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Tsuboyama M, Harini C, Liu S, Zhang B, Bolton J. Subclinical seizures detected on intracranial EEG: Patient characteristics and impact on surgical outcome in a single pediatric epilepsy surgery center. Epilepsy Behav 2021; 121:108040. [PMID: 34058491 DOI: 10.1016/j.yebeh.2021.108040] [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: 02/25/2021] [Revised: 05/02/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Subclinical seizures (SCS) are often captured during intracranial EEG monitoring of pediatric patients with refractory focal epilepsy. However, their clinical significance remains uncertain. We aimed to characterize features associated with SCS and whether their presence impacts epilepsy outcomes post-surgically. METHODS A single center retrospective chart review of patients with refractory focal epilepsy who underwent intracranial EEG monitoring at Boston Children's Hospital between 2004 and 2014 was conducted. Patient and seizure characteristics as well as post-operative outcome data were collected. RESULTS Of the 104 patients included in the study, SCS were recorded in 66 (63%). Fifty-eight had electroclinical seizures (ECS) and SCS (ECS + SCS), and eight patients only had SCS. There were no significant patient characteristics associated with the presence of SCS. One hundred one of the 104 patients (97%) underwent surgical resection after the intracranial EEG monitoring, 53 of which had Engel 1 outcomes (52%). Incomplete resection (OR 0.15, 95% confidence interval (CI) [0.06, 0.40], p < 0.001) or presence of temporal plus epilepsy (OR 0.23, 95% CI [0.06, 0.80], p = 0.04) was associated with poor Engel outcomes (Engel 2-4). Presence of SCS was not associated with epilepsy surgical outcomes (p = 0.99). SIGNIFICANCE Nearly 2/3 of patients in our study had SCS captured on intracranial EEG monitoring, and arose in overlapping regions with the ictal onset zone of ECS. Completeness of resection remains the most important predictor of seizure outcome, regardless of the presence of SCS. In the absence of ECS during intracranial EEG monitoring, SCS onset zones may provide useful localization information to guide surgical resection plans. This is the largest cohort reported in the literature describing characteristics associated with the presence of SCS and the impact of SCS on pediatric epilepsy surgery outcomes.
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Affiliation(s)
- Melissa Tsuboyama
- Division of Epilepsy and Neurophysiology, Boston Children's Hospital, Boston, MA, United States.
| | - Chellamani Harini
- Division of Epilepsy and Neurophysiology, Boston Children's Hospital, Boston, MA, United States
| | - Shanshan Liu
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, United States
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States; Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, United States
| | - Jeffrey Bolton
- Division of Epilepsy and Neurophysiology, Boston Children's Hospital, Boston, MA, United States
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Luz-Escamilla L, Morales-González JA. Association between Interictal Epileptiform Discharges and Autistic Spectrum Disorder. Brain Sci 2019; 9:brainsci9080185. [PMID: 31366163 PMCID: PMC6721430 DOI: 10.3390/brainsci9080185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023] Open
Abstract
It has been reported that bioelectric alterations in an electroencephalogram (EEG) may play an etiological role in neurodevelopmental disorders. The clinical impact of interictal epileptiform discharges (IEDs) in association with autistic spectrum disorder (ASD) is unknown. The Autism Diagnostic Interview-Revised (ADI-R) is one of the gold standards for the diagnosis of autistic spectrum disorder. Some studies have indicated high comorbidity of IED and ASD, while other studies have not supported an association between the central symptoms of autism and IED. This review examines the high comorbidity and clinical impact of IED; patients with epilepsy are excluded from the scope of this review. ASD can be disabling and is diagnosed at an average age of 5 years old, at which point the greatest neurological development has occurred. If an association between IED and ASD is identified, a clinical tool that entails an innocuous procedure could enable diagnosis in the first years of life. However, in the absence of reports that prove an association between IED and ASD, patients should not be subjected to expensive treatments, such as the administration of anticonvulsant therapies.
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Affiliation(s)
- Laura Luz-Escamilla
- Laboratorio de Medicina de Conservación y Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón S/N, Col. Casco de Santo Tomás, Alcaldía Miguel Hidalgo CP 11340, México.
- Departamento de Higiene Mental, Hospital General Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Distrito Federal CP 02990, México.
| | - José Antonio Morales-González
- Laboratorio de Medicina de Conservación y Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón S/N, Col. Casco de Santo Tomás, Alcaldía Miguel Hidalgo CP 11340, México.
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Pizarro D, Toth E, Irannejad A, Riley KO, Jaisani Z, Muhlhofer W, Martin R, Pati S. Auras localized to the temporal lobe disrupt verbal memory and learning - Causal evidence from direct electrical stimulation of the hippocampus. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:99-101. [PMID: 30181952 PMCID: PMC6120344 DOI: 10.1016/j.ebcr.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/19/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
Auras (focal aware seizure; FAS) are subjective ictal events with retained consciousness. Epileptiform activities can disrupt cognitive tasks, but studies are limited to seizures with impaired awareness. As a proof of concept, we examined the cognitive effects of direct electrical stimulation to the left hippocampus which induced a habitual FAS in a patient with left mesial temporal lobe epilepsy. During the induced habitual FAS, verbal memory performance declined significantly as compared to pre-stimulation testing. Tasks measuring auditory working memory and psychomotor processing speed were not affected by the stimulation. The study confirms that FAS can impair episodic verbal memory and learning.
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Affiliation(s)
- Diana Pizarro
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States of America
| | - Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States of America
| | - Auriana Irannejad
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States of America
| | - Kristen O. Riley
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States of America
| | - Zeenat Jaisani
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Wolfgang Muhlhofer
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Roy Martin
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States of America
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van Veenendaal TM, IJff DM, Aldenkamp AP, Lazeron RHC, Hofman PAM, de Louw AJA, Backes WH, Jansen JFA. Chronic antiepileptic drug use and functional network efficiency: A functional magnetic resonance imaging study. World J Radiol 2017; 9:287-294. [PMID: 28717415 PMCID: PMC5491656 DOI: 10.4329/wjr.v9.i6.287] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/24/2017] [Accepted: 03/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To increase our insight in the neuronal mechanisms underlying cognitive side-effects of antiepileptic drug (AED) treatment.
METHODS The relation between functional magnetic resonance-acquired brain network measures, AED use, and cognitive function was investigated. Three groups of patients with epilepsy with a different risk profile for developing cognitive side effects were included: A “low risk” category (lamotrigine or levetiracetam, n = 16), an “intermediate risk” category (carbamazepine, oxcarbazepine, phenytoin, or valproate, n = 34) and a “high risk” category (topiramate, n = 5). Brain connectivity was assessed using resting state functional magnetic resonance imaging and graph theoretical network analysis. The Computerized Visual Searching Task was used to measure central information processing speed, a common cognitive side effect of AED treatment.
RESULTS Central information processing speed was lower in patients taking AEDs from the intermediate and high risk categories, compared with patients from the low risk category. The effect of risk category on global efficiency was significant (P < 0.05, ANCOVA), with a significantly higher global efficiency for patient from the low category compared with the high risk category (P < 0.05, post-hoc test). Risk category had no significant effect on the clustering coefficient (ANCOVA, P > 0.2). Also no significant associations between information processing speed and global efficiency or the clustering coefficient (linear regression analysis, P > 0.15) were observed.
CONCLUSION Only the four patients taking topiramate show aberrant network measures, suggesting that alterations in functional brain network organization may be only subtle and measureable in patients with more severe cognitive side effects.
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Boly M, Jones B, Findlay G, Plumley E, Mensen A, Hermann B, Tononi G, Maganti R. Altered sleep homeostasis correlates with cognitive impairment in patients with focal epilepsy. Brain 2017; 140:1026-1040. [PMID: 28334879 DOI: 10.1093/brain/awx017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 12/20/2016] [Indexed: 11/13/2022] Open
Abstract
In animal studies, both seizures and interictal spikes induce synaptic potentiation. Recent evidence suggests that electroencephalogram slow wave activity during sleep reflects synaptic potentiation during wake, and that its homeostatic decrease during the night is associated with synaptic renormalization and its beneficial effects. Here we asked whether epileptic activity induces plastic changes that can be revealed by high-density electroencephalography recordings during sleep in 15 patients with focal epilepsy and 15 control subjects. Compared to controls, patients with epilepsy displayed increased slow wave activity power during non-rapid eye movement sleep over widespread, bilateral scalp regions. This global increase in slow wave activity power was positively correlated with the frequency of secondarily generalized seizures in the 3-5 days preceding the recordings. Individual patients also showed local increases in sleep slow wave activity power at scalp locations matching their seizure focus. This local increase in slow wave activity power was positively correlated with the frequency of interictal spikes during the last hour of wakefulness preceding sleep. By contrast, frequent interictal spikes during non-rapid eye movement sleep predicted a reduced homeostatic decrease in the slope of sleep slow waves during the night, which in turn predicted reduced daytime learning. Patients also showed an increase in sleep spindle power, which was negatively correlated with intelligence quotient. Altogether, these findings suggest that both seizures and interictal spikes may induce long-lasting changes in the human brain that can be sensitively detected by electroencephalographic markers of sleep homeostasis. Furthermore, abnormalities in sleep markers are correlated with cognitive impairment, suggesting that not only seizures, but also interictal spikes can have negative consequences.
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Affiliation(s)
- Melanie Boly
- Department of Neurology, University of Wisconsin, Madison, USA.,Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Benjamin Jones
- Department of Neurology, University of Wisconsin, Madison, USA.,Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Graham Findlay
- Department of Neurology, University of Wisconsin, Madison, USA.,Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Erin Plumley
- Department of Neurology, University of Wisconsin, Madison, USA
| | - Armand Mensen
- Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin, Madison, USA
| | - Guilio Tononi
- Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Rama Maganti
- Department of Neurology, University of Wisconsin, Madison, USA
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Dinkelacker V, Dupont S, Samson S. The new approach to classification of focal epilepsies: Epileptic discharge and disconnectivity in relation to cognition. Epilepsy Behav 2016; 64:322-328. [PMID: 27765519 DOI: 10.1016/j.yebeh.2016.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 12/23/2022]
Abstract
The new classification of epilepsy stratifies the disease into an acute level, based on seizures, and an overarching chronic level of epileptic syndromes (Berg et al., 2010). In this new approach, seizures are considered either to originate and evolve in unilateral networks or to rapidly encompass both hemispheres. This concept extends the former vision of focal and generalized epilepsies to a genuine pathology of underlying networks. These key aspects of the new classification can be linked to the concept of cognitive curtailing in focal epilepsy. The present review will discuss the conceptual implications for acute and chronic cognitive deficits with special emphasis on transient and structural disconnectivity. Acute transient disruption of brain function is the hallmark of focal seizures. Beyond seizures, however, interictal epileptic discharges (IEDs) are increasingly recognized to interfere with physiological brain circuitry. Both concomitant EEG and high-precision neuropsychological testing are necessary to detect these subtle effects, which may concern task-specific or default-mode networks. More recent data suggest that longstanding IEDs may affect brain maturation and eventually be considered as a biomarker of pathological wiring. This brings us to the overarching level of chronic cognitive and behavioral comorbidity. We will discuss alterations in structural connectivity measured with diffusion-weighted imaging and tractography. Among focal epilepsies, much of our current insights are derived from temporal lobe epilepsy and its impact on neuropsychological and psychiatric functioning. Structural disconnectivity is maximal in the temporal lobe but also concerns widespread language circuitry. Eventually, pathological wiring may contribute to the clinical picture of cognitive dysfunction. We conclude with the extrapolation of these concepts to current research topics and to the necessity of establishing individual patient profiles of network pathology with EEG, high-precision neuropsychological testing, and state-of-the-art neuroimaging. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".
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Affiliation(s)
- Vera Dinkelacker
- Neurology Unit, Rothschild Foundation, 25 Rue Manin, 75019, Paris, France; Centre de Recherche de l'Institut du Cerveau et de la Moëlle Épinière (CRICM), UPMC-UMR 7225 CNRS-UMRS 975 INSERM, Paris, France.
| | - Sophie Dupont
- Centre de Recherche de l'Institut du Cerveau et de la Moëlle Épinière (CRICM), UPMC-UMR 7225 CNRS-UMRS 975 INSERM, Paris, France; Epilepsy Unit, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Séverine Samson
- Epilepsy Unit, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75013, Paris, France; Laboratoire PSITEC (EA 4072), Université de Lille 3, France
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7
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van Veenendaal TM, IJff DM, Aldenkamp AP, Lazeron RHC, Puts NAJ, Edden RAE, Hofman PAM, de Louw AJA, Backes WH, Jansen JFA. Glutamate concentrations vary with antiepileptic drug use and mental slowing. Epilepsy Behav 2016; 64:200-205. [PMID: 27744245 DOI: 10.1016/j.yebeh.2016.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although antiepileptic drugs (AEDs) are effective in suppressing epileptic seizures, they also induce (cognitive) side effects, with mental slowing as a general effect. This study aimed to assess whether concentrations of MR detectable neurotransmitters, glutamate and GABA, are associated with mental slowing in patients with epilepsy taking AEDs. METHODS Cross-sectional data were collected from patients with localization-related epilepsy using a variety of AEDs from three risk categories, i.e., AEDs with low, intermediate, and high risks of developing cognitive problems. Patients underwent 3T MR spectroscopy, including a PRESS (n=55) and MEGA-PRESS (n=43) sequence, to estimate occipital glutamate and GABA concentrations, respectively. The association was calculated between neurotransmitter concentrations and central information processing speed, which was measured using the Computerized Visual Searching Task (CVST) and compared between the different risk categories. RESULTS Combining all groups, patients with lower processing speeds had lower glutamate concentrations. Patients in the high-risk category had a lower glutamate concentration and lower processing speed compared with patients taking low-risk AEDs. Patients taking intermediate-risk AEDs also had a lower glutamate concentration compared with patients taking low-risk AEDs, but processing speed did not differ significantly between those groups. No associations were found between the GABA concentration and risk category or processing speed. CONCLUSIONS For the first time, a relation is shown between glutamate concentration and both mental slowing and AED use. It is suggested that the reduced excitatory action, reflected by lowered glutamate concentrations, may have contributed to the slowing of information processing in patients using AEDs with higher risks of cognitive side effects.
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Affiliation(s)
- Tamar M van Veenendaal
- Departments of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Dominique M IJff
- School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands.
| | - Albert P Aldenkamp
- School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Department of Neurology, Gent University Hospital, De Pintelaan 185, 9000 Gent, Belgium; Faculty of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - Richard H C Lazeron
- Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands.
| | - Nicolaas A J Puts
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 N Caroline St., Baltimore 21287, MD, USA; F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, 707 North Broadway, Baltimore 21205, MD, USA.
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 N Caroline St., Baltimore 21287, MD, USA; F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, 707 North Broadway, Baltimore 21205, MD, USA.
| | - Paul A M Hofman
- Departments of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands.
| | - Anton J A de Louw
- Departments of Neurology and Neuropsychology, Epilepsy Center Kempenhaeghe, P.O. Box 61, 5590 AB Heeze, The Netherlands and Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Faculty of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - Walter H Backes
- Departments of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Jacobus F A Jansen
- Departments of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Interictal epileptic discharge correlates with global and frontal cognitive dysfunction in temporal lobe epilepsy. Epilepsy Behav 2016; 62:197-203. [PMID: 27494355 DOI: 10.1016/j.yebeh.2016.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/10/2016] [Accepted: 07/02/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Temporal lobe epilepsy (TLE) with hippocampal sclerosis has widespread effects on structural and functional connectivity and often entails cognitive dysfunction. EEG is mandatory to disentangle interactions in epileptic and physiological networks which underlie these cognitive comorbidities. Here, we examined how interictal epileptic discharges (IEDs) affect cognitive performance. METHODS Thirty-four patients (right TLE=17, left TLE=17) were examined with 24-hour video-EEG and a battery of neuropsychological tests to measure intelligence quotient and separate frontal and temporal lobe functions. Hippocampal segmentation of high-resolution T1-weighted imaging was performed with FreeSurfer. Partial correlations were used to compare the number and distribution of clinical interictal spikes and sharp waves with data from imagery and psychological tests. RESULTS The number of IEDs was negatively correlated with executive functions, including verbal fluency and intelligence quotient (IQ). Interictal epileptic discharge affected cognitive function in patients with left and right TLE differentially, with verbal fluency strongly related to temporofrontal spiking. In contrast, IEDs had no clear effects on memory functions after corrections with partial correlations for age, age at disease onset, disease duration, and hippocampal volume. CONCLUSION In patients with TLE of long duration, IED occurrence was strongly related to cognitive deficits, most pronounced for frontal lobe function. These data suggest that IEDs reflect dysfunctional brain circuitry and may serve as an independent biomarker for cognitive comorbidity.
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Liu A, Bryant A, Jefferson A, Friedman D, Minhas P, Barnard S, Barr W, Thesen T, O'Connor M, Shafi M, Herman S, Devinsky O, Pascual-Leone A, Schachter S. Exploring the efficacy of a 5-day course of transcranial direct current stimulation (TDCS) on depression and memory function in patients with well-controlled temporal lobe epilepsy. Epilepsy Behav 2016; 55:11-20. [PMID: 26720704 DOI: 10.1016/j.yebeh.2015.10.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/17/2015] [Accepted: 10/18/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depression and memory dysfunction significantly impact the quality of life of patients with epilepsy. Current therapies for these cognitive and psychiatric comorbidities are limited. We explored the efficacy and safety of transcranial direct current stimulation (TDCS) for treating depression and memory dysfunction in patients with temporal lobe epilepsy (TLE). METHODS Thirty-seven (37) adults with well-controlled TLE were enrolled in a double-blinded, sham-controlled, randomized, parallel-group study of 5 days of fixed-dose (2 mA, 20 min) TDCS. Subjects were randomized to receive either real or sham TDCS, both delivered over the left dorsolateral prefrontal cortex. Patients received neuropsychological testing and a 20-minute scalp EEG at baseline immediately after the TDCS course and at 2- and 4-week follow-up. RESULTS There was improvement in depression scores immediately after real TDCS, but not sham TDCS, as measured by changes in the Beck Depression Inventory (BDI change: -1.68 vs. 1.27, p<0.05) and NDDI-E (-0.83 vs. 0.9091, p=0.05). There was no difference between the groups at the 2- or 4-week follow-up. There was no effect on delayed or working memory performance. Transcranial direct current stimulation was well-tolerated and did not increase seizure frequency or interictal discharge frequency. Transcranial direct current stimulation induced an increase in delta frequency band power over the frontal region and delta, alpha, and theta band power in the occipital region after real stimulation compared to sham stimulation, although the difference did not reach statistical significance. DISCUSSION This study provides evidence for the use of TDCS as a safe and well-tolerated nonpharmacologic approach to improving depressive symptoms in patients with well-controlled TLE. However, there were no changes in memory function immediately following or persisting after a stimulation course. Further studies may determine optimal stimulation parameters for maximal mood benefit.
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Affiliation(s)
- Anli Liu
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA; Berenson Allen Center for Non-invasive Brain Stimulation, Division of Cognitive Neurology, USA.
| | - Andrew Bryant
- NYU Comprehensive Epilepsy Center, USA; NYU Graduate School of Psychology, USA
| | - Ashlie Jefferson
- NYU Comprehensive Epilepsy Center, USA; NYU Graduate School of Psychology, USA
| | - Daniel Friedman
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Preet Minhas
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Sarah Barnard
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - William Barr
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Thomas Thesen
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Margaret O'Connor
- Beth Israel Deaconess Medical Center, USA; Harvard Medical School, USA
| | - Mouhsin Shafi
- Beth Israel Deaconess Medical Center, USA; Berenson Allen Center for Non-invasive Brain Stimulation, Division of Cognitive Neurology, USA; Harvard Medical School, USA
| | - Susan Herman
- Beth Israel Deaconess Medical Center, USA; Harvard Medical School, USA
| | - Orrin Devinsky
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Alvaro Pascual-Leone
- Beth Israel Deaconess Medical Center, USA; Berenson Allen Center for Non-invasive Brain Stimulation, Division of Cognitive Neurology, USA; Harvard Medical School, USA
| | - Steven Schachter
- Beth Israel Deaconess Medical Center, USA; Harvard Medical School, USA
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10
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Braida D, Guerini FR, Ponzoni L, Corradini I, De Astis S, Pattini L, Bolognesi E, Benfante R, Fornasari D, Chiappedi M, Ghezzo A, Clerici M, Matteoli M, Sala M. Association between SNAP-25 gene polymorphisms and cognition in autism: functional consequences and potential therapeutic strategies. Transl Psychiatry 2015; 5:e500. [PMID: 25629685 PMCID: PMC4312830 DOI: 10.1038/tp.2014.136] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/19/2014] [Indexed: 12/27/2022] Open
Abstract
Synaptosomal-associated protein of 25 kDa (SNAP-25) is involved in different neuropsychiatric disorders, including schizophrenia and attention-deficit/hyperactivity disorder. Consistently, SNAP-25 polymorphisms in humans are associated with hyperactivity and/or with low cognitive scores. We analysed five SNAP-25 gene polymorphisms (rs363050, rs363039, rs363043, rs3746544 and rs1051312) in 46 autistic children trying to correlate them with Childhood Autism Rating Scale and electroencephalogram (EEG) abnormalities. The functional effects of rs363050 single-nucleotide polymorphism (SNP) on the gene transcriptional activity, by means of the luciferase reporter gene, were evaluated. To investigate the functional consequences that SNAP-25 reduction may have in children, the behaviour and EEG of SNAP-25(+/-) adolescent mice (SNAP-25(+/+)) were studied. Significant association of SNAP-25 polymorphism with decreasing cognitive scores was observed. Analysis of transcriptional activity revealed that SNP rs363050 encompasses a regulatory element, leading to protein expression decrease. Reduction of SNAP-25 levels in adolescent mice was associated with hyperactivity, cognitive and social impairment and an abnormal EEG, characterized by the occurrence of frequent spikes. Both EEG abnormalities and behavioural deficits were rescued by repeated exposure for 21 days to sodium salt valproate (VLP). A partial recovery of SNAP-25 expression content in SNAP-25(+/-) hippocampi was also observed by means of western blotting. A reduced expression of SNAP-25 is responsible for the cognitive deficits in children affected by autism spectrum disorders, as presumably occurring in the presence of rs363050(G) allele, and for behavioural and EEG alterations in adolescent mice. VLP treatment could result in novel therapeutic strategies.
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Affiliation(s)
- D Braida
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,Fondazione IRCCS Don Gnocchi, Milan, Italy
| | | | - L Ponzoni
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,Fondazione Fratelli Confalonieri, Milan, Italy
| | | | - S De Astis
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy
| | - L Pattini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - R Benfante
- CNR—Neuroscience Institute, Milan, Italy
| | - D Fornasari
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,CNR—Neuroscience Institute, Milan, Italy
| | - M Chiappedi
- Child Neuropsychiatry Unit, National Neurological Institute C. Mondino, Pavia, Italy
| | - A Ghezzo
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy,Associazione Nazionale Famiglie di Persone con Disabilitá Affettiva e/o Relazionale (ANFFAS), Macerata, Italy
| | - M Clerici
- Fondazione IRCCS Don Gnocchi, Milan, Italy,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - M Matteoli
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,Humanitas Clinical and Research Center, Rozzano, Italy
| | - M Sala
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy,CNR—Neuroscience Institute, Milan, Italy,Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Via Vanvitelli 32, Milan 20129, Italy. E-mail:
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11
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Witt JA, Alpherts W, Helmstaedter C. Computerized neuropsychological testing in epilepsy: Overview of available tools. Seizure 2013; 22:416-23. [DOI: 10.1016/j.seizure.2013.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 11/24/2022] Open
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12
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Corradini I, Donzelli A, Antonucci F, Welzl H, Loos M, Martucci R, De Astis S, Pattini L, Inverardi F, Wolfer D, Caleo M, Bozzi Y, Verderio C, Frassoni C, Braida D, Clerici M, Lipp HP, Sala M, Matteoli M. Epileptiform Activity and Cognitive Deficits in SNAP-25+/− Mice are Normalized by Antiepileptic Drugs. Cereb Cortex 2012; 24:364-76. [DOI: 10.1093/cercor/bhs316] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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13
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Vaessen MJ, Braakman HMH, Heerink JS, Jansen JFA, Debeij-van Hall MHJA, Hofman PAM, Aldenkamp AP, Backes WH. Abnormal modular organization of functional networks in cognitively impaired children with frontal lobe epilepsy. ACTA ACUST UNITED AC 2012; 23:1997-2006. [PMID: 22772649 DOI: 10.1093/cercor/bhs186] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Many children with frontal lobe epilepsy (FLE) have significant cognitive comorbidity, for which the underlying mechanism has not yet been unraveled, but is likely related to disturbed cerebral network integrity. Using resting-state fMRI, we investigated whether cerebral network characteristics are associated with epilepsy and cognitive comorbidity. We included 37 children with FLE and 41 healthy age-matched controls. Cognitive performance was determined by means of a computerized visual searching task. A connectivity matrix for 82 cortical and subcortical brain regions was generated for each subject by calculating the inter-regional correlation of the fMRI time signals. From the connectivity matrix, graph metrics were calculated and the anatomical configuration of aberrant connections and modular organization was investigated. Both patients and controls displayed efficiently organized networks. However, FLE patients displayed a higher modularity, implying that subnetworks are less interconnected. Impaired cognition was associated with higher modularity scores and abnormal modular organization of the brain, which was mainly expressed as a decrease in long-range and an increase in interhemispheric connectivity in patients. We showed that network modularity analysis provides a sensitive marker for cognitive impairment in FLE and suggest that abnormally interconnected functional subnetworks of the brain might underlie the cognitive problems in children with FLE.
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Affiliation(s)
- M J Vaessen
- Department of Radiology, Maastricht University Medical Centre, Maastricht 6202 AZ, The Netherlands
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14
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Sunderam S, Talathi SS, Lyubushin A, Sornette D, Osorio I. Challenges for emerging neurostimulation-based therapies for real-time seizure control. Epilepsy Behav 2011; 22:118-25. [PMID: 21664192 DOI: 10.1016/j.yebeh.2011.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 04/05/2011] [Indexed: 11/16/2022]
Abstract
In step with the worthwhile aim of this special issue, two junior investigators impart their insights on the therapeutic challenges imposed by pharmacoresistant epilepsies and offer viable approaches to improvement of treatment outcomes. Sunderam's comprehensive perspective addresses issues of critical importance for the design of efficacious therapies. Talathi delves into the thorny roles of so-called "interictal" spikes in ictio- and epileptogenesis, roles that are central to understanding the dynamics of these phenomena and implicitly of how to prevent them or abort them. First, however, Osorio and co-workers illustrate the complex behavior of the epileptogenic network and point to the importance of real-time intraindividual adaptation and optimization of therapies for seizures originating from the same epileptogenic network.
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