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Marchi A, Giusiano B, King M, Lagarde S, Trébuchon-Dafonseca A, Bernard C, Rheims S, Bartolomei F, McGonigal A. Postictal electroencephalographic (EEG) suppression: A stereo-EEG study of 100 focal to bilateral tonic-clonic seizures. Epilepsia 2018; 60:63-73. [PMID: 30565663 DOI: 10.1111/epi.14601] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We aimed to describe intracerebral aspects of postictal generalized electroencephalography suppression (PGES) following focal to bilateral tonic-clonic ("secondarily generalized tonic-clonic") seizures (GTCS) recorded using stereoelectroencephalographic (SEEG), and to correlate these with electroclinical features. METHODS Three independent observers scored semiologic and SEEG features. Patient and epilepsy characteristics were collected. Descriptive statistics and multivariate analysis were performed. The operational definition of PGES on SEEG used strict criteria (absence of visible signal at 20 μV/mm amplitude, in all readable channels). Postictal regional suppression (RS) was identified if only a subset of implanted electrodes showed absence of signal. RESULTS We evaluated 100 seizures in 52 patients. Interobserver agreement was good (κ 0.72 for clinical features and 0.73 for EEG features). PGES was present in 27 of 100 and RS without PGES present in 42 of 100 seizures. Region of RS included epileptogenic zone in 43 of 51 (86%). No effect of sampling (multilobar or bilateral exploration) was seen. Oral tonicity (mouth opening and/or tonic vocalization during the tonic phase of GTCS) was associated with the presence of PGES (P = 0.029; negative predictive value [NPV] 0.91). Bilateral upper limb extension during the tonic phase correlated with PGES (P = 0.041; NPV 0.85). Association of both oral tonicity and bilateral upper limb extension had a high NPV of 0.96. SIGNIFICANCE SEEG recordings confirm true absence of signal during postictal EEG suppression. PGES is unlikely when both upper limb extension and oral tonicity are absent. We hypothesize that bilateral tonic seizure discharge at bulbar level brainstem regions is associated with the production of oral signs and may relate to mechanisms of PGES.
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Affiliation(s)
- Angela Marchi
- Clinical Neurophysiology Department, Sainte Anne Hospital, AP-HP, Paris, France
| | - Bernard Giusiano
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France
| | - Mark King
- Department of Neurosciences, Alfred Hospital, Melbourne, Victoria, Australia
| | - Stanislas Lagarde
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Agnès Trébuchon-Dafonseca
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Christophe Bernard
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France
| | - Sylvain Rheims
- Lyon University, Claude Bernard University, Lyon, France.,Department of Functional Neurology and Epileptology, Hospices Civils de Lyon (Lyon University Hospital), Lyon, France.,Lyon's Neuroscience Research Center (INSERM U1028, CNRS 5292), Lyon, France
| | - Fabrice Bartolomei
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Aileen McGonigal
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
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Kim JA, Rosenthal ES, Biswal S, Zafar S, Shenoy AV, O'Connor KL, Bechek SC, Valdery Moura J, Shafi MM, Patel AB, Cash SS, Westover MB. Epileptiform abnormalities predict delayed cerebral ischemia in subarachnoid hemorrhage. Clin Neurophysiol 2017; 128:1091-1099. [PMID: 28258936 DOI: 10.1016/j.clinph.2017.01.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/14/2017] [Accepted: 01/21/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify whether abnormal neural activity, in the form of epileptiform discharges and rhythmic or periodic activity, which we term here ictal-interictal continuum abnormalities (IICAs), are associated with delayed cerebral ischemia (DCI). METHODS Retrospective analysis of continuous electroencephalography (cEEG) reports and medical records from 124 patients with moderate to severe grade subarachnoid hemorrhage (SAH). We identified daily occurrence of seizures and IICAs. Using survival analysis methods, we estimated the cumulative probability of IICA onset time for patients with and without delayed cerebral ischemia (DCI). RESULTS Our data suggest the presence of IICAs indeed increases the risk of developing DCI, especially when they begin several days after the onset of SAH. We found that all IICA types except generalized rhythmic delta activity occur more commonly in patients who develop DCI. In particular, IICAs that begin later in hospitalization correlate with increased risk of DCI. CONCLUSIONS IICAs represent a new marker for identifying early patients at increased risk for DCI. Moreover, IICAs might contribute mechanistically to DCI and therefore represent a new potential target for intervention to prevent secondary cerebral injury following SAH. SIGNIFICANCE These findings imply that IICAs may be a novel marker for predicting those at higher risk for DCI development.
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Affiliation(s)
- J A Kim
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - E S Rosenthal
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - S Biswal
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - S Zafar
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - A V Shenoy
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - K L O'Connor
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - S C Bechek
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - J Valdery Moura
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - M M Shafi
- Beth Israel Deaconess Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - A B Patel
- Massachusetts General Hospital, Department of Neurosurgery, Harvard Medical School Boston, MA, USA
| | - S S Cash
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - M B Westover
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA.
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Kramer DR, Fujii T, Ohiorhenuan I, Liu CY. Cortical spreading depolarization: Pathophysiology, implications, and future directions. J Clin Neurosci 2015; 24:22-7. [PMID: 26461911 DOI: 10.1016/j.jocn.2015.08.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/18/2015] [Indexed: 01/05/2023]
Abstract
Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury. First described by Leão in 1944, this disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.
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Affiliation(s)
- Daniel R Kramer
- Department of Neurosurgery, University of Southern California, Los Angeles, CA, USA.
| | - Tatsuhiro Fujii
- Department of Neurosurgery, University of Southern California, Los Angeles, CA, USA
| | - Ifije Ohiorhenuan
- Department of Neurosurgery, University of Southern California, Los Angeles, CA, USA
| | - Charles Y Liu
- Department of Neurosurgery, University of Southern California, Los Angeles, CA, USA
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