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Liu PC, Chen HH, Chou CC, Chen CJ, Chen YH, Lin CF, Chen C, Yu HY, Lee CC. Stereo-EEG for Epileptogenic Focus Localization in Schizencephaly: A Single-center Experience in Four Patients. World Neurosurg 2023; 172:e319-e325. [PMID: 36632895 DOI: 10.1016/j.wneu.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Schizencephaly is a congenital cerebral malformation characterized by clefts in the hemispheres of the brain, where variations in semiology often make it difficult to localize epileptogenic focus. Here, we report on a series of patients who underwent stereo-encephalography (SEEG) for epileptogenic focus localization and subsequent SEEG-guided surgical intervention. METHODS Four patients (ages 27, 33, 27, 25 years) with a mean seizure history of 16 years (range 8-22 years) were analyzed. Data pertaining to semiology, video encephalography (EEG), magnetic resonance imaging, positron emission tomography, and invasive EEG studies, surgical intervention and post-surgery outcome were collected and analyzed. RESULTS All seizure onset zones were within the extent of schizencephaly; however, the limbic system (including the hippocampus, amygdala, cingulate gyrus, or insula) was involved in early spreading. Two patients underwent SEEG-guided radiofrequency thermo-ablation (RFTA) in the seizure onset zone, 1 patient underwent lesionectomy via craniotomy, and 1 underwent neither RFTA nor lesionectomy. At 2 years post-surgery, the outcomes were as follows: Engel grade Ia (n = 2), Ib (n = 1), and III (n = 1). CONCLUSIONS This article reports on a precise approach to treating patients with schizencephaly dependent of seizure onset zone and functional cortex mapping. Subsequent SEEG-guided surgical interventions (radiofrequency thermo-ablation and lesionectomy) were shown to reduce seizure frequency, while preserving the neurologic functions in drug-resistant epilepsy patients with schizencephaly.
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Affiliation(s)
- Ping-Chuan Liu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Hung Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Chen Chou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA
| | - Yi-Hsiu Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Chokote E, Ngarka L, Takoeta EO, Kengni HNT, Nfor LN, Mengnjo MK, Mendo EL, Djeutcheu F, Yepnjio FN, Tatah GY, Mbassi HDA, Njamnshi AK. A rare case of drug sensitive adult‐onset temporal lobe epilepsy due to a focal cortical dysplasia revealed by ictal coughing: First report in sub‐Saharan Africa. Clin Case Rep 2023; 11:e7093. [PMID: 36992669 PMCID: PMC10041363 DOI: 10.1002/ccr3.7093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/30/2022] [Accepted: 02/25/2023] [Indexed: 03/30/2023] Open
Abstract
This case suggests that clinicians should consider seizures as a differential diagnosis of paroxystic cough with loss of consciousness. Focal cortical dysplasia should equally be screened for with magnetic resonance imaging (MRI) scans even in adults with epilepsy in sub‐Saharan Africa. This case suggests that clinicians should consider seizures as a differential diagnosis of paroxystic cough with loss of consciousness. Focal cortical dysplasia should equally be screened for with Magnetic Resonance Imaging (MRI) scans even in adults with epilepsy in sub‐Saharan Africa.
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Affiliation(s)
- Eric‐Samuel Chokote
- Department of NeurologyJordan Medical ServicesYaoundéCameroon
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
| | - Leonard Ngarka
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
| | | | - Hermann Nestor Tsague Kengni
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
- Department of CardiologyJordan Medical ServicesYaoundéCameroon
| | - Leonard N. Nfor
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
| | - Michel K. Mengnjo
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
| | - Edwige Laure Mendo
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of NeurologyEbolowa Regional HospitalEbolowaCameroon
| | | | | | - Godwin Y. Tatah
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
- Department of NeurologyCH Saint‐NazaireSaint‐NazaireFrance
| | - Hubert Désiré Awa Mbassi
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
- Chantal Biya FoundationMCCYaoundéCameroon
| | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
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Şah O, Türkdoğan D, Küçük S, Takış G, Asadov R, Öztürk G, Ünver O, Ekinci G. Neurodevelopmental Findings and Epilepsy in Malformations of Cortical Development. Turk Arch Pediatr 2022; 56:356-365. [PMID: 35005731 PMCID: PMC8655965 DOI: 10.5152/turkarchpediatr.2021.20148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022]
Abstract
Aim: The purpose of this study is to classify the malformations of cortical development in children according to the embryological formation, localization, and neurodevelopmental findings. Seizure/epilepsy and electrophysiological findings have also been compared. Material and Methods: Seventy-five children (age: 1 month-16.5 years; 56% male) followed with the diagnosis of malformation of cortical development, in Marmara University Pendik Research and Educational Hospital Department of Pediatric Neurology, were included in the study. Their epilepsy characteristics, electroencephalogram (EEG) findings, and prognosis were reported. Neurodevelopmental characteristics were evaluated by the Bayley Scales of Infant and Toddler Development (Bayley-III) for the ages of 0-42 months (n = 30); the Denver Developmental Screening Test-II (DDST-II) for ages 42 months-6 years (n = 11); and the Wechsler Intelligence Scales for Children (WISC-R), used for children 6 years and older (n = 34). Results: The patients were classified as 44% premigrational (14.6% microcephaly, 24% tuberous sclerosis, 2.7% focal cortical dysplasia, 1.3% hemimegalencephaly, and 1.3% diffuse cortical dysgenesis); 17.3% migrational (14.6% lissencephaly, 2.7% heterotopia); and 38.6% postmigrational (14.6% schizencephaly, 24% polymicrogyria) developmentally. According to involved area, the classification was 34.7% hemispheric/multilobar, 33.3% diffuse, and 32% focal. Seventy-five percent of the patients had a history of epilepsy, and 92% were resistant to treatment. The seizures started before the age of 12 months in diffuse malformations, and epileptic encephalopathy was more common in microcephaly with a rate of 80% and lissencephaly with a rate of 54.5% in the first EEGs. Ninety-five percent of patients had at least one level of neurodevelopmental delay detected by DDST/Bayley-III; this was more common in patients with accompanying epilepsy (P < .05). As seen more commonly in patients with diffuse pathologies and intractable frequent seizures, mental retardation was detected by WISC-R in 64.5% of patients (P < .05). Conclusion: In cases with cortical developmental malformation, epilepsy/EEG features and neurodevelopmental prognosis can be predicted depending on the developmental process and type and extent of involvement. Patients should be followed up closely with EEG.
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Affiliation(s)
- Olcay Şah
- Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey
| | - Dilşad Türkdoğan
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University School of Medicine, İstanbul, Turkey
| | - Selda Küçük
- Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey
| | - Gülnur Takış
- Department of Child and Adolescent Psychiatry, Marmara University School of Medicine, İstanbul, Turkey
| | - Ruslan Asadov
- Department of Radiology, Marmara University School of Medicine, İstanbul, Turkey
| | - Gülten Öztürk
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University School of Medicine, İstanbul, Turkey
| | - Olcay Ünver
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University School of Medicine, İstanbul, Turkey
| | - Gazanfer Ekinci
- Department of Radiology, Marmara University School of Medicine, İstanbul, Turkey
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Modeling Neurodevelopmental Disorders and Epilepsy Caused by Loss of Function of kif2a in Zebrafish. eNeuro 2021; 8:ENEURO.0055-21.2021. [PMID: 34404749 PMCID: PMC8425962 DOI: 10.1523/eneuro.0055-21.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
In recent years there has been extensive research on malformations of cortical development (MCDs) that result in clinical features like developmental delay, intellectual disability, and drug-resistant epilepsy (DRE). Various studies highlighted the contribution of microtubule-associated genes (including tubulin and kinesin encoding genes) in MCD development. It has been reported that de novo mutations in KIF2A, a member of the kinesin-13 family, are linked to brain malformations and DRE. Although it is known that KIF2A functions by regulating microtubule depolymerization via an ATP-driven process, in vivo implications of KIF2A loss of function remain partly unclear. Here, we present a novel kif2a knock-out zebrafish model, showing hypoactivity, habituation deficits, pentylenetetrazole-induced seizure susceptibility and microcephaly, as well as neuronal cell proliferation defects and increased apoptosis. Interestingly, kif2a−/− larvae survived until adulthood and were fertile. Notably, our kif2a zebrafish knock-out model demonstrated many phenotypic similarities to KIF2A mouse models. This study provides valuable insights into the functional importance of kif2a in zebrafish and phenotypical hallmarks related to KIF2A mutations. Ultimately, this model could be used in a future search for more effective therapies that alleviate the clinical symptoms typically associated with MCDs.
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D'Gama AM, Poduri A. Precision Therapy for Epilepsy Related to Brain Malformations. Neurotherapeutics 2021; 18:1548-1563. [PMID: 34608615 PMCID: PMC8608994 DOI: 10.1007/s13311-021-01122-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 02/04/2023] Open
Abstract
Malformations of cortical development (MCDs) represent a range of neurodevelopmental disorders that are collectively common causes of developmental delay and epilepsy, especially refractory childhood epilepsy. Initial treatment with antiseizure medications is empiric, and consideration of surgery is the standard of care for eligible patients with medically refractory epilepsy. In the past decade, advances in next generation sequencing technologies have accelerated progress in understanding the genetic etiologies of MCDs, and precision therapies for focal MCDs are emerging. Notably, mutations that lead to abnormal activation of the mammalian target of rapamycin (mTOR) pathway, which provides critical control of cell growth and proliferation, have emerged as a common cause of malformations. These include tuberous sclerosis complex (TSC), hemimegalencephaly (HME), and some types of focal cortical dysplasia (FCD). TSC currently represents the best example for the pathway from gene discovery to relatively safe and efficacious targeted therapy for epilepsy related to MCDs. Based on extensive pre-clinical and clinical data, the mTOR inhibitor everolimus is currently approved for the treatment of focal refractory seizures in patients with TSC. Although clinical studies are just emerging for FCD and HME, we believe the next decade will bring significant advancements in precision therapies for epilepsy related to these and other MCDs.
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Affiliation(s)
- Alissa M D'Gama
- Divisions of Newborn Medicine and Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Departments of Neurology and Pediatrics, Harvard Medical School, Boston, MA, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.
- Departments of Neurology and Pediatrics, Harvard Medical School, Boston, MA, USA.
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
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Foit NA, Bernasconi A, Ladbon-Bernasconi N. Contributions of Imaging to Neuromodulatory Treatment of Drug-Refractory Epilepsy. Brain Sci 2020; 10:E700. [PMID: 33023078 PMCID: PMC7601437 DOI: 10.3390/brainsci10100700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022] Open
Abstract
Epilepsy affects about 1% of the world's population, and up to 30% of all patients will ultimately not achieve freedom from seizures with anticonvulsive medication alone. While surgical resection of a magnetic resonance imaging (MRI) -identifiable lesion remains the first-line treatment option for drug-refractory epilepsy, surgery cannot be offered to all. Neuromodulatory therapy targeting "seizures" instead of "epilepsy" has emerged as a valuable treatment option for these patients, including invasive procedures such as deep brain stimulation (DBS), responsive neurostimulation (RNS) and peripheral approaches such as vagus nerve stimulation (VNS). The purpose of this review is to provide in-depth information on current concepts and evidence on network-level aspects of drug-refractory epilepsy. We reviewed the current evidence gained from studies utilizing advanced imaging methodology, with a specific focus on their contributions to neuromodulatory therapy.
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Affiliation(s)
- Niels Alexander Foit
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada; (A.B.); (N.L.-B.)
- Department of Neurosurgery, Medical Center–University of Freiburg, Faculty of Medicine, D-79106 Freiburg, Germany
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada; (A.B.); (N.L.-B.)
| | - Neda Ladbon-Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada; (A.B.); (N.L.-B.)
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Jayalakshmi S, Dhondji M, Vooturi S, Patil A, Vadapalli R. Inter-ictal EEG patterns in malformations of cortical development and epilepsy. Clin Neurol Neurosurg 2020; 196:106022. [PMID: 32599425 DOI: 10.1016/j.clineuro.2020.106022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Malformations of cortical Development (MCDs) are associated with refractory epilepsy. We evaluated scalp inter-ictal EEG patterns in various types of MCD, and its association with clinical features and seizure control. PATIENTS AND METHODS Retrospective analysis of demographic, clinical, inter-ictal EEG and seizure outcome data of 665 patients with epilepsy and MCD with at least two years follow up was performed. RESULTS Average age of study population was 15.95 ± 10.79 years with 291(43.8 %) women. Multiregional spikes were more common in children (22.7 % vs 8.5; p < 0.001), if age of onset of epilepsy was <2 years (21.8 % vs 11.4 %; p = 0.001) and polymicrogyria (12.1 % vs 37.3 %; p < 0.001). Generalized epileptiform discharges were more frequent in patients with developmental delay (24.7 % vs 12.6 %; p < 0.001); and were associated with lissencephaly(14.0 % vs 59.3 %; p < 0.001) and heterotopias(14.5 % vs 34.9 %;p = 0.002). Regional spikes were more common if age of onset of epilepsy is >2 years (26.2 % vs 38.4 %; p = 0.003), and also in FCD (17.1 % vs 42.6 %; p < 0.001). At latest follow-up, 151(22.7 %) patients were seizure free; 401(60.7 %) had refractory epilepsy and the rest had remissions with relapse. No association was found between inter-ictal EEG patterns and seizure control. CONCLUSION In patients with MCD, generalized epileptiform discharges were associated with developmental delay, lissencephaly and heterotopias. Regional spikes were frequent in FCD while multiregional spikes in children and polymicrogyria. Inter-ictal EEG patterns did not influence seizure outcome.
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Affiliation(s)
- Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, India.
| | - Madhukar Dhondji
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, India
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, India
| | - Anuja Patil
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, India
| | - Rammohan Vadapalli
- Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad, India
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Foit NA, Bernasconi A, Bernasconi N. Functional Networks in Epilepsy Presurgical Evaluation. Neurosurg Clin N Am 2020; 31:395-405. [PMID: 32475488 DOI: 10.1016/j.nec.2020.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Continuing advancements in neuroimaging methodology allow for increasingly detailed in vivo characterization of structural and functional brain networks, leading to the recognition of epilepsy as a disorder of large-scale networks. In surgical candidates, analysis of functional networks has proved invaluable for the identification of eloquent brain areas, such as hemispherical language dominance. More recently, connectome-based biomarkers have demonstrated potential to further inform clinical decision making in drug-refractory epilepsy. This article summarizes current evidence on epilepsy as a network disorder, emphasizing potential benefits of network analysis techniques for preoperative assessments and resection planning.
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Affiliation(s)
- Niels Alexander Foit
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 Rue Université, Montreal, Quebec H3A 2B4, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 Rue Université, Montreal, Quebec H3A 2B4, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 Rue Université, Montreal, Quebec H3A 2B4, Canada.
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Rikir E, Maillard LG, Abdallah C, Gavaret M, Bartolomei F, Vignal JP, Colnat-Coulbois S, Koessler L. Respective Contribution of Ictal and Inter-ictal Electrical Source Imaging to Epileptogenic Zone Localization. Brain Topogr 2020; 33:384-402. [DOI: 10.1007/s10548-020-00768-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
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Kuchukhidze G, Siedentopf C, Unterberger I, Koppelstaetter F, Kronbichler M, Zamarian L, Haberlandt E, Ischebeck A, Delazer M, Felber S, Trinka E. Language Dominance in Patients With Malformations of Cortical Development and Epilepsy. Front Neurol 2019; 10:1209. [PMID: 31824399 PMCID: PMC6881376 DOI: 10.3389/fneur.2019.01209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Language function may be reorganized in patients with malformations of cortical development (MCD). This prospective cohort study aimed in assessing language dominance in a large group of patients with MCD and epilepsy using functional MRI (fMRI). Methods: Sixty-eight patients (40 women) aged 10-73 years (median, 28.0; interquartile range, 19) with MCD and epilepsy underwent 1.5 T MRI and fMRI (word generation task). Single-subject image analysis was performed with statistical parametric mapping (SPM12). Language lateralization indices (LIs) were defined for statistically significantly activated voxels in Broca's and Wernicke's areas using the formula: LI = (V L - V R)/(V L + V R) × 100, where V L and V R were sets of activated voxels on the left and on the right, respectively. Language laterality was considered typical if LI was between +20 and +100 or atypical if LI was between +19 and -100. Results: fMRI signal was elicited in 55 of 68 (81%) patients. In 18 of 55 (33%) patients, language dominance was typical, and in 37 of 55 (67%) patients, atypical (in 68%, right hemispheric; in 32%, bilateral). Language dominance was not influenced by handedness, electroclinical, and imaging features. Conclusions: In this prospective study on a large group of patients with MCD and epilepsy, about two-thirds had atypical language dominance. These results may contribute to assessing risks of postsurgical language deficits and could assist in planning of "cortical mapping" with intracranial electrodes in patients who undergo presurgical assessment.
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Affiliation(s)
- Giorgi Kuchukhidze
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Siedentopf
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Iris Unterberger
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Koppelstaetter
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Radiology, Sanatorium Kettenbrücke, Innsbruck, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Edda Haberlandt
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
- Department of Pediatrics, City Hospital, Dornbirn, Austria
| | - Anja Ischebeck
- Institute of Psychology, University of Graz, Graz, Austria
| | - Margarete Delazer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Felber
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | - Eugen Trinka
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
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Salinas V, Vega P, Piccirilli MV, Chicco C, Ciraolo C, Christiansen S, Consalvo D, Perez-Maturo J, Medina N, González-Morón D, Novaro V, Perrone C, García MDC, Agosta G, Silva W, Kauffman M. Identification of a somatic mutation in the RHEB gene through high depth and ultra-high depth next generation sequencing in a patient with Hemimegalencephaly and drug resistant Epilepsy. Eur J Med Genet 2019; 62:103571. [DOI: 10.1016/j.ejmg.2018.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/18/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
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12
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Prevalence of neuropsychiatric symptoms associated with malformations of cortical development. Epilepsy Behav 2019; 92:306-310. [PMID: 30731297 DOI: 10.1016/j.yebeh.2019.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Malformations of cortical development (MCD) are structural abnormality of the cortex or brain parenchyma with diverse clinical manifestations. Little is known about the association of psychiatric and behavioral problems in MCD. We aimed to determine prevalence and risk factors of neuropsychiatric symptoms in a cohort of adult patients with MCD. METHODS We conducted a retrospective medical records review of 86 adult patients followed at the epilepsy clinic of the Montreal Neurological Hospital. Information on diagnosis of medical and psychiatric disorders, family history, intellectual disability, and psychiatric symptoms was obtained from their medical records. RESULTS The cohort (n = 86) had a mean age of 39 ± 14.07 (range: 18-74) years. The three most common MCD subtypes were focal cortical dysplasia (47.7%), periventricular nodular heterotopia (29.1%), and polymicrogyria (16.3%). Overall, prevalence of formally diagnosed psychiatric disorders and psychiatric symptoms were respectively 15.1% and 31.4%. The most frequently described symptoms were anxiety-related (59.3%), followed by irritability (40.7%) and agitation (37.0%). Patients with family psychiatric history (OR: 8.168, 95% CI: 1.44-46.48) and intellectual disability (OR: 5.824, 95% CI: 1.30-26.10) were significantly more likely to have psychiatric symptoms than those without. The prevalence of psychiatric symptoms did not defer between major groups of MCD. CONCLUSIONS Neuropsychiatric symptoms are commonly associated with MCD, but psychiatric disorders may be underrecognized given that only half of the patients with psychiatric symptoms were referred for a specialized consultation. The presence of intellectual disability and family psychiatric history may help identify and predict risk of psychiatric manifestations in MCD.
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Oegema R, Baillat D, Schot R, van Unen LM, Brooks A, Kia SK, Hoogeboom AJM, Xia Z, Li W, Cesaroni M, Lequin MH, van Slegtenhorst M, Dobyns WB, de Coo IFM, Verheijen FW, Kremer A, van der Spek PJ, Heijsman D, Wagner EJ, Fornerod M, Mancini GMS. Human mutations in integrator complex subunits link transcriptome integrity to brain development. PLoS Genet 2017; 13:e1006809. [PMID: 28542170 PMCID: PMC5466333 DOI: 10.1371/journal.pgen.1006809] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 06/09/2017] [Accepted: 05/09/2017] [Indexed: 02/06/2023] Open
Abstract
Integrator is an RNA polymerase II (RNAPII)-associated complex that was recently identified to have a broad role in both RNA processing and transcription regulation. Importantly, its role in human development and disease is so far largely unexplored. Here, we provide evidence that biallelic Integrator Complex Subunit 1 (INTS1) and Subunit 8 (INTS8) gene mutations are associated with rare recessive human neurodevelopmental syndromes. Three unrelated individuals of Dutch ancestry showed the same homozygous truncating INTS1 mutation. Three siblings harboured compound heterozygous INTS8 mutations. Shared features by these six individuals are severe neurodevelopmental delay and a distinctive appearance. The INTS8 family in addition presented with neuronal migration defects (periventricular nodular heterotopia). We show that the first INTS8 mutation, a nine base-pair deletion, leads to a protein that disrupts INT complex stability, while the second missense mutation introduces an alternative splice site leading to an unstable messenger. Cells from patients with INTS8 mutations show increased levels of unprocessed UsnRNA, compatible with the INT function in the 3’-end maturation of UsnRNA, and display significant disruptions in gene expression and RNA processing. Finally, the introduction of the INTS8 deletion mutation in P19 cells using genome editing alters gene expression throughout the course of retinoic acid-induced neural differentiation. Altogether, our results confirm the essential role of Integrator to transcriptome integrity and point to the requirement of the Integrator complex in human brain development. Neurodevelopmental disorders often have a genetic cause, however the genes and the underlying mechanisms that are involved are increasingly diverse, pointing to the complexity of brain development. For normal cell function and in general for normal development, mechanisms that regulate gene transcription into mRNA are of outermost importance as proper spatial and temporal expression of key developmentally regulated transcripts is essential. The Integrator complex was recently identified to have a broad role in both RNA processing and transcription regulation. This complex is assembled from at least 14 different subunits and several animal studies have pointed to an important role in development. Nevertheless, studies directly demonstrating the relevance of this complex in human health and development have been lacking until now. We show here that mutations in the Integrator Complex Subunit 1 gene (INTS1) and Subunit 8 gene (INTS8) cause a severe neurodevelopmental syndrome, characterized by profound intellectual disability, epilepsy, spasticity, facial and limb dysmorphism and subtle structural brain abnormalities. While the role of the Integrator complex in neuronal migration has recently been established, we provide evidence that INTS8 mutations lead in vitro to instability of the complex and impaired function. In patients cultured fibroblasts we found evidence for abnormalities in mRNA transcription and processing. In addition, introduction of INTS8 mutations in an in vitro model of retinoic acid-induced neuronal differentiation results also in transcription alterations. Altogether our results suggest an evolutionary conserved requirement of INTS1 and INTS8 in brain development.
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Affiliation(s)
- Renske Oegema
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - David Baillat
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston TX, United States of America
| | - Rachel Schot
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Leontine M. van Unen
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alice Brooks
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sima Kheradmand Kia
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Zheng Xia
- Division of Biostatistics, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States of America
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States of America
| | - Wei Li
- Division of Biostatistics, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States of America
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States of America
| | - Matteo Cesaroni
- The Fels Institute, Temple University School of Medicine, Philadelphia, PA, United States of America
| | - Maarten H. Lequin
- Department of Pediatric Radiology, Erasmus MC- Sophia, University Medical Center Rotterdam, The Netherlands
| | - Marjon van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - William B. Dobyns
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Irenaeus F. M. de Coo
- Department of Neurology, Erasmus MC- Sophia, University Medical Center Rotterdam, The Netherlands
| | - Frans W. Verheijen
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Andreas Kremer
- Department of Bioinformatics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Peter J. van der Spek
- Department of Bioinformatics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Daphne Heijsman
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Bioinformatics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Eric J. Wagner
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston TX, United States of America
- * E-mail: (GMSM); (EJW)
| | - Maarten Fornerod
- Department of Pediatric Oncology and Biochemistry, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Grazia M. S. Mancini
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- * E-mail: (GMSM); (EJW)
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Computational analysis in epilepsy neuroimaging: A survey of features and methods. NEUROIMAGE-CLINICAL 2016; 11:515-529. [PMID: 27114900 PMCID: PMC4833048 DOI: 10.1016/j.nicl.2016.02.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 12/15/2022]
Abstract
Epilepsy affects 65 million people worldwide, a third of whom have seizures that are resistant to anti-epileptic medications. Some of these patients may be amenable to surgical therapy or treatment with implantable devices, but this usually requires delineation of discrete structural or functional lesion(s), which is challenging in a large percentage of these patients. Advances in neuroimaging and machine learning allow semi-automated detection of malformations of cortical development (MCDs), a common cause of drug resistant epilepsy. A frequently asked question in the field is what techniques currently exist to assist radiologists in identifying these lesions, especially subtle forms of MCDs such as focal cortical dysplasia (FCD) Type I and low grade glial tumors. Below we introduce some of the common lesions encountered in patients with epilepsy and the common imaging findings that radiologists look for in these patients. We then review and discuss the computational techniques introduced over the past 10 years for quantifying and automatically detecting these imaging findings. Due to large variations in the accuracy and implementation of these studies, specific techniques are traditionally used at individual centers, often guided by local expertise, as well as selection bias introduced by the varying prevalence of specific patient populations in different epilepsy centers. We discuss the need for a multi-institutional study that combines features from different imaging modalities as well as computational techniques to definitively assess the utility of specific automated approaches to epilepsy imaging. We conclude that sharing and comparing these different computational techniques through a common data platform provides an opportunity to rigorously test and compare the accuracy of these tools across different patient populations and geographical locations. We propose that these kinds of tools, quantitative imaging analysis methods and open data platforms for aggregating and sharing data and algorithms, can play a vital role in reducing the cost of care, the risks of invasive treatments, and improve overall outcomes for patients with epilepsy. We introduce common epileptogenic lesions encountered in patients with drug resistant epilepsy. We discuss state of the art computational techniques used to detect lesions. There is a need for multi-institutional studies that combine these techniques. Clinically validated pipelines alongside the advances in imaging and electrophysiology will improve outcomes.
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Key Words
- DRE, drug resistant epilepsy
- DTI, diffusion tensor imaging
- DWI, diffusion weighted imaging
- Drug resistant epilepsy
- Epilepsy
- FCD, focal cortical dysplasia
- FLAIR, fluid-attenuated inversion recovery
- Focal cortical dysplasia
- GM, gray matter
- GW, gray-white junction
- HARDI, high angular resolution diffusion imaging
- MEG, magnetoencephalography
- MRS, magnetic resonance spectroscopy imaging
- Machine learning
- Malformations of cortical development
- Multimodal neuroimaging
- PET, positron emission tomography
- PNH, periventricular nodular heterotopia
- SBM, surface-based morphometry
- T1W, T1-weighted MRI
- T2W, T2-weighted MRI
- VBM, voxel-based morphometry
- WM, white matter
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15
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Liu W, An D, Xiao J, Li J, Hao N, Zhou D. Malformations of cortical development and epilepsy: A cohort of 150 patients in western China. Seizure 2015; 32:92-9. [PMID: 26552571 DOI: 10.1016/j.seizure.2015.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Malformations of cortical development (MCDs) are abnormalities of the cerebral cortex that arise from abnormal formation of the cortical plate, and have become increasingly identified as an important etiology for refractory epilepsy. Little is known about the spectrum, distribution and clinical features of MCDs, especially in resource-limited regions. This study investigates the distribution of MCDs and compares the clinical features and long-term prognosis between the two forms of MCDs: Simple and Multiple. METHOD One hundred and fifty epilepsy patients (138 adults, 12 pediatric patients) with radiologically diagnosed MCDs were identified at a tertiary epilepsy center in western China. Patients were divided into three subtypes according to the Barkovich classification. They were further divided into either Simple or Multiple MCD forms based on whether they had a single type of MCDs or other co-existing developmental brain abnormalities. RESULTS The most common type of MCD is focal cortical dysplasia. We found perinatal insults more common in group III patients. Multiple MCD was identified in 36 of 150 patients, and was associated with higher rates of delayed milestones (p=0.005), cognitive impairment (p=0.023) and neurological deficits (p=0.002) compared to Simple MCD. Extra-temporal epilepsy was more commonly seen among individuals with Multiple MCD (p=0.017). Participants with Multiple MCD were younger at time of seizure onset (p=0.003) and at assessment (p=0.002), had a lower seizure-free rate (p=0.033) and had worse outcomes overall. Patients with heterotopias were more commonly associated with other abnormalities. CONCLUSION MCDs are a critical cause of epilepsy and pose a big challenge for resource-limited countries. Imaging techniques are crucial in diagnosing and classifying cortical deformities. Multiple malformations lead to more severe clinical features and worse prognosis. Identifying and classifying MCDs can help physicians to better estimate patient prognosis and seek the best, individualized therapeutic options.
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Affiliation(s)
- Wenyu Liu
- Departments of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China.
| | - Dongmei An
- Departments of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China.
| | - Jiahe Xiao
- Departments of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China.
| | - Jinmei Li
- Departments of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China.
| | - Nanya Hao
- Departments of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China.
| | - Dong Zhou
- Departments of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, China.
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Wen M, Yan Y, Yan N, Chen XS, Liu SY, Feng ZH. Upregulation of RBFOX1 in the malformed cortex of patients with intractable epilepsy and in cultured rat neurons. Int J Mol Med 2015; 35:597-606. [PMID: 25571999 PMCID: PMC4314424 DOI: 10.3892/ijmm.2015.2061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 12/22/2014] [Indexed: 02/07/2023] Open
Abstract
Mutations in RNA-binding Fox 1 (RBFOX1) are known to be associated with neurodevelopmental disorders including epilepsy, mental retardation and autism spectrum disorder. The deletion of the Rbfox1 gene in mice has been shown to result in heightened susceptibility to seizures. However, other studies have revealed mutations or the downregulation of RBFOX1 in specimens obtained from patients with epilepsy or malformations of cortical development (MCD). Generally, the expression of RBFOX1 varies according to tissue type. In this study, we demonstrated the upregulation of RBFOX1 protein in the cortex of patients with MCD and intractable epilepsy. Electrophysiological recordings of cultured rat cortical neurons with increased Rbfox1 expression also revealed a significantly increased amplitude of action potential (AP) and Na+ current density. Some of these neurons (26.32%) even displayed spontaneous, recurrent, epileptiform discharges (SREDs). Additionally, certain Rbfox1 target transcripts associated with epilepsy, including glutamate receptor, ionotropic, N-methyl D-aspartate 1 [Grin1, also known as N-methyl-D-aspartate receptor subunit NR1 (NMDAR1)], synaptosomal-associated protein, 25 kDa (SNAP-25 or Snap25) and sodium channel, voltage gated, type VIII, alpha subunit (Scn8a, also known as Nav1.6) were identified to be upregulated in these cultured cortical neurons with an upregulated Rbfox1 expression. These data suggest that the upregulation of RBFOX1 contributes to neuronal hyperexcitation and seizures. The upregulation of NMDAR1 (Grin1), SNAP-25 (Snap25) and Scn8a may thus be involved in Rbfox1-related neuronal hyperexcitation.
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Affiliation(s)
- Ming Wen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing 400016, P.R. China
| | - Yong Yan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing 400016, P.R. China
| | - Ning Yan
- Department of Neurology, University‑Town Hospital of Chongqing Medical University, Chongqing 401331, P.R. China
| | - Xiao Shan Chen
- Department of Neurology, Xi'an Central Hospital, Xi'an 710003, P.R. China
| | - Shi Yong Liu
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| | - Zhan Hui Feng
- Department of Neurology, Affiliated Hospital of Guiyang Medical University, Guiyang 550004, P.R. China
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17
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Rikir E, Koessler L, Gavaret M, Bartolomei F, Colnat-Coulbois S, Vignal JP, Vespignani H, Ramantani G, Maillard LG. Electrical source imaging in cortical malformation-related epilepsy: A prospective EEG-SEEG concordance study. Epilepsia 2014; 55:918-32. [DOI: 10.1111/epi.12591] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Estelle Rikir
- Neurology Department; University Hospital of Nancy; Nancy France
- Neurology Department; University Hospital of Sart-Tilman; Liege Belgium
- Medical Faculty; Liege University; Liege Belgium
| | - Laurent Koessler
- CRAN; UMR 7039; Lorraine University; Vandœuvre-lès-Nancy Cedex France
- CNRS; CRAN; UMR 7039; Vandœuvre-lès-Nancy Cedex France
| | - Martine Gavaret
- Clinical Neurophysiology Department; AP-HM; University Hospital la Timone; Marseille France
- INSERM UMR 1106; Institut de Neurosciences des Systèmes; Marseille France
- Medical Faculty; Aix-Marseille University; Marseille France
| | - Fabrice Bartolomei
- Clinical Neurophysiology Department; AP-HM; University Hospital la Timone; Marseille France
- INSERM UMR 1106; Institut de Neurosciences des Systèmes; Marseille France
- Medical Faculty; Aix-Marseille University; Marseille France
| | - Sophie Colnat-Coulbois
- Medical Faculty; Lorraine University; Nancy France
- Neurosurgery Department; University Hospital of Nancy; Nancy France
| | - Jean-Pierre Vignal
- Neurology Department; University Hospital of Nancy; Nancy France
- CRAN; UMR 7039; Lorraine University; Vandœuvre-lès-Nancy Cedex France
- CNRS; CRAN; UMR 7039; Vandœuvre-lès-Nancy Cedex France
| | - Herve Vespignani
- Neurology Department; University Hospital of Nancy; Nancy France
- CRAN; UMR 7039; Lorraine University; Vandœuvre-lès-Nancy Cedex France
- CNRS; CRAN; UMR 7039; Vandœuvre-lès-Nancy Cedex France
- Medical Faculty; Lorraine University; Nancy France
| | | | - Louis G. Maillard
- Neurology Department; University Hospital of Nancy; Nancy France
- CRAN; UMR 7039; Lorraine University; Vandœuvre-lès-Nancy Cedex France
- CNRS; CRAN; UMR 7039; Vandœuvre-lès-Nancy Cedex France
- Medical Faculty; Lorraine University; Nancy France
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