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Reinnervation is effective in the management of UVFP, although the specific method may be dictated by anatomical limitations. Prospective studies utilizing uniform and consistent outcome parameters are necessary.

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Seizure spread into autonomic and respiratory brainstem regions is thought to play an important role in sudden unexpected death in epilepsy (SUDEP). As the clinical dataset of cases of definite SUDEP available for study grows, evidence points to a sequence of events that includes postictal apnea, bradycardia, and asystole as critical events that can lead to death. One possible link between the precipitating seizure and the critical postictal sequence is seizure-driven laryngospasm sufficient to completely obstruct the airway for an extended period, but ictal laryngospasm is difficult to fully assess. Herein, we demonstrate in a rat model how the electrical artifacts of attempts to inspire during airway obstruction and features of the cardiac rhythm establish this link between ictal and postictal activity and can be used as practical biomarkers of obstructive apnea due to laryngospasm or other causes of airway obstruction.

Previous studies ha ve evaluated the effe cts of como rbidity on survival in patient s with cance r. We app lied the Charlson comorbidity index (CCl) to a coho rt ofpatients with laryngeal cance r to validate its use and to assess the prognosti c impact of age . Our study p opulation consisted of 152 patients with laryngeal cance r who we re see n ove r a JO-yearperiod. Patient s we re ass igned CCl sco res and were catego rized into low-and high -grade como rbidity groups fo r comparison. Age adjustm ents we re p erformed by adding 1 p oint to the Charl son sco re f or each decad e ove r the median age.Low-vs. highgrade comorbidity was a valid predictor of survival independ ent of TNM (tum or, nodes, and m etastases) stage. Low-grade comorbidity was present in 126 patients; their median survival was 41 months. Highgrade comorbidity was p resent in 26 patients ; their median survival was 8 mon ths (p = 0.0002). The addition of the age factor to the CCl did not improve our prognostic ability. There was no difference in CCI groups with respect to tobacco and alcohol use, gender, treatment modality, or mean time to recurrence. The incidence and severity of complications were also similar in the two groups .We conclude that the CCI is a stro ng predictor of surv ival in patient s with laryngeal cance r. The conf ounding effects of com orbidity sho uld be considere d in the TNM stag ing of laryngeal cance r to improve our p rognosti c ability. Further investigat ions are necessary to assess the validity ofthis ind ex in patients with othe r head and neck cance rs.

Patient-related factors such as age and gender were not significant in predicting disease-specific outcome. Important tumor-related factors were the American Joint Committee on Cancer stage and the T stage. Among the oropharyngeal subsites, squamous cell carcinoma of the base of tongue was associated with the worst outcome.

Sudden unexpected death in epilepsy (SUDEP) claims the lives of one in every thousand epileptic patients each year. Autonomic, cardiac, and respiratory pieces to a mechanistic puzzle have not yet been completely assembled. We propose a single sequence of causes and effects that unifies disparate and competitive concepts into a single algorithm centered on ictal obstructive apnea. Based on detailed animal studies that are sometimes impossible in humans, and striking parallels with a growing body of clinical examples, this framework (1) accounts for the autonomic, cardiac, and respiratory data to date by showing the causal relationships between specific elements, and (2) highlights specific kinds of data that can be used to precisely classify various patient outcomes. The framework also justifies a "near miss" designation to be applied to any cases with evidence of obstructive apnea even, and perhaps especially, in individuals that do not require resuscitation. Lastly, the rationale for preventative oxygen therapy is demonstrated. With better mechanistic understanding of SUDEP, we suggest changes for detection and classification to increase survival rates and improve risk stratification.