1
|
Heebner M, Mainali G, Wei S, Kumar A, Naik S, Pradhan S, Kandel P, Tencer J, Carney P, Paudel S. Importance of Genetic Testing in Children With Generalized Epilepsy. Cureus 2024; 16:e59991. [PMID: 38854234 PMCID: PMC11162283 DOI: 10.7759/cureus.59991] [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] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION Epilepsy is a neurological disorder characterized by the predisposition for recurrent unprovoked seizures. It can broadly be classified as focal, generalized, unclassified, and unknown in its onset. Focal epilepsy originates in and involves networks localized to one region of the brain. Generalized epilepsy engages broader, more diffuse networks. The etiology of epilepsy can be structural, genetic, infectious, metabolic, immune, or unknown. Many generalized epilepsies have presumed genetic etiologies. The aim of this study is to compare the role of genetic testing to brain MRI as diagnostic tools for identifying the underlying causes of idiopathic (genetic) generalized epilepsy (IGE). METHODS We evaluated the diagnostic yield of these two categories in children diagnosed with IGE. Data collection was completed using ICD10 codes filtered by TriNetX to select 982 individual electronic medical records (EMRs) of children in the Penn State Children's Hospital who received a diagnosis of IGE. The diagnosis was confirmed after reviewing the clinical history and electroencephalogram (EEG) data for each patient. RESULTS From this dataset, neuroimaging and genetic testing results were gathered. A retrospective chart review was done on 982 children with epilepsy, of which 143 (14.5%) met the criteria for IGE. Only 18 patients underwent genetic testing. Abnormalities that could be a potential cause for epilepsy were seen in 72.2% (13/18) of patients with IGE and abnormal genetic testing, compared to 30% (37/123) for patients who had a brain MRI with genetic testing. CONCLUSION This study suggests that genetic testing may be more useful than neuroimaging for identifying an etiological diagnosis of pediatric patients with IGE.
Collapse
Affiliation(s)
| | - Gayatra Mainali
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Sharon Wei
- Neurology, Penn State University, Hershey, USA
| | - Ashutosh Kumar
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Sunil Naik
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | | | - Prakash Kandel
- Biostatistics, Penn State College of Medicine, Hershey, USA
| | - Jaclyn Tencer
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Paul Carney
- Pediatrics and Neurology, University of Missouri, Columbia, USA
| | - Sita Paudel
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| |
Collapse
|
2
|
Deehan MA, Kothuis JM, Sapp E, Chase K, Ke Y, Seeley C, Iuliano M, Kim E, Kennington L, Miller R, Boudi A, Shing K, Li X, Pfister E, Anaclet C, Brodsky M, Kegel-Gleason K, Aronin N, DiFiglia M. Nacc1 Mutation in Mice Models Rare Neurodevelopmental Disorder with Underlying Synaptic Dysfunction. J Neurosci 2024; 44:e1610232024. [PMID: 38388424 PMCID: PMC10993038 DOI: 10.1523/jneurosci.1610-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/05/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
A missense mutation in the transcription repressor Nucleus accumbens-associated 1 (NACC1) gene at c.892C>T (p.Arg298Trp) on chromosome 19 causes severe neurodevelopmental delay ( Schoch et al., 2017). To model this disorder, we engineered the first mouse model with the homologous mutation (Nacc1+/R284W ) and examined mice from E17.5 to 8 months. Both genders had delayed weight gain, epileptiform discharges and altered power spectral distribution in cortical electroencephalogram, behavioral seizures, and marked hindlimb clasping; females displayed thigmotaxis in an open field. In the cortex, NACC1 long isoform, which harbors the mutation, increased from 3 to 6 months, whereas the short isoform, which is not present in humans and lacks aaR284 in mice, rose steadily from postnatal day (P) 7. Nuclear NACC1 immunoreactivity increased in cortical pyramidal neurons and parvalbumin containing interneurons but not in nuclei of astrocytes or oligodendroglia. Glial fibrillary acidic protein staining in astrocytic processes was diminished. RNA-seq of P14 mutant mice cortex revealed over 1,000 differentially expressed genes (DEGs). Glial transcripts were downregulated and synaptic genes upregulated. Top gene ontology terms from upregulated DEGs relate to postsynapse and ion channel function, while downregulated DEGs enriched for terms relating to metabolic function, mitochondria, and ribosomes. Levels of synaptic proteins were changed, but number and length of synaptic contacts were unaltered at 3 months. Homozygosity worsened some phenotypes including postnatal survival, weight gain delay, and increase in nuclear NACC1. This mouse model simulates a rare form of autism and will be indispensable for assessing pathophysiology and targets for therapeutic intervention.
Collapse
Affiliation(s)
- Mark A Deehan
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Josine M Kothuis
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Ellen Sapp
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Kathryn Chase
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts 01655
| | - Yuting Ke
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Connor Seeley
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Maria Iuliano
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Emily Kim
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Lori Kennington
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts 01655
| | - Rachael Miller
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts 01655
| | - Adel Boudi
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Kai Shing
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Xueyi Li
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Edith Pfister
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts 01655
- Program in Bioinformatics and Integrative Biology, UMass Chan Medical School, Worcester, Massachusetts 01655
| | - Christelle Anaclet
- Department of Neurological Surgery, University of California Davis School of Medicine, Davis, California 95817
| | - Michael Brodsky
- Department of Molecular, Cell and Cancer Biology, UMass Chan Medical School, Worcester, Massachusetts 01655
| | - Kimberly Kegel-Gleason
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| | - Neil Aronin
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts 01655
| | - Marian DiFiglia
- Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts 02129
| |
Collapse
|
3
|
Deng L, Jiang H, Lin J, Xu D, Qi A, Guo Q, Li PP, Wang X, Liu JS, Fu X, Li P. Clock knockout in inhibitory neurons reduces predisposition to epilepsy and influences anxiety-like behaviors in mice. Neurobiol Dis 2024; 193:106457. [PMID: 38423191 DOI: 10.1016/j.nbd.2024.106457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024] Open
Abstract
Epilepsy is a brain disorder affecting up to 1 in 26 individuals. Despite its clinical importance, the molecular mechanisms of epileptogenesis are still far from clarified. Our previous study showed that disruption of Clock in excitatory neurons alters cortical circuits and leads to generation of focal epilepsy. In this study, a GAD-Cre;Clockflox/flox mouse line with conditional Clock gene knockout in inhibitory neurons was established. We observed that seizure latency was prolonged, the severity and mortality of pilocarpine-induced seizure were significantly reduced, and memory was improved in GAD-Cre;Clockflox/flox mice. We hypothesize that mice with CLOCK knockout in inhibitory neurons have increased threshold for seizure, opposite from mice with CLOCK knockout in excitatory neurons. Further investigation showed Clock knockout in inhibitory neurons upregulated the basal protein level of ARC, a synaptic plasticity-associated immediate-early gene product, likely through the BDNF-ERK pathway. Altered basal levels of ARC may play an important role in epileptogenesis after Clock deletion in inhibitory neurons. Although sEPSCs and intrinsic properties of layer 5 pyramidal neurons in the somatosensory cortex exhibit no changes, the spine density increased in apical dendrite of pyramidal neurons in CLOCK knockout group. Our results suggest an underlying mechanism by which the circadian protein CLOCK in inhibitory neurons participates in neuronal activity and regulates the predisposition to epilepsy.
Collapse
Affiliation(s)
- Lu Deng
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Hong Jiang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Jingjing Lin
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Di Xu
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Ailin Qi
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Qing Guo
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Ping-Ping Li
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, Zhejiang Province, China
| | - Judy S Liu
- Department of Neurology, Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, RI 02903, USA.
| | - Xiaoqin Fu
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Peijun Li
- Department of Geriatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China; Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China; Institute of Brain Science and Brain-inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China.
| |
Collapse
|
4
|
Yuan YG, Wang JL, Zhang YX, Li L, Reza AMMT, Gurunathan S. Biogenesis, Composition and Potential Therapeutic Applications of Mesenchymal Stem Cells Derived Exosomes in Various Diseases. Int J Nanomedicine 2023; 18:3177-3210. [PMID: 37337578 PMCID: PMC10276992 DOI: 10.2147/ijn.s407029] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023] Open
Abstract
Exosomes are nanovesicles with a wide range of chemical compositions used in many different applications. Mesenchymal stem cell-derived exosomes (MSCs-EXOs) are spherical vesicles that have been shown to mediate tissue regeneration in a variety of diseases, including neurological, autoimmune and inflammatory, cancer, ischemic heart disease, lung injury, and liver fibrosis. They can modulate the immune response by interacting with immune effector cells due to the presence of anti-inflammatory compounds and are involved in intercellular communication through various types of cargo. MSCs-EXOs exhibit cytokine storm-mitigating properties in response to COVID-19. This review discussed the potential function of MSCs-EXOs in a variety of diseases including neurological, notably epileptic encephalopathy and Parkinson's disease, cancer, angiogenesis, autoimmune and inflammatory diseases. We provided an overview of exosome biogenesis and factors that regulate exosome biogenesis. Additionally, we highlight the functions and potential use of MSCs-EXOs in the treatment of the inflammatory disease COVID-19. Finally, we covered a strategies and challenges of MSCs-EXOs. Finally, we discuss conclusion and future perspectives of MSCs-EXOs.
Collapse
Affiliation(s)
- Yu-Guo Yuan
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Jiangsu Co-Innovation Center of Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Jia-Lin Wang
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Jiangsu Co-Innovation Center of Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Ya-Xin Zhang
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Jiangsu Co-Innovation Center of Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Ling Li
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Jiangsu Co-Innovation Center of Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Abu Musa Md Talimur Reza
- Department of Molecular Biology and Genetics, Faculty of Science, Gebze Technical University, Gebze, Kocaeli, Türkiye
| | | |
Collapse
|
5
|
Sulentic V, Vrca A, Milic S, Klupka Saric I, Milosevic M, Placko Vrsnak D, Mandic I. Influence of weather regime and local geomagnetic activity on the occurrence of epileptic seizures. Epilepsy Res 2023; 193:107164. [PMID: 37187038 DOI: 10.1016/j.eplepsyres.2023.107164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 04/02/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
Epilepsy is a common neurologic disease and presents a major public health problem. Patients with epilepsy have unexpected occurrence of seizures with many triggered by existing triggering factors such as alcohol, stress etc. Other potential triggers include certain weather or atmospheric parameters and local geomagnetic activity. We have analyzed the impact of atmospheric parameters grouped in 6 grouped weather types or weather regimes and the local geomagnetic activity through the K - index. In the prospective study, we analyzed a total of 431 seizures over a 17-month period. In the results obtained, we found that the most severely common weather regime grouped type of weather was radiation and then precipitation regime. It was also found that grouped weather types of weather regimes had more impact on generalized than focal epileptic seizures. Local geomagnetic activity had no direct effect on the occurrence of epileptic seizures. Those results confirm the thesis how the impact of certain external factors is complex and that the further study is required in that respect.
Collapse
Affiliation(s)
- Vlatko Sulentic
- Department of Neurology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Andjelko Vrca
- Department of Neurology, Clinical Hospital "Dubrava", Av. Gojka Suska 6, 10000 Zagreb, Croatia; School of Medicine, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
| | - Simona Milic
- Department of Neurology, General Hospital "Dr. Josip Bencevic", A. Stampara 42, 35000 Slavonski Brod, Croatia.
| | - Inge Klupka Saric
- Department of Neurology, School of Medicine, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina
| | - Milan Milosevic
- University of Zagreb, School of Medicine, Andrija Stampar School of Public Health, Department for Environmental Health, Occupational and Sports Medicine, Rockfeller street 4, 10000 Zagreb, Croatia
| | | | - Igor Mandic
- Department of Geophysics, Faculty of Science, University of Zagreb, Horvatovac 95, 10000 Zagreb, Croatia
| |
Collapse
|
6
|
Miralles R, Patel MK. That’s a Wrap: Could Controlling Activity-Regulated Myelination Prevent Absence Seizures? Epilepsy Curr 2022; 22:395-397. [DOI: 10.1177/15357597221123898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
[Box: see text]
Collapse
Affiliation(s)
- Raquel Miralles
- University of Virginia Health System Ringgold Standard Institution–Anesthesiology, Charlottesville, VA, USA
| | - Manoj K. Patel
- University of Virginia Health System Ringgold Standard Institution–Anesthesiology, Charlottesville, VA, USA
| |
Collapse
|
7
|
Bartolini E, Ferrari AR, Lattanzi S, Pradella S, Zaccara G. Drug-resistant epilepsy at the age extremes: Disentangling the underlying etiology. Epilepsy Behav 2022; 132:108739. [PMID: 35636351 DOI: 10.1016/j.yebeh.2022.108739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
The incidence of epilepsy is highest at the extreme age ranges: childhood and elderly age. The most common syndromes in these demographics - self-limited epilepsies of childhood and idiopathic generalized epilepsies in pediatric age, focal epilepsy with structural etiology in older people - are expected to be drug responsive. In this work, we focus on such epilepsy types, overviewing the complex clinical background of unexpected drug-resistance. For self-limited epilepsies of childhood and idiopathic generalized epilepsies, we illustrate drug-resistance resulting from syndrome misinterpretation, reason on possible unexpected courses of epilepsy, and explicate the influence of inappropriate treatments. For elderly-onset epilepsy, we show the challenges in differential diagnosis possibly leading to pseudoresistance and analyze how drug-resistant epilepsy can arise in stroke, neurocognitive disorders, brain tumors, and autoimmune encephalitis. In children and senior people, drug-resistance can be regarded as a hint to review the diagnosis or explore alternative therapeutic strategies. Refractory seizures are not only a therapeutic challenge, but also a cardinal sign not to be overlooked in syndromes commonly deemed to be drug-responsive.
Collapse
Affiliation(s)
- Emanuele Bartolini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Silvia Pradella
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy.
| | | |
Collapse
|
8
|
Surgical Treatment of Drug-Resistant Generalized Epilepsy. Curr Neurol Neurosci Rep 2022; 22:459-465. [PMID: 35713776 DOI: 10.1007/s11910-022-01210-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To summarize current evidence and recent developments in the surgical treatment of drug-resistant generalized epilepsy. RECENT FINDINGS Current surgical treatments of drug-resistant generalized epilepsy include vagus nerve stimulation (VNS), deep brain stimulation (DBS) and corpus callosotomy (CC). Neurostimulation with VNS and/or DBS has been shown to be effective in reducing seizure frequency in patients with generalized epilepsy. DBS for generalized epilepsy is primarily consisted of open-loop stimulation directed at the centromedian (CM) nucleus in the thalamus, though closed-loop stimulation and additional targets are being explored. CC can be effective in treating some seizure types and can be performed using traditional surgical techniques or with the less invasive methods of laser ablation and radiosurgery. This current literature supports the use of VNS, DBS and CC, alone or in combination, as palliative treatments of drug-resistant generalized epilepsy.
Collapse
|
9
|
Basoglu Koseahmet F, Polat B, Gozubatik-Celik RG, Baytekin I, Soylu MG, Ceyhan Dirican A, Ozturk M. An invisible cause of disability: stigma in migraine and epilepsy. Neurol Sci 2022; 43:3831-3838. [DOI: 10.1007/s10072-022-05888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
|
10
|
Knowles JK, Xu H, Soane C, Batra A, Saucedo T, Frost E, Tam LT, Fraga D, Ni L, Villar K, Talmi S, Huguenard JR, Monje M. Maladaptive myelination promotes generalized epilepsy progression. Nat Neurosci 2022; 25:596-606. [PMID: 35501379 PMCID: PMC9076538 DOI: 10.1038/s41593-022-01052-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/14/2022] [Indexed: 12/18/2022]
Abstract
Activity-dependent myelination can fine-tune neural network dynamics. Conversely, aberrant neuronal activity, as occurs in disorders of recurrent seizures (epilepsy), could promote maladaptive myelination, contributing to pathogenesis. In this study, we tested the hypothesis that activity-dependent myelination resulting from absence seizures, which manifest as frequent behavioral arrests with generalized electroencephalography (EEG) spike-wave discharges, promote thalamocortical network hypersynchrony and contribute to epilepsy progression. We found increased oligodendrogenesis and myelination specifically within the seizure network in two models of generalized epilepsy with absence seizures (Wag/Rij rats and Scn8a+/mut mice), evident only after epilepsy onset. Aberrant myelination was prevented by pharmacological seizure inhibition in Wag/Rij rats. Blocking activity-dependent myelination decreased seizure burden over time and reduced ictal synchrony as assessed by EEG coherence. These findings indicate that activity-dependent myelination driven by absence seizures contributes to epilepsy progression; maladaptive myelination may be pathogenic in some forms of epilepsy and other neurological diseases.
Collapse
Affiliation(s)
- Juliet K Knowles
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Haojun Xu
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.,Ph.D. Program in Human Biology, School of Integrative and Global Majors, University of Tsukuba, Tsukuba, Japan
| | - Caroline Soane
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Ankita Batra
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Tristan Saucedo
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Eleanor Frost
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Lydia T Tam
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Danielle Fraga
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Lijun Ni
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Katlin Villar
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Sydney Talmi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - John R Huguenard
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA. .,Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA.
| |
Collapse
|
11
|
Aung T, Tenney JR, Bagić AI. Contributions of Magnetoencephalography to Understanding Mechanisms of Generalized Epilepsies: Blurring the Boundary Between Focal and Generalized Epilepsies? Front Neurol 2022; 13:831546. [PMID: 35572923 PMCID: PMC9092024 DOI: 10.3389/fneur.2022.831546] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/08/2022] [Indexed: 12/31/2022] Open
Abstract
According to the latest operational 2017 ILAE classification of epileptic seizures, the generalized epileptic seizure is still conceptualized as "originating at some point within and rapidly engaging, bilaterally distributed networks." In contrast, the focal epileptic seizure is defined as "originating within networks limited to one hemisphere." Hence, one of the main concepts of "generalized" and "focal" epilepsy comes from EEG descriptions before the era of source localization, and a presumed simultaneous bilateral onset and bi-synchrony of epileptiform discharges remains a hallmark for generalized seizures. Current literature on the pathophysiology of generalized epilepsy supports the concept of a cortical epileptogenic focus triggering rapidly generalized epileptic discharges involving intact corticothalamic and corticocortical networks, known as the cortical focus theory. Likewise, focal epilepsy with rich connectivity can give rise to generalized spike and wave discharges resulting from widespread bilateral synchronization. Therefore, making this key distinction between generalized and focal epilepsy may be challenging in some cases, and for the first time, a combined generalized and focal epilepsy is categorized in the 2017 ILAE classification. Nevertheless, treatment options, such as the choice of antiseizure medications or surgical treatment, are the reason behind the importance of accurate epilepsy classification. Over the past several decades, plentiful scientific research on the pathophysiology of generalized epilepsy has been conducted using non-invasive neuroimaging and postprocessing of the electromagnetic neural signal by measuring the spatiotemporal and interhemispheric latency of bi-synchronous or generalized epileptiform discharges as well as network analysis to identify diagnostic and prognostic biomarkers for accurate diagnosis of the two major types of epilepsy. Among all the advanced techniques, magnetoencephalography (MEG) and multiple other methods provide excellent temporal and spatial resolution, inherently suited to analyzing and visualizing the propagation of generalized EEG activities. This article aims to provide a comprehensive literature review of recent innovations in MEG methodology using source localization and network analysis techniques that contributed to the literature of idiopathic generalized epilepsy in terms of pathophysiology and clinical prognosis, thus further blurring the boundary between focal and generalized epilepsy.
Collapse
Affiliation(s)
- Thandar Aung
- Department of Neurology, University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
| | - Jeffrey R. Tenney
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Anto I. Bagić
- Department of Neurology, University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW This article reviews the clinical features, typical EEG findings, treatment, prognosis, and underlying molecular etiologies of the more common genetic epilepsy syndromes. Genetic generalized epilepsy, self-limited focal epilepsy of childhood, self-limited neonatal and infantile epilepsy, select developmental and epileptic encephalopathies, progressive myoclonus epilepsies, sleep-related hypermotor epilepsy, photosensitive occipital lobe epilepsy, and focal epilepsy with auditory features are discussed. Also reviewed are two familial epilepsy syndromes: genetic epilepsy with febrile seizures plus and familial focal epilepsy with variable foci. RECENT FINDINGS Recent years have seen considerable advances in our understanding of the genetic factors underlying genetic epilepsy syndromes. New therapies are emerging for some of these conditions; in some cases, these precision medicine approaches may dramatically improve the prognosis. SUMMARY Many recognizable genetic epilepsy syndromes exist, the identification of which is a crucial skill for neurologists, particularly those who work with children. Proper diagnosis of the electroclinical syndrome allows for appropriate treatment choices and counseling regarding prognosis and possible comorbidities.
Collapse
|
13
|
Genetic generalized epilepsies in adults - challenging assumptions and dogmas. Nat Rev Neurol 2022; 18:71-83. [PMID: 34837042 DOI: 10.1038/s41582-021-00583-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/16/2023]
Abstract
Genetic generalized epilepsy (GGE) syndromes start during childhood or adolescence, and four commonly persist into adulthood, making up 15-20% of all cases of epilepsy in adults. These four GGE syndromes are childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizures alone. However, in ~20% of patients with GGE, characteristics of more than one syndrome are present. Novel insights into the genetic aetiology, comorbidities and prognosis of the GGE syndromes have emerged and challenge traditional concepts about these conditions. Evidence has shown that the mode of inheritance in GGE is mostly polygenic. Neuropsychological and imaging studies indicate similar abnormalities in unaffected relatives of patients with GGE, supporting the concept that underlying alterations in bilateral frontothalamocortical networks are genetically determined. Contrary to popular belief, first-line anti-seizure medication often fails to provide seizure freedom in combination with good tolerability. Nevertheless, long-term follow-up studies have shown that with advancing age, many patients can discontinue their anti-seizure medication without seizure relapses. Several outcome predictors have been identified, but prognosis across the syndromes is more homogeneous than previously assumed. Overall, overlap in pathophysiology, seizure types, treatment responses and outcomes support the idea that GGEs are not separate nosological entities but represent a neurobiological continuum.
Collapse
|
14
|
Yan R, Zhang H, Wang J, Zheng Y, Luo Z, Zhang X, Xu Z. Application value of molecular imaging technology in epilepsy. IBRAIN 2021; 7:200-210. [PMID: 37786793 PMCID: PMC10528966 DOI: 10.1002/j.2769-2795.2021.tb00084.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 10/04/2023]
Abstract
Epilepsy is a common neurological disease with various seizure types, complicated etiologies, and unclear mechanisms. Its diagnosis mainly relies on clinical history, but an electroencephalogram is also a crucial auxiliary examination. Recently, brain imaging technology has gained increasing attention in the diagnosis of epilepsy, and conventional magnetic resonance imaging can detect epileptic foci in some patients with epilepsy. However, the results of brain magnetic resonance imaging are normal in some patients. New molecular imaging has gradually developed in recent years and has been applied in the diagnosis of epilepsy, leading to enhanced lesion detection rates. However, the application of these technologies in epilepsy patients with negative brain magnetic resonance must be clarified. Thus, we reviewed the relevant literature and summarized the information to improve the understanding of the molecular imaging application value of epilepsy.
Collapse
Affiliation(s)
- Rong Yan
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hai‐Qing Zhang
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Jing Wang
- Prevention and Health Care, The Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yong‐Su Zheng
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zhong Luo
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Xia Zhang
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zu‐Cai Xu
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| |
Collapse
|
15
|
Karoly PJ, Rao VR, Gregg NM, Worrell GA, Bernard C, Cook MJ, Baud MO. Cycles in epilepsy. Nat Rev Neurol 2021; 17:267-284. [PMID: 33723459 DOI: 10.1038/s41582-021-00464-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 01/31/2023]
Abstract
Epilepsy is among the most dynamic disorders in neurology. A canonical view holds that seizures, the characteristic sign of epilepsy, occur at random, but, for centuries, humans have looked for patterns of temporal organization in seizure occurrence. Observations that seizures are cyclical date back to antiquity, but recent technological advances have, for the first time, enabled cycles of seizure occurrence to be quantitatively characterized with direct brain recordings. Chronic recordings of brain activity in humans and in animals have yielded converging evidence for the existence of cycles of epileptic brain activity that operate over diverse timescales: daily (circadian), multi-day (multidien) and yearly (circannual). Here, we review this evidence, synthesizing data from historical observational studies, modern implanted devices, electronic seizure diaries and laboratory-based animal neurophysiology. We discuss advances in our understanding of the mechanistic underpinnings of these cycles and highlight the knowledge gaps that remain. The potential clinical applications of a knowledge of cycles in epilepsy, including seizure forecasting and chronotherapy, are discussed in the context of the emerging concept of seizure risk. In essence, this Review addresses the broad question of why seizures occur when they occur.
Collapse
Affiliation(s)
- Philippa J Karoly
- Graeme Clark Institute, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Vikram R Rao
- Department of Neurology, University of California, San Francisco, CA, USA.,Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Nicholas M Gregg
- Bioelectronics, Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Gregory A Worrell
- Bioelectronics, Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Christophe Bernard
- Aix Marseille University, Inserm, Institut de Neurosciences des Systèmes, Marseille, France
| | - Mark J Cook
- Graeme Clark Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maxime O Baud
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland. .,Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
16
|
Punia V. Rivaroxaban Plasma Levels and Levetiracetam. Ann Intern Med 2020; 173:771-772. [PMID: 33137272 DOI: 10.7326/l20-1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Vineet Punia
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio (V.P.)
| |
Collapse
|
17
|
Lopes MA, Junges L, Woldman W, Goodfellow M, Terry JR. The Role of Excitability and Network Structure in the Emergence of Focal and Generalized Seizures. Front Neurol 2020; 11:74. [PMID: 32117033 PMCID: PMC7027568 DOI: 10.3389/fneur.2020.00074] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 01/21/2020] [Indexed: 01/12/2023] Open
Abstract
Epileptic seizures are generally classified as either focal or generalized. It had been traditionally assumed that focal seizures imply localized brain abnormalities, whereas generalized seizures involve widespread brain pathologies. However, recent evidence suggests that large-scale brain networks are involved in the generation of focal seizures, and generalized seizures can originate in localized brain regions. Herein we study how network structure and tissue heterogeneities underpin the emergence of focal and widespread seizure dynamics. Mathematical modeling of seizure emergence in brain networks enables the clarification of the characteristics responsible for focal and generalized seizures. We consider neural mass network dynamics of seizure generation in exemplar synthetic networks and we measure the variance in ictogenicity across the network. Ictogenicity is defined as the involvement of network nodes in seizure activity, and its variance is used to quantify whether seizure patterns are focal or widespread across the network. We address both the influence of network structure and different excitability distributions across the network on the ictogenic variance. We find that this variance depends on both network structure and excitability distribution. High variance, i.e., localized seizure activity, is observed in networks highly heterogeneous with regard to the distribution of connections or excitabilities. However, networks that are both heterogeneous in their structure and excitability can underlie the emergence of generalized seizures, depending on the interplay between structure and excitability. Thus, our results imply that the emergence of focal and generalized seizures is underpinned by an interplay between network structure and excitability distribution.
Collapse
Affiliation(s)
- Marinho A Lopes
- Living Systems Institute, University of Exeter, Exeter, United Kingdom.,Wellcome Trust Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, United Kingdom.,EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, United Kingdom.,Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Leandro Junges
- Living Systems Institute, University of Exeter, Exeter, United Kingdom.,Wellcome Trust Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, United Kingdom.,EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, United Kingdom.,Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom.,Institute for Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Wessel Woldman
- Living Systems Institute, University of Exeter, Exeter, United Kingdom.,Wellcome Trust Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, United Kingdom.,EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, United Kingdom.,Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom.,Institute for Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Marc Goodfellow
- Living Systems Institute, University of Exeter, Exeter, United Kingdom.,Wellcome Trust Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, United Kingdom.,EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, United Kingdom
| | - John R Terry
- Living Systems Institute, University of Exeter, Exeter, United Kingdom.,Wellcome Trust Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, United Kingdom.,EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, United Kingdom.,Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom.,Institute for Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|