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Puligheddu M, Congiu P, Figorilli M, Tamburrino L, Pisanu P, Coa R, Mascia MG, Fonti D, Lecca R, Grossi E, Gagliano A. Neuropsychological and Behavioral Profile in Sleep-Related Hypermotor Epilepsy (SHE) and Disorders of Arousal (DOA): A Multimodal Analysis. J Clin Med 2023; 12:jcm12010374. [PMID: 36615172 PMCID: PMC9820873 DOI: 10.3390/jcm12010374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
STUDY OBJECTIVES Disorder of arousal (DOA) and sleep-related hypermotor epilepsy (SHE) are complex, often bizarre, involuntary sleep behaviors, whose differential diagnosis may be challenging because they share some clinical features, such as sleep fragmentation. Mounting evidence highlights the critical role of sleep in cognitive functions. Controversial findings are raised about the cognitive profile in SHE; however, no studies have investigated the cognitive profile in DOA. This study aimed to assess whether sleep instability affects cognitive functions in patients with SHE or DOA. METHODS This study analyzed 11 patients with DOA, 11 patients with SHE, and 22 healthy controls (HC). They underwent full-night video polysomnography (vPSG) and comprehensive neuropsychological and behavioral evaluation. Differences in the variables of interest among the SHE group, DOA group, and their respective control groups were evaluated. The auto-contractive map (auto-CM) system was used to evaluate the strength of association across the collected data. RESULTS The SHE group had reduced sleep efficiency and increased wake after sleep onset (WASO); both the SHE and DOA groups showed increased % of N2 and REM sleep compared to the HC group. Neuropsychological and behavioral evaluations showed a different cognitive profile in the SHE group with respect to the HC group. The auto-CM showed that Pittsburgh Sleep Quality Index (PSQI), Beck depression inventory (BDI), MWCST_PE, Epworth sleepiness scale (ESS), WASO, N1, and % REM were strictly correlated with SHE, whereas the SE and arousal index (AI) were strictly related to DOA. CONCLUSIONS Patients with SHE and DOA present different cognitive and psychiatric profiles, with subtle and selective cognitive impairments only in those with SHE, supporting the discriminative power of cognitive and psychiatric assessment in these two conditions.
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Affiliation(s)
- Monica Puligheddu
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
- Correspondence: ; Tel.: +39-0706754952
| | - Patrizia Congiu
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Michela Figorilli
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Ludovica Tamburrino
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Patrizia Pisanu
- UOC Riabilitazione Funzionale e Neuroriabilitazione, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Roberta Coa
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | | | - Davide Fonti
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Rosamaria Lecca
- Sleep Disorder Center, Department of Public Health & Clinical and Molecular Medicine, University of Cagliari, 09042 Cagliari, Italy
| | - Enzo Grossi
- Autism Research Unit, Villa Santa Maria Foundation, 22038 Tavernerio, Italy
| | - Antonella Gagliano
- Unità di Neuropsichiatria dell’infanzia e dell’adolescenza, Dipartimento di Scienze Biomediche, Università di Cagliari & Ospedale Pediatrico, 09100 Cagliari, Italy
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Wan H, Wang X, Chen Y, Jiang B, Chen Y, Hu W, Zhang K, Shao X. Sleep-Related Hypermotor Epilepsy: Etiology, Electro-Clinical Features, and Therapeutic Strategies. Nat Sci Sleep 2021; 13:2065-2084. [PMID: 34803415 PMCID: PMC8598206 DOI: 10.2147/nss.s330986] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022] Open
Abstract
Sleep-related hypermotor epilepsy (SHE) is a group of clinical syndromes with heterogeneous etiologies. SHE is difficult to diagnose and treat in the early stages due to its diverse clinical manifestations and difficulties in differentiating from non-epileptic events, which seriously affect patients' quality of life and social behavior. The overall prognosis for SHE is unsatisfactory, but different etiologies affect patients' prognoses. Surgical treatment is an effective method for carefully selected patients with refractory SHE; nevertheless, preoperative assessment remains challenging because of the low sensitivity of noninvasive scalp electroencephalogram and imaging to detect abnormalities. However, through a careful analysis of semiology, the clinician can deduce the potential epileptogenic zone. This paper summarizes the research status of the background, etiology, electro-clinical features, diagnostic criteria, prognosis, and treatment of SHE to provide a more in-depth understanding of its pathophysiological mechanism, improve the accuracy in the diagnosis of this group of syndromes, and further explore more targeted therapy plans.
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Affiliation(s)
- Huijuan Wan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China.,Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, People's Republic of China
| | - Xing Wang
- Department of Neurology, Chongqing University Central Hospital, Chongqing Emergency Medical Centre, Chongqing, People's Republic of China
| | - Yiyi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China
| | - Bin Jiang
- Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, People's Republic of China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Wenhan Hu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China
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Zhu L, Chen L, Xu P, Lu D, Dai S, Zhong L, Han Y, Zhang M, Xiao B, Chang L, Wu Q. Genetic and molecular basis of epilepsy-related cognitive dysfunction. Epilepsy Behav 2020; 104:106848. [PMID: 32028124 DOI: 10.1016/j.yebeh.2019.106848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 02/02/2023]
Abstract
Epilepsy is a common neurological disease characterized by recurrent seizures. About 70 million people were affected by epilepsy or epileptic seizures. Epilepsy is a complicated complex or symptomatic syndromes induced by structural, functional, and genetic causes. Meanwhile, several comorbidities are accompanied by epileptic seizures. Cognitive dysfunction is a long-standing complication associated with epileptic seizures, which severely impairs quality of life. Although the definitive pathogenic mechanisms underlying epilepsy-related cognitive dysfunction remain unclear, accumulating evidence indicates that multiple risk factors are probably involved in the development and progression of cognitive dysfunction in patients with epilepsy. These factors include the underlying etiology, recurrent seizures or status epilepticus, structural damage that induced secondary epilepsy, genetic variants, and molecular alterations. In this review, we summarize several theories that may explain the genetic and molecular basis of epilepsy-related cognitive dysfunction.
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Affiliation(s)
- Lin Zhu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Lu Chen
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Puying Xu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Di Lu
- Biomedicine Engineering Research Center, Kunming Medical University, 1168 Chun Rong West Road, Kunming, Yunnan 650500, PR China
| | - Shujuan Dai
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Lianmei Zhong
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Yanbing Han
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, Hunan 410008, PR China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, Hunan 410008, PR China
| | - Lvhua Chang
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China.
| | - Qian Wu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China.
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Profile of neuropsychological impairment in Sleep-related Hypermotor Epilepsy. Sleep Med 2018; 48:8-15. [DOI: 10.1016/j.sleep.2018.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/03/2018] [Accepted: 03/14/2018] [Indexed: 11/21/2022]
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Dynamic functional disturbances of brain network in seizure-related cognitive outcomes. Epilepsy Res 2018; 140:15-21. [DOI: 10.1016/j.eplepsyres.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/13/2017] [Accepted: 12/02/2017] [Indexed: 11/23/2022]
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Menghi V, Bisulli F, Tinuper P, Nobili L. Sleep-related hypermotor epilepsy: prevalence, impact and management strategies. Nat Sci Sleep 2018; 10:317-326. [PMID: 30349413 PMCID: PMC6186898 DOI: 10.2147/nss.s152624] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sleep-related hypermotor epilepsy (SHE), previously called nocturnal frontal lobe epilepsy (NFLE), is a focal epilepsy characterized by asymmetric tonic/dystonic posturing and/or complex hyperkinetic seizures occurring mostly during sleep. SHE fulfills the definition of rare disease with an estimated minimum prevalence of 1.8/100,000 individuals, and it represents about 10% of drug-resistant surgical cases. Although SHE and autosomal-dominant SHE (ADSHE) have been considered benign epileptic conditions for a long time, emerging data have shed light on the severity of this disorder and some peculiar features can impact negatively on the quality of life of SHE patients. In fact, seizure frequency can be very high, resulting in nocturnal sleep fragmentation with possible diurnal consequences such as excessive sleepiness and fatigue. Moreover, recent studies, adopting a systematic neuropsychological assessment, have shown deficits in memory, executive functions and visuo-spatial abilities in almost half of SHE patients. Intellectual disabilities and psychiatric disorders have also been reported in some genetic forms. SHE may also exert a negative effect on health-related quality of life, especially in domains pertaining to a patient's role in the family, social context and patient's illness experience. Despite a good response to pharmacological treatment, especially with carbamazepine, 30% of SHE patients suffer from drug-resistant seizures. Finally, recent studies suggest a poor prognosis in a high percentage of SHE patients with a 20.4% cumulative probability of achieving terminal remission at 10 years from onset. For selected drug-resistant SHE patients, epilepsy surgery is the only treatment offering high probability of recovery, both for seizures and for epilepsy-related sleep alterations.
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Affiliation(s)
- Veronica Menghi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lino Nobili
- "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy, .,Department of Neuroscience (DINOGMI), IRCCS, Giannina Gaslini Institute, University of Genoa, Genoa, Italy,
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The new approach to epilepsy classification: Cognition and behavior in adult epilepsy syndromes. Epilepsy Behav 2016; 64:253-256. [PMID: 27776297 DOI: 10.1016/j.yebeh.2016.09.003] [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: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 11/23/2022]
Abstract
The revised terminology and concepts for the organization of seizures and epilepsy proposed by the ILAE Commission on Classification and Terminology in 2010 allows for a number of new opportunities in the study of cognition and behavior in adults. This review examines the literature that has looked for behavioral and cognitive correlates of the newly recognized genetic epilepsies in adults. While some studies report clear cognitive phenotypes associated with specific genetic mutations in adults with epilepsy, others report remarkable clinical heterogeneity. In the second part of this review, we discuss some of the factors that may influence the findings in this literature. Cognitive function is the product of both genetic and environmental influences. Neuropsychological phenotypes under direct genetic influence may be wider and more subtle than specific deficits within discreet cognitive domains and may be reflected in broader, multidimensional measures of cognitive function than those tapped by scores on standardized tests of function. Future studies must be carefully designed to reflect these factors. It is also imperative that studies with negative findings are assigned as much value as those with positive results and published accordingly. This article is part of a Special Issue titled "The new approach to classification: Rethinking cognition and behavior in epilepsy.
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Baxendale S, Thompson P. Reprint of: The new approach to epilepsy classification: Cognition and behavior in adult epilepsy syndromes. Epilepsy Behav 2016; 64:318-321. [PMID: 27876294 DOI: 10.1016/j.yebeh.2016.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 02/05/2023]
Abstract
The revised terminology and concepts for the organization of seizures and epilepsy proposed by the ILAE Commission on Classification and Terminology in 2010 allows for a number of new opportunities in the study of cognition and behavior in adults. This review examines the literature that has looked for behavioral and cognitive correlates of the newly recognized genetic epilepsies in adults. While some studies report clear cognitive phenotypes associated with specific genetic mutations in adults with epilepsy, others report remarkable clinical heterogeneity. In the second part of this review, we discuss some of the factors that may influence the findings in this literature. Cognitive function is the product of both genetic and environmental influences. Neuropsychological phenotypes under direct genetic influence may be wider and more subtle than specific deficits within discreet cognitive domains and may be reflected in broader, multidimensional measures of cognitive function than those tapped by scores on standardized tests of function. Future studies must be carefully designed to reflect these factors. It is also imperative that studies with negative findings are assigned as much value as those with positive results and published accordingly. This article is part of a Special Issue titled "The new approach to classification: Rethinking cognition and behavior in epilepsy".
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Affiliation(s)
- Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, UK; University College Hospital, London, UK.
| | - Pamela Thompson
- Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; University College Hospital, London, UK
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Busch RM, Najm I, Hermann BP, Eng C. Genetics of cognition in epilepsy. Epilepsy Behav 2014; 41:297-306. [PMID: 24973143 PMCID: PMC4268334 DOI: 10.1016/j.yebeh.2014.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/23/2014] [Accepted: 05/24/2014] [Indexed: 01/19/2023]
Abstract
With the completion of the Human Genome Project and the advent of more advanced sequencing platforms capable of high throughput genotyping at reduced cost, research on the genetics/genomics of cognition has expanded rapidly over the past several decades. This has been facilitated even further by global consortia including HapMap, 1000 Genomes Project, ENCODE, and others, which have made information regarding genetic variation and genomic functional elements readily available to all researchers. Thus, the goal of this Targeted Review is not to provide an exhaustive review of the existing literature on the role of genetic factors in cognition. Rather, we will highlight some of the most consistent findings in this field, review the research in epilepsy to date, and provide a background within which to set forth unique opportunities epilepsy may provide to further elucidate the role of genetics in cognition.
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Affiliation(s)
- Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Imad Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce P Hermann
- Charles Matthew Neuropsychology Section, Department of Neurology, University of Wisconsin, Madison, WI, USA
| | - Charis Eng
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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Kenney D, Wirrell E. Patient considerations in the management of focal seizures in children and adolescents. Adolesc Health Med Ther 2014; 5:49-65. [PMID: 24808722 PMCID: PMC3986281 DOI: 10.2147/ahmt.s44316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Focal epilepsy accounts for approximately one-half to two-thirds of new-onset epilepsy in children. Etiologies are diverse, and range from benign epilepsy syndromes with normal neuroimaging and almost certain remission to focal malformations of cortical development or hippocampal sclerosis with intractable seizures persisting lifelong. Other important etiologies in children include pre-, peri-, or postnatal brain injury, low-grade neoplasms, vascular lesions, and neuroimmunological disorders. Cognitive, behavioral, and psychiatric comorbidities are commonly seen and must be addressed in addition to seizure control. Given the diverse nature of focal epilepsies in children and adolescents, investigations and treatments must be individualized. First-line therapy consists of prophylactic antiepileptic drugs; however, prognosis is poor after failure of two to three drugs for lack of efficacy. Refractory cases should be referred for an epilepsy surgery workup. Dietary treatments and neurostimulation may be considered in refractory cases who are not good candidates for surgery.
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Affiliation(s)
- Daniel Kenney
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Elaine Wirrell
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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O’Muircheartaigh J, Richardson MP. Epilepsy and the frontal lobes. Cortex 2012; 48:144-55. [DOI: 10.1016/j.cortex.2011.11.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 03/19/2011] [Accepted: 06/27/2011] [Indexed: 10/15/2022]
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Primary Sleep Disorders and Paroxysmal Nocturnal Nonepileptic Events in Adults With Epilepsy From the Perspective of Sleep Specialists. J Clin Neurophysiol 2011; 28:120-40. [DOI: 10.1097/wnp.0b013e3182120fed] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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