Philip Grewe

Trends in epilepsy surgery: stable surgical numbers despite increasing presurgical volumes

Introduction Despite the success of epilepsy surgery, recent reports suggest a decline in surgical numbers. We tested these trends in our cohort to elucidate potential reasons. Patients and methods Presurgical, surgical and postsurgical data of all patients undergoing presurgical evaluation in between 1990 and 2013 were retrospectively analysed. Patients were grouped according to the underlying pathology. Results A total of 3060 patients were presurgically studied, and resective surgery was performed in 66.8% (n=2044) of them: medial temporal sclerosis (MTS): n=675, 33.0%; benign tumour (BT): n=408, 20.0%; and focal cortical dysplasia (FCD): n=284, 13.9%. Of these, 1929 patients (94.4%) had a follow-up of 2 years, and 50.8% were completely seizure free (Engel IA). Seizure freedom rate slightly improved over time. Presurgical evaluations continuously increased, whereas surgical interventions did not. Numbers for MTS, BT and temporal lobe resections decreased since 2009. The number of non-lesional patients and the need for intracranial recordings increased. More evaluated patients did not undergo surgery (more than 50% in 2010–2013) because patients were not suitable (mainly due to missing hypothesis: 4.5% in 1990–1993 up to 21.1% in 2010–2013, total 13.4%) or declined from surgery (maximum 21.0% in 2010–2013, total 10.9%). One potential reason may be that increasingly detailed information on chances and risks were given over time. Conclusions The increasing volume of the presurgical programme largely compensates for decreasing numbers of surgically remediable syndromes and a growing rate of informed choice against epilepsy surgery. Although comprehensive diagnostic evaluation is offered to a larger group of epilepsy patients, surgical numbers remain stable.

Learning real-life cognitive abilities in a novel 360°-virtual reality supermarket: a neuropsychological study of healthy participants and patients with epilepsy

BackgroundTo increase the ecological validity of neuropsychological instruments the use of virtual reality (VR) applications can be considered as an effective tool in the field of cognitive neurorehabilitation. Despite the growing use of VR programs, only few studies have considered the application of everyday activities like shopping or travelling in VR training devices.MethodsWe developed a novel 360°- VR supermarket, which is displayed on a circular arrangement of 8 touch-screens – the “OctaVis”. In this setting, healthy human adults had to memorize an auditorily presented shopping list (list A) and subsequently buy all remembered products of this list in the VR supermarket. This procedure was accomplished on three consecutive days. On day four, a new shopping list (list B) was introduced and participants had to memorize and buy only products of this list. On day five, participants had to buy all remembered items of list A again, but without new presentation of list A. Additionally, we obtained measures of participants’ presence, immersion and figural-spatial memory abilities. We also tested a sample of patients with focal epilepsy with an extended version of our shopping task, which consisted of eight days of training.ResultsWe observed a comprehensive and stable effect of learning for the number of correct products, the required time for shopping, and the length of movement trajectories in the VR supermarket in the course of the training program. Task performance was significantly correlated with participants’ figural-spatial memory abilities and subjective level of immersion into the VR.ConclusionsLearning effects in our paradigm extend beyond mere verbal learning of the shopping list as the data show evidence for multi-layered learning (at least visual-spatial, strategic, and verbal) on concordant measures. Importantly, learning also correlated with measures of figural-spatial memory and the degree of immersion into the VR. We propose that cognitive training with the VR supermarket program in the OctaVis will be efficient for the assessment and training of real-life cognitive abilities in healthy subjects and patients with epilepsy. It is most likely that our findings will also apply for patients with cognitive disabilities resulting from other neurological and psychiatric syndromes.

The Bergen left-right discrimination test: practice effects, reliable change indices, and strategic performance in the standard and alternate form with inverted stimuli

Several authors pointed out that left–right discrimination (LRD) tasks may be entangled with differential demands on mental rotation (MR). However, studies considering this interrelationship are rare. To differentially assess LRD of stimuli with varying additional demands on MR, we constructed and evaluated an extended version of the Bergen right–left discrimination (BRLD) test including additional subtests with inverted stickmen stimuli in 174 healthy participants (50♂, 124♀) and measured subjective reports on participants’ strategies to accomplish the task. Moreover, we analyzed practice effects and reliable change indices (RCIs) on BRLD performance, as well as gender differences. Performance significantly differed between subtests with high and low demands on MR with best scores on subtests with low demands on MR. Participants’ subjective strategies corroborate these results: MR was most frequently reported for subtests with highest MR demands (and lowest test performance). Pronounced practice effects were observed for all subtests. Sex differences were not observed. We conclude that our extended version of the BRLD allows for the differentiation between LRD with high and low demands on MR abilities. The type of stimulus materials is likely to be critical for the differential assessment of MR and LRD. Moreover, RCIs provide a basis for the clinical application of the BRLD.

OctaVis: An Easy-to-Use VR-System for Clinical Studies

We present the OCTAVIS system, a novel virtual reality platform developed for rehabilitation and training of patients with brain function disorders. To meet the special requirements of clinical studies, our system has been designed with ease of use, patient safety, ease of maintenance, space and cost efficiency in mind. Patients are sitting on a rotating office chair in the center of eight touch screen displays arranged in octagon around them, thereby providing a 360◦ horizontal panorama view. Navigation is intuitively controlled through chair rotation and a joystick in the armrest. A touch interface enables easy object selection. The OCTAVIS system has been successfully deployed to four hospitals. We report first results of clinical studies conducted with patients and control groups, demonstrating that our system is immersive, easy to use, and supportive for rehabilitation purposes.

OctaVis: A Virtual Reality System for Clinical Studies and Rehabilitation

Brain function disorders, resulting for instance from stroke, epilepsy, or other incidents can be partially recovered by rehabilitation training. Performing neuro-rehabilitation in virtual reality systems allows for training scenarios close to daily tasks, is easily adaptable to the patients’ needs, is fully controllable by clinical staff, and guarantees patient safety at all times. In this paper, we describe the OCTAVIS system, a novel virtual reality platform developed primary for clinical studies with and rehabilitation training of patients with brain function disorders. To meet the special requirements for clinical use, our system has been designed with ease of use, ease of maintenance, patient safety, space and cost efficiency in mind. Our system has been successfully deployed to four hospitals, where it is used for rehabilitation training and clinical studies. We report first results of these studies, demonstrating that our system is immersive, easy to use, and supportive for rehabilitation purposes.

Epilepsy Center Bethel, Bielefeld, Germany

The Epilepsy Center Bethel is part of the von Bodelschwingh Foundations of Bethel (von Bodelschwinghsche Stiftungen Bethel), a nongovernmental diaconal foundation originating from 1867 under the name: “Rheinisch–Westfälische Anstalt für Epileptische” (Rhenish–Westphalian asylum for epileptics). From the very beginning, the care of patients with epilepsy has been the focus of this institution, a factor which has continued to play a major role throughout its development. The Bodelschwingh Foundations of Bethel can be traced back to 1865 when a resolution was passed at a conference on “Care for Epileptics”, held by the protestant “Rhenish–Westphalian Provincial Council”. To overcome the precarious situation for – especially poor – patients with epilepsy, and as there were very few asylums available for these patients, it was proposed that an institution should be built for young, male patients with epilepsy who were still capable of being educated in Bielefeld. This proposal was acted on by a group of Christian industrialists and clergymen who purchased a small farm house at the periphery of Bielefeld in 1867. The first patients with epilepsy moved into this house in October of that year. Remarkably, the foundation was originally based on the principle of integration; long-term care of patients with epilepsy had not been the initial idea. While the first head was a teacher, from 1872, the institution was led by a protestant pastor whose ideas and engagement in Bethel had an impressive and enduring impact on the work for patients with epilepsy: Pastor Friedrich von Bodelschwingh. Under his leadership, the institution grew rapidly. It was realized that amajority of patients coming to Bethel were mentally or physically severely disabled and did not fulfill the original criterion of being able to undergo education or – in modern terms – rehabilitation and integration in Bielefeld. Pastor von Bodelschwingh thus, recognized that what the institution needed to do was provide “asylum” (i.e., a place to live and work), not only for patients with epilepsy, but also for the homeless or unemployed. He also initiated the expansion of the institution and the construction of new buildings to offer more space for patients with epilepsy and – as a novelty in those times – places for female and male patients in the same building where a group of deaconesses cared for the patients. This new nursing home was called “Bethel” meaning “House of God”, the name that was later applied to the entire institution and which is still used today. During subsequent years, Bethel expanded, and continued to increase its activities and provisions for patients. In 1874, a carpentry shop was set up as the first workshop, giving patients with epilepsy the opportunity to pursue meaningful work. Many additional workshops for patients with epilepsy followed; these became increasingly important for the

Disturbed spatial cognitive processing of body-related stimuli in a case of a lesion to the right fusiform gyrus

The fusiform gyrus (FG) is well known as one of the main neural sites of human face and body processing. We report the case of a young male patient with epilepsy and a circumscribed lesion in the right FG who presented with isolated impairments in spatial cognitive processing of body-related stimuli. However, he did not show any clinical signs of prosopagnosia. In particular, handling/processing of body and face stimuli was impaired, when stimuli were presented in unconventional views and orientations, thus requiring additional spatial cognitive operations. In this case study, we discuss the patient’s selective impairment from the view of current empirical and theoretical work on the segregation of functions in the FG.