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Melzer N, Weber K, Räuber S, Rosenow F. [(Auto)immunity in focal epilepsy: mechanisms of (auto‑)immune-inflammatory epileptogenic neurodegeneration]. DER NERVENARZT 2024:10.1007/s00115-024-01695-5. [PMID: 38953922 DOI: 10.1007/s00115-024-01695-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE While the neuronal mechanisms of epileptic hyperexcitability (HE) have been studied in detail, recent findings suggest that extraneuronal, mainly immune-mediated inflammatory and vascular mechanisms play an important role in the development and progression of HE in epilepsy and the cognitive and behavioral comorbidities. MATERIAL AND METHODS Narrative review. RESULTS As in autoimmune (limbic) encephalitis (ALE/AIE) or Rasmussen's encephalitis (RE), the primary adaptive and innate immune responses and associated changes in the blood-brain barrier (BBB) and neurovascular unit (NVU) can cause acute cortical hyperexcitability (HE) and the development of hippocampal sclerosis (HS) and other structural cortical lesions with chronic HE. Cortical HE, which is associated with malformation of cortical development (MCD) and low-grade epilepsy-associated tumors (LEAT), for example, can be accompanied by secondary adaptive and innate immune responses and alterations in the BBB and NVU, potentially modulating the ictogenicity and epileptogenicity. These associations illustrate the influence of adaptive and innate immune mechanisms and associated changes in the BBB and NVU on cortical excitability and vice versa, suggesting a dynamic and complex interplay of these factors in the development and progression of epilepsy in general. DISCUSSION The described concept of a neuro-immune-vascular interaction in focal epilepsy opens up new possibilities for the pathogenetic understanding and thus also for the selective therapeutic intervention.
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Affiliation(s)
- Nico Melzer
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Katharina Weber
- Neurologisches Institut (Edinger Institut), Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Frankfurt Cancer Institute (FCI), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Partnerstätte Frankfurt, Frankfurt am Main und Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Deutschland
- Universitäres Centrum für Tumorerkrankungen Frankfurt (UCT), Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Saskia Räuber
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main, Klinik für Neurologie, Zentrum für Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland.
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland.
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Sanli E, Sirin NG, Kucukali CI, Baykan B, Ulusoy CA, Bebek N, Yilmaz V, Tuzun E. Peripheral blood regulatory B and T cells are decreased in patients with focal epilepsy. J Neuroimmunol 2024; 387:578287. [PMID: 38241950 DOI: 10.1016/j.jneuroim.2024.578287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/12/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
Patients with focal epilepsy of unknown cause (FEoUC) may display T cell infiltration in post-surgery brain specimens and increased serum levels of pro-inflammatory cytokines produced by B and T cells, indicating potential involvement of adaptive immunity. Our study aimed to investigate the peripheral blood distribution of B and T cell subgroups to find clues supporting the distinct organization of adaptive immunity in FEoUC. Twenty-two patients with FEoUC and 25 age and sex matched healthy individuals were included. Peripheral blood mononuclear cells were immunophenotyped by flow cytometry. Expression levels of anti-inflammatory cytokines and FOXP3 were measured by real-time PCR. Carboxyfluorescein succinimidyl ester (CFSE) proliferation assay was conducted using CD4+ T cells. Patients with FEoUC showed significantly decreased regulatory B (Breg), B1a, plasmablast and regulatory T (Treg) cell percentages, and increased switched memory B and Th17 cell ratios. Moreover, CD4+CD25+CD49d- Tregs of FEoUC patients displayed significantly reduced TGFB1 and FOXP3, but increased IL10 gene expression levels. CD4+ helper T cells of patients with FEoUC gave more exaggerated proliferation responses to phytohemagglutinin, anti-CD3 and anti-CD28 stimulation. Patients with FEoUC display increased effector lymphocyte, decreased regulatory lymphocyte ratios, and impaired Treg function and enhanced lymphocyte proliferation capacity. Overall, this pro-inflammatory phenotype lends support to the involvement of adaptive immunity in FEoUC.
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Affiliation(s)
- Elif Sanli
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey; Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
| | - Nermin Gorkem Sirin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cem Ismail Kucukali
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Betul Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neurology, EMAR Medical Center, Istanbul, Turkey
| | - Canan Aysel Ulusoy
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
| | - Erdem Tuzun
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
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Gallus M, Roll W, Dik A, Barca C, Zinnhardt B, Hicking G, Mueller C, Naik VN, Anstötz M, Krämer J, Rolfes L, Wachsmuth L, Pitsch J, van Loo KM, Räuber S, Okada H, Wimberley C, Strippel C, Golombeck KS, Johnen A, Kovac S, Groß CC, Backhaus P, Seifert R, Lewerenz J, Surges R, Elger CE, Wiendl H, Ruck T, Becker AJ, Faber C, Jacobs AH, Bauer J, Meuth SG, Schäfers M, Melzer N. Translational imaging of TSPO reveals pronounced innate inflammation in human and murine CD8 T cell-mediated limbic encephalitis. SCIENCE ADVANCES 2023; 9:eabq7595. [PMID: 37294768 PMCID: PMC10256169 DOI: 10.1126/sciadv.abq7595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/08/2023] [Indexed: 06/11/2023]
Abstract
Autoimmune limbic encephalitis (ALE) presents with new-onset mesial temporal lobe seizures, progressive memory disturbance, and other behavioral and cognitive changes. CD8 T cells are considered to play a key role in those cases where autoantibodies (ABs) target intracellular antigens or no ABs were found. Assessment of such patients presents a clinical challenge, and novel noninvasive imaging biomarkers are urgently needed. Here, we demonstrate that visualization of the translocator protein (TSPO) with [18F]DPA-714-PET-MRI reveals pronounced microglia activation and reactive gliosis in the hippocampus and amygdala of patients suspected with CD8 T cell ALE, which correlates with FLAIR-MRI and EEG alterations. Back-translation into a preclinical mouse model of neuronal antigen-specific CD8 T cell-mediated ALE allowed us to corroborate our preliminary clinical findings. These translational data underline the potential of [18F]DPA-714-PET-MRI as a clinical molecular imaging method for the direct assessment of innate immunity in CD8 T cell-mediated ALE.
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Affiliation(s)
- Marco Gallus
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurosurgery, University of Münster, Münster, Germany
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Wolfgang Roll
- Department of Nuclear Medicine, University of Münster, Münster, Germany
| | - Andre Dik
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Cristina Barca
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Bastian Zinnhardt
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
- Biomarkers and Translational Technologies (BTT), Pharma Research and Early Development (pRED), F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Gordon Hicking
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Christoph Mueller
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Venu Narayanan Naik
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Max Anstötz
- Institute of Anatomy II, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Julia Krämer
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Leoni Rolfes
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Lydia Wachsmuth
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Julika Pitsch
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Karen M. J. van Loo
- Section for Translational Epilepsy Research, Department of Neuropathology, University of Bonn, Bonn, Germany
- Department of Epileptology and Neurology, RWTH Aachen University, Aachen, Germany
| | - Saskia Räuber
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Hideho Okada
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Christine Strippel
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Kristin S. Golombeck
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Johnen
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Stjepana Kovac
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Catharina C. Groß
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Philipp Backhaus
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Jan Lewerenz
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Rainer Surges
- Department of Epileptology, University of Bonn, Bonn, Germany
| | | | - Heinz Wiendl
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Tobias Ruck
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Albert J. Becker
- Section for Translational Epilepsy Research, Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Cornelius Faber
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Andreas H. Jacobs
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Jan Bauer
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Sven G. Meuth
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Nico Melzer
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
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Bahna M, Hamed M, Ilic I, Salemdawod A, Schneider M, Rácz A, Baumgartner T, Güresir E, Eichhorn L, Lehmann F, Schuss P, Surges R, Vatter H, Borger V. The necessity for routine intensive care unit admission following elective craniotomy for epilepsy surgery: a retrospective single-center observational study. J Neurosurg 2022; 137:1203-1209. [PMID: 35120311 DOI: 10.3171/2021.12.jns211799] [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: 07/26/2021] [Accepted: 12/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, patients who underwent elective craniotomy for epilepsy surgery are monitored postoperatively in an intensive care unit (ICU) overnight in order to sufficiently respond to potential early postoperative complications. In the present study, the authors investigated the frequency of early postoperative events that entailed ICU monitoring in patients who had undergone elective craniotomy for epilepsy surgery. In a second step, they aimed at identifying pre- and intraoperative risk factors for the development of unfavorable events to distinguish those patients with the need for postoperative ICU monitoring at the earliest possible stage. METHODS The authors performed a retrospective observational cohort study assessing patients with medically intractable epilepsy (n = 266) who had undergone elective craniotomy for epilepsy surgery between 2012 and 2019 at a tertiary care epilepsy center, excluding those patients who had undergone invasive diagnostic approaches and functional hemispherectomy. Postoperative complications were defined as any unfavorable postoperative surgical and/or anesthesiological event that required further ICU therapy within 48 hours following surgery. A multivariate analysis was performed to reveal preoperatively identifiable risk factors for postoperative adverse events requiring an ICU setting. RESULTS Thirteen (4.9%) of 266 patients developed early postoperative adverse events that required further postoperative ICU care. The most prevalent event was a return to the operating room because of relevant postoperative intracranial hematoma (5 of 266 patients). Multivariate analysis revealed intraoperative blood loss ≥ 325 ml (OR 6.2, p = 0.012) and diabetes mellitus (OR 9.2, p = 0.029) as risk factors for unfavorable postoperative events requiring ICU therapy. CONCLUSIONS The present study revealed routinely collectable risk factors that would allow the identification of patients with an elevated risk of postsurgical complications requiring a postoperative ICU stay following epilepsy surgery. These findings may offer guidance for a stepdown unit admission policy following epilepsy surgical interventions after an external validation of the results.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lars Eichhorn
- 3Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Felix Lehmann
- 3Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Yavuz ENV, Altındağ E, Tüzün E, Baykan B. Do the neurologists recognize autoimmune epilepsy well enough? What is the effect of the pandemic on this matter? Neurol Sci 2022; 43:5029-5037. [PMID: 35381878 PMCID: PMC8983032 DOI: 10.1007/s10072-022-06044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
Introduction The concept of “autoimmune epilepsy” (AE) has been emphasized more frequently through the recent increase in recognition of various autoantibodies specific to neuronal proteins. Aims To evaluate the attitudes of neurologists in regard to AE, to review the differential diagnosis, treatment options, and to reveal the effect of COVID-19 on this matter. Methods A detailed questionnaire prepared for AE was sent to neurologists via social media and WhatsApp after the approval of the Ethics Committee. The responses of 245 respondents working in different settings were analyzed, and the group with 15 years or less experience in neurology was statistically compared to the group with more than 15 years of experience. Results Awareness and knowledge levels on AE seemed high in all groups, while 11% had never thought about AE during the differential diagnosis in real life. Before starting treatment, 20% thought that the autoantibody result should definitely support it, and 77.6% reported that they did not recognize AE well. Participants stated that satisfactory guidelines for diagnosis and treatment (88.2%) and widespread laboratory support (83.7%) were lacking. Neurologists with less experience and those working outside of training hospitals get more often consultation from an experienced clinician while diagnosing and conduct more detailed investigations at the diagnosis stage (p = 0.0025, p = 0.0001). Conclusion This first survey study conducted in a large group of neurologists on the attitudes for the concept of AE suggested that postgraduate education, and diagnostic and treatment guidelines should be organized and antibody screening tests need to be better disseminated. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06044-5.
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Affiliation(s)
- Ebru Nur Vanli Yavuz
- Department of Neurology, Faculty of Medicine, Demiroğlu Bilim University, Büyükdere Caddesi No: 120, 34394, Şişli/Istanbul, Turkey.
| | - Ebru Altındağ
- Department of Neurology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Research Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Arslan GA, Erkent I, Saygi S, Tezer FI. Changes of oxygen saturation in patients with pure temporal lobe epilepsy. Seizure 2022; 100:30-35. [PMID: 35728344 DOI: 10.1016/j.seizure.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Ictal hypoxemia is accepted as one of the mechanisms underlying sudden unexpected death in epilepsy (SUDEP). Although ictal hypoxemia is more common in generalized seizures, it also occurs in focal seizures with or without generalization. In this study, we aimed to show the relationship between clinical and electroencephalographic findings of seizures in patients with temporal lobe epilepsy (TLE) with periictal oxygen saturation. METHODS The data of 55 adult patients who were hospitalized in the Video EEG Monitoring Unit (VEMU) and operated on for drug-resistant TLE between January 2017 and December 2020 were examined. Forty-five seizures from 21 patients with ictal peripheral arterial saturation information and that were seizure-free for at least a year during the follow-up were included in the study. RESULTS The median patient age was 28 (IQR 25-39.5) years (women: 9, men: 12). Age at epilepsy onset was negatively correlated with saturation at seizure onset. Moreover, the age at VEMU admission was also negatively correlated with saturation at seizure onset and the lowest levels of saturation. The saturation at the end of the seizures and the lowest saturation measured in the periictal period with generalization of EEG were significantly lower than those without generalization. The onset of ictal EEG with the rhythmic theta pattern was significantly associated with the lowest level of saturation (<90%), postictal generalized electroencephalographic suppression (PGES), and the presence of generalization. CONCLUSION According to the study, rhythmic ictal theta activity, older age, nocturnal seizure, and generalization in ictal EEG might increase the potential risk of SUDEP. Further studies including a greater number of subjects and different epilepsy syndromes may provide more comprehensive information about potential biomarkers for SUDEP.
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Affiliation(s)
- Gokce Ayhan Arslan
- Hacettepe University Medicine Faculty, Department of Neurology, Ankara, Turkey.
| | - Irem Erkent
- Hacettepe University Medicine Faculty, Department of Neurology, Ankara, Turkey.
| | - Serap Saygi
- Hacettepe University Medicine Faculty, Department of Neurology, Ankara, Turkey.
| | - F Irsel Tezer
- Hacettepe University Medicine Faculty, Department of Neurology, Ankara, Turkey.
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Relation Between Orexin A and Epileptic Seizures. Epilepsy Res 2022; 184:106972. [DOI: 10.1016/j.eplepsyres.2022.106972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/23/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022]
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Temporal lobe epilepsy: Evaluation of central and systemic immune-inflammatory features associated with drug resistance. Seizure 2021; 91:447-455. [PMID: 34340190 DOI: 10.1016/j.seizure.2021.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 12/21/2022] Open
Abstract
Neuroinflammation is probably one of the factors involved in drug resistance in people with epilepsy. Finding peripheral markers reflecting the intensity of neuroinflammation could be of great help to decide for which patients anti-inflammatory treatment might be an option. In this context, peripheral cytokines levels and lymphocyte phenotypes were assessed by ELISA and flow cytometry in 3 groups of subjects: drug resistant patients with temporal lobe epilepsy (DR-TLE), non DR-TLE patients and healthy controls. The same parameters were assessed in brain tissue in the DR-TLE group. Differences in the peripheral immune-inflammatory status between the 3 groups of subjects, and correlations between the central and peripheral immune-inflammatory status in DR-TLE patients were evaluated. Forty-one patients with DR-TLE, ten with non-DR-TLE and twenty controls were included. In the periphery, decrease in regulatory cells were observed in DR-TLE patients compared to controls. In addition, significant increase of IL-6 and IL-5 was observed in patients with epilepsy (particularly DR-TLE patients). Two groups of DR-TLE patients with significant differences in several central inflammatory parameters were identified in a cluster analysis. The inflammatory cluster was associated with a peripheral increase of CD4+CD38+ cells and different significant correlations between central and systemic inflammatory parameters were observed. Although their interpretation is not immediate, they demonstrate a clear dialogue between central and peripheral inflammatory reactions. In conclusion, our results add new elements to better understand the interactions between the central and peripheral compartments in patients with DR-TLE, and to help better define treatment options in this group of patients.
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Temporal encephaloceles can be missed in patients with refractory temporal lobe epilepsy. Epilepsy Res 2021; 173:106640. [PMID: 33901986 DOI: 10.1016/j.eplepsyres.2021.106640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/30/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022]
Abstract
Temporal encephaloceles (TEs) are one of the cause of refractory temporal lobe epilepsy (TLE). We reviewed the neuroimaging and video-electroencephalography (EEG) records of epilepsy patients who underwent temporal lobectomy in our center to investigate frequency of TEs. We retrospectively reevaluated 294 patients who underwent epilepsy surgery in our tertiary epilepsy centre between January 2010 and March 2019 and included 159 patients (78 females, 49 %; 81 males) who had temporal lobectomy. Preoperatively, TEs were reported in 3 of 159 patients (1 female, 2 males). After reevaluation 4 more patients with TEs (1 female, 3 males) were added. The ratio of TE in patients who underwent temporal lobectomy increased from 1.8 % (n=3) to 4,4 % (n=7). The median ages were 18 (range 16-22) versus 10 years (range 5-17) at habitual seizure onset and the median of epilepsy duration was 5 (range 3-15) versus 175 (range 11-25) years between patients with and without TE. Habitual seizure onset age was significantly higher (p =, 007) in the patients with encephalocele and epilepsy duration was shorter (p =, 003) than patients without encephalocele. The ictal EEG records of all patients TE rhythmic delta activity which is suggested neocortical temporal lobe onset seizures. 4 of 7 patients' PET imaging showed temporal lobe hypometabolism compatible with ipsilateral to the TEs. The three patients underwent anterior temporal lobectomy without amygdalohippocampectomy and others had anterior temporal lobectomy with amygdalohippocampectomy. We suggested that there might be some clues for temporal encephalocele, an easily overlooked cause in patients with nonlesional temporal lobe epilepsy.TLE patients with TE had relatively late onset of epilepsy and rhythmic delta activity on ictal EEG. Also, temporal hypometabolism on PET may be a useful key to suspicion of TE.
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Sanli E, Akbayir E, Kuçukali CI, Baykan B, Sirin NG, Bebek N, Yilmaz V, Tuzun E. Adaptive immunity cells are differentially distributed in the peripheral blood of glycine receptor antibody-positive patients with focal epilepsy of unknown cause. Epilepsy Res 2020; 170:106542. [PMID: 33387801 DOI: 10.1016/j.eplepsyres.2020.106542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
AIM Glycine receptor (GlyR) autoantibodies (Ab) have been recently detected in epilepsy patients. Our study aimed to investigate the peripheral blood distribution of B and T cell subgroups responsible for antibody production to find clues supporting the distinct organization of adaptive immunity in focal epilepsy of unknown cause (FEUC). METHOD Seven GlyR-Ab positive and 15 GlyR-Ab negative FEUC patients and 25 age-sex matched healthy individuals were included. Peripheral blood mononuclear cells were isolated and immunophenotyped by flow cytometry. RESULTS There were no significant differences between CD19+ B, CD3+ T, CD4+ helper T, CD8+ cytotoxic T, and CD19+CD24++CD38++ regulatory B cell ratios among the groups. GlyR-Ab negative epilepsy patients had significantly higher CD19+IgD+CD27- naive B cells and GlyR-Ab positive patients showed reduced percentages of CD19+CD38+CD138+ plasma cells than healthy controls. By contrast, GlyR-Ab positive patients exhibited significantly increased CD3+CD4+CD25highregulatory T (Treg) cells and CD3+CD4+CD25highCD127low/- Treg cells and relatively increased CD19+IgD-CD27+ memory B cells without attaining statistical significance. CONCLUSION The increase of Tregs, which are capable of suppressing B cells, maybe a compensating countermeasure to prevent the conversion of effector B cell subgroups. Thus, our findings lend support to the involvement of adaptive immunity in focal epilepsy of unknown cause.
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Affiliation(s)
- Elif Sanli
- Neuroscience Department, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Ece Akbayir
- Neuroscience Department, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Cem Ismail Kuçukali
- Neuroscience Department, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Betul Baykan
- Neuroscience Department, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey; Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nermin Gorkem Sirin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vuslat Yilmaz
- Neuroscience Department, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
| | - Erdem Tuzun
- Neuroscience Department, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
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Basnyat P, Pesu M, Söderqvist M, Grönholm A, Liimatainen S, Peltola M, Raitanen J, Peltola J. Chronically reduced IL-10 plasma levels are associated with hippocampal sclerosis in temporal lobe epilepsy patients. BMC Neurol 2020; 20:241. [PMID: 32532251 PMCID: PMC7291453 DOI: 10.1186/s12883-020-01825-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background Increasing evidence supports the role of soluble inflammatory mediators in the pathogenesis of refractory temporal lobe epilepsy (TLE). Hippocampal sclerosis (HS) is a well-described pathohistological abnormality in TLE. The association of proinflammatory cytokines with epileptic disease profiles is well established; however, the potential significance of circulating interleukin 10 (IL-10), particularly in TLE-associated HS, is still poorly understood. Therefore, taking into consideration the neuroprotective and anticonvulsive effects of IL-10, we performed this study to examine the role of the plasma levels of IL-10 in patients with TLE with HS (TLE + HS), TLE without HS (TLE-HS) and with other types of epilepsy. Methods This study included 270 patients with refractory epilepsy who were classified into four groups: i) 34 patients with TLE + HS, ii) 105 patients with TLE-HS, iii) 95 patients with extra-TLE (XLE) and iv) 36 patients with idiopathic generalized epilepsy (IGE). The plasma IL-10 levels were quantified using a commercially available enzyme-linked immunosorbent assay (ELISA). Results IL-10 levels were significantly lower in TLE + HS than in TLE-HS (p = 0.013). In a subgroup of TLE-HS patients who had seizures 1 month before sampling, patients with seizures had significantly higher IL-10 levels than patients who were seizure-free (p = 0.039). Among a small group (n = 15) of non-refractory TLE-HS patients, IL-10 levels showed a moderate negative correlation with the duration of epilepsy (r = − 0.585, p = 0.023). Conclusions This study demonstrated that chronically reduced levels of plasma IL-10 were associated with HS in TLE patients, suggesting that there was an inadequate systemic anti-inflammatory immune response. These results could provide new biological insights into the pathophysiology of HS in TLE. We also found that the production of IL-10 could be affected by the seizure frequency and declined concomitantly with increased disease durations. Therefore, the measurement of plasma IL-10 may have diagnostic value as a biomarker for stratifying TLE + HS from other epilepsy types or as a marker of disease progression towards a progressive form of epilepsy.
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Affiliation(s)
- Pabitra Basnyat
- Department of Neurology, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, D532, 33520, Tampere, Finland. .,Department of Neurology, Tampere University Hospital, Tampere, Finland.
| | - Marko Pesu
- Immunoregulation, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Fimlab Laboratories, Tampere, Finland
| | - Mikael Söderqvist
- Department of Neurology, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, D532, 33520, Tampere, Finland
| | - Anna Grönholm
- Immunoregulation, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Suvi Liimatainen
- Department of Neurology, Tampere University Hospital, Tampere, Finland
| | - Maria Peltola
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.,UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jukka Peltola
- Department of Neurology, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, D532, 33520, Tampere, Finland.,Department of Neurology, Tampere University Hospital, Tampere, Finland
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12
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Impaired hippocampal functional connectivity in patients with drug resistant, generalized tonic-clonic seizures. Neuroreport 2020; 30:700-706. [PMID: 31116131 PMCID: PMC6571184 DOI: 10.1097/wnr.0000000000001262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to better understand the imaging features of drug-resistant epilepsy (DRE), especially in idiopathic generalized tonic-clonic seizure (GTCS), as well as to discover the associated mechanisms and functional connectivity (FC). A total of 31 idiopathic generalized epilepsy-GTCS patients and 17 healthy controls were enrolled. For each patient, resting-state functional MRI was performed. After a 12-month follow-up observation, patients were further divided into either drug-resistant (DR) or drug-sensitive (DS) groups. Compared to the DS group, DR patients had previously received more types of antiepileptic drugs and had taken more types of failed antiepileptic drugs. There were distinct FC changes toward the left thalamus, left putamen, left precuneus, and right precentral gyrus in the left hippocampus between DR and DS patients. FCs in the DR group largely decreased or remained unchanged, while DS patients exhibited compensatory enhancement. Disease duration was negatively correlated with FC between the left hippocampus and the left thalamus-putamen in patients with DRE. Further, DRE patients had an extremely high area under the curve (0.978) and a cut-off FC between the left hippocampus and thalamus-putamen of 0.282. Together, hippocampal FCs in patients with DR GTCS were impaired and time-dependently correlated with disease duration. Hippocampal FCs in DS patients showed overall compensatory enhancement, which could be used as a sensitive and specific marker to identify and predict DR GTCS.
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13
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“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
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14
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Shapiro L, Wong JC, Escayg A. Reduced cannabinoid 2 receptor activity increases susceptibility to induced seizures in mice. Epilepsia 2019; 60:2359-2369. [PMID: 31758544 DOI: 10.1111/epi.16388] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The endocannabinoid system (ECS) is comprised of cannabinoid receptors 1 and 2 (CB1R and CB2R), endogenous ligands, and regulatory enzymes, and serves to regulate several important physiological functions throughout the brain and body. Recent evidence suggests that the ECS may be a promising target for the treatment of epilepsy, including epilepsy subtypes that arise from mutations in the voltage-gated sodium channel SCN1A. The objective of this study was to explore the effects of modulating CB2R activity on seizure susceptibility. METHODS We examined susceptibility to induced seizures using a number of paradigms in CB2R knockout mice (Cnr2-/- ), and determined the effects of the CB2R agonist, JWH-133, and the CB2R antagonist, SR144528, on seizure susceptibility in wild-type mice. We also examined seizure susceptibility in Cnr2 mutants harboring the human SCN1A R1648H (RH) epilepsy mutation and performed Electroencephalography (EEG) analysis to determine whether the loss of CB2Rs would increase spontaneous seizure frequency in Scn1a RH mutant mice. RESULTS Both heterozygous (Cnr2+/- ) and homozygous (Cnr2-/- ) knockout mice exhibited increased susceptibility to pentylenetetrazole (PTZ)-induced seizures. The CB2R agonist JWH-133 did not significantly alter seizure susceptibility in wild-type mice; however, administration of the CB2R antagonist SR144528 resulted in increased susceptibility to PTZ-induced seizures. In offspring from a cross between the Cnr2 × RH lines, both Cnr2 and RH mutants were susceptible to PTZ-induced seizures; however, seizure susceptibility was not significantly increased in mutants expressing both mutations. No spontaneous seizures were observed in either RH or Cnr2/RH mutants during 336-504 hours of continuous EEG recordings. SIGNIFICANCE Our results demonstrate that reduced CB2R activity is associated with increased seizure susceptibility. CB2Rs might therefore provide a therapeutic target for the treatment of some forms of epilepsy.
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Affiliation(s)
- Lindsey Shapiro
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - Jennifer C Wong
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - Andrew Escayg
- Department of Human Genetics, Emory University, Atlanta, Georgia
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15
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Kobylarek D, Iwanowski P, Lewandowska Z, Limphaibool N, Szafranek S, Labrzycka A, Kozubski W. Advances in the Potential Biomarkers of Epilepsy. Front Neurol 2019; 10:685. [PMID: 31312171 PMCID: PMC6614180 DOI: 10.3389/fneur.2019.00685] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022] Open
Abstract
Epilepsy is a group of chronic neurological disorders characterized by recurrent, spontaneous, and unpredictable seizures. It is one of the most common neurological disorders, affecting tens of millions of people worldwide. Comprehensive studies on epilepsy in recent decades have revealed the complexity of epileptogenesis, in which immunological processes, epigenetic modifications, and structural changes in neuronal tissues have been identified as playing a crucial role. This review discusses the recent advances in the biomarkers of epilepsy. We evaluate the possible molecular background underlying the clinical changes observed in recent studies, focusing on therapeutic investigations, and the evidence of their safety and efficacy in the human population. This article reviews the pathophysiology of epilepsy, including recent reports on the effects of oxidative stress and hypoxia, and focuses on specific biomarkers and their clinical implications, along with further perspectives in epilepsy research.
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Affiliation(s)
- Dominik Kobylarek
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Iwanowski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zuzanna Lewandowska
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Sara Szafranek
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anita Labrzycka
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
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16
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Hansen N. Commentary on Nóbrega-Jr et al. "Mesial temporal lobe epilepsy with hippocampal sclerosis is infrequently associated with neuronal antibodies". Epilepsia 2018; 59:2340-2341. [PMID: 30451294 DOI: 10.1111/epi.14593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Niels Hansen
- Department of Epileptology, University of Bonn, Bonn, Germany.,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Germany
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17
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Nóbrega-Jr AW, Gregory CP, Schlindwein-Zanini R, Neves FDS, Wolf P, Walz R, Steindel M, Lin K. Mesial temporal lobe epilepsy with hippocampal sclerosis is infrequently associated with neuronal autoantibodies. Epilepsia 2018; 59:e152-e156. [PMID: 30146688 DOI: 10.1111/epi.14534] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 12/16/2022]
Abstract
Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is characterized by its well-defined clinical profile. Limbic encephalitis is increasingly recognized as a possible etiology of adult-onset MTLE-HS, and neuronal autoantibodies have been detected in patients even without previous signs of encephalitis. The aim of this study is to analyze the frequency of specific autoantibodies in patients with MTLE-HS. A case-control study was carried out with 100 patients with MTLE-HS and 50 healthy controls. Sera samples from subjects were tested by indirect immunofluorescence assay for detection of anti-N-methyl-d-aspartate receptor (NMDA-R), anti-contactin-associated protein-like 2 (CASPR2), anti-leucine-rich glioma inactivated 1 (LGI1), anti-gamma aminobutyric acid B receptor (GABA-B-R), anti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid 1 and 2 receptors (AMPA-1-R and AMPA-2-R), and enzyme-linked immunosorbent assay for detection of anti-glutamic acid decarboxylase 65 (GAD65). Mean age of patients and controls was 41.2 vs 42 years, and 55% vs 56% were female. Mean duration of epilepsy was 27.2 years. No neuronal autoantibodies were found in either group, except for anti-GAD65 in 3 patients and 2 controls. This study adds to the mounting evidence that, in Brazilian patients, MTLE-HS without signs and symptoms of autoimmune encephalitis may be infrequently associated with these autoantibodies. Differences regarding accuracy of used methodologies for autoantibody detection and genetic and environmental characteristics are discussed. Further works with different methodologies tested simultaneously in different populations may help clarify the incongruent study results about autoantibodies in MTLE-HS.
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Affiliation(s)
- Adaucto W Nóbrega-Jr
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | | | | | - Fabricio de Souza Neves
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Peter Wolf
- Center for Applied Neuroscience, HU, UFSC, Florianópolis, SC, Brazil.,Division of Neurology, Department of Internal Medicine, HU, UFSC, Florianópolis, SC, Brazil.,Danish Epilepsy Center, Dianalund, Denmark
| | - Roger Walz
- Center for Applied Neuroscience, HU, UFSC, Florianópolis, SC, Brazil.,Division of Neurology, Department of Internal Medicine, HU, UFSC, Florianópolis, SC, Brazil.,Epilepsy Center of Santa Catarina State (CEPESC), HU, UFSC, Florianópolis, SC, Brazil
| | - Mario Steindel
- Laboratory of Protozoology, Department of Microbiology, Immunology and Parasitology (MIP), Biological Science Center, UFSC, Florianópolis, SC, Brazil
| | - Katia Lin
- Center for Applied Neuroscience, HU, UFSC, Florianópolis, SC, Brazil.,Division of Neurology, Department of Internal Medicine, HU, UFSC, Florianópolis, SC, Brazil.,Epilepsy Center of Santa Catarina State (CEPESC), HU, UFSC, Florianópolis, SC, Brazil
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