Neuroscience Centre Research Articles

Hyponatremia Incidence After Subarachnoid Hemorrhage and Association with Outcomes: Systematic Review and Meta-Analysis.

Hyponatremia after aneurysmal subarachnoid hemorrhage (aSAH) is common; however, the incidence, and association with vasospasm, morbidity, and mortality, has yet to be defined. We aimed to identify incidence of hyponatremia after aSAH, and quantify its association with measurable outcomes. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis was conducted (international prospective register of systematic reviews ID CRD42022363472). Articles published in MEDLINE, Embase, and Cochrane Library between January 1990 and January 2024 were included. Hyponatremia definitions, incidence during admission, and association among vasospasm, length of hospital stay, and poor outcome (Glasgow Outcome Scale 3 or less) were identified. Pooled incidence rates and binary and continuous outcomes were calculated using random effects meta-analysis models. In total, 52 studies (10,512 patients) were included. Most studies included patients admitted to tertiary neuroscience centers (61.5%, N= 32), or critical care units (23.1%, N= 11). Sodium of less than 135 mmol/L was the most commonly used hyponatremia definition (84.6%, N= 44). The pooled incidence of hyponatremia was 37.0% (95% confidence interval [CI]: 31.7%-42.4%). Hyponatremia increased the risk of vasospasm (15 studies; odds ratio: 2.93; 95% CI: 1.77-4.84), and length of hospital stay (3studies, 16.4 days vs. 8.0 days, mean difference 8.5 [95% CI: 4.6-12.4]), but was not associated with poor outcome (10 studies; odds ratio 1.15; 95% CI 0.44-3.02). These findings remained when carrying out sensitivity analysis for different hyponatremia and outcome definitions, bias, and aSAH populations. Hyponatremia is common in aSAH, may increase the likelihood of vasospasm, but in isolation does not appear to affect overall outcomes. Managing hyponatremia effectively should be a priority for treating clinicians.

Spontaneous blinking and brain health in aging: Large-scale evaluation of blink-related oscillations across the lifespan.

Blink-related oscillations (BROs) are newly discovered neurophysiological brainwave responses associated with spontaneous blinking, and represent environmental monitoring and awareness processes as the brain evaluates new visual information appearing after eye re-opening. BRO responses have been demonstrated in healthy young adults across multiple task states and are modulated by both task and environmental factors, but little is known about this phenomenon in aging. To address this, we undertook the first large-scale evaluation of BRO responses in healthy aging using the Cambridge Centre for Aging and Neuroscience (Cam-CAN) repository, which contains magnetoencephalography (MEG) data from a large sample (N = 457) of healthy adults across a broad age range (18-88) during the performance of a simple target detection task. The results showed that BRO responses were present in all age groups, and the associated effects exhibited significant age-related modulations comprising an increase in sensor-level global field power (GFP) and source-level theta and alpha spectral power within the bilateral precuneus. Additionally, the extent of cortical activations also showed an inverted-U relationship with age, consistent with neurocompensation with aging. Crucially, these age-related differences were not observed in the behavioral measures of task performance such as reaction time and accuracy, suggesting that blink-related neural responses during the target detection task are more sensitive in capturing aging-related brain function changes compared to behavioral measures alone. Together, these results suggest that BRO responses are not only present throughout the adult lifespan, but the effects can also capture brain function changes in healthy aging-thus providing a simple yet powerful avenue for evaluating brain health in aging.

Etiological features of status epilepticus of the in-patient cohort in Tibet: A retrospective comparative study.

The etiology of status epilepticus (SE) in Tibet has not yet been reported. We aimed to establish the etiological baseline of SE in the Tibet Autonomous Region in China and compare it with a SE cohort from a regional neuroscience centre in Sichuan, Southwestern China to reveal whether there was a unique etiology distribution in the Tibetan region. We retrospectively captured clinical data of patients diagnosed with SE in the People's Hospital of Xizang Autonomous Region from January 2015 to December 2020. Control data were recorded during the same period from West China Hospital of Sichuan University, Sichuan Province. Clinical and etiology evaluations were conducted by 4 neurologists using a standard case report form. A total of 619 patients were enrolled, among whom 318 were from the Tibetan cohort. The median age of the Tibetan cohort was 37.5 years, with 109 (34.3%) being women. The main etiology in the Tibetan cohort was uncontrolled persistent epilepsy (70.1%, N = 223). Compared to the control cohort, the proportion of patients in Tibet whose SE could be controlled was higher (97.5% vs 81.1%, p<.001) and the proportion of patients with refractory SE was lower (8.8% vs 35.2%, p<.001). Among the 223 patients with epilepsy who developed SE, 111 had never been treated with anti-seizure medication, and 52 (23.3%) were judged only to have received inappropriate treatment of epilepsy. Forty patients (17.9%) were only receiving treatment with traditional Tibetan medicine for epilepsy prior to admission. Patients with epilepsy of infectious etiology were seen in 37 patients in Tibetan cohort. In twenty-eight patients neurocysticercosis was identified as the cause of epilepsy. And in two patients, the cause of epilepsy was brain hydatid. The main etiology of SE in the Tibet Autonomous Region was unsatisfactory seizure control in patients with pre-existing epilepsy, while a greater proportion of epilepsy due to infectious causes was noted. Improved education for physicians and patients is needed to improve the management of epilepsy and SE in this population.

Primary Ewing's Sarcoma affecting the Central Nervous System: A single-center experience and Narrative review.

Ewing's sarcoma (EWS) is a malignant round-cell tumor arising from the bone and soft tissue. It is a disease of children and young adults. EWS affecting the central nervous system (cranial and spinal column) is relatively rare with an annual incidence of approximately one case per million in the Western population. Due to their rarity, very few studies are available in the literature. We present our experience of managing 21 such cases, highlighting their clinical, and radiological findings, treatment strategy, and surgical outcomes in patients with primary EWS affecting the central nervous system. We retrospectively collected hospital records of patients with primary EWS affecting the CNS (cranial and spinal column), who had been surgically treated in our Neuroscience Center between 2015 and 2023. Patients' demographics, presentation, radiological findings, treatment strategy including surgery and biopsy followed by adjuvant therapy, and outcome at discharge, and the latest follow-up were analyzed from our database. There were sixteen male and five female patients with a mean age of 18.22 ± 12.73years (ranging from 6months to 59years). The commonest presentation was headache and vomiting in cranial lesions (5/13 patients, 38.46%), and back pain in spinal lesions (4/8 patients, 50%). The site of lesions was cranial in thirteen patients (61.9%) and spinal column in eight patients (38.1%). The commonest site was the frontal region in the cranial group (6 patients, 46.15%) and the lumbar region in the spinal group (4 patients, 50%). All patients underwent surgical intervention [tumor resection (18) and biopsy (3)]. Tumor resection was achieved in 18 patients (85.71%). The extent of resection was gross-total excision in 9 patients (42.86%), near-total excision in 5 patients (23.8%), and tumor decompression in 4 patients (19%). Four patients underwent spinal instrumentation. Fifteen patients (71.42%) received multiagent chemo-radiotherapy according to institute protocol. Five patients (23.8%) with poor KPS expired within 6months of surgery and could not receive adjuvant therapy. Two patients (9.52%) improved symptomatically, and nine patients (42.86%) remained asymptomatic at a mean follow-up of 25.1 ± 29months. One patient (4.76%) after receiving 2 cycles of adjuvant therapy had initial improvement but expired later due to disease progression. Four patients after adjuvant chemo-radiotherapy (19%) expired due to systemic spread. Primary EWS affecting the central nervous system is a rare variety. A detailed radiological assessment can aid in adequate planning for safe maximal resection. Timely tissue diagnosis is essential for initiating early treatment. Radical excision followed by adjuvant therapy offers a favorable outcome. Postoperative adjuvant chemo-radiotherapy aids in optimal disease control and surgical outcome. With the current treatment strategy, good surgical outcomes can be achieved. However, metastasis is not uncommon and should be evaluated regularly.

Neurorights Training of a Multidisciplinary Studentship Based on Realistic Neuroscience

As is usually the case with other topics addressed by neuroethics, a rigorous analysis of neurorights requires an interdisciplinary approach. In response to this need and in the context of the global expansion of regulatory initiatives on neurorights, we coordinated, under the auspices of the International Center for Neuroscience and Ethics (CINET), an introductory course on neurorights from a neuroscientific perspective. The course, aimed at sixty students from diverse backgrounds (neuroscience, psychology, and law, among others), consisted of a 10-hr training that showed the current approaches and discussions on neurorights and outlined cutting-edge technologies to register, analyze, and manipulate human brain activity from a realistic stance. The course succeeded in discarding some concerns and uncovering others not frequently found in the neurorights discussions. The most pressing issues identified were protecting brain data privacy, combating bias in algorithms used in neurotechnology, and improving informed consent mechanisms for interventions with invasive neuroscientific techniques.

THE PREVALENCE OF URINARY TRACT INFECTIONS WITH MULTIPLE SCLEROSIS PATIENTS

Background: Multiple sclerosis (MS) is an autoimmune disease characterized by the demyelination of axons in the central nervous system (CNS). Urinary tract infection (UTI) affects millions of people each year. UTI is a common risk factor that worsens attacks in patients with MS. Aims: The commonest pseudo exacerbations in patients with MS is UTI, in addition to the influence of UTI on disease activity and development; therefore, the research aims to study the prevalence of urinary tract Methods: The current study included sixty MS patients aged 15-57 years from May 2023 to March 2024 in MS clinic at Imam Al- Hussein medical city in Kerbala, Saad Al-Witry Hospital for Neuroscience in Baghdad and MS clinic at Middle Euphrates center for Neuroscience in Najaf. Ten ml of urine samples were collected from MS patients, and a general urine examination (GUE) was done. The urine sample was inoculated into the culture media, after which VITEK diagnosed it. Results: The UTI prevalence in patients with MS was about 23%; E. coli was the most frequent, while other bacteria were less frequent, ranging between (15-7%). Discussion: UTI infection is a risk factor in autoimmune diseases. Conclusions: Multiple sclerosis patients are likely to have UTI. They are community- and hospital-acquired, especially because of E. coli. In addition to autoimmune diseases, it is a risk of systemic infections.

Predicting brain age with global-local attention network from multimodal neuroimaging data: Accuracy, generalizability, and behavioral associations

Brain age, an emerging biomarker for brain diseases and aging, is typically predicted using single-modality T1-weighted structural MRI data. This study investigates the benefits of integrating structural MRI with diffusion MRI to enhance brain age prediction. We propose an attention-based deep learning model that fuses global-context information from structural MRI with local details from diffusion metrics. The model was evaluated using two large datasets: the Human Connectome Project (HCP, n = 1064, age 22–37) and the Cambridge Center for Aging and Neuroscience (Cam-CAN, n = 639, age 18–88). It was tested for generalizability and robustness on three independent datasets (n = 546, age 20–86), reproducibility on a test-retest dataset (n = 44, age 22–35), and longitudinal consistency (n = 129, age 46–92). We also examined the relationship between predicted brain age and behavioral measures. Results showed that the multimodal model improved prediction accuracy, achieving mean absolute errors (MAEs) of 2.44 years in the HCP dataset (sagittal plane) and 4.36 years in the Cam-CAN dataset (axial plane). The corresponding R2 values were 0.258 and 0.914, respectively, reflecting the model's ability to explain variance in the predictions across both datasets. Compared to single-modality models, the multimodal approach showed better generalization, reducing MAEs by 10–76 % and enhancing robustness by 22–82 %. While the multimodal model exhibited superior reproducibility, the sMRI model showed slightly better longitudinal consistency. Importantly, the multimodal model revealed unique associations between predicted brain age and behavioral measures, such as walking endurance and loneliness in the HCP dataset, which were not detected with chronological age alone. In the Cam-CAN dataset, brain age and chronological age exhibited similar correlations with behavioral measures. By integrating sMRI and dMRI through an attention-based model, our proposed approach enhances predictive accuracy and provides deeper insights into the relationship between brain aging and behavior.

Sex differences in brain MRI using deep learning toward fairer healthcare outcomes.

This study leverages deep learning to analyze sex differences in brain MRI data, aiming to further advance fairness in medical imaging. We employed 3D T1-weighted Magnetic Resonance images from four diverse datasets: Calgary-Campinas-359, OASIS-3, Alzheimer's Disease Neuroimaging Initiative, and Cambridge Center for Aging and Neuroscience, ensuring a balanced representation of sexes and a broad demographic scope. Our methodology focused on minimal preprocessing to preserve the integrity of brain structures, utilizing a Convolutional Neural Network model for sex classification. The model achieved an accuracy of 87% on the test set without employing total intracranial volume (TIV) adjustment techniques. We observed that while the model exhibited biases at extreme brain sizes, it performed with less bias when the TIV distributions overlapped more. Saliency maps were used to identify brain regions significant in sex differentiation, revealing that certain supratentorial and infratentorial regions were important for predictions. Furthermore, our interdisciplinary team, comprising machine learning specialists and a radiologist, ensured diverse perspectives in validating the results. The detailed investigation of sex differences in brain MRI in this study, highlighted by the sex differences map, offers valuable insights into sex-specific aspects of medical imaging and could aid in developing sex-based bias mitigation strategies, contributing to the future development of fair AI algorithms. Awareness of the brain's differences between sexes enables more equitable AI predictions, promoting fairness in healthcare outcomes. Our code and saliency maps are available at https://github.com/mahsadibaji/sex-differences-brain-dl.

Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data Analysis.

The optimal management of CSF drainage in acute hydrocephalus, in particular when to initiate drain weaning, remains uncertain. This study aimed to evaluate the impact of timing and method of drain weaning on patient outcomes. This prospective observational study in a large-volume tertiary neuroscience centre included all adult patients who required temporary CSF drainage for acute hydrocephalus of any cause between January 2020 and March 2021. Contemporaneous data collection was conducted, including patient demographics, time to clamp, weaning methods, and clinical outcomes of hospital length of stay (LOS), rate of shunt insertion, drain-related infections, and mechanical complications. Univariate and multivariate statistical analyses were performed to identify the independent associations of timing-related factors. A total of 69 patients were included (mean age = 59.4 years). A total of 59% had CSF diversion for aneurysmal subarachnoid haemorrhage, and 88% had EVD drainage. The length of drainage prior to the first clamp was significantly associated with the overall length of drainage (p < 0.0001), LOS (p = 0.004), and time to shunt (p = 0.02) following multivariate adjustment. For each day delayed in initiating the drain challenge, the overall LOS increased by an additional 1.25 days. There was no association between the weaning method and LOS, the rate of shunting, or CNS infection; however, those in the gradually weaned group had more mechanical complications, such as drain blockage or CSF leakage, than those rapidly weaned (p = 0.03) after adjustment. This study recommends challenging the drain early via a rapid wean to reduce LOS, mechanical complications, and possibly infections. The consequences of temporary CSF diversion have significant implications at financial and patient levels, but the quality of evidence regarding weaning remains poor. Further randomised multicentre studies and national databases of practice are required to allow definitive conclusions to be drawn.

Intracranial vasculopathy with MR vessel wall imaging: a case series.

Conventional luminal imaging, often the first line investigation, has helped physicians in diagnosing countless patients with cerebrovascular disease but regrettably, it offers little diagnostic clues in patients with challenging vasculopathy, which the latter often requires invasive histopathological diagnosis. In past decade, MR vessel wall imaging has quickly emerged as a non-invasive modality that greatly enhances radiologists' capability of differentiating underlying aetiology. Not only it minimizes surgical trauma to patients, but also provide timely and accurate diagnosis for physicians to offer prompt appropriate treatment and avoid devastating outcomes. Tuen Mun Hospital, the neuroscience centre serving more than 1.3 million population in New Territories, Hong Kong, has been the pioneer in optimizing this novel modality within the district. In this article, we hope to share few interesting cases in our centre on how we utilize its advantage in solving some challenging cases. We would also discuss some common imaging pitfalls and tips on interpretation.

Relationship Between Demographic Characteristics and Application of Instructional Program Concerning Self-Management Strategies of Patients with Epilepsy

Objective(s): The current study aims to determine the influence of demographic characteristics of patients with epilepsy on the application of instruction program for self-management strategies. Methodology: The study utilized a quasi-experimental (non-randomized) design at Al-Najaf Al-Ashraf City, within the Al-Najaf Al-Ashraf Health Directorate, specifically at The Middle Euphrates Neurosciences Center, from August 13, 2023, to November 13, 2023. The purposive sample comprised 87 patients, divided into two groups: the study group, consisting of 44 patients exposed to the instructional program, and the control group, consisting of 43 patients not exposed to the program. The research tools included a demographic questionnaire and an Epilepsy Self-Management Scale (ESMS) from Dr. Colleen Dilorio, which includes 38 questions measuring 5 subscales related to epilepsy self-management for people with epilepsy. Statistical calculations were performed using SPSS software version 22. Results: The study results showed no statistically significant differences between demographic characteristics and the application of instruction program for self-management strategies (P&gt;0.05). However, there were statistically significant differences between the patient's marital status and application of instruction program for safety and information self-management strategies, with a small size effect. Conclusions: The study concluded that there are no statistically significant differences between demographic characteristics and the application of instruction program for self-management strategies overall. Recommendations: The study recommended that the Ministry of Health implement a self-management program for patients with epilepsy.

Developing feasible person-centred care alternatives to emergency department responses for adults with epilepsy: a discrete choice analysis mixed-methods study.

Calls have been made for paramedics to have some form of care pathway that they could use to safely divert adults with epilepsy away from emergency departments and instigate ambulatory care improvements. Different configurations are possible. To know which to prioritise for implementation/evaluation, there is a need to determine which are acceptable to service users and likely National Health Service-feasible. (1) Identify configurations being considered, (2) understand service users' views of them and current provision, (3) identify what sort of care service users want and (4) determine which configuration(s) is considered to achieve optimal balance in meeting users' preference and being National Health Service-feasible. Service providers were surveyed to address objective 1. Interviews with service users addressed objective 2. Objective 3 was addressed by completing discrete choice experiments. These determined users' care preferences for different seizure scenarios. Objective 4 was addressed by completing 'knowledge exchange' workshops. At these, stakeholders considered the findings on users' stated preferences and judged different pathway configurations against Michie's 'acceptability, practicability, effectiveness, affordability, side-effects and equity' feasibility criteria. This project took place in England. The survey recruited representatives from neurology and neuroscience centres and from urgent and emergency care providers. For the interviews, recruitment occurred via third-sector support groups. Recruitment for discrete choice experiments occurred via the North West Ambulance Service NHS Trust and public advert. Workshop participants were recruited from neurology and neuroscience centres, urgent and emergency care providers, support groups and commissioning networks. Seventy-two services completed the survey. Interviews were conducted with 25 adults with epilepsy (and 5 relatives) who had emergency service contact in the prior 12 months. Discrete choice experiments were completed by 427 adults with epilepsy (and 167 relatives) who had ambulance service contact in the prior 12 months. Workshops were completed with 27 stakeholders. The survey identified a range of pathway configurations. They differed in where they would take the patient and their potential to instigate ambulatory care improvements. Users had been rarely consulted in designing them. The discrete choice experiments found that users want a configuration of care markedly different to that offered. Across the seizure scenarios, users wanted their paramedic to have access to their medical records; for an epilepsy specialist (e.g. an epilepsy nurse, neurologist) to be available to advise; for their general practitioner to receive a report; for the incident to generate an appointment with an epilepsy specialist; for the care episode to last < 6 hours; and there was a pattern of preference to avoid conveyance to emergency departments and stay where they were. Stakeholders judged this configuration to be National Health Service-feasible within 5-10 years, with some elements being immediately deployable. The discrete choice experiment sample was broadly representative, but those reporting recent contact with an epilepsy specialist were over-represented. Users state they want a configuration of care that is markedly different to current provision. The configuration they prefer was, with support and investment, judged to likely be National Health Service-feasible. The preferred configuration should now be developed and evaluated to determine its actual deliverability and efficacy. The study is registered as researchregistry4723. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/62) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 24. See the NIHR Funding and Awards website for further award information.

Pre-thymectomy disease severity predicts outcome in acetylcholine receptor antibody-positive generalised myasthenia gravis.

There are only a few studies exploring post-thymectomy outcome in patients with acetylcholine receptor antibody (AChR-Ab)-positive generalised myasthenia gravis (MG). To assess the predictors of outcome in patients with AChR-Ab-positive generalised MG who underwent thymectomy. A retrospective study of 53 patients from a single neuroscience centre in the UK. The mean disease duration from diagnosis was 6.2 ± 4.3years. Pre-thymectomy, 37 patients had mild weakness affecting muscles other than ocular muscles, 11 patients had moderate weakness and 5 patients had severe weakness. 27/53 patients had thymoma. Post-thymectomy (mean duration of 5.7 ± 4.2years), 34 patients (64%) had a good outcome characterised by Myasthenia Gravis Foundation of America Post-Intervention Status of complete stable remission (no symptoms or signs of MG for at least 1year without any therapy) or pharmacological remission (no symptoms or signs of MG with some form of therapy) or minimal manifestations (no symptoms of functional limitations from MG but weakness on examination of some muscles with or without some form of therapy) on last follow-up visit. Having thymomatous or non-thymomatous MG did not predict the outcome. The only variable that did predict outcome was pre-thymectomy disease severity; patients with mild weakness before thymectomy had a favourable outcome. We found an accuracy of 83% predicting outcome (95% confidence interval (CI) 60%, 100%) with a sensitivity of 84% (95% CI 68%, 94%) and specificity of 81% (95% CI 54%, 96%). Disease severity before thymectomy predicts outcome in patients with AChR-Ab-positive generalised MG.

BOLD Cerebrovascular Reactivity and NOVA Quantitative MR Angiography in Adult Patients with Moyamoya Vasculopathy Undergoing Cerebral Bypass Surgery.

Revascularization surgery for the symptomatic hemisphere with hemodynamic impairment is effective for Moyamoya vasculopathy patients. However, careful patient selection is crucial and ideally supported by advanced quantitative hemodynamic imaging. Recently, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) and quantitative magnetic resonance angiography with non-invasive optimal vessel analysis (qMRA-NOVA) have gained prominence in assessing these patients. This study aims to present the results of BOLD-CVR and qMRA-NOVA imaging along with the changes in cerebral hemodynamics and flow status following flow augmentation with superficial temporal artery-middle cerebral artery (STA-MCA) bypass in our Moyamoya vasculopathy patient cohort. Symptomatic patients with Moyamoya vasculopathy treated at the Clinical Neuroscience Center of the University Hospital Zurich who underwent hemodynamic and flow imaging (BOLD-CVR and qMRA-NOVA) before and after bypass were included in the analysis. Reduced hemispheric volume flow rates, as well as impaired BOLD-CVR, were measured in all 12 patients with Moyamoya vasculopathy before STA-MCA bypass surgery. Following the surgical procedure, post-operative BOLD-CVR demonstrated a non-significant increase in BOLD-CVR values within the revascularized, symptomatic middle cerebral artery territory and cerebral hemisphere. The results of the statistical tests should be viewed as indicative due to the small sample size. Additionally, post-operative qMRA-NOVA revealed a significant improvement in the hemispheric volume flow rate of the affected hemisphere due to the additional bypass flow rate. Our findings affirm the presence of hemodynamic and flow impairments in the symptomatic hemisphere of the Moyamoya vasculopathy patients. Bypass surgery proves effective in improving both BOLD-CVR impairment and the hemispheric volume flow rate in our patient cohort.

IMG-21. HOW CAN WE BEST UTILISE HISTORICAL IMAGING DATASETS FOR RESEARCH IN PAEDIATRIC NEURO-ONCOLOGY? A REVIEW OF HISTORICAL PRE-OPERATIVE IMAGING PERFORMED FOR 92 PAEDIATRIC BRAIN TUMOUR PATIENTS WITH COMPARISON TO 2021 SIOPE GUIDELINES

Abstract BACKGROUND Utilisation of historical imaging is important for studying long-term outcomes in paediatric brain tumours often pooling data across multiple centres retrospectively over many years. Disparities in MRI sequence parameters, imaging planes, fields of view and resolution limit quantitative radiomic analysis and segmentation algorithms. We review historical imaging datasets, analysing the MRI scans performed assessing suitability for modern research techniques. METHODS Retrospective review of presenting MRI scans was performed in 92 paediatric brain tumour patients between 2006-2020. Whether imaging was performed internally at our paediatric neurosciences centre or externally at their referring hospitals was recorded. Image sequences, planes and slice thickness were compared with 2021 SIOPE guidelines for paediatric brain tumour imaging. T2 signal intensities for tumour, white and grey matter were compared for scans completed in different centres. Statistical testing was performed with T-Test and Paired T-Test. RESULTS 75% of patients had all SIOPE essential sequences and 60.9% were in the recommended planes. Only 1 patient had the desired slice thickness in all sequences recommended for 1.5T scanners. 38.5% had T1 and 27.8% had post-contrast T1 in the ≤1mm slice thickness recommended for 3T scanners. Comparison between 62 internal and 30 external scans revealed statistically significant differences in T2 signal intensities for regions of interest (ROI) within tumour, white and grey matter (p&amp;lt;0.01). Comparison of matched ROI for 12 patients imaged internally and externally demonstrated statistically significant differences in T2 signal intensities (p&amp;lt;0.05). Differences persisted despite normalisation of T2 signal intensity as ratios between tumour and the weighted mean of white and grey matter (p&amp;lt;0.01). CONCLUSIONS This study highlights the challenges of non-standardisation of imaging resolution and acquisition parameters in historical imaging. One approach to utilise these datasets is to use qualitative classifications where human experts label imaging features and encode data for future statistical or machine learning analysis.

Illness perceptions, experiences of stigma and engagement in functional neurological disorder (FND): exploring the role of multidisciplinary group education sessions

BackgroundA critical first step in managing functional neurological disorder (FND) is a positive diagnosis and clear explanation using an understandable illness model. Multidisciplinary group education sessions are one way to...

Assessment of Gamma Knife Stereotactic Radiosurgery as an Adjuvant Therapy in First-Line Management of Newly Diagnosed Glioblastoma: Insights from Ten Years at a Neuroscience Center

Gamma knife radiosurgery (GKRS), a form of stereotactic radiosurgery (SRS), has gained importance in treating glioblastoma alongside conventional chemotherapy. This study aims to assess the efficacy of combining GKRS with surgery and chemotherapy to enhance treatment outcomes for glioblastoma patients. This prospective clinical study, adhering to STROBE guidelines, assessed 121 glioblastoma patients from June 2008 to December 2022. All patients who had not undergone prior radiotherapy underwent open surgical tumor resection, GKRS, and adjuvant chemotherapy. In the analyzed cohort, the median survival post-diagnosis was 21.2 months (95% CI: 11.4–26.7) and the median progression-free survival was 13.6 months (95% CI: 12.5–28.3). The median time to first recurrence post-treatment was 14.5 months (range: 4–33 months). The median prescribed dose for GKRS was 12 Gy (range: 10–17 Gy), with a median target volume of 6.0 cm3 (range: 1.6–68 cm3). Post GKRS, 92 patients experienced local recurrence, 21 experienced distant recurrence, and 87 received additional treatment, indicating diverse responses and treatment engagement. This study evaluates the use of GKRS for glioblastomas, emphasizing its efficacy and complications in a single-center trial. It suggests integrating GKRS into initial treatment and for recurrences, highlighting the comparable survival rates but underscoring the need for further research.

Intrinsic functional connectivity among memory networks does not predict individual differences in narrative recall

Abstract Individuals differ greatly in their ability to remember the details of past events, yet little is known about the brain processes that explain such individual differences in a healthy young population. Previous research suggests that episodic memory relies on functional communication among ventral regions of the default mode network (“DMN-C”) that are strongly interconnected with the medial temporal lobes. In this study, we investigated whether the intrinsic functional connectivity of the DMN-C subnetwork is related to individual differences in memory ability, examining this relationship across 243 individuals (ages 18-50 years) from the openly available Cambridge Center for Aging and Neuroscience (Cam-CAN) dataset. We first estimated each participant’s whole-brain intrinsic functional brain connectivity by combining data from resting-state, movie-watching, and sensorimotor task scans to increase statistical power. We then examined whether intrinsic functional connectivity predicted performance on a narrative recall task. We found no evidence that functional connectivity of the DMN-C, with itself, with other related DMN subnetworks, or with the rest of the brain, was related to narrative recall. Exploratory connectome-based predictive modeling (CBPM) analyses of the entire connectome revealed a whole-brain multivariate pattern that predicted performance, although these changes were largely outside of known memory networks. These results add to emerging evidence suggesting that individual differences in memory cannot be easily explained by brain differences in areas typically associated with episodic memory function.

EfficientNet Transfer Learning Approach for Multi-Class Brain Tumor Classification

- It can be difficult for radiologists to accurately diagnose brain tumors in the medical field. When radiologists manually identify tumors, it can result in incorrect treatment planning and medical errors. The Miami Neuroscience Center states that there are 120 different kinds of brain tumors that can impact an individual's brain. Brain tumors that are most common and dangerous include glioma, meningioma, and pituitary tumors. In this work, we developed an online diagnostic tool to accurately classify brain tumors, including Astrocytoma, Glioma, Meningioma, Neurocytoma and Pituitary. Additionally, our program is capable of classifying a normal brain. We added CT and MRI scan images to improve cross-modality and model capability. We employed the CNN based neural network architecture known as EfficientNet. With this model, we achieved over 93.4% accuracy. Our application will help the radiologist identify tumors quickly and promote better treatment planning. Key words: Deep Learning, Transfer Learning, CNN, MRI, CT, Multi-Class Classification.

Cross-sectional evaluation of health resource use in patients with functional neurological disorders referred to a tertiary neuroscience centre

IntroductionFunctional neurological disorder (FND) is a common cause of referral to neurology services. FND has been shown to lead to significant healthcare resource use and is associated with significant disability,...