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Liuzzi P, Grippo A, Sodero A, Castagnoli C, Pellegrini I, Burali R, Toci T, Barretta T, Mannini A, Hakiki B, Macchi C, Lolli F, Cecchi F. Quantitative EEG and prognosis for recovery in post-stroke patients: The effect of lesion laterality. Neurophysiol Clin 2024; 54:102952. [PMID: 38422721 DOI: 10.1016/j.neucli.2024.102952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE There is emerging confidence that quantitative EEG (qEEG) has the potential to inform clinical decision-making and guide individualized rehabilitation after stroke, but consensus on the best EEG biomarkers is needed for translation to clinical practice. This study investigates the spatial qEEG spectral and symmetry distribution in patients with a left/right hemispheric stroke, to evaluate their side-specific prognostic power in post-acute rehabilitation outcome. METHODS Resting-state 19-channel EEG recordings were collected with clinical information on admission to intensive inpatient rehabilitation (within 30 days post stroke), and six months post stroke. After preprocessing, spectral (Delta-to-Alpha Ratio, DAR) and symmetry (pairwise and hemispheric Brain Symmetry Index) features were extracted. Patients were divided into Affected Right and Left (AR/AL) groups, according to the location of their lesion. Within each group, DAR was compared between homologous electrode pairs and the pairwise difference between pairs was compared across pairs in the scalp. Then, the prognostic power of qEEG admission metrics was evaluated by performing correlations between admission metrics and discharge mBI values. RESULTS Fifty-two patients with hemorrhagic or ischemic stroke (20 females, 38.5 %, median age 76 years [IQR = 22]) were included in the study. DAR was significantly higher in the affected hemisphere for both AR and AL groups, and, a higher frontal (to posterior) asymmetry was found independent of the side of the lesion. DAR was found to be a prognostic marker of 6-months modified Barthel Index (mBI) only for the AL group, while hemispheric asymmetry did not correlate with follow-up outcomes in either group. DISCUSSION While the presence of EEG abnormalities in the affected hemisphere of a stroke is well recognized, we have shown that the extent of DAR abnormalities seen correlates with disability at 6 months post stroke, but only for left hemispheric lesions. Routine prognostic evaluation, in addition to motor and functional scales, can add information concerning neuro-prognostication and reveal neurophysiological abnormalities to be assessed during rehabilitation.
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Affiliation(s)
- Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy; Scuola Superiore Sant'Anna, Istituto di BioRobotica, Viale Rinaldo Piaggio 34, Pontedera, Italy.
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Chiara Castagnoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Ilaria Pellegrini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Rachele Burali
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Tanita Toci
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Teresa Barretta
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy; Università di Firenze, Dipartimento di Medicina Sperimentale e Clinica, Largo Brambilla 3, Firenze, Italy
| | - Francesco Lolli
- Università degli Studi di Firenze, Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Viale Morgagni 50, Firenze, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy; Università degli Studi di Firenze, Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Viale Morgagni 50, Firenze, Italy
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Goel K, Pek V, Shlobin NA, Chen JS, Wang A, Ibrahim GM, Hadjinicolaou A, Roessler K, Dudley RW, Nguyen DK, El-Tahry R, Fallah A, Weil AG. Clinical utility of intraoperative electrocorticography for epilepsy surgery: A systematic review and meta-analysis. Epilepsia 2023; 64:253-265. [PMID: 36404579 DOI: 10.1111/epi.17472] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
Despite the widespread use of intraoperative electrocorticography (iECoG) during resective epilepsy surgery, there are conflicting data on its overall efficacy and inability to predict benefit per pathology. Given the heterogeneity of iECoG use in resective epilepsy surgery, it is important to assess the utility of interictal-based iECoG. This individual patient data (IPD) meta-analysis seeks to identify the benefit of iECoG during resective epilepsy surgery in achieving seizure freedom for various pathologies. Embase, Scopus, and PubMed were searched from inception to January 31, 2021 using the following terms: "ecog", "electrocorticography", and "epilepsy". Articles were included if they reported seizure freedom at ≥12-month follow-up in cohorts with and without iECoG for epilepsy surgery. Non-English articles, noncomparative iECoG cohorts, and studies with <10% iECoG use were excluded. This meta-analysis followed the PRISMA 2020 guidelines. The primary outcome was seizure freedom at last follow-up and time to seizure recurrence, if applicable. Forest plots with random effects modeling assessed the relationship between iECoG use and seizure freedom. Cox regression of IPD was performed to identify predictors of longer duration of seizure freedom. Kaplan-Meier curves with log-rank test were created to visualize differences in time to seizure recurrence. Of 7504 articles identified, 18 were included for study-level analysis. iECoG was not associated with higher seizure freedom at the study level (relative risk = 1.09, 95% confidence interval [CI] = 0.96-1.23, p = .19, I2 = 64%), but on IPD (n = 7 studies, 231 patients) iECoG use was independently associated with more favorable seizure outcomes (hazard ratio = 0.47, 95% CI = .23-.95, p = .037). In Kaplan-Meier analysis of specific pathologies, iECoG use was significantly associated with longer seizure freedom only for focal cortical dysplasia (FCD; p < .001) etiology. Number needed to treat for iECoG was 8.8, and for iECoG in FCD it was 4.7. We show iECoG seizure freedom is not achieved uniformly across centers. iECoG is particularly beneficial for FCD etiology in improving seizure freedom.
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Affiliation(s)
- Keshav Goel
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Valérie Pek
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Andrew Wang
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Aristides Hadjinicolaou
- Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
- Brain and Development Research Axis, Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Roy W Dudley
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Dang K Nguyen
- Department of Neurology, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Riëm El-Tahry
- Saint Luc University Hospital, Brussels, Belgium
- Institute of Neuroscience, Neurology pole, Catholic University of Louvain, Brussels, Belgium
| | - Aria Fallah
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Brain and Development Research Axis, Sainte-Justine Research Centre, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Centre, Montreal, Quebec, Canada
- Department of Neuroscience, University of Montreal, Montreal, Quebec, Canada
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Imdad K, Abualait T, Kanwal A, AlGhannam ZT, Bashir S, Farrukh A, Khattak SH, Albaradie R, Bashir S. The Metabolic Role of Ketogenic Diets in Treating Epilepsy. Nutrients 2022; 14:5074. [PMID: 36501104 PMCID: PMC9738161 DOI: 10.3390/nu14235074] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
Epilepsy is a long-term neurological condition that results in recurrent seizures. Approximately 30% of patients with epilepsy have drug-resistant epilepsy (DRE). The ketogenic diet (KD) is considered an effective alternative treatment for epileptic patients. The aim of this study was to identify the metabolic role of the KD in epilepsy. Ketone bodies induce chemical messengers and alterations in neuronal metabolic activities to regulate neuroprotective mechanisms towards oxidative damage to decrease seizure rate. Here, we discuss the role of KD on epilepsy and related metabolic disorders, focusing on its mechanism of action, favorable effects, and limitations. We describe the significant role of the KD in managing epilepsy disorders.
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Affiliation(s)
- Kaleem Imdad
- Department of Biosciences, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Turki Abualait
- College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ammara Kanwal
- Department of Biosciences, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Ziyad Tareq AlGhannam
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Shahab Bashir
- Department of Biosciences, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Anum Farrukh
- Department of General Medicine, Fauji Foundation Hospital, Rawalpindi 45000, Pakistan
| | - Sahir Hameed Khattak
- National Institute for Genomics and Advanced Biotechnology (N.I.G.A.B.), National Agriculture Research Centre (NARC), Islamabad 44000, Pakistan
| | - Raidah Albaradie
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam 32253, Saudi Arabia
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam 32253, Saudi Arabia
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Cometa A, Falasconi A, Biasizzo M, Carpaneto J, Horn A, Mazzoni A, Micera S. Clinical neuroscience and neurotechnology: An amazing symbiosis. iScience 2022; 25:105124. [PMID: 36193050 PMCID: PMC9526189 DOI: 10.1016/j.isci.2022.105124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the last decades, clinical neuroscience found a novel ally in neurotechnologies, devices able to record and stimulate electrical activity in the nervous system. These technologies improved the ability to diagnose and treat neural disorders. Neurotechnologies are concurrently enabling a deeper understanding of healthy and pathological dynamics of the nervous system through stimulation and recordings during brain implants. On the other hand, clinical neurosciences are not only driving neuroengineering toward the most relevant clinical issues, but are also shaping the neurotechnologies thanks to clinical advancements. For instance, understanding the etiology of a disease informs the location of a therapeutic stimulation, but also the way stimulation patterns should be designed to be more effective/naturalistic. Here, we describe cases of fruitful integration such as Deep Brain Stimulation and cortical interfaces to highlight how this symbiosis between clinical neuroscience and neurotechnology is closer to a novel integrated framework than to a simple interdisciplinary interaction.
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High frequency oscillations associate with neuroinflammation in low-grade epilepsy associated tumors. Clin Neurophysiol 2021; 133:165-174. [PMID: 34774442 DOI: 10.1016/j.clinph.2021.08.025] [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: 04/20/2021] [Revised: 08/03/2021] [Accepted: 08/29/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE High frequency oscillations (HFOs) in intraoperative electrocorticography (ioECoG) are thought to be generated by hyperexcitable neurons. Inflammation may promote neuronal hyperexcitability. We investigated the relation between HFOs and inflammation in tumor-related epilepsy. METHODS We identified HFOs (ripples 80-250 Hz, fast ripples 250-500 Hz) in the preresection ioECoG of 32 patients with low-grade tumors. Localization of recorded HFOs was classified based on magnetic resonance imaging reconstructions: in tumor, in resected non-tumorous area and outside the resected area. We tested if the following inflammatory markers in the tumor or peritumoral tissue were related to HFOs: activated microglia, cluster of differentiation 3 (CD3)-positive T-cells, interleukin 1-beta (IL1β), toll-like receptor 4 (TLR4) and high mobility group box 1 protein (HMGB1). RESULTS Tumors that generated ripples were infiltrated by more CD3-positive cells than tumors without ripples. Ripple rate outside the resected area was positively correlated with IL1β/TLR4/HMGB1 pathway activity in peritumoral area. These two areas did not directly overlap. CONCLUSIONS Ripple rates may be associated with inflammatory processes. SIGNIFICANCE Our findings support that ripple generation and spread might be associated with synchronized fast firing of hyperexcitable neurons due to certain inflammatory processes. This pilot study provides arguments for further investigations in HFOs and inflammation.
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