Brief potentially ictal rhythmic discharges on intraoperative electrocorticography predict a good outcome of focal cortical dysplasia after surgical resection: a case report

Background Focal cortical dysplasia(FCD)is a common cause of drug-resistant epilepsy.Electroencephalography(EEG)biomarkers that predict good postoperative outcomes are essential for identifying patients with focal epilepsies.Case presentation We report the case of a 21-year-old female with seizure onset at the age of 9,characterized by left-hand dystonic posturing and impaired awareness,which evolved to bilateral tonic-clonic seizures,evaluated in a neurological referral center in Lima,Peru.During 6-h video-EEG,interictal EEG revealing focal brief potentially ictal rhythmic discharges(BIRDs)over the right frontal central region,lasting less than 10 s.The ictal features were characterized by low-voltage fast activity over the same area.Brain magnetic resonance imaging(MRI)demonstrated a focal lesion of focal cortical dysplasia type II in the right frontal lobe.The patient underwent a lesionectomy guided by electrocorticography,which showed continuous polyspikes.BIRDs showing a brief burst of spikes lasting longer than 0.5 s,were also identified on intraoperative electrocorticography(ECoG)and helped define the extent of resection.The patient obtained an Engel Outcome Class IA at 6 years of follow-up.Conclusions The atypical BIRDs on ECoG can be used as a prognostic biomarker for prolonged seizure-freedom outcome in patients with epilepsy.Additional reports are needed in developing countries with and without brain MRI lesions to advance outpatient presurgical evaluations despite limited resources.

Impact,economic evaluation,and sustainability of integrated vector management in urban settings to prevent vector-borne diseases:a scoping review

Background:The control of vector-borne diseases(VBD)is one of the greatest challenges on the global health agenda.Rapid and uncontrolled urbanization has heightened the interest in addressing these challenges through an integrated vector management(IVM)approach.The aim was to identify components related to impacts,economic evaluation,and sustainability that might contribute to this integrated approach to VBD prevention.Main body:We conducted a scoping review of available literature(2000-2016)using PubMed,Web of Science,Cochrane,CINAHL,Econlit,LILACS,Global Health Database,Scopus,and Embase,as well as Tropical Diseases Bulletin,WHOLIS,WHO Pesticide Evaluation Scheme,and Google Scholar.MeSH terms and free-text terms were used.A data extraction form was used,including TIDieR and ASTAIRE.MMAT and CHEERS were used to evaluate quality.Of the 42 documents reviewed,30 were focused on dengue,eight on malaria,and two on leishmaniasis.More than a half of the studies were conducted in the Americas.Half used a quantitative descriptive approach(n=21),followed by cluster randomized controlled trials(n=11).Regarding impacts,outcomes were:a)use of measures for vector control;b)vector control;c)health measures;and d)social measures.IVM reduced breeding sites,the entomology index,and parasite rates.Results were heterogeneous,with variable magnitudes,but in all cases were favourable to the intervention.Evidence of IVM impacts on health outcomes was very limited but showed reduced incidence.Social outcomes were improved abilities and capacities,empowerment,and community knowledge.Regarding economic evaluation,only four studies performed an economic analysis,and intervention benefits outweighed costs.Costeffectiveness was dependent on illness incidence.The results provided key elements to analyze sustainability in terms of three dimensions(social,economic,and environmental),emphasizing the implementation of a community-focused eco-bio-social approach.Conclusions:IVM has an impact on reducing vector breeding sites and the entomology index,but evidence of impacts on health outcomes is limited.Social outcomes are improved abilities and capacities,empowerment,and community knowledge.Economic evaluations are scarce,and cost-effectiveness is dependent on illness incidence.Community capacity building is the main component of sustainability,together with collaboration,institutionalization,and routinization of activities.Findings indicate a great heterogeneity in the interventions and highlight the need for characterizing interventions rigorously to facilitate transferability.