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Nie L, Jiang Y, Lv Z, Pang X, Liang X, Chang W, Zheng J. A study of brain functional network and alertness changes in temporal lobe epilepsy with and without focal to bilateral tonic-clonic seizures. BMC Neurol 2022; 22:14. [PMID: 34996377 PMCID: PMC8740350 DOI: 10.1186/s12883-021-02525-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 12/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Temporal lobe epilepsy (TLE) is commonly refractory. Epilepsy surgery is an effective treatment strategy for refractory epilepsy, but patients with a history of focal to bilateral tonic-clonic seizures (FBTCS) have poor outcomes. Previous network studies on epilepsy have found that TLE and idiopathic generalized epilepsy with generalized tonic-clonic seizures (IGE-GTCS) showed altered global and nodal topological properties. Alertness deficits also were found in TLE. However, FBTCS is a common type of seizure in TLE, and the implications for alertness as well as the topological rearrangements associated with this seizure type are not well understood. METHODS We obtained rs-fMRI data and collected the neuropsychological assessment data from 21 TLE patients with FBTCS (TLE- FBTCS), 18 TLE patients without FBTCS (TLE-non- FBTCS) and 22 controls, and constructed their respective functional brain networks. The topological properties were analyzed using the graph theoretical approach and correlations between altered topological properties and alertness were analyzed. RESULTS We found that TLE-FBTCS patients showed more serious impairment in alertness effect, intrinsic alertness and phasic alertness than the patients with TLE-non-FBTCS. They also showed significantly higher small-worldness, normalized clustering coefficient (γ) and a trend of higher global network efficiency (gE) compared to TLE-non-FBTCS patients. The gE showed a significant negative correlation with intrinsic alertness for TLE-non-FBTCS patients. CONCLUSION Our findings show different impairments in brain network information integration, segregation and alertness between the patients with TLE-FBTCS and TLE-non-FBTCS, demonstrating that impairments of the brain network may underlie the disruptions in alertness functions.
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Affiliation(s)
- Liluo Nie
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, 530021, China
| | - Yanchun Jiang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, 530021, China
| | - Zongxia Lv
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, 530021, China
| | - Xiaomin Pang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, 530021, China
| | - Xiulin Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, 530021, China
| | - Weiwei Chang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, 530021, China
| | - Jinou Zheng
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, 530021, China.
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Zu M, Fu L, Hu M, Cao X, Wang L, Zhang J, Deng Z, Qiu B, Wang Y. Amplitude of Low-Frequency Fluctuation With Different Clinical Outcomes in Patients With Generalized Tonic-Clonic Seizures. Front Psychiatry 2022; 13:847366. [PMID: 35432042 PMCID: PMC9010667 DOI: 10.3389/fpsyt.2022.847366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Generalized tonic-clonic seizures (GTCS) are associated with significant disability and sudden unexpected death when they cannot be controlled. We aimed to explore the underlying neural substrate of the different responses to antiseizure drugs between the seizure-free (SF) and non-seizure-free (NSF) patients with GTCS through the amplitude of low-frequency fluctuation (ALFF) method. METHODS We calculated ALFF among the SF group, NSF group, and healthy controls (HCs) by collecting resting-state functional magnetic resonance imaging (rs-fMRI) data. One-way ANOVA was used to compare the ALFF of the three groups, and post-hoc analysis was done at the same time. Pearson's correlation analysis between ALFF in the discrepant brain areas and the clinical characteristics (disease course and age of onset of GTCS) was calculated after then. RESULTS A significant group effect was found in the right fusiform gyrus (R.FG), left fusiform gyrus (L.FG), left middle occipital gyrus (L.MOG), right inferior frontal gyrus (R.IFG), right precentral gyrus (R.PreG), right postcentral gyrus (R.PostG), and left calcarine sulcus (L.CS). The SF and NSF groups both showed increased ALFF in all discrepant brain areas compared to HCs except the R.IFG in the NSF group. Significantly higher ALFF in the bilateral FG and lower ALFF in the R.IFG were found in the NSF group compared to the SF group. CONCLUSIONS Higher ALFF in the bilateral FG were found in the NSF group compared to the SF and HC groups. Our findings indicate that abnormal brain activity in the FG may be one potential neural substrate to interpret the failure of seizure control in patients with GTCS.
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Affiliation(s)
- Meidan Zu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lulan Fu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mingwei Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoyan Cao
- Department of Pediatrics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Long Wang
- Department of Neurology, The Second People's Hospital of Hefei, Hefei, China
| | - Juan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ziru Deng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bensheng Qiu
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Abstract
Impaired consciousness during seizures severely affects quality of life for people with
epilepsy but the mechanisms are just beginning to be understood. Consciousness is thought
to involve large-scale brain networks, so it is puzzling that focal seizures often impair
consciousness. Recent work investigating focal temporal lobe or limbic seizures in human
patients and experimental animal models suggests that impaired consciousness is caused by
active inhibition of subcortical arousal mechanisms. Focal limbic seizures exhibit
decreased neuronal firing in brainstem, basal forebrain, and thalamic arousal networks,
and cortical arousal can be restored when subcortical arousal circuits are stimulated
during seizures. These findings open the possibility of restoring arousal and
consciousness therapeutically during and following seizures by thalamic neurostimulation.
When seizures cannot be stopped by existing treatments, targeted subcortical stimulation
may improve arousal and consciousness, leading to improved safety and better psychosocial
function for people with epilepsy.
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Affiliation(s)
- Hal Blumenfeld
- Departments of Neurology, Neuroscience, Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
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54
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Pottkämper JCM, Verdijk JPAJ, Hofmeijer J, van Waarde JA, van Putten MJAM. Seizures induced in electroconvulsive therapy as a human epilepsy model: A comparative case study. Epilepsia Open 2021; 6:672-684. [PMID: 34351710 PMCID: PMC8633469 DOI: 10.1002/epi4.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/09/2021] [Accepted: 07/30/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Standardized investigation of epileptic seizures and the postictal state may contribute to a better understanding of ictal and postictal phenomena. This comparative case study aims to assess whether electrically induced seizures in electroconvulsive therapy (ECT) show sufficient similarities with spontaneous seizures to serve as a human epilepsy model. METHODS We compared six EEG recordings, three ECT-induced seizures and three generalized tonic-clonic seizures, using quantitative electroencephalography (EEG) analyses. EEG recordings during and after ECT sessions (under general anesthesia and muscle paralysis) were collected prospectively, whereas epilepsy data were selected retrospectively. Time-frequency representations, dominant ictal frequencies, and postictal alpha-delta ratios were calculated. RESULTS In all EEG recordings, a decrease in dominant ictal frequency was observed, as well as postictal suppression. Postictal alpha-delta ratio indicated the same trend for all: a gradual increase from predominantly delta to alpha frequencies on timescales of hours after the seizure. Postictal spectral representation was similar. Muscle artifacts were absent in ECT-induced seizures and present in spontaneous seizures. Ictal amplitude was higher in epileptic than in ECT-induced seizures. Temporospectral ictal dynamics varied slightly between groups. SIGNIFICANCE We show that ictal and postictal characteristics in ECT and patients with generalized tonic-clonic seizures are essentially similar. ECT-induced seizures may be used to investigate aspects of ictal and postictal states in a highly predictable manner and well-controlled environment. This suggests that clinical and electrophysiological observations during ECT may be extrapolated to epilepsy with generalized tonic-clonic seizures.
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Affiliation(s)
- Julia C. M. Pottkämper
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of PsychiatryRijnstate HospitalArnhemThe Netherlands
- Department of NeurologyRijnstate HospitalArnhemThe Netherlands
| | - Joey P. A. J. Verdijk
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of PsychiatryRijnstate HospitalArnhemThe Netherlands
| | - Jeannette Hofmeijer
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of NeurologyRijnstate HospitalArnhemThe Netherlands
| | | | - Michel J. A. M. van Putten
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
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High prevalence of pathological alertness and wakefulness on maintenance of wakefulness test in adults with focal-onset epilepsy. Epilepsy Behav 2021; 125:108400. [PMID: 34800802 DOI: 10.1016/j.yebeh.2021.108400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a common complaint in adults with epilepsy (AWE), but objective evaluation is lacking. We used the maintenance of wakefulness test (MWT) to objectively measure the ability of adults with focal-onset epilepsy to maintain wakefulness in soporific conditions. METHODS Adults with epilepsy participating in a study investigating the effects of lacosamide on sleep and wakefulness underwent baseline ambulatory polysomnography (PSG)/EEG followed by MWT. Mean sleep latency (MSL) and mean percent sleep time (MST, mean percentage of non-wake EEG scored in 3-sec bins from lights out to sleep onset averaged over the 4 MWT trials) were quantified. Subjective sleepiness was assessed by the Epworth Sleepiness Scale (ESS). Spearman correlation and linear regression assessed relationships between MWT parameters, ESS and relevant sleep and epilepsy-related variables. RESULTS Maintenance of wakefulness test MSL in 51 AWE (mean age 43.5 ± 13 years, 69% female, mean BMI 24.6 ± 11.2 kg/m2) was 21.7 ± 11.9 min; 45.1% had an abnormally short MSL <19.4 min and 15.7% <8 min. MST was 9.3% [3.3, 19.1]. Mean ESS score was 8.8 ± 5.7; 39% had elevated ESS (>10). No correlation between subjective ESS and objective MSL (p = 0.67) or MST (p = 0.61) was found. MSL was significantly shorter in subjects with focal to bilateral tonic-clonic seizures (FBTCS; 7.9 min [13.6, 22.3]) compared to those without (27.4 min [21.2, 33.6], p = 0.013). Younger subjects had shorter MSL; MSL increased 3.2 min for every 10-year increase in age. CONCLUSION We found a high prevalence of objective sleepiness/difficulty maintaining wakefulness on the MWT and subjective sleepiness using the ESS in AWE without a correlation between the two. More severe objective sleepiness was found in subjects with a history of FBTCS and younger age. Further research is needed to determine mechanistic underpinnings and optimal measurements of pathological sleepiness in people with epilepsy given the burden of it on quality of life.
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Hermann BP, Struck AF, Busch RM, Reyes A, Kaestner E, McDonald CR. Neurobehavioural comorbidities of epilepsy: towards a network-based precision taxonomy. Nat Rev Neurol 2021; 17:731-746. [PMID: 34552218 PMCID: PMC8900353 DOI: 10.1038/s41582-021-00555-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 02/06/2023]
Abstract
Cognitive and behavioural comorbidities are prevalent in childhood and adult epilepsies and impose a substantial human and economic burden. Over the past century, the classic approach to understanding the aetiology and course of these comorbidities has been through the prism of the medical taxonomy of epilepsy, including its causes, course, characteristics and syndromes. Although this 'lesion model' has long served as the organizing paradigm for the field, substantial challenges to this model have accumulated from diverse sources, including neuroimaging, neuropathology, neuropsychology and network science. Advances in patient stratification and phenotyping point towards a new taxonomy for the cognitive and behavioural comorbidities of epilepsy, which reflects the heterogeneity of their clinical presentation and raises the possibility of a precision medicine approach. As we discuss in this Review, these advances are informing the development of a revised aetiological paradigm that incorporates sophisticated neurobiological measures, genomics, comorbid disease, diversity and adversity, and resilience factors. We describe modifiable risk factors that could guide early identification, treatment and, ultimately, prevention of cognitive and broader neurobehavioural comorbidities in epilepsy and propose a road map to guide future research.
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Affiliation(s)
- Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,
| | - Aaron F. Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,William S. Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Robyn M. Busch
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anny Reyes
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Erik Kaestner
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Carrie R. McDonald
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
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Takamiya A, Kishimoto T, Hirano J, Nishikata S, Sawada K, Kurokawa S, Yamagata B, Kikuchi T, Mimura M. Neuronal network mechanisms associated with depressive symptom improvement following electroconvulsive therapy. Psychol Med 2021; 51:2856-2863. [PMID: 32476629 PMCID: PMC8640363 DOI: 10.1017/s0033291720001518] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/24/2020] [Accepted: 05/06/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective antidepressant treatment for severe depression. Although recent structural magnetic resonance imaging (MRI) studies have consistently reported ECT-induced hippocampal volume increases, most studies did not find the association of the hippocampal volume changes with clinical improvement. To understand the underlying mechanisms of ECT action, we aimed to identify the longitudinal effects of ECT on hippocampal functional connectivity (FC) and their associations with clinical improvement. METHODS Resting-state functional MRI was acquired before and after bilateral ECT in 27 depressed individuals. A priori hippocampal seed-based FC analysis and a data-driven multivoxel pattern analysis (MVPA) were conducted to investigate FC changes associated with clinical improvement. The statistical threshold was set at cluster-level false discovery rate-corrected p < 0.05. RESULTS Depressive symptom improvement after ECT was positively associated with the change in the right hippocampus-ventromedial prefrontal cortex FC, and negatively associated with the right hippocampus-superior frontal gyrus FC. MVPA confirmed the results of hippocampal seed-based analyses and identified the following additional clusters associated with clinical improvement following ECT: the thalamus, the sensorimotor cortex, and the precuneus. CONCLUSIONS ECT-induced change in the right frontotemporal connectivity and thalamocortical connectivity, and changes in the nodes of the default mode network were associated with clinical improvement. Modulation of these networks may explain the underlying mechanisms by which ECT exert its potent and rapid antidepressant effect.
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Affiliation(s)
- Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo160-8582, Japan
- Center for Psychiatry and Behavioral Science, Tokyo193-8505, Japan
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Jinichi Hirano
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Shiro Nishikata
- Center for Psychiatry and Behavioral Science, Tokyo193-8505, Japan
| | - Kyosuke Sawada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Shunya Kurokawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Bun Yamagata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo160-8582, Japan
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A systematic review of resting-state and task-based fmri in juvenile myoclonic epilepsy. Brain Imaging Behav 2021; 16:1465-1494. [PMID: 34786666 DOI: 10.1007/s11682-021-00595-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
Functional neuroimaging modalities have enhanced our understanding of juvenile myoclonic epilepsy (JME) underlying neural mechanisms. Due to its non-invasive, sensitive and analytical nature, functional magnetic resonance imaging (fMRI) provides valuable insights into relevant functional brain networks and their segregation and integration properties. We systematically reviewed the contribution of resting-state and task-based fMRI to the current understanding of the pathophysiology and the patterns of seizure propagation in JME Altogether, despite some discrepancies, functional findings suggest that corticothalamo-striato-cerebellar network along with default-mode network and salience network are the most affected networks in patients with JME. However, further studies are required to investigate the association between JME's main deficiencies, e.g., motor and cognitive deficiencies and fMRI findings. Moreover, simultaneous electroencephalography-fMRI (EEG-fMRI) studies indicate that alterations of these networks play a role in seizure modulation but fall short of identifying a causal relationship between altered functional properties and seizure propagation. This review highlights the complex pathophysiology of JME, which necessitates the design of more personalized diagnostic and therapeutic strategies in this group.
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Fitzgerald Z, Morita-Sherman M, Hogue O, Joseph B, Alvim MKM, Yasuda CL, Vegh D, Nair D, Burgess R, Bingaman W, Najm I, Kattan MW, Blumcke I, Worrell G, Brinkmann BH, Cendes F, Jehi L. Improving the prediction of epilepsy surgery outcomes using basic scalp EEG findings. Epilepsia 2021; 62:2439-2450. [PMID: 34338324 PMCID: PMC8488002 DOI: 10.1111/epi.17024] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/15/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the role of scalp electroencephalography (EEG; ictal and interictal patterns) in predicting resective epilepsy surgery outcomes. We use the data to further develop a nomogram to predict seizure freedom. METHODS We retrospectively reviewed the scalp EEG findings and clinical data of patients who underwent surgical resection at three epilepsy centers. Using both EEG and clinical variables categorized into 13 isolated candidate predictors and 6 interaction terms, we built a multivariable Cox proportional hazards model to predict seizure freedom 2 years after surgery. Harrell's step-down procedure was used to sequentially eliminate the least-informative variables from the model until the change in the concordance index (c-index) with variable removal was less than 0.01. We created a separate model using only clinical variables. Discrimination of the two models was compared to evaluate the role of scalp EEG in seizure-freedom prediction. RESULTS Four hundred seventy patient records were analyzed. Following internal validation, the full Clinical + EEG model achieved an optimism-corrected c-index of 0.65, whereas the c-index of the model without EEG data was 0.59. The presence of focal to bilateral tonic-clonic seizures (FBTCS), high preoperative seizure frequency, absence of hippocampal sclerosis, and presence of nonlocalizable seizures predicted worse outcome. The presence of FBTCS had the largest impact for predicting outcome. The analysis of the models' interactions showed that in patients with unilateral interictal epileptiform discharges (IEDs), temporal lobe surgery cases had a better outcome. In cases with bilateral IEDs, abnormal magnetic resonance imaging (MRI) predicted worse outcomes, and in cases without IEDs, patients with extratemporal epilepsy and abnormal MRI had better outcomes. SIGNIFICANCE This study highlights the value of scalp EEG, particularly the significance of IEDs, in predicting surgical outcome. The nomogram delivers an individualized prediction of postoperative outcome, and provides a unique assessment of the relationship between the outcome and preoperative findings.
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Affiliation(s)
| | | | - Olivia Hogue
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Boney Joseph
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Deborah Vegh
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Richard Burgess
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Bingaman
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael W. Kattan
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Frontal lobe hypometabolism associated with Sudden Unexpected Death in Epilepsy (SUDEP) risk: An objective PET study. Epilepsy Behav 2021; 122:108185. [PMID: 34252829 DOI: 10.1016/j.yebeh.2021.108185] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Abnormalities of brain structures and neuronal networks have been identified in MRI studies of patients with Sudden Unexpected Death in Epilepsy (SUDEP) as well as in those at elevated risk. The goal of this study was to identify common patterns of objectively detected brain glucose metabolic abnormalities associated with SUDEP patients and those at high SUDEP risk. METHODS Patients with refractory epilepsy (n = 78, age: 16-61 years, 44 females), who underwent comprehensive presurgical evaluation, were assessed for their risk of SUDEP using the revised SUDEP-7 inventory. From the 57 patients with low SUDEP risk, 35 were selected to match their demographic and clinical characteristics to those with high SUDEP risk (n = 21). [18F]fluoro-deoxy-glucose positron emission tomography (FDG-PET) abnormalities were evaluated in the high- and low-SUDEP risk subgroups compared to FDG-PET scans of a healthy adult control group using statistical parametric mapping (SPM). Individual FDG-PET scans of 4 additional patients, who died from SUDEP, were also analyzed by SPM. RESULTS Mean SUDEP-7 score was 6.1 in the high and 2.7 in the low SUDEP risk group. MRI showed no lesion in 36 patients (64%). Statistical parametric mapping analysis of the high SUDEP risk subgroup showed bilateral medial frontal and inferior frontal hypometabolism as a common pattern. The low-risk group showed no specific common metabolic abnormalities on SPM group analysis. Individual PET scans of all 4 patients who died from SUDEP also showed bilateral frontal lobe hypometabolism. CONCLUSIONS These data show that bilateral frontal lobe involvement on FDG-PET, especially the medial and inferior frontal cortex, may be a common metabolic pattern associated with high SUDEP risk and SUDEP itself, in patients with refractory focal epilepsy.
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61
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Leaver AM, Vasavada M, Kubicki A, Wade B, Loureiro J, Hellemann G, Joshi SH, Woods RP, Espinoza R, Narr KL. Hippocampal subregions and networks linked with antidepressant response to electroconvulsive therapy. Mol Psychiatry 2021; 26:4288-4299. [PMID: 32029885 PMCID: PMC7415508 DOI: 10.1038/s41380-020-0666-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/11/2019] [Accepted: 01/28/2020] [Indexed: 01/29/2023]
Abstract
Electroconvulsive therapy (ECT) has been repeatedly linked to hippocampal plasticity. However, it remains unclear what role hippocampal plasticity plays in the antidepressant response to ECT. This magnetic resonance imaging (MRI) study tracks changes in separate hippocampal subregions and hippocampal networks in patients with depression (n = 44, 23 female) to determine their relationship, if any, with improvement after ECT. Voxelwise analyses were restricted to the hippocampus, amygdala, and parahippocampal cortex, and applied separately for responders and nonresponders to ECT. In analyses of arterial spin-labeled (ASL) MRI, nonresponders exhibited increased cerebral blood flow (CBF) in bilateral anterior hippocampus, while responders showed CBF increases in right middle and left posterior hippocampus. In analyses of gray matter volume (GMV) using T1-weighted MRI, GMV increased throughout bilateral hippocampus and surrounding tissue in nonresponders, while responders showed increased GMV in right anterior hippocampus only. Using CBF loci as seed regions, BOLD-fMRI data from healthy controls (n = 36, 19 female) identified spatially separable neurofunctional networks comprised of different brain regions. In graph theory analyses of these networks, functional connectivity within a hippocampus-thalamus-striatum network decreased only in responders after two treatments and after index. In sum, our results suggest that the location of ECT-related plasticity within the hippocampus may differ according to antidepressant outcome, and that larger amounts of hippocampal plasticity may not be conducive to positive antidepressant response. More focused targeting of hippocampal subregions and/or circuits may be a way to improve ECT outcome.
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Affiliation(s)
- Amber M. Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Center for Translational Imaging, Department of Radiology,
Northwestern University, Chicago, IL, 60611,Corresponding Author: Amber M. Leaver Ph.D.,
Address: 737 N Michigan Ave, Suite 1600, Chicago, IL 60611, Phone 312 694 2966,
Fax 310 926 5991,
| | - Megha Vasavada
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Antoni Kubicki
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Joana Loureiro
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
| | - Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Roger P. Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
| | - Katherine L. Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
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62
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Abstract
Epilepsy is the fourth most common neurological disorder, but current treatment options provide limited efficacy and carry the potential for problematic adverse effects. There is an immense need to develop new therapeutic interventions in epilepsy, and targeting areas outside the seizure focus for neuromodulation has shown therapeutic value. While not traditionally associated with epilepsy, anatomical, clinical, and electrophysiological studies suggest the cerebellum can play a role in seizure networks, and importantly, may be a potential therapeutic target for seizure control. However, previous interventions targeting the cerebellum in both preclinical and clinical studies have produced mixed effects on seizures. These inconsistent results may be due in part to the lack of specificity inherent with open-loop electrical stimulation interventions. More recent studies, using more targeted closed-loop optogenetic approaches, suggest the possibility of robust seizure inhibition via cerebellar modulation for a range of seizure types. Therefore, while the mechanisms of cerebellar inhibition of seizures have yet to be fully elucidated, the cerebellum should be thoroughly revisited as a potential target for therapeutic intervention in epilepsy. This article is part of the Special Issue "NEWroscience 2018.
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63
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Gong J, Jiang S, Li Z, Pei H, Li Q, Yao D, Luo C. Distinct effects of the basal ganglia and cerebellum on the thalamocortical pathway in idiopathic generalized epilepsy. Hum Brain Mapp 2021; 42:3440-3449. [PMID: 33830581 PMCID: PMC8249897 DOI: 10.1002/hbm.25444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/04/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022] Open
Abstract
The aberrant thalamocortical pathways of epilepsy have been detected recently, while its underlying effects on epilepsy are still not well understood. Exploring pathoglytic changes in two important thalamocortical pathways, that is, the basal ganglia (BG)-thalamocortical and the cerebellum-thalamocortical pathways, in people with idiopathic generalized epilepsy (IGE), could deepen our understanding on the pathological mechanism of this disease. These two pathways were reconstructed and investigated in this study by combining diffusion and functional MRI. Both pathways showed connectivity changes with the perception and cognition systems in patients. Consistent functional connectivity (FC) changes were observed mainly in perception regions, revealing the aberrant integration of sensorimotor and visual information in IGE. The pathway-specific FC alterations in high-order regions give neuroimaging evidence of the neural mechanisms of cognitive impairment and epileptic activities in IGE. Abnormal functional and structural integration of cerebellum, basal ganglia and thalamus could result in an imbalance of inhibition and excitability in brain systems of IGE. This study located the regulated cortical regions of BG and cerebellum which been affected in IGE, established possible links between the neuroimaging findings and epileptic symptoms, and enriched the understanding of the regulatory effects of BG and cerebellum on epilepsy.
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Affiliation(s)
- Jinnan Gong
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,School of Computer Science, Chengdu University of Information Technology, Chengdu, China
| | - Sisi Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhiliang Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Haonan Pei
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Qifu Li
- Department of Neurology, Hainan Medical University, Haikou, China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,Department of Neurology, Hainan Medical University, Haikou, China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences 2019RU035, Chengdu, China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,Department of Neurology, Hainan Medical University, Haikou, China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences 2019RU035, Chengdu, China
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64
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Lattanzi S, Rinaldi C, Cagnetti C, Foschi N, Norata D, Broggi S, Rocchi C, Silvestrini M. Predictors of Pharmaco-Resistance in Patients with Post-Stroke Epilepsy. Brain Sci 2021; 11:brainsci11040418. [PMID: 33810310 PMCID: PMC8066362 DOI: 10.3390/brainsci11040418] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/31/2022] Open
Abstract
Objectives: The study aimed to explore the clinical predictors of pharmaco-resistance in patients with post-stroke epilepsy (PSE). Methods: Patients with epilepsy secondary to cerebral infarct or spontaneous intracerebral hemorrhage were included. The study outcome was the occurrence of pharmaco-resistance defined as the failure of adequate trials of two tolerated and appropriately chosen and used antiseizure medication schedules, whether as monotherapies or in combination, to achieve sustained seizure freedom. Results: One-hundred and fifty-nine patients with PSE and a median follow-up of 5 (3–9) years were included. The mean age of the patients at stroke onset was 56.7 (14.9) years, and 104 (65.4%) were males. In the study cohort, 29 participants were pharmaco-resistant. Age at stroke onset [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.93–0.99; p = 0.044], history of intracerebral hemorrhage (OR 2.95, 95% CI 1.06–8.24; p = 0.039), severe stroke (OR 5.43, 95% CI 1.82–16.16; p = 0.002), status epilepticus as initial presentation of PSE (OR 7.90, 1.66–37.55; p = 0.009), and focal to bilateral tonic-clonic seizures (OR 3.19, 95% CI 1.16–8.79; p = 0.025) were independent predictors of treatment refractoriness. Conclusions: Pharmaco-resistance developed in approximately 20% of patients with PSE and was associated with younger age at stroke onset, stroke type and severity, status epilepticus occurrence, and seizure types.
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Affiliation(s)
- Simona Lattanzi
- Correspondence: ; Tel.: +39-071-5964438; Fax: +39-071-887262
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65
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Brodovskaya A, Shiono S, Kapur J. Activation of the basal ganglia and indirect pathway neurons during frontal lobe seizures. Brain 2021; 144:2074-2091. [PMID: 33730155 DOI: 10.1093/brain/awab119] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/12/2020] [Accepted: 01/04/2021] [Indexed: 12/27/2022] Open
Abstract
There are no detailed descriptions of neuronal circuit active during frontal lobe motor seizures. Using activity reporter mice, local field potential recordings, tissue clearing, viral tracing, and super-resolution microscopy, we found neuronal activation after focal motor to bilateral tonic-clonic seizures in the striatum, globus pallidus externus, subthalamic nucleus, substantia nigra pars reticulata and neurons of the indirect pathway. Seizures preferentially activated dopamine D2 receptor-expressing neurons over D1 in the striatum, which have different projections. Furthermore, the D2 receptor agonist infused into the striatum exerted an anticonvulsant effect. Seizures activate structures via short and long latency loops, and anatomical connections of the seizure focus determine the seizure circuit. These studies, for the first time, show activation of neurons in the striatum, globus pallidus, subthalamic nucleus, and substantia nigra during frontal lobe motor seizures on the cellular level, revealing a complex neuronal activation circuit subject to modulation by the basal ganglia.
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Affiliation(s)
- Anastasia Brodovskaya
- Neuroscience Graduate Program, University of Virginia, Charlottesville, Virginia 22908, USA
| | - Shinnosuke Shiono
- Department of Neurology, University of Virginia, Charlottesville, Virginia 22908, USA
| | - Jaideep Kapur
- Department of Neurology, University of Virginia, Charlottesville, Virginia 22908, USA.,UVA Brain Institute, University of Virginia, Charlottesville, Virginia 22908, USA
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66
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Szaflarski JP. Thalamus and Seizures-Here We Come Again…. Epilepsy Curr 2021; 21:1535759721998407. [PMID: 33663247 PMCID: PMC8609598 DOI: 10.1177/1535759721998407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
[Box: see text].
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67
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Seethaler M, Lauseker M, Ernst K, Rémi J, Vollmar C, Noachtar S, Kaufmann E. Hemispheric differences in the duration of focal onset seizures. Acta Neurol Scand 2021; 143:248-255. [PMID: 33011970 DOI: 10.1111/ane.13356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess hemispheric differences in the duration of focal onset seizures and its association with clinical and demographic factors. METHODS A retrospective analysis was performed on adult patients with drug-resistant unifocal epilepsy, who underwent intracranial EEG recording between 01/2006 and 06/2016. Seizure duration was determined based on the subdural and/or stereo-EEG (sEEG) recordings. Hemispheric differences in seizure duration were statistically evaluated with regard to clinical and demographic data. RESULTS In total, 69 patients and 654 focal onset seizures were included. The duration of seizures with left-hemispheric onset (n = 297) was by trend longer (91.88 ± 93.92 s) than of right-hemispheric seizures (n = 357; 71.03 ± 68.53 s; p = .193). Significant hemispheric differences in seizures duration were found in temporal lobe seizures (n = 225; p = .013), especially those with automotor manifestation (n = 156; p = .045). A prolonged duration was also found for left-hemispheric onset seizures with secondary generalized commencing during waking state (n = 225; p = .034), but not during sleep. A similar hemispheric difference in seizure duration was found in female patients (p = .040), but not in men. CONCLUSIONS Hemispheric differences in seizure duration were revealed with significantly longer durations in case of left-hemispheric seizure onset. The observed differences in seizure duration might result from brain asymmetry and add new aspects to the understanding of seizure propagation and termination.
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Affiliation(s)
- Magdalena Seethaler
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
- Department of Psychiatry and Psychotherapy Charité University Medicine and St. Hedwig Hospital Berlin Germany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and Epidemiology LMU Munich Munich Germany
| | - Katharina Ernst
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Jan Rémi
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Christian Vollmar
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Elisabeth Kaufmann
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
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68
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Jehna M, Wurm W, Pinter D, Vogel K, Holl A, Hofmann P, Ebner C, Ropele S, Fuchs G, Kapfhammer HP, Deutschmann H, Enzinger C. Do increases in deep grey matter volumes after electroconvulsive therapy persist in patients with major depression? A longitudinal MRI-study. J Affect Disord 2021; 281:908-917. [PMID: 33279261 DOI: 10.1016/j.jad.2020.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/30/2020] [Accepted: 11/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous MRI studies reported deep grey matter volume increases after electroconvulsive therapy (ECT) in patients with major depressive disorder (MDD). However, the clinical correlates of these changes are still unclear. It remains debated whether such volume changes are transient, and if they correlate with affective changes over time. We here investigated if ECT induces deep grey matter volume increases in MDD-patients; and, if so, whether volume changes persist over more than 9 months and whether they are related to the clinical outcome. METHODS We examined 16 MDD-patients with 3Tesla MRI before (baseline) and after an ECT-series and followed 12 of them up for 10-36 months. Patients' data were compared to 16 healthy controls. Affective scales were used to investigate the relationship between therapy-outcome and MRI changes. RESULTS At baseline, MDD-patients had lower values in global brain volume, white matter and peripheral grey matter compared to healthy controls, but we observed no significant differences in deep grey matter volumes. After ECT, the differences in peripheral grey matter disappeared, and patients demonstrated significant volume increases in the right hippocampus and both thalami, followed by subsequent decreases after 10-36 months, especially in ECT-responders. Controls did not show significant changes over time. LIMITATIONS Beside the relatively small, yet carefully characterized cohort, we address the variability in time between the third scanning session and the baseline. CONCLUSIONS ECT-induced deep grey matter volume increases are transient. Our results suggest that the thalamus might be a key region for the understanding of the mechanisms of ECT action.
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Affiliation(s)
- Margit Jehna
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, 8036 Graz, Medical University of Graz, Austria
| | - Walter Wurm
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Daniela Pinter
- Department of Neurology, Division of General Neurology, 8036 Graz, Medical University of Graz, Austria; Research Unit for Neuronal Repair and Plasticity, 8036 Graz, Medical University of Graz, Austria
| | - Katrin Vogel
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Anna Holl
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Peter Hofmann
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Christoph Ebner
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Division of General Neurology, 8036 Graz, Medical University of Graz, Austria
| | - Gottfried Fuchs
- Department of Anesthesiology and Intensive Care Medicine, Division of Special Anesthesiology, Pain and Intensive Care Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Hannes Deutschmann
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, 8036 Graz, Medical University of Graz, Austria
| | - Christian Enzinger
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, 8036 Graz, Medical University of Graz, Austria; Department of Neurology, Division of General Neurology, 8036 Graz, Medical University of Graz, Austria; Research Unit for Neuronal Repair and Plasticity, 8036 Graz, Medical University of Graz, Austria.
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69
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Changes in resting-state cerebral blood flow and its connectivity in patients with focal to bilateral tonic-clonic seizures. Epilepsy Behav 2021; 115:107687. [PMID: 33360175 DOI: 10.1016/j.yebeh.2020.107687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
Arterial spin labeling (ASL) is an important tool for understanding cerebral perfusion in epilepsy patients. The aim of this study was to explore patterns of change in cerebral blood flow (CBF) and CBF connectivity in patients with focal to bilateral tonic-clonic seizures (FBTCS). High-resolution three-dimensional (3-D) T1-weighted and 3-D pseudo-continuous ASL magnetic resonance imaging (MRI) was collected from 32 patients with FBTCS and 16 healthy volunteers using a 3.0 T MRI scanner. Cerebral blood flow and its connectivity were compared between the FBTCS and control group. Correlation analysis was used to explore relationships of CBF and its connectivity changes with clinical parameters. Cerebral blood flow data of spatial standardization and normalization were used to improve statistical power. Patients with FBTCS exhibited increased CBF in the bilateral thalamus, caudate nucleus, olfactory cortex, and gyrus rectus, but decreased CBF in the bilateral supplementary motor areas (SMA) and middle cingulate cortex (MCC). Patients with FBTCS showed significant positive correlation between CBF and gray matter volume (GMV) in bilateral SMA and MCC. No significant correlations between CBF and clinical parameters were found among FBTCS patients. The anterior cingulate cortex (ACC) showed positive CBF connectivity with the bilateral SMA and MCC, and these CBF connectivity measures differed significantly between groups (cluster-level, FWE-corrected, P < 0.001). These findings suggest that patients with FBTCS have changes in cerebral CBF and CBF connectivity, which may relate to the underlying neuropathology of FBTCS.
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70
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Sip V, Scholly J, Guye M, Bartolomei F, Jirsa V. Evidence for spreading seizure as a cause of theta-alpha activity electrographic pattern in stereo-EEG seizure recordings. PLoS Comput Biol 2021; 17:e1008731. [PMID: 33635864 PMCID: PMC7946361 DOI: 10.1371/journal.pcbi.1008731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/10/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
Intracranial electroencephalography is a standard tool in clinical evaluation of patients with focal epilepsy. Various early electrographic seizure patterns differing in frequency, amplitude, and waveform of the oscillations are observed. The pattern most common in the areas of seizure propagation is the so-called theta-alpha activity (TAA), whose defining features are oscillations in the θ - α range and gradually increasing amplitude. A deeper understanding of the mechanism underlying the generation of the TAA pattern is however lacking. In this work we evaluate the hypothesis that the TAA patterns are caused by seizures spreading across the cortex. To do so, we perform simulations of seizure dynamics on detailed patient-derived cortical surfaces using the spreading seizure model as well as reference models with one or two homogeneous sources. We then detect the occurrences of the TAA patterns both in the simulated stereo-electroencephalographic signals and in the signals of recorded epileptic seizures from a cohort of fifty patients, and we compare the features of the groups of detected TAA patterns to assess the plausibility of the different models. Our results show that spreading seizure hypothesis is qualitatively consistent with the evidence available in the seizure recordings, and it can explain the features of the detected TAA groups best among the examined models.
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Affiliation(s)
- Viktor Sip
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Julia Scholly
- Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, CEMEREM, Pôle d’Imagerie Médicale, CHU, Marseille, France
- Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, Service de Neurophysiologie Clinique, CHU, Marseille, France
| | - Maxime Guye
- Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, CEMEREM, Pôle d’Imagerie Médicale, CHU, Marseille, France
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Fabrice Bartolomei
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, Service de Neurophysiologie Clinique, CHU, Marseille, France
| | - Viktor Jirsa
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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71
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Li R, Wang H, Wang L, Zhang L, Zou T, Wang X, Liao W, Zhang Z, Lu G, Chen H. Shared and distinct global signal topography disturbances in subcortical and cortical networks in human epilepsy. Hum Brain Mapp 2021; 42:412-426. [PMID: 33073893 PMCID: PMC7776006 DOI: 10.1002/hbm.25231] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/08/2020] [Accepted: 09/29/2020] [Indexed: 01/21/2023] Open
Abstract
Epilepsy is a common brain network disorder associated with disrupted large-scale excitatory and inhibitory neural interactions. Recent resting-state fMRI evidence indicates that global signal (GS) fluctuations that have commonly been ignored are linked to neural activity. However, the mechanisms underlying the altered global pattern of fMRI spontaneous fluctuations in epilepsy remain unclear. Here, we quantified GS topography using beta weights obtained from a multiple regression model in a large group of epilepsy with different subtypes (98 focal temporal epilepsy; 116 generalized epilepsy) and healthy population (n = 151). We revealed that the nonuniformly distributed GS topography across association and sensory areas in healthy controls was significantly shifted in patients. Particularly, such shifts of GS topography disturbances were more widespread and bilaterally distributed in the midbrain, cerebellum, visual cortex, and medial and orbital cortex in generalized epilepsy, whereas in focal temporal epilepsy, these networks spread beyond the temporal areas but mainly remain lateralized. Moreover, we found that these abnormal GS topography patterns were likely to evolve over the course of a longer epilepsy disease. Our study demonstrates that epileptic processes can potentially affect global excitation/inhibition balance and shift the normal GS topological distribution. These progressive topographical GS disturbances in subcortical-cortical networks may underlie pathophysiological mechanisms of global fluctuations in human epilepsy.
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Affiliation(s)
- Rong Li
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Hongyu Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Liangcheng Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Leiyao Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Ting Zou
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Xuyang Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Wei Liao
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Zhiqiang Zhang
- Department of Medical ImagingJinling Hospital, Nanjing University School of MedicineNanjingChina
| | - Guangming Lu
- Department of Medical ImagingJinling Hospital, Nanjing University School of MedicineNanjingChina
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
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72
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Sinha N, Peternell N, Schroeder GM, de Tisi J, Vos SB, Winston GP, Duncan JS, Wang Y, Taylor PN. Focal to bilateral tonic-clonic seizures are associated with widespread network abnormality in temporal lobe epilepsy. Epilepsia 2021; 62:729-741. [PMID: 33476430 PMCID: PMC8600951 DOI: 10.1111/epi.16819] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Our objective was to identify whether the whole-brain structural network alterations in patients with temporal lobe epilepsy (TLE) and focal to bilateral tonic-clonic seizures (FBTCS) differ from alterations in patients without FBTCS. METHODS We dichotomized a cohort of 83 drug-resistant patients with TLE into those with and without FBTCS and compared each group to 29 healthy controls. For each subject, we used diffusion-weighted magnetic resonance imaging to construct whole-brain structural networks. First, we measured the extent of alterations by performing FBTCS-negative (FBTCS-) versus control and FBTCS-positive (FBTCS+) versus control comparisons, thereby delineating altered subnetworks of the whole-brain structural network. Second, by standardizing each patient's networks using control networks, we measured the subject-specific abnormality at every brain region in the network, thereby quantifying the spatial localization and the amount of abnormality in every patient. RESULTS Both FBTCS+ and FBTCS- patient groups had altered subnetworks with reduced fractional anisotropy and increased mean diffusivity compared to controls. The altered subnetwork in FBTCS+ patients was more widespread than in FBTCS- patients (441 connections altered at t > 3, p < .001 in FBTCS+ compared to 21 connections altered at t > 3, p = .01 in FBTCS-). Significantly greater abnormalities-aggregated over the entire brain network as well as assessed at the resolution of individual brain areas-were present in FBTCS+ patients (p < .001, d = .82, 95% confidence interval = .32-1.3). In contrast, the fewer abnormalities present in FBTCS- patients were mainly localized to the temporal and frontal areas. SIGNIFICANCE The whole-brain structural network is altered to a greater and more widespread extent in patients with TLE and FBTCS. We suggest that these abnormal networks may serve as an underlying structural basis or consequence of the greater seizure spread observed in FBTCS.
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Affiliation(s)
- Nishant Sinha
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.,Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Natalie Peternell
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Gabrielle M Schroeder
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Jane de Tisi
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Sjoerd B Vos
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Centre for Medical Image Computing, University College London, London, UK.,Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Gavin P Winston
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - John S Duncan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chalfont St Peter, UK
| | - Yujiang Wang
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Peter N Taylor
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK
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73
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Kreilkamp BAK, McKavanagh A, Alonazi B, Bryant L, Das K, Wieshmann UC, Marson AG, Taylor PN, Keller SS. Altered structural connectome in non-lesional newly diagnosed focal epilepsy: Relation to pharmacoresistance. Neuroimage Clin 2021; 29:102564. [PMID: 33508622 PMCID: PMC7841400 DOI: 10.1016/j.nicl.2021.102564] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/19/2022]
Abstract
Despite an expanding literature on brain alterations in patients with longstanding epilepsy, few neuroimaging studies investigate patients with newly diagnosed focal epilepsy (NDfE). Understanding brain network impairments at diagnosis is necessary to elucidate whether or not brain abnormalities are principally due to the chronicity of the disorder and to develop prognostic markers of treatment outcome. Most adults with NDfE do not have MRI-identifiable lesions and the reasons for seizure onset and refractoriness are unknown. We applied structural connectomics to T1-weighted and multi-shell diffusion MRI data with generalized q-sampling image reconstruction using Network Based Statistics (NBS). We scanned 27 patients within an average of 3.7 (SD = 2.9) months of diagnosis and anti-epileptic drug treatment outcomes were collected 24 months after diagnosis. Seven patients were excluded due to lesional NDfE and outcome data was available in 17 patients. Compared to 29 healthy controls, patients with non-lesional NDfE had connectomes with significantly decreased quantitative anisotropy in edges connecting right temporal, frontal and thalamic nodes and increased diffusivity in edges between bilateral temporal, frontal, occipital and parietal nodes. Compared to controls, patients with persistent seizures showed the largest effect size (|d|>=1) for decreased anisotropy in right parietal edges and increased diffusivity in edges between left thalamus and left parietal nodes. Compared to controls, patients who were rendered seizure-free showed the largest effect size for decreased anisotropy in the edge connecting the left thalamus and right temporal nodes and increased diffusivity in edges connecting right frontal nodes. As demonstrated by large effect sizes, connectomes with decreased anisotropy (edge between right frontal and left insular nodes) and increased diffusivity (edge between right thalamus and left parietal nodes) were found in patients with persistent seizures compared to patients who became seizure-free. Patients who had persistent seizures showed larger effect sizes in all network metrics than patients who became seizure-free when compared to each other and compared to controls. Furthermore, patients with focal-to-bilateral tonic-clonic seizures (FBTCS, N = 11) had decreased quantitative anisotropy in a bilateral network involving edges between temporal, parietal and frontal nodes with greater effect sizes than those of patients without FBTCS (N = 9). NBS findings between patients and controls indicated that structural network changes are not necessarily a consequence of longstanding refractory epilepsy and instead are present at the time of diagnosis. Computed effect sizes suggest that there may be structural network MRI-markers of future pharmacoresistance and seizure severity in patients with a new diagnosis of focal epilepsy.
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Affiliation(s)
- Barbara A K Kreilkamp
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK; Department of Clinical Neurophysiology, University Medicine Göttingen, Göttingen, Germany.
| | - Andrea McKavanagh
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Batil Alonazi
- Department of Radiology and Medical Imaging, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Lorna Bryant
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kumar Das
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Udo C Wieshmann
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Peter N Taylor
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, UK; UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Simon S Keller
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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74
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Gruenbaum BF. Comparison of anaesthetic- and seizure-induced states of unconsciousness: a narrative review. Br J Anaesth 2021; 126:219-229. [PMID: 32951841 PMCID: PMC7844374 DOI: 10.1016/j.bja.2020.07.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/23/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022] Open
Abstract
In order to understand general anaesthesia and certain seizures, a fundamental understanding of the neurobiology of unconsciousness is needed. This review article explores similarities in neuronal and network changes during general anaesthesia and seizure-induced unconsciousness. Both seizures and anaesthetics cause disruption in similar anatomical structures that presumably lead to impaired consciousness. Despite differences in behaviour and mechanisms, both of these conditions are associated with disruption of the functionality of subcortical structures that mediate neuronal activity in the frontoparietal cortex. These areas are all likely to be involved in maintaining normal consciousness. An assessment of the similarities in the brain network disruptions with certain seizures and general anaesthesia might provide fresh insights into the mechanisms of the alterations of consciousness seen in these particular unconscious states, allowing for innovative therapies for seizures and the development of anaesthetic approaches targeting specific networks.
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75
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Xu Q, Zhang Q, Yang F, Weng Y, Xie X, Hao J, Qi R, Gumenyuk V, Stufflebeam SM, Bernhardt BC, Lu G, Zhang Z. Cortico-striato-thalamo-cerebellar networks of structural covariance underlying different epilepsy syndromes associated with generalized tonic-clonic seizures. Hum Brain Mapp 2020; 42:1102-1115. [PMID: 33372704 PMCID: PMC7856655 DOI: 10.1002/hbm.25279] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/16/2020] [Accepted: 10/31/2020] [Indexed: 01/05/2023] Open
Abstract
Generalized tonic-clonic seizures (GTCS) are the severest and most remarkable clinical expressions of human epilepsy. Cortical, subcortical, and cerebellar structures, organized with different network patterns, underlying the pathophysiological substrates of genetic associated epilepsy with GTCS (GE-GTCS) and focal epilepsy associated with focal to bilateral tonic-clonic seizure (FE-FBTS). Structural covariance analysis can delineate the features of epilepsy network related with long-term effects from seizure. Morphometric MRI data of 111 patients with GE-GTCS, 111 patients with FE-FBTS and 111 healthy controls were studied. Cortico-striato-thalao-cerebellar networks of structural covariance within the gray matter were constructed using a Winner-take-all strategy with five cortical parcellations. Comparisons of structural covariance networks were conducted using permutation tests, and module effects of disease duration on networks were conducted using GLM model. Both patient groups showed increased connectivity of structural covariance relative to controls, mainly within the striatum and thalamus, and mostly correlated with the frontal, motor, and somatosensory cortices. Connectivity changes increased as a function of epilepsy durations. FE-FBTS showed more intensive and extensive gray matter changes with volumetric loss and connectivity increment than GE-GTCS. Our findings implicated cortico-striato-thalamo-cerebellar network changes at a large temporal scale in GTCS, with FE-FBTS showing more severe network disruption. The study contributed novel imaging evidence for understanding the different epilepsy syndromes associated with generalized seizures.
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Affiliation(s)
- Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Medical school of Nanjing University, Nanjing, China.,College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Qirui Zhang
- Department of Medical Imaging, Jinling Hospital, Medical school of Nanjing University, Nanjing, China
| | - Fang Yang
- Department of Neurology, Jinling Hospital, Medical school of Nanjing University, Nanjing, China
| | - Yifei Weng
- Department of Medical Imaging, Jinling Hospital, Medical school of Nanjing University, Nanjing, China.,Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Xinyu Xie
- Department of Medical Imaging, Jinling Hospital, Medical school of Nanjing University, Nanjing, China
| | - Jingru Hao
- Department of Medical Imaging, Jinling Hospital, Medical school of Nanjing University, Nanjing, China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical school of Nanjing University, Nanjing, China
| | - Valentina Gumenyuk
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Steven M Stufflebeam
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Medical school of Nanjing University, Nanjing, China.,College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, China
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical school of Nanjing University, Nanjing, China.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, China
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76
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Cortical Excitability in Temporal Lobe Epilepsy with Bilateral Tonic-Clonic Seizures. Can J Neurol Sci 2020; 48:648-654. [PMID: 33308332 DOI: 10.1017/cjn.2020.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We investigated motor cortical excitability (CE) in unilateral temporal lobe epilepsy (TLE) and its relationship to bilateral tonic-clonic seizure (BTCS) using paired-pulse transcranial magnetic stimulation (TMS). METHODS In this cross-sectional study, we enrolled 46 unilateral TLE patients and 16 age-and sex-matched healthy controls. Resting motor thresholds (RMT); short-interval intracortical inhibition (SICI, GABAA receptor-mediated); facilitation (ICF, glutamatergic-mediated) with interstimulus intervals (ISIs) of 2, 5, 10, and 15 ms; and long-interval intracortical inhibition (LICI, GABAB receptor-mediated) with ISIs of 200-400 ms were measured via paired-pulse TMS. Comparisons were made between controls and patients with TLE, and then among the TLE subgroups (no BTCS, infrequent BTCS and frequent BTCS subgroup). RESULTS Compared with controls, TLE patients had higher RMT, lower SICI and higher LICI in both hemispheres, and higher ICF in the ipsilateral hemisphere. In patients with frequent BTCS, cortical hyperexcitability in the ipsilateral hemisphere was found in a parameter-dependent manner (SICI decreased at a stimulation interval of 5 ms, and ICF increased at a stimulation interval of 15 ms) compared with patients with infrequent or no BTCS. CONCLUSIONS Our results demonstrate that motor cortical hyper-excitability in the ipsilateral hemisphere underlies the epileptogenic network of patients with active BTCS, which is more extensive than those with infrequent or no BTCS.
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77
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Li Y, Chen Q, Huang W. Disrupted topological properties of functional networks in epileptic children with generalized tonic-clonic seizures. Brain Behav 2020; 10:e01890. [PMID: 33098362 PMCID: PMC7749549 DOI: 10.1002/brb3.1890] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Generalized tonic-clonic seizure (GTCS) is a condition that is characterized by generalized spike-wave discharge in bilateral cerebral hemispheres during the seizure. Although previous neuroimaging studies revealed functional abnormalities in the brain activities of children with GTCS, the topological alterations in whole-brain networks remain poorly understood. METHODS The present study used graph theory to investigate the topological organization of functional networks in 13 GTCS children and 30 age-matched healthy controls. RESULTS We found that both groups exhibited a small-world topology of the functional network. However, children with GTCS showed a significant decrease in nodal local efficiency and clustering coefficient in some key nodes compared with the controls. The connections within the default mode network (DMN) were decreased significantly, and the internetwork connections were increased significantly. The altered topological properties may be an effect of chronic epilepsy. As a result, the optimal topological organization of the functional network was disrupted in the patient group. Notably, clustering coefficient and nodal local efficiency in the bilateral temporal pole of the middle temporal gyrus negatively correlated with the epilepsy duration. CONCLUSION These results suggest that the bilateral temporal pole plays an important role in reflecting the effect of chronic epilepsy on the topological properties in GTCS children. The present study demonstrated a disrupted topological organization in children with GTCS. These findings provide new insight into our understanding of this disorder.
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Affiliation(s)
- Yongxin Li
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Qian Chen
- Department of Pediatric Neurosurgery, Shenzhen Children Hospital, Shenzhen, China
| | - Wenhua Huang
- Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
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78
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Gernert M, Feja M. Bypassing the Blood-Brain Barrier: Direct Intracranial Drug Delivery in Epilepsies. Pharmaceutics 2020; 12:pharmaceutics12121134. [PMID: 33255396 PMCID: PMC7760299 DOI: 10.3390/pharmaceutics12121134] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
Epilepsies are common chronic neurological diseases characterized by recurrent unprovoked seizures of central origin. The mainstay of treatment involves symptomatic suppression of seizures with systemically applied antiseizure drugs (ASDs). Systemic pharmacotherapies for epilepsies are facing two main challenges. First, adverse effects from (often life-long) systemic drug treatment are common, and second, about one-third of patients with epilepsy have seizures refractory to systemic pharmacotherapy. Especially the drug resistance in epilepsies remains an unmet clinical need despite the recent introduction of new ASDs. Apart from other hypotheses, epilepsy-induced alterations of the blood-brain barrier (BBB) are thought to prevent ASDs from entering the brain parenchyma in necessary amounts, thereby being involved in causing drug-resistant epilepsy. Although an invasive procedure, bypassing the BBB by targeted intracranial drug delivery is an attractive approach to circumvent BBB-associated drug resistance mechanisms and to lower the risk of systemic and neurologic adverse effects. Additionally, it offers the possibility of reaching higher local drug concentrations in appropriate target regions while minimizing them in other brain or peripheral areas, as well as using otherwise toxic drugs not suitable for systemic administration. In our review, we give an overview of experimental and clinical studies conducted on direct intracranial drug delivery in epilepsies. We also discuss challenges associated with intracranial pharmacotherapy for epilepsies.
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Affiliation(s)
- Manuela Gernert
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, D-30559 Hannover, Germany;
- Center for Systems Neuroscience, D-30559 Hannover, Germany
- Correspondence: ; Tel.: +49-(0)511-953-8527
| | - Malte Feja
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, D-30559 Hannover, Germany;
- Center for Systems Neuroscience, D-30559 Hannover, Germany
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79
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Disrupted alertness and related functional connectivity in patients with focal impaired awareness seizures in temporal lobe epilepsy. Epilepsy Behav 2020; 112:107369. [PMID: 32858367 DOI: 10.1016/j.yebeh.2020.107369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Focal impaired awareness seizures are common in temporal lobe epilepsy (TLE). The cognitive impairment associated with this type of seizure is unclear. Alertness is a fundamental aspect of cognition. The locus coeruleus (LC) is closely related to alertness. We aimed to assess the impairment in alertness and LC-related alertness network in patients with focal impaired awareness seizures. METHODS Patients with unilateral TLE were grouped into the only focal impaired awareness seizure group (focal group, n = 19) and the focal impaired awareness seizure with focal to bilateral tonic-clonic seizure (FBTCS) group (FBTCS group, n = 19) and compared with matched healthy controls (HC, n = 19). Alertness was assessed with the attention network test. Functional magnetic resonance imaging (fMRI) was used to construct an alertness-related LC-based functional connectivity (FC) network. RESULTS The focal group exhibited impaired tonic and phasic alertness and exhibited a decreased trend of LC-based FC to the left superior frontal gyrus (SFG). The FBTCS group exhibited impaired tonic alertness, phasic alertness, and alertness efficiency. No significant difference or trend in LC-based FC was found in the FBTCS group. SIGNIFICANCE This study reveals disrupted alertness and alertness-related LC-based FC in patients with focal impaired awareness seizures. Our results further demonstrate that the patterns of impaired alertness and of changed LC-based FC were not significantly different between focal impaired awareness seizures and FBTCS.
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80
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Schröter J, Döring JH, Garbade SF, Hoffmann GF, Kölker S, Ries M, Syrbe S. Cross-sectional quantitative analysis of the natural history of TUBA1A and TUBB2B tubulinopathies. Genet Med 2020; 23:516-523. [PMID: 33082561 PMCID: PMC7935713 DOI: 10.1038/s41436-020-01001-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/09/2022] Open
Abstract
Purpose TUBA1A and TUBB2B tubulinopathies are rare neurodevelopmental disorders characterized by cortical and extracortical malformations and heterogenic phenotypes. There is a need for quantitative clinical endpoints that will be beneficial for future diagnostic and therapeutic trials. Methods Quantitative natural history modeling of individuals with TUBA1A and TUBB2B tubulinopathies from clinical reports and database entries of DECIPHER and ClinVar. Main outcome measures were age at disease onset, survival, and diagnostic delay. Phenotypical, neuroradiological, and histopathological features were descriptively illustrated. Results Mean age at disease onset was 4 (TUBA1A) and 6 months (TUBB2B), respectively. Mortality was equally estimated with 7% at 3.2 (TUBA1A) and 8.0 years (TUBB2B). Diagnostic delay was significantly higher in TUBB2B (12.3 years) compared with TUBA1A tubulinopathy (4.2 years). We delineated the isotype-dependent clinical, neuroradiological, and histopathological phenotype of affected individuals and present brain malformations associated with epilepsy and an unfavorable course of disease. Conclusion The natural history of tubulinopathies is defined by the genotype and associated brain malformations. Defined data on estimated survival, diagnostic delay, and disease characteristics of TUBA1A and TUBB2B tubulinopathy will help to raise disease awareness and encourage future clinical trials to optimize genetic testing, family counseling, and supportive care.
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Affiliation(s)
- Julian Schröter
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan H Döring
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sven F Garbade
- Division of Neuropediatrics and Inherited Metabolic Diseases, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg F Hoffmann
- Division of Neuropediatrics and Inherited Metabolic Diseases, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kölker
- Division of Neuropediatrics and Inherited Metabolic Diseases, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Ries
- Division of Neuropediatrics and Inherited Metabolic Diseases, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Steffen Syrbe
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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81
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Järvenpää S, Lehtimäki K, Rainesalo S, Möttönen T, Peltola J. Improving the effectiveness of ANT DBS therapy for epilepsy with optimal current targeting. Epilepsia Open 2020; 5:406-417. [PMID: 32913949 PMCID: PMC7469781 DOI: 10.1002/epi4.12407] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Deep brain stimulation of the ANT is a novel treatment option in refractory epilepsy with an established efficacy at the group level. However, data on the effect of individualized programming are currently lacking. We report the effect of programming changes on outcome in deep brain stimulation of anterior nucleus of thalamus (ANT DBS). Secondly, we investigated whether the effect differs between seizure types. Thirdly, we compared the response status between patients with stimulation contacts verified inside the ANT with patients with contacts located outside of ANT. METHODS The participants were 27 consecutive patients with ANT DBS implantation with at least two-year follow-up. Seizures were subdivided into focal aware (FAS), focal impaired awareness (FIAS), and focal to bilateral tonic-clonic seizures (FBTCS). The patients' seizure diaries were analyzed retrospectively to assess changes in different seizure types. Active contact locations for each patient were verified from preoperative MRI and postoperative CT fusion images using SureTune III (Medtronic Inc, Minneapolis, MN) software. RESULTS A significant reduction in monthly mean seizure frequency occurred in FIAS: 56% at two-year and 65% at five-year follow-up. The effects on FAS and FBTCS were less pronounced. Patients with contacts inside the ANT or on the anterolateral border of ANT experienced a greater reduction in seizure frequency than patients with outside-ANT contacts. Ultimately, seven patients became responders due to changes in DBS programming or repositioning of contacts, increasing our responder rate from 44% to 70% as measured by a seizure reduction of at least 50%. SIGNIFICANCE ANT DBS appears to be especially effective in reducing FIAS, when the appropriately chosen contacts are activated.
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Affiliation(s)
- Soila Järvenpää
- Department of Neurosciences and RehabilitationTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Kai Lehtimäki
- Department of Neurosciences and RehabilitationTampere University HospitalTampereFinland
| | - Sirpa Rainesalo
- Department of Neurosciences and RehabilitationTampere University HospitalTampereFinland
| | - Timo Möttönen
- Department of Neurosciences and RehabilitationTampere University HospitalTampereFinland
| | - Jukka Peltola
- Department of Neurosciences and RehabilitationTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
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82
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He X, Chaitanya G, Asma B, Caciagli L, Bassett DS, Tracy JI, Sperling MR. Disrupted basal ganglia-thalamocortical loops in focal to bilateral tonic-clonic seizures. Brain 2020; 143:175-190. [PMID: 31860076 DOI: 10.1093/brain/awz361] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/16/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Focal to bilateral tonic-clonic seizures are associated with lower quality of life, higher risk of seizure-related injuries, increased chance of sudden unexpected death, and unfavourable treatment outcomes. Achieving greater understanding of their underlying circuitry offers better opportunity to control these seizures. Towards this goal, we provide a network science perspective of the interactive pathways among basal ganglia, thalamus and cortex, to explore the imprinting of secondary seizure generalization on the mesoscale brain network in temporal lobe epilepsy. Specifically, we parameterized the functional organization of both the thalamocortical network and the basal ganglia-thalamus network with resting state functional MRI in three groups of patients with different focal to bilateral tonic-clonic seizure histories. Using the participation coefficient to describe the pattern of thalamocortical connections among different cortical networks, we showed that, compared to patients with no previous history, those with positive histories of focal to bilateral tonic-clonic seizures, including both remote (none for >1 year) and current (within the past year) histories, presented more uniform distribution patterns of thalamocortical connections in the ipsilateral medial-dorsal thalamic nuclei. As a sign of greater thalamus-mediated cortico-cortical communication, this result comports with greater susceptibility to secondary seizure generalization from the epileptogenic temporal lobe to broader brain networks in these patients. Using interregional integration to characterize the functional interaction between basal ganglia and thalamus, we demonstrated that patients with current history presented increased interaction between putamen and globus pallidus internus, and decreased interaction between the latter and the thalamus, compared to the other two patient groups. Importantly, through a series of 'disconnection' simulations, we showed that these changes in interactive profiles of the basal ganglia-thalamus network in the current history group mainly depended upon the direct but not the indirect basal ganglia pathway. It is intuitively plausible that such disruption in the striatum-modulated tonic inhibition of the thalamus from the globus pallidus internus could lead to an under-suppressed thalamus, which in turn may account for their greater vulnerability to secondary seizure generalization. Collectively, these findings suggest that the broken balance between basal ganglia inhibition and thalamus synchronization can inform the presence and effective control of focal to bilateral tonic-clonic seizures. The mechanistic underpinnings we uncover may shed light on the development of new treatment strategies for patients with temporal lobe epilepsy.
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Affiliation(s)
- Xiaosong He
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ganne Chaitanya
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Burcu Asma
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Joseph I Tracy
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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83
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Recurrent seizures cause immature brain injury and changes in GABA a receptor α1 and γ2 subunits. Epilepsy Res 2020; 163:106328. [DOI: 10.1016/j.eplepsyres.2020.106328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/05/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023]
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84
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Chow CY, Absalom N, Biggs K, King GF, Ma L. Venom-derived modulators of epilepsy-related ion channels. Biochem Pharmacol 2020; 181:114043. [PMID: 32445870 DOI: 10.1016/j.bcp.2020.114043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022]
Abstract
Epilepsy is characterised by spontaneous recurrent seizures that are caused by an imbalance between neuronal excitability and inhibition. Since ion channels play fundamental roles in the generation and propagation of action potentials as well as neurotransmitter release at a subset of excitatory and inhibitory synapses, their dysfunction has been linked to a wide variety of epilepsies. Indeed, these unique proteins are the major biological targets for antiepileptic drugs. Selective targeting of a specific ion channel subtype remains challenging for small molecules, due to the high level of homology among members of the same channel family. As a consequence, there is a growing trend to target ion channels with biologics. Venoms are the best known natural source of ion channel modulators, and venom peptides are increasingly recognised as potential therapeutics due to their high selectivity and potency gained through millions of years of evolutionary selection pressure. Here we describe the major ion channel families involved in the pathogenesis of various types of epilepsy, including voltage-gated Na+, K+, Ca2+ channels, Cys-loop receptors, ionotropic glutamate receptors and P2X receptors, and currently available venom-derived peptides that target these channel proteins. Although only a small number of venom peptides have successfully progressed to the clinic, there is reason to be optimistic about their development as antiepileptic drugs, notwithstanding the challenges associated with development of any class of peptide drug.
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Affiliation(s)
- Chun Yuen Chow
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Nathan Absalom
- Brain and Mind Centre, School of Pharmacy, Faculty of Health and Medicine, The University of Sydney, Sydney, NSW 2050, Australia
| | - Kimberley Biggs
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Glenn F King
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Linlin Ma
- Griffith Institute for Drug Discovery, Griffith University, Nathan, QLD 4111, Australia.
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85
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Weng Y, Larivière S, Caciagli L, Vos de Wael R, Rodríguez-Cruces R, Royer J, Xu Q, Bernasconi N, Bernasconi A, Thomas Yeo BT, Lu G, Zhang Z, Bernhardt BC. Macroscale and microcircuit dissociation of focal and generalized human epilepsies. Commun Biol 2020; 3:244. [PMID: 32424317 PMCID: PMC7234993 DOI: 10.1038/s42003-020-0958-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/15/2020] [Indexed: 01/01/2023] Open
Abstract
Thalamo-cortical pathology plays key roles in both generalized and focal epilepsies, but there is little work directly comparing these syndromes at the level of whole-brain mechanisms. Using multimodal imaging, connectomics, and computational simulations, we examined thalamo-cortical and cortico-cortical signatures and underlying microcircuits in 96 genetic generalized (GE) and 107 temporal lobe epilepsy (TLE) patients, along with 65 healthy controls. Structural and functional network profiling highlighted extensive atrophy, microstructural disruptions and decreased thalamo-cortical connectivity in TLE, while GE showed only subtle structural anomalies paralleled by enhanced thalamo-cortical connectivity. Connectome-informed biophysical simulations indicated modest increases in subcortical drive contributing to cortical dynamics in GE, while TLE presented with reduced subcortical drive and imbalanced excitation-inhibition within limbic and somatomotor microcircuits. Multiple sensitivity analyses supported robustness. Our multiscale analyses differentiate human focal and generalized epilepsy at the systems-level, showing paradoxically more severe microcircuit and macroscale imbalances in the former.
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Affiliation(s)
- Yifei Weng
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A2B4, Canada
| | - Sara Larivière
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A2B4, Canada
| | - Lorenzo Caciagli
- University College London Queen Square Institute of Neurology, London, United Kingdom
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Reinder Vos de Wael
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A2B4, Canada
| | - Raúl Rodríguez-Cruces
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A2B4, Canada
| | - Jessica Royer
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A2B4, Canada
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Neda Bernasconi
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A2B4, Canada
| | - Andrea Bernasconi
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A2B4, Canada
| | - B T Thomas Yeo
- Department of Electrical and Computer Engineering, Centre for Sleep and Cognition, Clinical Imaging Research Centre and N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
| | - Boris C Bernhardt
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A2B4, Canada.
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86
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Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten MJAM. The postictal state - What do we know? Epilepsia 2020; 61:1045-1061. [PMID: 32396219 PMCID: PMC7317965 DOI: 10.1111/epi.16519] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
This narrative review provides a broad and comprehensive overview of the most important discoveries on the postictal state over the past decades as well as recent developments. After a description and definition of the postictal state, we discuss postictal sypmtoms, their clinical manifestations, and related findings. Moreover, pathophysiological advances are reviewed, followed by current treatment options.
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Affiliation(s)
- Julia C M Pottkämper
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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87
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Morgan VL, Rogers BP, Anderson AW, Landman BA, Englot DJ. Divergent network properties that predict early surgical failure versus late recurrence in temporal lobe epilepsy. J Neurosurg 2020; 132:1324-1333. [PMID: 30952126 PMCID: PMC6778487 DOI: 10.3171/2019.1.jns182875] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objectives of this study were to identify functional and structural network properties that are associated with early versus long-term seizure outcomes after mesial temporal lobe epilepsy (mTLE) surgery and to determine how these compare to current clinically used methods for seizure outcome prediction. METHODS In this case-control study, 26 presurgical mTLE patients and 44 healthy controls were enrolled to undergo 3-T MRI for functional and structural connectivity mapping across an 8-region network of mTLE seizure propagation, including the hippocampus (left and right), insula (left and right), thalamus (left and right), one midline precuneus, and one midline mid-cingulate. Seizure outcome was assessed annually for up to 3 years. Network properties and current outcome prediction methods related to early and long-term seizure outcome were investigated. RESULTS A network model was previously identified across 8 patients with seizure-free mTLE. Results confirmed that whole-network propagation connectivity patterns inconsistent with the mTLE model predict early surgical failure. In those patients with networks consistent with the mTLE network, specific bilateral within-network hippocampal to precuneus impairment (rather than unilateral impairment ipsilateral to the seizure focus) was associated with mild seizure recurrence. No currently used clinical variables offered the same ability to predict long-term outcome. CONCLUSIONS It is known that there are important clinical differences between early surgical failure that lead to frequent disabling seizures and late recurrence of less frequent mild seizures. This study demonstrated that divergent network connectivity variability, whole-network versus within-network properties, were uniquely associated with these disparate outcomes.
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Affiliation(s)
- Victoria L. Morgan
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Baxter P. Rogers
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam W. Anderson
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Bennett A. Landman
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Dario J. Englot
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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88
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Snider SB, Hsu J, Darby RR, Cooke D, Fischer D, Cohen AL, Grafman JH, Fox MD. Cortical lesions causing loss of consciousness are anticorrelated with the dorsal brainstem. Hum Brain Mapp 2020. [DOI: 10.1002/hbm.24892#.xho8mgjbvfa.twitter] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Samuel B. Snider
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women's HospitalHarvard Medical School Boston Massachusetts
| | - Joey Hsu
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center Boston Massachusetts
| | - R. Ryan Darby
- Department of NeurologyVanderbilt University Medical Center Nashville Tennessee
| | - Danielle Cooke
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center Boston Massachusetts
| | - David Fischer
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women's HospitalHarvard Medical School Boston Massachusetts
| | - Alexander L. Cohen
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center Boston Massachusetts
- Department of NeurologyBoston Children's Hospital, Harvard Medical School Boston Massachusetts
| | - Jordan H. Grafman
- Rehabilitation Institute of Chicago Chicago Illinois
- Department of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Weinberg College of Arts and SciencesNorthwestern University Chicago Illinois
| | - Michael D. Fox
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center Boston Massachusetts
- Department of Neurology, Massachusetts General HospitalHarvard Medical School Boston Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging Charlestown Massachusetts
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89
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Deeba F, Sanz-Leon P, Robinson PA. Effects of physiological parameter evolution on the dynamics of tonic-clonic seizures. PLoS One 2020; 15:e0230510. [PMID: 32240175 PMCID: PMC7117716 DOI: 10.1371/journal.pone.0230510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 02/02/2023] Open
Abstract
The temporal and spectral characteristics of tonic-clonic seizures are investigated using a neural field model of the corticothalamic system in the presence of a temporally varying connection strength between the cerebral cortex and thalamus. Increasing connection strength drives the system into ∼ 10 Hz seizure oscillations once a threshold is passed and a subcritical Hopf bifurcation occurs. In this study, the spectral and temporal characteristics of tonic-clonic seizures are explored as functions of the relevant properties of physiological connection strengths, such as maximum strength, time above threshold, and the ramp rate at which the strength increases or decreases. Analysis shows that the seizure onset time decreases with the maximum connection strength and time above threshold, but increases with the ramp rate. Seizure duration and offset time increase with maximum connection strength, time above threshold, and rate of change. Spectral analysis reveals that the power of nonlinear harmonics and the duration of the oscillations increase as the maximum connection strength and the time above threshold increase. A secondary limit cycle at ∼ 18 Hz, termed a saddle-cycle, is also seen during seizure onset and becomes more prominent and robust with increasing ramp rate. If the time above the threshold is too small, the system does not reach the 10 Hz limit cycle, and only exhibits 18 Hz saddle-cycle oscillations. It is also seen that the time to reach the saturated large amplitude limit-cycle seizure oscillation from both the instability threshold and from the end of the saddle-cycle oscillations is inversely proportional to the square root of the ramp rate.
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Affiliation(s)
- F. Deeba
- School of Physics, University of Sydney, Sydney, NSW, Australia
- Center for Integrative Brain Function, University of Sydney, Sydney, NSW, Australia
- * E-mail: ,
| | - P. Sanz-Leon
- School of Physics, University of Sydney, Sydney, NSW, Australia
- Center for Integrative Brain Function, University of Sydney, Sydney, NSW, Australia
| | - P. A. Robinson
- School of Physics, University of Sydney, Sydney, NSW, Australia
- Center for Integrative Brain Function, University of Sydney, Sydney, NSW, Australia
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90
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The Optogenetic Revolution in Cerebellar Investigations. Int J Mol Sci 2020; 21:ijms21072494. [PMID: 32260234 PMCID: PMC7212757 DOI: 10.3390/ijms21072494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
The cerebellum is most renowned for its role in sensorimotor control and coordination, but a growing number of anatomical and physiological studies are demonstrating its deep involvement in cognitive and emotional functions. Recently, the development and refinement of optogenetic techniques boosted research in the cerebellar field and, impressively, revolutionized the methodological approach and endowed the investigations with entirely new capabilities. This translated into a significant improvement in the data acquired for sensorimotor tests, allowing one to correlate single-cell activity with motor behavior to the extent of determining the role of single neuronal types and single connection pathways in controlling precise aspects of movement kinematics. These levels of specificity in correlating neuronal activity to behavior could not be achieved in the past, when electrical and pharmacological stimulations were the only available experimental tools. The application of optogenetics to the investigation of the cerebellar role in higher-order and cognitive functions, which involves a high degree of connectivity with multiple brain areas, has been even more significant. It is possible that, in this field, optogenetics has changed the game, and the number of investigations using optogenetics to study the cerebellar role in non-sensorimotor functions in awake animals is growing. The main issues addressed by these studies are the cerebellar role in epilepsy (through connections to the hippocampus and the temporal lobe), schizophrenia and cognition, working memory for decision making, and social behavior. It is also worth noting that optogenetics opened a new perspective for cerebellar neurostimulation in patients (e.g., for epilepsy treatment and stroke rehabilitation), promising unprecedented specificity in the targeted pathways that could be either activated or inhibited.
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91
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Abstract
Disrupted Basal Ganglia–Thalamocortical Loops in Focal to Bilateral Tonic-Clonic
Seizures He X, Chaitanya G, Asma B, et al. Brain. 2020;143(1):175-190.
doi:10.1093/brain/awz361. Focal to bilateral tonic-clonic seizures are associated with lower quality of life,
higher risk of seizure-related injuries, increased chance of sudden unexpected death,
and unfavorable treatment outcomes. Achieving greater understanding of their
underlying circuitry offers better opportunity to control these seizures. Toward this
goal, we provide a network science perspective of the interactive pathways among basal
ganglia, thalamus and cortex, to explore the imprinting of secondary seizure
generalization on the mesoscale brain network in temporal lobe epilepsy. Specifically,
we parameterized the functional organization of both the thalamocortical network and
the basal ganglia–thalamus network with resting state functional magnetic resonance
imaging in 3 groups of patients with different focal to bilateral tonic-clonic seizure
histories. Using the participation coefficient to describe the pattern of
thalamocortical connections among different cortical networks, we showed that,
compared to patients with no previous history, those with positive histories of focal
to bilateral tonic-clonic seizures, including both remote (none for >1 year) and
current (within the past year) histories, presented more uniform distribution patterns
of thalamocortical connections in the ipsilateral medial-dorsal thalamic nuclei. As a
sign of greater thalamus-mediated cortico-cortical communication, this result comports
with greater susceptibility to secondary seizure generalization from the epileptogenic
temporal lobe to broader brain networks in these patients. Using interregional
integration to characterize the functional interaction between basal ganglia and
thalamus, we demonstrated that patients with current history presented increased
interaction between putamen and globus pallidus internus, and decreased interaction
between the latter and the thalamus, compared to the other 2 patient groups.
Importantly, through a series of “disconnection” simulations, we showed that these
changes in interactive profiles of the basal ganglia–thalamus network in the current
history group mainly depended upon the direct but not the indirect basal ganglia
pathway. It is intuitively plausible that such disruption in the striatum-modulated
tonic inhibition of the thalamus from the globus pallidus internus could lead to an
under-suppressed thalamus, which in turn may account for their greater vulnerability
to secondary seizure generalization. Collectively, these findings suggest that the
broken balance between basal ganglia inhibition and thalamus synchronization can
inform the presence and effective control of focal to bilateral tonic-clonic seizures.
The mechanistic underpinnings we uncover may shed light on the development of new
treatment strategies for patients with temporal lobe epilepsy.
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92
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Cerebello-cerebral connectivity in idiopathic generalized epilepsy. Eur Radiol 2020; 30:3924-3933. [DOI: 10.1007/s00330-020-06674-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/17/2019] [Accepted: 01/24/2020] [Indexed: 12/24/2022]
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93
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Snider SB, Hsu J, Darby RR, Cooke D, Fischer D, Cohen AL, Grafman JH, Fox MD. Cortical lesions causing loss of consciousness are anticorrelated with the dorsal brainstem. Hum Brain Mapp 2020; 41:1520-1531. [PMID: 31904898 PMCID: PMC7268053 DOI: 10.1002/hbm.24892] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/11/2019] [Accepted: 11/27/2019] [Indexed: 01/01/2023] Open
Abstract
Brain lesions can provide unique insight into the neuroanatomical substrate of human consciousness. For example, brainstem lesions causing coma map to a specific region of the tegmentum. Whether specific lesion locations outside the brainstem are associated with loss of consciousness (LOC) remains unclear. Here, we investigate the topography of cortical lesions causing prolonged LOC (N = 16), transient LOC (N = 91), or no LOC (N = 64). Using standard voxel lesion symptom mapping, no focus of brain damage was associated with LOC. Next, we computed the network of brain regions functionally connected to each lesion location using a large normative connectome dataset (N = 1,000). This technique, termed lesion network mapping, can test whether lesions causing LOC map to a connected brain circuit rather than one brain region. Connectivity between cortical lesion locations and an a priori coma-specific region of brainstem tegmentum was an independent predictor of LOC (B = 1.2, p = .004). Connectivity to the dorsal brainstem was the only predictor of LOC in a whole-brain voxel-wise analysis. This relationship was driven by anticorrelation (negative correlation) between lesion locations and the dorsal brainstem. The map of regions anticorrelated to the dorsal brainstem thus defines a distributed brain circuit that, when damaged, is most likely to cause LOC. This circuit showed a slight posterior predominance and had peaks in the bilateral claustrum. Our results suggest that cortical lesions causing LOC map to a connected brain circuit, linking cortical lesions that disrupt consciousness to brainstem sites that maintain arousal.
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Affiliation(s)
- Samuel B Snider
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joey Hsu
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - R Ryan Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Danielle Cooke
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David Fischer
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander L Cohen
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jordan H Grafman
- Rehabilitation Institute of Chicago, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, Illinois
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts
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94
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Streng ML, Krook-Magnuson E. Excitation, but not inhibition, of the fastigial nucleus provides powerful control over temporal lobe seizures. J Physiol 2019; 598:171-187. [PMID: 31682010 DOI: 10.1113/jp278747] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022] Open
Abstract
KEY POINTS On-demand optogenetic inhibition of glutamatergic neurons in the fastigial nucleus of the cerebellum does not alter hippocampal seizures in a mouse model of temporal lobe epilepsy. In contrast, on-demand optogenetic excitation of glutamatergic neurons in the fastigial nucleus successfully inhibits hippocampal seizures. With this approach, even a single 50 ms pulse of light is able to significantly inhibit seizures. On-demand optogenetic excitation of glutamatergic fastigial neurons either ipsilateral or contralateral to the seizure focus is able to inhibit seizures. Selective excitation of glutamatergic nuclear neurons provides greater seizure inhibition than broadly exciting nuclear neurons without cell-type specificity. ABSTRACT Temporal lobe epilepsy is the most common form of epilepsy in adults, but current treatment options provide limited efficacy, leaving as many as one-third of patients with uncontrolled seizures. Recently, attention has shifted towards more closed-loop therapies for seizure control, and on-demand optogenetic modulation of the cerebellar cortex was shown to be highly effective at attenuating hippocampal seizures. Intriguingly, both optogenetic excitation and inhibition of cerebellar cortical output neurons, Purkinje cells, attenuated seizures. The mechanisms by which the cerebellum impacts seizures, however, are unknown. In the present study, we targeted the immediate downstream projection of vermal Purkinje cells - the fastigial nucleus - in order to determine whether increases and/or decreases in fastigial output can underlie seizure cessation. Though Purkinje cell input to fastigial neurons is inhibitory, direct optogenetic inhibition of the fastigial nucleus had no effect on seizure duration. Conversely, however, fastigial excitation robustly attenuated hippocampal seizures. Seizure cessation was achieved at multiple stimulation frequencies, regardless of laterality relative to seizure focus, and even with single light pulses. Seizure inhibition was greater when selectively targeting glutamatergic fastigial neurons than when an approach that lacked cell-type specificity was used. Together, these results suggest that stimulating excitatory neurons in the fastigial nucleus may be a promising approach for therapeutic intervention in temporal lobe epilepsy.
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Affiliation(s)
- Martha L Streng
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
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95
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Abstract
Mapping the circuits underlying the generation and propagation of seizures is critically important for understanding their pathophysiology. We review evidence to suggest that circuits engaged in secondarily generalized seizures are likely to be more complex than those currently proposed. Focal seizures have been proposed to engage canonical thalamocortical circuits that mediate primarily generalized absence seizures, leading to secondarily generalized tonic-clonic seizures. In addition to traveling through the canonical thalamocortical circuits, secondarily generalized seizures could also travel through the striatum, globus pallidus, substantia nigra reticulata, and corpus callosum to the contralateral hemisphere. Recruitment of principal neurons in superficial layers 2/3 of the cortex can play a critical role in corticocortical seizure spread. Understanding the neuronal structures engaged in generating secondarily generalized seizures could provide novel targets for neuromodulation for the treatment of seizures. Furthermore, these sites may be loci of neuronal plasticity facilitating epileptogenesis. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".
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Affiliation(s)
- Anastasia Brodovskaya
- Neuroscience Graduate Program, University of Virginia, Charlottesville, VA 22908, USA
| | - Jaideep Kapur
- Departments of Neurology, University of Virginia, Charlottesville, VA 22908, USA; Neuroscience, University of Virginia, Charlottesville, VA 22908, USA; UVA Brain Institute, University of Virginia, Charlottesville, VA 22908, USA.
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96
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Lertwittayanon W, Devinsky O, Carlen PL. Cardiorespiratory depression from brainstem seizure activity in freely moving rats. Neurobiol Dis 2019; 134:104628. [PMID: 31669732 DOI: 10.1016/j.nbd.2019.104628] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022] Open
Abstract
Cardiorespiratory dysfunction during or after seizures may contribute to sudden unexpected death in epilepsy. Disruption of lower brainstem cardiorespiratory systems by seizures is postulated to impair respiratory and cardiac function. Here, we explore the effects of brainstem seizures and stimulation on cardiorespiratory function using a rat model of intrahippocampal 4-aminopyridine (4-AP)-induced acute recurrent seizures. Cardiac and respiratory monitoring together with local field potential recordings from hippocampus, contralateral parietal cortex and caudal dorsomedial brainstem, were conducted in freely moving adult male Wistar rats. Seizures were induced by intrahippocampal injection of 4-AP. Increased respiratory rate but unchanged heart rate occurred during hippocampal and secondarily generalized cortical seizures. Status epilepticus without brainstem seizures increased respiratory and heart rates, whereas status epilepticus with intermittent brainstem seizures induced repeated episodes of cardiorespiratory depression leading to death. Respiratory arrest occurred prior to asystole which was the terminal event. Phenytoin (100 mg/kg, intraperitoneal injection), administered after 4-AP intrahippocampal injection, terminated brainstem seizures and the associated cardiorespiratory depression, preventing death in five of six rats. Focal electrical stimulation of the caudal dorsomedial brainstem also suppressed cardiorespiratory rates. We conclude that in our model, brainstem seizures were associated with respiratory depression followed by cardiac arrest, and then death. We hypothesize this model shares mechanisms in common with the classic sudden unexpected death in epilepsy (SUDEP) syndrome associated with spontaneous seizures.
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Affiliation(s)
- Wanida Lertwittayanon
- Krembil Research Institute, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Department of Physiology, Prince of Songkla University, Hat Yai, Songkhla, Thailand; Research unit for EEG biomarkers of neuronal diseases, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Orrin Devinsky
- New York University Medical Center, Neurology, NY, New York, United States
| | - Peter L Carlen
- Krembil Research Institute, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Departments of Medicine (Neurology), Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada.
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97
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Takamiya A, Kishimoto T, Liang KC, Terasawa Y, Nishikata S, Tarumi R, Sawada K, Kurokawa S, Hirano J, Yamagata B, Mimura M. Thalamic volume, resting-state activity, and their association with the efficacy of electroconvulsive therapy. J Psychiatr Res 2019; 117:135-141. [PMID: 31419618 DOI: 10.1016/j.jpsychires.2019.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022]
Abstract
Electroconvulsive therapy (ECT) is the most effective antidepressant treatment. Biological predictors of clinical outcome to ECT are valuable. We aimed to examine multimodal magnetic resonance imaging (MRI) data that correlates to the efficacy of ECT. Structural and resting-state functional MRI data were acquired from 46 individuals (25 depressed individuals who received ECT, and 21 healthy controls). Whole-brain grey matter volume (GMV) and fractional amplitude of low frequency fluctuations (fALFF) were investigated to identify brain regions associated with post-ECT Hamilton Depression Rating Scale (HAM-D) total scores. GMV and fALFF values were compared with those in healthy controls using analysis of covariance (ANCOVA). Remission was defined by HAM-D ≤7. A multiple regression analysis revealed that pretreatment smaller GMV in the left thalamus was associated with worse response to ECT (i.e. higher post-ECT HAM-D). Pretreatment higher fALFF in the right anterior insula, and lower fALFF in the left thalamus and the cerebellum were associated with worse outcomes. The left thalamus was identified in both GMV and fALFF analyses. Nonremitters showed significantly smaller thalamic GMV compared to remitters and controls. We found that pretreatment thalamic volume and resting-state activity were associated with the efficacy of ECT. Our results highlight the importance of the thalamus as a possible biological predictor and its role in the underlying mechanisms of ECT action.
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Affiliation(s)
- Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Center for Psychiatry and Behavioral Science, Tokyo, Japan
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Kuo-Ching Liang
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yuri Terasawa
- Center for Psychiatry and Behavioral Science, Tokyo, Japan
| | | | - Ryosuke Tarumi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Center for Psychiatry and Behavioral Science, Tokyo, Japan
| | - Kyosuke Sawada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shunya Kurokawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jinichi Hirano
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Bun Yamagata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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98
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Loonen ICM, Jansen NA, Cain SM, Schenke M, Voskuyl RA, Yung AC, Bohnet B, Kozlowski P, Thijs RD, Ferrari MD, Snutch TP, van den Maagdenberg AMJM, Tolner EA. Brainstem spreading depolarization and cortical dynamics during fatal seizures in Cacna1a S218L mice. Brain 2019; 142:412-425. [PMID: 30649209 DOI: 10.1093/brain/awy325] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/29/2018] [Indexed: 12/26/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a fatal complication of epilepsy in which brainstem spreading depolarization may play a pivotal role, as suggested by animal studies. However, patiotemporal details of spreading depolarization occurring in relation to fatal seizures have not been investigated. In addition, little is known about behavioural and neurophysiological features that may discriminate spontaneous fatal from non-fatal seizures. Transgenic mice carrying the missense mutation S218L in the α1A subunit of Cav2.1 (P/Q-type) Ca2+ channels exhibit enhanced excitatory neurotransmission and increased susceptibility to spreading depolarization. Homozygous Cacna1aS218L mice show spontaneous non-fatal and fatal seizures, occurring throughout life, resulting in reduced life expectancy. To identify characteristics of fatal and non-fatal spontaneous seizures, we compared behavioural and electrophysiological seizure dynamics in freely-behaving homozygous Cacna1aS218L mice. To gain insight on the role of brainstem spreading depolarization in SUDEP, we studied the spatiotemporal distribution of spreading depolarization in the context of seizure-related death. Spontaneous and electrically-induced seizures were investigated by video monitoring and electrophysiological recordings in freely-behaving Cacna1aS218L and wild-type mice. Homozygous Cacna1aS218L mice showed multiple spontaneous tonic-clonic seizures and died from SUDEP in adulthood. Death was preceded by a tonic-clonic seizure terminating with hindlimb clonus, with suppression of cortical neuronal activity during and after the seizure. Induced seizures in freely-behaving homozygous Cacna1aS218L mice were followed by multiple spreading depolarizations and death. In wild-type or heterozygous Cacna1aS218L mice, induced seizures and spreading depolarization were never followed by death. To identify temporal and regional features of seizure-induced spreading depolarization related to fatal outcome, diffusion-weighted MRI was performed in anaesthetized homozygous Cacna1aS218L and wild-type mice. In homozygous Cacna1aS218L mice, appearance of seizure-related spreading depolarization in the brainstem correlated with respiratory arrest that was followed by cardiac arrest and death. Recordings in freely-behaving homozygous Cacna1aS218L mice confirmed brainstem spreading depolarization during spontaneous fatal seizures. These data underscore the value of the homozygous Cacna1aS218L mouse model for identifying discriminative features of fatal compared to non-fatal seizures, and support a key role for cortical neuronal suppression and brainstem spreading depolarization in SUDEP pathophysiology.
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Affiliation(s)
- Inge C M Loonen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Jansen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stuart M Cain
- Michael Smith Laboratories and Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Maarten Schenke
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A Voskuyl
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew C Yung
- UBC MRI Research Center, University of British Columbia, Vancouver, Canada
| | - Barry Bohnet
- UBC MRI Research Center, University of British Columbia, Vancouver, Canada
| | - Piotr Kozlowski
- UBC MRI Research Center, University of British Columbia, Vancouver, Canada
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,SEIN Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Terrance P Snutch
- Michael Smith Laboratories and Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Arn M J M van den Maagdenberg
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Else A Tolner
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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99
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Dabrowska N, Joshi S, Williamson J, Lewczuk E, Lu Y, Oberoi S, Brodovskaya A, Kapur J. Parallel pathways of seizure generalization. Brain 2019; 142:2336-2351. [PMID: 31237945 PMCID: PMC6658865 DOI: 10.1093/brain/awz170] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 01/13/2023] Open
Abstract
Generalized convulsive status epilepticus is a life-threatening emergency, because recurrent convulsions can cause death or injury. A common form of generalized convulsive status epilepticus is of focal onset. The neuronal circuits activated during seizure spread from the hippocampus, a frequent site of seizure origin, to the bilateral motor cortex, which mediates convulsive seizures, have not been delineated. Status epilepticus was initiated by electrical stimulation of the hippocampus. Neurons transiently activated during seizures were labelled with tdTomato and then imaged following brain slice clearing. Hippocampus was active throughout the episode of status epilepticus. Neuronal activation was observed in hippocampus parahippocampal structures: subiculum, entorhinal cortex and perirhinal cortex, septum, and olfactory system in the initial phase status epilepticus. The tdTomato-labelled neurons occupied larger volumes of the brain as seizures progressed and at the peak of status epilepticus, motor and somatosensory cortex, retrosplenial cortex, and insular cortex also contained tdTomato-labelled neurons. In addition, motor thalamic nuclei such as anterior and ventromedial, midline, reticular, and posterior thalamic nuclei were also activated. Furthermore, circuits proposed to be crucial for systems consolidation of memory: entorhinal cortex, retrosplenial cortex, cingulate gyrus, midline thalamic nuclei and prefrontal cortex were intensely active during periods of generalized tonic-clonic seizures. As the episode of status epilepticus waned, smaller volume of brain was activated. These studies suggested that seizure spread could have occurred via canonical thalamocortical pathway and many cortical structures involved in memory consolidation. These studies may help explain retrograde amnesia following seizures.
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Affiliation(s)
- Natalia Dabrowska
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
| | - Suchitra Joshi
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
| | - John Williamson
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
| | - Ewa Lewczuk
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
| | - Yanhong Lu
- College of Arts and Sciences, University of Virginia, Charlottesville, VA 22908, USA
| | - Samrath Oberoi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA
| | - Anastasia Brodovskaya
- Neuroscience Graduate Program, University of Virginia, Charlottesville, VA 22908, USA
| | - Jaideep Kapur
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
- UVA Brain Institute, University of Virginia, Charlottesville, VA 22908, USA
- Department of Neuroscience, University of Virginia, Charlottesville, VA 22908, USA
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100
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A pilot study of combined endurance and resistance exercise rehabilitation for verbal memory and functional connectivity improvement in epilepsy. Epilepsy Behav 2019; 96:44-56. [PMID: 31078935 DOI: 10.1016/j.yebeh.2019.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 12/18/2022]
Abstract
Memory impairment is common in persons with epilepsy (PWE), and exercise may be a strategy for its improvement. In this pilot study, we hypothesized that exercise rehabilitation would improve physical fitness and verbal memory and induce changes in brain networks involved in memory processes. We examined the effects of combined endurance and resistance exercise rehabilitation on memory and resting state functional connectivity (rsFC). Participants were randomized to exercise (PWE-E) or control (PWE-noE). The exercise intervention consisted of 18 supervised sessions on nonconsecutive days over 6 weeks. Before and after the intervention period, both groups completed self-report assessments (Short Form-36 (SF-36), Baecke Questionnaire (BQ) of habitual physical activity, and Profile of Mood States (POMS)), cognitive testing (California Verbal Learning Test-II (CVLT-II)), and magnetic resonance imaging (MRI); PWE-E also completed exercise performance tests. After completing the study, PWE-noE were offered cross-over to the exercise arm. There were no differences in baseline demographic, clinical, or assessment variables between 8 PWE-noE and 9 PWE-E. Persons with epilepsy that participated in exercise intervention increased maximum voluntary strength (all strength tests p < 0.05) and exhibited nonsignificant improvement in cardiorespiratory fitness (p = 0.15). Groups did not show significant changes in quality of life (QOL) or habitual physical activity between visits. However, there was an effect of visit on POMS total mood disturbance (TMD) measure showing improvement from baseline to visit 2 (p = 0.023). There were significant group by visit interactions on CVLT-II learning score (p = 0.044) and total recognition discriminability (d') (p = 0.007). Persons with epilepsy that participated in exercise intervention had significant reductions in paracingulate rsFC with the anterior cingulate and increases in rsFC for the cerebellum, thalamus, posterior cingulate cortex (PCC), and left and right inferior parietal lobule (IPL) (corrected p < 0.05). Change in CVLT-II learning score was associated with rsFC changes for the paracingulate cortex (rS = -0.67; p = 0.0033), left IPL (rS = 0.70; p = 0.0019), and right IPL (rS = 0.71; p = 0.0015) while change in d' was associated with change in cerebellum rsFC to angular/middle occipital gyrus (rS = 0.68; p = 0.0025). Our conclusion is that exercise rehabilitation may facilitate verbal memory improvement and brain network functional connectivity changes in PWE and that improved memory performance is associated with changes in rsFC. A larger randomized controlled trial of exercise rehabilitation for cognitive improvement in PWE is warranted.
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