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Tang G, Zhou H, Zeng C, Jiang Y, Li Y, Hou L, Liao K, Tan Z, Wu H, Tang Y, Cheng Y, Ling X, Guo Q, Xu H. Alterations of apparent diffusion coefficient from ultra high b-values in the bilateral thalamus and striatum in MRI-negative drug-resistant epilepsy. Epilepsia Open 2024; 9:1515-1525. [PMID: 38943548 PMCID: PMC11296122 DOI: 10.1002/epi4.12990] [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] [Revised: 04/01/2024] [Accepted: 05/26/2024] [Indexed: 07/01/2024] Open
Abstract
OBJECTIVE Subcortical nuclei such as the thalamus and striatum have been shown to be related to seizure modulation and termination, especially in drug-resistant epilepsy. Enhance diffusion-weighted imaging (eDWI) technique and tri-component model have been used in previous studies to calculate apparent diffusion coefficient from ultra high b-values (ADCuh). This study aimed to explore the alterations of ADCuh in the bilateral thalamus and striatum in MRI-negative drug-resistant epilepsy. METHODS Twenty-nine patients with MRI-negative drug-resistant epilepsy and 18 healthy controls underwent eDWI scan with 15 b-values (0-5000 s/mm2). The eDWI parameters including standard ADC (ADCst), pure water diffusion (D), and ADCuh were calculated from the 15 b-values. Regions-of-interest (ROIs) analyses were conducted in the bilateral thalamus, caudate nucleus, putamen, and globus pallidus. ADCst, D, and ADCuh values were compared between the MRI-negative drug-resistant epilepsy patients and controls using multivariate generalized linear models. Inter-rater reliability was assessed using the intra-class correlation coefficient (ICC) and Bland-Altman (BA) analysis. False discovery rate (FDR) method was applied for multiple comparisons correction. RESULTS ADCuh values in the bilateral thalamus, caudate nucleus, putamen, and globus pallidus in MRI-negative drug-resistant epilepsy were significantly higher than those in the healthy control subjects (all p < 0.05, FDR corrected). SIGNIFICANCE The alterations of the ADCuh values in the bilateral thalamus and striatum in MRI-negative drug-resistant epilepsy might reflect abnormal membrane water permeability in MRI-negative drug-resistant epilepsy. ADCuh might be a sensitive measurement for evaluating subcortical nuclei-related brain damage in epilepsy patients. PLAIN LANGUAGE SUMMARY This study aimed to explore the alterations of apparent diffusion coefficient calculated from ultra high b-values (ADCuh) in the subcortical nuclei such as the bilateral thalamus and striatum in MRI-negative drug-resistant epilepsy. The bilateral thalamus and striatum showed higher ADCuh in epilepsy patients than healthy controls. These findings may add new evidences of subcortical nuclei abnormalities related to water and ion hemostasis in epilepsy patients, which might help to elucidate the underlying epileptic neuropathophysiological mechanisms and facilitate the exploration of therapeutic targets.
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Affiliation(s)
- Guixian Tang
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Hailing Zhou
- Department of RadiologyCentral People's Hospital of ZhanjiangZhanjiangChina
| | - Chunyuan Zeng
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Yuanfang Jiang
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Ying Li
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Lu Hou
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Kai Liao
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Zhiqiang Tan
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Huanhua Wu
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Yongjin Tang
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Yong Cheng
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Xueying Ling
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Qiang Guo
- Epilepsy Center, Guangdong 999 Brain HospitalAffiliated Brain Hospital of Jinan UniversityGuangzhouChina
| | - Hao Xu
- Department of Nuclear Medicine, PET/CT‐MRI Center, Center of Cyclotron and PET RadiopharmaceuticalsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
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Yamada N, Inoue T, Kuki I, Yamamoto N, Fukuoka M, Nukui M, Okuno H, Ishikawa J, Amo K, Togawa M, Sakuma H, Okazaki S. Higher incidence of acute symptomatic seizures in probable antibody-negative pediatric autoimmune encephalitis than in major antibody-positive autoimmune encephalitis. Front Neurol 2024; 15:1418083. [PMID: 39099783 PMCID: PMC11294254 DOI: 10.3389/fneur.2024.1418083] [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: 04/16/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose To delineate the characteristics of probable antibody-negative pediatric autoimmune encephalitis (probable Ab-negative AE), we compared the clinical features of probable Ab-negative AE to those of major antibody-positive AE. Methods We retrospectively reviewed the clinical features of 18 patients with probable Ab-negative AE, 13 with anti-N-methyl-D-aspartate receptor encephalitis (NMDARE), and 13 with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Clinical characteristics, neuroimaging findings, treatments, and outcomes were analyzed. Results The age of onset and length of hospital stay were significantly higher in the NMDARE group than in the other groups (p = 0.02 and p < 0.01). Regarding initial neurological symptoms, acute symptomatic seizures in the probable Ab-negative AE group (67%) were significantly more frequent than in the NMDARE (15%) and MOGAD (23%) groups (p < 0.01). Paraclinical evidence of neuroinflammation within 1 month of disease onset revealed that single-photon emission computed tomography (SPECT) detected abnormal alterations in 14/14 (100%), cerebrospinal fluid (CSF) analysis in 15/18 (83%), and magnetic resonance imaging (MRI) in 11/18 (61%) in patients with probable Ab-negative AE. In the probable Ab-negative AE group, seven patients (39%) developed autoimmune-associated epilepsy, whereas one patient (8%) had both NMDARE and MOGAD (not statistically significant, p = 0.07). Conclusion Patients with probable Ab-negative AE exhibited acute symptomatic seizures as initial neurological symptoms significantly more frequently. They developed autoimmune-associated epilepsy more frequently than those with NMDARE and MOGAD, which was not statistically significant. SPECT within 1 month of disease onset might be a valuable surrogate marker of ongoing neuroinflammation and neuronal dysfunction, even in patients with negative MRI findings.
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Affiliation(s)
- Naoki Yamada
- Department of Pediatric Neurology and Logopedics, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Inoue
- Department of Pediatric Neurology and Logopedics, Osaka City General Hospital, Osaka, Japan
| | - Ichiro Kuki
- Department of Pediatric Neurology and Logopedics, Osaka City General Hospital, Osaka, Japan
| | - Naohiro Yamamoto
- Department of Pediatric Neurology and Logopedics, Osaka City General Hospital, Osaka, Japan
| | - Masataka Fukuoka
- Department of Pediatric Neurology and Logopedics, Osaka City General Hospital, Osaka, Japan
| | - Megumi Nukui
- Department of Pediatric Neurology and Logopedics, Osaka City General Hospital, Osaka, Japan
| | - Hideo Okuno
- Department of Pediatric Emergency, Infectious Disease Internal Medicine, Osaka City General Hospital, Osaka, Japan
| | - Junichi Ishikawa
- Department of Pediatric Emergency, Infectious Disease Internal Medicine, Osaka City General Hospital, Osaka, Japan
| | - Kiyoko Amo
- Department of Pediatric Emergency, Infectious Disease Internal Medicine, Osaka City General Hospital, Osaka, Japan
| | - Masao Togawa
- Department of Pediatric Emergency, Infectious Disease Internal Medicine, Osaka City General Hospital, Osaka, Japan
| | - Hiroshi Sakuma
- Department of Brain and Neuroscience, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shin Okazaki
- Department of Pediatric Neurology and Logopedics, Osaka City General Hospital, Osaka, Japan
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Wan X, Zeng Y, Wang J, Tian M, Yin X, Zhang J. Structural and functional abnormalities and cognitive profiles in older adults with early-onset and late-onset focal epilepsy. Cereb Cortex 2024; 34:bhae300. [PMID: 39052362 DOI: 10.1093/cercor/bhae300] [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: 03/10/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
This study aimed to determine the patterns of changes in structure, function, and cognitive ability in early-onset and late-onset older adults with focal epilepsy (OFE). This study first utilized the deformation-based morphometry analysis to identify structural abnormalities, which were used as the seed region to investigate the functional connectivity with the whole brain. Next, a correlation analysis was performed between the altered imaging findings and neuropsychiatry assessments. Finally, the potential role of structural-functional abnormalities in the diagnosis of epilepsy was further explored by using mediation analysis. Compared with healthy controls (n = 28), the area of reduced structural volume was concentrated in the bilateral cerebellum, right thalamus, and right middle cingulate cortex, with frontal, temporal, and occipital lobes also affected in early-onset focal epilepsy (n = 26), while late-onset patients (n = 31) displayed cerebellar, thalamic, and cingulate atrophy. Furthermore, correlation analyses suggest an association between structural abnormalities and cognitive assessments. Dysfunctional connectivity in the cerebellum, cingulate cortex, and frontal gyrus partially mediates the relationship between structural abnormalities and the diagnosis of early-onset focal epilepsy. This study identified structural and functional abnormalities in early-onset and late-onset focal epilepsy and explored characters in cognitive performance. Structural-functional coupling may play a potential role in the diagnosis of epilepsy.
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Affiliation(s)
- Xinyue Wan
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
- Human Phenome Institute, Fudan University, Shanghai 201203, China
| | - Yanwei Zeng
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
| | - Jianhong Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Mei Tian
- Human Phenome Institute, Fudan University, Shanghai 201203, China
| | - Xuyang Yin
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Fudan University, Shanghai 200040, China
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Al-Redouan A, Salaj M, Kubova H, Druga R. Compartmental neuronal degeneration in the ventral striatum induced by status epilepticus in young rats' brain in comparison with adults. Int J Dev Neurosci 2024; 84:328-341. [PMID: 38631684 DOI: 10.1002/jdn.10331] [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: 11/09/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
According to experimental and clinical studies, status epilepticus (SE) causes neurodegenerative morphological changes not only in the hippocampus and other limbic structures, it also affects the thalamus and the neocortex. In addition, several studies reported atrophy, metabolic changes, and neuronal degeneration in the dorsal striatum. The literature lacks studies investigating potential neuronal damage in the ventral component of the striatopallidal complex (ventral striatum [VS] and ventral pallidum) in SE experimentations. To better understand the development of neuronal damage in the striatopallidal complex associated with SE, the detected neuronal degeneration in the compartments of the VS, namely, the nucleus accumbens (NAc) and the olfactory tubercle (OT), was analyzed. The experiments were performed on Wistar rats at age of 25-day-old pups and 3-month-old adult animals. Lithium-pilocarpine model of SE was used. Lithium chloride (3 mmol/kg, ip) was injected 24 h before administering pilocarpine (40 mg/kg, ip). This presented study demonstrates the variability of post SE neuronal damage in 25-day-old pups in comparison with 3-month-old adult rats. The NAc exhibited small to moderate number of Fluoro-Jade B (FJB)-positive neurons detected 4 and 8 h post SE intervals. The number of degenerated neurons in the shell subdivision of the NAc significantly increased at survival interval of 12 h after the SE. FJB-positive neurons were evidently more prominent occupying the whole anteroposterior and mediolateral extent of the nucleus at longer survival intervals of 24 and 48 h after the SE. This was also the case in the bordering vicinity between the shell and the core compartments but with clusters of degenerating cells. The severity of damage of the shell subdivision of the NAc reached its peak at an interval of 24 h post SE. Isolated FJB-positive neurons were detected in the ventral peripheral part of the core compartment. Degenerated neurons persisted in the shell subdivision of the NAc 1 week after SE. However, the quantity of cell damage had significantly reduced in comparison with the aforementioned shorter intervals. The third layer of the OT exhibited more degenerated neurons than the second layer. The FJB-positive cells in the young animals were higher than in the adult animals. The morphology of those cells was identical in the two age groups except in the OT.
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Affiliation(s)
- Azzat Al-Redouan
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Salaj
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Kubova
- Department of developmental Epileptology, Institute of Physiology, The Czech Academy of Sciences, Prague, Czech Republic
| | - Rastislav Druga
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of developmental Epileptology, Institute of Physiology, The Czech Academy of Sciences, Prague, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Cooper MS, Mackay MT, Shepherd DA, Dagia C, Fahey MC, Reddihough D, Reid SM, Harvey AS. Distinct manifestations and potential mechanisms of seizures due to cortical versus white matter injury in children. Epilepsy Res 2024; 199:107267. [PMID: 38113603 DOI: 10.1016/j.eplepsyres.2023.107267] [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: 07/03/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To study seizure manifestations and outcomes in children with cortical versus white matter injury, differences potentially explaining variability of epilepsy in children with cerebral palsy. METHODS In this population-based retrospective cohort study, MRIs of children with cerebral palsy due to ischemia or haemorrhage were classified according to presence or absence of cortical injury. MRI findings were then correlated with history of neonatal seizures, seizures during childhood, epilepsy syndromes, and seizure outcomes. RESULTS Of 256 children studied, neonatal seizures occurred in 57 and seizures during childhood occurred in 93. Children with neonatal seizures were more likely to develop seizures during childhood, mostly those with cortical injury. Cortical injury was more strongly associated with (1) developing seizures during childhood, (2) more severe epilepsy syndromes (infantile spasms syndrome, focal epilepsy, Lennox-Gastaut syndrome), and (3) less likelihood of reaching > 2 years without seizures at last follow-up, compared to children without cortical injury. Children without cortical injury, mainly those with white matter injury, were less likely to develop neonatal seizures and seizures during childhood, and when they did, epilepsy syndromes were more commonly febrile seizures and self-limited focal epilepsies of childhood, with most achieving > 2 years without seizures at last follow-up. The presence of cortical injury also influenced seizure occurrence, severity, and outcome within the different predominant injury patterns of the MRI Classification System in cerebral palsy, most notably white matter injury. CONCLUSIONS Epileptogenesis is understood with cortical injury but not well with white matter injury, the latter potentially related to altered postnatal white matter development or myelination leading to apoptosis, abnormal synaptogenesis or altered thalamic connectivity of cortical neurons. These findings, and the potential mechanisms discussed, likely explain the variability of epilepsy in children with cerebral palsy and epilepsy following early-life brain injury in general.
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Affiliation(s)
- Monica S Cooper
- Department of Neurodevelopment & Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia.
| | - Mark T Mackay
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia; Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Daisy A Shepherd
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Charuta Dagia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia; Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Dinah Reddihough
- Department of Neurodevelopment & Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Susan M Reid
- Department of Neurodevelopment & Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - A Simon Harvey
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia; Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Widdess-Walsh P. Resting But Not Idle: Insights Into Epilepsy Network Suppression From Intracranial EEG. Epilepsy Curr 2024; 24:25-27. [PMID: 38327528 PMCID: PMC10846507 DOI: 10.1177/15357597231213247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
The Interictal Suppression Hypothesis in Focal Epilepsy: Network-Level Supporting Evidence Johnson GW, Doss DJ, Morgan VL, Paulo DL, Cai LY, Shless JS, Negi AS, Gummadavelli A, Kang H, Reddy SB, Naftel RP, Bick SK, Williams Roberson S, Dawant BM, Wallace MT, Englot DJ. Brain . 2023;146(7):2828-2845. doi:10.1093/brain/awad016 Why are people with focal epilepsy not continuously having seizures? Previous neuronal signalling work has implicated gamma-aminobutyric acid balance as integral to seizure generation and termination, but is a high-level distributed brain network involved in suppressing seizures? Recent intracranial electrographic evidence has suggested that seizure-onset zones have increased inward connectivity that could be associated with interictal suppression of seizure activity. Accordingly, we hypothesize that seizure-onset zones are actively suppressed by the rest of the brain network during interictal states. Full testing of this hypothesis would require collaboration across multiple domains of neuroscience. We focused on partially testing this hypothesis at the electrographic network level within 81 individuals with drug-resistant focal epilepsy undergoing presurgical evaluation. We used intracranial electrographic resting-state and neurostimulation recordings to evaluate the network connectivity of seizure onset, early propagation and non-involved zones. We then used diffusion imaging to acquire estimates of white-matter connectivity to evaluate structure–function coupling effects on connectivity findings. Finally, we generated a resting-state classification model to assist clinicians in detecting seizure-onset and propagation zones without the need for multiple ictal recordings. Our findings indicate that seizure onset and early propagation zones demonstrate markedly increased inwards connectivity and decreased outwards connectivity using both resting-state (one-way ANOVA, P -value = 3.13 × 10−13) and neurostimulation analyses to evaluate evoked responses (one-way ANOVA, P -value = 2.5 × 10−3). When controlling for the distance between regions, the difference between inwards and outwards connectivity remained stable up to 80 mm between brain connections (two-way repeated measures ANOVA, group effect P -value of 2.6 × 10−12). Structure–function coupling analyses revealed that seizure-onset zones exhibit abnormally enhanced coupling (hypercoupling) of surrounding regions compared to presumably healthy tissue (two-way repeated measures ANOVA, interaction effect P -value of 9.76 × 10−21). Using these observations, our support vector classification models achieved a maximum held-out testing set accuracy of 92.0 ± 2.2% to classify early propagation and seizure-onset zones. These results suggest that seizure-onset zones are actively segregated and suppressed by a widespread brain network. Furthermore, this electrographically observed functional suppression is disproportionate to any observed structural connectivity alterations of the seizure-onset zones. These findings have implications for the identification of seizure-onset zones using only brief electrographic recordings to reduce patient morbidity and augment the presurgical evaluation of drug-resistant epilepsy. Further testing of the interictal suppression hypothesis can provide insight into potential new resective, ablative and neuromodulation approaches to improve surgical success rates in those suffering from drug-resistant focal epilepsy.
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Thompson SA. Kindling in humans: Does secondary epileptogenesis occur? Epilepsy Res 2023; 198:107155. [PMID: 37301727 DOI: 10.1016/j.eplepsyres.2023.107155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/01/2022] [Accepted: 04/25/2023] [Indexed: 06/12/2023]
Abstract
The relevance of secondary epileptogenesis for human epilepsy remains a controversial subject decades after it was first described in animal models. Whether or not a previously normal brain region can become independently epileptogenic through a kindling-like process has not, and cannot, be definitely proven in humans. Rather than reliance on direct experimental evidence, attempts to answering this question must depend on observational data. In this review, observations based largely upon contemporary surgical series will advance the case for secondary epileptogenesis in humans. As will be argued, hypothalamic hamartoma-related epilepsy provides the strongest case for this process; all the stages of secondary epileptogenesis can be observed. Hippocampal sclerosis (HS) is another pathology where the question of secondary epileptogenesis frequently arises, and observations from bitemporal and dual pathology series are explored. The verdict here is far more difficult to reach, in large part because of the scarcity of longitudinal cohorts; moreover, recent experimental data have challenged the claim that HS is acquired consequent to recurrent seizures. Synaptic plasticity more than seizure-induced neuronal injury is the likely mechanism of secondary epileptogenesis. Postoperative running-down phenomenon provides the best evidence that a kindling-like process occurs in some patients, evidenced by its reversal. Finally, a network perspective of secondary epileptogenesis is considered, as well as the possible role for subcortical surgical interventions.
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Affiliation(s)
- Stephen A Thompson
- Department of Medicine (Neurology), McMaster University, Hamilton, ON, Canada.
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Labate A, Bertino S, Morabito R, Smorto C, Militi A, Cammaroto S, Anfuso C, Tomaiuolo F, Tonin P, Marino S, Cerasa A, Quartarone A. MR-Guided Focused Ultrasound for Refractory Epilepsy: Where Are We Now? J Clin Med 2023; 12:7070. [PMID: 38002683 PMCID: PMC10672423 DOI: 10.3390/jcm12227070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Epilepsy is one of the most common neurological diseases in both adults and children. Despite improvements in medical care, 20 to 30% of patients are still resistant to the best medical treatment. The quality of life, neurologic morbidity, and even mortality of patients are significantly impacted by medically intractable epilepsy. Nowadays, conservative therapeutic approaches consist of increasing medication dosage, changing to a different anti-seizure drug as monotherapy, and combining different antiseizure drugs using an add-on strategy. However, such measures may not be sufficient to efficiently control seizure recurrence. Resective surgery, ablative procedures and non-resective neuromodulatory (deep-brain stimulation, vagus nerve stimulation) treatments are the available treatments for these kinds of patients. However, invasive procedures may involve lengthy inpatient stays for the patients, risks of long-term neurological impairment, general anesthesia, and other possible surgery-related complications (i.e., hemorrhage or infection). In the last few years, MR-guided focused ultrasound (MRgFUS) has been proposed as an emerging treatment for neurological diseases because of technological advancements and the goal of minimally invasive neurosurgery. By outlining the current knowledge obtained from both preclinical and clinical studies and discussing the technical opportunities of this therapy for particular epileptic phenotypes, in this perspective review, we explore the various mechanisms and potential applications (thermoablation, blood-brain barrier opening for drug delivery, neuromodulation) of high- and low-intensity ultrasound, highlighting possible novel strategies to treat drug-resistant epileptic patients who are not eligible or do not accept currently established surgical approaches. Taken together, the available studies support a possible role for lesional treatment over the anterior thalamus with high-intensity ultrasound and neuromodulation of the hippocampus via low-intensity ultrasound in refractory epilepsy. However, more studies, likely conceiving epilepsy as a network disorder and bridging together different scales and modalities, are required to make ultrasound delivery strategies meaningful, effective, and safe.
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Affiliation(s)
- Angelo Labate
- Neurophysiopathology and Movement Disorders Unit, BIOMORF Department, University of Messina, 98124 Messina, Italy;
| | - Salvatore Bertino
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (S.B.); (F.T.)
| | - Rosa Morabito
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (C.S.); (A.M.); (S.C.); (C.A.); (S.M.); (A.Q.)
| | - Chiara Smorto
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (C.S.); (A.M.); (S.C.); (C.A.); (S.M.); (A.Q.)
| | - Annalisa Militi
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (C.S.); (A.M.); (S.C.); (C.A.); (S.M.); (A.Q.)
| | - Simona Cammaroto
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (C.S.); (A.M.); (S.C.); (C.A.); (S.M.); (A.Q.)
| | - Carmelo Anfuso
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (C.S.); (A.M.); (S.C.); (C.A.); (S.M.); (A.Q.)
| | - Francesco Tomaiuolo
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (S.B.); (F.T.)
| | | | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (C.S.); (A.M.); (S.C.); (C.A.); (S.M.); (A.Q.)
| | - Antonio Cerasa
- S.Anna Institute, 88900 Crotone, Italy;
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
| | - Angelo Quartarone
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (C.S.); (A.M.); (S.C.); (C.A.); (S.M.); (A.Q.)
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Xiao F, Caciagli L, Wandschneider B, Sone D, Young AL, Vos SB, Winston GP, Zhang Y, Liu W, An D, Kanber B, Zhou D, Sander JW, Thom M, Duncan JS, Alexander DC, Galovic M, Koepp MJ. Identification of different MRI atrophy progression trajectories in epilepsy by subtype and stage inference. Brain 2023; 146:4702-4716. [PMID: 37807084 PMCID: PMC10629797 DOI: 10.1093/brain/awad284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/30/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Artificial intelligence (AI)-based tools are widely employed, but their use for diagnosis and prognosis of neurological disorders is still evolving. Here we analyse a cross-sectional multicentre structural MRI dataset of 696 people with epilepsy and 118 control subjects. We use an innovative machine-learning algorithm, Subtype and Stage Inference, to develop a novel data-driven disease taxonomy, whereby epilepsy subtypes correspond to distinct patterns of spatiotemporal progression of brain atrophy.In a discovery cohort of 814 individuals, we identify two subtypes common to focal and idiopathic generalized epilepsies, characterized by progression of grey matter atrophy driven by the cortex or the basal ganglia. A third subtype, only detected in focal epilepsies, was characterized by hippocampal atrophy. We corroborate external validity via an independent cohort of 254 people and confirm that the basal ganglia subtype is associated with the most severe epilepsy.Our findings suggest fundamental processes underlying the progression of epilepsy-related brain atrophy. We deliver a novel MRI- and AI-guided epilepsy taxonomy, which could be used for individualized prognostics and targeted therapeutics.
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Affiliation(s)
- Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
| | - Daichi Sone
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, 105-8461, Japan
| | - Alexandra L Young
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Sjoerd B Vos
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
- Centre for Microscopy, Characterisation, and Analysis, University of Western Australia, Perth, WA 6009, Australia
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, K7L 3N6, Canada
- Centre for Neuroscience Studies, Queen’s University, Kingston, K7L 3N6, Canada
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wenyu Liu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Dongmei An
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Baris Kanber
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
- Stichting Epilepsie Instellingen Nederland – (SEIN), Heemstede, 2103SW, The Netherlands
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, CH-8091, Switzerland
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
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10
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Denis C, Dabbs K, Nair VA, Mathis J, Almane DN, Lakshmanan A, Nencka A, Birn RM, Conant L, Humphries C, Felton E, Raghavan M, DeYoe EA, Binder JR, Hermann B, Prabhakaran V, Bendlin BB, Meyerand ME, Boly M, Struck AF. T1-/T2-weighted ratio reveals no alterations to gray matter myelination in temporal lobe epilepsy. Ann Clin Transl Neurol 2023; 10:2149-2154. [PMID: 37872734 PMCID: PMC10647008 DOI: 10.1002/acn3.51653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/29/2022] [Accepted: 06/09/2022] [Indexed: 10/25/2023] Open
Abstract
Short-range functional connectivity in the limbic network is increased in patients with temporal lobe epilepsy (TLE), and recent studies have shown that cortical myelin content correlates with fMRI connectivity. We thus hypothesized that myelin may increase progressively in the epileptic network. We compared T1w/T2w gray matter myelin maps between TLE patients and age-matched controls and assessed relationships between myelin and aging. While both TLE patients and healthy controls exhibited increased T1w/T2w intensity with age, we found no evidence for significant group-level aberrations in overall myelin content or myelin changes through time in TLE.
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Affiliation(s)
- Colin Denis
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Kevin Dabbs
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Veena A. Nair
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Jedidiah Mathis
- Department of RadiologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Dace N. Almane
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | | | - Andrew Nencka
- Department of RadiologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Rasmus M. Birn
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of PsychiatryUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Lisa Conant
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Colin Humphries
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Elizabeth Felton
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Manoj Raghavan
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Edgar A. DeYoe
- Department of RadiologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Jeffrey R. Binder
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Bruce Hermann
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Vivek Prabhakaran
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Barbara B. Bendlin
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Mary E. Meyerand
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Biomedical EngineeringUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Mélanie Boly
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of PsychiatryUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Aaron F. Struck
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S. Middleton Veterans Administration HospitalMadisonWisconsinUSA
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11
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Poprelka K, Patrikelis P, Takousi M, Messinis L, Fasilis T, Margariti S, Ntinopoulou E, Verentzioti A, Stefanatou M, Alexoudi A, Korfias S, Zalonis I, Gatzonis S. Arousal deregulation in the co-shaping of neuropsychological dysfunction in frontal and mesial temporal lobe epilepsy. Epilepsy Res 2023; 194:107189. [PMID: 37421714 DOI: 10.1016/j.eplepsyres.2023.107189] [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: 03/02/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Our work aims to investigate the role of physiological arousal in the expression of neuropsychological deficits in frontal lobe epilepsy (FLE) and mesial temporal lobe epilepsy (mTLE), by drawing on the Lurian theory of brain function. METHODS For this study a total of 43 patients with focal onset epilepsy has been taken; twenty-four patients with FLE, 19 patients with mTLE and 26 healthy controls, all matched for age and education. Participants underwent a comprehensive neuropsychological assessment including various cognitive domains, such as attention, episodic memory, speed of information processing, response inhibition and mental flexibility, working memory, verbal fluency (phonological & semantic). RESULTS There were no significant differences between FLE and mTLE patients in terms of neuropsychological performance. However, both FLE and mTLE patients showed significantly worse performance in several cognitive domains than HCs. The results seem to support our hypothesis that aberrant physiological arousal, as reflected in patients' worse performance in vigilance and attention, response inhibition, and processing speed, along with other disease-specific variables, may co-determine neuropsychological dysfunction and/or impairment in both FLE and mTLE. CONCLUSION Identifying a differential arousal-related neuropsychological affection in FLE and mTLE, among the known deleterious effects of the functional deficit zone and other disease-related variables, may further our understanding of the underlying cognitive-pathophysiological mechanisms in focal epilepsy syndromes.
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Affiliation(s)
- Katerina Poprelka
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece.
| | - Panayiotis Patrikelis
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece; Laboratory of Cognitive Neuroscience, Department of Psychology, Aristotle University of Thessaloniki, Greece
| | - Maria Takousi
- School of Health Sciences, Metropolitan College, Athens, Greece
| | - Lambros Messinis
- Laboratory of Cognitive Neuroscience, Department of Psychology, Aristotle University of Thessaloniki, Greece
| | - Theodoros Fasilis
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece
| | - Sofia Margariti
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece
| | - Evniki Ntinopoulou
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece
| | - Anastasia Verentzioti
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece
| | - Maria Stefanatou
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece
| | - Athanasia Alexoudi
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece
| | - Stefanos Korfias
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece
| | - Ioannis Zalonis
- Aeginition Hospital, Medical School, National & Kapodistrian University of Athens, Neuropsychological Laboratory, 1st Department of Neurology, Greece
| | - Stylianos Gatzonis
- 1st Department of Neurosurgery, National & Kapodistrian University of Athens, Greece
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12
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Englot DJ. Networks Inhibited and Networks Excited: Loss of Consciousness in Epilepsy. Epilepsy Curr 2023; 23:217-219. [PMID: 37662463 PMCID: PMC10470105 DOI: 10.1177/15357597231166203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Distinct Signatures of Loss of Consciousness in Focal Impaired Awareness Versus Tonic-Clonic Seizures Juan E, Górska U, Kozma C, Papantonatos C, Bugnon T, Denis C, Kremen V, Worrell G, Struck AF, Bateman LM, Merricks EM, Blumenfeld H, Tononi G, Schevon C, Boly M. Brain . 20235;146(1):109-123. doi:10.1093/brain/awac291 Loss of consciousness is a hallmark of many epileptic seizures and carries risks of serious injury and sudden death. While cortical sleep-like activities accompany loss of consciousness during focal impaired awareness seizures, the mechanisms of loss of consciousness during focal to bilateral tonic-clonic seizures remain unclear. Quantifying differences in markers of cortical activation and ictal recruitment between focal impaired awareness and focal to bilateral tonic-clonic seizures may also help us to understand their different consequences for clinical outcomes and to optimize neuromodulation therapies. We quantified clinical signs of loss of consciousness and intracranial EEG activity during 129 focal impaired awareness and 50 focal to bilateral tonic-clonic from 41 patients. We characterized intracranial EEG changes both in the seizure onset zone and in areas remote from the seizure onset zone with a total of 3386 electrodes distributed across brain areas. First, we compared the dynamics of intracranial EEG sleep-like activities: slow-wave activity (1-4 Hz) and beta/delta ratio (a validated marker of cortical activation) during focal impaired awareness versus focal to bilateral tonic-clonic. Second, we quantified differences between focal to bilateral tonic-clonic and focal impaired awareness for a marker validated to detect ictal cross-frequency coupling: phase-locked high gamma (high-gamma phased-locked to low frequencies) and a marker of ictal recruitment: the epileptogenicity index. Third, we assessed changes in intracranial EEG activity preceding and accompanying behavioural generalization onset and their correlation with electromyogram channels. In addition, we analysed human cortical multi-unit activity recorded with Utah arrays during three focal to bilateral tonic-clonic seizures. Compared to focal impaired awareness, focal to bilateral tonic-clonic seizures were characterized by deeper loss of consciousness, even before generalization occurred. Unlike during focal impaired awareness, early loss of consciousness before generalization was accompanied by paradoxical decreases in slow-wave activity and by increases in high-gamma activity in parieto-occipital and temporal cortex. After generalization, when all patients displayed loss of consciousness, stronger increases in slow-wave activity were observed in parieto-occipital cortex, while more widespread increases in cortical activation (beta/delta ratio), ictal cross-frequency coupling (phase-locked high gamma) and ictal recruitment (epileptogenicity index). Behavioural generalization coincided with a whole-brain increase in high-gamma activity, which was especially synchronous in deep sources and could not be explained by EMG. Similarly, multi-unit activity analysis of focal to bilateral tonic-clonic revealed sustained increases in cortical firing rates during and after generalization onset in areas remote from the seizure onset zone. Overall, these results indicate that unlike during focal impaired awareness, the neural signatures of loss of consciousness during focal to bilateral tonic-clonic consist of paradoxical increases in cortical activation and neuronal firing found most consistently in posterior brain regions. These findings suggest differences in the mechanisms of ictal loss of consciousness between focal impaired awareness and focal to bilateral tonic-clonic and may account for the more negative prognostic consequences of focal to bilateral tonic-clonic.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center
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13
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van Noort SAM, van der Veen S, de Koning TJ, de Koning-Tijssen MAJ, Verbeek DS, Sival DA. Early onset ataxia with comorbid myoclonus and epilepsy: A disease spectrum with shared molecular pathways and cortico-thalamo-cerebellar network involvement. Eur J Paediatr Neurol 2023; 45:47-54. [PMID: 37301083 DOI: 10.1016/j.ejpn.2023.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Early onset ataxia (EOA) concerns a heterogeneous disease group, often presenting with other comorbid phenotypes such as myoclonus and epilepsy. Due to genetic and phenotypic heterogeneity, it can be difficult to identify the underlying gene defect from the clinical symptoms. The pathological mechanisms underlying comorbid EOA phenotypes remain largely unknown. The aim of this study is to investigate the key pathological mechanisms in EOA with myoclonus and/or epilepsy. METHODS For 154 EOA-genes we investigated (1) the associated phenotype (2) reported anatomical neuroimaging abnormalities, and (3) functionally enriched biological pathways through in silico analysis. We assessed the validity of our in silico results by outcome comparison to a clinical EOA-cohort (80 patients, 31 genes). RESULTS EOA associated gene mutations cause a spectrum of disorders, including myoclonic and epileptic phenotypes. Cerebellar imaging abnormalities were observed in 73-86% (cohort and in silico respectively) of EOA-genes independently of phenotypic comorbidity. EOA phenotypes with comorbid myoclonus and myoclonus/epilepsy were specifically associated with abnormalities in the cerebello-thalamo-cortical network. EOA, myoclonus and epilepsy genes shared enriched pathways involved in neurotransmission and neurodevelopment both in the in silico and clinical genes. EOA gene subgroups with myoclonus and epilepsy showed specific enrichment for lysosomal and lipid processes. CONCLUSIONS The investigated EOA phenotypes revealed predominantly cerebellar abnormalities, with thalamo-cortical abnormalities in the mixed phenotypes, suggesting anatomical network involvement in EOA pathogenesis. The studied phenotypes exhibit a shared biomolecular pathogenesis, with some specific phenotype-dependent pathways. Mutations in EOA, epilepsy and myoclonus associated genes can all cause heterogeneous ataxia phenotypes, which supports exome sequencing with a movement disorder panel over conventional single gene panel testing in the clinical setting.
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Affiliation(s)
- Suus A M van Noort
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sterre van der Veen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Tom J de Koning
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pediatrics, University Medical Center Groningen, Groningen, the Netherlands; Pediatrics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marina A J de Koning-Tijssen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Dineke S Verbeek
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Genetics, University Medical Center Groningen, Groningen, the Netherlands
| | - Deborah A Sival
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands.
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14
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Ishizaki T, Maesawa S, Nakatsubo D, Yamamoto H, Torii J, Mutoh M, Natsume J, Hoshiyama M, Saito R. Connectivity alteration in thalamic nuclei and default mode network-related area in memory processes in mesial temporal lobe epilepsy using magnetoencephalography. Sci Rep 2023; 13:10632. [PMID: 37391474 PMCID: PMC10313774 DOI: 10.1038/s41598-023-37834-2] [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: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 07/02/2023] Open
Abstract
This work aimed to investigate the involvement of the thalamic nuclei in mesial temporal lobe epilepsy (MTLE) and identify the influence of interictal epileptic discharges on the neural basis of memory processing by evaluating the functional connectivity (FC) between the thalamic nuclei and default mode network-related area (DMNRA) using magnetoencephalography. Preoperative datasets of nine patients with MTLE with seizure-free status after surgery and those of nine healthy controls were analyzed. The FC between the thalamic nuclei (anterior nucleus [ANT], mediodorsal nucleus [MD], intralaminar nuclei [IL]), hippocampus, and DMNRA was examined for each of the resting, pre-spike, spike, and post-spike periods in the delta to ripple bands using magnetoencephalography. The FC between the ANT, MD, hippocampus, and medial prefrontal cortex increased in the gamma to ripple bands, whereas the FC between the ANT, IL, and DMNRA decreased in the delta to beta bands, compared with that of the healthy controls at rest. Compared with the rest period, the pre-spike period had significantly decreased FC between the ANT, MD, and DMNRA in the ripple band. Different FC changes between the thalamic nuclei, hippocampus, and DMNRA of specific connections in a particular band may reflect impairment or compensation in the memory processes.
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Affiliation(s)
- Tomotaka Ishizaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan.
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan.
| | - Daisuke Nakatsubo
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Hiroyuki Yamamoto
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Jun Torii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Manabu Mutoh
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Jun Natsume
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Minoru Hoshiyama
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
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15
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Zheng J, Yang Q, Makris N, Huang K, Liang J, Ye C, Yu X, Tian M, Ma T, Mou T, Guo W, Kikinis R, Gao Y. Three-Dimensional Digital Reconstruction of the Cerebellar Cortex: Lobule Thickness, Surface Area Measurements, and Layer Architecture. CEREBELLUM (LONDON, ENGLAND) 2023; 22:249-260. [PMID: 35286708 PMCID: PMC9470778 DOI: 10.1007/s12311-022-01390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
The cerebellum is ontogenetically one of the first structures to develop in the central nervous system; nevertheless, it has been only recently reconsidered for its significant neurobiological, functional, and clinical relevance in humans. Thus, it has been a relatively under-studied compared to the cerebrum. Currently, non-invasive imaging modalities can barely reach the necessary resolution to unfold its entire, convoluted surface, while only histological analyses can reveal local information at the micrometer scale. Herein, we used the BigBrain dataset to generate area and point-wise thickness measurements for all layers of the cerebellar cortex and for each lobule in particular. We found that the overall surface area of the cerebellar granular layer (including Purkinje cells) was 1,732 cm2 and the molecular layer was 1,945 cm2. The average thickness of the granular layer is 0.88 mm (± 0.83) and that of the molecular layer is 0.32 mm (± 0.08). The cerebellum (both granular and molecular layers) is thicker at the depth of the sulci and thinner at the crowns of the gyri. Globally, the granular layer is thicker in the lateral-posterior-inferior region than the medial-superior regions. The characterization of individual layers in the cerebellum achieved herein represents a stepping-stone for investigations interrelating structural and functional connectivity with cerebellar architectonics using neuroimaging, which is a matter of considerable relevance in basic and clinical neuroscience. Furthermore, these data provide templates for the construction of cerebellar topographic maps and the precise localization of structural and functional alterations in diseases affecting the cerebellum.
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Affiliation(s)
- Junxiao Zheng
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Qinzhu Yang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Nikos Makris
- Center for Morphometric Analysis, Departments of Psychiatry, Neurology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Department of Anatomy and Neurobiology, Boston University Medical School, Boston, USA
| | - Kaibin Huang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Jianwen Liang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Chenfei Ye
- Pengcheng Lab, Shenzhen, Guangdong, China
| | - Xiaxia Yu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Mu Tian
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Ting Ma
- Pengcheng Lab, Shenzhen, Guangdong, China
- Department of Electronic and Information Engineering, Harbin Institute of Technology Campus, Shenzhen, Guangdong, China
| | - Tian Mou
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Wenlong Guo
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Yi Gao
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China.
- Pengcheng Lab, Shenzhen, Guangdong, China.
- Marshall Laboratory of Biomedical Engineering, Shenzhen, Guangdong, China.
- Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen, Guangdong, China.
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La Rocca M, Barisano G, Garner R, Ruf SF, Amoroso N, Monti M, Vespa P, Bellotti R, Erdoğmuş D, Toga AW, Duncan D. Functional connectivity alterations in traumatic brain injury patients with late seizures. Neurobiol Dis 2023; 179:106053. [PMID: 36871641 DOI: 10.1016/j.nbd.2023.106053] [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: 07/01/2022] [Revised: 01/24/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023] Open
Abstract
PTE is a neurological disorder characterized by recurrent and spontaneous epileptic seizures. PTE is a major public health problem occurring in 2-50% of TBI patients. Identifying PTE biomarkers is crucial for the development of effective treatments. Functional neuroimaging studies in patients with epilepsy and in epileptic rodents have observed that abnormal functional brain activity plays a role in the development of epilepsy. Network representations of complex systems ease quantitative analysis of heterogeneous interactions within a unified mathematical framework. In this work, graph theory was used to study resting state functional magnetic resonance imaging (rs-fMRI) and reveal functional connectivity abnormalities that are associated with seizure development in traumatic brain injury (TBI) patients. We examined rs-fMRI of 75 TBI patients from Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx) which aims to identify validated Post-traumatic epilepsy (PTE) biomarkers and antiepileptogenic therapies using multimodal and longitudinal data acquired from 14 international sites. The dataset includes 28 subjects who had at least one late seizure after TBI and 47 subjects who had no seizures within 2 years post-injury. Each subject's neural functional network was investigated by computing the correlation between the low frequency time series of 116 regions of interest (ROIs). Each subject's functional organization was represented as a network consisting of nodes, brain regions, and edges that show the relationship between the nodes. Then, several graph measures concerning the integration and the segregation of the functional brain networks were extracted in order to highlight changes in functional connectivity between the two TBI groups. Results showed that the late seizure-affected group had a compromised balance between integration and segregation and presents functional networks that are hyperconnected, hyperintegrated but at the same time hyposegregated compared with seizure-free patients. Moreover, TBI subjects who developed late seizures had more low betweenness hubs.
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Affiliation(s)
- Marianna La Rocca
- Dipartimento Interateneo di Fisica M. Merlin, Universitá degli Studi di Bari A. Moro, Bari, Italy; Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA; Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Italy.
| | - Giuseppe Barisano
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Rachael Garner
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Sebastian F Ruf
- Cognitive Systems Laboratory, ECE Department, Northeastern University, Boston, MA, USA
| | - Nicola Amoroso
- Dipartimento di Farmacia - Scienze del Farmaco, Università degli studi di Bari A. Moro, Bari, Italy; Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Italy
| | - Martin Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Paul Vespa
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Roberto Bellotti
- Dipartimento Interateneo di Fisica M. Merlin, Universitá degli Studi di Bari A. Moro, Bari, Italy; Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Italy
| | - Deniz Erdoğmuş
- Cognitive Systems Laboratory, ECE Department, Northeastern University, Boston, MA, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Dominique Duncan
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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17
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Waafi AK, Husna M, Damayanti R, Setijowati N. Clinical risk factors related to post-stroke epilepsy patients in Indonesia: a hospital-based study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Stroke had been accounted to cause almost 50% of epilepsy in the elderly and may lead to poor functional outcomes. Many studies examining the risk factors have been conducted despite showing inconsistent results and currently still difficult to predict the occurrence of post-stroke epilepsy. The study aimed to determine risk factors related to post-stroke epilepsy that influence clinical seizure, electroencephalography (EEG), and functional outcome of patients. Analytic retrospective case–control study was conducted with a total sampling of 62 samples of post-stroke epilepsy and 62 samples of control from all stroke patients in the Neurology Clinic from January 2019 to December 2021. Epilepsy was classified according to the criteria of the International League Against Epilepsy (ILAE) in 2017. The relevant demographic and clinical data were collected.
Result
The study involved 62 patients in the case group (average age of onset = 57.69; 42 men, 20 women; 51 ischemic stroke, 11 hemorrhagic stroke) and 62 patients in the control group (average age of onset = 56.90; 24 men, 38 women; 52 ischemic stroke, 10 hemorrhagic stroke). We found that 31 patients had focal-to-bilateral seizures, 26 patients had generalized seizures and 5 patients had focal seizures. Men (p = 0.001; OR 3.325) and NIHSS Score (p = 0.027; OR 5.094) had significant correlations with post-stroke epilepsy. Ischemic stroke had a significant correlation (p = 0.008) with seizure onset. Women also had a significant correlation (p = 0.012) with EEG abnormalities. The study found that 59 of 62 post-stroke epilepsy patients had poor functional outcomes (mRS > 2).
Conclusion
Our study confirmed that most patients had focal-to-bilateral seizure patterns that occurred in 1–2 years after stroke, and had poor functional outcomes. Men had 3.325 times more likely to develop post-stroke epilepsy than women. Also, NIHSS score ≥ 15 correlated and 5.094 times more likely to develop post-stroke epilepsy. Ischemic stroke had a peak of epilepsy onset at 1–2 years after stroke and women had significant showing abnormalities on EEG recording than men.
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18
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Du X, Wei L, Yang B, Long S, Wang J, Sun A, Jiang Y, Qiao Z, Wang H, Wang Y. Cortical and subcortical morphological alteration in Angelman syndrome. J Neurodev Disord 2023; 15:7. [PMID: 36788499 PMCID: PMC9930225 DOI: 10.1186/s11689-022-09469-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/28/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Angelman syndrome (AS) is a neurodevelopmental disorder with serious seizures. We aim to explore the brain morphometry of patients with AS and figure out whether the seizure is associated with brain development. METHODS Seventy-three patients and 26 healthy controls (HC) underwent high-resolution structural brain MRI. Group differences between the HC group and the AS group and also between AS patients with seizure (AS-Se) and age-matched AS patients with non-seizure (AS-NSe) were compared. The voxel-based and surface-based morphometry analyses were used in our study. Gray matter volume, cortical thickness (CTH), and local gyrification index (LGI) were assessed to analyze the cortical and subcortical structure alteration in the AS brain. RESULTS Firstly, compared with the HC group, children with AS were found to have a significant decrease in gray matter volume in the subcortical nucleus, cortical, and cerebellum. However, the gray matter volume of AS patients in the inferior precuneus was significantly increased. Secondly, patients with AS had significantly increased LGI in the whole brain as compared with HC. Thirdly, the comparison of AS-Se and the AS-NSe groups revealed a significant decrease in caudate volume in the AS-Se group. Lastly, we further selected the caudate and the precuneus as ROIs for volumetric analysis, the AS group showed significantly increased LGI in the precuneus and reduced CTH in the right precuneus. Between the AS-Se and the AS-NSe groups, the AS-Se group exhibited significantly lower density in the caudate, while only the CTH in the left precuneus showed a significant difference. CONCLUSIONS These results revealed cortical and subcortical morphological alterations in patients with AS, including globally the decreased brain volume in the subcortical nucleus, the increased gray matter volume of precuneus, and the whole-brain increase of LGI and reduction of CTH. The abnormal brain pattern was more serious in patients with seizures, suggesting that the occurrence of seizures may be related to abnormal brain changes.
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Affiliation(s)
- Xiaonan Du
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.,Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Lei Wei
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Baofeng Yang
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Shasha Long
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ji Wang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Aiqi Sun
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Yonghui Jiang
- Department of Genetics and Paediatrics, Yale School of Medicine, CT, New Haven, China
| | - Zhongwei Qiao
- Department of Radiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - He Wang
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China. .,Human Phenome Institute, Fudan University, Shanghai, China. .,Key Laboratory of Computational Neuroscience and BrainInspired Intelligence (Fudan University), Ministry of Education, Shanghai, USA.
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Arnts H, Coolen SE, Fernandes FW, Schuurman R, Krauss JK, Groenewegen HJ, van den Munckhof P. The intralaminar thalamus: a review of its role as a target in functional neurosurgery. Brain Commun 2023; 5:fcad003. [PMID: 37292456 PMCID: PMC10244065 DOI: 10.1093/braincomms/fcad003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/06/2022] [Accepted: 01/03/2023] [Indexed: 09/29/2023] Open
Abstract
The intralaminar thalamus, in particular the centromedian-parafascicular complex, forms a strategic node between ascending information from the spinal cord and brainstem and forebrain circuitry that involves the cerebral cortex and basal ganglia. A large body of evidence shows that this functionally heterogeneous region regulates information transmission in different cortical circuits, and is involved in a variety of functions, including cognition, arousal, consciousness and processing of pain signals. Not surprisingly, the intralaminar thalamus has been a target area for (radio)surgical ablation and deep brain stimulation (DBS) in different neurological and psychiatric disorders. Historically, ablation and stimulation of the intralaminar thalamus have been explored in patients with pain, epilepsy and Tourette syndrome. Moreover, DBS has been used as an experimental treatment for disorders of consciousness and a variety of movement disorders. In this review, we provide a comprehensive analysis of the underlying mechanisms of stimulation and ablation of the intralaminar nuclei, historical clinical evidence, and more recent (experimental) studies in animals and humans to define the present and future role of the intralaminar thalamus as a target in the treatment of neurological and psychiatric disorders.
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Affiliation(s)
- Hisse Arnts
- Department of Neurosurgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stan E Coolen
- Department of Neurosurgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | | | - Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Henk J Groenewegen
- Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
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20
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Huels ER, Kafashan M, Hickman LB, Ching S, Lin N, Lenze EJ, Farber NB, Avidan MS, Hogan RE, Palanca BJA. Central-positive complexes in ECT-induced seizures: Possible evidence for thalamocortical mechanisms. Clin Neurophysiol 2023; 146:77-86. [PMID: 36549264 PMCID: PMC10273093 DOI: 10.1016/j.clinph.2022.11.015] [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: 05/04/2022] [Revised: 10/20/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Central-positive complexes (CPCs) are elicited during electroconvulsive therapy (ECT) as generalized high-amplitude waveforms with maximum positive voltage over the vertex. While these complexes have been qualitatively assessed in previous literature, quantitative analyses are lacking. This study aims to characterize CPCs across temporal, spatial, and spectral domains. METHODS High-density 64-electrode electroencephalogram (EEG) recordings during 50 seizures acquired from 11 patients undergoing right unilateral ECT allowed for evaluation of spatiotemporal characteristics of CPCs via source localization and spectral analysis. RESULTS Peak-amplitude CPC scalp topology was consistent across seizures, showing maximal positive polarity over the midline fronto-central region and maximal negative polarity over the suborbital regions. The sources of these peak potentials were localized to the bilateral medial thalamus and cingulate cortical regions. Delta, beta, and gamma oscillations were correlated with the peak amplitude of CPCs during seizures induced during ketamine, whereas delta and gamma oscillations were associated with CPC peaks during etomidate anesthesia (excluding the dose-charge titration). CONCLUSIONS Our findings demonstrate the consistency of CPC presence across participant, stimulus charge, time, and anesthetic agent, with peaks localized to bilateral medial thalamus and cingulate cortical regions and associated with delta, beta, and gamma band oscillations (depending on the anesthetic condition). SIGNIFICANCE The consistency and reproducibility of CPCs offers ECT as a new avenue for studying the dynamics of generalized seizure activity and thalamocortical networks.
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Affiliation(s)
- Emma R Huels
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Center for Consciousness Science, University of Michigan, Ann Arbor, MI, USA
| | - MohammadMehdi Kafashan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - L Brian Hickman
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - ShiNung Ching
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Nan Lin
- Department of Mathematics and Statistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Nuri B Farber
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - R Edward Hogan
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Ben Julian A Palanca
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Neuroimaging Labs Research Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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21
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Froula JM, Hastings SD, Krook-Magnuson E. The little brain and the seahorse: Cerebellar-hippocampal interactions. Front Syst Neurosci 2023; 17:1158492. [PMID: 37034014 PMCID: PMC10076554 DOI: 10.3389/fnsys.2023.1158492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
There is a growing appreciation for the cerebellum beyond its role in motor function and accumulating evidence that the cerebellum and hippocampus interact across a range of brain states and behaviors. Acute and chronic manipulations, simultaneous recordings, and imaging studies together indicate coordinated coactivation and a bidirectional functional connectivity relevant for various physiological functions, including spatiotemporal processing. This bidirectional functional connectivity is likely supported by multiple circuit paths. It is also important in temporal lobe epilepsy: the cerebellum is impacted by seizures and epilepsy, and modulation of cerebellar circuitry can be an effective strategy to inhibit hippocampal seizures. This review highlights some of the recent key hippobellum literature.
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22
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Yin Y, Wang F, Ma Y, Yang J, Li R, Li Y, Wang J, Liu H. Structural and functional changes in drug-naïve benign childhood epilepsy with centrotemporal spikes and their associated gene expression profiles. Cereb Cortex 2022; 33:5774-5782. [PMID: 36444721 PMCID: PMC10183734 DOI: 10.1093/cercor/bhac458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/30/2022] Open
Abstract
Abstract
Benign epilepsy with centrotemporal spikes (BECTS) is a common pediatric epilepsy syndrome that has been widely reported to show abnormal brain structure and function. However, the genetic mechanisms underlying structural and functional changes remain largely unknown. Based on the structural and resting-state functional magnetic resonance imaging data of 22 drug-naïve children with BECTS and 33 healthy controls, we conducted voxel-based morphology (VBM) and fractional amplitude of low-frequency fluctuation (fALFF) analyses to compare cortical morphology and spontaneous brain activity between the 2 groups. In combination with the Allen Human Brain Atlas, transcriptome-neuroimaging spatial correlation analyses were applied to explore gene expression profiles associated with gray matter volume (GMV) and fALFF changes in BECTS. VBM analysis demonstrated significantly increased GMV in the right brainstem and right middle cingulate gyrus in BECTS. Moreover, children with BECTS exhibited significantly increased fALFF in left temporal pole, while decreased fALFF in right thalamus and left precuneus. These brain structural and functional alterations were closely related to behavioral and cognitive deficits, and the fALFF-linked gene expression profiles were enriched in voltage-gated ion channel and synaptic activity as well as neuron projection. Our findings suggest that brain morphological and functional abnormalities in children with BECTS involve complex polygenic genetic mechanisms.
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Affiliation(s)
- Yu Yin
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province , Zunyi 563003 , China
| | - Fuqin Wang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province , Zunyi 563003 , China
| | - Yingzi Ma
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology , Kunming 650500 , China
- Yunnan Key Laboratory of Primate Biomedical Research , Kunming 650500, Yunnan , China
| | - Jia Yang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology , Kunming 650500 , China
- Yunnan Key Laboratory of Primate Biomedical Research , Kunming 650500, Yunnan , China
| | - Rui Li
- School of Electrical Engineering and Electronic Information, Xihua University , Chengdu 610039 , China
| | - Yuanyuan Li
- School of Life Science and Technology, University of Electronic Science and Technology of China , Chengdu 625014 , China
| | - Jiaojian Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology , Kunming 650500 , China
- Yunnan Key Laboratory of Primate Biomedical Research , Kunming 650500, Yunnan , China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province , Zunyi 563003 , China
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23
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Piper RJ, Richardson RM, Worrell G, Carmichael DW, Baldeweg T, Litt B, Denison T, Tisdall MM. Towards network-guided neuromodulation for epilepsy. Brain 2022; 145:3347-3362. [PMID: 35771657 PMCID: PMC9586548 DOI: 10.1093/brain/awac234] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/30/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
Epilepsy is well-recognized as a disorder of brain networks. There is a growing body of research to identify critical nodes within dynamic epileptic networks with the aim to target therapies that halt the onset and propagation of seizures. In parallel, intracranial neuromodulation, including deep brain stimulation and responsive neurostimulation, are well-established and expanding as therapies to reduce seizures in adults with focal-onset epilepsy; and there is emerging evidence for their efficacy in children and generalized-onset seizure disorders. The convergence of these advancing fields is driving an era of 'network-guided neuromodulation' for epilepsy. In this review, we distil the current literature on network mechanisms underlying neurostimulation for epilepsy. We discuss the modulation of key 'propagation points' in the epileptogenic network, focusing primarily on thalamic nuclei targeted in current clinical practice. These include (i) the anterior nucleus of thalamus, now a clinically approved and targeted site for open loop stimulation, and increasingly targeted for responsive neurostimulation; and (ii) the centromedian nucleus of the thalamus, a target for both deep brain stimulation and responsive neurostimulation in generalized-onset epilepsies. We discuss briefly the networks associated with other emerging neuromodulation targets, such as the pulvinar of the thalamus, piriform cortex, septal area, subthalamic nucleus, cerebellum and others. We report synergistic findings garnered from multiple modalities of investigation that have revealed structural and functional networks associated with these propagation points - including scalp and invasive EEG, and diffusion and functional MRI. We also report on intracranial recordings from implanted devices which provide us data on the dynamic networks we are aiming to modulate. Finally, we review the continuing evolution of network-guided neuromodulation for epilepsy to accelerate progress towards two translational goals: (i) to use pre-surgical network analyses to determine patient candidacy for neurostimulation for epilepsy by providing network biomarkers that predict efficacy; and (ii) to deliver precise, personalized and effective antiepileptic stimulation to prevent and arrest seizure propagation through mapping and modulation of each patients' individual epileptogenic networks.
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Affiliation(s)
- Rory J Piper
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | | | - Torsten Baldeweg
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Brian Litt
- Department of Neurology and Bioengineering, University of Pennsylvania, Philadelphia, USA
| | | | - Martin M Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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24
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Correlation of Clinicopathological Factors with Brain Tumor-Related Epilepsy in Glioma. DISEASE MARKERS 2022; 2022:4918294. [PMID: 36246555 PMCID: PMC9553557 DOI: 10.1155/2022/4918294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/03/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022]
Abstract
Objectives. Glioma patients with brain tumor-related epilepsy (BTRE) have a complex profile due to the simultaneous presence of two pathologies, glioma and epilepsy; however, they have not traditionally received as much attention as those with more malignant brain tumors. The underlying pathophysiology of brain tumor-related epilepsy remains poorly understood. The purpose of this study was to investigate the possible correlation between molecular neuropathology and glioma with BTRE and a wide range of BTRE-associated molecular markers of glioma patients. Methods. A retrospective cohort study of 186 glioma patients was evaluated at our hospital, of which 64 had BTRE. The chi-square test, Spearman rank correlation, and multivariate logistic analyses were used to identify clinicopathological factors associated with BTRE in glioma patients. Results. Of the 186 patients examined in this study, 64 (34.4%) had BTRE. Based on the analysis of the characteristics of these patients, the results showed that patient age (over 40 years;
), low WHO grade (grade I, II;
), IDH-1 positive mutation (
), low ATR-X expression level (
; 95% CI: 0.21, 0.92), and low Ki-67 PI (
; 95% CI: 0.10, 0.68) were associated with the occurrence of BTRE. In our cohort, BTRE patients did not differ by sex, tumor location, or expression of olig-2 and CD34. The results of the matching study showed that low Ki-67 PI and negative ATR-X expression levels were independent factors for a higher incidence of preoperative seizures in glioma patients. Conclusion. The current study updates existing information on genetic markers in gliomas with BTRE and explores the correlation of a wide range of clinicopathological factors and glioma patients with BTRE and suggests three putative biomarkers for BTRE: positive IDH1 mutation, low Ki-67 PI, and negative ATR-X expression. These factors may provide insights for developing a more thorough understanding of the pathogenesis of epilepsy and effective treatment strategies aimed at seizure control.
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25
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Maher C, D'Souza A, Zeng R, Barnett M, Kavehei O, Nikpour A, Wang C. White matter alterations in focal to bilateral tonic-clonic seizures. Front Neurol 2022; 13:972590. [PMID: 36188403 PMCID: PMC9515421 DOI: 10.3389/fneur.2022.972590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
We examined the white matter of patients with and without focal to bilateral tonic-clonic seizures (FBTCS), and control participants. A neural network based tract segmentation model (Tractseg) was used to isolate tract-specific, track-weighted tensor-based measurements from the tracts of interest. We compared the group differences in the track-weighted tensor-based measurements derived from whole and hemispheric tracts. We identified several regions that displayed significantly altered white matter in patients with focal epilepsy compared to controls. Furthermore, patients without FBTCS showed significantly increased white matter disruption in the inferior fronto-occipital fascicle and the striato-occipital tract. In contrast, the track-weighted tensor-based measurements from the FBTCS cohort exhibited a stronger resemblance to the healthy controls (compared to the non-FBTCS group). Our findings revealed marked alterations in a range of subcortical tracts considered critical in the genesis of seizures in focal epilepsy. Our novel application of tract-specific, track-weighted tensor-based measurements to a new clinical dataset aided the elucidation of specific tracts that may act as a predictive biomarker to distinguish patients likely to develop FBTCS.
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Affiliation(s)
- Christina Maher
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Australian Research Council Training Centre for Innovative BioEngineering, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Christina Maher
| | - Arkiev D'Souza
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rui Zeng
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia
| | - Omid Kavehei
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, NSW, Australia
- Australian Research Council Training Centre for Innovative BioEngineering, The University of Sydney, Sydney, NSW, Australia
| | - Armin Nikpour
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Chenyu Wang
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia
- Chenyu Wang
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26
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Song C, Zhang X, Han S, Ma K, Wang K, Mao X, Lian Y, Zhang X, Zhu J, Zhang Y, Cheng J. More than just statics: Static and temporal dynamic changes in intrinsic brain activity in unilateral temporal lobe epilepsy. Front Hum Neurosci 2022; 16:971062. [PMID: 36118964 PMCID: PMC9471141 DOI: 10.3389/fnhum.2022.971062] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Temporal lobe epilepsy (TLE) is the most prevalent refractory focal epilepsy and is more likely accompanied by cognitive impairment. The fully understanding of the neuronal activity underlying TLE is of great significance. Objective This study aimed to comprehensively explore the potential brain activity abnormalities affected by TLE and detect whether the changes were associated with cognition. Methods Six static intrinsic brain activity (IBA) indicators [amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), degree centrality (DC), global signal correlation (GSCorr), and voxel-mirrored homotopic connectivity (VMHC)] and their corresponding dynamic indicators, such as dynamic ALFF (dALFF), dynamic fALFF (dfALFF), dynamic ReHo (dReHo), dynamic DC (dDC), dynamic VMHC (dVMHC), and dynamic GSCorr (dGSCorr), in 57 patients with unilateral TLE and 42 healthy volunteers were compared. Correlation analyses were also performed between these indicators in areas displaying group differences and cognitive function, epilepsy duration, and severity. Results Marked overlap was present among the abnormal brain regions detected using various static and dynamic indicators, primarily including increased ALFF/dALFF/fALFF in the bilateral medial temporal lobe and thalamus, decreased ALFF/dALFF/fALFF in the frontal lobe contralateral to the epileptogenic side, decreased fALFF, ReHo, dReHo, DC, dDC, GSCorr, dGSCorr, and VMHC in the temporal neocortex ipsilateral to the epileptogenic foci, decreased dReHo, dDC, dGSCorr, and dVMHC in the occipital lobe, and increased ALFF, fALFF, dfALFF, ReHo, and DC in the supplementary motor area ipsilateral to the epileptogenic foci. Furthermore, most IBA indicators in the abnormal brain region significantly correlated with the duration of epilepsy and several cognitive scale scores (P < 0.05). Conclusion The combined application of static and dynamic IBA indicators could comprehensively reveal more real abnormal neuronal activity and the impairment and compensatory mechanisms of cognitive function in TLE. Moreover, it might help in the lateralization of epileptogenic foci and exploration of the transmission and inhibition pathways of epileptic activity.
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Affiliation(s)
- Chengru Song
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Xiaonan Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Keran Ma
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Kefan Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Xinyue Mao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
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Wang Y, Li Z, Zhang Y, Long Y, Xie X, Wu T. Classification of partial seizures based on functional connectivity: A MEG study with support vector machine. Front Neuroinform 2022; 16:934480. [PMID: 36059865 PMCID: PMC9435583 DOI: 10.3389/fninf.2022.934480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is a chronic neurological disorder that is divided into two subtypes, complex partial seizures (CPS) and simple partial seizures (SPS), based on clinical phenotypes. Revealing differences among the functional networks of different types of TLE can lead to a better understanding of the symbology of epilepsy. Whereas Although most studies had focused on differences between epileptic patients and healthy controls, the neural mechanisms behind the differences in clinical representations of CPS and SPS were unclear. In the context of the era of precision, medicine makes precise classification of CPS and SPS, which is crucial. To address the above issues, we aimed to investigate the functional network differences between CPS and SPS by constructing support vector machine (SVM) models. They mainly include magnetoencephalography (MEG) data acquisition and processing, construction of functional connectivity matrix of the brain network, and the use of SVM to identify differences in the resting state functional connectivity (RSFC). The obtained results showed that classification was effective and accuracy could be up to 82.69% (training) and 81.37% (test). The differences in functional connectivity between CPS and SPS were smaller in temporal and insula. The differences between the two groups were concentrated in the parietal, occipital, frontal, and limbic systems. Loss of consciousness and behavioral disturbances in patients with CPS might be caused by abnormal functional connectivity in extratemporal regions produced by post-epileptic discharges. This study not only contributed to the understanding of the cognitive-behavioral comorbidity of epilepsy but also improved the accuracy of epilepsy classification.
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Affiliation(s)
- Yingwei Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhongjie Li
- College of Intelligence and Computing, Tianjin Key Laboratory of Cognitive Computing and Application, Tianjin University, Tianjin, China
| | - Yujin Zhang
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Yingming Long
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinyan Xie
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ting Wu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Magnetoencephalography, Nanjing Brain Hospital, Affiliated to Nanjing Medical University, Nanjing, China
- *Correspondence: Ting Wu
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Yang T, Zhang Y, Zhang T, Zhou H, Yang M, Ren J, Li L, Lei D, Gong Q, Zhou D. Altered dynamic functional connectivity of striatal-cortical circuits in Juvenile Myoclonic Epilepsy. Seizure 2022; 101:103-108. [DOI: 10.1016/j.seizure.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
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Agarwal S, Basu I, Kumar M, Salami P, Cash SS. Classification of Seizure Termination Patterns using Deep Learning on intracranial EEG. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2933-2936. [PMID: 36086368 DOI: 10.1109/embc48229.2022.9871579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Seizure termination has received significantly less attention than initiation and propagation and consequently, remains a poorly understood phase of seizure evolution. Yet, its study may have a significant impact on the development of efficient interventional approaches, i.e., it may be critical for the design of treatments that induce or reproduce termination mechanisms that are triggered in self-terminating seizures. In this work, we aim to study temporal and spectral features of intracranial EEG (iEEG) during epileptic seizures to find time-frequency signatures that can predict the termination patterns. We propose a deep learning model for classification of multi channel iEEG epileptic seizure termination pattern into burst suppression and continuous bursting. We decompose the raw time series seizure data into time-frequency maps using Morlet Wavelet Transform. A Convolution Neural Network (CNN) is then trained on cross-patient time-frequency maps to classify the seizure termination patterns. For evaluation of classification performance, we compared the proposed method with k-Nearest Neighbour (k-NN). The CNN is shown to achieve an accuracy of 90 % and precision of 92 % as compared to 70% and 72% accuracy and precision achieved with the k-NN respectively. The proposed model is thus able to capture the temporal and spatial patterns which results in high performance of the classifier. This method of classification can be used to predict how a particular seizure will end and can potentially inform seizure management and treatment. Clinical relevance- This method establishes a model that can be used to classify seizure termination patterns with an accuracy of 90 % which can assist in better treatment of epilepsy patients.
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Schwitalla JC, Pakusch J, Mücher B, Brückner A, Depke DA, Fenzl T, De Zeeuw CI, Kros L, Hoebeek FE, Mark MD. Controlling absence seizures from the cerebellar nuclei via activation of the G q signaling pathway. Cell Mol Life Sci 2022; 79:197. [PMID: 35305155 PMCID: PMC8934336 DOI: 10.1007/s00018-022-04221-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
Absence seizures (ASs) are characterized by pathological electrographic oscillations in the cerebral cortex and thalamus, which are called spike-and-wave discharges (SWDs). Subcortical structures, such as the cerebellum, may well contribute to the emergence of ASs, but the cellular and molecular underpinnings remain poorly understood. Here we show that the genetic ablation of P/Q-type calcium channels in cerebellar granule cells (quirky) or Purkinje cells (purky) leads to recurrent SWDs with the purky model showing the more severe phenotype. The quirky mouse model showed irregular action potential firing of their cerebellar nuclei (CN) neurons as well as rhythmic firing during the wave of their SWDs. The purky model also showed irregular CN firing, in addition to a reduced firing rate and rhythmicity during the spike of the SWDs. In both models, the incidence of SWDs could be decreased by increasing CN activity via activation of the Gq-coupled designer receptor exclusively activated by designer drugs (DREADDs) or via that of the Gq-coupled metabotropic glutamate receptor 1. In contrast, the incidence of SWDs was increased by decreasing CN activity via activation of the inhibitory Gi/o-coupled DREADD. Finally, disrupting CN rhythmic firing with a closed-loop channelrhodopsin-2 stimulation protocol confirmed that ongoing SWDs can be ceased by activating CN neurons. Together, our data highlight that P/Q-type calcium channels in cerebellar granule cells and Purkinje cells can be relevant for epileptogenesis, that Gq-coupled activation of CN neurons can exert anti-epileptic effects and that precisely timed activation of the CN can be used to stop ongoing SWDs.
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Affiliation(s)
| | - Johanna Pakusch
- Department of Behavioral Neuroscience, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Brix Mücher
- Department of Zoology and Neurobiology, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Alexander Brückner
- Institute of Physiology I, Medical Faculty, University of Bonn, 53127, Bonn, Germany
| | - Dominic Alexej Depke
- European Institute of Molecular Imaging, University of Münster, 48149, Münster, Germany
| | - Thomas Fenzl
- Department of Anesthesiology and Intensive Care, TUM School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Chris I De Zeeuw
- Department of Neuroscience, Erasmus MC, 3015 AA, Rotterdam, The Netherlands.,Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, 1105, BA, Amsterdam, The Netherlands
| | - Lieke Kros
- Department of Neuroscience, Erasmus MC, 3015 AA, Rotterdam, The Netherlands
| | - Freek E Hoebeek
- Department for Developmental Origins of Disease, Wilhelmina Children's Hospital and Brain Center, University Medical Center Utrecht, 3584 EA, Utrecht, The Netherlands
| | - Melanie D Mark
- Department of Behavioral Neuroscience, Ruhr-University Bochum, 44801, Bochum, Germany.
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Hsieh H, Xu Q, Yang F, Zhang Q, Hao J, Liu G, Liu R, Yu Q, Zhang Z, Xing W, Bernhardt BC, Lu G, Zhang Z. Distinct Functional Cortico-Striato-Thalamo-Cerebellar Networks in Genetic Generalized and Focal Epilepsies with Generalized Tonic-Clonic Seizures. J Clin Med 2022; 11:jcm11061612. [PMID: 35329938 PMCID: PMC8951449 DOI: 10.3390/jcm11061612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/18/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
This study aimed to delineate cortico-striato-thalamo-cerebellar network profiles based on static and dynamic connectivity analysis in genetic generalized and focal epilepsies with generalized tonic-clonic seizures, and to evaluate its potential for distinguishing these two epilepsy syndromes. A total of 342 individuals participated in the study (114 patients with genetic generalized epilepsy with generalized tonic-clonic seizures (GE-GTCS), and 114 age- and sex-matched patients with focal epilepsy with focal to bilateral tonic-clonic seizure (FE-FBTS), 114 healthy controls). Resting-state fMRI data were examined through static and dynamic functional connectivity (dFC) analyses, constructing cortico-striato-thalamo-cerebellar networks. Network patterns were compared between groups, and were correlated to epilepsy duration. A pattern-learning algorithm was applied to network features for classifying both epilepsy syndromes. FE-FBTS and GE-GTCS both presented with altered functional connectivity in subregions of the motor/premotor and somatosensory networks. Among these two groups, the connectivity within the cerebellum increased in the static, while the dFC variability decreased; conversely, the connectivity of the thalamus decreased in FE-FBTS and increased in GE-GTCS in the static state. Connectivity differences between patient groups were mainly located in the thalamus and cerebellum, and correlated with epilepsy duration. Support vector machine (SVM) classification had accuracies of 66.67%, 68.42%, and 77.19% when using static, dynamic, and combined approaches to categorize GE-GTCS and FE-GTCS. Network features with high discriminative ability predominated in the thalamic and cerebellar connectivities. The network embedding of the thalamus and cerebellum likely plays an important differential role in GE-GTCS and FE-FBTS, and could serve as an imaging biomarker for differential diagnosis.
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Affiliation(s)
- Hsinyu Hsieh
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Qiang Xu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Fang Yang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Qirui Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Jingru Hao
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Gaoping Liu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Ruoting Liu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Qianqian Yu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Zixuan Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University/Changzhou First People’s Hospital, Changzhou 213004, China;
| | - Boris C. Bernhardt
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC H3A 2B4, Canada;
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
| | - Zhiqiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210093, China; (H.H.); (Q.X.); (F.Y.); (Q.Z.); (J.H.); (G.L.); (R.L.); (Q.Y.); (Z.Z.); (G.L.)
- Correspondence:
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Salami P, Borzello M, Kramer MA, Westover MB, Cash SS. Quantifying seizure termination patterns reveals limited pathways to seizure end. Neurobiol Dis 2022; 165:105645. [PMID: 35104646 PMCID: PMC8860887 DOI: 10.1016/j.nbd.2022.105645] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Despite their possible importance in the design of novel neuromodulatory approaches and in understanding status epilepticus, the dynamics and mechanisms of seizure termination are not well studied. We examined intracranial recordings from patients with epilepsy to differentiate seizure termination patterns and investigated whether these patterns are indicative of different underlying mechanisms. METHODS Seizures were classified into one of two termination patterns: (a) those that end simultaneously across the brain (synchronous), and (b) those whose termination is piecemeal across the cortex (asynchronous). Both types ended with either a burst suppression pattern, or continuous seizure activity. These patterns were quantified and compared using burst suppression ratio, absolute energy, and network connectivity. RESULTS Seizures with electrographic generalization showed burst suppression patterns in 90% of cases, compared with only 60% of seizures which remained focal. Interestingly, we found similar absolute energy and burst suppression ratios in seizures with synchronous and asynchronous termination, while seizures with continuous seizure activity were found to be different from seizures with burst suppression, showing lower energy during seizure and lower burst suppression ratio at the start and end of seizure. Finally, network density was observed to increase with seizure progression, with significantly lower densities in seizures with continuous seizure activity compared to seizures with burst suppression. SIGNIFICANCE Based on this spatiotemporal classification scheme, we suggest that there are a limited number of seizure termination patterns and dynamics. If this bears out, it would imply that the number of mechanisms underlying seizure termination is also constrained. Seizures with different termination patterns exhibit different dynamics even before their start. This may provide useful clues about how seizures may be managed, which in turn may lead to more targeted modes of therapy for seizure control.
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Affiliation(s)
- Pariya Salami
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Mia Borzello
- Department of Cognitive Science, University of California, San Diego, CA, USA; Computational Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - Mark A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Ye Y, Hu Z, Mai J, Chen L, Cao D, Liao J, Duan J. A de novo PUM1 Variant in a Girl With a Dravet-Like Syndrome: Case Report and Literature Review. Front Pediatr 2022; 10:759889. [PMID: 35386260 PMCID: PMC8978559 DOI: 10.3389/fped.2022.759889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/07/2022] [Indexed: 02/05/2023] Open
Abstract
In the recent 3 years, subjects with Pumilio1-associated developmental disability, ataxia, and seizure syndrome have been identified as harboring Pumilio homolog 1 (PUM1) mutations. However, the characteristics of the seizure phenotype remain to be elucidated. We herein described a 3-year-old female proband who was diagnosed with developmental and epileptic encephalopathy presenting with some features suggestive of a Dravet-like syndrome. For genetic analyses, trio-based whole-exome sequencing and array comparative genomic hybridization were performed. Consequently, a de novo heterozygous missense variant was identified in exon 22 of the PUM1 gene: NM_001020658: c.3439C > T (p.Arg1147Trp). Upon thoroughly reviewing the existing literature, nine cases of PUM1 mutation-related epilepsy were identified, and their clinical features were summarized. A relationship between PUM1 mutation and clinical manifestations characteristic of a Dravet-like syndrome was proposed. To our knowledge, this is the first report of a patient with PUM1 mutation presenting with a Dravet-like syndrome.
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Abstract
Impaired consciousness during seizures severely affects quality of life for people with
epilepsy but the mechanisms are just beginning to be understood. Consciousness is thought
to involve large-scale brain networks, so it is puzzling that focal seizures often impair
consciousness. Recent work investigating focal temporal lobe or limbic seizures in human
patients and experimental animal models suggests that impaired consciousness is caused by
active inhibition of subcortical arousal mechanisms. Focal limbic seizures exhibit
decreased neuronal firing in brainstem, basal forebrain, and thalamic arousal networks,
and cortical arousal can be restored when subcortical arousal circuits are stimulated
during seizures. These findings open the possibility of restoring arousal and
consciousness therapeutically during and following seizures by thalamic neurostimulation.
When seizures cannot be stopped by existing treatments, targeted subcortical stimulation
may improve arousal and consciousness, leading to improved safety and better psychosocial
function for people with epilepsy.
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Affiliation(s)
- Hal Blumenfeld
- Departments of Neurology, Neuroscience, Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
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35
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Chen Y, Fallon N, Kreilkamp BAK, Denby C, Bracewell M, Das K, Pegg E, Mohanraj R, Marson AG, Keller SS. Probabilistic mapping of thalamic nuclei and thalamocortical functional connectivity in idiopathic generalised epilepsy. Hum Brain Mapp 2021; 42:5648-5664. [PMID: 34432348 PMCID: PMC8559489 DOI: 10.1002/hbm.25644] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
It is well established that abnormal thalamocortical systems play an important role in the generation and maintenance of primary generalised seizures. However, it is currently unknown which thalamic nuclei and how nuclear‐specific thalamocortical functional connectivity are differentially impacted in patients with medically refractory and non‐refractory idiopathic generalised epilepsy (IGE). In the present study, we performed structural and resting‐state functional magnetic resonance imaging (MRI) in patients with refractory and non‐refractory IGE, segmented the thalamus into constituent nuclear regions using a probabilistic MRI segmentation method and determined thalamocortical functional connectivity using seed‐to‐voxel connectivity analyses. We report significant volume reduction of the left and right anterior thalamic nuclei only in patients with refractory IGE. Compared to healthy controls, patients with refractory and non‐refractory IGE had significant alterations of functional connectivity between the centromedian nucleus and cortex, but only patients with refractory IGE had altered cortical connectivity with the ventral lateral nuclear group. Patients with refractory IGE had significantly increased functional connectivity between the left and right ventral lateral posterior nuclei and cortical regions compared to patients with non‐refractory IGE. Cortical effects were predominantly located in the frontal lobe. Atrophy of the anterior thalamic nuclei and resting‐state functional hyperconnectivity between ventral lateral nuclei and cerebral cortex may be imaging markers of pharmacoresistance in patients with IGE. These structural and functional abnormalities fit well with the known importance of thalamocortical systems in the generation and maintenance of primary generalised seizures, and the increasing recognition of the importance of limbic pathways in IGE.
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Affiliation(s)
- Yachin Chen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Barbara A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | | | - Martyn Bracewell
- The Walton Centre NHS Foundation Trust, Liverpool, UK.,Schools of Medical Sciences and Psychology, Bangor University, Bangor, UK
| | - Kumar Das
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emily Pegg
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Rajiv Mohanraj
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
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36
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A systematic review of resting-state and task-based fmri in juvenile myoclonic epilepsy. Brain Imaging Behav 2021; 16:1465-1494. [PMID: 34786666 DOI: 10.1007/s11682-021-00595-5] [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] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
Functional neuroimaging modalities have enhanced our understanding of juvenile myoclonic epilepsy (JME) underlying neural mechanisms. Due to its non-invasive, sensitive and analytical nature, functional magnetic resonance imaging (fMRI) provides valuable insights into relevant functional brain networks and their segregation and integration properties. We systematically reviewed the contribution of resting-state and task-based fMRI to the current understanding of the pathophysiology and the patterns of seizure propagation in JME Altogether, despite some discrepancies, functional findings suggest that corticothalamo-striato-cerebellar network along with default-mode network and salience network are the most affected networks in patients with JME. However, further studies are required to investigate the association between JME's main deficiencies, e.g., motor and cognitive deficiencies and fMRI findings. Moreover, simultaneous electroencephalography-fMRI (EEG-fMRI) studies indicate that alterations of these networks play a role in seizure modulation but fall short of identifying a causal relationship between altered functional properties and seizure propagation. This review highlights the complex pathophysiology of JME, which necessitates the design of more personalized diagnostic and therapeutic strategies in this group.
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37
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Suarez A, Valdés-Hernández PA, Bernal B, Dunoyer C, Khoo HM, Bosch-Bayard J, Riera JJ. Identification of Negative BOLD Responses in Epilepsy Using Windkessel Models. Front Neurol 2021; 12:659081. [PMID: 34690906 PMCID: PMC8531269 DOI: 10.3389/fneur.2021.659081] [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: 01/27/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
Alongside positive blood oxygenation level–dependent (BOLD) responses associated with interictal epileptic discharges, a variety of negative BOLD responses (NBRs) are typically found in epileptic patients. Previous studies suggest that, in general, up to four mechanisms might underlie the genesis of NBRs in the brain: (i) neuronal disruption of network activity, (ii) altered balance of neurometabolic/vascular couplings, (iii) arterial blood stealing, and (iv) enhanced cortical inhibition. Detecting and classifying these mechanisms from BOLD signals are pivotal for the improvement of the specificity of the electroencephalography–functional magnetic resonance imaging (EEG-fMRI) image modality to identify the seizure-onset zones in refractory local epilepsy. This requires models with physiological interpretation that furnish the understanding of how these mechanisms are fingerprinted by their BOLD responses. Here, we used a Windkessel model with viscoelastic compliance/inductance in combination with dynamic models of both neuronal population activity and tissue/blood O2 to classify the hemodynamic response functions (HRFs) linked to the above mechanisms in the irritative zones of epileptic patients. First, we evaluated the most relevant imprints on the BOLD response caused by variations of key model parameters. Second, we demonstrated that a general linear model is enough to accurately represent the four different types of NBRs. Third, we tested the ability of a machine learning classifier, built from a simulated ensemble of HRFs, to predict the mechanism underlying the BOLD signal from irritative zones. Cross-validation indicates that these four mechanisms can be classified from realistic fMRI BOLD signals. To demonstrate proof of concept, we applied our methodology to EEG-fMRI data from five epileptic patients undergoing neurosurgery, suggesting the presence of some of these mechanisms. We concluded that a proper identification and interpretation of NBR mechanisms in epilepsy can be performed by combining general linear models and biophysically inspired models.
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Affiliation(s)
- Alejandro Suarez
- Neuronal Mass Dynamics Laboratory, Florida International University, Miami, FL, United States
| | | | - Byron Bernal
- Nicklaus Children Hospital, Miami, FL, United States
| | | | - Hui Ming Khoo
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Department of Neurosurgery, Osaka University, Suita, Japan
| | - Jorge Bosch-Bayard
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Jorge J Riera
- Neuronal Mass Dynamics Laboratory, Florida International University, Miami, FL, United States
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38
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Dai XJ, Yang Y, Wang Y. Interictal epileptiform discharges changed epilepsy-related brain network architecture in BECTS. Brain Imaging Behav 2021; 16:909-920. [PMID: 34677785 DOI: 10.1007/s11682-021-00566-w] [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] [Accepted: 09/25/2021] [Indexed: 11/25/2022]
Abstract
To investigate directed information flow of epileptiform activity in benign epilepsy with centrotemporal spikes (BECTS) during ictal epileptiform discharges (IEDs) and non-IEDs periods. In this multi-center study, a total of 188 subjects, including 50 BECTS and 138 normal children's controls (NCs) from three different centers (Center 1: females/males, 38/55; mean age, 9.33 ± 2.6 years; Center 2: females/males,7/10; mean age, 8.59 ± 2.32 years; Center 3: females/males, 14/14; mean age, 13 ± 3.42 years) were recruited. The BECTS were classified into IEDs (females/males, 12/15; mean age, 8.15 ± 1.68 years) and non-IEDs (females/males, 10/13; mean age, 9.09 ± 1.98 years) subgroups depending on presence of central-temporal spikes from an EEG-fMRI examination. Three new methods, structural equation parametric modeling, dynamic causal modeling and granger causality density (GCD) were used to determine optimal network architectures for BECTS. Three multicentric NCs determined a reliable and consistent network architecture by structural equation parametric modeling method. Further analyses were used for IEDs and non-IEDs to determine the brain network architecture by structural equation parametric modeling, dynamic causal modeling and GCD, respectively. The brain network architecture of IEDs substate, non-IEDs substate and NCs are different. IEDs promoted the driving effect of the Rolandic areas with more output information flows, and increased the targeted effect of the top of pre-/post-central gyrus with more input information flows. The information flow arises from the Rolandic areas, and subsequently propagates to the top of pre-/post-central gyrus and thalamus. From non-IEDs status to IEDs status, the thalamus load may play an important role in the modulation and regulation of epileptiform activity. These findings shed new light on pathophysiological mechanism of directed localization of epileptiform activity in BECTS.
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Affiliation(s)
- Xi-Jian Dai
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 518020, China.
- Shenzhen Kangning Hospital, Shenzhen Mental Health Centre, 1080#, Cuizhu Rd, Luohu District, Shenzhen, 518003, China.
| | - Yang Yang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yongjun Wang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Centre, 1080#, Cuizhu Rd, Luohu District, Shenzhen, 518003, China.
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39
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Brownhill D, Chen Y, Kreilkamp BAK, de Bezenac C, Denby C, Bracewell M, Biswas S, Das K, Marson AG, Keller SS. Automated subcortical volume estimation from 2D MRI in epilepsy and implications for clinical trials. Neuroradiology 2021; 64:935-947. [PMID: 34661698 PMCID: PMC9005416 DOI: 10.1007/s00234-021-02811-x] [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: 04/02/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
Purpose Most techniques used for automatic segmentation of subcortical brain regions are developed for three-dimensional (3D) MR images. MRIs obtained in non-specialist hospitals may be non-isotropic and two-dimensional (2D). Automatic segmentation of 2D images may be challenging and represents a lost opportunity to perform quantitative image analysis. We determine the performance of a modified subcortical segmentation technique applied to 2D images in patients with idiopathic generalised epilepsy (IGE). Methods Volume estimates were derived from 2D (0.4 × 0.4 × 3 mm) and 3D (1 × 1x1mm) T1-weighted acquisitions in 31 patients with IGE and 39 healthy controls. 2D image segmentation was performed using a modified FSL FIRST (FMRIB Integrated Registration and Segmentation Tool) pipeline requiring additional image reorientation, cropping, interpolation and brain extraction prior to conventional FIRST segmentation. Consistency between segmentations was assessed using Dice coefficients and volumes across both approaches were compared between patients and controls. The influence of slice thickness on consistency was further assessed using 2D images with slice thickness increased to 6 mm. Results All average Dice coefficients showed excellent agreement between 2 and 3D images across subcortical structures (0.86–0.96). Most 2D volumes were consistently slightly lower compared to 3D volumes. 2D images with increased slice thickness showed lower agreement with 3D images with lower Dice coefficients (0.55–0.83). Significant volume reduction of the left and right thalamus and putamen was observed in patients relative to controls across 2D and 3D images. Conclusion Automated subcortical volume estimation of 2D images with a resolution of 0.4 × 0.4x3mm using a modified FIRST pipeline is consistent with volumes derived from 3D images, although this consistency decreases with an increased slice thickness. Thalamic and putamen atrophy has previously been reported in patients with IGE. Automated subcortical volume estimation from 2D images is feasible and most reliable at using in-plane acquisitions greater than 1 mm x 1 mm and provides an opportunity to perform quantitative image analysis studies in clinical trials. Supplementary Information The online version contains supplementary material available at 10.1007/s00234-021-02811-x.
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Affiliation(s)
- Daniel Brownhill
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Neurological Science, Clinical Sciences Centre, Aintree University Hospital, Lower Lane, Liverpool, L9 7LJ, UK.
| | - Yachin Chen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Barbara A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Clinical Neurophysiology, University Medicine Göttingen, Göttingen, Germany
| | - Christophe de Bezenac
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | | | - Martyn Bracewell
- The Walton Centre NHS Foundation Trust, Liverpool, UK.,Schools of Medical Sciences and Psychology, Bangor University, Bangor, UK
| | | | - Kumar Das
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
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40
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Foutz T, Wong M. Brain Stimulation Treatments in Epilepsy: Basic Mechanisms and Clinical Advances. Biomed J 2021; 45:27-37. [PMID: 34482013 PMCID: PMC9133258 DOI: 10.1016/j.bj.2021.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022] Open
Abstract
Drug-resistant epilepsy, characterized by ongoing seizures despite appropriate trials of anti-seizure medications, affects approximately one-third of people with epilepsy. Brain stimulation has recently become available as an alternative treatment option to reduce symptomatic seizures in short and long-term follow-up studies. Several questions remain on how to optimally develop patient-specific treatments and manage therapy over the long term. This review aims to discuss the clinical use and mechanisms of action of Responsive Neural Stimulation and Deep Brain Stimulation in the treatment of epilepsy and highlight recent advances that may both improve outcomes and present new challenges. Finally, a rational approach to device selection is presented based on current mechanistic understanding, clinical evidence, and device features.
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Affiliation(s)
- Thomas Foutz
- Department of Neurology, Washington University in St. Louis, USA.
| | - Michael Wong
- Department of Neurology, Washington University in St. Louis, USA.
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41
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Piper RJ, Tangwiriyasakul C, Shamshiri EA, Centeno M, He X, Richardson MP, Tisdall MM, Carmichael DW. Functional Connectivity of the Anterior Nucleus of the Thalamus in Pediatric Focal Epilepsy. Front Neurol 2021; 12:670881. [PMID: 34408719 PMCID: PMC8365837 DOI: 10.3389/fneur.2021.670881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Whilst stimulation of the anterior nucleus of the thalamus has shown efficacy for reducing seizure frequency in adults, alterations in thalamic connectivity have not been explored in children. We tested the hypotheses that (a) the anterior thalamus has increased functional connectivity in children with focal epilepsy, and (b) this alteration in the connectome is a persistent effect of the disease rather than due to transient epileptiform activity. Methods: Data from 35 children (7–18 years) with focal, drug-resistant epilepsy and 20 healthy children (7–17 years) were analyzed. All subjects underwent functional magnetic resonance imaging (fMRI) whilst resting and were simultaneously monitored with scalp electroencephalography (EEG). The fMRI timeseries were extracted for each Automated Anatomical Labeling brain region and thalamic subregion. Graph theory metrics [degree (DC) and eigenvector (EC) centrality] were used to summarize the connectivity profile of the ipsilateral thalamus, and its thalamic parcellations. The effect of interictal epileptiform discharges (IEDs) captured on EEG was used to determine their effect on DC and EC. Results: DC was significantly higher in the anterior nucleus (p = 0.04) of the thalamus ipsilateral to the epileptogenic zone in children with epilepsy compared to controls. On exploratory analyses, we similarly found a higher DC in the lateral dorsal nucleus (p = 0.02), but not any other thalamic subregion. No differences in EC measures were found between patients and controls. We did not find any significant difference in DC or EC in any thalamic subregion when comparing the results of children with epilepsy before, and after the removal of the effects of IEDs. Conclusions: Our data suggest that the anterior and lateral dorsal nuclei of the thalamus are more highly functionally connected in children with poorly controlled focal epilepsy. We did not detect a convincing change in thalamic connectivity caused by transient epileptiform activity, suggesting that it represents a persistent alteration to network dynamics.
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Affiliation(s)
- Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, United Kingdom.,Department of Neurosurgery, Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Wellcome EPSRC Centre for Medical Imaging, Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Chayanin Tangwiriyasakul
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Elhum A Shamshiri
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.,Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco, CA, United States
| | - Maria Centeno
- Epilepsy Unit, Neurology Department, Hospital Clinic, Barcelona, Spain
| | - Xiaosong He
- Department of Psychology, University of Science and Technology of China, Hefei, China
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Martin M Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - David W Carmichael
- Wellcome EPSRC Centre for Medical Imaging, Department of Biomedical Engineering, King's College London, London, United Kingdom
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42
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Dai XJ, Liu H, Yang Y, Wang Y, Wan F. Brain network excitatory/inhibitory imbalance is a biomarker for drug-naive Rolandic epilepsy: A radiomics strategy. Epilepsia 2021; 62:2426-2438. [PMID: 34346086 DOI: 10.1111/epi.17011] [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: 04/14/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Seizure occurs when the balance between excitatory and inhibitory (E/I) inputs to neurons is perturbed, resulting in abnormal electrical activity. This study investigated whether an existing E/I imbalance in neural networks is a useful diagnostic biomarker for Rolandic epilepsy by a resting-state dynamic causal modeling-based support vector machine (rs-DCM-SVM) algorithm. METHODS This multicenter study enrolled a discovery cohort (76 children with Rolandic epilepsy and 76 normal controls [NCs]) and a replication cohort (59 children with Rolandic epilepsy and 60 NCs). Spatial independent component analysis was used to seven canonical neural networks, and a total of 25 regions of interest were selected from these networks. The rs-DCM-SVM classifier was used for individual classification, consensus feature selection, and feature ranking. RESULTS The rs-DCM-SVM classifier showed that the E/I imbalance in brain networks is a useful neuroimaging biomarker for Rolandic epilepsy, with an accuracy of 88.2% and 81.5% and an area under curve of .92 and .83 in the discovery and the replication cohorts, respectively. Consensus brain regions with the highest contributions to the classification were located within the epilepsy-related networks, indicating that this classifier was suitable. Consensus functional connection pairs with the highest contributions to the classification were associated with an excitation network loop and an inhibition network loop. The excitation loop mediated the integration of advanced cognitive networks (subcortex, dorsal attention, default mode, executive control, and salience networks), whereas the inhibition loop was involved in the segregation of sensorimotor and language networks. The two loops showed functional segregation. SIGNIFICANCE Brain E/I imbalance has potential to serve as a biomarker for individual classification in children with Rolandic epilepsy, and might be an important mechanism for causing seizures and cognitive impairment in children with Rolandic epilepsy.
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Affiliation(s)
- Xi-Jian Dai
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China.,Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau, China.,Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Yang Yang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Yongjun Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Feng Wan
- Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau, China.,Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau, China
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43
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Gummadavelli A, Martin R, Goshay D, Sieu LA, Xu J, Gruenbaum BF, McCafferty C, Gerrard JL, Blumenfeld H. Cortical low-frequency power correlates with behavioral impairment in animal model of focal limbic seizures. Epilepsia 2021; 62:1960-1970. [PMID: 34240747 PMCID: PMC8349876 DOI: 10.1111/epi.16964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Impairment in consciousness is a debilitating symptom during and after seizures; however, its mechanism remains unclear. Limbic seizures have been shown to spread to arousal circuitry to result in a "network inhibition" phenomenon. However, prior animal model studies did not relate physiological network changes to behavioral responses during or following seizures. METHODS Focal onset limbic seizures were induced while rats were performing an operant conditioned behavioral task requiring response to an auditory stimulus to quantify how and when impairment of behavioral response occurs. Correct responses were rewarded with sucrose. Cortical and hippocampal electrophysiology measured by local field potential recordings was analyzed for changes in low- and high-frequency power in relation to behavioral responsiveness during seizures. RESULTS As seen in patients with seizures, ictal (p < .0001) and postictal (p = .0015) responsiveness was variably impaired. Analysis of cortical and hippocampal electrophysiology revealed that ictal (p = .002) and postictal (p = .009) frontal cortical low-frequency 3-6-Hz power was associated with poor behavioral performance. In contrast, the hippocampus showed increased power over a wide frequency range during seizures, and suppression postictally, neither of which were related to behavioral impairment. SIGNIFICANCE These findings support prior human studies of temporal lobe epilepsy as well as anesthetized animal models suggesting that focal limbic seizures depress consciousness through remote network effects on the cortex, rather than through local hippocampal involvement. By identifying the cortical physiological changes associated with impaired arousal and responsiveness in focal seizures, these results may help guide future therapies to restore ictal and postictal consciousness, improving quality of life for people with epilepsy.
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Affiliation(s)
- Abhijeet Gummadavelli
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Reese Martin
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Derek Goshay
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Lim-Anna Sieu
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Jingwen Xu
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Benjamin F. Gruenbaum
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Cian McCafferty
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Jason L. Gerrard
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
- Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
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44
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McGonigal A, Bartolomei F, Chauvel P. On seizure semiology. Epilepsia 2021; 62:2019-2035. [PMID: 34247399 DOI: 10.1111/epi.16994] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/30/2022]
Abstract
The clinical expression of seizures represents the main symptomatic burden of epilepsy. Neural mechanisms of semiologic production in epilepsy, especially for complex behaviors, remain poorly known. In a framework of epilepsy as a network rather than as a focal disorder, we can think of semiology as being dynamically produced by a set of interconnected structures, in which specific rhythmic interactions, and not just anatomical localization, are likely to play an important part in clinical expression. This requires a paradigm shift in how we think about seizure organization, including from a presurgical evaluation perspective. Semiology is a key data source, albeit with significant methodological challenges for its use in research, including observer bias and choice of semiologic categories. Better understanding of semiologic categorization and pathophysiological correlates is relevant to seizure classification systems. Advances in knowledge of neural mechanisms as well as anatomic correlates of different semiologic patterns could help improve knowledge of epilepsy networks and potentially contribute to therapeutic innovations.
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Affiliation(s)
- Aileen McGonigal
- Inserm, INS, Institut de Neurosciences des Systèmes, Aix Marseille Univ, Marseille, France.,Clinical Neurophysiology, APHM, Timone Hospital, Marseille, France
| | - Fabrice Bartolomei
- Inserm, INS, Institut de Neurosciences des Systèmes, Aix Marseille Univ, Marseille, France.,Clinical Neurophysiology, APHM, Timone Hospital, Marseille, France
| | - Patrick Chauvel
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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45
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Loushy I, Gurevitch G, Gazit T, Medvedovsky M, Khoo HM, Gotman J, Fahoum F. Bilateral epileptic networks in congenital and acquired corpus callosum defects: EEG-fMRI study. Epilepsy Behav 2021; 120:107986. [PMID: 33965723 DOI: 10.1016/j.yebeh.2021.107986] [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: 01/05/2021] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Electroencephalography-correlated functional magnetic resonance imaging (EEG-fMRI) allows imaging of brain-wide epileptic networks, and demonstrates that focal interictal epileptic activity is sometimes accompanied by bilateral functional activations. The corpus callosum (CC) facilitates bilateral spread of epileptic activity and at times targeted surgically for drug-resistant epilepsy (DRE). We hypothesized that focal epileptic networks are more unilateral in patients lacking intact CC. METHODS We included focal DRE patients who underwent pre-surgical EEG-fMRI and had CC agenesis (group A, n = 5), patients who previously underwent anterior callosotomy as treatment for drop attacks and continued having seizures (group B, n = 6), and control group of patients with focal epilepsy and intact CC (group C, n = 9). Blood-oxygenation-level-dependent (BOLD) signal maps were generated for interictal epileptic discharges. To quantify bi-hemispheric distribution of epileptic networks, laterality indices were compared between groups. Anatomical and diffusion-weighted imaging demonstrated white matter pathways. RESULTS 96% of studies demonstrated bilateral activations. Laterality indices were similar in groups A and C, whereas group B demonstrated a more bilateral network than group C (p = 0.028). Diffusion-weighted and anatomical imaging showed aberrant white matter pathways and larger anterior commissure in groups A and B. 68% of studies showed maximal activation cluster concordant with the presumed epileptic focus, 28% showed non-maximal activation at presumed focus. SIGNIFICANCE Focal epileptic activity is associated with bilateral functional activations despite lack of intact CC, and is associated with stronger contralateral activation in patients after anterior callosotomy compared to controls. These findings disprove our initial hypothesis, and combined with white matter structural imaging, may indicate that the CC is not a sole route of propagation of epileptic activity, which might spread via anterior commissure. Our study demonstrates the utility of EEG-fMRI in assessing epileptic networks and potentially aiding in tailoring surgical treatments in DRE patients with callosal anomalies, and in callosal surgeries.
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Affiliation(s)
- Itai Loushy
- Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Guy Gurevitch
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Gazit
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordekhay Medvedovsky
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Agnes Ginges Center of Neurogenetics, Department of Neurology, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Hui Ming Khoo
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada; Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jean Gotman
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Firas Fahoum
- Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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46
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Gong J, Jiang S, Li Z, Pei H, Li Q, Yao D, Luo C. Distinct effects of the basal ganglia and cerebellum on the thalamocortical pathway in idiopathic generalized epilepsy. Hum Brain Mapp 2021; 42:3440-3449. [PMID: 33830581 PMCID: PMC8249897 DOI: 10.1002/hbm.25444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/04/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022] Open
Abstract
The aberrant thalamocortical pathways of epilepsy have been detected recently, while its underlying effects on epilepsy are still not well understood. Exploring pathoglytic changes in two important thalamocortical pathways, that is, the basal ganglia (BG)-thalamocortical and the cerebellum-thalamocortical pathways, in people with idiopathic generalized epilepsy (IGE), could deepen our understanding on the pathological mechanism of this disease. These two pathways were reconstructed and investigated in this study by combining diffusion and functional MRI. Both pathways showed connectivity changes with the perception and cognition systems in patients. Consistent functional connectivity (FC) changes were observed mainly in perception regions, revealing the aberrant integration of sensorimotor and visual information in IGE. The pathway-specific FC alterations in high-order regions give neuroimaging evidence of the neural mechanisms of cognitive impairment and epileptic activities in IGE. Abnormal functional and structural integration of cerebellum, basal ganglia and thalamus could result in an imbalance of inhibition and excitability in brain systems of IGE. This study located the regulated cortical regions of BG and cerebellum which been affected in IGE, established possible links between the neuroimaging findings and epileptic symptoms, and enriched the understanding of the regulatory effects of BG and cerebellum on epilepsy.
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Affiliation(s)
- Jinnan Gong
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,School of Computer Science, Chengdu University of Information Technology, Chengdu, China
| | - Sisi Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhiliang Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Haonan Pei
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Qifu Li
- Department of Neurology, Hainan Medical University, Haikou, China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,Department of Neurology, Hainan Medical University, Haikou, China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences 2019RU035, Chengdu, China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,Department of Neurology, Hainan Medical University, Haikou, China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences 2019RU035, Chengdu, China
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47
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Chen L, Li X, Shen L. Self-limited focal epilepsy decreased regional brain activity in sensorimotor areas. Acta Neurol Scand 2021; 143:188-194. [PMID: 32975833 DOI: 10.1111/ane.13350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The fractional amplitude of low-frequency fluctuation (fALFF) method was used to identify the regional brain activity deficits of self-limited focal epilepsy with centrotemporal spikes (SLFECS) relative to normal controls (NCs). METHODS A total of 21 SLFECS (10 females, 11 males; mean age, 8.57 ± 1.5 years) and 21 status-matched (age, sex, and education) NCs (10 females, 11 males; mean age, 8.76 ± 2.19 years) were recruited. The fALFF method was applied to identify SLFECS-related regional brain alterations. Receiver operating characteristic (ROC) curve was applied to identify the ability of these regional brain areas in distinguishing the SLFECS group from the NCs group. The relationships between the regional brain activity deficits and clinical features were evaluated by Pearson's correlation analysis. RESULTS Self-limited focal epilepsy with centrotemporal spikes was associated with widespread regional brain activity alterations, including left cuneus with higher fALFF values, and bilateral striatum, bilateral precentral gyrus, ventral and dorsal pathway of sensory area, left dorsolateral prefrontal cortex, and left Rolandic area with lower fALFF values. ROC curve revealed excellent AUC value (0.964) of these areas in distinguishing the SLFECS group from the NCs group with high degree of sensitivity (90.5%) and specificity (95.2%). Intelligence quotient score positively correlated with the fALFF value in the left striatum (r = 0.453, p = 0.039). CONCLUSIONS The fALFF parameter could be served as a potential biomarker to identify the SLFECS-related regional brain deficits in the sensorimotor cortex and their pathways, which may be the etiology of paresthesia in SLFECS.
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Affiliation(s)
- Liu‐cheng Chen
- Department of radiology The First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Digital Medicine and Intelligent Health Bengbu China
- Department of Imaging Diagnosis, Medical Imaging College Bengbu Medical College Bengbu China
| | - Xiaofen Li
- Department of radiology Jiangxi Provincial People's Hospital Affiliated to Nanchang University Nanchang China
| | - Longshan Shen
- Department of radiology The Second Affiliated Hospital of Bengbu Medical College Bengbu China
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48
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Li R, Wang H, Wang L, Zhang L, Zou T, Wang X, Liao W, Zhang Z, Lu G, Chen H. Shared and distinct global signal topography disturbances in subcortical and cortical networks in human epilepsy. Hum Brain Mapp 2021; 42:412-426. [PMID: 33073893 PMCID: PMC7776006 DOI: 10.1002/hbm.25231] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/08/2020] [Accepted: 09/29/2020] [Indexed: 01/21/2023] Open
Abstract
Epilepsy is a common brain network disorder associated with disrupted large-scale excitatory and inhibitory neural interactions. Recent resting-state fMRI evidence indicates that global signal (GS) fluctuations that have commonly been ignored are linked to neural activity. However, the mechanisms underlying the altered global pattern of fMRI spontaneous fluctuations in epilepsy remain unclear. Here, we quantified GS topography using beta weights obtained from a multiple regression model in a large group of epilepsy with different subtypes (98 focal temporal epilepsy; 116 generalized epilepsy) and healthy population (n = 151). We revealed that the nonuniformly distributed GS topography across association and sensory areas in healthy controls was significantly shifted in patients. Particularly, such shifts of GS topography disturbances were more widespread and bilaterally distributed in the midbrain, cerebellum, visual cortex, and medial and orbital cortex in generalized epilepsy, whereas in focal temporal epilepsy, these networks spread beyond the temporal areas but mainly remain lateralized. Moreover, we found that these abnormal GS topography patterns were likely to evolve over the course of a longer epilepsy disease. Our study demonstrates that epileptic processes can potentially affect global excitation/inhibition balance and shift the normal GS topological distribution. These progressive topographical GS disturbances in subcortical-cortical networks may underlie pathophysiological mechanisms of global fluctuations in human epilepsy.
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Affiliation(s)
- Rong Li
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Hongyu Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Liangcheng Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Leiyao Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Ting Zou
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Xuyang Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Wei Liao
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Zhiqiang Zhang
- Department of Medical ImagingJinling Hospital, Nanjing University School of MedicineNanjingChina
| | - Guangming Lu
- Department of Medical ImagingJinling Hospital, Nanjing University School of MedicineNanjingChina
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
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Abstract
OBJECTIVE. The purpose of this article is to summarize the role of molecular imaging of the brain by use of SPECT, FDG PET, and non-FDG PET radiotracers in epilepsy. CONCLUSION. Quantitative image analysis with PET and SPECT has increased the diagnostic utility of these modalities in localizing epileptogenic onset zones. A multi-modal platform approach integrating the functional imaging of PET and SPECT with the morphologic information from MRI in presurgical evaluation of epilepsy can greatly improve outcomes.
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50
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Zhao B, Seguin C, Ai L, Sun T, Hu W, Zhang C, Wang X, Liu C, Wang Y, Mo J, Zalesky A, Zhang K, Zhang J. Aberrant Metabolic Patterns Networks in Insular Epilepsy. Front Neurol 2021; 11:605256. [PMID: 33424756 PMCID: PMC7786135 DOI: 10.3389/fneur.2020.605256] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Insular epilepsy is clinically challenging. This study aimed to map cerebral metabolic networks in insular epilepsy and investigate their graph-theoretic properties, with the goal of elucidating altered metabolic network architectures that underlie interictal hypometabolism. Aims: Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) imaging was performed in 17 individuals with a stereoelectroencephalography (SEEG) confirmed diagnosis of insula epilepsy and 14 age- and sex-matched healthy comparison individuals. Metabolic covariance networks were mapped for each group and graph theoretical analyses of these networks were undertaken. For each pair of regions comprising a whole-brain parcellation, regionally-averaged FDG uptake values were correlated across individuals to estimate connection weights. Results: Correlation in regionally-averaged FDG uptake values in the insular epilepsy group was substantially increased for several pairs of regions compared to the healthy comparison group, particularly for the opercular cortex and subcortical structures. This effect was less prominent in brainstem structures. Metabolic covariance networks in the epilepsy group showed reduced small-worldness as well as altered nodal properties in the ipsilateral hemisphere, compared to the healthy comparison group. Conclusions: Cerebral glucose metabolism in insular epilepsy is marked by a lack of normal regional heterogeneity in metabolic patterns, resulting in metabolic covariance networks that are more tightly coupled between regions than healthy comparison individuals. Metabolic networks in insular epilepsy exhibit altered topological properties and evidence of potentially compensatory formation of aberrant local connections. Taken together, these results demonstrate that insular epilepsy is a systemic neurological disorder with widespread disruption to cerebral metabolic networks.
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Affiliation(s)
- Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Caio Seguin
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - Lin Ai
- Department of Imaging and Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Sun
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, VIC, Australia.,Department of Biomedical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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