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Xiang LY, Chen XY, Lu LM, Kong MH, Ji Q, Xiong Y, Xie MM, Jian XL, Zhu ZR. Mechanisms of Neuronal Reactivation in Memory Consolidation: A Perspective from Pathological Conditions. Neuroscience 2024; 551:196-204. [PMID: 38810690 DOI: 10.1016/j.neuroscience.2024.05.030] [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: 01/29/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
Memory consolidation refers to a process by which labile newly formed memory traces are progressively strengthened into long term memories and become more resistant to interference. Recent work has revealed that spontaneous hippocampal activity during rest, commonly referred to as "offline" activity, plays a critical role in the process of memory consolidation. Hippocampal reactivation occurs during sharp-wave ripples (SWRs), which are events associated with highly synchronous neural firing in the hippocampus and modulation of neural activity in distributed brain regions. Memory consolidation occurs primarily through a coordinated communication between hippocampus and neocortex. Cortical slow oscillations drive the repeated reactivation of hippocampal memory representations together with SWRs and thalamo-cortical spindles, inducing long-lasting cellular and network modifications responsible for memory stabilization.In this review, we aim to comprehensively cover the field of "reactivation and memory consolidation" research by detailing the physiological mechanisms of neuronal reactivation and firing patterns during SWRs and providing a discussion of more recent key findings. Several mechanistic explanations of neuropsychiatric diseases propose that impaired neural replay may underlie some of the symptoms of the disorders. Abnormalities in neuronal reactivation are a common phenomenon and cause pathological impairment in several diseases, such as Alzheimer's disease (AD), epilepsy and schizophrenia. However, the specific pathological changes and mechanisms of reactivation in each disease are different. Recent work has also enlightened some of the underlying pathological mechanisms of neuronal reactivation in these diseases. In this review, we further describe how SWRs, ripples and slow oscillations are affected in Alzheimer's disease, epilepsy, and schizophrenia. We then compare the differences of neuronal reactivation and discuss how different reactivation abnormalities cause pathological changes in these diseases. Aberrant neural reactivation provides insights into disease pathogenesis and may even serve as biomarkers for early disease progression and treatment response.
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Affiliation(s)
- Lei-Ying Xiang
- School of Educational Sciences, Chongqing Normal University, Chongqing, PR China
| | - Xiao-Yi Chen
- School of Educational Sciences, Chongqing Normal University, Chongqing, PR China
| | - Li-Ming Lu
- School of Educational Sciences, Chongqing Normal University, Chongqing, PR China
| | - Ming-Hui Kong
- School of Educational Sciences, Chongqing Normal University, Chongqing, PR China
| | - Qi Ji
- Department of Medical Psychology, Army Medical University, Chongqing, PR China
| | - Yu Xiong
- Department of Stomatology, Southwest Hospital, Chongqing, PR China
| | - Mei-Ming Xie
- Chinese People's Liberation Army Western Theater General Hospital, Chengdu, PR China
| | - Xin-Ling Jian
- No. 950 Hospital of the Chinese People's Liberation Army, Yecheng, PR China
| | - Zhi-Ru Zhu
- Department of Medical Psychology, Army Medical University, Chongqing, PR China.
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Duma GM, Cuozzo S, Wilson L, Danieli A, Bonanni P, Pellegrino G. Excitation/Inhibition balance relates to cognitive function and gene expression in temporal lobe epilepsy: a high density EEG assessment with aperiodic exponent. Brain Commun 2024; 6:fcae231. [PMID: 39056027 PMCID: PMC11272395 DOI: 10.1093/braincomms/fcae231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/22/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Patients with epilepsy are characterized by a dysregulation of excitation/inhibition balance (E/I). The assessment of E/I may inform clinicians during the diagnosis and therapy management, even though it is rarely performed. An accessible measure of the E/I of the brain represents a clinically relevant feature. Here, we exploited the exponent of the aperiodic component of the power spectrum of the electroencephalography (EEG) signal, as a non-invasive and cost-effective proxy of the E/I balance. We recorded resting-state activity with high-density EEG from 67 patients with temporal lobe epilepsy and 35 controls. We extracted the exponent of the aperiodic fit of the power spectrum from source-reconstructed EEG and tested differences between patients with epilepsy and controls. Spearman's correlation was performed between the exponent and clinical variables (age of onset, epilepsy duration and neuropsychology) and cortical expression of epilepsy-related genes derived from the Allen Human Brain Atlas. Patients with temporal lobe epilepsy showed a significantly larger exponent, corresponding to inhibition-directed E/I balance, in bilateral frontal and temporal regions. Lower E/I in the left entorhinal and bilateral dorsolateral prefrontal cortices corresponded to a lower performance of short-term verbal memory. Limited to patients with temporal lobe epilepsy, we detected a significant correlation between the exponent and the cortical expression of GABRA1, GRIN2A, GABRD, GABRG2, KCNA2 and PDYN genes. EEG aperiodic exponent maps the E/I balance non-invasively in patients with epilepsy and reveals a close relationship between altered E/I patterns, cognition and genetics.
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Affiliation(s)
- Gian Marco Duma
- Scientific Institute IRCCS E.Medea, Epilepsy and Clinical Neurophysiology Unit, 31015, Conegliano, Italy
| | - Simone Cuozzo
- Scientific Institute IRCCS E.Medea, Epilepsy and Clinical Neurophysiology Unit, 31015, Conegliano, Italy
| | - Luc Wilson
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Alberto Danieli
- Scientific Institute IRCCS E.Medea, Epilepsy and Clinical Neurophysiology Unit, 31015, Conegliano, Italy
| | - Paolo Bonanni
- Scientific Institute IRCCS E.Medea, Epilepsy and Clinical Neurophysiology Unit, 31015, Conegliano, Italy
| | - Giovanni Pellegrino
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London N6A5C1, Canada
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Höller Y, Eyjólfsdóttir S, Van Schalkwijk FJ, Trinka E. The effects of slow wave sleep characteristics on semantic, episodic, and procedural memory in people with epilepsy. Front Pharmacol 2024; 15:1374760. [PMID: 38725659 PMCID: PMC11079234 DOI: 10.3389/fphar.2024.1374760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Slow wave sleep (SWS) is highly relevant for verbal and non-verbal/spatial memory in healthy individuals, but also in people with epilepsy. However, contradictory findings exist regarding the effect of seizures on overnight memory retention, particularly relating to procedural and non-verbal memory, and thorough examination of episodic memory retention with ecologically valid tests is missing. This research explores the interaction of SWS duration with epilepsy-relevant factors, as well as the relation of spectral characteristics of SWS on overnight retention of procedural, verbal, and episodic memory. In an epilepsy monitoring unit, epilepsy patients (N = 40) underwent learning, immediate and 12 h delayed testing of memory retention for a fingertapping task (procedural memory), a word-pair task (verbal memory), and an innovative virtual reality task (episodic memory). We used multiple linear regression to examine the impact of SWS duration, spectral characteristics of SWS, seizure occurrence, medication, depression, seizure type, gender, and epilepsy duration on overnight memory retention. Results indicated that none of the candidate variables significantly predicted overnight changes for procedural memory performance. For verbal memory, the occurrence of tonic-clonic seizures negatively impacted memory retention and higher psychoactive medication load showed a tendency for lower verbal memory retention. Episodic memory was significantly impacted by epilepsy duration, displaying a potential nonlinear impact with a longer duration than 10 years negatively affecting memory performance. Higher drug load of anti-seizure medication was by tendency related to better overnight retention of episodic memory. Contrary to expectations longer SWS duration showed a trend towards decreased episodic memory performance. Analyses on associations between memory types and EEG band power during SWS revealed lower alpha-band power in the frontal right region as significant predictor for better episodic memory retention. In conclusion, this research reveals that memory modalities are not equally affected by important epilepsy factors such as duration of epilepsy and medication, as well as SWS spectral characteristics.
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Affiliation(s)
- Yvonne Höller
- Faculty of Psychology, University of Akureyri, Akureyri, Iceland
| | | | - Frank Jasper Van Schalkwijk
- Hertie-Institute for Clinical Brain Research, Center for Neurology, University Medical Center Tübingen, Tübingen, Germany
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Neuroscience Institute, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Salzburg, Austria
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Leduc T, El Alami H, Bougadir K, Bélanger-Nelson E, Mongrain V. Neuroligin-2 shapes individual slow waves during slow-wave sleep and the response to sleep deprivation in mice. Mol Autism 2024; 15:13. [PMID: 38570872 PMCID: PMC10993465 DOI: 10.1186/s13229-024-00594-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Sleep disturbances are a common comorbidity to most neurodevelopmental disorders and tend to worsen disease symptomatology. It is thus crucial to understand mechanisms underlying sleep disturbances to improve patients' quality of life. Neuroligin-2 (NLGN2) is a synaptic adhesion protein regulating GABAergic transmission. It has been linked to autism spectrum disorders and schizophrenia in humans, and deregulations of its expression were shown to cause epileptic-like hypersynchronized cerebral activity in rodents. Importantly, the absence of Nlgn2 (knockout: KO) was previously shown to alter sleep-wake duration and quality in mice, notably increasing slow-wave sleep (SWS) delta activity (1-4 Hz) and altering its 24-h dynamics. This type of brain oscillation is involved in memory consolidation, and is also a marker of homeostatic sleep pressure. Sleep deprivation (SD) is notably known to impair cognition and the physiological response to sleep loss involves GABAergic transmission. METHODS Using electrocorticographic (ECoG) recordings, we here first aimed to verify how individual slow wave (SW; 0.5-4 Hz) density and properties (e.g., amplitude, slope, frequency) contribute to the higher SWS delta activity and altered 24-h dynamics observed in Nlgn2 KO mice. We further investigated the response of these animals to SD. Finally, we tested whether sleep loss affects the gene expression of Nlgn2 and related GABAergic transcripts in the cerebral cortex of wild-type mice using RNA sequencing. RESULTS Our results show that Nlgn2 KO mice have both greater SW amplitude and density, and that SW density is the main property contributing to the altered 24-h dynamics. We also found the absence of Nlgn2 to accelerate paradoxical sleep recovery following SD, together with profound alterations in ECoG activity across vigilance states. Sleep loss, however, did not modify the 24-h distribution of the hypersynchronized ECoG events observed in these mice. Finally, RNA sequencing confirmed an overall decrease in cortical expression of Nlgn2 and related GABAergic transcripts following SD in wild-type mice. CONCLUSIONS This work brings further insight into potential mechanisms of sleep duration and quality deregulation in neurodevelopmental disorders, notably involving NLGN2 and GABAergic neurotransmission.
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Affiliation(s)
- Tanya Leduc
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900, St-Denis street, Tour Viger Montréal, Montreal, QC, H2X 0A9, Canada
| | - Hiba El Alami
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Khadija Bougadir
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Erika Bélanger-Nelson
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- Pfizer Canada ULC, Montreal, QC, Canada
| | - Valérie Mongrain
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada.
- Centre d'études avancées en médecine du sommeil (CÉAMS), Recherche - Centre intégré universitaire de santé et services sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900, St-Denis street, Tour Viger Montréal, Montreal, QC, H2X 0A9, Canada.
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Sheybani L, Vivekananda U, Rodionov R, Diehl B, Chowdhury FA, McEvoy AW, Miserocchi A, Bisby JA, Bush D, Burgess N, Walker MC. Wake slow waves in focal human epilepsy impact network activity and cognition. Nat Commun 2023; 14:7397. [PMID: 38036557 PMCID: PMC10689494 DOI: 10.1038/s41467-023-42971-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Slow waves of neuronal activity are a fundamental component of sleep that are proposed to have homeostatic and restorative functions. Despite this, their interaction with pathology is unclear and there is only indirect evidence of their presence during wakefulness. Using intracortical recordings from the temporal lobe of 25 patients with epilepsy, we demonstrate the existence of local wake slow waves (LoWS) with key features of sleep slow waves, including a down-state of neuronal firing. Consistent with a reduction in neuronal activity, LoWS were associated with slowed cognitive processing. However, we also found that LoWS showed signatures of a homeostatic relationship with interictal epileptiform discharges (IEDs): exhibiting progressive adaptation during the build-up of network excitability before an IED and reducing the impact of subsequent IEDs on network excitability. We therefore propose an epilepsy homeostasis hypothesis: that slow waves in epilepsy reduce aberrant activity at the price of transient cognitive impairment.
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Affiliation(s)
- Laurent Sheybani
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Umesh Vivekananda
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Roman Rodionov
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Fahmida A Chowdhury
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - James A Bisby
- Division of Psychiatry, University College London, London, UK
| | - Daniel Bush
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK.
| | - Neil Burgess
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK.
- Institute of Cognitive Neuroscience, University College London, London, UK.
| | - Matthew C Walker
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK.
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
- NIHR University College London Hospitals Biomedical Research Centre, London, UK.
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6
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Shah P, Kaneria A, Fleming G, Williams CRO, Sullivan RM, Lemon CH, Smiley J, Saito M, Wilson DA. Homeostatic NREM sleep and salience network function in adult mice exposed to ethanol during development. Front Neurosci 2023; 17:1267542. [PMID: 38033546 PMCID: PMC10682725 DOI: 10.3389/fnins.2023.1267542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Developmental exposure to ethanol is a leading cause of cognitive, emotional and behavioral problems, with fetal alcohol spectrum disorder (FASD) affecting more than 1:100 children. Recently, comorbid sleep deficits have been highlighted in these disorders, with sleep repair a potential therapeutic target. Animal models of FASD have shown non-REM (NREM) sleep fragmentation and slow-wave oscillation impairments that predict cognitive performance. Here we use a mouse model of perinatal ethanol exposure to explore whether reduced sleep pressure may contribute to impaired NREM sleep, and compare the function of a brain network reported to be impacted by insomnia-the Salience network-in developmental ethanol-exposed mice with sleep-deprived, saline controls. Mice were exposed to ethanol or saline on postnatal day 7 (P7) and allowed to mature to adulthood for testing. At P90, telemetered cortical recordings were made for assessment of NREM sleep in home cage before and after 4 h of sleep deprivation to assess basal NREM sleep and homeostatic NREM sleep response. To assess Salience network functional connectivity, mice were exposed to the 4 h sleep deprivation period or left alone, then immediately sacrificed for immunohistochemical analysis of c-Fos expression. The results show that developmental ethanol severely impairs both normal rebound NREM sleep and sleep deprivation induced increases in slow-wave activity, consistent with reduced sleep pressure. Furthermore, the Salience network connectome in rested, ethanol-exposed mice was most similar to that of sleep-deprived, saline control mice, suggesting a sleep deprivation-like state of Salience network function after developmental ethanol even without sleep deprivation.
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Affiliation(s)
- Prachi Shah
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY,United States
| | - Aayush Kaneria
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY,United States
| | - Gloria Fleming
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY,United States
| | - Colin R. O. Williams
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY,United States
| | - Regina M. Sullivan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY,United States
- School of Biological Sciences, University of Oklahoma, Norman, OK, United States
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York, NY, United States
| | - Christian H. Lemon
- School of Biological Sciences, University of Oklahoma, Norman, OK, United States
| | - John Smiley
- Division of Neurochemistry, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY,United States
- Department of Psychiatry, New York University Medical Center, New York, NY,United States
| | - Mariko Saito
- Division of Neurochemistry, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY,United States
- Department of Psychiatry, New York University Medical Center, New York, NY,United States
| | - Donald A. Wilson
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY,United States
- School of Biological Sciences, University of Oklahoma, Norman, OK, United States
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York, NY, United States
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Ciliento R, Gjini K, Dabbs K, Hermann B, Riedner B, Jones S, Fatima S, Johnson S, Bendlin B, Lam AD, Boly M, Struck AF. Prevalence and localization of nocturnal epileptiform discharges in mild cognitive impairment. Brain Commun 2023; 5:fcad302. [PMID: 37965047 PMCID: PMC10642616 DOI: 10.1093/braincomms/fcad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/18/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Recent evidence shows that identifying and treating epileptiform abnormalities in patients with Alzheimer's disease could represent a potential avenue to improve clinical outcome. Specifically, animal and human studies have revealed that in the early phase of Alzheimer's disease, there is an increased risk of seizures. It has also been demonstrated that the administration of anti-seizure medications can slow the functional progression of the disease only in patients with EEG signs of cortical hyperexcitability. In addition, although it is not known at what disease stage hyperexcitability emerges, there remains no consensus regarding the imaging and diagnostic methods best able to detect interictal events to further distinguish different phenotypes of Alzheimer's disease. In this exploratory work, we studied 13 subjects with amnestic mild cognitive impairment and 20 healthy controls using overnight high-density EEG with 256 channels. All participants also underwent MRI and neuropsychological assessment. Electronic source reconstruction was also used to better select and localize spikes. We found spikes in six of 13 (46%) amnestic mild cognitive impairment compared with two of 20 (10%) healthy control participants (P = 0.035), representing a spike prevalence similar to that detected in previous studies of patients with early-stage Alzheimer's disease. The interictal events were low-amplitude temporal spikes more prevalent during non-rapid eye movement sleep. No statistically significant differences were found in cognitive performance between amnestic mild cognitive impairment patients with and without spikes, but a trend in immediate and delayed memory was observed. Moreover, no imaging findings of cortical and subcortical atrophy were found between amnestic mild cognitive impairment participants with and without epileptiform spikes. In summary, our exploratory study shows that patients with amnestic mild cognitive impairment reveal EEG signs of hyperexcitability early in the disease course, while no other significant differences in neuropsychological or imaging features were observed among the subgroups. If confirmed with longitudinal data, these exploratory findings could represent one of the first signatures of a preclinical epileptiform phenotype of amnestic mild cognitive impairment and its progression.
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Affiliation(s)
- Rosario Ciliento
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Klevest Gjini
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Brady Riedner
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Stephanie Jones
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Safoora Fatima
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Sterling Johnson
- Department of Medicine, University of Wisconsin, Madison, WI 53705, USA
| | - Barbara Bendlin
- Department of Medicine, University of Wisconsin, Madison, WI 53705, USA
| | - Alice D Lam
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Melanie Boly
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
- Department of Neurology, William S. Middleton Veterans Administration Hospital, Madison, WI 53705, USA
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Denis C, Dabbs K, Nair VA, Mathis J, Almane DN, Lakshmanan A, Nencka A, Birn RM, Conant L, Humphries C, Felton E, Raghavan M, DeYoe EA, Binder JR, Hermann B, Prabhakaran V, Bendlin BB, Meyerand ME, Boly M, Struck AF. T1-/T2-weighted ratio reveals no alterations to gray matter myelination in temporal lobe epilepsy. Ann Clin Transl Neurol 2023; 10:2149-2154. [PMID: 37872734 PMCID: PMC10647008 DOI: 10.1002/acn3.51653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/29/2022] [Accepted: 06/09/2022] [Indexed: 10/25/2023] Open
Abstract
Short-range functional connectivity in the limbic network is increased in patients with temporal lobe epilepsy (TLE), and recent studies have shown that cortical myelin content correlates with fMRI connectivity. We thus hypothesized that myelin may increase progressively in the epileptic network. We compared T1w/T2w gray matter myelin maps between TLE patients and age-matched controls and assessed relationships between myelin and aging. While both TLE patients and healthy controls exhibited increased T1w/T2w intensity with age, we found no evidence for significant group-level aberrations in overall myelin content or myelin changes through time in TLE.
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Affiliation(s)
- Colin Denis
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Kevin Dabbs
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Veena A. Nair
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Jedidiah Mathis
- Department of RadiologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Dace N. Almane
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | | | - Andrew Nencka
- Department of RadiologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Rasmus M. Birn
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of PsychiatryUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Lisa Conant
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Colin Humphries
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Elizabeth Felton
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Manoj Raghavan
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Edgar A. DeYoe
- Department of RadiologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Jeffrey R. Binder
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Bruce Hermann
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Vivek Prabhakaran
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Barbara B. Bendlin
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Mary E. Meyerand
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Biomedical EngineeringUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Mélanie Boly
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of PsychiatryUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Aaron F. Struck
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S. Middleton Veterans Administration HospitalMadisonWisconsinUSA
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9
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Wang L, Zhu R, Zhou X, Zhang Z, Peng D. Altered local and remote functional connectivity in mild Alzheimer's disease patients with sleep disturbances. Front Aging Neurosci 2023; 15:1269582. [PMID: 37920381 PMCID: PMC10619161 DOI: 10.3389/fnagi.2023.1269582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
Objectives This study aimed to investigate local and remote functional connectivity in mild Alzheimer's disease patients with sleep disturbances (ADSD) and those without sleep disturbances (ADNSD). Methods Thirty eight mild AD patients with sleep disturbances and 21 mild AD patients without sleep disturbances participated in this study. All subjects underwent neuropsychological assessments and 3.0 Tesla magnetic resonance scanning. Static and dynamic regional homogeneity (ReHo) were used to represent the local functional connectivity. Seed-based whole-brain functional connectivity was used to represent the remote functional connectivity. The seed was chosen based on the results of ReHo. Results Compared to ADNSD, ADSD showed decreased static ReHo in the left posterior central gyrus and the right cuneus and increased dynamic ReHo in the left posterior central gyrus. As for the remote functional connectivity, comparing ADSD to ADNSD, it was found that there was a decreased functional connection between the left posterior central gyrus and the left cuneus as well as the left calcarine. Conclusion The current study demonstrated that, compared with ADNSD, ADSD is impaired in both local and remote functional connectivity, manifested as reduced functional connectivity involving the primary sensory network and the primary visual network. The abnormality of the above functional connectivity is one of the reasons why sleep disorders promote cognitive impairment in AD. Moreover, sleep disorders change the temporal sequence of AD pathological damage to brain functional networks, but more evidence is needed to support this conclusion.
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Affiliation(s)
- Lei Wang
- Department of Neurology, Beijing Geriatric Hospital, Beijing, China
| | - Rui Zhu
- Department of Neurology, Beijing Geriatric Hospital, Beijing, China
| | - Xiao Zhou
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhiyong Zhang
- Department of Neurology, Beijing Geriatric Hospital, Beijing, China
| | - Dantao Peng
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
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10
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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.
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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
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11
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Liu L, Tian Y. Capsaicin Changes the Pattern of Brain Rhythms in Sleeping Rats. Molecules 2023; 28:4736. [PMID: 37375291 DOI: 10.3390/molecules28124736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
The heat and capsaicin sensor TRPV1 ion channels were originally discovered in sensory neurons of dorsal root ganglia, and later found in many other tissues and organs. However, whether TRPV1 channels are present in brain regions other than the hypothalamus has been a subject of debate. Here, we addressed this issue with an unbiased functional test by recording electroencephalograms (EEGs) to examine whether capsaicin injection directly into the rat lateral ventricle could alter brain electrical activity. We observed that EEGs during the sleep stage could be significantly perturbed by capsaicin, whereas EEGs during the awake stage did not show a detectable change. Our results are consistent with TRPV1 expression in selective brain regions whose activities are dominative during the sleep stage.
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Affiliation(s)
- Lei Liu
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, No. 1 Ningde Road, Qingdao 266073, China
| | - Yuhua Tian
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, No. 1 Ningde Road, Qingdao 266073, China
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12
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Geva-Sagiv M, Mankin EA, Eliashiv D, Epstein S, Cherry N, Kalender G, Tchemodanov N, Nir Y, Fried I. Augmenting hippocampal-prefrontal neuronal synchrony during sleep enhances memory consolidation in humans. Nat Neurosci 2023:10.1038/s41593-023-01324-5. [PMID: 37264156 DOI: 10.1038/s41593-023-01324-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/06/2023] [Indexed: 06/03/2023]
Abstract
Memory consolidation during sleep is thought to depend on the coordinated interplay between cortical slow waves, thalamocortical sleep spindles and hippocampal ripples, but direct evidence is lacking. Here, we implemented real-time closed-loop deep brain stimulation in human prefrontal cortex during sleep and tested its effects on sleep electrophysiology and on overnight consolidation of declarative memory. Synchronizing the stimulation to the active phases of endogenous slow waves in the medial temporal lobe (MTL) enhanced sleep spindles, boosted locking of brain-wide neural spiking activity to MTL slow waves, and improved coupling between MTL ripples and thalamocortical oscillations. Furthermore, synchronized stimulation enhanced the accuracy of recognition memory. By contrast, identical stimulation without this precise time-locking was not associated with, and sometimes even degraded, these electrophysiological and behavioral effects. Notably, individual changes in memory accuracy were highly correlated with electrophysiological effects. Our results indicate that hippocampo-thalamocortical synchronization during sleep causally supports human memory consolidation.
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Affiliation(s)
- Maya Geva-Sagiv
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Center of Neuroscience, University of California, Davis, Davis, CA, USA
| | - Emily A Mankin
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dawn Eliashiv
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shdema Epstein
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalie Cherry
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Guldamla Kalender
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Natalia Tchemodanov
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yuval Nir
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
| | - Itzhak Fried
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA.
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13
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Drew VJ, Wang C, Kim T. Progressive sleep disturbance in various transgenic mouse models of Alzheimer's disease. Front Aging Neurosci 2023; 15:1119810. [PMID: 37273656 PMCID: PMC10235623 DOI: 10.3389/fnagi.2023.1119810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
Alzheimer's disease (AD) is the leading cause of dementia. The relationship between AD and sleep dysfunction has received increased attention over the past decade. The use of genetically engineered mouse models with enhanced production of amyloid beta (Aβ) or hyperphosphorylated tau has played a critical role in the understanding of the pathophysiology of AD. However, their revelations regarding the progression of sleep impairment in AD have been highly dependent on the mouse model used and the specific techniques employed to examine sleep. Here, we discuss the sleep disturbances and general pathology of 15 mouse models of AD. Sleep disturbances covered in this review include changes to NREM and REM sleep duration, bout lengths, bout counts and power spectra. Our aim is to describe in detail the severity and chronology of sleep disturbances within individual mouse models of AD, as well as reveal broader trends of sleep deterioration that are shared among most models. This review also explores a variety of potential mechanisms relating Aβ accumulation and tau neurofibrillary tangles to the progressive deterioration of sleep observed in AD. Lastly, this review offers perspective on how study design might impact our current understanding of sleep disturbances in AD and provides strategies for future research.
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Affiliation(s)
- Victor J. Drew
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Chanung Wang
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tae Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
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14
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Shen M, Zhang L, Gong Y, Li L, Liu X. Epileptic Tissue Localization through Skewness-Based Functional Connectivity in the High-Frequency Band of Intracranial EEG. Bioengineering (Basel) 2023; 10:bioengineering10040461. [PMID: 37106648 PMCID: PMC10136084 DOI: 10.3390/bioengineering10040461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Functional connectivity analysis of intracranial electroencephalography (iEEG) plays an important role in understanding the mechanism of epilepsy and seizure dynamics. However, existing connectivity analysis is only suitable for low-frequency bands below 80 Hz. High-frequency oscillations (HFOs) and high-frequency activity (HFA) in the high-frequency band (80-500 Hz) are thought to be specific biomarkers in epileptic tissue localization. However, the transience in duration and variability of occurrence time and amplitudes of these events pose a challenge for conducting effective connectivity analysis. To deal with this problem, we proposed skewness-based functional connectivity (SFC) in the high-frequency band and explored its utility in epileptic tissue localization and surgical outcome evaluation. SFC comprises three main steps. The first step is the quantitative measurement of amplitude distribution asymmetry between HFOs/HFA and baseline activity. The second step is functional network construction on the basis of rank correlation of asymmetry across time. The third step is connectivity strength extraction from the functional network. Experiments were conducted in two separate datasets which consist of iEEG recordings from 59 patients with drug-resistant epilepsy. Significant difference (p<0.001) in connectivity strength was found between epileptic and non-epileptic tissue. Results were quantified via the receiver operating characteristic curve and the area under the curve (AUC). Compared with low-frequency bands, SFC demonstrated superior performance. With respect to pooled and individual epileptic tissue localization for seizure-free patients, AUCs were 0.66 (95% confidence interval (CI): 0.63-0.69) and (0.63 95% CI 0.56-0.71), respectively. For surgical outcome classification, the AUC was 0.75 (95% CI 0.59-0.85). Therefore, SFC can act as a promising assessment tool in characterizing the epileptic network and potentially provide better treatment options for patients with drug-resistant epilepsy.
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Affiliation(s)
- Mu Shen
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing 100876, China
| | - Lin Zhang
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing 100876, China
| | - Yi Gong
- School of Information and Communication Engineering, Beijing Information Science and Technology University, Beijing 100096, China
| | - Lei Li
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing 100876, China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, and Peking University Clinical Research Institute, Beijing 102206, China
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15
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Lai N, Li Z, Xu C, Wang Y, Chen Z. Diverse nature of interictal oscillations: EEG-based biomarkers in epilepsy. Neurobiol Dis 2023; 177:105999. [PMID: 36638892 DOI: 10.1016/j.nbd.2023.105999] [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: 12/02/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Interictal electroencephalogram (EEG) patterns, including high-frequency oscillations (HFOs), interictal spikes (ISs), and slow wave activities (SWAs), are defined as specific oscillations between seizure events. These interictal oscillations reflect specific dynamic changes in network excitability and play various roles in epilepsy. In this review, we briefly describe the electrographic characteristics of HFOs, ISs, and SWAs in the interictal state, and discuss the underlying cellular and network mechanisms. We also summarize representative evidence from experimental and clinical epilepsy to address their critical roles in ictogenesis and epileptogenesis, indicating their potential as electrophysiological biomarkers of epilepsy. Importantly, we put forwards some perspectives for further research in the field.
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Affiliation(s)
- Nanxi Lai
- Institute of Pharmacology & Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhisheng Li
- Institute of Pharmacology & Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yi Wang
- Institute of Pharmacology & Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhong Chen
- Institute of Pharmacology & Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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16
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Konduru SR, Isaacson JR, Lasky DJ, Zhou Z, Rao RK, Vattem SS, Rewey SJ, Jones MV, Maganti RK. Dual orexin antagonist normalized sleep homeostatic drive, enhanced GABAergic inhibition, and suppressed seizures after traumatic brain injury. Sleep 2022; 45:zsac238. [PMID: 36165953 PMCID: PMC9742898 DOI: 10.1093/sleep/zsac238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/16/2022] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVES Traumatic brain injury (TBI) can result in posttraumatic epilepsy (PTE) and sleep disturbances. We hypothesized that treatment with sleep aids after TBI can ameliorate PTE. METHODS CD-1 mice underwent controlled cortical impact (CCI), sham injury, or no craniotomy. Sham and CCI groups underwent a monthlong daily treatment with sleep aids including a dual orexin antagonist (DORA-22) or THIP (gaboxadol) or a respective vehicle starting on the day of CCI. We performed continuous EEG (electroencephalography) recordings at week 1 and months 1, 2, and 3 for ~1 week each time. Seizure analysis occurred at all-time points and sleep analysis occurred in week 1 and month-1/2 in all groups. Subsets of CCI and sham groups were subjected to voltageclamp experiments in hippocampal slices to evaluate GABAergic synaptic inhibition. RESULTS DORA-22 treatment suppressed seizures in month 1-3 recordings. TBI reduced the amplitude and frequency of miniature inhibitory synaptic currents (mIPSCs) in dentate granule cells and these changes were rescued by DORA-22 treatment. Sleep analysis showed that DORA-22 increased nonrapid eye movement (NREM) sleep during lights-off whereas THIP increased REM sleep during lights-on in week 1. Both treatments displayed subtle changes in time spent in NREM or REM at month-1/2 as well. TBI not only increased normalized EEG delta power (NΔ) at week-1 and month-1 but also resulted in the loss of the homeostatic diurnal oscillation of NΔ, which was restored by DORA-22 but not THIP treatment. CONCLUSIONS Dual orexin antagonists may have a therapeutic potential in suppressing PTE potentially by enhancing GABAergic inhibition and impacting sleep homeostatic drive.
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Affiliation(s)
- Sruthi R Konduru
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Jesse R Isaacson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Danny J Lasky
- Department of Neuroscience, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Zihao Zhou
- Rock Bridge High School, Columbia, MO, USA
| | | | - Swati S Vattem
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sophie J Rewey
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mathew V Jones
- Department of Neuroscience, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rama K Maganti
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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17
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Okadome T, Yamaguchi T, Mukaino T, Sakata A, Ogata K, Shigeto H, Isobe N, Uehara T. The effect of interictal epileptic discharges and following spindles on motor sequence learning in epilepsy patients. Front Neurol 2022; 13:979333. [PMID: 36438951 PMCID: PMC9686303 DOI: 10.3389/fneur.2022.979333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/25/2022] [Indexed: 09/05/2023] Open
Abstract
PURPOSE Interictal epileptic discharges (IEDs) are known to affect cognitive function in patients with epilepsy, but the mechanism has not been elucidated. Sleep spindles appearing in synchronization with IEDs were recently demonstrated to impair memory consolidation in rat, but this has not been investigated in humans. On the other hand, the increase of sleep spindles at night after learning is positively correlated with amplified learning effects during sleep for motor sequence learning. In this study, we examined the effects of IEDs and IED-coupled spindles on motor sequence learning in patients with epilepsy, and clarified their pathological significance. MATERIALS AND METHODS Patients undergoing long-term video-electroencephalography (LT-VEEG) at our hospital from June 2019 to November 2021 and age-matched healthy subjects were recruited. Motor sequence learning consisting of a finger-tapping task was performed before bedtime and the next morning, and the improvement rate of performance was defined as the sleep-dependent learning effect. We searched for factors associated with the changes in learning effect observed between the periods of when antiseizure medications (ASMs) were withdrawn for LT-VEEG and when they were returned to usual doses after LT-VEEG. RESULTS Excluding six patients who had epileptic seizures at night after learning, nine patients and 11 healthy subjects were included in the study. In the patient group, there was no significant learning effect when ASMs were withdrawn. The changes in learning effect of the patient group during ASM withdrawal were not correlated with changes in sleep duration or IED density; however, they were significantly negatively correlated with changes in IED-coupled spindle density. CONCLUSION We found that the increase of IED-coupled spindles correlated with the decrease of sleep-dependent learning effects of procedural memory. Pathological IED-coupled sleep spindles could hinder memory consolidation, that is dependent on physiological sleep spindles, resulting in cognitive dysfunction in patients with epilepsy.
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Affiliation(s)
- Toshiki Okadome
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiro Yamaguchi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiko Mukaino
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Katsuya Ogata
- Department of Pharmacy, School of Pharmaceutical Sciences at Fukuoka, International University of Health and Welfare, Okawa, Japan
| | - Hiroshi Shigeto
- Division of Medical Technology, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taira Uehara
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neurology, School of Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
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18
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Eriksson MH, Baldeweg T, Pressler R, Boyd SG, Huber R, Cross JH, Bölsterli BK, Chan SYS. Sleep homeostasis, seizures, and cognition in children with focal epilepsy. Dev Med Child Neurol 2022; 65:701-711. [PMID: 36069073 DOI: 10.1111/dmcn.15403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
AIM To investigate the link between sleep disruption and cognitive impairment in childhood epilepsy by studying the effect of epilepsy on sleep homeostasis, as reflected in slow-wave activity (SWA). METHOD We examined SWA from overnight EEG-polysomnography in 19 children with focal epilepsy (mean [SD] age 11 years 6 months [3 years], range 6 years 6 months-15 years 6 months; 6 females, 13 males) and 18 age- and sex-matched typically developing controls, correlating this with contemporaneous memory consolidation task scores, full-scale IQ, seizures, and focal interictal discharges. RESULTS Children with epilepsy did not differ significantly from controls in overnight SWA decline (p = 0.12) or gain in memory performance with sleep (p = 0.27). SWA was lower in patients compared to controls in the first hour of non-rapid eye movement sleep (p = 0.021), although not in those who remained seizure-free (p = 0.26). Full-scale IQ did not correlate with measures of SWA in patients or controls. There was no significant difference in SWA measures between focal and non-focal electrodes. INTERPRETATION Overnight SWA decline is conserved in children with focal epilepsy and may underpin the preservation of sleep-related memory consolidation in this patient group. Reduced early-night SWA may reflect impaired or immature sleep homeostasis in those with a higher seizure burden.
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Affiliation(s)
- Maria H Eriksson
- Developmental Neurosciences Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Neuropsychology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Torsten Baldeweg
- Developmental Neurosciences Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Neuropsychology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Ronit Pressler
- Neurophysiology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Stewart G Boyd
- Neurophysiology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Pediatric Sleep Disorders Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - J Helen Cross
- Developmental Neurosciences Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Neurology, Great Ormond Street Hospital NHS Trust, London, UK.,Young Epilepsy, Lingfield, UK
| | - Bigna K Bölsterli
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Pediatric Neurology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Samantha Y S Chan
- Developmental Neurosciences Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Paediatric Neurology, St George's Hospital, London, UK
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19
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Mercier MR, Dubarry AS, Tadel F, Avanzini P, Axmacher N, Cellier D, Vecchio MD, Hamilton LS, Hermes D, Kahana MJ, Knight RT, Llorens A, Megevand P, Melloni L, Miller KJ, Piai V, Puce A, Ramsey NF, Schwiedrzik CM, Smith SE, Stolk A, Swann NC, Vansteensel MJ, Voytek B, Wang L, Lachaux JP, Oostenveld R. Advances in human intracranial electroencephalography research, guidelines and good practices. Neuroimage 2022; 260:119438. [PMID: 35792291 DOI: 10.1016/j.neuroimage.2022.119438] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/23/2022] [Accepted: 06/30/2022] [Indexed: 12/11/2022] Open
Abstract
Since the second-half of the twentieth century, intracranial electroencephalography (iEEG), including both electrocorticography (ECoG) and stereo-electroencephalography (sEEG), has provided an intimate view into the human brain. At the interface between fundamental research and the clinic, iEEG provides both high temporal resolution and high spatial specificity but comes with constraints, such as the individual's tailored sparsity of electrode sampling. Over the years, researchers in neuroscience developed their practices to make the most of the iEEG approach. Here we offer a critical review of iEEG research practices in a didactic framework for newcomers, as well addressing issues encountered by proficient researchers. The scope is threefold: (i) review common practices in iEEG research, (ii) suggest potential guidelines for working with iEEG data and answer frequently asked questions based on the most widespread practices, and (iii) based on current neurophysiological knowledge and methodologies, pave the way to good practice standards in iEEG research. The organization of this paper follows the steps of iEEG data processing. The first section contextualizes iEEG data collection. The second section focuses on localization of intracranial electrodes. The third section highlights the main pre-processing steps. The fourth section presents iEEG signal analysis methods. The fifth section discusses statistical approaches. The sixth section draws some unique perspectives on iEEG research. Finally, to ensure a consistent nomenclature throughout the manuscript and to align with other guidelines, e.g., Brain Imaging Data Structure (BIDS) and the OHBM Committee on Best Practices in Data Analysis and Sharing (COBIDAS), we provide a glossary to disambiguate terms related to iEEG research.
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Proost R, Lagae L, Van Paesschen W, Jansen K. Sleep in children with refractory epilepsy and epileptic encephalopathies: A systematic review of literature. Eur J Paediatr Neurol 2022; 38:53-61. [PMID: 35395626 DOI: 10.1016/j.ejpn.2022.03.010] [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: 11/23/2021] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
Children with epilepsy have more sleep disorders compared to healthy children. The bidirectional interaction between epilepsy and sleep is not completely understood. However, disruption of sleep architecture during childhood may have consequences for cognitive development. As children with drug-refractory epilepsy often have intellectual disability, sleep disruption could be an important contributing factor in severity of their cognitive impairment. To better understand these interactions, sleep architecture in children with drug-refractory epilepsy and epileptic encephalopathies should be investigated. In this review, we conducted a systematic literature search on this topic. Articles that investigated sleep macro- and/or microstructure by means of electroencephalogram/polysomnography were included, as well as articles that used validated questionnaires. Sixteen articles were reviewed, eight of which used polysomnography. Only 2 articles examined sleep in children with epileptic encephalopathies. Consistent findings on measures of sleep architecture were a reduction in REM percentage and an increase in sleep fragmentation when comparing drug-refractory patients with non-refractory and healthy subjects. The findings on slow wave sleep were less clear. Studies with questionnaires unambiguously confirmed subjectively more sleep problems in children with drug-refractory epilepsy. This is the first review of literature in this patient population. More good quality sleep studies in children with drug-refractory epilepsy are warranted. The use of wearables in the home setting together with automatic sleep staging could provide more insights.
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Affiliation(s)
- R Proost
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium.
| | - L Lagae
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium
| | - W Van Paesschen
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - K Jansen
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium.
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21
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Avvenuti G, Bernardi G. Local sleep: A new concept in brain plasticity. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:35-52. [PMID: 35034748 DOI: 10.1016/b978-0-12-819410-2.00003-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traditionally, sleep and wakefulness have been considered as two global, mutually exclusive states. However, this view has been challenged by the discovery that sleep and wakefulness are actually locally regulated and that islands of these two states may often coexist in the same individual. Importantly, such a local regulation seems to be the key for many essential functions of sleep, including the maintenance of cognitive efficiency and the consolidation of new skills and memories. Indeed, local changes in sleep-related oscillations occur in brain areas that are used and involved in learning during wakefulness. In turn, these changes directly modulate experience-dependent brain adaptations and the consolidation of newly acquired memories. In line with these observations, alterations in the regional balance between wake- and sleep-like activity have been shown to accompany many pathologic conditions, including psychiatric and neurologic disorders. In the last decade, experimental research has started to shed light on the mechanisms involved in the local regulation of sleep and wakefulness. The results of this research have opened new avenues of investigation regarding the function of sleep and have revealed novel potential targets for the treatment of several pathologic conditions.
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Affiliation(s)
- Giulia Avvenuti
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Giulio Bernardi
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy.
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22
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Starnes K, Britton JW, Burkholder DB, Suchita IA, Gregg NM, Klassen BT, Lundstrom BN. Case Report: Prolonged Effects of Short-Term Transcranial Magnetic Stimulation on EEG Biomarkers, Spectral Power, and Seizure Frequency. Front Neurosci 2022; 16:866212. [PMID: 35757550 PMCID: PMC9232187 DOI: 10.3389/fnins.2022.866212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive modality of focal brain stimulation in which a fluctuating magnetic field induces electrical currents within the cortex. It remains unclear to what extent TMS alters EEG biomarkers and how EEG biomarkers may guide treatment of focal epilepsy. We present a case of a 48-year-old man with focal epilepsy, refractory to multiple medication trials, who experienced a dramatic reduction in seizures after targeting the area of seizure onset within the left parietal-occipital region with low-frequency repetitive TMS (rTMS). Prior to treatment, he experienced focal seizures that impacted cognition including apraxia at least 50-60 times daily. MRI of the brain showed a large focal cortical dysplasia with contrast enhancement involving the left occipital-parietal junction. Stimulation for 5 consecutive days was well-tolerated and associated with a day-by-day reduction in seizure frequency. In addition, he was monitored with continuous video EEG, which showed continued and progressive changes in spectral power (decreased broadband power and increased infraslow delta activity) and a gradual reduction in seizure frequency and duration. One month after initial treatment, 2-day ambulatory EEG demonstrated seizure-freedom and MRI showed resolution of focal contrast enhancement. He continues to receive 2-3 days of rTMS every 2-4 months. He was seizure-free for 6 months, and at last follow-up of 17 months was experiencing auras approximately every 2 weeks without progression to disabling seizures. This case demonstrates that rTMS can be a well-tolerated and effective means of controlling medication-refractory seizures, and that EEG biomarkers change gradually in a fashion in association with seizure frequency. TMS influences cortical excitability, is a promising non-invasive means of treating focal epilepsy, and has measurable electrophysiologic effects.
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23
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Oser N, Hubacher M, Nageleisen-Weiss A, van Mierlo P, Huber R, Weber P, Bölsterli BK, Datta AN. 6-year course of sleep homeostasis in a case with epilepsy-aphasia spectrum disorder. Epilepsy Behav Rep 2021; 16:100488. [PMID: 34693247 PMCID: PMC8517280 DOI: 10.1016/j.ebr.2021.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/27/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022] Open
Abstract
The overnight change of the slope of SSW as EEG marker for nocturnal regeneration. Reorganization of brain networks can rescue cognitive functions at least partially. Corticosteroids lead to a stabilization of the homeostasis of slope of SSW.
The epilepsy-aphasia spectrum consists of epilepsies with a strong activation of epileptic discharges during non-rapid-eye-movement (NREM) sleep, variable seizure burden and language problems. The homeostatic decrease of slow waves (SW) during NREM sleep (i.e. their amplitude/slope and power) has been related to brain recovery and cognitive function. Epileptic discharges during NREM-sleep were related to an impairment of the decrease of the slope of SW and to cognitive deficits. In this longitudinal case study, we aim to relate this electrophysiological marker, i.e. overnight change of slope of SW, to imaging and behavior. We report a young girl with a fluctuating course in the epilepsy-aphasia spectrum, ranging from the benign end with self-limited childhood epilepsy with centrotemporal spikes (SLECTS) to the severe end with epileptic encephalopathy with continuous spike waves during sleep (CSWS) with two phases of cognitive regression. She was documented over a period of six years including 12 PSGs, six language fMRIs and seven neuropsychological assessments. We longitudinally studied focal and total spike wave index (SWI), detected SW during NREM sleep, calculated their slopes (first and last hour of NREM sleep and overnight change). Deterioration of overnight decrease of the slope of SW was paralleled by the occurrence of the EEG picture of bilateral synchronous electrical status epilepticus during sleep (ESES) and neuropsychological deficits, and this impairment was reversible with resolution of ESES and was accompanied by cognitive improvement. A laterality switch from left to right sided language dominance occurred during recovery from the second regression phase. This might reflect a compensating process. Later, the laterality switched back to the left, possibly facilitated by a low SWI on the left hemisphere. The qualitative analysis of this case supports the view that the longitudinal course of the overnight change of the slope of SW, as an objective, quantitative EEG measure, is related to the course of cognitive function and functional language MR analysis.
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Affiliation(s)
- Nadine Oser
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
| | - Martina Hubacher
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
| | - Annette Nageleisen-Weiss
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
| | - Pieter van Mierlo
- Epilog NV, Ghent, Belgium.,Medical Image and Signal Processing Group, Ghent University, Belgium
| | - Reto Huber
- Department of Pediatric Neurology and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Switzerland.,Child Development Center and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Switzerland
| | - Peter Weber
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
| | - Bigna K Bölsterli
- Department of Pediatric Neurology and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Switzerland
| | - Alexandre N Datta
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
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Lucey BP, Wisch J, Boerwinkle AH, Landsness EC, Toedebusch CD, McLeland JS, Butt OH, Hassenstab J, Morris JC, Ances BM, Holtzman DM. Sleep and longitudinal cognitive performance in preclinical and early symptomatic Alzheimer's disease. Brain 2021; 144:2852-2862. [PMID: 34668959 PMCID: PMC8536939 DOI: 10.1093/brain/awab272] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 06/13/2021] [Accepted: 07/01/2021] [Indexed: 11/12/2022] Open
Abstract
Sleep monitoring may provide markers for future Alzheimer's disease; however, the relationship between sleep and cognitive function in preclinical and early symptomatic Alzheimer's disease is not well understood. Multiple studies have associated short and long sleep times with future cognitive impairment. Since sleep and the risk of Alzheimer's disease change with age, a greater understanding of how the relationship between sleep and cognition changes over time is needed. In this study, we hypothesized that longitudinal changes in cognitive function will have a non-linear relationship with total sleep time, time spent in non-REM and REM sleep, sleep efficiency and non-REM slow wave activity. To test this hypothesis, we monitored sleep-wake activity over 4-6 nights in 100 participants who underwent standardized cognitive testing longitudinally, APOE genotyping, and measurement of Alzheimer's disease biomarkers, total tau and amyloid-β42 in the CSF. To assess cognitive function, individuals completed a neuropsychological testing battery at each clinical visit that included the Free and Cued Selective Reminding test, the Logical Memory Delayed Recall assessment, the Digit Symbol Substitution test and the Mini-Mental State Examination. Performance on each of these four tests was Z-scored within the cohort and averaged to calculate a preclinical Alzheimer cognitive composite score. We estimated the effect of cross-sectional sleep parameters on longitudinal cognitive performance using generalized additive mixed effects models. Generalized additive models allow for non-parametric and non-linear model fitting and are simply generalized linear mixed effects models; however, the linear predictors are not constant values but rather a sum of spline fits. We found that longitudinal changes in cognitive function measured by the cognitive composite decreased at low and high values of total sleep time (P < 0.001), time in non-REM (P < 0.001) and REM sleep (P < 0.001), sleep efficiency (P < 0.01) and <1 Hz and 1-4.5 Hz non-REM slow wave activity (P < 0.001) even after adjusting for age, CSF total tau/amyloid-β42 ratio, APOE ε4 carrier status, years of education and sex. Cognitive function was stable over time within a middle range of total sleep time, time in non-REM and REM sleep and <1 Hz slow wave activity, suggesting that certain levels of sleep are important for maintaining cognitive function. Although longitudinal and interventional studies are needed, diagnosing and treating sleep disturbances to optimize sleep time and slow wave activity may have a stabilizing effect on cognition in preclinical or early symptomatic Alzheimer's disease.
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Affiliation(s)
- Brendan P Lucey
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Julie Wisch
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Anna H Boerwinkle
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Eric C Landsness
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Cristina D Toedebusch
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Jennifer S McLeland
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Omar H Butt
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Jason Hassenstab
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St Louis, MO 63110, USA
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO 63110, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St Louis, MO 63110, USA
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Beau M Ances
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David M Holtzman
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St Louis, MO 63110, USA
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO 63110, USA
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25
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Lundstrom BN, Brinkmann BH, Worrell GA. Low frequency novel interictal EEG biomarker for localizing seizures and predicting outcomes. Brain Commun 2021; 3:fcab231. [PMID: 34704030 PMCID: PMC8536865 DOI: 10.1093/braincomms/fcab231] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 11/14/2022] Open
Abstract
Localizing hyperexcitable brain tissue to treat focal seizures remains challenging. We want to identify the seizure onset zone from interictal EEG biomarkers. We hypothesize that a combination of interictal EEG biomarkers, including a novel low frequency marker, can predict mesial temporal involvement and can assist in prognosis related to surgical resections. Interictal direct current wide bandwidth invasive EEG recordings from 83 patients implanted with 5111 electrodes were retrospectively studied. Logistic regression was used to classify electrodes and patient outcomes. A feed-forward neural network was implemented to understand putative mechanisms. Interictal infraslow frequency EEG activity was decreased for seizure onset zone electrodes while faster frequencies such as delta (2-4 Hz) and beta-gamma (20-50 Hz) activity were increased. These spectral changes comprised a novel interictal EEG biomarker that was significantly increased for mesial temporal seizure onset zone electrodes compared to non-seizure onset zone electrodes. Interictal EEG biomarkers correctly classified mesial temporal seizure onset zone electrodes with a specificity of 87% and positive predictive value of 80%. These interictal EEG biomarkers also correctly classified patient outcomes after surgical resection with a specificity of 91% and positive predictive value of 87%. Interictal infraslow EEG activity is decreased near the seizure onset zone while higher frequency power is increased, which may suggest distinct underlying physiologic mechanisms. Narrowband interictal EEG power bands provide information about the seizure onset zone and can help predict mesial temporal involvement in seizure onset. Narrowband interictal EEG power bands may be less useful for predictions related to non-mesial temporal electrodes. Together with interictal epileptiform discharges and high-frequency oscillations, these interictal biomarkers may provide prognostic information prior to surgical resection. Computational modelling suggests changes in neural adaptation may be related to the observed low frequency power changes.
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26
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Fonseca E, Campos Blanco DM, Castro Vilanova MD, Garamendi Í, Gómez-Eguilaz M, Pérez Díaz H, Poza JJ, Querol-Pascual MR, Quiroga-Subirana P, Rodríguez-Osorio X, Zurita Santamaría J, Centeno M, Díaz de Cerio Julián L, Estévez-María JC, Martínez Agredano P, Mauri Llerda JÁ, Sala-Padró J, Falip M, Abraira L, Santamarina E, Seijo-Raposo I, Quintana M, Toledo M. Relationship between sleep quality and cognitive performance in patients with epilepsy. Epilepsy Behav 2021; 122:108127. [PMID: 34147020 DOI: 10.1016/j.yebeh.2021.108127] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the relationship between self-reported sleep quality and cognitive function in patients with epilepsy (PWE), as well as anxiety and depressive symptoms and patient quality of life (QoL). METHODS This multicenter cross-sectional study included PWE aged ≥12 years who were receiving ≥1 anti-seizure medication (ASM) and had not been diagnosed with a sleep disorder. Patients completed the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Montreal Cognitive Assessment test (MoCA), the Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory-10 (QOLIE-10). RESULTS The study enrolled 150 patients aged 16-83 years, mean age (standard deviation [SD]) 40.6 (15.2) years; 58.7% were female and 75.3% had focal epilepsy. Mean (SD) PSQI score was 4.71 (3.08), 44.4% of patients had impaired sleep quality (PSQI score ≥5), 19.9% had pathologic excessive daytime sleepiness (ESS score >12), and 32.7% had mild cognitive impairment (MoCA score <26). Within the PSQI, sleep disturbance (P = 0.036) and use of sleep medication (P = 0.006) scores were significantly higher in patients with mild cognitive impairment. Multiple regression analysis showed older age (regression coefficient [B], -0.086; 95% confidence interval [CI], -0.127, -0.045; P < 0.001) and the use of sleep medication component of the PSQI [B, -1.157; 95% CI, -2.064, -0.220; P = 0.013) were independently associated with lower MoCA score. Poor sleep quality was associated with probable anxiety and depression symptoms, and directly correlated with reduced QoL. CONCLUSIONS In PWE, sleep quality was not significantly independently associated with mild cognitive impairment, although poor sleep quality had a negative effect on mood and QoL.
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Affiliation(s)
- Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Xiana Rodríguez-Osorio
- Epilepsy Unit, Neurology Service, Hospital Clínico Universitario of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - María Centeno
- Clínica Universitaria de Navarra, Pamplona, Spain; Hospital Clínic de Barcelona, Barcelona, Spain
| | - Leyre Díaz de Cerio Julián
- Neurology Department, Lozano Blesa University Hospital, Aragon Sanitary Research Institute, Zaragoza, Spain
| | | | | | - José Ángel Mauri Llerda
- Neurology Department, Lozano Blesa University Hospital, Aragon Sanitary Research Institute, Zaragoza, Spain
| | | | - Mercè Falip
- Epilepsy Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Iván Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
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27
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Sousouri G, Krugliakova E, Skorucak J, Leach S, Snipes S, Ferster ML, Da Poian G, Karlen W, Huber R. Neuromodulation by means of phase-locked auditory stimulation affects key marker of excitability and connectivity during sleep. Sleep 2021; 45:6347149. [PMID: 34373925 DOI: 10.1093/sleep/zsab204] [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: 05/06/2021] [Revised: 07/15/2021] [Indexed: 11/12/2022] Open
Abstract
The propagating pattern of sleep slow waves (high-amplitude oscillations < 4.5 Hz) serves as a blueprint of cortical excitability and brain connectivity. Phase-locked auditory stimulation is a promising tool for the modulation of ongoing brain activity during sleep; however, its underlying mechanisms remain unknown. Here, eighteen healthy young adults were measured with high-density electroencephalography (hd-EEG) in three experimental conditions; one with no stimulation, one with up- and one with down-phase stimulation; ten participants were included in the analysis. We show that up-phase auditory stimulation on a right prefrontal area locally enhances cortical involvement and promotes traveling by increasing the propagating distance and duration of targeted small-amplitude waves. On the contrary, down-phase stimulation proves more efficient at perturbing large-amplitude waves and interferes with ongoing traveling by disengaging cortical regions and interrupting high synchronicity in the target area as indicated by increased traveling speed. These results point out to different underlying mechanisms mediating the effects of up- and down-phase stimulation and highlight the strength of traveling analysis as a sensitive and informative method for the study of connectivity and cortical excitability alterations.
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Affiliation(s)
- Georgia Sousouri
- Child Development Centre and Children's Research Centre, University Children's Hospital Zürich, University of Zurich, Zurich, Switzerland
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Elena Krugliakova
- Child Development Centre and Children's Research Centre, University Children's Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Jelena Skorucak
- Child Development Centre and Children's Research Centre, University Children's Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Sven Leach
- Child Development Centre and Children's Research Centre, University Children's Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Sophia Snipes
- Child Development Centre and Children's Research Centre, University Children's Hospital Zürich, University of Zurich, Zurich, Switzerland
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Maria Laura Ferster
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Giulia Da Poian
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Walter Karlen
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Reto Huber
- Child Development Centre and Children's Research Centre, University Children's Hospital Zürich, University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Zurich, Switzerland
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28
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Yeh WC, Lin PJ, Chuang YC, Hsu CY. Quantitative evaluation of the microstructure of rapid eye movement sleep in refractory epilepsy: a preliminary study using electroencephalography and heart rate variability analysis. Sleep Med 2021; 85:239-245. [PMID: 34364095 DOI: 10.1016/j.sleep.2021.07.022] [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: 06/03/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with epilepsy have a disturbed sleep architecture. Polysomnographic studies have shown that patients with refractory epilepsy have decreased rapid eye movement (REM) sleep and longer REM latency than those with medically controlled epilepsy. However, little is known about the differences in the REM sleep microstructure between these patient groups. METHODS We conducted a retrospective case-control study of 20 patients with refractory epilepsy (refractory group) and 28 patients with medically controlled epilepsy (medically controlled group). All patients completed sleep questionnaires and underwent overnight in-lab polysomnography. Five-minute electroencephalogram recordings at the C3 and C4 electrodes from each REM sleep were selected for spectral analysis, and 5-min electrocardiogram segments recorded during REM sleep were used for heart rate variability analysis. The groups' scores on the sleep questionnaires, polysomnographic sleep parameters, indices of sleep-related breathing disorders, and REM sleep electroencephalogram spectra were compared. RESULTS The refractory group had decreased REM sleep (p < 0.001) and longer REM latency (p = 0.0357) than those of the medically controlled group. Moreover, electroencephalogram spectral analysis revealed that the refractory group had decreased absolute beta power (p = 0.0039) and relative beta power (p = 0.0035) as well as increased relative delta power (p = 0.0015) compared with the medically controlled group. CONCLUSIONS Differences in the polysomnographic macrostructure and REM sleep microstructure between the study groups suggest REM sleep dysregulation in patients with refractory epilepsy.
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Affiliation(s)
- Wei-Chih Yeh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Pei-Jung Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Neurology, Da-Sin Hospital, Pingtung County, Taiwan.
| | - Yao-Chung Chuang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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Gefferie SR, Maric A, Critelli H, Gueden S, Kurlemann G, Kurth S, Nosadini M, Plecko B, Ringli M, Rostásy K, Sartori S, Schmitt B, Suppiej A, Van Bogaert P, Wehrle FM, Huber R, Bölsterli BK. Altered EEG markers of synaptic plasticity in a human model of NMDA receptor deficiency: Anti-NMDA receptor encephalitis. Neuroimage 2021; 239:118281. [PMID: 34147627 DOI: 10.1016/j.neuroimage.2021.118281] [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: 07/24/2020] [Revised: 03/15/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
Plasticity of synaptic strength and density is a vital mechanism enabling memory consolidation, learning, and neurodevelopment. It is strongly dependent on the intact function of N-Methyl-d-Aspartate Receptors (NMDAR). The importance of NMDAR is further evident as their dysfunction is involved in many diseases such as schizophrenia, Alzheimer's disease, neurodevelopmental disorders, and epilepsies. Synaptic plasticity is thought to be reflected by changes of sleep slow wave slopes across the night, namely higher slopes after wakefulness at the beginning of sleep than after a night of sleep. Hence, a functional NMDAR deficiency should theoretically lead to altered overnight changes of slow wave slopes. Here we investigated whether pediatric patients with anti-NMDAR encephalitis, being a very rare but unique human model of NMDAR deficiency due to autoantibodies against receptor subunits, indeed show alterations in this sleep EEG marker for synaptic plasticity. We retrospectively analyzed 12 whole-night EEGs of 9 patients (age 4.3-20.8 years, 7 females) and compared them to a control group of 45 healthy individuals with the same age distribution. Slow wave slopes were calculated for the first and last hour of Non-Rapid Eye Movement (NREM) sleep (factor 'hour') for patients and controls (factor 'group'). There was a significant interaction between 'hour' and 'group' (p = 0.013), with patients showing a smaller overnight decrease of slow wave slopes than controls. Moreover, we found smaller slopes during the first hour in patients (p = 0.022), whereas there was no group difference during the last hour of NREM sleep (p = 0.980). Importantly, the distribution of sleep stages was not different between the groups, and in our main analyses of patients without severe disturbance of sleep architecture, neither was the incidence of slow waves. These possible confounders could therefore not account for the differences in the slow wave slope values, which we also saw in the analysis of the whole sample of EEGs. These results suggest that quantitative EEG analysis of slow wave characteristics may reveal impaired synaptic plasticity in patients with anti-NMDAR encephalitis, a human model of functional NMDAR deficiency. Thus, in the future, the changes of sleep slow wave slopes may contribute to the development of electrophysiological biomarkers of functional NMDAR deficiency and synaptic plasticity in general.
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Affiliation(s)
- Silvano R Gefferie
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW, Heemstede, Netherlands
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland
| | - Hanne Critelli
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
| | - Sophie Gueden
- Service de Pédiatrie, CHU d'Angers, 49933, Angers, France
| | | | - Salome Kurth
- Pulmonary Clinic, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland; Department of Psychology, University of Fribourg, 1700, Fribourg, Switzerland
| | - Margherita Nosadini
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, 35122, Padua, Italy
| | - Barbara Plecko
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, 8036, Graz, Austria
| | - Maya Ringli
- Department of Neurology, Inselspital, University Hospital Bern, 3010, Bern, Switzerland
| | - Kevin Rostásy
- Department of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, 58448, Datteln/Witten, Germany
| | - Stefano Sartori
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, 35122, Padua, Italy
| | - Bernhard Schmitt
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
| | - Agnese Suppiej
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, 35122, Padua, Italy; Department of Medical Sciences, Pediatric Section, University of Ferrara, 44121, Ferrara, Italy
| | | | - Flavia M Wehrle
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8091, Zurich, Switzerland
| | - Bigna K Bölsterli
- Department of Neuropediatrics, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland.
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Yokosako S, Muraoka N, Watanabe S, Kosugi K, Takayama Y, Iijima K, Kimura Y, Kaneko Y, Sumitomo N, Saito T, Nakagawa E, Iwasaki M. Corpus callosotomy in pediatric patients with non-lesional epileptic encephalopathy with electrical status epilepticus during sleep. Epilepsy Behav Rep 2021; 16:100463. [PMID: 34195590 PMCID: PMC8239855 DOI: 10.1016/j.ebr.2021.100463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022] Open
Abstract
Corpus callosotomy (CC) was performed in 3 pediatric patients with refractory epileptic encephalopathy with ESES. IQ was improved after CC with complete resolution of ESES in one patient. Developmental regression ceased after CC with worthwhile seizure reduction and temporary improvement of ESES in 2 patients. Epileptiform discharges disappeared or became lateralized after CC.
Epileptic encephalopathy with electrical status epilepticus during sleep (ESES) is often refractory to medical treatment and leads to poor cognitive outcomes. Corpus callosotomy may be an effective treatment option for drug-resistant ESES with no focal etiology. We retrospectively identified three patients who underwent corpus callosotomy for drug-resistant ESES in our institution. Electroencephalography (EEG) findings and cognitive functions were evaluated before surgery, at 3 months, 6 months, 1 year, and 2 years after surgery. Age at surgery was 6 years 10 months, 7 years 9 months, and 8 years 4 months, respectively. Period between the diagnosis of ESES and surgery ranged from 7 to 25 months. All patients had no obvious structural abnormalities and presented with cognitive decline despite multiple antiseizure medications and steroid therapies. One patient showed complete resolution of ESES and an improvement of intelligence quotient after surgery. Epileptiform EEG was lateralized to one hemisphere after surgery and spike wave index (SWI) was decreased with moderate improvement in development and seizures in the other 2 patients. SWI re-exacerbated from 6 months after surgery, but without subsequent developmental regression in these 2 patients. Corpus callosotomy may become an important treatment option for drug-resistant ESES in patients with no structural abnormalities.
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Affiliation(s)
- Suguru Yokosako
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Norihiro Muraoka
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Shiena Watanabe
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yuiko Kimura
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yu Kaneko
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Corresponding author.
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Gulf War veterans exhibit broadband sleep EEG power reductions in regions overlying the frontal lobe. Life Sci 2021; 280:119702. [PMID: 34111462 DOI: 10.1016/j.lfs.2021.119702] [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: 02/26/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022]
Abstract
AIMS Nearly a third of U.S. veterans who deployed in support of the 1990-1991 Persian Gulf War are affected by Gulf War illness (GWI). Here we aimed to characterize whether subjective sleep complaints in GWI veterans are associated with objective sleep EEG disturbances relative to healthy veterans and controls; and whether Gulf War veterans show alterations in neural activity during sleep that differentiate them from healthy subjects. MAIN METHODS We used high-density EEG (HDEEG) to assess regional patterns of rapid eye movement (REM) sleep and non-REM (NREM) sleep between three groups: Gulf War male veterans with fatigue and GWI, Gulf War male veterans without fatigue or GWI, and control males. The groups were matched relative to age, sex and obstructive sleep apnea. Topographic comparisons of nocturnal NREM and REM sleep were made between groups for all frequency bands. KEY FINDINGS Topographic analysis revealed a broadband reduction in EEG power in a circumscribed region overlying the frontal lobe in both groups of Gulf War veterans, regardless of GWI and fatigue. This frontal reduction in neural activity was present, to some extent, across all frequency bands in NREM and REM sleep. SIGNIFICANCE Given that our findings were observed in all Gulf War veterans, it appears unlikely that frontal sleep HDEEG power reductions prove wholly responsible for fatigue symptoms. These results provide avenues for research which may someday contribute to improved clinical care of formerly deployed veterans of the Persian Gulf War.
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Bernardi G, Avvenuti G, Cataldi J, Lattanzi S, Ricciardi E, Polonara G, Silvestrini M, Siclari F, Fabri M, Bellesi M. Role of corpus callosum in sleep spindle synchronization and coupling with slow waves. Brain Commun 2021; 3:fcab108. [PMID: 34164621 PMCID: PMC8215432 DOI: 10.1093/braincomms/fcab108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/25/2022] Open
Abstract
Sleep spindles of non-REM sleep are transient, waxing-and-waning 10–16 Hz EEG oscillations, whose cortical synchronization depends on the engagement of thalamo-cortical loops. However, previous studies in animal models lacking the corpus callosum due to agenesis or total callosotomy and in humans with agenesis of the corpus callosum suggested that cortico-cortical connections may also have a relevant role in cortical (inter-hemispheric) spindle synchronization. Yet, most of these works did not provide direct quantitative analyses to support their observations. By studying a rare sample of callosotomized, split-brain patients, we recently demonstrated that the total resection of the corpus callosum is associated with a significant reduction in the inter-hemispheric propagation of non-REM slow waves. Interestingly, sleep spindles are often temporally and spatially grouped around slow waves (0.5–4 Hz), and this coordination is thought to have an important role in sleep-dependent learning and memory consolidation. Given these premises, here we set out to investigate whether total callosotomy may affect the generation and spreading of sleep spindles, as well as their coupling with sleep slow waves. To this aim, we analysed overnight high-density EEG recordings (256 electrodes) collected in five patients who underwent total callosotomy due to drug-resistant epilepsy (age 40–53, two females), three non-callosotomized neurological patients (age 44–66, two females), and in a sample of 24 healthy adult control subjects (age 20–47, 13 females). Individual sleep spindles were automatically detected using a validated algorithm and their properties and topographic distributions were computed. All analyses were performed with and without a regression-based adjustment accounting for inter-subject age differences. The comparison between callosotomized patients and healthy subjects did not reveal systematic variations in spindle density, amplitude or frequency. However, callosotomized patients were characterized by a reduced spindle duration, which could represent the result of a faster desynchronization of spindle activity across cortical areas of the two hemispheres. In contrast with our previous findings regarding sleep slow waves, we failed to detect in callosotomized patients any clear, systematic change in the inter-hemispheric synchronization of sleep spindles. In line with this, callosotomized patients were characterized by a reduced extension of the spatial association between temporally coupled spindles and slow waves. Our findings are consistent with a dependence of spindles on thalamo-cortical rather than cortico-cortical connections in humans, but also revealed that, despite their temporal association, slow waves and spindles are independently regulated in terms of topographic expression.
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Affiliation(s)
- Giulio Bernardi
- Molecular Mind Laboratory, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Giulia Avvenuti
- Molecular Mind Laboratory, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Jacinthe Cataldi
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona 60126, Italy
| | - Emiliano Ricciardi
- Molecular Mind Laboratory, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Gabriele Polonara
- Department of Odontostomatologic and Specialized Clinical Sciences, Marche Polytechnic University, Ancona 60126, Italy
| | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona 60126, Italy
| | - Francesca Siclari
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Mara Fabri
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona 60126, Italy
| | - Michele Bellesi
- School of Bioscience and Veterinary Medicine, University of Camerino, Camerino 62032, Italy
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Wu YJ, Chien ME, Chiang CC, Huang YZ, Durand DM, Hsu KS. Delta oscillation underlies the interictal spike changes after repeated transcranial direct current stimulation in a rat model of chronic seizures. Brain Stimul 2021; 14:771-779. [PMID: 33989818 DOI: 10.1016/j.brs.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) provides a noninvasive polarity-specific constant current to treat epilepsy, through a mechanism possibly involving excitability modulation and neural oscillation. OBJECTIVE To determine whether EEG oscillations underlie the interictal spike changes after tDCS in rats with chronic spontaneous seizures. METHODS Rats with kainic acid-induced spontaneous seizures were subjected to cathodal tDCS or sham stimulation for 5 consecutive days. Video-EEG recordings were collected immediately pre- and post-stimulation and for the subsequent 2 weeks following stimulation. The acute pre-post stimulation and subacute follow-up changes of interictal spikes and EEG oscillations in tDCS-treated rats were compared with sham. Ictal EEG with seizure behaviors, hippocampal brain-derived neurotrophic factor (BDNF) protein expression, and mossy fiber sprouting were compared between tDCS and sham rats. RESULTS Interictal spike counts were reduced immediately following tDCS with augmented delta and diminished beta and gamma oscillations compared with sham. Cathodal tDCS also enhanced delta oscillations in normal rats. However, increased numbers of interictal spikes with a decrease of delta and theta oscillations were observed in tDCS-treated rats compared with sham during the following 2 weeks after stimulation. Resuming tDCS suppressed the increase of interictal spike activity. In tDCS rats, hippocampal BDNF protein expression was decreased while mossy fiber sprouting did not change compared with sham. CONCLUSIONS The inverse relationship between the changes of delta oscillation and interictal spikes during tDCS on and off stimulation periods indicates that an enhanced endogenous delta oscillation underlies the tDCS inhibitory effect on epileptic excitability.
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Affiliation(s)
- Yi-Jen Wu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70457, Taiwan; Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
| | - Miao-Er Chien
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70457, Taiwan
| | - Chia-Chu Chiang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ying-Zu Huang
- Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; Medical School and Healthy Aging Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
| | - Dominique M Durand
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Kuei-Sen Hsu
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.
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Cucchiara F, Frumento P, Banfi T, Sesso G, Di Galante M, D'Ascanio P, Valvo G, Sicca F, Faraguna U. Electrophysiological features of sleep in children with Kir4.1 channel mutations and Autism-Epilepsy phenotype: a preliminary study. Sleep 2021; 43:5625283. [PMID: 31722434 PMCID: PMC7157183 DOI: 10.1093/sleep/zsz255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/17/2019] [Indexed: 12/24/2022] Open
Abstract
Study Objectives Recently, a role for gain-of-function (GoF) mutations of the astrocytic potassium channel Kir4.1 (KCNJ10 gene) has been proposed in subjects with Autism–Epilepsy phenotype (AEP). Epilepsy and autism spectrum disorder (ASD) are common and complexly related to sleep disorders. We tested whether well characterized mutations in KCNJ10 could result in specific sleep electrophysiological features, paving the way to the discovery of a potentially relevant biomarker for Kir4.1-related disorders. Methods For this case–control study, we recruited seven children with ASD either comorbid or not with epilepsy and/or EEG paroxysmal abnormalities (AEP) carrying GoF mutations of KCNJ10 and seven children with similar phenotypes but wild-type for the same gene, comparing period-amplitude features of slow waves detected by fronto-central bipolar EEG derivations (F3-C3, F4-C4, and Fz-Cz) during daytime naps. Results Children with Kir4.1 mutations displayed longer slow waves periods than controls, in Fz-Cz (mean period = 112,617 ms ± SE = 0.465 in mutated versus mean period = 105,249 ms ± SE = 0.375 in controls, p < 0.001). An analog result was found in F3-C3 (mean period = 125,706 ms ± SE = 0.397 in mutated versus mean period = 120,872 ms ± SE = 0.472 in controls, p < 0.001) and F4-C4 (mean period = 127,914 ms ± SE = 0.557 in mutated versus mean period = 118,174 ms ± SE = 0.442 in controls, p < 0.001). Conclusion This preliminary finding suggests that period-amplitude slow wave features are modified in subjects carrying Kir4.1 GoF mutations. Potential clinical applications of this finding are discussed.
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Affiliation(s)
- Federico Cucchiara
- SONNOLab, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.,Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Frumento
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tommaso Banfi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Gianluca Sesso
- Neuropsychiatry Complex Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Di Galante
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Paola D'Ascanio
- SONNOLab, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Giulia Valvo
- Child and Adolescent Neuropsychiatric Unit, Azienda USL Toscana Sudest, Grosseto, Italy
| | - Federico Sicca
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Ugo Faraguna
- SONNOLab, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.,Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
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Konduru SS, Wallace EP, Pfammatter JA, Rodrigues PV, Jones MV, Maganti RK. Sleep-wake characteristics in a mouse model of severe traumatic brain injury: Relation to posttraumatic epilepsy. Epilepsia Open 2021; 6:181-194. [PMID: 33681661 PMCID: PMC7918302 DOI: 10.1002/epi4.12462] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/01/2022] Open
Abstract
Study objectives Traumatic brain injury (TBI) results in sequelae that include posttraumatic epilepsy (PTE) and sleep-wake disturbances. Here, we sought to determine whether sleep characteristics could predict development of PTE in a model of severe TBI. Methods Following controlled cortical impact (CCI) or sham injury (craniotomy only), CD-1 mice were implanted with epidural electroencephalography (EEG) and nuchal electromyography (EMG) electrodes. Acute (1st week) and chronic (months 1, 2, or 3) 1-week-long video-EEG recordings were performed after the injury to examine epileptiform activity. High-amplitude interictal events were extracted from EEG using an automated method. After scoring sleep-wake patterns, sleep spindles and EEG delta power were derived from nonrapid eye movement (NREM) sleep epochs. Brain CTs (computerized tomography) were performed in sham and CCI cohorts to quantify the brain lesions. We then employed a no craniotomy (NC) control to perform 1-week-long EEG recordings at week 1 and month 1 after surgery. Results Posttraumatic seizures were seen in the CCI group only, whereas interictal epileptiform activity was seen in CCI or sham. Sleep-wake disruptions consisted of shorter wake or NREM bout lengths and shorter duration or lower power for spindles in CCI and sham. NREM EEG delta power increased in CCI and sham groups compared with NC though the CCI group with posttraumatic seizures had lower power at a chronic time point compared with those without. Follow-up brain CTs showed a small lesion in the sham injury group suggesting a milder form of TBI that may account for their interictal activity and sleep changes. Significance In our TBI model, tracking changes in NREM delta power distinguishes between CCI acutely and animals that will eventually develop PTE, but further work is necessary to identify sleep biomarkers of PTE. Employing NC controls together with sham controls should be considered in future TBI studies.
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Affiliation(s)
- Sai Sruthi Konduru
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Eli P. Wallace
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Department of NeuroscienceUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Cellular and Molecular Pathology Graduate ProgramUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Jesse A. Pfammatter
- Department of NeuroscienceUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Paulo V. Rodrigues
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Mathew V. Jones
- Department of NeuroscienceUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Rama K. Maganti
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
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Hanson JE, Ma K, Elstrott J, Weber M, Saillet S, Khan AS, Simms J, Liu B, Kim TA, Yu GQ, Chen Y, Wang TM, Jiang Z, Liederer BM, Deshmukh G, Solanoy H, Chan C, Sellers BD, Volgraf M, Schwarz JB, Hackos DH, Weimer RM, Sheng M, Gill TM, Scearce-Levie K, Palop JJ. GluN2A NMDA Receptor Enhancement Improves Brain Oscillations, Synchrony, and Cognitive Functions in Dravet Syndrome and Alzheimer's Disease Models. Cell Rep 2021; 30:381-396.e4. [PMID: 31940483 PMCID: PMC7017907 DOI: 10.1016/j.celrep.2019.12.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/11/2019] [Accepted: 12/06/2019] [Indexed: 01/28/2023] Open
Abstract
NMDA receptors (NMDARs) play subunit-specific roles in synaptic function and are implicated in neuropsychiatric and neurodegenerative disorders. However, the in vivo consequences and therapeutic potential of pharmacologically enhancing NMDAR function via allosteric modulation are largely un-known. We examine the in vivo effects of GNE-0723, a positive allosteric modulator of GluN2A-subunit-containing NMDARs, on brain network and cognitive functions in mouse models of Dravet syndrome (DS) and Alzheimer’s disease (AD). GNE-0723 use dependently potentiates synaptic NMDA receptor currents and reduces brain oscillation power with a predominant effect on low-frequency (12–20 Hz) oscillations. Interestingly, DS and AD mouse models display aberrant low-frequency oscillatory power that is tightly correlated with network hypersynchrony. GNE-0723 treatment reduces aberrant low-frequency oscillations and epileptiform discharges and improves cognitive functions in DS and AD mouse models. GluN2A-subunit-containing NMDAR enhancers may have therapeutic benefits in brain disorders with network hypersynchrony and cognitive impairments. Hanson et al. examine the therapeutic effects of enhancing GluN2A-subunit-containing NMDAR function in Dravet syndrome and Alzheimer’s disease mice. GNE-0723 treatment reduces aberrant low-frequency oscillations and epileptiform discharges and improves cognitive functions in both disease models. GluN2A NMDAR enhancers may benefit brain disorders with network hypersynchrony and cognitive impairments.
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Affiliation(s)
- Jesse E Hanson
- Department of Neuroscience, Genentech Inc., South San Francisco, CA 94080, USA.
| | - Keran Ma
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA; Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Justin Elstrott
- Department of Biomedical Imaging, Genentech Inc., South San Francisco, CA 94080, USA
| | - Martin Weber
- Department of Neuroscience, Genentech Inc., South San Francisco, CA 94080, USA
| | - Sandrine Saillet
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA; Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Abdullah S Khan
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
| | - Jeffrey Simms
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
| | - Benjamin Liu
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
| | - Thomas A Kim
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
| | - Gui-Qiu Yu
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
| | - Yelin Chen
- Department of Neuroscience, Genentech Inc., South San Francisco, CA 94080, USA
| | - Tzu-Ming Wang
- Department of Neuroscience, Genentech Inc., South San Francisco, CA 94080, USA
| | - Zhiyu Jiang
- Department of Neuroscience, Genentech Inc., South San Francisco, CA 94080, USA
| | - Bianca M Liederer
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, CA 94080, USA
| | - Gauri Deshmukh
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, CA 94080, USA
| | - Hilda Solanoy
- Department of Neuroscience, Genentech Inc., South San Francisco, CA 94080, USA
| | - Connie Chan
- Department of Pharmaceuticals, Genentech Inc., South San Francisco, CA 94080, USA
| | - Benjamin D Sellers
- Department of Discovery Chemistry, Genentech Inc., South San Francisco, CA 94080, USA
| | - Matthew Volgraf
- Department of Discovery Chemistry, Genentech Inc., South San Francisco, CA 94080, USA
| | - Jacob B Schwarz
- Department of Discovery Chemistry, Genentech Inc., South San Francisco, CA 94080, USA
| | - David H Hackos
- Department of Neuroscience, Genentech Inc., South San Francisco, CA 94080, USA
| | - Robby M Weimer
- Department of Neuroscience, Genentech Inc., South San Francisco, CA 94080, USA; Department of Biomedical Imaging, Genentech Inc., South San Francisco, CA 94080, USA
| | - Morgan Sheng
- Department of Neuroscience, Genentech Inc., South San Francisco, CA 94080, USA
| | - T Michael Gill
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA
| | | | - Jorge J Palop
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158, USA; Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA.
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Maganti RK, Jones MV. Untangling a Web: Basic Mechanisms of the Complex Interactions Between Sleep, Circadian Rhythms, and Epilepsy. Epilepsy Curr 2021; 21:105-110. [PMID: 33541118 PMCID: PMC8010879 DOI: 10.1177/1535759721989674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Seizures have sleep–wake and circadian patterns in various epilepsies and, in turn, disrupt sleep and circadian rhythms. The resultant sleep deprivation (SD) is an exacerbating factor for seizures that sets up a vicious cycle that can potentially lead to disease progression and even to epilepsy-related mortality. A variety of cellular or network electrophysiological changes and changes in expression of clock-controlled genes or other transcription factors underlie sleep–wake and circadian distribution of seizures, as well as the disruptions seen in both. A broad understanding of these mechanisms may help in designing better treatments to prevent SD-induced seizure exacerbation, disrupt the vicious cycle of disease progression, and reduce epilepsy-related mortality.
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Affiliation(s)
- Rama K Maganti
- Department of Neurology, 5228University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mathew V Jones
- Department of Neuroscience, 5228University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Moore JL, Carvalho DZ, St Louis EK, Bazil C. Sleep and Epilepsy: a Focused Review of Pathophysiology, Clinical Syndromes, Co-morbidities, and Therapy. Neurotherapeutics 2021; 18:170-180. [PMID: 33786803 PMCID: PMC8116418 DOI: 10.1007/s13311-021-01021-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 10/21/2022] Open
Abstract
A healthy brain requires balancing of waking and sleeping states. The normal changes in waking and sleeping states result in neurophysiological conditions that either increase or decrease the tendency of seizures and interictal discharges to occur. This article reviews the manifold and complex relationships between sleep and epilepsy and discusses treatment of the sleep-related epilepsies. Several forms of epilepsy predominantly or exclusively manifest during sleep and seizures tend to arise especially from light NREM sleep. Diagnostic interictal epileptiform discharges on the electroencephalogram are also most likely to be activated during deep NREM sleep stage N3. Epileptiform discharges and antiepileptic medications may in turn detrimentally impact sleep. Co-morbid sleep disorders also have the potential to worsen seizure control. Sleep has an important key association with sudden unexpected death in epilepsy (SUDEP). Further research is necessary to understand the complex relationships between sleep and epileptic disorders and their treatments.
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Affiliation(s)
- J Layne Moore
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Diego Z Carvalho
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
- Departments of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Erik K St Louis
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA.
- Departments of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA.
| | - Carl Bazil
- Division of Epilepsy and Sleep, Columbia University, New York, NY, USA
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Storz S, Wilhelm I, Critelli H, Feldmann M, Ramirez A, Ramantani G, Huber R, Bölsterli BK. Sleep-dependent memory consolidation in children with self-limited focal epilepsies. Epilepsy Behav 2020; 113:107513. [PMID: 33129045 DOI: 10.1016/j.yebeh.2020.107513] [Citation(s) in RCA: 4] [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: 06/14/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Children with self-limited focal epilepsies of childhood (SLFE) are known to show impaired memory functions, particularly in the verbal domain. Interictal epileptiform discharges (IED) in these epilepsies are more pronounced in nonrapid eye movement (NREM) sleep. Nonrapid eye movement sleep is crucial for consolidation of newly-encoded memories. Therefore, we hypothesize that sleep-dependent memory consolidation is altered in relation to IED in children with SLFE. METHODS We conducted a prospective case-control study. We applied a verbal (word pair) and a visuospatial (two-dimensional [2D] object location) learning task, both previously shown to benefit from sleep in terms of memory consolidation. Learning took place in the evening, and retrieval was tested in the morning after a night of sleep. Electroencephalogram (EEG) was recorded across night. After sleep-stage scoring, the spike-wave index (SWI) was assessed at the beginning and the end of sleep. Fourteen patients with SLFE (age: 5.5 to 11.6 years) were compared with 15 healthy controls (age: 6.8 to 9.1 years) examined in a previous study. RESULTS In contrast to healthy controls (mean: +12.9% recalled word pairs, p = .003, standard deviation (SD) = 12.4%), patients did not show overnight performance gains in the verbal memory task (mean: +6.4% recalled word pairs, p > .05, SD = 17.3) Neither patients nor controls showed significant overnight changes in visuospatial task performance. Spike-wave index was negatively correlated with recall performance in the verbal but not in the visuospatial task. SIGNIFICANCE We found evidence for impaired overnight improvement of performance in children with SLFE in a verbal learning task, with high SWI rates predicting low recall performance. We speculate that spike-waves hamper long-term memory consolidation by interfering with NREM sleep.
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Affiliation(s)
- Sarah Storz
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Ines Wilhelm
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit (TPU), University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Hanne Critelli
- Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Maria Feldmann
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Ana Ramirez
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Georgia Ramantani
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Bigna K Bölsterli
- Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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40
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van den Munckhof B, Gefferie SR, van Noort SAM, van Teeseling HC, Schijvens MP, Smit W, Teunissen NW, Plate JDJ, Huiskamp GJM, Leijten FSS, Braun KPJ, Jansen FE, Bölsterli BK. Sleep slow-wave homeostasis and cognitive functioning in children with electrical status epilepticus in sleep. Sleep 2020; 43:5831237. [PMID: 32374855 DOI: 10.1093/sleep/zsaa088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/03/2020] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVES Encephalopathy with electrical status epilepticus in sleep (ESES) is characterized by non-rapid eye movement (non-REM)-sleep-induced epileptiform activity and acquired cognitive deficits. The synaptic homeostasis hypothesis describes the process of daytime synaptic potentiation balanced by synaptic downscaling in non-REM-sleep and is considered crucial to retain an efficient cortical network. We aimed to study the overnight decline of slow waves, an indirect marker of synaptic downscaling, in patients with ESES and explore whether altered downscaling relates to neurodevelopmental and behavioral problems. METHODS Retrospective study of patients with ESES with at least one whole-night electroencephalogram (EEG) and neuropsychological assessment (NPA) within 4 months. Slow waves in the first and last hour of non-REM-sleep were analyzed. Differences in slow-wave slope (SWS) and overnight slope course between the epileptic focus and non-focus electrodes and relations to neurodevelopment and behavior were analyzed. RESULTS A total of 29 patients with 44 EEG ~ NPA combinations were included. Mean SWS decreased from 357 to 327 µV/s (-8%, p < 0.001) across the night and the overnight decrease was less pronounced in epileptic focus than in non-focus electrodes (-5.6% vs. -8.7%, p = 0.003). We found no relation between SWS and neurodevelopmental test results in cross-sectional and longitudinal analyses. Patients with behavioral problems showed less SWS decline than patients without and the difference was most striking in the epileptic focus (-0.9% vs. -8.8%, p = 0.006). CONCLUSIONS Slow-wave homeostasis-a marker of synaptic homeostasis-is disturbed by epileptiform activity in ESES. Behavioral problems, but not neurodevelopmental test results, were related to severity of this disturbance.
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Affiliation(s)
- Bart van den Munckhof
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Silvano R Gefferie
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Suus A M van Noort
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Heleen C van Teeseling
- Department of Pediatric Neuropsychology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mischa P Schijvens
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - William Smit
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico W Teunissen
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joost D J Plate
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert Jan M Huiskamp
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans S S Leijten
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bigna K Bölsterli
- Division of Clinical Neurophysiology, Department of Neurology, University Children's Hospital Zurich, Zurich, Switzerland
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41
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Moffet EW, Verhagen R, Jones B, Findlay G, Juan E, Bugnon T, Mensen A, Aparicio MK, Maganti R, Struck AF, Tononi G, Boly M. Local Sleep Slow-Wave Activity Colocalizes With the Ictal Symptomatogenic Zone in a Patient With Reflex Epilepsy: A High-Density EEG Study. Front Syst Neurosci 2020; 14:549309. [PMID: 33192347 PMCID: PMC7609881 DOI: 10.3389/fnsys.2020.549309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Slow-wave activity (SWA) during non-rapid eye movement (NREM) sleep reflects synaptic potentiation during preceding wakefulness. Epileptic activity may induce increases in state-dependent SWA in human brains, therefore, localization of SWA may prove useful in the presurgical workup of epileptic patients. We analyzed high-density electroencephalography (HDEEG) data across vigilance states from a reflex epilepsy patient with a clearly localizable ictal symptomatogenic zone to provide a proof-of-concept for the testability of this hypothesis. Methods: Overnight HDEEG recordings were obtained in the patient during REM sleep, NREM sleep, wakefulness, and during a right facial motor seizure then compared to 10 controls. After preprocessing, SWA (i.e., delta power; 1–4 Hz) was calculated at each channel. Scalp level and source reconstruction analyses were computed. We assessed for statistical differences in maximum SWA between the patient and controls within REM sleep, NREM sleep, wakefulness, and seizure. Then, we completed an identical statistical comparison after first subtracting intrasubject REM sleep SWA from that of NREM sleep, wakefulness, and seizure SWA. Results: The topographical analysis revealed greater left hemispheric SWA in the patient vs. controls in all vigilance states except REM sleep (which showed a right hemispheric maximum). Source space analysis revealed increased SWA in the left inferior frontal cortex during NREM sleep and wakefulness. Ictal data displayed poor source-space localization. Comparing each state to REM sleep enhanced localization accuracy; the most clearly localizing results were observed when subtracting REM sleep from wakefulness. Conclusion: State-dependent SWA during NREM sleep and wakefulness may help to identify aspects of the potential epileptogenic zone. Future work in larger cohorts may assess the clinical value of sleep SWA to help presurgical planning.
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Affiliation(s)
- Eric W Moffet
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States.,Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ruben Verhagen
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States.,Department of Philosophy, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Benjamin Jones
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Graham Findlay
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Elsa Juan
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States.,Department of Philosophy, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Tom Bugnon
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Armand Mensen
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Rama Maganti
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Melanie Boly
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
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42
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Abstract
We aimed to explore the link between NREM sleep and epilepsy. Based on human and experimental data we propose that a sleep-related epileptic transformation of normal neurological networks underlies epileptogenesis. Major childhood epilepsies as medial temporal lobe epilepsy (MTLE), absence epilepsy (AE) and human perisylvian network (PN) epilepsies - made us good models to study. These conditions come from an epileptic transformation of the affected functional systems. This approach allows a system-based taxonomy instead of the outworn generalized-focal classification. MTLE links to the memory-system, where epileptic transformation results in a switch of normal sharp wave-ripples to epileptic spikes and pathological high frequency oscillations, compromising sleep-related memory consolidation. Absence epilepsy (AE) and juvenile myoclonic epilepsy (JME) belong to the corticothalamic system. The burst-firing mode of NREM sleep normally producing sleep-spindles turns to an epileptic working mode ejecting bilateral synchronous spike-waves. There seems to be a progressive transition from AE to JME. Shared absences and similar bilateral synchronous discharges show the belonging of the two conditions, while the continuous age windows - AE affecting schoolchildren, JME the adolescents - and the increased excitability in JME compared to AE supports the notion of progression. In perisylvian network epilepsies - idiopathic focal childhood epilepsies and electrical status epilepticus in sleep including Landau-Kleffner syndrome - centrotemporal spikes turn epileptic, with the potential to cause cognitive impairment. Postinjury epilepsies modeled by the isolated cortex model highlight the shared way of epileptogenesis suggesting the derailment of NREM sleep-related homeostatic plasticity as a common step. NREM sleep provides templates for plasticity derailing to epileptic variants under proper conditions. This sleep-origin explains epileptiform discharges' link and similarity with NREM sleep slow oscillations, spindles and ripples. Normal synaptic plasticity erroneously overgrowing homeostatic processes may derail toward an epileptic working-mode manifesting the involved system's features. The impact of NREM sleep is unclear in epileptogenesis occurring in adolescence and adulthood, when plasticity is lower. The epileptic process interferes with homeostatic synaptic plasticity and may cause cognitive impairment. Its type and degree depends on the affected network's function. We hypothesize a vicious circle between sleep end epilepsy. The epileptic derailment of normal plasticity interferes with sleep cognitive functions. Sleep and epilepsy interconnect by the pathology of plasticity.
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Affiliation(s)
- Péter Halász
- Szentágothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Anna Szűcs
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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43
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Chan SYS. Sleep architecture and homeostasis in children with epilepsy: a neurodevelopmental perspective. Dev Med Child Neurol 2020; 62:426-433. [PMID: 31879946 DOI: 10.1111/dmcn.14437] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
Abstract
Although the influence of sleep on epilepsy has long been recognized, this relationship has yet to be fully exploited to benefit patients. The past decade has seen significant advances in understanding paediatric sleep, providing a framework by which to properly evaluate the sleep of children with epilepsy, which itself has been subject to increasing scrutiny. The role of sleep in learning and the potential for interictal discharges to disrupt sleep-related memory consolidation provide a novel perspective for understanding the association of childhood epilepsy with a high rate of intellectual disability. In this review, I outline the evolution of sleep duration, architecture, and homeostasis across childhood, relating this to the development of cognitive functions. I describe how these may be disrupted or preserved in children with epilepsy; in particular, collating data from polysomnography. Finally, I explore how sleep may, in the future, be modulated to improve cognitive outcome in these patients. WHAT THIS PAPER ADDS: Children with epilepsy have less rapid eye movement sleep than controls, but this improves with seizure cessation. Deep or slow-wave sleep is highly conserved in children with epilepsy. Sleep homeostasis may be disrupted either at a local or global level by the presence of interictal epileptiform discharges.
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Affiliation(s)
- Samantha Yuen-Sum Chan
- Clinical Neurosciences Section, Developmental Neurosciences Programme, UCL GOS Institute of Child Health, London, UK
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44
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Kang X, Boly M, Findlay G, Jones B, Gjini K, Maganti R, Struck AF. Quantitative spatio-temporal characterization of epileptic spikes using high density EEG: Differences between NREM sleep and REM sleep. Sci Rep 2020; 10:1673. [PMID: 32015406 PMCID: PMC6997449 DOI: 10.1038/s41598-020-58612-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
In this study, we applied high-density EEG recordings (HD-EEG) to quantitatively characterize the fine-grained spatiotemporal distribution of inter-ictal epileptiform discharges (IEDs) across different sleep stages. We quantified differences in spatial extent and duration of IEDs at the scalp and cortical levels using HD-EEG source-localization, during non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep, in six medication-refractory focal epilepsy patients during epilepsy monitoring unit admission. Statistical analyses were performed at single subject level and group level across different sleep stages for duration and distribution of IEDs. Tests were corrected for multiple comparisons across all channels and time points. Compared to NREM sleep, IEDs during REM sleep were of significantly shorter duration and spatially more restricted. Compared to NREM sleep, IEDs location in REM sleep also showed a higher concordance with electrographic ictal onset zone from scalp EEG recording. This study supports the localizing value of REM IEDs over NREM IEDs and suggests that HD-EEG may be of clinical utility in epilepsy surgery work-up.
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Affiliation(s)
- Xuan Kang
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA
| | - Melanie Boly
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA.,University of Wisconsin-Madison Department of Psychiatry, Madison, Wisconsin, 53705, USA
| | - Graham Findlay
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA.,University of Wisconsin-Madison Department of Psychiatry, Madison, Wisconsin, 53705, USA
| | - Benjamin Jones
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA.,University of Wisconsin-Madison Department of Psychiatry, Madison, Wisconsin, 53705, USA
| | - Klevest Gjini
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA
| | - Rama Maganti
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA
| | - Aaron F Struck
- University of Wisconsin-Madison Department of Neurology, Madison, Wisconsin, 53705, USA.
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45
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Ellenrieder N, Gotman J, Zelmann R, Rogers C, Nguyen DK, Kahane P, Dubeau F, Frauscher B. How the Human Brain Sleeps: Direct Cortical Recordings of Normal Brain Activity. Ann Neurol 2019; 87:289-301. [DOI: 10.1002/ana.25651] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/29/2019] [Accepted: 11/24/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Nicolás Ellenrieder
- Montreal Neurological Institute and HospitalMcGill University Montreal Quebec Canada
| | - Jean Gotman
- Montreal Neurological Institute and HospitalMcGill University Montreal Quebec Canada
| | - Rina Zelmann
- Montreal Neurological Institute and HospitalMcGill University Montreal Quebec Canada
- Department of NeurologyMassachusetts General Hospital and Harvard Medical School Boston MA
| | - Christine Rogers
- Montreal Neurological Institute and HospitalMcGill University Montreal Quebec Canada
| | | | - Philippe Kahane
- Department of NeurologyGrenoble‐Alpes University Hospital and Grenoble‐Alpes University Grenoble France
| | - François Dubeau
- Montreal Neurological Institute and HospitalMcGill University Montreal Quebec Canada
| | - Birgit Frauscher
- Montreal Neurological Institute and HospitalMcGill University Montreal Quebec Canada
- Department of MedicineQueen's University Kingston Ontario Canada
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46
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Lundstrom BN, Gompel JV, Khadjevand F, Worrell G, Stead M. Chronic subthreshold cortical stimulation and stimulation-related EEG biomarkers for focal epilepsy. Brain Commun 2019; 1:fcz010. [PMID: 31667473 PMCID: PMC6798788 DOI: 10.1093/braincomms/fcz010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 01/05/2023] Open
Abstract
Brain stimulation offers an alternative to focal resection for the treatment of focal drug-resistant epilepsy. Chronic subthreshold cortical stimulation is an individualized biomarker-informed open-loop continuous electrical stimulation approach targeting the seizure onset zone and surrounding areas. Before permanent implantation, trial stimulation is performed during invasive monitoring to assess stimulation efficacy as well as to optimize stimulation location and parameters by modifying interictal EEG biomarkers. We present clinical and neurophysiological results from a retrospective analysis of 21 patients, showing a median percent reduction in seizure frequency of 100% and responder rate of 89% with a median follow-up of 27 months. About 40% of patients were free of disabling seizures for a 12-month period or longer. We find that stimulation-induced decreases in delta (1–4 Hz) power and increases in alpha and beta (8–20 Hz) power during trial stimulation correlate with improved long-term clinical outcomes. These results suggest chronic subthreshold cortical stimulation may be an effective alternative approach to treating focal drug-resistant epilepsy and that short-term stimulation-related changes in spectral power may be a useful interictal biomarker and relate to long-term clinical outcome.
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Affiliation(s)
| | - Jamie Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Fatemeh Khadjevand
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Tufts University School of Medicine, Boston, MA, USA
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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47
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Salmi M, Del Gallo F, Minlebaev M, Zakharov A, Pauly V, Perron P, Pons‐Bennaceur A, Corby‐Pellegrino S, Aniksztejn L, Lenck‐Santini P, Epsztein J, Khazipov R, Burnashev N, Bertini G, Szepetowski P. Impaired vocal communication, sleep‐related discharges, and transient alteration of slow‐wave sleep in developing mice lacking the GluN2A subunit of
N
‐methyl‐
d
‐aspartate receptors. Epilepsia 2019; 60:1424-1437. [DOI: 10.1111/epi.16060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Manal Salmi
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
| | - Federico Del Gallo
- Department of Neurosciences, Biomedicine, and Movement Sciences University of Verona Verona Italy
| | - Marat Minlebaev
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
- Laboratory of Neurobiology Kazan Federal University Kazan Russia
| | - Andrey Zakharov
- Laboratory of Neurobiology Kazan Federal University Kazan Russia
| | - Vanessa Pauly
- Public Health Laboratory, Recognized Team (EA) 3279 Associate Center for Drug Dependency and Addictovigilance Faculty of Medicine Aix‐Marseille University Marseille France
| | - Pauline Perron
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
| | - Alexandre Pons‐Bennaceur
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
| | - Séverine Corby‐Pellegrino
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
| | - Laurent Aniksztejn
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
| | - Pierre‐Pascal Lenck‐Santini
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
| | - Jérôme Epsztein
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
| | - Rustem Khazipov
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
- Laboratory of Neurobiology Kazan Federal University Kazan Russia
| | - Nail Burnashev
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
| | - Giuseppe Bertini
- Department of Neurosciences, Biomedicine, and Movement Sciences University of Verona Verona Italy
| | - Pierre Szepetowski
- National Institute of Health and Medical Research INSERM Joint Research Unit UMR 1249Mediterranean Institute of Neurobiology INMEDAix‐Marseille University Marseille France
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48
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The Interface Between Sleep and Epilepsy. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Fattinger S, Heinzle BB, Ramantani G, Abela L, Schmitt B, Huber R. Closed-Loop Acoustic Stimulation During Sleep in Children With Epilepsy: A Hypothesis-Driven Novel Approach to Interact With Spike-Wave Activity and Pilot Data Assessing Feasibility. Front Hum Neurosci 2019; 13:166. [PMID: 31164813 PMCID: PMC6536690 DOI: 10.3389/fnhum.2019.00166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
Slow waves, the electroencephalographic (EEG) hallmark of deep sleep, can be systematically manipulated by acoustic stimulation: stimulation time-locked to the down phase of slow waves reduces, whereas stimulation time-locked to the up phase increases slow waves. Spike-waves during sleep seem to be related to slow waves, raising the question of whether spike-waves can be systematically influenced by such acoustic stimulation. In five pediatric patients, all-night EEG was recorded, combined with real-time slow wave detection. Throughout the night, acoustic stimulation was performed in a 3 × 5-min-block design (no stimulation—stimulation—no stimulation). Tones were applied time-locked either to the up or to the down phase of the detected slow waves in an alternating pattern. All patients tolerated the acoustic stimulation during sleep well. They showed high sleep quality and no signs of clinical or non-convulsive electrographic seizures. Our preliminary analysis shows no systematic effect of acoustic stimulation on spike-wave activity. Moreover, with our stimulation approach tones were distributed over a rather broad phase-range during the DOWN or UP stimulation and showed inter-individual differences in their distribution. In this study, we applied for the first time an acoustic closed-loop slow wave stimulation tool for a non-invasive manipulation of spike-wave activity. Thus, our pilot data show that closed-loop acoustic stimulation is feasible and well tolerated in children with spike wave activity during sleep. Improved precision in phase targeting and personalized stimulation parameters in a larger sample of subjects might be needed to show systematic effects.
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Affiliation(s)
- Sara Fattinger
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bigna Bölsterli Heinzle
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Georgia Ramantani
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lucia Abela
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bernhard Schmitt
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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50
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Jobst BC, Ben-Menachem E, Chapman KE, Fu A, Goldman A, Hirsch LJ, Jehi LE, Kossoff EH, Plueger M, Rho JM, Schevon CA, Shinnar S, Sperling MR, Simeone TA, Wagner JL, Lado F. Highlights From the Annual Meeting of the American Epilepsy Society 2018. Epilepsy Curr 2019; 19:152-158. [PMID: 31050308 PMCID: PMC6610384 DOI: 10.1177/1535759719844486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The American Epilepsy Society Meeting in New Orleans attracted more than 5900 attendees. There was a lively exchange of new science, innovation, education, clinical practice, and many other items related to epilepsy. Educational symposia were a major part of the meeting and explored varying topics of interest for all types of epilepsy professionals. This article reviews highlights of the meeting presented in major symposia. Topics ranged from how to treat varying aspects of epilepsy as a consultant in the hospital to finding the scientific underpinning of the interaction between sleep and epilepsy. Pros and cons of novel antiseizure medications, dietary, and stimulation treatments were discussed. Epilepsy may impair memory and we need to learn what is the pathophysiologic relationship. Febrile status epilepticus may have severe consequences for a later life with seizures. Epilepsy professionals should be very well aware of the ethical implications of devasting seizures and their associated disability. These are just a few select topics of the many that we need to study further to archive the final goal to improve the lives of patients with epilepsy.
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