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Rubinos C, San-Juan D, Alva-Diaz C, Burneo J, Fernandez A, Mayor-Romero LC, Vidaurre J, Rios-Pohl L, Bruzzone MJ. Epilepsy Care in Latin America and the Caribbean: Overcoming Challenges and Embracing Opportunities. Semin Neurol 2024; 44:130-146. [PMID: 38537703 DOI: 10.1055/s-0044-1782616] [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: 04/19/2024]
Abstract
The burden of epilepsy in the Latin America and the Caribbean (LAC) region causes a profound regional impact on the health care system and significantly contributes to the global epilepsy burden. As in many other resource-limited settings worldwide, health care professionals and patients with epilepsy in LAC countries face profound challenges due to a combination of factors, including high disease prevalence, stigmatization of epilepsy, disparities in access to care, limited resources, substantial treatment gaps, insufficient training opportunities for health care providers, and a diverse patient population with varying needs. This article presents an overview of the epidemiology of epilepsy and discusses the principal obstacles to epilepsy care and key contributors to the epilepsy diagnosis and treatment gap in the LAC region. We conclude by highlighting various initiatives across different LAC countries to improve epilepsy care in marginalized communities, listing strategies to mitigate treatment gaps and facilitate better health care access for patients with epilepsy by enhancing the epilepsy workforce.
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Affiliation(s)
- Clio Rubinos
- Division of Critical Care Neurology and Division of Epilepsy, Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel San-Juan
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Epilepsy Service, Mexico City, Mexico
| | - Carlos Alva-Diaz
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación, Hospital Daniel Alcides Carrión, Callao, Perú
| | - Jorge Burneo
- Epilepsy Program and Neuroepidemiology Unit, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andres Fernandez
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Jorge Vidaurre
- Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
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Wu X, Xie D, Zheng Q, Peng S, Liu Y, Ma P, Ye L, Mo X, Feng Z. Downregulation of NHE1 expression attenuates apoptosis of primary hippocampal neurons of an epilepsy model through the calpain-1 pathway. Neurosci Lett 2023; 815:137494. [PMID: 37748674 DOI: 10.1016/j.neulet.2023.137494] [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: 05/24/2023] [Revised: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Na(+)/H(+) exchanger isoform 1 (NHE1), a membrane protein that regulates intracellular pH, is abundantly expressed in brain tissues. It is associated with pathophysiologies in several brain diseases. The present study aimed to investigate the effects of NHE1 on the apoptosis of primary neurons of an epilepsy model. METHODS Primary hippocampal neurons were cultured in an Mg2+-free medium to establish an epilepsy cell model. Designed shNHE1 lentivirus was used to silence NHE1 level in primary neurons. Nonselective pharmacological inhibitor MDL-28170 (20 μmol/L) was used to inhibit calpain-1 protein in neurons treated with Mg2+-free medium. The expression levels of NHE1 and calpain-1, intracellular Ca2+ (Ca2+i) and H+ (H+i) levels, and the expression levels of apoptosis-related proteins Bcl-2 and Bax were detected in neurons. TUNEL staining was performed to determine apoptosis in different groups. RESULTS NHE1 expression was increased in primary neurons treated with an Mg2+-free medium, and it was correlated with increased expression of calpain-1 and cell apoptosis. Neurons from the in vitro epilepsy model showed significantly decreased Bcl-2 protein expression and significantly increased Bax protein expression. In the presence of LV-shNHE1 and the calpain-1 inhibitor MDL-28170, the changes in the expression of apoptosis-related proteins Bcl-2 and Bax were blocked in the epileptic model, and the percentage of apoptotic neurons among neurons from the in vitro epilepsy model was significantly decreased. The increase in calpain-1 expression was suppressed by LV-shNHE1; however, the inhibition of calpain-1 did not affect NHE1 expression. CONCLUSION These results demonstrate that NHE1 participates in the promotion of neuronal apoptosis of epilepsy model in vitro through the calpain-1 pathway. Downregulation of NHE1 expression could exert a neuroprotective effect on epilepsy.
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Affiliation(s)
- Xuling Wu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Dongjun Xie
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qian Zheng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shuang Peng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ying Liu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Pengfei Ma
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Lan Ye
- The Medical Science Function Laboratory of Experimental Teaching Center of Basic Medicine, School of Basic Medical Science, Guizhou Medical University, Guiyang, China.
| | - Xiangang Mo
- Department of Comprehensive Care Ward, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
| | - Zhanhui Feng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
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Hoffmann L, Blümcke I. Neuropathology and epilepsy surgery. Curr Opin Neurol 2022; 35:202-207. [PMID: 35067500 DOI: 10.1097/wco.0000000000001030] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW Neurosurgical treatment of patients suffering from drug-resistant focal epilepsy is recognized as a successful, yet underutilized medical treatment option. By searching PubMed for articles published between January 2020 and September 2021 with the broad search terms 'neuropathology' AND 'epilepsy surgery', this review highlights the active field of etiology-based epilepsy research in human tissue. RECENT FINDINGS All papers addressing the most common epileptogenic human brain disease entities, i.e. focal cortical dysplasia (FCD), brain tumors or hippocampal sclerosis, and written in English language were eligible for our review. We can conclude from this review that etiology-based studies are of foremost interest for (1) the development of prediction models for postsurgical seizure outcome; (2) decipher genetic and molecular alterations to better define disease entities and underlying molecular pathomechanisms, and (3) the translation of human tissue-derived biomarker into clinically useful diagnostics or novel therapeutic targets in the near future. SUMMARY Highlighting FCD brain somatic gain-of-function variants in mammalian target of Rapamycin are a leading pathway to better classify FCD. An integrated genotype-phenotype analysis enables to classify the broad spectrum of low-grade and epilepsy-associated brain tumors. Further DNA-methylation-based disease classification will increase the mechanistic understanding and diagnostic precision of difficult to classify pathologies in the future.
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Affiliation(s)
- Lucas Hoffmann
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
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Jabari S, Kobow K, Pieper T, Hartlieb T, Kudernatsch M, Polster T, Bien CG, Kalbhenn T, Simon M, Hamer H, Rössler K, Feucht M, Mühlebner A, Najm I, Peixoto-Santos JE, Gil-Nagel A, Delgado RT, Aledo-Serrano A, Hou Y, Coras R, von Deimling A, Blümcke I. DNA methylation-based classification of malformations of cortical development in the human brain. Acta Neuropathol 2022; 143:93-104. [PMID: 34797422 PMCID: PMC8732912 DOI: 10.1007/s00401-021-02386-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022]
Abstract
Malformations of cortical development (MCD) comprise a broad spectrum of structural brain lesions frequently associated with epilepsy. Disease definition and diagnosis remain challenging and are often prone to arbitrary judgment. Molecular classification of histopathological entities may help rationalize the diagnostic process. We present a retrospective, multi-center analysis of genome-wide DNA methylation from human brain specimens obtained from epilepsy surgery using EPIC 850 K BeadChip arrays. A total of 308 samples were included in the study. In the reference cohort, 239 formalin-fixed and paraffin-embedded (FFPE) tissue samples were histopathologically classified as MCD, including 12 major subtype pathologies. They were compared to 15 FFPE samples from surgical non-MCD cortices and 11 FFPE samples from post-mortem non-epilepsy controls. We applied three different statistical approaches to decipher the DNA methylation pattern of histopathological MCD entities, i.e., pairwise comparison, machine learning, and deep learning algorithms. Our deep learning model, which represented a shallow neuronal network, achieved the highest level of accuracy. A test cohort of 43 independent surgical samples from different epilepsy centers was used to test the precision of our DNA methylation-based MCD classifier. All samples from the test cohort were accurately assigned to their disease classes by the algorithm. These data demonstrate DNA methylation-based MCD classification suitability across major histopathological entities amenable to epilepsy surgery and age groups and will help establish an integrated diagnostic classification scheme for epilepsy-associated MCD.
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Affiliation(s)
- Samir Jabari
- Department of Neuropathology, Affiliated Partner of the ERN EpiCARE, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katja Kobow
- Department of Neuropathology, Affiliated Partner of the ERN EpiCARE, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Vogtareuth, Germany
| | - Till Hartlieb
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Vogtareuth, Germany
- Research Institute, Rehabilitation, Transition, Palliation", PMU Salzburg, Salzburg, Austria
| | - Manfred Kudernatsch
- Center for Neurosurgery and Epilepsy Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
- Research Institute, Rehabilitation, Transition, Palliation", PMU Salzburg, Salzburg, Austria
| | - Tilman Polster
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Thilo Kalbhenn
- Department of Neurosurgery - Epilepsy Surgery, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld University, Bielefeld, Germany
| | - Matthias Simon
- Department of Neurosurgery - Epilepsy Surgery, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld University, Bielefeld, Germany
| | - Hajo Hamer
- Department of Neurology, Epilepsy Center, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Martha Feucht
- Department of Pediatrics and Adolescent Medicine, Affiliated Partner of the ERN EpiCARE, Medical University Vienna, Vienna, Austria
| | - Angelika Mühlebner
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of (Neuro) Pathology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Imad Najm
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | - Yanghao Hou
- Department of Neuropathology, German Cancer Research Center (DKFZ), Universitätsklinikum Heidelberg, and CCU Neuropathology, Heidelberg, Germany
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Roland Coras
- Department of Neuropathology, Affiliated Partner of the ERN EpiCARE, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andreas von Deimling
- Department of Neuropathology, German Cancer Research Center (DKFZ), Universitätsklinikum Heidelberg, and CCU Neuropathology, Heidelberg, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, Affiliated Partner of the ERN EpiCARE, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Montaño-Lozada JM, López N, Espejo-Zapata LM, Soto-Añari M, Ramos-Henderson M, Caldichoury-Obando N, Camargo L. Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation. Epilepsy Behav 2021; 122:108158. [PMID: 34182417 DOI: 10.1016/j.yebeh.2021.108158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. OBJECTIVE To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors. MATERIALS AND METHODOLOGY One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE). RESULTS Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p < 0.01), particularly in attention (t = 3.22; p < 0.02) and memory (t = 5.04; p < 0.01) dimensions. Additionally, a significant association was observed between years of schooling and (MoCA) scores (p = 0,019) but not between socioeconomic level (p = 0,510), age (p = 0,452) and the frequency of seizures (p = 0,471). DISCUSSION Patients with epilepsy show lower scores in several cognitive domains in respect of the control group. The (MoCA) has proven its appropriateness for cognitive screening in the contexts of clinical neurology outpatient consultation.
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Affiliation(s)
- J M Montaño-Lozada
- Medico, Residente IV año de Neurología Clínica, Universidad del Sinú EBZ. Cartagena, Colombia
| | | | - L M Espejo-Zapata
- Medico, Especialista en Salud Mental del niño y Adolescente. Universidad CES. Medellín, Colombia
| | | | - Miguel Ramos-Henderson
- Escuela de Psicología, Facultad de Ciencias Sociales y de la Comunicación, Universidad Santo Tomás, Antofagasta, Chile
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Yacubian EÁ, Carrizosa J, Cavalheiro EA. Introduction to the special issue. Seizure 2021; 90:1-3. [PMID: 34215509 DOI: 10.1016/j.seizure.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Elza Árcia Yacubian
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Jaime Carrizosa
- Department of Pediatrics, Titular Professor University of Antioquia, Medellín, Colombia
| | - Esper A Cavalheiro
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.
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