fMRI can be used to detect asymmetries in memory activation in patients with TLE. Because fMRI studies are noninvasive and provide excellent spatial resolution for functional activation, these preliminary results suggest a promising role for fMRI in improving the preoperative evaluation for epilepsy surgery.

Results suggest that PTM is associated with cognitive impairments and protracted recovery and that headache alone is not a good predictor of recovery.

OBJECTIVE: Despite increases in education and awareness, many athletes continue to play with signs and symptoms of a sport-related concussion (SRC). The impact that continuing to play has on recovery is unknown. This study compared recovery time and related outcomes between athletes who were immediately removed from play and athletes who continued to play with an SRC. METHODS:A prospective, repeated measures design was used to compare neurocognitive performance, symptoms, and recovery time between 35 athletes (mean ± SD age, 15.61 ± 1.65 years) immediately removed after an SRC (REMOVED group) compared with 34 athletes (mean ± SD age, 15.35 ± 1.73 years) who continued to play (PLAYED group) with SRC. Neurocognitive and symptom data were obtained at baseline and at 1 to 7 days and 8 to 30 days after an SRC. RESULTS:The PLAYED group took longer to recover than the REMOVED group (44.4 ± 36.0 vs 22.0 ± 18.7 days; P = .003) and were 8.80 times more likely to demonstrate protracted recovery (≥21 days) (P < .001). Removal from play status was associated with the greatest risk of protracted recovery (adjusted odds ratio, 14.27; P = .001) compared with other predictors (eg, sex). The PLAYED group exhibited significantly worse neurocognitive and greater symptoms than the REMOVED group.CONCLUSIONS: SRC recovery time may be reduced if athletes are removed from participation. Immediate removal from play is the first step in mitigating prolonged SRC recovery, and these data support current consensus statements and management guidelines. Dr Elbin conceptualized and designed the study, conducted the analyses, interpreted the results, and drafted the initial manuscript; Dr Sufrinko coordinated data collection and management, assisted with data analysis and interpretation, and drafted the initial manuscript; Dr Schatz conducted statistical analyses and drafted the initial manuscript; Dr French assisted with data collection, statistical analysis and interpretation, and manuscript preparation; Dr Henry conceptualized and designed the study and drafted the initial manuscript; Dr Burkhart conceptualized and designed the study and interpreted the results; Dr. Collins interpreted the results and contributed to the manuscript; Dr Kontos conceptualized and designed the study, assisted with interpreting the results, and drafted the initial manuscript; and all authors approved the fi nal manuscript as submitted. DOI WHAT'S KNOWN ON THIS SUBJECT:Immediate removal from play is recommended for athletes with suspected concussion. The majority of concussions go unreported, and the catastrophic consequences of continuing to play with concussion are documented. The impact of removal from play on recovery outcomes is unknown. WHAT THIS STUDY ADDS:Athletes who were not removed from play took longer to recover and demonstrated worse neurocognitive and symptom outcomes after a sport-related concussion. Removal from play status is a new predictor for protracted recovery and supports consensus guidelines. 3,5,6 These guidelines are based on d...

The Epilepsy Innovation Institute (Ei2) is a new research program of the Epilepsy Foundation designed to be an innovation incubator for epilepsy. Ei2 research areas are selected based on community surveys that ask people impacted by epilepsy what they would like researchers to focus on. In their 2016 survey, unpredictability was selected as a top issue regardless of seizure frequency or severity. In response to this need, Ei2 launched the My Seizure Gauge challenge, with the end goal of creating a personalized seizure advisory system device. Prior to moving forward, Ei2 convened a diverse group of stakeholders from people impacted by epilepsy and clinicians, to device developers and data scientists, to basic science researchers and regulators, for a state of the science assessment on seizure forecasting. From the discussions, it was clear that we are at an exciting crossroads. With the advances in bioengineering, we can utilize digital markers, wearables, and biosensors as parameters for a seizure-forecasting algorithm. There are also over a thousand individuals who have been implanted with ambulatory intracranial EEG recording devices. Pairing up peripheral measurements to brain states could identify new relationships and insights. Another key component is the heterogeneity of the relationships indicating that pooling findings across groups is suboptimal, and that data collection will need to be done on longer time scales to allow for individualization of potential seizure-forecasting algorithms.

IMPORTANCE Recovery after concussion varies, with adolescents taking longer (approximately 30 days) than adults. Many factors have been reported to influence recovery, including preinjury factors, perceptions about recovery, comorbid conditions, and sex. However, 1 factor that may play a role in recovery but has received little attention from researchers is the timeliness of clinical evaluation and care. OBJECTIVE To investigate the association of time since injury with initiation of clinical care on recovery time following concussion. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study was conducted in a sports medicine clinic between August 2016 and March 2018. Eligible participants were aged 12 to 22 years and had a diagnosed, symptomatic concussion; patients were excluded if recovery data were incomplete. Participants were divided into 2 groups: those seen within 7 days of the injury (early) vs between 8 and 20 days of the injury (late). Data were analyzed between June 2019 and August 2019. EXPOSURES Time from injury (concussion) to initiation of clinical care. MAIN OUTCOMES AND MEASURES Recovery time; testing with the Post-Concussion Symptom Scale, Immediate Post-Concussion Assessment and Cognitive Testing, and Vestibular/Ocular Motor Screening instruments; demographic factors, medical history, and injury information. RESULTS A total of 416 individuals were eligible, and 254 (61.1%) were excluded, leaving 162 (38.9%) in analyses. The early group (98 patients) and late group (64 patients) did not differ in age (mean [SD] age, early, 15.3 [1.6] years; late, 15.4 [1.6] years), number of female patients (early, 51 of 98 [52.0%]; late, 40 of 64 [62.5%]), or other demographic, medical history, or injury information. The groups also were similar on symptom severity, cognitive, ocular, and vestibular outcomes at the first clinic visit. Results from a logistical regression supported being in the late group (adjusted odds ratio, 5.8 [95% CI, 1.9-17.6]; P = .001) and visual motion sensitivity symptoms greater than 2 (adjusted odds ratio, 4.5 [95% CI, 1.1-18.0]; P = .04) as factors significantly associated with recovery time.CONCLUSIONS AND RELEVANCE Findings suggest that earlier initiation of clinical care is associated with faster recovery after concussion. Other factors may also influence recovery time. Further research is needed to determine the role of active rehabilitation and treatment strategies, as well as demographic factors, medical history, and injury characteristics on the current findings.

Electrical stimulation of the vagus nerve, a recently available option for patients with refractory epilepsy, has demonstrated safety and efficacy. We report four patients with refractory epilepsy who experienced ventricular asystole intraoperatively during initial testing for implantation of the vagus nerve stimulator. Acute intraoperative vagus nerve stimulation may create ventricular asystole in humans. Extracorporeal cervical vagus nerve stimulation testing with continuous EKG monitoring intraoperatively before generator implantation is warranted.

The distribution of AED use likely reflects current prescribing patterns for PWWE cared for in USA tertiary epilepsy centers. This distribution has changed markedly since the turn of the century, but changes in the general population remain uncertain.

There is no accepted clinical imaging modality for concussion, and current imaging modalities including fMRI, DTI, and PET are expensive and inaccessible to most clinics/ patients. Functional near-infrared spectroscopy (fNIRS) is a non-invasive, portable, and low-cost imaging modality that can measure brain activity. The purpose of this study was to compare brain activity as measured by fNIRS in concussed and age-matched controls during the performance of cognitive tasks from a computerized neurocognitive test battery. Participants included nine currently symptomatic patients aged 18–45 years with a recent (15–45 days) sport-related concussion and five age-matched healthy controls. The participants completed a computerized neurocognitive test battery while wearing the fNIRS unit. Our results demonstrated reduced brain activation in the concussed subject group during word memory, (spatial) design memory, digit-symbol substitution (symbol match), and working memory (X’s and O’s) tasks. Behavioral performance (percent-correct and reaction time respectively) was lower for concussed participants on the word memory, design memory, and symbol match tasks than controls. The results of this preliminary study suggest that fNIRS could be a useful, portable assessment tool to assess reduced brain activation and augment current approaches to assessment and management of patients following concussion.