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Auvin S, Bellavoine V, Merdariu D, Delanoë C, Elmaleh-Bergés M, Gressens P, Boespflug-Tanguy O. Hemiconvulsion-hemiplegia-epilepsy syndrome: current understandings. Eur J Paediatr Neurol 2012; 16:413-21. [PMID: 22341151 DOI: 10.1016/j.ejpn.2012.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 01/03/2012] [Accepted: 01/07/2012] [Indexed: 11/30/2022]
Abstract
Hemiconvulsion-Hemiplegia (HH) syndrome is an uncommon consequence of prolonged focal febrile convulsive seizures in infancy and early childhood. It is characterized by the occurrence of prolonged clonic seizures with unilateral predominance occurring in a child and followed by the development of hemiplegia. Neuroradiological studies showed unilateral edematous swelling of the epileptic hemisphere at the time of initial status epilepticus (SE). This acute phase is followed by characteristic cerebral hemiatrophy with subsequent appearance of epilepsy, so called Hemiconvulsion-Hemiplegia-Epilepsy (HHE) syndrome. The etiologies and the underlying mechanisms remain to be understood. Using a review of the literature, we summarized the data of the last 20 years. It appears that idiopathic HH/HHE syndrome is the most common reported form. The basic science data suggest that immature brain is relatively resistant to SE-induced cell injury. Several factors might contribute to the pathogenesis of HH/HHE syndrome: 1. prolonged febrile seizure in which inflammation may worsen the level of cell injury; 2. inflammation and prolonged ictal activity that act on blood-brain-barrier permeability; 3. predisposing factors facilitating prolonged seizure such as genetic factors or focal epileptogenic lesion. However, these factors cannot explain the elective involvement of an entire hemisphere. We draw new hypothesis that may explain the involvement of one hemisphere such as maturation of brain structure such as corpus callosum or genetic factors (CACNA1A gene) that are specifically discussed. An early diagnosis and a better understanding of the underlying mechanisms of HHE are needed to improve the outcome of this condition.
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Kramer K, Schaudien D, Eisel ULM, Herzog S, Richt JA, Baumgärtner W, Herden C. TNF-overexpression in Borna disease virus-infected mouse brains triggers inflammatory reaction and epileptic seizures. PLoS One 2012; 7:e41476. [PMID: 22848506 PMCID: PMC3405098 DOI: 10.1371/journal.pone.0041476] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 06/26/2012] [Indexed: 11/19/2022] Open
Abstract
Proinflammatory state of the brain increases the risk for seizure development. Neonatal Borna disease virus (BDV)-infection of mice with neuronal overexpression of tumor necrosis factor-α (TNF) was used to investigate the complex relationship between enhanced cytokine levels, neurotropic virus infection and reaction pattern of brain cells focusing on its role for seizure induction. Viral antigen and glial markers were visualized by immunohistochemistry. Different levels of TNF in the CNS were provided by the use of heterozygous and homozygous TNF overexpressing mice. Transgenic TNF, total TNF (native and transgenic), TNF-receptor (TNFR1, TNFR2), IL-1 and N-methyl-D-aspartate (NMDA)-receptor subunit 2B (NR2B) mRNA values were measured by real time RT-PCR. BDV-infection of TNF-transgenic mice resulted in non-purulent meningoencephalitis accompanied by epileptic seizures with a higher frequency in homozygous animals. This correlated with lower weight gain, stronger degree and progression of encephalitis and early, strong microglia activation in the TNF-transgenic mice, most obviously in homozygous animals. Activation of astroglia could be more intense and associated with an unusual hypertrophy in the transgenic mice. BDV-antigen distribution and infectivity in the CNS was comparable in TNF-transgenic and wild-type animals. Transgenic TNF mRNA-expression was restricted to forebrain regions as the transgene construct comprised the promoter of NMDA-receptor subunit2B and induced up-regulation of native TNF mRNA. Total TNF mRNA levels did not increase significantly after BDV-infection in the brain of transgenic mice but TNFR1, TNFR2 and IL-1 mRNA values, mainly in the TNF overexpressing brain areas. NR2B mRNA levels were not influenced by transgene expression or BDV-infection. Neuronal TNF-overexpression combined with BDV-infection leads to cytokine up-regulation, CNS inflammation and glial cell activation and confirmed the presensitizing effect of elevated cytokine levels for the development of spontaneous epileptic seizures when exposed to additional infectious noxi.
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MESH Headings
- Animals
- Borna Disease/genetics
- Borna Disease/metabolism
- Borna Disease/pathology
- Borna disease virus/genetics
- Borna disease virus/metabolism
- Epilepsy/genetics
- Epilepsy/metabolism
- Epilepsy/pathology
- Epilepsy/virology
- Interleukin-18 Receptor alpha Subunit/biosynthesis
- Interleukin-18 Receptor alpha Subunit/genetics
- Mice
- Mice, Transgenic
- Nerve Tissue Proteins/genetics
- Nerve Tissue Proteins/metabolism
- Neuroglia/metabolism
- Neuroglia/pathology
- Neuroglia/virology
- Prosencephalon/metabolism
- Prosencephalon/pathology
- Prosencephalon/virology
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- Receptors, N-Methyl-D-Aspartate/biosynthesis
- Receptors, N-Methyl-D-Aspartate/genetics
- Receptors, Tumor Necrosis Factor, Type I/biosynthesis
- Receptors, Tumor Necrosis Factor, Type I/genetics
- Receptors, Tumor Necrosis Factor, Type II/biosynthesis
- Receptors, Tumor Necrosis Factor, Type II/genetics
- Tumor Necrosis Factor-alpha/biosynthesis
- Tumor Necrosis Factor-alpha/genetics
- Up-Regulation/genetics
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Affiliation(s)
- Katharina Kramer
- Department of Pathology, University of Veterinary Medicine, Hannover, Germany
| | - Dirk Schaudien
- Department of Pathology, University of Veterinary Medicine, Hannover, Germany
| | - Ulrich L. M. Eisel
- Department of Molecular Neurobiology, University of Groningen, Groningen, The Netherlands
| | - Sibylle Herzog
- Institute of Virology, Justus-Liebig-University, Gießen, Germany
| | - Jürgen A. Richt
- Department of Diagnostic Medicine/Pathobiology, Kansas State University, Manhattan, Kansas, United States of America
| | | | - Christiane Herden
- Department of Pathology, University of Veterinary Medicine, Hannover, Germany
- * E-mail:
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53
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Hesdorffer DC, Shinnar S, Lewis DV, Moshé SL, Nordli DR, Pellock JM, MacFall J, Shinnar RC, Masur D, Frank LM, Epstein LG, Litherland C, Seinfeld S, Bello JA, Chan S, Bagiella E, Sun S. Design and phenomenology of the FEBSTAT study. Epilepsia 2012; 53:1471-80. [PMID: 22742587 DOI: 10.1111/j.1528-1167.2012.03567.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Febrile status epilepticus (FSE) has been associated with hippocampal injury and subsequent hippocampal sclerosis (HS) and temporal lobe epilepsy. The FEBSTAT study was designed to prospectively examine the association between prolonged febrile seizures and development of HS and associated temporal lobe epilepsy, one of the most controversial issues in epilepsy. We report on the baseline phenomenology of the final cohorts as well as detailed aims and methodology. METHODS The "Consequences of Prolonged Febrile Seizures in Childhood" (FEBSTAT) study is a prospective, multicenter study. Enrolled are children, aged 1 month to 6 years of age, presenting with a febrile seizure lasting 30 min or longer based on ambulance, emergency department, and hospital records, and parental interview. At baseline, procedures included a magnetic resonance imaging (MRI) study and electroencephalography (EEG) recording done within 72 h of FSE, and a detailed history and neurologic examination. Baseline development and behavior are assessed at 1 month. The baseline assessment is repeated, with age-appropriate developmental testing at 1 and 5 years after enrollment as well as at the development of epilepsy and 1 year after that. Telephone calls every 3 months document additional seizures. Two other groups of children are included: a "control" group consisting of children with a first febrile seizure ascertained at Columbia University and with almost identical baseline and 1-year follow-up examinations and a pilot cohort of FSE from Duke University. KEY FINDINGS The FEBSTAT cohort consists of 199 children with a median age at baseline of 16.0 months (interquartile range [IQR] 12.0-24.0) and a median duration of FSE of 70.0 min (IQR 47.0-110.0). Seizures were continuous in 57.3% and behaviorally intermittent (without recovery in between) in 31.2%; most were partial (2.0%) or secondary generalized (65.8%), and almost all (98.0%) culminated in a generalized tonic-clonic seizure. Of the 199 children, 86.4% had normal development and 20% had prior febrile seizures. In one third of cases, FSE was unrecognized in the emergency department. The Duke existing cohort consists of 23 children with a median age of FSE onset of 18.0 months (IQR 14.0-28.0) and median duration of FSE of 90.0 min (IQR 50.0-170.0). The Columbia control cohort consists of 159 children with a first febrile seizure who received almost the same workup as the FEBSTAT cohort at baseline and at 1 year. They were followed by telephone every 4 months for a median of 42 months. Among the control cohort, 64.2% had a first simple FS, 26.4% had a first complex FS that was not FSE, and 9.4% had FSE. Among the 15 with FSE, the median age at onset was 14.0 months (IQR 12.0-20.0) and the median duration of FSE was 43.0 min (IQR 35.0-75.0). SIGNIFICANCE The FEBSTAT study presents an opportunity to prospectively study the relationship between FSE and acute hippocampal damage, the development of mesial temporal sclerosis, epilepsy (particularly temporal lobe epilepsy), and impaired hippocampal function in a large cohort. It is hoped that this study may illuminate a major mystery in clinical epilepsy today, and permit the development of interventions designed to prevent the sequelae of FSE.
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Affiliation(s)
- Dale C Hesdorffer
- GH Sergievsky Center, Columbia University, 630 West 168th Street, P & S Unit 16, New York, NY 10032, USA.
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54
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Amirian ES, Scheurer ME. Chromosomally-integrated human herpesvirus 6 in familial glioma etiology. Med Hypotheses 2012; 79:193-6. [PMID: 22591997 DOI: 10.1016/j.mehy.2012.04.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/20/2012] [Indexed: 01/28/2023]
Abstract
Human herpesvirus 6 (HHV-6) is a highly neurotropic beta-herpesvirus with demonstrated transformative properties. HHV-6 infection has been implicated in the etiologies of cancers, including lymphoma and leukemia; conditions with brain involvement, including epilepsy and encephalitis; and other disorders. HHV-6 is also the only human herpesvirus that has been proven to integrate into the chromosomes of a proportion (1-12%) of infected individuals. Because several traditional genetic association studies have failed to identify a variant that can account for the established relationship between family history and glioma risk, the possibility that chromosomally-integrated HHV-6 (CI-HHV-6), as a heritable factor, may explain a proportion of familial glioma cases warrants evaluation. To test this hypothesis, the prevalence of CI-HHV-6 in familial glioma cases and related and unrelated cancer-free control groups should be compared. Among glioma-affected families, the inheritance pattern of CI-HHV-6 could be evaluated by constructing pedigrees. If CI-HHV-6 is found to be associated with familial glioma risk, this knowledge could potentially lead to the future development of novel therapeutic and preventive approaches, including vaccines and immunotherapies targeted at the HHV-6 sequences.
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Affiliation(s)
- E Susan Amirian
- Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
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55
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Howell KB, Tiedemann K, Haeusler G, Mackay MT, Kornberg AJ, Freeman JL, Harvey AS. Symptomatic generalized epilepsy after HHV6 posttransplant acute limbic encephalitis in children. Epilepsia 2012; 53:e122-6. [DOI: 10.1111/j.1528-1167.2012.03494.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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56
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Kaplan PW, Rossetti AO, Kaplan EH, Wieser HG. Proposition: limbic encephalitis may represent limbic status epilepticus. A review of clinical and EEG characteristics. Epilepsy Behav 2012; 24:1-6. [PMID: 22459869 DOI: 10.1016/j.yebeh.2011.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/25/2011] [Indexed: 10/28/2022]
Abstract
Limbic encephalitis (LE) with waxing and waning neuropsychiatric manifestations including behavioral, personality, psychiatric, and memory changes can evolve over days to months. Many features of LE show remarkable overlap with the characteristics of mesial-temporal (limbic) status epilepticus (MTLSE or LSE). With LE, these prolonged impaired states are assumed not to be due to ongoing epileptic activity or MTLSE, because scalp EEGs usually show no epileptiform spike-wave activity; cycling behavioral and motor changes are attributed to LE; there may be little immediate improvement with antiepileptic drugs (AEDs); and of course, implanted electrodes are rarely used. Conversely, it is known that in pre-surgical patients with refractory limbic epilepsy, implanted electrodes have revealed limbic seizures that cannot be seen at the scalp. This paper assembles a chain of inferences to advance the proposition that refractory LE might represent LSE more often than is thought, and that implanted electrodes should be considered in some cases. We present two cases that suggest that LE was also LSE, one of which warranted implanted electrodes (case 1).
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Affiliation(s)
- Peter W Kaplan
- The Johns Hopkins Bayview Medical Center, Department of Neurology, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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57
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Atypical febrile seizures, mesial temporal lobe epilepsy, and dual pathology. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:342928. [PMID: 22957226 PMCID: PMC3420631 DOI: 10.1155/2012/342928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 02/02/2012] [Accepted: 02/07/2012] [Indexed: 12/02/2022]
Abstract
Febrile seizures occurring in the neonatal period, especially when prolonged, are thought to be involved in the later development of mesial temporal lobe epilepsy (mTLE) in children. The presence of an often undetected, underlying cortical malformation has also been reported to be implicated in the epileptogenesis process following febrile seizures. This paper highlights some of the various animal models of febrile seizures and of cortical malformation and portrays a two-hit model that efficiently mimics these two insults and leads to spontaneous recurrent seizures in adult rats. Potential mechanisms are further proposed to explain how these two insults may each, or together, contribute to network hyperexcitability and epileptogenesis. Finally the clinical relevance of the two-hit model is briefly discussed in light of a therapeutic and preventive approach to mTLE.
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58
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Natural history of temporal lobe epilepsy: antecedents and progression. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:195073. [PMID: 22937237 PMCID: PMC3420774 DOI: 10.1155/2012/195073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/20/2011] [Accepted: 12/29/2011] [Indexed: 11/17/2022]
Abstract
Temporal lobe epilepsy represents the largest group of patients with treatment resistant/medically intractable epilepsy undergoing epilepsy surgery. The underpinnings of common forms of TLE in many instances begin in early life with the occurrence of an initial precipitating event. The first epileptic seizure often occurs after a variable latency period following this event. The precise natural history and progression following the first seizure to the development of TLE, its subsequent resolution through spontaneous remission or the development of treatment resistant epilepsy remain poorly understood. Our present understanding of the role played by these initial events, the subsequent latency to development of temporal lobe epilepsy, and the emergence of treatment resistance remains incomplete. A critical analysis of published data suggest that TLE is a heterogeneous condition, where the age of onset, presence or absence of a lesion on neuroimaging, the initial precipitating event, association with febrile seizures, febrile status epilepticus, and neurotropic viral infections influence the natural history and outcome. The pathways and processes through which these variables coalesce into a framework will provide the basis for an understanding of the natural history of TLE. The questions raised need to be addressed in future prospective and longitudinal observational studies.
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59
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Gomes WA, Shinnar S. Prospects for imaging-related biomarkers of human epileptogenesis: a critical review. Biomark Med 2012; 5:599-606. [PMID: 22003908 DOI: 10.2217/bmm.11.66] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
To facilitate the study of epileptogenesis in humans, noninvasive biomarkers of epileptogenesis are required. No validated biomarker is currently available, but brain imaging techniques provide many attractive candidates. In this article we examine the imaging features of temporal lobe epilepsy, focusing on those that may precede the onset of epilepsy and correlate with epileptogenesis. Hippocampal volumetry and T(2) relaxometry are proposed as candidate biomarkers of epileptogenesis in temporal lobe epilepsy following febrile status epilepticus. Preliminary data suggest that these have promise, and the ongoing Consequences of Prolonged Febrile Seizures in Childhood (FEBSTAT) study will provide more conclusive evidence as to their validity. At this time there are no other clear candidates for imaging-related biomarkers of epileptogenesis in human studies.
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Affiliation(s)
- William A Gomes
- Comprehensive Epilepsy Management Center, Montefiore Medical Center, 111 E. 210th St, Bronx, NY 10467, USA
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60
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61
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Affiliation(s)
- Ciğdem Ozkara
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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62
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Hedlund GL. Comments on hippocampal sclerosis in children younger than 2 years. Pediatr Radiol 2011; 41:1229-31. [PMID: 21779893 DOI: 10.1007/s00247-011-2168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/08/2011] [Indexed: 10/18/2022]
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Abstract
Central nervous system (CNS) infections are the main cause of seizures and acquired epilepsy in the developing world. Geographical variations determine the common causes in a particular region. Acute seizures are common in severe meningitis, viral encephalitis, malaria, and neurocysticercosis, and in most cases are associated with increased mortality and morbidity, including subsequent epilepsy. Neuronal excitability secondary to proinflammatory signals induced by CNS infections are an important common mechanism for the generation of seizures, in addition to various other specific mechanisms. Newer insights into the neurobiology of these infections and the associated epilepsy could help in developing neuroprotective interventions. Management issues include prompt treatment of acute seizures and the underlying CNS infection, correction of associated predisposing factors, and decisions regarding the appropriate choice and duration of antiepileptic therapy. Strategies for the prevention of epilepsy in CNS infections such as early anti-infective and anti-inflammatory therapy need scientific exploration. Prevention of CNS infections is the only definitive way forward to reduce the burden of epilepsy in developing countries.
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Affiliation(s)
- Pratibha Singhi
- Department of Paediatrics, Advanced Paediatrics Centre, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India.
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64
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Abstract
A pathogenic role of immunity in epilepsies has long been suggested based on observations of the efficacy of immune-modulating treatments and, more recently, by the finding of inflammation markers including autoantibodies in individuals with a number of epileptic disorders. Clinical and experimental data suggest that both innate and adaptive immunity may be involved in epilepsy. Innate immunity represents an immediate, nonspecific host response against pathogens via activation of resident brain immune cells and inflammatory mediators. These are hypothesized to contribute to seizures and epileptogenesis. Adaptive immunity employs activation of antigen-specific B and T lymphocytes or antibodies in the context of viral infections and autoimmune disorders. In this article we critically review the evidence for pathogenic roles of adaptive immune responses in several types of epilepsy, and discuss potential mechanisms and therapeutic targets. We highlight future directions for preclinical and clinical research that are required for improved diagnosis and treatment of immune-mediated epilepsies.
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Affiliation(s)
- Tiziana Granata
- Department of Child Neurology, Carlo Besta Neurological Institute, Milan, Italy.
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65
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Revest M, Minjolle S, Veyer D, Lagathu G, Michelet C, Colimon R. Detection of HHV-6 in over a thousand samples: new types of infection revealed by an analysis of positive results. J Clin Virol 2011; 51:20-4. [PMID: 21376662 DOI: 10.1016/j.jcv.2011.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 01/28/2011] [Accepted: 02/02/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinical manifestations of human herpesvirus-6 (HHV-6) have not been clearly defined, and the role of HHV-6 in human disease remains to be fully elucidated. OBJECTIVE To determine the frequency of HHV-6 infections at Rennes Teaching Hospital and to describe all possible symptoms of such infections. STUDY DESIGN We systematically analyzed in a retrospective study all the samples between May 2003 and December 2004 from patients with HHV-6 by polymerase chain reaction (PCR). Clinical records of patients with positive HHV-6 PCR were recorded. Diagnosis of HHV-6 infection was accepted if all other possible diagnoses had been eliminated. RESULTS Over the study period, 1591 PCRs were performed from various tissues, including blood, cerebrospinal fluid, ascitis and tissue biopsies. Forty-three samples from 25 patients tested positive (3%). We describe three groups of clinical manifestations of HHV-6 infection. The first group consisted of neurological complications (32% of patients), including convulsions, encephalitis and chronic psychiatric disorders in immunocompetent patients. The second group consisted of clinical problems relating to gastrointestinal tract, which was found in 9 of our patients (36%). All of these patients were immunocompromised. Four of them presented colitis, and one of them died one month after liver transplantation because of this colitis. The last group of clinical symptoms was associated with maternal-fetal infection leading to abortion following HHV-6 seroconversion during pregnancy. CONCLUSION Three clinical types of HHV-6 infections are described: neurological manifestations including encephalitis in non-immunocompromised patients, digestive problems in immunosuppressed patients and severe maternal-fetal infection.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child, Preschool
- DNA, Viral/blood
- DNA, Viral/cerebrospinal fluid
- Digestive System Diseases/virology
- Encephalitis, Viral/virology
- Female
- Fetal Diseases/virology
- Herpesvirus 6, Human/genetics
- Herpesvirus 6, Human/isolation & purification
- Herpesvirus 6, Human/pathogenicity
- Humans
- Immunocompetence
- Immunocompromised Host
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/virology
- Infectious Disease Transmission, Vertical
- Male
- Middle Aged
- Polymerase Chain Reaction/methods
- Pregnancy
- Pregnancy Complications, Infectious/virology
- Retrospective Studies
- Roseolovirus Infections/classification
- Roseolovirus Infections/virology
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Affiliation(s)
- Matthieu Revest
- Infectious Disease and Intensive Care Unit, Pontchaillou University Hospital, Rennes 35033, France.
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66
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Li JM, Lei D, Peng F, Zeng YJ, Li L, Xia ZL, Xia XQ, Zhou D. Detection of human herpes virus 6B in patients with mesial temporal lobe epilepsy in West China and the possible association with elevated NF-κB expression. Epilepsy Res 2011; 94:1-9. [DOI: 10.1016/j.eplepsyres.2010.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 10/31/2010] [Accepted: 11/14/2010] [Indexed: 11/28/2022]
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67
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Yao K, Crawford JR, Komaroff AL, Ablashi DV, Jacobson S. Review part 2: Human herpesvirus-6 in central nervous system diseases. J Med Virol 2010; 82:1669-78. [PMID: 20827763 DOI: 10.1002/jmv.21861] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Karen Yao
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
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68
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Niehusmann P, Mittelstaedt T, Bien CG, Drexler JF, Grote A, Schoch S, Becker AJ. Presence of human herpes virus 6 DNA exclusively in temporal lobe epilepsy brain tissue of patients with history of encephalitis. Epilepsia 2010; 51:2478-83. [DOI: 10.1111/j.1528-1167.2010.02741.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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69
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Tang H, Kawabata A, Yoshida M, Oyaizu H, Maeki T, Yamanishi K, Mori Y. Human herpesvirus 6 encoded glycoprotein Q1 gene is essential for virus growth. Virology 2010; 407:360-7. [PMID: 20863544 DOI: 10.1016/j.virol.2010.08.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 07/23/2010] [Accepted: 08/18/2010] [Indexed: 11/19/2022]
Abstract
Human herpesvirus 6 (HHV-6) glycoprotein Q1 (gQ1), a unique gene in HHV-6, forms a complex with glycoproteinH (gH) and gL, which is the viral ligand for its cellular receptor, CD46. However, whether gQ1 is essential for virus growth is unknown, because a system is lacking for making gene knockouts for HHV-6. Recently, bacterial artificial chromosome (BAC) and E. coli mutagenesis techniques have been applied to herpesvirus investigation. Here we successfully inserted the HHV-6A genome into a BAC, and obtained reconstituted infectious virus from the HHV-6A-containing BAC DNA. Using this system, we generated a gQ1 mutant virus genome, which failed to yield reconstituted infectious virus, whereas its revertant virus could be produced, indicating that the HHV-6 gQ1 gene is essential for virus growth. Therefore, we successfully applied BAC and E. coli mutagenesis techniques to the study of HHV-6, and discovered that HHV-6 gQ1 is an essential gene for virus growth.
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Affiliation(s)
- Huamin Tang
- Laboratory of Virology and Vaccinology, Division of Biomedical Research, National Institute of Biomedical Innovation, 7-6-8, Saito-Asagi, Ibaraki, Osaka 567-0085, Japan
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70
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Ahmad S, Marsh ED. Febrile status epilepticus: current state of clinical and basic research. Semin Pediatr Neurol 2010; 17:150-4. [PMID: 20727483 DOI: 10.1016/j.spen.2010.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Febrile status epilepticus occurs in up to 5% of all cases of febrile seizures and has been linked to the development of focal epilepsy. This article reviews the clinical characteristics and treatment issues of febrile status. Controversy exists regarding the relationship of febrile status epilepticus to the subsequent development of epilepsy. This subject is discussed by first reviewing the clinical research literature and then highlighting the basic science research regarding this controversial question. The current literature appears to support a role for febrile status in the development of focal epilepsy but is clearly neither necessary nor sufficient in the focal epileptogenisis process. Multiple insults are likely necessary for a child with febrile status epilepticus to develop epilepsy later in life.
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Affiliation(s)
- Saba Ahmad
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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71
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Muehlebner A, Groeppel G, Pahs G, Hainfellner JA, Prayer D, Czech T, Feucht M. Beneficial effect of epilepsy surgery in a case of childhood non-paraneoplastic limbic encephalitis. Epilepsy Res 2010; 90:295-9. [DOI: 10.1016/j.eplepsyres.2010.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 04/24/2010] [Accepted: 05/16/2010] [Indexed: 10/19/2022]
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72
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Abstract
Viral infections of the pediatric central nervous system (CNS) encompass a broad spectrum of both perinatally and postnatally acquired diseases with potentially devastating effects on the developing brain. In children, viral infections have been associated with chronic encephalopathy, encephalitis, demyelinating disease, tumors, and epilepsy. Older diagnostic techniques of biopsy, viral culture, electron microscopy, gel-based polymerase chain reaction (PCR), and viral titer quantification are being replaced with more rapid, sensitive, and specific real-time and microarray-based PCR technologies. Advances in neuroimaging technologies have provided for earlier recognition of CNS injury without elucidation of specific viral etiology. Although the mainstay therapy of many pediatric neurovirologic diseases, aside from HIV, includes intravenous acyclovir, much work is being done to develop novel antiviral immunotherapies aimed at both treating and preventing pediatric CNS viral disease.
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Affiliation(s)
- John R Crawford
- Department of Neurosciences and Pediatrics, University of California, 9500 Gilman Drive Box 0935, San Diego, CA 92093, USA.
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73
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Laina I, Syriopoulou VP, Daikos GL, Roma ES, Papageorgiou F, Kakourou T, Theodoridou M. Febrile seizures and primary human herpesvirus 6 infection. Pediatr Neurol 2010; 42:28-31. [PMID: 20004859 DOI: 10.1016/j.pediatrneurol.2009.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 07/22/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
Abstract
Primary human herpesvirus 6 infection is acquired mainly during the first two years of life and is often associated with febrile seizures. The aim of the present study was to investigate in Greece the frequency and clinical characteristics of primary human herpesvirus 6 (HHV-6) infection in hospitalized children with febrile seizures. Children aged from 6 months to 5 years without known neurologic disease were examined for primary HHV-6 infection, by real-time polymerase chain reaction in acute-phase plasma and by indirect immunofluorescent assay for antibody titers in acute and convalescent serum. Of 65 children included in the analysis, 55 experienced the first febrile episode of seizures and 10 the second. Primary HHV-6 infection was verified in 10 of 55 children with a first febrile episode (18%), whereas none of the 10 children with a second episode of seizures had primary HHV-6 infection. Eight children were infected with HHV-6 type B and two with type A. None of the 85 control subjects had primary HHV-6 infection, but 49% had immunoglobulin G antibodies against the virus. These findings suggest that primary HHV-6 infection is frequently associated with febrile seizures in children in this geographic region and should be considered, especially for a first episode of febrile seizures.
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Affiliation(s)
- Ioanna Laina
- First Department of Pediatrics, Aghia Sophia Children's Hospital, Athens University, Athens, Greece
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74
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Giraudon P, Bernard A. Chronic viral infections of the central nervous system: Aspects specific to multiple sclerosis. Rev Neurol (Paris) 2009; 165:789-95. [PMID: 19656540 PMCID: PMC7118785 DOI: 10.1016/j.neurol.2009.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The involvement of a viral infection in the physiopathology of multiple sclerosis has been said to cause certain viruses to target the central nervous system and induce neuroinflammation leading to cell dysfunction, as seen, for example, by demyelination or neuronal death. The most recent results of the literature have focused on the Herpes family viruses (HHV-6 and HHV-4/Epstein-Barr virus) and their possible role in the development of multiple sclerosis. Even if no virus has been identified so far as the multiple sclerosis etiological agent, our aim here is to show that some viruses may be responsible for triggering or sustaining neurological diseases. This is particularly the case for Paramyxoviruses, in the late appearance of functional alterations, Picornaviruses, in inducing a breakdown of immune tolerance, epitope spreading and demyelination, and Herpes viruses in inducing T and B lymphocyte activation, T lymphocytes dysregulation and autoimmunity after their reactivation. Therefore, “common” viruses can play a role as potential modulators of the immune and nervous systems which, in the specific context of dysimmunity and genetic susceptibility, stimulate a favorable background to the development of multiple sclerosis. Tracing and studying viruses in multiple sclerosis patients may improve our understanding of their actual involvement in multiple sclerosis physiopathology.
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75
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Galic MA, Riazi K, Henderson AK, Tsutsui S, Pittman QJ. Viral-like brain inflammation during development causes increased seizure susceptibility in adult rats. Neurobiol Dis 2009; 36:343-51. [PMID: 19660546 DOI: 10.1016/j.nbd.2009.07.025] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Revised: 07/26/2009] [Accepted: 07/29/2009] [Indexed: 11/26/2022] Open
Abstract
Viral infections of the CNS and their accompanying inflammation can cause long-term neurological effects, including increased risk for seizures. To examine the effects of CNS inflammation, we infused polyinosinic:polycytidylic acid, intracerebroventricularly to mimic a viral CNS infection in 14 day-old rats. This caused fever and an increase in the pro-inflammatory cytokine, interleukin (IL)-1beta in the brain. As young adults, these animals were more susceptible to lithium-pilocarpine and pentylenetetrazol-induced seizures and showed memory deficits in fear conditioning. Whereas there was no alteration in adult hippocampal cytokine levels, we found a marked increase in NMDA (NR2A and C) and AMPA (GluR1) glutamate receptor subunit mRNA expression. The increase in seizure susceptibility, glutamate receptor subunits, and hippocampal IL-1beta levels were suppressed by neonatal systemic minocycline. Thus, a novel model of viral CNS inflammation reveals pathophysiological relationships between brain cytokines, glutamate receptors, behaviour and seizures, which can be attenuated by anti-inflammatory agents like minocycline.
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Affiliation(s)
- M A Galic
- Epilepsy and Brain Circuits Program, Hotchkiss Brain Institute, Department of Neuroscience, University of Calgary, Calgary, Alberta, Canada
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76
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Bien CG, Schramm J. Treatment of Rasmussen encephalitis half a century after its initial description: promising prospects and a dilemma. Epilepsy Res 2009; 86:101-12. [PMID: 19615863 DOI: 10.1016/j.eplepsyres.2009.06.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 06/03/2009] [Accepted: 06/07/2009] [Indexed: 11/26/2022]
Abstract
Rasmussen encephalitis (RE), initially described half a century ago, is an inflammatory unihemispheric brain disorder. Its two clinical key facets are the progressive tissue and function loss and the epilepsy, often in form of epilepsia partialis continua. For both, treatment options are available. Anti-seizure effect of anti-epilepsy drugs is usually limited to secondarily generalized seizures and complex partial seizures whereas epilepsia partialis continua usually is totally refractory. Hemispherectomy in one of its modern variants offers a very high chance of seizure freedom, however at the price of irreversible loss of functions located in the affected hemisphere. In a proportion of patients, long-term immunotherapy is able to prevent or slow down hemispheric tissue loss and the associated functional decline. It does, however, mostly not improve the epilepsy. Whereas for many patients unequivocal treatment proposals can be readily made, a dilemma may emerge in those with severe epilepsy but still preserved hemispheric function.
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Affiliation(s)
- Christian G Bien
- University of Bonn, Department of Epileptology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
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77
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Crawford JR, Santi MR, Cornelison R, Sallinen SL, Haapasalo H, MacDonald TJ. Detection of human herpesvirus-6 in adult central nervous system tumors: predominance of early and late viral antigens in glial tumors. J Neurooncol 2009; 95:49-60. [PMID: 19424665 DOI: 10.1007/s11060-009-9908-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 04/22/2009] [Indexed: 12/21/2022]
Abstract
The purpose is to determine the incidence of active and latent human herpesvirus-6 (HHV-6) infection in a large cohort of adult primary and recurrent CNS tumors. We screened a tissue microarray (TMA) containing more than 200 adult primary and recurrent CNS tumors with known clinical information for the presence of HHV-6 DNA by in situ hybridization (ISH) and protein by immunohistochemistry (IHC). One hundred six of 224 (47%) CNS tumors were positive for HHV-6 U57 Major Capsid Protein (MCP) gene by ISH compared to 0/25 non tumor control brain (P = 0.001). Fourteen of 30 (47%) tumors were HHV-6 MCP positive by nested PCR compared to 0/25 non-tumor brain controls (P = 0.001), revealing HHV-6 Variant A in 6 of 14 samples. HHV-6A/B early (p41) and late (gp116/64/54) antigens were detected by IHC in 66 of 277 (24%) (P = 0.003) and 84 of 282 (35%) (P = 0.002) tumors, respectively, suggesting active infection. HHV-6 p41 (P = 0.645) and gp116/64/54 (P = 0.198) antigen detection was independent of recurrent disease. Glial tumors were 3 times more positive by IHC compared to non glial tumors for both HHV-6 gp116/64/54 (P = 0.0002) and HHV-6 p41 (P = 0.004). Kaplan Meier survival analysis showed no effect of HHV-6 gp116/64/54 (P = 0.852) or HHV-6 p41 (P = 0.817) antigen detection on survival. HHV-6 early and late antigens are detected in adult primary and recurrent CNS tumors more frequently in glial tumors. We hypothesize that the glial-tropic features of HHV-6 may play an important modifying role in tumor biology that warrants further investigation.
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Affiliation(s)
- John R Crawford
- Department of Neurology, The George Washington University, 111 Michigan Ave NW, Washington, DC, 20010, USA.
- The Brain Tumor Institute, Children's National Medical Center, The George Washington University, 111 Michigan Ave NW, Washington, DC, 20010, USA.
- Department of Neurology, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
| | - Maria Rita Santi
- Department of Pathology, The George Washington University, 111 Michigan Ave NW, Washington, DC, 20010, USA
- The Brain Tumor Institute, Children's National Medical Center, The George Washington University, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Robbie Cornelison
- Molecular Genetics Section, The National Cancer Institute, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Satu-Leena Sallinen
- Department of Pediatrics, Genetics Outpatient Clinics, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
| | - Hannu Haapasalo
- Department of Pathology, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
| | - Tobey J MacDonald
- Department of Hematology-Oncology, The George Washington University, 111 Michigan Ave NW, Washington, DC, 20010, USA
- The Brain Tumor Institute, Children's National Medical Center, The George Washington University, 111 Michigan Ave NW, Washington, DC, 20010, USA
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