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Costs and cost-driving factors of acute treatment of status epilepticus in children and adolescents: A cohort study from Germany. Seizure 2022; 97:63-72. [DOI: 10.1016/j.seizure.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/22/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
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Salimeen MSA, Liu C, Li X, Wang M, Singh M, Si S, Li M, Cheng Y, Wang X, Zhao H, Wu F, Zhang Y, Tafawa H, Pradhan A, Yang G, Yang J. Exploring Variances of White Matter Integrity and the Glymphatic System in Simple Febrile Seizures and Epilepsy. Front Neurol 2021; 12:595647. [PMID: 33967932 PMCID: PMC8097149 DOI: 10.3389/fneur.2021.595647] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Simple febrile seizures (SFS) and epilepsy are common seizures in childhood. However, the mechanism underlying SFS is uncertain, and the presence of obvious variances in white matter (WM) integrity and glymphatic function between SFS and epilepsy remain unclear. Therefore, this study aimed to investigate the differences in WM integrity and glymphatic function between SFS and epilepsy. Material and Methods: We retrospectively included 26 children with SFS, 33 children with epilepsy, and 28 controls aged 6–60 months who underwent magnetic resonance imaging (MRI). Tract-based spatial statistics (TBSS) were used to compare the diffusion tensor imaging (DTI) metrics of WM among the above-mentioned groups. T2-weighted imaging (T2WI) was used to segment the visible Virchow-Robin space (VRS) through a custom-designed automated method. VRS counts and volume were quantified and compared among the SFS, epilepsy, and control groups. Correlations of the VRS metrics and seizure duration and VRS metrics and the time interval between seizure onset and MRI scan were also investigated. Results: In comparison with controls, children with SFS showed no significant changes in fractional anisotropy (FA), axial diffusivity (AD), or radial diffusivity (RD) in the WM (P > 0.05). Decreased FA, unchanged AD, and increased RD were observed in the epilepsy group in comparison with the SFS and control groups (P < 0.05). Meanwhile, VRS counts were higher in the SFS and epilepsy groups than in the control group (VRS_SFS, 442.42 ± 74.58, VRS_epilepsy, 629.94 ± 106.55, VRS_control, 354.14 ± 106.58; P < 0.001), and similar results were found for VRS volume (VRS_SFS, 6,228.18 ± 570.74 mm3, VRS_epilepsy, 9,684.84 ± 7,292.66mm3, VRS_control, 4,007.22 ± 118.86 mm3; P < 0.001). However, VRS metrics were lower in the SFS group than in the epilepsy group (P < 0.001). In both SFS and epilepsy, VRS metrics positively correlated with seizure duration and negatively correlated with the course after seizure onset. Conclusion: SFS may not be associated with WM microstructural disruption; however, epilepsy is related to WM alterations. Seizures are associated with glymphatic dysfunction in either SFS or epilepsy.
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Affiliation(s)
- Mustafa Salimeen Abdelkareem Salimeen
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Radiology, Dongola Teaching Hospital, University of Dongola, Dongola, Sudan
| | - Congcong Liu
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xianjun Li
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Miaomiao Wang
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Martha Singh
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuqing Si
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengxuan Li
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yannan Cheng
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoyu Wang
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huifang Zhao
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fan Wu
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuli Zhang
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Habib Tafawa
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Anuja Pradhan
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guanyu Yang
- School of Electronic Engineering, Xidian University, Xi'an, China
| | - Jian Yang
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Chin RFM. The outcomes of childhood convulsive status epilepticus. Epilepsy Behav 2019; 101:106286. [PMID: 31196823 DOI: 10.1016/j.yebeh.2019.04.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/19/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Few studies focus specifically on childhood convulsive status epilepticus (CSE). Geographical differences and study design may influence research findings. A comprehensive understanding of the outcomes of childhood CSE needs to bear these factors in mind when examining the published literature. A systematic review of the outcome of childhood CSE was carried out more than a decade ago. Since then, there have been major prospective studies (in the United Kingdom, the United States of America, and in sub-Saharan Africa (SSA)) focused on childhood CSE. METHODS Six major prospective studies are described, and their results combined through a narrative synthesis with findings of the earlier systematic review. The following CSE outcomes are described: (1) recurrence; (2) short-term mortality; (3) subsequent epilepsy; (4) neurological, cognitive, and behavioral impairments outside of epilepsy; (5) long-term mortality; (6) association with hippocampal injury and mesial temporal sclerosis (MTS); and (7) white matter changes. RESULTS One-year recurrence after the first-ever CSE, whether its prolonged febrile seizures (PFS) or non-PFS, is 16% (95% confidence interval [CI]: 10-24). Twenty percent will have a recurrence within 4 years. Case fatality during hospitalization in high income countries is 2.7-5.2%, and 15% in SSA. The cumulative incidence of subsequent epilepsy nine years post-CSE is 25% (95% CI: 16-36). Neurological, cognitive, and behavioral impairments outside of epilepsy are detectable within 6 weeks of CSE. This persists at one year, and by 9 years follow-up, at least at third of subjects will be affected. Long-term mortality ranges from 5 to 17%, with the true estimate at 9 years follow-up to be 8% with standardized mortality ratio of 46. Mesial temporal sclerosis is uncommon, and decreased hippocampal volume is seen in both PFS and non-PFS. Duration is not but etiology/CSE type is, associated with outcome. CONCLUSION Childhood CSE is associated with substantial morbidity and mortality. Etiology but not duration is the main determinant. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures.
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Affiliation(s)
- Richard F M Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK; Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK.
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Martinos MM, Pujar S, O'Reilly H, de Haan M, Neville BG, Scott RC, Chin RF. Intelligence and memory outcomes within 10 years of childhood convulsive status epilepticus. Epilepsy Behav 2019; 95:18-25. [PMID: 31009825 PMCID: PMC6586081 DOI: 10.1016/j.yebeh.2019.03.039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/27/2019] [Accepted: 03/20/2019] [Indexed: 01/21/2023]
Abstract
Long-term intelligence and memory outcomes of children post convulsive status epilepticus (CSE) have not been systematically investigated despite evidence of short-term impairments in CSE. The present study aimed to describe intelligence and memory outcomes in children within 10 years of CSE and identify potential risk factors for adverse outcomes. In this cohort study, children originally identified by the population-based North London Convulsive Status Epilepticus in Childhood Surveillance Study (NLSTEPSS) were prospectively recruited between July 2009 and February 2013 and invited for neuropsychological assessments and magnetic resonance imaging (MRI) scans. Full-scale intelligence quotients (FSIQs) were measured using the Wechsler Abbreviated Scales of Intelligence (WASI), and global memory scores (GMS) was assessed using the Children's Memory Scale (CMS). The cohort was analyzed as a whole and stratified into a prolonged febrile seizures (PFS) and non-PFS group. Their performance was compared with population norms and controls. Regression models were fitted to identify predictors of outcomes. With a mean of 8.9 years post-CSE, 28.5% of eligible participants were unable to undertake testing because of their severe neurodevelopmental deficits. Children with CSE who undertook formal testing (N = 94) were shown to have significantly lower FSIQ (p = 0.001) and GMS (p = 0.025) from controls; the PFS group (N = 34) had lower FSIQs (p = 0.022) but similar memory quotients (p = 0.88) with controls. Intracranial volume (ICV), developmental delay at baseline, and active epilepsy at follow-up were predictive of long-term outcomes in the non-PFS group. The relationship between ICV and outcomes was absent in the PFS group despite its presence in the control and non-PFS groups. Post-CSE, survivors reveal significant intelligence and memory impairments, but prognosis differs by CSE type; memory scores are uncompromised in the PFS group despite evidence of their lower FSIQ whereas both are compromised in the non-PFS group. Correlations between brain volumes and outcomes differ in the PFS, non-PFS, and control groups and require further investigation.
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Affiliation(s)
- Marina M. Martinos
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK,Corresponding author at: Cognitive Neuroscience and Neuropsychiatry, UCL Institute of Child Health, 30 Guilford Street, WC1N 1EH London, UK.
| | - Suresh Pujar
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK
| | - Helen O'Reilly
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK
| | - Michelle de Haan
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK
| | - Brian G.R. Neville
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK
| | - Rod C. Scott
- Department of Neurological Sciences, University of Vermont, VT, USA
| | - Richard F.M. Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK
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Moldovan K, Boxerman JL, O'Muircheartaigh J, Dean D, Eyerly-Webb S, Cosgrove GR, Pucci FG, Deoni SCL, Spader HS. Myelin water fraction changes in febrile seizures. Clin Neurol Neurosurg 2018; 175:61-67. [PMID: 30384118 DOI: 10.1016/j.clineuro.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/27/2018] [Accepted: 10/07/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objective of this feasibility study was to investigate whether myelin water fraction (MWF) patterns can differentiate children presenting with febrile seizures who will go on to develop nonfebrile epilepsy from those who will not. PATIENTS AND METHODS As part of a prospective study of myelination patterns in pediatric epilepsy, seven subjects with febrile seizures underwent magnetic resonance imaging (MRI) including the following standard sequences-T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR)-and an additional experimental sequence, multicomponent-derived equilibrium single-pulse observation of T1 and T2 (mcDESPOT) to quantify MWF. For each of these subjects, MWF maps were derived and compared with an age-matched population-averaged MWF atlas. RESULTS All seven subjects (<5 years old) initially presented with febrile seizures. Of the seven, four had complex seizures and three had simple seizures. All of the children with simple febrile seizures had higher MWF compared with model-derived controls and did not develop epilepsy. All of the children with complex febrile seizures had lower MWF than their model-derived control, and two of these subjects later developed epilepsy. CONCLUSION This is the first study in which MWF maps were used to study children with febrile *seizures. This data suggests that relatively higher or stable MWF compared with normative data indicates a lower risk of nonfebrile epilepsy while relatively lower MWF may indicate a pathological condition that could lead to nonfebrile epilepsy.
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Affiliation(s)
- Krisztina Moldovan
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Jerrold L Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | | | - Doug Dean
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA.
| | - Stephanie Eyerly-Webb
- Office of Human Research, Memorial Healthcare System, 3501 Johnson Street, Hollywood, FL, 33021, USA.
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Neurosciences Center, 60 Fenwood Road, 1st Floor, Boston, MA, 02115, USA.
| | - Francesco G Pucci
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Sean C L Deoni
- Brown University Advanced Baby Imaging Lab, Memorial Hospital of Rhode Island, Department of Pediatrics, 111 Brewster Street, Pawtucket, RI, 02860, USA.
| | - Heather S Spader
- Division of Pediatric Neurosurgery, Joe DiMaggio Children's Hospital, 1150N 35th Ave, Hollywood, FL, 33021, USA.
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Martinos MM, Pujar S, Gillberg C, Cortina‐Borja M, Neville BGR, De Haan M, Scott RC, Chin RFM. Long-term behavioural outcomes after paediatric convulsive status epilepticus: a population-based cohort study. Dev Med Child Neurol 2018; 60:409-416. [PMID: 29226310 PMCID: PMC5900729 DOI: 10.1111/dmcn.13636] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2017] [Indexed: 12/18/2022]
Abstract
AIM To describe behavioural and psychiatric outcomes of children within 10 years of convulsive status epilepticus (CSE). METHOD Children originally identified by the population-based North London Convulsive Status Epilepticus in Childhood Surveillance Study were followed-up between July 2009 and February 2013. They were grouped into epilepsy- and non-epilepsy-related CSE, and compared with population norms and healthy controls using the Strengths and Difficulties Questionnaire; the Autism Spectrum Screening Questionnaire; and the Swanson, Nolan, and Pelham questionnaire. Children who scored above recommended clinical cut-offs on any scale were invited for a neuropsychiatric assessment. Regression models were fitted to identify clinically relevant covariates associated with behavioural outcomes. RESULTS At a mean follow-up of 8.1 years post-CSE, 28% of enrolled children were found to have a psychiatric disorder. Children with epilepsy-related CSE scored higher than norms on all scales and children with non-epilepsy-related CSE scored higher than norms on the Strengths and Difficulties Questionnaire and the Autism Spectrum Screening Questionnaire. Presence of seizures at baseline and recurrence of CSE was associated with worse outcomes in the group with epilepsy. Intellectual abilities were associated with behavioural outcomes in all participants. INTERPRETATION A large proportion of children manifest behavioural issues 8 years after CSE. The present data highlight the need for behavioural screening in children with neurodevelopmental impairments post-CSE. WHAT THIS PAPER ADDS Eight years post convulsive status epilepticus (CSE), 37% of parents report behavioural issues. Of enrolled children, 28% were found to have a Diagnostic and Statistical Manual mental disorder. Intellectual abilities are strongly associated with behavioural outcomes in children post-CSE.
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Affiliation(s)
- Marina M Martinos
- Developmental Neurosciences ProgrammeUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Suresh Pujar
- Developmental Neurosciences ProgrammeUCL Great Ormond Street Institute of Child HealthLondonUK
| | | | - Mario Cortina‐Borja
- Population, Policy and Practice ProgrammeUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Brian G R Neville
- Developmental Neurosciences ProgrammeUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Michelle De Haan
- Developmental Neurosciences ProgrammeUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Rod C Scott
- Developmental Neurosciences ProgrammeUCL Great Ormond Street Institute of Child HealthLondonUK,Department of Neurological SciencesUniversity of VermontBurlingtonVTUSA
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Pujar SS, Seunarine KK, Martinos MM, Neville BGR, Scott RC, Chin RFM, Clark CA. Long-term white matter tract reorganization following prolonged febrile seizures. Epilepsia 2017; 58:772-780. [PMID: 28332711 PMCID: PMC5484997 DOI: 10.1111/epi.13724] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 12/17/2022]
Abstract
Objective Diffusion magnetic resonance imaging (MRI) studies have demonstrated acute white matter changes following prolonged febrile seizures (PFS), but their longer‐term evolution is unknown. We investigated a population‐based cohort to determine white matter diffusion properties 8 years after PFS. Methods We used diffusion tensor imaging (DTI) and applied Tract‐Based Spatial Statistics for voxel‐wise comparison of white matter microstructure between 26 children with PFS and 27 age‐matched healthy controls. Age, gender, handedness, and hippocampal volumes were entered as covariates for voxel‐wise analysis. Results Mean duration between the episode of PFS and follow‐up was 8.2 years (range 6.7–9.6). All children were neurologically normal, and had normal conventional neuroimaging. On voxel‐wise analysis, compared to controls, the PFS group had (1) increased fractional anisotropy in early maturing central white matter tracts, (2) increased mean and axial diffusivity in several peripheral white matter tracts and late‐maturing central white matter tracts, and (3) increased radial diffusivity in peripheral white matter tracts. None of the tracts had reduced fractional anisotropy or diffusivity indices in the PFS group. Significance In this homogeneous, population‐based sample, we found increased fractional anisotropy in early maturing central white matter tracts and increased mean and axial diffusivity with/without increased radial diffusivity in several late‐maturing peripheral white matter tracts 8 years post‐PFS. We propose disruption in white matter maturation secondary to seizure‐induced axonal injury, with subsequent neuroplasticity and microstructural reorganization as a plausible explanation.
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Affiliation(s)
- Suresh S Pujar
- Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Young Epilepsy, Lingfield, Surrey, United Kingdom
| | - Kiran K Seunarine
- Imaging and Biophysics Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Marina M Martinos
- Developmental Cognitive Neuroscience Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Brian G R Neville
- Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Young Epilepsy, Lingfield, Surrey, United Kingdom
| | - Rod C Scott
- Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Young Epilepsy, Lingfield, Surrey, United Kingdom.,Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont, U.S.A
| | - Richard F M Chin
- Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Muir Maxwell Epilepsy Centre, Department of Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
| | - Chris A Clark
- Imaging and Biophysics Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Wagner J, Schoene-Bake JC, Witt JA, Helmstaedter C, Malter MP, Stoecker W, Probst C, Weber B, Elger CE. Distinct white matter integrity in glutamic acid decarboxylase and voltage-gated potassium channel-complex antibody-associated limbic encephalitis. Epilepsia 2016; 57:475-83. [PMID: 26749370 DOI: 10.1111/epi.13297] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Autoantibodies against glutamic acid decarboxylase (GAD) and the voltage-gated potassium channel (VGKC) complex are associated with distinct subtypes of limbic encephalitis regarding clinical presentation, response to therapy, and outcome. The aim of this study was to investigate white matter changes in these two limbic encephalitis subtypes by means of diffusion tensor imaging (DTI). METHODS Diffusion data were obtained in 14 patients with GAD antibodies and 16 patients with VGKC-complex antibodies and compared with age- and gender-matched control groups. Voxelwise statistical analysis was carried out using tract-based spatial statistics. The results were furthermore compared with those of 15 patients with unilateral histologically confirmed hippocampal sclerosis and correlated with verbal and figural memory performance. RESULTS We found widespread changes of fractional anisotropy and all diffusivity parameters in GAD-associated limbic encephalitis, whereas no changes were found in VGKC-complex-associated limbic encephalitis. The changes observed in the GAD group were even more extensive when compared against those of the hippocampal sclerosis group, although the disease duration was markedly shorter in patients with GAD antibodies. Correlation analysis revealed areas with a trend toward a negative correlation of diffusivity parameters with figural memory performance located mainly in the right temporal lobe in the GAD group as well. SIGNIFICANCE The present study provides further evidence that, depending on the associated antibody, limbic encephalitis features clearly distinct imaging characteristics by showing widespread white matter changes in GAD-associated limbic encephalitis and preserved white matter integrity in VGKC-complex-associated limbic encephalitis. Furthermore, our results contribute to a better understanding of the specific pathophysiologic properties in these two subforms of limbic encephalitis by revealing that patients with GAD antibodies show widespread affections of white matter across various regions of the brain. In contrast to this, the inflammatory process seems to be more localized in VGKC-complex-associated limbic encephalitis, primarily affecting mesiotemporal gray matter.
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Affiliation(s)
- Jan Wagner
- Department of Epileptology, University of Bonn, Bonn, Germany.,Department of NeuroCognition/Imaging, Life & Brain Center, Bonn, Germany
| | - Jan-Christoph Schoene-Bake
- Department of Epileptology, University of Bonn, Bonn, Germany.,Department of NeuroCognition/Imaging, Life & Brain Center, Bonn, Germany.,Department of Pediatrics, Klinikum Braunschweig, Braunschweig, Germany
| | | | | | - Michael P Malter
- Department of Epileptology, University of Bonn, Bonn, Germany.,Department of Neurology, University of Cologne, Cologne, Germany
| | - Winfried Stoecker
- Institute of Experimental Immunology, affiliated with Euroimmun AG Luebeck, Luebeck, Germany
| | - Christian Probst
- Institute of Experimental Immunology, affiliated with Euroimmun AG Luebeck, Luebeck, Germany
| | - Bernd Weber
- Department of Epileptology, University of Bonn, Bonn, Germany.,Department of NeuroCognition/Imaging, Life & Brain Center, Bonn, Germany.,Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn, Bonn, Germany.,Department of NeuroCognition/Imaging, Life & Brain Center, Bonn, Germany.,Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
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Jain P, Sharma S, Dhingra D, Aneja S. Transient restricted diffusion of corpus callosum and subcortical white matter following febrile status epilepticus. J Child Neurol 2015; 30:757-9. [PMID: 24850571 DOI: 10.1177/0883073814535497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/14/2014] [Indexed: 01/11/2023]
Abstract
We describe the case of a 4½-year-old girl with prolonged febrile status followed by abnormal behavior and loss of speech. Interesting findings on diffusion-restricted imaging were noted. The clinicoradiologic possibilities are discussed.
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Affiliation(s)
- Puneet Jain
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Suvasini Sharma
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Dhulika Dhingra
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Satinder Aneja
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
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10
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Rodríguez-Cruces R, Concha L. White matter in temporal lobe epilepsy: clinico-pathological correlates of water diffusion abnormalities. Quant Imaging Med Surg 2015; 5:264-78. [PMID: 25853084 DOI: 10.3978/j.issn.2223-4292.2015.02.06] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/14/2015] [Indexed: 02/05/2023]
Abstract
Using magnetic resonance imaging, it is possible to measure the behavior of diffusing water molecules, and the metrics derived can be used as indirect markers of tissue micro-architectural properties. Numerous reports have demonstrated that patients with temporal lobe epilepsy (TLE) have water diffusion abnormalities in several white matter structures located within and beyond the epileptogenic temporal lobe, showing that TLE is not a focal disorder, but rather a brain network disease. Differences in severity and spatial extent between patients with or without mesial temporal sclerosis (MTS), as well as differences related to hemispheric seizure onset, are suggestive of different pathophysiological mechanisms behind different forms of TLE, which in turn result in specific cognitive disabilities. The biological interpretation of diffusion abnormalities is based on a wealth of information from animal models of white matter damage, and is supported by recent reports that directly correlate diffusion metrics with histological characteristics of surgical specimens of TLE patients. Thus, there is now more evidence showing that the increased mean diffusivity (MD) and concomitant reductions of diffusion anisotropy that are frequently observed in several white matter bundles in TLE patients reflect reduced axonal density (increased extra-axonal space) due to smaller-caliber axons, and abnormalities in the myelin sheaths of the remaining axons. Whether these histological and diffusion features are a predisposing factor for epilepsy or secondary to seizures is still uncertain; some reports suggest the latter. This article summarizes recent findings in this field and provides a synopsis of the histological features seen most frequently in post-surgical specimens of TLE patients in an effort to aid the interpretation of white matter diffusion abnormalities.
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Affiliation(s)
- Raúl Rodríguez-Cruces
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Luis Concha
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
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Abstract
PURPOSE OF REVIEW There is a long-standing hypothesis that febrile status epilepticus (FSE) can cause brain injury, particularly to the hippocampus. This review will evaluate recent evidence on the relationships between FSE and later epilepsy and cognitive impairments. Potential strategies for minimizing adverse outcomes will be discussed. RECENT FINDINGS There are two major longitudinal studies evaluating the outcomes for FSE. These studies provide evidence of acute hippocampal edema that evolves to mesial temporal sclerosis in a small number of children (∼7%). However, none of these children have developed temporal lobe epilepsy. There is also evidence of more global white matter injury. Development is affected, with a loss of about 10 developmental quotient points and there is evidence for accelerated forgetting. These findings do not correlate with MRI parameters. Therefore, FSE can cause a wide spectrum of injury, but the relationship between this and clinically relevant adverse outcomes remains uncertain. SUMMARY Although there is accumulating evidence that FSE can cause brain injury, the strategies to minimize the impact remain uncertain. Imaging requires sedation, with inherent risks, and may not be appropriate for all children with FSE, given the small number with significant hippocampal edema that could be a biomarker. The alternative of treating all children requires a very safe drug which currently does not exist.
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Feng B, Tang YS, Chen B, Dai YJ, Xu CL, Xu ZH, Zhang XN, Zhang SH, Hu WW, Chen Z. Dysfunction of thermoregulation contributes to the generation of hyperthermia-induced seizures. Neurosci Lett 2014; 581:129-34. [PMID: 25172570 DOI: 10.1016/j.neulet.2014.08.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/31/2014] [Accepted: 08/19/2014] [Indexed: 12/13/2022]
Abstract
Febrile seizures (FS) are generally defined as seizures taking place during fever. Long-term prognosis, including development of epilepsy and malformation of cognitive function, has been demonstrated after infantile FS. However, the mechanism that triggers seizures in hyperthermic environment is still unclear. We here found that the body temperature of rat pups that experienced experimental FS was markedly decreased (∼28°C) after they were removed from the hyperthermic environment. Both the seizure generation and the temperature drop after seizure attack were abolished by either pre-treatment with chlorpromazine (CPZ), which impairs the thermoregulation, or by an electrolytic lesion of the preoptic area and anterior hypothalamus (PO/AH). However, the non-steroidal anti-inflammatory drug celecoxib did not affect the seizure incidence and the decrease in body temperature after seizure attack. In addition, pentobarbital prevented the generation of seizures, but did not reverse the decrease of body temperature after FS. Therefore, our work indicates that an over-regulation of body temperature occurs during hyperthermic environment, and that the dysfunction of thermoregulation in the PO/AH following hyperthermia contributes to the generation of FS.
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Affiliation(s)
- Bo Feng
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yang-Shun Tang
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Bin Chen
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yun-Jian Dai
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Ceng-Lin Xu
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Zheng-Hao Xu
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Xiang-Nan Zhang
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Shi-Hong Zhang
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Wei-Wei Hu
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China.
| | - Zhong Chen
- Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China.
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