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Ercoli T, Bagella CF, Frau C, Ruiu E, Othmani S, Gusinu G, Masala C, Sechi LA, Solla P, Defazio G. Phantosmia in Parkinson's Disease: A Systematic Review of the Phenomenology of Olfactory Hallucinations. Neurol Int 2023; 16:20-32. [PMID: 38251050 PMCID: PMC10801480 DOI: 10.3390/neurolint16010002] [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: 10/17/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Olfactory dysfunction is a prevalent non-motor symptom in Parkinson's disease (PD), affecting approximately 65-90% of subjects. PD patients may also report odor perception in the absence of any external source, often referred to as olfactory hallucinations (OHs) or phantosmia. This study aims to explore the current understanding of OHs in PD and offer a comprehensive overview of their prevalence and characteristics. We conducted a systematic search of the literature published on PubMed from inception to July 2023 regarding OHs in PD, following PRISMA guidelines. From the 2875 studies identified through database searching, 29 studies fulfilled the necessary criteria and underwent data extraction. The frequency of OHs in PD patients varies widely, ranging from 0.5% to 18.2%, with female prevalence ranging from 36% to 75% of the patients. Olfactory experiences may vary widely, ranging from pleasant scents to unpleasant odors. Several studies have indicated the concurrent presence of other types of hallucinations alongside phantosmia, especially visual and auditory hallucinations. OHs in PD are a type of hallucination that has been largely overlooked. To gain a deeper understanding of OHs in PD patients, the next crucial step should involve the development and validation of a dedicated questionnaire.
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Affiliation(s)
- Tommaso Ercoli
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Caterina Francesca Bagella
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Claudia Frau
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Elisa Ruiu
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Sabrine Othmani
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Giansalvo Gusinu
- Department of Biomedical Sciences, Sassari University, 07100 Sassari, Italy; (G.G.); (L.A.S.)
| | - Carla Masala
- Department of Biomedical Sciences, University of Cagliari, SP 8 Cittadella Universitaria, 09042 Monserrato, Italy
| | - Leonardo Antonio Sechi
- Department of Biomedical Sciences, Sassari University, 07100 Sassari, Italy; (G.G.); (L.A.S.)
| | - Paolo Solla
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70121 Bari, Italy;
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2
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Cretin B, Philippi N, Bousiges O, Blanc F. Transient epileptic amnesia: a retrospective cohort study of 127 cases, including CSF amyloid and tau features. J Neurol 2023; 270:2256-2270. [PMID: 36715748 DOI: 10.1007/s00415-023-11576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transient epileptic amnesia (TEA) is a late-onset epilepsy syndrome encompassing transient iterative amnesias and interictal cognitive impairment, two features that overlap with incipient neurodegenerative dementias. We, therefore, examined the yield of CSF amyloid and tau biomarkers in TEA. METHODS In this retrospective study, 127 TEA patients with unremarkable imaging findings were divided into 2 groups, namely, CSF (n = 71) and no-CSF (n = 56). Both were compared for demographics; medical history; baseline neurological, cognitive, and behavioral features; baseline mesial temporal lobe atrophy; and cognitive follow-up at a median of 13 months. CSF samples were examined for amyloid β-42 peptide as well as phospho-tau and total-tau levels. RESULTS At baseline, the CSF-TEA group had significantly (p < 0.01) more frequent mild parkinsonism (42.9% vs. 20%) and cognitive concerns (31% vs. 10.7%), a more blunted sense of smell (34.3% vs. 9.4%), a lower baseline MMSE score (27 vs. 28.9), a more frequent amnestic mild cognitive impairment profile (69% vs. 42.6%), and more atrophic hippocampal changes. At follow-up, the CSF-TEA group had significantly (p < 0.01) lower MMSE scores (27.8 vs. 28.9). CSF analyses revealed amyloid and/or tau changes in 27 patients (38%), including an Alzheimer's disease (AD) profile in 17 (24%). CONCLUSIONS This study shows a good diagnostic value of CSF sampling in a specific population of TEA with characteristics suggestive of incipient degenerative diseases (i.e., red flags). It argues for TEA being the inaugurating feature in some cases of AD. More broadly, our results suggest an etiological heterogeneity in TEA.
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Affiliation(s)
- Benjamin Cretin
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Pôle Tête et Cou, 1 Avenue Molière, 67200, Strasbourg, France.
- Unité de Neuropsychologie, Service de Neurologie et hôpital de jour de Gériatrie, pôle de Gériatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto Strasbourg, Strasbourg, France.
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Nathalie Philippi
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Pôle Tête et Cou, 1 Avenue Molière, 67200, Strasbourg, France
- Unité de Neuropsychologie, Service de Neurologie et hôpital de jour de Gériatrie, pôle de Gériatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto Strasbourg, Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Bousiges
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Pôle Tête et Cou, 1 Avenue Molière, 67200, Strasbourg, France
- University Hospital of Strasbourg, Laboratory of Biochemistry and Molecular Biology, CNRS, Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR7364, Strasbourg, France
| | - Frédéric Blanc
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Pôle Tête et Cou, 1 Avenue Molière, 67200, Strasbourg, France
- Unité de Neuropsychologie, Service de Neurologie et hôpital de jour de Gériatrie, pôle de Gériatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto Strasbourg, Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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3
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Krämer G. Riech- und Schmeckstörungen bei Epilepsien und anderen neurologischen Erkrankungen. DGNEUROLOGIE 2022. [PMCID: PMC9336133 DOI: 10.1007/s42451-022-00464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G. Krämer
- Neurozentrum Bellevue, Theaterstr. 8, 8001 Zürich, Schweiz
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4
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The potential for retronasally delivered olfactory stimuli to assess psychiatric conditions. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00238-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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5
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Lyons-Warren AM, Herman I, Hunt PJ, Arenkiel BR. A systematic-review of olfactory deficits in neurodevelopmental disorders: From mouse to human. Neurosci Biobehav Rev 2021; 125:110-121. [PMID: 33610612 PMCID: PMC8142839 DOI: 10.1016/j.neubiorev.2021.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/15/2021] [Accepted: 02/15/2021] [Indexed: 01/07/2023]
Abstract
Olfactory impairment is a common clinical motif across neurodevelopmental disorders, suggesting olfactory circuits are particularly vulnerable to disease processes and can provide insight into underlying disease mechanisms. The mouse olfactory bulb is an ideal model system to study mechanisms of neurodevelopmental disease due to its anatomical accessibility, behavioral relevance, ease of measuring circuit input and output, and the feature of adult neurogenesis. Despite the clinical relevance and experimental benefits, olfactory testing across animal models of neurodevelopmental disease has been inconsistent and non-standardized. Here we performed a systematic literature review of olfactory function testing in mouse models of neurodevelopmental disorders, and identified intriguing inconsistencies that include evidence for both increased and decreased acuity in odor detection in various mouse models of Autism Spectrum Disorder (ASD). Based on our identified gaps in the literature, we recommend direct comparison of different mouse models of ASD using standardized tests for odor detection and discrimination. This review provides a framework to guide future olfactory function testing in mouse models of neurodevelopmental diseases.
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Affiliation(s)
- Ariel M Lyons-Warren
- Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience; Clinical Care Center, Suite 1250, 6621 Fannin St, Houston, TX 77030, United States of America;,Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030 USA
| | - Isabella Herman
- Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience; Clinical Care Center, Suite 1250, 6621 Fannin St, Houston, TX 77030, United States of America;,Baylor College of Medicine, Department of Molecular & Human Genetics; 1250 Moursund Street, Suite 1170.12, Houston TX 77030, United States of America
| | - Patrick J Hunt
- Baylor College of Medicine, Department of Molecular & Human Genetics; 1250 Moursund Street, Suite 1170.12, Houston TX 77030, United States of America
| | - Benjamin R Arenkiel
- Baylor College of Medicine, Department of Molecular & Human Genetics; 1250 Moursund Street, Suite 1170.12, Houston TX 77030, United States of America;,Baylor College of Medicine, Department of Neuroscience; 1250 Moursund Street, Suite 1170.12, Houston TX 77030, United States of America;,Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX 77030 USA.,McNair Medical Institute, Baylor College of Medicine, Houston, TX 77030
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6
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A Review of Accelerated Long-Term Forgetting in Epilepsy. Brain Sci 2020; 10:brainsci10120945. [PMID: 33297371 PMCID: PMC7762289 DOI: 10.3390/brainsci10120945] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Accelerated long-term forgetting (ALF) is a memory disorder that manifests by a distinct pattern of normal memory for up to an hour after learning, but an increased rate of forgetting during the subsequent hours and days. The topic of ALF has gained much attention in group studies with epilepsy patients and the phenomenon has been shown to have contradictory associations with seizures, epileptiform activity, imaging data, sleep, and antiepileptic medication. The aim of this review was to explore how clinical and imaging data could help determine the topographic and physiological substrate of ALF, and what is the possible use of this information in the clinical setting. We have reviewed 51 group studies in English to provide a synthesis of the existing findings concerning ALF in epilepsy. Analysis of recently reported data among patients with temporal lobe epilepsy, transient epileptic amnesia, and generalized and extratemporal epilepsies provided further indication that ALF is likely a disorder of late memory consolidation. The spatial substrate of ALF might be located along the parts of the hippocampal-neocortical network and novel studies reveal the increasingly possible importance of damage in extrahippocampal sites. Further research is needed to explore the mechanisms of cellular impairment in ALF and to develop effective methods of care for patients with the disorder.
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7
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Klonarakis M, Pettersen JA. Transient Epileptic Amnesia: Under-Diagnosed but Treatable Cause of Memory Dysfunction. Am J Med 2020; 133:e724-e725. [PMID: 32502482 DOI: 10.1016/j.amjmed.2020.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Klonarakis
- Northern Medical Program, University of British Columbia, Prince George, BC, Canada
| | - Jacqueline A Pettersen
- Northern Medical Program, University of British Columbia, Prince George, BC, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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8
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Morosanu CO, Clamp PJ, Teo MK. Phantosmia as the first presentation of a cavernous sinus - clinoidal meningioma. Br J Neurosurg 2020; 37:1-7. [PMID: 33050720 DOI: 10.1080/02688697.2020.1834510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
Cavernous sinus meningiomas (CSM) are complex skull base lesions that, due to their particular anatomical location, render surgical management difficult. Their symptomatology is versatile, and the clinical outcome is difficult to predict. We present the case of a 57-year old female patient who experienced phantosmia - an abnormal, persistent, olfactory sensation of cigarette smell for 18 months. MRI was performed and revealed a left cavernous sinus meningioma, extending into the left temporal fossa, with olfactory and optic nerve distortion. To our knowledge, this is the first reported case of phantosmia as the initial presentation of a lesion in the cavernous sinus.
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Affiliation(s)
| | - Philip J Clamp
- Department of Otolaryngology and Head & Neck Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Mario K Teo
- Department of Neurosurgery, Southmead Hospital, Bristol, UK
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9
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Iannella G, Magliulo G, Maniaci A, Meccariello G, Cocuzza S, Cammaroto G, Gobbi R, Sgarzani R, Firinu E, Corso RM, Pace A, Gulotta G, Visconti IC, Di Luca M, Pelucchi S, Bianchi G, Melegatti M, Abita P, Solito C, La Mantia I, Grillo C, Vicini C. Olfactory function in patients with obstructive sleep apnea: a meta-analysis study. Eur Arch Otorhinolaryngol 2020; 278:883-891. [PMID: 32914257 DOI: 10.1007/s00405-020-06316-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This meta-analysis study was designed to analyze the olfactory function in obstructive sleep apnea patients (OSA). METHODS A comprehensive review of the English language literature regarding OSA patients and olfactory function/dysfunction was performed. The papers assessing olfactory dysfunction with Sniffin' Sticks test were taken into consideration. RESULTS A total of 420 OSA patients were judged eligible for the study. The average TDI score was found to be 24.3 ± 5.6. The olfactory identification (OD), the olfactory discrimination (OD), and the olfactory threshold (OT) average values were calculated resulting 9.9 ± 2.1, 9.8 ± 1.5, and 5.3 ± 2, respectively. There were 161 healthy control subjects in this meta-analysis. The average TDI of the control group was 30.7 ± 6.0 showing a statistical difference with the group of OSA patients (p = 0.03). A linear correlation between Apnea-Hypopnea Index (AHI) increase and TDI decrease (R2 = 0.1, p = 0.05) was detected. Finally, the average values of TDI of 151 patients classified as mild-moderate OSA and 159 patients considered as severe OSA were calculated. The difference between these two groups resulted not statistically significant (p = 0.3). CONCLUSION The comparison between OSA patients and healthy subjects using Sniffin' Sticks test showed lower values of the various olfactory parameters. Although a linear correlation between AHI increase and olfactory dysfunction was observed, no statistical difference between mild-moderate and severe OSA patients in terms of the severity of olfactory dysfunction could be proved.
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Affiliation(s)
- Giannicola Iannella
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy. .,Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy.
| | - Giuseppe Magliulo
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Antonino Maniaci
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Giuseppe Meccariello
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Salvatore Cocuzza
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Giovanni Cammaroto
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Riccardo Gobbi
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Rossella Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL Della Romagna, viale Giovanni Ghirotti, 286, 47521, Cesena, Italy
| | - Elisabetta Firinu
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Ruggero Massimo Corso
- Intensive Care Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Annalisa Pace
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Giampiero Gulotta
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Irene Claudia Visconti
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Milena Di Luca
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Stefano Pelucchi
- Department ENT and Audiology, University of Ferrara, Via Savonarola, 9, 44121, Ferrara, Italy
| | - Giulia Bianchi
- Department ENT and Audiology, University of Ferrara, Via Savonarola, 9, 44121, Ferrara, Italy
| | - Michela Melegatti
- Department ENT and Audiology, University of Ferrara, Via Savonarola, 9, 44121, Ferrara, Italy
| | - Pietro Abita
- Unit of Otorhinolaryngology, Department of Adult and Development Age Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Carmen Solito
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Ignazio La Mantia
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Calogero Grillo
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Claudio Vicini
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy.,Department ENT and Audiology, University of Ferrara, Via Savonarola, 9, 44121, Ferrara, Italy
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10
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Khurshid K, Crow AJD, Rupert PE, Minniti NL, Carswell MA, Mechanic-Hamilton DJ, Kamath V, Doty RL, Moberg PJ, Roalf DR. A Quantitative Meta-analysis of Olfactory Dysfunction in Epilepsy. Neuropsychol Rev 2019; 29:328-337. [PMID: 31144106 PMCID: PMC6766414 DOI: 10.1007/s11065-019-09406-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 04/11/2019] [Indexed: 11/25/2022]
Abstract
Olfactory dysfunction in epilepsy is well-documented in several olfactory domains. However, the clinical specificity of these deficits remains unknown. The aim of this systematic meta-analysis was to determine which domains of olfactory ability were most impaired in individuals with epilepsy, and to assess moderating factors affecting olfactory ability. Extant peer-reviewed literature on olfaction in epilepsy were identified via a computerized literature search using PubMed, MEDLINE, PsycInfo, and Google Scholar databases. Twenty-one articles met inclusion criteria. These studies included a total of 912 patients with epilepsy and 794 healthy comparison subjects. Included studies measured olfaction using tests of odor identification, discrimination, memory, and detection threshold in patients with different types of epilepsy, including temporal lobe epilepsy (TLE), mixed frontal epilepsy (M-F), and mixed epilepsy (MIX). Olfactory deficits were robust in patients with epilepsy when compared to healthy individuals, with effect sizes in the moderate to large range for several olfactory domains, including odor identification (d = -1.59), memory (d = -1.10), discrimination (d = -1.04), and detection threshold (d = -0.58). Olfactory deficits were most prominent in patients with TLE and M-F epilepsy. Amongst patients with epilepsy, sex, age, smoking status, education, handedness, and age of illness onset were significantly related to olfactory performance. Overall, these meta-analytic findings indicate that the olfactory system is compromised in epilepsy and suggest that detailed neurobiological investigations of the olfactory system may provide further insight into this disorder.
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Affiliation(s)
- Kiran Khurshid
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew J D Crow
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Petra E Rupert
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nancy L Minniti
- Department of Physical Medicine and Rehabilitation, Temple University Hospital, Philadelphia, PA, USA
| | | | - Dawn J Mechanic-Hamilton
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard L Doty
- Smell & Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul J Moberg
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Smell & Taste Center, Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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11
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Baker J, Libretto T, Henley W, Zeman A. The prevalence and clinical features of epileptic seizures in a memory clinic population. Seizure 2019; 71:83-92. [PMID: 31226566 DOI: 10.1016/j.seizure.2019.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine the prevalence and clinical features of epileptic seizures occurring in a memory clinic population. METHOD We recruited patients receiving a diagnosis of dementia or mild cognitive impairment (MCI) at a regional memory clinic. We interviewed patients and informants using a proforma designed to elicit symptoms suggestive of epilepsy. Informants also completed the Clinical Dementia Rating Scale (CDR) and the Cambridge Behavioural Inventory- Revised (CBI-R). Patients underwent cognitive testing using the Addenbrooke's Cognitive Examination - III (ACE-III). We also recruited an age- and gender- matched control group with no history of cognitive impairment. Diagnoses of dementia/MCI were checked against current diagnostic criteria. RESULTS We recruited 144 patients (mean age 77.98, mean ACE-III 74.16, 124 with dementia, 20 with MCI). We diagnosed epilepsy in 25.7%: probable in 12.5% (17 with dementia, 1 with MCI), possible 13.2% (18 with dementia, 1 with MCI). Seizure features included altered responsiveness, speech/behavioural arrest, oral/pharyngeal automatism, olfactory/gustatory aura, focal motor seizure, other sensory phenomena (including hallucination), and amnesia on waking. Epilepsy prevalence was significantly increased in the dementia and MCI group vs controls (p = 0.004). Cognitive performance in the patient groups did not distinguish those in whom epilepsy was suspected from those in whom it was not. Patients in whom epilepsy was suspected were more impaired on informant completed measures of daily function. CONCLUSIONS The prevalence of epilepsy is increased in dementia. The seizures are often subtle and easily missed. The presence of epilepsy predicts more severe impairment in the activities of daily living.
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Affiliation(s)
- John Baker
- Cognitive and Behavioural Neurology, University of Exeter, College of Medicine and Health, UK.
| | - Tina Libretto
- NIHR Exeter Clinical Research Facility, RD&E NHS FT, UK; University of Exeter, College of Medicine and Health, Exeter, UK
| | - William Henley
- University of Exeter, College of Medicine and Health, Exeter, UK
| | - Adam Zeman
- Cognitive and Behavioural Neurology, University of Exeter, College of Medicine and Health, UK
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12
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Savage SA, Irani SR, Leite MI, Zeman AZ. NMDA receptor antibody encephalitis presenting as Transient Epileptic Amnesia. J Neuroimmunol 2019; 327:41-43. [PMID: 30686545 PMCID: PMC6367595 DOI: 10.1016/j.jneuroim.2019.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 01/27/2023]
Abstract
Transient Epileptic Amnesia (TEA) is a subtype of temporal lobe epilepsy, typically presenting in a person's early 60s, and of unknown aetiology. Encephalitis caused by antibodies to NMDA receptors (NMDARE) has not previously been documented in TEA. We describe a 47-year-old male who satisfied criteria for TEA, but given his atypical symptoms, was also screened for autoimmune epilepsy. High levels of serum NMDAR antibodies were found, suggesting NMDARE. Immunosuppressive treatment gradually eliminated the NMDA receptor antibodies. Our case extends the clinical spectrum associated with neuronal cell-surface autoantibodies to include atypical cases of TEA.
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Affiliation(s)
- Sharon A Savage
- Cognitive Neurology Research Group, University of Exeter Medical School, Exeter, UK; Discipline of Psychology, University of Exeter, Exeter, UK.
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M Isabel Leite
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Adam Z Zeman
- Cognitive Neurology Research Group, University of Exeter Medical School, Exeter, UK
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Doty RL, Tourbier I, Neff JK, Silas J, Turetsky B, Moberg P, Kim T, Pluta J, French J, Sharan AD, Sperling MJ, Mirza N, Risser A, Baltuch G, Detre JA. Influences of temporal lobe epilepsy and temporal lobe resection on olfaction. J Neurol 2018; 265:1654-1665. [PMID: 29767353 PMCID: PMC6239967 DOI: 10.1007/s00415-018-8891-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
Abstract
Although temporal lobe epilepsy (TLE) and resection (TLR) impact olfactory eloquent brain structures, their influences on olfaction remain enigmatic. We sought to more definitively assess the influences of TLE and TLR on olfaction using three well-validated olfactory tests and measuring the tests' associations with the volume of numerous temporal lobe brain structures. The University of Pennsylvania Smell Identification Test and an odor detection threshold test were administered to 71 TLE patients and 71 age- and sex-matched controls; 69 TLE patients and controls received an odor discrimination/memory test. Fifty-seven patients and 57 controls were tested on odor identification and threshold before and after TLR; 27 patients and 27 controls were similarly tested for odor detection/discrimination. Scores were compared using analysis of variance and correlated with pre- and post-operative volumes of the target brain structures. TLE was associated with bilateral deficits in all test measures. TLR further decreased function on the side ipsilateral to resection. The hippocampus and other structures were smaller on the focus side of the TLE subjects. Although post-operative volumetric decreases were evident in most measured brain structures, modest contralateral volumetric increases were observed in some cases. No meaningful correlations were evident pre- or post-operatively between the olfactory test scores and the structural volumes. In conclusion, we demonstrate that smell dysfunction is clearly a key element of both TLE and TLR, impacting odor identification, detection, and discrimination/memory. Whether our novel finding of significant post-operative increases in the volume of brain structures contralateral to the resection side reflects plasticity and compensatory processes requires further study.
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Affiliation(s)
- Richard L Doty
- Smell and Taste Center, Perelman School of Medicine, Hospital of the University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4283, USA.
- Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Isabelle Tourbier
- Smell and Taste Center, Perelman School of Medicine, Hospital of the University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4283, USA
- Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica K Neff
- Smell and Taste Center, Perelman School of Medicine, Hospital of the University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4283, USA
- Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Silas
- Smell and Taste Center, Perelman School of Medicine, Hospital of the University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4283, USA
- Department of Psychology, Middlesex University, London, UK
| | - Bruce Turetsky
- Smell and Taste Center, Perelman School of Medicine, Hospital of the University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4283, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Moberg
- Smell and Taste Center, Perelman School of Medicine, Hospital of the University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4283, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Taehoon Kim
- Smell and Taste Center, Perelman School of Medicine, Hospital of the University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4283, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Pluta
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaqueline French
- Department of Neurology, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Ashwini D Sharan
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael J Sperling
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Natasha Mirza
- Smell and Taste Center, Perelman School of Medicine, Hospital of the University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4283, USA
- Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony Risser
- Smell and Taste Center, Perelman School of Medicine, Hospital of the University of Pennsylvania, 5 Ravdin Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104-4283, USA
| | - Gordon Baltuch
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John A Detre
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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The evolution of accelerated long-term forgetting: Evidence from the TIME study. Cortex 2017; 110:16-36. [PMID: 29122206 PMCID: PMC6330058 DOI: 10.1016/j.cortex.2017.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/10/2017] [Accepted: 09/09/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Accelerated long-term forgetting (ALF) occurs when newly learned information decays faster than normal over extended delays. It has been recognised most frequently in temporal lobe epilepsy, including Transient Epileptic Amnesia (TEA), but can also be drug-induced. Little is known about the evolution of ALF over time and its impacts upon other memory functions, such as autobiographical memory (ABM). Here we investigate the long-term outcome of ALF and ABM in a group of patients with TEA and a single case of baclofen-induced ALF. METHODS Study 1 involved a longitudinal follow-up of 14 patients with TEA over a 10-year period. Patients repeated a neuropsychological battery, three ALF measures (with free recall probed at 30-min and 1-week), and a modified Autobiographical Memory Interview (MAMI). Performance was compared with a group of healthy age-matched controls. In Study 2, patient CS, who previously experienced baclofen-induced ALF, was followed over 4 years, and re-tested now, 18 months after ceasing baclofen. CS repeated a neuropsychological battery, three ALF experimental tasks (each probed after 30 min and 1 week), and a modified autobiographical interview (AI). Her performance was compared with healthy age-matched controls. RESULTS On ALF measures, the TEA group performed significantly below controls, but when analysed individually, 4 of the 7 patients who originally showed ALF no longer did so. In two, this was accompanied by improvements in ABM for recent but not remote memory. Patient CS no longer demonstrated ALF on standard lab-based tests and now appeared to retain new episodic autobiographical events with a similar degree of episodic richness as controls. CONCLUSION Long-term follow up suggests that ALF can resolve, with improvements translating to recent ABM in some cases.
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