The aim of this study is to determine the strength and accuracy of diffusion tensor imaging (DTI) parameters to predict neurological injury and recovery in adult cervical spinal cord injury (SCI). DTI magnetic resonance imaging (MRI) was performed on 23 acute cervical SCI patients within 12 h after injury and on 45 controls utilizing a rapid DTI sequence (∼5 min). Neurological assessments were conducted from within 24 h of injury up to 6 months utilizing detailed International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examinations. Spearman correlation and receiver operating characteristic (ROC) analysis were used to identify relationships between the DTI parameters at the lesion epicenter and adjacent regions, with injury severity and recovery. In proximity to the anatomical injury (within one level above and below epicenter), there was significant reduction in fractional anisotropy (FA), and elevation in mean diffusivity (MD) and radial diffusivity (RD). DTI values measured one level rostral to the injury epicenter showed stronger correlations with multiple clinical features at several time-points. Area under the curve (AUC) obtained from ROC analysis showed FA (AUC = 0.77) measured at lesion epicenter, and FA (0.83), MD (0.76), and RD (0.83) values measured immediately rostral (one level above) to epicenter discriminate injury severity. Further, MD (0.78) measured at lesion epicenter, and MD (0.79) and RD (0.74) values measured immediately rostral to epicenter discriminate neurological recovery. DTI indices measured immediately rostral to the anatomical level of injury consistently showed better correlation (moderate to strong) and accuracy in predicting neurological injury (FA, r = −0.51 and RD, r = 0.54) and recovery (MD, r = −0.51) than indices measured at the epicenter. There was weak to moderate correlation of all measures at lesion epicenter in predicting neurological injury (FA: r = −0.48; MD: r = 0.23; RD: r = 0.34; axial diffusivity [AD]: r = 0.02) and recovery (FA: r = 0.27; MD: r = −0.44; RD: r = −0.35; AD: r = −0.34).

Imaging in the field of epilepsy surgery remains an essential tool in terms of its ability to identify regions where the seizure focus might present as a resectable area. However, in many instances, an obvious structural abnormality is not visualized. This has created the opportunity for new approaches and imaging innovation in the field of epilepsy, such as with Diffusion Tensor Imaging (DTI) and Diffusion Tensor Tractography (DTT). In this study, we aim to evaluate the use of DTI and DTT as a predictive model in the field of epilepsy, specifically Temporal Lobe Epilepsy (TLE), and correlate their clinical significance with respect to postsurgical outcomes. A hemispheric based analysis was used to compare the tract density, as well as DTI indices of the specific regions of interest from the pathologic hemisphere to the healthy hemisphere in TLE patients. A total of 22 patients with TLE (12 males, 10 females, 22–57 age range) underwent either a craniotomy, Anterior Temporal Lobectomy (ATL), or a less invasive method of Selective Laser Amygdalohippocampectomy (SLAH) and were imaged using 3.0 T Philips Achieva MR scanner. Of the participants, 12 underwent SLAH while 10 underwent ATL. The study was approved by the institutional review board of Thomas Jefferson University Hospital. Informed consent was obtained from all patients. All patients had a diagnosis of TLE according to standard clinical criteria. DTI images were acquired axially in the same anatomical location prescribed for the T1-weighted images. The raw data set consisting of diffusion volumes were first corrected for eddy current distortions and motion artifacts. Various DTI indices such as Fractional Anisotropy (FA), Mean Diffusivity (MD), Radial Diffusivity (RD) and Axial Diffusivity (AD) were estimated and co-registered to the brain parcellation map obtained by freesurfer. 16 consolidated cortical and subcortical regions were selected as regions of interest (ROIs) by a functional neurosurgeon and DTI values for each ROI were calculated and compared with the corresponding ROI in the opposite hemisphere. Also, track density imaging (TDI) of 68 white matter parcels were generated using fiber orientation distribution (FOD) based deterministic fiber tracking and compared with contralateral side of the brain in each epileptic group: left mesial temporal sclerosis (LMTS) and right MTS (RMTS)). In patients with LMTS, MD and RD values of the left hippocampus decreased significantly using two-tailed t-test (p = 0.03 and p = 0.01 respectively) compared to the right hippocampus. Also, RD showed a marginally significant decrease in left amygdala (p = 0.05). DTT analysis in LMTS shows a marginally significant decrease in the left white matter supramarginal parcel (p = 0.05). In patients with RMTS, FA showed a significant decrease in the ipsilateral mesial temporal lobe (p = 0.02), parahippocampal area (p = 0.03) and thalamus (p = 0.006). RD showed a marginally significant increase in the ipsilateral hippocampus (p = 0.05) and a significant increase in the ipsilateral parahippocampal area (p = 0.03). Also, tract density of the ipsilateral white matter inferior parietal parcel showed a marginally significant increase compared to the contralateral side (p = 0.05). With respect to postsurgical outcomes, we found an association between residual seizures and tract density in five white matter segments including ipsilateral lingual (p = 0.04), ipsilateral temporal pole (p = 0.007), ipsilateral pars opercularis (p = 0.03), ipsilateral inferior parietal (p = 0.04) and contralateral frontal pole (p = 0.04). These results may have the potential to be developed into imaging prognostic markers of postoperative outcomes and provide new insights for why some patients with TLE continue to experience postoperative seizures if pathological/clinical correlates are further confirmed.

There is a growing interest in the potential beneficial effects of mindfulness meditation training in protecting against age-related physical, emotional, and cognitive decline. The current prospective, single-center, single-arm study investigated if functional magnetic resonance imaging-based changes in cerebral blood flow and brain functional connectivity could be observed in 11 elderly adults (mean age 79) after participation in a Mindfulness-Based Stress Reduction (MBSR) program. The results showed significantly (p < 0.05) altered cerebral blood flow and functional connectivity in the cingulate gyrus, limbic structures, and subregions of the temporal and frontal lobes, similar to findings of other meditation-related studies in younger populations. Furthermore, these changes were also associated with significant improvements in depression symptoms. This study suggests that the MBSR program can potentially modify cerebral blood flow and connectivity in this population.

In the update of selegiline (27 November 1989, page 95) we concluded that the drug had not been proven to delay the progression of Parkinson’s disease. Interim results from the large DATATOP trial now provides strong evidence that selegiline 10mg/day delays the untreated disease (The Parkinson Study Group. N Engl J. Med 1989; 321: 1364–71). The report appeared after we had gone to press.