1
|
Posar A, Visconti P. Continuous Spike-Waves during Slow Sleep Today: An Update. CHILDREN (BASEL, SWITZERLAND) 2024; 11:169. [PMID: 38397281 PMCID: PMC10887038 DOI: 10.3390/children11020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
In the context of childhood epilepsy, the concept of continuous spike-waves during slow sleep (CSWS) includes several childhood-onset heterogeneous conditions that share electroencephalograms (EEGs) characterized by a high frequency of paroxysmal abnormalities during sleep, which have negative effects on the cognitive development and behavior of the child. These negative effects may have the characteristics of a clear regression or of a slowdown in development. Seizures are very often present, but not constantly. The above makes it clear why CSWS have been included in epileptic encephalopathies, in which, by definition, frequent EEG paroxysmal abnormalities have an unfavorable impact on cognitive functions, including socio-communicative skills, causing autistic features, even regardless of the presence of clinically overt seizures. Although several decades have passed since the original descriptions of the electroclinical condition of CSWS, there are still many areas that are little-known and deserve to be further studied, including the EEG diagnostic criteria, the most effective electrophysiological parameter for monitoring the role of the thalamus in CSWS pathogenesis, its long-term evolution, the nosographic location of Landau-Kleffner syndrome, standardized neuropsychological and behavioral assessments, and pharmacological and non-pharmacological therapies.
Collapse
Affiliation(s)
- Annio Posar
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Disturbi dello Spettro Autistico, 40139 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, Bologna University, 40139 Bologna, Italy
| | - Paola Visconti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Disturbi dello Spettro Autistico, 40139 Bologna, Italy;
| |
Collapse
|
2
|
DÜZKALIR HG, GENÇ B, SAĞER SG, TÜRKYILMAZ A, GÜNBEY HP. Microstructural evaluation of the brain with advanced magnetic resonance imaging techniques in cases of electrical status epilepticus during sleep (ESES). Turk J Med Sci 2023; 53:1840-1851. [PMID: 38813507 PMCID: PMC10760578 DOI: 10.55730/1300-0144.5754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/12/2023] [Accepted: 10/25/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim The cause and treatment of electrical status epilepticus during sleep (ESES), one of the epileptic encephalopathies of childhood, is unclear. The aim of this study was to evaluate possible microstructural abnormalities in the brain using advanced magnetic resonance imaging (MRI) techniques in ESES patients with and without genetic mutations. Materials and methods This research comprised 12 ESES patients without structural thalamic lesions (6 with genetic abnormalities and 6 without) and 12 healthy children. Whole-exome sequencing was used for the genetic mutation analysis. Brain MRI data were evaluated using tractus-based spatial statistics, voxel-based morphometry, a local gyrification index, subcortical shape analysis, FreeSurfer volume, and cortical thickness. The data of the groups were compared. Results The mean age in the control group was 9.05 ± 1.85 years, whereas that in the ESES group was 9.45 ± 2.72 years. Compared to the control group, the ESES patients showed higher mean thalamus diffusivity (p < 0.05). ESES patients with genetic mutations had lower axial diffusivity in the superior longitudinal fasciculus and gray matter volume in the entorhinal region, accumbens area, caudate, putamen, cerebral white matter, and outer cerebellar areas. The superior and middle temporal cortical thickness increased in the ESES patients. Conclusion This study is important in terms of presenting the microstructural evaluation of the brain in ESES patients with advanced MRI analysis methods as well as comparing patients with and without genetic mutations. These findings may be associated with corticostriatal transmission, ictogenesis, epileptogenesis, neuropsychiatric symptoms, cognitive impairment, and cerebellar involvement in ESES. Expanded case-group studies may help to understand the physiology of the corticothalamic circuitry in its etiopathogenesis and develop secondary therapeutic targets for ESES.
Collapse
Affiliation(s)
| | - Barış GENÇ
- Department of Radiology, Samsun Education and Research Hospital, Samsun,
Turkiye
| | - Safiye Güneş SAĞER
- Department of Pediatric Neurology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul,
Turkiye
| | - Ayberk TÜRKYILMAZ
- Department of Medical Genetics, Faculty of Medicine, Karadeniz Technical University, Trabzon,
Turkiye
| | - Hediye Pınar GÜNBEY
- Department of Radiology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul,
Turkiye
| |
Collapse
|
3
|
Chinappen DM, Ostrowski LM, Spencer ER, Kwon H, Kramer MA, Hämäläinen MS, Chu CJ. Decreased thalamocortical connectivity in resolved Rolandic epilepsy. Clin Neurophysiol 2023; 153:21-27. [PMID: 37419052 PMCID: PMC10520846 DOI: 10.1016/j.clinph.2023.05.013] [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: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Median nerve somatosensory evoked fields (SEFs) conduction times reflect the integrity of neural transmission across the thalamocortical circuit. We hypothesized median nerve SEF conduction time would be abnormal in children with Rolandic epilepsy (RE). METHODS 22 children with RE (10 active; 12 resolved) and 13 age-matched controls underwent structural and diffusion MRI and median nerve and visual stimulation during magnetoencephalography (MEG). N20 SEF responses were identified in contralateral somatosensory cortices. P100 were identified in contralateral occipital cortices as controls. Conduction times were compared between groups in linear models controlling for height. N20 conduction time was also compared to thalamic volume and Rolandic thalamocortical structural connectivity inferred using probabilistic tractography. RESULTS The RE group had slower N20 conduction compared to controls (p = 0.042, effect size 0.6 ms) and this difference was driven by the resolved RE group (p = 0.046). There was no difference in P100 conduction time between groups (p = 0.83). Ventral thalamic volume positively correlated with N20 conduction time (p = 0.014). CONCLUSIONS Children with resolved RE have focally decreased Rolandic thalamocortical connectivity. SIGNIFICANCE These results identify a persistent focal thalamocortical circuit abnormality in resolved RE and suggest that decreased Rolandic thalamocortical connectivity may support symptom resolution in this self-limited epilepsy.
Collapse
Affiliation(s)
- Dhinakaran M Chinappen
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Graduate Program in Neuroscience, Boston University, Boston, MA 02215, USA.
| | - Lauren M Ostrowski
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA
| | - Elizabeth R Spencer
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Graduate Program in Neuroscience, Boston University, Boston, MA 02215, USA
| | - Hunki Kwon
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA
| | - Mark A Kramer
- Department of Mathematics and Statistics and Center for Systems Neuroscience, Boston University, Boston, MA 02215, USA
| | - Matti S Hämäläinen
- Massachusetts General Hospital, Department of Radiology, Boston, MA 02114, USA; Athinoula A, Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Catherine J Chu
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA.
| |
Collapse
|
4
|
Sager G, Takis G, Vatansever Pinar Z, Duzkalir H, Turkyilmaz A, Çağ Y, Akin Y. Evaluation of long-term neurocognitive functions in patients with epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS)/epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS). Neurophysiol Clin 2023; 53:102861. [PMID: 37058916 DOI: 10.1016/j.neucli.2023.102861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/18/2023] [Accepted: 03/19/2023] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVES Epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS) or the newly named Epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS) is a syndrome in which epileptiform abnormalities are associated with the progressive impairment of cognitive functions. This study aimed to evaluate the neurocognitive executive functions of patients at later ages and determine the long-term prognosis of the condition, as well as the factors affecting this. METHODS This is a hospital-based cross-sectional study of 17 patients with a diagnosis of CSWS, and a minimum age of 7.5 years. The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was used for neurocognitive assessment. The use of immunotherapy (intravenous immunoglobulin and/or steroid for at least 6 months) at the time of initial diagnosis, baseline activity and spike wave index (SWI) of the last wake and sleep EEG, cranial MRI findings, active epileptic seizures since the last examination, and WISC-IV parameters were statistically compared. The results of patients with genetic etiology determined by the whole exome sequencing (WES) method are also reported. RESULTS A total of 17 patients were included in the study, with a mean age of 10.30 ± 3.15 years (range from 7.9 to 15.8 years). The mean full scale IQ score of the subjects was 61.41 ± 17.81 (range 39-91), classified as follows: 5.9% (n = 1), average; 23.5% (n = 4), low average; 5.9% (n = 1), very low; 35.3% (n = 6), extremely low (upper range); 29.4% (n = 5), extremely low (lower range) intelligence. Among the four domains of WISC-IV, the most affected index was the Working Memory Index (WMI). EEG parameters, cranial MRI findings and treatment with immunotherapy did not have a significant effect on neurocognitive outcomes. Thirteen patients (76%) were evaluated with WES for a genetic etiology. Pathogenic variants in 5 different genes (GRIN2A, SLC12A5, SCN1A, SCN8A, ADGRV1) associated with epilepsy were detected in 5/13 patients (38%). CONCLUSION These results indicated that neurocognition is highly affected in the long term in CSWS.
Collapse
Affiliation(s)
- Gunes Sager
- Department of Pediatric Neurology, University of Health Sciences, Kartal Dr. LutfiKirdar City Hospital, Istanbul, Turkey.
| | - Gulnur Takis
- Specialized Psychologist, Medeniyet University, Istanbul, Turkey
| | - Zeynep Vatansever Pinar
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Kartal Dr. LutfiKirdar City Hospital, Istanbul, Turkey
| | - Hanife Duzkalir
- Department of Radiology, University of Health Sciences, Kartal Dr. LutfiKirdar City Hospital, Istanbul, Turkey
| | - Ayberk Turkyilmaz
- Department of Medical Genetics, KaradenizTechical University Faculty of Medicine, Trabzon, Turkey
| | - Yakup Çağ
- Department of Pediatrics, University of Health Sciences, Kartal Dr. LutfiKirdar City Hospital, Istanbul, Turkey
| | - Yasemin Akin
- Department of Pediatrics, University of Health Sciences, Kartal Dr. LutfiKirdar City Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW To review the mutual interactions between sleep and epilepsy, including mechanisms of epileptogenesis, the relationship between sleep apnea and epilepsy, and potential strategies to treat seizures. RECENT FINDINGS Recent studies have highlighted the role of functional network systems underlying epileptiform activation in sleep in several epilepsy syndromes, including absence epilepsy, benign focal childhood epilepsy, and epileptic encephalopathy with spike-wave activation in sleep. Sleep disorders are common in epilepsy, and early recognition and treatment can improve seizure frequency and potentially reduce SUDEP risk. Additionally, epilepsy is associated with cyclical patterns, which has led to new treatment approaches including chronotherapy, seizure monitoring devices, and seizure forecasting. Adenosine kinase and orexin receptor antagonists are also promising new potential drug targets that could be used to treat seizures. Sleep and epilepsy have a bidirectional relationship that intersects with many aspects of clinical management. In this article, we identify new areas of research involving future therapeutic opportunities in the field of epilepsy.
Collapse
|
6
|
Kwon H, Chinappen DM, Huang JF, Berja ED, Walsh KG, Shi W, Kramer MA, Chu CJ. Transient, developmental functional and structural connectivity abnormalities in the thalamocortical motor network in Rolandic epilepsy. NEUROIMAGE: CLINICAL 2022; 35:103102. [PMID: 35777251 PMCID: PMC9251597 DOI: 10.1016/j.nicl.2022.103102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
Children with active Rolandic epilepsy have increasing thalamocortical functional connectivity in the motor circuit with age. Children with resolved Rolandic epilepsy have increasing thalamocortical structural connectivity in the motor circuit with age. Children with Rolandic epilepsy have no differences in thalamocortical connectivity in the sensory circuit compared to controls. Rolandic thalamocortical structural connectivity does not predict functional connectivity in Rolandic epilepsy or controls.
Rolandic epilepsy (RE) is the most common focal, idiopathic, developmental epilepsy, characterized by a transient period of sleep-potentiated seizures and epileptiform discharges in the inferior Rolandic cortex during childhood. The cause of RE remains unknown but converging evidence has identified abnormalities in the Rolandic thalamocortical circuit. To better localize this transient disease, we evaluated Rolandic thalamocortical functional and structural connectivity in the sensory and motor circuits separately during the symptomatic and asymptomatic phases of this disease. We collected high resolution structural, diffusion, and resting state functional MRI data in a prospective cohort of children with active RE (n = 17), resolved RE (n = 21), and controls (n = 33). We then computed the functional and structural connectivity between the inferior Rolandic cortex and the ventrolateral (VL) nucleus of the thalamus (efferent pathway) and the ventroposterolateral (VPL) nucleus of the thalamus (afferent pathway) across development in children with active, resolved RE and controls. We compared connectivity with age in each group using linear mixed-effects models. We found that children with active RE have increasing thalamocortical functional connectivity between the VL thalamus and inferior motor cortex with age (p = 0.022) that is not observed in controls or resolved RE. In contrast, children with resolved RE have increasing thalamocortical structural connectivity between the VL nucleus and the inferior motor cortex with age (p = 0.025) that is not observed in controls or active RE. No relationships were identified between VPL nuclei and the inferior sensory cortex with age in any group. These findings localize the functional and structural thalamocortical circuit disruption in RE to the efferent thalamocortical motor pathway. Further work is required to determine how these circuit abnormalities contribute to the emergence and resolution of symptoms in this developmental disease.
Collapse
Affiliation(s)
- Hunki Kwon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Dhinakaran M Chinappen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Jonathan F Huang
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Erin D Berja
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Katherine G Walsh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Wen Shi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mark A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA; Center for Systems Neuroscience, Boston University, Boston, MA, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
7
|
Kilic H, Yilmaz K, Asgarova P, Kizilkilic O, Hatay GH, Ozturk-Isik E, Yalcinkaya C, Saltik S. Electrical status epilepticus in sleep: The role of thalamus in etiopathogenesis. Seizure 2021; 93:44-50. [PMID: 34687985 DOI: 10.1016/j.seizure.2021.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In patients diagnosed with epilepsy, decreased ratio of N-acetyl aspartate to creatine (NAA/Cr) measured in magnetic resonance spectroscopy (MRS) has been accepted as a sign of neuronal cell loss or dysfunction. In this study, we aimed to determine whether a similar neuronal cell loss is present in a group of encephalopathy with electrical status epilepticus in sleep (ESES) patients METHODS: We performed this case-control study at a tertiary pediatric neurology center with patients with ESES. Inclusion criteria for the patient group were as follows: 1) a spike-wave index of at least 50%, 2) acquired neuropsychological regression, 3) normal cranial MRI. Eventually, a total of 21 patients with ESES and 17 control subjects were enrolled in the study. MRI of all control subjects was also within normal limits. 3D Slicer program was used for the analysis of thalamic and brain volumes. LCModel spectral fitting software was used to analyze single-voxel MRS data from the right and left thalamus of the subjects. RESULTS The mean age was 8.0 ± 1.88 years and 8.3 ± 1.70 years in ESES patients and the control subjects. After correcting for the main potential confounders (age and gender) with a linear regression model, NAA/Creatine ratio of the right thalamus was significantly lower in the ESES patient group compared to the healthy control group (p = 0.026). Likewise, the left thalamus NAA/Cr ratio was significantly lower in the ESES patient group than the healthy control group (p = 0.007). After correcting for age and gender, right thalamic volume was not statistically significantly smaller in ESES patients than in healthy controls (p = 0.337), but left thalamic volume was smaller in ESES patients than in healthy controls (p = 0.024). CONCLUSION In ESES patients, the NAA/Creatine ratio, which is an indicator of neuronal cell loss or dysfunction in the right and left thalamus, which appears regular on MRI, was found to be significantly lower than the healthy control group. This metabolic-induced thalamic dysfunction, which was reported for the first time up to date, may play a role in ESES epileptogenesis.
Collapse
Affiliation(s)
- Huseyin Kilic
- Department of Pediatric Neurology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Kubra Yilmaz
- Department of Pediatric Neurology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Parvana Asgarova
- Department of Neuroradiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Neuroradiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gokçe Hale Hatay
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Esin Ozturk-Isik
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Cengiz Yalcinkaya
- Department of Neurology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sema Saltik
- Department of Pediatric Neurology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
8
|
Drees M, Kulkarni N, Vidaurre J. Electrical Status Epilepticus during Sleep and Evaluating the Electroencephalogram. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0041-1731412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractElectrical status epilepticus during sleep (ESES) is an age-related, self-limited epileptic encephalopathy characterized by heterogeneous clinical manifestations and a specific electroencephalographic pattern of continuous spikes and waves during slow sleep. The etiology of ESES is not completely clear, although structural brain lesions, abnormal immunological markers, and genetic mutations have been associated with the syndrome. ESES was first described in 1971 and since then, the diagnostic criteria have changed multiple times. Additionally, inconsistency between authors in how to record and evaluate the electroencephalogram also leads to variability between studies. These inconsistencies hamper objectivity, comparison, and generalization. Because of this, one of the first priorities of physicians treating this condition should be defining the parameters of this disease so that cooperative building can occur.
Collapse
Affiliation(s)
- Michael Drees
- Department of Pediatric Neurology, Nationwide Children's Hospital, Tipp City, Ohio, United States
| | - Neil Kulkarni
- Department of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, United States
| | - Jorge Vidaurre
- Department of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, United States
| |
Collapse
|
9
|
Successful Hemispherotomy in a Patient with Encephalopathy with Continuous Spikes and Waves during Sleep Related to Neonatal Thalamic Hemorrhage: A Case Report with Intracranial Electroencephalogram Findings. Brain Sci 2021; 11:brainsci11070827. [PMID: 34206592 PMCID: PMC8301857 DOI: 10.3390/brainsci11070827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 11/17/2022] Open
Abstract
Neonatal thalamic hemorrhage is a strong risk factor for developing encephalopathy with continuous spikes and waves during sleep (ECSWS), even when not accompanied by widespread cortical destruction. The efficacy and indication of resective epilepsy surgery in such patients has not yet been reported. A 4-year-old boy was diagnosed with ECSWS based on strong epileptiform activation during sleep and neurocognitive deterioration. He had a history of left thalamic hemorrhage related to a straight sinus thrombosis during the newborn period. He presented with daily absence seizures that were refractory to medical treatment. At age 5, he underwent intracranial electroencephalogram (EEG) recording using depth and subdural strip electrodes placed in the left thalamus and over bilateral cortex, respectively. Interictal and ictal epileptiform discharges were observed in the thalamus, always preceded by discharges in the left or right parietal lobe. Left hemispherotomy successfully normalized the EEG of his unaffected hemisphere and extinguished his seizures. This is the first case report documenting resective epilepsy surgery in a patient with ECSWS due to neonatal thalamic injury without widespread cerebral destruction. Based on intracranial EEG findings, his injured thalamus did not directly generate the EEG abnormalities or absence seizures on its own. Patients with ipsilateral neonatal thalamic injury and even mild lateralized cortical changes may be candidates for resective or disconnective surgery for ECSWS.
Collapse
|
10
|
Li Q, Westover MB, Zhang R, Chu CJ. Computational Evidence for a Competitive Thalamocortical Model of Spikes and Spindle Activity in Rolandic Epilepsy. Front Comput Neurosci 2021; 15:680549. [PMID: 34220477 PMCID: PMC8249809 DOI: 10.3389/fncom.2021.680549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/12/2021] [Indexed: 11/24/2022] Open
Abstract
Rolandic epilepsy (RE) is the most common idiopathic focal childhood epilepsy syndrome, characterized by sleep-activated epileptiform spikes and seizures and cognitive deficits in school age children. Recent evidence suggests that this disease may be caused by disruptions to the Rolandic thalamocortical circuit, resulting in both an abundance of epileptiform spikes and a paucity of sleep spindles in the Rolandic cortex during non-rapid eye movement sleep (NREM); electrographic features linked to seizures and cognitive symptoms, respectively. The neuronal mechanisms that support the competitive shared thalamocortical circuitry between pathological epileptiform spikes and physiological sleep spindles are not well-understood. In this study we introduce a computational thalamocortical model for the sleep-activated epileptiform spikes observed in RE. The cellular and neuronal circuits of this model incorporate recent experimental observations in RE, and replicate the electrophysiological features of RE. Using this model, we demonstrate that: (1) epileptiform spikes can be triggered and promoted by either a reduced NMDA current or h-type current; and (2) changes in inhibitory transmission in the thalamic reticular nucleus mediates an antagonistic dynamic between epileptiform spikes and spindles. This work provides the first computational model that both recapitulates electrophysiological features and provides a mechanistic explanation for the thalamocortical switch between the pathological and physiological electrophysiological rhythms observed during NREM sleep in this common epileptic encephalopathy.
Collapse
Affiliation(s)
- Qiang Li
- Medical Big Data Research Center, Northwest University, Xi'an, China
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - M. Brandon Westover
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Rui Zhang
- Medical Big Data Research Center, Northwest University, Xi'an, China
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
11
|
Arican P, Gencpinar P, Olgac Dundar N, Tekgul H. Electrical Status Epilepticus During Slow-wave Sleep (ESES): Current Perspectives. J Pediatr Neurosci 2021; 16:91-96. [PMID: 35018175 PMCID: PMC8706590 DOI: 10.4103/jpn.jpn_137_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
Electrical status epilepticus during slow-wave sleep (ESES) is an epilepsy syndrome with sleep-induced epileptic discharges and acquired impairment of cognition or behavior. Since the disease’s original description in 1971, no clear consensus has emerged on diagnostic criteria or optimal treatment. The treatment of ESES can be challenging, often including numerous antiepileptic drugs, immunomodulatory agents, and even surgical interventions. There is little evidence to guide treatment because only retrospective studies and case reports on the efficacy of treatment of ESES are present in literature. In this paper, we aim to analyze the etiopathogenesis of ESES in the new genetic era and to evaluate the treatment modalities in accordance with the genetic data and electroclinic spectrum of ESES.
Collapse
Affiliation(s)
- Pinar Arican
- Department of Pediatric Neurology, Kahramanmaraş Necip Fazil Hospital, Kahramanmaraş, Turkey
| | - Pinar Gencpinar
- Department of Pediatric Neurology, Izmir Katip Celebi University, Izmir, Turkey
| | - Nihal Olgac Dundar
- Department of Pediatric Neurology, Izmir Katip Celebi University, Izmir, Turkey
| | - Hasan Tekgul
- Department of Pediatric Neurology, Ege University, Izmır, Turkey
| |
Collapse
|
12
|
Reduced thalamic volume is strongly associated with electrical status epilepticus in sleep. Acta Neurol Belg 2021; 121:211-217. [PMID: 31456121 DOI: 10.1007/s13760-019-01202-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 08/20/2019] [Indexed: 01/19/2023]
Abstract
To identify the relationship between thalamic volume and electrical status epilepticus in sleep (ESES). We analyzed subcortical gray matter volumes in patients with an ESES pattern on their electroencephalographs. All magnetic resonance imaging scans were considered within normal limits. The patients were not receiving antiepileptic drug at the time of the MRI study. High resolution T1-weighted 3-dimensional MPRAGE scans were assessed for segmentation and quantitative volumetric analysis of the brain by using the "volBrain" method. After correcting for total brain volume, volumes were compared with a group of healthy controls (HCs) and patients with benign childhood epilepsy with centrotemporal spikes (BECTS). Fifteen patients with ESES, 15 patients with BECTS, and 30 HCs were included. The median age of the patients with ESES was 8.5 (range, 5.8-13) years, 8 (range, 5-14) years for the HCs, and 7.8 (range, 4-13.5) years for the patients with BECTS. The total relative thalamic volume was significantly lower in patients with ESES than in the healthy controls (0.87 ± 0.07 vs. 0.93 ± 0.03, p = 0.002), and in patients with ESES than in those with BECTS (0.87 ± 0.07 vs. 0.93 ± 0.03, p = 0.006). There was no significant difference the HCs and patients with BECTS (0.93 ± 0.03 vs. 0.93 ± 0.03, p = 0.999). Both right and left relative thalamic volumes were lower in patients with ESES than in HCs (right thalamus: 0.43 ± 0.04 vs. 0.46 ± 0.02, p = 0.003, left thalamus: 0.44 ± 0.03 vs. 0.47 ± 0.02, p = 0.002), in patients with ESES than in patients with BECTS (right thalamus: 0.43 ± 0.04 vs. 0.46 ± 0.01, p = 0.01, left thalamus: 0.43 ± 0.04 vs. 0.47 ± 0.01, p = 0.007); however, there was no significant difference between the HCs and patients with BECTS (right thalamus: 0.46 ± 0.02 vs. 0.46 ± 0.01, p = 0.999, left thalamus: 0.47 ± 0.02 vs. 0.47 ± 0.01, p = 0.999). This study highlights the association between thalamic involvement and ESES, even when not severe enough to cause a detectable lesion on visual interpretation of MRI.
Collapse
|
13
|
Focal Sleep Spindle Deficits Reveal Focal Thalamocortical Dysfunction and Predict Cognitive Deficits in Sleep Activated Developmental Epilepsy. J Neurosci 2021; 41:1816-1829. [PMID: 33468567 DOI: 10.1523/jneurosci.2009-20.2020] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 01/08/2023] Open
Abstract
Childhood epilepsy with centrotemporal spikes (CECTS) is the most common focal epilepsy syndrome, yet the cause of this disease remains unknown. Now recognized as a mild epileptic encephalopathy, children exhibit sleep-activated focal epileptiform discharges and cognitive difficulties during the active phase of the disease. The association between the abnormal electrophysiology and sleep suggests disruption to thalamocortical circuits. Thalamocortical circuit dysfunction resulting in pathologic epileptiform activity could hinder the production of sleep spindles, a brain rhythm essential for memory processes. Despite this pathophysiologic connection, the relationship between spindles and cognitive symptoms in epileptic encephalopathies has not been previously evaluated. A significant challenge limiting such work has been the poor performance of available automated spindle detection methods in the setting of sharp activities, such as epileptic spikes. Here, we validate a robust new method to accurately measure sleep spindles in patients with epilepsy. We then apply this detector to a prospective cohort of male and female children with CECTS with combined high-density EEGs during sleep and cognitive testing at varying time points of disease. We show that: (1) children have a transient, focal deficit in spindles during the symptomatic phase of disease; (2) spindle rate anticorrelates with spike rate; and (3) spindle rate, but not spike rate, predicts performance on cognitive tasks. These findings demonstrate focal thalamocortical circuit dysfunction and provide a pathophysiological explanation for the shared seizures and cognitive symptoms in CECTS. Further, this work identifies sleep spindles as a potential treatment target of cognitive dysfunction in this common epileptic encephalopathy.SIGNIFICANCE STATEMENT Childhood epilepsy with centrotemporal spikes is the most common idiopathic focal epilepsy syndrome, characterized by self-limited focal seizures and cognitive symptoms. Here, we provide the first evidence that focal thalamocortical circuit dysfunction underlies the shared seizures and cognitive dysfunction observed. In doing so, we identify sleep spindles as a mechanistic biomarker, and potential treatment target, of cognitive dysfunction in this common developmental epilepsy and provide a novel method to reliably quantify spindles in brain recordings from patients with epilepsy.
Collapse
|
14
|
Thorn EL, Ostrowski LM, Chinappen DM, Jing J, Westover MB, Stufflebeam SM, Kramer MA, Chu CJ. Persistent abnormalities in Rolandic thalamocortical white matter circuits in childhood epilepsy with centrotemporal spikes. Epilepsia 2020; 61:2500-2508. [PMID: 32944938 DOI: 10.1111/epi.16681] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/01/2020] [Accepted: 08/12/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Childhood epilepsy with centrotemporal spikes (CECTS) is a common, focal, transient, developmental epilepsy syndrome characterized by unilateral or bilateral, independent epileptiform spikes in the Rolandic regions of unknown etiology. Given that CECTS presents during a period of dramatic white matter maturation and thatspikes in CECTS are activated during non-rapid eye movement (REM) sleep, we hypothesized that children with CECTS would have aberrant development of white matter connectivity between the thalamus and the Rolandic cortex. We further tested whether Rolandic thalamocortical structural connectivity correlates with spike rate during non-REM sleep. METHODS Twenty-three children with CECTS (age = 8-15 years) and 19 controls (age = 7-15 years) underwent 3-T structural and diffusion-weighted magnetic resonance imaging and 72-electrode electroencephalographic recordings. Thalamocortical structural connectivity to Rolandic and non-Rolandic cortices was quantified using probabilistic tractography. Developmental changes in connectivity were compared between groups using bootstrap analyses. Longitudinal analysis was performed in four subjects with 1-year follow-up data. Spike rate was quantified during non-REM sleep using manual and automated techniques and compared to Rolandic connectivity using regression analyses. RESULTS Children with CECTS had aberrant development of thalamocortical connectivity to the Rolandic cortex compared to controls (P = .01), where the expected increase in connectivity with age was not observed in CECTS. There was no difference in the development of thalamocortical connectivity to non-Rolandic regions between CECTS subjects and controls (P = .19). Subjects with CECTS observed longitudinally had reductions in thalamocortical connectivity to the Rolandic cortex over time. No definite relationship was found between Rolandic connectivity and non-REM spike rate (P > .05). SIGNIFICANCE These data provide evidence that abnormal maturation of thalamocortical white matter circuits to the Rolandic cortex is a feature of CECTS. Our data further suggest that the abnormalities in these tracts do not recover, but are increasingly dysmature over time, implicating a permanent but potentially compensatory process contributing to disease resolution.
Collapse
Affiliation(s)
- Emily L Thorn
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Lauren M Ostrowski
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jin Jing
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Stufflebeam
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Mark A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Escobar Fernández L, Coccolo Góngora A, Vázquez López M, Polo Arrondo AP, Miranda Herrero MC, Barredo Valderrama E, Castro de Castro P. Continuous spike-waves during slow–wave sleep: Experience during 20 years. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
16
|
Escobar Fernández L, Coccolo Góngora A, Vázquez López M, Polo Arrondo AP, Miranda Herrero MC, Barredo Valderrama E, Castro de Castro P. [Continuous spike-waves during slow-wave sleep: Experience during 20 years]. An Pediatr (Barc) 2019; 91:180-188. [PMID: 30772272 DOI: 10.1016/j.anpedi.2018.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/15/2018] [Accepted: 12/19/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Continuous spikes and waves during slow sleep (CSWS) is an EEG pattern that appears during childhood, and is often associated with cognitive impairment. It can appear in the course of epileptic syndromes, as well as in benign epilepsy. The aim of this study is to analyse epidemiological and clinical characteristic of patients with CSWS, in order to describe possible predictive factors in their outcome. METHODS A retrospective study was conducted on paediatric patients with CSWS treated in a third-level hospital from November 1997 to November 2017. RESULTS The study included 25 patients (68% male), of whom 76% had abnormalities in the neuroimaging or suffered from psychomotor development disorder (secondary CSWS). The rest were healthy, or diagnosed with idiopathic epilepsy. The mean age of onset of CSWS was 6.7 years, but earlier in the secondary CSWS cases. Symptoms were present during the CSWS episode in 72% of cases. All of them were treated with antiepileptic drugs, which were effective in 36%. CSWS stopped in 72%, and remission was longer if the CSWS onset occurred at an older age. One-third (33%) presented with sequelae, mostly cognitive and behavioural alterations. Outcome was poorer in those with secondary CSWS and, in those whose CSWS started at an earlier age and lasted longer. CONCLUSION The CSWS pattern, although rare, is still a therapeutic challenge. A close follow-up of the patients with epilepsy is important, especially if associated with cognitive impairment, in order to establish an early diagnosis and treatment.
Collapse
Affiliation(s)
| | | | - María Vázquez López
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | | | | | | | | |
Collapse
|
17
|
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: 9] [Impact Index Per Article: 1.5] [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.
Collapse
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.
| |
Collapse
|