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Noninvasive Imaging, Earlier Surgery Can Stop Seizures in Tuberous Sclerosis Complex

By MedImaging International staff writers
Posted on 15 Mar 2010

When medication fails to control seizures in children with tuberous sclerosis complex (TSC), a rare genetic disorder that affects multiple organ systems and frequently causes epilepsy, surgery to remove part of the brain is frequently necessary. However, presurgical testing, which involves the implanting of electrodes into a child's head, can lead to longer hospital stays and greater risks from surgery. Now, a study has determined that an alternative, noninvasive approach to presurgical testing, along with earlier consideration for surgery, is associated with the best seizure-free surgical outcome in patients with TSC.

The study was led by researchers from the University of California, Los Angeles' (UCLA; USA) Pediatric Epilepsy Surgery Program. "Surgery to remove the portion of the brain causing the epilepsy is the most successful treatment for children with TSC and intractable epilepsy, but mapping which parts to take out can be challenging in a disease with multiple tubers in the brain and therefore multiple potential seizure-generating regions,” said lead study author Dr. Joyce Wu, an associate professor of pediatric neurology at Mattel Children's Hospital at UCLA. "The standard test of implanting electrodes into the patient's head is uncomfortable, leads to a prolonged hospital stay with increased costs, and potentially increases the risks from surgery. Our study looked at the effectiveness of our noninvasive, diagnostic imaging approach, which appeared to work just as well.”

The study is the first to examine UCLA's noninvasive approach, which utilizes a combination of magnetic resonance imaging (MRI), fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic source imaging (MSI) to identify the area of brain to be removed. The study's findings demonstrated that approximately two-thirds of TSC patients became seizure-free after surgery. The noninvasive results were similar to the traditional surgical testing method of implanting electrodes into the patient's head for several days of monitoring.

Researchers also unexpectedly discovered that shorter seizure duration before surgery was associated with the best chance of children with TSC becoming seizure-free following surgery. Therefore, they reported, it is important to consider surgery early, when medications fail to control seizures. The study findings were published in the February 2, 2010, issue of Neurology, the medical journal of the American Academy of Neurology.

Up to 90% of patients with TSC have epilepsy, with a significant portion suffering from medication-resistant (intractable) epilepsy. For these patients, surgical removal of the tuber and surrounding cerebral cortex may offer seizure freedom.

The study included 28 TSC patients with intractable epilepsy referred to UCLA between 2000 and 2007. In addition to the standard presurgical evaluation, these patients had MSI and FDG-PET/MRI coregistration. None had the invasive intracranial test. Of these patients, 18 (64%) underwent surgical resection, and of those, 12 (67%) were seizure-free postoperatively with an average follow up of 4.1 years.

The study also confirmed that a younger age at surgery and shorter seizure duration were associated with postoperative freedom of seizures. Since epilepsy in children can be severely debilitating, early diagnosis and treatment are vital in helping a child reach full cognitive potential.

Anya, now two-and-a-half years old, underwent the surgery at UCLA when she was 16 months, after suffering up to 30 seizures a day and her medications not working effectively. Dr. Wu and her team suggested that Anya be evaluated for surgery to remove the offending tubers. It has been more than a year since her seven-hour operation, and she is still seizure-free. "TSC is a pretty devastating disease,” said Anya's mother, Anita Smith, who wrote an article about her daughter's condition for a parenting website. "It's important for parents to know that they do not have to put their child through so many invasive tests and that surgery can be more successful if it's done earlier.”

The next stage of research will focus on applying this approach to non-TSC patients, encouraging earlier considerations for surgery, reporting seizure outcomes after longer postoperative follow-ups, and assessing long-term developmental outcomes. "UCLA is one of the few centers with the ability and experience to treat kids with this rare disorder,” said senior author Dr. Gary Mathern, professor of neurosurgery at UCLA. "By developing improved technologies to help these young patients, we hope to make a difference in their lives.”

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57 (!!!!! 1132.9650878906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

58 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

59 (!!!!! 3049.1352081299): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

60 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

61 (!!!!! 1401.1859893799): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (514.98413085938): SELECT fid FROM jos_deeppockets WHERE id=294728493 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728493 AND published='1' LIMIT 1

63 (442.0280456543): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (67.949295043945): select jos_twitters.link from jos_twitters where cat=10

65 (43.869018554688): select jos_facebook.link from jos_facebook where cat=10

66 (43.153762817383): select jos_google_plus.link from jos_google_plus where cat=10

67 (42.915344238281): select jos_linkedin.link from jos_linkedin where cat=10

68 (76.055526733398): SELECT fid FROM jos_deeppockets WHERE id=294728493 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728493 AND published='1' LIMIT 1

69 (50.067901611328): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (358.81996154785): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728493 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (335.9317779541): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728493 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (52.928924560547): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (69.856643676758): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728493 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (32.901763916016): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728493 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.954879760742): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (74.863433837891): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

105 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

106 (63.180923461914): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294728493 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294728493 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

109 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

110 (66.995620727539): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294728493 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (499.01008605957): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294728493 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (609.15946960449): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (516.17622375488): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

115 (119.92454528809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

116 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

117 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

118 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

119 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

120 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

121 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

122 (359.05838012695): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 20619.15397644): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (484.94338989258): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728493 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728493 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7447.0043182373): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (186.92016601562): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (459.90943908691): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (51.021575927734): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (242.94853210449): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (53.882598876953): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (260.1146697998): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (38.14697265625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (220.06034851074): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (547.88589477539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (405.07316589355): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (221.96769714355): SELECT name FROM jos_deeppockets WHERE id=212

138 (33.140182495117): SELECT name FROM jos_deeppockets WHERE id=212

139 (696.18225097656): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (478.98292541504): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

142 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

143 (!!!!! 8774.0421295166): TRUNCATE TABLE jos_trademed_module

144 (109.19570922852): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294728493 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (77.962875366211): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294728493 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (723.12355041504): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

149 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

150 (!!!!! 1174.9267578125): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

152 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

153 (57.93571472168): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728493 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728493 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (41.007995605469): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (32.901763916016): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (35.04753112793): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (404.11949157715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

158 (124.93133544922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728493 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728493 AND published='1' LIMIT 1

159 (83.92333984375): select jos_twitters.link from jos_twitters where cat=10

160 (77.009201049805): select jos_facebook.link from jos_facebook where cat=10

161 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

162 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

163 (390.05279541016): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1013.9942169189): insert into jos_banners_delta values (14615,'2025-06-28 13:37:04','216.73.216.249','view'),(14202,'2025-06-28 13:37:04','216.73.216.249','view'),(14203,'2025-06-28 13:37:04','216.73.216.249','view')

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