A review and meta-analysis of 42 group and ringlecase studies evaluating antecedent exercise (AE) as a means of reducing disrupti-behaviors was conducted.Of 16 group studies, 12 produced positive results and 4 produced negative results. The weighted mean effect size, expressed as Cohen's d, was .33 with a standard error of .08. Moderator analysis indicated that studies using direct behavioral obsewation, hyperactive subjects, or nonaerobic exercise obtained greater effects, and that studies of higher quality obtained weaker effects. Of 26 single-use studies, 22 produced positive msults, 1 produced no effect, and 3 produced negative results. The weighted mean effect size, expressed as d, was 1.99 with a standard error of .411. Among the single-subject studies, moderator analyses were unable t o detect statistically significant moderatom of effect size. Information was reviewed suggesting that AE is socially acceptable, can be implemented with treatment integrity, and has a benign side effoct profile. The extent t o which AE is functionally based remains open to question due to a lack of understanding regarding mechanism of action. Ten hypothesized mechanisms of action are briefly discussed.
Background: The stereoelectroencephalographic (SEEG) implantation procedures still represent a challenge due to the intrinsic complexity of the method and the number of depth electrodes required. Objectives: We aim at designing and evaluating the accuracy of a custom stereotactic fixture based on the StarFix™ technology (FHC Inc., Bowdoin, ME) that significantly simplifies and optimizes the implantation of depth electrodes used in presurgical evaluation of patients with drug-resistant epilepsy. Methods: Fiducial markers that also serve as anchors for the fixture are implanted into the patient's skull prior to surgery. A 3D fixture model is designed within the surgical planning software, with the planned trajectories incorporated in its design, aligned with the patient's anatomy. The stereotactic fixture is built using 3D laser sintering technology based on the computer-generated model. Bilateral rectangular grids of guide holes orthogonal to the midsagittal plane and centered on the midcommissural point are incorporated in the fixture design, allowing a wide selection of orthogonal trajectories. Up to two additional grids can be accommodated for targeting structures where oblique trajectories are required. The frame has no adjustable parts, this feature reducing the risk of inaccurate coordinate settings while simultaneously reducing procedure time significantly. Results: We have used the fixture for the implantation of depth electrodes for presurgical evaluation of 4 patients with drug-resistant focal epilepsy, with nearly 2-fold reduction in the duration of the implantation procedure. We have obtained a high accuracy with a submillimetric mean positioning error of 0.68 mm for the anchor bolts placed at the trajectory entry point and 1.64 mm at target. Conclusions: The custom stereotactic fixture design greatly simplifies the planning procedure and significantly reduces the time in the operating room, while maintaining a high accuracy.
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