摘要 :
Objective In patients with medically refractory epilepsy (MRE), interictal ripples (80–250Hz) are observed in large brain areas whose resection may be unnecessary for seizure freedom. This limits their utility as epilepsy biomark...
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Objective In patients with medically refractory epilepsy (MRE), interictal ripples (80–250Hz) are observed in large brain areas whose resection may be unnecessary for seizure freedom. This limits their utility as epilepsy biomarkers for surgery. We assessed the spatiotemporal propagation of interictal ripples on intracranial electroencephalography (iEEG) in children with MRE, compared it with the propagation of spikes, identified ripples that initiated propagation ( onset‐ripples ), and evaluated their clinical value as epilepsy biomarkers. Methods Twenty‐seven children who underwent epilepsy surgery were studied. We identified propagation sequences of ripples and spikes across multiple iEEG contacts and calculated each ripple or spike latency from the propagation onset. We classified ripples and spikes into categories (ie, onset , spread , and isolated ) based on their spatiotemporal characteristics and correlated their mean rate inside and outside resection with outcome (good outcome, Engel 1 versus poor outcome, Engel≥2). We determined, as onset‐zone , spread‐zone , and isolated‐zone , the areas generating the corresponding ripple or spike category and evaluated the predictive value of their resection. Results We observed ripple propagation in all patients and spike propagation in 25 patients. Mean rate of onset‐ripples inside resection predicted the outcome (odds ratio = 5.37; p = 0.02) and correlated with Engel class (rho = ?0.55; p = 0.003). Resection of the onset‐ripple‐zone was associated with good outcome ( p = 0.047). No association was found for the spread‐ripple‐zone , isolated‐ripple‐zone , or any spike‐zone. Interpretation Interictal ripples propagate across iEEG contacts in children with MRE. The association between the onset‐ripple‐zone resection and good outcome indicates that onset‐ripple s are promising epilepsy biomarkers, which estimate the epileptogenic tissue better than spread‐ripples or onset‐spikes. Ann Neurol 2018;84:331–346
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摘要 :
Background: Electroconvulsive therapy (ECT) is one of the commonly used treatment modalities for patients with severe mental disorders. However, acceptance of ECT by the patient and relatives often depends on how the health-care p...
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Background: Electroconvulsive therapy (ECT) is one of the commonly used treatment modalities for patients with severe mental disorders. However, acceptance of ECT by the patient and relatives often depends on how the health-care professionals themselves present the treatment modality to the patients and their relatives. There is a lack of information about the knowledge and attitude toward ECT among health professionals. Aim: This study aimed to evaluate the knowledge about and attitude toward ECT among nursing students. Methodology: Knowledge of and attitudes toward ECT among nursing students were assessed using ECT knowledge and attitude questionnaires. Results: The study included 183 nursing students. Majority ( n = 62; 60.8%) of the participants obtained information about ECT from media (movies, television, print media, etc.). None of the students had full knowledge about ECT. Although a significant proportion of students had knowledge about the ECT procedure and consent procedure, majority of them had poor knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitudes were also highly prevalent, with more than two-thirds of the participants having negative attitudes toward ECT on more than half of the attitude items of the scale. Total knowledge score positively correlated with total attitude score, suggesting that higher knowledge was associated with more positive attitude. Conclusions: Although nursing students have knowledge about basic ECT procedure and consent, they lack knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitude toward ECT is also highly prevalent among nursing students. Accordingly, there is a need to improve the knowledge and address the negative attitude of nursing students, which may ultimately lead to better acceptance of the treatment. K EYWORDS : Attitude , electroconvulsive therapy , knowledge , nurses , students
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