Cortical low-frequency power correlates with behavioral impairment in animal model of focal limbic seizures

OBJECTIVE

Impairment in consciousness is a debilitating symptom during and after seizures; however, its mechanism remains unclear. Limbic seizures have been shown to spread to arousal circuitry to result in a "network inhibition" phenomenon. However, prior animal model studies did not relate physiological network changes to behavioral responses during or following seizures.

METHODS

Focal onset limbic seizures were induced while rats were performing an operant conditioned behavioral task requiring response to an auditory stimulus to quantify how and when impairment of behavioral response occurs. Correct responses were rewarded with sucrose. Cortical and hippocampal electrophysiology measured by local field potential recordings was analyzed for changes in low- and high-frequency power in relation to behavioral responsiveness during seizures.

RESULTS

As seen in patients with seizures, ictal (p < .0001) and postictal (p = .0015) responsiveness was variably impaired. Analysis of cortical and hippocampal electrophysiology revealed that ictal (p = .002) and postictal (p = .009) frontal cortical low-frequency 3-6-Hz power was associated with poor behavioral performance. In contrast, the hippocampus showed increased power over a wide frequency range during seizures, and suppression postictally, neither of which were related to behavioral impairment.

SIGNIFICANCE

These findings support prior human studies of temporal lobe epilepsy as well as anesthetized animal models suggesting that focal limbic seizures depress consciousness through remote network effects on the cortex, rather than through local hippocampal involvement. By identifying the cortical physiological changes associated with impaired arousal and responsiveness in focal seizures, these results may help guide future therapies to restore ictal and postictal consciousness, improving quality of life for people with epilepsy.

Factors associated with patients not proceeding with proposed resective epilepsy surgery

BACKGROUND

This study evaluated the association between eligible patients not proceeding with resective epilepsy surgery and various demographic, disease-specific, and epilepsy-evaluation variables.

METHODS

This retrospective case-control study included patients identified as candidates for resective epilepsy surgery at the Montefiore Medical Center between January 1, 2009 and June 30, 2017. Chi-squared, two-tailed, independent sample t-test, Mann-Whitney U test and logistic regression were utilized to identify variables associated with patients not proceeding with surgery.

RESULTS

Among the 159 potential surgical candidates reviewed over the 8.5-year study period, only 53 ultimately proceeded with surgery (33%). Eighty-seven (55%) out of these 159 patients were identified as appropriate for resective epilepsy surgery during the study period. Thirty-four (39%) of these 87 patients did not proceed with surgery. Variables independently correlated (either positively or negatively) with the patient not proceeding with surgery were: being employed [Odds Ratio (OR) 4.2, 95% confidence interval (CI) 1.12-15.73], temporal lobe lesion on MRI (OR 0.35, 95% CI 0.14-0.84), temporal lobe EEG ictal onsets (OR 0.21, 95% CI 0.07-0.62), and temporal lobe epileptogenic zone (OR 0.19, 95% CI 0.07-0.55).

CONCLUSION

The novel finding in this study is the association between employment status and whether the patient had epilepsy surgery: employed patients were 4.2 times more likely to not proceed with surgery compared to unemployed patients. In addition, patients with a temporal lobe lesion on MRI, temporal lobe EEG ictal onsets, and/or a temporal epileptogenic zone were more likely to proceed with surgery. Future work will be needed to evaluate these findings prospectively, determine if they generalize to other patient populations, explore the decision whether or not to proceed with epilepsy surgery from a patient-centered perspective, and suggest strategies to reduce barriers to this underutilized treatment.

Structural Connectivity Gradients of the Temporal Lobe Serve as Multiscale Axes of Brain Organization and Cortical Evolution

The temporal lobe is implicated in higher cognitive processes and is one of the regions that underwent substantial reorganization during primate evolution. Its functions are instantiated, in part, by the complex layout of its structural connections. Here, we identified low-dimensional representations of structural connectivity variations in human temporal cortex and explored their microstructural underpinnings and associations to macroscale function. We identified three eigenmodes which described gradients in structural connectivity. These gradients reflected inter-regional variations in cortical microstructure derived from quantitative magnetic resonance imaging and postmortem histology. Gradient-informed models accurately predicted macroscale measures of temporal lobe function. Furthermore, the identified gradients aligned closely with established measures of functional reconfiguration and areal expansion between macaques and humans, highlighting their potential role in shaping temporal lobe function throughout primate evolution. Findings were replicated in several datasets. Our results provide robust evidence for three axes of structural connectivity in human temporal cortex with consistent microstructural underpinnings and contributions to large-scale brain network function.

Diurnal burden of spontaneous seizures in early epileptogenesis in the post-kainic acid rat model of epilepsy

Patients with epilepsy can experience diurnal seizure patterns. However, few studies in rodent models of temporal lobe epilepsy (TLE) routinely quantify the diurnal pattern of spontaneous recurrent seizures (SRS), and those that have conducted such assessments used small groups. This study thus aimed to define whether there was a diurnal pattern of SRS in the early phases of epileptogenesis in a large cohort (n = 40) of post-kainic acid (KA)-induced status epilepticus (SE) male Sprague Dawley rats. Rats were monitored by continuous 24/7 video-EEG in two-week epochs up to 6 weeks post-KA-induced SE. The total number of SRS by 6 weeks post-SE correlated to body weight at the time of SE insult (R2  = .1465, P = .0143). The total number of spontaneous behavioral and electrographic seizures, seizure severity, and seizure burden was recorded during lights ON (light) or lights OFF (dark) phases. All measures significantly increased with time post-SE; we detected significantly more seizures during the lights OFF phase of the post-SE monitoring periods. Moreover, a subset of rats demonstrated marked seizure preference in the lights OFF phase. Our study confirms that a diurnal pattern of SRS is variably detectable in early epileptogenesis in this model of TLE.

Reconfiguration dynamics of a language-and-memory network in healthy participants and patients with temporal lobe epilepsy

Current theoretical frameworks suggest that human behaviors are based on strong and complex interactions between cognitive processes such as those underlying language and memory functions in normal and neurological populations. We were interested in assessing the dynamic cerebral substrate of such interaction between language and declarative memory, as the composite function, in healthy controls (HC, N = 19) and patients with temporal lobe epilepsy (TLE, N = 16). Our assumption was that the language and declarative memory integration is based on a language-and-memory network (LMN) that is dynamic and reconfigures according to task demands and brain status. Therefore, we explored two types of LMN dynamics, a state reconfiguration (intrinsic resting-state compared to extrinsic state assessed with a sentence recall task) and a reorganization of state reconfiguration (TLE compared to HC). The dynamics was evaluated in terms of segregation (community or module detection) and integration (connector hubs). In HC, the level of segregation was the same in both states and the mechanism of LMN state reconfiguration was shown through module change of key language and declarative memory regions with integrative roles. In TLE patients, the reorganization of LMN state reconfiguration was reflected in segregation increase and extrinsic modules that were based on shorter-distance connections. While lateral and mesial temporal regions enabled state reconfiguration in HC, these regions showed reduced flexibility in TLE. We discuss our results in a connectomic perspective and propose a dynamic model of language and declarative memory functioning. We claim that complex and interactive cognitive functions, such as language and declarative memory, should be investigated dynamically, considering the interaction between cognitive networks.

Aura: epilepsy vs. functional (psychogenic) seizures

PURPOSE

To compare auras between three groups of people with seizures [i.e., Idiopathic generalized epilepsies (IGE) vs. Temporal lobe epilepsy (TLE) vs. Functional seizures (FS)].

METHODS

All patients, 10 years of age or older, with a diagnosis of IGE, TLE, or FS were prospectively registered in an electronic database and retrospectively studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020.

RESULTS

One thousand and three hundred ninety-one patients were studied (480 with IGE, 617 with TLE, and 294 with FS). Among patients with TLE, 63.5% of individuals reported auras; this figure was 68% in the FS and 12.7% in the IGE groups (p < 0.00001). Odds ratio of having auras in the TLE group compared with the IGE group was 11.96 (95% CI: 8.73-16.39; p = 0.0001). Odds ratio of having auras in the TLE group compared with the FS group was 0.81 (95% CI: 0.61-1.10; p = 0.1840). Odds ratio of having auras in the FS group compared with the IGE group was 14.61 (95% CI: 10.15-21.02; p = 0.0001). The following auras were more frequent among patients with TLE: emotional, cognitive, epigastric, and olfactory/gustatory. The following auras were more frequent among patients with FS: headache and dizziness/vertigo.

CONCLUSION

Auras are not specific to focal epilepsies. Future studies should investigate auras in large cohorts of patients with focal or generalized epilepsies and also those with FS to determine the exact clinical value of each aura.

Giant calcified pseudoplasm of the nerve axis of the temporal lobe: a case report and review of the literature

Calcifying pseudoneoplasms of the neuraxis (CAPNONs) are rare and can occur along the neural axis. The pathogenesis of these masses is still unknown, and they are diagnosed by histopathological analysis. We report the largest CAPNON in the temporal lobe reported to date and a review of the literature on all previously reported CAPNON cases located in the temporal lobe. According to the literature review, prior to 2020, the largest CAPNON in the temporal lobe that had ever been reported measured 30 × 30 × 20 mm (Mohapatra et al.). However, we report a larger temporal lobe CAPNON (45 × 35 × 35 mm) in a female patient admitted to our hospital. In addition, among 22 patients with CAPNONs aged from 6 to 62 years, 45.5% were female and 54.5% were male. A total of 72.8% of patients presented with seizures, 9.1% had pituitary dysfunction and 9.1% did not have symptoms. Of the cases in the patients with seizures, 83.2% were completely surgically resected, 5.6% were partially surgically resected, and one was treated medically; one patient refused treatment. Except for one patient who had multiple lesions, all patients who underwent surgery exhibited improved or the disappearance of symptoms of epilepsy. The patient in whom epilepsy resolved had undergone total resection. CAPNON is a rare benign lesion that occurs throughout the nervous system, and the pathogenesis remains unclear. Although the hardness of these lesions vary, surgery is still the preferred treatment and yields good results, and total resection is recommended for patients with epilepsy in the temporal lobe.

Spatiotemporal distribution and age of seizure onset in a pediatric epilepsy surgery cohort with cortical dysplasia

OBJECTIVE

Focal Cortical Dysplasias (CD) are a common etiology of refractory pediatric epilepsy and are amenable to epilepsy surgery. We investigated the association of lesion volume and location to age of seizure onset among children with CD who underwent epilepsy surgery.

METHODS

A retrospective study of epilepsy surgery patients with pathologically-confirmed CD. Regions of interest (ROI) determined preoperative lesion volumes on 1.5 T and 3 T T2 and SPGR MRIs, and location in 7 distributed neural networks. Descriptive and inferential statistics were used.

RESULTS

Fifty-five patients were identified: 35 girls (56.5 %). Median age of seizure onset: 19.0 months (range 0.02 months - 16.0 years). Median age of surgery: 7.8 years (range 2.89 months - 24.45 years). CD were frontal (n = 21, 38 %); temporal (n = 15, 27 %); parietal (n = 10, 18 %); occipital (n = 3, 5%); multilobar (n = 6, 11 %). Frontal FCD had seizure onset < 1-year-old (P = 0.10); temporal lobe CD seizure onset was more likely > 5-years-old (P= 0.06). Median lesion volume for CD was 23.23 cm³ (range: 1.87-591.73 cm³). Larger CD lesions were associated with earlier epilepsy (P = 0.01, r = -0.16). We did not find that lesions proximal to early maturing cortical regions were associated with earlier seizure onset. We found an association with CD location in the default mode network (DMN) and age onset < 5years old (P = 0.03). Age of seizure onset was negatively correlated with percent of CD overlapping motor cortex (P = 0.001, r =-0.794) but not with CD overlap of the visual cortex (P = 0.35). There was no effect of CD type on age of epilepsy onset.

SIGNIFICANCE

Larger CD lesions are associated with earlier onset epilepsy. CD most commonly occurs within the DMN and Limbic network, and DMN is associated with seizure onset before 5-years-old. Percent of CD overlapping motor cortex correlates with earlier seizure onset. These observations may reflect patterns of brain maturation or regional differences in clinical expression of seizures.

Epileptic olfactory auras: a clinical spectrum

OBJECTIVE

To investigate the relative frequency of olfactory aura in a large number of patients with focal epilepsy, and examine the full clinical spectrum of epileptic olfactory auras (OAs) and their relationship to hemispheric lateralization and localization of epileptogenic focus.

METHODS

This retrospective study was based on the medical records of 1384 patients with focal epilepsy. Of these, 71 (5.1%) patients were present with OAs, comprising 25 (35.2%) men and 46 (64.8%) women with a mean age of 35.43 ± 12.89 years. These 71 patients were classified according to the clinical features of the OAs, and the electroencephalography and magnetic resonance imaging findings were examined.

RESULTS

The relative frequency of OAs was 5.1% in the focal epileptic patients. The clinical spectrum of OAs in our cases was outlined as follows, complex OAs and elementary OAs. Elementary OAs were divided into three subgroups: elementary neutral OAs, elementary unpleasant OAs, and elementary pleasant OAs. In our cases, there was no difference between the right and left hemispheres in terms of lateralization of the epileptogenic focus. In all the 71 patients, the epileptogenic zone was most commonly localized in the temporal lobe (n = 58; 81.7%).

CONCLUSIONS

The relative frequency of OAs in focal epilepsies is likely to be found higher than expected. Elementary OAs occur much more frequently than complex OAs. Among the elementary OAs, elementary unpleasant OAs and elementary neutral OAs are the most common types, whereas elementary pleasant OAs are extremely rare.

[Magnetic resonance imaging morphological study of the effects of juvenile febrile convulsions on the brain structure of medial temporal lobe epilepsy]

Objective: To investigate the effect of febrile convulsions on gray matter volume (GMV) in medial temporal lobe epilepsy (mTLE) and its correlation with disease duration. Methods: A retrospective study was conducted to collect 41 mTLE patients with a history of febrile convulsions (mTLE-FC), 42 mTLE patients with no initial precipitating injury (mTLE-noIPI), and 42 normal and age and sex matched normal controls. High-resolution T1-weighted (T(1)WI) whole brain MR scans were performed on all subjects. Voxel-based morphometry were used to obtain GMV brain maps, and the GMV differences between the three groups of subjects were compared (P<0.01, GRF corrected). Finally, Spearmen rank correlation analysis was used to explore the correlation between GMV changes and the course of disease. Results: Compared with the normal control subjects, each mTLE group showed extensive GMV reduction, mainly in the affected hippocampus, thalamus, temporal lobe, and bilateral cerebellum. Further analysis found that mTLE-FC group had more significant reductions in GMV than the mTLE-noIPI group in the affected hippocampus, amygdala, inferior temporal gyrus, contralateral hippocampus, para hippocampus, and inner cingulate gyrus. At the same time, the affected amygdala and hippocampal GMV in the mTLE-FC group was significantly negatively related to the course of disease (r=-0.381, P=0.014), while the mTLE-noIPI group had no downward trend (r=0.081, P=0.611). The atrophic trend of the affected amygdala and hippocampus in patients with mTLE-FC was significantly greater than that in patients with mTLE-noIPI (P=0.029, permutation test). Conclusions: There is extensive damage to the gray matter structure of bilateral cerebral hemispheres, mainly in the hippocampus, in mTLE patients. The brain damage of mTLE patients with a history of juvenile fever convulsions is more extensive and serious, and the trend of progressive exacerbation with the course of the disease is more obvious, suggesting mTLE associated with juvenile fever convulsions may have different pathophysiological mechanisms.

Time-variant Epileptic Brain Functional Connectivity of Focal and Generalized Seizure in Chronic Temporal Lobe Epilepsy Rat. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020;2020:2833-2836. [PMID: 33018596 DOI: 10.1109/embc44109.2020.9175924]

Seizure types and characteristics may vary with time in a patient with distinct mechanisms underlying the propagation of ictal activity. Similarly, we found that both focal and generalized seizures coexist in some pilocarpine-induced chronic temporal lobe epilepsy (TLE) rats. In different seizure patterns, mapping complex networks and analyzing epileptic characteristics involved in seizure propagation are likely to reflect seizure propagation mechanisms, and indicate the establishment of stimulation strategy for epilepsy treatment, especially on the selection of stimulation targets. In our study, we used Granger causality method to track the time-variant epileptic brain functional connectivity in focal and generalized seizures from multi-site local field potentials (LFPs). Results showed that these two major types of seizures had different propagation patterns during ictal period. When comparing them, generalized seizures involved in a network with more complex relationships and spread to more extensive brain regions than in local seizures at mid-ictal stage. Moreover, we observed that focal seizures had a focused causal hub with strong interactions, while generalized seizures had relative distributed causal hubs to drive the development of seizure during seizure-onset stage. These findings suggest that stimulation strategy might need to be adapted to different seizure types thus allowing for retuning abnormal epileptic brain network and obtaining better treatment effect on seizure suppression.

[Clinico-pathological features of temporal lobe epilepsy with enlarged amygdala]

OBJECTIVE

To summarize the clinical, video electroencephalogram (VEEG), radiological and pathological features of 3 patients of temporal lobe epilepsy (TLE) with amygdala enlargement (AE).

METHODS

Three TLE patients with AE who were hospitalized in Peking University International Hospital were collected. The above features were retrospectively analyzed, and the amygdala volume was measured as well.

RESULTS

Of all the 3 patients, 2 were females and 1 male, whose seizure onset ages varied from 21 to 40 years. Two cases presented with secondarily generalized tonicclonic seizures after falling asleep during the night. One of the 2 cases had complex partial seizures (CPSs) with episodic memory and automatism after one year, and the third one had CPSs with lip smacking and tongue wagging during the night. All the patients suffered from obvious anxious disorder. Unilateral AE by MRI was demonstrated in the 3 cases, one on the right side, and the other two on the left side. The average amygdala volume of the enlarged side and the other side were (2 123.7±131.8) mm³ and (1 276.3±156.9) mm³, respectively. Unilateral interictal epileptic discharges were ipsilateral to the AE in 2 cases, while the other patient showed bilateral interictal epileptic discharges. The ictal VEEG showed that the seizure onset zone was ipsilateral to the AE and was confined to the anterior and middle temporal regions in the 3 patients. The interictal single-photon emission computed tomography (SPECT) was negative in 2 cases. The interictal positron emission tomography (PET) showed hypometabolism in the AE in one case. The histological pathology revealed focal cortical dysplasia in the amygdala and temporal lobe in the 3 cases, and one of the 3 cases was combined with hippocampal sclerosis. All the patients became seizure free after surgery in the half year following-up. VEEG revealed slow wave activity and occasional spike wave in the operated side.

CONCLUSION

AE may be one subtype of TLE. It is necessary to recognize AE in TLE with MRI-negative. For those poorly responsive to antiepileptic drugs, surgical treatment could provide a better solution. Focal cortical dysplasia may be one of the most common pathological features of TLE with AE.

Temporal Pattern of Ripple Events in Temporal Lobe Epilepsy: Towards a Pattern-based Localization of the Seizure Onset Zone

Ripples (80-250 Hz) are brief high-frequency oscillations that are often detected in intracranial EEG (iEEG) and are currently investigated as a potential biomarker to facilitate the Iocalization of the seizure onset zone (SOZ) in patients with drug-resistant epilepsy. While the rate and shape of these oscillations have been positively correlated with the SOZ, the temporal pattern of these oscillations in the epileptic brain still requires investigation. In this study, we investigate the temporal pattern of ripple events in five patients with temporal lobe epilepsy (TLE), which is one of the most common forms of epilepsy. The rate of ripple events is positively correlated with the SOZ in TLE but its diagnostic utility in localizing the SOZ remains unclear, which suggests that additional ripple-related features should be investigated. By combining point process modeling and cluster analysis, we show that a recurrent, non-stationary bursting pattern characterizes the SOZ channels consistently across patients, while the non-SOZ channels have poor between-channel similarity and no consistent pattern over time nor across patients. Furthermore, the degree of separation between SOZ and non-SOZ model parameter vectors is significantly higher (ANOVA test, ${P}$-value $P\lt 0.01$) than the degree of separation between the ripple rates, which suggests that the temporal pattern more than the rate may contribute to the pre- surgical Iocalization of the SOZ.

Evolution of Graph Theory in Dynamic Functional Connectivity for Lateralization of Temporal Lobe Epilepsy

Resting-state functional magnetic resonance imaging (rsfMRI) has described the functional architecture of the human brain in the absence of any task or stimulus. Since the functional connectivity (FC), has non-stationary nature, it is evidenced to be varying over time. Using dynamic functional connectivity, six graph theoretical characteristics were measured and compared between left and right temporal lobe epilepsy (TLE). We also obtain a trend for each characteristic in the time course of experiments. The results demonstrated that the static connectivity analysis failed to fully separate the left and right TLE patients for some characteristics, whereby the dynamic analysis has been shown capable of identifying the laterality. Furthermore, the results suggest that the temporal trend of some graph theoretical characteristics can be exploited as a novel marker for TLE laterality.

[Chronic phosphoproteomic in temporal lobe epilepsy mouse models induced by kainic acid]

OBJECTIVE

To investigate functions of proteins and signaling pathways involved in epileptogenesis during the chronic stage of temporal lobe epilepsy in mouse models.

METHODS

Kainic acid-induced temporal lobe epilepsy models were conducted, when reaching stage 4 using racine scale, the mice of experimental group were supposed to be successfully established. Pentobarbital sodium was injected to stop epileptic seizure in case of death. Twenty-eight days after the kainic acid injection, when the experimental group generally turned into chronic spontaneous seizures, mice hippocampal tissues were extracted from the control and the experimental groups respectively for phosphoproteomic. Enriched phosphorylated proteins were detected using mass spectrometry, only the proteins whose density was greater than 10⁶ were analyzed by matching the Gene Ontology (GO) database, Kyoto Encyclopedia of Genes and Genomes (KEGG) database and STRING database to detect proteins involved in epileptogenesis in protein functions, signaling pathways and protein-protein interaction respectively. After that, literatures were reviewed about the key proteins.

RESULTS

(1) Total of 12 697 phosphorylation sites of enriched proteins were detected by mass spectrometry, and there were 159 sites whose phosphorylation levels were significantly different from the control (P<0.001). (2) GO database showed that 35.7% of the 159 sites were about "catalytic activity", 39.5% were about "binding" and 20.8% were about "cell communication", and the 159 proteins also participated in many biological processes, such as "primary metabolic process" "response to stimulus" "developmental process" "localization" and "phosphate-containing compound metabolic process". (3) KEGG database showed that the 159 protein sites mainly involved in 10 signaling pathways: glutamatergic synapse, Ras signaling pathway, African trypanosomiasis, Cocaine addiction, Circadian entrainment, Amyotrophic lateral sclerosis (ALS), Long-term potentiation, Endocytosis, Gap junction, Nicotine addiction. (4) STRING database showed that the protein-protein interaction network formed by the 159 proteins was focused on Grin1/Dlg3, Arhgef 2/Arhgap33/Tiam1 and Sptnb1/3/4/Add3/Ank2 protein group respectively. (5) Phosphorylation levels of Grin1, Arhgef 2, Arhgap33, Tiam1, Sptbn1/2/4 and Ank2 in experimental group were significantly higher than in the control (P<0.001).

CONCLUSION

Phosphoproteomic illustrated integral distribution of phosphorylated proteins at the chronic stage of temporal lobe epilepsy in the mouse model. Literatures showed that most key proteins were closely related to epileptogenesis, suggesting that some proteins or signaling pathways may play a role in epileptogenesis, such as dopamine and Kir3.1.

[Visual field disorder after surgery of temporal lobe epilepsy associated to hippocampus sclerosis]

OBJECTIVE

Assessment of frequency and severity of visual field disorders after neurosurgical operations at patients with pharmacoresistant form of epilepsy in hippocampus sclerosis.

MATERIAL AND METHODS

The study included 48 patients having surgical operations for a pharmacoresistant form of temporal lobe epilepsy due to hippocampus sclerosis. Anterior lobectomy with amygdalohippocampectomy (LE + AHE) was performed in 25 patients; Selective amygdalohippocampectomy (SAHE) was performed in 23 patients. We evaluated both the frequency of cases of homonymous visual field disorders and their severity.

RESULTS

After surgery the normal visual field was preserved at 7 (14.6%) patients. The appearance of visual field disorder by the type of homonymous hemianopsia was observed at 41 (85.4%) patients. When assessing the severity of visual field disorder, the smallest disorder was at patients who underwent sub-temporal access of SAHE: a statistically significant difference in the frequency of severe visual field disorder was revealed when comparing this group with patients having LE + AHE (p<0.02), as well as with patients having SAHE with access through sylvian gap (p<0.02).

CONCLUSION

SAHE with sub-temporal access allows maintaining or minimally injuring the central optic neuron fibers, including the Meyer loop at patients operated for symptomatic temporal lobe epilepsy.

[Targeting diagnosis and treatment value of chelating anti-IL-1β mAb-SPIONs in temporal lobe epilepsy model]

Objective: In order to study the diagnosis and treatment value of chelating anti-IL-1β mAb-SPIONs in temporal lobe epilepsy model induced by lithium chlorid and pilocarpine. Methods: Forty-five temporal lobe epilepsy model rats were randomly and equally divided into saline group, plain-SPIONs group, anti-IL-1β mAb-SPIONs group. Each group was injected with equal particles at day 3 and day 14 after the onset of seizures. MRI were conducteds before and 4 hours after particles injection and T₂ values were measured. The distribution of iron particles in the epileptic tissue was observed and the neuronal loss, astrocyte proliferation and microglia activation were detected. The expressions of IL-1β and NF-κBp65 in each group were detected meanwhile. Results: At day 14 after seizure, the value of T₂ was 84±14 after injecting anti-IL-1β mAb-SPIONs. Compared with the control group, the value of T₂ obviously declined. These phenomena of neuron loss, astrocyte proliferation and microglia activation had been improved obviously. IL-1βand NF-κBp65 expression also significantly reduced. Conclusion: Anti-IL-1β mAb-SPIONs can penetrate blood brain barrier and plays an important role in targeting positioning and targeting therapy in temporal lobe epilepsy.

Impact of injection time on migration of SPECT seizure onset in temporal lobe epilepsy

In this work, we investigated an impact of injection time on migration of seizure-onset in ictal/interictal single photon emission computed tomography (SPECT) study for patients with temporal lobe epilepsy. We selected 33 patients with refractory temporal lobe epilepsy who underwent ictal/interictal SPECT studies and had preoperative intracranial EEG result or surgical resection which was used as reference for seizure location. We divided all patients into two groups, which are the fast and the delayed groups; the delayed group comprised patients with injection time more than a cutoff time and vice versa. Using the subtraction ictal-interictal SPECT co-registered with SPECT (SISCOS) with varied Z-threshold (1.0, 1.5, 2.0 and 2.5), a method similar to subtraction ictal SPECT co-registered to magnetic resonance imaging (MRI) (SISCOM), a seizure-onset region in the SISCOS image was localized at the region with maximum sum of Z-scores. For each pair of cutoff time and Z-threshold, we determined the migratory proportion which was defined as the proportion of patients whose seizure-onset location based on SISCOS image was discordant with the reference. At cutoff time of 32-35 seconds and the Z-threshold of 2.0, the migratory proportion values were 7/26 (26.9%) and 5/7 (71.4%) in the fast and the delayed groups, respectively. At the same range of cutoff time with the Z-threshold of 2.5, the migratory proportion was 8/26 (30.8%) in the fast group while the proportion was 5/7 (71.4%) in the delayed group. Using Fisher's exact test, the migratory proportion values at the Z-threshold of 2.0 and 2.5 were significantly different between the fast and the delayed groups (p = 0.0709 and 0.0838, respectively), suggesting that patients with temporal lobe epilepsy who undergo an ictal/interictal SPECT study with injection time longer than 35 seconds tend to have seizure-onset zone migration in the SISCOS analysis with the traditionally-used Z-threshold of 2.0.

Valproic acid and its congener propylisopropylacetic acid reduced the amount of soluble amyloid-β oligomers released from 7PA2 cells

The amyloid hypothesis of Alzheimer's disease suggests that synaptic degeneration and pathology is caused by the accumulation of amyloid-β (Aβ) peptides derived from the amyloid precursor protein (APP). Subsequently, soluble Aβ oligomers cause the loss of synaptic proteins from neurons, a histopathological feature of Alzheimer's disease that correlates with the degree of dementia. In this study, the production of toxic forms of Aβ was examined in vitro using 7PA2 cells stably transfected with human APP. We show that conditioned media from 7PA2 cells containing Aβ oligomers caused synapse degeneration as measured by the loss of synaptic proteins, including synaptophysin and cysteine-string protein, from cultured neurons. Critically, conditioned media from 7PA2 cells treated with valproic acid (2-propylpentanoic acid (VPA)) or propylisopropylacetic acid (PIA) did not cause synapse damage. Treatment with VPA or PIA did not significantly affect total Aβ42 concentrations; rather these drugs selectively reduced the concentrations of Aβ42 oligomers in conditioned media. In contrast, treatment significantly increased the concentrations of Aβ42 monomers in conditioned media. VPA or PIA treatment reduced the concentrations of APP within lipid rafts, membrane compartments associated with Aβ production. These effects of VPA and PIA were reversed by the addition of platelet-activating factor, a bioactive phospholipid produced following activation of phospholipase A2, an enzyme sensitive to VPA and PIA. Collectively these data suggest that VPA and PIA reduce Aβ oligomers through inhibition of phospholipase A2 and suggest a novel therapeutic approach to Alzheimer's treatment.

Establishing and validating a new source analysis method using phase

Electroencephalogram (EEG) measures the brain oscillatory activity non-invasively. The localization of deep brain generators of the electric fields is essential for understanding neuronal function in healthy humans and for damasking specific regions that cause abnormal activity in patients with neurological disorders. The aim of this study was to test whether the phase estimation from scalp data can be reliably used to identify the number of dipoles in source analyses. The steps performed included: i) modeling different phasic oscillatory signals using auto-regressive processes at a particular frequency, ii) simulation of two different noises, namely white and colored noise, having different signal-to-noise ratios, iii) simulation of dipoles at different areas in the brain and iv) estimation of the number of dipoles by calculating the phase differences of the simulated signals. Moreover we applied this method of source analysis on real data from temporal lobe epilepsy (TLE) patients. The analytical framework was successful in identifying the sources and their orientations in the simulated data and identified the epileptogenic area in the studied patients which was confirmed by pathological studies after TLE surgery.

A machine learning approach to characterizing the effect of asynchronous distributed electrical stimulation on hippocampal neural dynamics in vivo

Asynchronous distributed microelectrode theta stimulation (ADMETS) of the hippocampus has been shown to reduce seizure frequency in the tetanus toxin rat model of mesial temporal lobe epilepsy suggesting a hypothesis that ADMETS induces a seizure resistant state. Here we present a machine learning approach to characterize the nature of neural state changes induced by distributed stimulation. We applied the stimulation to two animals under sham and ADMETS conditions and used a combination of machine learning techniques on intra-hippocampal recordings of Local Field Potentials (LFPs) to characterize the difference in the neural state between sham and ADMETS. By iteratively fitting a logistic regression with data from the inter-stimulation interval under sham and ADMETS condition we found that the classification performance improves for both animals until 90s post stimulation before leveling out at AUC of 0.64 ± 0.2 and 0.67 ± 0.02 when all inter-stimulation data is included. The models for each animal were re-fit using elastic net regularization to force many of the model coefficients to 0, identifying those that do not optimally contribute to the classifier performance. We found that there is significant variation in the non-zero coefficients between animals (p <; 0.01), suggesting that the ADMETS induced state is represented differently between subject. These findings lay the foundation for using machine learning to robustly and quantitatively characterize neural state.