileptogenic zone. One patient is awaiting further resection. Five patients had findings consistent with a nonresectable epileptogenic zone, and 1 of these patients underwent a callosotomy. Seven patients had Engel Class I outcomes, 1 was Class II, 3 were Class III, and 3 were Class IV (mean follow-up 25 months). CONCLUSIONS: Bilateral intracranial EEG can identify potential resectable seizure foci in nonlateralizable epilepsy in TSC. Although 6 of 20 patients did not undergo resection (1 patient is pending future resection), significant improvements in seizures (Engel Class I or II) were noted in 8 patients. In the authors' experience, this invasive monitoring provided a safe method for identifying the ictal onset zone
— id: 132575, year: 2011, vol: 7, page: 421, stat: Journal Article,

Abnormalities of cortical thickness in postictal psychosis
Dubois, J M; Devinsky, O; Carlson, C; Kuzniecky, R; Quinn, B T; Alper, K; Butler, T; Starner, K; Halgren, E; Thesen, T
2011 Jun;21(2):132-136, Epilepsy & behavior
Postictal psychosis (PIP), the occurrence of psychotic episodes following a seizure, is a common and serious comorbidity in patients with epilepsy. Yet, the anatomical correlates remain poorly defined. Here, we used quantitative MRI morphometry to identify structural abnormalities in the cortex of patients with PIP relative to patients with epilepsy without PIP and age- and gender-matched normal healthy controls. Comparison of patients with epilepsy and PIP with patients with epilepsy without PIP revealed increased cortical thickness in the right lateral prefrontal cortex, right anterior cingulate cortex, and right middle temporal gyrus. The PIP group was distinguished from the EC and NC groups by thicker cortex in the right rostral anterior cingulate cortex and thinner cortex in the right angular gyrus and the left middle temporal region. Findings indicate that PIP is associated with thickening of the right anterior cingulate cortex, which may serve as a marker for patients at risk for developing PIP
— id: 134446, year: 2011, vol: 21, page: 132, stat: Journal Article,

Widespread Brain Areas Engaged during a Classical Auditory Streaming Task Revealed by Intracranial EEG
Dykstra, Andrew R; Halgren, Eric; Thesen, Thomas; Carlson, Chad E; Doyle, Werner; Madsen, Joseph R; Eskandar, Emad N; Cash, Sydney S
2011 ;5:74-74, Frontiers in Human Neuroscience
The auditory system must constantly decompose the complex mixture of sound arriving at the ear into perceptually independent streams constituting accurate representations of individual sources in the acoustic environment. How the brain accomplishes this task is not well understood. The present study combined a classic behavioral paradigm with direct cortical recordings from neurosurgical patients with epilepsy in order to further describe the neural correlates of auditory streaming. Participants listened to sequences of pure tones alternating in frequency and indicated whether they heard one or two 'streams.' The intracranial EEG was simultaneously recorded from sub-dural electrodes placed over temporal, frontal, and parietal cortex. Like healthy subjects, patients heard one stream when the frequency separation between tones was small and two when it was large. Robust evoked-potential correlates of frequency separation were observed over widespread brain areas. Waveform morphology was highly variable across individual electrode sites both within and across gross brain regions. Surprisingly, few evoked-potential correlates of perceptual organization were observed after controlling for physical stimulus differences. The results indicate that the cortical areas engaged during the streaming task are more complex and widespread than has been demonstrated by previous work, and that, by-and-large, correlates of bistability during streaming are probably located on a spatial scale not assessed - or in a brain area not examined - by the present study
— id: 140414, year: 2011, vol: 5, page: 74, stat: Journal Article,

Impact of Failed Intracranial Epilepsy Surgery on the Effectiveness of Subsequent Vagus Nerve Stimulation
Elliott RE; Morsi A; Geller EB; Carlson CC; Devinsky O; Doyle WK
2011 Dec;69(6):1210-1217, Neurosurgery
BACKGROUND:: Using the Cyberonics registry, Amar and colleagues (2004) reported poorer efficacy of vagus nerve stimulation (VNS) in patients who failed intracranial epilepsy surgery (IES). OBJECTIVE:: To study the impact of failed IES and other surrogate marker of severe epilepsy on VNS effectiveness in a large cohort with treatment-resistant epilepsy (TRE). METHODS:: We retrospectively reviewed 376 patients (188 females; 265 adults; mean age of 29.4 years at implantation) with TRE who underwent VNS implantation between 1997 and 2008 and had at least 1 year of follow-up. One hundred ten patients (29.3%) had failed one or more prior craniotomies for TRE and 266 (70.7%) had no history of IES. RESULTS:: The mean duration of VNS therapy was 5.1 years. Patients with prior IES were more commonly male and adult, had a greater number of seizure types and more commonly had focal or multifocal versus generalized seizures (P<0.05). There was no significant difference in the mean percentage seizure reduction between patients with and without a history of IES (59.1% vs. 56.5%, P=0.42). There was no correlation between type of failed IES (callosotomy versus resection) and seizure reduction with VNS therapy. CONCLUSION:: Failed IES did not affect the response to VNS therapy. Unlike prior reports, patients with callosotomy did not respond better than those who had resective surgery. Nearly 50% of patients experienced at least 50% reduction in seizure frequency. VNS should be considered a palliative treatment option for patients with TRE, including patients who failed cranial epilepsy surgeries
— id: 134075, year: 2011, vol: 69, page: 1210, stat: Journal Article,

Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: Long-term outcomes and predictors of response
Elliott, Robert E; Morsi, Amr; Kalhorn, Stephen P; Marcus, Joshua; Sellin, Jonathan; Kang, Matthew; Silverberg, Alyson; Rivera, Edwin; Geller, Eric; Carlson, Chad; Devinsky, Orrin; Doyle, Werner K
2011 Jan;20(1):57-63, Epilepsy & behavior
OBJECTIVE: The goal of this study was to assess the efficacy and safety of vagus nerve stimulation in a consecutive series of adults and children with treatment-resistant epilepsy (TRE). METHODS: In this retrospective review of a prospectively created database of 436 consecutive patients who underwent vagus nerve stimulator implantation for TRE between November 1997 and April 2008, there were 220 (50.5%) females and 216 (49.5%) males ranging in age from 1 to 76years at the time of implantation (mean: 29.0+/-16.5). Thirty-three patients (7.6%) in the primary implantation group had inadequate follow-up (<3months from implantation) and three patients had early device removal because of infection and were excluded from seizure control outcome analyses. RESULTS: Duration of vagus nerve stimulation treatment varied from 10days to 11years (mean: 4.94years). Mean seizure frequency significantly improved following implantation (mean reduction: 55.8%, P<0.0001). Seizure control >/=90% was achieved in 90 patients (22.5%), >/=75% seizure control in 162 patients (40.5%), >/=50% improvement in 255 patients (63.75%), and <50% improvement in 145 patients (36.25%). Permanent injury to the vagus nerve occurred in 2.8% of patients. CONCLUSION: Vagus nerve stimulation is a safe and effective palliative treatment option for focal and generalized TRE in adults and children. When used in conjunction with a multidisciplinary and multimodality treatment regimen including aggressive antiepileptic drug regimens and epilepsy surgery when appropriate, more than 60% of patients with TRE experienced at least a 50% reduction in seizure burden. Good results were seen in patients with non-U.S. Food and Drug Administration-approved indications. Prospective, randomized trials are needed for patients with generalized epilepsies and for younger children to potentially expand the number of patients who may benefit from this palliative treatment
— id: 120645, year: 2011, vol: 20, page: 57, stat: Journal Article,

Efficacy of vagus nerve stimulation over time: Review of 65 consecutive patients with treatment-resistant epilepsy treated with VNS >10years
Elliott, Robert E; Morsi, Amr; Tanweer, Omar; Grobelny, Bartosz; Geller, Eric; Carlson, Chad; Devinsky, Orrin; Doyle, Werner K
2011 Mar;20(3):478-483, Epilepsy & behavior
OBJECTIVE: Studies have reported improved seizure control with increased duration of vagus nerve stimulation (VNS) but are prone to methodological biases. We analyzed the efficacy of VNS over time in patients with treatment-resistant epilepsy (TRE) who underwent VNS therapy 10 or more years. METHODS: We retrospectively reviewed 65 consecutive patients (29 females) who underwent VNS therapy >/=10years. The mean age at VNS insertion was 30.0years. Forty-four adults (>/=18years; 67.7%) and 21 children (32.3%) were included. Seizure frequency and antiepileptic drug (AED) regimens were recorded prior to VNS and, following VNS insertion, at 6months, 1year, 2years, and every 2years thereafter. RESULTS: The mean duration of VNS therapy for this group was 10.4years, and the mean decrease in seizure frequency at last follow-up was 76.3%. The mean reduction in seizures at 6months and years 1, 2, 4, 6, 8, and 10years was 35.7, 52.1, 58.3, 60.4, 65.7, 75.5, and 75.5%, respectively. Seizure frequency was significantly reduced from baseline at each of the recorded intervals (P<0.001). There was a trend toward increased AED burden in the latter years of the follow-up period. CONCLUSION: Following a 'ramp-up' and accommodation period throughout the initial 24months after VNS implantation, seizure control improved slightly over the subsequent years of therapy and eventually stabilized. Variation in seizure frequency, however, was common, and frequent changes in AED regimens or stimulation parameters were likely an important and possibly synergistic component of seizure control
— id: 128791, year: 2011, vol: 20, page: 478, stat: Journal Article,

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases
Elliott, Robert E; Rodgers, Shaun D; Bassani, Luigi; Morsi, Amr; Geller, Eric B; Carlson, Chad; Devinsky, Orrin; Doyle, Werner K
2011 May;7(5):491-500, Journal of Neurosurgery: Pediatrics
Object The authors undertook this study to analyze the efficacy of vagus nerve stimulation (VNS) in a large consecutive series of children 18 years of age and younger with treatment-resistant epilepsy and compare the safety and efficacy in children under 12 years of age with the outcomes in older children. Methods The authors retrospectively reviewed 141 consecutive cases involving children (75 girls and 66 boys) with treatment-resistant epilepsy in whom primary VNS implantation was performed by the senior author between November 1997 and April 2008 and who had at least 1 year of follow-up since implantation. The patients' mean age at vagus nerve stimulator insertion was 11.1 years (range 1-18 years). Eighty-six children (61.0%) were younger than 12 years at time of VNS insertion (which constitutes off-label usage of this device). Results Follow-up was complete for 91.8% of patients and the mean duration of VNS therapy in these patients was 5.2 years (range 25 days-11.4 years). Seizure frequency significantly improved with VNS therapy (mean reduction 58.9%, p < 0.0001) without a significant reduction in antiepileptic medication burden (median number of antiepileptic drugs taken 3, unchanged). Reduction in seizure frequency of at least 50% occurred in 64.8% of patients and 41.4% of patients experienced at least a 75% reduction. Major (3) and minor (6) complications occurred in 9 patients (6.4%) and included 1 deep infection requiring device removal, 1 pneumothorax, 2 superficial infections treated with antibiotics, 1 seroma/hematoma treated with aspiration, persistent cough in 1 patient, severe but transient neck pain in 1 patient, and hoarseness in 2 patients. There was no difference in efficacy or complications between children 12 years of age and older (FDA-approved indication) and those younger than 12 years of age (off-label usage). Linear regression analyses did not identify any demographic and clinical variables that predicted response to VNS. Conclusions Vagus nerve stimulation is a safe and effective treatment for treatment-resistant epilepsy in young adults and children. Over 50% of patients experienced at least 50% reduction in seizure burden. Children younger than 12 years had a response similar to that of older children with no increase in complications. Given the efficacy of this device and the devastating effects of persistent epilepsy during critical developmental epochs, randomized trials are needed to potentially expand the indications for VNS to include younger children
— id: 134077, year: 2011, vol: 7, page: 491, stat: Journal Article,

Hemispheric asymmetries of cortical volume in the human brain
Goldberg E; Roediger D; Kucukboyaci NE; Carlson C; Devinsky O; Kuzniecky R; Halgren E; Thesen T
2011 Nov 19;:?-?, Cortex
Hemispheric asymmetry represents a cardinal feature of cerebral organization, but the nature of structural and functional differences between the hemispheres is far from fully understood. Using Magnetic Resonance Imaging morphometry, we identified several volumetric differences between the two hemispheres of the human brain. Heteromodal inferoparietal and lateral prefrontal cortices are more extensive in the right than left hemisphere, as is visual cortex. Heteromodal mesial and orbital prefrontal and cingulate cortices are more extensive in the left than right hemisphere, as are somatosensory, parts of motor, and auditory cortices. Thus, heteromodal association cortices are more extensively represented on the lateral aspect of the right than in the left hemisphere, and modality-specific cortices are more extensively represented on the lateral aspect of the left than in the right hemisphere. On the mesial aspect heteromodal association cortices are more extensively represented in the left than right hemisphere
— id: 149915, year: 2011, vol: , page: ?, stat: Journal Article,

An implantable triple-function device for local drug delivery, cerebrospinal fluid removal and EEG recording in the cranial subdural/subarachnoid space of primates
Ludvig N; Medveczky G; Rizzolo R; Tang HM; Baptiste SL; Doyle WK; Devinsky O; Carlson C; French JA; Kral JG; Charchaflieh J; Kuzniecky RI
2011 Oct 17;203(2):275-283, Journal of neuroscience methods
Transmeningeal pharmacotherapy for cerebral cortical disorders requires drug delivery through the subdural/subarachnoid space, ideally with a feedback controlled mechanism. We have developed a device suitable for this function. The first novel component of the apparatus is a silicone rubber strip equipped with (a) fluid-exchange ports for both drug delivery and local cerebrospinal fluid (CSF) removal, and (b) EEG recording electrode contacts. This strip can be positioned between the dura and pia maters. The second novel component is an implantable dual minipump that directs fluid movement to and from the silicone strip and is accessible for refilling and emptying the drug and CSF reservoirs, respectively. This minipump is regulated by a battery-powered microcontroller integrating a bi-directional radiofrequency (RF) communication module. The entire apparatus was implanted in 5 macaque monkeys, with the subdural strip positioned over the frontal cortex and the minipump assembly secured to the cranium under a protective cap. The system was successfully tested for up to 8months for (1) transmeningeal drug delivery using acetylcholine (ACh) and muscimol as test compounds, (2) RF-transmission of neocortical EEG data to assess the efficacy of drug delivery, and (3) local CSF removal for subsequent diagnostic analyses. The device can be used for (a) monitoring neocortical electrophysiology and neurochemistry in freely behaving nonhuman primates for more than 6months, (b) determining the neurobiological impact of subdural/subarachnoid drug delivery interfaces, (c) obtaining novel neuropharmacological data on the effects of central nervous system (CNS) drugs, and (d) performing translational studies to develop subdural pharmacotherapy devices
— id: 139939, year: 2011, vol: 203, page: 275, stat: Journal Article,

Medically refractory epilepsy in autism
Sansa, Gemma; Carlson, Chad; Doyle, Werner; Weiner, Howard L; Bluvstein, Judith; Barr, William; Devinsky, Orrin
2011 Jun;52(6):1071-1075, Epilepsia
Purpose: Epilepsy and electroencephalographic abnormalities are frequent in idiopathic autism, but there is little information regarding treatment-resistant epilepsy (TRE) in this group. We sought to define the clinical and electrophysiologic characteristics and treatment outcomes in these patients. Methods: We retrospectively reviewed clinical and laboratory data of patients with idiopathic autism evaluated at NYU Epilepsy Center during a 20-year period. Key Findings: One hundred twenty-seven patients had idiopathic autism and at least one epileptic seizure; 33.9% had TRE and 27.5% were seizure free. The remaining 38.6% of patients had infrequent seizures or insufficient data to categorize. Patients with TRE had a significantly earlier onset of seizures than seizure-free patients, and a trend for more developmental regression and motor and language delays. Three patients had surgical resection (two had limited improvement and one had no improvement) and one had an anterior callosotomy (no improvement). Vagus nerve stimulator (VNS) implantation provided limited improvement (2 patients) and no improvement (7). Significance: This study found that TRE is common in idiopathic autism and more common with early age of seizure onset. Relatively few patients underwent surgical resection due to multifocal partial epilepsy, comorbid generalized epilepsy, or limited impact of ongoing partial seizures given other problems related to autism. Our small sample suggests that surgical and VNS outcomes in this group are less favorable than in other TRE populations
— id: 134461, year: 2011, vol: 52, page: 1071, stat: Journal Article,

Detection of epileptogenic cortical malformations with surface-based MRI morphometry
Thesen, Thomas; Quinn, Brian T; Carlson, Chad; Devinsky, Orrin; DuBois, Jonathan; McDonald, Carrie R; French, Jacqueline; Leventer, Richard; Felsovalyi, Olga; Wang, Xiuyuan; Halgren, Eric; Kuzniecky, Ruben
2011 ;6(2):e16430-e16430, PLoS ONE
Magnetic resonance imaging has revolutionized the detection of structural abnormalities in patients with epilepsy. However, many focal abnormalities remain undetected in routine visual inspection. Here we use an automated, surface-based method for quantifying morphometric features related to epileptogenic cortical malformations to detect abnormal cortical thickness and blurred gray-white matter boundaries. Using MRI morphometry at 3T with surface-based spherical averaging techniques that precisely align anatomical structures between individual brains, we compared single patients with known lesions to a large normal control group to detect clusters of abnormal cortical thickness, gray-white matter contrast, local gyrification, sulcal depth, jacobian distance and curvature. To assess the effects of threshold and smoothing on detection sensitivity and specificity, we systematically varied these parameters with different thresholds and smoothing levels. To test the effectiveness of the technique to detect lesions of epileptogenic character, we compared the detected structural abnormalities to expert-tracings, intracranial EEG, pathology and surgical outcome in a homogeneous patient sample. With optimal parameters and by combining thickness and GWC, the surface-based detection method identified 92% of cortical lesions (sensitivity) with few false positives (96% specificity), successfully discriminating patients from controls 94% of the time. The detected structural abnormalities were related to the seizure onset zones, abnormal histology and positive outcome in all surgical patients. However, the method failed to adequately describe lesion extent in most cases. Automated surface-based MRI morphometry, if used with optimized parameters, may be a valuable additional clinical tool to improve the detection of subtle or previously occult malformations and therefore could improve identification of patients with intractable focal epilepsy who may benefit from surgery
— id: 134079, year: 2011, vol: 6, page: e16430, stat: Journal Article,

GEP constitutes a negative feedback loop with MyoD and acts as a novel mediator in controlling skeletal muscle differentiation
Wang D; Bai X; Tian Q; Lai Y; Lin EA; Shi Y; Mu X; Feng JQ; Carlson CS; Liu CJ
2011 Dec 17;:?-? #, Cellular & molecular life sciences: CMLS
Granulin-epithelin precursor (GEP) is an autocrine growth factor that has been implicated in embryonic development, tissue repair, tumorigenesis, and inflammation. Here we report that GEP was expressed in skeletal muscle tissue and its level was differentially altered in the course of C2C12 myoblast fusion. The GEP expression during myoblast fusion was a consequence of MyoD transcription factor binding to several E-box (CANNTG) sequences in the 5'-flanking regulatory region of GEP gene, followed by transcription. Recombinant GEP potently inhibited myotube formation from C2C12 myoblasts whereas the knockdown of endogenous of GEP via a siRNA approach accelerated the fusion of myoblasts to myotubes. Interestingly, the muscle fibers of GEP knockdown mice were larger in number but noticeably smaller in size when compared to the wild-type. Mechanistic studies revealed that during myoblast fusion, the addition of GEP led to remarkable reductions in the expressions of muscle-specific transcription factors, including MyoD. In addition, the regulation of myotube formation by GEP is mediated by the anti-myogenic factor JunB, which is upregulated following GEP stimulation. Thus, GEP growth factor, JunB, and MyoD transcription factor form a regulatory loop and act in concert in the course of myogenesis
— id: 148767, year: 2011, vol: , page: ?, stat: Journal Article,

Phonetically irregular word pronunciation and cortical thickness in the adult brain
Blackmon, Karen; Barr, William B; Kuzniecky, Ruben; Dubois, Jonathan; Carlson, Chad; Quinn, Brian T; Blumberg, Mark; Halgren, Eric; Hagler, Donald J; Mikhly, Mark; Devinsky, Orrin; McDonald, Carrie R; Dale, Anders M; Thesen, Thomas
2010 Jul 15;51(4):1453-1458, Neuroimage
Accurate pronunciation of phonetically irregular words (exception words) requires prior exposure to unique relationships between orthographic and phonemic features. Whether such word knowledge is accompanied by structural variation in areas associated with orthographic-to-phonemic transformations has not been investigated. We used high-resolution MRI to determine whether performance on a visual word-reading test composed of phonetically irregular words, the Wechsler Test of Adult Reading (WTAR), is associated with regional variations in cortical structure. A sample of 60 right-handed, neurologically intact individuals were administered the WTAR and underwent 3T volumetric MRI. Using quantitative, surface-based image analysis, cortical thickness was estimated at each vertex on the cortical mantle and correlated with WTAR scores while controlling for age. Higher scores on the WTAR were associated with thicker cortex in bilateral anterior superior temporal gyrus, bilateral angular gyrus/posterior superior temporal gyrus, and left hemisphere intraparietal sulcus. Higher scores were also associated with thinner cortex in left hemisphere posterior fusiform gyrus and central sulcus, bilateral inferior frontal gyrus, and right hemisphere lingual gyrus and supramarginal gyrus. These results suggest that the ability to correctly pronounce phonetically irregular words is associated with structural variations in cortical areas that are commonly activated in functional neuroimaging studies of word reading, including areas associated with grapheme-to-phonemic conversion
— id: 109791, year: 2010, vol: 51, page: 1453, stat: Journal Article,

Epilepsy treatment stimulus package? Deep brain stimulation in treatment-resistant focal epilepsy
Carlson, Chad
2010 Nov;10(6):148-150, Epilepsy currents
— id: 149917, year: 2010, vol: 10, page: 148, stat: Journal Article,

Wada you do for language: fMRI and language lateralization?
Carlson, Chad
2010 Jul;10(4):86-88, Epilepsy currents
— id: 149918, year: 2010, vol: 10, page: 86, stat: Journal Article,

Impaired consciousness in temporal lobe seizures: role of cortical slow activity
Englot, Dario J; Yang, Li; Hamid, Hamada; Danielson, Nathan; Bai, Xiaoxiao; Marfeo, Anthony; Yu, Lissa; Gordon, Aliza; Purcaro, Michael J; Motelow, Joshua E; Agarwal, Ravi; Ellens, Damien J; Golomb, Julie D; Shamy, Michel C F; Zhang, Heping; Carlson, Chad; Doyle, Werner; Devinsky, Orrin; Vives, Kenneth; Spencer, Dennis D; Spencer, Susan S; Schevon, Catherine; Zaveri, Hitten P; Blumenfeld, Hal
2010 Dec;133(Pt 12):3764-3777, Brain
Impaired consciousness requires altered cortical function. This can occur either directly from disorders that impair widespread bilateral regions of the cortex or indirectly through effects on subcortical arousal systems. It has therefore long been puzzling why focal temporal lobe seizures so often impair consciousness. Early work suggested that altered consciousness may occur with bilateral or dominant temporal lobe seizure involvement. However, other bilateral temporal lobe disorders do not impair consciousness. More recent work supports a 'network inhibition hypothesis' in which temporal lobe seizures disrupt brainstem-diencephalic arousal systems, leading indirectly to depressed cortical function and impaired consciousness. Indeed, prior studies show subcortical involvement in temporal lobe seizures and bilateral frontoparietal slow wave activity on intracranial electroencephalography. However, the relationships between frontoparietal slow waves and impaired consciousness and between cortical slowing and fast seizure activity have not been directly investigated. We analysed intracranial electroencephalography recordings during 63 partial seizures in 26 patients with surgically confirmed mesial temporal lobe epilepsy. Behavioural responsiveness was determined based on blinded review of video during seizures and classified as impaired (complex-partial seizures) or unimpaired (simple-partial seizures). We observed significantly increased delta-range 1-2 Hz slow wave activity in the bilateral frontal and parietal neocortices during complex-partial compared with simple-partial seizures. In addition, we confirmed prior work suggesting that propagation of unilateral mesial temporal fast seizure activity to the bilateral temporal lobes was significantly greater in complex-partial than in simple-partial seizures. Interestingly, we found that the signal power of frontoparietal slow wave activity was significantly correlated with the temporal lobe fast seizure activity in each hemisphere. Finally, we observed that complex-partial seizures were somewhat more common with onset in the language-dominant temporal lobe. These findings provide direct evidence for cortical dysfunction in the form of bilateral frontoparietal slow waves associated with impaired consciousness in temporal lobe seizures. We hypothesize that bilateral temporal lobe seizures may exert a powerful inhibitory effect on subcortical arousal systems. Further investigations will be needed to fully determine the role of cortical-subcortical networks in ictal neocortical dysfunction and may reveal treatments to prevent this important negative consequence of temporal lobe epilepsy
— id: 134080, year: 2010, vol: 133, page: 3764, stat: Journal Article,

Heterogeneous neuronal firing patterns during interictal epileptiform discharges in the human cortex
Keller, Corey J; Truccolo, Wilson; Gale, John T; Eskandar, Emad; Thesen, Thomas; Carlson, Chad; Devinsky, Orrin; Kuzniecky, Ruben; Doyle, Werner K; Madsen, Joseph R; Schomer, Donald L; Mehta, Ashesh D; Brown, Emery N; Hochberg, Leigh R; Ulbert, Istvan; Halgren, Eric; Cash, Sydney S
2010 Jun;133(Pt 6):1668-1681, Brain
Epileptic cortex is characterized by paroxysmal electrical discharges. Analysis of these interictal discharges typically manifests as spike-wave complexes on electroencephalography, and plays a critical role in diagnosing and treating epilepsy. Despite their fundamental importance, little is known about the neurophysiological mechanisms generating these events in human focal epilepsy. Using three different systems of microelectrodes, we recorded local field potentials and single-unit action potentials during interictal discharges in patients with medically intractable focal epilepsy undergoing diagnostic workup for localization of seizure foci. We studied 336 single units in 20 patients. Ten different cortical areas and the hippocampus, including regions both inside and outside the seizure focus, were sampled. In three of these patients, high density microelectrode arrays simultaneously recorded between 43 and 166 single units from a small (4 mm x 4 mm) patch of cortex. We examined how the firing rates of individual neurons changed during interictal discharges by determining whether the firing rate during the event was the same, above or below a median baseline firing rate estimated from interictal discharge-free periods (Kruskal-Wallis one-way analysis, P<0.05). Only 48% of the recorded units showed such a modulation in firing rate within 500 ms of the discharge. Units modulated during the discharge exhibited significantly higher baseline firing and bursting rates than unmodulated units. As expected, many units (27% of the modulated population) showed an increase in firing rate during the fast segment of the discharge (+ or - 35 ms from the peak of the discharge), while 50% showed a decrease during the slow wave. Notably, in direct contrast to predictions based on models of a pure paroxysmal depolarizing shift, 7.7% of modulated units recorded in or near the seizure focus showed a decrease in activity well ahead (0-300 ms) of the discharge onset, while 12.2% of units increased in activity in this period. No such pre-discharge changes were seen in regions well outside the seizure focus. In many recordings there was also a decrease in broadband field potential activity during this same pre-discharge period. The different patterns of interictal discharge-modulated firing were classified into more than 15 different categories. This heterogeneity in single unit activity was present within small cortical regions as well as inside and outside the seizure onset zone, suggesting that interictal epileptiform activity in patients with epilepsy is not a simple paroxysm of hypersynchronous excitatory activity, but rather represents an interplay of multiple distinct neuronal types within complex neuronal networks
— id: 114446, year: 2010, vol: 133, page: 1668, stat: Journal Article,

Multimodal imaging of repetition priming: Using fMRI, MEG, and intracranial EEG to reveal spatiotemporal profiles of word processing
McDonald, Carrie R; Thesen, Thomas; Carlson, Chad; Blumberg, Mark; Girard, Holly M; Trongnetrpunya, Amy; Sherfey, Jason S; Devinsky, Orrin; Kuzniecky, Rubin; Dolye, Werner K; Cash, Sydney S; Leonard, Matthew K; Hagler, Donald J Jr; Dale, Anders M; Halgren, Eric
2010 Nov 1;53(2):707-717, Neuroimage
Repetition priming is a core feature of memory processing whose anatomical correlates remain poorly understood. In this study, we use advanced multimodal imaging (functional magnetic resonance imaging (fMRI) and magnetoencephalography; MEG) to investigate the spatiotemporal profile of repetition priming. We use intracranial electroencephalography (iEEG) to validate our fMRI/MEG measurements. Twelve controls completed a semantic judgment task with fMRI and MEG that included words presented once (new, 'N') and words that repeated (old, 'O'). Six patients with epilepsy completed the same task during iEEG recordings. Blood-oxygen level dependent (BOLD) responses for N vs. O words were examined across the cortical surface and within regions of interest. MEG waveforms for N vs. O words were estimated using a noise-normalized minimum norm solution, and used to interpret the timecourse of fMRI. Spatial concordance was observed between fMRI and MEG repetition effects from 350 to 450 ms within bilateral occipitotemporal and medial temporal, left prefrontal, and left posterior temporal cortex. Additionally, MEG revealed widespread sources within left temporoparietal regions, whereas fMRI revealed bilateral reductions in occipitotemporal and left superior frontal, and increases in inferior parietal, precuneus, and dorsolateral prefrontal activity. BOLD suppression in left posterior temporal, left inferior prefrontal, and right occipitotemporal cortex correlated with MEG repetition-related reductions. IEEG responses from all three regions supported the timecourse of MEG and localization of fMRI. Furthermore, iEEG decreases to repeated words were associated with decreased gamma power in several regions, providing evidence that gamma oscillations are tightly coupled to cognitive phenomena and reflect regional activations seen in the BOLD signal
— id: 134081, year: 2010, vol: 53, page: 707, stat: Journal Article,

DISRUPTIONS OF THE DEFAULT MODE NETWORK IN PATIENTS WITH PRIMARY GENERALIZED EPILEPSY
McGill, M.; Milhalm, M.; Carlson, C.; DuBois, J.; Quinn, B.; Wang, H.; Kuzniecky, R.; Devinsky, O.; French, J.; Halgren, E.; Castellano, X.; Thesen, T.
2010 JUN ;51(8):90-90, Epilepsia
— id: 112189, year: 2010, vol: 51, page: 90, stat: Journal Article,

Do tubers contain function? Resection of epileptogenic foci in perirolandic cortex in children with tuberous sclerosis complex
Moshel, Yaron A; Elliott, Robert; Teutonico, Federica; Sellin, Jonathan; Carlson, Chad; Devinsky, Orrin; Weiner, Howard L
2010 Jul;51(7):1242-1251, Epilepsia
PURPOSE: Surgical resection of single, dominant, epileptogenic lesions in patients with tuberous sclerosis complex (TSC) is now accepted as an effective therapy. However, patients with symptomatic tubers in eloquent cortex are sometimes not offered surgery because of the concern for postoperative neurologic morbidity. In this study, we examine our results in children undergoing surgery for resection of tubers and associated seizure foci in rolandic and perirolandic cortex. METHODS: Between 1998 and 2008, 52 pediatric patients (mean age 4 years) with TSC underwent epilepsy surgery at the NYU Comprehensive Epilepsy Center. Fifteen of these patients underwent multistage surgery for invasive mapping of seizure foci and surrounding functional cortex followed by resection of tubers/seizure foci in or near rolandic cortex. Data were retrospectively collected and neurologic outcomes were tabulated. RESULTS: Postoperatively, four patients (27%) had either new hemiparesis or worsening of a preexisting hemiparesis. However, all patients were back to their neurologic baselines at 3-month follow-up, yielding no permanent postoperative deficits. The modified Engel outcome was class I in nine patients (60%), class II in three patients (20%), class III in two patients (13%), and class IV in one patient (7%) after 40 months mean follow-up. DISCUSSION: Surgical resection of tubers and associated epileptogenic foci in rolandic and perirolandic cortex in children with TSC is feasible, with low neurologic morbidity, and yields good seizure control. These results suggest that tubers and perituberal epileptogenic foci can be safely resected even in eloquent regions because of reorganization of functional cortex or because these lesions contain no neurologic function
— id: 138143, year: 2010, vol: 51, page: 1242, stat: Journal Article,

Bilateral intracranial electroencephalographic monitoring immediately following corpus callosotomy
Silverberg, Alyson; Parker-Menzer, Kimberly; Devinsky, Orrin; Doyle, Werner; Carlson, Chad
2010 Oct;51(10):2203-2206, Epilepsia
Although many patients with medically refractory focal epilepsy are candidates for resective surgery, patients with multifocal epilepsy and symptomatic generalized epilepsy remain difficult to treat medically and surgically. Corpus callosotomy has been utilized since 1940 for the treatment of seizures, with reports of efficacy in multiple seizure types. Previous studies have demonstrated subsequent lateralization of bilateral/bisynchronous epileptiform activity following callosotomy. To investigate the efficacy of bilateral intracranial electroencephalographic studies immediately following corpus callosotomy, we retrospectively identified 26 patients who underwent corpus callosotomy at our center, 18 of whom had intracranial monitoring following corpus callosotomy. Five of the 18 had focal resections following intracranial electroencephalography (EEG). No patients were seizure free following callosotomy or resection. No differences in postoperative outcomes were seen between patients with intracranial EEG versus those without
— id: 114166, year: 2010, vol: 51, page: 2203, stat: Journal Article,

Extraoperative functional mapping and staged resection of supratentorial tumors near eloquent cortex in children
Bollo, Robert J; Carlson, Chad; Schevon, Catherine; Wisoff, Jeffrey H; Devinsky, Orrin; Weiner, Howard L
2009 ;45(3):175-180, Pediatric neurosurgery
We present our technique for extraoperative functional mapping in awake children with supratentorial tumors near eloquent cortex. This technique may help optimize tumor resection and/or the functional outcome, especially when an awake craniotomy is not possible or in the setting of coincident seizures. After subdural electrode implantation, extraoperative functional mapping and seizure focus mapping were performed, followed by staged tumor resection. Gross total resection was achieved in 6 patients and subtotal resection in 2. No complications due to electrode placement or invasive monitoring were observed. Staged resection of pediatric brain tumors near the eloquent cortex appears safe, allows functional mapping in awake patients, and may assist in decisions between maximal tumor resection and optimal functional outcome
— id: 100605, year: 2009, vol: 45, page: 175, stat: Journal Article,

QUANTITATIVE MAGNETIC RESONANCE IMAGING FINDINGS IN IDIOPATHIC GENERALIZED EPILEPSY
Carlson, C; DuBois, J; Marcuse, L; Kuzniecky, R; Devinsky, O; Boo, C; Mikhly, M; Blumberg, M; Thesen, T
2009 ;50:442-442, Epilepsia
— id: 106075, year: 2009, vol: 50, page: 442, stat: Journal Article,

Axial back pain in the athlete: pathophysiology and approach to rehabilitation
Carlson, Chad
2009 Jun;2(2):88-93, Current reviews in musculoskeletal medicine
Back pain in athletes is common. Proper management of an athlete with back pain who is trying to return to competition must take into account the probable biomechanical contributors and incorporate these into a comprehensive rehabilitation program that moves steadily forward towards defined goals. This study will attempt to discuss pathological commonalities of low-back pain in athletes and how these can be applied to an evidence-based rehabilitation approach
— id: 149921, year: 2009, vol: 2, page: 88, stat: Journal Article,

First do no harm: safety in the epilepsy monitoring unit
Carlson, Chad
2009 Nov-Dec;9(6):162-163, Epilepsy currents
— id: 149919, year: 2009, vol: 9, page: 162, stat: Journal Article,

Detecting nocturnal convulsions: Efficacy of the MP5 monitor
Carlson, Chad; Arnedo, Vanessa; Cahill, Maria; Devinsky, Orrin
2009 Apr;18(3):225-227, Seizure
Although the cause of sudden unexplained death in epilepsy patients (SUDEP) is unknown, evidence implicates respiratory compromise. Most cases occur while the patient is in bed and unsupervised. We investigated the efficacy of the Medpage bed seizure monitor to detect generalized tonic-clonic seizures. Patients with a history of tonic-clonic seizures were enrolled on a video-EEG unit. The MP5 device was placed between the mattress and bed base between midnight and 8:00 a.m. 64 subjects were enrolled (1528h). Five of eight tonic-clonic seizures were detected. There were 269 false positive alarms (146h with false positive alarms). The sensitivity and specificity of the alarm were 62.5% and 90.4%, respectively. The negative predictive value of 99.8% illustrates the potential for this device to provide additional security for patients with tonic-clonic seizures, however individual calibration would likely be necessary to improve the positive predictive value of 3.3%, which requires further validation
— id: 96912, year: 2009, vol: 18, page: 225, stat: Journal Article,

The Excitable Cerebral Cortex
Carlson, Chad; Devinsky, Orrin
2009 Jun;15(2):131-132, Epilepsy & behavior
— id: 96910, year: 2009, vol: 15, page: 131, stat: Journal Article,

STRUCTURAL BRAIN ABNORMALITIES IN POSTICTAL PSYCHOSIS
DuBois, J; Carlson, C; Kuzniecky, R; Devinsky, O; Alper, K; Blumberg, M; Mikhly, M; Starner, K; Thesen, T
2009 ;50:447-447, Epilepsia
— id: 106076, year: 2009, vol: 50, page: 447, stat: Journal Article,

VAGUS NERVE STIMULATION FOR REFRACTORY EPILEPSY: SINGLE SURGEON EXPERIENCE OF OVER 700 CONSECUTIVE OPERATIONS
Elliott, RE; Morsi, A; Kalhorn, S; Marcus, J; Sellin, J; Kang, M; Silverberg, A; Carlson, C; Geller, E; Devinsky, O; Doyle, W
2009 ;50:486-487, Epilepsia
— id: 106078, year: 2009, vol: 50, page: 486, stat: Journal Article,

Refractory epilepsy in tuberous sclerosis: Vagus nerve stimulation with or without subsequent resective surgery
Elliott, Robert E; Carlson, Chad; Kalhorn, Stephen P; Moshel, Yaron A; Weiner, Howard L; Devinsky, Orrin; Doyle, Werner K
2009 Nov;16(3):454-460, Epilepsy & behavior
OBJECTIVE: The goal of the work described here was to assess the efficacy and safety of vagus nerve stimulation in a cohort of patients with tuberous sclerosis complex with refractory epilepsy. Furthermore, we examined the impact of vagus nerve stimulation failure on the ultimate outcome following subsequent intracranial epilepsy surgery. METHODS: A retrospective review was performed on 19 patients with refractory epilepsy and TSC who underwent vagus nerve stimulator (VNS) implantation. There were 11 (58%) females and 8 (42%) males aged 2 to 44 years when the VNS was implanted (mean: 14.7+/-12 years). Twelve patients underwent primary VNS implantation after having failed a mean of 7.1 antiepileptic drugs. Two patients (17%) had generalized epilepsy, one had a single seizure focus, three (25%) had multifocal epilepsy, and six (50%) had multifocal and generalized epilepsy. Seven patients were referred for device removal and evaluation for intracranial procedures. One patient in the primary implantation group was lost to follow-up and excluded from outcome analysis. RESULTS: All implantations and removals were performed without permanent complications. The duration of treatment for primary VNS implants varied from 8.5 months to 9.6 years (mean: 4.9 years). Mean seizure frequency significantly improved following VNS implantation (mean reduction: 72%, P<0.002). Two patients had Engel Class I (18%), one had Class II (9%), seven had Class III (64%), and one had Class IV (9%) outcome. Three patients with poor response to vagus nerve stimulation therapy at our center underwent resection of one or more seizure foci (Engel Class I, two patients; Engel Class III, one patient). Seven patients referred to our center for VNS removal and craniotomy underwent seizure focus resection (6) or corpus callosotomy (1) (Engel Class II: 2, Engel III: 2; Engel IV: 3). In total, 8 of 10 (80%) patients experienced improved seizure control following intracranial surgery (mean reduction: 65%, range: 0-100%, P<0.05). CONCLUSIONS: VNS is a safe and effective treatment option for medically refractory epilepsy in patients with tuberous sclerosis complex. Nine of 11 patients (82%) experienced at least a 67% reduction in seizure burden. Lack of response to vagus nerve stimulation does not preclude subsequent improvement in seizure burden with intracranial epilepsy surgery
— id: 105245, year: 2009, vol: 16, page: 454, stat: Journal Article,

VAGUS NERVE STIMULATION IN PATIENTS WITH TUBEROUS SCLEROSIS COMPLEX: EFFICACY OF NEW IMPLANTATIONS AND ASSOCIATION OF DEVICE INEFFICACY WITH SUBSEQUENT OUTCOME OF INTRACRANIAL EPILEPSY SURGERY
Kalhorn, SP; Elliott, R; Carlson, C; Moshel, Y; Weiner, H; Devinsky, O; Doyle, W
2009 ;50:455-456, Epilepsia
— id: 106077, year: 2009, vol: 50, page: 455, stat: Journal Article,

Intracranial microprobe for evaluating neuro-hemodynamic coupling in unanesthetized human neocortex
Keller, Corey J; Cash, Sydney S; Narayanan, Suresh; Wang, Chunmao; Kuzniecky, Ruben; Carlson, Chad; Devinsky, Orrin; Thesen, Thomas; Doyle, Werner; Sassaroli, Angelo; Boas, David A; Ulbert, Istvan; Halgren, Eric
2009 May 15;179(2):208-218, Journal of neuroscience methods
Measurement of the blood-oxygen-level dependent (BOLD) response with fMRI has revolutionized cognitive neuroscience and is increasingly important in clinical care. The BOLD response reflects changes in deoxy-hemoglobin concentration, blood volume, and blood flow. These hemodynamic changes ultimately result from neuronal firing and synaptic activity, but the linkage between these domains is complex, poorly understood, and may differ across species, cortical areas, diseases, and cognitive states. We describe here a technique that can measure neural and hemodynamic changes simultaneously from cortical microdomains in waking humans. We utilize a 'laminar optode,' a linear array of microelectrodes for electrophysiological measures paired with a micro-optical device for hemodynamic measurements. Optical measurements include laser Doppler to estimate cerebral blood flow as well as point spectroscopy to estimate oxy- and deoxy-hemoglobin concentrations. The microelectrode array records local field potential gradients (PG) and multi-unit activity (MUA) at 24 locations spanning the cortical depth, permitting estimation of population trans-membrane current flows (Current Source Density, CSD) and population cell firing in each cortical lamina. Comparison of the laminar CSD/MUA profile with the origins and terminations of cortical circuits allows activity in specific neuronal circuits to be inferred and then directly compared to hemodynamics. Access is obtained in epileptic patients during diagnostic evaluation for surgical therapy. Validation tests with relatively well-understood manipulations (EKG, breath-holding, cortical electrical stimulation) demonstrate the expected responses. This device can provide a new and robust means for obtaining detailed, quantitative data for defining neurovascular coupling in awake humans
— id: 114450, year: 2009, vol: 179, page: 208, stat: Journal Article,

Assessing Effort During Neuropsychological Evaluation with the TOMM in Children and Adolescents with Epilepsy
Macallister, William S; Nakhutina, Luba; Bender, Heidi A; Karantzoulis, Stella; Carlson, Chad
2009 Nov;15(6):521-531, Child neuropsychology : a journal on normal & abnormal development in childhood & adolescence
Effort assessment is of particular importance in pediatric epilepsy where neuropsychological findings may influence treatment decisions, especially if surgical interventions are being considered. The present investigation examines the Test of Memory Malingering (TOMM) in 60 children and adolescents with epilepsy. The overall pass rate for the sample was 90%. TOMM scores were unrelated to age, though there was a significant correlation between TOMM Trial 2 scores and intelligence estimates. Overall, the TOMM appears to be a valid measure of effort in young epilepsy patients, though caution should be used when interpreting scores for those with very low IQ, especially if behavioral problems are also evident. Caution should also be exercised in interpreting scores in children with ongoing interictal epileptiform activity that may disrupt attention
— id: 138384, year: 2009, vol: 15, page: 521, stat: Journal Article,

Distributed source modeling of language with magnetoencephalography: Application to patients with intractable epilepsy
McDonald, Carrie R; Thesen, Thomas; Hagler, Donald J Jr; Carlson, Chad; Devinksy, Orrin; Kuzniecky, Rubin; Barr, William; Gharapetian, Lusineh; Trongnetrpunya, Amy; Dale, Anders M; Halgren, Eric
2009 Oct;50(10):2256-2266, Epilepsia
Purpose: To examine distributed patterns of language processing in healthy controls and patients with epilepsy using magnetoencephalography (MEG), and to evaluate the concordance between laterality of distributed MEG sources and language laterality as determined by the intracarotid amobarbital procedure (IAP). Methods: MEG was performed in 10 healthy controls using an anatomically constrained, noise-normalized distributed source solution (dynamic statistical parametric map, dSPM). Distributed source modeling of language was then applied to eight patients with intractable epilepsy. Average source strengths within temporoparietal and frontal lobe regions of interest (ROIs) were calculated, and the laterality of activity within ROIs during discrete time windows was compared to results from the IAP. Results: In healthy controls, dSPM revealed activity in visual cortex bilaterally from approximately 80 to 120 ms in response to novel words and sensory control stimuli (i.e., false fonts). Activity then spread to fusiform cortex approximately 160-200 ms, and was dominated by left hemisphere activity in response to novel words. From approximately 240 to 450 ms, novel words produced activity that was left-lateralized in frontal and temporal lobe regions, including anterior and inferior temporal, temporal pole, and pars opercularis, as well as bilaterally in posterior superior temporal cortex. Analysis of patient data with dSPM demonstrated that from 350 to 450 ms, laterality of temporoparietal sources agreed with the IAP 75% of the time, whereas laterality of frontal MEG sources agreed with the IAP in all eight patients. Discussion: Our results reveal that dSPM can unveil the timing and spatial extent of language processes in patients with epilepsy and may enhance knowledge of language lateralization and localization for use in preoperative planning
— id: 101387, year: 2009, vol: 50, page: 2256, stat: Journal Article,

Postictal psychosis in partial epilepsy: a case-control study
Alper, Kenneth; Kuzniecky, Ruben; Carlson, Chad; Barr, William B; Vorkas, Charles K; Patel, Jignasa G; Carrelli, Angela L; Starner, Karen; Flom, Peter L; Devinsky, Orrin
2008 May;63(5):602-610, Annals of neurology
OBJECTIVE: Divergent findings among prior studies on correlates of risk for postictal psychosis (PIP) suggest the value of a controlled study involving a relatively large number of patients. METHODS: The study population consisted of a consecutive series of 59 patients with partial epilepsy and a history of PIP, and 94 control patients with partial epilepsy and no history of PIP evaluated as inpatients with video-electroencephalography. The groups did not differ significantly regarding demographic features. Exact tests yielded a subset of variables and a tentative interpretation that were evaluated further utilizing principal components analysis and logistic regression. RESULTS: PIP was associated with extratemporal versus temporal (p = 0.036) or undetermined (p = 0.001) localization of seizure onset, bilateral interictal epileptiform activity (p = 0.017), secondary generalization (p = 0.049), and history of encephalitis (p = 0.018). Interictal slow activity was more frequently absent in control patients (p = 0.045). PIP was associated with family histories of psychiatric disorders (p = 0.007) and epilepsy (p = 0.042), which themselves were significantly intercorrelated (r = 0.225; p = 0.006). Age of onset or duration of epilepsy and lateralized electroencephalographic or magnetic resonance imaging asymmetries did not differ significantly between control and PIP groups. The analysis indicated four underlying domains of risk for PIP: ambiguous/extratemporal localization, family neuropsychiatric history, abnormal interictal electroencephalographic activity, and encephalitis. Each unit increase on a simple additive scale composed of 9 dichotomous independent variables multiplied the odds ratio for PIP by 1.71 (95% confidence interval, 1.36-2.15; p < 0.0001). INTERPRETATION: PIP in partial epilepsy is associated with relatively broadly and bilaterally distributed epileptogenic networks, genetic determinants of psychiatric disorders and seizures, and encephalitis
— id: 79550, year: 2008, vol: 63, page: 602, stat: Journal Article,

Epilepsy surgery and tuberous sclerosis complex: special considerations
Bollo, Robert J; Kalhorn, Stephen P; Carlson, Chad; Haegeli, Veronique; Devinsky, Orrin; Weiner, Howard L
2008 Sep;25(3):E13-E13, Neurosurgical focus
Epilepsy surgery for medically refractory seizures among patients with tuberous sclerosis complex (TSC) is a well-accepted treatment option. Many epilepsy centers around the world have published their experience over the past several years, supporting the idea that the best seizure control is obtained when a single tuber and associated epileptogenic zone is documented and targeted surgically. Recent advances in imaging and physiological techniques that reveal the epileptogenic zone have been used successfully in children with TSC who are being evaluated for surgery. As a result, a number of different surgical strategies have emerged, each reflecting the experience, strengths, and referral biases of the individual treating teams. Experience suggests that some patients with TSC who present with seizures that are difficult to localize and do not meet the classic selection criteria for epilepsy surgery may, nevertheless, benefit from surgery. Tuberectomy alone is often not sufficient for obtaining seizure control. Intracranial electrode recordings performed in a large number of children with TSC undergoing epilepsy surgery have raised new questions about the relationship of the cortical tuber to the epileptogenic zone in TSC. A careful assessment of the risks and benefits of any surgical strategy, compared with those associated with continued refractory epilepsy, should be considered by the treating team in conjunction with the patient's family. Epilepsy surgery has not only benefited many children with TSC, but it also facilitates the understanding of epileptogenesis in TSC
— id: 86950, year: 2008, vol: 25, page: E13, stat: Journal Article,

The natural history and management of hamstring injuries
Carlson, Chad
2008 Jun;1(2):120-123, Current reviews in musculoskeletal medicine
Hamstring injuries in sport can be debilitating. The anatomical complexity of this muscle makes uniform assessment of injury epidemiology difficult and insures that post-injury management strategies must be individually focused. This article reviews the anatomy of the hamstring, its role in athletic movement, common mechanisms of injury, and management guidelines with the goal of return into sporting activity in mind
— id: 149920, year: 2008, vol: 1, page: 120, stat: Journal Article,

Characterization of defect luminescence in Yb doped silica fibers: part I NBOHC
Dragic, Peter D; Carlson, Chad G; Croteau, Andre
2008 Mar 31;16(7):4688-4697, Optics express
We present an analysis of non-bridging oxygen hole center (NBOHC) defects in Yb-doped silica fibers. Red photoluminescence is observed when several fiber samples are irradiated with green light (532 nm). Both highly Ge-doped and moderately P-doped Yb fibers exhibit red-shifted NBOHC emission spectra while highly Al-doped Yb fibers seem to exhibit NBOHC spectra closer to that of pure silica. NBOHC centers may play a role in the photodarkening process of Yb doped fibers
— id: 149922, year: 2008, vol: 16, page: 4688, stat: Journal Article,

Effects of subdural application of lidocaine in patients with focal epilepsy
Madhavan, Deepak; Mirowski, Piotr; Ludvig, Nandor; Carlson, Chad; Doyle, Werner; Devinsky, Orrin; Kuzniecky, Ruben
2008 Feb;78(2-3):235-239, Epilepsy research
Antiepileptic drug (AED) delivery directly into the neocortex has recently been shown to be able to both prevent and terminate focal seizures in rats. The present clinical experiment aimed to test the local effects of lidocaine delivered onto the pia mater adjacent to epileptogenic zones in human patients. Administration of lidocaine resulted in a marked diminishment of spike counts on all patients, with a decremental effect of lidocaine on the faster frequency elements of individual spikes and overall testing epochs. The direct cortical application of lidocaine appears to affect local epileptogenic activity in human patients with intractable focal epilepsy
— id: 78353, year: 2008, vol: 78, page: 235, stat: Journal Article,

Distributed Source Modeling of Language with Magnetoencephalography: Application to Patients with Left Temporal Lobe Epilepsy
McDonald, CR; Thesen, T; Hagler, DJ; Carlson, C; Devinksy, O; Kuzniecky, R; Barr, W; Patel, RH; Gharapetian, L; Dale, AM; Halgren, E
2008 DEC ;64(6):S150-S150, Annals of neurology
— id: 98111, year: 2008, vol: 64, page: S150, stat: Journal Article,

Tibial compartment syndrome and the cavovarus foot
Thati, Srinivas; Carlson, Chad; Maskill, John D; Anderson, John G; Bohay, Donald R
2008 Jun;13(2):275-305, vii, Foot & ankle clinics
Compartment syndrome of the leg is an orthopedic emergency that requires a high index of suspicion for diagnosis and a low threshold for surgical management to prevent devastating complications. Where the clinical findings are subtle, continuous monitoring of compartment pressures, with clinical correlation, is the key to diagnosis. Surgical management should include decompression of all four compartments and early rehabilitation to prevent ischemic contracture. If contracture develops, it may cause varying degrees of equinocavovarus deformity of the foot and ankle. Appropriate evaluation and careful surgical planning that considers all components of this complex deformity are essential for obtaining good clinical results
— id: 149923, year: 2008, vol: 13, page: 275, stat: Journal Article,

Effects of the subdural application of lidocaine on EEG spiking in patients with focal epilepsy
Madhavan, D; Mirowski, PW; Ludvig, N; Carlson, C; Devinsky, O; Doyle, W; Kuzniecky, R
2007 OCT ;48(4):307-308, Epilepsia
— id: 104242, year: 2007, vol: 48, page: 307, stat: Journal Article,

Local epileptogenic networks in tuberous sclerosis complex: a case review
Madhavan, Deepak; Weiner, Howard L; Carlson, Chad; Devinsky, Orrin; Kuzniecky, Ruben
2007 Aug;11(1):140-146, Epilepsy & behavior
OBJECTIVE: Cortical tubers are a pathognomonic finding in some patients with tuberous sclerosis complex (TSC), and are believed to be epileptogenic foci. Surgery is an effective option in selected patients with TSC who are refractory to medical therapy. This article describes three patients with TSC who underwent three-stage epilepsy surgery at our center, with the intention of examining local electrophysiological changes after each stage of the procedure. METHODS: Magnetic resonance images were obtained after initial implantation of electrodes and after resection and electrode reimplantation. These images were co-registered and overlaid. The intracranial grids were overlaid in a similar procedure and manually traced, and then added to the volumetric image. Mean spike counts were obtained for each patient and expressed in spikes per minute. Statistical analysis was performed on spike counts prior to and after resection. RESULTS: All three patients displayed intense spiking in the regions around the dominant epileptogenic tuber. On tuber removal, spike counts diminished significantly. In each case, new areas of spiking emerged in regions remote from the tuber periphery after tuber resection, with the emergence of secondary ictal onset zones in the resection margin. CONCLUSION: This retrospective study highlights some common electrophysiological features among the patients examined. The observed epileptogenic activity and regions of ictal onset suggest that it may be the region of brain tissue surrounding the tuber that is responsible for the majority of epileptogenic activity in these patients
— id: 73894, year: 2007, vol: 11, page: 140, stat: Journal Article,

Pediatric language mapping: sensitivity of neurostimulation and Wada testing in epilepsy surgery
Schevon, Catherine A; Carlson, Chad; Zaroff, Charles M; Weiner, Howard J; Doyle, Werner K; Miles, Daniel; Lajoie, Josiane; Kuzniecky, Ruben; Pacia, Steven; Vazquez, Blanca; Luciano, Daniel; Najjar, Souhel; Devinsky, Orrin
2007 Mar;48(3):539-545, Epilepsia
PURPOSE: Functional mapping of eloquent cortex with electrical neurostimulation is used both intra- and extraoperatively to tailor resections. In pediatric patients, however, functional mapping studies frequently fail to localize language. Wada testing has also been reported to be less sensitive in children. METHODS: Thirty children (4.7 - 14.9 years) and 18 adult controls (18-59 years) who underwent extraoperative language mapping via implanted subdural electrodes at the NYU Comprehensive Epilepsy Center were included in the study. Ten children and 14 adults underwent preoperative Wada testing. Success of the procedures was defined as the identification of at least one language site by neurostimulation mapping and determination of hemispheric language dominance on the Wada test. RESULTS: In children younger than 10.2 years, cortical stimulation identified language cortex at a lower rate than was seen in children older than 10.2 years and in adults (p<0.05). This threshold, demonstrated by survival and chi2 analysis, was sharply defined in our data set. Additionally, Wada testing was more likely to be successful than was extraoperative mapping in this younger age group (p<0.05). CONCLUSIONS: Analysis of our series demonstrates that language cortex is less likely to be identified in children younger than 10 years, suggesting that alternatives to the current methods of cortical electrical stimulation, particularly the use of preoperative language lateralization, may be required in this age group
— id: 71610, year: 2007, vol: 48, page: 539, stat: Journal Article,

Comparing fMRI and MEG in the study of language processing
Thesen, T; Carlson, CE; McDonald, CM; Kuzniecky, RI; Hagler, DJ; Stout, JD; Nearing, KI; Dale, AM; Barr, WB; Devinsky, O; Halgren, E
2007 OCT ;48(3):221-222, Epilepsia
— id: 98145, year: 2007, vol: 48, page: 221, stat: Journal Article,

Extraoperative functional mapping via staged resection of supratentorial tumors in children [Abstact]
Bollo, RJ; Carlson, C; Schevon, C; Wisoff, JY; Devinsky, O; Weiner, H
2006 APR ;104(4):634-634, Journal of neurosurgery
— id: 104255, year: 2006, vol: 104, page: 634, stat: Journal Article,

Magnetic source imaging for pre-surgical lateralization of refractory epilepsy
Carlson, C; Schevon, C; Stout, J; Nadkami, S; Doyle, W; Weiner, H; Pacia, S; Devinsky, O; Kuzniecky, R
2006 MAR ;47(1):4-5, Epilepsia
— id: 104248, year: 2006, vol: 47, page: 4, stat: Journal Article,

Inter- and intra-modality reliability of magnetoencephalographic somatosensory localization utilizing pneumatic digit and median nerve stimulation
Carlson, C; Stout, J; Schevon, C; Kuzniecky, R; Devinsky, O; Pacia, S
2006 MAR 14 ;66(5):A180-A180, Neurology
— id: 104257, year: 2006, vol: 66, page: A180, stat: Journal Article,

Multi-staged epilepsy surgery in multifocal tuberous sclerosis complex
Carlson, C; Weiner, H; Ridgway, E; Zaroff, C; Miles, D; LaJoie, J; Kuzniecky, R; Devinsky, O
2006 MAR 14 ;66(5):A322-A322, Neurology
— id: 104258, year: 2006, vol: 66, page: A322, stat: Journal Article,

Acute language changes following epilepsy surgery
Morrison, CE; Barr, WB; Doyle, W; Carlson, C; Zaroff, CM; Devinsky, O
2006 MAR ;47(1):101-102, Epilepsia
— id: 104251, year: 2006, vol: 47, page: 101, stat: Journal Article,

Pediatric language mapping: Effectiveness of neurostimulation and Wada testing
Schevon, C; Carlson, C; Zaroff, C; Weiner, H; Kuzniecky, R; Devinsky, O
2006 MAR 14 ;66(5):A68-A68, Neurology
— id: 104256, year: 2006, vol: 66, page: A68, stat: Journal Article,

Hypersynchronous margins identify epileptogenic tubers
Schevon, CA; Carlson, C; Cappell, J; Emerson, RG; Devinsky, O; Weiner, HL
2006 MAR ;47(1):46-46, Epilepsia
— id: 104249, year: 2006, vol: 47, page: 46, stat: Journal Article,

Pediatric language mapping: Sensitivity of neurostimulation and Wada testing in epilepsy surgery
Weiner, HL; Schevon, C; Carlson, C; Doyle, W; Miles, D; LaJoie, J; Kuzniecky, R; Devinsky, O
2006 AUG ;59(2):480-481, Neurosurgery
— id: 104252, year: 2006, vol: 59, page: 480, stat: Journal Article,

Epilepsy surgery in young children with tuberous sclerosis: results of a novel approach
Weiner, Howard L; Carlson, Chad; Ridgway, Emily B; Zaroff, Charles M; Miles, Daniel; LaJoie, Josiane; Devinsky, Orrin
2006 May;117(5):1494-1502, Pediatrics
OBJECTIVE: Tuberous sclerosis complex (TSC) is associated with medically refractory epilepsy and developmental delay in children and usually results from cortical tubers. Seizures that begin in young patients are often refractory and may contribute to development delay. Functional outcome is improved when seizures are controlled at an early age. Previous reports have shown modest benefit from surgical resection of single tubers/seizure foci in older children; however, many children with TSC develop uncontrolled seizures before age 1. To identify patients who might benefit from surgery and to maximize outcome, we used a novel surgical approach in young children that consists of invasive intracranial monitoring, which is typically 3-staged and often bilateral. METHODS: Of 110 consecutive children who underwent epilepsy surgery by a single surgeon in the past 6 years, 25 patients (9 boys and 16 girls) had TSC. At the time of their first surgery at our institution, they were a median age of 4.0 years. A total of 31 separate admissions for epilepsy surgery in these 25 patients were identified. Bilateral electrode placement was performed in 13 children whose seizures could not be lateralized definitively preoperatively, and 22 patients underwent 3-stage surgeries. RESULTS: At 6 months or longer after the initial resection, 21 (84%) children were class I, 2 (8%) children were class II, and 2 (8%) children were class IV. At a mean follow-up of 28 months, 17 (68%) children were class I, 6 (24%) were class II, and 2 (8%) were class III. Four of the 5 children who initially were rejected as surgical candidates because of multifocality and who required initial bilateral electrode study are now seizure-free. CONCLUSIONS: This approach can help to identify both primary and secondary epileptogenic zones in young TSC patients with multiple tubers. Multiple or bilateral seizure foci are not necessarily a contraindication to surgery. Long-term follow-up will determine whether this approach has durable effects
— id: 64210, year: 2006, vol: 117, page: 1494, stat: Journal Article,

Mental retardation and relation to seizure and tuber burden in tuberous sclerosis complex
Zaroff, Charles M; Barr, William B; Carlson, Chad; LaJoie, Josiane; Madhavan, Deepak; Miles, Daniel K; Nass, Ruth; Devinsky, Orrin
2006 Oct;15(7):558-562, Seizure
In patients with tuberous sclerosis complex (TSC), the high rates of mental retardation are associated with cortical tubers, seizure activity, and genetic factors. The goal of the study was to investigate the relationship between bilateral cortical tubers and seizure variables and mental retardation in individuals with TSC. The records of 27 patients with TSC (age 6 months to 33 years) undergoing neuropsychological assessment and the following clinical variables were examined: bilateral versus non-bilateral cortical tubers, the age of seizure onset, and presence of infantile spasms. Results were statistically analyzed. Bilateral cortical tubers (p=0.02) and early age of seizure onset (p=0.04) were significantly related to impaired cognitive functioning. Only one of the seven patients with normal cognitive functioning had bilateral tubers, whereas 13/21 patients with intellectual impairment had bilateral tubers. Patients with normal cognitive functioning experienced a mean age of seizure onset after 6 years. A trend was observed between infantile spasms and cognitive functioning (p=0.06); the lack of statistical significance likely reflects the small sample size. Neither age nor gender was related to cognitive status. Further investigation incorporating additional neuroimaging factors, antiepileptic treatment effects, and genetic variables, is needed
— id: 69073, year: 2006, vol: 15, page: 558, stat: Journal Article,

Vacuum cleaner epilepsy
Carlson, Chad; St Louis, Erik K
2004 Jul 13;63(1):190-191, Neurology
— id: 79551, year: 2004, vol: 63, page: 190, stat: Journal Article,