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Kowkabi S, Yavarian M, Kaboodkhani R, Mohammadi M, Shervin Badv R. PCDH19-clustering epilepsy, pathophysiology and clinical significance. Epilepsy Behav 2024; 154:109730. [PMID: 38521028 DOI: 10.1016/j.yebeh.2024.109730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/07/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
PCDH19 clustering epilepsy (PCDH19-CE) is an X-linked epilepsy disorder associated with intellectual disability (ID) and behavioral disturbances, which is caused by PCDH19 gene variants. PCDH19 pathogenic variant leads to epilepsy in heterozygous females, not in hemizygous males and the inheritance pattern is unusual. The hypothesis of cellular interference was described as a key pathogenic mechanism. According to that, males do not develop the disease because of the uniform expression of PCDH19 (variant or wild type) unless they have a somatic variation. We conducted a literature review on PCDH19-CE pathophysiology and concluded that other significant mechanisms could contribute to pathogenesis including: asymmetric cell division and heterochrony, female-related allopregnanolone deficiency, altered steroid gene expression, decreased Gamma-aminobutyric acid receptor A (GABAA) function, and blood-brain barrier (BBB) dysfunction. Being aware of these mechanisms helps us when we should decide which therapeutic option is more suitable for which patient.
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Affiliation(s)
- Safoura Kowkabi
- Child Neurology Division and Children's Epilepsy Monitoring Unit, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran; Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Majid Yavarian
- Hematology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Mahmood Mohammadi
- Child Neurology Division and Children's Epilepsy Monitoring Unit, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Child Neurology Division and Children's Epilepsy Monitoring Unit, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
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2
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Leduc T, El Alami H, Bougadir K, Bélanger-Nelson E, Mongrain V. Neuroligin-2 shapes individual slow waves during slow-wave sleep and the response to sleep deprivation in mice. Mol Autism 2024; 15:13. [PMID: 38570872 PMCID: PMC10993465 DOI: 10.1186/s13229-024-00594-5] [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: 11/28/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Sleep disturbances are a common comorbidity to most neurodevelopmental disorders and tend to worsen disease symptomatology. It is thus crucial to understand mechanisms underlying sleep disturbances to improve patients' quality of life. Neuroligin-2 (NLGN2) is a synaptic adhesion protein regulating GABAergic transmission. It has been linked to autism spectrum disorders and schizophrenia in humans, and deregulations of its expression were shown to cause epileptic-like hypersynchronized cerebral activity in rodents. Importantly, the absence of Nlgn2 (knockout: KO) was previously shown to alter sleep-wake duration and quality in mice, notably increasing slow-wave sleep (SWS) delta activity (1-4 Hz) and altering its 24-h dynamics. This type of brain oscillation is involved in memory consolidation, and is also a marker of homeostatic sleep pressure. Sleep deprivation (SD) is notably known to impair cognition and the physiological response to sleep loss involves GABAergic transmission. METHODS Using electrocorticographic (ECoG) recordings, we here first aimed to verify how individual slow wave (SW; 0.5-4 Hz) density and properties (e.g., amplitude, slope, frequency) contribute to the higher SWS delta activity and altered 24-h dynamics observed in Nlgn2 KO mice. We further investigated the response of these animals to SD. Finally, we tested whether sleep loss affects the gene expression of Nlgn2 and related GABAergic transcripts in the cerebral cortex of wild-type mice using RNA sequencing. RESULTS Our results show that Nlgn2 KO mice have both greater SW amplitude and density, and that SW density is the main property contributing to the altered 24-h dynamics. We also found the absence of Nlgn2 to accelerate paradoxical sleep recovery following SD, together with profound alterations in ECoG activity across vigilance states. Sleep loss, however, did not modify the 24-h distribution of the hypersynchronized ECoG events observed in these mice. Finally, RNA sequencing confirmed an overall decrease in cortical expression of Nlgn2 and related GABAergic transcripts following SD in wild-type mice. CONCLUSIONS This work brings further insight into potential mechanisms of sleep duration and quality deregulation in neurodevelopmental disorders, notably involving NLGN2 and GABAergic neurotransmission.
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Affiliation(s)
- Tanya Leduc
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900, St-Denis street, Tour Viger Montréal, Montreal, QC, H2X 0A9, Canada
| | - Hiba El Alami
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Khadija Bougadir
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Erika Bélanger-Nelson
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- Pfizer Canada ULC, Montreal, QC, Canada
| | - Valérie Mongrain
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada.
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900, St-Denis street, Tour Viger Montréal, Montreal, QC, H2X 0A9, Canada.
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Chen L, Huang J, Jiang T, Luo H, Wei C, Wu H, Shao J, Li W. Comparing Sleep Patterns and Clinical Features between Preschool and School-Age Children with OSA. Laryngoscope 2024; 134:1472-1478. [PMID: 37812391 DOI: 10.1002/lary.31051] [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: 05/16/2023] [Revised: 08/14/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE This study aimed to evaluate sleep patterns and investigate differences in clinical features among young individuals with snoring and obstructive sleep apnea (OSA). METHODS Data from 213 children and adolescents who underwent polysomnography (PSG) for primary snoring or OSA were collected between July 2017 and December 2021. To analyze differences in sleep architecture, hypoxia levels, and other clinical features, the participants were divided into two age groups: a preschool group and a school-age group. RESULTS The school-age group had significantly higher apnea-hypopnea index, obstructive apnea index, oxygen desaturation index, and body mass index than the preschool group. Both the lowest and average oxygen saturation levels were lower in the school-age group. Adenoid hypertrophy was more prevalent in the preschool group. The rate of overweight or obesity was 35.6% in the preschool group and even 94.2% in the school-age group. There were higher percentages of N1 and N2 sleep stages, and lower percentages of N3 and REM sleep stages in the school-age group. The groups exhibiting moderate to severe OSA demonstrated significant alterations in the difference between sleeping and waking diastolic blood pressure. CONCLUSION There is a higher frequency of respiratory events among school-age children compared with their preschool peers. Moreover, alterations in sleep structure are more prominent in the school-age group. Adenoid hypertrophy may serve as the primary instigator of OSA in preschool children, whereas the predominant causes in school-age children may be obesity or excessive weight. LEVEL OF EVIDENCE Retrospective chart review, 3 Laryngoscope, 134:1472-1478, 2024.
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Affiliation(s)
- Le Chen
- Department of Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Jingjing Huang
- Department of Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Sleep Disordered Medical Center, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Tao Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Huiping Luo
- Department of Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Sleep Disordered Medical Center, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Chunsheng Wei
- Department of Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Sleep Disordered Medical Center, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Haitao Wu
- Department of Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Sleep Disordered Medical Center, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Jun Shao
- Department of Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Sleep Disordered Medical Center, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Wenyan Li
- Department of Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
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Sands TT, Gelinas JN. Epilepsy and Encephalopathy. Pediatr Neurol 2024; 150:24-31. [PMID: 37948790 DOI: 10.1016/j.pediatrneurol.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Epilepsy encompasses more than the predisposition to unprovoked seizures. In children, epileptic activity during (ictal) and between (interictal) seizures has the potential to disrupt normal brain development. The term "epileptic encephalopathy (EE)" refers to the concept that such abnormal activity may contribute to cognitive and behavioral impairments beyond that expected from the underlying cause of the epileptic activity. METHODS In this review, we survey the concept of EE across a diverse selection of syndromes to illustrate its broad applicability in pediatric epilepsy. We review experimental evidence that provides mechanistic insights into how epileptic activity has the potential to impact normal brain processes and the development of neural networks. We then discuss opportunities to improve developmental outcomes in epilepsy now and in the future. RESULTS Epileptic activity in the brain poses a threat to normal physiology and brain development. CONCLUSION Until we have treatments that reliably target and effectively treat the underlying causes of epilepsy, a major goal of management is to prevent epileptic activity from worsening developmental outcomes.
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Affiliation(s)
- Tristan T Sands
- Center for Translational Research in Neurodevelopmental Disease, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Departments of Neurology and Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
| | - Jennifer N Gelinas
- Center for Translational Research in Neurodevelopmental Disease, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Departments of Neurology and Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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Skorucak J, Bölsterli BK, Storz S, Leach S, Schmitt B, Ramantani G, Huber R. Automated analysis of a large-scale paediatric dataset illustrates the interdependent relationship between epilepsy and sleep. Sci Rep 2023; 13:12882. [PMID: 37553387 PMCID: PMC10409812 DOI: 10.1038/s41598-023-39984-9] [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: 05/15/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
Slow waves are an electrophysiological characteristic of non-rapid eye movement sleep and a marker of the restorative function of sleep. In certain pathological conditions, such as different types of epilepsy, slow-wave sleep is affected by epileptiform discharges forming so-called "spike-waves". Previous evidence shows that the overnight change in slope of slow waves during sleep is impaired under these conditions. However, these past studies were performed in a small number of patients, considering only short segments of the recording night. Here, we screened a clinical data set of 39'179 pediatric EEG recordings acquired in the past 25 years (1994-2019) at the University Children's Hospital Zurich and identified 413 recordings of interest. We applied an automated approach based on machine learning to investigate the relationship between sleep and epileptic spikes in this large-scale data set. Our findings show that the overnight change in the slope of slow waves was correlated with the spike-wave index, indicating that the impairment of the net reduction in synaptic strength during sleep is spike dependent.
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Affiliation(s)
- Jelena Skorucak
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bigna K Bölsterli
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Pediatric Neurology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Sarah Storz
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sven Leach
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernhard Schmitt
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Georgia Ramantani
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reto Huber
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
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Halász P, Szũcs A. Self-limited childhood epilepsies are disorders of the perisylvian communication system, carrying the risk of progress to epileptic encephalopathies-Critical review. Front Neurol 2023; 14:1092244. [PMID: 37388546 PMCID: PMC10301767 DOI: 10.3389/fneur.2023.1092244] [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: 11/07/2022] [Accepted: 04/04/2023] [Indexed: 07/01/2023] Open
Abstract
"Sleep plasticity is a double-edged sword: a powerful machinery of neural build-up, with a risk to epileptic derailment." We aimed to review the types of self-limited focal epilepsies..."i.e. keep as two separate paragraphs" We aimed to review the types of self-limited focal epilepsies: (1) self-limited focal childhood epilepsy with centrotemporal spikes, (2) atypical Rolandic epilepsy, and (3) electrical status epilepticus in sleep with mental consequences, including Landau-Kleffner-type acquired aphasia, showing their spectral relationship and discussing the debated topics. Our endeavor is to support the system epilepsy concept in this group of epilepsies, using them as models for epileptogenesis in general. The spectral continuity of the involved conditions is evidenced by several features: language impairment, the overarching presence of centrotemporal spikes and ripples (with changing electromorphology across the spectrum), the essential timely and spatial independence of interictal epileptic discharges from seizures, NREM sleep relatedness, and the existence of the intermediate-severity "atypical" forms. These epilepsies might be the consequences of a genetically determined transitory developmental failure, reflected by widespread neuropsychological symptoms originating from the perisylvian network that have distinct time and space relations from secondary epilepsy itself. The involved epilepsies carry the risk of progression to severe, potentially irreversible encephalopathic forms.
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Affiliation(s)
- Péter Halász
- Department of Neurology, University Medical School, Pécs, Hungary
| | - Anna Szũcs
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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Atacan Yaşgüçlükal M, Ayça S, Demirbilek V, Saltık S, Yalçınkaya C, Erdoğan Döventaş Y, Çokar Ö. Serum Levels of Neuropeptides in Epileptic Encephalopathy With Spike-and-Wave Activation in Sleep. Pediatr Neurol 2023; 144:110-114. [PMID: 37229878 DOI: 10.1016/j.pediatrneurol.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/13/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS) is a syndrome of childhood, characterized by diffuse or generalized spike-wave activity in electroencephalography during non-rapid eye movement sleep. Neuropeptides have been demonstrated in several studies to function in the sleep-wake cycle and display convulsant and anticonvulsant features. In this study, we aimed to investigate the relationship between EE-SWAS and neuropeptides such as dynorphin, galanin, ghrelin, leptin, melatonin, and orexin. METHODS This multicenter study was conducted from July 2019 to January 2021. There were three groups: Group 1 contained patients with EE-SWAS. Group 2 consisted of patients with self-limited focal epilepsy of childhood (SeLFE), and group 3 was the control group. Levels of neuropeptides were compared in the sera of these three groups. RESULTS There were 59 children aged between four and 15 years. Group 1 contained 14 children, group 2 contained 24 children, and group 3 contained 21 children. The level of leptin is higher and the level of melatonin is lower in group 1 than in group 3 (P = 0.01 and P = 0.005, respectively). In group 3, the level of orexin was lower than in both groups 2 and 3 (P = 0.01 and P = 0.01). CONCLUSIONS These data show that the level of leptin was higher and the level of melatonin was lower in patients with EE-SWAS than in the control group. Furthermore, patients with EE-SWAS had lower orexin levels than both the control group and patients with SeLFE. Further research is required to understand the potential role of these neuropeptides in the pathophysiology of EE-SWAS.
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Affiliation(s)
- Miray Atacan Yaşgüçlükal
- Neurology Department, University of Health Sciences Haseki Education and Research Hospital, Istanbul, Turkey.
| | - Senem Ayça
- Department of Pediatric Neurology, University of Health Sciences Haseki Education and Research Hospital, Istanbul, Turkey
| | - Veysi Demirbilek
- Cerrahpaşa Medical Faculty, Neurology Department, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sema Saltık
- Cerrahpaşa Medical Faculty, Department of Pediatric Neurology, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Cengiz Yalçınkaya
- Cerrahpaşa Medical Faculty, Neurology Department, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yasemin Erdoğan Döventaş
- Department of Medical Biochemistry, University of Health Sciences Haseki Education and Research Hospital, Istanbul, Turkey
| | - Özlem Çokar
- Neurology Department, University of Health Sciences Haseki Education and Research Hospital, Istanbul, Turkey
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Jaramillo V, Schoch SF, Markovic A, Kohler M, Huber R, Lustenberger C, Kurth S. An infant sleep electroencephalographic marker of thalamocortical connectivity predicts behavioral outcome in late infancy. Neuroimage 2023; 269:119924. [PMID: 36739104 DOI: 10.1016/j.neuroimage.2023.119924] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Infancy represents a critical period during which thalamocortical brain connections develop and mature. Deviations in the maturation of thalamocortical connectivity are linked to neurodevelopmental disorders. There is a lack of early biomarkers to detect and localize neuromaturational deviations, which can be overcome with mapping through high-density electroencephalography (hdEEG) assessed in sleep. Specifically, slow waves and spindles in non-rapid eye movement (NREM) sleep are generated by the thalamocortical system, and their characteristics, slow wave slope and spindle density, are closely related to neuroplasticity and learning. Spindles are often subdivided into slow (11.0-13.0 Hz) and fast (13.5-16.0 Hz) frequencies, for which not only different functions have been proposed, but for which also distinctive developmental trajectories have been reported across the first years of life. Recent studies further suggest that information processing during sleep underlying sleep-dependent learning is promoted by the temporal coupling of slow waves and spindles, yet slow wave-spindle coupling remains unexplored in infancy. Thus, we evaluated three potential biomarkers: 1) slow wave slope, 2) spindle density, and 3) the temporal coupling of slow waves with spindles. We use hdEEG to first examine the occurrence and spatial distribution of these three EEG features in healthy infants and second to evaluate a predictive relationship with later behavioral outcomes. We report four key findings: First, infants' EEG features appear locally: slow wave slope is maximal in occipital and frontal areas, whereas slow and fast spindle density is most pronounced frontocentrally. Second, slow waves and spindles are temporally coupled in infancy, with maximal coupling strength in the occipital areas of the brain. Third, slow wave slope, fast spindle density, and slow wave-spindle coupling are not associated with concurrent behavioral status (6 months). Fourth, fast spindle density in central and frontocentral regions at age 6 months predicts overall developmental status at age 12 months, and motor skills at age 12 and 24 months. Neither slow wave slope nor slow wave-spindle coupling predict later behavioral development. We further identified spindle frequency as a determinant of slow and fast spindle density, which accordingly, also predicts motor skills at 24 months. Our results propose fast spindle density, or alternatively spindle frequency, as early EEG biomarker for identifying thalamocortical maturation, which can potentially be used for early diagnosis of neurodevelopmental disorders in infants. These findings are in support of a role of sleep spindles in sensorimotor microcircuitry development. A crucial next step will be to evaluate whether early therapeutic interventions may be effective to reverse deviations in identified individuals at risk.
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Affiliation(s)
- Valeria Jaramillo
- Department of Pulmonology, University Hospital Zurich, Zurich, CH; Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom; Neuromodulation Laboratory, School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Sarah F Schoch
- Department of Pulmonology, University Hospital Zurich, Zurich, CH; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, CH; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, NL
| | - Andjela Markovic
- Department of Pulmonology, University Hospital Zurich, Zurich, CH; Department of Psychology, University of Fribourg, Fribourg, CH
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, CH; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, CH
| | - Reto Huber
- Child Development Center, University Children's Hospital Zurich, Zurich, CH; Children's Research Center, University Children's Hospital Zurich, University of Zurich (UZH), Zürich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, CH; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, CH
| | - Caroline Lustenberger
- Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, CH; Neural Control of Movement Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Salome Kurth
- Department of Pulmonology, University Hospital Zurich, Zurich, CH; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, CH; Department of Psychology, University of Fribourg, Fribourg, CH.
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Rubboli G, Gardella E, Cantalupo G, Alberto Tassinari C. Encephalopathy related to status epilepticus during slow sleep (ESES). Pathophysiological insights and nosological considerations. Epilepsy Behav 2023; 140:109105. [PMID: 36758358 DOI: 10.1016/j.yebeh.2023.109105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
Encephalopathy related to Status Epilepticus during slow Sleep (ESES) is a childhood epilepsy syndrome characterized by the appearance of cognitive, behavioral, and motor disturbances in conjunction with a striking activation of EEG epileptic abnormalities during non-REM sleep. After more than 50 years since the first description, the pathophysiological mechanisms underlying the appearance of encephalopathy in association with a sleep-related enhancement of epileptic discharges are incompletely elucidated. Recent experimental data support the hypothesis that the development of the ESES encephalopathic picture depends on a spike-induced impairment of the synaptic homeostasis processes occurring during normal sleep and that is particularly pronounced during the developmental age. During sleep, synaptic homeostasis is promoted by synaptic weakening/elimination after the increment of synaptic strength that occurs during wakefulness. The EEG can display modifications in synaptic strength by changes in sleep slow wave activity (SWA). Recent studies during active ESES have failed to show changes in sleep SWA, while these changes occurred again after recovery from ESES, thus supporting a spike-related interference on the normal homeostatic processes of sleep. This impairment, during the developmental period, can lead to disruption of cortical wiring and brain plastic remodeling, which lead to the, often irreversible, neuropsychological compromise typical of ESES. From the nosographic point of view, these pathophysiological data lend support to the maintenance of the term ESES, i.e., "encephalopathy related to status epilepticus during sleep". Indeed, this term conveys the concept that the extreme activation of epileptic discharges during sleep is directly responsible for the encephalopathy, hence the importance of defining this condition as an encephalopathy related to the exaggerated activation of epileptic activity during sleep. In this respect, ESES represents a genuine example of a "pure" epileptic encephalopathy in which sleep-related epileptic activity "per se" has a crucial role in determining the encephalopathic picture. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Guido Rubboli
- Danish Epilepsy Center, member of ERN EpiCARE, Kolonivej 1, 4293 Dianalund, Denmark; Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Elena Gardella
- Danish Epilepsy Center, member of ERN EpiCARE, Kolonivej 1, 4293 Dianalund, Denmark; University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Via S. Francesco, 22, 37129 Verona, Italy; Centro Ricerca per le Epilessie in età Pediatrica (CREP), Azienda Ospedaliera Universitaria di Verona, Verona, Italy.
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Lehner J, Frueh JS, Datta AN. Sleep quality and architecture in Idiopathic generalized epilepsy: A systematic review and meta-analysis. Sleep Med Rev 2022; 65:101689. [PMID: 36037570 DOI: 10.1016/j.smrv.2022.101689] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
Idiopathic generalized epilepsies are a group of sleep related epilepsy syndromes with sleep deprivation as a strong trigger for seizures and increased spike-wave activity during sleep and transition to sleep. Neuropsychological deficits are common in Idiopathic generalized epilepsy patients. Learning and memory processes are closely linked to sleep. Therefore, this systematic review and meta-analysis investigates the evidence of sleep disturbances in Idiopathic generalized epilepsy patients. A search of the databases EMBASE, Medline and Scopus identified 22 studies comparing polysomnographic parameters and scores of sleep questionnaires between Idiopathic generalized epilepsy patients and healthy controls. Random effect univariate meta-analyses revealed reduced sleep efficiency, total sleep time, proportion of N2 stage and prolonged REM onset latency in Idiopathic generalized epilepsy patients. Self-assessed sleep quality of patients measured by the Pittsburgh sleep quality index was lower in two thirds of reporting studies. Considering the influence on behavioral issues, cognitive performance and quality of life, the revealed alteration in sleep architecture and lower subjective sleep quality emphasizes the importance of screening for sleep disturbances in the medical care of patients with Idiopathic generalized epilepsy.
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Affiliation(s)
- Julia Lehner
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Julia S Frueh
- Department of Pediatric Neurology, Boston Children's Hospital, Boston, MA, United States of America
| | - Alexandre N Datta
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel UKBB, Basel, Switzerland.
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11
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Electrical status epilepticus during sleep electroencephalogram waveform identification and analysis based on a graph convolutional neural network. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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12
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Lin JJ, Meletti S, Vaudano AE, Lin KL. Developmental and epileptic encephalopathies: Is prognosis related to different epileptic network dysfunctions? Epilepsy Behav 2022; 131:107654. [PMID: 33349540 DOI: 10.1016/j.yebeh.2020.107654] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/19/2022]
Abstract
Developmental and epileptic encephalopathies are a group of rare, severe epilepsies, which are characterized by refractory seizures starting in infancy or childhood and developmental delay or regression. Developmental changes might be independent of epilepsy. However, interictal epileptic activity and seizures can further deteriorate cognition and behavior. Recently, the concept of developmental and epileptic encephalopathies has moved from the lesions associated with epileptic encephalopathies toward the epileptic network dysfunctions on the functioning of the brain. Early recognition and differentiation of patients with developmental and epileptic encephalopathies is important, as precision therapies need to be holistic to address the often devastating symptoms. In this review, we discuss the evolution of the concept of developmental and epileptic encephalopathies in recent years, as well as the current understanding of the genetic basis of developmental and epileptic encephalopathies. Finally, we will discuss the role of epileptic network dysfunctions on prognosis for these severe conditions.
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Affiliation(s)
- Jainn-Jim Lin
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Study Group for Intensive and Integrated Care of Pediatric Central Nervous System (iCNS Group), Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Stefano Meletti
- Division of Neurology, University Hospital of Modena, Modena, Italy; Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Elisabetta Vaudano
- Division of Neurology, University Hospital of Modena, Modena, Italy; Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Study Group for Intensive and Integrated Care of Pediatric Central Nervous System (iCNS Group), Chang Gung Children's Hospital, Taoyuan, Taiwan.
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13
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Nobili L, Frauscher B, Eriksson S, Gibbs SA, Halasz P, Lambert I, Manni R, Peter-Derex L, Proserpio P, Provini F, de Weerd A, Parrino L. Sleep and epilepsy: A snapshot of knowledge and future research lines. J Sleep Res 2022; 31:e13622. [PMID: 35487880 PMCID: PMC9540671 DOI: 10.1111/jsr.13622] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Sleep and epilepsy have a reciprocal relationship, and have been recognized as bedfellows since antiquity. However, research on this topic has made a big step forward only in recent years. In this narrative review we summarize the most stimulating discoveries and insights reached by the "European school." In particular, different aspects concerning the sleep-epilepsy interactions are analysed: (a) the effects of sleep on epilepsy; (b) the effects of epilepsy on sleep structure; (c) the relationship between epilepsy, sleep and epileptogenesis; (d) the impact of epileptic activity during sleep on cognition; (e) the relationship between epilepsy and the circadian rhythm; (f) the history and features of sleep hypermotor epilepsy and its differential diagnosis; (g) the relationship between epilepsy and sleep disorders.
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Affiliation(s)
- Lino Nobili
- Child Neuropsychiatric Unit, Istituto G. Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Sofia Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Steve Alex Gibbs
- Department of Neurosciences, Center for Advanced Research in Sleep Medicine, Sacred Heart Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Isabelle Lambert
- Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.,APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, CNRS UMR 5292/INSERM U1028, Lyon, France
| | - Paola Proserpio
- Department of Neuroscience, Sleep Medicine Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Provini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
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14
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Klinzing JG, Tashiro L, Ruf S, Wolff M, Born J, Ngo HVV. Auditory stimulation during sleep suppresses spike activity in benign epilepsy with centrotemporal spikes. Cell Rep Med 2021; 2:100432. [PMID: 34841286 PMCID: PMC8606903 DOI: 10.1016/j.xcrm.2021.100432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/12/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
Benign epilepsy with centrotemporal spikes (BECTS) is a common form of childhood epilepsy linked to diverse cognitive abnormalities. The electroencephalogram of patients shows focal interictal epileptic spikes, particularly during non-rapid eye movement (NonREM) sleep. Spike formation involves thalamocortical networks, which also contribute to the generation of sleep slow oscillations (SOs) and spindles. Motivated by evidence that SO-spindle activity can be controlled through closed-loop auditory stimulation, here, we show in seven patients that auditory stimulation also reduces spike rates in BECTS. Stimulation during NonREM sleep decreases spike rates, with most robust reductions when tones are presented 1.5 to 3.5 s after spikes. Stimulation further reduces the amplitude of spikes closely following tones. Sleep spindles are negatively correlated with spike rates, suggesting that tone-evoked spindle activity mediates the spike suppression. We hypothesize spindle-related refractoriness in thalamocortical circuits as a potential mechanism. Our results open an avenue for the non-pharmacological treatment of BECTS. Spikes in BECTS epilepsy and sleep spindles may share thalamocortical generation Auditory stimulation during sleep evokes sleep spindles and suppresses spikes Stimulation may reduce spiking by inducing thalamocortical refractoriness
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Affiliation(s)
- Jens G Klinzing
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany.,Centre for Integrative Neuroscience, University of Tübingen, 72076 Tübingen, Germany.,Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08540, USA
| | - Lilian Tashiro
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany
| | - Susanne Ruf
- University Children's Hospital Tübingen, 72076 Tübingen, Germany
| | - Markus Wolff
- Department of Pediatric Neurology, Vivantes Hospital Neukölln, 12351 Berlin, Germany
| | - Jan Born
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany.,Centre for Integrative Neuroscience, University of Tübingen, 72076 Tübingen, Germany
| | - Hong-Viet V Ngo
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany.,Department of Psychology, University of Lübeck, 23562 Lübeck, Germany
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15
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Oser N, Hubacher M, Nageleisen-Weiss A, van Mierlo P, Huber R, Weber P, Bölsterli BK, Datta AN. 6-year course of sleep homeostasis in a case with epilepsy-aphasia spectrum disorder. Epilepsy Behav Rep 2021; 16:100488. [PMID: 34693247 PMCID: PMC8517280 DOI: 10.1016/j.ebr.2021.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/27/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022] Open
Abstract
The overnight change of the slope of SSW as EEG marker for nocturnal regeneration. Reorganization of brain networks can rescue cognitive functions at least partially. Corticosteroids lead to a stabilization of the homeostasis of slope of SSW.
The epilepsy-aphasia spectrum consists of epilepsies with a strong activation of epileptic discharges during non-rapid-eye-movement (NREM) sleep, variable seizure burden and language problems. The homeostatic decrease of slow waves (SW) during NREM sleep (i.e. their amplitude/slope and power) has been related to brain recovery and cognitive function. Epileptic discharges during NREM-sleep were related to an impairment of the decrease of the slope of SW and to cognitive deficits. In this longitudinal case study, we aim to relate this electrophysiological marker, i.e. overnight change of slope of SW, to imaging and behavior. We report a young girl with a fluctuating course in the epilepsy-aphasia spectrum, ranging from the benign end with self-limited childhood epilepsy with centrotemporal spikes (SLECTS) to the severe end with epileptic encephalopathy with continuous spike waves during sleep (CSWS) with two phases of cognitive regression. She was documented over a period of six years including 12 PSGs, six language fMRIs and seven neuropsychological assessments. We longitudinally studied focal and total spike wave index (SWI), detected SW during NREM sleep, calculated their slopes (first and last hour of NREM sleep and overnight change). Deterioration of overnight decrease of the slope of SW was paralleled by the occurrence of the EEG picture of bilateral synchronous electrical status epilepticus during sleep (ESES) and neuropsychological deficits, and this impairment was reversible with resolution of ESES and was accompanied by cognitive improvement. A laterality switch from left to right sided language dominance occurred during recovery from the second regression phase. This might reflect a compensating process. Later, the laterality switched back to the left, possibly facilitated by a low SWI on the left hemisphere. The qualitative analysis of this case supports the view that the longitudinal course of the overnight change of the slope of SW, as an objective, quantitative EEG measure, is related to the course of cognitive function and functional language MR analysis.
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Affiliation(s)
- Nadine Oser
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
| | - Martina Hubacher
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
| | - Annette Nageleisen-Weiss
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
| | - Pieter van Mierlo
- Epilog NV, Ghent, Belgium.,Medical Image and Signal Processing Group, Ghent University, Belgium
| | - Reto Huber
- Department of Pediatric Neurology and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Switzerland.,Child Development Center and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Switzerland
| | - Peter Weber
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
| | - Bigna K Bölsterli
- Department of Pediatric Neurology and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Switzerland
| | - Alexandre N Datta
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
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16
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Jaramillo V, Jendoubi J, Maric A, Mensen A, Heyse NC, Eberhard-Moscicka AK, Wiest R, Bassetti CLA, Huber R. Thalamic Influence on Slow Wave Slope Renormalization During Sleep. Ann Neurol 2021; 90:821-833. [PMID: 34516002 PMCID: PMC9291607 DOI: 10.1002/ana.26217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 02/01/2023]
Abstract
Objective Slow waves are thought to mediate an overall reduction in synaptic strength during sleep. The specific contribution of the thalamus to this so‐called synaptic renormalization is unknown. Thalamic stroke is associated with daytime sleepiness, along with changes to sleep electroencephalography and cognition, making it a unique “experiment of nature” to assess the relationship between sleep rhythms, synaptic renormalization, and daytime functions. Methods Sleep was studied by polysomnography and high‐density electroencephalography over 17 nights in patients with thalamic (n = 12) and 15 nights in patients with extrathalamic (n = 11) stroke. Sleep electroencephalographic overnight slow wave slope changes and their relationship with subjective daytime sleepiness, cognition, and other functional tests were assessed. Results Thalamic and extrathalamic patients did not differ in terms of age, sleep duration, or apnea–hypopnea index. Conversely, overnight slope changes were reduced in a large cluster of electrodes in thalamic compared to extrathalamic stroke patients. This reduction was related to increased daytime sleepiness. No significant differences were found in other functional tests between the 2 groups. Interpretation In patients with thalamic stroke, a reduction in overnight slow wave slope change and increased daytime sleepiness was found. Sleep‐ and wake‐centered mechanisms for this relationship are discussed. Overall, this study suggests a central role of the thalamus in synaptic renormalization. ANN NEUROL 2021;90:821–833
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Affiliation(s)
- Valeria Jaramillo
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich.,Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich
| | - Jasmine Jendoubi
- Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.,Center for Experimental Neurology, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Armand Mensen
- Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.,Center for Experimental Neurology, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Natalie C Heyse
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich.,Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich
| | - Aleksandra K Eberhard-Moscicka
- Perception and Eye Movement Laboratory, Departments of Neurology and Biomedical Research, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.,Center for Experimental Neurology, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich.,Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich
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17
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Abstract
Electroencephalogram (EEG) recording is essential in the evaluation of complex movement and behaviors during sleep, but in particular for differentiating epileptic versus nonepileptic events. In general, epileptiform discharges occur with greater density in the first few nonerapid eye movement cycles, and approximately 12% to 20% of seizures occur exclusively at night. This review examines the epilepsy types and syndromes whose presentation is strongly influenced by the sleep state, with an appraisal about the role that sleep plays in facilitating seizures, while deleaneatign EEG findings and clinical manifestation. The review will summarize the typical semiology of sleep-related hypermotor seizures and contrasted with those occurring during none/rapid eye movement parasomnias and sleep-related movement disorders.
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Affiliation(s)
- Ting Wu
- Ronald Reagan Medical Center, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Room 1-240, Los Angeles, CA 90095, USA
| | - Alon Y Avidan
- UCLA Sleep Disorders Center, UCLA Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, RNRC, C153, Mail Code 176919, Los Angeles, CA, USA.
| | - Jerome Engel
- UCLA Seizure Disorder Center, Brain Research Institute, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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18
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Gefferie SR, Maric A, Critelli H, Gueden S, Kurlemann G, Kurth S, Nosadini M, Plecko B, Ringli M, Rostásy K, Sartori S, Schmitt B, Suppiej A, Van Bogaert P, Wehrle FM, Huber R, Bölsterli BK. Altered EEG markers of synaptic plasticity in a human model of NMDA receptor deficiency: Anti-NMDA receptor encephalitis. Neuroimage 2021; 239:118281. [PMID: 34147627 DOI: 10.1016/j.neuroimage.2021.118281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/15/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
Plasticity of synaptic strength and density is a vital mechanism enabling memory consolidation, learning, and neurodevelopment. It is strongly dependent on the intact function of N-Methyl-d-Aspartate Receptors (NMDAR). The importance of NMDAR is further evident as their dysfunction is involved in many diseases such as schizophrenia, Alzheimer's disease, neurodevelopmental disorders, and epilepsies. Synaptic plasticity is thought to be reflected by changes of sleep slow wave slopes across the night, namely higher slopes after wakefulness at the beginning of sleep than after a night of sleep. Hence, a functional NMDAR deficiency should theoretically lead to altered overnight changes of slow wave slopes. Here we investigated whether pediatric patients with anti-NMDAR encephalitis, being a very rare but unique human model of NMDAR deficiency due to autoantibodies against receptor subunits, indeed show alterations in this sleep EEG marker for synaptic plasticity. We retrospectively analyzed 12 whole-night EEGs of 9 patients (age 4.3-20.8 years, 7 females) and compared them to a control group of 45 healthy individuals with the same age distribution. Slow wave slopes were calculated for the first and last hour of Non-Rapid Eye Movement (NREM) sleep (factor 'hour') for patients and controls (factor 'group'). There was a significant interaction between 'hour' and 'group' (p = 0.013), with patients showing a smaller overnight decrease of slow wave slopes than controls. Moreover, we found smaller slopes during the first hour in patients (p = 0.022), whereas there was no group difference during the last hour of NREM sleep (p = 0.980). Importantly, the distribution of sleep stages was not different between the groups, and in our main analyses of patients without severe disturbance of sleep architecture, neither was the incidence of slow waves. These possible confounders could therefore not account for the differences in the slow wave slope values, which we also saw in the analysis of the whole sample of EEGs. These results suggest that quantitative EEG analysis of slow wave characteristics may reveal impaired synaptic plasticity in patients with anti-NMDAR encephalitis, a human model of functional NMDAR deficiency. Thus, in the future, the changes of sleep slow wave slopes may contribute to the development of electrophysiological biomarkers of functional NMDAR deficiency and synaptic plasticity in general.
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Affiliation(s)
- Silvano R Gefferie
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW, Heemstede, Netherlands
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland
| | - Hanne Critelli
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
| | - Sophie Gueden
- Service de Pédiatrie, CHU d'Angers, 49933, Angers, France
| | | | - Salome Kurth
- Pulmonary Clinic, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland; Department of Psychology, University of Fribourg, 1700, Fribourg, Switzerland
| | - Margherita Nosadini
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, 35122, Padua, Italy
| | - Barbara Plecko
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, 8036, Graz, Austria
| | - Maya Ringli
- Department of Neurology, Inselspital, University Hospital Bern, 3010, Bern, Switzerland
| | - Kevin Rostásy
- Department of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, 58448, Datteln/Witten, Germany
| | - Stefano Sartori
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, 35122, Padua, Italy
| | - Bernhard Schmitt
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
| | - Agnese Suppiej
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, 35122, Padua, Italy; Department of Medical Sciences, Pediatric Section, University of Ferrara, 44121, Ferrara, Italy
| | | | - Flavia M Wehrle
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8091, Zurich, Switzerland
| | - Bigna K Bölsterli
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland.
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19
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Simon KC, Malerba P, Nakra N, Harrison A, Mednick SC, Nagel M. Slow oscillation density and amplitude decrease across development in pediatric Duchenne and Becker muscular dystrophy. Sleep 2021; 44:5986496. [PMID: 33202016 DOI: 10.1093/sleep/zsaa240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/21/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES From childhood through adolescence, brain rhythms during non-rapid eye movement (NREM) sleep show dramatic development that mirror underlying brain maturation. For example, the function and characteristics of slow oscillations (SOs, <1 Hz) in healthy children are linked to brain development, motor skill, and cognition. However, little is known of possible changes in pediatric populations with neurologic abnormalities. METHODS We measured slow oscillations in 28 Duchenne and Becker muscular dystrophy male patients from age 4 to 20 years old during overnight in-lab clinical sleep studies. We compared our pediatric patients by age to evaluate the developmental changes of SOs from childhood to early and late adolescence. RESULTS Consistent with the current neuro- and physically typical literature, we found greater slow oscillation density (count of SOs per minute of each sleep stage) in NREM N3 than N2, and significantly greater slow oscillation density in frontal compared to central and occipital regions. However, separating patients into age-defined groups (child, early adolescent, and late adolescent) revealed a significant age effect, with a specific decline in the rate and amplitude of SOs. CONCLUSIONS We found that with age, pediatric patients with Duchenne muscular dystrophy show a significant decline in slow oscillation density. Given the role that slow oscillations play in memory formation and retention, it is critical to developmentally characterize these brain rhythms in medically complex populations. Our work converges with previous pediatric sleep literature that promotes the use of sleep electroencephalographic markers as prognostic tools and identifies potential targets to promote our patients' quality of life.
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Affiliation(s)
- Katharine C Simon
- Cognitive Science Department, University of California, Irvine, Irvine, CA
| | - Paola Malerba
- Battelle Center for Mathematical Medicine, Nationwide's Children Hospital, Columbus, OH
| | - Neal Nakra
- Pulmonology Department, Children's Hospital of Orange County, Orange, CA
| | - Amy Harrison
- Pulmonology Department, Children's Hospital of Orange County, Orange, CA
| | - Sara C Mednick
- Cognitive Science Department, University of California, Irvine, Irvine, CA
| | - Marni Nagel
- Pulmonology Department, Children's Hospital of Orange County, Orange, CA.,Psychology Department, Children's Hospital of Orange County, Orange, CA
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20
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Öztoprak Ü, Yayici Köken Ö, Aksoy E, Yüksel D. Spike-Wave Index Assessment and Electro-Clinical Correlation in Patients with Encephalopathy Associated with Epileptic State During Slow Sleep (ESES / CSWS); Single-Center Experience. Epilepsy Res 2021; 170:106549. [PMID: 33450525 DOI: 10.1016/j.eplepsyres.2021.106549] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/06/2020] [Accepted: 12/30/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to describe the electroclinical spectrum and neurocognitive outcome in children with epileptic encephalopathy with status epilepticus during sleep (ESES) according to the EEG patterns. METHODS Records of 48 (19 males, 29 females) patients with ESES/CSWS syndrome were retrospectively evaluated for data on sleep and awake EEGs, psychometric tests, and brain MRI. Patients with a spike-wave index (SWI) of at least 50 % in the NREM sleep EEG were included in the study. Electrophysiologic findings were separated into two groups based on SWI: SWI>85-100 % (typical ESES) and SWI < 85 % (atypical ESES). The neurocognitive prognosis was also evaluated in two groups; favorable and unfavorable. RESULTS The median age at the onset of ESES was 6 years and 5 months and ranged from 3 to 13 years. The median duration of follow-up after the ESES diagnosis was 57 months (range 24-150 months). Etiology was evaluated in three groups: symptomatic/structural, idiopathic, and unknown (cryptogenic). Twenty-seven (56.25 %) patients had atypical ESES patterns and 21 patients (43.75 %) had typical ESES patterns. Twenty-eight patients (58.3 %) had cognitive deterioration. Long term neurocognitive outcome was unfavorable in half of the patients. Symptomatic/structural etiology was more common in patients with unfavorable (p < 0.001) outcomes. The median age at the diagnosis of ESES (p < 0.001) was significantly earlier in the patients with unfavorable neurocognitive outcomes. The longer duration of ESES(p < 0.001), and the longer time between the onset of epilepsy and ESES (p = 0.039) was significantly associated with unfavorable outcomes. We found that patients with typical ESES had a higher risk for poor neurocognitive outcomes than patients with atypical ESES (OR: 31.096 [1.565-617.696]). CONCLUSION The long-term outcome of ESES is exceedingly variable. An unfavorable neurocognitive outcome seems to be related to ESES with a long-duration and early-onset epileptic activity, SWI ≥ 85 %, and etiology.
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Affiliation(s)
- Ülkühan Öztoprak
- University of Health Sciences, Dr. Sami Ulus Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey.
| | - Özlem Yayici Köken
- Ankara City Hospital, Children's Hospital, Department of Pediatric Neurology, Ankara, Turkey.
| | - Erhan Aksoy
- University of Health Sciences, Dr. Sami Ulus Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey.
| | - Deniz Yüksel
- University of Health Sciences, Dr. Sami Ulus Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey.
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21
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Clinical spectrum and treatment outcome of 95 children with continuous spikes and waves during sleep (CSWS). Eur J Paediatr Neurol 2021; 30:121-127. [PMID: 33132036 DOI: 10.1016/j.ejpn.2020.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/22/2020] [Accepted: 10/24/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Continuous spikes and waves during sleep (CSWS) is an epileptic encephalopathy characterized by generalised epileptiform activity and neurocognitive dysfunction. Causes and outcome are diverse and treatment is mainly empirical. METHODS Retrospective descriptive analysis of clinical and EEG data of children with CSWS diagnosed between 1998 and 2018 at the University Hospital Heidelberg. RESULTS Ninety-five children were included with a median age at diagnosis of 5.4 years. A structural/metabolic aetiology was found in 43.2%, genetic alterations in 17.9%, while it remained unknown in 38.9%. The proportion of patients with genetic aetiology increased from 10.3% (1998-2007) to 22.8% (2008-2018). On average, each patient received 5 different treatments. CSWS was refractory in >70% of cases, steroids and neurosurgery were most effective. No difference was observed between children with CSWS or Near-CSWS (Spike-Wave-Index 40-85%). CONCLUSIONS Our cohort confirms CSWS as an age-dependent epileptic encephalopathy. Structural brain abnormalities were most frequent, but genetic causes are increasingly identified. More specific criteria for the diagnosis and treatment goals should be elaborated and implemented based on evidence. SIGNIFICANCE This study is the largest monocentric observational study on treatment effects in children with CSWS, providing data for diagnostic and therapeutic decisions.
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22
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Azeem A, Kirton A, Appendino JP, Kozlik S, Mineyko A. Automated quantification of spike-wave activity may be used to predict the development of electrical status epilepticus in sleep (ESES) in children with perinatal stroke. Clin Neurophysiol 2020; 132:146-153. [PMID: 33278667 DOI: 10.1016/j.clinph.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Continuous spike and wave in slow-wave sleep (CSWS), an epileptic encephalopathy, occurs after perinatal stroke where it is associated with cognitive decline. CSWS features a distinct EEG pattern, electrical status epilepticus in sleep (ESES). Biomarkers for the prediction of ESES have not been identified but will facilitate earlier diagnosis and treatment. We hypothesized that spike-frequency and differences in power spectra would be predictive of subsequent ESES. METHODS A cross-sectional study comparing EEG spike-frequency and Power before the development of ESES in patients with perinatal stroke, patients with focal epilepsy, and appropriate controls. RESULTS 43 patients met the inclusion criteria; 11 stroke-ESES, 10 stroke controls, 14 epilepsy-ESES, 8 epilepsy controls. ESES patients had higher pre-diagnosis mean spike-frequency (24.0 ± 24 versus 6.6 ± 9.1 SW/min, p = 0.002) than patients that did not develop ESES; these differences present ~ 3 years before ESES diagnosis. Pre-diagnosis, normalized delta power (1-4 Hz) was higher in the stroke-ESES group (105.7 ± 58 dB/Hz) compared to stroke controls (57.4 ± 45 dB/Hz, p = 0.036). CONCLUSION Spike-frequency and delta power may represent EEG biomarkers of the risk of developing ESES in children with perinatal stroke. SIGNIFICANCE EEG biomarkers may be used by clinicians to assess which patients are more at-risk for ESES. Using spike-frequency, clinicians may be able to identify patients at risk of developing ESES.
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Affiliation(s)
- Abdullah Azeem
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB T2N 1N4, Canada
| | - Adam Kirton
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB T2N 1N4, Canada; Department of Pediatrics, Section of Neurology, Cumming School of Medicine, University of Calgary, Calgary AB T2N 1N4, Canada; Alberta Children's Hospital, Calgary AB T3B 6A8, Canada
| | - Juan Pablo Appendino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB T2N 1N4, Canada; Department of Pediatrics, Section of Neurology, Cumming School of Medicine, University of Calgary, Calgary AB T2N 1N4, Canada; Alberta Children's Hospital, Calgary AB T3B 6A8, Canada
| | - Silvia Kozlik
- Alberta Children's Hospital, Calgary AB T3B 6A8, Canada
| | - Aleksandra Mineyko
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary AB T2N 1N4, Canada; Department of Pediatrics, Section of Neurology, Cumming School of Medicine, University of Calgary, Calgary AB T2N 1N4, Canada; Alberta Children's Hospital, Calgary AB T3B 6A8, Canada.
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23
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Storz S, Wilhelm I, Critelli H, Feldmann M, Ramirez A, Ramantani G, Huber R, Bölsterli BK. Sleep-dependent memory consolidation in children with self-limited focal epilepsies. Epilepsy Behav 2020; 113:107513. [PMID: 33129045 DOI: 10.1016/j.yebeh.2020.107513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Children with self-limited focal epilepsies of childhood (SLFE) are known to show impaired memory functions, particularly in the verbal domain. Interictal epileptiform discharges (IED) in these epilepsies are more pronounced in nonrapid eye movement (NREM) sleep. Nonrapid eye movement sleep is crucial for consolidation of newly-encoded memories. Therefore, we hypothesize that sleep-dependent memory consolidation is altered in relation to IED in children with SLFE. METHODS We conducted a prospective case-control study. We applied a verbal (word pair) and a visuospatial (two-dimensional [2D] object location) learning task, both previously shown to benefit from sleep in terms of memory consolidation. Learning took place in the evening, and retrieval was tested in the morning after a night of sleep. Electroencephalogram (EEG) was recorded across night. After sleep-stage scoring, the spike-wave index (SWI) was assessed at the beginning and the end of sleep. Fourteen patients with SLFE (age: 5.5 to 11.6 years) were compared with 15 healthy controls (age: 6.8 to 9.1 years) examined in a previous study. RESULTS In contrast to healthy controls (mean: +12.9% recalled word pairs, p = .003, standard deviation (SD) = 12.4%), patients did not show overnight performance gains in the verbal memory task (mean: +6.4% recalled word pairs, p > .05, SD = 17.3) Neither patients nor controls showed significant overnight changes in visuospatial task performance. Spike-wave index was negatively correlated with recall performance in the verbal but not in the visuospatial task. SIGNIFICANCE We found evidence for impaired overnight improvement of performance in children with SLFE in a verbal learning task, with high SWI rates predicting low recall performance. We speculate that spike-waves hamper long-term memory consolidation by interfering with NREM sleep.
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Affiliation(s)
- Sarah Storz
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Ines Wilhelm
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit (TPU), University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Hanne Critelli
- Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Maria Feldmann
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Ana Ramirez
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Georgia Ramantani
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Bigna K Bölsterli
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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24
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van den Munckhof B, Arzimanoglou A, Perucca E, van Teeseling HC, Leijten FSS, Braun KPJ, Jansen FE. Corticosteroids versus clobazam in epileptic encephalopathy with ESES: a European multicentre randomised controlled clinical trial (RESCUE ESES*). Trials 2020; 21:957. [PMID: 33228736 PMCID: PMC7686710 DOI: 10.1186/s13063-020-04874-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epileptic encephalopathy with electrical status epilepticus in sleep (ESES) is an epilepsy syndrome occurring almost exclusively in children, usually at an age between 4 and 12 years. It is characterised by abundant sleep-induced epileptic activity in the electroencephalogram (EEG) and by acquired cognitive and behavioural deficits. The goal of treatment is to prevent further decline or even improve cognitive functioning. Based on mostly small and retrospective studies, corticosteroids and clobazam are regarded by many clinicians as the most effective pharmacological treatments. This European multicentre randomised controlled trial is designed to compare the effects of corticosteroids and clobazam on cognitive functioning after 6 months. Secondary outcomes include cognitive functioning after 18 months, EEG abnormalities in sleep, safety and tolerability, and seizure frequency. We also aimed at investigating whether treatment response in epileptic encephalopathy with ESES can be predicted by measurement of inflammatory mediators and autoantibodies in serum. METHODS The pragmatic study will be performed in centres with expertise in the treatment of rare paediatric epilepsy syndromes across Europe. A total of 130 patients, 2 to 12 years of age, with epileptic encephalopathy with ESES will be enrolled and randomised in a 1:1 ratio to receive either corticosteroids (monthly intravenous methylprednisolone pulses or daily oral prednisolone) or oral clobazam for 6 months according to an open-label parallel-group design. Follow-up visits with clinical assessment, EEGs, and neuropsychological testing are scheduled for up to 18 months. Blood samples for cytokine and autoantibody testing are obtained before treatment and 8 months after treatment initiation. DISCUSSION The treatment of epileptic encephalopathy with ESES aims at improving cognitive outcome. This randomised controlled study will compare the most frequently used treatments, i.e. corticosteroids and clobazam. If the study proves superiority of one treatment over the other or identifies biomarkers of treatment response, results will guide clinicians in the early treatment of this severe epilepsy syndrome. TRIAL REGISTRATION ISRCTN, ISRCTN42686094 . Registered on 24 May 2013.
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Affiliation(s)
- Bart van den Munckhof
- Department of Paediatric Neurology, Brain Center, University Medical Center Utrecht, Member of the European Reference Network EpiCARE, Utrecht University, KC 03.063.0, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Alexis Arzimanoglou
- Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology Department, University Hospitals of Lyon (HCL), Coordinator of the European Reference Network EpiCARE, Lyon Neurosciences Research Centre, Lyon, France.,Paediatric Epilepsy Unit, Child Neurology Department, Hospital San Juan de Dios, Universitat de Barcelona, Barcelona, Spain
| | - Emilio Perucca
- Clinical Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia and Clinical Trial Center, IRCCS Mondino Foundation, Member of the European Reference Network EpiCARE, Pavia, Italy
| | - Heleen C van Teeseling
- Department of Paediatric Neuropsychology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans S S Leijten
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Paediatric Neurology, Brain Center, University Medical Center Utrecht, Member of the European Reference Network EpiCARE, Utrecht University, KC 03.063.0, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Floor E Jansen
- Department of Paediatric Neurology, Brain Center, University Medical Center Utrecht, Member of the European Reference Network EpiCARE, Utrecht University, KC 03.063.0, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
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25
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van den Munckhof B, Gefferie SR, van Noort SAM, van Teeseling HC, Schijvens MP, Smit W, Teunissen NW, Plate JDJ, Huiskamp GJM, Leijten FSS, Braun KPJ, Jansen FE, Bölsterli BK. Sleep slow-wave homeostasis and cognitive functioning in children with electrical status epilepticus in sleep. Sleep 2020; 43:5831237. [PMID: 32374855 DOI: 10.1093/sleep/zsaa088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/03/2020] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVES Encephalopathy with electrical status epilepticus in sleep (ESES) is characterized by non-rapid eye movement (non-REM)-sleep-induced epileptiform activity and acquired cognitive deficits. The synaptic homeostasis hypothesis describes the process of daytime synaptic potentiation balanced by synaptic downscaling in non-REM-sleep and is considered crucial to retain an efficient cortical network. We aimed to study the overnight decline of slow waves, an indirect marker of synaptic downscaling, in patients with ESES and explore whether altered downscaling relates to neurodevelopmental and behavioral problems. METHODS Retrospective study of patients with ESES with at least one whole-night electroencephalogram (EEG) and neuropsychological assessment (NPA) within 4 months. Slow waves in the first and last hour of non-REM-sleep were analyzed. Differences in slow-wave slope (SWS) and overnight slope course between the epileptic focus and non-focus electrodes and relations to neurodevelopment and behavior were analyzed. RESULTS A total of 29 patients with 44 EEG ~ NPA combinations were included. Mean SWS decreased from 357 to 327 µV/s (-8%, p < 0.001) across the night and the overnight decrease was less pronounced in epileptic focus than in non-focus electrodes (-5.6% vs. -8.7%, p = 0.003). We found no relation between SWS and neurodevelopmental test results in cross-sectional and longitudinal analyses. Patients with behavioral problems showed less SWS decline than patients without and the difference was most striking in the epileptic focus (-0.9% vs. -8.8%, p = 0.006). CONCLUSIONS Slow-wave homeostasis-a marker of synaptic homeostasis-is disturbed by epileptiform activity in ESES. Behavioral problems, but not neurodevelopmental test results, were related to severity of this disturbance.
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Affiliation(s)
- Bart van den Munckhof
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Silvano R Gefferie
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Suus A M van Noort
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Heleen C van Teeseling
- Department of Pediatric Neuropsychology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mischa P Schijvens
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - William Smit
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico W Teunissen
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joost D J Plate
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert Jan M Huiskamp
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans S S Leijten
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bigna K Bölsterli
- Division of Clinical Neurophysiology, Department of Neurology, University Children's Hospital Zurich, Zurich, Switzerland
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26
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Jaramillo V, Volk C, Maric A, Furrer M, Fattinger S, Kurth S, Lustenberger C, Huber R. Characterization of overnight slow-wave slope changes across development in an age-, amplitude-, and region-dependent manner. Sleep 2020; 43:5802398. [PMID: 32154557 DOI: 10.1093/sleep/zsaa038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/21/2020] [Indexed: 12/16/2022] Open
Abstract
STUDY OBJECTIVES The restorative function of sleep has been linked to a net reduction in synaptic strength. The slope of slow-waves, a major characteristic of non-rapid eye movement (NREM) sleep, has been shown to directly reflect synaptic strength, when accounting for amplitude changes across the night. In this study, we aimed to investigate overnight slope changes in the course of development in an age-, amplitude-, and region-dependent manner. METHODS All-night high-density electroencephalography data were analyzed in a cross-sectional population of 60 healthy participants in the age range of 8-29 years. To control for amplitude changes across the night, we matched slow-waves from the first and the last hour of NREM sleep according to their amplitude. RESULTS We found a reduction of slow-wave slopes from the first to the last hour of NREM sleep across all investigated ages, amplitudes, and most brain regions. The overnight slope change was largest in children and decreased toward early adulthood. A topographical analysis revealed regional differences in slope change. Specifically, for small amplitude waves the decrease was smallest in an occipital area, whereas for large amplitude waves, the decrease was smallest in a central area. CONCLUSIONS The larger slope decrease in children might be indicative of a boosted renormalization of synapses during sleep in childhood, which, in turn, might be related to increased plasticity during brain maturation. Regional differences in the extent of slow-wave slope reduction may reflect a "smart" down-selection process or, alternatively, indicate amplitude-dependent differences in the generation of slow-waves.
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Affiliation(s)
- Valeria Jaramillo
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Carina Volk
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Melanie Furrer
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Sara Fattinger
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Salome Kurth
- Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland
| | | | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, Zurich, Switzerland
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27
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Abstract
We aimed to explore the link between NREM sleep and epilepsy. Based on human and experimental data we propose that a sleep-related epileptic transformation of normal neurological networks underlies epileptogenesis. Major childhood epilepsies as medial temporal lobe epilepsy (MTLE), absence epilepsy (AE) and human perisylvian network (PN) epilepsies - made us good models to study. These conditions come from an epileptic transformation of the affected functional systems. This approach allows a system-based taxonomy instead of the outworn generalized-focal classification. MTLE links to the memory-system, where epileptic transformation results in a switch of normal sharp wave-ripples to epileptic spikes and pathological high frequency oscillations, compromising sleep-related memory consolidation. Absence epilepsy (AE) and juvenile myoclonic epilepsy (JME) belong to the corticothalamic system. The burst-firing mode of NREM sleep normally producing sleep-spindles turns to an epileptic working mode ejecting bilateral synchronous spike-waves. There seems to be a progressive transition from AE to JME. Shared absences and similar bilateral synchronous discharges show the belonging of the two conditions, while the continuous age windows - AE affecting schoolchildren, JME the adolescents - and the increased excitability in JME compared to AE supports the notion of progression. In perisylvian network epilepsies - idiopathic focal childhood epilepsies and electrical status epilepticus in sleep including Landau-Kleffner syndrome - centrotemporal spikes turn epileptic, with the potential to cause cognitive impairment. Postinjury epilepsies modeled by the isolated cortex model highlight the shared way of epileptogenesis suggesting the derailment of NREM sleep-related homeostatic plasticity as a common step. NREM sleep provides templates for plasticity derailing to epileptic variants under proper conditions. This sleep-origin explains epileptiform discharges' link and similarity with NREM sleep slow oscillations, spindles and ripples. Normal synaptic plasticity erroneously overgrowing homeostatic processes may derail toward an epileptic working-mode manifesting the involved system's features. The impact of NREM sleep is unclear in epileptogenesis occurring in adolescence and adulthood, when plasticity is lower. The epileptic process interferes with homeostatic synaptic plasticity and may cause cognitive impairment. Its type and degree depends on the affected network's function. We hypothesize a vicious circle between sleep end epilepsy. The epileptic derailment of normal plasticity interferes with sleep cognitive functions. Sleep and epilepsy interconnect by the pathology of plasticity.
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Affiliation(s)
- Péter Halász
- Szentágothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Anna Szűcs
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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28
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Slow wave activity during NREM sleep in patients with electrical status epilepticus in sleep. Seizure 2020; 80:257-258. [DOI: 10.1016/j.seizure.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 11/18/2022] Open
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29
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Heinrich B, Schmitt B, Bölsterli BK, Critelli H, Huber R, Fattinger S. Disparate effects of hormones and vigabatrin on sleep slow waves in patients with West syndrome - An indication of their mode of action? J Sleep Res 2020; 30:e13137. [PMID: 32657499 DOI: 10.1111/jsr.13137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/17/2020] [Accepted: 06/08/2020] [Indexed: 01/22/2023]
Abstract
Synaptic downscaling during sleep, a physiological process to restore synaptic homeostasis and maintain learning efficiency and healthy brain development, has been related to a reduction of the slope of sleep slow waves (SSW). However, such synaptic downscaling seems not to be reflected in high-amplitude SSW. Recently we have shown reduced SSW slopes during hormonal treatment (adrenocorticotrophic hormone, prednisolone) in patients with West syndrome (WS). Yet, whether this reduction was related to successful treatment or reflects a specific effect of hormone therapy is unknown. Thus, we retrospectively analysed nap electroencephalograms of 61 patients with WS successfully treated with hormones, vigabatrin (VGB), or both. The slope of SSW during treatment (T1) and 2-7 months later (T2) when hormonal treatment was tapered off were compared between the treatment groups and healthy, age-matched controls. At T1 hormone treatment reduced the slope of low-amplitude SSW, whereas VGB increased the slope of high-amplitude SSW (linear mixed effect model: FGroup = 7.04, p < 0.001; FAmplitude = 1,646.68, p < 0.001; FGroup*Amplitude = 3.38, p < 0.001). At T2, untreated patients did not differ anymore from healthy controls, whereas those still under VGB showed the same alterations as those with VGB at T1. This result indicates a disparate effect of VGB and hormone on the SSW slope. In particular, hormones seem to reduce the slope of cortical generated low-amplitude SSW, similar to the physiological synaptic downscaling during sleep. Thus, a loss of functional neuronal connectivity might be an alternative explanation of the antiepileptic effect of hormonal treatment.
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Affiliation(s)
- Bianka Heinrich
- Department of Neuropediatrics, University Children's Hospital Zurich, Zürich, Switzerland
| | - Bernhard Schmitt
- Department of Neuropediatrics, University Children's Hospital Zurich, Zürich, Switzerland.,Pediatric Sleep Disorders Center, University Children's Hospital Zurich, Zürich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zürich, Switzerland
| | - Bigna K Bölsterli
- Department of Neuropediatrics, University Children's Hospital Zurich, Zürich, Switzerland.,Pediatric Sleep Disorders Center, University Children's Hospital Zurich, Zürich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zürich, Switzerland
| | - Hanne Critelli
- Department of Neuropediatrics, University Children's Hospital Zurich, Zürich, Switzerland.,Pediatric Sleep Disorders Center, University Children's Hospital Zurich, Zürich, Switzerland
| | - Reto Huber
- Pediatric Sleep Disorders Center, University Children's Hospital Zurich, Zürich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zürich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zürich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | - Sara Fattinger
- Pediatric Sleep Disorders Center, University Children's Hospital Zurich, Zürich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zürich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zürich, Switzerland
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30
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Jin B, Aung T, Geng Y, Wang S. Epilepsy and Its Interaction With Sleep and Circadian Rhythm. Front Neurol 2020; 11:327. [PMID: 32457690 PMCID: PMC7225332 DOI: 10.3389/fneur.2020.00327] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/03/2020] [Indexed: 12/12/2022] Open
Abstract
Growing evidence shows the bidirectional interactions between sleep, circadian rhythm, and epilepsy. Comprehending how these interact with each other may help to advance our understanding of the pathophysiology of epilepsy and develop new treatment strategies to improve seizure control by reducing the medication side effects and the risks associated with seizures. In this review, we present the overview of different temporal patterns of interictal epileptiform discharges and epileptic seizures over a period of 24 consecutive hours. Furthermore, we discuss the underlying mechanism of the core-clock gene in periodic seizure occurrences. Finally, we outline the role of circadian patterns of seizures on seizure forecasting models and its implication for chronotherapy in epilepsy.
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Affiliation(s)
- Bo Jin
- Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Thandar Aung
- Barrow Neurological Institute, Epilepsy Center, Phoenix, AZ, United States
| | - Yu Geng
- Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shuang Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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31
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Chan SYS. Sleep architecture and homeostasis in children with epilepsy: a neurodevelopmental perspective. Dev Med Child Neurol 2020; 62:426-433. [PMID: 31879946 DOI: 10.1111/dmcn.14437] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
Abstract
Although the influence of sleep on epilepsy has long been recognized, this relationship has yet to be fully exploited to benefit patients. The past decade has seen significant advances in understanding paediatric sleep, providing a framework by which to properly evaluate the sleep of children with epilepsy, which itself has been subject to increasing scrutiny. The role of sleep in learning and the potential for interictal discharges to disrupt sleep-related memory consolidation provide a novel perspective for understanding the association of childhood epilepsy with a high rate of intellectual disability. In this review, I outline the evolution of sleep duration, architecture, and homeostasis across childhood, relating this to the development of cognitive functions. I describe how these may be disrupted or preserved in children with epilepsy; in particular, collating data from polysomnography. Finally, I explore how sleep may, in the future, be modulated to improve cognitive outcome in these patients. WHAT THIS PAPER ADDS: Children with epilepsy have less rapid eye movement sleep than controls, but this improves with seizure cessation. Deep or slow-wave sleep is highly conserved in children with epilepsy. Sleep homeostasis may be disrupted either at a local or global level by the presence of interictal epileptiform discharges.
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Affiliation(s)
- Samantha Yuen-Sum Chan
- Clinical Neurosciences Section, Developmental Neurosciences Programme, UCL GOS Institute of Child Health, London, UK
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32
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Kang X, Boly M, Findlay G, Jones B, Gjini K, Maganti R, Struck AF. Quantitative spatio-temporal characterization of epileptic spikes using high density EEG: Differences between NREM sleep and REM sleep. Sci Rep 2020; 10:1673. [PMID: 32015406 PMCID: PMC6997449 DOI: 10.1038/s41598-020-58612-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
In this study, we applied high-density EEG recordings (HD-EEG) to quantitatively characterize the fine-grained spatiotemporal distribution of inter-ictal epileptiform discharges (IEDs) across different sleep stages. We quantified differences in spatial extent and duration of IEDs at the scalp and cortical levels using HD-EEG source-localization, during non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep, in six medication-refractory focal epilepsy patients during epilepsy monitoring unit admission. Statistical analyses were performed at single subject level and group level across different sleep stages for duration and distribution of IEDs. Tests were corrected for multiple comparisons across all channels and time points. Compared to NREM sleep, IEDs during REM sleep were of significantly shorter duration and spatially more restricted. Compared to NREM sleep, IEDs location in REM sleep also showed a higher concordance with electrographic ictal onset zone from scalp EEG recording. This study supports the localizing value of REM IEDs over NREM IEDs and suggests that HD-EEG may be of clinical utility in epilepsy surgery work-up.
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Affiliation(s)
- Xuan Kang
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA
| | - Melanie Boly
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA.,University of Wisconsin-Madison Department of Psychiatry, Madison, Wisconsin, 53705, USA
| | - Graham Findlay
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA.,University of Wisconsin-Madison Department of Psychiatry, Madison, Wisconsin, 53705, USA
| | - Benjamin Jones
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA.,University of Wisconsin-Madison Department of Psychiatry, Madison, Wisconsin, 53705, USA
| | - Klevest Gjini
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA
| | - Rama Maganti
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA
| | - Aaron F Struck
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA.
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Vaudano AE, Avanzini P, Cantalupo G, Filippini M, Ruggieri A, Talami F, Caramaschi E, Bergonzini P, Vignoli A, Veggiotti P, Guerra A, Gessaroli G, Santucci M, Canevini MP, Piccolo B, Pisani F, Gobbi G, Dalla Bernardina B, Meletti S. Mapping the Effect of Interictal Epileptic Activity Density During Wakefulness on Brain Functioning in Focal Childhood Epilepsies With Centrotemporal Spikes. Front Neurol 2019; 10:1316. [PMID: 31920937 PMCID: PMC6930928 DOI: 10.3389/fneur.2019.01316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022] Open
Abstract
Childhood epilepsy with centrotemporal spikes (CECTS) is the most common type of “self-limited focal epilepsies.” In its typical presentation, CECTS is a condition reflecting non-lesional cortical hyperexcitability of rolandic regions. The benign evolution of this disorder is challenged by the frequent observation of associated neuropsychological deficits and behavioral impairment. The abundance (or frequency) of interictal centrotemporal spikes (CTS) in CECTS is considered a risk factor for deficits in cognition. Herein, we captured the hemodynamic changes triggered by the CTS density measure (i.e., the number of CTS for time bin) obtained in a cohort of CECTS, studied by means of video electroencephalophy/functional MRI during quite wakefulness. We aim to demonstrate a direct influence of the diurnal CTS frequency on epileptogenic and cognitive networks of children with CECTS. A total number of 8,950 CTS (range between 27 and 801) were recorded in 23 CECTS (21 male), with a mean number of 255 CTS/patient and a mean density of CTS/30 s equal to 10,866 ± 11.46. Two independent general linear model models were created for each patient based on the effect of interest: “individual CTS” in model 1 and “CTS density” in model 2. Hemodynamic correlates of CTS density revealed the involvement of a widespread cortical–subcortical network encompassing the sensory-motor cortex, the Broca's area, the premotor cortex, the thalamus, the putamen, and red nucleus, while in the CTS event-related model, changes were limited to blood–oxygen-level-dependent (BOLD) signal increases in the sensory-motor cortices. A linear relationship was observed between the CTS density hemodynamic changes and both disease duration (positive correlation) and age (negative correlation) within the language network and the bilateral insular cortices. Our results strongly support the critical role of the CTS frequency, even during wakefulness, to interfere with the normal functioning of language brain networks.
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Affiliation(s)
- Anna Elisabetta Vaudano
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Avanzini
- Italian National Research Council, Parma Research Unit, Parma, Italy
| | | | - Melissa Filippini
- Child Neuropsychiatry Unit, IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Francesca Talami
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Aglaia Vignoli
- Department of Health Sciences, University of Milano, Milan, Italy
| | | | - Azzura Guerra
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Giuliana Gessaroli
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Margherita Santucci
- Child Neuropsychiatry Unit, IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | - Benedetta Piccolo
- Child Neuropsychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Pisani
- Child Neuropsychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Gobbi
- Child Neuropsychiatry Unit, IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | - Stefano Meletti
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Tassinari CA. An electroencephalographer recalls the history of the Federation on the 70th anniversary of its journal, Clinical Neurophysiology. Clin Neurophysiol 2019; 130:2258-2263. [PMID: 31761715 DOI: 10.1016/j.clinph.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Carlo Alberto Tassinari
- Università degli Studi di Bologna, Italy; Centro Ricerca per le Epilessie in età Pediatrica (CREP), Verona, Italy.
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35
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The role of sleep-related cognitive functions in the spectrum of benign epilepsy with centro-temporal spikes. Eur J Pediatr 2019; 178:1129-1137. [PMID: 31227889 DOI: 10.1007/s00431-019-03413-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 01/02/2023]
Abstract
Heterogeneous cognitive deficits have been described in the spectrum of benign epilepsy with centro-temporal spikes, which strongly correlate with the intensity of interictal epileptiform discharges and its spreading, in particular during sleep, mostly within the perisylvian cognitive network. The aim of this review is to discuss current findings regarding the connection between sleep alterations and cognitive function in the spectrum of benign epilepsy with centro-temporal spikes. A longer sleep onset latency is the only evident sleep macrostructure alteration reported in the spectrum of benign epilepsy with centro-temporal spikes. On a microstructural level, a higher spike count of descending compared to ascending slopes of sleep cycles, an impairment of slow wave downscaling, and amplitude and slope of slow waves were found in the spectrum of benign epilepsy with centro-temporal spikes. Moreover, children with benign epilepsy with centro-temporal spikes had a reduced non-rapid eye movement sleep instability, in terms of cyclic alternating pattern, similar to that found in children with attention-deficit hyperactivity disorders and in children with obstructive sleep apnea and centro-temporal spike during sleep. Children with benign epilepsy with centro-temporal spikes have a known comorbidity with attention-deficit hyperactivity disorders and obstructive sleep apnea.Conclusion: Considering the common sleep microstructure alterations, the presence of attention deficit and hyperactivity and/or sleep apnea may be a considered warning sign in the case of benign epilepsy with centro-temporal spikes. What is Known: • Sleep related-cognitive deficits have been described in the spectrum of benign epilepsy with centro-temporal spikes. The degree of sleep alterations may predict the neurocognitive outcome, and help clinicians to choose the right treatment. What is New: • Considering the common sleep microstructure alterations, attention deficit and sleep apnea, may be a considered warning signs.
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36
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Pavlidis E, Møller RS, Nikanorova M, Kölmel MS, Stendevad P, Beniczky S, Tassinari CA, Rubboli G, Gardella E. Idiopathic encephalopathy related to status epilepticus during slow sleep (ESES) as a "pure" model of epileptic encephalopathy. An electroclinical, genetic, and follow-up study. Epilepsy Behav 2019; 97:244-252. [PMID: 31254844 DOI: 10.1016/j.yebeh.2019.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of the study was to investigate electroclinical and neuropsychological features, genetic background, and evolution of children with idiopathic encephalopathy with status epilepticus during slow sleep (ESES), including Landau-Kleffner syndrome (LKS). MATERIAL AND METHODS All children diagnosed with idiopathic ESES at the Danish Epilepsy Centre between March 2003 and December 2014 were retrospectively reviewed. Repeated 24-hour electroencephalography (24-h EEG) recordings, neuropsychological assessments, and clinical-neurological evaluation were performed throughout the follow-up in all patients. In 13 children, genetic investigations were performed. RESULTS We collected 24 children (14 males and 10 females). Mean age at ESES diagnosis was 6 years, and mean ESES duration was 2 years and 7 months. Twenty-one children had epileptic seizures. Three children had LKS. Topography of sleep-related EEG epileptic abnormalities was diffuse in 3 subjects, hemispheric in 6, multifocal in 9, and focal in 6. During the active phase of ESES, all children presented with a heterogeneous combination of behavioral and cognitive disturbances. In 14 children, a parallel between severity of the clinical picture and spike-wave index (SWI) was observed. We could not find a strict correlation between the type and severity of neurobehavioral impairment and the side/topography of sleep-related EEG discharges during the active phase of ESES. At the last follow-up, 21 children were in remission from ESES. Complete recovery from neurobehavioral disorders was observed in 5 children. Genetic assessment, performed in 13 children, showed GRIN2A variant in two (15.4%). SIGNIFICANCE Our patients with idiopathic ESES showed a heterogeneous pattern of epileptic seizures, neurobehavioral disorders, and sleep EEG features. Only one-fourth of children completely recovered from the neuropsychological disturbances after ESES remission. Lack of correlation between severity/type of cognitive derangement and SWI and/or topography of sleep EEG epileptic abnormalities may suggest the contribution of additional factors (including impaired sleep homeostasis due to epileptic activity) in the neurobehavioral derangement that characterize ESES.
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Affiliation(s)
- Elena Pavlidis
- Danish Epilepsy Centre - Filadelfia, Dianalund, Denmark; Child Neuropsychiatry Unit, Department of Neuroscience, University of Parma, Parma, Italy; Child Neuropsychiatry Service of Carpi, Mental Health Department, AUSL Modena, Carpi, Italy.
| | - Rikke S Møller
- Danish Epilepsy Centre - Filadelfia, Dianalund, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marina Nikanorova
- Danish Epilepsy Centre - Filadelfia, Dianalund, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Pia Stendevad
- Danish Epilepsy Centre - Filadelfia, Dianalund, Denmark
| | - Sandor Beniczky
- Danish Epilepsy Centre - Filadelfia, Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Guido Rubboli
- Danish Epilepsy Centre - Filadelfia, Dianalund, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Elena Gardella
- Danish Epilepsy Centre - Filadelfia, Dianalund, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Fattinger S, Heinzle BB, Ramantani G, Abela L, Schmitt B, Huber R. Closed-Loop Acoustic Stimulation During Sleep in Children With Epilepsy: A Hypothesis-Driven Novel Approach to Interact With Spike-Wave Activity and Pilot Data Assessing Feasibility. Front Hum Neurosci 2019; 13:166. [PMID: 31164813 PMCID: PMC6536690 DOI: 10.3389/fnhum.2019.00166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
Slow waves, the electroencephalographic (EEG) hallmark of deep sleep, can be systematically manipulated by acoustic stimulation: stimulation time-locked to the down phase of slow waves reduces, whereas stimulation time-locked to the up phase increases slow waves. Spike-waves during sleep seem to be related to slow waves, raising the question of whether spike-waves can be systematically influenced by such acoustic stimulation. In five pediatric patients, all-night EEG was recorded, combined with real-time slow wave detection. Throughout the night, acoustic stimulation was performed in a 3 × 5-min-block design (no stimulation—stimulation—no stimulation). Tones were applied time-locked either to the up or to the down phase of the detected slow waves in an alternating pattern. All patients tolerated the acoustic stimulation during sleep well. They showed high sleep quality and no signs of clinical or non-convulsive electrographic seizures. Our preliminary analysis shows no systematic effect of acoustic stimulation on spike-wave activity. Moreover, with our stimulation approach tones were distributed over a rather broad phase-range during the DOWN or UP stimulation and showed inter-individual differences in their distribution. In this study, we applied for the first time an acoustic closed-loop slow wave stimulation tool for a non-invasive manipulation of spike-wave activity. Thus, our pilot data show that closed-loop acoustic stimulation is feasible and well tolerated in children with spike wave activity during sleep. Improved precision in phase targeting and personalized stimulation parameters in a larger sample of subjects might be needed to show systematic effects.
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Affiliation(s)
- Sara Fattinger
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bigna Bölsterli Heinzle
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Georgia Ramantani
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lucia Abela
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bernhard Schmitt
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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38
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Moehlman TM, de Zwart JA, Chappel-Farley MG, Liu X, McClain IB, Chang C, Mandelkow H, Özbay PS, Johnson NL, Bieber RE, Fernandez KA, King KA, Zalewski CK, Brewer CC, van Gelderen P, Duyn JH, Picchioni D. All-night functional magnetic resonance imaging sleep studies. J Neurosci Methods 2019; 316:83-98. [PMID: 30243817 PMCID: PMC6524535 DOI: 10.1016/j.jneumeth.2018.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/08/2018] [Accepted: 09/17/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Previous functional magnetic resonance imaging (fMRI) sleep studies have been hampered by the difficulty of obtaining extended amounts of sleep in the sleep-adverse environment of the scanner and often have resorted to manipulations such as sleep depriving subjects before scanning. These manipulations limit the generalizability of the results. NEW METHOD The current study is a methodological validation of procedures aimed at obtaining all-night fMRI data in sleeping subjects with minimal exposure to experimentally induced sleep deprivation. Specifically, subjects slept in the scanner on two consecutive nights, allowing the first night to serve as an adaptation night. RESULTS/COMPARISON WITH EXISTING METHOD(S) Sleep scoring results from simultaneously acquired electroencephalography data on Night 2 indicate that subjects (n = 12) reached the full spectrum of sleep stages including slow-wave (M = 52.1 min, SD = 26.5 min) and rapid eye movement (REM, M = 45.2 min, SD = 27.9 min) sleep and exhibited a mean of 2.1 (SD = 1.1) nonREM-REM sleep cycles. CONCLUSIONS It was found that by diligently applying fundamental principles and methodologies of sleep and neuroimaging science, performing all-night fMRI sleep studies is feasible. However, because the two nights of the study were performed consecutively, some sleep deprivation from Night 1 as a cause of the Night 2 results is likely, so consideration should be given to replicating the current study with a washout period. It is envisioned that other laboratories can adopt the core features of this protocol to obtain similar results.
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Affiliation(s)
- Thomas M Moehlman
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA
| | - Jacco A de Zwart
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA
| | - Miranda G Chappel-Farley
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA
| | - Xiao Liu
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA; Department of Biomedical Engineering, Pennsylvania State University, USA
| | - Irene B McClain
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, USA
| | - Catie Chang
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA; Department of Electrical Engineering and Computer Science, Vanderbilt University, USA
| | - Hendrik Mandelkow
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA
| | - Pinar S Özbay
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA
| | - Nicholas L Johnson
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA
| | - Rebecca E Bieber
- Audiology Unit, National Institute on Deafness and Other Communication Disorders, USA
| | - Katharine A Fernandez
- Section on Sensory Cell Biology, National Institute on Deafness and Other Communication Disorders, USA
| | - Kelly A King
- Audiology Unit, National Institute on Deafness and Other Communication Disorders, USA
| | | | - Carmen C Brewer
- Audiology Unit, National Institute on Deafness and Other Communication Disorders, USA
| | - Peter van Gelderen
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA
| | - Jeff H Duyn
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA
| | - Dante Picchioni
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, USA; Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, USA.
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Mohammadi M, kowkabi S, Asadi-Pooya AA, Malamiri RA, Badv RS. Hemi-ESES associated with agenesis of the corpus callosum and normal cognition. EPILEPSY & BEHAVIOR CASE REPORTS 2019; 11:96-98. [PMID: 30834195 PMCID: PMC6384300 DOI: 10.1016/j.ebcr.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/24/2022]
Abstract
Corpus callosum plays the important role in bilateral synchronous expression of focal discharges of ESES. Sparing dominant hemisphere form continuous spike and slow waves during sleep accounts for normal cognitive scores. Early detection and treatment of ESES have a great impact on cognitive and language scores and final prognosis.
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Affiliation(s)
- Mahmoud Mohammadi
- Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Safoura kowkabi
- Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author at: Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali A. Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Azizi Malamiri
- Department of Pediatric Neurology, Golestan Medical, Educational and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Shervin Badv
- Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
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Halász P, Ujma PP, Fabó D, Bódizs R, Szűcs A. Epilepsy as a derailment of sleep plastic functions may cause chronic cognitive impairment - A theoretical review. Sleep Med Rev 2019; 45:31-41. [PMID: 30878843 DOI: 10.1016/j.smrv.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/31/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
We report on a peculiar way of chronic cognitive impairment associated with interictal epileptic activity during NREM sleep. We review three major groups of epilepsy: mesiotemporal epilepsy (MTLE) involving the epileptic derailment of the hippocampal declarative memory system; childhood developmental epileptic encephalopathies; and the spectrum disorders of the perisylvian communication network with the centrotemporal spike phenomenon, overarching child- and adulthood epilepsies, totaling up the majority of epilepsies in childhood. We outline high impact research-lines on the cognitive harm of epilepsy; causing specific or global cognitive decline through its interference with sleep plastic functions. We highlight the key role of interictal activity in the development of cognitive impairment and the fact that we are unarmed against this harm, antiepileptic pharmaco-therapy being ineffective against the interictal process marked by spikes and high frequency oscillations.
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Affiliation(s)
- Péter Halász
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary.
| | - Péter Przemyslaw Ujma
- Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Róbert Bódizs
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary; Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Anna Szűcs
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary; Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
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41
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Halász P, Kelemen A, Rosdy B, Rásonyi G, Clemens B, Szűcs A. Perisylvian epileptic network revisited. Seizure 2019; 65:31-41. [DOI: 10.1016/j.seizure.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022] Open
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Halász P, Bódizs R, Ujma PP, Fabó D, Szűcs A. Strong relationship between NREM sleep, epilepsy and plastic functions - A conceptual review on the neurophysiology background. Epilepsy Res 2019; 150:95-105. [PMID: 30712997 DOI: 10.1016/j.eplepsyres.2018.11.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/08/2018] [Accepted: 11/15/2018] [Indexed: 12/15/2022]
Abstract
The aim of this review is to summarize and discuss the strong bond between NREM sleep and epilepsy underlain by the shared link and effect on brain plasticity. Beyond the seizure occurrence rate, sleep relatedness may manifest in the enhancement of interictal epileptic discharges (spikes and pathological ripples). The number of the discharges as well as their propagation increase during NREM sleep, unmasking the epileptic network that is hidden during wakefulness. The interictal epileptic discharges associate with different sleep constituents (sleep slow waves, spindling and high frequency oscillations); known to play essential role in memory and learning. We highlight three major groups of epilepsies, in which sleep-related plastic functions suffer an epileptic derailment. In absence epilepsy mainly involving the thalamo-cortical system, sleep spindles transform to generalized spike-wave activity. In mesio-temporal epilepsy affecting the hippocampal declarative memory system, the sharp wave ripples derail to dysfunctional epileptic oscillations (spikes and pathological ripples). Idiopathic childhood epilepsies affecting the perisylvian network may progress to catastrophic status electricus during NREM sleep. In these major epilepsies, NREM sleep has a pivotal role in the development and course of the disorder. Epilepsy is born in-, and exhibits its pathological properties during NREM sleep. Interictal discharges are important causative agents in this process.
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Affiliation(s)
- Péter Halász
- National Institute of Clinical Neuroscience, Amerikai út 57. Budapest, H-1145, Hungary.
| | - Róbert Bódizs
- Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Péter Przemyslaw Ujma
- Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neuroscience, Amerikai út 57. Budapest, H-1145, Hungary
| | - Anna Szűcs
- National Institute of Clinical Neuroscience, Amerikai út 57. Budapest, H-1145, Hungary
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Systad S, Bjørnvold M, Sørensen C, Lyster SAH. The Value of Electroencephalogram in Assessing Children With Speech and Language Impairments. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:153-168. [PMID: 30950754 DOI: 10.1044/2018_jslhr-l-17-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose We sought to estimate the prevalence of isolated epileptiform activity (IEA) in children with speech and language impairments and discuss the utility of an electroencephalogram (EEG) in assessing these children. Method We conducted a systematic review and searched for eligible studies in 8 databases. All languages were included, and meta-analyses were performed. Results We found 55 prevalence estimates (8 with control group). The odds of having IEA were 6 times greater for children with speech and language impairments than for typically developing children. The overall pooled prevalence of IEA was 27.3%. A wide variation between the prevalence estimates was, to a certain degree, explained by type of impairment (8.1% in speech impairments, 25.8% in language impairments, and 51.5% in language regression). Sleep EEGs detected a significantly higher prevalence than awake EEGs. Although the presence of epilepsy gave a significantly higher prevalence than if epilepsy was not present, 33.5% of children with language impairment but without epilepsy were found to have IEA in sleep EEGs. Conclusions This systematic review shows that IEA is 6 times more prevalent in children with speech and language impairment than in typically developing children. However, the prevalence rates vary to a great extent. Uncovering IEA will, in addition to information from other clinical assessments, provide a more comprehensive understanding of the child's impairments. We argue that, although EEG is of questionable value when assessing children with speech impairments, sleep EEG could be valuable when assessing children with language impairments and, in particular, children who experience language regression.
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Affiliation(s)
- Silje Systad
- Department of Special Needs Education, University of Oslo, Norway
- Solberg School, Akershus County, Norway
| | - Marit Bjørnvold
- Department of Refractory Epilepsy-SSE, Oslo University Hospital, Norway
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Mathieu ML, de Bellescize J, Till M, Flurin V, Labalme A, Chatron N, Sanlaville D, Chemaly N, des Portes V, Ostrowsky K, Arzimanoglou A, Lesca G. Electrical status epilepticus in sleep, a constitutive feature of Christianson syndrome? Eur J Paediatr Neurol 2018; 22:1124-1132. [PMID: 30126759 DOI: 10.1016/j.ejpn.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 06/25/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
Christianson syndrome (CS) is a X-linked neurodevelopmental disorder, including severe intellectual disability (ID), progressive microcephaly, ataxia, autistic behaviour (ASD), near absent speech, and epilepsy. Electrical status epilepticus in sleep (ESES) has been reported in two patients. We describe five male patients from three unrelated families with Christianson syndrome caused by a pathogenic nucleotide variation or a copy-number variation involving SLC9A6. ESES was present in three out of the five patients in the critical age window between 4 and 8 years. All patients presented with severe intellectual disability, autistic features, and hyperactivity. Epilepsy onset occurred within the first two years of life. Seizures were of various types. In the two boys with a 20-years follow-up, epilepsy was drug-resistant during childhood, and became less active in early adolescence. Psychomotor regression was noted in two patients presenting with ESES. It was difficult to assess to what extent ESES could have contributed to the pathophysiological process, leading to regression of the already very limited communication skills. The two published case reports and our observation suggests that ESES could be a constitutive feature of Christianson syndrome, as it has already been shown for other Mendelian epileptic disorders, such as GRIN2A and CNKSR2-related developmental epileptic encephalopathies. Sleep EEG should be performed in patients with Christianson syndrome between 4 and 8 years of age. ESES occurring in the context of ID, ASD and severe speech delay, could be helpful to make a diagnosis of CS.
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Affiliation(s)
- Marie-Laure Mathieu
- Neuropaediatrics Department, Femme Mère Enfant Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Julitta de Bellescize
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France
| | - Marianne Till
- Department of Medical Genetics, Lyon University Hospital, Lyon, France
| | - Vincent Flurin
- Department of Paediatric Intensive Care, Le Mans Hospital, Le Mans, France
| | - Audrey Labalme
- Department of Medical Genetics, Lyon University Hospital, Lyon, France
| | - Nicolas Chatron
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France
| | - Damien Sanlaville
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France
| | - Nicole Chemaly
- Reference Centre for Rare Epilepsies, APHP, Necker-Enfants Malades Hospital, Imagine Institute, Paris, France; INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif sur Yvette, France
| | - Vincent des Portes
- Neuropaediatrics Department, Femme Mère Enfant Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Karine Ostrowsky
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France; DYCOG Team, Lyon Neuroscience Research Centre (CRNL), INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Gaëtan Lesca
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France.
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Neuropsychological Outcome in Perinatal Stroke Associated With Epileptiform Discharges in Sleep. Can J Neurol Sci 2018; 44:358-365. [PMID: 28767035 DOI: 10.1017/cjn.2017.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with arterial perinatal stroke often suffer long-term motor sequelae, difficulties in language, social development, and behaviour as well as epilepsy. Despite homogeneous lesions, long-term behavioural and cognitive outcomes are variable and unpredictable. Sleep-related epileptic encephalopathies can occur after early brain injury and are associated with global developmental delays. We hypothesized that sleep-potentiated epileptiform abnormalities are associated with worse developmental outcomes after perinatal stroke. METHODS Participants were identified from a population-based cohort (Alberta Perinatal Stroke Project). Inclusion criteria were magnetic resonance imaging-confirmed arterial perinatal stroke, age 4 to 18 years, electroencephalogram (EEG) including sleep, and comprehensive neuropsychological evaluation. Sleep-related EEG abnormalities were categorized by an epileptologist blinded to the cognitive outcome. Associations between EEG classification and neuropsychological outcomes were explored (t tests, Bonferroni correction for multiple comparisons). RESULTS Of 128 potentially eligible participants, 34 (53% female) had complete EEG (mean age, 8.1 years; range, 0.2-16.4) and neuropsychology testing (mean age, 9.8 years; range 4.4-16.7). Twelve (35%) were classified as having electrical status epilepticus in sleep. Patients with abnormal EEGs were more likely to have statistically worse scores when corrected for multiple comparisons, in receptive language (median, 1st percentile; IQR 1-7th percentile; p<0.05), and externalizing behaviours (median, 82nd percentile; IQR, 79-97th percentile; p<0.05). CONCLUSIONS Developmental outcome in language and behaviour in children with arterial perinatal stroke is associated with electrical status epilepticus in sleep. Increased screening with sleep EEG is suggested, whereas further studies are necessary to determine if treatment of EEG abnormalities can improve outcome.
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Danhofer P, Pejčochová J, Dušek L, Rektor I, Ošlejšková H. The influence of EEG-detected nocturnal centrotemporal discharges on the expression of core symptoms of ADHD in children with benign childhood epilepsy with centrotemporal spikes (BCECTS): A prospective study in a tertiary referral center. Epilepsy Behav 2018; 79:75-81. [PMID: 29253678 DOI: 10.1016/j.yebeh.2017.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/02/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
Abstract
Benign childhood epilepsy with centrotemporal spikes (BCECTS) is the most frequent benign focal epilepsy in childhood. Although it is described as a benign epilepsy syndrome, many studies have revealed that a significant number of patients have some degree of neuropsychological impairment. Thirty-two patients with BCECTS aged 6-11years were included in the study. All patients (without any antiepileptic or psychiatric medication) underwent all-night EEG monitoring and complex neuropsychological testing to diagnose the presence of core symptoms of attention-deficit/hyperactivity disorder (ADHD). The spike index (number of spikes per minute) on awake and asleep EEG, age at seizure onset, family history of epilepsy, and perinatal risks were correlated with the results of neuropsychological testing. Of the 32 patients, 21 patients (65.6%) fulfilled the criteria for ADHD diagnosis. Children who were younger at epilepsy onset demonstrated lower IQ and higher attention deficit (P=0.004) and higher impulsivity (P=0.016). The occurence of epileptiform discharges on nocturnal EEG was positively related to higher attention deficit and higher impulsivity. The findings are discussed in terms of how interictal discharges in the centrotemporal region during sleep affect the development of cognitive functions in children during critical epochs of neuropsychological development.
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Affiliation(s)
- Pavlína Danhofer
- Brno Epilepsy Center, Department of Pediatric Neurology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Jana Pejčochová
- Brno Epilepsy Center, Department of Pediatric Neurology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Ladislav Dušek
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Ivan Rektor
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic.
| | - Hana Ošlejšková
- Brno Epilepsy Center, Department of Pediatric Neurology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Treatment of electrical status epilepticus in sleep: Clinical and EEG characteristics and response to 147 treatments in 47 patients. Eur J Paediatr Neurol 2018; 22:64-71. [PMID: 29128194 DOI: 10.1016/j.ejpn.2017.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 08/11/2017] [Accepted: 08/26/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Electrical status epilepticus in sleep (ESES) syndrome is characterized by near-continuous sleep-induced epileptiform activity and acquired cognitive deficits. Treatment is assumed mandatory to improve cognitive outcome. We aimed to compare EEG characteristics, subjective evaluation and objective neuropsychological assessment as measures to evaluate treatment efficacy, and to analyze possible predictors. METHODS We retrospectively included patients with ESES syndrome treated in our center. Treatment effect was analyzed on sleep EEG spike wave index (SWI) and cognitive functioning. RESULTS 47 patients had 147 (43 steroid and 104 non-steroid) treatments. Cognitive improvement was reported after 36% of treatments at first follow-up and 45% of treatments at last follow-up. The median SWI change for treatments resulting in subjective cognitive improvement was -44%, and 0% for those not resulting in subjective cognitive improvement at first follow-up (p = 0.008) and -50% vs. +5% at last follow-up (p = 0.002). No clear association between subjective cognitive improvement and IQ change, and between SWI and IQ change was found. By means of logistic regression we found that steroid treatment, as compared to non-steroid treatment, was associated with cognitive improvement at first follow-up (multivariate OR after multiple imputation 2.5, 95% CI 1.1-5.7), while at last follow-up, higher age at diagnosis was related to cognitive improvement only in univariate analysis (OR 1.02, 95% CI 1.01-1.04). CONCLUSIONS We found that in children with ESES, cognitive improvement after treatment was strongly associated with SWI decrease, while it was not reflected by a significant IQ increase. Steroid treatment was most successful in improving cognitive performance.
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Bölsterli BK, Gardella E, Pavlidis E, Wehrle FM, Tassinari CA, Huber R, Rubboli G. Remission of encephalopathy with status epilepticus (ESES) during sleep renormalizes regulation of slow wave sleep. Epilepsia 2017; 58:1892-1901. [DOI: 10.1111/epi.13910] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Bigna K. Bölsterli
- Division of Clinical Neurophysiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
| | - Elena Gardella
- Department of Clinical Neurophysiology; Danish Epilepsy Center; Dianalund Denmark
- University of Southern Denmark; Odense Denmark
| | - Elena Pavlidis
- Danish Epilepsy Center; Dianalund Denmark
- Child Neuropsychiatry Unit; Department of Neuroscience; University of Parma; Parma Italy
| | - Flavia M. Wehrle
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
| | | | - Reto Huber
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy; Psychiatric Hospital; University of Zurich; Zurich Switzerland
| | - Guido Rubboli
- Danish Epilepsy Center; Filadelfia/University of Copenhagen; Copenhagen Denmark
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Pellegrino G, Tombini M, Curcio G, Campana C, Di Pino G, Assenza G, Tomasevic L, Di Lazzaro V. Slow Activity in Focal Epilepsy During Sleep and Wakefulness. Clin EEG Neurosci 2017; 48:200-208. [PMID: 27287223 DOI: 10.1177/1550059416652055] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We aimed to test differences between healthy subjects and patients with respect to slow wave activity during wakefulness and sleep. METHODS Fifteen patients affected by nonlesional focal epilepsy originating within temporal areas and fourteen matched controls underwent a 24-hour EEG recording. We studied the EEG power spectral density during wakefulness and sleep in delta (1-4 Hz), theta (5-7 Hz), alpha (8-11 Hz), sigma (12-15 Hz), and beta (16-20 Hz) bands. RESULTS During sleep, patients with focal epilepsy showed higher power from delta to beta frequency bands compared with controls. The effect was widespread for alpha band and above, while localized over the affected hemisphere for delta (sleep cycle 1, P = .006; sleep cycle 2, P = .008; sleep cycle 3, P = .017). The analysis of interhemispheric differences showed that the only frequency band stronger over the affected regions was the delta band during the first 2 sleep cycles (sleep cycle 1, P = .014; sleep cycle 2, P = .002). During wakefulness, patients showed higher delta/theta activity over the affected regions compared with controls. CONCLUSIONS Patients with focal epilepsy showed a pattern of power increases characterized by a selective slow wave activity enhancement over the epileptic regions during daytime and sleep. This phenomenon was stronger and asymmetric during the first sleep cycles.
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Affiliation(s)
- Giovanni Pellegrino
- 1 Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,2 Fondazione Alberto Sordi-Research Institute for Ageing, Rome, Italy.,3 Multimodal Functional Imaging Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Mario Tombini
- 1 Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,2 Fondazione Alberto Sordi-Research Institute for Ageing, Rome, Italy
| | - Giuseppe Curcio
- 4 Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Chiara Campana
- 1 Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,2 Fondazione Alberto Sordi-Research Institute for Ageing, Rome, Italy
| | - Giovanni Di Pino
- 1 Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,2 Fondazione Alberto Sordi-Research Institute for Ageing, Rome, Italy
| | - Giovanni Assenza
- 1 Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,2 Fondazione Alberto Sordi-Research Institute for Ageing, Rome, Italy
| | - Leo Tomasevic
- 5 Danish Research Center for Magnetic Resonance (DRCMR), Hvidovre, Denmark
| | - Vincenzo Di Lazzaro
- 1 Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,2 Fondazione Alberto Sordi-Research Institute for Ageing, Rome, Italy
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Boly M, Jones B, Findlay G, Plumley E, Mensen A, Hermann B, Tononi G, Maganti R. Altered sleep homeostasis correlates with cognitive impairment in patients with focal epilepsy. Brain 2017; 140:1026-1040. [PMID: 28334879 DOI: 10.1093/brain/awx017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 12/20/2016] [Indexed: 11/13/2022] Open
Abstract
In animal studies, both seizures and interictal spikes induce synaptic potentiation. Recent evidence suggests that electroencephalogram slow wave activity during sleep reflects synaptic potentiation during wake, and that its homeostatic decrease during the night is associated with synaptic renormalization and its beneficial effects. Here we asked whether epileptic activity induces plastic changes that can be revealed by high-density electroencephalography recordings during sleep in 15 patients with focal epilepsy and 15 control subjects. Compared to controls, patients with epilepsy displayed increased slow wave activity power during non-rapid eye movement sleep over widespread, bilateral scalp regions. This global increase in slow wave activity power was positively correlated with the frequency of secondarily generalized seizures in the 3-5 days preceding the recordings. Individual patients also showed local increases in sleep slow wave activity power at scalp locations matching their seizure focus. This local increase in slow wave activity power was positively correlated with the frequency of interictal spikes during the last hour of wakefulness preceding sleep. By contrast, frequent interictal spikes during non-rapid eye movement sleep predicted a reduced homeostatic decrease in the slope of sleep slow waves during the night, which in turn predicted reduced daytime learning. Patients also showed an increase in sleep spindle power, which was negatively correlated with intelligence quotient. Altogether, these findings suggest that both seizures and interictal spikes may induce long-lasting changes in the human brain that can be sensitively detected by electroencephalographic markers of sleep homeostasis. Furthermore, abnormalities in sleep markers are correlated with cognitive impairment, suggesting that not only seizures, but also interictal spikes can have negative consequences.
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Affiliation(s)
- Melanie Boly
- Department of Neurology, University of Wisconsin, Madison, USA.,Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Benjamin Jones
- Department of Neurology, University of Wisconsin, Madison, USA.,Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Graham Findlay
- Department of Neurology, University of Wisconsin, Madison, USA.,Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Erin Plumley
- Department of Neurology, University of Wisconsin, Madison, USA
| | - Armand Mensen
- Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin, Madison, USA
| | - Guilio Tononi
- Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Rama Maganti
- Department of Neurology, University of Wisconsin, Madison, USA
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