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Deng DZ, Husari KS. Approach to Patients with Seizures and Epilepsy: A Guide for Primary Care Physicians. Prim Care 2024; 51:211-232. [PMID: 38692771 DOI: 10.1016/j.pop.2024.02.008] [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] [Indexed: 05/03/2024]
Abstract
Seizures and epilepsy are common neurologic conditions that are frequently encountered in the outpatient primary care setting. An accurate diagnosis relies on a thorough clinical history and evaluation. Understanding seizure semiology and classification is crucial in conducting the initial assessment. Knowledge of common seizure triggers and provoking factors can further guide diagnostic testing and initial management. The pharmacodynamic characteristics and side effect profiles of anti-seizure medications are important considerations when deciding treatment and counseling patients, particularly those with comorbidities and in special populations such as patient of childbearing potential.
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Affiliation(s)
- Doris Z Deng
- Department of Neurology, Comprehensive Epilepsy Center, Johns Hopkins University, 600 N. Wolfe Street, Meyer 2-147, Baltimore, MD 21287, USA
| | - Khalil S Husari
- Department of Neurology, Comprehensive Epilepsy Center, Johns Hopkins University, 600 N. Wolfe Street, Meyer 2-147, Baltimore, MD 21287, USA.
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2
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van Asch CJJ, Spetgens WPJ, Bourez-Swart MD, Meppelink AM, Deckers CLP, van Blooijs D, Kasteleijn-Nolst Trenité DGA. Photosensitivity and self-induction in patients aged 50 and older. Epileptic Disord 2024. [PMID: 38497935 DOI: 10.1002/epd2.20209] [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: 11/23/2023] [Revised: 01/26/2024] [Accepted: 02/07/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Photosensitivity is known to occur predominantly in children and adolescents and with a clear female predominance. Little is known on the prevalence of photosensitivity in older patients (50+) and its phenotypical appearance. METHODS A retrospective observational study was performed investigating the prevalence of a photoparoxysmal EEG response (PPR) on at least one EEG during the period 2015-2021. Data were gathered from patients aged 50 years and older by retrieving clinical and EEG characteristics from existing medical records. Data on photosensitivity-related symptoms in daily life were gathered with telephone interviewing. RESULTS In 248 patients a PPR had been elicited, of whom 16 patients (6.5%) were 50 years or older. In older patients, photosensitivity was a persistent feature of childhood-onset epilepsy (n = 8), of adult-onset epilepsy (n = 7), or an incidental finding (n = 1). In the 50+ group, 56% of photosensitive patients was female, whereas 72% in the total PPR-group. In six of 16 older patients, eye closure sensitivity was observed; two of these patients reported self-induction. Symptoms of photosensitivity in daily life were present in eight out of nine patients who consented in a telephone interview. For seven of these patients, wearing sunglasses was helpful. SIGNIFICANCE Female preponderance for photosensitivity was not found in epilepsy patients of 50 years and older. In 44% of the older photosensitive patients in this series, the PPR was a feature of adult-onset epilepsy. Symptoms of photosensitivity in daily life in older patients with epilepsy seem comparable to those in younger patients, and thus worthwhile to diagnose and treat them equally.
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Affiliation(s)
- C J J van Asch
- Stichting Epilepsie Instellingen Nederland (SEIN), Hoofddorp, The Netherlands
| | - W P J Spetgens
- Stichting Epilepsie Instellingen Nederland (SEIN), Hoofddorp, The Netherlands
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M D Bourez-Swart
- Stichting Epilepsie Instellingen Nederland (SEIN), Hoofddorp, The Netherlands
| | - A M Meppelink
- Stichting Epilepsie Instellingen Nederland (SEIN), Hoofddorp, The Netherlands
| | - C L P Deckers
- Stichting Epilepsie Instellingen Nederland (SEIN), Hoofddorp, The Netherlands
| | - D van Blooijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Hoofddorp, The Netherlands
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Yılmaz Erol T, İlgezdi Kaya İ, Ur Özçelik E, Aksu S, Şirin NG, Bebek N, Kurt A, Karamürsel S, Baykan B. Acute effect of transcranial direct current stimulation on photoparoxysmal response. Epilepsy Res 2024; 201:107320. [PMID: 38412793 DOI: 10.1016/j.eplepsyres.2024.107320] [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: 11/29/2023] [Revised: 01/22/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Transcranial direct current stimulation (tDCS) is a non-invasive technique, used to modify the excitability of the central nervous system. The main mechanism of tDCS is to change the excitability by subthreshold modulation by affecting neuronal membrane potentials in the direction of depolarization or repolarization. tDCS was previously investigated as an alternative adjunctive therapy in patients with epilepsy. We aimed here to investigate the acute effect of tDCS on the photoparoxysmal response (PPR) in EEG. METHODS We enrolled 11 consecutive patients diagnosed with idiopathic generalized epilepsy who had PPR on at least 2 EEGs. Three different procedures, including sham, anodal, and cathodal tDCS were applied to the patients at intervals of one week by placing the active electrode over Oz, for 2 mA, 20 minutes. Spike-wave indices (SWI) were counted by two researchers independently and were compared during intermittent photic stimulation (IPS) on EEGs both before and after the application. RESULTS After cathodal tDCS, SWI increased compared to baseline EEG and sham EEG in 3 patients, and after anodal tDCS, SWI increased in 2 patients. Although the SWI values did not change significantly, 8 patients reported subjectively that the applications were beneficial for them and that they experienced less discomfort during photic stimulation after the sessions. There were no side effects except transient skin rash in one patient, only. CONCLUSIONS In our sham controlled tDCS study with both cathodal and anodal stimulation, our data showed that there was no significant change in SWI during IPS, despite subjective well-being. tDCS' modulatory effect does not seem to act in the acute phase on EEG parameters after photic stimulation.
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Affiliation(s)
- Tülay Yılmaz Erol
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - İrem İlgezdi Kaya
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Emel Ur Özçelik
- Department of Neurology, University of Health Sciences, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey.
| | - Serkan Aksu
- Department of Physiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Nermin Görkem Şirin
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Nerses Bebek
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Adnan Kurt
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey.
| | - Sacit Karamürsel
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey.
| | - Betül Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neurology, EMAR Medical Center, Istanbul, Turkey.
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Mazzeo A, Cerulli Irelli E, Leodori G, Mancuso M, Morano A, Giallonardo AT, Di Bonaventura C. Resting-state electroencephalography microstates as a marker of photosensitivity in juvenile myoclonic epilepsy. Brain Commun 2024; 6:fcae054. [PMID: 38444911 PMCID: PMC10914451 DOI: 10.1093/braincomms/fcae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
Juvenile myoclonic epilepsy is an idiopathic generalized epilepsy syndrome associated with photosensitivity in approximately 30-40% of cases. Microstates consist of a brief period of time during which the topography of the whole resting-state electroencephalography signal is characterized by a specific configuration. Previous neurophysiological and neuroimaging studies have suggested that Microstate B may represent activity within the visual network. In this case-control study, we aimed to investigate whether anatomical and functional alterations in the visual network observed in individuals with photosensitivity could lead to changes in Microstate B dynamics in photosensitive patients with juvenile myoclonic epilepsy. Resting-state electroencephalography microstate analysis was performed on 28 patients with juvenile myoclonic epilepsy. Of these, 15 patients exhibited photosensitivity, while the remaining 13 served as non-photosensitive controls. The two groups were carefully matched in terms of age, sex, seizure control and anti-seizure medications. Multivariate analysis of variance and repeated-measures analysis of variance were performed to assess significant differences in microstate metrics and syntax between the photosensitive and the non-photosensitive group. Post hoc false discovery rate adjusted unpaired t-tests were used to determine differences in specific microstate classes between the two groups. The four classical microstates (Classes A, B, C and D) accounted for 72.8% of the total electroencephalography signal variance in the photosensitive group and 75.64% in the non-photosensitive group. Multivariate analysis of variance revealed a statistically significant class-group interaction on microstate temporal metrics (P = 0.021). False discovery rate adjusted univariate analyses of variance indicated a significant class-group interaction for both mean occurrence (P = 0.002) and coverage (P = 0.03), but not for mean duration (P = 0.14). Post hoc false discovery rate adjusted unpaired t-tests showed significantly higher coverage (P = 0.02) and occurrence (P = 0.04) of Microstate B in photosensitive patients compared with non-photosensitive participants, along with an increased probability of transitioning from Microstates C (P = 0.04) and D (P = 0.02) to Microstate B. No significant differences were found concerning the other microstate classes between the two groups. Our study provides novel insights on resting-state electroencephalography microstate dynamics underlying photosensitivity in patients with juvenile myoclonic epilepsy. The increased representation of Microstate B in these patients might reflect the resting-state overactivation of the visual system underlying photosensitivity. Further research is warranted to investigate microstate dynamics in other photosensitive epilepsy syndromes.
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Affiliation(s)
- Adolfo Mazzeo
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
| | | | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
- IRCCS Neuromed, Pozzilli 86077, Italy
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
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Niu Y, Gong P, Jiao X, Xu Z, Zhou Z, Zhang Y, Qin J, Yang Z. Electroclinical Features and Long-Term Photosensitivity Outcome in Patients With Photoparoxysmal Response With Epilepsy. Pediatr Neurol 2023; 147:88-94. [PMID: 37598572 DOI: 10.1016/j.pediatrneurol.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/14/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND To investigate electroclinical phenotypes and long-term photosensitivity outcome in a large pediatric cohort of patients with epilepsy with photosensitivity. METHODS Patients with epilepsy with photosensitivity with four or more years of follow-up were included. Sustained terminal remission (STR) of photosensitivity (≥3.5 years) and seizure control were investigated, as well as the prognostic factors of photosensitivity. Furthermore, a cluster analysis was used to study the different subgroups of photoparoxysmal responses (PPR). RESULTS We included 190 individuals with a median age at diagnosis of photosensitivity of 93.1 months (interquartile range [IQR] 62.8 to 120 months) and a median follow-up duration of 68.5 months (IQR 51.8 to 84 months). STR of photosensitivity was achieved in 97 (51.1%) patients, and the mean time from age at diagnosis of photosensitivity onset to STR was 16.5 months. Age at the last follow-up (9 to 18 years [P = 0.001]), a history of photoconvulsive response (PCR) (P = 0.009), and posterior epileptiform discharges (EDs) of PPRs (P = 0.05) were significantly associated with a lower chance of entering STR according to a Cox proportional hazards model. The subgroup of generalized epilepsy syndrome exhibited 46.2% of eye closure sensitivity and 47.7% of PCR. The rates of focal epilepsy syndrome (cluster 1), generalized epilepsy syndrome (cluster 2), and unclassified epilepsy (cluster 3) were similar and not statistically different in photosensitive outcome (P = 0.527). CONCLUSIONS Age nine to 18 years, a history of PCR, and posterior EDs of PPRs were the adverse factors affecting photosensitivity, suggesting the effect of age-related brain changes in STR. There was no difference in the prognosis of photosensitivity in different epileptic syndromes.
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Affiliation(s)
- Yue Niu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Pan Gong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xianru Jiao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhao Xu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Zongpu Zhou
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China.
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Myren‐Svelstad S, Jamali A, Ophus SS, D'gama PP, Ostenrath AM, Mutlu AK, Hoffshagen HH, Hotz AL, Neuhauss SCF, Jurisch‐Yaksi N, Yaksi E. Elevated photic response is followed by a rapid decay and depressed state in ictogenic networks. Epilepsia 2022; 63:2543-2560. [PMID: 36222083 PMCID: PMC9804334 DOI: 10.1111/epi.17380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The switch between nonseizure and seizure states involves profound alterations in network excitability and synchrony. In this study, we aimed to identify and compare features of neural excitability and dynamics across multiple zebrafish seizure and epilepsy models. METHODS Inspired by video-electroencephalographic recordings in patients, we developed a framework to study spontaneous and photically evoked neural and locomotor activity in zebrafish larvae, by combining high-throughput behavioral tracking and whole-brain in vivo two-photon calcium imaging. RESULTS Our setup allowed us to dissect behavioral and physiological features that are divergent or convergent across multiple models. We observed that spontaneous locomotor and neural activity exhibit great diversity across models. Nonetheless, during photic stimulation, hyperexcitability and rapid response dynamics were well conserved across multiple models, highlighting the reliability of photically evoked activity for high-throughput assays. Intriguingly, in several models, we observed that the initial elevated photic response is often followed by rapid decay of neural activity and a prominent depressed state. Elevated photic response and following depressed state in seizure-prone networks are significantly reduced by the antiseizure medication valproic acid. Finally, rapid decay and depression of neural activity following photic stimulation temporally overlap with slow recruitment of astroglial calcium signals that are enhanced in seizure-prone networks. SIGNIFICANCE We argue that fast decay of neural activity and depressed states following photic response are likely due to homeostatic mechanisms triggered by excessive neural activity. An improved understanding of the interplay between elevated and depressed excitability states might suggest tailored epilepsy therapies.
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Affiliation(s)
- Sverre Myren‐Svelstad
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway,Department of Neurology and Clinical NeurophysiologySt Olav's University HospitalTrondheimNorway
| | - Ahmed Jamali
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway,Department of Neurology and Clinical NeurophysiologySt Olav's University HospitalTrondheimNorway
| | - Sunniva S. Ophus
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Percival P. D'gama
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Anna M. Ostenrath
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Aytac Kadir Mutlu
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Helene Homme Hoffshagen
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Adriana L. Hotz
- Department of Molecular Life SciencesUniversity of ZürichZürichSwitzerland
| | | | - Nathalie Jurisch‐Yaksi
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway,Department of Neurology and Clinical NeurophysiologySt Olav's University HospitalTrondheimNorway,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Emre Yaksi
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway,Koç University Research Center for Translational Medicine, Department of NeurologyKoç University School of MedicineIstanbulTurkey
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7
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Wired for sound: The effect of sound on the epileptic brain. Seizure 2022; 102:22-31. [PMID: 36179456 DOI: 10.1016/j.seizure.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Sound waves are all around us resonating at audible and inaudible frequencies. Our ability to hear is crucial in providing information and enabling interaction with our environment. The human brain generates neural oscillations or brainwaves through synchronised electrical impulses. In epilepsy these brainwaves can change and form rhythmic bursts of abnormal activity outwardly appearing as seizures. When two waveforms meet, they can superimpose onto one another forming constructive, destructive or mixed interference. The effects of audible soundwaves on epileptic brainwaves has been largely explored with music. The Mozart Sonata for Two Pianos in D major, K. 448 has been examined in a number of studies where significant clinical and methodological heterogeneity exists. These studies report variable reductions in seizures and interictal epileptiform discharges. Treatment effects of Mozart Piano Sonata in C Major, K.545 and other composer interventions have been examined with some musical exposures, for example Hayden's Symphony No. 94 appearing pro-epileptic. The underlying anti-epileptic mechanism of Mozart music is currently unknown, but interesting research is moving away from dopamine reward system theories to computational analysis of specific auditory parameters. In the last decade several studies have examined inaudible low intensity focused ultrasound as a neuro-modulatory intervention in focal epilepsy. Whilst acute and chronic epilepsy rodent model studies have consistently demonstrated an anti-epileptic treatment effect this is yet to be reported within large scale human trials. Inaudible infrasound is of concern since at present there are no reported studies on the effects of exposure to infrasound on epilepsy. Understanding the impact of infrasound on epilepsy is critical in an era where sustainable energies are likely to increase exposure.
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Jeavons syndrome featured with visual sensitivity existing as occipital cortex originating focal-to-generalized continuum epilepsy. Eur J Paediatr Neurol 2022; 40:51-56. [PMID: 35940103 DOI: 10.1016/j.ejpn.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 05/14/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the relationship between eye closure sensitivity (ECLS), photosensitivity, and the mechanism of Jeavons syndrome (JS). METHODS The interictal and the ictal epileptiform discharges (EDs) of 80 patients with electroencephalograms were classified (I: focal posterior EDs; II: the posterior spread into the frontal EDs; and III: generalized EDs) and analyzed under different provoked conditions. RESULTS During the interictal and the ictal period, the positive rates of ECLS were higher than those of photosensitivity (100% vs 57.5%, P = 0.001; 97.5% vs 27.4%, P = 0.001). After a one-year interval, eyelid-myoclonia with ECLS remitted in 16 out of 21 patients (P = 0.002), and eyelid-myoclonia with photo-convulsion response (PCR) disappeared in all the previous six patients (P = 0.021). For the interictal EDs with ECLS, grade I accounted for 11.2%; grade I, II, and III 51.3%; and grade III 32.5%. Interictal EDs classification of photosensitivity showed a similar trend as that of ECLS. For the ictal EDs, grade I accounted for 10.2% of patients with ECLS and 6.7% of patients with PCR; grade I, II, and III, 33.3% of patients with ECLS and 46.6% of patients with PCR; and grade III, 53.9% of patients with ECLS and 40% of patients with PCR. CONCLUSION ECLS was more common than photosensitivity in JS. Photosensitivity was more likely to disappear than ECLS. Both eye closure and intermittent-photic-stimulation could induce three grades of EDs, confirming that visual stimuli could trigger occipital cortex originating epileptic neural network to varying degrees, which further recognizes JS as another continuum epilepsy.
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Niu Y, Gong P, Jiao X, Xu Z, Zhang Y, Yang Z. Genetic and phenotypic spectrum of Chinese patients with epilepsy and photosensitivity. Front Neurol 2022; 13:907228. [PMID: 36034301 PMCID: PMC9416002 DOI: 10.3389/fneur.2022.907228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the contribution of genetic etiologies in epilepsy with photosensitivity. Methods A total of 35 epileptic patients with genetic photosensitivity from January 2019 to May 2021 were analyzed. Results Pathogenic variants were identified in 35 patients, including SCN1A(7) CHD2(6), TPP1(3), SYNGAP1(3), GABRA1(2), GABRG2(1), KCTD7(1), MFSD8(1), KCNC1(1) GBA(1), CACNA1A(1), KCNMA1(1), FLNA(1), SZT2(1), SLC2A1(1), 5q33.2-34del(1), and mitochondrial variants(3). The predominant epileptic syndrome was progressive myoclonus epilepsy (PME) and Dravet syndrome, while the most common seizure type in both spontaneous seizures and photoconvulsive response (PCR) was myoclonic seizures. The abnormal EEG background and brain MRI were mainly seen in the PME patients. In PME, initial low-frequencies (1–6 Hz) photosensitivity was observed in 70% (7/10) of patients. Among the other patients, 12 patients (48.0%, 12/25) had photosensitivity at initial low -frequencies and 12 patients (48.0%, 12/25) had photosensitivity at initial middle frequencies (6–20 Hz). At the 1-year follow-up, 77.7% (21/27) still remained photosensitive. Conclusion The most common genes for epilepsy with genetic photosensitivity are SCN1A and CHD2, and the most common syndromes are PME and Dravet syndrome. MFSD8, KCNMA1, SZT2, FLNA, and SLC2A1 variants might be candidate genes for photosensitivity. PPRs at initial low-frequencies may be a marker of PME, and the most typical feature of genetic photosensitivity may be low- or middle- frequencies induced PPRs. Photosensitivity in epilepsy with genetic photosensitivity may be difficult to disappear in a short period of time.
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Affiliation(s)
- Yue Niu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Pan Gong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xianru Jiao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhao Xu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Strzelecka J, Mazurkiewicz DW, Skadorwa T, Gąsior JS, Jóźwiak S. Photo-Dependent Reflex Seizures—A Scoping Review with Proposal of Classification. J Clin Med 2022; 11:jcm11133766. [PMID: 35807051 PMCID: PMC9267825 DOI: 10.3390/jcm11133766] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
Children and adolescents are the largest at-risk group for the appearance of reflex seizures or epilepsy syndromes with a photoparoxysmal response. The aim of this study was to present an overview of the literature regarding photo-dependent reflex seizures. Epilepsy with seizures provoked by intermittent light stimulation is a distinct group of epilepsies; therefore, we focused on reflex seizures provoked by different factors whose common feature is the patient’s response to intermittent photic stimulation. A qualitative search of PubMed/MEDLINE, Scopus, EBSCO, and Cochrane Library electronic databases for selected terms was carried out for scientific articles published up to May 2020 outlining the outcomes of control, observational, and case studies. This scoping review was developed and followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review of the qualitative evidence for the synthesis of photosensitive epilepsy allowed us to distinguish the following categories: light-induced seizures and light-deprived seizures. Differentiating between intermittent photic stimulation-related epilepsy syndromes and seizures is essential in order to determine the length of appropriate treatment. Photo-dependent reflex seizures make up the majority of this type of disorder among reflex seizures. Since there are many seizures provoking factors in the world around us, it is important to distinguish amongst them in order to be able to protect the patient exposed to this factor. It is recommended that the photostimulation procedure be performed during a routine electroencephalogram study.
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Affiliation(s)
- Jolanta Strzelecka
- Department of Pediatric Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Correspondence: ; Tel.: +48-605-598-644
| | | | - Tymon Skadorwa
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Jakub S. Gąsior
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Sergiusz Jóźwiak
- Department of Pediatric Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland;
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11
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Feng W, Fang F, Wang X, Chen C, Lu J, Deng J. Clinical analysis of
CHD2
gene mutations in pediatric patients with epilepsy. Pediatr Investig 2022; 6:93-99. [PMID: 35774528 PMCID: PMC9218986 DOI: 10.1002/ped4.12321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Weixing Feng
- Department of Neurology Beijing Children's Hospital, Capital Medical University, National Center for Children's Health Beijing China
| | - Fang Fang
- Department of Neurology Beijing Children's Hospital, Capital Medical University, National Center for Children's Health Beijing China
| | - Xiaohui Wang
- Department of Neurology Beijing Children's Hospital, Capital Medical University, National Center for Children's Health Beijing China
| | - Chunhong Chen
- Department of Neurology Beijing Children's Hospital, Capital Medical University, National Center for Children's Health Beijing China
| | - Junlan Lu
- Department of Neurology Beijing Children's Hospital, Capital Medical University, National Center for Children's Health Beijing China
| | - Jie Deng
- Department of Neurology Beijing Children's Hospital, Capital Medical University, National Center for Children's Health Beijing China
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Tatum WO. EEG Essentials. Continuum (Minneap Minn) 2022; 28:261-305. [PMID: 35393960 DOI: 10.1212/con.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW EEG is the best study for evaluating the electrophysiologic function of the brain. The relevance of EEG is based on an accurate interpretation of the recording. Understanding the neuroscientific basis for EEG is essential. The basis for recording and interpreting EEG is both brain site-specific and technique-dependent to detect and represent a complex series of waveforms. Separating normal from abnormal EEG lies at the foundation of essential interpretative skills. RECENT FINDINGS Seizures and epilepsy are the primary targets for clinical use of EEG in diagnosis, seizure classification, and management. Interictal epileptiform discharges on EEG support a clinical diagnosis of seizures, but only when an electrographic seizure is recorded is the diagnosis confirmed. New variations of normal waveforms, benign variants, and artifacts can mimic epileptiform patterns and are potential pitfalls for misinterpretation for inexperienced interpreters. A plethora of medical conditions involve nonepileptiform and epileptiform abnormalities on EEG along the continuum of people who appear healthy to those who are critically ill. Emerging trends in long-term EEG monitoring to diagnose, classify, quantify, and characterize patients with seizures have unveiled epilepsy syndromes in patients and expanded medical and surgical options for treatment. Advances in terminology and application of continuous EEG help unify neurologists in the diagnosis of nonconvulsive seizures and status epilepticus in patients with encephalopathy and prognosticate recovery from serious neurologic injury involving the brain. SUMMARY After 100 years, EEG has retained a key role in the neurologist's toolkit as a safe, widely available, versatile, portable test of neurophysiology, and it is likely to remain at the forefront for patients with neurologic diseases. Interpreting EEG is based on qualitative review, and therefore, the accuracy of reporting is based on the interpreter's training, experience, and exposure to many new and older waveforms.
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Fisher RS, Acharya JN, Baumer FM, French JA, Parisi P, Solodar JH, Szaflarski JP, Thio LL, Tolchin B, Wilkins AJ, Kasteleijn-Nolst Trenité D. Visually sensitive seizures: An updated review by the Epilepsy Foundation. Epilepsia 2022; 63:739-768. [PMID: 35132632 DOI: 10.1111/epi.17175] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/19/2022]
Abstract
Light flashes, patterns, or color changes can provoke seizures in up to 1 in 4000 persons. Prevalence may be higher because of selection bias. The Epilepsy Foundation reviewed light-induced seizures in 2005. Since then, images on social media, virtual reality, three-dimensional (3D) movies, and the Internet have proliferated. Hundreds of studies have explored the mechanisms and presentations of photosensitive seizures, justifying an updated review. This literature summary derives from a nonsystematic literature review via PubMed using the terms "photosensitive" and "epilepsy." The photoparoxysmal response (PPR) is an electroencephalography (EEG) phenomenon, and photosensitive seizures (PS) are seizures provoked by visual stimulation. Photosensitivity is more common in the young and in specific forms of generalized epilepsy. PS can coexist with spontaneous seizures. PS are hereditable and linked to recently identified genes. Brain imaging usually is normal, but special studies imaging white matter tracts demonstrate abnormal connectivity. Occipital cortex and connected regions are hyperexcitable in subjects with light-provoked seizures. Mechanisms remain unclear. Video games, social media clips, occasional movies, and natural stimuli can provoke PS. Virtual reality and 3D images so far appear benign unless they contain specific provocative content, for example, flashes. Images with flashes brighter than 20 candelas/m2 at 3-60 (particularly 15-20) Hz occupying at least 10 to 25% of the visual field are a risk, as are red color flashes or oscillating stripes. Equipment to assay for these characteristics is probably underutilized. Prevention of seizures includes avoiding provocative stimuli, covering one eye, wearing dark glasses, sitting at least two meters from screens, reducing contrast, and taking certain antiseizure drugs. Measurement of PPR suppression in a photosensitivity model can screen putative antiseizure drugs. Some countries regulate media to reduce risk. Visually-induced seizures remain significant public health hazards so they warrant ongoing scientific and regulatory efforts and public education.
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Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jayant N Acharya
- Department of Neurology, Penn State Health, Hershey, Pennsylvania, USA
| | - Fiona Mitchell Baumer
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jacqueline A French
- NYU Comprehensive Epilepsy Center, Epilepsy Foundation, New York, New York, USA
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Jessica H Solodar
- American Medical Writers Association-New England Chapter, Boston, Massachusetts, USA
| | - Jerzy P Szaflarski
- Department of Neurology, Neurobiology and Neurosurgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Liu Lin Thio
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin Tolchin
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
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Jousmäki V. Gratifying Gizmos for Research and Clinical MEG. Front Neurol 2022; 12:814573. [PMID: 35153989 PMCID: PMC8830907 DOI: 10.3389/fneur.2021.814573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Experimental designs are of utmost importance in neuroimaging. Experimental repertoire needs to be designed with the understanding of physiology, clinical feasibility, and constraints posed by a particular neuroimaging method. Innovations in introducing natural, ecologically-relevant stimuli, with successful collaboration across disciplines, correct timing, and a bit of luck may cultivate novel experiments, new discoveries, and open pathways to new clinical practices. Here I introduce some gizmos that I have initiated in magnetoencephalography (MEG) and applied with my collaborators in my home laboratory and in several other laboratories. These gizmos have been applied to address neuronal correlates of audiotactile interactions, tactile sense, active and passive movements, speech processing, and intermittent photic stimulation (IPS) in humans. This review also includes additional notes on the ideas behind the gizmos, their evolution, and results obtained.
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Affiliation(s)
- Veikko Jousmäki
- Aalto NeuroImaging, Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- Cognitive Neuroimaging Centre, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- *Correspondence: Veikko Jousmäki
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15
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Yıldırım F, Aydin Z, Sakcı Z, Yalçın AED. Investigation of Patients With Eye Closure Sensitive Epilepsy With Magnetic Resonance Spectroscopy. Clin EEG Neurosci 2022; 53:45-53. [PMID: 34558322 DOI: 10.1177/15500594211040953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction and aim: A proportion of patients diagnosed with genetic generalized epilepsy (GGE) experience eye-closure sensitivity (ECS), the underlying pathogenesis of which is unknown. In this study, we compare magnetic resonance spectroscopy (MRS) findings of healthy volunteers with patients diagnosed with GGE, with and without ECS, to detect possible explanatory differences between groups. Materials and methods: A total of 33 patients diagnosed with GGE: 17 with ECS and 16 without, and 12 healthy volunteers are included. MRS measurements of N-acetyl-aspartate (NAA), choline (Cho), and creatine (Cr) were made of bilateral occipital lobes and thalamus, and values of patients with GGE were compared with those of normal controls, and within subgroups with different clinical variables, using appropriate statistical tests. Results: Left occipital NAA and NAA/Cr levels were found to be significantly higher in the ECS group than in the control group. In the ECS epilepsy group, a significant moderate positive correlation was noted between left thalamic Cr and duration of drug therapy (r = .539, P = .047) and left thalamic Cr and age at epilepsy onset (r = .564, P = .036). Additionally, left thalamic NAA and NAA/Cr levels were observed to be lower in GGE patients compared to healthy subjects, although not to a statistically significant degree. Conclusion:The differences in MRS-measurable metabolites in the left occipital lobe in those with ECS epilepsy suggest an association between the ECS mechanism and the left occipital lobe. Our results also support the multifocal thalamocortical pathway disorder in the pathophysiology of GGE based on the observation of cellular dysfunction in the thalamus.
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Affiliation(s)
- Feyza Yıldırım
- University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Zeynep Aydin
- University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey.,52947Beykent University, İstanbul, Turkey
| | - Zakir Sakcı
- University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Ays E Destînâ Yalçın
- University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
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16
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Strzelecka J, Skadorwa T, Jóźwiak S. The quantitative effect of blue lenses on pediatric photoparoxysmal response - An electroencephalographic cohort study. Seizure 2021; 93:1-7. [PMID: 34644671 DOI: 10.1016/j.seizure.2021.09.022] [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: 07/14/2021] [Revised: 09/20/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine and quantify the effect of blue lenses (Z1) on photosensitivity (PS) suppression in patients aged 5-18 years with and without epilepsy. METHODS The retrospective cohort study was carried out in 100 pediatric patients aged 5-18 years with grade 4 PS assessed with EEG for medical indications. All EEG procedures were carried out and recordings assessed by two independent researchers. The study cohort was divided into groups with and without the diagnosis of epilepsy. The overall effect of the Z1 lenses on photoparoxysmal response (PPR) was determined by directly comparing the maximum discharge values in each patient without and with Z1 lenses in a within-subject design yielding the index of overall improvement (IOI). The differences in PS suppression by brain region and side were assessed by an additional between-subject comparison of age groups (below and above 14 years). Then, overall findings were compared with the PPR change criteria developed in 2006 by Capovilla (PPR disappearance, persistence, or attenuation) which warranted another subset analysis. Finally, in a between-subject design, we assessed whether the presence of epilepsy affects the intensity of PPR in children with PS, compared to non-epilepsy children. RESULTS The IOI in the entire cohort was 66.1±2.5% (P<0.001). There were no significant differences in IOI between the left and right hemispheres, between the age groups, and between the epilepsy and non-epilepsy groups, despite some qualitative variation. With reference to literature findings, whereas median IOI were comparable in PPR disappearance and attenuation subsets, they differed significantly from the median IOI in the PPR persistence subset. CONCLUSION Using Z1 lenses results in neither a complete PPR disappearance, nor a complete lack of effect. However, the correlation between the quantified PS suppression and the Z1 filter may be expected to become a valuable piece of information for both clinicians and manufacturers.
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Affiliation(s)
- Jolanta Strzelecka
- Department of Pediatric Neurology, Medical University of Warsaw, Poland; EEG Laboratory, Bogdanowicz Memorial Hospital for Children in Warsaw, Poland
| | - Tymon Skadorwa
- Department of Pediatric Neurosurgery, Bogdanowicz Memorial Hospital for Children, Warsaw, Poland; Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Poland.
| | - Sergiusz Jóźwiak
- Department of Pediatric Neurology, Medical University of Warsaw, Poland
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Sager G, Vatansever Z, Batu U, Çağ Y, Akin Y. Neuropsychiatric comorbidities in genetic/idiopathic generalized epilepsies and their effects on psychosocial outcomes. Epilepsy Behav 2021; 124:108339. [PMID: 34600282 DOI: 10.1016/j.yebeh.2021.108339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Idiopathic/genetic generalized epilepsy (GGE) accounts for 15-20% of all epilepsy cases. Neuropsychiatric comorbidities and disorders, such as attention-deficit hyperactivity disorder (ADHD), academic failure, and poor social competence, are present at a higher rate in patients with epilepsy compared with the general population. In this study, we aimed to determine the frequency of neuropsychiatric comorbidities in GGE subgroups, and to reveal the risk factors in the patient group with neuropsychiatric comorbidities. MATERIAL AND METHOD This hospital-based, cross-sectional study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients with seizure-controlled GGE were invited to a semi-structured interview at the hospital. Variables [photosensitivity, valproic acid (VPA) resistance, timing of the neuropsychiatric comorbidities Attention deficit and hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and low academic performance), seizure control, and timing of the antiepileptic treatment] were statistically analyzed and evaluated in terms of their association with GGE subgroups [Generalized tonic-clonic seizures alone (EGTGS), juvenile myoclonic epilepsy (JME), and juvenile absence epilepsy (JAE)], RESULTS: Total 101 patients with GGE were included in the study and the mean age was 13.94 ± 1.66 years. A total of 12.9% (n = 13) of the patients had EGTGS, 49.5% (n = 50) had JME, and 37.6% (n = 38) had JAE. VPA resistance, photosensitivity, and the presence of neuropsychiatric symptoms before the starting of epilepsy were found to be risk factors in the GGE group with neuropsychiatric comorbidities compared with the group without neuropsychiatric comorbidities (p < 0.001). The subgroups of GGE did not show any relationship with psychiatric disorders, including ADHD, ODD, and low academic performance (neuropsychiatric comorbidities) (p > 0.005). No correlation was found between seizure control and decline in neuropsychiatric symptoms (p > 0.05). CONCLUSION In this study, the onset of psychiatric symptoms prior to the onset of epilepsy, photosensitivity, and VPA resistance were the most important factors affecting neuropsychiatric comorbidities. The JME, JAE, and EGTCS subgroups, early initiation of antiepileptic treatment, and seizure control were found to have no effect on poor psychosocial outcome and neuropsychiatric comorbidities.
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Affiliation(s)
- Gunes Sager
- Department of Pediatric Neurology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
| | - Zeynep Vatansever
- Department of Child and Adolescent Psychiatry Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Utku Batu
- Department of Pediatrics, Van Education and Research Hospital, Van, Turkey
| | - Yakup Çağ
- Department of Pediatrics, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Yasemin Akin
- Department of Pediatrics, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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18
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Differences in visual information processing style between Idiopathic Generalized Epilepsy with and without photosensitivity. Epilepsy Behav 2021; 122:108183. [PMID: 34252831 DOI: 10.1016/j.yebeh.2021.108183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Recently, altered visual cortical processes i.e., lack of habituation to visual evoked potentials (VEP), has been highlighted in both photosensitive epilepsy and in a specific i.e., analytic mode of processing visual inputs. In this study we aimed at evaluating the relationship between photosensitivity (PS) and analytic style of processing visual information, in a sample of 30 patients with Idiopathic Generalized Epilepsy (IGE) and matched healthy controls. METHODS At our Epilepsy unit of the Sapienza University of Rome, we consecutively enrolled 15 patients with IGE with PSand matched them with 15 patients with IGE without PS and 15 Healthy Volunteers. All patients underwent EEG recording in basal conditions during hyperventilation (3 Min), and intermittent light stimulation. The most effective frequencies comprised from 12 to 16 Hz. The instruments used to gather psychological cognitive behavioral data, consisted of participation in two tests: the Sternberg-Wagner Self-Assessment Inventory and the Mariani Learning Style Questionnaire. RESULTS Compared to controls, both IGE groups show significantly higher scores for the analytic style (One-way ANOVA, F(2,44) = 110.3, p < 0.0001). Epilepsy groups thereby showed very distinctive cognitive styles as measured with the Sternberg test. In the visual style, scores of the photosensitive Individuals with IGE were significantly higher than the non-photosensitive individuals with IGE (p < 0.0001, Tukey's post hoc test). CONCLUSIONS An association between analytic style of processing visual information and PS in IGE has been shown. The common neurophysiological features between these two factors, suggest the possibility to evaluate this cognitive behavior as a potential target for nonpharmacological therapeutic strategies in photosensitive epilepsy.
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Thakor B, Jagtap SA, Joshi A. Juvenile Huntington's disease masquerading as progressive myoclonus epilepsy. Epilepsy Behav Rep 2021; 16:100470. [PMID: 34377971 PMCID: PMC8327331 DOI: 10.1016/j.ebr.2021.100470] [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: 04/16/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
Juvenile Huntington’s Disease (JHD) seizure can be presenting feature. Seizures are common in patients with JHD than adult onset HD and more difficult to treat. The EEG varies from normal EEG to generalized spike polyspike wave discharges, focal or multifocal discharges as well as paroxysmal slowing. In patients with progressive myoclonic epilepsy, differential diagnosis of Juvenile Huntington’s disease should be considered.
Juvenile Huntington’s disease (JHD) has an onset before 20 years of age, and is characterized by behavioural issues, epilepsy, rigidity, bradykinesia and dystonia. It contributes to 0.5–5% of all Huntington disease (HD) cases. JHD demonstrates a more rapid progression and is characterised by dystonia, as opposed to the slow progression with predominant chorea seen in adult-onset HD. Seizures are described in 38% of JHD as compared to 2% in the adult onset HD. The different types of seizures reported in JHD are generalized seizures, myoclonus, absence seizures and less commonly tonic and focal seizures with impaired awareness. JHD patients have good seizure control initially and develop drug-resistant epilepsy in the later stages of the disease which is rarely reported. Here, we report the case of a 13 -year-old boy, who initially presented with generalized tonic-clonic seizures followed by myoclonic jerks, with subsequent cognitive decline, ataxia, involuntary movements and drug resistant epilepsy mimicking a progressive myoclonus sepilepsy. His EEG changed from normal background with generalized interictal epileptiform discharges to diffuse slowing with fast activity devoid of epileptiform activity to reflect electroclinical evolution of the disease process.
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Affiliation(s)
- Bina Thakor
- Department of Paediatric Neurology, Bharati Vidyapeeth Medical College, Pune, India
| | - Sujit A Jagtap
- Bharati Vidyapeeth Medical College, Pune, India.,Bajaj Allianz Comprehensive Center for Epilepsy Care, Deenanaath Mangeshkar Hospital and Research Centre, Pune, India
| | - Aniruddha Joshi
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
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20
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Ur Özçelik E, Lin K, Mameniškienè R, Sauter Dalbem J, Siqueira HH, Samaitienė R, Vega Zeissig LE, Fonseca AF, Mazini Alves J, Dos Santos Lunardi M, de Queiroz LP, Zubavičiūtė E, Wolf P, Baykan B. Perceptions of Modulatory Factors in Migraine and Epilepsy: A Multicenter Study. Front Neurol 2021; 12:672860. [PMID: 34149603 PMCID: PMC8209378 DOI: 10.3389/fneur.2021.672860] [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: 02/26/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Migraine and epilepsy are both common episodic disorders, typically precipitated or inhibited by some modulatory factors (MFs). Objective: To assess the self-perception of MFs in patients with migraine (PWM) compared to patients with epilepsy (PWE) with a standardized protocol in different countries. Methods: Transcultural multicenter comparative cross-sectional study. All consecutive patients who fulfilled the ICHD-3 criteria for migraine and ILAE's criteria for epilepsy, with at least 1 year of follow-up were interviewed with a semi-structured questionnaire on clinical and epidemiological data and were asked to identify all experienced MFs from a provided list. Results: A total of 608 individuals were surveyed at five university referral centers in Brazil, Guatemala, Lithuania and Turkey. Two hundred and nineteen (91.6%) PWM and 305 (82.7%) PWE identified attack precipitating factors (PFs; p < 0.001). The most frequent three PFs reported by epilepsy patients were: "lack of sleep" (56.6%), "emotional stress" (55.3%), "negative feelings" (53.9%), while among migraine patients "emotional stress" (81.6%), "lack of sleep" (77.8%), "negative feelings" (75.7%) were cited. Inhibitory factors (IFs) for the episodes were reported by 68 (28.5%) PWM and 116 (31.4%) PWE. "Darkness" was the most common one, described by 35.6% of PWM whereas "positive feelings" reported by 10.6% of PWE. Most MFs are concordant across the countries but some transcultural differences were noted. Conclusion: The MFs of migraine and epilepsy attacks and their varying frequencies according to different countries were investigated with the same standardized questionnaire, for the first time. MFs were recognized very often in both migraine and epilepsy cohorts, but in distinct disease-specific prevalence, being more frequent in migraine. Recognition of self-perceived MFs may be helpful for the management of both illnesses.
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Affiliation(s)
- Emel Ur Özçelik
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Katia Lin
- Department of Neurology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | - Juiane Sauter Dalbem
- Department of Neurology, Universidade Federal de Santa Catarina, Florianópolis, Brazil.,Department of Neurology, Universidade Federal de Mato Grosso, Cuiabá, Brazil
| | - Heloise Helena Siqueira
- Department of Neurology, Universidade Federal de Santa Catarina, Florianópolis, Brazil.,Department of Neurology, Universidade Federal de Mato Grosso, Cuiabá, Brazil
| | - Rūta Samaitienė
- Faculty of Medicine, Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania
| | | | | | - Juliana Mazini Alves
- Department of Neurology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | - Luiz Paulo de Queiroz
- Department of Neurology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | - Peter Wolf
- Department of Neurology, Universidade Federal de Santa Catarina, Florianópolis, Brazil.,Danish Epilepsy Center, Dianalund, Denmark
| | - Betül Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Ascoli M, Mastroianni G, Gasparini S, Striano P, Cianci V, Neri S, Bova V, Mammì A, Gambardella A, Labate A, Aguglia U, Ferlazzo E. Diagnostic and therapeutic approach to drug-resistant juvenile myoclonic epilepsy. Expert Rev Neurother 2021; 21:1265-1273. [PMID: 33993822 DOI: 10.1080/14737175.2021.1931126] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Juvenile myoclonic epilepsy (JME), also known as Janz syndrome, is a common form of generalized epilepsy of presumed genetic origin representing up to 10% of all epilepsy cases. Despite adequate anti-seizure medication (ASM) treatment, seizures persist in one-third of JME patients. AREAS COVERED A literature search was conducted using Pubmed search on the topics of drug-resistant JME. EXPERT OPINION About 30% of JME patients are drug-resistant. Valproate (VPA) is considered the first-choice drug. In women of childbearing potential, levetiracetam (LEV) should represent the first-choice treatment. Alternative monotherapy or add-on therapy should be considered in subjects with resistant seizures after the exclusion of pseudo-drug resistance. The choice of the add-on ASM depends on the predominant seizure type. In subjects with persistent bilateral tonic-clonic seizures, LEV or lamotrigine should be firstly considered. In patients with difficult-to-treat myoclonic seizures, clonazepam or LEV are recommended. In case of persistent absences, ethosuximide should be considered. With appropriate selection and safeguards in place, VPA should remain available as an option in women of childbearing potential whose seizures are resistant to other treatments.
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Affiliation(s)
- Michele Ascoli
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Giovanni Mastroianni
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Disease Unit, IRCCS Institute "Giannina Gaslini", Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Sabrina Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Valentina Bova
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Anna Mammì
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Angelo Labate
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy
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22
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Ghannam R, Xia Y, Shen D, Fernandez FA, Heidari H, Roy VAL. Reconfigurable Surfaces Using Fringing Electric Fields from Nanostructured Electrodes in Nematic Liquid Crystals. ADVANCED THEORY AND SIMULATIONS 2021. [DOI: 10.1002/adts.202100058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Rami Ghannam
- James Watt School of Engineering University of Glasgow Glasgow G12 8QQ UK
| | - Yuanjie Xia
- James Watt School of Engineering University of Glasgow Glasgow G12 8QQ UK
| | - Dezhi Shen
- Department of Electronic and Electrical Engineering University College London London WC1E 7JE UK
| | - F. Anibal Fernandez
- Department of Electronic and Electrical Engineering University College London London WC1E 7JE UK
| | - Hadi Heidari
- James Watt School of Engineering University of Glasgow Glasgow G12 8QQ UK
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23
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Giuliano L, Mainieri G, Aguglia U, Bilo L, Durante V, Ermio C, Galimberti CA, La Neve A, Monti G, Ranzato F, Zambrelli E, Mostacci B. Long-term prognosis of juvenile myoclonic epilepsy: A systematic review searching for sex differences. Seizure 2021; 86:41-48. [DOI: 10.1016/j.seizure.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/31/2022] Open
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Kamali G, Smith RJ, Hays M, Coogan C, Crone NE, Kang JY, Sarma SV. Transfer Function Models for the Localization of Seizure Onset Zone From Cortico-Cortical Evoked Potentials. Front Neurol 2020; 11:579961. [PMID: 33362689 PMCID: PMC7758451 DOI: 10.3389/fneur.2020.579961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022] Open
Abstract
Surgical resection of the seizure onset zone (SOZ) could potentially lead to seizure-freedom in medically refractory epilepsy patients. However, localizing the SOZ can be a time consuming and tedious process involving visual inspection of intracranial electroencephalographic (iEEG) recordings captured during passive patient monitoring. Cortical stimulation is currently performed on patients undergoing invasive EEG monitoring for the main purpose of mapping functional brain networks such as language and motor networks. We hypothesized that evoked responses from single pulse electrical stimulation (SPES) can also be used to localize the SOZ as they may express the natural frequencies and connectivity of the iEEG network. To test our hypothesis, we constructed patient specific transfer function models from the evoked responses recorded from 22 epilepsy patients that underwent SPES evaluation and iEEG monitoring. We then computed the frequency and connectivity dependent “peak gain” of the system as measured by the H∞ norm from systems theory. We found that in cases for which clinicians had high confidence in localizing the SOZ, the highest peak gain transfer functions with the smallest “floor gain” (gain at which the dipped H∞ 3dB below DC gain) corresponded to when the clinically annotated SOZ and early spread regions were stimulated. In more complex cases, there was a large spread of the peak-to-floor (PF) ratios when the clinically annotated SOZ was stimulated. Interestingly for patients who had successful surgeries, our ratio of gains, agreed with clinical localization, no matter the complexity of the case. For patients with failed surgeries, the PF ratio did not match clinical annotations. Our findings suggest that transfer function gains and their corresponding frequency responses computed from SPES evoked responses may improve SOZ localization and thus surgical outcomes.
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Affiliation(s)
- Golnoosh Kamali
- Neuromedical Control Systems Laboratory, Department of Electrical and Computer Engineering, Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel June Smith
- Neuromedical Control Systems Laboratory, Department of Biomedical Engineering, Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Mark Hays
- Cognitive Research, Online Neuroengineering and Electrophysiology Laboratory, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Christopher Coogan
- Cognitive Research, Online Neuroengineering and Electrophysiology Laboratory, Department of Neurology-Epilepsy, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Nathan E Crone
- Cognitive Research, Online Neuroengineering and Electrophysiology Laboratory, Department of Neurology-Epilepsy, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Joon Y Kang
- Department of Neurology-Epilepsy, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sridevi V Sarma
- Neuromedical Control Systems Laboratory, Department of Electrical and Computer Engineering, Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, United States.,Neuromedical Control Systems Laboratory, Department of Biomedical Engineering, Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
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25
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Wan Yunus F, Tan XZ, Romli MH. Investigating the Feasibility of Exergame on Sleep and Emotion Among University Students. Games Health J 2020; 9:415-424. [DOI: 10.1089/g4h.2019.0077] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Farahiyah Wan Yunus
- Centre for Rehabilitation and Special Needs Studies, Occupational Therapy Programme. Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Xiu Zhen Tan
- Centre for Rehabilitation and Special Needs Studies, Occupational Therapy Programme. Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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26
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Asadi-Pooya AA, Homayoun M. Sex differences in characteristics of idiopathic generalized epilepsies. Neurol Sci 2020; 42:2421-2424. [PMID: 33074451 DOI: 10.1007/s10072-020-04834-3] [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: 06/19/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We compared the demographic, clinical, and electroencephalographic (EEG) characteristics between females and males with idiopathic generalized epilepsy (IGE). METHODS In this retrospective study, all patients with a clinical diagnosis of IGE were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2019. Age, gender, age at seizure onset, seizure type(s), epilepsy risk factors, and EEG findings of all patients were registered routinely. RESULTS Six hundred one patients with IGE were studied: 361 patients (60%) were females, and 240 people (40%) were males. The mean age at onset of seizures was 1.3 years earlier in males compared with that in females. Myoclonic seizures were more frequently reported by females than that by males. Photoparoxysmal response during intermittent photic stimulation in the EEG laboratory was more often observed in females than that in males. The difference in the syndromic diagnosis between the sexes was significant (p = 0.02). Among male patients, 88% were on valproate, and among female patients, 49% were on valproate (p = 0.0001). At the last follow-up visit, 83 males (61%) and 108 females (49%) were seizure-free (p = 0.02). CONCLUSION There are significant demographic, clinical, and electrographic differences between females and males with IGEs. The reasons behind these sex differences among patients with IGE are not clear. However, it is likely that sex hormones and sex chromosome genes-related brain differences play a role in the development of these differences. These interesting findings and the proposed hypothesis should be explored in future studies.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Maryam Homayoun
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Photosensitive Epilepsy and Polycystic Ovary Syndrome as Manifestations of MERRF. Case Rep Neurol Med 2020; 2020:8876272. [PMID: 33062354 PMCID: PMC7542499 DOI: 10.1155/2020/8876272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Although endocrinologic involvement and epilepsy are frequent features of myoclonic epilepsy with ragged-red fibers (MERRF), polycystic ovary syndrome (PCOS) and photosensitive epilepsy have not been reported. Case Report. A 32-year-old female was diagnosed with MERRF at age 19 y upon presence of the four canonical features and the variant m.8344A > G in MT-TK (tRNA (Lys)) (blood heteroplasmy rate: 50%). She experienced recurrent photosensitive focal and generalised seizures since age 19 y, which could be triggered by flickering light or by looking at small stones, leaves, or dirty snow on the ground. Since the last 42 months, she was seizure-free upon levetiracetam (4000 mg/d), clonazepam (1.5 mg/d), and topiramate (25 mg/d). Additionally, she suffered from secondary amenorrhoea since adolescence. She was married between ages 19 y and 25 y but did not get pregnant. PCOS was diagnosed and treated with desogestrel plus estradiol. Nonetheless, the course was progressive, particularly with regard to ataxia, myocloni, and myopathy. Conclusions The phenotypic spectrum of MERRF is broader than anticipated and may additionally include PCOS and photosensitive epilepsy. PCOS in MERRF may respond to hormone substitution and photosensitive epilepsy to levetiracetam, clonazepam, and topiramate.
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van Win OA, Barnes JG, Ferrier CF, Booth F, Prasad AN, Kasteleijn-Nolst Trenite DGA. A study of the significance of photoparoxysmal responses and spontaneous epileptiform discharges in the EEG in childhood epilepsy. Epilepsy Behav 2020; 107:107046. [PMID: 32304987 DOI: 10.1016/j.yebeh.2020.107046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 12/26/2022]
Abstract
AIM In clinical practice, there is a prevailing notion that photosensitivity mostly occurs in children with epilepsy (CWE) with idiopathic generalized epilepsy. We investigated the distribution of epilepsy types and etiology in photosensitive children and the associations with specific clinical and electroencephalogram (EEG) variables. METHODS In this retrospective cohort study, clinical data were acquired from all children that showed photosensitivity during systematic intermittent photic stimulation (IPS), over a 10-year interval at a tertiary level Children's Hospital, Winnipeg. Patient demographics, EEG findings, and clinical data and symptoms during IPS were abstracted. Classification of diagnoses using the International League Against Epilepsy (ILAE) 2017 guidelines was done by an expert panel. RESULTS Seventy-eight photosensitive children were identified. Forty (51.3%) had generalized epilepsy (idiopathic: 27, structural: 2, other: 11) compared with 19 (24.4%) focal (idiopathic: 1, structural: 2, other: 16), 8 (10.3%) combined focal and generalized (structural: 4, other: 4), and 11 (14.1%) unknown epilepsy (other: 11); (χ2 (3) = 32.1, p = .000). Self-sustaining or outlasting photoparoxysmal responses (PPRs) occurred in association with all epilepsy types; however, the EEGs of focal CWE without treatment comprised almost solely of PPRs which outlasted the stimulus (8/10), in contrast to only 8/17 of focal CWE with treatment and to 13/26 of generalized epilepsy without treatment. Most frequency intervals in individual patients were less under treatment: a decrease in standardized photosensitivity range (SPR) was seen in 5 CWE, an increase in 2, and no change in 1 during treatment. Both CWE with focal and generalized epilepsy showed abnormal activity on EEG during hyperventilation (40% vs 65.7%). Thirteen out of 14 CWE with clinical signs during IPS had independent spontaneous epileptiform discharges (SEDs) in the EEG recording. CONCLUSION Photosensitivity occurs in all types of epilepsy rather than in idiopathic generalized epilepsy alone. Surprisingly, there is a tendency for focal epilepsy to be associated with self-sustaining PPRs, especially when no treatment is used. Treatment tends to make the PPR more self-limiting and decrease the SPR. There is a tendency that clinical signs during IPS occur in EEGs in individuals with SEDs.
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Affiliation(s)
- Odile Alexandra van Win
- Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Jeffrey G Barnes
- Section of Neurology, Health Sciences Centre, St Boniface Hospital, 409 Tache Ave, Winnipeg, MB R2H 2A6, Canada
| | - Cyrille F Ferrier
- Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Fran Booth
- Section of Pediatric Neurology from Division of Pediatric Clinical Neurosciences, Children's Hospital, Health Sciences Centre, Winnipeg, Canada
| | - Asuri N Prasad
- Division of Pediatric Neurology and Clinical Neurosciences, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
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Tychsen L, Thio LL. Concern of Photosensitive Seizures Evoked by 3D Video Displays or Virtual Reality Headsets in Children: Current Perspective. Eye Brain 2020; 12:45-48. [PMID: 32104130 PMCID: PMC7023866 DOI: 10.2147/eb.s233195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022] Open
Abstract
This review assesses the risk of a photic-induced seizure in a child during viewing of 3D (binocular 3 dimensional, stereoscopic) movies or games, either on standard video displays or when wearing a virtual reality (VR) headset. Studies published by pediatric epilepsy experts emphasize the low risk of 3D viewing even for children with known photosensitive epilepsy (PSE). The low incidence of PSE is noteworthy because the number of hours devoted to 2D or 3D screen viewing and/or VR headset use by children worldwide has increased markedly over the last decade. The medical literature does not support the notion that VR headset use poses a risk for PSE.
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Affiliation(s)
- Lawrence Tychsen
- Department of Ophthalmology and Visual Sciences
- Department of Pediatrics
- Department of Neuroscience
| | - Liu Lin Thio
- Department of Pediatrics
- Department of Neuroscience
- Department of Neurology, St. Louis Children’s Hospital, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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30
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Atalar AÇ, Vanlı-Yavuz EN, Yılmaz E, Bebek N, Baykan B. Investigation of Generalized EEG Paroxysms Accompanying Focal Epilepsies. Clin EEG Neurosci 2019; 50:413-422. [PMID: 31248273 DOI: 10.1177/1550059419841837] [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] [Indexed: 11/16/2022]
Abstract
Interictal focal EEG features were frequently observed in generalized, epilepsies, but there is limited information about interictal, epileptiform/nonepileptiform generalized paroxysms in focal epilepsies. We aimed to report the frequency and associated factors of generalized EEG discharges in focal epilepsy with unknown cause (FEUC) and mesial, temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). A total of 200 patients (FEUC in 90 patients; MTLE-HS in 110 patients) were included. Generalized epileptiform (spike/sharp waves simultaneously in all regions) and nonspecific generalized discharges (paroxysmal slow waves) were investigated. All clinical and laboratory findings of 2 groups were compared with each other and with remaining control group, without generalized paroxysms, statistically. Generalized EEG features were present in 22 (11%; 4 males) patients; 9 in the FEUC group (10%; 2) and 13 in the MTLE-HS group (11.8%). Female gender (P < .021), febrile seizure (P < .034), precipitant factors (P < .025), and parental consanguinity (P < .033) were significantly higher in the group with generalized EEG findings. Monotherapy rates were lower in the MTLE-HS group (P < .05). The relationship of generalized EEG features with female gender and parental consanguinity may point out to a genetic property among focal epilepsies, while the relationship with febrile seizures and precipitant factors may be a clue about mechanisms with more extensive involvement of the neuronal networks.
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Affiliation(s)
- Arife Çimen Atalar
- 1 Istanbul University, Istanbul, Turkey.,2 Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Ebru Nur Vanlı-Yavuz
- 1 Istanbul University, Istanbul, Turkey.,3 Koç University Hospital, Istanbul, Turkey
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31
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He Z. Cellular and Network Mechanisms for Temporal Signal Propagation in a Cortical Network Model. Front Comput Neurosci 2019; 13:57. [PMID: 31507397 PMCID: PMC6718730 DOI: 10.3389/fncom.2019.00057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023] Open
Abstract
The mechanisms underlying an effective propagation of high intensity information over a background of irregular firing and response latency in cognitive processes remain unclear. Here we propose a SSCCPI circuit to address this issue. We hypothesize that when a high-intensity thalamic input triggers synchronous spike events (SSEs), dense spikes are scattered to many receiving neurons within a cortical column in layer IV, many sparse spike trains are propagated in parallel along minicolumns at a substantially high speed and finally integrated into an output spike train toward or in layer Va. We derive the sufficient conditions for an effective (fast, reliable, and precise) SSCCPI circuit: (i) SSEs are asynchronous (near synchronous); (ii) cortical columns prevent both repeatedly triggering SSEs and incorrectly synaptic connections between adjacent columns; and (iii) the propagator in interneurons is temporally complete fidelity and reliable. We encode the membrane potential responses to stimuli using the non-linear autoregressive integrated process derived by applying Newton's second law to stochastic resilience systems. We introduce a multithreshold decoder to correct encoding errors. Evidence supporting an effective SSCCPI circuit includes that for the condition, (i) time delay enhances SSEs, suggesting that response latency induces SSEs in high-intensity stimuli; irregular firing causes asynchronous SSEs; asynchronous SSEs relate to healthy neurons; and rigorous SSEs relate to brain disorders. For the condition (ii) neurons within a given minicolumn are stereotypically interconnected in the vertical dimension, which prevents repeated triggering SSEs and ensures signal parallel propagation; columnar segregation avoids incorrect synaptic connections between adjacent columns; and signal propagation across layers overwhelmingly prefers columnar direction. For the condition (iii), accumulating experimental evidence supports temporal transfer precision with millisecond fidelity and reliability in interneurons; homeostasis supports a stable fixed-point encoder by regulating changes to synaptic size, synaptic strength, and ion channel function in the membrane; together all-or-none modulation, active backpropagation, additive effects of graded potentials, and response variability functionally support the multithreshold decoder; our simulations demonstrate that the encoder-decoder is temporally complete fidelity and reliable in special intervals contained within the stable fixed-point range. Hence, the SSCCPI circuit provides a possible mechanism of effective signal propagation in cortical networks.
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Affiliation(s)
- Zonglu He
- Faculty of Management and Economics, Kaetsu University, Tokyo, Japan
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32
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Bartolini E, Sander JW. Dealing with the storm: An overview of seizure precipitants and spontaneous seizure worsening in drug-resistant epilepsy. Epilepsy Behav 2019; 97:212-218. [PMID: 31254841 DOI: 10.1016/j.yebeh.2019.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
In drug-resistant epilepsy, periods of seizure stability may alternate with abrupt worsening, with frequent seizures limiting the individual's independence and physical, social, and psychological well-being. Here, we review the literature focusing on different clinical scenarios related to seizure aggravation in people with drug-resistant epilepsy. The role of antiseizure medication (ASM) changes is examined, especially focusing on paradoxical seizure aggravation after increased treatment. The external provocative factors that unbalance the brittle equilibrium of seizure control are reviewed, distinguishing between unspecific triggering factors, specific precipitants, and 'reflex' mechanisms. The chance of intervening surgical or medical conditions, including somatic comorbidities and epilepsy surgery failure, causing increased seizures is discussed. Spontaneous exacerbation is also explored, emphasizing recent findings on subject-specific circadian and ultradian rhythms. Awareness of external precipitants and understanding the subject-specific spontaneous epilepsy course may allow individuals to modify their lifestyles. It also allows clinicians to counsel appropriately and to institute suitable medical treatment to avoid sudden loss of seizure control.
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Affiliation(s)
- Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, via suor Niccolina Infermiera 20, 59100 Prato, Italy.
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Achterweg 5, Heemstede 2103 SW, the Netherlands.
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33
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Hill AS, Jain P, Folan NE, Ben-Shahar Y. The Drosophila ERG channel seizure plays a role in the neuronal homeostatic stress response. PLoS Genet 2019; 15:e1008288. [PMID: 31393878 PMCID: PMC6687100 DOI: 10.1371/journal.pgen.1008288] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
Neuronal physiology is particularly sensitive to acute stressors that affect excitability, many of which can trigger seizures and epilepsies. Although intrinsic neuronal homeostasis plays an important role in maintaining overall nervous system robustness and its resistance to stressors, the specific genetic and molecular mechanisms that underlie these processes are not well understood. Here we used a reverse genetic approach in Drosophila to test the hypothesis that specific voltage-gated ion channels contribute to neuronal homeostasis, robustness, and stress resistance. We found that the activity of the voltage-gated potassium channel seizure (sei), an ortholog of the mammalian ERG channel family, is essential for protecting flies from acute heat-induced seizures. Although sei is broadly expressed in the nervous system, our data indicate that its impact on the organismal robustness to acute environmental stress is primarily mediated via its action in excitatory neurons, the octopaminergic system, as well as neuropile ensheathing and perineurial glia. Furthermore, our studies suggest that human mutations in the human ERG channel (hERG), which have been primarily implicated in the cardiac Long QT Syndrome (LQTS), may also contribute to the high incidence of seizures in LQTS patients via a cardiovascular-independent neurogenic pathway.
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Affiliation(s)
- Alexis S. Hill
- Department of Biology, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Poorva Jain
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Nicole E. Folan
- Department of Biology, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Yehuda Ben-Shahar
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, United States of America
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Chung J, Martinez GW, Lencioni KC, Sadda SR, Yang C. Computational aberration compensation by coded-aperture-based correction of aberration obtained from optical Fourier coding and blur estimation. OPTICA 2019; 6:647-661. [PMID: 33134437 PMCID: PMC7597901 DOI: 10.1364/optica.6.000647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We report a novel generalized optical measurement system and computational approach to determine and correct aberrations in optical systems. The system consists of a computational imaging method capable of reconstructing an optical system's pupil function by adapting overlapped Fourier coding to an incoherent imaging modality. It recovers the high-resolution image latent in an aberrated image via deconvolution. The deconvolution is made robust to noise by using coded apertures to capture images. We term this method coded-aperture-based correction of aberration obtained from overlapped Fourier coding and blur estimation (CACAO-FB). It is well-suited for various imaging scenarios where aberration is present and where providing a spatially coherent illumination is very challenging or impossible. We report the demonstration of CACAO-FB with a variety of samples including an in vivo imaging experiment on the eye of a rhesus macaque to correct for its inherent aberration in the rendered retinal images. CACAO-FB ultimately allows for an aberrated imaging system to achieve diffraction-limited performance over a wide field of view by casting optical design complexity to computational algorithms in post-processing.
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Affiliation(s)
- Jaebum Chung
- Department of Electrical Engineering, California Institute of Technology, Pasadena, California 91125, USA
- Corresponding author:
| | - Gloria W. Martinez
- Office of Laboratory Animal Resources, California Institute of Technology, Pasadena, California 91125, USA
| | - Karen C. Lencioni
- Office of Laboratory Animal Resources, California Institute of Technology, Pasadena, California 91125, USA
| | - Srinivas R. Sadda
- Doheny Eye Institute, University of California-Los Angeles, Los Angeles, California 90033, USA
| | - Changhuei Yang
- Department of Electrical Engineering, California Institute of Technology, Pasadena, California 91125, USA
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35
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Asavapanumas N, Brawek B, Martus P, Garaschuk O. Role of intracellular Ca2+ stores for an impairment of visual processing in a mouse model of Alzheimer's disease. Neurobiol Dis 2019; 121:315-326. [DOI: 10.1016/j.nbd.2018.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/28/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022] Open
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36
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La Morgia C, Carelli V, Carbonelli M. Melanopsin Retinal Ganglion Cells and Pupil: Clinical Implications for Neuro-Ophthalmology. Front Neurol 2018; 9:1047. [PMID: 30581410 PMCID: PMC6292931 DOI: 10.3389/fneur.2018.01047] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023] Open
Abstract
Melanopsin retinal ganglion cells (mRGCs) are intrinsically photosensitive RGCs that mediate many relevant non-image forming functions of the eye, including the pupillary light reflex, through the projections to the olivary pretectal nucleus. In particular, the post-illumination pupil response (PIPR), as evaluated by chromatic pupillometry, can be used as a reliable marker of mRGC function in vivo. In the last years, pupillometry has become a promising tool to assess mRGC dysfunction in various neurological and neuro-ophthalmological conditions. In this review we will present the most relevant findings of pupillometric studies in glaucoma, hereditary optic neuropathies, ischemic optic neuropathies, idiopathic intracranial hypertension, multiple sclerosis, Parkinson's disease, and mood disorders. The use of PIPR as a marker for mRGC function is also proposed for other neurodegenerative disorders in which circadian dysfunction is documented.
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Affiliation(s)
- Chiara La Morgia
- Unità Operativa Complessa Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Valerio Carelli
- Unità Operativa Complessa Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Michele Carbonelli
- Unità Operativa Complessa Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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Lamar KMJ, Carvill GL. Chromatin Remodeling Proteins in Epilepsy: Lessons From CHD2-Associated Epilepsy. Front Mol Neurosci 2018; 11:208. [PMID: 29962935 PMCID: PMC6013553 DOI: 10.3389/fnmol.2018.00208] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/25/2018] [Indexed: 12/24/2022] Open
Abstract
The chromodomain helicase DNA-binding (CHD) family of proteins are ATP-dependent chromatin remodelers that contribute to the reorganization of chromatin structure and deposition of histone variants necessary to regulate gene expression. CHD proteins play an important role in neurodevelopment, as pathogenic variants in CHD1, CHD2, CHD4, CHD7 and CHD8 have been associated with a range of neurological phenotypes, including autism spectrum disorder (ASD), intellectual disability (ID) and epilepsy. Pathogenic variants in CHD2 are associated with developmental epileptic encephalopathy (DEE) in humans, however little is known about how these variants contribute to this disorder. Of the nine CHD family members, CHD2 is the only one that leads to a brain-restricted phenotype when disrupted in humans. This suggests that despite being expressed ubiquitously, CHD2 has a unique role in human brain development and function. In this review, we will discuss the phenotypic spectrum of patients with pathogenic variants in CHD2, current animal models of CHD2 deficiency, and the role of CHD2 in proliferation, neurogenesis, neuronal differentiation, chromatin remodeling and DNA-repair. We also consider how CHD2 depletion can affect each of these biological mechanisms and how these defects may underpin neurodevelopmental disorders including epilepsy.
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Affiliation(s)
- Kay-Marie J Lamar
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Gemma L Carvill
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Zheng YM, Chen B, Jiang JD, Zhang JP. Syntaxin 1B Mediates Berberine's Roles in Epilepsy-Like Behavior in a Pentylenetetrazole-Induced Seizure Zebrafish Model. Front Mol Neurosci 2018; 11:378. [PMID: 30534049 PMCID: PMC6275243 DOI: 10.3389/fnmol.2018.00378] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/21/2018] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is a neuronal dysfunction syndrome characterized by transient and diffusely abnormal discharges of neurons in the brain. Previous studies have shown that mutations in the syntaxin 1b (stx1b) gene cause a familial, fever-associated epilepsy syndrome. It is unclear as to whether the stx1b gene also correlates with other stimulations such as flashing and/or mediates the effects of antiepileptic drugs. In this study, we found that the expression of stx1b was present mainly in the brain and was negatively correlated with seizures in a pentylenetetrazole (PTZ)-induced seizure zebrafish model. The transcription of stx1b was inhibited by PTZ but rescued by valproate, a broad-spectrum epilepsy treatment drug. In the PTZ-seizure zebrafish model, stx1b knockdown aggravated larvae hyperexcitatory swimming and prompted abnormal trajectory movements, particularly under lighting stimulation; at the same time, the expression levels of the neuronal activity marker gene c-fos increased significantly in the brain. In contrast, stx1b overexpression attenuated seizures and decreased c-fos expression levels following PTZ-induced seizures in larvae. Thus, we speculated that a deficiency of stx1b gene expression may be related with the onset occurrence of clinical seizures, particularly photosensitive seizures. In addition, we found that berberine (BBR) reduced larvae hyperexcitatory locomotion and abnormal movement trajectory in a concentration-dependent manner, slowed down excessive photosensitive seizure-like swimming, and assisted in the recovery of the expression levels of STX1B. Under the downregulation of STX1B, BBR's roles were limited: specifically, it only slightly regulated the levels of the two genes stx1b and c-fos and the hyperexcitatory motion of zebrafish in dark conditions and had no effect on the overexcited swimming behavior seen in conjunction with lighting stimulation. These findings further demonstrate that STX1B protein levels are negatively correlated with a seizure and can decrease the sensitivity of the photosensitive response in a PTZ-induced seizure zebrafish larvae; furthermore, STX1B may partially mediate the anticonvulsant effect of BBR. Additional investigation regarding the relationship between STX1B, BBR, and seizures could provide new cues for the development of novel anticonvulsant drugs.
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Affiliation(s)
- Yang-Min Zheng
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bo Chen
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jian-Dong Jiang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing-Pu Zhang
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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