1
|
Ge J, Xie S, Duan J, Tian B, Ren P, Hu E, Huang Q, Mao H, Zou Y, Chen Q, Wang W. Imbalance between hippocampal projection cell and parvalbumin interneuron architecture increases epileptic susceptibility in mouse model of methyl CpG binding protein 2 duplication syndrome. Epilepsia 2024; 65:2483-2496. [PMID: 38819633 DOI: 10.1111/epi.18027] [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: 01/20/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE Methyl CpG-binding protein 2 (MECP2) duplication syndrome is a rare X-linked genomic disorder affecting predominantly males, which is usually manifested as epilepsy and autism spectrum disorder (ASD) comorbidity. The transgenic line MeCP2Tg1 was used for mimicking MECP2 duplication syndrome and showed autism-epilepsy co-occurrence. Previous works suggested that the excitatory/inhibitory (E/I) imbalance is a potential common mechanism for both epilepsy and ASD. The projection neurons and parvalbumin (PV) interneurons account for the majority of E/I balance in the hippocampus. Therefore, we explored how structural changes of projection and PV+ neurons occur in the hippocampus of MeCP2Tg1 mice and whether these morphological changes contribute to epilepsy susceptibility. METHODS We used the interneuron Designer receptors exclusively activated by designer drugs mouse model to inhibit inhibitory neurons in the hippocampus to verify the epilepsy susceptibility of MeCP2Tg1 (FVB, an inbred strain named as sensitivity to Friend leukemia virus) mice. Electroencephalograms were recorded for the definition of seizure. We performed retro-orbital injection of virus in MeCP2Tg1 (FVB):CaMKIIα-Cre (C57BL/6) mice or MeCP2Tg1:PV-Cre (C57BL/6) mice and their littermate controls to specifically label projection and PV+ neurons for structural analysis. RESULTS Epilepsy susceptibility was increased in MeCP2Tg1 mice. There was a reduced number of PV neurons and reduced dendritic complexity in the hippocampus of MeCP2Tg1 mice. The dendritic complexity in MeCP2Tg1 mice was increased compared to wild-type mice, and total dendritic spine density in dentate gyrus of MeCP2Tg1 mice was also increased. Total dendritic spine density was increased in CA1 of MeCP2Tg1 mice. SIGNIFICANCE Overexpression of MeCP2 may disrupt crucial signaling pathways, resulting in decreased dendritic complexity of PV interneurons and increased dendritic spine density of projection neurons. This reciprocal modulation of excitatory and inhibitory neuronal structures associated with MeCP2 implies its significance as a potential target in the development of epilepsy and offers a novel perspective on the co-occurrence of autism and epilepsy.
Collapse
Affiliation(s)
- Junye Ge
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Shengjun Xie
- Jingzhou Hospital affiliated with Yangtze University, Jingzhou, China
| | - Jiamei Duan
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Biqing Tian
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Pengfei Ren
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Erling Hu
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Qiyi Huang
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Honghui Mao
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Yuxin Zou
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Qian Chen
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
- Zhongshan Institute for Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Zhongshan, China
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Wenting Wang
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| |
Collapse
|
2
|
Sammarra I, Caligiuri ME, Bonacci MC, Di Gennaro G, Fortunato F, Martino I, Giugno A, Labate A, Gambardella A. May anti-seizure medications alter brain structure in temporal lobe epilepsy? A prospective study. Epilepsia Open 2024; 9:1076-1082. [PMID: 38475905 PMCID: PMC11145604 DOI: 10.1002/epi4.12912] [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: 06/09/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
Mild mesial temporal lobe epilepsy (MTLE) patients may remain untreated for a considerable time after disease onset or achieve seizure control with a single anti-seizures medication (ASM). Thus, they represent an optimal population to investigate whether ASMs might have influence on brain structure. We consecutively enrolled 56 mild MTLE patients (22/56 untreated, 34/56 on-monotherapy) and 58 healthy controls, matched for age and gender. All subjects underwent 3T-brain MRI, using FreeSurfer for automated morphometry. Differences in gray matter were assessed using one-way Analysis of Covariance (ANCOVA), adjusting for age, disease duration and intracranial volume. No significant change was observed between treated and untreated patients. We observed a significant reduction in cortical thickness of left inferior parietal, inferior temporal, middle temporal gyri, and right inferior parietal gyrus, temporal pole in monotherapy patients compared to healthy controls, as well as an increase in left isthmus of cingulate gyrus in untreated MTLE subjects compared to controls. Surface and subcortical volumes analysis revealed no differences among groups. Our study demonstrated no substantial morphological abnormalities between untreated mild MTLE patients and those undergoing monotherapy. Although exploratory, these results may reassure about safety of commonly used drugs and their marginal role in influencing neuroimaging results. PLAIN LANGUAGE SUMMARY: This study investigated the following question: can medications against epileptic seizures have an effect on brain structure in mild mesial temporal lobe? Preliminary results from our analyses suggest not, as we did not find any difference in brain gray matter between untreated patients and those treated with a single anti-seizures medication. On the other hand, epilepsy patients presented cortical thinning compared to healthy controls in several regions of the temporal and parietal lobes, in line with previous studies investigating the disease.
Collapse
Affiliation(s)
- Ilaria Sammarra
- Department of Medical and Surgical Sciences, Institute of NeurologyMagna Græcia University of CatanzaroCatanzaroItaly
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | - Maria Celeste Bonacci
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | | | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of NeurologyMagna Græcia University of CatanzaroCatanzaroItaly
| | - Iolanda Martino
- Department of Medical and Surgical Sciences, Institute of NeurologyMagna Græcia University of CatanzaroCatanzaroItaly
| | - Alessia Giugno
- Department of Medical and Surgical Sciences, Institute of NeurologyMagna Græcia University of CatanzaroCatanzaroItaly
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders ClinicUniversity of MessinaMessinaItaly
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Institute of NeurologyMagna Græcia University of CatanzaroCatanzaroItaly
| |
Collapse
|
3
|
Peña-Ceballos J, Moloney PB, Kilbride RD, Naggar HE, Widdess-Walsh P, Delanty N. Oligoepilepsy and lifelong seizure susceptibility in epilepsy with generalized tonic-clonic seizures alone: Experience at an adult tertiary center. Epilepsy Res 2024; 202:107362. [PMID: 38652996 DOI: 10.1016/j.eplepsyres.2024.107362] [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: 02/23/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Epilepsy with generalized tonic-clonic seizures alone (GTCA) is the least studied syndrome within the idiopathic generalized epilepsy (IGE) spectrum. We characterize a large cohort of adult patients with GTCA to understand natural history and drug responsiveness. METHODS In this retrospective single-center study using our epilepsy electronic record, we evaluated clinical characteristics, seizure outcomes, anti-seizure medication (ASM) response including seizure recurrence after ASM withdrawal, and sex differences in a cohort of GTCA patients aged ≥17 years. RESULTS Within a cohort of 434 IGE patients, 87 patients (20 %) with GTCA were included. The mean age was 34.9 years (range 17-73 years). Forty-six patients (52.8 %) were females. Seventy-two patients (82.8 %) were seizure-free and 15 (17.2 %) had active epilepsy over the previous 12 months. Thirty-four patients (39.1 %) had ≤5 lifetime seizures, aligning with a prior definition of 'oligoepilepsy'. Sixty-five patients (74.7 %) were treated with monotherapy, 19 (21.8 %) were treated with polytherapy, and three were not taking any ASM. Levetiracetam (37.9 %) was the most commonly prescribed ASM, followed by lamotrigine (32.1 %) and valproate (31 %). Seventeen patients (19.5 %) attempted to withdraw their ASM. The rate of seizure recurrence after ASM withdrawal was 88.2 % (15/17), including two patients who relapsed more than 20 years after ASM discontinuation. Females had more seizures in their lifetime and had trialed more ASM compared to males. SIGNIFICANCE GTCA has a relatively good prognosis, with most patients becoming seizure-free on monotherapy. The high rate of seizure recurrence after ASM withdrawal supports lifetime seizure susceptibility. We found potential sex differences in seizure outcomes and ASM response, although further research is needed to validate this finding.
Collapse
Affiliation(s)
| | - Patrick B Moloney
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | | | - Hany El Naggar
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | | | - Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland.
| |
Collapse
|
4
|
Aitken CBA, Jentzsch I, O'Connor AR. Towards a conflict account of déjà vu: The role of memory errors and memory expectation conflict in the experience of déjà vu. Neurosci Biobehav Rev 2023; 155:105467. [PMID: 37979736 DOI: 10.1016/j.neubiorev.2023.105467] [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: 05/10/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
Déjà vu can be defined as conflict between a subjective evaluation of familiarity and a concurrent evaluation of novelty. Accounts of the déjà vu experience have not explicitly referred to a "conflict account of déjà vu" despite the acceptance of conflict-based definitions of déjà vu and relatively recent neuroimaging work that has implicated brain areas associated with conflict as underpinning the experience. Conflict monitoring functioning follows a similar age-related trajectory to déjà vu with a peak in young adulthood and a subsequent age-related decline. In this narrative review of the literature to date, we consider how déjà vu is defined and how this has influenced the understanding of déjà vu. We also review how déjà vu can be understood within theories of recognition memory and cognitive control. Finally, we summarise the conflict account of déjà vu and propose that this account of the experience may provide a coherent explanation as to why déjà vu experiences tend to decrease with age in the non-clinical population.
Collapse
Affiliation(s)
- Courtney B A Aitken
- School of Psychology & Neuroscience, University of St Andrews, United Kingdom.
| | - Ines Jentzsch
- School of Psychology & Neuroscience, University of St Andrews, United Kingdom
| | - Akira R O'Connor
- School of Psychology & Neuroscience, University of St Andrews, United Kingdom
| |
Collapse
|
5
|
Perversi F, Costa C, Labate A, Lattanzi S, Liguori C, Maschio M, Meletti S, Nobili L, Operto FF, Romigi A, Russo E, Di Bonaventura C. The broad-spectrum activity of perampanel: state of the art and future perspective of AMPA antagonism beyond epilepsy. Front Neurol 2023; 14:1182304. [PMID: 37483446 PMCID: PMC10359664 DOI: 10.3389/fneur.2023.1182304] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
Glutamate is the brain's main excitatory neurotransmitter. Glutamatergic neurons primarily compose basic neuronal networks, especially in the cortex. An imbalance of excitatory and inhibitory activities may result in epilepsy or other neurological and psychiatric conditions. Among glutamate receptors, AMPA receptors are the predominant mediator of glutamate-induced excitatory neurotransmission and dictate synaptic efficiency and plasticity by their numbers and/or properties. Therefore, they appear to be a major drug target for modulating several brain functions. Perampanel (PER) is a highly selective, noncompetitive AMPA antagonist approved in several countries worldwide for treating different types of seizures in various epileptic conditions. However, recent data show that PER can potentially address many other conditions within epilepsy and beyond. From this perspective, this review aims to examine the new preclinical and clinical studies-especially those produced from 2017 onwards-on AMPA antagonism and PER in conditions such as mesial temporal lobe epilepsy, idiopathic and genetic generalized epilepsy, brain tumor-related epilepsy, status epilepticus, rare epileptic syndromes, stroke, sleep, epilepsy-related migraine, cognitive impairment, autism, dementia, and other neurodegenerative diseases, as well as provide suggestions on future research agenda aimed at probing the possibility of treating these conditions with PER and/or other AMPA receptor antagonists.
Collapse
Affiliation(s)
| | - Cinzia Costa
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Neurological Clinic, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome ‘Tor Vergata”, Rome, Italy
- Epilepsy Center, Neurology Unit, University Hospital “Tor Vergata”, Rome, Italy
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Meletti
- Neurology Department, University Hospital of Modena, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genova, Genova, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Andrea Romigi
- Sleep Medicine Center, Neurological Mediterranean Institute IRCCS Neuromed, Pozzilli, Italy
- Psychology Faculty, International Telematic University Uninettuno, Rome, Italy
| | - Emilio Russo
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
6
|
Lafourcade CA, Sparks FT, Bordey A, Wyneken U, Mohammadi MH. Cannabinoid regulation of neurons in the dentate gyrus during epileptogenesis: Role of CB1R-associated proteins and downstream pathways. Epilepsia 2023. [PMID: 36869624 DOI: 10.1111/epi.17569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/05/2023]
Abstract
The hippocampal formation plays a central role in the development of temporal lobe epilepsy (TLE), a disease characterized by recurrent, unprovoked epileptic discharges. TLE is a neurologic disorder characterized by acute long-lasting seizures (i.e., abnormal electrical activity in the brain) or seizures that occur in close proximity without recovery, typically after a brain injury or status epilepticus. After status epilepticus, epileptogenic hyperexcitability develops gradually over the following months to years, resulting in the emergence of chronic, recurrent seizures. Acting as a filter or gate, the hippocampal dentate gyrus (DG) normally prevents excessive excitation from propagating through the hippocampus, and is considered a critical region in the progression of epileptogenesis in pathological conditions. Importantly, lipid-derived endogenous cannabinoids (endocannabinoids), which are produced on demand as retrograde messengers, are central regulators of neuronal activity in the DG circuit. In this review, we summarize recent findings concerning the role of the DG in controlling hyperexcitability and propose how DG regulation by cannabinoids (CBs) could provide avenues for therapeutic interventions. We also highlight possible pathways and manipulations that could be relevant for the control of hyperexcitation. The use of CB compounds to treat epilepsies is controversial, as anecdotal evidence is not always validated by clinical trials. Recent publications shed light on the importance of the DG as a region regulating incoming hippocampal excitability during epileptogenesis. We review recent findings concerning the modulation of the hippocampal DG circuitry by CBs and discuss putative underlying pathways. A better understanding of the mechanisms by which CBs exert their action during seizures may be useful to improve therapies.
Collapse
Affiliation(s)
- Carlos A Lafourcade
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Fraser T Sparks
- Department of Neuroscience, Columbia University, New York, New York, USA.,Current: Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Angelique Bordey
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ursula Wyneken
- Centro de Investigación e Innovación Biomédica, Laboratorio de Neurociencias, Universidad de Los Andes, Santiago, Chile.,Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
| | | |
Collapse
|
7
|
Cheval M, Houot M, Chastan N, Szurhaj W, Marchal C, Catenoix H, Valton L, Gavaret M, Herlin B, Biraben A, Lagarde S, Mazzola L, Minotti L, Maillard L, Dupont S. Early identification of seizure freedom with medical treatment in patients with mesial temporal lobe epilepsy and hippocampal sclerosis. J Neurol 2023; 270:2715-2723. [PMID: 36763175 DOI: 10.1007/s00415-023-11603-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is usually associated with a poor response to antiseizure medications. We focused on MTLE-HS patients who were seizure free on medication to: (1) determine the clinical factors associated with seizure freedom and (2) develop a machine-learning classifier to better earlier identify those patients. METHODS We performed a retrospective, multicentric study comparing 64 medically treated seizure-free MTLE-HS patients with 200 surgically treated drug-resistant MTLE-HS patients. First, we collected medical history and seizure semiology data. Then, we developed a machine-learning classifier based on clinical data. RESULTS Medically treated seizure-free MTLE-HS patients were seizure-free for at least 2 years, and for a median time of 7 years at last follow-up. Compared to drug-resistant MTLE-HS patients, they exhibited: an older age at epilepsy onset (22.5 vs 8.0 years, p < 0.001), a lesser rate of: febrile seizures (39.0% vs 57.5%, p = 0.035), focal aware seizures (previously referred to as aura)(56.7% vs 90.0%, p < 0.001), autonomic focal aware seizures in presence of focal aware seizure (17.6% vs 59.4%, p < 0.001), dystonic posturing of the limbs (9.8% vs 47.0%, p < 0.001), gestural (27.4% vs 94.0%, p < 0.001), oro-alimentary (32.3% vs 75.5%, p < 0.001) or verbal automatisms (12.9% vs 36.0%, p = 0.001). The classifier had a positive predictive value of 0.889, a sensitivity of 0.727, a specificity of 0.962, a negative predictive value of 0.893. CONCLUSIONS Medically treated seizure-free MTLE-HS patients exhibit a distinct clinical profile. A classifier built with readily available clinical data can identify them accurately with excellent positive predictive value. This may help to individualize the management of MTLE-HS patients according to their expected pharmacosensitivity.
Collapse
Affiliation(s)
- Margaux Cheval
- Reference Center for Rare Epilepsies, Department of Neurology, Epileptology Unit, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'hôpital, 75651, Paris Cedex 13, France. .,Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France. .,Sorbonne Université, Paris, France.
| | - Marion Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.,Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital Paris, Paris, France
| | - Nathalie Chastan
- Department of Neurophysiology, Rouen University Hospital, Rouen, France
| | - William Szurhaj
- Department of Clinical Neurophysiology, Amiens University Hospital, Amiens, France
| | - Cécile Marchal
- Neurology-Epilepsy Unit, Bordeaux University Hospital, Bordeaux, France
| | - Hélène Catenoix
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France.,INSERM U1028, CNRS 5292, Lyon, France
| | - Luc Valton
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Centre de Recherche Cerveau et Cognition, CNRS, UMR5549, Toulouse, France
| | - Martine Gavaret
- Neurophysiology and Epileptology Department, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM UMR 1266, IPNP, Paris, France
| | - Bastien Herlin
- Reference Center for Rare Epilepsies, Department of Neurology, Epileptology Unit, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'hôpital, 75651, Paris Cedex 13, France.,Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne Université, Paris, France
| | - Arnaud Biraben
- Neurology Department, Rennes University Hospital, Rennes, France
| | - Stanislas Lagarde
- Epileptology and Cerebral Rythmology Department, Timone Hospital, APHM, Marseille, France.,Aix Marseille Univ, Inserm, INS, Inst Neurosci Syst, Marseille, France
| | - Laure Mazzola
- Department of Neurology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Lorella Minotti
- Department of Neurology, Grenoble-Alpes University Hospital, Grenoble, France.,Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Louis Maillard
- Reference Center for Rare Epilepsies, Neurology Department, CHU de Nancy, Nancy, France.,CRAN UMR 7039, Université de Lorraine, Nancy, France
| | - Sophie Dupont
- Reference Center for Rare Epilepsies, Department of Neurology, Epileptology Unit, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'hôpital, 75651, Paris Cedex 13, France. .,Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France. .,Sorbonne Université, Paris, France. .,Institut du Cerveau Et de La Moelle Épinière (ICM), Pitié-Salpêtrière Hospital Paris, Paris, France.
| |
Collapse
|
8
|
Fortunato F, Labate A, Gambardella A. Babylonian knowledge about temporal lobe epilepsy: distinguishing mesial from lateral forms. Neurol Sci 2022; 43:6149-6150. [DOI: 10.1007/s10072-022-06243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
|
9
|
Pizzanelli C, Pesaresi I, Milano C, Cecchi P, Fontanelli L, Giannoni S, Giorgi FS, Cosottini M, Bonanni E. Distinct limbic connectivity in left and right benign mesial temporal lobe epilepsy: Evidence from a resting state functional MRI study. Front Neurol 2022; 13:943660. [PMID: 36247782 PMCID: PMC9558280 DOI: 10.3389/fneur.2022.943660] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFunctional connectivity (FC) studies showed that pharmaco-resistant mesial temporal lobe epilepsy (MTLE) affects not only the limbic system, but also several extra-limbic regions, including areas belonging to resting state networks. Less is known about FC in subjects with benign MTLE (i.e., sensitive to antiseizure medication, bMTLE).Aim and methodsWe evaluated FC of hippocampus and amygdala in subjects with bMTLE, distinguished based on the epileptic focus lateralization. We enrolled 19 patients (10 with left and 9 with right bMTLE) and 10 age-matched healthy subjects. Connectivity was investigated at rest by using a seed-based regression analyses approach with four regions of interest (left and right hippocampus, left and right amygdala). Patients were also tested with a neuropsychological battery and their scores were correlated with fMRI data.Results and conclusionsOur study documented an asymmetrical disruption of FC in bMTLE, in relation to the side of the focus. Right subjects only exhibited limited altered connections, while left subjects—who performed worse in verbal memory tests—showed a wide bilateral hypoconnectivity of hippocampus and amygdala with areas belonging to language and memory network. The strength of FC between left limbic areas and language and memory network correlated with better performances in verbal memory tests. Moreover, we observed an increased FC with areas of default mode network, more pronounced in left subjects, a possible attempt to compensate cognitive deficit but without effectiveness.We believe that these findings could help to better characterize bMTLE, in which a dysfunction of limbic connectivity is detectable despite well-controlled epilepsy.
Collapse
Affiliation(s)
- Chiara Pizzanelli
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
- *Correspondence: Chiara Pizzanelli
| | | | - Chiara Milano
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Paolo Cecchi
- Department of Translational Research and New Technologies in Medicine and Surgery, Neuroradiology Unit, University of Pisa, Pisa, Italy
| | - Lorenzo Fontanelli
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Sara Giannoni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Filippo Sean Giorgi
- Department of Translational Research and New Technologies in Medicine and Surgery, Human Anatomy, University of Pisa, Pisa, Italy
| | - Mirco Cosottini
- Neuroradiology Unit, Pisa University Hospital, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, Neuroradiology Unit, University of Pisa, Pisa, Italy
| | - Enrica Bonanni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| |
Collapse
|
10
|
Manna I, Fortunato F, De Benedittis S, Sammarra I, Bertoli G, Labate A, Gambardella A. Non-Coding RNAs: New Biomarkers and Therapeutic Targets for Temporal Lobe Epilepsy. Int J Mol Sci 2022; 23:ijms23063063. [PMID: 35328484 PMCID: PMC8954985 DOI: 10.3390/ijms23063063] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy; it is considered a network disorder associated with structural changes. Incomplete knowledge of the pathological changes in TLE complicates a therapeutic approach; indeed, 30 to 50% of patients with TLE are refractory to drug treatment. Non-coding RNAs (ncRNAs), acting as epigenetic factors, participate in the regulation of the pathophysiological processes of epilepsy and are dysregulated during epileptogenesis. Abnormal expression of ncRNA is observed in patients with epilepsy and in animal models of epilepsy. Furthermore, ncRNAs could also be used as biomarkers for the diagnosis and prognosis of treatment response in epilepsy. In summary, ncRNAs can represent important mechanisms and targets for the modulation of brain excitability and can provide information on pathomechanisms, biomarkers and novel therapies for epilepsy. In this review, we summarize the latest research advances concerning mainly molecular mechanisms, regulated by ncRNA, such as synaptic plasticity, inflammation and apoptosis, already associated with the pathogenesis of TLE. Moreover, we discuss the role of ncRNAs, such as microRNAs, long non-coding RNAs and circular RNAs, in the pathophysiology of epilepsy, highlighting their use as potential biomarkers for future therapeutic approaches.
Collapse
Affiliation(s)
- Ida Manna
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council (CNR), Section of Germaneto, 88100 Catanzaro, Italy
- Correspondence: (I.M.); (A.G.)
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
| | - Selene De Benedittis
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
| | - Ilaria Sammarra
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
| | - Gloria Bertoli
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council (CNR), 20090 Milan, Italy;
| | - Angelo Labate
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
| | - Antonio Gambardella
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council (CNR), Section of Germaneto, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
- Correspondence: (I.M.); (A.G.)
| |
Collapse
|
11
|
Im K, Lee SA, Kim JH, Kim DW, Lee SK, Seo DW, Lee JW. Long-term efficacy and safety of perampanel as a first add-on therapy in patients with focal epilepsy: Three-year extension study. Epilepsy Behav 2021; 125:108407. [PMID: 34785411 DOI: 10.1016/j.yebeh.2021.108407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE We investigated the long-term efficacy and safety of perampanel as a first add-on therapy in patients with focal epilepsy. METHODS This retrospective study represented the 3-year extension phase of a multicenter, open-label, phase 4, prospective study of perampanel as a first add-on therapy in patients with focal epilepsy. Seizure and safety outcomes were assessed annually from the start of the extension study, and the retention rate was calculated from the start of perampanel exposure in the original study. RESULTS The 50% responder and seizure freedom rates were 84.8% and 58.7%, respectively, during the third year and 71.7% and 32.6%, respectively, during the entire 3-year period of the extension study. The 1-, 2-, and 3-year retention rates were 62.5%, 53.1%, and 52.1%, respectively. Efficacies were higher in patients that were aged >55 years, male, and receiving ≤4 mg of perampanel. Perampanel was generally well tolerated; 47.3% of patients experienced at least one adverse event during the 3 years of extension (46 adverse events (AEs) in 35 patients). The most common AEs were dizziness (33.8%), somnolence (5.4%), anger (4.1%), and irritability (4.1%). AEs were resolved with perampanel dose reduction or discontinuation in 10 (13.5%) and 12 (16.2%) patients, respectively. CONCLUSION Long-term treatment with perampanel as a first add-on therapy did not raise new safety signals in patients with focal epilepsy. Especially at low perampanel doses (≤4 mg/day), sustained improvement in seizure control was achieved, which could potentially avoid adverse drug reactions.
Collapse
Affiliation(s)
- Kayeong Im
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dae Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | |
Collapse
|
12
|
Subjective distinguishability of seizure and non-seizure Déjà Vu: A case report, brief literature review, and research prospects. Epilepsy Behav 2021; 125:108373. [PMID: 34735965 PMCID: PMC8639800 DOI: 10.1016/j.yebeh.2021.108373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/24/2022]
Abstract
Roughly two-thirds of all people report having experienced déjà vu-the odd feeling that a current experience is both novel and a repeat or replay of a previous, unrecalled experience. Reports of an association between déjà vu and seizure aura symptomatology have accumulated for over a century, and frequent déjà vu is also now known to be associated with focal seizures, particularly those of a medial temporal lobe (MTL) origin. A longstanding question is whether seizure-related déjà vu has the same basis and is the same subjective experience as non-seizure déjà vu. Survey research suggests that people who experience both seizure-related and non-seizure déjà vu can often subjectively distinguish between the two. We present a case of a person with a history of focal MTL seizures who reports having experienced both seizure-related and non-seizure common déjà vu, though the non-seizure type was more frequent during this person's youth than it is currently. The patient was studied with a virtual tour paradigm that has previously been shown to elicit déjà vu among non-clinical, young adult participants. The patient reported experiencing déjà vu of the common non-seizure type during the virtual tour paradigm, without associated abnormalities of the intracranial EEG. We situate this work in the context of broader ongoing projects examining the subjective correlates of seizures. The importance for memory research of virtual scenes, spatial tasks, virtual reality (VR), and this paradigm for isolating familiarity in the context of recall failure are discussed.
Collapse
|
13
|
Longitudinal analysis of interictal electroencephalograms in patients with temporal lobe epilepsy with hippocampal sclerosis. Seizure 2021; 90:141-144. [DOI: 10.1016/j.seizure.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/14/2022] Open
|
14
|
Alqadi KS, Rammal SA, Alam ME, Alshahrani AM, Baeesa SS, Kayyali HR, Babtain FA, Al-Said YA. Consanguinity in patients with mesial temporal lobe epilepsy due to hippocampal sclerosis in a Saudi population. ACTA ACUST UNITED AC 2021; 25:276-280. [PMID: 33130813 PMCID: PMC8015614 DOI: 10.17712/nsj.2020.4.20200055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives: To investigate if there is an association between consanguinity and hippocampal sclerosis (HS) in the Saudi population. Methods: A retrospective case-control study was conducted by assessing the prevalence of consanguinity in patients with pathologically proven HS, who underwent epilepsy surgery at King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, between January 2004 and December 2015. We reviewed the medical records to extract data, which included; age, gender, duration of epilepsy, history of febrile seizure, family history of epilepsy in a first or second-degree relative, and pathology reports. Results: A total of 120 patients, out of which 40 patients (65% male) having mesial temporal lobe epilepsy due to HS, and 80 controls (56% male) with cryptogenic epilepsy, were identified. Twenty-two patients (53.5%) in the HS group had a history of consanguinity. In the control group, 30 patients (37.5%) had a history of consanguinity. The odds ratio was 2.04 (95% confidence interval = 0.94 - 4.4, p = 0.052). A family history of epilepsy was found in 28% of the patients with HS and 32.5% cryptogenic epilepsy. Only 8 patients (19.5%) with HS reported a history of febrile seizure. Conclusion: Our retrospective case-control study suggests that consanguinity might increase the likelihood of developing HS.
Collapse
Affiliation(s)
- Khalid S Alqadi
- Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia. E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Guzmán-Jiménez DE, Campos JB, Venegas-Vega CA, Sánchez MA, Velasco AL. Familial mesial temporal lobe epilepsy in Mexico: Inheritance pattern and clinical features. Epilepsy Res 2020; 167:106450. [PMID: 32949980 DOI: 10.1016/j.eplepsyres.2020.106450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The objectives of this study were to determine the inheritance pattern by which familial mesial temporal lobe epilepsy (FMTLE) is segregated in Mexican families, and to identify if there was an association between the clinical characteristics and the inheritance pattern. METHOD We included a total of 25 families with two or more members affected with MTLE during two years and elaborated a family pedigree for each family. The inheritance pattern was classified as autosomal dominant (AD) or autosomal recessive (AR), considering the affected members. We used statistical analysis association and differences between clinical characteristics and inheritance patterns. RESULTS The affected families with the AD pattern were 15.7 fold times more likely to start seizures at 5 years of age or earlier than families with AR pattern, OR = 15.7 (IC 95% = 1.9-128.9). We observed a predominance and greater déjà vu association (64.4% vs 31.3%; p = 0.021), OR = 3.9 (CI 95% = 1.1-13.5) in patients with AD versus AR pattern. Finally, we identified that patients with AD pattern had a likelihood of presenting emotional alterations 5.6 times higher than AR (OR = 5.6, IC = 1.1-27.5). CONCLUSION FMTLE is a heterogeneous syndrome, both phenotypically and genotypically; thus, our findings may be helpful for clinical use to perform an early diagnosis, to provide timely treatment, and to prevent comorbidities associated to this disease. However, in order to identify the possible genetic causes underlying these inheritance patterns, the use of molecular studies is necessary.
Collapse
Affiliation(s)
- Diana Elena Guzmán-Jiménez
- Epilepsy Clinic, General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico; Programa de Doctorado en Ciencias Biomédicas, División de Estudios de Posgrado, Universidad Nacional Autónoma de México (UNAM), Universidad 3000, 04510, Mexico City, Mexico.
| | - Jaime Berumen Campos
- Medical School, Universidad Nacional Autónoma de México, Mexico City, Mexico; Experimental Medicine Unit, Universidad Nacional Autónoma de México, in the General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico.
| | - Carlos Alberto Venegas-Vega
- Medical School, Universidad Nacional Autónoma de México, Mexico City, Mexico; Genetic Unit, General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico.
| | - Mariana Alejandre Sánchez
- Epilepsy Clinic, General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico.
| | - Ana Luisa Velasco
- Epilepsy Clinic, General Hospital of México "Dr. Eduardo Liceaga", Dr. Balmis 148, 06720, Doctores, Mexico City, Mexico.
| |
Collapse
|
16
|
Labate A, Caligiuri ME, Fortunato F, Ferlazzo E, Aguglia U, Gambardella A. Late drug-resistance in mild MTLE: Can it be influenced by preexisting white matter alterations? Epilepsia 2020; 61:924-934. [PMID: 32311085 DOI: 10.1111/epi.16503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify early structural alterations preceding the development of drug-resistance in mild mesial temporal lobe epilepsy (mMTLE), a drug-responsive syndrome ideal for investigating epilepsy pathophysiology and potential prognostic markers of long-term clinical outcome, using magnetic resonance imaging (MRI) at baseline and after 12-year follow-up. METHODS Since 2002, a total of 55 participants with a baseline diagnosis of mMTLE underwent three-dimensional (3D) T1 1.5T MRI. Based on long-term outcome (follow-up 12 ± 3 years), we identified 39 patients with stable mMTLE (smMTLE) and 16 patients who had developed drug-resistance overtime (refractory MTLE [rMTLE]). At follow-up, 21 smMTLE and 13 rMTLE patients underwent 3T-MRI including diffusion-weighted scans. Structural images were processed using longitudinal voxel-based morphometry and standard Freesurfer analysis. Statistical analyses were carried out accounting for age, age at onset, gender, hippocampal volume, and hippocampal sclerosis (Hs). RESULTS Patients presented similar demographic, clinical, and Hs features. White matter volume of the arcuate fasciculi, corticospinal tracts, left retrosplenial cingulum, and left inferior longitudinal fasciculus was reduced only in rMTLE patients before the development of drug-resistance. At follow-up, rMTLE showed decreased fractional anisotropy in the corpus callosum, superior longitudinal fasciculi, and major bundles of the right hemisphere. SIGNIFICANCE White matter temporal and extratemporal abnormalities are preexisting in patients with mild MTLE who will develop drug-resistance, independently from the presence of Hs. Thus, these changes might be due to an inherited genetic alteration rather than a subordinate worsening after repeated seizures, multiple antiepileptic drugs, or initial precipitating factors.
Collapse
Affiliation(s)
- Angelo Labate
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Neuroscience Research Center, University Magna Graecia, Catanzaro, Italy
| | | | | | - Edoardo Ferlazzo
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital of Reggio Calabria, Reggio Calabria, Italy
| | - Umberto Aguglia
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital of Reggio Calabria, Reggio Calabria, Italy
| | - Antonio Gambardella
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Neuroscience Research Center, University Magna Graecia, Catanzaro, Italy
| |
Collapse
|
17
|
“Benign” temporal lobe epilepsy with hippocampal sclerosis: A forgotten entity? Epilepsy Behav Rep 2020; 14:100407. [PMID: 33313502 PMCID: PMC7720020 DOI: 10.1016/j.ebr.2020.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/18/2020] [Accepted: 10/18/2020] [Indexed: 11/21/2022] Open
|
18
|
Stefanatou M, Gatzonis S, Peskostas A, Paraskevas G, Koutroumanidis M. Drug-responsive versus drug-refractory mesial temporal lobe epilepsy: a single-center prospective outcome study. Postgrad Med 2019; 131:479-485. [PMID: 31513436 DOI: 10.1080/00325481.2019.1663126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: To evaluate clinical, electrophysiological, and neuroradiological factors which correlate with the prognosis in patients with mesial temporal lobe epilepsy (MTLE). Methods: This was a single-center prospective outcome study in patients with MTLE. The patients' family history, clinical characteristics, neurophysiological data (electroencephalography - EEG), neuroimaging, antiepileptic therapy, and outcome were collected and analyzed. The population was divided into four groups depending on the frequency of the seizures when they attended their last follow up. All variables and outcome measures were compared between the four groups. Results: In total 83 consecutive patients were included within the four groups. Group 1 (seizure-free) consisted of 7 patients, (9%), Group 2 (rare seizures) consisted of 15 patients (18%), Group 3 (often seizures) consisted of 30 patients (36%), and Group 4 (very often seizures) consisted of 31 patients (37%). The groups did not differ significantly in demographic characteristics. There was a strong positive correlation between resistance to therapy and sleep activation on EEG (p = 0.005), occurrence of focal to bilateral seizures (p = 0.007), automatisms (p = 0.004), and the number of previously used antiepileptic drugs (AEDs) (p = 0.002). There was no association between febrile convulsions (FC), hippocampal sclerosis (HS), and the outcome that was found. Conclusion: MTLE is a heterogeneous syndrome. Establishing the factors responsible for, and associated with, drug resistance is important for optimal management and treatment, as early identification of drug resistance should then ensure a timely referral for surgical treatment is made. This prospective study shows that sleep activation on EEG, ictal automatisms, occurrence of focal to bilateral tonic-clonic seizures, and increased number of tried AEDs are negative prognostic factors.
Collapse
Affiliation(s)
- Maria Stefanatou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Aeginition Hospital , Athens , Greece.,Department of Clinical Neurophysiology and Epilepsies, Guy's and St. Thomas' NHS Foundation Trust , London , UK
| | - Stylianos Gatzonis
- 1st Department of Neurosurgery, Epilepsy Centre, National and Kapodistrian University of Athens, "Evangelismos" Hospital , Athens , Greece
| | - Antonis Peskostas
- Department of Statistics and Insurance Science, University of Piraeus , Piraeus , Greece
| | - George Paraskevas
- 1st Department of Neurology, National and Kapodistrian University of Athens, Aeginition Hospital , Athens , Greece
| | - Michael Koutroumanidis
- Department of Clinical Neurophysiology and Epilepsies, Guy's and St. Thomas' NHS Foundation Trust , London , UK
| |
Collapse
|
19
|
Psychiatric Assessment in Patients with Mild Temporal Lobe Epilepsy. Behav Neurol 2019; 2019:4139404. [PMID: 30733834 PMCID: PMC6348858 DOI: 10.1155/2019/4139404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/10/2018] [Accepted: 12/02/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives The findings of previous studies focused on personality disorders in epileptic patients are difficult to interpret due to nonhomogeneous samples and noncomparable methods. Here, we aimed at studying the personality profile in patients with mild temporal lobe epilepsy (mTLE) with psychiatric comorbidity. Materials and Methods Thirty-five patients with mTLE (22 males, mean age 40.7 ± 12.1) underwent awake and sleep EEG, 3T brain MRI, and an extensive standardized diagnostic neuropsychiatric battery: Temperament and Character Inventory-Revised (TCI-R), Beck Depression Inventory-2, and State-Trait Anxiety Inventory. Drug history was collected in detail. Hierarchical Cluster Analysis was performed on TCI-R data, while all other clinical and psychological variables were compared across the resulting clusters. Results Scores of Harm Avoidance (HA), Reward Dependence (RD), Persistence (P), Cooperativeness (C), and Self-Transcendence (ST) allowed the identification of two clusters, describing different personality subtypes. Cluster 1 was characterized by an early onset, more severe anxiety traits, and combined drug therapy (antiepileptic drug and Benzodiazepine/Selective Serotonin Reuptake Inhibitors) compared to Cluster 2. Conclusions Our findings suggest that different personality traits may play a role in determining the clinical outcome in patients with mTLE. Specifically, lower scores of HA, RD, P, C, and ST were associated with worse clinical outcome. Thus, personality assessment could serve as an early indicator of greater disease severity, improving the management of mTLE.
Collapse
|
20
|
Wichova H, Shew M, Alvi S, Lin J. A Case of Mesial Temporal Lobe Sclerosis Following Temporal Bone Encephalocele Repair for Medically Refractory Seizures. Cureus 2018; 10:e3623. [PMID: 30693169 PMCID: PMC6344067 DOI: 10.7759/cureus.3623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this report is to present a case of mesial temporal lobe sclerosis (MTS) causing medically refractory seizures, which was initially disguised as temporal lobe encephalocele secondary to prior otologic surgery. Temporal lobe encephaloceles are characterized by a defect within the middle cranial fossa that results in the abnormal communication of the meninges into the pneumatized skull base. After the temporal lobe encephalocele repair, the patient continued to have seizures and was subsequently diagnosed with mesial temporal lobe sclerosis. Imaging revealed the serial progression of hippocampal atrophy and loss of internal architecture. Differentiation between mesial temporal sclerosis and encephalocele as the underlying epileptic etiology is critical. While repairing encephaloceles is necessary to address other potential sequelae, patients with mesial temporal lobe sclerosis will require additional interventions.
Collapse
Affiliation(s)
- Helena Wichova
- Otolaryngology, University of Kansas Medical Center, Kansas City, USA
| | - Matthew Shew
- Otolaryngology, University of Kansas Medical Center, Kansas City, USA
| | - Sameer Alvi
- Otolaryngology, Rush University Medical Center, Chicago, USA
| | - James Lin
- Otolaryngology, University of Kansas Medical Center, Kansas City, USA
| |
Collapse
|
21
|
Vaccaro MG, Trimboli M, Scarpazza C, Palermo L, Bruni A, Gambardella A, Labate A. Neuropsychological profile of mild temporal lobe epilepsy. Epilepsy Behav 2018; 85:222-226. [PMID: 30032811 DOI: 10.1016/j.yebeh.2018.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/25/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In the current literature, whether patients with mild mesial temporal lobe epilepsy (mMTLE) have typical neurocognitive profile similar to patients with treatment-refractory seizures still remains unknown. The purpose of the present work was to analyze the neuropsychological profile in a group of consecutive patients with mMTLE. METHODS Forty consecutive patients whose conditions were diagnosed with mMTLE and 30 healthy controls (HC) were evaluated with an extensive neuropsychological battery. In addition, self-report questionnaires were also administered to evaluate the subjective impairments in prospective and retrospective memories. Finally, the levels of depression and anxiety were evaluated using the Beck Depression Inventory II (BDI-II) and the State-Trait Anxiety Inventory - Form Y1 (STAI-YI e 2). RESULTS Patients with mMTLE patients showed higher BDI-II scores (15.9 ± 13.9 vs 7.2 ± 6.7; p =, 002), and higher STAI-Y1 (41.2 ± 14.6 vs 32.6 ± 9.8; p =, 005) together with both objective and subjective memory deficits. Although BDI-II and STAI scores strongly correlated to the outcome in Rey Auditory Verbal Learning Test (RAVLT) and prospective and retrospective memory questionnaire (PRMQ) (p < 0.0021), these results did not change without depression scores. CONCLUSION We showed that a specific neurocognitive profile in patients with mMTLE exists. The neuropsychological features are mood depression, verbal memory immediate and delayed deficits, and subjective prospective and retrospective memory deficits.
Collapse
Affiliation(s)
- Maria Grazia Vaccaro
- Department of Medical Sciences, Institute of Neurology, University Magna Græcia, Catanzaro, Italy
| | - Michele Trimboli
- Department of Medical Sciences, Institute of Neurology, University Magna Græcia, Catanzaro, Italy
| | - Cristina Scarpazza
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of General Psychology, University of Padua, Italy
| | - Liana Palermo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Antonella Bruni
- Department of Medical Sciences, Institute of Neurology, University Magna Græcia, Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical Sciences, Institute of Neurology, University Magna Græcia, Catanzaro, Italy
| | - Angelo Labate
- Department of Medical Sciences, Institute of Neurology, University Magna Græcia, Catanzaro, Italy.
| |
Collapse
|
22
|
Vasta R, Sarica A, Bisulli F, Di Gennaro G, D'Aniello A, Difrancesco JC, Canafoglia L, Casazza M, Franceschetti S, Stipa C, Tinuper P, Mumoli L, Gambardella A, Labate A. Advanced morphological neuroimaging study in lateral temporal lobe epilepsy: A multicentric study. Epilepsy Behav 2017; 74:69-72. [PMID: 28728046 DOI: 10.1016/j.yebeh.2017.06.017] [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: 04/05/2017] [Revised: 06/01/2017] [Accepted: 06/11/2017] [Indexed: 11/30/2022]
Abstract
Lateral temporal lobe epilepsy (lTLE) is a rare condition characterized by auditory auras or receptive aphasia, negative MRI, and relatively benign evolution. With the low number of cases in the world, our objective was to analyze a cohort of sporadic cases with lTLE (slTLE), in order to investigate possible cerebral morphological alterations. Forty patients with lTLE (34.93±12.08years of age) and 38 healthy controls (CTRL, 34.55±9.08years of age) were enrolled from four tertiary Italian epilepsy centers, which provided brain MRI T1-weighted images following a standard protocol for patients with epilepsy. We performed group comparison by following different approaches: voxel-based morphometry (VBM, SPM8), cortical thickness (CT), and local gyrification index (lGI) (FreeSurfer 5.3). At a more conservative threshold (p<0.05, FWE correction), no significant differences between groups survived, neither in VBM nor CT/lGI. Multicenter studies have more power than smaller studies in conducting sophisticated evaluations of rare diseases, and further investigations are required to develop a full picture of this rare phenotype.
Collapse
Affiliation(s)
- Roberta Vasta
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy
| | - Alessia Sarica
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy
| | - Francesca Bisulli
- IRCCS Institute of Neurological Science of Bologna, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | | | | | - Jacopo C Difrancesco
- Neurology Unit, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Neurophysiology and Diagnostic Epilepsy, Besta's Institute, Milano, Italy
| | - Laura Canafoglia
- Neurophysiology and Diagnostic Epilepsy, Besta's Institute, Milano, Italy
| | - Marina Casazza
- Neurophysiology and Diagnostic Epilepsy, Besta's Institute, Milano, Italy
| | | | - Carlotta Stipa
- IRCCS Institute of Neurological Science of Bologna, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Science of Bologna, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Laura Mumoli
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Antonio Gambardella
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy; Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Angelo Labate
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy; Institute of Neurology, University "Magna Graecia", Catanzaro, Italy.
| |
Collapse
|
23
|
Abstract
Epilepsy is one of the most common neurologic disorders, affecting about 50 million people worldwide. The disease is characterized by recurrent seizures, which are due to aberrant neuronal networks resulting in synchronous discharges. The term epilepsy encompasses a large spectrum of syndromes and diseases with different etiopathogenesis. The recent development of imaging and epilepsy surgery techniques is now enabling the identification of structural abnormalities that are part of the epileptic network, and the removal of these lesions may result in control of seizures. Access of this clinically well-characterized neurosurgical material has provided neuropathologists with the opportunity to study a variety of structural brain abnormalities associated with epilepsy, by combining traditional routine histopathologic methods with molecular genetics and functional analysis of the resected tissue. This approach has contributed greatly to a better diagnosis and classification of these structural lesions, and has provided important new insights into their pathogenesis and epileptogenesis. The present chapter provides a detailed description of the large spectrum of histopathologic findings encountered in epilepsy surgery patients, addressing in particular the nonneoplastic pathologies, including hippocampal sclerosis, malformations of cortical development, Sturge-Weber syndrome, and Rasmussen encephalitis, and reviews current knowledge regarding the underlying molecular pathomechanisms and cellular mechanisms mediating hyperexcitability.
Collapse
Affiliation(s)
- Eleonora Aronica
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland, the Netherlands.
| | - Angelika Mühlebner
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
24
|
AlQassmi A, Burneo JG, McLachlan RS, Mirsattari SM. Benign mesial temporal lobe epilepsy: A clinical cohort and literature review. Epilepsy Behav 2016; 65:60-64. [PMID: 27889242 DOI: 10.1016/j.yebeh.2016.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/10/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We present a single-center retrospective study of benign mesial temporal lobe epilepsy (bMTLE) between 1995 and 2014. METHODS Hospital records and clinic charts were reviewed. The clinical, Eelectroencephalographic (EEG), imaging features, and response to treatment with antiepileptic drugs (AEDs) were documented. Patients were included in this study if they were seizure-free for a minimum of 24months with or without an AED. RESULTS Twenty-seven patients were identified. There were 19 (70%) females, mean age at first seizure was 32.2 (range: 15-80years). In all patients, seizures were mild, and seizure freedom was readily achieved with the initiation of AED therapy. Sixteen patients (59%) had mesial temporal sclerosis (MTS). In three patients, we attempted to discontinue AED therapy after a prolonged period of remission (5-8years), but all had seizure recurrence within 2 to 4weeks. SIGNIFICANCE Not all temporal lobe epilepsy is refractory to medication, despite the presence of MTS. Until clinical trials indicate otherwise, surgery is not indicated but life-long medical treatment is advocated.
Collapse
Affiliation(s)
- Amal AlQassmi
- Epilepsy Program, Department of Clinical Neurological Sciences, Western University, London, Canada.
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Western University, London, Canada
| | - Richard S McLachlan
- Epilepsy Program, Department of Clinical Neurological Sciences, Western University, London, Canada
| | - Seyed M Mirsattari
- Epilepsy Program, Department of Clinical Neurological Sciences, Western University, London, Canada; Department of Medical Imaging, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada; Department of Psychology, Western University, London, Canada
| |
Collapse
|
25
|
Gambardella A, Labate A, Cifelli P, Ruffolo G, Mumoli L, Aronica E, Palma E. Pharmacological modulation in mesial temporal lobe epilepsy: Current status and future perspectives. Pharmacol Res 2016; 113:421-425. [DOI: 10.1016/j.phrs.2016.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/13/2016] [Accepted: 09/17/2016] [Indexed: 11/29/2022]
|
26
|
The Natural History of Epilepsy in 163 Untreated Patients: Looking for "Oligoepilepsy". PLoS One 2016; 11:e0161722. [PMID: 27657542 PMCID: PMC5033474 DOI: 10.1371/journal.pone.0161722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022] Open
Abstract
The clinical evolution of untreated epilepsy has been rarely studied in developed countries, and the existence of a distinct syndrome characterized by rarely repeated seizures (oligoepilepsy) is debated. The aim of this study is to assess the natural history of 163 untreated patients with epilepsy in order to evaluate whether oligoepilepsy retains specific features. We retrospectively evaluated 7344 patients with ≥2 unprovoked seizures. Inclusion criteria: sufficient anamnestic/EEG data, disease duration ≥10 years, follow-up ≥3 years. Exclusion criteria: psychogenic seizures, natural history of disease <5 years. The 163 included subjects were divided into 2 groups according to seizure frequency: oligoepilepsy (≤1/year; 47 subjects) and controls (>1/year; 116 subjects). We also evaluated seizure frequency during the natural history. There were no differences between groups regarding duration of natural history, family history of epilepsy/febrile seizures, interictal EEG. Subjects with oligoepilepsy differed from controls in terms of sex (females 38% vs. 58%, p = 0.03) and drug resistance (6% vs 28%; p = 0.003). Juvenile myoclonic epilepsy was more frequent in controls (9.5% vs 0%, p = 0.04). Patients with oligoepilepsy, differently from controls, had stable seizure frequency. Oligoepilepsy represents a favourable evolution of different epileptic syndromes and keeps a stable seizure frequency over time.
Collapse
|
27
|
Kuzmanovski I, Cvetkovska E, Babunovska M, Kiteva Trencevska G, Kuzmanovska B, Boshkovski B, Isjanovska R. Seizure outcome following medical treatment of mesial temporal lobe epilepsy: Clinical phenotypes and prognostic factors. Clin Neurol Neurosurg 2016; 144:91-5. [DOI: 10.1016/j.clineuro.2016.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/20/2016] [Accepted: 03/08/2016] [Indexed: 01/03/2023]
|
28
|
Alvim MKM, Coan AC, Yasuda CL, Morita ME, Cendes F. In response: Brain atrophy in seizure-free temporal lobe epilepsy: Implications for predicting pharmacoresistance. Epilepsia 2016; 57:856-7. [DOI: 10.1111/epi.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Marina K. M. Alvim
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
| | - Ana C. Coan
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
| | - Clarissa L. Yasuda
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
| | - Marcia E. Morita
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
| |
Collapse
|
29
|
Labate A, Aguglia U, Tripepi G, Mumoli L, Ferlazzo E, Baggetta R, Quattrone A, Gambardella A. Long-term outcome of mild mesial temporal lobe epilepsy: A prospective longitudinal cohort study. Neurology 2016; 86:1904-10. [PMID: 27164663 DOI: 10.1212/wnl.0000000000002674] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/02/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify clinical and imaging features at presentation that might predict long-term outcome in patients with mild mesial temporal lobe epilepsy (mMTLE), which is defined by at least 24 seizure-free months with or without antiepileptic medication. METHODS In the setting of a prospective, population-based, longitudinal cohort study, we followed up 101 patients, all with mMTLE at enrolment. By protocol, patients underwent clinical evaluation every 3-12 months. Independent t test, Mann-Whitney test, or χ(2) test was used for comparing 2 groups. The incidence rate of refractory MTLE (rMTLE) was expressed as number of cases every 100 person-years. RESULTS After a mean follow-up of 12.2 ± 3.7 years, 16 patients dropped out and 85/101 (mean age 46.5 ± 13.3 years) were available for the present analysis. Of these, 64/85 (75%) patients remained seizure-free and 21/85 (25%) became refractory (rMTLE), the latter corresponding to 2.0 cases per 100 persons per year. Patients with rMTLE showed a longer duration of epilepsy (p < 0.001), earlier age at epilepsy onset (p = 0.006), more frequent febrile convulsions (p = 0.02), and hippocampal sclerosis (HS) at MRI (p = 0.004) as compared to those with mMTLE. CONCLUSIONS mMTLE is a syndrome representing the mildest form of the wide spectrum of MTLE. Earlier age at onset, history of febrile convulsions, longer duration of epilepsy, and the presence of HS on MRI predict a worse outcome.
Collapse
Affiliation(s)
- Angelo Labate
- From the Institute of Neurology (A.L., U.A., L.M., E.F., A.Q., A.G.), University Magna Græcia, Catanzaro; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR) (A.L., U.A., E.F., A.Q., A.G.), Viale Europa, Germaneto (CZ); and Institute of Clinical Physiology (G.T., R.B.), National Research Council (IFC-CNR), Research Unit, Reggio Calabria, Italy.
| | - Umberto Aguglia
- From the Institute of Neurology (A.L., U.A., L.M., E.F., A.Q., A.G.), University Magna Græcia, Catanzaro; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR) (A.L., U.A., E.F., A.Q., A.G.), Viale Europa, Germaneto (CZ); and Institute of Clinical Physiology (G.T., R.B.), National Research Council (IFC-CNR), Research Unit, Reggio Calabria, Italy
| | - Giovanni Tripepi
- From the Institute of Neurology (A.L., U.A., L.M., E.F., A.Q., A.G.), University Magna Græcia, Catanzaro; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR) (A.L., U.A., E.F., A.Q., A.G.), Viale Europa, Germaneto (CZ); and Institute of Clinical Physiology (G.T., R.B.), National Research Council (IFC-CNR), Research Unit, Reggio Calabria, Italy
| | - Laura Mumoli
- From the Institute of Neurology (A.L., U.A., L.M., E.F., A.Q., A.G.), University Magna Græcia, Catanzaro; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR) (A.L., U.A., E.F., A.Q., A.G.), Viale Europa, Germaneto (CZ); and Institute of Clinical Physiology (G.T., R.B.), National Research Council (IFC-CNR), Research Unit, Reggio Calabria, Italy
| | - Edoardo Ferlazzo
- From the Institute of Neurology (A.L., U.A., L.M., E.F., A.Q., A.G.), University Magna Græcia, Catanzaro; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR) (A.L., U.A., E.F., A.Q., A.G.), Viale Europa, Germaneto (CZ); and Institute of Clinical Physiology (G.T., R.B.), National Research Council (IFC-CNR), Research Unit, Reggio Calabria, Italy
| | - Rossella Baggetta
- From the Institute of Neurology (A.L., U.A., L.M., E.F., A.Q., A.G.), University Magna Græcia, Catanzaro; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR) (A.L., U.A., E.F., A.Q., A.G.), Viale Europa, Germaneto (CZ); and Institute of Clinical Physiology (G.T., R.B.), National Research Council (IFC-CNR), Research Unit, Reggio Calabria, Italy
| | - Aldo Quattrone
- From the Institute of Neurology (A.L., U.A., L.M., E.F., A.Q., A.G.), University Magna Græcia, Catanzaro; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR) (A.L., U.A., E.F., A.Q., A.G.), Viale Europa, Germaneto (CZ); and Institute of Clinical Physiology (G.T., R.B.), National Research Council (IFC-CNR), Research Unit, Reggio Calabria, Italy
| | - Antonio Gambardella
- From the Institute of Neurology (A.L., U.A., L.M., E.F., A.Q., A.G.), University Magna Græcia, Catanzaro; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR) (A.L., U.A., E.F., A.Q., A.G.), Viale Europa, Germaneto (CZ); and Institute of Clinical Physiology (G.T., R.B.), National Research Council (IFC-CNR), Research Unit, Reggio Calabria, Italy.
| |
Collapse
|
30
|
Caligiuri ME, Labate A, Cherubini A, Mumoli L, Ferlazzo E, Aguglia U, Quattrone A, Gambardella A. Integrity of the corpus callosum in patients with benign temporal lobe epilepsy. Epilepsia 2016; 57:590-6. [DOI: 10.1111/epi.13339] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Maria Eugenia Caligiuri
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR); Catanzaro Italy
| | - Angelo Labate
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR); Catanzaro Italy
- Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - Andrea Cherubini
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR); Catanzaro Italy
| | - Laura Mumoli
- Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - Edoardo Ferlazzo
- Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - Umberto Aguglia
- Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - Aldo Quattrone
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR); Catanzaro Italy
- Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - Antonio Gambardella
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR); Catanzaro Italy
- Institute of Neurology; University Magna Graecia; Catanzaro Italy
| |
Collapse
|
31
|
Alvim MKM, Coan AC, Campos BM, Yasuda CL, Oliveira MC, Morita ME, Cendes F. Progression of gray matter atrophy in seizure-free patients with temporal lobe epilepsy. Epilepsia 2016; 57:621-9. [PMID: 26865066 DOI: 10.1111/epi.13334] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To investigate the presence and progression of gray matter (GM) reduction in seizure-free patients with temporal lobe epilepsy (TLE). METHODS We enrolled 39 consecutive TLE patients, seizure-free for at least 2 years--20 with magnetic resonance imaging (MRI) signs of hippocampal sclerosis (TLE-HS), 19 with normal MRI (TLE-NL), and 74 healthy controls. For longitudinal analysis, we included individuals who had a second MRI with minimum interval of 18 months: 21 patients (10 TLE-HS, 11 TLE-NL) and 11 controls. Three-dimensional (3D) T1 -weighted images acquired in 3 Tesla MRI were analyzed with voxel-based morphometry (VBM). The images of patients with right-sided interictal epileptogenic zone (EZ) were right-left flipped, as well as a comparable proportion of controls. Cross-sectional analysis: The patients' images from each group were compared to controls to investigate differences in GM volumes. Longitudinal analysis: The first and second images were compared in each group to look for decreased GM volume. RESULTS Cross-sectional analysis: Patients with TLE-HS had diffuse GM atrophy, including hippocampus and parahippocampal gyrus, insula, frontal, and occipital lobes ipsilateral to EZ, bilateral thalamus and contralateral orbitofrontal gyrus, and caudate. In contrast, TLE-NL group did not present significant differences compared to controls. Longitudinal analysis: TLE-HS presented progressive GM reduction in ipsilateral insula and occipital lobe, contralateral motor area, and bilateral temporal and frontal lobes. TLE-NL had GM progression in ipsilateral hypothalamus and parietal lobe, contralateral cerebellum, and bilateral temporal lobe. Controls did not show changes in GM volume between MRIs. SIGNIFICANCE Diffuse extrahippocampal GM atrophy is present in seizure-free patients with TLE-HS. In addition, there is progressive GM atrophy in patients with and without HS. These results demonstrate that not only ongoing seizures are involved in the progression of GM atrophy. An underlying pathologic mechanism could be responsible for progressive brain volume loss in TLE patients even in seizure-free periods.
Collapse
Affiliation(s)
- Marina K M Alvim
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Ana C Coan
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Brunno M Campos
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Clarissa L Yasuda
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Mariana C Oliveira
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Marcia E Morita
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| |
Collapse
|
32
|
Kim J, Kim SH, Lim SC, Kim W, Shon YM. Clinical characteristics of patients with benign nonlesional temporal lobe epilepsy. Neuropsychiatr Dis Treat 2016; 12:1887-91. [PMID: 27555776 PMCID: PMC4968857 DOI: 10.2147/ndt.s110400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the evolution of nonlesional temporal lobe epilepsy (TLE-NL) in patients treated exclusively with antiepileptic drugs and to elucidate clinical phenotypes related to the prognosis of these patients. METHODS Clinical, radiological, and electroencephalographic (EEG) findings in 84 patients with TLE-NL were reviewed. A good response group (GRG) and a poor response group (PRG) were defined if the duration of their seizure-free period was >1 year, or <1 year, respectively. RESULTS There were 46 (54.8%) patients in the GRG and 38 (45.2%) patients in the PRG. The number of antiepileptic drugs administered was significantly lower in the GRG than that in the PRG (1.3±0.8 vs 2.8±1.0, respectively; P<0.05). The GRG had a significantly older age of onset than the PRG and a lower occurrence of initial precipitating events, such as febrile seizures, central nervous system infection, and head trauma (P<0.05). The prevalence of EEG abnormality, presence of aura, generalized seizures, and automatism was less frequently observed in the GRG (P<0.05). Multivariate analysis showed that the presence of automatism and initial precipitating events were significantly associated with a poor prognosis (P<0.05). CONCLUSION In contrast to the commonly assumed intractability of TLE, we found that more than 54% of patients with TLE-NL achieved a long seizure-free period. Older age at onset of TLE-NL was associated with a better prognosis. However, the presence of automatism and initial precipitating events were related to a poor prognosis. Future prospective studies with a much larger population are warranted.
Collapse
Affiliation(s)
- Jiyeon Kim
- Department of Neurology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan
| | - Seong Hoon Kim
- Department of Neurology, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seocho-gu
| | - Sung Chul Lim
- Department of Neurology, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seocho-gu
| | - Woojun Kim
- Department of Neurology, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seocho-gu
| | - Young-Min Shon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
33
|
Combined effect between two functional polymorphisms of SLC6A12 gene is associated with temporal lobe epilepsy. J Genet 2015; 94:637-42. [DOI: 10.1007/s12041-015-0567-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Azab M, Carone M, Ying SH, Yousem DM. Mesial Temporal Sclerosis: Accuracy of NeuroQuant versus Neuroradiologist. AJNR Am J Neuroradiol 2015; 36:1400-6. [PMID: 25907519 DOI: 10.3174/ajnr.a4313] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/19/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE We sought to compare the accuracy of a volumetric fully automated computer assessment of hippocampal volume asymmetry versus neuroradiologists' interpretations of the temporal lobes for mesial temporal sclerosis. Detecting mesial temporal sclerosis (MTS) is important for the evaluation of patients with temporal lobe epilepsy as it often guides surgical intervention. One feature of MTS is hippocampal volume loss. MATERIALS AND METHODS Electronic medical record and researcher reports of scans of patients with proved mesial temporal sclerosis were compared with volumetric assessment with an FDA-approved software package, NeuroQuant, for detection of mesial temporal sclerosis in 63 patients. The degree of volumetric asymmetry was analyzed to determine the neuroradiologists' threshold for detecting right-left asymmetry in temporal lobe volumes. RESULTS Thirty-six patients had left-lateralized MTS, 25 had right-lateralized MTS, and 2 had bilateral MTS. The estimated accuracy of the neuroradiologist was 72.6% with a κ statistic of 0.512 (95% CI, 0.315-0.710) [moderate agreement, P < 3 × 10(-6)]), whereas the estimated accuracy of NeuroQuant was 79.4% with a κ statistic of 0.588 (95% CI, 0.388-0.787) [moderate agreement, P < 2 × 10(-6)]). This discrepancy in accuracy was not statistically significant. When at least a 5%-10% volume discrepancy between temporal lobes was present, the neuroradiologists detected it 75%-80% of the time. CONCLUSIONS As a stand-alone fully automated software program that can process temporal lobe volume in 5-10 minutes, NeuroQuant compares favorably with trained neuroradiologists in predicting the side of mesial temporal sclerosis. Neuroradiologists can often detect even small temporal lobe volumetric changes visually.
Collapse
Affiliation(s)
- M Azab
- From the Division of Neuroradiology (M.A., S.H.Y., D.M.Y.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland Department of Radiology (M.A.), Suez Canal University, Ismaïlia, Ismailia Governorate
| | - M Carone
- Department of Biostatistics (M.C.), University of Washington, Seattle, Washington
| | - S H Ying
- From the Division of Neuroradiology (M.A., S.H.Y., D.M.Y.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - D M Yousem
- From the Division of Neuroradiology (M.A., S.H.Y., D.M.Y.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|
35
|
Voltzenlogel V, Hirsch E, Vignal JP, Valton L, Manning L. Preserved anterograde and remote memory in drug-responsive temporal lobe epileptic patients. Epilepsy Res 2015. [PMID: 26220389 DOI: 10.1016/j.eplepsyres.2015.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate cognition, particularly anterograde and remote memory, in patients suffering from unilateral drug-responsive mesial temporal lobe epilepsy (mTLE) patients and to compare their performance with that observed in drug-resistant mTLE patients. METHODS Sixteen drug-responsive mTLE patients, with only infrequent seizures in their lifetime, were matched for demographic and clinical variables to 18 patients suffering from drug-resistant unilateral mTLE. A comprehensive neuropsychological examination, including baseline, anterograde memory tasks, and a large range of remote memory tests was carried out. RESULTS Patients with drug-responsive epilepsy obtained average scores on every anterograde memory test. Although in general, they obtained lower scores than the healthy controls on remote memory tests, the differences failed to reach significance. Moreover, the drug-responsive group performed significantly better than the drug-resistant group on anterograde recall tests and an episodic autobiographical memory test. Performance was not significantly different between the patient groups in personal semantics or memory for public events. CONCLUSION Our results show that a mild clinical course of mTLE with no cognitive deficits can occur notwithstanding hippocampal sclerosis. The differences in cognitive function between the two groups are likely due to distinct pathophysiology of the underlying cause of epilepsy. Drug-resistant seizures and cognitive deficits may be the consequence of a more severe underlying cerebral process. Better understanding of the variety of pathogenesis of mTLE could help to answer this open question.
Collapse
Affiliation(s)
| | - Edouard Hirsch
- Fédération de médecine translationnelle, University Hospital, Strasbourg, France.
| | | | - Luc Valton
- Explorations Neurophysiologiques, Department of Neurology, Hôpital Pierre Paul Riquet, University Hospital, & CerCo, Centre de recherche Cerveau et Cognition UMR 5549 - CNRS, Toulouse, France.
| | - Liliann Manning
- INSERM, U1114 and Strasbourg University, Strasbourg, France.
| |
Collapse
|
36
|
Coan AC, Campos BM, Bergo FPG, Kubota BY, Yasuda CL, Morita ME, Guerreiro CAM, Cendes F. Patterns of seizure control in patients with mesial temporal lobe epilepsy with and without hippocampus sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:79-82. [PMID: 25742574 DOI: 10.1590/0004-282x20140199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/14/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with mesial temporal lobe epilepsy (MTLE) may present unstable pattern of seizures. We aimed to evaluate the occurrence of relapse-remitting seizures in MTLE with (MTLE-HS) and without (MTLE-NL) hippocampal sclerosis. METHOD We evaluated 172 patients with MTLE-HS (122) or MTLE-NL (50). Relapse-remitting pattern was defined as periods longer than two years of seizure-freedom intercalated with seizure recurrence. "Infrequent seizures" was considered as up to three seizures per year and "frequent seizures" as any period of seizures higher than that. RESULTS Thirty-seven (30%) MTLE-HS and 18 (36%) MTLE-NL patients had relapse-remitting pattern (X2, p = 0.470). This was more common in those with infrequent seizures (X2, p < 0.001). Twelve MTLE-HS and one MTLE-NL patients had prolonged seizure remission between the first and second decade of life (X2, p = 0.06). CONCLUSION Similar proportion of MTLE-HS or MTLE-NL patients present relapse-remitting seizures and this occurs more often in those with infrequent seizures.
Collapse
Affiliation(s)
- Ana Carolina Coan
- Laboratório de Neuroimagem, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Brunno M Campos
- Laboratório de Neuroimagem, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Felipe P G Bergo
- Laboratório de Neuroimagem, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Bruno Y Kubota
- Laboratório de Neuroimagem, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Clarissa L Yasuda
- Laboratório de Neuroimagem, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Marcia E Morita
- Laboratório de Neuroimagem, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Carlos A M Guerreiro
- Laboratório de Neuroimagem, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Fernando Cendes
- Laboratório de Neuroimagem, Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| |
Collapse
|
37
|
Labate A, Cherubini A, Tripepi G, Mumoli L, Ferlazzo E, Aguglia U, Quattrone A, Gambardella A. White matter abnormalities differentiate severe from benign temporal lobe epilepsy. Epilepsia 2015; 56:1109-16. [PMID: 26096728 DOI: 10.1111/epi.13027] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Temporal and extratemporal white matter abnormalities have been identified frequently in patients with refractory mesial temporal lobe epilepsy (rMTLE). However, the identification of potential water diffusion abnormalities in patients with drug-responsive, benign MTLE (bMTLE) is still missing. The aim of this study was to identify markers of refractoriness in MTLE. METHODS The study group included 48 patients with bMTLE (mean age 42.8 + 13.5 years), 38 with rMTLE (mean age 41.7 + 14.1 years) and 54 healthy volunteers. Diffusion tensor imaging (DTI) was performed to measure mean diffusivity (MD) and fractional anisotropy (FA) in a regions-of-interest analysis comprising hippocampi and temporal lobe gray and white matter regions. The presence of hippocampal sclerosis (Hs) was assessed using automated magnetic resonance imaging (MRI) evaluation. For statistics we used chi-square test; two-tailed, two-sample t-test; and stratified linear regression. RESULTS The significant demographic differences between the two patient groups were sex (p = 0.003), duration of epilepsy (p = 0.003) and complex febrile convulsions (p = 0.0001). In rMTLE, temporal white matter MD was higher and FA lower, as compared to bMTLE. The analysis of diagnostic accuracy (area under the receiver operator characteristic [ROC] curve [AUC]) showed that FA had an AUC for discriminating patients affected from those unaffected by refractory MTLE of 74.0% (p < 0.001), a value that was higher than that of temporal MD (64.0%), hippocampus volume (65.0%), and Hs (66.0%). SIGNIFICANCE We performed DTI measurements in MTLE and found a significant reduction of FA along the white matter of the temporal lobes in rMTLE, suggesting it as a valuable measure of refractoriness in MTLE.
Collapse
Affiliation(s)
- Angelo Labate
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, Catanzaro, Italy
| | - Andrea Cherubini
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, Catanzaro, Italy
| | - Giovanni Tripepi
- Research Unit, Institute of Clinical Physiology, National Research Council (IFC-CNR), Reggio Calabria, Italy
| | - Laura Mumoli
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Umberto Aguglia
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Aldo Quattrone
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, Catanzaro, Italy
| | - Antonio Gambardella
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, Catanzaro, Italy
| |
Collapse
|
38
|
MTLE with hippocampal sclerosis in adult as a syndrome. Rev Neurol (Paris) 2015; 171:259-66. [DOI: 10.1016/j.neurol.2015.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 11/19/2022]
|
39
|
Labate A, Cerasa A, Mumoli L, Ferlazzo E, Aguglia U, Quattrone A, Gambardella A. Neuro-anatomical differences among epileptic and non-epileptic déjà-vu. Cortex 2015; 64:1-7. [DOI: 10.1016/j.cortex.2014.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/19/2014] [Accepted: 09/23/2014] [Indexed: 11/26/2022]
|
40
|
Thom M. Review: Hippocampal sclerosis in epilepsy: a neuropathology review. Neuropathol Appl Neurobiol 2015; 40:520-43. [PMID: 24762203 PMCID: PMC4265206 DOI: 10.1111/nan.12150] [Citation(s) in RCA: 328] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/23/2014] [Indexed: 12/12/2022]
Abstract
Hippocampal sclerosis (HS) is a common pathology encountered in mesial temporal lobe epilepsy (MTLE) as well as other epilepsy syndromes and in both surgical and post-mortem practice. The 2013 International League Against Epilepsy (ILAE) classification segregates HS into typical (type 1) and atypical (type 2 and 3) groups, based on the histological patterns of subfield neuronal loss and gliosis. In addition, granule cell reorganization and alterations of interneuronal populations, neuropeptide fibre networks and mossy fibre sprouting are distinctive features of HS associated with epilepsies; they can be useful diagnostic aids to discriminate from other causes of HS, as well as highlighting potential mechanisms of hippocampal epileptogenesis. The cause of HS remains elusive and may be multifactorial; the contribution of febrile seizures, genetic susceptibility, inflammatory and neurodevelopmental factors are discussed. Post-mortem based research in HS, as an addition to studies on surgical samples, has the added advantage of enabling the study of the wider network changes associated with HS, the long-term effects of epilepsy on the pathology and associated comorbidities. It is likely that HS is heterogeneous in aspects of its cause, epileptogenetic mechanisms, network alterations and response to medical and surgical treatments. Future neuropathological studies will contribute to better recognition and understanding of these clinical and patho-aetiological subtypes of HS.
Collapse
Affiliation(s)
- Maria Thom
- Departments of Neuropathology and Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| |
Collapse
|
41
|
Gasparini S, Ferlazzo E, Beghi E, Sofia V, Mumoli L, Labate A, Cianci V, Fatuzzo D, Bellavia MA, Arcudi L, Russo E, De Sarro G, Gambardella A, Aguglia U. Epilepsy associated with Leukoaraiosis mainly affects temporal lobe: a casual or causal relationship? Epilepsy Res 2015; 109:1-8. [DOI: 10.1016/j.eplepsyres.2014.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/14/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
|
42
|
Bandopadhyay R, Liu JYW, Sisodiya SM, Thom M. A comparative study of the dentate gyrus in hippocampal sclerosis in epilepsy and dementia. Neuropathol Appl Neurobiol 2014; 40:177-90. [PMID: 24028428 PMCID: PMC4282449 DOI: 10.1111/nan.12087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/04/2013] [Indexed: 12/25/2022]
Abstract
Aims: Hippocampal sclerosis (HS) is long-recognized in association with epilepsy (HSE) and more recently in the context of cognitive decline or dementia in the elderly (HSD), in some cases as a component of neurodegenerative diseases, including Alzheimer's disease (AD) and fronto-temporal lobe dementia (FTLD). There is an increased risk of seizures in AD and spontaneous epileptiform discharges in the dentate gyrus of transgenic AD models; epilepsy can be associated with an age-accelerated increase in AD-type pathology and cognitive decline. The convergence between these disease processes could be related to hippocampal pathology. HSE typically shows re-organization of both excitatory and inhibitory neuronal networks in the dentate gyrus, and is considered to be relevant to hippocampal excitability. We sought to compare the pathology of HSE and HSD, focusing on re-organization in the dentate gyrus. Methods: In nine post mortem cases with HSE and bilateral damage, 18 HSD and 11 controls we carried out immunostaining for mossy fibres (dynorphin), and interneuronal networks (NPY, calbindin and calretinin) on sections from the mid-hippocampal body. Fibre sprouting (FS) or loss of expression in the dentate gyrus was semi-quantitatively graded from grade 0 (normal) to grade 3 (marked alteration). Results: Significantly more re-organization was seen with all four markers in the HSE than HSD group (P < 0.01). Mild alterations were noted in HSD group with dynorphin (FS in 3 cases), calretinin (FS in 6 cases), NPY (FS in 11 cases) and calbindin (loss in 10 cases). In eight HSD cases, alteration was seen with more than one antibody but in no cases were the highest grades seen. We also noted NPY and, to a lesser extent, calretinin labelling of Hirano bodies in CA1 of AD cases and some older controls, but not in HSE. Conclusion: Reorganization of excitatory and inhibitory networks in the dentate gyrus is more typical of HSE. Subtle alterations in HSD may be a result of increased hippocampal excitability, including unrecognized seizure activity. An unexpected finding was the identification of NPY-positive Hirano bodies in HSD but not HSE, which may be a consequence of the relative vulnerabilities of interneurons in these conditions.
Collapse
Affiliation(s)
- R Bandopadhyay
- Department of Clinical and Experimental Epilepsy, UCL, Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | | |
Collapse
|
43
|
Ferlazzo E, Italiano D, Belcastro V, Gasparini S, Spina E, Aguglia U. Transient global amnesia as a presenting aura or epilepsy? Headache 2014; 54:1233-5. [PMID: 25040813 DOI: 10.1111/head.12396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | | | | | | | | | | |
Collapse
|
44
|
Cendes F, Sakamoto AC, Spreafico R, Bingaman W, Becker AJ. Epilepsies associated with hippocampal sclerosis. Acta Neuropathol 2014; 128:21-37. [PMID: 24823761 DOI: 10.1007/s00401-014-1292-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 01/22/2023]
Abstract
Hippocampal sclerosis (HS) is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy (MTLE). Hippocampal specimens of pharmacoresistant MTLE patients that underwent epilepsy surgery for seizure control reveal the characteristic pattern of segmental neuronal cell loss and concomitant astrogliosis. However, classification issues of hippocampal lesion patterns have been a matter of intense debate. International consensus classification has only recently provided significant progress for comparisons of neurosurgical and clinic-pathological series between different centers. The respective four-tiered classification system of the International League Against Epilepsy subdivides HS into three types and includes a term of "gliosis only, no-HS". Future studies will be necessary to investigate whether each of these subtypes of HS may be related to different etiological factors or with postoperative memory and seizure outcome. Molecular studies have provided potential deeper insights into the pathogenesis of HS and MTLE on the basis of epilepsy-surgical hippocampal specimens and corresponding animal models. These include channelopathies, activation of NMDA receptors, and other conditions related to Ca(2+) influx into neurons, the imbalance of Ca(2+)-binding proteins, acquired channelopathies that increase neuronal excitability, paraneoplastic and non-paraneoplastic inflammatory events, and epigenetic regulation promoting or facilitating hippocampal epileptogenesis. Genetic predisposition for HS is clearly suggested by the high incidence of family history in patients with HS, and by familial MTLE with HS. So far, it is clear that HS is multifactorial and there is no individual pathogenic factor either necessary or sufficient to generate this intriguing histopathological condition. The obvious variety of pathogenetic combinations underlying HS may explain the multitude of clinical presentations, different responses to clinical and surgical treatment. We believe that the stratification of neuropathological patterns can help to characterize specific clinic-pathological entities and predict the postsurgical seizure control in an improved fashion.
Collapse
|
45
|
Pacagnella D, Lopes TM, Morita ME, Yasuda CL, Cappabianco FAM, Bergo F, Balthazar MLF, Coan AC, Cendes F. Memory impairment is not necessarily related to seizure frequency in mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsia 2014; 55:1197-204. [DOI: 10.1111/epi.12691] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Denise Pacagnella
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Tatila M. Lopes
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Marcia E. Morita
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Clarissa L. Yasuda
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Fabio A. M. Cappabianco
- Department of Science and Technology; Federal University of Sao Paulo; São José dos Campos SP Brazil
| | - Felipe Bergo
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | | | - Ana C. Coan
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Fernando Cendes
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| |
Collapse
|
46
|
Labate A, Mumoli L, Gambardella A. Thalamotemporal impairment in benign temporal lobe epilepsy: same hypotheses? Epilepsia 2014; 55:944. [PMID: 24924646 DOI: 10.1111/epi.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Angelo Labate
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy; Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Viale Europa, Germaneto (CZ), Italy.
| | | | | |
Collapse
|
47
|
Coan AC, Campos BM, Yasuda CL, Kubota BY, Bergo FPG, Guerreiro CAM, Cendes F. Frequent seizures are associated with a network of gray matter atrophy in temporal lobe epilepsy with or without hippocampal sclerosis. PLoS One 2014; 9:e85843. [PMID: 24475055 PMCID: PMC3903486 DOI: 10.1371/journal.pone.0085843] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/02/2013] [Indexed: 11/23/2022] Open
Abstract
Objective Patients with temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS) have diffuse subtle gray matter (GM) atrophy detectable by MRI quantification analyses. However, it is not clear whether the etiology and seizure frequency are associated with this atrophy. We aimed to evaluate the occurrence of GM atrophy and the influence of seizure frequency in patients with TLE and either normal MRI (TLE-NL) or MRI signs of HS (TLE-HS). Methods We evaluated a group of 172 consecutive patients with unilateral TLE-HS or TLE-NL as defined by hippocampal volumetry and signal quantification (122 TLE-HS and 50 TLE-NL) plus a group of 82 healthy individuals. Voxel-based morphometry was performed with VBM8/SPM8 in 3T MRIs. Patients with up to three complex partial seizures and no generalized tonic-clonic seizures in the previous year were considered to have infrequent seizures. Those who did not fulfill these criteria were considered to have frequent seizures. Results Patients with TLE-HS had more pronounced GM atrophy, including the ipsilateral mesial temporal structures, temporal lobe, bilateral thalami and pre/post-central gyri. Patients with TLE-NL had more subtle GM atrophy, including the ipsilateral orbitofrontal cortex, bilateral thalami and pre/post-central gyri. Both TLE-HS and TLE-NL showed increased GM volume in the contralateral pons. TLE-HS patients with frequent seizures had more pronounced GM atrophy in extra-temporal regions than TLE-HS with infrequent seizures. Patients with TLE-NL and infrequent seizures had no detectable GM atrophy. In both TLE-HS and TLE-NL, the duration of epilepsy correlated with GM atrophy in extra-hippocampal regions. Conclusion Although a diffuse network GM atrophy occurs in both TLE-HS and TLE-NL, this is strikingly more evident in TLE-HS and in patients with frequent seizures. These findings suggest that neocortical atrophy in TLE is related to the ongoing seizures and epilepsy duration, while thalamic atrophy is more probably related to the original epileptogenic process.
Collapse
Affiliation(s)
- Ana C. Coan
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Brunno M. Campos
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Clarissa L. Yasuda
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Bruno Y. Kubota
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Felipe PG. Bergo
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Carlos AM. Guerreiro
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
- * E-mail:
| |
Collapse
|
48
|
Coan AC, Cendes F. Understanding the spectrum of temporal lobe epilepsy: contributions for the development of individualized therapies. Expert Rev Neurother 2014; 13:1383-94. [DOI: 10.1586/14737175.2013.857604] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
49
|
Baulac S. Genetics advances in autosomal dominant focal epilepsies. PROGRESS IN BRAIN RESEARCH 2014; 213:123-39. [DOI: 10.1016/b978-0-444-63326-2.00007-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
50
|
Fanciulli M, Di Bonaventura C, Egeo G, Fattouch J, Dazzo E, Radovic S, Spadotto A, Giallonardo AT, Nobile C. Suggestive linkage of familial mesial temporal lobe epilepsy to chromosome 3q26. Epilepsy Res 2013; 108:232-40. [PMID: 24315020 DOI: 10.1016/j.eplepsyres.2013.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 09/26/2013] [Accepted: 11/03/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe the clinical findings in a family with a benign form of mesial temporal lobe epilepsy and to identify the causative genetic factors. METHODS All participants were personally interviewed and underwent neurologic examination. The affected subjects underwent EEG and most of them neuroradiological examinations (MRI). All family members were genotyped with the HumanCytoSNP-12 v1.0 beadchip and linkage analysis was performed with Merlin and Simwalk2 programs. Exome sequencing was performed on HiSeq2000, after exome capture with SureSelect 50 Mb kit v2.0. RESULTS The family had 6 members with temporal lobe epilepsy. Age at seizure onset ranged from 8 to 13 years. Five patients had epigastric auras often associated to oro-alimentary automatic activity, 3 patients presented loss of contact, and 2 experienced secondary generalizations. Febrile seizures occurred in 2 family members, 1 of whom also had temporal lobe epilepsy. EEG showed focal slow waves and epileptic abnormalities on temporal regions in 1 patient and was normal in the other affected individuals. MRI was normal in all temporal lobe epilepsy patients. We performed single nucleotide polymorphism-array linkage analysis of the family and found suggestive evidence of linkage (LOD score=2.106) to a region on chromosome 3q26. Haplotype reconstruction supported the linkage data and showed that the majority of unaffected family members carried the haplotype at risk. Whole exome sequencing failed to identify pathogenic mutations in genes of the candidate region. CONCLUSIONS Our data suggest the existence of a novel locus for benign familial mesial temporal lobe epilepsy on chromosome 3q26. Our failure to identify pathogenic mutations in genes of this region may be due to limitations of the exome sequencing technology.
Collapse
Affiliation(s)
| | | | - Gabriella Egeo
- Department of Neurological Sciences, University of Rome "Sapienza", Roma, Italy; IRCCS San Raffaele Pisana, Roma, Italy
| | - Jinane Fattouch
- Department of Neurological Sciences, University of Rome "Sapienza", Roma, Italy
| | - Emanuela Dazzo
- CNR - Institute of Neurosciences, Section of Padua, Padova, Italy
| | | | | | | | - Carlo Nobile
- CNR - Institute of Neurosciences, Section of Padua, Padova, Italy.
| |
Collapse
|