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Uliel-Sibony S, Chernuha V, Tokatly Latzer I, Leitner Y. Epilepsy and attention-deficit/hyperactivity disorder in children and adolescents: An overview of etiology, prevalence, and treatment. Front Hum Neurosci 2023; 17:1021605. [PMID: 37113319 PMCID: PMC10126237 DOI: 10.3389/fnhum.2023.1021605] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Epilepsy and attention-deficit/hyperactivity disorder (ADHD) are closely connected and commonly seen in both children and adults. Each of the disorders has major psychosocial and quality of life (QOL) effects, and their co-occurrence makes coping even more challenging for both the patients and their families. Moreover, an adverse effect of some anti-seizure medications can potentially induce or exacerbate symptoms of ADHD on the one hand, while some ADHD medications may increase seizure risk on the other. The combination of proper diagnosis and appropriate treatment may improve or even prevent many of the complications associated with these conditions. The objectives of this review are to present the complex relationship between epilepsy and ADHD, looking into the pathophysiological, anatomical, and functional perspectives along with the psychosocial and QOL influences and the recommended treatment approaches in accordance with the latest literature.
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Affiliation(s)
| | - Veronika Chernuha
- Pediatric Neurology Institute, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - Itay Tokatly Latzer
- Pediatric Neurology Institute, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - Yael Leitner
- The Pediatric ADHD Clinic, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Auvin S. Paediatric epilepsy and cognition. Dev Med Child Neurol 2022; 64:1444-1452. [PMID: 35801543 DOI: 10.1111/dmcn.15337] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 01/31/2023]
Abstract
Cognitive comorbidities are more frequent in children with epilepsy than in the general population. The cognitive function of children with epilepsy should be appropriately screened, and when there is an impairment, it must be diagnosed and managed. Several factors contribute to the occurrence of this comorbidity. The underlying aetiology and epilepsy syndrome are the major risk factors. Other factors also play a role, such as seizure recurrence, antiseizure medication, and interictal abnormalities. Recent evidence also suggested that cognitive involvement is an ongoing process that interacts with the normal maturation of cognitive function in children with epilepsy. Furthermore, some patients experience rapid cognitive deterioration related to epileptic activity, resulting in epileptic encephalopathy. Further research is needed to better understand how to prevent or modify factors that affect cognitive function in children with epilepsy. WHAT THIS PAPER ADDS: Cognitive comorbidities are more frequent in children with epilepsy than in the general population. The risk factors for cognitive impairment are the underlying aetiology/syndrome, seizure recurrence, antiseizure medication, and interictal abnormalities. Advanced genetic and neuroimaging studies are useful tools to better understand cognitive impairment in children with epilepsy.
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Affiliation(s)
- Stéphane Auvin
- Assistance Publique-Hôpitaux de Paris, Service de Neurologie Pédiatrique, Hôpital Robert Debré, Paris, France.,Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale NeuroDiderot, Paris, France.,Institut Universitaire de France, Paris, France
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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.
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Puttaert D, Wens V, Fery P, Rovai A, Trotta N, Coquelet N, De Breucker S, Sadeghi N, Coolen T, Goldman S, Peigneux P, Bier JC, De Tiège X. Decreased Alpha Peak Frequency Is Linked to Episodic Memory Impairment in Pathological Aging. Front Aging Neurosci 2021; 13:711375. [PMID: 34475819 PMCID: PMC8406997 DOI: 10.3389/fnagi.2021.711375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/21/2021] [Indexed: 12/04/2022] Open
Abstract
The Free and Cued Selective Reminding Test (FCSRT) is a largely validated neuropsychological test for the identification of amnestic syndrome from the early stage of Alzheimer's disease (AD). Previous electrophysiological data suggested a slowing down of the alpha rhythm in the AD-continuum as well as a key role of this rhythmic brain activity for episodic memory processes. This study therefore investigates the link between alpha brain activity and alterations in episodic memory as assessed by the FCSRT. For that purpose, 37 patients with altered FCSRT performance underwent a comprehensive neuropsychological assessment, supplemented by 18F-fluorodeoxyglucose positron emission tomography/structural magnetic resonance imaging (18FDG-PET/MR), and 10 min of resting-state magnetoencephalography (MEG). The individual alpha peak frequency (APF) in MEG resting-state data was positively correlated with patients' encoding efficiency as well as with the efficacy of semantic cues in facilitating patients' retrieval of previous stored word. The APF also correlated positively with patients' hippocampal volume and their regional glucose consumption in the posterior cingulate cortex. Overall, this study demonstrates that alterations in the ability to learn and store new information for a relatively short-term period are related to a slowing down of alpha rhythmic activity, possibly due to altered interactions in the extended mnemonic system. As such, a decreased APF may be considered as an electrophysiological correlate of short-term episodic memory dysfunction accompanying pathological aging.
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Affiliation(s)
- Delphine Puttaert
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Wens
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Fery
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Service of Neuropsychology and Speech Therapy, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Antonin Rovai
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicola Trotta
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Coquelet
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Sandra De Breucker
- Department of Geriatrics, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Niloufar Sadeghi
- Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Tim Coolen
- Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Goldman
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Peigneux
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Christophe Bier
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Xavier De Tiège
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Niesen M, Trotta N, Noel A, Coolen T, Fayad G, Leurkin-Sterk G, Delpierre I, Henrard S, Sadeghi N, Goffard JC, Goldman S, De Tiège X. Structural and metabolic brain abnormalities in COVID-19 patients with sudden loss of smell. Eur J Nucl Med Mol Imaging 2021; 48:1890-1901. [PMID: 33398411 PMCID: PMC7781559 DOI: 10.1007/s00259-020-05154-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Sudden loss of smell is a very common symptom of coronavirus disease 19 (COVID-19). This study characterizes the structural and metabolic cerebral correlates of dysosmia in patients with COVID-19. METHODS Structural brain magnetic resonance imaging (MRI) and positron emission tomography with [18F]-fluorodeoxyglucose (FDG-PET) were prospectively acquired simultaneously on a hybrid PET-MR in 12 patients (2 males, 10 females, mean age: 42.6 years, age range: 23-60 years) with sudden dysosmia and positive detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on nasopharyngeal swab specimens. FDG-PET data were analyzed using a voxel-based approach and compared with that of a group of healthy subjects. RESULTS Bilateral blocking of the olfactory cleft was observed in six patients, while subtle olfactory bulb asymmetry was found in three patients. No MRI signal abnormality downstream of the olfactory tract was observed. Decrease or increase in glucose metabolism abnormalities was observed (p < .001 uncorrected, k ≥ 50 voxels) in core olfactory and high-order neocortical areas. A modulation of regional cerebral glucose metabolism by the severity and the duration of COVID-19-related dysosmia was disclosed using correlation analyses. CONCLUSIONS This PET-MR study suggests that sudden loss of smell in COVID-19 is not related to central involvement due to SARS-CoV-2 neuroinvasiveness. Loss of smell is associated with subtle cerebral metabolic changes in core olfactory and high-order cortical areas likely related to combined processes of deafferentation and active functional reorganization secondary to the lack of olfactory stimulation.
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Affiliation(s)
- Maxime Niesen
- Department of Otorhinolaryngology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium.
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.
| | - Nicola Trotta
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Antoine Noel
- Department of Otorhinolaryngology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Tim Coolen
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Georges Fayad
- Department of Otorhinolaryngology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Gil Leurkin-Sterk
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Delpierre
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Sophie Henrard
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Internal Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Niloufar Sadeghi
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Christophe Goffard
- Department of Internal Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Goldman
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Xavier De Tiège
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
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6
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Puttaert D, Coquelet N, Wens V, Peigneux P, Fery P, Rovai A, Trotta N, Sadeghi N, Coolen T, Bier JC, Goldman S, De Tiège X. Alterations in resting-state network dynamics along the Alzheimer's disease continuum. Sci Rep 2020; 10:21990. [PMID: 33319785 PMCID: PMC7738511 DOI: 10.1038/s41598-020-76201-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Human brain activity is intrinsically organized into resting-state networks (RSNs) that transiently activate or deactivate at the sub-second timescale. Few neuroimaging studies have addressed how Alzheimer's disease (AD) affects these fast temporal brain dynamics, and how they relate to the cognitive, structural and metabolic abnormalities characterizing AD. We aimed at closing this gap by investigating both brain structure and function using magnetoencephalography (MEG) and hybrid positron emission tomography-magnetic resonance (PET/MR) in 10 healthy elders, 10 patients with subjective cognitive decline (SCD), 10 patients with amnestic mild cognitive impairment (aMCI) and 10 patients with typical Alzheimer's disease with dementia (AD). The fast activation/deactivation state dynamics of RSNs were assessed using hidden Markov modeling (HMM) of power envelope fluctuations at rest measured with MEG. Correlations were sought between temporal properties of HMM states and participants' cognitive test scores, whole hippocampal grey matter volume and regional brain glucose metabolism. The posterior default-mode network (DMN) was less often activated and for shorter durations in AD patients than matched healthy elders. No significant difference was found in patients with SCD or aMCI. The time spent by participants in the activated posterior DMN state did not correlate significantly with cognitive scores, nor with the whole hippocampal volume. However, it correlated positively with the regional glucose consumption in the right dorsolateral prefrontal cortex (DLPFC). AD patients present alterations of posterior DMN power activation dynamics at rest that identify an additional electrophysiological correlate of AD-related synaptic and neural dysfunction. The right DLPFC may play a causal role in the activation of the posterior DMN, possibly linked to the occurrence of mind wandering episodes. As such, these data might suggest a neural correlate of the decrease in mind wandering episodes reported in pathological aging.
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Affiliation(s)
- D Puttaert
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium. .,Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.
| | - N Coquelet
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - V Wens
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - P Peigneux
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - P Fery
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Service of Neuropsychology and Speech Therapy, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - A Rovai
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - N Trotta
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - N Sadeghi
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - T Coolen
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - J-C Bier
- Department of Neurology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - S Goldman
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - X De Tiège
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
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Aeby A, Santalucia R, Van Hecke A, Nebbioso A, Vermeiren J, Deconinck N, De Tiège X, Van Bogaert P. A qualitative awake EEG score for the diagnosis of continuous spike and waves during sleep (CSWS) syndrome in self-limited focal epilepsy (SFE): A case-control study. Seizure 2020; 84:34-39. [PMID: 33276197 DOI: 10.1016/j.seizure.2020.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine whether awake EEG criteria can differentiate epileptic encephalopathy with continuous spike and waves during sleep (EE-CSWS) at the time of cognitive regression from typical, self-limited focal epilepsy (SFE). METHODS This retrospective case-control study was based on the analysis of awake EEGs and included 15 patients with EE-CSWS and 15 age-matched and sex-matched patients with typical SFE. The EEGs were anonymised and scored by four independent readers. The following qualitative and quantitative EEG indices were analysed: slow-wave index (SLWI), spike-wave index (SWI), spike-wave frequency (SWF), long spike-wave clusters (CLSW) and EEG score (between grades 0 and 4). Sensitivity and specificity were assessed using receiver operating characteristic (ROC) curves and their reproducibility with a kappa test. RESULTS Based on a highly sensitive cut-off, EE-CSWS patients were 8.4 times more likely than those with SFE to have an SLWI > 6%, 15 times more likely to have an SWI > 10 % and six times more likely to have a CLSW of ≥ 1 s. There was substantial agreement between readers (with kappa values of 0.64, 0.69 and 0.67). EE-CSWS patients were 13 times more likely to have an SWF of > 11 % and 149 times more likely to have an EEG score of ≥ 3 than typical SFE patients. Agreement about these ratings was almost perfect (kappa 0.91 and 0.86). CONCLUSION An EEG score of ≥ 3 on a 20-min awake EEG differentiates typical SFE from EE-CSWS at the time of cognitive regression, with good reliability across readers with different levels of expertise.
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Affiliation(s)
- Alec Aeby
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Roberto Santalucia
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium; Department of Paediatric Neurology, Hôpital Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Audrey Van Hecke
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Andrea Nebbioso
- Department of Paediatrics, Hôpital d'Ixelles-ULB, Brussels, Belgium
| | - Justine Vermeiren
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Deconinck
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Xavier De Tiège
- Department of Functional Neuroimaging, Nuclear Medicine Service, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Van Bogaert
- Unité de Neurologie et de Neurochirurgie de l'enfant, service de pédiatrie, CHU Angers, France; Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), University of Angers, France
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8
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Reh R, Williams LJ, Todd RM, Ward LM. Warped rhythms: Epileptic activity during critical periods disrupts the development of neural networks for human communication. Behav Brain Res 2020; 399:113016. [PMID: 33212087 DOI: 10.1016/j.bbr.2020.113016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/27/2022]
Abstract
It is well established that temporal lobe epilepsy-the most common and well-studied form of epilepsy-can impair communication by disrupting social-emotional and language functions. In pediatric epilepsy, where seizures co-occur with the development of critical brain networks, age of onset matters: The earlier in life seizures begin, the worse the disruption in network establishment, resulting in academic hardship and social isolation. Yet, little is known about the processes by which epileptic activity disrupts developing human brain networks. Here we take a synthetic perspective-reviewing a range of research spanning studies on molecular and oscillatory processes to those on the development of large-scale functional networks-in support of a novel model of how such networks can be disrupted by epilepsy. We seek to bridge the gap between research on molecular processes, on the development of human brain circuitry, and on clinical outcomes to propose a model of how epileptic activity disrupts brain development.
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Affiliation(s)
- Rebecca Reh
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver BC V6T 1Z4, Canada
| | - Lynne J Williams
- BC Children's Hospital MRI Research Facility, 4480 Oak Street, Vancouver, BC V6H 0B3, Canada
| | - Rebecca M Todd
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver BC V6T 1Z4, Canada; University of British Columbia, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Lawrence M Ward
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver BC V6T 1Z4, Canada; University of British Columbia, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
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9
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Curnow SR, Vogrin SJ, Barton S, Bailey CA, Harvey AS. Focal cortical hypermetabolism in atypical benign rolandic epilepsy. Epilepsy Res 2020; 161:106288. [PMID: 32086099 DOI: 10.1016/j.eplepsyres.2020.106288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Atypical benign rolandic epilepsy (BRE) is an underrecognized and poorly understood manifestation of a common epileptic syndrome. Most consider it a focal epileptic encephalopathy in which frequent, interictal, centrotemporal spikes lead to negative motor seizures and interfere with motor and sometimes speech and cognitive abilities. We observed focal cortical hypermetabolism on PET in three children with atypical BRE and investigated the spatial and temporal relationship with their centrotemporal spikes. METHODS EEG, MRI and PET were performed clinically in three children with atypical BRE. The frequency and source localization of centrotemporal spikes was determined and compared with the location of maximal metabolic activity on PET. RESULTS Cortical hypermetabolism on thresholded PET t-maps and current density reconstructions of centrotemporal spikes overlapped in each child, in the central sulcus region, the distances between the "centers of maxima" being 2 cm or less. Hypermetabolism was not due to recent seizures or frequent centrotemporal spikes at the time of FDG uptake. SIGNIFICANCE The findings suggest that localized, increased cortical activity, in the region of the EEG focus, underlies the negative clinical manifestations of atypical BRE. Similar findings are reported in the broader group of epileptic encephalopathies associated with electrical status epilepticus in sleep.
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Affiliation(s)
- Sarah R Curnow
- Department of Neurology, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Developmental Brain Imaging and Neuroscience Research Groups, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Simon J Vogrin
- Developmental Brain Imaging and Neuroscience Research Groups, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Sarah Barton
- Department of Neurology, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Developmental Brain Imaging and Neuroscience Research Groups, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Catherine A Bailey
- Department of Neurology, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - A Simon Harvey
- Department of Neurology, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Developmental Brain Imaging and Neuroscience Research Groups, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Pediatrics, The University of Melbourne, Grattan Street, Parkville, 3010, Australia.
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Bonardi CM, Mignot C, Serratosa JM, Giraldez BG, Moretti R, Rudolf G, Reale C, Gellert PM, Johannesen KM, Lesca G, Tassinari CA, Gardella E, Møller RS, Rubboli G. Expanding the clinical and EEG spectrum of CNKSR2-related encephalopathy with status epilepticus during slow sleep (ESES). Clin Neurophysiol 2020; 131:1030-1039. [PMID: 32197126 DOI: 10.1016/j.clinph.2020.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the clinical and EEG features of Encephalopathy with Status Epilepticus during slow Sleep (ESES) related to CNKSR2 pathogenic variants. METHODS Detailed clinical history, repeated wakefulness/overnight sleep EEGs, brain MRI were collected in five patients, including one female, with CNKSR2-related ESES. RESULTS Neurodevelopment in infancy was normal in two patients, delayed in three. Epilepsy onset (age range: 2-6 years) was associated with appearance or aggravation of cognitive impairment, language regression and/or behavioral disorders. Worsening of epilepsy and of cognitive/behavioral disturbances paralleled by enhancement of non-rapid eye movement (NREM) sleep-related, frontally predominant, EEG epileptic discharges [spike-wave-index (SWI): range 60-96%] was consistent with ESES. In three patients, episodes of absence status epilepticus or aggravation of atypical absences occurred, in this latter case associated with striking increment of awake SWI. Speech/oro-motor dyspraxia was diagnosed in four patients. In two patients, long-term follow-up showed epilepsy remission and persistence of mild/moderate cognitive disorders and behavioral disturbances into adulthood. CONCLUSIONS Novel findings of our study are occurrence also in females, normal neurodevelopment before epilepsy onset, epilepsy aggravation associated with enhanced awake SWI, mild/moderate evolution in adulthood and language disorder due to speech/oro-motor dyspraxia. SIGNIFICANCE Our findings expand the phenotypic spectrum of CNKSR2-related ESES.
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Affiliation(s)
- Claudia M Bonardi
- Danish Epilepsy Centre, Dianalund, Denmark; Department of Woman's and Child's Health, University Hospital of Padua, Italy.
| | - Cyril Mignot
- APHP, Groupe Hospitalier Pitié Salpêtrière, Unité Fonctionnelle de Génétique Médicale, Paris, France; Centre de Référence Déficiences Intellectuelles de Causes Rares, Paris, France; INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France.
| | - Jose M Serratosa
- Neurology Laboratory and Epilepsy Unit, Department of Neurology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.
| | - Beatriz G Giraldez
- Neurology Laboratory and Epilepsy Unit, Department of Neurology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.
| | | | - Gabrielle Rudolf
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, CNRS U7104, INSERM U1258 Illkirch 67400, France; Department of Neurology, Strasbourg University Hospital, Université de Strasbourg Strasbourg, France.
| | - Chiara Reale
- Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | | | | | - Gaetan Lesca
- Hospices Civils de Lyon, Service de Génétique, CHU de Lyon, Lyon, France.
| | | | - Elena Gardella
- Danish Epilepsy Centre, Dianalund, Denmark; Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark.
| | - Rikke S Møller
- Danish Epilepsy Centre, Dianalund, Denmark; Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark.
| | - Guido Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark; University of Copenhagen, Copenhagen, Denmark.
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11
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Epilepsy syndromes of childhood with sleep activation: Insights from functional imaging. Eur J Paediatr Neurol 2020; 24:58-60. [PMID: 31875835 DOI: 10.1016/j.ejpn.2019.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/06/2019] [Indexed: 11/21/2022]
Abstract
In epilepsy syndromes of childhood with sleep activation, defined as the spectrum of epileptic conditions going from classical benign childhood epilepsy with centrotemporal spikes (BECTS) to epileptic encephalopathy (EE) with continuous spike and waves during slow-wave sleep (CSWS) including Landau-Kleffner syndrome (LKS), a lot of functional imaging studies have been performed so far, leading to results that are not always consistent, related to the technique of neuroimaging performed and to the variability of the clinical phenotype. Most consistent findings are, depending of the method used, activations or increased regional glucose metabolism in the epileptogenic regions, and deactivations, hypometabolism or decreased functional connectivity in cortical regions that belong to the default mode network. Functional changes are either transitory, temporally related to the occurrence of interictal epileptiform discharges (IED), or permanent, persisting across IED-free periods. Some studies have shown that the more severe phenotype, i.e. EE with CSWS, displays the more profound functional disturbances. Taken together, functional imaging studies support the concept that IED impact cognition in epilepsy syndromes of childhood with sleep activation. However, the precise chronology between the occurrence of IED and the functional disturbances, the neuropsychological correlates of the functional disturbances, and the effects of the anti-epileptic treatments on IED, functional disturbances and cognition need to be further studied.
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12
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Vaudano AE, Avanzini P, Cantalupo G, Filippini M, Ruggieri A, Talami F, Caramaschi E, Bergonzini P, Vignoli A, Veggiotti P, Guerra A, Gessaroli G, Santucci M, Canevini MP, Piccolo B, Pisani F, Gobbi G, Dalla Bernardina B, Meletti S. Mapping the Effect of Interictal Epileptic Activity Density During Wakefulness on Brain Functioning in Focal Childhood Epilepsies With Centrotemporal Spikes. Front Neurol 2019; 10:1316. [PMID: 31920937 PMCID: PMC6930928 DOI: 10.3389/fneur.2019.01316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022] Open
Abstract
Childhood epilepsy with centrotemporal spikes (CECTS) is the most common type of “self-limited focal epilepsies.” In its typical presentation, CECTS is a condition reflecting non-lesional cortical hyperexcitability of rolandic regions. The benign evolution of this disorder is challenged by the frequent observation of associated neuropsychological deficits and behavioral impairment. The abundance (or frequency) of interictal centrotemporal spikes (CTS) in CECTS is considered a risk factor for deficits in cognition. Herein, we captured the hemodynamic changes triggered by the CTS density measure (i.e., the number of CTS for time bin) obtained in a cohort of CECTS, studied by means of video electroencephalophy/functional MRI during quite wakefulness. We aim to demonstrate a direct influence of the diurnal CTS frequency on epileptogenic and cognitive networks of children with CECTS. A total number of 8,950 CTS (range between 27 and 801) were recorded in 23 CECTS (21 male), with a mean number of 255 CTS/patient and a mean density of CTS/30 s equal to 10,866 ± 11.46. Two independent general linear model models were created for each patient based on the effect of interest: “individual CTS” in model 1 and “CTS density” in model 2. Hemodynamic correlates of CTS density revealed the involvement of a widespread cortical–subcortical network encompassing the sensory-motor cortex, the Broca's area, the premotor cortex, the thalamus, the putamen, and red nucleus, while in the CTS event-related model, changes were limited to blood–oxygen-level-dependent (BOLD) signal increases in the sensory-motor cortices. A linear relationship was observed between the CTS density hemodynamic changes and both disease duration (positive correlation) and age (negative correlation) within the language network and the bilateral insular cortices. Our results strongly support the critical role of the CTS frequency, even during wakefulness, to interfere with the normal functioning of language brain networks.
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Affiliation(s)
- Anna Elisabetta Vaudano
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Avanzini
- Italian National Research Council, Parma Research Unit, Parma, Italy
| | | | - Melissa Filippini
- Child Neuropsychiatry Unit, IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Francesca Talami
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Aglaia Vignoli
- Department of Health Sciences, University of Milano, Milan, Italy
| | | | - Azzura Guerra
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Giuliana Gessaroli
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Margherita Santucci
- Child Neuropsychiatry Unit, IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | - Benedetta Piccolo
- Child Neuropsychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Pisani
- Child Neuropsychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Gobbi
- Child Neuropsychiatry Unit, IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | - Stefano Meletti
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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13
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Bear JJ, Chapman KE, Tregellas JR. The epileptic network and cognition: What functional connectivity is teaching us about the childhood epilepsies. Epilepsia 2019; 60:1491-1507. [PMID: 31247129 PMCID: PMC7175745 DOI: 10.1111/epi.16098] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/09/2019] [Accepted: 06/05/2019] [Indexed: 12/13/2022]
Abstract
Our objective was to summarize and evaluate the rapidly expanding body of literature studying functional connectivity in childhood epilepsy. In the self-limited childhood epilepsies, awareness of cognitive comorbidities has been steadily increasing, and recent advances in our understanding of the network effects of these disorders promise insights into the underlying neurobiology. We reviewed publications addressing functional connectivity in children with epilepsy with an emphasis on studies of children with self-limited childhood epilepsies. The majority of studies have been published in the past 10 years and predominantly examine childhood epilepsy with centrotemporal spikes and childhood absence epilepsy. Cognitive network alterations are commonly observed across the childhood epilepsies. Some of these effects appear to be nonspecific to epilepsy syndrome or even to category of neurological disorder. Other patterns, such as changes in the connectivity of cortical language areas in childhood epilepsy with centrotemporal spikes, provide clues to the underlying cognitive deficits seen in affected children. The literature to date is dominated by general observations of connectivity patterns without a priori hypotheses. These data-driven studies build an important foundation for hypothesis generation and are already providing useful insights into the neuropathology of the childhood epilepsies. Future work should emphasize hypothesis-driven approaches and rigorous clinical correlations to better understand how the knowledge of network alterations can be applied to guidance and treatment for the children in our clinics.
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Affiliation(s)
- Joshua J Bear
- Department of Pediatrics, Section of Neurology, Children’s Hospital Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
| | - Kevin E Chapman
- Department of Pediatrics, Section of Neurology, Children’s Hospital Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
| | - Jason R Tregellas
- Department of Psychiatry, University of Colorado Anschutz Medical Campus
- Research Service, Rocky Mountain Regional VA Medical Center
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14
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Personality profile and health-related quality of life in adults with previous continuous spike-waves during slow sleep syndrome. Brain Dev 2019; 41:522-530. [PMID: 30797668 DOI: 10.1016/j.braindev.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Epilepsy with continuous spike-waves during slow sleep syndrome (CSWSS) is characterized by various seizure types, a characteristic EEG pattern and neuropsychological disorders. The main purpose of this study was to evaluate the long-term outcome of CSWSS occurred in childhood and to evaluate the variables that could influence the quality of social adaptation and the personality profile. MATERIAL AND METHODS This is a prospective study on 24 young adults with previous CSWSS (median age 24.5 yrs) who were enrolled between January and July 2011 at the G. Gaslini Children's Hospital, Genoa, Italy. Patients were divided into two groups: twelve with previous spike-wave index (SWI > 85%) defined as typical CSWSS (T-CSWSS) and twelve with previous SWI = 50-85% defined as atypical CSWSS (A-CSWSS). All the subjects were submitted to Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Psychological General Well-Being Index (PGWBI), and to a structured interview. RESULTS A correlation was observed with the severity of EEG abnormalities expressed by the SWI and outcome. The T-CSWSS group showed a significantly lower perceived well-being. Similarly in the T-CSWSS group the percentage of MMPI-2 clinical scales with T-scores ≥65 was higher than in the A-CSWSS group. Finally, a significant lower schooling in the T-CSWSS group was observed. CONCLUSION There seem to be two forms of the same disease, with similar onset and clinical evolution but a different outcome regarding the social and psychological conditions. The outcome of the social adaptation and of the personality consciousness was related with the severity of the EEG abnormalities: more favorable in patients with less intense SWI activity (A-CSWSS) compared those with a more severe EEG impairment (T-CSWSS).
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15
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Mathieu ML, de Bellescize J, Till M, Flurin V, Labalme A, Chatron N, Sanlaville D, Chemaly N, des Portes V, Ostrowsky K, Arzimanoglou A, Lesca G. Electrical status epilepticus in sleep, a constitutive feature of Christianson syndrome? Eur J Paediatr Neurol 2018; 22:1124-1132. [PMID: 30126759 DOI: 10.1016/j.ejpn.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 06/25/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
Christianson syndrome (CS) is a X-linked neurodevelopmental disorder, including severe intellectual disability (ID), progressive microcephaly, ataxia, autistic behaviour (ASD), near absent speech, and epilepsy. Electrical status epilepticus in sleep (ESES) has been reported in two patients. We describe five male patients from three unrelated families with Christianson syndrome caused by a pathogenic nucleotide variation or a copy-number variation involving SLC9A6. ESES was present in three out of the five patients in the critical age window between 4 and 8 years. All patients presented with severe intellectual disability, autistic features, and hyperactivity. Epilepsy onset occurred within the first two years of life. Seizures were of various types. In the two boys with a 20-years follow-up, epilepsy was drug-resistant during childhood, and became less active in early adolescence. Psychomotor regression was noted in two patients presenting with ESES. It was difficult to assess to what extent ESES could have contributed to the pathophysiological process, leading to regression of the already very limited communication skills. The two published case reports and our observation suggests that ESES could be a constitutive feature of Christianson syndrome, as it has already been shown for other Mendelian epileptic disorders, such as GRIN2A and CNKSR2-related developmental epileptic encephalopathies. Sleep EEG should be performed in patients with Christianson syndrome between 4 and 8 years of age. ESES occurring in the context of ID, ASD and severe speech delay, could be helpful to make a diagnosis of CS.
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Affiliation(s)
- Marie-Laure Mathieu
- Neuropaediatrics Department, Femme Mère Enfant Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Julitta de Bellescize
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France
| | - Marianne Till
- Department of Medical Genetics, Lyon University Hospital, Lyon, France
| | - Vincent Flurin
- Department of Paediatric Intensive Care, Le Mans Hospital, Le Mans, France
| | - Audrey Labalme
- Department of Medical Genetics, Lyon University Hospital, Lyon, France
| | - Nicolas Chatron
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France
| | - Damien Sanlaville
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France
| | - Nicole Chemaly
- Reference Centre for Rare Epilepsies, APHP, Necker-Enfants Malades Hospital, Imagine Institute, Paris, France; INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif sur Yvette, France
| | - Vincent des Portes
- Neuropaediatrics Department, Femme Mère Enfant Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Karine Ostrowsky
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France; DYCOG Team, Lyon Neuroscience Research Centre (CRNL), INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Gaëtan Lesca
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France.
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16
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Bölsterli BK, Gardella E, Pavlidis E, Wehrle FM, Tassinari CA, Huber R, Rubboli G. Remission of encephalopathy with status epilepticus (ESES) during sleep renormalizes regulation of slow wave sleep. Epilepsia 2017; 58:1892-1901. [DOI: 10.1111/epi.13910] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Bigna K. Bölsterli
- Division of Clinical Neurophysiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
| | - Elena Gardella
- Department of Clinical Neurophysiology; Danish Epilepsy Center; Dianalund Denmark
- University of Southern Denmark; Odense Denmark
| | - Elena Pavlidis
- Danish Epilepsy Center; Dianalund Denmark
- Child Neuropsychiatry Unit; Department of Neuroscience; University of Parma; Parma Italy
| | - Flavia M. Wehrle
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
| | | | - Reto Huber
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy; Psychiatric Hospital; University of Zurich; Zurich Switzerland
| | - Guido Rubboli
- Danish Epilepsy Center; Filadelfia/University of Copenhagen; Copenhagen Denmark
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17
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De Giorgis V, Filippini M, Macasaet JA, Masnada S, Veggiotti P. Neurobehavioral consequences of continuous spike and waves during slow sleep (CSWS) in a pediatric population: A pattern of developmental hindrance. Epilepsy Behav 2017; 74:1-9. [PMID: 28654799 DOI: 10.1016/j.yebeh.2017.01.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Continuous spike and waves during slow sleep (CSWS) is a typical EEG pattern defined as diffuse, bilateral and recently also unilateral or focal localization spike-wave occurring in slow sleep or non-rapid eye movement sleep. Literature results so far point out a progressive deterioration and decline of intellectual functioning in CSWS patients, i.e. a loss of previously normally acquired skills, as well as persistent neurobehavioral disorders, beyond seizure and EEG control. The objective of this study was to shed light on the neurobehavioral impact of CSWS and to identify the potential clinical risk factors for development. METHODS We conducted a retrospective study involving a series of 16 CSWS idiopathic patients age 3-16years, considering the entire duration of epilepsy from the onset to the outcome, i.e. remission of CSWS pattern. All patients were longitudinally assessed taking into account clinical (sex, age at onset, lateralization and localization of epileptiform abnormalities, spike wave index, number of antiepileptic drugs) and behavioral features. Intelligent Quotient (IQ) was measured in the whole sample, whereas visuo-spatial attention, visuo-motor skills, short term memory and academic abilities (reading and writing) were tested in 6 out of 16 patients. RESULTS Our results showed that the most vulnerable from an intellectual point of view were those children who had an early-onset of CSWS whereas those with later onset resulted less affected (p=0.004). Neuropsychological outcome was better than the behavioral one and the lexical-semantic route in reading and writing resulted more severely affected compared to the phonological route. CONCLUSIONS Cognitive deterioration is one but not the only consequence of CSWS. Especially with respect to verbal skills, CSWS is responsible of a pattern of consequences in terms of developmental hindrance, including slowing of development and stagnation, whereas deterioration is rare. Behavioral and academic problems tend to persist beyond epilepsy resolution.
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Affiliation(s)
- Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" National Neurological Institute, Pavia, Italy; Brain and Behaviour Department, University of Pavia, Pavia, Italy.
| | - Melissa Filippini
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | - Silvia Masnada
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" National Neurological Institute, Pavia, Italy; Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - Pierangelo Veggiotti
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" National Neurological Institute, Pavia, Italy; Brain and Behaviour Department, University of Pavia, Pavia, Italy
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18
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Zhu Y, Feng J, Wu S, Hou H, Ji J, Zhang K, Chen Q, Chen L, Cheng H, Gao L, Chen Z, Zhang H, Tian M. Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy. J Nucl Med 2017; 58:1293-1299. [PMID: 28104740 DOI: 10.2967/jnumed.116.187492] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
PET with 18F-FDG has been used for presurgical localization of epileptogenic foci; however, in nonsurgical patients, the correlation between cerebral glucose metabolism and clinical severity has not been fully understood. The aim of this study was to evaluate the glucose metabolic profile using 18F-FDG PET/CT imaging in patients with epilepsy. Methods: One hundred pediatric epilepsy patients who underwent 18F-FDG PET/CT, MRI, and electroencephalography examinations were included. Fifteen age-matched controls were also included. 18F-FDG PET images were analyzed by visual assessment combined with statistical parametric mapping (SPM) analysis. The absolute asymmetry index (|AI|) was calculated in patients with regional abnormal glucose metabolism. Results: Visual assessment combined with SPM analysis of 18F-FDG PET images detected more patients with abnormal glucose metabolism than visual assessment only. The |AI| significantly positively correlated with seizure frequency (P < 0.01) but negatively correlated with the time since last seizure (P < 0.01) in patients with abnormal glucose metabolism. The only significant contributing variable to the |AI| was the time since last seizure, in patients both with hypometabolism (P = 0.001) and with hypermetabolism (P = 0.005). For patients with either hypometabolism (P < 0.01) or hypermetabolism (P = 0.209), higher |AI| values were found in those with drug resistance than with seizure remission. In the post-1-y follow-up PET studies, a significant change of |AI| (%) was found in patients with clinical improvement compared with those with persistence or progression (P < 0.01). Conclusion:18F-FDG PET imaging with visual assessment combined with SPM analysis could provide cerebral glucose metabolic profiles in nonsurgical epilepsy patients. |AI| might be used for evaluation of clinical severity and progress in these patients. Patients with a prolonged period of seizure freedom may have more subtle (or no) metabolic abnormalities on PET. The clinical value of PET might be enhanced by timing the scan closer to clinical seizures.
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Affiliation(s)
- Yuankai Zhu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianhua Feng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Shuang Wu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Haifeng Hou
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianfeng Ji
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Kai Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Qing Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Lin Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Haiying Cheng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Liuyan Gao
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Zexin Chen
- Department of Clinical Epidemiology & Biostatistics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Mei Tian
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China .,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
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Current understanding and neurobiology of epileptic encephalopathies. Neurobiol Dis 2016; 92:72-89. [DOI: 10.1016/j.nbd.2016.03.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 12/25/2022] Open
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Nickels KC, Zaccariello MJ, Hamiwka LD, Wirrell EC. Cognitive and neurodevelopmental comorbidities in paediatric epilepsy. Nat Rev Neurol 2016; 12:465-76. [PMID: 27448186 DOI: 10.1038/nrneurol.2016.98] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive and behavioural comorbidities are often seen in children with epilepsy, and are more common and severe in refractory epilepsy. These comorbidities are associated with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. To enable early intervention and therapy, children and teens with epilepsy should be periodically screened for cognitive comorbidities. The location of the epileptic focus can, to a certain degree, predict the type(s) of comorbidity; however, the spectrum of disability is often broad, presumably because focal perturbations can cause network dysfunction. Comorbidities often result from underlying structural or functional pathology that has led to seizures. In selected cases, therapy targeting the underlying cause, such as the ketogenic diet for GLUT1 deficiency syndromes, may be remarkably effective in ameliorating both seizures and cognitive concerns. In many cases, however, cognitive impairment persists despite seizure control. In epileptic encephalopathies, frequent seizures and/or interictal epileptiform abnormalities exacerbate neurocognitive dysfunction, owing to synaptic reorganization or impaired neurogenesis, or to other effects on developing neural circuits, and prompt initiation of effective antiepileptic therapy is essential to limit cognitive comorbidities.
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Affiliation(s)
- Katherine C Nickels
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Michael J Zaccariello
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Lorie D Hamiwka
- Seattle Children's Hospital, MB.7.420 - Neurology, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Elaine C Wirrell
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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Galer S, Urbain C, De Tiège X, Emeriau M, Leproult R, Deliens G, Nonclerq A, Peigneux P, Van Bogaert P. Impaired sleep-related consolidation of declarative memories in idiopathic focal epilepsies of childhood. Epilepsy Behav 2015; 43:16-23. [PMID: 25546732 DOI: 10.1016/j.yebeh.2014.11.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/27/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Declarative memory is consolidated during sleep in healthy children. We tested the hypothesis that consolidation processes are impaired in idiopathic focal epilepsies (IFE) of childhood in association with frequent interictal epileptiform discharges (IEDs) during sleep. METHODS A verbal (word-pair association) and a nonverbal (2D object location) declarative memory task were administrated to 15 children with IFEs and 8 control children 6-12 years of age. Patients had either centrotemporal (11 patients) or occipital (4 patients) IEDs. All but 3 patients had a history of unprovoked seizures, and 6 of them were treated with valproate (VPA). The learning procedure (location of object pairs presented on a grid; association of word pairs) was executed in the evening. Retrieval was tested immediately after learning and on the next morning after a night of sleep. Participants were tested twice, once in natural home conditions and one month later in the unfamiliar conditions of the sleep unit under EEG monitoring. RESULTS Overnight recall performance was lower in children with IFE than in control children on both tasks (ps<0.05). Performance in home conditions was similar to that in hospital conditions. Higher spike-wave index (SWI) during nonrapid eye movement (NREM) sleep was associated with poorer performance in the nonverbal task (p<0.05). Valproate treatment was not associated with overnight recall performance for both tasks (ps>0.05). CONCLUSION Memory consolidation is impaired in IFE of childhood. The association between higher SWI during NREM sleep and poorer nonverbal declarative memory consolidation supports the hypothesis that interictal epileptic activity could disrupt sleep memory consolidation.
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Affiliation(s)
- Sophie Galer
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium; UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.
| | - Charline Urbain
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium; UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Xavier De Tiège
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Mathilde Emeriau
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Rachel Leproult
- UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Gaetane Deliens
- UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Antoine Nonclerq
- LISA - Laboratories of Image, Signal Processing and Acoustics, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Peigneux
- UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Van Bogaert
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
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Değerliyurt A, Yalnizoğlu D, Bakar EE, Topçu M, Turanli G. Electrical status epilepticus during sleep: a study of 22 patients. Brain Dev 2015; 37:250-64. [PMID: 24815826 DOI: 10.1016/j.braindev.2014.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/12/2014] [Accepted: 04/14/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical and imaging characteristics, treatment results, and prognosis of patients with electrical status epilepticus during sleep (ESES). METHOD A total of 22 patients with ESES pattern on EEG were retrospectively studied. RESULTS The first neurological symptoms were seen at a mean age of 4.4years. The first symptoms in 77% of the patients were seizures. Other symptoms were hyperactivity, restlessness, insomnia, disinhibition, autistic behavior, speech retardation and deterioration in school performance. Diagnosis of ESES was made at a mean age of 7.45years, approximately 3years after the first symptom. Magnetic resonance imaging (MRI) was abnormal in 36% of the patients. Single photon emission computed tomography (SPECT) showed focal hypoperfusion after resolution of ESES involving left temporoparietal and right posterior temporal areas in four patients including three with normal MRI, and one with periventricular leukomalacia without focal cortical lesion. First line treatment with valproic acid monotherapy was not effective. Electrical status epilepticus during sleep disappeared in 82% of the patients on clobazam and 70% of the patients on clonazepam in combination with valproic acid within a few months. Topiramate was not found to be effective. A significant decrease in intelligence quotient (IQ) scores was found in 66% of the patients compared to the baseline. CONCLUSIONS ESES should be considered in children with new onset behavioral, cognitive, and speech problems with or without seizures. The high frequency of focal seizures and focal findings on SPECT suggest a focal origin. Clonazepam and clobazam were most effective in our cohort.
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Affiliation(s)
- Aydan Değerliyurt
- Hacettepe University, Department of Pediatric Neurology, Ankara, Turkey.
| | - Dilek Yalnizoğlu
- Hacettepe University, Department of Pediatric Neurology, Ankara, Turkey
| | | | - Meral Topçu
- Hacettepe University, Department of Pediatric Neurology, Ankara, Turkey
| | - Güzide Turanli
- Hacettepe University, Department of Pediatric Neurology, Ankara, Turkey
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Abstract
Epileptic encephalopathy with continuous spikes and waves during slow sleep (EECSWSS) is an age-related childhood condition characterized by epilepsy, cognitive or behavioral impairment, and electroencephalographic abnormality of continuous spike-wave discharges during slow sleep. Continuous spikes and waves during slow sleep (or electrical status epilepticus during sleep) is an electrographic pattern characterized by nearly continuous spike-wave discharges during non-REM sleep, with a frequency of 1.5-3 Hz and usually diffuse and bilateral in distribution. Most authors consider EECSWSS as wide spectrum of epileptic conditions of different origin associated with heterogeneous clinical manifestations and neuropsychological impairment of different severity in close temporal concordance with the appearance of the electroencephalographic pattern of electrical status epilepticus during sleep. The long-term prognosis of this condition is overall poor owing to the persistence of neuropsychological impairment. Therefore, early recognition and effective therapy are necessary to improve long-term prognosis.
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Default mode network hypometabolism in epileptic encephalopathies with CSWS. Epilepsy Res 2014; 108:861-71. [PMID: 24746674 DOI: 10.1016/j.eplepsyres.2014.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/12/2014] [Accepted: 03/16/2014] [Indexed: 11/20/2022]
Abstract
Previous studies investigating cerebral metabolic changes associated with continuous spike-waves during sleep (CSWS) compared the metabolism of children with CSWS with that of healthy adults, precluding any assessment in brain areas showing physiologic age-related metabolic changes. Here, we investigated the metabolic and connectivity changes characterizing the acute phase of CSWS activity by comparing awake brain metabolism of children with CSWS with that of pediatric pseudo-controls. Positron emission tomography using [18F]-fluorodeoxyglucose (FDG-PET) was performed in 17 awake children with cryptogenic CSWS (5 girls, age: 5-11 years). Voxel-based analyses identified significant metabolic changes in CSWS patients compared with 18 pediatric pseudo-controls (12 girls, age: 6-11 years, non-CSWS focal cryptogenic epilepsy with normal FDG-PET). CSWS-induced changes in the contribution of brain areas displaying metabolic changes to the level of metabolic activity in other brain areas were investigated using pathophysiological interaction. Hypermetabolism in perisylvian regions bilaterally and hypometabolism in lateral and mesial prefrontal cortex, precuneus, posterior cingulate cortex and parahippocampal gyri characterized the acute phase of CSWS (p<0.05 FWE). No change in thalamic metabolism was disclosed. Altered functional connectivity was found between hyper- and hypometabolic regions in CSWS patients compared with pediatric pseudo-controls. This study demonstrates hypometabolism in key nodes of the default mode network (DMN) in awake patients with CSWS, in relation with a possible phenomenon of sustained remote inhibition from the epileptic foci. This hypometabolism might account for some of the acquired cognitive or behavioral features of CSWS epileptic encephalopathies. This study failed to find any evidence of thalamic metabolic changes, which supports the primary involvement of the cortex in CSWS genesis.
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Siniatchkin M, Capovilla G. Functional neuroimaging in epileptic encephalopathies. Epilepsia 2013; 54 Suppl 8:27-33. [DOI: 10.1111/epi.12420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Michael Siniatchkin
- Clinic of Child and Adolescents Psychiatry; Goethe-University of Frankfurt; Frankfurt Germany
| | - Giuseppe Capovilla
- Department of Child Neuropsychiatry; Epilepsy Center; C. Poma Hospital; Mantova Italy
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Lado FA, Rubboli G, Capovilla G, Avanzini G, Moshé SL. Pathophysiology of epileptic encephalopathies. Epilepsia 2013; 54 Suppl 8:6-13. [PMID: 24571111 PMCID: PMC3937844 DOI: 10.1111/epi.12417] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The application of metabolic imaging and genetic analysis, and now the development of appropriate animal models, has generated critical insights into the pathogenesis of epileptic encephalopathies. In this article we present ideas intended to move from the lesions associated with epileptic encephalopathies toward understanding the effects of these lesions on the functioning of the brain, specifically of the cortex. We argue that the effects of focal lesions may be magnified through the interaction between cortical and subcortical structures, and that disruption of subcortical arousal centers that regulate cortex early in life may lead to alterations of intracortical synapses that affect a critical period of cognitive development. Impairment of interneuronal function globally through the action of a genetic lesion similarly causes widespread cortical dysfunction manifesting as increased delta slow waves on electroencephalography (EEG) and as developmental delay or arrest clinically. Finally, prolonged focal epileptic activity during sleep (as occurring in the syndrome of continuous spike-wave in slow sleep, or CSWSS) might interfere with local slow wave activity at the site of the epileptic focus, thereby impairing the neural processes and, possibly, the local plastic changes associated with learning and other cognitive functions. Seizures may certainly add to these pathologic processes, but they are likely not necessary for the development of the cognitive pathology. Nevertheless, although seizures may be either a consequence or symptom of the underlying lesion, their effective treatment can improve outcomes as both clinical and experimental studies may suggest. Understanding their substrates may lead to novel, effective treatments for all aspects of the epileptic encephalopathy phenotype.
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Affiliation(s)
- Fred A. Lado
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center; Bronx, New York, U.S.A
| | - Guido Rubboli
- Danish Epilepsy Center, Epilepsihospitalet, Dianalund, Denmark and Neurology Unit, Department of Neurosciences, Bellaria Hospital, Bologna, Italy
| | - Giuseppe Capovilla
- Epilepsy Center, Department of Child Neuropsychiatry, C. Poma Hospital, Mantova, Italy
| | - Giuliano Avanzini
- Department of Neurophysiology IRCCS Foundation Neurological Institute, Milano, Italy
| | - Solomon L. Moshé
- Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience and Department of Pediatrics, Laboratory of Developmental Epilepsy, Montefiore/Einstein Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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Filippini M, Boni A, Giannotta M, Gobbi G. Neuropsychological development in children belonging to BECTS spectrum: long-term effect of epileptiform activity. Epilepsy Behav 2013; 28:504-11. [PMID: 23896351 DOI: 10.1016/j.yebeh.2013.06.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/12/2013] [Accepted: 06/18/2013] [Indexed: 11/25/2022]
Abstract
Benign epilepsy with centrotemporal spikes (BECTS) is an idiopathic focal epileptic syndrome in childhood. It is called "benign" because the seizure and cognitive outcomes are usually favorable, but a significant number of children with BECTS present heterogeneous cognitive deficits correlated to NREM sleep epileptiform discharges. The atypical evolutions of BECTS form a spectrum of conditions suggesting that slow sleep nocturnal interictal epileptiform discharges (IEDs) specifically determine the neuropsychological deficit. Few follow-up studies of neuropsychological outcome in BECTS are available, and very often, slow sleep has not been recorded throughout night sleep. The present study analyzed the long-term effects of IEDs during NREM sleep on neuropsychological development in children with rolandic spikes. Thirty-three children with a diagnosis of BECTS were monitored for at least two years. Results show that these children are at higher risk for residual verbal difficulties, and the abnormal neuropsychological development is significantly correlated with a greater frequency of NREM sleep discharges, school-age epilepsy onset, and a higher number of antiepileptic drugs (AEDs). The findings are discussed in terms of how slow sleep IEDs affect the consolidation of verbal skills during critical epochs of neuropsychological development.
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Affiliation(s)
- Melissa Filippini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Child Neurology Unit, Ospedale Bellaria, Via Altura 3, 40139 Bologna, Italy.
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Encephalopathy with hemi-status epilepticus during sleep or hemi-continuous spikes and waves during slow sleep syndrome: A study of 21 patients. Seizure 2013; 22:565-71. [DOI: 10.1016/j.seizure.2013.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/04/2013] [Accepted: 04/09/2013] [Indexed: 11/22/2022] Open
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Continuous Spikes and Waves during Sleep: Electroclinical Presentation and Suggestions for Management. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:583531. [PMID: 23991336 PMCID: PMC3748771 DOI: 10.1155/2013/583531] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/07/2013] [Indexed: 01/21/2023]
Abstract
Continuous spikes and waves during sleep (CSWS) is an epileptic encephalopathy characterized in most patients by (1) difficult to control seizures, (2) interictal epileptiform activity that becomes prominent during sleep leading to an electroencephalogram (EEG) pattern of electrical status epilepticus in sleep (ESES), and (3) neurocognitive regression. In this paper, we will summarize current epidemiological, clinical, and EEG knowledge on CSWS and will provide suggestions for treatment. CSWS typically presents with seizures around 2-4 years of age. Neurocognitive regression occurs around 5-6 years of age, and it is accompanied by subacute worsening of EEG abnormalities and seizures. At approximately 6-9 years of age, there is a gradual resolution of seizures and EEG abnormalities, but the neurocognitive deficits persist in most patients. The cause of CSWS is unknown, but early developmental lesions play a major role in approximately half of the patients, and genetic associations have recently been described. High-dose benzodiazepines and corticosteroids have been successfully used to treat clinical and electroencephalographic features. Corticosteroids are often reserved for refractory disease because of adverse events. Valproate, ethosuximide, levetiracetam, sulthiame, and lamotrigine have been also used with some success. Epilepsy surgery may be considered in a few selected patients.
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Urbain C, Galer S, Van Bogaert P, Peigneux P. Pathophysiology of sleep-dependent memory consolidation processes in children. Int J Psychophysiol 2013; 89:273-83. [DOI: 10.1016/j.ijpsycho.2013.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/13/2013] [Accepted: 06/17/2013] [Indexed: 11/30/2022]
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De Tiège X, Trotta N, Op de beeck M, Bourguignon M, Marty B, Wens V, Nonclercq A, Goldman S, Van Bogaert P. Neurophysiological activity underlying altered brain metabolism in epileptic encephalopathies with CSWS. Epilepsy Res 2013; 105:316-25. [DOI: 10.1016/j.eplepsyres.2013.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/03/2013] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
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Encephalopathy with status epilepticus during sleep or continuous spikes and waves during slow sleep syndrome: A multicenter, long-term follow-up study of 117 patients. Epilepsy Res 2013; 105:164-73. [DOI: 10.1016/j.eplepsyres.2013.02.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/14/2013] [Accepted: 02/19/2013] [Indexed: 11/19/2022]
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van Bogaert P, King MD, Paquier P, Wetzburger C, Labasse C, Dubru JM, Deonna T. Acquired auditory agnosia in childhood and normal sleep electroencephalography subsequently diagnosed as Landau-Kleffner syndrome: a report of three cases. Dev Med Child Neurol 2013; 55:575-9. [PMID: 23121226 DOI: 10.1111/dmcn.12025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM We report three cases of Landau-Kleffner syndrome (LKS) in children (two females, one male) in whom diagnosis was delayed because the sleep electroencephalography (EEG) was initially normal. METHOD Case histories including EEG, positron emission tomography findings, and long-term outcome were reviewed. RESULTS Auditory agnosia occurred between the age of 2 years and 3 years 6 months, after a period of normal language development. Initial awake and sleep EEG, recorded weeks to months after the onset of language regression, during a nap period in two cases and during a full night of sleep in the third case, was normal. Repeat EEG between 2 months and 2 years later showed epileptiform discharges during wakefulness and strongly activated by sleep, with a pattern of continuous spike-waves during slow-wave sleep in two patients. Patients were diagnosed with LKS and treated with various antiepileptic regimens, including corticosteroids. One patient in whom EEG became normal on hydrocortisone is making significant recovery. The other two patients did not exhibit a sustained response to treatment and remained severely impaired. INTERPRETATION Sleep EEG may be normal in the early phase of acquired auditory agnosia. EEG should be repeated frequently in individuals in whom a firm clinical diagnosis is made to facilitate early treatment.
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Affiliation(s)
- Patrick van Bogaert
- Department of Paediatric Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Bjørnæs H, Bakke KA, Larsson PG, Heminghyt E, Rytter E, Brager-Larsen LM, Eriksson AS. Subclinical epileptiform activity in children with electrical status epilepticus during sleep: effects on cognition and behavior before and after treatment with levetiracetam. Epilepsy Behav 2013; 27:40-8. [PMID: 23376335 DOI: 10.1016/j.yebeh.2012.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 12/02/2012] [Accepted: 12/08/2012] [Indexed: 11/17/2022]
Abstract
We performed a double-blind placebo-controlled crossover study of the effects of spike activity during sleep and when awake on learning, long-term memory, vigilance and behavior before and after treatment with levetiracetam in children with electrical status epilepticus during sleep. At baseline, verbal learning declined with increasing spike activity, but there were no relations between spike activity and memory, vigilance or behavior. Levetiracetam was effective in reducing sleep-related spike activity, but on a group level, this had no clear effects on behavior, vigilance or learning and memory. Our results do not allow firm conclusions whether to treat nocturnal epileptiform activity or not; larger samples and longer follow-up may be needed.
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Affiliation(s)
- Helge Bjørnæs
- National Centre for Epilepsy, Oslo University Hospital, Norway.
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Archambaud F, Bouilleret V, Hertz-Pannier L, Chaumet-Riffaud P, Rodrigo S, Dulac O, Chassoux F, Chiron C. Optimizing statistical parametric mapping analysis of 18F-FDG PET in children. EJNMMI Res 2013; 3:2. [PMID: 23289862 PMCID: PMC3558387 DOI: 10.1186/2191-219x-3-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/27/2012] [Indexed: 01/18/2023] Open
Abstract
UNLABELLED BACKGROUND Statistical parametric mapping (SPM) procedure is an objective tool to analyze 18F-fluoro-2-deoxy-d-glucose-positron-emission tomography (FDG-PET) images and a useful complement to visual analysis. However, SPM requires a comparison to control data set that cannot be obtained in healthy children for ethical reasons. Using adults as controls showed some limitations. The purpose of the present study was to generate and validate a group of pseudo-normal children as a control group for FDG-PET studies in pediatrics. METHODS FDG-PET images of 47 children (mean ± SD age 10.2 ± 3.1 years) with refractory symptomatic (MRI-positive, n = 20) and cryptogenic (MRI-negative, n = 27) focal epilepsy planned for surgery were analyzed using visual and SPM analysis. Performances of SPM analysis were compared using two different control groups: (1) an adult control group consisting of healthy young adults (n = 25, 30.5 ± 5.8 years, adult PET template) and (2) a pediatric pseudo-control group consisting of patients (n = 24, 10.6 ± 3.1 years, children PET template) with refractory focal epilepsy but with negative MRI and with PET considered normal not only on visual analysis but also on SPM. RESULTS Among the 47 children, visual analysis succeeded detecting at least one hypometabolic area in 87% of the cases (interobserver kappa = 0.81). Regarding SPM analysis, the best compromise between sensitivity and specificity was obtained with a threshold of p less than 0.001 as an extent of more than 40 voxels. There was a significant concordance to detect hypometabolic areas between both SPM analyses [kappa (K) = 0.59; p < 0.005] and between both SPM and visual analyses (K = 0.45; p < 0.005), in symptomatic (K = 0.74; p < 0.005) as in cryptogenic patients (K = 0.26; p < 0.01). The pediatric pseudo-control group dramatically improved specificity (97% vs. 89%; p < 0.0001) by increasing the positive predictive value (86% vs. 65%). Sensitivity remained acceptable although it was not better (79% vs. 87%, p = 0.039). The main impact was to reduce by 41% the number of hypometabolic cortical artifacts detected by SPM, especially in the younger epileptic patients, which is a key point in clinical practice. CONCLUSIONS This age-matched pseudo-control group is a way to optimize SPM analysis of FDG-PET in children with epilepsy. It might also be considered for other brain pathologies in pediatrics in the future.
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Affiliation(s)
- Frederique Archambaud
- Inserm, U663, Service de Neurologie et Métabolisme, Hôpital Necker, 149 rue de Sèvres, Paris, 75015, France.
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Van Bogaert P. Epileptic encephalopathy with continuous spike-waves during slow-wave sleep including Landau-Kleffner syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:635-40. [PMID: 23622211 DOI: 10.1016/b978-0-444-52891-9.00066-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epileptic encephalopathy with continuous spike-waves during slow-wave sleep (CSWS) is a spectrum of epileptic conditions best defined by the association of cognitive or behavioral impairment acquired during childhood and not related to another factor other than the presence of abundant interictal epileptiform discharges (IED) during sleep, which tend to diffuse over the whole scalp. It is part of the childhood focal epileptic syndromes, some cases being idiopathic and overlapping with benign rolandic epilepsy, and others being symptomatic of a structural brain lesion. Landau-Kleffner syndrome (LKS) is a particular presentation where acquired aphasia is the core symptom. Clinical, neurophysiological, and cerebral glucose metabolism data support the hypothesis that IED play a prominent role in the cognitive deficits by interfering with the neuronal networks at the site of the epileptic foci but also at distant connected areas. Therefore, the treatment should aim to suppress IED. This may be achieved using conventional antiepileptic drugs, but corticosteroids seem to have more pronounced and sustained efficacy. Outcome for epilepsy is usually good, CSWS being an age-dependent EEG pattern, whereas outcome for cognition, language, and behavior is variable. Rehabilitation represents an important part of the treatment and visual forms of language should be encouraged in children with LKS.
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Sánchez Fernández I, Loddenkemper T, Peters JM, Kothare SV. Electrical status epilepticus in sleep: clinical presentation and pathophysiology. Pediatr Neurol 2012; 47:390-410. [PMID: 23127259 DOI: 10.1016/j.pediatrneurol.2012.06.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/20/2012] [Indexed: 10/27/2022]
Abstract
Electrical status epilepticus in sleep involves an electroencephalographic pattern where interictal epileptiform activity is potentiated in the transition from wakefulness to sleep. Near-continuous spikes and waves that occupy a significant proportion of nonrapid eye movement sleep appear as a result of sleep-potentiated epileptiform activity. This electroencephalographic pattern appears in different electroclinical syndromes that present three common characteristics with different degrees of severity: seizures, sleep-potentiated epileptiform activity, and neuropsychologic regression. Continuous spikes and waves during sleep comprise the severest epileptic encephalopathy in the electroclinical spectrum. Landau-Kleffner syndrome presents with intermediate severity. Some "benign" pediatric focal epileptic syndromes represent the mildest end of this continuum. Based on published data, we provide a framework for clinical and electrical events. The underlying mechanisms leading to sleep potentiation of epileptiform activity in electrical status epilepticus in sleep are incompletely understood. A genetic basis or acquired early developmental insult may disrupt the normal maturation of neuronal networks. These factors may dynamically alter normal processes of brain development, leading to an age-related pattern of electroclinical expression of electrical status epilepticus in sleep.
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Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Tracy JI, Osipowicz K, Spechler P, Sharan A, Skidmore C, Doucet G, Sperling MR. Functional connectivity evidence of cortico-cortico inhibition in temporal lobe epilepsy. Hum Brain Mapp 2012; 35:353-66. [PMID: 22987774 DOI: 10.1002/hbm.22181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 07/03/2012] [Accepted: 07/22/2012] [Indexed: 11/11/2022] Open
Abstract
Epileptic seizures can initiate a neural circuit and lead to aberrant neural communication with brain areas outside the epileptogenic region. We focus on interictal activity in focal temporal lobe epilepsy and evaluate functional connectivity (FC) differences that emerge as function of bilateral versus strictly unilateral epileptiform activity. We assess the strength of FC at rest between the ictal and non-ictal temporal lobes, in addition to whole brain connectivity with the ictal temporal lobe. Results revealed strong connectivity between the temporal lobes for both patient groups, but this did not vary as a function of unilateral versus bilateral interictal status. Both the left and right unilateral temporal lobe groups showed significant anti-correlated activity in regions outside the epileptogenic temporal lobe, primarily involving the contralateral (non-ictal/non-pathologic) hemisphere, with precuneus involvement prominent. The bilateral groups did not show this contralateral anti-correlated activity. This anti-correlated connectivity may represent a form of protective and adaptive inhibition, helping to constrain epileptiform activity to the pathologic temporal lobe. The absence of this activity in the bilateral groups may be indicative of flawed inhibitory mechanisms, helping to explain their more widespread epileptiform activity. Our data suggest that the location and build up of epilepsy networks in the brain are not truly random, and are not limited to the formation of strictly epileptogenic networks. Functional networks may develop to take advantage of the regulatory function of structures such as the precuneus to instantiate an anti-correlated network, generating protective cortico-cortico inhibition for the purpose of limiting seizure spread or epileptogenesis.
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Affiliation(s)
- Joseph I Tracy
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Epileptic Encephalopathies with Status Epilepticus during Sleep: New Techniques for Understanding Pathophysiology and Therapeutic Options. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:642725. [PMID: 22934163 PMCID: PMC3420558 DOI: 10.1155/2012/642725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 11/17/2022]
Abstract
Encephalopathy with status epilepticus during sleep (ESES) is an epileptic encephalopathy, as defined by the International League Against Epilepsy (ILAE) Task Force on Classification and Terminology, that is, a condition in which the epileptic processes themselves are believed to contribute to the disturbance in cerebral function. Clinical manifestations of ESES are heterogeneous: apart from different seizure types, they consist in combinations of cognitive, motor, and behavioural disturbances associated with a peculiar electroencephalographic pattern of paroxysmal activity significantly activated during slow sleep, which culminates in a picture of continuous spikes and waves during sleep (CSWS). The pathophysiological mechanisms underlying this condition are still incompletely understood. Establishing a clear-cut correlation between EEG abnormalities and clinical data, though interesting, is very complex. Computer-assisted EEG analyses especially if combined with functional magnetic resonance imaging (EEG-fMRI) and metabolic neuroimaging have recently emerged as useful approaches to better understand the pathophysiological processes underlying ESES. Treatment of ESES is not just limited to seizures control but it should be focused on controlling neuropsychological outcome through an improvement of the continuous epileptiform activity. General agreement on treatment guidelines is still lacking. Implementation of new techniques might allow a better understanding of the pathophysiology of ESES and could enhance therapeutics options.
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Seegmüller C, Deonna T, Dubois CM, Valenti-Hirsch MP, Hirsch E, Metz-Lutz MN, de Saint Martin A, Roulet-Perez E. Long-term outcome after cognitive and behavioral regression in nonlesional epilepsy with continuous spike-waves during slow-wave sleep. Epilepsia 2012; 53:1067-76. [PMID: 22524856 DOI: 10.1111/j.1528-1167.2012.03465.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To present the long-term follow-up of 10 adolescents and young adults with documented cognitive and behavioral regression as children due to nonlesional focal, mainly frontal, epilepsy with continuous spike-waves during slow wave sleep (CSWS). METHODS Past medical and electroencephalography (EEG) data were reviewed and neuropsychological tests exploring main cognitive functions were administered. KEY FINDINGS After a mean duration of follow-up of 15.6 years (range, 8-23 years), none of the 10 patients had recovered fully, but four regained borderline to normal intelligence and were almost independent. Patients with prolonged global intellectual regression had the worst outcome, whereas those with more specific and short-lived deficits recovered best. The marked behavioral disorders resolved in all but one patient. Executive functions were neither severely nor homogenously affected. Three patients with a frontal syndrome during the active phase (AP) disclosed only mild residual executive and social cognition deficits. The main cognitive gains occurred shortly after the AP, but qualitative improvements continued to occur. Long-term outcome correlated best with duration of CSWS. SIGNIFICANCE Our findings emphasize that cognitive recovery after cessation of CSWS depends on the severity and duration of the initial regression. None of our patients had major executive and social cognition deficits with preserved intelligence, as reported in adults with early destructive lesions of the frontal lobes. Early recognition of epilepsy with CSWS and rapid introduction of effective therapy are crucial for a best possible outcome.
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Affiliation(s)
- Caroline Seegmüller
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
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Mahowald MW, Cramer Bornemann MA, Schenck CH. State Dissociation: Implications for Sleep and Wakefulness, Consciousness, and Culpability. Sleep Med Clin 2011. [DOI: 10.1016/j.jsmc.2011.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Impact of focal interictal epileptiform discharges on behaviour and cognition in children. Neurophysiol Clin 2011; 42:53-8. [PMID: 22200342 DOI: 10.1016/j.neucli.2011.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/29/2011] [Accepted: 11/01/2011] [Indexed: 11/23/2022] Open
Abstract
It is hypothesised that focal interictal epileptiform discharges (IED) may exert a deleterious effect on behaviour and cognition in children. This hypothesis is supported by the abnormally high prevalence of IED in several developmental disorders, like specific language impairment, and of cognitive and behavioural deficits in epileptic children after excluding confounding factors such as underlying structural brain lesions, drug effects, or the occurrence of frequent or prolonged epileptic seizures. Neurophysiological and functional neuroimaging evidence suggests that IED may impact cognition through either transient effects on brain processing mechanisms, or through more long-lasting effects leading to prolonged inhibition of brain areas distant from but connected with the epileptic focus (i.e. remote inhibition effect). Sustained IED may also impair sleep-related learning consolidation processes. Nowadays, the benefits of anti-epileptic treatment aimed at reducing IED are not established except in specific situations like epileptic encephalopathies with continuous spike and waves during slow-wave sleep. Well-designed pharmacological studies are still necessary to address this issue.
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Ebus SCM, Overvliet GM, Arends JBAM, Aldenkamp AP. Reading performance in children with rolandic epilepsy correlates with nocturnal epileptiform activity, but not with epileptiform activity while awake. Epilepsy Behav 2011; 22:518-22. [PMID: 21940218 DOI: 10.1016/j.yebeh.2011.08.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 06/22/2011] [Accepted: 08/05/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE An association between language impairment and rolandic epilepsy is frequently reported. This impairment could be correlated with the amount of nocturnal epileptiform activity. METHODS We retrospectively analyzed 26 children with rolandic epilepsy and/or rolandic spikes. All had undergone a 24-hour EEG and neuropsychological assessment within 2 weeks. Reading performance (reading words and sentences) and intelligence were measured. RESULTS There was a significant negative correlation between amount of nocturnal epileptiform activity and reading sentences R=-0.525 (P=0.008). There was a trend in this correlation for reading words R=-0.398 (P=0.054). We found a negative correlation between amount of nocturnal epileptiform activity and Verbal IQ (R=-0.51 P=0.08). No correlation was found between reading performance or Verbal IQ and amount of diurnal epileptiform activity. CONCLUSIONS Reading performance is impaired in children with rolandic epilepsy and is correlated with the amount of nocturnal epileptiform activity.
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Affiliation(s)
- S C M Ebus
- Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.
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Is sleep-related consolidation impaired in focal idiopathic epilepsies of childhood? A pilot study. Epilepsy Behav 2011; 22:380-4. [PMID: 21872533 DOI: 10.1016/j.yebeh.2011.07.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/29/2011] [Accepted: 07/18/2011] [Indexed: 11/20/2022]
Abstract
We investigated sleep-related declarative memory consolidation in four children with focal idiopathic epilepsy. In a population of healthy control children, recall of learned pairs of words was increased after a night of sleep, but not after a daytime wakefulness period. In children with epilepsy (1 case of benign epilepsy with centro-temporal spikes, 1 case of benign childhood epilepsy with occipital paroxysms, and 2 cases of epileptic encephalopathy (EE) with continuous spike and waves during slow-wave sleep, CSWS), recall performance significantly decreased overnight, suggesting impairment in sleep-related declarative memory consolidation. Hydrocortisone treatment in one patient with EE with CSWS resulted in normalization of the sleep EEG together with normalization of overnight memory performance, which was not the case in the other EE/CSWS patient whose sleep EEG was only partially improved. These preliminary results suggest that interictal epileptiform discharges in idiopathic focal epilepsies may disrupt the brain processes underlying sleep-related memory consolidation.
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Trotta N, Goldman S, Legros B, Ligot N, Guerry N, Baete K, Van Laere K, Van Bogaert P, De Tiège X. Metabolic evidence for episodic memory plasticity in the nonepileptic temporal lobe of patients with mesial temporal epilepsy. Epilepsia 2011; 52:2003-12. [PMID: 21933182 DOI: 10.1111/j.1528-1167.2011.03271.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Metabolic changes have been described in the nonepileptic temporal lobe of patients with unilateral mesiotemporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS). To better understand the functional correlate of this metabolic finding, we have sought to characterize brain regions in patients with MTLE that show correlation between unilateral episodic memory performances, as assessed by intracarotid amobarbital test (IAT), and interictal regional cerebral metabolism measured by [(18) F]-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS Resting FDG-PET was performed interictally in 26 patients with unilateral MTLE caused by HS (16 female, mean age: 36 years; 16 left HS). Using statistical parametric mapping (SPM8), we performed a group comparison analysis comparing brain metabolism in the patients and in 54 adult controls (27 female, mean age: 32 years), with FDG-PET data of right HS patients being flipped. IAT scores of nonepileptic hemisphere functions (amobarbital injection ipsilateral to HS) were used as covariates of interest in a correlation analysis with regional brain metabolism. KEY FINDINGS The group comparison analysis revealed significant hypometabolic areas in a widespread temporofrontal network ipsilateral to HS. In addition, a significant increase in metabolism was found in mesial and lateral temporal regions contralateral to HS. Significant positive correlations were found between IAT scores of nonepileptic hemisphere functions and mesial temporal metabolism in this hemisphere. SIGNIFICANCE This study demonstrates the existence of significant increase in relative regional cerebral glucose metabolism in mesial and lateral temporal regions contralateral to the epileptic focus in patients with unilateral MTLE associated with HS. The positive correlation in these brain regions between IAT scores and metabolism supports the role of disease-induced plasticity mechanisms contralateral to HS in the preservation of episodic memory processes.
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Affiliation(s)
- Nicola Trotta
- Laboratoire de Cartographie Fonctionnelle du Cerveau, Hpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
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De Tiege X, Goldman S, Van Bogaert P. Neuronal networks in children with continuous spikes and waves during slow sleep. Brain 2011; 134:e177. [DOI: 10.1093/brain/awq389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mazzuca M, Jambaque I, Hertz-Pannier L, Bouilleret V, Archambaud F, Caviness V, Rodrigo S, Dulac O, Chiron C. 18F-FDG PET Reveals Frontotemporal Dysfunction in Children with Fever-Induced Refractory Epileptic Encephalopathy. J Nucl Med 2010; 52:40-7. [DOI: 10.2967/jnumed.110.077214] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Siniatchkin M, Groening K, Moehring J, Moeller F, Boor R, Brodbeck V, Michel CM, Rodionov R, Lemieux L, Stephani U. Neuronal networks in children with continuous spikes and waves during slow sleep. Brain 2010; 133:2798-813. [DOI: 10.1093/brain/awq183] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Richardson M. Current themes in neuroimaging of epilepsy: brain networks, dynamic phenomena, and clinical relevance. Clin Neurophysiol 2010; 121:1153-75. [PMID: 20185365 DOI: 10.1016/j.clinph.2010.01.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 12/24/2009] [Accepted: 01/05/2010] [Indexed: 11/15/2022]
Abstract
Brain scanning methods were first applied in patients with epilepsy more than 30years ago. A very substantial literature now exists in this field, which is exponentially increasing. Contemporary neuroimaging studies in epilepsy reflect new concepts in the epilepsies, as well as current methodological developments. In particular, this area is emphasising the role of networks in epileptogenicity, the existence of dynamic phenomena which can be captured by imaging, and is beginning to validate the implementation of neuroimaging in the clinic. Here, recent studies of the last 5years are reviewed, covering the full range of neuroimaging methods with SPECT, PET and MRI in epilepsy.
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Affiliation(s)
- Mark Richardson
- P043 Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
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