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Background Extensive and complex vascular malformations often cause chronic pain and severe functional restraint. Conventional treatments, such as surgery and/or sclerotherapy, are rarely curative, underscoring the great need for new therapeutic modalities. Recent preclinical and clinical data demonstrated that sirolimus could offset the progression of vascular malformations and significantly improve quality of life of patients through inhibition of the Phosphatidylinositol-3-kinase (PI3K)/AKT/mammalian Target of Rapamycin (mTOR) pathway. The purpose of this prospective study was to assess the efficacy and safety of this treatment in patients with extensive or complex slow-flow vascular malformations. Methods Sirolimus was administered orally on a continuous dosing schedule with pharmacokinetic-guided target serum concentration level of 10 to 15 ng/ml. Patients were seen every month for the first three months and subsequently every three months. The primary endpoints were safety and efficacy, based on clinical, biological and radiological evaluations, as well as a quality of life questionnaire. Results Nineteen patients, from 3 to 64 years old, with lymphatic (LM), venous (VM) or complex slow-flow malformations, refractory to standard care, were enrolled and received sirolimus continuously. After 12 months of follow-up, 16 patients were available for assessment of efficacy and safety: all had a significant and rapid improvement of their symptoms and quality of life. In two patients, sirolimus treatment permitted sclerotherapy and surgery, initially evaluated unfeasible. Sirolimus was well tolerated, with mucositis as the most common (10% of patients) grade 3 adverse event. Conclusions Sirolimus was efficient in extensive LM, VM and/or complex malformations that were refractory to conventional treatments and was well tolerated.

Background Epilepsy is one of the most common neurological conditions worldwide. As a chronic condition, epilepsy imposes a significant burden on people with epilepsy and society. We aimed to assess the burden and unmet need of individuals with epilepsy and their caregivers, focusing on focal seizures, the main type of seizure in adults and children. Methods A targeted evidence review of the burden of epilepsy, focusing on focal seizures, was conducted to identify articles reporting: epidemiology, mortality, morbidity, quality of life (QoL), and costs. Results Focal seizures affect up to ∼61% of people with epilepsy. They are associated with an increased risk of injury and premature death than the general population. People with epilepsy also have high comorbidity, particularly depression, anxiety, and cognitive impairments. Higher seizure frequency, adverse treatment events, and employment concerns reduce QoL. A reduction in caregivers' QoL is also often reported. Epilepsy requires long‐term treatment accounting for high individual costs. Hospitalizations and antiseizure medications (ASMs) are the leading cost drivers of inpatient management and indirect costs with high unemployment rates, particularly in drug‐resistant populations. Despite the advent of new treatments, a high unmet need remains unaddressed; approximately 40% of people with epilepsy are drug‐resistant, further increasing the risks associated with epilepsy. Conclusions Our findings highlight a substantial burden of illness and unmet needs in individuals with focal seizures, especially those with drug‐resistant epilepsy. Suboptimal treatment options negatively impact QoL and, consequently, a sizeable economic burden indicating the need for new treatments and prioritizing this condition Seizure freedom is the ultimate goal for the treatment of focal epilepsy. A 30‐year study found that the probability of achieving seizure freedom decreases substantially with each additional antiseizure medication regimen attempted. If the first ASM is ineffective, the second ASM results in an 11.6% chance of seizure freedom, decreasing to 4.4% if a third drug is required. After this, only 2.1% achieved seizure control on subsequent ASM regimens.

Our knowledge on temporal lobe epilepsy (TLE) with hippocampal sclerosis has evolved towards the view that this syndrome affects widespread brain networks. Diffusion weighted imaging studies have shown alterations of large white matter tracts, most notably in left temporal lobe epilepsy, but the degree of altered connections between cortical and subcortical structures remains to be clarified. We performed a whole brain connectome analysis in 39 patients with refractory temporal lobe epilepsy and unilateral hippocampal sclerosis (20 right and 19 left) and 28 healthy subjects. We performed whole-brain probabilistic fiber tracking using MRtrix and segmented 164 cortical and subcortical structures with Freesurfer. Individual structural connectivity graphs based on these 164 nodes were computed by mapping the mean fractional anisotropy (FA) onto each tract. Connectomes were then compared using two complementary methods: permutation tests for pair-wise connections and Network Based Statistics to probe for differences in large network components. Comparison of pair-wise connections revealed a marked reduction of connectivity between left TLE patients and controls, which was strongly lateralized to the ipsilateral temporal lobe. Specifically, infero-lateral cortex and temporal pole were strongly affected, and so was the perisylvian cortex. In contrast, for right TLE, focal connectivity loss was much less pronounced and restricted to bilateral limbic structures and right temporal cortex. Analysis of large network components revealed furthermore that both left and right hippocampal sclerosis affected diffuse global and interhemispheric connectivity. Thus, left temporal lobe epilepsy was associated with a much more pronounced pattern of reduced FA, that included major landmarks of perisylvian language circuitry. These distinct patterns of connectivity associated with unilateral hippocampal sclerosis show how a focal pathology influences global network architecture, and how left or right-sided lesions may have differential and specific impacts on cerebral connectivity. •We computed the structural network of 39 temporal lobe epilepsy (TLE) patients.•Two strategies, pairwise connection analysis and network based statistics, were used.•Widespread disconnections were found in TLE patients with respect to controls.•Left TLE patients were much more affected than right TLE patients.•Left TLE showed a strongly lateralized fronto-temporal disconnection pattern.

In wild vertebrates, the increase of breeding success with advancing age has been extensively studied through laying date, clutch size, hatching success, and fledging success. However, to better evaluate the influence of age on reproductive performance in species with high reproductive success, assessing not only reproductive success but also other proxies of reproductive performance appear crucial. For example, the quality of developmental conditions and offspring phenotype can provide robust and complementary information on reproductive performance. In long-lived vertebrate species, several proxies of developmental conditions can be used to estimate the quality of the produced offspring (i.e., body size, body condition, corticosterone levels, and telomere length), and therefore, their probability to survive. By sampling chicks reared by known-aged mothers, we investigated the influence of maternal age on reproductive performance and offspring quality in a long-lived bird species, the snow petrel (Pagodroma nivea). Older females bred and left their chick alone earlier. Moreover, older females had larger chicks that grew faster, and ultimately, those chicks had a higher survival probability at the nest. In addition, older mothers produced chicks with a higher sensitivity to stress, as shown by moderately higher stress-induced corticosterone levels. Overall, our study demonstrated that maternal age is correlated to reproductive performance (hatching date, duration of the guarding period and survival) and offspring quality (body size, growth rate and sensitivity to stress), suggesting that older individuals provide better parental cares to their offspring. These results also demonstrate that maternal age can affect the offspring phenotype with potential long-term consequences.

Background and purposeSeizures represent a core symptom of autoimmune encephalitides with specific therapeutic issues. To date, patients with new-onset seizures or established epilepsy are not systematically tested for autoimmune antibodies. We aimed to identify clinical and paraclinical criterion that could help to select patients requiring additional autoimmune antibodies serum and cerebrospinal fluid (CSF) detection.MethodsIn this retrospective single center study from the French Salpêtrière Hospital, data from 286 adult patients with epilepsy who received an autoantibody assay for the first time were analyzed. All patients were evaluated at our institution between January 2007 and December 2018 for assessment of new-onset epilepsy (n = 90) or established epilepsy (n = 196). We only analyzed patients that were screened for autoimmune antibodies. Demographic, clinical and neuroimaging measures were compared between patients with and without autoimmune encephalitis using Fisher’s exact test for categorical variables and Welch’s t test for continuous variables. Our primary goal was to identify significant factors that differentiated patients with and without autoimmune encephalitis.ResultsWe identified 27 patients with autoimmune epilepsy (9.4% of the patients who had been tested for autoantibodies). The significant factors differentiating patients with and without autoimmune encephalitis were: (i) the existence of a new-onset focal epilepsy + (e.g., newly diagnosed epilepsy < 6 months associated with additional symptoms, mainly cognitive or psychiatric symptoms), (ii) the presence of faciobrachial dystonic seizures very suggestive of anti- Leucine-rich glioma inactivated 1 (LGI1) encephalitis, and (iii) the presence of magnetic resonance imaging (MRI) abnormalities suggestive of encephalitis.ConclusionNew-onset focal seizures combined with cognitive or psychiatric symptoms support the test for autoimmune antibodies. Further clinical already known red flags for an autoimmune origin are the presence of faciobrachial dystonic seizures and MRI signal changes consistent with encephalitis. On the other hand, isolated new-onset seizures and chronic epilepsy, even with associated symptoms, seem rarely linked to autoimmune encephalitis and should not lead to systematic testing.

Brain-computer interfaces (BCIs) have been largely developed to allow communication, control, and neurofeedback in human beings. Despite their great potential, BCIs perform inconsistently across individuals and the neural processes that enable humans to achieve good control remain poorly understood. To address this question, we performed simultaneous high-density electroencephalographic (EEG) and magnetoencephalographic (MEG) recordings in a motor imagery-based BCI training involving a group of healthy subjects. After reconstructing the signals at the cortical level, we showed that the reinforcement of motor-related activity during the BCI skill acquisition is paralleled by a progressive disconnection of associative areas which were not directly targeted during the experiments. Notably, these network connectivity changes reflected growing automaticity associated with BCI performance and predicted future learning rate. Altogether, our findings provide new insights into the large-scale cortical organizational mechanisms underlying BCI learning, which have implications for the improvement of this technology in a broad range of real-life applications. •We discovered that BCI skill acquisition depends on specific brain network changes.•These network changes predict the BCI learning rate in a longitudinal training.•Our results could pave the way to an improvement of the BCI performance.

In wild vertebrates, young parents are less likely to successfully rear offspring relative to older ones because of lower parental skills (‘the constraint hypothesis’), lower parental investment (‘the restraint hypothesis’) or because of a progressive disappearance of lower-quality individ-uals at young ages (‘the selection hypothesis’). Because it is practically difficult to follow an offspring during its entire life, most studies have only focused on the ability of individuals to breed or produce young, while neglecting the ability of such young to subsequently survive and reproduce. Several proxies of individual quality can be useful to assess the ability of young to survive and recruit into the population. Among them, telomere length measurement appears especially promising because telomere length has been linked to longevity and fit-ness in captive and wild animals. By sampling 51 chicks reared by known-aged parents, we specifically tested whether parental age was correlated to offspring telomere length and body condition in a long-lived bird species, the Black-browed Albatross (Thalassarche mela-nophrys). Young Black-browed albatrosses produced chicks with shorter telomere relative to those raised by older ones. Short offspring telomeres could result from poor developmental conditions or heritability of telomere length. Moreover, young parents also had chicks of lower body condition when compared with older parents, although this effect was significant in female offspring only. Overall, our study demonstrates that parental age is correlated to two proxies of offspring fitness (body condition and telomere length), suggesting therefore that older individuals provide better parental cares to their offspring because of increased parental investment (restraint hypothesis), better foraging/parental skills (constraint hypothesis) or because only high-quality individuals reach older ages (selection hypothesis).

In vertebrates, developmental conditions can affect not only fledging success but also the phenotype of the offspring, with potential long-term consequences on adult performance. However, surprisingly the potential impact of anthropogenic disturbance on developing chicks is rarely investigated, notably in Antarctic wildlife. In this study, we specifically investigated the effects of repeated nest visits, capture, and handling on offspring survival and several complementary offspring phenotypic traits in the Snow Petrel (Pagodroma nivea) chicks after thermal emancipation. We did not find any significant effect of our disturbance protocol on the morphology (body size, body mass, body condition), the physiology (breath rate, stress-induced corticosterone levels) and the behaviour (defense behaviour) of developing Snow Petrels. This specific disturbance protocol did not have any significant effect on chick survival, but there was a non-significant trend towards a lower survival for the disturbed group (p = 0.1006), which showed an especially high mortality during a period of repeated snow storms. To conclude, investigator disturbance seems to have little effect on Snow Petrel chicks after thermal emancipation, but to remain cautious, we recommend to avoid capture and handling of Snow Petrel chicks during or soon after inclement weather.

Background and purpose Around 30% of patients with epilepsy show drug‐resistant epilepsy (DRE). While cannabidiol has demonstrated efficacy as an adjunctive treatment in Dravet syndrome (DS), Lennox–Gastaut Syndrome (LGS), and epilepsy related to tuberous sclerosis complex (TSC), its more global effectiveness in adult patients with DRE apart from these three specific contexts needs to be clarified. Methods We conducted a retrospective study at the epilepsy unit of Pitié Salpêtrière Hospital. Patients initiating pharmaceutical cannabidiol treatment and followed for at least 1 year were included. Patients were categorized into “authorized” (LGS, DS, or TSC) and “off‐label” groups. Cannabidiol effectiveness and tolerance were compared between groups, and characteristics of responders (patients with >50% reduction in seizure frequency) in the off‐label group were examined. Results Ninety‐one patients, followed by a median duration of 24 months, were included. A total of 35.2% of the patients were in the authorized group. No significant differences were observed in responder rates between groups (31.3% vs. 35.6%, p = 0.85) and retention rates at 1 year (75.0% vs. 74.6%, p = 0.97). Sleepiness was more commonly reported in the authorized group (50.0% vs. 22.0%, p = 0.01), with no other significant differences. Among off‐label patients (n = 59), clobazam co‐prescription was more prevalent in responders (71.4% vs. 28.9%, p = 0.002). Conclusion Our findings suggest that cannabidiol may benefit all adult patients with DRE, particularly those already receiving clobazam. Randomized controlled trials are warranted in off‐label patients to validate these observational findings. We extracted all adult patients treated at our tertiary center with cannabidiol for pharmacoresistant epilepsy, with a follow‐up of at least 1 year, and evaluated the efficacy and retention based on the indication. We found similar efficacy and retention rates in patients with Lennox–Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex compared to other forms of pharmacoresistant epilepsy.

Songs naturally bind lyrics and melody into a unified representation. Using a subsequent memory paradigm, we examined the neural processes associated with binding lyrics and melodies during song encoding. Participants were presented with songs in two conditions: a unified condition (melodies sung with lyrics), and a separate condition (melodies sung with the syllable “la”). In both cases, written lyrics were displayed and participants were instructed to memorize them by repeating them covertly or by generating mental images of the songs. We expected the unified condition to recruit the posterior superior temporal gyrus, known to be involved in perceptual integration of songs, as well as the left inferior frontal gyrus (IFG). Conversely, we hypothesized that the separate condition would engage a larger network including the hippocampus to bind lyrics and melodies of songs, and the basal ganglia and the cerebellum to ensure the correct sequence coupling of verbal and musical information in time. Binding lyrics and melodies in the unified condition revealed activation of the left IFG, bilateral middle temporal gyrus (MTG), and left motor cortex, suggesting a strong linguistic processing for this condition. Binding in the separate compared to the unified condition revealed greater activity in the right hippocampus as well as other areas including the left caudate, left cerebellum, and right IFG. This study provides novel evidence for the role of the right hippocampus in binding lyrics and melodies in songs. Results are discussed in light of studies of binding in the visual domain and highlight the role of regions involved in timing and synchronization such as the basal ganglia and the cerebellum. •We examined the neural processes associated with binding lyrics and melodies during song encoding.•We dissociated two brain networks for memory binding following a unified or the separate presentation of lyrics and melodies.•The left IFG contributed to bind lyrics and melodies when presented in a unified song.•The right hippocampus was only predictive of successful memory in the separate condition.•The basal ganglia and the cerebellum seem to be additionally relevant for binding auditory information.