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Nagahama Y, Joshi C, Dlouhy B, Wu AY, Abel TJ, Baumbach G, Kawasaki H. Functional hemispherotomy in Rasmussen syndrome in the absence of classic MRI findings. EPILEPSY & BEHAVIOR CASE REPORTS 2017; 7:24-27. [PMID: 28239546 PMCID: PMC5315437 DOI: 10.1016/j.ebcr.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/19/2016] [Accepted: 11/25/2016] [Indexed: 12/02/2022]
Abstract
A 7-year-old previously healthy girl presented with a left-sided focal seizure without impaired consciousness and subsequently developed epilepsia partialis continua. Initial MRI was normal, and the subsequent images only showed a focal T2/FLAIR hyperintense area without cortical atrophy. She was diagnosed with Rasmussen syndrome by pathology and promptly treated with functional hemispherotomy. Rasmussen syndrome is a rare progressive neurological disorder, the only definitive cure for which is hemispheric disconnection. The disease presents a management dilemma, especially early in disease course without characteristic neuroimaging features. A high index of suspicion, multidisciplinary approach, and clear timely communication with the family are critical.
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Affiliation(s)
- Yasunori Nagahama
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Charuta Joshi
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Brian Dlouhy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Angela Y Wu
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Taylor J Abel
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Gary Baumbach
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Hiroto Kawasaki
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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202
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Thompson KK, Tsirka SE. The Diverse Roles of Microglia in the Neurodegenerative Aspects of Central Nervous System (CNS) Autoimmunity. Int J Mol Sci 2017; 18:ijms18030504. [PMID: 28245617 PMCID: PMC5372520 DOI: 10.3390/ijms18030504] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 02/07/2023] Open
Abstract
Autoimmune diseases of the central nervous system (CNS) involve inflammatory components and result in neurodegenerative processes. Microglia, the resident macrophages of the CNS, are the first responders after insults to the CNS and comprise a major link between the inflammation and neurodegeneration. Here, we will focus on the roles of microglia in two autoimmune diseases: the prevalent condition of multiple sclerosis (MS) and the much rarer Rasmussen’s encephalitis (RE). Although there is an abundance of evidence that microglia actively contribute to neuronal damage in pathological states such as MS and RE, there is also evidence of important reparative functions. As current research supports a more complex and diverse array of functions and phenotypes that microglia can assume, it is an especially interesting time to examine what is known about both the damaging and restorative roles that microglia can play in the inflammatory CNS setting. We will also discuss the pharmacological approaches to modulating microglia towards a more neuroprotective state.
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Affiliation(s)
- Kaitlyn K Thompson
- Molecular and Cellular Pharmacology Graduate Program, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY 11794-8651, USA.
| | - Stella E Tsirka
- Molecular and Cellular Pharmacology Graduate Program, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY 11794-8651, USA.
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203
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Abstract
Seizures are a common manifestation of autoimmune limbic encephalitis and multifocal paraneoplastic disorders. Accumulating evidence supports an autoimmune basis for seizures in the absence of syndromic manifestations of encephalitis. The autoimmune epilepsies are immunologically mediated disorders in which recurrent seizures are a primary and persistent clinical feature. When other etiologies have been excluded, an autoimmune etiology is suggested in a patient with epilepsy upon detection of neural autoantibodies and/or the presence of inflammatory changes on cerebrospinal fluid (CSF) or magnetic resonance imaging. In such patients, immunotherapy may be highly effective, depending on the particular autoimmune epilepsy syndrome present. In this chapter, several autoimmune epilepsy syndromes are discussed. First, epilepsies secondary to other primary autoimmune disorders will be discussed, and then those associated with antibodies that are likely to be pathogenic, such as voltage-gated potassium channel-complex and N-methyl-d-aspartate receptor, gamma-aminobutyric acid A and B receptor antibodies. For each syndrome, the typical clinical, imaging, electroencephaloram, CSF, and serologic features, and pathophysiology and treatment are described. Finally, suggested guidelines for the recognition, evaluation, and treatment of autoimmune epilepsy syndromes are provided.
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204
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Co DO, Bordini BJ, Meyers AB, Inglese C. Immune-Mediated Diseases of the Central Nervous System: A Specificity-Focused Diagnostic Paradigm. Pediatr Clin North Am 2017; 64:57-90. [PMID: 27894452 DOI: 10.1016/j.pcl.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Immune-mediated diseases of the central nervous system show wide variability both symptomatically and with respect to underlying pathophysiology. Recognizing aberrant immunologic activity as the cause of neurologic dysfunction requires establishing as precise a neuroanatomic and functional phenotype as possible, and a diagnostic and therapeutic strategy that stabilizes the patient, excludes broad categories of disease via rapidly available diagnostic assays, and maintains a broad differential diagnosis that includes immune-mediated conditions. This process is aided by recognizing the appropriate clinical circumstances under which immune-mediated disease should be suspected, and how to differentiate these conditions from other causes of similar neurologic dysfunction.
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Affiliation(s)
- Dominic O Co
- Section of Pediatric Rheumatology, Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Brett J Bordini
- Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Arthur B Meyers
- Department of Radiology, University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA
| | - Christopher Inglese
- Section of Pediatric Neurology, Department of Neurology, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA
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205
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Cho SM, Zeft A, Knight EP, Kotagal P, Wyllie E, Moosa ANV. Refractory status epilepticus secondary to atypical Rasmussen encephalitis successfully managed with aggressive immunotherapy. Neurol Clin Pract 2017; 7:e5-e8. [PMID: 29849226 DOI: 10.1212/cpj.0000000000000261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sung-Min Cho
- Epilepsy Center (S-MC, EPK, PK, EW, ANVM), Cleveland Clinic Neurological Institute; and Center for Pediatric Rheumatology and Immunology (AZ), Cleveland Clinic, OH
| | - Andrew Zeft
- Epilepsy Center (S-MC, EPK, PK, EW, ANVM), Cleveland Clinic Neurological Institute; and Center for Pediatric Rheumatology and Immunology (AZ), Cleveland Clinic, OH
| | - Elia Pestana Knight
- Epilepsy Center (S-MC, EPK, PK, EW, ANVM), Cleveland Clinic Neurological Institute; and Center for Pediatric Rheumatology and Immunology (AZ), Cleveland Clinic, OH
| | - Prakash Kotagal
- Epilepsy Center (S-MC, EPK, PK, EW, ANVM), Cleveland Clinic Neurological Institute; and Center for Pediatric Rheumatology and Immunology (AZ), Cleveland Clinic, OH
| | - Elaine Wyllie
- Epilepsy Center (S-MC, EPK, PK, EW, ANVM), Cleveland Clinic Neurological Institute; and Center for Pediatric Rheumatology and Immunology (AZ), Cleveland Clinic, OH
| | - Ahsan N V Moosa
- Epilepsy Center (S-MC, EPK, PK, EW, ANVM), Cleveland Clinic Neurological Institute; and Center for Pediatric Rheumatology and Immunology (AZ), Cleveland Clinic, OH
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206
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Benjumea-Cuartas V, Eisermann M, Simonnet H, Hully M, Nabbout R, Desguerre I, Kaminska A. Unilateral predominance of abnormal movements: A characteristic feature of the pediatric anti-NMDA receptor encephalitis? EPILEPSY & BEHAVIOR CASE REPORTS 2017; 7:42-44. [PMID: 28348963 PMCID: PMC5357742 DOI: 10.1016/j.ebcr.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/29/2016] [Accepted: 12/24/2016] [Indexed: 12/27/2022]
Abstract
Anti-NMDA receptor encephalitis is a treatable autoimmune disease characterized by cognitive, motor and psychiatric features that primarily affects young adults and children. We present a case of a 7-year-old boy with asymmetrical (mainly right hemibody) and abnormal polymorphic movements without concomitant scalpictal EEG changes but had background slowing predominating over the left hemisphere. This report illustrates previous descriptions of asymmetric presentation of abnormal movements in pediatric anti-NMDA receptor encephalitis and emphasizes the importance of video-EEG interpreted within the overall clinical context, to differentiate epileptic from non-epileptic abnormal movements in patients with autoimmune encephalitis.
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Affiliation(s)
| | - Monika Eisermann
- Department of Clinical Neurophysiology, Necker-Enfants Malades Hospital, APHP, Paris, France; INSERM U1129, Paris, France; Paris Descartes University, Sorbonne Paris Cité; CEA, Gif sur Yvette, France
| | - Hina Simonnet
- Reference Center for Rare Epilepsies, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Marie Hully
- Reference Center for Rare Epilepsies, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Rima Nabbout
- INSERM U1129, Paris, France; Paris Descartes University, Sorbonne Paris Cité; CEA, Gif sur Yvette, France; Department of Pediatric Neurology, APHP, Necker-Enfants Malades Hospital, Paris, France; Reference Center for Rare Epilepsies, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Isabelle Desguerre
- Reference Center for Rare Epilepsies, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Anna Kaminska
- Department of Clinical Neurophysiology, Necker-Enfants Malades Hospital, APHP, Paris, France; INSERM U1129, Paris, France; Paris Descartes University, Sorbonne Paris Cité; CEA, Gif sur Yvette, France
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207
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Ogawa R, Nakashima I, Takahashi T, Kaneko K, Akaishi T, Takai Y, Sato DK, Nishiyama S, Misu T, Kuroda H, Aoki M, Fujihara K. MOG antibody-positive, benign, unilateral, cerebral cortical encephalitis with epilepsy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e322. [PMID: 28105459 PMCID: PMC5241006 DOI: 10.1212/nxi.0000000000000322] [Citation(s) in RCA: 292] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/15/2016] [Indexed: 01/21/2023]
Abstract
Objective: To describe the features of adult patients with benign, unilateral cerebral cortical encephalitis positive for the myelin oligodendrocyte glycoprotein (MOG) antibody. Methods: In this retrospective, cross-sectional study, after we encountered an index case of MOG antibody–positive unilateral cortical encephalitis with epileptic seizure, we tested for MOG antibody using our in-house, cell-based assay in a cohort of 24 consecutive adult patients with steroid-responsive encephalitis of unknown etiology seen at Tohoku University Hospital (2008–2014). We then analyzed the findings in MOG antibody–positive cases. Results: Three more patients, as well as the index case, were MOG antibody–positive, and all were adult men (median age 37 years, range 23–39 years). The main symptom was generalized epileptic seizure with or without abnormal behavior or consciousness disturbance. Two patients also developed unilateral benign optic neuritis (before or after seizure). In all patients, brain MRI demonstrated unilateral cerebral cortical fluid-attenuated inversion recovery hyperintense lesions, which were swollen and corresponded to hyperperfusion on SPECT. CSF studies showed moderate mononuclear pleocytosis with some polymorphonuclear cells and mildly elevated total protein levels, but myelin basic protein was not elevated. A screening of encephalitis-associated autoantibodies, including aquaporin-4, glutamate receptor, and voltage-gated potassium channel antibodies, was negative. All patients received antiepilepsy drugs and fully recovered after high-dose methylprednisolone, and the unilateral cortical MRI lesions subsequently disappeared. No patient experienced relapse. Conclusions: These MOG antibody–positive cases represent unique benign unilateral cortical encephalitis with epileptic seizure. The pathology may be autoimmune, although the findings differ from MOG antibody–associated demyelination and Rasmussen and other known immune-mediated encephalitides.
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Affiliation(s)
- Ryo Ogawa
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Ichiro Nakashima
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Toshiyuki Takahashi
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Kimihiko Kaneko
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Tetsuya Akaishi
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Yoshiki Takai
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Douglas Kazutoshi Sato
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Shuhei Nishiyama
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Tatsuro Misu
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Hiroshi Kuroda
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Masashi Aoki
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Kazuo Fujihara
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
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208
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Kharal GA, Prasad S. Rasmussen Encephalitis. Neurohospitalist 2017; 7:51-52. [PMID: 28042372 DOI: 10.1177/1941874416637408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Abbas Kharal
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Sashank Prasad
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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209
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Abstract
Epilepsy is one of the most common neurologic disorders, affecting about 50 million people worldwide. The disease is characterized by recurrent seizures, which are due to aberrant neuronal networks resulting in synchronous discharges. The term epilepsy encompasses a large spectrum of syndromes and diseases with different etiopathogenesis. The recent development of imaging and epilepsy surgery techniques is now enabling the identification of structural abnormalities that are part of the epileptic network, and the removal of these lesions may result in control of seizures. Access of this clinically well-characterized neurosurgical material has provided neuropathologists with the opportunity to study a variety of structural brain abnormalities associated with epilepsy, by combining traditional routine histopathologic methods with molecular genetics and functional analysis of the resected tissue. This approach has contributed greatly to a better diagnosis and classification of these structural lesions, and has provided important new insights into their pathogenesis and epileptogenesis. The present chapter provides a detailed description of the large spectrum of histopathologic findings encountered in epilepsy surgery patients, addressing in particular the nonneoplastic pathologies, including hippocampal sclerosis, malformations of cortical development, Sturge-Weber syndrome, and Rasmussen encephalitis, and reviews current knowledge regarding the underlying molecular pathomechanisms and cellular mechanisms mediating hyperexcitability.
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Affiliation(s)
- Eleonora Aronica
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland, the Netherlands.
| | - Angelika Mühlebner
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
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210
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Dandekar S, Wijesuriya H, Geiger T, Hamm D, Mathern GW, Owens GC. Shared HLA Class I and II Alleles and Clonally Restricted Public and Private Brain-Infiltrating αβ T Cells in a Cohort of Rasmussen Encephalitis Surgery Patients. Front Immunol 2016; 7:608. [PMID: 28066418 PMCID: PMC5165278 DOI: 10.3389/fimmu.2016.00608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/01/2016] [Indexed: 11/26/2022] Open
Abstract
Rasmussen encephalitis (RE) is a rare pediatric neuroinflammatory disease characterized by intractable seizures and unilateral brain atrophy. T cell infiltrates in affected brain tissue and the presence of circulating autoantibodies in some RE patients have indicated that RE may be an autoimmune disease. The strongest genetic links to autoimmunity reside in the MHC locus, therefore, we determined the human leukocyte antigen (HLA) class I and class II alleles carried by a cohort of 24 RE surgery cases by targeted in-depth genomic sequencing. Compared with a reference population the allelic frequency of three alleles, DQA1*04:01:01, DQB1*04:02:01, and HLA-C*07:02:01:01 indicated that they might confer susceptibility to the disease. It has been reported that HLA-C*07:02 is a risk factor for Graves disease. Further, eight patients in the study cohort carried HLA-A*03:01:01:01, which has been linked to susceptibility to multiple sclerosis. Four patients carried a combination of three HLA class II alleles that has been linked to type 1 diabetes (DQA1*05:01:01:01~DQB1*02:01:01~DRB1*03:01:01:01), and five patients carried a combination of HLA class II alleles that has been linked to the risk of contracting multiple sclerosis (DQA1*01:02:01:01, DQB1*06:02:01, DRB1*15:01:01:01). We also analyzed the diversity of αβ T cells in brain and blood specimens from 14 of these RE surgery cases by sequencing the third complementarity regions (CDR3s) of rearranged T cell receptor β genes. A total of 31 unique CDR3 sequences accounted for the top 5% of all CDR3 sequences in the 14 brain specimens. Thirteen of these sequences were found in sequencing data from healthy blood donors; the remaining 18 sequences were patient specific. These observations provide evidence for the clonal expansion of public and private T cells in the brain, which might be influenced by the RE patient’s HLA haplotype.
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Affiliation(s)
- Sugandha Dandekar
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles , Los Angeles, CA , USA
| | - Hemani Wijesuriya
- Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California Los Angeles , Los Angeles, CA , USA
| | - Tim Geiger
- Adaptive Biotechnologies Inc. , Seattle, WA , USA
| | - David Hamm
- Adaptive Biotechnologies Inc. , Seattle, WA , USA
| | - Gary W Mathern
- Department of Neurosurgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA; Intellectual and Developmental Disabilities Research Center, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA; Brain Research Institute, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA; Mattel Children's Hospital, Los Angeles, CA, USA
| | - Geoffrey C Owens
- Department of Neurosurgery, David Geffen School of Medicine at the University of California Los Angeles , Los Angeles, CA , USA
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211
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The Changing Landscape of Childhood Inflammatory Central Nervous System Disorders. J Pediatr 2016; 179:24-32.e2. [PMID: 27720407 DOI: 10.1016/j.jpeds.2016.08.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 08/03/2016] [Accepted: 08/17/2016] [Indexed: 12/13/2022]
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212
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Yang Z, Sun G. Headache maybe the initial symptom in Rasmussen's syndrome: A child case report. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 6:75-77. [PMID: 27830116 PMCID: PMC5094153 DOI: 10.1016/j.ebcr.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/16/2016] [Accepted: 09/04/2016] [Indexed: 11/27/2022]
Abstract
Objective The aim of this case report was to study that headache maybe the initial symptom in Rasmussen's syndrome (RS). Introduction Headache has not yet been reported as prodromal symptom. Methods We studied a case of RS in which the patient experienced a recurring headache for about one year prior to the onset of partial seizures. Results Magnetic resonance imaging (MRI) results were normal when the headache first occurred and showed left brain atrophy three years later. It was difficult to relieve the patient's headache, even once seizures were controlled. Conclusions This case demonstrates that the initial symptom of RS may involve only headache.
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Affiliation(s)
- Zhiliang Yang
- Department of Pediatrics, First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Guilian Sun
- Department of Pediatrics, First Affiliated Hospital of China Medical University, Shenyang 110001, China
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213
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El Tawil S, Morris R, Mullatti N, Nashef L, Rajakulendran S. Adult onset Rasmussen’s encephalitis associated with reflex language induced seizures responsive to Rituximab therapy. Seizure 2016; 42:60-62. [DOI: 10.1016/j.seizure.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 09/16/2016] [Accepted: 09/18/2016] [Indexed: 10/20/2022] Open
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Wang ZI, Krishnan B, Shattuck DW, Leahy RM, Moosa ANV, Wyllie E, Burgess RC, Al-Sharif NB, Joshi AA, Alexopoulos AV, Mosher JC, Udayasankar U, Jones SE. Automated MRI Volumetric Analysis in Patients with Rasmussen Syndrome. AJNR Am J Neuroradiol 2016; 37:2348-2355. [PMID: 27609620 DOI: 10.3174/ajnr.a4914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Rasmussen syndrome, also known as Rasmussen encephalitis, is typically associated with volume loss of the affected hemisphere of the brain. Our aim was to apply automated quantitative volumetric MR imaging analyses to patients diagnosed with Rasmussen encephalitis, to determine the predictive value of lobar volumetric measures and to assess regional atrophy differences as well as monitor disease progression by using these measures. MATERIALS AND METHODS Nineteen patients (42 scans) with diagnosed Rasmussen encephalitis were studied. We used 2 control groups: one with 42 age- and sex-matched healthy subjects and the other with 42 epileptic patients without Rasmussen encephalitis with the same disease duration as patients with Rasmussen encephalitis. Volumetric analysis was performed on T1-weighted images by using BrainSuite. Ratios of volumes from the affected hemisphere divided by those from the unaffected hemisphere were used as input to a logistic regression classifier, which was trained to discriminate patients from controls. Using the classifier, we compared the predictive accuracy of all the volumetric measures. These ratios were used to further assess regional atrophy differences and correlate with epilepsy duration. RESULTS Interhemispheric and frontal lobe ratios had the best prediction accuracy for separating patients with Rasmussen encephalitis from healthy controls and patient controls without Rasmussen encephalitis. The insula showed significantly more atrophy compared with all the other cortical regions. Patients with longitudinal scans showed progressive volume loss in the affected hemisphere. Atrophy of the frontal lobe and insula correlated significantly with epilepsy duration. CONCLUSIONS Automated quantitative volumetric analysis provides accurate separation of patients with Rasmussen encephalitis from healthy controls and epileptic patients without Rasmussen encephalitis, and thus may assist the diagnosis of Rasmussen encephalitis. Volumetric analysis could also be included as part of follow-up for patients with Rasmussen encephalitis to assess disease progression.
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Affiliation(s)
- Z I Wang
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - B Krishnan
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - D W Shattuck
- Ahmanson-Lovelace Brain Mapping Center (D.W.S., N.B.A.-S.), Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - R M Leahy
- Signal and Image Processing Institute (A.A.J., R.M.L.), University of Southern California, Los Angeles, California
| | - A N V Moosa
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - E Wyllie
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - R C Burgess
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - N B Al-Sharif
- Ahmanson-Lovelace Brain Mapping Center (D.W.S., N.B.A.-S.), Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - A A Joshi
- Signal and Image Processing Institute (A.A.J., R.M.L.), University of Southern California, Los Angeles, California
| | - A V Alexopoulos
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - J C Mosher
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - U Udayasankar
- Department of Radiology (U.U.), University of Arizona College of Medicine, Tucson, Arizona
| | | | - S E Jones
- Imaging Institute (S.E.J.), Cleveland Clinic, Cleveland, Ohio
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Chen S, Chen S, Guan Y, Zhang Y, Qi X, An J, Wang Y, Luan G. Elevated expression of human papillomavirus antigen in brain tissue of patients with Rasmussen's encephalitis. Epilepsy Res 2016; 126:119-25. [PMID: 27490897 DOI: 10.1016/j.eplepsyres.2016.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/11/2016] [Accepted: 07/25/2016] [Indexed: 11/28/2022]
Abstract
OBJECTS To investigate the expression of human papillomavirus (HPV)-specific antigen in the brain tissue of patients with Rasmussen's Encephalitis (RE) and its possible link to the clinical manifestation of RE. METHODS The correlation between RE and HPV antigen expression in brain tissue sections was investigated using immunohistochemical (IHC) staining, pathological examination, MRI and clinical manifestations. RESULTS HPV antigen expression was elevated in three out of four patients with RE, whereas there were no detectable HPV antigens in six control patients. Significant staining for HPV antigen was located mainly around or in the nucleus and cytoplasm of neurons. Among these RE patients, three with elevated expression of HPV antigens had obvious hemisphere atrophy, whereas the patient with negative staining for HPV antigens had mild atrophy. CONCLUSIONS Elevated expression of HPV antigens was observed in the brain tissue of RE patients, which may correlate with hemisphere atrophy. Thus, our results may suggest that HPV infection or being a carrier of HPV may play a role in the initiation and progression of RE.
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Affiliation(s)
- Shuai Chen
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China
| | - Sichang Chen
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China
| | - Yao Zhang
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China
| | - Xueling Qi
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China
| | - Jing An
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China; School of Basic Medical Science, Capital Medical University, Beijing 100069, China
| | - Yisong Wang
- School of Basic Medical Science, Capital Medical University, Beijing 100069, China.
| | - Guoming Luan
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China.
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216
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Nagae LM, Lall N, Dahmoush H, Nyberg E, Mirsky D, Drees C, Honce JM. Diagnostic, treatment, and surgical imaging in epilepsy. Clin Imaging 2016; 40:624-36. [DOI: 10.1016/j.clinimag.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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217
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Acute Disseminated Encephalomyelitis. J Clin Apher 2016; 31:163-202. [PMID: 27322219 DOI: 10.1002/jca.21474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Holec M, Nagahama Y, Kovach C, Joshi C. Rethinking the Magnetic Resonance Imaging Findings in Early Rasmussen Encephalitis: A Case Report and Review of the Literature. Pediatr Neurol 2016; 59:85-9. [PMID: 27004940 DOI: 10.1016/j.pediatrneurol.2015.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/12/2015] [Accepted: 12/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We present a child with Rasmussen encephalitis and highlight the pitfalls of diagnosis when magnetic resonance imaging (MRI) is negative for atrophy. We review the literature regarding this issue, introduce the FreeSurfer software as a potential means of noninvasive diagnosis, and discuss methods for prompt and definitive treatment. METHODS In addition to the patient description, we review the English language literature regarding pathologic diagnosis of Rasmussen encephalitis using the key words Rasmussen encephalitis, focal lesions, MRI, atrophy, epilepsia partialis continua and hemiparesis in PubMed. We conducted a retrospective, volumetric analysis of our patient's MRIs using FreeSurfer. RESULTS Unlike the majority of patients in the literature with Rasmussen encephalitis, our patient's initial MRI was normal and later showed only a small area of T2 and fluid-attenuated inversion recovery high signal despite the presence of epilepsia partialis continua and a rapidly deteriorating clinical course. She did not meet the Rasmussen encephalitis diagnostic criteria until biopsy was obtained but is now seizure-free after functional hemispherotomy performed six months after her initial seizure. FreeSurfer analysis did not show cortical atrophy. CONCLUSION The Bien criteria have poor sensitivity for the diagnosis of Rasmussen encephalitis when the MRI is negative for atrophy. Tissue diagnosis is essential in such instances. We suggest a high clinical index of suspicion and multidisciplinary collaboration between radiology, pathology, and neurosurgery to facilitate a greater emphasis on biopsy followed by hemispherotomy as definitive therapy for individuals with early Rasmussen encephalitis.
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Affiliation(s)
- Megan Holec
- Pediatric Neurology, University of Iowa Children's Hospital, Iowa City, Iowa.
| | - Yasunori Nagahama
- Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christopher Kovach
- Department of Neurosurgery, University of Iowa Children's Hospital, Iowa City, Iowa
| | - Charuta Joshi
- Pediatric Neurology, University of Iowa Children's Hospital, Iowa City, Iowa
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Göde K, Grossmann A, Rösche J. Successful treatment of epilepsia partialis continua due to Rassmussen encephalitis with perampanel. JOURNAL OF EPILEPTOLOGY 2016. [DOI: 10.1515/joepi-2016-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
Background. Epilepsia partialis continua (EPC) is a difficult to treat condition, which tends to be refractory to antiepileptic drugs (AEDs). We previously published two other treatment episodes of EPC due to stroke and vascular dementia with a possible effect of perampanel (PER).
Aim. With the publication of a third treatment episode of EPC terminated by the administration of PER we would like to suggest that PER may be an effective treatment option in this condition.
Material and Methods. We present a case where PER was the last AED introduced in the treatment of a patient with EPC and individual seizures due to Rasmussen encephalitis before his seizure frequency could be reduced significantly.
Results. A 44 years old male patient, who had been on a combination therapy of at least 4 AEDs since the age of 24, was admitted to our hospital presenting with an EPC. After the introduction of PER in the therapy EPC stopped and he remained seizure free for more than a year. Two of his other AEDs could be tapered of.
Conclusion. PER might be especially effective in EPC.
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Lagarde S, Villeneuve N, Trébuchon A, Kaphan E, Lepine A, McGonigal A, Roubertie A, Barthez MAJ, Trommsdorff V, Lefranc J, Wehbi S, des Portes V, Laguitton V, Quartier P, Scavarda D, Giusiano B, Milh M, Bulteau C, Bartolomei F. Anti-tumor necrosis factor alpha therapy (adalimumab) in Rasmussen's encephalitis: An open pilot study. Epilepsia 2016; 57:956-66. [DOI: 10.1111/epi.13387] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Stanislas Lagarde
- Clinical Neurophysiology and Epileptology Department; Timone Hospital; APHM; Marseille France
| | - Nathalie Villeneuve
- Henri Gastaut Hospital; Marseille France
- Pediatric Neurology Department; Timone Hospital; APHM; Marseille France
| | - Agnès Trébuchon
- Clinical Neurophysiology and Epileptology Department; Timone Hospital; APHM; Marseille France
| | - Elsa Kaphan
- Neurology Department; Timone Hospital; APHM; Marseille France
| | - Anne Lepine
- Henri Gastaut Hospital; Marseille France
- Pediatric Neurology Department; Timone Hospital; APHM; Marseille France
| | - Aileen McGonigal
- Clinical Neurophysiology and Epileptology Department; Timone Hospital; APHM; Marseille France
| | - Agathe Roubertie
- Pediatric Neurology Department; “Gui de Chauliac” Hospital; Montpellier France
| | | | | | - Jérémie Lefranc
- Pediatric Neurology Department; Brest Hospital; Brest France
| | - Samer Wehbi
- Pediatrics Department; André Mignot Hospital; Le Chesnay France
| | | | | | - Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit and IMAGINE Institute; “Necker-Enfants Malades” Hospital; APHP; Paris France
| | - Didier Scavarda
- Pediatric Neurosurgery Department; Timone Hospital; APHM; Marseille France
| | - Bernard Giusiano
- Division of Public Health; Timone Hospital; APHM; Marseille France
- Brain Dynamic Institute; INSERM UMR 1106 and Aix-Marseille University; Marseille France
| | - Mathieu Milh
- Pediatric Neurology Department; Timone Hospital; APHM; Marseille France
| | - Christine Bulteau
- Pediatric Neurosurgery Department; Ophthalmologic Foundation “A. de Rothschild”; Paris France
| | - Fabrice Bartolomei
- Pediatric Neurosurgery Department; Timone Hospital; APHM; Marseille France
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Abstract
Investigators from Rothschild Foundation Hospital in Paris report language outcome in children after (left) dominant-hemisphere hemispherotomy for Rasmussen Syndrome.
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Affiliation(s)
- Sophia Varadkar
- Neurosciences Unit, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Institute of Child Health, London, UK
| | - Martin Tisdall
- Neurosciences Unit, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Institute of Child Health, London, UK
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CD8(+) T-cell pathogenicity in Rasmussen encephalitis elucidated by large-scale T-cell receptor sequencing. Nat Commun 2016; 7:11153. [PMID: 27040081 PMCID: PMC4822013 DOI: 10.1038/ncomms11153] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/25/2016] [Indexed: 11/29/2022] Open
Abstract
Rasmussen encephalitis (RE) is a rare paediatric epilepsy with uni-hemispheric inflammation and progressive neurological deficits. To elucidate RE immunopathology, we applied T-cell receptor (TCR) sequencing to blood (n=23), cerebrospinal fluid (n=2) and brain biopsies (n=5) of RE patients, and paediatric controls. RE patients present with peripheral CD8+ T-cell expansion and its strength correlates with disease severity. In addition, RE is the only paediatric epilepsy with prominent T-cell expansions in the CNS. Consistently, common clones are shared between RE patients, who also share MHC-I alleles. Public RE clones share Vβ genes and length of the CDR3. Rituximab/natalizumab/basiliximab treatment does not change TCR diversity, stem cell transplantation replaces the TCR repertoire with minimal overlap between donor and recipient, as observed in individual cases. Our study supports the hypothesis of an antigen-specific attack of peripherally expanded CD8+ lymphocytes against CNS structures in RE, which might be ameliorated by restricting access to the CNS. Rasmussen Encephalitis is a rare neurological disease accompanied by inflammation and T cell infiltration in the brain. Here the authors show that the severity of this disease correlates with clonal CD8 T cell expansion.
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224
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Abstract
PURPOSE OF REVIEW Autoimmune epileptic encephalopathy is a potentially treatable neurological syndrome characterized by the coexistence of a neuronal antibody in serum and, often, cerebrospinal fluid. Patients present with combinations of seizures, neuropsychiatric features, movement disorder, and cognitive decline, but some patients have isolated seizures either at first presentation or during their illness. This review summarizes our current understanding of the roles of specific neuronal antibodies in epilepsy-related syndromes and aims to aid the clinician in diagnosis and treatment. RECENT FINDINGS Antigen discovery methods in three neuroimmunology centres independently identified antibodies to different subunits of the γ amino butyric acid-A receptor; high levels of these antibodies were found mainly in patients with severe refractory seizures. These and other antibodies were also found in a proportion (<10%) of children and adults with epilepsy. A clinical study comparing immunotherapy in patients with autoantibodies or without an identified target antigen found neuroinflammatory features were predictive of a therapeutic response. New in-vitro and in-vivo studies, and spontaneous animal models, have confirmed the pathogenicity and epileptogenicity of neuronal antibodies and their relevance to other mammals. SUMMARY Neuronal antibodies are an important cause of autoimmune epileptic encephalopathy, early recognition is important as there may be an underlying tumour, and early treatment is associated with a better outcome. In the absence of an antibody, the clinician should adopt a pragmatic approach and consider a trial of immunotherapy when other causes have been excluded.
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Affiliation(s)
- Sukhvir Wright
- aDepartment of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK bNuffield Department of Clinical Neurosciences, John Radcliffe University Hospital, Oxford, UK
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225
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Hoffman CE, Ochi A, Snead OC, Widjaja E, Hawkins C, Tisdal M, Rutka JT. Rasmussen's encephalitis: advances in management and patient outcomes. Childs Nerv Syst 2016; 32:629-40. [PMID: 26780781 DOI: 10.1007/s00381-015-2994-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Rasmussen's encephalitis (RE) is a hemispheric inflammatory disorder resulting in progressive epilepsy, hemiparesis, and cognitive decline. Controversy surrounds the most effective timing of surgery with respect to language dominance, functional status, and seizure outcome. We describe our experience with RE to inform treatment decisions. METHODS A retrospective chart review was performed in children diagnosed with RE from 1983 to 2012. RESULTS Thirteen consecutive cases were identified: six males and seven females with a mean age of 10.6 years (range 5-18). Nine patients received immunotherapy, with transient benefit in three, treatment-associated complications in two, and no difference in their mean time to treatment (5.38 vs 6.37 years p = 0.74) or long-term outcome. Mean follow-up was 5.6 years (range 0.58-12.25). There was no difference in outcome based on pre-operative duration of seizures. At last follow-up, 63 % of surgically treated patients achieved seizure freedom, 100 % had improved seizure control, 90 % had improved cognitive function, 36 % stopped medication, and 63 % tapered medication. Language improved in 83 % of patients with dominant disease. These findings were not associated with age at treatment. All surgical patients were ambulatory at last follow-up. CONCLUSIONS Hemispherotomy achieves good seizure control with cognitive improvement and ambulatory status post-operatively. Time to surgery and dominant disease were not associated with outcome, suggesting that hemispherotomy can be offered early or late, with expectations of good seizure control and functional outcome, even with dominant disease.
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Affiliation(s)
- Caitlin E Hoffman
- Division of Pediatric Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, USA.
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Orlando Carter Snead
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elysa Widjaja
- Division of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cynthia Hawkins
- Division of Neuropathology, Hospital for Sick Children, Toronto, ON, Canada
| | - Martin Tisdal
- Division of Pediatric Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James T Rutka
- Division of Pediatric Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Nibber A, Clover L, Pettingill P, Waters P, Elger CE, Bien CG, Vincent A, Lang B. Antibodies to AMPA receptors in Rasmussen's encephalitis. Eur J Paediatr Neurol 2016; 20:222-227. [PMID: 26785913 DOI: 10.1016/j.ejpn.2015.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/26/2015] [Accepted: 12/26/2015] [Indexed: 02/02/2023]
Abstract
Rasmussen's encephalitis is a rare progressive childhood disorder characterized by frequent severe seizures, hemiparesis, encephalitis and mental deterioration, and associated with severe unilateral neuroinflammation. Autoantibodies, particularly to the GluA3 subtype of the alpha-amino-3-hydroxy-5-methyl-isoxazole-4-propinonic acid receptor (AMPAR) were reported in the 1990s but not always confirmed. To explore further, sera from 52 patients with Rasmussen's encephalitis were tested by cell-based assays for antibodies to AMPAR GluA1/2/3, N-methyl-d-aspartate (NMDA NR1/2b), γ-aminobutyric acid type A and B (GABAAR α1/γ2/β2 and GABABR b1/b2) receptors, for potassium channel complex proteins, and for binding to live cortical and hippocampal neuronal cultures. Two patients' sera (3.8%) bound to HEK cells co-transfected with the GluA2 and GluA3 subunits. One additional patient had a low level of VGKC-complex antibodies. These three, and seven additional, sera bound to hippocampal cultures. No other antibodies were detected. Thus, despite the rarity of GluA2/3 antibodies, 10 patients (19.2%) had evidence of antibodies to neuronal antigens. Whether these antibodies play a primary role in RE, or appear secondary to the neuro-inflammatory damage in this highly destructive disease, requires further study.
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Affiliation(s)
- Anjan Nibber
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Linda Clover
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Philippa Pettingill
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | | | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Pradeep K, Sinha S, Mahadevan A, Saini J, Arivazhagan A, Bharath R, Bindu P, Jamuna R, Rao M, Govekar S, Ravikumar B, Chandramouli B, Satishchandra P. Clinical, electrophysiological, imaging, pathological and therapeutic observations among 18 patients with Rasmussen’s encephalitis. J Clin Neurosci 2016; 25:96-104. [DOI: 10.1016/j.jocn.2015.05.062] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/16/2015] [Accepted: 05/17/2015] [Indexed: 11/28/2022]
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228
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Owens GC, Chang JW, Huynh MN, Chirwa T, Vinters HV, Mathern GW. Evidence for Resident Memory T Cells in Rasmussen Encephalitis. Front Immunol 2016; 7:64. [PMID: 26941743 PMCID: PMC4763066 DOI: 10.3389/fimmu.2016.00064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/09/2016] [Indexed: 12/19/2022] Open
Abstract
Rasmussen encephalitis (RE) is a rare pediatric neuroinflammatory disease of unknown etiology characterized by intractable seizures, and progressive atrophy usually confined to one cerebral hemisphere. Surgical removal or disconnection of the affected cerebral hemisphere is currently the only intervention that effectively stops the seizures. Histopathological evaluation of resected brain tissue has shown that activated brain resident macrophages (microglia) and infiltrating T cells are involved in the inflammatory reaction. Here, we report that T cells isolated from seven RE brain surgery specimens express the resident memory T cell (TRM) marker CD103. CD103 was expressed by >50% of CD8+ αβ T cells and γδ T cells irrespective of the length of time from seizure onset to surgery, which ranged from 0.3 to 8.4 years. Only ~10% of CD4+ αβ were CD103+, which was consistent with the observation that few CD4+ T cells are found in RE brain parenchyma. Clusters of T cells in brain parenchyma, which are a characteristic of RE histopathology, stained for CD103. Less than 10% of T cells isolated from brain specimens from eight surgical cases of focal cortical dysplasia (FCD), a condition that is also characterized by intractable seizures, were CD103+. In contrast to the RE cases, the percent of CD103+ T cells increased with the length of time from seizure onset to surgery. In sections of brain tissue from the FCD cases, T cells were predominantly found around blood vessels, and did not stain for CD103. The presence of significant numbers of TRM cells in RE brain irrespective of the length of time between clinical presentation and surgical intervention supports the conclusion that a cellular immune response to an as yet unidentified antigen(s) occurs at an early stage of the disease. Reactivated TRM cells may contribute to disease progression.
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Affiliation(s)
- Geoffrey C Owens
- Department of Neurosurgery, David Geffen School of Medicine at UCLA , Los Angeles, CA , USA
| | - Julia W Chang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Intellectual and Developmental Disabilities Research Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - My N Huynh
- Department of Neurosurgery, David Geffen School of Medicine at UCLA , Los Angeles, CA , USA
| | - Thabiso Chirwa
- Department of Neurosurgery, David Geffen School of Medicine at UCLA , Los Angeles, CA , USA
| | - Harry V Vinters
- Intellectual and Developmental Disabilities Research Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gary W Mathern
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Intellectual and Developmental Disabilities Research Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Mattel Children's Hospital, Los Angeles, CA, USA
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Martin-Blondel G, Brassat D, Bauer J, Lassmann H, Liblau RS. CCR5 blockade for neuroinflammatory diseases — beyond control of HIV. Nat Rev Neurol 2016; 12:95-105. [DOI: 10.1038/nrneurol.2015.248] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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230
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Abstract
Autoimmune neurologic diseases are of major clinical importance in children. Antibody-mediated diseases of the central nervous system are now increasingly recognized in childhood, where the antibodies bind to cell surface epitopes on neuronal or glial proteins, and the patients demonstrate either focal or more generalized clinical signs depending on the extent of brain regions targeted by the antibodies. The antibodies are directed towards ion channels, receptors, and membrane proteins; and the diseases include limbic encephalitis and N-methyl-d-aspartate receptor-antibody encephalitis, among many others. Additionally there are conditions where the wider immune system is implicated. Neurologic features like seizures, movement disorders, autonomic dysfunction, and sleep disorders, with neuroimaging and electrophysiologic features, may indicate a specific antibody-mediated or immune disorder. Often, phenotypic overlap is observed between these conditions, and phenotypic variation seen in children with the same condition. Nevertheless, many patients benefit from immunotherapy with substantial improvement, although huge efforts are still required to optimize the outcome for many patients. In many patients no antibodies have yet been identified, even though they respond to immunotherapies. Here we describe the known antibodies and associated diseases, discuss conditions that are thought to be immune-mediated but have no known immunologic biomarker, and provide guidelines for the investigation and classification of these disorders.
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Herrera-Vázquez O, Rojas AT, Fleury A. NEUROINFLAMACIÓN Y EPILEPSIA. TIP REVISTA ESPECIALIZADA EN CIENCIAS QUÍMICO-BIOLÓGICAS 2016. [DOI: 10.1016/j.recqb.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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232
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Bulteau C, Grosmaitre C, Save-Pédebos J, Leunen D, Delalande O, Dorfmüller G, Dulac O, Jambaqué I. Language recovery after left hemispherotomy for Rasmussen encephalitis. Epilepsy Behav 2015; 53:51-7. [PMID: 26519666 DOI: 10.1016/j.yebeh.2015.07.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/10/2015] [Accepted: 07/25/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Hemispherotomy (H) is the gold standard treatment to cure epilepsy in Rasmussen encephalitis (RE). Linguistic prognosis after surgery remains the main issue when the dominant hemisphere is involved. The topic of the present research is to specify the long-term linguistic profile of the right hemisphere after left dominant H for RE. METHODS We followed 6 children 8.4 to 14.6 years of age who underwent left H for RE. Preoperatively, four children experienced aphasia, but for two, worsening occurred after surgery. Age at H ranged from 4.1 to 8.4 years. The mean duration of epilepsy was 1.2 years and 5.6 years for follow-up. Neuropsychological evaluation included longitudinal follow-up of intellectual efficiency measurement and a long-term outcome of language using various components of receptive and expressive oral speech with computerized tasks. KEY FINDINGS Preoperatively, verbal comprehension index (VCI) was dramatically decreased in 4/6 patients, and performance reasoning index (PRI) was low in 5/6 participants, demonstrating a global impact of RE itself. Postoperatively, all children recovered sufficiently to attend a regular VCI (above 70) in a mean of 5 years after H, and 5/6 recovered normal or adapted school. There was a dissociation in favor of VCI, while PRI decreased in 5/6 patients. We found a specific linguistic profile for these children recovering language in the right hemisphere: normal verbal comprehension, and weakness of grammatical judgment, word repetition, statement production, semantic verbal fluency and metaphonological abilities. Language recovery scores were statistically correlated with those of Working Memory Index. SIGNIFICANCE This study emphasizes for the first time the ability of the right hemisphere to functionally reorganize language over a long period of time following left H for RE. Syntactic abilities and phonology remain low and support the hypothesis of an early left hemispheric specialization. Nevertheless, lexico-semantic processes recover in the right hemisphere that could reflect a pre-existing potential of both hemispheres. Our results support a decision to proceed to H in classical left RE disease until the late childhood even if there is no complete aphasia before surgery. These data should be taken in account in the overall postoperative follow-up and rehabilitation strategy.
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Affiliation(s)
- Christine Bulteau
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France.
| | - Catherine Grosmaitre
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Jessica Save-Pédebos
- Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Dorothée Leunen
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Olivier Delalande
- Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Georg Dorfmüller
- Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Olivier Dulac
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
| | - Isabelle Jambaqué
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; CEA, Gif sur Yvette, France; Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France
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233
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Iori V, Frigerio F, Vezzani A. Modulation of neuronal excitability by immune mediators in epilepsy. Curr Opin Pharmacol 2015; 26:118-23. [PMID: 26629681 DOI: 10.1016/j.coph.2015.11.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/08/2015] [Indexed: 01/02/2023]
Abstract
A complex set of inflammatory molecules and their receptors has been described in epileptogenic foci in different forms of pharmacoresistant epilepsies. By activating receptor-mediated pathways in neurons, these molecules have profound neuromodulatory effects that are distinct from their canonical activation of immune functions. Importantly, the neuromodulatory actions of some inflammatory molecules contribute to hyperexcitability in neural networks that underlie seizures. This review summarizes recent findings related to the role of cytokines (IL-1beta and TNF-alpha) and danger signals (HMGB1) in decreasing seizure threshold, thereby contributing to seizure generation and the associated neuropathology. We will discuss preclinical studies suggesting that pharmacological inhibition of specific inflammatory signals may be useful to treat drug-resistant seizures in human epilepsy, and possibly arrest epileptogenesis in individuals at risk of developing the disease.
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Affiliation(s)
- Valentina Iori
- IRCCS-Mario Negri Institute for Pharmacological Research, Department of Neuroscience, Milano, Italy
| | - Federica Frigerio
- IRCCS-Mario Negri Institute for Pharmacological Research, Department of Neuroscience, Milano, Italy
| | - Annamaria Vezzani
- IRCCS-Mario Negri Institute for Pharmacological Research, Department of Neuroscience, Milano, Italy.
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234
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Waisman A, Liblau RS, Becher B. Innate and adaptive immune responses in the CNS. Lancet Neurol 2015; 14:945-55. [PMID: 26293566 DOI: 10.1016/s1474-4422(15)00141-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 04/22/2015] [Accepted: 06/11/2015] [Indexed: 12/11/2022]
Abstract
Almost every disorder of the CNS is said to have an inflammatory component, but the precise nature of inflammation in the CNS is often imprecisely defined, and the role of CNS-resident cells is uncertain compared with that of cells that invade the tissue from the systemic immune compartment. To understand inflammation in the CNS, the term must be better defined, and the response of tissue to disturbances in homoeostasis (eg, neurodegenerative processes) should be distinguished from disorders in which aberrant immune responses lead to CNS dysfunction and tissue destruction (eg, autoimmunity). Whether the inflammatory tissue response to injury is reparative or degenerative seems to be dependent on context and timing, as are the windows of opportunity for therapeutic intervention in inflammatory CNS diseases.
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Affiliation(s)
- Ari Waisman
- Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Roland S Liblau
- Centre de Physiopathologie Toulouse-Purpan, Université Toulouse 3, Toulouse, France
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
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235
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Gorman KM, Farrell M, Madigan C, King MD, Shahwan A. Rasmussen's encephalitis, should absence of seizures influence or delay treatment? Childs Nerv Syst 2015; 31:2009-10. [PMID: 26409880 DOI: 10.1007/s00381-015-2917-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 10/23/2022]
Affiliation(s)
- K M Gorman
- Department of Child Neurology & Clinical Neurophysiology, Children's University Hospital, Temple St., Dublin, Ireland.
| | - M Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland.
| | - C Madigan
- Department of Child Neurology & Clinical Neurophysiology, Children's University Hospital, Temple St., Dublin, Ireland.
| | - M D King
- Department of Child Neurology & Clinical Neurophysiology, Children's University Hospital, Temple St., Dublin, Ireland. .,Academic Centre on Rare Diseases, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
| | - A Shahwan
- Department of Child Neurology & Clinical Neurophysiology, Children's University Hospital, Temple St., Dublin, Ireland.
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236
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Ravindra VM, Mazur MD, Mohila CA, Sweney MT, Hersh A, Bollo RJ. Rasmussen encephalitis with dual pathology in a patient without seizures: case report and literature review. Childs Nerv Syst 2015; 31:2165-71. [PMID: 26033376 DOI: 10.1007/s00381-015-2757-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/21/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Rasmussen encephalitis without seizures is rare. We report a case of Rasmussen encephalitis and cortical dysplasia without epilepsy as well as describe the imaging, pathology, and clinical course and review the literature to investigate whether this may represent a rare subset of Rasmussen encephalitis. CASE REPORT We report the case of a 12-year-old girl with a history of cognitive decline and right arm weakness. Magnetic resonance imaging demonstrated diffuse left hemispheric cortical and subcortical atrophy suggestive of Rasmussen encephalitis. The patient had no clinical history of seizures, and electroencephalography did not demonstrate epileptiform abnormalities. Craniotomy for open brain biopsy was performed, and histopathologic evaluation identified Rasmussen encephalitis with cortical dysplasia (dual pathology). CONCLUSIONS To the best of our knowledge, this is the third case of Rasmussen encephalitis diagnosed by both imaging and histopathology that had no clinical or electroencephalographic evidence of seizures and is the only case of Rasmussen encephalitis with cortical dysplasia without epilepsy.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 1475, Salt Lake City, UT, 84113, USA
| | - Marcus D Mazur
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 1475, Salt Lake City, UT, 84113, USA
| | - Carrie A Mohila
- Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Matthew T Sweney
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Division of Pediatric Neurology, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Aimee Hersh
- Department of Rheumatology/Immunology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Division of Pediatric Rheumatology/Immunology, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Robert J Bollo
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Division of Pediatric Neurosurgery, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 1475, Salt Lake City, UT, 84113, USA.
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237
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Warrilow A, Morton M. Autoimmune disorders in child psychiatry: keeping up with the field. BJPSYCH ADVANCES 2015. [DOI: 10.1192/apt.bp.115.014472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryAutoimmune disorders in children and adolescents can have significant neuropsychiatric complications and there is growing interest in the association between autoimmune conditions and psychiatric syndromes, particularly in Down syndrome. Acute presentations with psychiatric symptoms require careful assessment in order to recognise and plan treatment of underlying autoimmune disease in collaboration with paediatric colleagues. Difficult treatment decisions arise in children with established autoimmune diagnoses and psychiatric symptoms that may be a result of neuroimmunological processes associated with their condition, psychiatric side-effects of drug treatments or psychopathology resulting from other factors in the history that may or may not have a direct relation to the autoimmune diagnosis. This article illustrates these complexities through discussion of specific autoimmune disorders and three case histories.
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238
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Venkatesan A, Benavides DR. Autoimmune encephalitis and its relation to infection. Curr Neurol Neurosci Rep 2015; 15:3. [PMID: 25637289 DOI: 10.1007/s11910-015-0529-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Encephalitis, an inflammatory condition of the brain that results in substantial morbidity and mortality, has numerous causes. Over the past decade, it has become increasingly recognized that autoimmune conditions contribute significantly to the spectrum of encephalitis causes. Clinical suspicion and early diagnosis of autoimmune etiologies are of particular importance due to the need for early institution of immune suppressive therapies to improve outcome. Emerging clinical observations suggest that the most commonly recognized cause of antibody-mediated autoimmune encephalitis, anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, may in some cases be triggered by herpes virus infection. Other conditions such as Rasmussen's encephalitis (RE) and febrile infection-related epilepsy syndrome (FIRES) have also been posited to be autoimmune conditions triggered by infectious agents. This review focuses on emerging concepts in central nervous system autoimmunity and addresses clinical and mechanistic findings linking autoimmune encephalitis and infections. Particular consideration will be given to anti-NMDA receptor encephalitis and its relation to herpes simplex encephalitis.
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Affiliation(s)
- Arun Venkatesan
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA,
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239
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Michelucci R, Pasini E, Marliani FA, Cirillo L. Teaching NeuroImages: Diffusion tensor tractography of cortico-ponto-cerebellar pathways in Rasmussen encephalitis. Neurology 2015; 85:e15-6. [PMID: 26170405 DOI: 10.1212/wnl.0000000000001733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Roberto Michelucci
- From IRCCS-Institute of Neurological Sciences, Units of Neurology (R.M.) and Neuroradiology (F.A.M., L.C.), and the Department of Biological and Neuromotor Sciences (E.P.), Bellaria Hospital, Bologna; and DIMES (L.C.), Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Italy
| | - Elena Pasini
- From IRCCS-Institute of Neurological Sciences, Units of Neurology (R.M.) and Neuroradiology (F.A.M., L.C.), and the Department of Biological and Neuromotor Sciences (E.P.), Bellaria Hospital, Bologna; and DIMES (L.C.), Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Italy.
| | - Federica Anna Marliani
- From IRCCS-Institute of Neurological Sciences, Units of Neurology (R.M.) and Neuroradiology (F.A.M., L.C.), and the Department of Biological and Neuromotor Sciences (E.P.), Bellaria Hospital, Bologna; and DIMES (L.C.), Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Italy
| | - Luigi Cirillo
- From IRCCS-Institute of Neurological Sciences, Units of Neurology (R.M.) and Neuroradiology (F.A.M., L.C.), and the Department of Biological and Neuromotor Sciences (E.P.), Bellaria Hospital, Bologna; and DIMES (L.C.), Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Italy
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240
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Owens GC, Erickson KL, Malone CC, Pan C, Huynh MN, Chang JW, Chirwa T, Vinters HV, Mathern GW, Kruse CA. Evidence for the involvement of gamma delta T cells in the immune response in Rasmussen encephalitis. J Neuroinflammation 2015; 12:134. [PMID: 26186920 PMCID: PMC4506578 DOI: 10.1186/s12974-015-0352-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/24/2015] [Indexed: 02/03/2023] Open
Abstract
Background Rasmussen encephalitis (RE) is a rare neuroinflammatory disease characterized by intractable seizures and progressive atrophy on one side of the cerebrum. Perivascular cuffing and clusters of T cells in the affected cortical hemisphere are indicative of an active cellular immune response. Methods Peripheral blood mononuclear cells (PBMCs) and brain-infiltrating lymphocytes (BILs) were isolated from 20 RE surgery specimens by standard methods, and CD3+ T cell populations were analyzed by flow cytometry. Gamma delta T cell receptor spectratyping was carried out by nested PCR of reversed transcribed RNA extracted from RE brain tissue, followed by high resolution capillary electrophoresis. A MiSeq DNA sequencing platform was used to sequence the third complementarity determining region (CDR3) of δ1 chains. Results CD3+ BILs from all of the RE brain specimens comprised both αβ and γδ T cells. The median αβ:γδ ratio was 1.9 (range 0.58–5.2) compared with a median ratio of 7.7 (range 2.7–40.8) in peripheral blood from the same patients. The αβ T cells isolated from brain tissue were predominantly CD8+, and the majority of γδ T cells were CD4− CD8−. Staining for the early activation marker CD69 showed that a fraction of the αβ and γδ T cells in the BILs were activated (median 42 %; range 13–91 %, and median 47 %; range 14–99 %, respectively). Spectratyping T cell receptor (TCR) Vδ1-3 chains from 14 of the RE brain tissue specimens indicated that the γδ T cell repertoire was relatively restricted. Sequencing δ1 chain PCR fragments revealed that the same prevalent CDR3 sequences were found in all of the brain specimens. These CDR3 sequences were also detected in brain tissue from 15 focal cortical dysplasia (FCD) cases. Conclusion Neuroinflammation in RE involves both activated αβ and γδ T cells. The presence of γδ T cells with identical TCR δ1 chain CDR3 sequences in all of the brain specimens examined suggests that a non-major histocompatibility complex (MHC)-restricted immune response to the same antigen(s) is involved in the etiology of RE. The presence of the same δ1 clones in CD brain implies the involvement of a common inflammatory pathway in both diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12974-015-0352-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Geoffrey C Owens
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, 300 Stein Plaza, Ste. 562, Los Angeles, CA, 90095-6901, USA.
| | - Kate L Erickson
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, 300 Stein Plaza, Ste. 562, Los Angeles, CA, 90095-6901, USA.
| | - Colin C Malone
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, 300 Stein Plaza, Ste. 562, Los Angeles, CA, 90095-6901, USA.
| | - Calvin Pan
- Department of Human Genetics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, USA.
| | - My N Huynh
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, 300 Stein Plaza, Ste. 562, Los Angeles, CA, 90095-6901, USA.
| | - Julia W Chang
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, 300 Stein Plaza, Ste. 562, Los Angeles, CA, 90095-6901, USA. .,Intellectual and Developmental Disabilities Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA.
| | - Thabiso Chirwa
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, 300 Stein Plaza, Ste. 562, Los Angeles, CA, 90095-6901, USA.
| | - Harry V Vinters
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA. .,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA. .,Intellectual and Developmental Disabilities Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA. .,Brain Research Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA.
| | - Gary W Mathern
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, 300 Stein Plaza, Ste. 562, Los Angeles, CA, 90095-6901, USA. .,Intellectual and Developmental Disabilities Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA. .,Brain Research Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA. .,Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA.
| | - Carol A Kruse
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, 300 Stein Plaza, Ste. 562, Los Angeles, CA, 90095-6901, USA.,Brain Research Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
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241
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Ehling P, Melzer N, Budde T, Meuth SG. CD8(+) T Cell-Mediated Neuronal Dysfunction and Degeneration in Limbic Encephalitis. Front Neurol 2015; 6:163. [PMID: 26236280 PMCID: PMC4502349 DOI: 10.3389/fneur.2015.00163] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/02/2015] [Indexed: 12/31/2022] Open
Abstract
Autoimmune inflammation of the limbic gray matter structures of the human brain has recently been identified as major cause of mesial temporal lobe epilepsy with interictal temporal epileptiform activity and slowing of the electroencephalogram, progressive memory disturbances, as well as a variety of other behavioral, emotional, and cognitive changes. Magnetic resonance imaging exhibits volume and signal changes of the amygdala and hippocampus, and specific anti-neuronal antibodies binding to either intracellular or plasma membrane neuronal antigens can be detected in serum and cerebrospinal fluid. While effects of plasma cell-derived antibodies on neuronal function and integrity are increasingly becoming characterized, potentially contributing effects of T cell-mediated immune mechanisms remain poorly understood. CD8+ T cells are known to directly interact with major histocompatibility complex class I-expressing neurons in an antigen-specific manner. Here, we summarize current knowledge on how such direct CD8+ T cell–neuron interactions may impact neuronal excitability, plasticity, and integrity on a single cell and network level and provide an overview on methods to further corroborate the in vivo relevance of these mechanisms mainly obtained from in vitro studies.
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Affiliation(s)
- Petra Ehling
- Department of Neurology, Westfälische Wilhelms-University of Münster , Münster , Germany ; Institute of Physiology I - Neuropathophysiology, Westfälische Wilhelms-University , Münster , Germany
| | - Nico Melzer
- Department of Neurology, Westfälische Wilhelms-University of Münster , Münster , Germany
| | - Thomas Budde
- Institute of Physiology I, Westfälische Wilhelms-University , Münster , Germany
| | - Sven G Meuth
- Department of Neurology, Westfälische Wilhelms-University of Münster , Münster , Germany ; Institute of Physiology I - Neuropathophysiology, Westfälische Wilhelms-University , Münster , Germany
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242
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Bedarf JR, Marek M, Bien CG, Elger CE, Paus S. Sustained Effect of Botulinum Neurotoxin in Myoclonus Owing to Epilepsia Partialis Continua. Mov Disord Clin Pract 2015; 2:402-406. [PMID: 30838240 DOI: 10.1002/mdc3.12216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/25/2015] [Accepted: 05/29/2015] [Indexed: 11/07/2022] Open
Abstract
Background Epilepsia partialis continua (EPC) is defined as continuous myoclonic jerking of a body part of cortical origin and often resembles a movement disorder. Unfortunately, anti-epileptic therapy is frequently ineffective. Currently, the effect of botulinum neurotoxin (BoNT) therapy in EPC is controversial. Methods We analyzed case histories, treatment protocols, and video documentation of 5 patients with EPC, who received BoNT therapy in our movement disorders unit. The Unified Myoclonus Rating Scale was used to document treatment effects. Results In all patients, BoNT treatment significantly reduced severity and frequency of myoclonus and led to pronounced improvement of speech and arm utilization, regardless of etiology or duration of EPC. Conclusion BoNT represents a safe, effective treatment in EPC, offering long-term abatement of myoclonus. The substantial functional profit may hint at mechanisms beyond local impairment of neuromuscular transmission, such as modulation of maladaptive cortical plasticity, as observed in dystonia and poststroke spasticity.
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Affiliation(s)
| | - Milena Marek
- Department of Neurology University of Bonn Bonn Germany
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243
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Esposito S, Di Pietro GM, Madini B, Mastrolia MV, Rigante D. A spectrum of inflammation and demyelination in acute disseminated encephalomyelitis (ADEM) of children. Autoimmun Rev 2015; 14:923-9. [PMID: 26079482 PMCID: PMC7105213 DOI: 10.1016/j.autrev.2015.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 11/15/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that involves multifocal areas of the white matter, rarely the gray matter and spinal cord, mainly affecting children and mostly occurring 1-2weeks after infections or more rarely after vaccinations. Though a specific etiologic agent is not constantly identified, to evaluate carefully patient's clinical history and obtain adequate samples for the search of a potential ADEM causal agent is crucial. In the case of a prompt diagnosis and adequate treatment, most children with ADEM have a favorable outcome with full recovery, but in the case of diagnostic delays or inappropriate treatment some patients might display neurological sequelae and persistent deficits or even show an evolution to multiple sclerosis. The suspicion of ADEM rises on a clinical basis and derives from systemic and neurologic signs combined with magnetic resonance imaging of the central nervous system. Other advanced imaging techniques may help an appropriate differential diagnosis and definition of exact disease extension. Although there is no standardized protocol or management for ADEM, corticosteroids, intravenous immunoglobulin, and plasmapheresis have been successfully used. There is no marker that permits to identify the subset of children with worse prognosis and future studies should try to detect any biological clue for prevision of neurologic damage as well as should optimize treatment strategies using an approach based on the effective risk of negative evolution.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giada Maria Di Pietro
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Madini
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Vincenza Mastrolia
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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244
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Abstract
Type 1 narcolepsy is a sleep disorder characterized by excessive daytime sleepiness with unintentional sleep attacks and cataplexy. The disorder is caused by a loss of hypocretinergic neurons in the brain. The specific loss of these neurons in narcolepsy is thought to result from an autoimmune attack, and this is supported by evidence of both environmental and genetic factors pointing toward an involvement of the immune system. However, definitive proof of an autoimmune etiology is still missing. Several different immune-mediated disorders targeting neurons are known, and many of these are believed to be caused by autoreactive CD8(+) T cells. In this paper, we review the current knowledge on CD8(+) T cell-mediated neuronal damage on the basis of our understanding of other autoimmune disorders and experimental studies. We identify major histocompatibility complex class I presentation of autoantigens on neurons as a possible mechanism in the development of the disease, and propose T cell-mediated pathogenesis, with cytotoxic CD8(+) T cells targeting the hypocretinergic neurons, as a central element.
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Affiliation(s)
- Matilda Degn
- Department of Diagnostics, Molecular Sleep Laboratory, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Birgitte Rahbek Kornum
- Department of Diagnostics, Molecular Sleep Laboratory, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet Glostrup, Glostrup, Denmark
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245
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Stafstrom CE, Carmant L. Seizures and epilepsy: an overview for neuroscientists. Cold Spring Harb Perspect Med 2015; 5:5/6/a022426. [PMID: 26033084 DOI: 10.1101/cshperspect.a022426] [Citation(s) in RCA: 381] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Epilepsy is one of the most common and disabling neurologic conditions, yet we have an incomplete understanding of the detailed pathophysiology and, thus, treatment rationale for much of epilepsy. This article reviews the clinical aspects of seizures and epilepsy with the goal of providing neuroscientists an introduction to aspects that might be amenable to scientific investigation. Seizures and epilepsy are defined, diagnostic methods are reviewed, various clinical syndromes are discussed, and aspects of differential diagnosis, treatment, and prognosis are considered to enable neuroscientists to formulate basic and translational research questions.
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Affiliation(s)
- Carl E Stafstrom
- Division of Pediatric Neurology, Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Lionel Carmant
- Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital, Universite Montreal, Montreal, Quebec H3T 1C5, Canada
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246
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Suleiman J, Dale RC. The recognition and treatment of autoimmune epilepsy in children. Dev Med Child Neurol 2015; 57:431-40. [PMID: 25483277 DOI: 10.1111/dmcn.12647] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 01/07/2023]
Abstract
There is emerging interest in autoimmune epilepsy, which represents a small but potentially treatable form of epilepsy. Most insights into autoimmune epilepsy derive from the recent descriptions of autoimmune encephalitis that takes two general forms: a focal encephalitis (such as limbic) or a diffuse encephalitis (such as anti-N-methyl-D-aspartate receptor [NMDAR] encephalitis). The features of autoimmune epilepsy include acute or subacute onset of seizures, usually in the context of encephalopathy, and inflammation of the central nervous system on testing cerebrospinal fluid or magnetic resonance imaging. Neuronal antibodies associated with autoimmune encephalitis and seizures in children include NMDAR, voltage-gated potassium channel complex, glycine receptor, γ-Aminobutyric acid type A receptor (GABA(A)R), γ-Aminobutyric acid type B receptor (GABA(B)R), and glutamic acid decarboxylase antibodies. These antibodies support the diagnosis of autoimmune epilepsy, but are not essential for diagnosis. When autoimmune epilepsy is suspected, first-line immune therapy with corticosteroids in addition to intravenous immunoglobulin or plasma exchange should be considered. Second-line therapy with rituximab or cyclophosphamide can be considered if the syndrome is severe. A response to immune therapy supports the diagnosis of autoimmune epilepsy. Neuronal antibodies are increasingly found in patients with focal epilepsy of unknown cause who do not have 'encephalitis'. Recent epidemiological studies support the link between epilepsy and autoimmune diseases. Future studies need to define the spectrum of autoimmune epilepsy and focus on early identification and treatment.
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Affiliation(s)
- Jehan Suleiman
- Department of Paediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; Paediatrics and Child Health Discipline, Clinical School, The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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247
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Liba Z, Muthaffar O, Tang J, Minassian B, Halliday W, Branson H, Ann Yeh E. Rasmussen encephalitis: Response to early immunotherapy in a case of immune-mediated encephalitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e69. [PMID: 25738166 PMCID: PMC4335812 DOI: 10.1212/nxi.0000000000000069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/07/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Zuzana Liba
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - Osama Muthaffar
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - Joyce Tang
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - Berge Minassian
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - William Halliday
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - Helen Branson
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - E Ann Yeh
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
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248
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Young woman with a four-year history of epilepsy and progressive focal cortical atrophy - What is the diagnosis? EPILEPSY & BEHAVIOR CASE REPORTS 2015; 2:91-5. [PMID: 25667879 PMCID: PMC4307882 DOI: 10.1016/j.ebcr.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The pathogenesis of disease progression in drug-refractory epilepsy is poorly understood. We report the case of a young woman with a four-year history of epilepsy that progressed rapidly as evidenced by the development of progressive focal cortical atrophy. She underwent biopsy that showed perinatal ischemia and a prominent inflammatory response, including T-cell infiltration and microglial activation. There was no consensus reached on the final diagnosis although the hypothesis of dual pathology (adult variant of Rasmussen's encephalitis and perinatal stroke) was considered. The possible role of inflammation in the progression of epilepsy caused by a “static” lesion (perinatal stroke) is discussed.
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249
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Abstract
Febrile seizures can arise in response to fevers induced by viral infection or as an adverse reaction to live-virus vaccines such as measles, mumps and rubella (MMR) vaccination. A new study has now identified common genetic variants influencing susceptibility to febrile seizures, including two loci specifically associated with MMR-related events.
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250
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Dupuis N, Auvin S. Inflammation and epilepsy in the developing brain: clinical and experimental evidence. CNS Neurosci Ther 2014; 21:141-51. [PMID: 25604829 DOI: 10.1111/cns.12371] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/25/2014] [Accepted: 11/28/2014] [Indexed: 12/12/2022] Open
Abstract
There is an increasing evidence to support a role of inflammatory processes in epilepsy. However, most clinical and experimental studies have been conducted in adult patients or using adult rodents. The pediatric epilepsies constitute a varied group of diseases that are most frequently age specific. In this review, we will focus on the possible role of inflammation in pediatric epilepsy syndromes. We will first describe the clinical data available and provide an overview of our current understanding of the role of inflammation in these clinical situations. We will then review experimental data regarding the role of inflammation in epilepsy in the developing brain. To summarize, inflammation contributes to seizure precipitation, and reciprocally, prolonged seizures induce inflammation. There is also a relationship between inflammation and cell injury following status epilepticus, which differs according to the developmental stage. Finally, inflammation seems to contribute to epileptogenesis even in the developing brain. Based on the available data, we highlight the need for further studies dissecting the exact role of inflammation in epilepsy during development.
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Affiliation(s)
- Nina Dupuis
- INSERM U1141, Paris, France; APHP, Hôpital Robert Debré, Service de Neurologie Pédiatrique, DHU Protect, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
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