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Traub-Weidinger T, Arbizu J, Barthel H, Boellaard R, Borgwardt L, Brendel M, Cecchin D, Chassoux F, Fraioli F, Garibotto V, Guedj E, Hammers A, Law I, Morbelli S, Tolboom N, Van Weehaeghe D, Verger A, Van Paesschen W, von Oertzen TJ, Zucchetta P, Semah F. EANM practice guidelines for an appropriate use of PET and SPECT for patients with epilepsy. Eur J Nucl Med Mol Imaging 2024; 51:1891-1908. [PMID: 38393374 PMCID: PMC11139752 DOI: 10.1007/s00259-024-06656-3] [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: 11/01/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Epilepsy is one of the most frequent neurological conditions with an estimated prevalence of more than 50 million people worldwide and an annual incidence of two million. Although pharmacotherapy with anti-seizure medication (ASM) is the treatment of choice, ~30% of patients with epilepsy do not respond to ASM and become drug resistant. Focal epilepsy is the most frequent form of epilepsy. In patients with drug-resistant focal epilepsy, epilepsy surgery is a treatment option depending on the localisation of the seizure focus for seizure relief or seizure freedom with consecutive improvement in quality of life. Beside examinations such as scalp video/electroencephalography (EEG) telemetry, structural, and functional magnetic resonance imaging (MRI), which are primary standard tools for the diagnostic work-up and therapy management of epilepsy patients, molecular neuroimaging using different radiopharmaceuticals with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) influences and impacts on therapy decisions. To date, there are no literature-based praxis recommendations for the use of Nuclear Medicine (NM) imaging procedures in epilepsy. The aims of these guidelines are to assist in understanding the role and challenges of radiotracer imaging for epilepsy; to provide practical information for performing different molecular imaging procedures for epilepsy; and to provide an algorithm for selecting the most appropriate imaging procedures in specific clinical situations based on current literature. These guidelines are written and authorized by the European Association of Nuclear Medicine (EANM) to promote optimal epilepsy imaging, especially in the presurgical setting in children, adolescents, and adults with focal epilepsy. They will assist NM healthcare professionals and also specialists such as Neurologists, Neurophysiologists, Neurosurgeons, Psychiatrists, Psychologists, and others involved in epilepsy management in the detection and interpretation of epileptic seizure onset zone (SOZ) for further treatment decision. The information provided should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals and imaging modalities.
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Affiliation(s)
- Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Javier Arbizu
- Department of Nuclear Medicine, University of Navarra Clinic, Pamplona, Spain
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University Medical Centre, Leipzig, Germany
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Lise Borgwardt
- Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen, Blegdamsvej 9, DK-2100, RigshospitaletCopenhagen, Denmark
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig Maximilian-University of Munich, Munich, Germany
- DZNE-German Center for Neurodegenerative Diseases, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, University-Hospital of Padova, Padova, Italy
| | - Francine Chassoux
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, 91401, Orsay, France
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
- NIMTLab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | - Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London & Guy's and St Thomas' PET Centre, King's College London, London, UK
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Silvia Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy, Université de Lorraine, IADI, INSERM U1254, Nancy, France
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, KU Leuven and Department of Neurology, University Hospitals, Leuven, Belgium
| | - Tim J von Oertzen
- Depts of Neurology 1&2, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine-DIMED, University-Hospital of Padova, Padova, Italy
| | - Franck Semah
- Nuclear Medicine Department, University Hospital, Inserm, CHU Lille, U1172-LilNCog-Lille, F-59000, Lille, France.
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Tung H, Tsai SC, Huang PR, Hsieh PF, Lin YC, Peng SJ. Morphological and metabolic asymmetries of the thalamic subregions in temporal lobe epilepsy predict cognitive functions. Sci Rep 2023; 13:22611. [PMID: 38114641 PMCID: PMC10730825 DOI: 10.1038/s41598-023-49856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
Both morphological and metabolic imaging were used to determine how asymmetrical changes of thalamic subregions are involved in cognition in temporal lobe epilepsy (TLE). We retrospectively recruited 24 left-TLE and 15 right-TLE patients. Six thalamic subnuclei were segmented by magnetic resonance imaging, and then co-registered onto Positron emission tomography images. We calculated the asymmetrical indexes of the volumes and normalized standard uptake value ratio (SUVR) of the entire and individual thalamic subnuclei. The SUVR of ipsilateral subnuclei were extensively and prominently decreased compared with the volume loss. The posterior and medial subnuclei had persistently lower SUVR in both TLE cases. Processing speed is the cognitive function most related to the metabolic asymmetry. It negatively correlated with the metabolic asymmetrical indexes of subregions in left-TLE, while positively correlated with the subnuclei volume asymmetrical indexes in right-TLE. Epilepsy duration negatively correlated with the volume asymmetry of most thalamic subregions in left-TLE and the SUVR asymmetry of ventral and intralaminar subnuclei in right-TLE. Preserved metabolic activity of contralateral thalamic subregions is the key to maintain the processing speed in both TLEs. R-TLE had relatively preserved volume of the ipsilateral thalamic volume, while L-TLE had relatively decline of volume and metabolism in posterior subnucleus.
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Affiliation(s)
- Hsin Tung
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Center of Faculty Development, Taichung Veterans General Hospital, Taichung, Taiwan
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Chuan Tsai
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Imaging and Radiological Technology, Institute of Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Pu-Rong Huang
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Peiyuan F Hsieh
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ching Lin
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Imaging and Radiological Technology, Institute of Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan.
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
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3
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Smetana RM, Batchala PP, Lee BG, Albataineh T, Broshek DK, Fountain NB, Abbas S, Quigg M. Multifocal hypometabolic correlates to deficits of verbal memory in mesial temporal lobe epilepsy. Epilepsy Behav 2023; 143:109244. [PMID: 37192585 DOI: 10.1016/j.yebeh.2023.109244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuropsychological research on mesial temporal lobe epilepsy (MTLE) often highlights material-specific memory deficits, but a lesion-focused model may not accurately reflect the underlying networks that support episodic memory in these patients. Our study evaluated the pathophysiology behind verbal learning/memory deficits as revealed by hypometabolism quantified through 18-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS This retrospective study included thirty presurgical patients with intractable unilateral MTLE who underwent interictal FDG-PET and verbal memory assessment (12 females, mean age: 38.73 years). Fluorodeoxyglucose-positron emission tomography mapping was performed with voxel-based mapping of glucose utilization to a database of age-matched controls to derive regional Z-scores. Neuropsychological outcome variables included scores on learning and recall trials of two distinct verbal memory measures validated for use in epilepsy research. Pearson's correlations evaluated relationships between clinical variables and verbal memory. Linear regression was used to relate regional hypometabolism and verbal memory assessment. Post hoc analyses assessed areas of FDG-PET hypometabolism (threshold Z ≤ -1.645 below mean) where verbal memory was impaired. RESULTS Verbal memory deficits correlated with hypometabolism in limbic structures ipsilateral to language dominance but also correlated with hypometabolism in networks involving the ipsilateral perisylvian cortex and contralateral limbic and nonlimbic structures. DISCUSSION We conclude that traditional models of verbal memory may not adequately capture cognitive deficits in a broader sample of patients with MTLE. This study has important implications for epilepsy surgery protocols that use neuropsychological data and FDG-PET to draw conclusions about surgical risks.
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Affiliation(s)
- Racheal M Smetana
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Bern G Lee
- Department of Neuropsychology, Ochsner Health, Baton Rouge, LA, USA.
| | - Tamer Albataineh
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Nathan B Fountain
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA.
| | - Salma Abbas
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Mark Quigg
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA.
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Wang X, Lin D, Zhao C, Li H, Fu L, Huang Z, Xu S. Abnormal metabolic connectivity in default mode network of right temporal lobe epilepsy. Front Neurosci 2023; 17:1011283. [PMID: 37034164 PMCID: PMC10076532 DOI: 10.3389/fnins.2023.1011283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Aims Temporal lobe epilepsy (TLE) is a common neurological disorder associated with the dysfunction of the default mode network (DMN). Metabolic connectivity measured by 18F-fluorodeoxyglucose Positron Emission Computed Tomography (18F-FDG PET) has been widely used to assess cumulative energy consumption and provide valuable insights into the pathophysiology of TLE. However, the metabolic connectivity mechanism of DMN in TLE is far from fully elucidated. The present study investigated the metabolic connectivity mechanism of DMN in TLE using 18F-FDG PET. Method Participants included 40 TLE patients and 41 health controls (HC) who were age- and gender-matched. A weighted undirected metabolic network of each group was constructed based on 14 primary volumes of interest (VOIs) in the DMN, in which Pearson's correlation coefficients between each pair-wise of the VOIs were calculated in an inter-subject manner. Graph theoretic analysis was then performed to analyze both global (global efficiency and the characteristic path length) and regional (nodal efficiency and degree centrality) network properties. Results Metabolic connectivity in DMN showed that regionally networks changed in the TLE group, including bilateral posterior cingulate gyrus, right inferior parietal gyrus, right angular gyrus, and left precuneus. Besides, significantly decreased (P < 0.05, FDR corrected) metabolic connections of DMN in the TLE group were revealed, containing bilateral hippocampus, bilateral posterior cingulate gyrus, bilateral angular gyrus, right medial of superior frontal gyrus, and left inferior parietal gyrus. Conclusion Taken together, the present study demonstrated the abnormal metabolic connectivity in DMN of TLE, which might provide further insights into the understanding the dysfunction mechanism and promote the treatment for TLE patients.
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Affiliation(s)
- Xiaoyang Wang
- Department of Medical Imaging, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
- Department of Medical Imaging, Affiliated Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Dandan Lin
- Department of Clinical Medicine, Fujian Health College, Fuzhou, Fujian, China
| | - Chunlei Zhao
- Department of Medical Imaging, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
- Department of Medical Imaging, Affiliated Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Hui Li
- Department of Medical Imaging, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
| | - Liyuan Fu
- Department of Medical Imaging, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
- Department of Medical Imaging, Affiliated Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Zhifeng Huang
- Department of Medical Imaging, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
- Department of Medical Imaging, Affiliated Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
| | - Shangwen Xu
- Department of Medical Imaging, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, Fujian, China
- Department of Medical Imaging, Affiliated Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China
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5
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He X, Caciagli L, Parkes L, Stiso J, Karrer TM, Kim JZ, Lu Z, Menara T, Pasqualetti F, Sperling MR, Tracy JI, Bassett DS. Uncovering the biological basis of control energy: Structural and metabolic correlates of energy inefficiency in temporal lobe epilepsy. SCIENCE ADVANCES 2022; 8:eabn2293. [PMID: 36351015 PMCID: PMC9645718 DOI: 10.1126/sciadv.abn2293] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 09/22/2022] [Indexed: 05/11/2023]
Abstract
Network control theory is increasingly used to profile the brain's energy landscape via simulations of neural dynamics. This approach estimates the control energy required to simulate the activation of brain circuits based on structural connectome measured using diffusion magnetic resonance imaging, thereby quantifying those circuits' energetic efficiency. The biological basis of control energy, however, remains unknown, hampering its further application. To fill this gap, investigating temporal lobe epilepsy as a lesion model, we show that patients require higher control energy to activate the limbic network than healthy volunteers, especially ipsilateral to the seizure focus. The energetic imbalance between ipsilateral and contralateral temporolimbic regions is tracked by asymmetric patterns of glucose metabolism measured using positron emission tomography, which, in turn, may be selectively explained by asymmetric gray matter loss as evidenced in the hippocampus. Our investigation provides the first theoretical framework unifying gray matter integrity, metabolism, and energetic generation of neural dynamics.
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Affiliation(s)
- Xiaosong He
- Department of Psychology, School of Humanities and Social Sciences, University of Science and Technology of China, Hefei, Anhui, China
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chesham Lane, Chalfont St Peter, Buckinghamshire, UK
| | - Linden Parkes
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Stiso
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Teresa M. Karrer
- Personalized Health Care, Product Development, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Jason Z. Kim
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhixin Lu
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Tommaso Menara
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, San Diego, CA, USA
| | - Fabio Pasqualetti
- Department of Mechanical Engineering, University of California, Riverside, Riverside, CA, USA
| | | | - Joseph I. Tracy
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dani S. Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Departments of Electrical and Systems Engineering, Physics and Astronomy, Psychiatry, and Neurology, University of Pennsylvania, Philadelphia, PA, USA
- Santa Fe Institute, Santa Fe, NM, USA
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6
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Li ZM, Liu XX, Li C, Wei ZC, Shi Y, Song HY, Chen X, Zhang Y, Li JW, Zhu RF, Hu BH, Ye WF, Huo D, Jiang GJ, Sasaki T, Zhang L, Han F, Lu YM. Decreased synapse-associated proteins are associated with the onset of epileptic memory impairment in endothelial CDK5-deficient mice. MedComm (Beijing) 2022; 3:e128. [PMID: 35770064 PMCID: PMC9209881 DOI: 10.1002/mco2.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/07/2022] Open
Abstract
Accumulating evidence indicates that epilepsy has a higher risk of inducing memory impairment and dementia. However, the underlying onset mechanism remains unclear. Here, we found that mice with spontaneous epilepsy induced by endothelial CDK5 deficiency exhibited hippocampal‐dependent memory impairment at 6 months of age, but not at 2 months of age. Moreover, the persistent epileptic seizures induce aberrant changes in phosphorylation of CaMKII protein in the hippocampus of spontaneous epileptic mice. Using genome‐wide RNA sequencing and intergenic interaction analysis of STRING, we found that in addition to epilepsy‐related genes, there are changes in synaptic organization pathway node genes, such as Bdnf and Grin1. The synapse‐related proteins by Western blot analysis, such as NMDA receptors (NR1 and NR2B), PSD95, and the phosphorylation of synapsin1, are progressively decreased during epileptic seizures in Cdh5‐CreERT2;CDK5f/f mice. Notably, we found that valproate (VPA) and phenytoin (PHT) augment mRNA expression and protein levels of synapse‐related genes and ameliorate memory impairment in Cdh5‐CreERT2;CDK5f/f mice. Our study elucidates a potential mechanism of memory deficits in epilepsy, and pharmacological reversal of synaptic pathology targeting might provide a new therapeutic intervention for epileptic memory deficits.
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Affiliation(s)
- Zheng-Mao Li
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine School of Pharmacy Nanjing Medical University Nanjing China
| | - Xiu-Xiu Liu
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine School of Pharmacy Nanjing Medical University Nanjing China
| | - Chen Li
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine School of Pharmacy Nanjing Medical University Nanjing China
| | - Zhao-Cong Wei
- Department of Physiology Nanjing Medical University Nanjing China
| | - Yi Shi
- Department of Physiology Nanjing Medical University Nanjing China
| | - Heng-Yi Song
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine School of Pharmacy Nanjing Medical University Nanjing China
| | - Xiang Chen
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine School of Pharmacy Nanjing Medical University Nanjing China
| | - Yu Zhang
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine School of Pharmacy Nanjing Medical University Nanjing China
| | - Jia-Wei Li
- The First Clinical Medical College of Nanjing Medical University Nanjing Medical University Nanjing China
| | - Rui-Fang Zhu
- The First Clinical Medical College of Nanjing Medical University Nanjing Medical University Nanjing China
| | - Ben-Hui Hu
- Key Laboratory of Clinical and Medical Engineering School of Biomedical Engineering and Informatics Nanjing Medical University Nanjing China
| | - Wei-Feng Ye
- Department of Pharmacy The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health Hangzhou China
| | - Da Huo
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine School of Pharmacy Nanjing Medical University Nanjing China
| | - Guo-Jun Jiang
- Department of Pharmacy Zhejiang Xiaoshan Hospital Hangzhou China
| | - Takuya Sasaki
- Department of Pharmacology Graduate School of Pharmaceutical Sciences Tohoku University Sendai Japan
| | - Li Zhang
- Institute of Brain Science The Affiliated Brain Hospital of Nanjing Medical University Nanjing China
| | - Feng Han
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine School of Pharmacy Nanjing Medical University Nanjing China.,Institute of Brain Science The Affiliated Brain Hospital of Nanjing Medical University Nanjing China.,Gusu School Nanjing Medical University, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University Suzhou China
| | - Ying-Mei Lu
- Department of Physiology Nanjing Medical University Nanjing China.,Institute of Brain Science The Affiliated Brain Hospital of Nanjing Medical University Nanjing China
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7
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Vinti V, Dell'Isola GB, Tascini G, Mencaroni E, Cara GD, Striano P, Verrotti A. Temporal Lobe Epilepsy and Psychiatric Comorbidity. Front Neurol 2021; 12:775781. [PMID: 34917019 PMCID: PMC8669948 DOI: 10.3389/fneur.2021.775781] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
Most focal seizures originate in the temporal lobe and are commonly divided into mesial and lateral temporal epilepsy, depending upon the neuronal circuitry involved. The hallmark features of the mesial temporal epilepsy are aura, unconsciousness, and automatisms. Symptoms often overlap with the lateral temporal epilepsy. However, the latter present a less evident psychomotor arrest, frequent clones and dystonic postures, and common focal to bilateral tonic–clonic seizures. Sclerosis of the hippocampus is the most frequent cause of temporal lobe epilepsy (TLE). TLE is among all epilepsies the most frequently associated with psychiatric comorbidity. Anxiety, depression, and interictal dysphoria are recurrent psychiatric disorders in pediatric patients with TLE. In addition, these alterations are often combined with cognitive, learning, and behavioral impairment. These comorbidities occur more frequently in TLE with hippocampal sclerosis and with pharmacoresistance. According to the bidirectional hypothesis, the close relationship between TLE and psychiatric features should lead to considering common pathophysiology underlying these disorders. Psychiatric comorbidities considerably reduce the quality of life of these children and their families. Thus, early detection and appropriate management and therapeutic strategies could improve the prognosis of these patients. The aim of this review is to analyze TLE correlation with psychiatric disorders and its underlying conditions.
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Affiliation(s)
- Valerio Vinti
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | - Giorgia Tascini
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini (IRCCS "G. Gaslini") Institute, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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8
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Hermann BP, Struck AF, Busch RM, Reyes A, Kaestner E, McDonald CR. Neurobehavioural comorbidities of epilepsy: towards a network-based precision taxonomy. Nat Rev Neurol 2021; 17:731-746. [PMID: 34552218 PMCID: PMC8900353 DOI: 10.1038/s41582-021-00555-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 02/06/2023]
Abstract
Cognitive and behavioural comorbidities are prevalent in childhood and adult epilepsies and impose a substantial human and economic burden. Over the past century, the classic approach to understanding the aetiology and course of these comorbidities has been through the prism of the medical taxonomy of epilepsy, including its causes, course, characteristics and syndromes. Although this 'lesion model' has long served as the organizing paradigm for the field, substantial challenges to this model have accumulated from diverse sources, including neuroimaging, neuropathology, neuropsychology and network science. Advances in patient stratification and phenotyping point towards a new taxonomy for the cognitive and behavioural comorbidities of epilepsy, which reflects the heterogeneity of their clinical presentation and raises the possibility of a precision medicine approach. As we discuss in this Review, these advances are informing the development of a revised aetiological paradigm that incorporates sophisticated neurobiological measures, genomics, comorbid disease, diversity and adversity, and resilience factors. We describe modifiable risk factors that could guide early identification, treatment and, ultimately, prevention of cognitive and broader neurobehavioural comorbidities in epilepsy and propose a road map to guide future research.
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Affiliation(s)
- Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,
| | - Aaron F. Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,William S. Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Robyn M. Busch
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anny Reyes
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Erik Kaestner
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Carrie R. McDonald
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
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9
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DiFrancesco JC, Isella V, Licciardo D, Crivellaro C, Musarra M, Guerra L, Salvadori N, Chipi E, Calvello C, Costa C, Ferrarese C. Temporal lobe dysfunction in late-onset epilepsy of unknown origin. Epilepsy Behav 2021; 117:107839. [PMID: 33611099 DOI: 10.1016/j.yebeh.2021.107839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Epilepsy with onset in the adulthood is an increasing health problem, due to the progressive aging of the worldwide population. Whether the causes remain undetermined, the disease is defined as Late-Onset Epilepsy of Unknown origin (LOEU). The aim of this study was to evaluate the semiological, electroencephalographic, metabolic, and neuropsychological features of LOEU. METHODS We selected patients with late-onset epilepsy (LOE) (≥55 years), whose causes of the disease have been excluded with a deep clinical-instrumental characterization, including brain MRI, EEG, 18F-labeled fluoro-2-deoxyglucose positron emission tomography (FDG-PET), and neuropsychological assessment. RESULTS Twenty-three LOEU cases were retrospectively recruited. Half presented focal-onset seizures (FOS), the others focal to bilateral tonic-clonic seizures (FBTCS). All demonstrated a mild phenotype, with no recurrence of seizures on single antiseizure treatment at prolonged follow-up. Brain MRI scans were normal in 12 patients (52.3%) and showed nonspecific gliosis or mild atrophy in ten (43.5%); hippocampal sclerosis (HS) was observed in one. In 17/23 (73.9%), the EEG showed slow and/or epileptiform activity of the temporal areas. Brain FDG-PET revealed temporal lobe hypometabolism, mostly ipsilateral to EEG abnormal activity, or multifocal temporal and extra-temporal (cortical, subcortical and subtentorial) clusters of hypometabolism. The neuropsychological analysis demonstrated three different profiles: normal (43.5%), with focal deficits (39.1%) or mild multidomain impairment (17.4%). SIGNIFICANCE Late-Onset Epilepsy of Unknown origin can present as FOS or FBTCS, both with good prognosis. The application of metabolic imaging and neurophysiology techniques in these patients points to the dysfunction of the temporal structures, whose role in the pathogenetic process of the disease remains to be clarified.
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Affiliation(s)
- Jacopo C DiFrancesco
- Department of Neurology, ASST S. Gerardo Hospital, University of Milano - Bicocca, Monza, Italy; Milan Center for Neuroscience (NeuroMI), Italy.
| | - Valeria Isella
- Department of Neurology, ASST S. Gerardo Hospital, University of Milano - Bicocca, Monza, Italy; Milan Center for Neuroscience (NeuroMI), Italy.
| | - Daniele Licciardo
- Department of Neurology, ASST S. Gerardo Hospital, University of Milano - Bicocca, Monza, Italy; Milan Center for Neuroscience (NeuroMI), Italy
| | - Cinzia Crivellaro
- Milan Center for Neuroscience (NeuroMI), Italy; Nuclear Medicine Unit, ASST S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Monica Musarra
- Milan Center for Neuroscience (NeuroMI), Italy; Nuclear Medicine Unit, ASST S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Luca Guerra
- Milan Center for Neuroscience (NeuroMI), Italy; Nuclear Medicine Unit, ASST S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Nicola Salvadori
- Neurology Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Elena Chipi
- Neurology Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carmen Calvello
- Neurology Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Cinzia Costa
- Neurology Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carlo Ferrarese
- Department of Neurology, ASST S. Gerardo Hospital, University of Milano - Bicocca, Monza, Italy; Milan Center for Neuroscience (NeuroMI), Italy
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10
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Paudel YN, Othman I, Shaikh MF. Anti-High Mobility Group Box-1 Monoclonal Antibody Attenuates Seizure-Induced Cognitive Decline by Suppressing Neuroinflammation in an Adult Zebrafish Model. Front Pharmacol 2021; 11:613009. [PMID: 33732146 PMCID: PMC7957017 DOI: 10.3389/fphar.2020.613009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/27/2020] [Indexed: 12/31/2022] Open
Abstract
Epilepsy is a chronic brain disease afflicting around 70 million global population and is characterized by persisting predisposition to generate epileptic seizures. The precise understanding of the etiopathology of seizure generation is still elusive, however, brain inflammation is considered as a major contributor to epileptogenesis. HMGB1 protein being an initiator and crucial contributor of inflammation is known to contribute significantly to seizure generation via activating its principal receptors namely RAGE and TLR4 reflecting a potential therapeutic target. Herein, we evaluated an anti-seizure and memory ameliorating potential of an anti-HMGB1 monoclonal antibody (mAb) (1, 2.5 and 5 mg/kg, I.P.) in a second hit Pentylenetetrazol (PTZ) (80 mg/kg, I.P.) induced seizure model earlier stimulated with Pilocarpine (400 mg/kg, I.P.) in adult zebrafish. Pre-treatment with anti-HMGB1 mAb dose-dependently lowered the second hit PTZ-induced seizure but does not alter the disease progression. Moreover, anti-HMGB1 mAb also attenuated the second hit Pentylenetetrazol induced memory impairment in adult zebrafish as evidenced by an increased inflection ration at 3 and 24 h trail in T-maze test. Besides, decreased level of GABA and an upregulated Glutamate level was observed in the second hit PTZ induced group, which was modulated by pre-treatment with anti-HMGB1 mAb. Inflammatory responses occurred during the progression of seizures as evidenced by upregulated mRNA expression of HMGB1, TLR4, NF-κB, and TNF-α, in a second hit PTZ group, which was in-turn downregulated upon pre-treatment with anti-HMGB1 mAb reflecting its anti-inflammatory potential. Anti-HMGB1 mAb modulates second hit PTZ induced changes in mRNA expression of CREB-1 and NPY. Our findings indicates anti-HMGB1 mAb attenuates second hit PTZ-induced seizures, ameliorates related memory impairment, and downregulates the seizure induced upregulation of inflammatory markers to possibly protect the zebrafish from the incidence of further seizures through via modulation of neuroinflammatory pathway.
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Affiliation(s)
- Yam Nath Paudel
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Iekhsan Othman
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.,Liquid Chromatography-Mass Spectrometry Platform, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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11
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Al-Malt AM, Abo Hammar SA, Rashed KH, Ragab OA. The effect of nocturnal epileptic seizures on cognitive functions in children with idiopathic epilepsy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cognitive impairment is a common finding epileptic children. Studies have linked nocturnal epileptic discharges to delayed cognitive abilities in children.
Objective
The study aims to evaluate the effect of nocturnal epileptic seizures on cognitive functions in children with idiopathic epilepsy.
Patients and methods
The study was conducted on 70 children with idiopathic generalized or benign focal epilepsy. Based on seizures semiology, they were classified into cases either with nocturnal epileptic seizures (NES) (n = 40) or with diurnal epileptic seizures (DES) (n = 30). Patients receiving antiepileptic drugs (AEDs) that affect cognitive function, patients with intelligence quotient (IQ) below 70, and those having other neurological or psychiatric disorders' were excluded. All patients were subjected to neurological examination, brain magnetic resonance imaging (MRI), and electroencephalography. Cognition was assessed using Wechsler Intelligence scale for children (WISC) to measure IQ, Wisconsin card sorting test (WCST) (computerized version), Trail Making Test, and Digit spans test.
Results
There was no significant difference between both groups regarding age, sex, age of epilepsy onset, or seizure frequency. There was a significant difference in almost all cognitive variables including digit forward, digit backward, processing speed, verbal IQ, WCST perseverative responses, WCST failure to maintain set, Trail Making Test A (error), Trail Making Test B (Time), and Trail Making Test B (error). There was no significant difference regarding the associated sleep disturbances between the studied groups.
Conclusion
Children with idiopathic epilepsy suffering from predominant nocturnal seizure have overt and subtle cognitive functions impairments compared to children with predominant diurnal seizure.
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The association of cognitive phenotypes with postoperative outcomes after epilepsy surgery in patients with temporal lobe epilepsy. Epilepsy Behav 2020; 112:107386. [PMID: 32911298 DOI: 10.1016/j.yebeh.2020.107386] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The concept of cognitive phenotypes has been developed to categorize the heterogeneity of neuropsychological profiles in patients with temporal lobe epilepsy (TLE). This study examines the utility of cognitive phenotypes derived from clinical criteria in the prediction of postoperative outcomes. METHODS Scores from 9 standardized neuropsychological tests were used to sample preoperative performance in 4 core domains (intellectual, memory, language, & executive function) in 445 patients with TLE (206 right: 236 left). Patients were grouped into 3 clinical phenotypes using clinical criteria: 1. intact cognition, 2. isolated memory and/or language impairment, and 3. widespread impairment. Patients who did not meet the criteria for these phenotypes were characterized as having a mixed profile phenotype. RESULTS Approximately half of the sample had intact cognitive function, with one-quarter demonstrating isolated impairments in language and memory function. The remainder demonstrated widespread impairment or a mixed pattern of cognitive impairments. The clinically derived cognitive phenotypes were associated with demographic and clinical characteristics. Patients with widespread cognitive impairments had an earlier onset of seizures than those with other cognitive phenotypes. They also reported higher levels of depression. Higher levels of anxiety were reported in those with isolated memory/language impairments. Phenotypes were not associated with postoperative seizure outcome or postoperative declines in verbal memory or language function, but an intact phenotype was associated with a greater risk of decline in visual learning than right-sided surgery. CONCLUSIONS Distinct cognitive phenotypes in TLE can be identified using clinical criteria and may reflect neurodevelopmental influences and mood in addition to progression of the disease. Phenotype may be a more powerful predictor of postoperative decline in visual memory than laterality of surgery.
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