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98 Cognitive Outcomes Following Bilateral Focused Ultrasound Thalamotomy for Tremor
- Jennifer Rabin, Georgia Gopinath, Melissa McSweeney, Camryn Rohringer, Nadia Scantlebury, Clement Hamani, Peter Giacobbe, Sean Nestor, Yana Yunusova, Richard Swartz, Michael Schwartz, Nir Lipsman, Agessandro Abrahao
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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. 197-198
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Objective:
Essential tremor (ET) is the most common movement disorder, characterized by bilateral action tremors of the upper extremities. Surgical interventions can be considered for severe cases that are refractory to medication. Magnetic resonance-guided focused ultrasound (MRgFUS) of the ventral intermediate nucleus of the thalamus (Vim) is a recently approved, minimally invasive treatment for unilateral tremor. While patients are generally pleased with unilateral treatment, many patients are bothered by tremor on the untreated side. Historically, bilateral thalamotomy has been associated with a higher rate of adverse events, including cognitive impairment. MRgFUS Vim thalamotomy for bilateral tremor is currently being investigated. The goal of the present study was to evaluate the effect of bilateral MRgFUS Vim thalamotomy on cognition.
Participants and Methods:Twelve patients with medication-refractory essential tremor (mean age = 68.77 +/- 11.78 years, mean education = 14.34 +/- 2.71 years, 8 male) were included in the present study. Three of the 12 patients met criteria for mild cognitive impairment (MCI). All patients successfully underwent unilateral MRgFUS thalamotomy at least 48 weeks before the second thalamotomy. A battery of neuropsychological tests was administered to patients before (considered baseline in the present study) and three months following the second thalamotomy. Baseline evaluations occurred on average 144.64 +/- 91.53 weeks (range: 55.00 - 346.58) after the first thalamotomy. The neuropsychological battery assessed domains of processing speed (Oral Symbol Digit Modalities Test, D-KEFS Color-Word Naming and Reading), attention (WAIS-IV Digit Span Forward), executive function (D-KEFS Color-Word Inhibition and Inhibition/Switching), working memory (WAIS-IV Digit Span Backward and Sequencing), verbal fluency (D-KEFS Letter Fluency and Animal Fluency), confrontation naming (Boston Naming Test), verbal memory (Hopkins Verbal Learning Test-Revised), and visuospatial perception (Judgment of Line Orientation). Alternate versions of tests were used when possible. Cognitive changes were analyzed at the group and individual level. Group level changes were assessed with paired sample t-tests (corrected for multiple comparisons). At the individual level, postoperative declines > 1.5 SD from baseline were considered clinically significant.
Results:Participants’ baseline intellectual functioning ranged from low average to superior (as measured by the WTAR). The mean baseline score on the Montreal Cognitive Assessment was 24.58 (range: 17 - 30). At the group level, there were no significant changes in cognitive scores from baseline to follow-up (all p values > 0.635). At the individual level, one patient with MCI declined > 1.5 SD on the verbal memory composite. No other patients showed declines > 1.5 SD.
Conclusions:Our preliminary findings suggest that bilateral MRgFUS Vim thalamotomy is relatively safe from a cognitive perspective. However, a single patient with MCI exhibited clinically significant postoperative decline in verbal memory. Future studies with larger sample sizes are needed to investigate the factors that increase the risk of postoperative cognitive decline, including pre-existing cognitive impairment, older age, and lesion size.
41 Characterizing the Cognitive Profile of Pediatric Insular Epilepsy
- Szimonetta Mulati, Jeffrey Bolton, Trey Moore, Brigitte Wilson, Song Dam, Alena Hornak, Katrina Boyer, Clemente Vega, Melissa Tsuboyama, Moshe Maiman, Phillip L Pearl
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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. 39-40
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Objective:
Little research exists characterizing the neuropsychological profile of pediatric insular epilepsy. Accurate diagnosis of insular epilepsy is challenging due to difficulties localizing deep brain structures with current non-invasive neurodiagnostic tools, as well as seizure semiology that may mimic temporal, frontal, and parietal seizures for this patient population [1]. Therefore, we investigated trends across neuropsychological data to help characterize the cognitive profile of pediatric insular epilepsy. This is important because studies that could accurately characterize insular epilepsy into cognitive phenotypes could potentially provide supporting evidence for insular localization during epilepsy surgery work-up. The insula is situated underneath the temporal, parietal, and frontal opercula, and has a number of diffuse projections to key brain structures involved in language, executive functioning, motor coordination, and sensory function [2]. Therefore, we hypothesized that children with insular epilepsy will demonstrate particular weaknesses in language and executive functioning skills.
Participants and Methods:Retrospective medical records review identified 19 children with insular epilepsy who completed neuropsychological assessment (Age: M=8.2 years, SD=3.4) at Boston Children’s Hospital. Insular epilepsy was defined by ictal insular localization on long-term monitoring EEG. The current sample includes 59% males and 41% females. The majority of participants (69%) had left sided lateralization and more than one seizure type (63%). MRI findings were widely distributed across frontal, temporal, and multiple lobes as well as insular and perisylvian brain regions. A lesion was identified on MRI findings for most participants (63%).
Results:Descriptive analyses showed that overall IQ (FSIQ: M=84, SD=12, range=68-102) fell in the Low Average range. Verbal and visual reasoning skills were equally developed in the Low Average range (VIQ: M=88, SD=12, range=70-104; PIQ: M=88, SD=16, range=53-117). Participants exhibited lower performance on speeded expressive language measures, including measures of phonemic fluency (M=5.5, SD=1.5, range=2-8) and semantic fluency (M=6.7, SD=2.5, range=3-11). With regard to executive functioning, reduced cognitive flexibility was observed on D-KEFS Trail Making Test (Trial 4, Number-Letter Switching: M=5.9, SD=4.9, range=1-12). Additionally, working memory skills fell in the Below Average range (WMIQ: M=77, SD=8.5, range=67-88).
Conclusions:Our results indicate that pediatric patients with insular epilepsy present with reduced scores across aspects of speeded expressive language and executive functioning, including working memory and cognitive flexibility. Additional research is needed to replicate these preliminary findings with a larger sample size and determine whether these trends in cognitive profile would help with seizure localization. Future research should investigate whether insular epilepsy has a clearly identifiable and distinct cognitive phenotype that could be helpful in differential diagnostic workup.
Agricultural Research Service Weed Science Research: Past, Present, and Future
- Stephen L. Young, James V. Anderson, Scott R. Baerson, Joanna Bajsa-Hirschel, Dana M. Blumenthal, Chad S. Boyd, Clyde D. Boyette, Eric B. Brennan, Charles L. Cantrell, Wun S. Chao, Joanne C. Chee-Sanford, Charlie D. Clements, F. Allen Dray, Stephen O. Duke, Kayla M. Eason, Reginald S. Fletcher, Michael R. Fulcher, John F. Gaskin, Brenda J. Grewell, Erik P. Hamerlynck, Robert E. Hoagland, David P. Horvath, Eugene P. Law, John D. Madsen, Daniel E. Martin, Clint Mattox, Steven B. Mirsky, William T. Molin, Patrick J. Moran, Rebecca C. Mueller, Vijay K. Nandula, Beth A. Newingham, Zhiqiang Pan, Lauren M. Porensky, Paul D. Pratt, Andrew J. Price, Brian G. Rector, Krishna N. Reddy, Roger L. Sheley, Lincoln Smith, Melissa C. Smith, Keirith A. Snyder, Matthew A. Tancos, Natalie M. West, Gregory S. Wheeler, Martin M. Williams, Julie Wolf, Carissa L. Wonkka, Alice A. Wright, Jing Xi, Lew H. Ziska
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- Journal:
- Weed Science / Volume 71 / Issue 4 / July 2023
- Published online by Cambridge University Press:
- 16 August 2023, pp. 312-327
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The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.
The Nature of Adjustments and Monitoring for Students With Special Educational Needs in Mainstream Schools
- Mark Carter, Amanda Webster, Jennifer Stephenson, Neale Waddy, Robert Stevens, Melissa Clements, Talia Morris
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- Journal:
- Australasian Journal of Special and Inclusive Education / Volume 46 / Issue 1 / July 2022
- Published online by Cambridge University Press:
- 27 September 2021, pp. 1-18
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The current study was conducted to examine the types of adjustments used to support students with special educational needs in mainstream classrooms and how schools monitored the effectiveness of the adjustments they use. A range of stakeholders were interviewed in 22 mainstream schools across New South Wales, Australia, and the interviews were analysed for key themes. Some schools had a narrow focus on a few key areas, with teaching assistants being the most commonly reported adjustment. Few schools used formal formative monitoring to evaluate the effectiveness of adjustments. Options for improvement schools could consider include examining the breadth of adjustments, establishing clear measurable goals, considering alternative strategies for use of teaching assistants, and ensuring adjustments are monitored.