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Höller Y, Eyjólfsdóttir SG, Rusiňák M, Guðmundsson LS, Trinka E. Movement Termination of Slow-Wave Sleep-A Potential Biomarker? Brain Sci 2024; 14:493. [PMID: 38790471 PMCID: PMC11120257 DOI: 10.3390/brainsci14050493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
The duration of slow-wave sleep (SWS) is related to the reported sleep quality and to the important variables of mental and physical health. The internal cues to end an episode of SWS are poorly understood. One such internal cue is the initiation of a body movement, which is detectable as electromyographic (EMG) activity in sleep-electroencephalography (EEG). In the present study, we characterized the termination of SWS episodes by movement to explore its potential as a biomarker. To this end, we characterized the relation between the occurrence of SWS termination by movement and individual characteristics (age, sex), SWS duration and spectral content, chronotype, depression, medication, overnight memory performance, and, as a potential neurological application, epilepsy. We analyzed 94 full-night EEG-EMG recordings (75/94 had confirmed epilepsy) in the video-EEG monitoring unit of the EpiCARE Centre Salzburg, Austria. Segments of SWS were counted and rated for their termination by movement or not through the visual inspection of continuous EEG and EMG recordings. Multiple linear regression was used to predict the number of SWS episodes that ended with movement by depression, chronotype, type of epilepsy (focal, generalized, no epilepsy, unclear), medication, gender, total duration of SWS, occurrence of seizures during the night, occurrence of tonic-clonic seizures during the night, and SWS frequency spectra. Furthermore, we assessed whether SWS movement termination was related to overnight memory retention. According to multiple linear regression, patients with overall longer SWS experienced more SWS episodes that ended with movement (t = 5.64; p = 0.001). No other variable was related to the proportion of SWS that ended with movement, including no epilepsy-related variable. A small sample (n = 4) of patients taking Sertraline experienced no SWS that ended with movement, which was significant compared to all other patients (t = 8.00; p < 0.001) and to n = 35 patients who did not take any medication (t = 4.22; p < 0.001). While this result was based on a small subsample and must be interpreted with caution, it warrants replication in a larger sample with and without seizures to further elucidate the role of the movement termination of SWS and its potential to serve as a biomarker for sleep continuity and for medication effects on sleep.
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Affiliation(s)
- Yvonne Höller
- Faculty of Psychology, University of Akureyri, 600 Akureyri, Iceland; (S.G.E.); (M.R.)
| | | | - Matej Rusiňák
- Faculty of Psychology, University of Akureyri, 600 Akureyri, Iceland; (S.G.E.); (M.R.)
- Faculty of Social Studies, Masaryk University, 601 77 Brno, Czech Republic
| | | | - Eugen Trinka
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, 5020 Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience, 5020 Salzburg, Austria
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Höller Y, Eyjólfsdóttir S, Van Schalkwijk FJ, Trinka E. The effects of slow wave sleep characteristics on semantic, episodic, and procedural memory in people with epilepsy. Front Pharmacol 2024; 15:1374760. [PMID: 38725659 PMCID: PMC11079234 DOI: 10.3389/fphar.2024.1374760] [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: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Slow wave sleep (SWS) is highly relevant for verbal and non-verbal/spatial memory in healthy individuals, but also in people with epilepsy. However, contradictory findings exist regarding the effect of seizures on overnight memory retention, particularly relating to procedural and non-verbal memory, and thorough examination of episodic memory retention with ecologically valid tests is missing. This research explores the interaction of SWS duration with epilepsy-relevant factors, as well as the relation of spectral characteristics of SWS on overnight retention of procedural, verbal, and episodic memory. In an epilepsy monitoring unit, epilepsy patients (N = 40) underwent learning, immediate and 12 h delayed testing of memory retention for a fingertapping task (procedural memory), a word-pair task (verbal memory), and an innovative virtual reality task (episodic memory). We used multiple linear regression to examine the impact of SWS duration, spectral characteristics of SWS, seizure occurrence, medication, depression, seizure type, gender, and epilepsy duration on overnight memory retention. Results indicated that none of the candidate variables significantly predicted overnight changes for procedural memory performance. For verbal memory, the occurrence of tonic-clonic seizures negatively impacted memory retention and higher psychoactive medication load showed a tendency for lower verbal memory retention. Episodic memory was significantly impacted by epilepsy duration, displaying a potential nonlinear impact with a longer duration than 10 years negatively affecting memory performance. Higher drug load of anti-seizure medication was by tendency related to better overnight retention of episodic memory. Contrary to expectations longer SWS duration showed a trend towards decreased episodic memory performance. Analyses on associations between memory types and EEG band power during SWS revealed lower alpha-band power in the frontal right region as significant predictor for better episodic memory retention. In conclusion, this research reveals that memory modalities are not equally affected by important epilepsy factors such as duration of epilepsy and medication, as well as SWS spectral characteristics.
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Affiliation(s)
- Yvonne Höller
- Faculty of Psychology, University of Akureyri, Akureyri, Iceland
| | | | - Frank Jasper Van Schalkwijk
- Hertie-Institute for Clinical Brain Research, Center for Neurology, University Medical Center Tübingen, Tübingen, Germany
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Neuroscience Institute, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Salzburg, Austria
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Mayor C, Moser C, Korff C. Long-term memory consolidation of new words in children with self-limited epilepsy with centro-temporal spikes. Epilepsy Behav 2024; 153:109720. [PMID: 38428174 DOI: 10.1016/j.yebeh.2024.109720] [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: 11/01/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
Accelerated long-term forgetting has been studied and demonstrated in adults with epilepsy. In contrast, the question of long-term consolidation (delays > 1 day) in children with epilepsy shows conflicting results. However, childhood is a period of life in which the encoding and long-term storage of new words is essential for the development of knowledge and learning. The aim of this study was therefore to investigate long-term memory consolidation skills in children with self-limited epilepsy with centro-temporal spikes (SeLECTS), using a paradigm exploring new words encoding skills and their long-term consolidation over one-week delay. As lexical knowledge, working memory skills and executive/attentional skills has been shown to contribute to long-term memory/new word learning, we added standardized measures of oral language and executive/attentional functions to explore the involvement of these cognitive skills in new word encoding and consolidation. The results showed that children with SeLECTS needed more repetitions to encode new words, struggled to encode the phonological forms of words, and when they finally reached the level of the typically developing children, they retained what they had learned, but didn't show improved recall skills after a one-week delay, unlike the control participants. Lexical knowledge, verbal working memory skills and phonological skills contributed to encoding and/or recall abilities, and interference sensitivity appeared to be associated with the number of phonological errors during the pseudoword encoding phase. These results are consistent with the functional model linking working memory, phonology and vocabulary in a fronto-temporo-parietal network. As SeLECTS involves perisylvian dysfunction, the associations between impaired sequence storage (phonological working memory), phonological representation storage and new word learning are not surprising. This dual impairment in both encoding and long-term consolidation may result in large learning gap between children with and without epilepsy. Whether these results indicate differences in the sleep-induced benefits required for long-term consolidation or differences in the benefits of retrieval practice between the epilepsy group and healthy children remains open. As lexical development is associated with academic achievement and comprehension, the impact of such deficits in learning new words is certainly detrimental.
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Affiliation(s)
- C Mayor
- Child Neuropsychology Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland.
| | - C Moser
- Child Neuropsychology Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
| | - C Korff
- Pediatric Neurology Unit, University Hospitals of Geneva, Geneva, Switzerland
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Dontaine P, Rouge C, Urbain C, Galer S, Raffoul R, Nonclercq A, Van Dyck D, Baijot S, Aeby A. How the Spreading and Intensity of Interictal Epileptic Activity Are Associated with Visuo-Spatial Skills in Children with Self-Limited Focal Epilepsy with Centro-Temporal Spikes. Brain Sci 2023; 13:1566. [PMID: 38002525 PMCID: PMC10669985 DOI: 10.3390/brainsci13111566] [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: 09/21/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
This paper investigates brain-behaviour associations between interictal epileptic discharges and cognitive performance in a population of children with self-limited focal epilepsy with centro-temporal spikes (SeLECTS). Sixteen patients with SeLECTS underwent an extensive neuropsychological assessment, including verbal short-term and episodic memory, non-verbal short-term memory, attentional abilities and executive function. Two quantitative EEG indices were analysed, i.e., the Spike Wave Index (SWI) and the Spike Wave Frequency (SWF), and one qualitative EEG index, i.e., the EEG score, was used to evaluate the spreading of focal SW to other parts of the brain. We investigated associations between EEG indices and neuropsychological performance with non-parametric Spearman correlation analyses, including correction for multiple comparisons. The results showed a significant negative correlation between (i) the awake EEG score and the Block Tapping Test, a visuo-spatial short-term memory task, and (ii) the sleep SWI and the Tower of London, a visuo-spatial planning task (pcorr < 0.05). These findings suggest that, in addition to the usual quantitative EEG indices, the EEG analysis should include the qualitative EEG score evaluating the spreading of focal SW to other parts of the brain and that neuropsychological assessment should include visuo-spatial skills.
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Affiliation(s)
- Pauline Dontaine
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Coralie Rouge
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN2T), UNI-ULB Neurosciences Institute, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Charline Urbain
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN2T), UNI-ULB Neurosciences Institute, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Sophie Galer
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Romain Raffoul
- BEAMS (Bio-, Electro- And Mechanical Systems), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Antoine Nonclercq
- BEAMS (Bio-, Electro- And Mechanical Systems), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Dorine Van Dyck
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Simon Baijot
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Alec Aeby
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
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Rubboli G, Gardella E, Cantalupo G, Alberto Tassinari C. Encephalopathy related to status epilepticus during slow sleep (ESES). Pathophysiological insights and nosological considerations. Epilepsy Behav 2023; 140:109105. [PMID: 36758358 DOI: 10.1016/j.yebeh.2023.109105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
Encephalopathy related to Status Epilepticus during slow Sleep (ESES) is a childhood epilepsy syndrome characterized by the appearance of cognitive, behavioral, and motor disturbances in conjunction with a striking activation of EEG epileptic abnormalities during non-REM sleep. After more than 50 years since the first description, the pathophysiological mechanisms underlying the appearance of encephalopathy in association with a sleep-related enhancement of epileptic discharges are incompletely elucidated. Recent experimental data support the hypothesis that the development of the ESES encephalopathic picture depends on a spike-induced impairment of the synaptic homeostasis processes occurring during normal sleep and that is particularly pronounced during the developmental age. During sleep, synaptic homeostasis is promoted by synaptic weakening/elimination after the increment of synaptic strength that occurs during wakefulness. The EEG can display modifications in synaptic strength by changes in sleep slow wave activity (SWA). Recent studies during active ESES have failed to show changes in sleep SWA, while these changes occurred again after recovery from ESES, thus supporting a spike-related interference on the normal homeostatic processes of sleep. This impairment, during the developmental period, can lead to disruption of cortical wiring and brain plastic remodeling, which lead to the, often irreversible, neuropsychological compromise typical of ESES. From the nosographic point of view, these pathophysiological data lend support to the maintenance of the term ESES, i.e., "encephalopathy related to status epilepticus during sleep". Indeed, this term conveys the concept that the extreme activation of epileptic discharges during sleep is directly responsible for the encephalopathy, hence the importance of defining this condition as an encephalopathy related to the exaggerated activation of epileptic activity during sleep. In this respect, ESES represents a genuine example of a "pure" epileptic encephalopathy in which sleep-related epileptic activity "per se" has a crucial role in determining the encephalopathic picture. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Guido Rubboli
- Danish Epilepsy Center, member of ERN EpiCARE, Kolonivej 1, 4293 Dianalund, Denmark; Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Elena Gardella
- Danish Epilepsy Center, member of ERN EpiCARE, Kolonivej 1, 4293 Dianalund, Denmark; University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Via S. Francesco, 22, 37129 Verona, Italy; Centro Ricerca per le Epilessie in età Pediatrica (CREP), Azienda Ospedaliera Universitaria di Verona, Verona, Italy.
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Latreille V, Schiller K, Peter-Derex L, Frauscher B. Does epileptic activity impair sleep-related memory consolidation in epilepsy? A critical and systematic review. J Clin Sleep Med 2022; 18:2481-2495. [PMID: 35866226 PMCID: PMC9516593 DOI: 10.5664/jcsm.10166] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES People with epilepsy often complain about disturbed sleep and cognitive impairment. Beyond seizures, the occurrence of interictal epileptic activity during sleep is also increasingly recognized to negatively impact cognitive functioning, including memory processes. The aim of this study was to critically review the effect of interictal epileptic activity on sleep-related memory consolidation. METHODS PubMed and PsychINFO databases were systematically searched to identify experimental studies that investigated sleep-related memory consolidation and the relationships between sleep-related epileptic activity and memory in adults and children with epilepsy. This review also highlights hypotheses regarding the potential pathophysiological mechanisms. RESULTS A total of 261 studies were identified; 27 of these met selection criteria. Only 13 studies prospectively assessed the effect of sleep on memory in epilepsy. Most studies reported no alteration of sleep-related memory consolidation in patients, with either similar retention levels following a period containing sleep (n = 5) or improved memory performance postsleep (n = 4). Two studies in children with epilepsy found impaired sleep-related memory consolidation. Ten studies, of which 6 were in childhood epilepsy syndromes, reported a debilitating effect of sleep-related epileptic activity on memory functioning. CONCLUSIONS Conclusions from existing studies were hampered by small sample sizes, heterogeneous patient groups, and variations in memory assessment techniques. Overall, results to date preclude any definitive conclusions on the alteration of sleep-related memory consolidation in epilepsy. We discuss methodological considerations specific to people with epilepsy and provide suggestions on how to best investigate the relationship between epileptic activity, sleep, and memory consolidation in future studies. CITATION Latreille V, Schiller K, Peter-Derex L, Frauscher B. Does epilepticimpair sleep-related memory consolidation in epilepsy? A critical and systematic review. J Clin Sleep Med. 2022;18(10):2481-2495.
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Affiliation(s)
- Véronique Latreille
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Katharina Schiller
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Department of Pediatrics, Hospital Group Ostallgaeu-Kaufbeuren, Kaufbeuren, Germany
| | - Laure Peter-Derex
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, University Hospital of Lyon, Lyon 1 University, France
- Lyon Neuroscience Research Center, INSERM 1028/CNRS 5292, Lyon, France
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
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Georgopoulou V, Spruyt K, Garganis K, Kosmidis MH. Altered Sleep-Related Consolidation and Neurocognitive Comorbidity in CECTS. Front Hum Neurosci 2021; 15:563807. [PMID: 34163335 PMCID: PMC8215163 DOI: 10.3389/fnhum.2021.563807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/21/2021] [Indexed: 12/03/2022] Open
Abstract
Our aim is to use neurophysiological sleep-related consolidation (SRC) phenomena to identify putative pathophysiological mechanisms in CECTS linked to diffuse neurocognitive deficits. We argue that there are numerous studies on the association between seizure aspects and neurocognitive functioning but not as many on interictal variables and neurocognitive deficits. We suggest two additional foci. First, the interictal presentation in CECTS and second, neuronal oscillations involved in SRC processes. Existing data on mechanisms through which interictal epileptiform spikes (IES) impact upon SRC indicate that they have the potential to: (a) perturb cross-regional coupling of neuronal oscillations, (b) mimic consolidation processes, (c) alter the precision of the spatiotemporal coupling of oscillations, and (d) variably impact upon SRC performance. Sleep spindles merit systematic study in CECTS in order to clarify: (a) the state of the slow oscillations (SOs) with which they coordinate, (b) the precision of slow oscillation-spindle coupling, and (c) whether their developmental trajectories differ from those of healthy children. We subsequently review studies on the associations between IES load during NREM sleep and SRC performance in childhood epilepsy. We then use sleep consolidation neurophysiological processes and their interplay with IES to help clarify the diffuse neurocognitive deficits that have been empirically documented in CECTS. We claim that studying SRC in CECTS will help to clarify pathophysiological mechanisms toward diverse neurocognitive deficits. Future developments could include close links between the fields of epilepsy and sleep, as well as new therapeutic neurostimulation targets. At the clinical level, children diagnosed with CECTS could benefit from close monitoring with respect to epilepsy, sleep and neurocognitive functions.
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Affiliation(s)
- Victoria Georgopoulou
- 2nd Centre for Educational and Counseling Support of Eastern Thessaloniki, Ministry of Education, Thessaloniki, Greece.,Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Karen Spruyt
- INSERM, Claude Bernard University, School of Medicine, Lyon, France
| | | | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Storz S, Wilhelm I, Critelli H, Feldmann M, Ramirez A, Ramantani G, Huber R, Bölsterli BK. Sleep-dependent memory consolidation in children with self-limited focal epilepsies. Epilepsy Behav 2020; 113:107513. [PMID: 33129045 DOI: 10.1016/j.yebeh.2020.107513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Children with self-limited focal epilepsies of childhood (SLFE) are known to show impaired memory functions, particularly in the verbal domain. Interictal epileptiform discharges (IED) in these epilepsies are more pronounced in nonrapid eye movement (NREM) sleep. Nonrapid eye movement sleep is crucial for consolidation of newly-encoded memories. Therefore, we hypothesize that sleep-dependent memory consolidation is altered in relation to IED in children with SLFE. METHODS We conducted a prospective case-control study. We applied a verbal (word pair) and a visuospatial (two-dimensional [2D] object location) learning task, both previously shown to benefit from sleep in terms of memory consolidation. Learning took place in the evening, and retrieval was tested in the morning after a night of sleep. Electroencephalogram (EEG) was recorded across night. After sleep-stage scoring, the spike-wave index (SWI) was assessed at the beginning and the end of sleep. Fourteen patients with SLFE (age: 5.5 to 11.6 years) were compared with 15 healthy controls (age: 6.8 to 9.1 years) examined in a previous study. RESULTS In contrast to healthy controls (mean: +12.9% recalled word pairs, p = .003, standard deviation (SD) = 12.4%), patients did not show overnight performance gains in the verbal memory task (mean: +6.4% recalled word pairs, p > .05, SD = 17.3) Neither patients nor controls showed significant overnight changes in visuospatial task performance. Spike-wave index was negatively correlated with recall performance in the verbal but not in the visuospatial task. SIGNIFICANCE We found evidence for impaired overnight improvement of performance in children with SLFE in a verbal learning task, with high SWI rates predicting low recall performance. We speculate that spike-waves hamper long-term memory consolidation by interfering with NREM sleep.
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Affiliation(s)
- Sarah Storz
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Ines Wilhelm
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit (TPU), University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Hanne Critelli
- Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Maria Feldmann
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Ana Ramirez
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Georgia Ramantani
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Bigna K Bölsterli
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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Moresco L, Bruschettini M, Calevo MG, Siri L. Pharmacological treatment for continuous spike-wave during slow wave sleep syndrome and Landau-Kleffner Syndrome. Cochrane Database Syst Rev 2020; 11:CD013132. [PMID: 33174224 PMCID: PMC8078191 DOI: 10.1002/14651858.cd013132.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Continuous spike-wave during slow wave sleep syndrome (CSWS) and Landau-Kleffner syndrome (LKS) are two epileptic encephalopathies that present with neurocognitive regression, aphasia, and clinical seizures, typically presenting in children around five years of age. The pathophysiology of these conditions is not completely understood. Some studies suggest a common origin for both. No systematic reviews have assessed the efficacy of pharmacological interventions for these conditions. OBJECTIVES To assess the benefit and adverse effects of pharmacological interventions for the treatment of CSWS and LKS. SEARCH METHODS On 8 September 2020, we searched the Cochrane Register of Studies (CRS Web) and MEDLINE Ovid (1946 to September 04, 2020). We applied no language restrictions. CRS Web includes randomised or quasi-randomised, controlled trials from CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled trials, and cluster-randomised trials comparing antiepileptic drugs alone, or with steroids or intravenous immunoglobulins, or both versus other antiepileptic drugs, or placebo, or no treatment, administered to children with CSWS and LKS. We planned to compare treatments for the two conditions separately. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies identified by the search strategy for inclusion. The primary outcomes considered in this review were neuropsychological-neurolinguistic functions. MAIN RESULTS Our search strategy yielded 18 references. Two review authors independently assessed all references. We did not find any completed studies to include. We identified one ongoing trial, which was terminated because of lack of enrolment. AUTHORS' CONCLUSIONS There was no evidence from trials to support or refute the use of pharmacological treatment for continuous spike-wave during slow wave sleep syndrome or Landau-Kleffner syndrome. Well-designed randomised controlled trials are needed to inform practice.
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Affiliation(s)
- Luca Moresco
- Pediatric and Neonatology Unit, Ospedale San Paolo, Savona, Italy
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Maria Grazia Calevo
- Epidemiology, Biostatistics Unit, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
| | - Laura Siri
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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10
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Saraf UU, Asranna A, Menon RN, Mohan P M, Vp V, Radhakrishnan A, Cherian A, V Thomas S. Predictors of one-year language and seizure outcomes in children with epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS). Seizure 2020; 81:315-324. [PMID: 32961503 DOI: 10.1016/j.seizure.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/25/2020] [Accepted: 08/23/2020] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS), with its associated impact on language, is an important cause of morbidity with epilepsy in children. The effects of various treatment-approaches and the aetiological/electrophysiological factors affecting therapeutic response are not fully understood. METHOD A retrospective study of patients admitted to the institute and diagnosed to have CSWS pattern on EEG was conducted. Spike and Wave Frequency/100 s(SWF) was calculated from sleep-EEG records. Language development and seizure outcomes were assessed at baseline and 1 year. RESULTS Fifty-two children were included (idiopathic CSWS, N = 19; symptomatic CSWS N = 33).The 2 groups differed in terms of younger age at seizure onset in symptomatic CSWS (p = 0.006), early age at language regression (p = 0.046), history of neonatal seizures (p = 0.038) and slowing of background activity on EEG (p = 0.024). Language regression was noted in 63.5 % of the cohort. Twenty-five (48%) patients received steroids with improvement in seizures (p < 0.001). Twenty-one (40.3 %) received steroids and intravenous immunoglobulin (IVIG) with improvement in seizure score (p = 0.002) at 1 year. Both immune-modulation arms irrespective of etiological subgroups had comparable proportions of children with expressive and receptive language gains. On 1 year follow-up, seizure remission was noted in 13(25 %) patients, with improved seizure score in 32/39 (61.5 %) patients and language improvement in 32 children (60.8 %). Patients with normal background on baseline EEG, generalised spikes, absent frontal-negative spikes and SWF < 170 were found to have improved language estimates on follow-up. CONCLUSIONS Despite clinical and therapeutic outcome differences between idiopathic and symptomatic CSWS, immune-modulation appears effective irrespective of aetiology. Analysis of EEG variables enables prediction of language outcomes at 1 year follow-up.
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Affiliation(s)
- Udit U Saraf
- R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Ajay Asranna
- R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Ramshekhar N Menon
- R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India.
| | - Manju Mohan P
- R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Vipina Vp
- R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Ashalatha Radhakrishnan
- R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Ajith Cherian
- R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Sanjeev V Thomas
- R Madhavan Nayar Centre for Comprehensive Epilepsy Care, Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
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11
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Chan SYS. Sleep architecture and homeostasis in children with epilepsy: a neurodevelopmental perspective. Dev Med Child Neurol 2020; 62:426-433. [PMID: 31879946 DOI: 10.1111/dmcn.14437] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
Abstract
Although the influence of sleep on epilepsy has long been recognized, this relationship has yet to be fully exploited to benefit patients. The past decade has seen significant advances in understanding paediatric sleep, providing a framework by which to properly evaluate the sleep of children with epilepsy, which itself has been subject to increasing scrutiny. The role of sleep in learning and the potential for interictal discharges to disrupt sleep-related memory consolidation provide a novel perspective for understanding the association of childhood epilepsy with a high rate of intellectual disability. In this review, I outline the evolution of sleep duration, architecture, and homeostasis across childhood, relating this to the development of cognitive functions. I describe how these may be disrupted or preserved in children with epilepsy; in particular, collating data from polysomnography. Finally, I explore how sleep may, in the future, be modulated to improve cognitive outcome in these patients. WHAT THIS PAPER ADDS: Children with epilepsy have less rapid eye movement sleep than controls, but this improves with seizure cessation. Deep or slow-wave sleep is highly conserved in children with epilepsy. Sleep homeostasis may be disrupted either at a local or global level by the presence of interictal epileptiform discharges.
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Affiliation(s)
- Samantha Yuen-Sum Chan
- Clinical Neurosciences Section, Developmental Neurosciences Programme, UCL GOS Institute of Child Health, London, UK
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12
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Gorgoni M, D'Atri A, Scarpelli S, Reda F, De Gennaro L. Sleep electroencephalography and brain maturation: developmental trajectories and the relation with cognitive functioning. Sleep Med 2020; 66:33-50. [PMID: 31786427 DOI: 10.1016/j.sleep.2019.06.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- M Gorgoni
- Department of Psychology, University of Rome "Sapienza", Rome, Italy
| | - A D'Atri
- Department of Psychology, University of Rome "Sapienza", Rome, Italy
| | - S Scarpelli
- Department of Psychology, University of Rome "Sapienza", Rome, Italy
| | - F Reda
- Department of Psychology, University of Rome "Sapienza", Rome, Italy
| | - L De Gennaro
- Department of Psychology, University of Rome "Sapienza", Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy.
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13
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Fattinger S, Heinzle BB, Ramantani G, Abela L, Schmitt B, Huber R. Closed-Loop Acoustic Stimulation During Sleep in Children With Epilepsy: A Hypothesis-Driven Novel Approach to Interact With Spike-Wave Activity and Pilot Data Assessing Feasibility. Front Hum Neurosci 2019; 13:166. [PMID: 31164813 PMCID: PMC6536690 DOI: 10.3389/fnhum.2019.00166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
Slow waves, the electroencephalographic (EEG) hallmark of deep sleep, can be systematically manipulated by acoustic stimulation: stimulation time-locked to the down phase of slow waves reduces, whereas stimulation time-locked to the up phase increases slow waves. Spike-waves during sleep seem to be related to slow waves, raising the question of whether spike-waves can be systematically influenced by such acoustic stimulation. In five pediatric patients, all-night EEG was recorded, combined with real-time slow wave detection. Throughout the night, acoustic stimulation was performed in a 3 × 5-min-block design (no stimulation—stimulation—no stimulation). Tones were applied time-locked either to the up or to the down phase of the detected slow waves in an alternating pattern. All patients tolerated the acoustic stimulation during sleep well. They showed high sleep quality and no signs of clinical or non-convulsive electrographic seizures. Our preliminary analysis shows no systematic effect of acoustic stimulation on spike-wave activity. Moreover, with our stimulation approach tones were distributed over a rather broad phase-range during the DOWN or UP stimulation and showed inter-individual differences in their distribution. In this study, we applied for the first time an acoustic closed-loop slow wave stimulation tool for a non-invasive manipulation of spike-wave activity. Thus, our pilot data show that closed-loop acoustic stimulation is feasible and well tolerated in children with spike wave activity during sleep. Improved precision in phase targeting and personalized stimulation parameters in a larger sample of subjects might be needed to show systematic effects.
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Affiliation(s)
- Sara Fattinger
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bigna Bölsterli Heinzle
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Georgia Ramantani
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lucia Abela
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bernhard Schmitt
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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14
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Abstract
The relationship between sleep and seizure disorders is a particularly vicious cycle. Nocturnal seizures can interrupt sleep while a number of factors, including antiepileptics and sleep disorders that cause sleep fragmentation, can worsen seizures. Understanding and managing seizures and related sleep disturbance is therefore an important and treatable intervention target that could potentially improve children's sleep, but also their learning, mood, behaviour, seizures and parental quality of life.
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Affiliation(s)
| | | | - Paul Gringras
- Children’s Sleep Medicine, Evelina Childrens Hospital, London, UK
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15
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Moresco L, Bruschettini M, Calevo MG, Siri L. Pharmacological treatment for Continuous spike-wave during Slow Wave Sleep and Landau-Kleffner Syndrome. Hippokratia 2018. [DOI: 10.1002/14651858.cd013132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Luca Moresco
- Ospedale San Paolo; Pediatric and Neonatology Unit; Savona Italy
| | - Matteo Bruschettini
- Lund University, Skåne University Hospital; Department of Paediatrics; Lund Sweden
| | - Maria Grazia Calevo
- Istituto Giannina Gaslini; Epidemiology, Biostatistics and Committees Unit; Genoa Italy 16147
| | - Laura Siri
- Ospedale San Paolo; Pediatric and Neurology Unit; Via Genova Savona Savona Italy 17100
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16
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Hahn M, Joechner AK, Roell J, Schabus M, Heib DP, Gruber G, Peigneux P, Hoedlmoser K. Developmental changes of sleep spindles and their impact on sleep-dependent memory consolidation and general cognitive abilities: A longitudinal approach. Dev Sci 2018; 22:e12706. [PMID: 30252185 PMCID: PMC6492121 DOI: 10.1111/desc.12706] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 05/31/2018] [Indexed: 11/30/2022]
Abstract
Sleep spindles are related to sleep‐dependent memory consolidation and general cognitive abilities. However, they undergo drastic maturational changes during adolescence. Here we used a longitudinal approach (across 7 years) to explore whether developmental changes in sleep spindle density can explain individual differences in sleep‐dependent memory consolidation and general cognitive abilities. Ambulatory polysomnography was recorded during four nights in 34 healthy subjects (24 female) with two nights (baseline and experimental) at initial recording (age range 8–11 years) and two nights at follow‐up recording (age range 14–18 years). For declarative learning, participants encoded word pairs with a subsequent recall before and after sleep. General cognitive abilities were measured by the Wechsler Intelligence Scale. Higher slow (11–13 Hz) than fast (13–15 Hz) spindle density at frontal, central, and parietal sites during initial recordings, followed by a shift to higher fast than slow spindle density at central and parietal sites during follow‐up recordings, suggest that mature spindle topography develops throughout adolescence. Fast spindle density increases from baseline to experimental night were positively related to sleep‐dependent memory consolidation. In addition, we found that the development of fast spindles predicted the improvement in memory consolidation across the two longitudinal measurements, a finding that underlines a crucial role for mature fast spindles for sleep‐dependent memory consolidation. Furthermore, slow spindle changes across adolescence were related to general cognitive abilities, a relationship that could indicate the maturation of frontal networks relevant for efficient cognitive processing. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=7NXJzm8HbIw and https://www.youtube.com/watch?v=iuMQY1OIJ0s
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Affiliation(s)
- Michael Hahn
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Ann-Kathrin Joechner
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Judith Roell
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Dominik Pj Heib
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Georg Gruber
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.,The Siesta Group, Vienna, Austria
| | - Philippe Peigneux
- UR2NF - Neuropsychology and Functional Neuroimaging Research Unit affiliated at CRCN - Centre de Recherches en Cognition et Neurosciences and UNI - ULB Neurosciences Institute, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Kerstin Hoedlmoser
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
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17
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Chan S, Pressler R, Boyd SG, Baldeweg T, Cross JH. Does sleep benefit memory consolidation in children with focal epilepsy? Epilepsia 2017; 58:456-466. [DOI: 10.1111/epi.13668] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Samantha Chan
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| | - Ronit Pressler
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| | - Stewart G. Boyd
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| | - Torsten Baldeweg
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
| | - J. Helen Cross
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital NHS Trust; London United Kingdom
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18
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Atherton KE, Nobre AC, Lazar AS, Wulff K, Whittaker RG, Dhawan V, Lazar ZI, Zeman AZ, Butler CR. Slow wave sleep and accelerated forgetting. Cortex 2016; 84:80-89. [PMID: 27710778 PMCID: PMC5084685 DOI: 10.1016/j.cortex.2016.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/04/2016] [Accepted: 08/29/2016] [Indexed: 12/12/2022]
Abstract
We investigated whether the benefit of slow wave sleep (SWS) for memory consolidation typically observed in healthy individuals is disrupted in people with accelerated long-term forgetting (ALF) due to epilepsy. SWS is thought to play an active role in declarative memory in healthy individuals and, furthermore, electrographic epileptiform activity is often more prevalent during SWS than during wakefulness or other sleep stages. We studied the relationship between SWS and the benefit of sleep for memory retention using a word-pair associates task. In both the ALF and the healthy control groups, sleep conferred a memory benefit. However, the relationship between the amount of SWS and sleep-related memory benefits differed significantly between the groups. In healthy participants, the amount of SWS correlated positively with sleep-related memory benefits. In stark contrast, the more SWS, the smaller the sleep-related memory benefit in the ALF group. Therefore, contrary to its role in healthy people, SWS-associated brain activity appears to be deleterious for memory in patients with ALF.
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Affiliation(s)
- Kathryn E Atherton
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anna C Nobre
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
| | - Alpar S Lazar
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Katharina Wulff
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Vandana Dhawan
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Zsolt I Lazar
- Department of Physics, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Adam Z Zeman
- Cognitive and Behavioural Neurology, Peninsular Medical School, University of Exeter, UK
| | - Christopher R Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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19
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Pera MC, Randazzo G, Masnada S, Dontin SD, De Giorgis V, Balottin U, Veggiotti P. Intravenous methylprednisolone pulse therapy for children with epileptic encephalopathy. FUNCTIONAL NEUROLOGY 2016; 30:173-9. [PMID: 26910177 DOI: 10.11138/fneur/2015.30.3.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this retrospective study of children affected by epileptic encephalopathy was to evaluate seizure frequency, electroencephalographic pattern and neuropsychological status, before and after intravenous methylprednisolone therapy. Eleven children with epileptic encephalopathy were administered one cycle of intravenous methylprednisolone (15-30 mg/kg/day for three consecutive days, once a month for four months) in addition to constant dosages of their regular antiepileptic drugs. The treatment resulted in statistically significant reductions of generalized slow spike-and-wave discharges (p<0.0028) and seizure frequency (p<0.013), which persisted even after methylprednisolone pulse therapy was stopped. A globally positive outcome was noted in 9/11 patients (81.8%). This methylprednisolone treatment regimen did not cause significant or persistent adverse effects. We suggest that children with epileptic encephalopathy without an underlying structural lesion could be the best candidates for intravenous methylprednisolone pulse therapy.
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20
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Nickels KC, Zaccariello MJ, Hamiwka LD, Wirrell EC. Cognitive and neurodevelopmental comorbidities in paediatric epilepsy. Nat Rev Neurol 2016; 12:465-76. [PMID: 27448186 DOI: 10.1038/nrneurol.2016.98] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive and behavioural comorbidities are often seen in children with epilepsy, and are more common and severe in refractory epilepsy. These comorbidities are associated with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. To enable early intervention and therapy, children and teens with epilepsy should be periodically screened for cognitive comorbidities. The location of the epileptic focus can, to a certain degree, predict the type(s) of comorbidity; however, the spectrum of disability is often broad, presumably because focal perturbations can cause network dysfunction. Comorbidities often result from underlying structural or functional pathology that has led to seizures. In selected cases, therapy targeting the underlying cause, such as the ketogenic diet for GLUT1 deficiency syndromes, may be remarkably effective in ameliorating both seizures and cognitive concerns. In many cases, however, cognitive impairment persists despite seizure control. In epileptic encephalopathies, frequent seizures and/or interictal epileptiform abnormalities exacerbate neurocognitive dysfunction, owing to synaptic reorganization or impaired neurogenesis, or to other effects on developing neural circuits, and prompt initiation of effective antiepileptic therapy is essential to limit cognitive comorbidities.
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Affiliation(s)
- Katherine C Nickels
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Michael J Zaccariello
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Lorie D Hamiwka
- Seattle Children's Hospital, MB.7.420 - Neurology, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Elaine C Wirrell
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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21
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Urbain C, De Tiège X, Op De Beeck M, Bourguignon M, Wens V, Verheulpen D, Van Bogaert P, Peigneux P. Sleep in children triggers rapid reorganization of memory-related brain processes. Neuroimage 2016; 134:213-222. [DOI: 10.1016/j.neuroimage.2016.03.055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022] Open
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22
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Japaridze N, Muthuraman M, Dierck C, von Spiczak S, Boor R, Mideksa KG, Anwar RA, Deuschl G, Stephani U, Siniatchkin M. Neuronal networks in epileptic encephalopathies with CSWS. Epilepsia 2016; 57:1245-55. [DOI: 10.1111/epi.13428] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Natia Japaridze
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
| | | | - Carina Dierck
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
| | - Sarah von Spiczak
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
- Northern German Epilepsy Center for Children & Adolescents; Raisdorf Germany
| | - Rainer Boor
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
- Northern German Epilepsy Center for Children & Adolescents; Raisdorf Germany
| | - Kidist G. Mideksa
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
- Digital Signal Processing and System Theory; Christian-Albrechts-University; Kiel Germany
| | - Rauf A. Anwar
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
- Digital Signal Processing and System Theory; Christian-Albrechts-University; Kiel Germany
| | - Günther Deuschl
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
| | - Ulrich Stephani
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
- Northern German Epilepsy Center for Children & Adolescents; Raisdorf Germany
| | - Michael Siniatchkin
- Department of Medical Psychology and Medical Sociology; Christian-Albrechts-University; Kiel Germany
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23
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Höller Y, Trinka E. Is There a Relation between EEG-Slow Waves and Memory Dysfunction in Epilepsy? A Critical Appraisal. Front Hum Neurosci 2015; 9:341. [PMID: 26124717 PMCID: PMC4463866 DOI: 10.3389/fnhum.2015.00341] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 05/28/2015] [Indexed: 12/12/2022] Open
Abstract
Is there a relationship between peri-ictal slow waves, loss of consciousness, memory, and slow-wave sleep, in patients with different forms of epilepsy? We hypothesize that mechanisms, which result in peri-ictal slow-wave activity as detected by the electroencephalogram, could negatively affect memory processes. Slow waves (≤4 Hz) can be found in seizures with impairment of consciousness and also occur in focal seizures without impairment of consciousness but with inhibited access to memory functions. Peri-ictal slow waves are regarded as dysfunctional and are probably caused by mechanisms, which are essential to disturb the consolidation of memory entries in these patients. This is in strong contrast to physiological slow-wave activity during deep sleep, which is thought to group memory-consolidating fast oscillatory activity. In patients with epilepsy, slow waves may not only correlate with the peri-ictal clouding of consciousness, but could be the epiphenomenon of mechanisms, which interfere with normal brain function in a wider range. These mechanisms may have transient impacts on memory, such as temporary inhibition of memory systems, altered patterns of hippocampal-neocortical interactions during slow-wave sleep, or disturbed cross-frequency coupling of slow and fast oscillations. In addition, repeated tonic-clonic seizures over the years in uncontrolled chronic epilepsy may cause a progressive cognitive decline. This hypothesis can only be assessed in long-term prospective studies. These studies could disentangle the reversible short-term impacts of seizures, and the impacts of chronic uncontrolled seizures. Chronic uncontrolled seizures lead to irreversible memory impairment. By contrast, short-term impacts do not necessarily lead to a progressive cognitive decline but result in significantly impaired peri-ictal memory performance.
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Affiliation(s)
- Yvonne Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
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24
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Galer S, Urbain C, De Tiège X, Emeriau M, Leproult R, Deliens G, Nonclerq A, Peigneux P, Van Bogaert P. Impaired sleep-related consolidation of declarative memories in idiopathic focal epilepsies of childhood. Epilepsy Behav 2015; 43:16-23. [PMID: 25546732 DOI: 10.1016/j.yebeh.2014.11.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/27/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Declarative memory is consolidated during sleep in healthy children. We tested the hypothesis that consolidation processes are impaired in idiopathic focal epilepsies (IFE) of childhood in association with frequent interictal epileptiform discharges (IEDs) during sleep. METHODS A verbal (word-pair association) and a nonverbal (2D object location) declarative memory task were administrated to 15 children with IFEs and 8 control children 6-12 years of age. Patients had either centrotemporal (11 patients) or occipital (4 patients) IEDs. All but 3 patients had a history of unprovoked seizures, and 6 of them were treated with valproate (VPA). The learning procedure (location of object pairs presented on a grid; association of word pairs) was executed in the evening. Retrieval was tested immediately after learning and on the next morning after a night of sleep. Participants were tested twice, once in natural home conditions and one month later in the unfamiliar conditions of the sleep unit under EEG monitoring. RESULTS Overnight recall performance was lower in children with IFE than in control children on both tasks (ps<0.05). Performance in home conditions was similar to that in hospital conditions. Higher spike-wave index (SWI) during nonrapid eye movement (NREM) sleep was associated with poorer performance in the nonverbal task (p<0.05). Valproate treatment was not associated with overnight recall performance for both tasks (ps>0.05). CONCLUSION Memory consolidation is impaired in IFE of childhood. The association between higher SWI during NREM sleep and poorer nonverbal declarative memory consolidation supports the hypothesis that interictal epileptic activity could disrupt sleep memory consolidation.
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Affiliation(s)
- Sophie Galer
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium; UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.
| | - Charline Urbain
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium; UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Xavier De Tiège
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Mathilde Emeriau
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Rachel Leproult
- UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Gaetane Deliens
- UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Antoine Nonclerq
- LISA - Laboratories of Image, Signal Processing and Acoustics, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Peigneux
- UR2NF - Neuropsychology and Functional Neuroimaging Research Group at CRCN - Center for Research in Cognition and Neurosciences, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Van Bogaert
- LCFC - Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
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Mellish LC, Dunkley C, Ferrie CD, Pal DK. Antiepileptic drug treatment of rolandic epilepsy and Panayiotopoulos syndrome: clinical practice survey and clinical trial feasibility. Arch Dis Child 2015; 100:62-7. [PMID: 25202134 PMCID: PMC4283698 DOI: 10.1136/archdischild-2013-304211] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The evidence base for management of childhood epilepsy is poor, especially for the most common specific syndromes such as rolandic epilepsy (RE) and Panayiotopoulos syndrome (PS). Considerable international variation in management and controversy about non-treatment indicate the need for high quality randomised controlled trials (RCT). The aim of this study is, therefore, to describe current UK practice and explore the feasibility of different RCT designs for RE and PS. METHODS We conducted an online survey of 590 UK paediatricians who treat epilepsy. Thirty-two questions covered annual caseload, investigation and management practice, factors influencing treatment, antiepileptic drug preferences and hypothetical trial design preferences. RESULTS 132 responded (22%): 81% were paediatricians and 95% at consultant seniority. We estimated, annually, 751 new RE cases and 233 PS cases. Electroencephalography (EEG) is requested at least half the time in approximately 70% of cases; MRI brain at least half the time in 40%-65% cases and neuropsychological evaluation in 7%-8%. Clinicians reported non-treatment in 40%: main reasons were low frequency of seizures and parent/child preferences. Carbamazepine is the preferred older, and levetiracetam the preferred newer, RCT arm. Approximately one-half considered active and placebo designs acceptable, choosing seizures as primary and cognitive/behavioural measures as secondary outcomes. CONCLUSIONS Management among respondents is broadly in line with national guidance, although with possible overuse of brain imaging and underuse of EEG and neuropsychological assessments. A large proportion of patients in the UK remains untreated, and clinicians seem amenable to a range of RCT designs, with carbamazepine and levetiracetam the preferred active drugs.
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Affiliation(s)
| | | | - Colin D Ferrie
- Department of Paediatric Neurology, Leeds General Infirmary, Leeds, UK
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Neurobiology of continuous spike-wave in slow-wave sleep and Landau-Kleffner syndromes. Pediatr Neurol 2014; 51:287-96. [PMID: 25160535 DOI: 10.1016/j.pediatrneurol.2014.04.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several pediatric seizure disorders have common electrophysiological features during slow-wave sleep that produce different syndromes based on which part of the developing brain is involved. These disorders, of which continuous spike-wave in slow-wave sleep and Landau-Kleffner are the most common, are characterized by continuous spike-wave activity during slow-wave sleep, developmentally regulated onset and termination of abnormal electrical activity, and loss of previously acquired skills. Over the last 20 years, a variety of basic science findings suggest how spike-wave activity during sleep can cause the observed clinical outcomes. METHODS Literature review and analysis. RESULTS The role of slow-wave sleep in normal cortical plasticity during developmental critical periods, how disruption of slow-wave sleep by electrographic seizures could affect cortical maps and development, and the organization and functional connectivity of the thalamic structures that when damaged are thought to produce these seizure disorders are reviewed. CONCLUSIONS Potential therapeutic directions are proposed based on the mechanisms of plasticity and anatomical structures involved in cortical plasticity during slow-wave sleep.
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Moroni F, Nobili L, Iaria G, Sartori I, Marzano C, Tempesta D, Proserpio P, Lo Russo G, Gozzo F, Cipolli C, De Gennaro L, Ferrara M. Hippocampal slow EEG frequencies during NREM sleep are involved in spatial memory consolidation in humans. Hippocampus 2014; 24:1157-68. [PMID: 24796545 DOI: 10.1002/hipo.22299] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Fabio Moroni
- Department of Psychology; “Sapienza” University of Rome; Roma Italy
- Laboratory of Psychology; Department of Specialized; Diagnostics and Experimental Medicine, University of Bologna; Bologna Italy
| | - Lino Nobili
- Centre of Epilepsy Surgery “C. Munari”, Center of Sleep Medicine, Niguarda Hospital; Milan Italy
- Institute of Bioimaging and Molecular Physiology, Section of Genoa, National Research Council; Genova Italy
| | - Giuseppe Iaria
- Department of Psychology and Clinical Neurosciences; and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Ivana Sartori
- Centre of Epilepsy Surgery “C. Munari”, Center of Sleep Medicine, Niguarda Hospital; Milan Italy
| | - Cristina Marzano
- Department of Psychology; “Sapienza” University of Rome; Roma Italy
| | - Daniela Tempesta
- Department of Life; Health and Environmental Sciences; University of L'Aquila; L'Aquila Italy
| | - Paola Proserpio
- Centre of Epilepsy Surgery “C. Munari”, Center of Sleep Medicine, Niguarda Hospital; Milan Italy
| | - Giorgio Lo Russo
- Centre of Epilepsy Surgery “C. Munari”, Center of Sleep Medicine, Niguarda Hospital; Milan Italy
| | - Francesca Gozzo
- Centre of Epilepsy Surgery “C. Munari”, Center of Sleep Medicine, Niguarda Hospital; Milan Italy
| | - Carlo Cipolli
- Laboratory of Psychology; Department of Specialized; Diagnostics and Experimental Medicine, University of Bologna; Bologna Italy
| | - Luigi De Gennaro
- Department of Psychology; “Sapienza” University of Rome; Roma Italy
| | - Michele Ferrara
- Department of Life; Health and Environmental Sciences; University of L'Aquila; L'Aquila Italy
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Bölsterli Heinzle BK, Fattinger S, Kurth S, LeBourgeois MK, Ringli M, Bast T, Critelli H, Schmitt B, Huber R. Spike wave location and density disturb sleep slow waves in patients with CSWS (continuous spike waves during sleep). Epilepsia 2014; 55:584-91. [DOI: 10.1111/epi.12576] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Bigna K. Bölsterli Heinzle
- Pediatric Sleep Disorders Center; University Children's Hospital Zurich; Zurich Switzerland
- Division of Clinical Neurophysiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
| | - Sara Fattinger
- Pediatric Sleep Disorders Center; University Children's Hospital Zurich; Zurich Switzerland
- Division of Clinical Neurophysiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
| | - Salomé Kurth
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
- Sleep and Development Laboratory; Department of Integrative Physiology; University of Colorado Boulder; Boulder Colorado U.S.A
| | - Monique K. LeBourgeois
- Sleep and Development Laboratory; Department of Integrative Physiology; University of Colorado Boulder; Boulder Colorado U.S.A
| | - Maya Ringli
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
| | - Thomas Bast
- Pediatric Neurology; University Children's Hospital; Heidelberg Germany
- Epilepsy Center Kork; Kehl Germany
| | - Hanne Critelli
- Pediatric Sleep Disorders Center; University Children's Hospital Zurich; Zurich Switzerland
- Division of Clinical Neurophysiology; University Children's Hospital Zurich; Zurich Switzerland
| | - Bernhard Schmitt
- Pediatric Sleep Disorders Center; University Children's Hospital Zurich; Zurich Switzerland
- Division of Clinical Neurophysiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
| | - Reto Huber
- Pediatric Sleep Disorders Center; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
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Atherton KE, Nobre AC, Zeman AZ, Butler CR. Sleep-dependent memory consolidation and accelerated forgetting. Cortex 2014; 54:92-105. [PMID: 24657478 PMCID: PMC4007033 DOI: 10.1016/j.cortex.2014.02.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/28/2014] [Accepted: 02/10/2014] [Indexed: 11/26/2022]
Abstract
Accelerated long-term forgetting (ALF) is a form of memory impairment in which learning and initial retention of information appear normal but subsequent forgetting is excessively rapid. ALF is most commonly associated with epilepsy and, in particular, a form of late-onset epilepsy called transient epileptic amnesia (TEA). ALF provides a novel opportunity to investigate post-encoding memory processes, such as consolidation. Sleep is implicated in the consolidation of memory in healthy people and a deficit in sleep-dependent memory consolidation has been proposed as an explanation for ALF. If this proposal were correct, then sleep would not benefit memory retention in people with ALF as much as in healthy people, and ALF might only be apparent when the retention interval contains sleep. To test this theory, we compared performance on a sleep-sensitive memory task over a night of sleep and a day of wakefulness. We found, contrary to the hypothesis, that sleep benefits memory retention in TEA patients with ALF and that this benefit is no smaller in magnitude than that seen in healthy controls. Indeed, the patients performed significantly more poorly than the controls only in the wake condition and not the sleep condition. Patients were matched to controls on learning rate, initial retention, and the effect of time of day on cognitive performance. These results indicate that ALF is not caused by a disruption of sleep-dependent memory consolidation. Instead, ALF may be due to an encoding abnormality that goes undetected on behavioural assessments of learning, or by a deficit in memory consolidation processes that are not sleep-dependent.
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Affiliation(s)
- Kathryn E Atherton
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Anna C Nobre
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
| | - Adam Z Zeman
- Cognitive and Behavioural Neurology Research Group, University of Exeter Medical School, UK
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Sud S, Sadaka Y, Massicotte C, Smith ML, Bradbury L, Go C, Weiss SK. Memory consolidation in children with epilepsy: does sleep matter? Epilepsy Behav 2014; 31:176-80. [PMID: 24434309 DOI: 10.1016/j.yebeh.2013.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/10/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Children with epilepsy have frequent sleep disturbance and challenges in learning and memory. There is little research on the consolidation of memory during sleep in this population. The goal of this pilot study was to determine whether children with epilepsy are able to consolidate memories better after a sleep versus wake period as has been demonstrated in typically developing children. METHODS This study was a prospective evaluation of children with epilepsy to determine if sleep improved episodic memory (using word lists) as compared with memory following a wake period of similar duration. The study was conducted in patients in the Epilepsy Monitoring Unit at a single academic health science center. In the sleep recall condition, the learning trials were presented in the evening, and delayed recall of the words was tested in the morning. In the wake condition, the learning took place in the morning, and the delayed recall took place later in the day. Subjects wore an actigraph to evaluate sleep/wake patterns. Data regarding the children's epilepsy, antiepileptic medications, and frequency of interictal epileptiform discharges were also documented. RESULTS Ten children (agd 8-17years) participated in the study. For the entire sample, recall after sleep was better than recall after awake (p=0.03), and 7 of the 10 children showed this effect. However, reanalyses removing an outlier showed no difference between the two recall conditions. The mean number of interictal epileptiform discharges was 8.8 during the recall after sleep and 7.8 during the recall after awake. Three children had seizures during the evaluation. CONCLUSION In this pilot study, we demonstrated that a small cohort of children with epilepsy, with similar interictal epileptiform discharges during sleep and wake, showed no advantage in memory for a word list after a period of sleep than after a period of being awake. This finding requires further study in a larger cohort. Poor memory consolidation during sleep may contribute to the cognitive deficits in children with epilepsy.
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Affiliation(s)
- Shama Sud
- Division of Neurology, University of Toronto, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G1X8, Canada.
| | - Yair Sadaka
- Pediatric Neurology Unit, Ben Gurion University, Soroka Medical Center of the Negev, Be'er Sheva 84101 Israel.
| | - Colin Massicotte
- Division of Respiratory Medicine, University of Toronto, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G1X8, Canada.
| | - Mary Lou Smith
- Dept. of Psychology, Division of Neurology, University of Toronto, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G1X8, Canada.
| | - Laura Bradbury
- Division of Neurology, University of Toronto, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G1X8, Canada.
| | - Cristina Go
- Division of Neurology, University of Toronto, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G1X8, Canada.
| | - Shelly K Weiss
- Division of Neurology, University of Toronto, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G1X8, Canada.
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Memory impairment and Benign Epilepsy with centrotemporal spike (BECTS): A growing suspicion. Brain Cogn 2014; 84:123-31. [DOI: 10.1016/j.bandc.2013.11.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/23/2013] [Accepted: 11/27/2013] [Indexed: 11/18/2022]
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Abstract
Human brain dynamics are nowadays routinely explored at the macroscopic level using a wide variety of non-invasive neuroimaging techniques, including single photon emission computed tomography (SPECT) and positron emission tomography (PET), near infrared spectroscopy (NIRS) and functional magnetic resonance imaging (fMRI). In the past decades, the application of brain imaging methods to the study of sleep raised a renewed interest for the field, especially in the domain of neuroscience. Indeed, these studies enabled researchers to characterize the functional neuroanatomy of sleep stages and identify the neural correlates of phasic and tonic sleep mechanisms. Furthermore, they provided the scientific community with tools to address the crucial question of brain plasticity processes during human sleep, the role of sleep-related plasticity for memory consolidation, and how sleep and the lack of post-training sleep impacts brain functioning in the neural networks underlying memory-related cognitive processes. This chapter reviews the contributions of neuroimaging to our understanding of the functional neuroanatomy of sleep and sleep stages, and discusses how sleep contributes to the long-term consolidation of recently acquired memories in light of contemporary neural models for memory consolidation during sleep.
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Affiliation(s)
- Philippe Peigneux
- UR2NF-Neuropsychology and Functional Neuroimaging Research Unit, CRCN-Centre de Recherches Cognition et Neurosciences and UNI-ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), CP191, Av. F Roosevelt 50, 1050, Bruxelles, Belgium,
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Urbain C, Galer S, Van Bogaert P, Peigneux P. Pathophysiology of sleep-dependent memory consolidation processes in children. Int J Psychophysiol 2013; 89:273-83. [DOI: 10.1016/j.ijpsycho.2013.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/13/2013] [Accepted: 06/17/2013] [Indexed: 11/30/2022]
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Del Felice A, Arcaro C, Storti SF, Fiaschi A, Manganotti P. Slow spindles' cortical generators overlap with the epileptogenic zone in temporal epileptic patients: an electrical source imaging study. Clin Neurophysiol 2013; 124:2336-44. [PMID: 23849700 DOI: 10.1016/j.clinph.2013.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/31/2013] [Accepted: 06/06/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether temporal epileptic patients and normal volunteers display similar sleep spindles' cortical generators as determined by electrical source imaging (ESI), and whether such generators overlap in epilepsy patients with the epileptogenic zone identified by ESI. METHODS Twelve healthy subjects and twelve temporal lobe pharmaco-resistant epileptic patients underwent a 256-channel EEG recording during a daytime nap. Sleep spindles were analyzed off line, distinguishing slow (10-12 Hz) and fast (12-14 Hz) ones, and the final averaged signal was projected onto a MNI (Montreal Neurological Institute) space to localize cortical generators. The same procedure was performed for averaged epileptic spikes, obtaining their cortical source. Intra- and inter-group statistical analyses were conducted. RESULTS Multiple, concomitant generators were detected in both populations for slow and fast spindles. Slow spindles in epileptics displayed higher source amplitude in comparison to healthy volunteers (Z=0.001), as well as a preferential localization over the affected temporal cortices (p=0.039). Interestingly, at least one of slow spindles' generators overlapped with the epileptogenic zone. CONCLUSION Slow spindles, but not fast ones, in temporal epilepsy are mainly generated by the affected temporal lobe. SIGNIFICANCE These results point to the strict relation between sleep and epilepsy and to the possible cognitive implications of spikes arising from memory-encoding brain structures.
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Affiliation(s)
- Alessandra Del Felice
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Neurology, University of Verona, Italy.
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Bjørnæs H, Bakke KA, Larsson PG, Heminghyt E, Rytter E, Brager-Larsen LM, Eriksson AS. Subclinical epileptiform activity in children with electrical status epilepticus during sleep: effects on cognition and behavior before and after treatment with levetiracetam. Epilepsy Behav 2013; 27:40-8. [PMID: 23376335 DOI: 10.1016/j.yebeh.2012.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 12/02/2012] [Accepted: 12/08/2012] [Indexed: 11/17/2022]
Abstract
We performed a double-blind placebo-controlled crossover study of the effects of spike activity during sleep and when awake on learning, long-term memory, vigilance and behavior before and after treatment with levetiracetam in children with electrical status epilepticus during sleep. At baseline, verbal learning declined with increasing spike activity, but there were no relations between spike activity and memory, vigilance or behavior. Levetiracetam was effective in reducing sleep-related spike activity, but on a group level, this had no clear effects on behavior, vigilance or learning and memory. Our results do not allow firm conclusions whether to treat nocturnal epileptiform activity or not; larger samples and longer follow-up may be needed.
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Affiliation(s)
- Helge Bjørnæs
- National Centre for Epilepsy, Oslo University Hospital, Norway.
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Nonclercq A, Urbain C, Verheulpen D, Decaestecker C, Van Bogaert P, Peigneux P. Sleep spindle detection through amplitude–frequency normal modelling. J Neurosci Methods 2013; 214:192-203. [DOI: 10.1016/j.jneumeth.2013.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 01/17/2013] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
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Abstract
Benign epilepsy with centrotemporal spikes, early-onset childhood occipital epilepsy (Panayiotopoulos syndrome [PS]) and late-onset childhood occipital epilepsy (Gastaut type [LOCE-G]) are the principal pediatric focal epilepsy syndromes. They share major common characteristics: the appearance and resolution of electroclinical features are age related, there is a strong genetic predisposition, the clinical course is often mild with infrequent and easy to control seizures, interictal epileptiform activity is disproportionately abundant when compared with the clinical correlate, and tends to potentiate and generalize during sleep. In this review, we outline the relevant pathophysiology underlying this electroclinical spectrum. Then, the initial description of individual syndromes is followed by a summary of overlapping features and intermediate presentations that question the boundaries between these entities and provide the basis for the concept of a childhood seizure susceptibility syndrome. Additionally, we outline the main features of the related epileptic encephalopathies. An outlook on potential future lines of research completes this review.
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Van Bogaert P. Epileptic encephalopathy with continuous spike-waves during slow-wave sleep including Landau-Kleffner syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:635-40. [PMID: 23622211 DOI: 10.1016/b978-0-444-52891-9.00066-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epileptic encephalopathy with continuous spike-waves during slow-wave sleep (CSWS) is a spectrum of epileptic conditions best defined by the association of cognitive or behavioral impairment acquired during childhood and not related to another factor other than the presence of abundant interictal epileptiform discharges (IED) during sleep, which tend to diffuse over the whole scalp. It is part of the childhood focal epileptic syndromes, some cases being idiopathic and overlapping with benign rolandic epilepsy, and others being symptomatic of a structural brain lesion. Landau-Kleffner syndrome (LKS) is a particular presentation where acquired aphasia is the core symptom. Clinical, neurophysiological, and cerebral glucose metabolism data support the hypothesis that IED play a prominent role in the cognitive deficits by interfering with the neuronal networks at the site of the epileptic foci but also at distant connected areas. Therefore, the treatment should aim to suppress IED. This may be achieved using conventional antiepileptic drugs, but corticosteroids seem to have more pronounced and sustained efficacy. Outcome for epilepsy is usually good, CSWS being an age-dependent EEG pattern, whereas outcome for cognition, language, and behavior is variable. Rehabilitation represents an important part of the treatment and visual forms of language should be encouraged in children with LKS.
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Sánchez Fernández I, Loddenkemper T, Peters JM, Kothare SV. Electrical status epilepticus in sleep: clinical presentation and pathophysiology. Pediatr Neurol 2012; 47:390-410. [PMID: 23127259 DOI: 10.1016/j.pediatrneurol.2012.06.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/20/2012] [Indexed: 10/27/2022]
Abstract
Electrical status epilepticus in sleep involves an electroencephalographic pattern where interictal epileptiform activity is potentiated in the transition from wakefulness to sleep. Near-continuous spikes and waves that occupy a significant proportion of nonrapid eye movement sleep appear as a result of sleep-potentiated epileptiform activity. This electroencephalographic pattern appears in different electroclinical syndromes that present three common characteristics with different degrees of severity: seizures, sleep-potentiated epileptiform activity, and neuropsychologic regression. Continuous spikes and waves during sleep comprise the severest epileptic encephalopathy in the electroclinical spectrum. Landau-Kleffner syndrome presents with intermediate severity. Some "benign" pediatric focal epileptic syndromes represent the mildest end of this continuum. Based on published data, we provide a framework for clinical and electrical events. The underlying mechanisms leading to sleep potentiation of epileptiform activity in electrical status epilepticus in sleep are incompletely understood. A genetic basis or acquired early developmental insult may disrupt the normal maturation of neuronal networks. These factors may dynamically alter normal processes of brain development, leading to an age-related pattern of electroclinical expression of electrical status epilepticus in sleep.
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Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Epileptic Encephalopathies with Status Epilepticus during Sleep: New Techniques for Understanding Pathophysiology and Therapeutic Options. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:642725. [PMID: 22934163 PMCID: PMC3420558 DOI: 10.1155/2012/642725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 11/17/2022]
Abstract
Encephalopathy with status epilepticus during sleep (ESES) is an epileptic encephalopathy, as defined by the International League Against Epilepsy (ILAE) Task Force on Classification and Terminology, that is, a condition in which the epileptic processes themselves are believed to contribute to the disturbance in cerebral function. Clinical manifestations of ESES are heterogeneous: apart from different seizure types, they consist in combinations of cognitive, motor, and behavioural disturbances associated with a peculiar electroencephalographic pattern of paroxysmal activity significantly activated during slow sleep, which culminates in a picture of continuous spikes and waves during sleep (CSWS). The pathophysiological mechanisms underlying this condition are still incompletely understood. Establishing a clear-cut correlation between EEG abnormalities and clinical data, though interesting, is very complex. Computer-assisted EEG analyses especially if combined with functional magnetic resonance imaging (EEG-fMRI) and metabolic neuroimaging have recently emerged as useful approaches to better understand the pathophysiological processes underlying ESES. Treatment of ESES is not just limited to seizures control but it should be focused on controlling neuropsychological outcome through an improvement of the continuous epileptiform activity. General agreement on treatment guidelines is still lacking. Implementation of new techniques might allow a better understanding of the pathophysiology of ESES and could enhance therapeutics options.
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Bruni O, Novelli L, Mallucci A, Corte MD, Romeo A, Ferri R. Benign Rolandic and Occipital Epilepsies of Childhood. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2011.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Impact of focal interictal epileptiform discharges on behaviour and cognition in children. Neurophysiol Clin 2011; 42:53-8. [PMID: 22200342 DOI: 10.1016/j.neucli.2011.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/29/2011] [Accepted: 11/01/2011] [Indexed: 11/23/2022] Open
Abstract
It is hypothesised that focal interictal epileptiform discharges (IED) may exert a deleterious effect on behaviour and cognition in children. This hypothesis is supported by the abnormally high prevalence of IED in several developmental disorders, like specific language impairment, and of cognitive and behavioural deficits in epileptic children after excluding confounding factors such as underlying structural brain lesions, drug effects, or the occurrence of frequent or prolonged epileptic seizures. Neurophysiological and functional neuroimaging evidence suggests that IED may impact cognition through either transient effects on brain processing mechanisms, or through more long-lasting effects leading to prolonged inhibition of brain areas distant from but connected with the epileptic focus (i.e. remote inhibition effect). Sustained IED may also impair sleep-related learning consolidation processes. Nowadays, the benefits of anti-epileptic treatment aimed at reducing IED are not established except in specific situations like epileptic encephalopathies with continuous spike and waves during slow-wave sleep. Well-designed pharmacological studies are still necessary to address this issue.
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