1
|
Rautela RS, Gulabani M, Kumar P, Salhotra R, Mohta M, Verma K. Comparative assessment of dexmedetomidine and butorphanol for attenuation of etomidate-induced myoclonus: A double-blind, randomised controlled study. Indian J Anaesth 2023; 67:815-820. [PMID: 37829775 PMCID: PMC10566664 DOI: 10.4103/ija.ija_414_23] [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: 05/08/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 10/14/2023] Open
Abstract
Background and Aims Etomidate is a popular induction agent, but its use is associated with myoclonus in 50%-80% of non-premedicated patients. This study aims to compare dexmedetomidine and butorphanol for their relative efficacy in preventing etomidate-induced myoclonus. Methods This randomised study was conducted after obtaining institutional ethical committee clearance and written informed consent from sixty American Society of Anesthesiologists (ASA) I or II consenting patients between 18 and 60 years of age of either sex who had been scheduled for elective surgeries under general anaesthesia. Patients were randomly allocated to dexmedetomidine 0.5 μg/kg (Group D) or butorphanol 0.015 mg/kg (Group B). Both the drugs were given as an infusion over a period of 10 min before induction of anaesthesia. The primary outcome was the incidence of myoclonic movements after etomidate, and the secondary outcomes were the severity of myoclonus, changes in the haemodynamic parameters and incidence of airway complications. Normally distributed variables were compared using Student's t-test, and non-normally distributed variables were compared using Mann-Whitney U test. Qualitative data were analysed using Chi-square/Fisher's exact test. A P-value <0.05 was considered significant. Results The incidence of etomidate-induced myoclonus was significantly higher in group B compared to group D (P = 0.035). The median (interquartile range [IQR]) of myoclonus grade in patients of group D was 0.00 (0.00-3.00), and group B was 2.50 (0.00-3.00) (P = 0.035). Haemodynamics and airway-related complications were comparable between the groups. Conclusion Dexmedetomidine was more effective than butorphanol in preventing etomidate-induced myoclonus.
Collapse
Affiliation(s)
- Rajesh S. Rautela
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Michell Gulabani
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Pramod Kumar
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Rashmi Salhotra
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Medha Mohta
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Kshitiz Verma
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| |
Collapse
|
2
|
Feng Y, Chang P, Kang Y, Liao P, Li CY, Liu J, Zhang WS. Etomidate-Induced Myoclonus in Sprague-Dawley Rats Involves Neocortical Glutamate Accumulation and N -Methyl- d -Aspartate Receptor Activity. Anesth Analg 2023; 137:221-233. [PMID: 36607803 DOI: 10.1213/ane.0000000000006292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Etomidate-induced myoclonus, a seizure-like movement, is of interest to anesthetists. However, its origin in the brain and its underlying mechanism remain unclear. METHODS Adult male Sprague-Dawley rats were anesthetized with etomidate, propofol, or lidocaine plus etomidate. We assessed the incidence of myoclonus, behavioral scores, and levels of glutamate and γ-aminobutyric acid (GABA) in the neocortex and hippocampus. To determine the origin and how N -methyl- d -aspartate receptors (NMDARs) modulate etomidate-induced neuroexcitability, the local field potential and muscular tension were monitored. Calcium imaging in vitro and immunoblotting in vivo were conducted to investigate the mechanisms underlying myoclonus. RESULTS The incidence of etomidate (1.5 mg/kg in vivo)-induced myoclonus was higher than that of propofol (90% vs 10%, P = .0010) and lidocaine plus etomidate (90% vs 20%, P = .0050). Etomidate at doses of 3.75 and 6 mg/kg decreased the mean behavioral score at 1 (mean difference [MD]: 1.80, 95% confidence interval [CI], 0.58-3.02; P = .0058 for both), 2 (MD: 1.60, 95% CI, 0.43-2.77; P = .0084 and MD: 1.70, 95% CI, 0.54-2.86; P = .0060), 3 (MD: 1.60, 95% CI, 0.35-2.85; P = .0127 and MD: 1.70, 95% CI, 0.46-2.94; P = .0091) minutes after administration compared to etomidate at a dose of 1.5 mg/kg. In addition, 0.5 and 1 µM etomidate in vitro increased neocortical intracellular calcium signaling; this signaling decreased when the concentration increased to 5 and 10 μM. Etomidate increased the glutamate level compared to propofol (mean rank difference: 18.20; P = .003), and lidocaine plus etomidate (mean rank difference: 21.70; P = .0002). Etomidate in vivo activated neocortical ripple waves and was positively correlated with muscular tension amplitude (Spearman's r = 0.785, P < .0001). Etomidate at 1.5 mg/kg decreased the K-Cl cotransporter isoform 2 (KCC2) level compared with propofol (MD: -1.15, 95% CI, -1.47 to -0.83; P < .0001) and lidocaine plus etomidate (MD: -0.64, 95% CI, -0.96 to -0.32; P = .0002), DL-2-amino-5-phosphopentanoic acid (AP5) suppressed these effects, while NMDA enhanced them. CONCLUSIONS Etomidate-induced myoclonus or neuroexcitability is concentration dependent. Etomidate-induced myoclonus originates in the neocortex. The underlying mechanism involves neocortical glutamate accumulation and NMDAR modulation and myoclonus correlates with NMDAR-induced downregulation of KCC2 protein expression.
Collapse
Affiliation(s)
- Yan Feng
- From the Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pan Chang
- From the Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Kang
- From the Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ping Liao
- From the Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chen-Yang Li
- From the Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jin Liu
- From the Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wen-Sheng Zhang
- From the Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| |
Collapse
|
3
|
Li X, Zhang H, Lai H, Wang J, Wang W, Yang X. High-Frequency Oscillations and Epileptogenic Network. Curr Neuropharmacol 2022; 20:1687-1703. [PMID: 34503414 PMCID: PMC9881061 DOI: 10.2174/1570159x19666210908165641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022] Open
Abstract
Epilepsy is a network disease caused by aberrant neocortical large-scale connectivity spanning regions on the scale of several centimeters. High-frequency oscillations, characterized by the 80-600 Hz signals in electroencephalography, have been proven to be a promising biomarker of epilepsy that can be used in assessing the severity and susceptibility of epilepsy as well as the location of the epileptogenic zone. However, the presence of a high-frequency oscillation network remains a topic of debate as high-frequency oscillations have been previously thought to be incapable of propagation, and the relationship between high-frequency oscillations and the epileptogenic network has rarely been discussed. Some recent studies reported that high-frequency oscillations may behave like networks that are closely relevant to the epileptogenic network. Pathological highfrequency oscillations are network-driven phenomena and elucidate epileptogenic network development; high-frequency oscillations show different characteristics coincident with the epileptogenic network dynamics, and cross-frequency coupling between high-frequency oscillations and other signals may mediate the generation and propagation of abnormal discharges across the network.
Collapse
Affiliation(s)
- Xiaonan Li
- Bioland Laboratory, Guangzhou, China; ,Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | | | | | - Jiaoyang Wang
- Bioland Laboratory, Guangzhou, China; ,Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Wei Wang
- Bioland Laboratory, Guangzhou, China; ,Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Xiaofeng Yang
- Bioland Laboratory, Guangzhou, China; ,Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China,Address correspondence to this author at the Bioland Laboratory, Guangzhou, China; Tel: 86+ 18515855127; E-mail:
| |
Collapse
|
4
|
Tewari A, Mahmoud M, Rose D, Ding L, Tenney J. Intravenous dexmedetomidine sedation for magnetoencephalography: A retrospective study. Paediatr Anaesth 2020; 30:799-805. [PMID: 32436319 DOI: 10.1111/pan.13925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/13/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Magnetoencephalography (MEG) plays a preponderant role in the preoperative assessment of patients with drug-resistant epilepsy (DRE). However, the magnetoencephalography of patients with drug-resistant epilepsy can be difficult without sedation and/or general anesthesia. Our objective is to describe our experience with intravenous dexmedetomidine as sedation for magnetoencephalography and its effect, if any, on the ability to recognize epileptic spikes. METHODS In this retrospective study, we reviewed the records of 89 children who presented for Magnetoencephalography/electroencephalography (EEG) scans between August of 2008 and May of 2015. Data analyzed included demographics and the frequency of epileptic spikes. Sedated magnetoencephalography recordings were compared to nonsedated video-electroencephalography (vEEG) recordings in the same patients to determine the impact of dexmedetomidine. RESULTS Spike frequency between magnetoencephalography with sedation and video-electroencephalography without sedation was compared in 85 patients. Magnetoencephalography and video-electroencephalography were considered clinically concordant in 80 patients (94.1%) and discordant in 5 patients (5.9%), all with less spikes during Magnetoencephalography. The median (range) bolus dose of dexmedetomidine was 2 (1-2) mcg/kg. The median (range) infusion rate of dexmedetomidine was 2 (0.5-4) mcg/kg/h. All patients experienced reductions in heart rate after administration of dexmedetomidine; these reductions were statistically, but not clinically, significant. CONCLUSIONS Our results suggest that dexmedetomidine-based protocol provides reliable sedation in children undergoing MEG scanning because of the high success rate, limited interictal artifacts, and minimal impacts on spike frequency.
Collapse
Affiliation(s)
- Anurag Tewari
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mohamed Mahmoud
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Douglas Rose
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey Tenney
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
5
|
Gulati P, Jain P, Lou Smith M, Kerr E, Muthusami P, Shroff M, Whitney R, Carter Snead O, Go C. Reliability and safety of Etomidate speech test in children with drug resistant focal epilepsy. Epilepsy Res 2019; 156:106150. [PMID: 31239182 DOI: 10.1016/j.eplepsyres.2019.106150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/18/2019] [Accepted: 06/09/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To review our experience with the Etomidate speech test (EST) for lateralizing language in children undergoing epilepsy surgery evaluation METHODS: This retrospective study included children (<18 years) with drug refractory focal epilepsy undergoing EST for bilateral or poorly reliable language representation on functional MRI. Data for consecutive children who underwent EST between January 2013 to June 2017 were reviewed. RESULTS Twenty-one children (mean age at EST, 13.1 ± 4.4 years) were studied, with 19-right hemispheric and 20 left hemispheric injections. Six patients had neurological co-morbidities. Duration of ipsilateral EEG slowing was sufficient for speech testing in all children with a single bolus of Etomidate per carotid artery. Language was lateralized to one hemisphere in 17 (80.9%) and bilateral in two cases. EST was unsuccessful in two patients because of diffuse EEG slowing. Contralateral transient frontal EEG slowing was seen in 14 (73.7%) cases. EST was well tolerated in all the patients. CONCLUSIONS The EST was found to be successful and safe in lateralizing language in most of our drug refractory pediatric epilepsy cohort.
Collapse
Affiliation(s)
- Pratima Gulati
- Pratima Gulati, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - Puneet Jain
- Pratima Gulati, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada; Division of Pediatric Neurology, Department of Pediatrics, BL Kapur (BLK) Super Speciality Hospital, Pusa Road, New Delhi 110005 India.
| | - Mary Lou Smith
- Mary Lou Smith, Division of Neurology, The Hospital for Sick Children, Department of Psychology, University of Toronto, Ontario, M5G1X8, Canada.
| | - Elizabeth Kerr
- Division of Neurology, Department of Psychology, University of Toronto, M5G1X8, Ontario, Canada.
| | - Prakash Muthusami
- Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - Manohar Shroff
- Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - Robyn Whitney
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - O Carter Snead
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| | - Cristina Go
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada.
| |
Collapse
|
6
|
Abstract
BACKGROUND Epilepsy is a serious brain disorder characterized by recurrent unprovoked seizures. Approximately two-thirds of seizures can be controlled with antiepileptic medications (Kwan 2000). For some of the others, surgery can completely eliminate or significantly reduce the occurrence of disabling seizures. Localization of epileptogenic areas for resective surgery is far from perfect, and new tools are being investigated to more accurately localize the epileptogenic zone (the zone of the brain where the seizures begin) and improve the likelihood of freedom from postsurgical seizures. Recordings of pathological high-frequency oscillations (HFOs) may be one such tool. OBJECTIVES To assess the ability of HFOs to improve the outcomes of epilepsy surgery by helping to identify more accurately the epileptogenic areas of the brain. SEARCH METHODS For the latest update, we searched the Cochrane Epilepsy Group Specialized Register (25 July 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO, 25 July 2016), MEDLINE (Ovid, 1946 to 25 July 2016), CINAHL Plus (EBSCOhost, 25 July 2016), Web of Science (Thomson Reuters, 25 July 2016), ClinicalTrials.gov (25 July 2016), and the World Health Organization International Clinical Trials Registry Platform ICTRP (25 July 2016). SELECTION CRITERIA We included studies that provided information on the outcomes of epilepsy surgery for at least six months and which used high-frequency oscillations in making decisions about epilepsy surgery. DATA COLLECTION AND ANALYSIS The primary outcome of the review was the Engel Class Outcome System (class I = no disabling seizures, II = rare disabling seizures, III = worthwhile improvement, IV = no worthwhile improvement). Secondary outcomes were responder rate, International League Against Epilepsy (ILAE) epilepsy surgery outcome, frequency of adverse events from any source and quality of life outcomes. We intended to analyse outcomes via an aggregated data fixed-effect model meta-analysis. MAIN RESULTS Two studies representing 11 participants met the inclusion criteria. Both studies were small non-randomised trials, with no control group and no blinding. The quality of evidence for all outcomes was very low. The combination of these two studies resulted in 11 participants who prospectively used ictal HFOs for epilepsy surgery decision making. Results of the postsurgical seizure freedom Engel class I to IV outcome were determined over a period of 12 to 38 months (average 23.4 months) and indicated that six participants had an Engel class I outcome (seizure freedom), two had class II (rare disabling seizures), three had class III (worthwhile improvement). No adverse effects were reported. Neither study compared surgical results guided by HFOs versus surgical results guided without HFOs. AUTHORS' CONCLUSIONS No reliable conclusions can be drawn regarding the efficacy of using HFOs in epilepsy surgery decision making at present.
Collapse
Affiliation(s)
- David Gloss
- Charleston Area Medical CenterCAMC Neurology415 Morris StSuite 300CharlestonUSAWV 25301
| | - Sarah J Nevitt
- University of LiverpoolDepartment of BiostatisticsBlock F, Waterhouse Building1‐5 Brownlow HillLiverpoolUKL69 3GL
| | - Richard Staba
- University of CaliforniaDepartment of NeurologyReed Neurologic Research Center710 Westwood Plaza, Suite 1‐250Los AngelesCaliforniaUSA90095
| | | |
Collapse
|
7
|
Frauscher B, Bartolomei F, Kobayashi K, Cimbalnik J, van 't Klooster MA, Rampp S, Otsubo H, Höller Y, Wu JY, Asano E, Engel J, Kahane P, Jacobs J, Gotman J. High-frequency oscillations: The state of clinical research. Epilepsia 2017; 58:1316-1329. [PMID: 28666056 DOI: 10.1111/epi.13829] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 01/03/2023]
Abstract
Modern electroencephalographic (EEG) technology contributed to the appreciation that the EEG signal outside the classical Berger frequency band contains important information. In epilepsy, research of the past decade focused particularly on interictal high-frequency oscillations (HFOs) > 80 Hz. The first large application of HFOs was in the context of epilepsy surgery. This is now followed by other applications such as assessment of epilepsy severity and monitoring of antiepileptic therapy. This article reviews the evidence on the clinical use of HFOs in epilepsy with an emphasis on the latest developments. It highlights the growing literature on the association between HFOs and postsurgical seizure outcome. A recent meta-analysis confirmed a higher resection ratio for HFOs in seizure-free versus non-seizure-free patients. Residual HFOs in the postoperative electrocorticogram were shown to predict epilepsy surgery outcome better than preoperative HFO rates. The review further discusses the different attempts to separate physiological from epileptic HFOs, as this might increase the specificity of HFOs. As an example, analysis of sleep microstructure demonstrated a different coupling between HFOs inside and outside the epileptogenic zone. Moreover, there is increasing evidence that HFOs are useful to measure disease activity and assess treatment response using noninvasive EEG and magnetoencephalography. This approach is particularly promising in children, because they show high scalp HFO rates. HFO rates in West syndrome decrease after adrenocorticotropic hormone treatment. Presence of HFOs at the time of rolandic spikes correlates with seizure frequency. The time-consuming visual assessment of HFOs, which prevented their clinical application in the past, is now overcome by validated computer-assisted algorithms. HFO research has considerably advanced over the past decade, and use of noninvasive methods will make HFOs accessible to large numbers of patients. Prospective multicenter trials are awaited to gather information over long recording periods in large patient samples.
Collapse
Affiliation(s)
- Birgit Frauscher
- Department of Medicine and Center for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Fabrice Bartolomei
- National Institute of Health and Medical Research, Institute of Neurosciences of Systems, Aix Marseille University, Marseille, France
| | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Jan Cimbalnik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Maryse A van 't Klooster
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Hiroshi Otsubo
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yvonne Höller
- Department of Neurology, Christian Doppler Medical Center and Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Joyce Y Wu
- Division of Pediatric Neurology, Mattel Children's Hospital at UCLA, Los Angeles, California, U.S.A
| | - Eishi Asano
- Departments of Pediatrics and Neurology, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, U.S.A
| | - Jerome Engel
- Departments of Neurology, Neurobiology, and Psychiatry, Brain Research Institute, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Philippe Kahane
- Department of Neurology, Grenoble-Alpes University Hospital and Grenoble-Alpes University, Grenoble, France
| | - Julia Jacobs
- Department of Neuropediatrics and Muscular Diseases, University Medical Center Freiburg, Freiburg, Germany
| | - Jean Gotman
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
8
|
Etomidate: A Complementary Diagnostic Tool for Pre-Surgical Evaluation in Temporal Lobe Epilepsy. ARCHIVES OF NEUROSCIENCE 2016. [DOI: 10.5812/archneurosci.34915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
9
|
Greiner HM, Horn PS, Tenney JR, Arya R, Jain SV, Holland KD, Leach JL, Miles L, Rose DF, Fujiwara H, Mangano FT. Preresection intraoperative electrocorticography (ECoG) abnormalities predict seizure-onset zone and outcome in pediatric epilepsy surgery. Epilepsia 2016; 57:582-9. [DOI: 10.1111/epi.13341] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Hansel M. Greiner
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Paul S. Horn
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Jeffrey R. Tenney
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Ravindra Arya
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Sejal V. Jain
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Katherine D. Holland
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - James L. Leach
- Division of Neuroradiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Lili Miles
- Division of Pathology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Douglas F. Rose
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Hisako Fujiwara
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Francesco T. Mangano
- Division of Pediatric Neurosurgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| |
Collapse
|
10
|
Vega-Zelaya L, Pastor J, Tormo I, de Sola RG, Ortega GJ. Assessing the equivalence between etomidate and seizure network dynamics in temporal lobe epilepsy. Clin Neurophysiol 2015; 127:169-178. [PMID: 26070516 DOI: 10.1016/j.clinph.2015.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/09/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Etomidate mimics some typical epileptic neurophysiological features, such as the appearance of spikes and high frequency oscillations, when it is administrated to epileptic patients. However, little is known about its influence on the underlying cortical network. An assessment of comparable cortical dynamics between seizures and etomidate would allow for a more detailed study of the network parameters underlying the ictal stage by using etomidate as a proxy. The objective of the present work is to show that temporal lobe seizures produce network changes comparable to the ones elicited by etomidate administration. METHODS Scalp and foramen ovale electrodes (FOE) recordings from nine temporal lobe epilepsy patients were analyzed under the complex network perspective. The clustering coefficients, average path lengths, density of links, modularity and spectral entropy were calculated during the pre-ictal and ictal stages and post-etomidate administration. Etomidate administration produced no seizure in any of the analyzed cases. RESULTS The density of lines (six of nine patients) and spectral entropy (eight of nine patients) displayed similar behavior to the preictal-ictal transition when etomidate effects altered the epileptic network (FOE+scalp). When considering only the mesial sub-network, changes induced by etomidate perfusion replicated the same type of imbalance observed during the ictal stage in the nine patient's sample and in eight out of nine regarding the preictal stage. Both statistical significance at a level of 1% and size effects, evaluated by using the standardized mean differences, show similar network changes during the preictal-ictal and preictal-etomidate transitions. CONCLUSIONS Etomidate perfusion in patients with temporal lobe epilepsy induces network changes comparable to the changes resulting from seizures. SIGNIFICANCE The finding reported here could improve the study of network dynamics during the ictal phase, not only with electrophysiological methods, but also in other cases, such as functional magnetic resonance imaging.
Collapse
Affiliation(s)
- Lorena Vega-Zelaya
- Clinical Neurophysiology, Hospital Universitario de la Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, Spain
| | - Jesús Pastor
- Clinical Neurophysiology, Hospital Universitario de la Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, Spain
| | - Isabel Tormo
- Clinical Neurophysiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Rafael G de Sola
- Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, Spain
| | - Guillermo J Ortega
- Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, Spain.
| |
Collapse
|
11
|
Leiken K, Xiang J, Zhang F, Shi J, Tang L, Liu H, Wang X. Magnetoencephalography detection of high-frequency oscillations in the developing brain. Front Hum Neurosci 2014; 8:969. [PMID: 25566015 PMCID: PMC4264504 DOI: 10.3389/fnhum.2014.00969] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/13/2014] [Indexed: 11/13/2022] Open
Abstract
Increasing evidence from invasive intracranial recordings suggests that the matured brain generates both physiological and pathological high-frequency signals. The present study was designed to detect high-frequency brain signals in the developing brain using newly developed magnetoencephalography (MEG) methods. Twenty healthy children were studied with a high-sampling rate MEG system. Functional high-frequency brain signals were evoked by electrical stimulation applied to the index fingers. To determine if the high-frequency neuromagnetic signals are true brain responses in high-frequency range, we analyzed the MEG data using the conventional averaging as well as newly developed time-frequency analysis along with beamforming. The data of healthy children showed that very high-frequency brain signals (>1000 Hz) in the somatosensory cortex in the developing brain could be detected and localized using MEG. The amplitude of very high-frequency brain signals was significantly weaker than that of the low-frequency brain signals. Very high-frequency brain signals showed a much earlier latency than those of a low-frequency. Magnetic source imaging (MSI) revealed that a portion of the high-frequency signals was from the somatosensory cortex, another portion of the high-frequency signals was probably from the thalamus. Our results provide evidence that the developing brain generates high-frequency signals that can be detected with the non-invasive technique of MEG. MEG detection of high-frequency brain signals may open a new window for the study of developing brain function.
Collapse
Affiliation(s)
- Kimberly Leiken
- Department of Pediatrics, Magnetoencephalography (MEG) Center, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA ; Department of Neurology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA
| | - Jing Xiang
- Department of Pediatrics, Magnetoencephalography (MEG) Center, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA ; Department of Neurology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA
| | - Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati , Cincinnati, OH , USA
| | - Jingping Shi
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University , Jiangsu , China
| | - Lu Tang
- Department of Pediatrics, Magnetoencephalography (MEG) Center, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA ; Department of Neurology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA ; Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University , Jiangsu , China
| | - Hongxing Liu
- Department of Pediatrics, Magnetoencephalography (MEG) Center, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA ; Department of Neurology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA ; Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University , Jiangsu , China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University , Jiangsu , China
| |
Collapse
|
12
|
|
13
|
Abstract
BACKGROUND Epilepsy is a serious brain disorder characterized by recurrent unprovoked seizures. Approximately two-thirds of seizures can be controlled with antiepileptic medications (Kwan 2000). For some of the others, surgery can completely eliminate or significantly reduce the occurrence of disabling seizures. Localization of epileptogenic areas for resective surgery is far from perfect, and new tools are being investigated to more accurately localize the epileptogenic zone (the zone of the brain where the seizures begin) and improve the likelihood of freedom from postsurgical seizures. Recordings of pathological high-frequency oscillations (HFOs) may be one such tool. OBJECTIVES To assess the ability of HFOs to improve the outcomes of epilepsy surgery by helping to identify more accurately the epileptogenic areas of the brain. SEARCH METHODS We searched the Cochrane Epilepsy Group Specialized Register (15 April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 3), MEDLINE (Ovid) (1946 to 15 April 2013), CINAHL (EBSCOhost) (15 April 2013), Web of Knowledge (Thomson Reuters) (15 April 2013), www.clinicaltrials.gov (15 April 2013), and the World Health Organization International Clinical Trials Registry Platform (15 April 2013). SELECTION CRITERIA We included studies that provided information on the outcomes of epilepsy surgery at at least six months and which used high-frequency oscillations in making decisions about epilepsy surgery. DATA COLLECTION AND ANALYSIS The primary outcome of the review was the Engel Class Outcome System. Secondary outcomes were responder rate, International League Against Epilepsy (ILAE) epilepsy surgery outcome, frequency of adverse events from any source and quality of life outcomes. We intended to analyse outcomes via an aggregated data fixed-effect model meta-analysis. MAIN RESULTS Two studies met the inclusion criteria. Both studies were small non-randomised trials, with no control group and no blinding. The quality of evidence for all outcomes was very low. The combination of these two studies resulted in 11 participants who prospectively used ictal HFOs for epilepsy surgery decision making. Results of the postsurgical seizure freedom Engel class I to IV outcome were determined over a period of 12 to 38 months (average 23.4 months) and indicated that six participants had an Engel class I outcome (seizure freedom), two had class II (rare disabling seizures), three had class III (worthwhile improvement). No adverse effects were reported. Neither study compared surgical results guided by HFOs versus surgical results guided without HFOs. AUTHORS' CONCLUSIONS No reliable conclusions can be drawn regarding the efficacy of using HFOs in epilepsy surgery decision making at present.
Collapse
Affiliation(s)
| | - Sarah J Nolan
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Richard Staba
- Department of Neurology, University of California, Los Angeles, California, USA
| |
Collapse
|