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32 Prediction of Seizure Outcome with Presurgical IAT, MRI, and PET in Patients with Temporal Lobe Epilepsy Undergoing Surgery
- Grant G Moncrief, Stephen L Aita, Jennifer Lee, Bryce Jacobson, George P Thomas, Robert M Roth, Angeline S Andrew, Krzysztof A Bujarski, Vijay M Thadani, Erik J Kobylarz, Stephen J Guerin, David W Roberts, Barbara C Jobst
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 31-32
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- Article
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Objective:
Anterior temporal lobectomy is a common surgical approach for medication-resistant temporal lobe epilepsy (TLE). Prior studies have shown inconsistent findings regarding the utility of presurgical intracarotid sodium amobarbital testing (IAT; also known as Wada test) and neuroimaging in predicting postoperative seizure control. In the present study, we evaluated the predictive utility of IAT, as well as structural magnetic resonance imaging (MRI) and positron emission tomography (PET), on long-term (3-years) seizure outcome following surgery for TLE.
Participants and Methods:Patients consisted of 107 adults (mean age=38.6, SD=12.2; mean education=13.3 years, SD=2.0; female=47.7%; White=100%) with TLE (mean epilepsy duration =23.0 years, SD=15.7; left TLE surgery=50.5%). We examined whether demographic, clinical (side of resection, resection type [selective vs. non-selective], hemisphere of language dominance, epilepsy duration), and presurgical studies (normal vs. abnormal MRI, normal vs. abnormal PET, correctly lateralizing vs. incorrectly lateralizing IAT) were associated with absolute (cross-sectional) seizure outcome (i.e., freedom vs. recurrence) with a series of chi-squared and t-tests. Additionally, we determined whether presurgical evaluations predicted time to seizure recurrence (longitudinal outcome) over a three-year period with univariate Cox regression models, and we compared survival curves with Mantel-Cox (log rank) tests.
Results:Demographic and clinical variables (including type [selective vs. whole lobectomy] and side of resection) were not associated with seizure outcome. No associations were found among the presurgical variables. Presurgical MRI was not associated with cross-sectional (OR=1.5, p=.557, 95% CI=0.4-5.7) or longitudinal (HR=1.2, p=.641, 95% CI=0.4-3.9) seizure outcome. Normal PET scan (OR= 4.8, p=.045, 95% CI=1.0-24.3) and IAT incorrectly lateralizing to seizure focus (OR=3.9, p=.018, 95% CI=1.2-12.9) were associated with higher odds of seizure recurrence. Furthermore, normal PET scan (HR=3.6, p=.028, 95% CI =1.0-13.5) and incorrectly lateralized IAT (HR= 2.8, p=.012, 95% CI=1.2-7.0) were presurgical predictors of earlier seizure recurrence within three years of TLE surgery. Log rank tests indicated that survival functions were significantly different between patients with normal vs. abnormal PET and incorrectly vs. correctly lateralizing IAT such that these had seizure relapse five and seven months earlier on average (respectively).
Conclusions:Presurgical normal PET scan and incorrectly lateralizing IAT were associated with increased risk of post-surgical seizure recurrence and shorter time-to-seizure relapse.
34 - Multimedia Learning with Hypermedia
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- By Andrew Dillon, University of Texas, Jennifer Jobst, University of Texas
- Edited by Richard Mayer, University of California, Santa Barbara
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- Book:
- The Cambridge Handbook of Multimedia Learning
- Published online:
- 05 June 2012
- Print publication:
- 15 August 2005, pp 569-588
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- Chapter
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Summary
Abstract
Hypermedia proponents suggest that its ability to make information available in a multitude of formats, provide individual control, engage the learner, and cater to various learning styles and needs makes it the harbinger of a new learning revolution. However, despite nearly two decades of research on hypermedia in education, researchers have not yet solved some of the basic issues raised by this technology. In this chapter, we review empirical studies performed since Dillon and Gabbard's (1998) landmark review in an attempt to analyze and draw conclusions from this diverse and extensive literature.
Introduction
Since Vannevar Bush's ground-breaking article As We May Think (Bush, 1945), the idea of using technology to link the world's information resources in new ways has been heralded by some as a revolutionary opportunity to design new instructional media. The term hypermedia is commonly used to refer to this type of information resources and is based on the term hypertext, coined by Ted Nelson around 1965 to refer to “nonsequential” or “nonlinear” text where authors and readers were free to explore and to link information in ways that made personal sense for them (Nelson, 1965). In general usage, the terms are often used interchangeably but to be strictly accurate, hypermedia consists of more than linked texts; it includes other forms of media as well, such as images, video, and sound.