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Yang M, Zhang Y, Zhang T, Zhou H, Ren J, Zhou D, Yang T. Altered dynamic functional connectivity of motor cerebellum with sensorimotor network and default mode network in juvenile myoclonic epilepsy. Front Neurol 2024; 15:1373125. [PMID: 38903166 PMCID: PMC11187336 DOI: 10.3389/fneur.2024.1373125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Objective To investigate whether changes occur in the dynamic functional connectivity (dFC) of motor cerebellum with cerebral cortex in juvenile myoclonic epilepsy (JME). Methods We adopted resting-state electroencephalography-functional magnetic resonance imaging (EEG-fMRI) and a sliding-window approach to explore the dFC of motor cerebellum with cortex in 36 JME patients compared with 30 and age-matched health controls (HCs). The motor cerebellum was divided into five lobules (I-V, VI, VIIb, VIIIa, and VIIIb). Additionally, correlation analyses were conducted between the variability of dFC and clinical variables in the Juvenile Myoclonic Epilepsy (JME) group, such as disease duration, age at disease onset, and frequency score of myoclonic seizures. Results Compared to HCs, the JME group presented increased dFC between the motor cerebellum with SMN and DMN. Specifically, connectivity between lobule VIIb and left precentral gyrus and right inferior parietal lobule (IPL); between lobule VIIIa and right inferior frontal gyrus (IFG) and left IPL; and between lobule VIIIb and left middle frontal gyrus (MFG), bilateral superior parietal gyrus (SPG), and left precuneus. In addition, within the JME group, the strength of dFC between lobule VIIIb and left precuneus was negatively (r = -0.424, p = 0.025, Bonferroni correction) related with the frequency score of myoclonic seizures. Conclusion In patients with JME, there is a functional dysregulation between the motor cerebellum with DMN and SMN, and the variability of dynamic functional connectivity may be closely associated with the occurrence of motor symptoms in JME.
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Affiliation(s)
- Menghan Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingying Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianyu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huanyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiechuan Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianhua Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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2
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Chen J, Jiang S, Lu B, Liao J, Yang Z, Li H, Pei H, Li J, Iturria-Medina Y, Yao D, Luo C. The role of the primary sensorimotor system in generalized epilepsy: Evidence from the cerebello-cerebral functional integration. Hum Brain Mapp 2024; 45:e26551. [PMID: 38063289 PMCID: PMC10789200 DOI: 10.1002/hbm.26551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/12/2023] [Accepted: 11/16/2023] [Indexed: 01/16/2024] Open
Abstract
The interaction between cerebellum and cerebrum participates widely in function from motor processing to high-level cognitive and affective processing. Because of the motor symptom, idiopathic generalized epilepsy (IGE) patients with generalized tonic-clonic seizure have been recognized to associate with motor abnormalities, but the functional interaction in the cerebello-cerebral circuit is still poorly understood. Resting-state functional magnetic resonance imaging data were collected for 101 IGE patients and 106 healthy controls. The voxel-based functional connectivity (FC) between cerebral cortex and the cerebellum was contacted. The functional gradient and independent components analysis were applied to evaluate cerebello-cerebral functional integration on the voxel-based FC. Cerebellar motor components were further linked to cerebellar gradient. Results revealed cerebellar motor functional modules were closely related to cerebral motor components. The altered mapping of cerebral motor components to cerebellum was observed in motor module in patients with IGE. In addition, patients also showed compression in cerebello-cerebral functional gradient between motor and cognition modules. Interestingly, the contribution of the motor components to the gradient was unbalanced between bilateral primary sensorimotor components in patients: the increase was observed in cerebellar cognitive module for the dominant hemisphere primary sensorimotor, but the decrease was found in the cerebellar cognitive module for the nondominant hemisphere primary sensorimotor. The present findings suggest that the cerebral primary motor system affects the hierarchical architecture of cerebellum, and substantially contributes to the functional integration evidence to understand the motor functional abnormality in IGE patients.
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Affiliation(s)
- Junxia Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Sisi Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Bao Lu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Jiangyan Liao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Zhihuan Yang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Hechun Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Haonan Pei
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Jianfu Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Yasser Iturria-Medina
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P. R. China
- Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, Chengdu, P. R. China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, P. R. China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P. R. China
- Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, Chengdu, P. R. China
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3
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Beckinghausen J, Ortiz-Guzman J, Lin T, Bachman B, Salazar Leon LE, Liu Y, Heck DH, Arenkiel BR, Sillitoe RV. The cerebellum contributes to generalized seizures by altering activity in the ventral posteromedial nucleus. Commun Biol 2023; 6:731. [PMID: 37454228 PMCID: PMC10349834 DOI: 10.1038/s42003-023-05100-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
Thalamo-cortical networks are central to seizures, yet it is unclear how these circuits initiate seizures. We test whether a facial region of the thalamus, the ventral posteromedial nucleus (VPM), is a source of generalized, convulsive motor seizures and if convergent VPM input drives the behavior. To address this question, we devise an in vivo optogenetic mouse model to elicit convulsive motor seizures by driving these inputs and perform single-unit recordings during awake, convulsive seizures to define the local activity of thalamic neurons before, during, and after seizure onset. We find dynamic activity with biphasic properties, raising the possibility that heterogenous activity promotes seizures. Virus tracing identifies cerebellar and cerebral cortical afferents as robust contributors to the seizures. Of these inputs, only microinfusion of lidocaine into the cerebellar nuclei blocks seizure initiation. Our data reveal the VPM as a source of generalized convulsive seizures, with cerebellar input providing critical signals.
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Affiliation(s)
- Jaclyn Beckinghausen
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
| | - Joshua Ortiz-Guzman
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
| | - Tao Lin
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
| | - Benjamin Bachman
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Luis E Salazar Leon
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
| | - Yu Liu
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, 103515 University Dr., Duluth, MN, USA
| | - Detlef H Heck
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, 103515 University Dr., Duluth, MN, USA
| | - Benjamin R Arenkiel
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Roy V Sillitoe
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA.
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA.
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA.
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4
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Schwitalla JC, Pakusch J, Mücher B, Brückner A, Depke DA, Fenzl T, De Zeeuw CI, Kros L, Hoebeek FE, Mark MD. Controlling absence seizures from the cerebellar nuclei via activation of the G q signaling pathway. Cell Mol Life Sci 2022; 79:197. [PMID: 35305155 PMCID: PMC8934336 DOI: 10.1007/s00018-022-04221-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
Absence seizures (ASs) are characterized by pathological electrographic oscillations in the cerebral cortex and thalamus, which are called spike-and-wave discharges (SWDs). Subcortical structures, such as the cerebellum, may well contribute to the emergence of ASs, but the cellular and molecular underpinnings remain poorly understood. Here we show that the genetic ablation of P/Q-type calcium channels in cerebellar granule cells (quirky) or Purkinje cells (purky) leads to recurrent SWDs with the purky model showing the more severe phenotype. The quirky mouse model showed irregular action potential firing of their cerebellar nuclei (CN) neurons as well as rhythmic firing during the wave of their SWDs. The purky model also showed irregular CN firing, in addition to a reduced firing rate and rhythmicity during the spike of the SWDs. In both models, the incidence of SWDs could be decreased by increasing CN activity via activation of the Gq-coupled designer receptor exclusively activated by designer drugs (DREADDs) or via that of the Gq-coupled metabotropic glutamate receptor 1. In contrast, the incidence of SWDs was increased by decreasing CN activity via activation of the inhibitory Gi/o-coupled DREADD. Finally, disrupting CN rhythmic firing with a closed-loop channelrhodopsin-2 stimulation protocol confirmed that ongoing SWDs can be ceased by activating CN neurons. Together, our data highlight that P/Q-type calcium channels in cerebellar granule cells and Purkinje cells can be relevant for epileptogenesis, that Gq-coupled activation of CN neurons can exert anti-epileptic effects and that precisely timed activation of the CN can be used to stop ongoing SWDs.
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Affiliation(s)
| | - Johanna Pakusch
- Department of Behavioral Neuroscience, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Brix Mücher
- Department of Zoology and Neurobiology, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Alexander Brückner
- Institute of Physiology I, Medical Faculty, University of Bonn, 53127, Bonn, Germany
| | - Dominic Alexej Depke
- European Institute of Molecular Imaging, University of Münster, 48149, Münster, Germany
| | - Thomas Fenzl
- Department of Anesthesiology and Intensive Care, TUM School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Chris I De Zeeuw
- Department of Neuroscience, Erasmus MC, 3015 AA, Rotterdam, The Netherlands.,Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, 1105, BA, Amsterdam, The Netherlands
| | - Lieke Kros
- Department of Neuroscience, Erasmus MC, 3015 AA, Rotterdam, The Netherlands
| | - Freek E Hoebeek
- Department for Developmental Origins of Disease, Wilhelmina Children's Hospital and Brain Center, University Medical Center Utrecht, 3584 EA, Utrecht, The Netherlands
| | - Melanie D Mark
- Department of Behavioral Neuroscience, Ruhr-University Bochum, 44801, Bochum, Germany.
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5
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Nie L, Jiang Y, Lv Z, Pang X, Liang X, Chang W, Li J, Zheng J. Deep Cerebellar Nuclei Functional Connectivity with Cerebral Cortex in Temporal Lobe Epilepsy With and Without Focal to Bilateral Tonic-Clonic Seizures: a Resting-State fMRI Study. THE CEREBELLUM 2021; 21:253-263. [PMID: 34164777 DOI: 10.1007/s12311-021-01266-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
We aimed to explore the altered functional connectivity patterns within cerebello-cerebral circuits in temporal lobe epilepsy (TLE) patients with and without focal to bilateral tonic-clonic seizures (FBTCS). Forty-two patients with unilateral TLE (21 with and 21 without FBTCS) and 22 healthy controls were recruited. We chose deep cerebellar nuclei as seed regions, calculated static and dynamic functional connectivity (sFC and dFC) in the patients with and without FBTCS and healthy controls, and compared sFC and dFC among the three groups. Correlation analyses were used to assess relationships between the significantly altered imaging features and patient clinical parameters. Compared to the group without FBTCS, the FBTCS group showed decreased sFC between the right dentate nuclei and left hemisphere regions including the middle frontal gyrus, superior temporal gyrus, superior medial frontal gyrus and posterior cingulate gyrus, and significantly increased dFC between the right interposed nuclei and contralateral precuneus. Relative to HCs, the FBTCS group demonstrated prominently decreased sFC between the right dentate nuclei and left middle frontal gyrus. No significant correlations between the altered imaging features and patient clinical parameters were observed. Our results suggest that the disrupted cerebello-cerebral FC might be related to cognitive impairment, epileptogenesis, and propagation of epileptic activities in patients with FBTCS.
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Affiliation(s)
- Liluo Nie
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanchun Jiang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zongxia Lv
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaomin Pang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiulin Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Weiwei Chang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Li
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinou Zheng
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
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6
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Zhang Y, Huang G, Liu M, Li M, Wang Z, Wang R, Yang D. Functional and structural connective disturbance of the primary and default network in patients with generalized tonic-clonic seizures. Epilepsy Res 2021; 174:106595. [PMID: 33993017 DOI: 10.1016/j.eplepsyres.2021.106595] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The present study aims to investigate the disturbance of functional and structural profiles of patients with generalized tonic-clonic seizures (GTCS). METHODS Resting-state fMRI and diffusion tensor imaging (DTI) data was collected from fifty-six patients and sixty-two healthy controls. Degree centrality (DC) of functional connectivity was first calculated and compared between groups using a two-sample t-test. Furthermore, the regions with significant alteration of DC in patients with GTCS were used as nodes to construct the brain network. Functional connectivity (FC) network was constructed using the Person's correlation analysis and structural connectivity (SC) network was obtained using deterministic tractography technology. Gray matter volume (GMV) and cortical thickness (CT) were computed and correlated with connective profiles. RESULTS The patients with GTCS showed increased DC in the primary network (PN), including bilateral precentral gyrus, supplementary motor areas (SMA), and visual cortex, and decreased DC in core regions of default mode network (DMN), bilateral anterior insular, and supramarginal gyrus. In the present study, 14 regions were identified to construct networks. In patients, the FC and SC were increased within the sensorimotor network (mainly linking with SMA) and decreased within DMN (mainly linking with the posterior cingulate cortex (PCC)). Except for the decreased FC and SC between cerebellum and SMA, patients demonstrated increased connectivity between DMN and PN. Besides, the insula demonstrated decreased FC with DMN and increased FC with PN, without significant SC alterations in patients with GTCS. Decreased GMV in bilateral thalamus and increased GMV in frontoparietal regions were found in patients. The decreased GMV of thalamus and increased GMV of SMA positively and negatively correlated with the FC between PCC and left superior frontal cortex, the FC between SMA and left precuneus respectively. CONCLUSION Hyper-connectivity within PN helps to understand the disturbance of primary functions, especially the motor abnormality in GTCS. The hypo-connectivity within DMN suggested abnormal network organization possibly related to epileptogenesis. Moreover, over-interaction between DMN and PN and unbalanced connectivity between them and insula provided potential evidence reflecting abnormal interactions between primary and high-order function systems.
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Affiliation(s)
- Yaodan Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China; Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's Hospital, Chengdu, PR China
| | - Gengzhen Huang
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Meijun Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Mao Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Zhiqiang Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Rongyu Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Dongdong Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China.
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Abstract
Epilepsy is considered a major serious chronic neurological disorder, characterized by recurrent seizures. It is usually associated with a history of a lesion in the nervous system. Irregular activation of inflammatory molecules in the injured tissue is an important factor in the development of epilepsy. It is unclear how the imbalanced regulation of inflammatory mediators contributes to epilepsy. A recent research goal is to identify interconnected inflammation pathways which may be involved in the development of epilepsy. The clinical use of available antiepileptic drugs is often restricted by their limitations, incidence of several side effects, and drug interactions. So development of new drugs, which modulate epilepsy through novel mechanisms, is necessary. Alternative therapies and diet have recently reported positive treatment outcomes in epilepsy. Vitamin D (Vit D) has shown prophylactic and therapeutic potential in different neurological disorders. So, the aim of current study was to review the associations between different brain inflammatory mediators and epileptogenesis, to strengthen the idea that targeting inflammatory pathway may be an effective therapeutic strategy to prevent or treat epilepsy. In addition, neuroprotective effects and mechanisms of Vit D in clinical and preclinical studies of epilepsy were reviewed.
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8
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Cerebello-cerebral connectivity in idiopathic generalized epilepsy. Eur Radiol 2020; 30:3924-3933. [DOI: 10.1007/s00330-020-06674-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/17/2019] [Accepted: 01/24/2020] [Indexed: 12/24/2022]
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9
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Budman E, Deeb W, Martinez-Ramirez D, Pilitsis JG, Peng-Chen Z, Okun MS, Ramirez-Zamora A. Potential indications for deep brain stimulation in neurological disorders: an evolving field. Eur J Neurol 2018; 25:434-e30. [PMID: 29266596 DOI: 10.1111/ene.13548] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022]
Abstract
Deep brain stimulation (DBS) is an established therapy for appropriately selected patients with movement disorders and neuropsychiatric conditions. Although the exact mechanisms and biology of DBS are not fully understood, it is a safe and well-tolerated therapy for many refractory cases of neuropsychiatric disease. Increasingly, DBS has been explored in other conditions with encouraging results. In this paper, available data is reviewed and new DBS targets, challenges and future directions in neurological disorders are explored. A detailed search of the medical literature discussing the potential use of DBS for neurological disorders excluding accepted indications was conducted. All reports were analyzed individually for content and redundant articles were excluded by examining individual abstracts. The level of evidence for each indication was summarized. Multiple studies report promising preliminary data regarding the safety and efficacy of DBS for a variety of neurological indications including chronic pain, tinnitus, epilepsy, Tourette syndrome, Huntington's disease, tardive dyskinesia and Alzheimer's disease. The initial results of DBS studies for diverse neurological disorders are encouraging but larger, controlled, prospective, homogeneous clinical trials are necessary to establish long-term safety and effectiveness. The field of neuromodulation continues to evolve and advances in DBS technology, stereotactic techniques, neuroimaging and DBS programming capabilities are shaping the present and future of DBS research and use in practice.
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Affiliation(s)
- E Budman
- Department of Neurology, Albany Medical College, Albany, NY, USA
| | - W Deeb
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - D Martinez-Ramirez
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - J G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Z Peng-Chen
- Unidad de Neurología, Hospital Padre Hurtado, Santiago, Chile.,Unidad Movimientos Anormales, Centro Medico Clínica Dávila, Santiago, Chile
| | - M S Okun
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - A Ramirez-Zamora
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
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10
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Saniya K, Patil BG, Chavan MD, Prakash KG, Sailesh KS, Archana R, Johny M. Neuroanatomical Changes in Brain Structures Related to Cognition in Epilepsy: An Update. J Nat Sci Biol Med 2017; 8:139-143. [PMID: 28781476 PMCID: PMC5523517 DOI: 10.4103/0976-9668.210016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Understanding the microanatomical changes in brain structures is necessary for developing innovative therapeutic approaches to prevent/delay the cognitive impairment in epilepsy. We review here the microanatomical changes in the brain structures related to cognition in epilepsy. Here, we have presented the changes in major brain structures related to cognition, which helps the clinicians understand epilepsy more clearly and also helps researchers develop new treatment procedures.
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Affiliation(s)
- K Saniya
- Department of Anatomy, Azeezia Institute of Medical Sciences, Kollam, Kerala, India
| | - B G Patil
- Department of Anatomy, Shri B. M. Patil Medical College, Bijapur, Karnataka, India
| | - Madhavrao D Chavan
- Department of Pharmacology, Azeezia Institute of Medical Sciences, Kollam, Kerala, India
| | - K G Prakash
- Department of Anatomy, Azeezia Institute of Medical Sciences, Kollam, Kerala, India
| | - Kumar Sai Sailesh
- Department of Physiology, Little Flower Institute of Medical Sciences and Research, Angamaly, Kerala, India
| | - R Archana
- Department of Anatomy, Saveetha Medical College, Saveetha University, Chennai, Tamil Nadu, India
| | - Minu Johny
- Department of Physiology, Little Flower Institute of Medical Sciences and Research, Angamaly, Kerala, India
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11
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Effects of low-frequency electrical stimulation of the anterior piriform cortex on kainate-induced seizures in rats. Epilepsy Behav 2017; 72:1-7. [PMID: 28564587 DOI: 10.1016/j.yebeh.2017.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Recent evidence in animals and humans suggests that low-frequency stimulation (LFS) has significant antiepileptic properties. The anterior piriform cortex (APC) is a highly susceptible seizure-trigger zone and may be critical for the initiation and propagation of seizures originating from cortical and limbic foci. We used the kainic acid (KA) seizure model in rats to assess the therapeutic effect of LFS of the APC on seizures. METHODS Adult male Sprague-Dawley rats were implanted with electrodes in the left APC and recording electrodes bilaterally in the hippocampal CA3 regions. Rats were monitored continuously with video-EEG after the emergence of spontaneous recurrent seizures that followed induction of status epilepticus by intraperitoneal KA. After two weeks of baseline recordings to determine seizure frequency, LFS of the APC was applied 60-min On 15-min Off, for two weeks with 1Hz biphasic square waves, 0.2ms pulse width, at 200μA. Another 2-week period of video-EEG monitoring was done after the cessation of LFS to study the carry-over effect. Changes in seizure frequency, severity, and duration between baseline, during LFS, and post-LFS were analyzed using the Poisson regression model. RESULTS Overall seizure frequency decreased during the post-LFS period to 5% of that at baseline (p=0.003). Severe seizures (stages 4 and 5 on the Racine scale) decreased to 0% of the baseline during the post-LFS period. CONCLUSIONS Two weeks of LFS of the APC reduced spontaneous seizure frequency and severity in the KA model with the effect outlasting the stimulation. Our findings suggest that the APC can be an important therapeutic target for stimulation in epilepsy.
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12
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Kim BR, Lee YJ, Nam SO, Park KH. Venous angioma may be associated with epilepsy in children. KOREAN JOURNAL OF PEDIATRICS 2016; 59:341-5. [PMID: 27610183 PMCID: PMC5014914 DOI: 10.3345/kjp.2016.59.8.341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 11/27/2022]
Abstract
Purpose Venous angioma (VA) is the most common congenital abnormality of the intracranial vasculature. This study aimed to investigate the relationship between VA and epilepsy and to identify the characteristics of children with VA and epilepsy. Methods The records of all patients aged less than 18 years who underwent brain magnetic resonance imaging (MRI) at Pusan National University Hospital were retrospectively reviewed. Patients with isolated VA and patients with normal MRI were compared in terms of the prevalence of epilepsy. Results In total, 2,385 pediatric patients who underwent brain MRI were enrolled. Isolated VA was identified in 26 patients (VA group). Among the patients with normal MRI findings, 225 age- and sex-matched patients to the VA-group were assigned to the control group. Nine patients in the VA group (9 of 26, 34.6%) and 27 patients in the control group (26 of 225, 11.5%; P<0.001) had epilepsy. In the VA group, 20 patients (76.9%) had the VA in the cerebral hemispheres, and 6 patients (23.1%) had the VA in the brainstem and cerebellum. The latter showed a higher prevalence of epilepsy (5 of 6, 83.3%) than the former (4 of 20, 20.0%; P=0.004). Among the nine patients who had epilepsy with VA, patients whose VA involved the brainstem and cerebellum showed a significantly higher frequency of abnormal Electroencephalographic findings than patients whose VA involved the cerebral hemispheres (P=0.016). Conclusion VA, especially in the brainstem and cerebellum, might be associated with epilepsy.
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Affiliation(s)
- Bo Ryung Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yun Jin Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Ook Nam
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Girgis F, Miller JP. White matter stimulation for the treatment of epilepsy. Seizure 2016; 37:28-31. [PMID: 26926734 DOI: 10.1016/j.seizure.2016.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/03/2016] [Accepted: 02/06/2016] [Indexed: 10/22/2022] Open
Abstract
Electrical stimulation in the treatment of epilepsy has been tried in numerous forms and with a variety of targets. Some of these, such as anterior thalamic stimulation, responsive cortical stimulation, and vagal nerve stimulation, have shown promise. A relatively novel concept, that of white matter stimulation, offers a different mechanism in that a small population of stimulated axons can transmit current to a large population of epileptogenic neurons. In theory, this allows for the modulation of seizure circuits and neural networks using lower stimulation volumes. Although clinical data is currently sparse, we review the relevant studies pertaining to white matter stimulation in epilepsy thus far, and offer explanations as to its effects, potential advantages, and utility.
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Affiliation(s)
- Fady Girgis
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States of America.
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Kros L, Eelkman Rooda OHJ, De Zeeuw CI, Hoebeek FE. Controlling Cerebellar Output to Treat Refractory Epilepsy. Trends Neurosci 2015; 38:787-799. [PMID: 26602765 DOI: 10.1016/j.tins.2015.10.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/12/2015] [Accepted: 10/18/2015] [Indexed: 11/27/2022]
Abstract
Generalized epilepsy is characterized by recurrent seizures caused by oscillatory neuronal firing throughout thalamocortical networks. Current therapeutic approaches often intervene at the level of the thalamus or cerebral cortex to ameliorate seizures. We review here the therapeutic potential of cerebellar stimulation. The cerebellum forms a prominent ascending input to the thalamus and, whereas stimulation of the foliated cerebellar cortex exerts inconsistent results, stimulation of the centrally located cerebellar nuclei (CN) reliably stops generalized seizures in experimental models. Stimulation of this area indicates that the period of stimulation with respect to the phase of the oscillations in thalamocortical networks can optimize its effect, opening up the possibility of developing on-demand deep brain stimulation (DBS) treatments.
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Affiliation(s)
- Lieke Kros
- Department of Neuroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Oscar H J Eelkman Rooda
- Department of Neuroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Chris I De Zeeuw
- Department of Neuroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Freek E Hoebeek
- Department of Neuroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
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15
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Kros L, Eelkman Rooda OHJ, Spanke JK, Alva P, van Dongen MN, Karapatis A, Tolner EA, Strydis C, Davey N, Winkelman BHJ, Negrello M, Serdijn WA, Steuber V, van den Maagdenberg AMJM, De Zeeuw CI, Hoebeek FE. Cerebellar output controls generalized spike-and-wave discharge occurrence. Ann Neurol 2015; 77:1027-49. [PMID: 25762286 PMCID: PMC5008217 DOI: 10.1002/ana.24399] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 01/13/2023]
Abstract
Objective Disrupting thalamocortical activity patterns has proven to be a promising approach to stop generalized spike‐and‐wave discharges (GSWDs) characteristic of absence seizures. Here, we investigated to what extent modulation of neuronal firing in cerebellar nuclei (CN), which are anatomically in an advantageous position to disrupt cortical oscillations through their innervation of a wide variety of thalamic nuclei, is effective in controlling absence seizures. Methods Two unrelated mouse models of generalized absence seizures were used: the natural mutant tottering, which is characterized by a missense mutation in Cacna1a, and inbred C3H/HeOuJ. While simultaneously recording single CN neuron activity and electrocorticogram in awake animals, we investigated to what extent pharmacologically increased or decreased CN neuron activity could modulate GSWD occurrence as well as short‐lasting, on‐demand CN stimulation could disrupt epileptic seizures. Results We found that a subset of CN neurons show phase‐locked oscillatory firing during GSWDs and that manipulating this activity modulates GSWD occurrence. Inhibiting CN neuron action potential firing by local application of the γ‐aminobutyric acid type A (GABA‐A) agonist muscimol increased GSWD occurrence up to 37‐fold, whereas increasing the frequency and regularity of CN neuron firing with the use of GABA‐A antagonist gabazine decimated its occurrence. A single short‐lasting (30–300 milliseconds) optogenetic stimulation of CN neuron activity abruptly stopped GSWDs, even when applied unilaterally. Using a closed‐loop system, GSWDs were detected and stopped within 500 milliseconds. Interpretation CN neurons are potent modulators of pathological oscillations in thalamocortical network activity during absence seizures, and their potential therapeutic benefit for controlling other types of generalized epilepsies should be evaluated. Ann Neurol 2015;77:1027–1049
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Affiliation(s)
- Lieke Kros
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Jochen K Spanke
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Parimala Alva
- Science and Technology Research Institute, University of Hertfordshire, Hatfield, United Kingdom
| | - Marijn N van Dongen
- Bioelectronics Section, Faculty of Electrical Engineering, Mathematics, and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Athanasios Karapatis
- Bioelectronics Section, Faculty of Electrical Engineering, Mathematics, and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Else A Tolner
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Christos Strydis
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Neil Davey
- Science and Technology Research Institute, University of Hertfordshire, Hatfield, United Kingdom
| | - Beerend H J Winkelman
- Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, Amsterdam, the Netherlands
| | - Mario Negrello
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Wouter A Serdijn
- Bioelectronics Section, Faculty of Electrical Engineering, Mathematics, and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Volker Steuber
- Science and Technology Research Institute, University of Hertfordshire, Hatfield, United Kingdom
| | - Arn M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Chris I De Zeeuw
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
- Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, Amsterdam, the Netherlands
| | - Freek E Hoebeek
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
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Chen S, Wang S, Rong P, Liu J, Zhang H, Zhang J. Acupuncture for refractory epilepsy: role of thalamus. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:950631. [PMID: 25548594 PMCID: PMC4273587 DOI: 10.1155/2014/950631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 12/29/2022]
Abstract
Neurostimulation procedures like vagus nerve stimulation (VNS) and deep brain stimulation have been used to treat refractory epilepsy and other neurological disorders. While holding promise, they are invasive interventions with serious complications and adverse effects. Moreover, their efficacies are modest with less seizure free. Acupuncture is a simple, safe, and effective traditional healing modality for a wide range of diseases including pain and epilepsy. Thalamus takes critical role in sensory transmission and is highly involved in epilepsy genesis particularly the absence epilepsy. Considering thalamus serves as a convergent structure for both acupuncture and VNS and the thalamic neuronal activities can be modulated by acupuncture, we propose that acupuncture could be a promising therapy or at least a screening tool to select suitable candidates for those invasive modalities in the management of refractory epilepsy.
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Affiliation(s)
- Shuping Chen
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shubin Wang
- China General Meitan Hospital, Beijing 100028, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Junling Liu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Hongqi Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong
| | - Jianliang Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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Cerebellar Directed Optogenetic Intervention Inhibits Spontaneous Hippocampal Seizures in a Mouse Model of Temporal Lobe Epilepsy. eNeuro 2014; 1. [PMID: 25599088 PMCID: PMC4293636 DOI: 10.1523/eneuro.0005-14.2014] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Epilepsy is a condition of spontaneous recurrent seizures. Current treatment options for epilepsy can have major negative side effects and for many patients fail to control seizures. We detected seizures on-line and tested a new selective intervention using a mouse model of temporal lobe epilepsy. Krook-Magnuson et al. report a bidirectional functional connectivity between the hippocampus and the cerebellum in a mouse model of temporal lobe epilepsy, and demonstrate that cerebellar directed on-demand optogenetic intervention can stop seizures recorded from the hippocampus. ![]()
Temporal lobe epilepsy is often medically refractory and new targets for intervention are needed. We used a mouse model of temporal lobe epilepsy, on-line seizure detection, and responsive optogenetic intervention to investigate the potential for cerebellar control of spontaneous temporal lobe seizures. Cerebellar targeted intervention inhibited spontaneous temporal lobe seizures during the chronic phase of the disorder. We further report that the direction of modulation as well as the location of intervention within the cerebellum can affect the outcome of intervention. Specifically, on-demand optogenetic excitation or inhibition of parvalbumin-expressing neurons, including Purkinje cells, in the lateral or midline cerebellum results in a decrease in seizure duration. In contrast, a consistent reduction in spontaneous seizure frequency occurs uniquely with on-demand optogenetic excitation of the midline cerebellum, and was not seen with intervention directly targeting the hippocampal formation. These findings demonstrate that the cerebellum is a powerful modulator of temporal lobe epilepsy, and that intervention targeting the cerebellum as a potential therapy for epilepsy should be revisited.
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18
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Laxpati NG, Kasoff WS, Gross RE. Deep brain stimulation for the treatment of epilepsy: circuits, targets, and trials. Neurotherapeutics 2014; 11:508-26. [PMID: 24957200 PMCID: PMC4121455 DOI: 10.1007/s13311-014-0279-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Deep brain stimulation (DBS) has proven remarkably safe and effective in the treatment of movement disorders. As a result, it is being increasingly applied to a range of neurologic and psychiatric disorders, including medically refractory epilepsy. This review will examine the use of DBS in epilepsy, including known targets, mechanisms of neuromodulation and seizure control, published clinical evidence, and novel technologies. Cortical and deep neuromodulation for epilepsy has a long experimental history, but only recently have better understanding of epileptogenic networks, precise stereotactic techniques, and rigorous trial design combined to improve the quality of available evidence and make DBS a viable treatment option. Nonetheless, underlying mechanisms, anatomical targets, and stimulation parameters remain areas of active investigation.
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Affiliation(s)
- Nealen G. Laxpati
- />Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA 30322 USA
- />Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - Willard S. Kasoff
- />Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, AZ USA
| | - Robert E. Gross
- />Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA 30322 USA
- />Department of Neurology, Emory University School of Medicine, Atlanta, GA USA
- />Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA USA
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Abstract
Neurostimulation is now an established therapy for the treatment of movement disorders, pain, and epilepsy. While most neurostimulation systems available today provide stimulation in an open-loop manner (i.e., therapy is delivered according to preprogrammed settings and is unaffected by changes in the patient's clinical symptoms or in the underlying disease), closed-loop neurostimulation systems, which modulate or adapt therapy in response to physiological changes, may provide more effective and efficient therapy. At present, few such systems exist owing to the complexities of designing and implementing implantable closed-loop systems. This review focuses on the clinical experience of four implantable closed-loop neurostimulation systems: positional-adaptive spinal cord stimulation for treatment of pain, responsive cortical stimulation for treatment of epilepsy, closed-loop vagus nerve stimulation for treatment of epilepsy, and concurrent sensing and stimulation for treatment of Parkinson disease. The history that led to the development of the closed-loop systems, the sensing, detection, and stimulation technology that closes the loop, and the clinical experiences are presented.
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Affiliation(s)
- Felice T Sun
- NeuroPace Inc., 445 N. Bernardo Avenue, Mountain View, CA, 94043, USA,
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21
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Koubeissi MZ, Kahriman E, Syed TU, Miller J, Durand DM. Low-frequency electrical stimulation of a fiber tract in temporal lobe epilepsy. Ann Neurol 2013; 74:223-31. [PMID: 23613463 DOI: 10.1002/ana.23915] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/08/2013] [Accepted: 04/19/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Surgical resection of the temporal lobe is an effective treatment for medically intractable temporal lobe epilepsy, but can cause memory impairment. Deep brain stimulation in epilepsy has targeted gray matter structures using high frequencies, but achieved limited success. We tested the hypothesis that low-frequency stimulation of the fornix reduces interictal epileptiform discharges and seizures in patients with intractable mesial temporal lobe epilepsy, without affecting memory. METHODS We implanted depth electrodes in 11 patients for surgical evaluation of intractable epilepsy. Low-frequency stimulation of the fornix occurred in 4-hour sessions in the video-electroencephalography unit. Mental status assessment was performed at baseline and during stimulation. We studied the effect of stimulation on hippocampal spikes and seizures. RESULTS There were no complications, and the patients were unaware of the stimulation. Fornix stimulation elicited evoked responses in the hippocampus and the posterior cingulate gyrus. Hourly Mini-Mental Status Examination (MMSE) scores showed an increase during stimulation when compared to prestimulation MMSE, largely due to improvement in recall, possibly representing a practice effect. Hippocampal spikes were significantly reduced during and outlasting each stimulation session. Seizure odds (n = 7) were reduced by 92% in the 2 days that followed stimulation. INTERPRETATION Low-frequency stimulation of the fornix activates the hippocampus and other areas of the declarative memory circuit. The results of this preliminary study suggest that low-frequency stimulation is tolerable and reduces epileptiform discharges and seizures in patients with intractable mesial temporal lobe epilepsy. A controlled clinical trial may be warranted.
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Affiliation(s)
- Mohamad Z Koubeissi
- Department of Neurology, George Washington University, Washington, DC; Departments of Neurology, University Hospitals Case Medical Center, Cleveland, OH
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22
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Abstract
Neurostimulation as a treatment for epilepsy has been around for almost 20 years in the form of vagus nerve stimulation. Newer types of neurostimulation are being developed and stand on the brink of approval for use. The two newest therapies, not yet approved in the United States, are deep brain stimulation and the Responsive Neurostimulator System . In fact, in Europe, approval has already been given for deep brain stimulation and newer forms of vagus nerve stimulation. Efficacy is similar between these therapies, and side effects are moderate, so what will be the future? The challenge will be to learn how to use these therapies correctly and offer the right treatment for the right patient.
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23
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Intracranial Neurostimulation for Epilepsy. Can J Neurol Sci 2012. [DOI: 10.1017/s0317167100018126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bari AA, Pouratian N. Brain imaging correlates of peripheral nerve stimulation. Surg Neurol Int 2012; 3:S260-8. [PMID: 23230531 PMCID: PMC3514912 DOI: 10.4103/2152-7806.103016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/04/2012] [Indexed: 11/04/2022] Open
Abstract
Direct peripheral nerve stimulation is an effective treatment for a number of disorders including epilepsy, depression, neuropathic pain, cluster headache, and urological dysfunction. The efficacy of this stimulation is ultimately due to modulation of activity in the central nervous system. However, the exact brain regions involved in each disorder and how they are modulated by peripheral nerve stimulation is not fully understood. The use of functional neuroimaging such as SPECT, PET and fMRI in patients undergoing peripheral nerve stimulation can help us to understand these mechanisms. We review the literature for functional neuroimaging performed in patients implanted with peripheral nerve stimulators for the above-mentioned disorders. These studies suggest that brain activity in response to peripheral nerve stimulation is a complex interaction between the stimulation parameters, disease type and severity, chronicity of stimulation, as well as nonspecific effects. From this information we may be able to understand which brain structures are involved in the mechanism of peripheral nerve stimulation as well as define the neural substrates underlying these disorders.
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Affiliation(s)
- Ausaf A Bari
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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25
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Sankar T, Tierney TS, Hamani C. Novel applications of deep brain stimulation. Surg Neurol Int 2012; 3:S26-33. [PMID: 22826807 PMCID: PMC3400483 DOI: 10.4103/2152-7806.91607] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 12/20/2011] [Indexed: 11/11/2022] Open
Abstract
The success of deep brain stimulation (DBS) surgery in treating medically refractory symptoms of some movement disorders has inspired further investigation into a wide variety of other treatment-resistant conditions. These range from disorders of gait, mood, and memory to problems as diverse as obesity, consciousness, and addiction. We review the emerging indications, rationale, and outcomes for some of the most promising new applications of DBS in the treatment of postural instability associated with Parkinson's disease, depression, obsessive–compulsive disorder, obesity, substance abuse, epilepsy, Alzheimer′s-type dementia, and traumatic brain injury. These studies reveal some of the excitement in a field at the edge of a rapidly expanding frontier. Much work still remains to be done on basic mechanism of DBS, optimal target and patient selection, and long-term durability of this technology in treating new indications.
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Affiliation(s)
- Tejas Sankar
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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Haghdoost-Yazdi H, Rajaei F, Janahmadi M. Cerebellar Purkinje cells fire paroxysmal depolarization shift (PDS)-like events in response to epileptogenic drugs. Neurol Res 2011; 33:50-5. [PMID: 21208532 DOI: 10.1179/016164110x12816242542454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Cerebellar Purkinje cells (PCs) fire burst of Na(+) spikes riding on a Ca(2+) spike which basically involves the same ionic channels and currents establishing the paroxysmal depolarization shift (PDS) discharges. METHODS Intracellular recordings were taken from somata of PCs to explore effects of the epileptogenic drugs of pentylenetetrazol (PTZ), bicuculline methiodide (BCC) and 4-aminopyridine (4-AP) on the firing behavior of these cells. RESULTS PCs showed spontaneous PDS-like events in presence of these drugs. Generally, PTZ and BCC-induced PDSs were similar in shape and properties but were remarkably different from 4-AP-induced PDSs. Blockade of glutamate transmission inhibited generation of PDSs by PTZ and BCC but it did not affect discharge of PDSs induced by 4-AP. Careful analysis of PDS discharges revealed that they have remarkable differences with normal and 4-AP-induced spontaneous activity. DISCUSSION Data presented here indicate that PDS discharges in PCs are induced either by the imbalance between excitatory and inhibitory synaptic transmission or by the suppression of 4-AP-sensitive currents.
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Affiliation(s)
- H Haghdoost-Yazdi
- Department of Physiology and Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Tehran, Iran.
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Li Y, Du H, Xie B, Wu N, Wang J, Wu G, Feng H, Jiang T. Cerebellum abnormalities in idiopathic generalized epilepsy with generalized tonic-clonic seizures revealed by diffusion tensor imaging. PLoS One 2010; 5:e15219. [PMID: 21203575 PMCID: PMC3006341 DOI: 10.1371/journal.pone.0015219] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 10/29/2010] [Indexed: 11/18/2022] Open
Abstract
Although there is increasing evidence suggesting that there may be subtle abnormalities in idiopathic generalized epilepsy (IGE) patients using modern neuroimaging techniques, most of these previous studies focused on the brain grey matter, leaving the underlying white matter abnormalities in IGE largely unknown, which baffles the treatment as well as the understanding of IGE. In this work, we adopted multiple methods from different levels based on diffusion tensor imaging (DTI) to analyze the white matter abnormalities in 14 young male IGE patients with generalized tonic-clonic seizures (GTCS) only, comparing with 29 age-matched male healthy controls. First, we performed a voxel-based analysis (VBA) of the fractional anisotropy (FA) images derived from DTI. Second, we used a tract-based spatial statistics (TBSS) method to explore the alterations within the white matter skeleton of the patients. Third, we adopted region-of-interest (ROI) analyses based on the findings of VBA and TBSS to further confirm abnormal brain regions in the patients. At last, considering the convergent evidences we found by VBA, TBSS and ROI analyses, a subsequent probabilistic fiber tractography study was performed to investigate the abnormal white matter connectivity in the patients. Significantly decreased FA values were consistently observed in the cerebellum of patients, providing fresh evidence and new clues for the important role of cerebellum in IGE with GTCS.
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Affiliation(s)
- Yonghui Li
- National Research Center for Intelligent Computing Systems, Institute of Computing Technology, Chinese Academy of Sciences, Beijing, People's Republic of China
- National Laboratory of Pattern Recognition, LIAMA Center for Computational Medicine, Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Hanjian Du
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Bing Xie
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Nan Wu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Guocai Wu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
- * E-mail: (HF); (TJ)
| | - Tianzi Jiang
- National Laboratory of Pattern Recognition, LIAMA Center for Computational Medicine, Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- * E-mail: (HF); (TJ)
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Fountas KN, Kapsalaki E, Hadjigeorgiou G. Cerebellar stimulation in the management of medically intractable epilepsy: a systematic and critical review. Neurosurg Focus 2010; 29:E8. [DOI: 10.3171/2010.5.focus10111] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Object
The wide application of deep brain stimulation in the management of movement as well as other degenerative neurological and psychiatric disorders has renewed the interest in using deep brain stimulation in the management of medically intractable epilepsy. Various stimulation targets have been used with significantly varying results in aborting seizure activity. Electrical cerebellar stimulation (CS) has been used for more than 50 years in the management of epilepsy, with conflicting results. In the current study, the authors review the pertinent literature to outline the role of CS in the management of medically refractory epilepsy.
Methods
The PubMed medical database was systematically searched for the following terms: “cerebellar,” “epilepsy,” “stimulation,” and “treatment,” and all their combinations. Case reports were excluded from this study.
Results
The pertinent articles were categorized into 2 large groups: animal experimental and human clinical studies. Particular emphasis on the following aspects was given when reviewing the human clinical studies: their methodological characteristics, the number of participants, their seizure types, the implantation technique and its associated complications, the exact stimulation target, the stimulation technique, the seizure outcome, and the patients' psychological and social poststimulation status. Three clinical double-blind studies were found, with similar implantation surgical technique, stimulation target, and stimulation parameters, but quite contradictory results. Two of these studies failed to demonstrate any significant seizure reduction, whereas the third one showed a significant poststimulation decrease in seizure frequency. All possible factors responsible for these differences in the findings are analyzed in the present study.
Conclusions
Cerebellar stimulation seems to remain a stimulation target worth exploring for defining its potential in the treatment of medically intractable epilepsy, although the data from the double-blind clinical studies that were performed failed to establish a clear benefit in regard to seizure frequency. A large-scale, double-blind clinical study is required for accurately defining the efficacy of CS in epilepsy treatment.
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Affiliation(s)
| | | | - Georgios Hadjigeorgiou
- 3Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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Toward rational design of electrical stimulation strategies for epilepsy control. Epilepsy Behav 2010; 17:6-22. [PMID: 19926525 PMCID: PMC2818293 DOI: 10.1016/j.yebeh.2009.10.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 10/12/2009] [Indexed: 11/21/2022]
Abstract
Electrical stimulation is emerging as a viable alternative for patients with epilepsy whose seizures are not alleviated by drugs or surgery. Its attractions are temporal and spatial specificity of action, flexibility of waveform parameters and timing, and the perception that its effects are reversible unlike resective surgery. However, despite significant advances in our understanding of mechanisms of neural electrical stimulation, clinical electrotherapy for seizures relies heavily on empirical tuning of parameters and protocols. We highlight concurrent treatment goals with potentially conflicting design constraints that must be resolved when formulating rational strategies for epilepsy electrotherapy, namely, seizure reduction versus cognitive impairment, stimulation efficacy versus tissue safety, and mechanistic insight versus clinical pragmatism. First, treatment markers, objectives, and metrics relevant to electrical stimulation for epilepsy are discussed from a clinical perspective. Then the experimental perspective is presented, with the biophysical mechanisms and modalities of open-loop electrical stimulation, and the potential benefits of closed-loop control for epilepsy.
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Schulze-Bonhage A. Deep brain stimulation: a new approach to the treatment of epilepsy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:407-12. [PMID: 19623308 DOI: 10.3238/arztebl.2009.0407] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 11/06/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deep brain stimulation, known to be effective in the treatment of movement disorders, is now attracting increasing interest in the treatment of other neurological and psychiatric diseases, particularly pain syndromes and epilepsy. It may be a new treatment option for intractable epilepsy. METHODS Selective literature review of human applications of deep brain stimulation in epilepsy presented together with the author's own experimental and clinical experience. RESULTS Conceptually, deep brain stimulation might be used to prevent the spread of epileptic discharges or to suppress their generation. Various target structures in the brain, including the thalamus, the subthalamic nucleus, and foci in the hippocampus and neocortex, are currently of interest and are being analyzed in multicenter clinical studies. In parallel, experimental models of epilepsy are being used to help determine the suitable stimulation parameters, e.g., frequency or type of stimulation. Recent clinical studies on stimulation of epileptic foci indicate a favorable ratio of efficacy to adverse effects in the treatment of temporal lobe epilepsy, although only a small number of patients have been so treated to date. CONCLUSIONS Large-scale studies involving stimulation of the thalamus and of cortical foci are now underway in the United States. On the basis of the favorable results of focus stimulation, a multicenter study in Europe is currently comparing the safety and efficacy of hippocampal stimulation to that of surgical treatments. These studies are expected to yield benchmark findings in the next few years that will determine the role deep brain stimulation will play in the treatment of epilepsy.
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