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Jin BZ, Capiglioni M, Federspiel A, Ahmadli U, Schindler K, Kiefer C, Wiest R. Neuronal current imaging of epileptic activity: An MRI study in patients with a first unprovoked epileptic seizure. Epilepsia Open 2024. [PMID: 38970780 DOI: 10.1002/epi4.13001] [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: 12/05/2023] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 07/08/2024] Open
Abstract
OBJECTIVE This study evaluates the performance of the novel MRI sequence stimulus-induced rotary saturation (SIRS) to map responses to interictal epileptic activity in the human cortex. Spin-lock pulses have been applied to indirectly detect neuronal activity through magnetic field perturbations. Following initial reports about the feasibility of the method in humans and animals with epilepsy, we aimed to investigate the diagnostic yield of spin-lock MR pulses in comparison with scalp-EEG in first seizure patients. METHODS We employed a novel method for measurements of neuronal activity through the detection of a resonant oscillating field, stimulus-induced rotary saturation contrast (SIRS) at spin-lock frequencies of 120 and 240 Hz acquired at a single 3T MRI system. Within a prospective observational study, we conducted SIRS experiments in 55 patients within 7 days after a suspected first unprovoked epileptic seizure and 61 healthy control subjects. In this study, we report on the analysis of data from a single 3T MRI system, encompassing 35 first seizure patients and 31 controls. RESULTS The SIRS method was applicable in all patients and healthy controls at frequencies of 120 and 240 Hz. We did not observe any significant age- or sex-related differences. Specificity of SIRS at 120 Hz was 90.3% and 93.5% at 240 Hz. Sensitivity was 17.1% at 120 Hz and 40.0% at 240 Hz. SIGNIFICANCE SIRS targets neuronal oscillating magnetic fields in patients with epilepsy. The coupling of presaturated spins to epilepsy-related magnetic field perturbations may serve as a-at this stage experimental-diagnostic test in first seizure patients to complement EEG findings as a standard screening test. PLAIN LANGUAGE SUMMARY Routine diagnostic tests carry several limitations when applied after a suspected first seizure. SIRS is a noninvasive MRI method to enable time-sensitive diagnosis of image correlates of epileptic activity with increased sensitivity compared to routine EEG.
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Affiliation(s)
- Baudouin Zongxin Jin
- Support Center of Advanced Neuroimaging, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, Medical Faculty, University of Bern, Bern, Switzerland
| | - Milena Capiglioni
- Support Center of Advanced Neuroimaging, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
| | - Andrea Federspiel
- Support Center of Advanced Neuroimaging, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
| | - Uzeyir Ahmadli
- Support Center of Advanced Neuroimaging, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
| | - Kaspar Schindler
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claus Kiefer
- Support Center of Advanced Neuroimaging, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
| | - Roland Wiest
- Support Center of Advanced Neuroimaging, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
- Swiss Institute for Translational and Entrepreneurial Medicine, Sitem-Insel, Bern, Switzerland
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Lucas A, Vadali C, Mouchtaris S, Arnold TC, Gugger JJ, Kulick-Soper C, Josyula M, Petillo N, Das S, Dubroff J, Detre JA, Stein JM, Davis KA. Enhancing the Diagnostic Utility of ASL Imaging in Temporal Lobe Epilepsy through FlowGAN: An ASL to PET Image Translation Framework. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.28.24308027. [PMID: 38853910 PMCID: PMC11160820 DOI: 10.1101/2024.05.28.24308027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background and Significance Positron Emission Tomography (PET) using fluorodeoxyglucose (FDG-PET) is a standard imaging modality for detecting areas of hypometabolism associated with the seizure onset zone (SOZ) in temporal lobe epilepsy (TLE). However, FDG-PET is costly and involves the use of a radioactive tracer. Arterial Spin Labeling (ASL) offers an MRI-based quantification of cerebral blood flow (CBF) that could also help localize the SOZ, but its performance in doing so, relative to FDG-PET, is limited. In this study, we seek to improve ASL's diagnostic performance by developing a deep learning framework for synthesizing FDG-PET-like images from ASL and structural MRI inputs. Methods We included 68 epilepsy patients, out of which 36 had well lateralized TLE. We compared the coupling between FDG-PET and ASL CBF values in different brain regions, as well as the asymmetry of these values across the brain. We additionally assessed each modality's ability to lateralize the SOZ across brain regions. Using our paired PET-ASL data, we developed FlowGAN, a generative adversarial neural network (GAN) that synthesizes PET-like images from ASL and T1-weighted MRI inputs. We tested our synthetic PET images against the actual PET images of subjects to assess their ability to reproduce clinically meaningful hypometabolism and asymmetries in TLE. Results We found variable coupling between PET and ASL CBF values across brain regions. PET and ASL had high coupling in neocortical temporal and frontal brain regions (Spearman's r > 0.30, p < 0.05) but low coupling in mesial temporal structures (Spearman's r < 0.30, p > 0.05). Both whole brain PET and ASL CBF asymmetry values provided good separability between left and right TLE subjects, but PET (AUC = 0.96, 95% CI: [0.88, 1.00]) outperformed ASL (AUC = 0.81; 95% CI: [0.65, 0.96]). FlowGAN-generated images demonstrated high structural similarity to actual PET images (SSIM = 0.85). Globally, asymmetry values were better correlated between synthetic PET and original PET than between ASL CBF and original PET, with a mean correlation increase of 0.15 (95% CI: [0.07, 0.24], p<0.001, Cohen's d = 0.91). Furthermore, regions that had poor ASL-PET correlation (e.g. mesial temporal structures) showed the greatest improvement with synthetic PET images. Conclusions FlowGAN improves ASL's diagnostic performance, generating synthetic PET images that closely mimic actual FDG-PET in depicting hypometabolism associated with TLE. This approach could improve non-invasive SOZ localization, offering a promising tool for epilepsy presurgical assessment. It potentially broadens the applicability of ASL in clinical practice and could reduce reliance on FDG-PET for epilepsy and other neurological disorders.
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Affiliation(s)
- Alfredo Lucas
- Perelman School of Medicine, University of Pennsylvania
- Department of Bioengineering, University of Pennsylvania
| | - Chetan Vadali
- Department of Bioengineering, University of Pennsylvania
| | | | | | | | | | | | - Nina Petillo
- Department of Neurology, University of Pennsylvania
| | | | | | - John A Detre
- Department of Neurology, University of Pennsylvania
| | - Joel M Stein
- Department of Radiology, University of Pennsylvania
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Lee DA, Sohn G, Park KM, Kim SE. Neuroimaging correlation with EEG in status epilepticus. Seizure 2024; 114:106-110. [PMID: 38118284 DOI: 10.1016/j.seizure.2023.12.007] [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: 08/07/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
PURPOSE This study was to correlate EEG patterns with peri‑ictal perfusion CT abnormality (PCA) or peri‑ictal MR abnormality (PMA) in patients with status epilepticus (SE). METHODS This is a retrospective study done with SE patients from January 2016 to December 2021. We defined the PCA as single or multi-territorial cortical and/or thalamic hyper-perfusion. The PMA was defined as increased signal intensity in multiple brain regions including the cortex and subcortical regions. EEG patterns were categorized into electrographic seizure (ESz)/electroclinical seizure (ECSz), ictal-interictal continuum (IIC), and lateralized periodic discharges (LPDs) per the American Clinical Neurophysiology Society's guideline. We analyzed the association between the patterns of EEG and the presence of PCA or PMA. RESULTS Among 73 patients, 26 % (19/73) showed PCA and 25 % (18/73) demonstrated PMA. The patterns of EEG were as follows; ESz/ECSz in 25 % (18/73), IIC in 34 % (25/73), and LPD in 12 % (9/73). There was a significant correlation between the patterns of EEG and the presence of PMA, but not PCA. 48 % (12/25) had both PMA and PCA whereas 52 % (13/25) showed either PMA (6/25) or PCA (7/25). CONCLUSION Although PCA did not reveal an electro-radiographical correlation, PMA was strongly linked to ESz, ECSz, IIC, and LPD.
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Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - GyeongMo Sohn
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sung Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
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Prener M, Drejer V, Ziebell M, Jensen P, Madsen CG, Olsen S, Thomsen G, Pinborg LH, Paulson OB. Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. II: Methodological considerations on hyper- and hypoperfusion. Epilepsia Open 2023; 8:1503-1511. [PMID: 37750050 PMCID: PMC10690685 DOI: 10.1002/epi4.12833] [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: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Single-photon emission computed tomography (SPECT) with the tracer 99m Tc-HMPAO is a method to visualize the cerebral hyperperfusion during an epileptic seizure and thus localize the epileptogenic zone and seizure propagation. Subtraction of interictal from Ictal SPECT Co-registered to MRI (SISCOM) visualizes areas with relative increases in cerebral blood flow. The purpose of this retrospective study is to explore the added value of visualizing areas of hypoperfusion as well as hyperperfusion, so-called reversed SISCOM. METHODS Fifty-six patients operated for epilepsy who had been investigated with SISCOM were included in the analysis. The patients were divided into two groups based on seizure duration after tracer injection, above or below 30 s. The preoperative SISCOM description was compared to the area of resection and given a concordance score. The 56 SISCOM were recalculated visualizing also areas of hypoperfusion and again compared to the site of resection using the same scale of concordance. The reversed SISCOM were categorized into three subgroups: "Altered Conclusion," "Confirmed Conclusion," and "Adds Nothing." If an area of hyperperfusion had an area of hypoperfusion in close proximity, it was re-interpreted as noise, thus possibly altering the conclusion. If the areas of hypoperfusion were in the opposite hemisphere it was interpreted as confirming factor. Further the concordance scores from conventional SISCOM and reversed SISCOM was compared to surgical outcome to explore the difference in sensitivity, positive predictive value (PPV), and odds ratio. RESULTS In approximately half of the cases reversed SISCOM added additional value, meaning either altered the conclusion or confirmed the conclusion. The sensitivity, PPV, and odds ratio was also better in the subgroup of long, >30 s seizure duration after injection, and got worse in the group with short, <30 s seizure duration after injection. SIGNIFICANCE Adding reversed SISCOM performed better than conventional SISCOM at predicting good surgical outcome.
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Affiliation(s)
- Martin Prener
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Veronica Drejer
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Morten Ziebell
- Department of NeurosurgeryRigshospitaletCopenhagenDenmark
| | - Per Jensen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Camilla Gøbel Madsen
- Department of Radiology, Centre for Functional and Diagnostic imaging and ResearchCopenhagen University Hospital Amager and HvidovreHvidovreDenmark
| | - Svitlana Olsen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Gerda Thomsen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Lars H. Pinborg
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
- Epilepsy Clinic, Department of Neurology, Rigshospitalet, Copenhagen, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Olaf B. Paulson
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Kawano G, Tokutomi K, Kikuchi Y, Sakata K, Sakaguchi H, Yokochi T, Akita Y, Matsuishi T. Arterial spin labeling image findings in the acute phase in paediatric patients with acute encephalopathy with biphasic seizures and late reduced diffusion. Front Neurosci 2023; 17:1252410. [PMID: 37795188 PMCID: PMC10545960 DOI: 10.3389/fnins.2023.1252410] [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: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Diagnosing acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) after the first seizure (early seizure/seizures, ES/ESs) is challenging because a reduced apparent diffusion coefficient (ADC) in the cortical or subcortical white matter, often described as having a "bright-tree appearance (BTA)," is usually not observed until secondary seizures (late seizures, LSs) occur. Previous studies have reported hypoperfusion on arterial spin labeling (ASL) within 24 h after ES/ESs in patients with AESD and hyperperfusion within 24 h after LS onset. This study aimed to investigate cerebral blood flow in the hyperacute phase (between ES/ESs and LSs) using ASL in patients with AESD. Methods Eight ASL images were acquired in six patients with AESD admitted to our hospital from October 2021 to October 2022. ASL findings in the hyperacute phase were investigated and video-electroencephalogram findings obtained around ASL image acquisition in the hyperacute phase were evaluated. Results Four ASL images were obtained for three patients before LS onset, with three images showing hyperperfusion areas and one image showing hypoperfusion areas. These hyperperfuion regions coincided with BTA on subsequent images of these patients.In one patient, the first ASL image was obtained in the late hyperacute phase and revealed hyperperfusion areas with a slightly abnormal change on diffusion-weighted image (DWI), which were not accompanied by ADC abnormalities. The second ASL image obtained 51 h after the first ASL, and before LS onset revealed more prominent hyperperfusion areas than the first ASL image, which were accompanied by BTA. In another patient, the ASL image obtained 82 h after ES revealed hyperperfusion areas without abnormal change on DWI or ADC. Conclusion This study revealed that two patients exhibited hyperperfusion regions and another patient exhibited hypoperfusion regions among three patients who underwent ASL imaging during the period from 24 h after ES/ESs to LSs in patients with LSs or cooling initiation in patients without LSs due to early anaesthesia induction (late hyperacute phase). Further prospective studies on cerebral blood flow are required to explore the relationship among the timing of image acquisition, the presence of electrographic seizures, and ASL findings in patients with AESD.
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Affiliation(s)
- Go Kawano
- Department of Paediatrics, St Mary’s Hospital, Fukuoka, Japan
| | | | | | - Kensuke Sakata
- Department of Paediatrics, St Mary’s Hospital, Fukuoka, Japan
| | | | - Takaoki Yokochi
- Department of Paediatrics, St Mary’s Hospital, Fukuoka, Japan
| | - Yukihiro Akita
- Department of Paediatrics, St Mary’s Hospital, Fukuoka, Japan
| | - Toyojiro Matsuishi
- Department of Paediatrics, St Mary’s Hospital, Fukuoka, Japan
- Research Centre for Children and Research Centre for Rett Syndrome, St Mary’s Hospital, Fukuoka, Japan
- Division of Gene Therapy and Regenerative Medicine, Cognitive and Molecular Research Institute of Brain Diseases, Kurume University School of Medicine, Fukuoka, Japan
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Villa BR, Bhatt D, Wolff MD, Addo-Osafo K, Epp JR, Teskey GC. Repeated episodes of postictal hypoxia are a mechanism for interictal cognitive impairments. Sci Rep 2023; 13:15474. [PMID: 37726428 PMCID: PMC10509159 DOI: 10.1038/s41598-023-42741-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
Comorbidities during the period between seizures present a significant challenge for individuals with epilepsy. Despite their clinical relevance, the pathophysiology of the interictal symptomatology is largely unknown. Postictal severe hypoxia (PIH) in those brain regions participating in the seizure has been indicated as a mechanism underlying several negative postictal manifestations. It is unknown how repeated episodes of PIH affect interictal symptoms in epilepsy. Using a rat model, we observed that repeated seizures consistently induced episodes of PIH that become increasingly severe with each seizure occurrence. Additionally, recurrent seizure activity led to decreased levels of oxygen in the hippocampus during the interictal period. However, these reductions were prevented when we repeatedly blocked PIH using either the COX-inhibitor acetaminophen or the L-type calcium channel antagonist nifedipine. Moreover, we found that interictal cognitive deficits caused by seizures were completely alleviated by repeated attenuation of PIH events. Lastly, mitochondrial dysfunction may contribute to the observed pathological outcomes during the interictal period. These findings provide evidence that seizure-induced hypoxia may play a crucial role in several aspects of epilepsy. Consequently, developing and implementing treatments that specifically target and prevent PIH could potentially offer significant benefits for individuals with refractory epilepsy.
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Affiliation(s)
- Bianca R Villa
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada.
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Dhyey Bhatt
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Marshal D Wolff
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Kwaku Addo-Osafo
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Jonathan R Epp
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - G Campbell Teskey
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
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George AG, Federico A, Gom RC, Harris SA, Teskey GC. Caffeine exacerbates seizure-induced death via postictal hypoxia. Sci Rep 2023; 13:14150. [PMID: 37644198 PMCID: PMC10465499 DOI: 10.1038/s41598-023-41409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading epilepsy-related cause of premature mortality in people with intractable epilepsy, who are 27 times more likely to die than the general population. Impairment of the central control of breathing following a seizure has been identified as a putative cause of death, but the mechanisms underlying this seizure-induced breathing failure are largely unknown. Our laboratory has advanced a vascular theory of postictal behavioural dysfunction, including SUDEP. We have recently reported that seizure-induced death occurs after seizures invade brainstem breathing centres which then leads to local hypoxia causing breathing failure and death. Here we investigated the effects of caffeine and two adenosine receptors in two models of seizure-induced death. We recorded local oxygen levels in brainstem breathing centres as well as time to cessation of breathing and cardiac activity relative to seizure activity. The administration of the non-selective A1/A2A antagonist caffeine or the selective A1 agonist N6-cyclopentyladenosine reveals a detrimental effect on postictal hypoxia, providing support for caffeine modulating cerebral vasculature leading to brainstem hypoxia and cessation of breathing. Conversely, A2A activation with CGS-21680 was found to increase the lifespan of mice in both our models of seizure-induced death.
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Affiliation(s)
- Antis G George
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada.
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB, Canada.
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive N.W. Calgary, Alberta, T2N 4N, Canada.
| | - Alyssa Federico
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Renaud C Gom
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB, Canada
| | - Sydney A Harris
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - G Campbell Teskey
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Takanashi JI, Uetani H. Neuroimaging in acute infection-triggered encephalopathy syndromes. Front Neurosci 2023; 17:1235364. [PMID: 37638320 PMCID: PMC10447893 DOI: 10.3389/fnins.2023.1235364] [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: 06/06/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Acute encephalopathy associated with infectious diseases occurs frequently in Japanese children (400-700 children/year) and is the most common in infants aged 0-3 years. Acute encephalopathy is classified into several clinicoradiological syndromes; acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is the most common subtype, followed by clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and acute necrotizing encephalopathy (ANE). Neuroimaging, especially magnetic resonance imaging (MRI), is useful for the diagnosis, assessment of treatment efficacy, and evaluation of the pathophysiology of encephalopathy syndromes. MRI findings essential for diagnosis include delayed subcortical reduced diffusion (bright tree appearance) for AESD, reversible splenial lesions with homogeneously reduced diffusion for MERS, and symmetric hemorrhagic thalamic lesions for ANE. We reviewed several MRI techniques that have been applied in recent years, including diffusion-weighted imaging for the characterization of cerebral edema, arterial spin labeling for evaluating cerebral perfusion, and magnetic resonance spectroscopy for evaluating metabolic abnormality.
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Affiliation(s)
- Jun-ichi Takanashi
- Department of Pediatrics, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Hiroyuki Uetani
- Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Rentzeperis F, Abdennadher M, Snyder K, Dembny K, Abdollahi S, Zaghloul KA, Talagala L, Theodore WH, Inati SK. Lateralization of interictal temporal lobe hypoperfusion in lesional and non-lesional temporal lobe epilepsy using arterial spin labeling MRI. Epilepsy Res 2023; 193:107163. [PMID: 37187039 PMCID: PMC10247543 DOI: 10.1016/j.eplepsyres.2023.107163] [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: 12/28/2022] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Non-invasive imaging studies play a critical role in the presurgical evaluation of patients with drug-resistant temporal lobe epilepsy (TLE), particularly in helping to lateralize the seizure focus. Arterial Spin Labeling (ASL) MRI has been widely used to non-invasively study cerebral blood flow (CBF), with somewhat variable interictal alterations reported in TLE. Here, we compare temporal lobe subregional interictal perfusion and symmetry in lesional (MRI+) and non-lesional (MRI-) TLE compared to healthy volunteers (HVs). METHODS Twenty TLE patients (9 MRI+, 11 MRI-) and 14 HVs under went 3 T Pseudo-Continuous ASL MRI through an epilepsy imaging research protocol at the NIH Clinical Center. We compared normalized CBF and absolute asymmetry indices in multiple temporal lobe subregions. RESULTS Compared to HVs, both MRI+ and MRI- TLE groups demonstrated significant ipsilateral mesial and lateral temporal hypoperfusion, specifically in the hippocampal and anterior temporal neocortical subregions, with additional hypoperfusion in the ipsilateral parahippocampal gyrus in the MRI+ and contralateral hippocampus in the MRI- TLE groups. Contralateral to the seizure focus, there was significant relative hypoperfusion in multiple subregions in the MRI- compared to the MRI+ TLE groups. The MRI+ group therefore had significantly greater asymmetry across multiple temporal subregions compared to the MRI- TLE and HV groups. No significant differences in asymmetry were found between the MRI- TLE and HV groups. CONCLUSION We found a similar extent of interictal ipsilateral temporal hypoperfusion in MRI+ and MRI- TLE. However, significantly increased asymmetries were found only in the MRI+ group due to differences in perfusion contralateral to the seizure focus between the patient groups. The lack of asymmetry in the MRI- group may negatively impact the utility of interictal ASL for seizure focus lateralization in this patient population.
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Affiliation(s)
- Frederika Rentzeperis
- Office of the Clinical Director, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Myriam Abdennadher
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn Snyder
- Office of the Clinical Director, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Kate Dembny
- Office of the Clinical Director, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Shervin Abdollahi
- Office of the Clinical Director, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, NINDS, National Institutes of Health, USA
| | - Lalith Talagala
- NIH MRI Research Facility, NINDS, National Institutes of Health, USA
| | | | - Sara K Inati
- Office of the Clinical Director, NINDS, National Institutes of Health, Bethesda, MD, USA.
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Cauli B, Dusart I, Li D. Lactate as a determinant of neuronal excitability, neuroenergetics and beyond. Neurobiol Dis 2023:106207. [PMID: 37331530 DOI: 10.1016/j.nbd.2023.106207] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/20/2023] Open
Abstract
Over the last decades, lactate has emerged as important energy substrate for the brain fueling of neurons. A growing body of evidence now indicates that it is also a signaling molecule modulating neuronal excitability and activity as well as brain functions. In this review, we will briefly summarize how different cell types produce and release lactate. We will further describe different signaling mechanisms allowing lactate to fine-tune neuronal excitability and activity, and will finally discuss how these mechanisms could cooperate to modulate neuroenergetics and higher order brain functions both in physiological and pathological conditions.
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Affiliation(s)
- Bruno Cauli
- Sorbonne Université, CNRS, INSERM, Neurosciences Paris Seine - Institut de Biologie Paris Seine (NPS-IBPS), 9 quai Saint Bernard, 75005 Paris, France.
| | - Isabelle Dusart
- Sorbonne Université, CNRS, INSERM, Neurosciences Paris Seine - Institut de Biologie Paris Seine (NPS-IBPS), 9 quai Saint Bernard, 75005 Paris, France
| | - Dongdong Li
- Sorbonne Université, CNRS, INSERM, Neurosciences Paris Seine - Institut de Biologie Paris Seine (NPS-IBPS), 9 quai Saint Bernard, 75005 Paris, France
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11
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Uher D, Drenthen GS, Schijns OEMG, Colon AJ, Hofman PAM, van Lanen RHGJ, Hoeberigs CM, Jansen JFA, Backes WH. Advances in Image Processing for Epileptogenic Zone Detection with MRI. Radiology 2023; 307:e220927. [PMID: 37129491 DOI: 10.1148/radiol.220927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Focal epilepsy is a common and severe neurologic disorder. Neuroimaging aims to identify the epileptogenic zone (EZ), preferably as a macroscopic structural lesion. For approximately a third of patients with chronic drug-resistant focal epilepsy, the EZ cannot be precisely identified using standard 3.0-T MRI. This may be due to either the EZ being undetectable at imaging or the seizure activity being caused by a physiologic abnormality rather than a structural lesion. Computational image processing has recently been shown to aid radiologic assessments and increase the success rate of uncovering suspicious regions by enhancing their visual conspicuity. While structural image analysis is at the forefront of EZ detection, physiologic image analysis has also been shown to provide valuable information about EZ location. This narrative review summarizes and explains the current state-of-the-art computational approaches for image analysis and presents their potential for EZ detection. Current limitations of the methods and possible future directions to augment EZ detection are discussed.
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Affiliation(s)
- Daniel Uher
- From the Department of Radiology and Nuclear Medicine (D.U., G.S.D., P.A.M.H., C.M.H., J.F.A.J., W.H.B.) and Department of Neurosurgery (O.E.M.G.S., R.H.G.J.v.L.), Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (D.U., G.S.D., O.E.M.G.S., R.H.G.J.v.L., J.F.A.J., W.H.B.); Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze/Maastricht, the Netherlands (O.E.M.G.S., A.J.C., P.A.M.H., C.M.H., J.F.A.J.); and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Gerhard S Drenthen
- From the Department of Radiology and Nuclear Medicine (D.U., G.S.D., P.A.M.H., C.M.H., J.F.A.J., W.H.B.) and Department of Neurosurgery (O.E.M.G.S., R.H.G.J.v.L.), Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (D.U., G.S.D., O.E.M.G.S., R.H.G.J.v.L., J.F.A.J., W.H.B.); Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze/Maastricht, the Netherlands (O.E.M.G.S., A.J.C., P.A.M.H., C.M.H., J.F.A.J.); and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Olaf E M G Schijns
- From the Department of Radiology and Nuclear Medicine (D.U., G.S.D., P.A.M.H., C.M.H., J.F.A.J., W.H.B.) and Department of Neurosurgery (O.E.M.G.S., R.H.G.J.v.L.), Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (D.U., G.S.D., O.E.M.G.S., R.H.G.J.v.L., J.F.A.J., W.H.B.); Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze/Maastricht, the Netherlands (O.E.M.G.S., A.J.C., P.A.M.H., C.M.H., J.F.A.J.); and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Albert J Colon
- From the Department of Radiology and Nuclear Medicine (D.U., G.S.D., P.A.M.H., C.M.H., J.F.A.J., W.H.B.) and Department of Neurosurgery (O.E.M.G.S., R.H.G.J.v.L.), Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (D.U., G.S.D., O.E.M.G.S., R.H.G.J.v.L., J.F.A.J., W.H.B.); Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze/Maastricht, the Netherlands (O.E.M.G.S., A.J.C., P.A.M.H., C.M.H., J.F.A.J.); and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Paul A M Hofman
- From the Department of Radiology and Nuclear Medicine (D.U., G.S.D., P.A.M.H., C.M.H., J.F.A.J., W.H.B.) and Department of Neurosurgery (O.E.M.G.S., R.H.G.J.v.L.), Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (D.U., G.S.D., O.E.M.G.S., R.H.G.J.v.L., J.F.A.J., W.H.B.); Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze/Maastricht, the Netherlands (O.E.M.G.S., A.J.C., P.A.M.H., C.M.H., J.F.A.J.); and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Rick H G J van Lanen
- From the Department of Radiology and Nuclear Medicine (D.U., G.S.D., P.A.M.H., C.M.H., J.F.A.J., W.H.B.) and Department of Neurosurgery (O.E.M.G.S., R.H.G.J.v.L.), Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (D.U., G.S.D., O.E.M.G.S., R.H.G.J.v.L., J.F.A.J., W.H.B.); Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze/Maastricht, the Netherlands (O.E.M.G.S., A.J.C., P.A.M.H., C.M.H., J.F.A.J.); and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Christianne M Hoeberigs
- From the Department of Radiology and Nuclear Medicine (D.U., G.S.D., P.A.M.H., C.M.H., J.F.A.J., W.H.B.) and Department of Neurosurgery (O.E.M.G.S., R.H.G.J.v.L.), Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (D.U., G.S.D., O.E.M.G.S., R.H.G.J.v.L., J.F.A.J., W.H.B.); Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze/Maastricht, the Netherlands (O.E.M.G.S., A.J.C., P.A.M.H., C.M.H., J.F.A.J.); and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Jacobus F A Jansen
- From the Department of Radiology and Nuclear Medicine (D.U., G.S.D., P.A.M.H., C.M.H., J.F.A.J., W.H.B.) and Department of Neurosurgery (O.E.M.G.S., R.H.G.J.v.L.), Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (D.U., G.S.D., O.E.M.G.S., R.H.G.J.v.L., J.F.A.J., W.H.B.); Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze/Maastricht, the Netherlands (O.E.M.G.S., A.J.C., P.A.M.H., C.M.H., J.F.A.J.); and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Walter H Backes
- From the Department of Radiology and Nuclear Medicine (D.U., G.S.D., P.A.M.H., C.M.H., J.F.A.J., W.H.B.) and Department of Neurosurgery (O.E.M.G.S., R.H.G.J.v.L.), Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (D.U., G.S.D., O.E.M.G.S., R.H.G.J.v.L., J.F.A.J., W.H.B.); Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze/Maastricht, the Netherlands (O.E.M.G.S., A.J.C., P.A.M.H., C.M.H., J.F.A.J.); and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
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12
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Lim HK, Bae S, Han K, Kang BM, Jeong Y, Kim SG, Suh M. Seizure-induced neutrophil adhesion in brain capillaries leads to a decrease in postictal cerebral blood flow. iScience 2023; 26:106655. [PMID: 37168551 PMCID: PMC10164910 DOI: 10.1016/j.isci.2023.106655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 05/13/2023] Open
Abstract
Cerebral hypoperfusion has been proposed as a potential cause of postictal neurological dysfunction in epilepsy, but its underlying mechanism is still unclear. We show that a 30% reduction in postictal cerebral blood flow (CBF) has two contributing factors: the early hypoperfusion up to ∼30 min post-seizure was mainly induced by arteriolar constriction, while the hypoperfusion that persisted for over an hour was due to increased capillary stalling induced by neutrophil adhesion to brain capillaries, decreased red blood cell (RBC) flow accompanied by constriction of capillaries and venules, and elevated intercellular adhesion molecule-1 (ICAM-1) expression. Administration of antibodies against the neutrophil marker Ly6G and against LFA-1, which mediates adhesive interactions with ICAM-1, prevented neutrophil adhesion and recovered the prolonged CBF reductions to control levels. Our findings provide evidence that seizure-induced neutrophil adhesion to cerebral microvessels via ICAM-1 leads to prolonged postictal hypoperfusion, which may underlie neurological dysfunction in epilepsy.
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Affiliation(s)
- Hyun-Kyoung Lim
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University, Suwon 16419, South Korea
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, South Korea
| | - Sungjun Bae
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, South Korea
- IMNEWRUN Inc, N Center Bldg. A 5F, Sungkyunkwan University, Suwon 16419, South Korea
| | - Kayoung Han
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University, Suwon 16419, South Korea
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, South Korea
| | - Bok-Man Kang
- IMNEWRUN Inc, N Center Bldg. A 5F, Sungkyunkwan University, Suwon 16419, South Korea
| | - Yoonyi Jeong
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, South Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, South Korea
- Department of Intelligent Precision Healthcare Convergence (IPHC), Sungkyunkwan University, Suwon 16419, South Korea
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, South Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, South Korea
- Department of Intelligent Precision Healthcare Convergence (IPHC), Sungkyunkwan University, Suwon 16419, South Korea
| | - Minah Suh
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University, Suwon 16419, South Korea
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, South Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon 16419, South Korea
- IMNEWRUN Inc, N Center Bldg. A 5F, Sungkyunkwan University, Suwon 16419, South Korea
- Department of Intelligent Precision Healthcare Convergence (IPHC), Sungkyunkwan University, Suwon 16419, South Korea
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Suwon 16419, South Korea
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13
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George AG, Farrell JS, Colangeli R, Wall AK, Gom RC, Kesler MT, Rodriguez de la Hoz C, Villa BR, Perera T, Rho JM, Kurrasch D, Teskey GC. Sudden unexpected death in epilepsy is prevented by blocking postictal hypoxia. Neuropharmacology 2023; 231:109513. [PMID: 36948357 DOI: 10.1016/j.neuropharm.2023.109513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/21/2023] [Accepted: 03/18/2023] [Indexed: 03/24/2023]
Abstract
Epilepsy is at times a fatal disease. Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality in people with intractable epilepsy and is defined by exclusion; non-accidental, non-toxicologic, and non-anatomic causes of death. While SUDEP often follows a bilateral tonic-clonic seizure, the mechanisms that ultimately lead to terminal apnea and then asystole remain elusive and there is a lack of preventative treatments. Based on the observation that discrete seizures lead to local and postictal vasoconstriction, resulting in hypoperfusion, hypoxia and behavioural disturbances in the forebrain we reasoned those similar mechanisms may play a role in SUDEP when seizures invade the brainstem. Here we tested this neurovascular-based hypothesis of SUDEP in awake non-anesthetized mice by pharmacologically preventing seizure-induced vasoconstriction, with cyclooxygenase-2 or L-type calcium channel antagonists. In both acute and chronic mouse models of seizure-induced premature mortality, ibuprofen and nicardipine extended life while systemic drug levels remained high enough to be effective. We also examined the potential role of spreading depolarization in the acute model of seizure-induced premature mortality. These data provide a proof-of-principle for the neurovascular hypothesis of SUDEP rather than spreading depolarization and the use of currently available drugs to prevent it.
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Affiliation(s)
- Antis G George
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada; Department of Cell Biology and Anatomy, University of Calgary, Calgary, Alberta, Canada
| | - Jordan S Farrell
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada; Department of Neurosurgery, Stanford University, Palo Alto, CA, 94305, USA
| | - Roberto Colangeli
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada; Department of Cell Biology and Anatomy, University of Calgary, Calgary, Alberta, Canada; Department of Experimental and Clinical Medicine, Section of Neuroscience and Cell Biology, Marche Polytechnic University, Ancona, Italy
| | - Alexandra K Wall
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada; Department of Cell Biology and Anatomy, University of Calgary, Calgary, Alberta, Canada
| | - Renaud C Gom
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada; Department of Cell Biology and Anatomy, University of Calgary, Calgary, Alberta, Canada
| | - Mitchell T Kesler
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | | | - Bianca R Villa
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada; Department of Cell Biology and Anatomy, University of Calgary, Calgary, Alberta, Canada
| | - Tefani Perera
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Jong M Rho
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, Pediatrics and Pharmacology, University of California, San Diego and Rady Children's Hospital, San Diego, CA, USA
| | - Deborah Kurrasch
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada; Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - G Campbell Teskey
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada; Department of Cell Biology and Anatomy, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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14
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Yeom JS, Kim YS, Choi DS. Focality in Febrile Seizures: A Retrospective Assessment Using Arterial Spin Labeling MRI. Neuropediatrics 2023; 54:197-205. [PMID: 36848944 DOI: 10.1055/s-0043-1761922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
PURPOSE Defining focality of febrile seizures (FS) in clinical practice remains controversial. We investigated focality issues in FS with a postictal arterial spin labeling (ASL) sequence. METHODS We retrospectively reviewed 77 children (median: 19.0 months, range: 15.0-33.0 months) who consecutively visited our emergency room for FS and underwent brain magnetic resonance imaging (MRI), including the ASL sequence, within 24 hours of seizure onset. ASL data were visually analyzed to assess perfusion changes. Factors related to the perfusion changes were investigated. RESULTS The mean time to ASL acquisition was 7.0 (interquartile range: 4.0-11.0) hours. The most common seizure classification was unknown-onset seizures (n = 37, 48%), followed by focal-onset (n = 26, 34%) and generalized-onset seizures (n = 14, 18%). Perfusion changes were observed in 43 (57%) patients: most were hypoperfusion (n = 35, 83%). The temporal regions were the most common location of perfusion changes (n = 26, 60%); the majority of these were distributed in the unilateral hemisphere. Perfusion changes were independently associated with seizure classification (focal-onset seizures, adjusted odds ratio [aOR]: 9.6, p = 0.01; unknown-onset seizures aOR: 10.4, p < 0.01), and prolonged seizures (aOR: 3.1, p = 0.04), but not with other factors (age, sex, time to MRI acquisition, previous FS, repeated FS within 24 hour, family history of FS, structural abnormality on MRI, and developmental delay). The focality scale of seizure semiology positively correlated with perfusion changes (R = 0.334, p < 0.01). CONCLUSION Focality in FS may be common, and its primary origin might be the temporal regions. ASL can be useful for assessing focality in FS, particularly when seizure onset is unknown.
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Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University of Hospital, Jinju, South Korea.,Gyeongsang National University College of Medicine, Institute of Health Science, Jinju, South Korea
| | - Young-Soo Kim
- Gyeongsang National University College of Medicine, Institute of Health Science, Jinju, South Korea.,Department of Neurology, Gyeongsang National University of Hospital, Jinju, South Korea
| | - Dae-Seob Choi
- Gyeongsang National University College of Medicine, Institute of Health Science, Jinju, South Korea.,Department of Radiology, Gyeongsang National University of Hospital, Jinju, South Korea
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15
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Reiss Y, Bauer S, David B, Devraj K, Fidan E, Hattingen E, Liebner S, Melzer N, Meuth SG, Rosenow F, Rüber T, Willems LM, Plate KH. The neurovasculature as a target in temporal lobe epilepsy. Brain Pathol 2023; 33:e13147. [PMID: 36599709 PMCID: PMC10041171 DOI: 10.1111/bpa.13147] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
The blood-brain barrier (BBB) is a physiological barrier maintaining a specialized brain micromilieu that is necessary for proper neuronal function. Endothelial tight junctions and specific transcellular/efflux transport systems provide a protective barrier against toxins, pathogens, and immune cells. The barrier function is critically supported by other cell types of the neurovascular unit, including pericytes, astrocytes, microglia, and interneurons. The dysfunctionality of the BBB is a hallmark of neurological diseases, such as ischemia, brain tumors, neurodegenerative diseases, infections, and autoimmune neuroinflammatory disorders. Moreover, BBB dysfunction is critically involved in epilepsy, a brain disorder characterized by spontaneously occurring seizures because of abnormally synchronized neuronal activity. While resistance to antiseizure drugs that aim to reduce neuronal hyperexcitability remains a clinical challenge, drugs targeting the neurovasculature in epilepsy patients have not been explored. The use of novel imaging techniques permits early detection of BBB leakage in epilepsy; however, the detailed mechanistic understanding of causes and consequences of BBB compromise remains unknown. Here, we discuss the current knowledge of BBB involvement in temporal lobe epilepsy with the emphasis on the neurovasculature as a therapeutic target.
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Affiliation(s)
- Yvonne Reiss
- Institute of Neurology (Edinger Institute), University Hospital, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany
| | - Sebastian Bauer
- Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany.,Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Bastian David
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Kavi Devraj
- Institute of Neurology (Edinger Institute), University Hospital, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany
| | - Elif Fidan
- Institute of Neurology (Edinger Institute), University Hospital, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany.,Institute of Neuroradiology, Center of Neurology and Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Stefan Liebner
- Institute of Neurology (Edinger Institute), University Hospital, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany
| | - Nico Melzer
- Department of Neurology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Sven G Meuth
- Department of Neurology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Felix Rosenow
- Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany.,Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Theodor Rüber
- Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany.,Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany.,Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Laurent M Willems
- Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany.,Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Karl H Plate
- Institute of Neurology (Edinger Institute), University Hospital, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), University Hospital, Goethe University, Frankfurt, Germany
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16
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Köstner M, Rebsamen M, Radojewski P, Rummel C, Jin B, Meier R, Ahmadli U, Schindler K, Wiest R. Large-scale transient peri-ictal perfusion magnetic resonance imaging abnormalities detected by quantitative image analysis. Brain Commun 2023; 5:fcad047. [PMID: 36926367 PMCID: PMC10012410 DOI: 10.1093/braincomms/fcad047] [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: 04/10/2022] [Revised: 12/08/2022] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
Epileptic seizures require a rapid and safe diagnosis to minimize the time from onset to adequate treatment. Some epileptic seizures can be diagnosed clinically with the respective expertise. For more subtle seizures, imaging is mandatory to rule out treatable structural lesions and potentially life-threatening conditions. MRI perfusion abnormalities associated with epileptic seizures have been reported in CT and MRI studies. However, the interpretation of transient peri-ictal MRI abnormalities is routinely based on qualitative visual analysis and therefore reader dependent. In this retrospective study, we investigated the diagnostic yield of visual analysis of perfusion MRI during ictal and postictal states based on comparative expert ratings in 51 patients. We further propose an automated semi-quantitative method for perfusion analysis to determine perfusion abnormalities observed during ictal and postictal MRI using dynamic susceptibility contrast MRI, which we validated on a subcohort of 27 patients. The semi-quantitative method provides a parcellation of 3D T1-weighted images into 32 standardized cortical regions of interests and subcortical grey matter structures based on a recently proposed method, direct cortical thickness estimation using deep learning-based anatomy segmentation and cortex parcellation for brain anatomy segmentation. Standard perfusion maps from a Food and Drug Administration-approved image analysis tool (Olea Sphere 3.0) were co-registered and investigated for region-wise differences between ictal and postictal states. These results were compared against the visual analysis of two readers experienced in functional image analysis in epilepsy. In the ictal group, cortical hyperperfusion was present in 17/18 patients (94% sensitivity), whereas in the postictal cohort, cortical hypoperfusion was present only in 9/33 (27%) patients while 24/33 (73%) showed normal perfusion. The (semi-)quantitative dynamic susceptibility contrast MRI perfusion analysis indicated increased thalamic perfusion in the ictal cohort and hypoperfusion in the postictal cohort. Visual ratings between expert readers performed well on the patient level, but visual rating agreement was low for analysis of subregions of the brain. The asymmetry of the automated image analysis correlated significantly with the visual consensus ratings of both readers. We conclude that expert analysis of dynamic susceptibility contrast MRI effectively discriminates ictal versus postictal perfusion patterns. Automated perfusion evaluation revealed favourable interpretability and correlated well with the classification of the visual ratings. It may therefore be employed for high-throughput, large-scale perfusion analysis in extended cohorts, especially for research questions with limited expert rater capacity.
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Affiliation(s)
- Manuel Köstner
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland.,Faculty of Medicine, University of Bern, Bern CH-3008, Switzerland
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern CH-3012, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland.,Translational Imaging Center (TIC), sitem-Insel, Bern University Hospital, Bern CH-3010, Switzerland
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland
| | - Baudouin Jin
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Raphael Meier
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland
| | - Uzeyir Ahmadli
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland
| | - Kaspar Schindler
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern University Hospital, Bern CH-3010, Switzerland.,Translational Imaging Center (TIC), sitem-Insel, Bern University Hospital, Bern CH-3010, Switzerland
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17
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Verdijk JPAJ, Schuur G, Pottkämper JCM, Ten Doesschate F, Hofmeijer J, van Waarde JA. Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study. Front Psychiatry 2023; 14:1026014. [PMID: 36846232 PMCID: PMC9947286 DOI: 10.3389/fpsyt.2023.1026014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is associated with postictal confusion and cognitive side-effects. In rats, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and calcium antagonists decreased postictal cerebral hypoperfusion along with reduction in postictal symptoms. In this study, in ECT-patients, we explore associations between use of these potentially protective medications and occurrence of postictal confusion and cognitive outcome. MATERIALS AND METHODS In this retrospective, naturalistic cohort study, patient-, treatment-, and ECT-characteristics, were collected from medical files of patients treated with ECT for major depressive disorder (MDD) or bipolar depressive episode. To test for associations of use of these medications with occurrence of postictal confusion, 295 patients could be included. Cognitive outcome data were available in a subset of 109 patients. Univariate analyses and multivariate censored regression models were used to test for associations. RESULTS Occurrence of severe postictal confusion was not associated with use of acetaminophen, NSAIDs or calcium antagonists (n = 295). Regarding the cognitive outcome measure (n = 109), use of calcium antagonists was associated with higher post-ECT cognitive scores (i.e., better cognitive outcome; β = 2.23; p = 0.047), adjusted for age (β = -0.02; p = 0.23), sex (β = -0.21; p = 0.73), pre-ECT cognitive score (β = 0.47; p < 0.0001), and post-ECT depression score (β = -0.02; p = 0.62), but use of acetaminophen (β = -1.55; p = 0.07) as well as NSAIDs (β = -1.02; p = 0.23) showed no associations. CONCLUSION This retrospective study does not find arguments for protective effects of acetaminophen, NSAIDs or calcium antagonists against severe postictal confusion in ECT. As a preliminary finding, the use of calcium antagonists was associated with improved cognitive outcome after ECT in this cohort. Prospective controlled studies are necessary.
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Affiliation(s)
- Joey P A J Verdijk
- Department of Psychiatry, Rijnstate Hospital, Arnhem, Netherlands.,Department of Clinical Neurophysiology, TechMed Centre, University of Twente, Enschede, Netherlands
| | - Gijsbert Schuur
- Department of Psychiatry, Rijnstate Hospital, Arnhem, Netherlands
| | - Julia C M Pottkämper
- Department of Psychiatry, Rijnstate Hospital, Arnhem, Netherlands.,Department of Clinical Neurophysiology, TechMed Centre, University of Twente, Enschede, Netherlands
| | | | - Jeannette Hofmeijer
- Department of Clinical Neurophysiology, TechMed Centre, University of Twente, Enschede, Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, Netherlands
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18
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Harris SA, George AG, Barrett KT, Scantlebury MH, Teskey GC. Febrile seizures lead to prolonged epileptiform activity and hyperoxia that when blocked prevents learning deficits. Epilepsia 2022; 63:2650-2663. [DOI: 10.1111/epi.17371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Sydney A. Harris
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
| | - Antis G. George
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
| | - Karlene T. Barrett
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Departments of Pediatrics and Clinical Neurosciences University of Calgary Calgary AB Canada
| | - Morris H. Scantlebury
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Departments of Pediatrics and Clinical Neurosciences University of Calgary Calgary AB Canada
| | - G. Campbell Teskey
- Hotchkiss Brain Institute University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Department of Cell Biology and Anatomy University of Calgary Calgary AB Canada
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19
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Horsley JJ, Schroeder GM, Thomas RH, de Tisi J, Vos SB, Winston GP, Duncan JS, Wang Y, Taylor PN. Volumetric and structural connectivity abnormalities co-localise in TLE. Neuroimage Clin 2022; 35:103105. [PMID: 35863179 PMCID: PMC9421455 DOI: 10.1016/j.nicl.2022.103105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/17/2022] [Accepted: 06/29/2022] [Indexed: 12/02/2022]
Abstract
Patients with temporal lobe epilepsy (TLE) exhibit both volumetric and structural connectivity abnormalities relative to healthy controls. How these abnormalities inter-relate and their mechanisms are unclear. We computed grey matter volumetric changes and white matter structural connectivity abnormalities in 144 patients with unilateral TLE and 96 healthy controls. Regional volumes were calculated using T1-weighted MRI, while structural connectivity was derived using white matter fibre tractography from diffusion-weighted MRI. For each regional volume and each connection strength, we calculated the effect size between patient and control groups in a group-level analysis. We then applied hierarchical regression to investigate the relationship between volumetric and structural connectivity abnormalities in individuals. Additionally, we quantified whether abnormalities co-localised within individual patients by computing Dice similarity scores. In TLE, white matter connectivity abnormalities were greater when joining two grey matter regions with abnormal volumes. Similarly, grey matter volumetric abnormalities were greater when joined by abnormal white matter connections. The extent of volumetric and connectivity abnormalities related to epilepsy duration, but co-localisation did not. Co-localisation was primarily driven by neighbouring abnormalities in the ipsilateral hemisphere. Overall, volumetric and structural connectivity abnormalities were related in TLE. Our results suggest that shared mechanisms may underlie changes in both volume and connectivity alterations in patients with TLE.
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Affiliation(s)
- Jonathan J Horsley
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gabrielle M Schroeder
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rhys H Thomas
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia; Centre for Medical Image Computing, Computer Science Department, University College London, London, United Kingdom
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Division of Neurology, Department of Medicine, Queen's University, Kingston, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yujiang Wang
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter N Taylor
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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20
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Watanabe Y, Sano F, Fukao T, Shimizu T, Sawanobori E, Kobayashi A, Fujioka K, Yagasaki H, Inukai T, Kaga Y. Arterial spin labeling perfusion imaging in an infant with anti-N-methyl-D-aspartate receptor encephalitis: A case report. Brain Dev 2022; 44:405-409. [PMID: 35346541 DOI: 10.1016/j.braindev.2022.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/31/2022] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an autoimmune encephalitis characterized by complex neuropsychiatric syndromes and the presence of cerebrospinal fluid (CSF) antibodies against NMDAR. The characteristics of anti-NMDAR encephalitis in children, particularly infants, are unclear due to difficulties in neurologic assessment such as psychiatric symptoms. Additionally, subtle or non-specific findings of conventional magnetic resonance imaging (MRI) make early diagnosis even more difficult. Herein, we present the first case of infant anti-NMDAR encephalitis in which perfusion imaging demonstrated marked abnormalities and the absence of conventional MRI findings. CASE PRESENTATION The patient was an 11-month-old boy who was admitted because of seizure and prolonged fever. He presented with involuntary movements of the mouth and tongue. Brain MRI showed no morphological abnormalities, but three-dimensional arterial spin labeling (ASL) perfusion imaging showed reduced blood flow in the left temporal and frontal regions and the right cerebellum. After that, a positive anti-NMDAR antibody test result was received. Despite treatment with IVIG and methylprednisolone, the involuntary movements and autonomic dysfunction gradually became more prominent. After rituximab administration, the clinical symptoms improved slightly, and follow-up MRI revealed diffuse brain atrophy and improvement in the balance of brain perfusion. CONCLUSIONS To the best of our knowledge, this is the first case report of infantile anti-NMDAR encephalitis in which cerebral blood flow was evaluated using three-dimensional ASL perfusion imaging. Indeed, our case, which showed abnormalities only in ASL perfusion imaging, suggests that CBF assessment could aid in the early diagnosis of anti-NMDAR encephalitis in infants.
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Affiliation(s)
- Yuriko Watanabe
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Fumikazu Sano
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
| | - Toshimichi Fukao
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuya Shimizu
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Emi Sawanobori
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Anna Kobayashi
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kaoru Fujioka
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hideaki Yagasaki
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takeshi Inukai
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yoshimi Kaga
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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21
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Li R, Jin S, Wang Y, Li JF, Xiao HF, Wang YL, Ma L. Brain Perfusion Alterations on 3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in Patients with Autoimmune Encephalitis: A Case Series and Literature Review. AJNR Am J Neuroradiol 2022; 43:701-706. [PMID: 35393361 PMCID: PMC9089268 DOI: 10.3174/ajnr.a7478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/08/2022] [Indexed: 01/26/2023]
Abstract
Autoimmune encephalitis is a heterogeneous group of newly identified disorders that are being diagnosed with increasing frequency. Early recognition and treatment of autoimmune encephalitis are crucial for patients, but diagnosis remains challenging and time-consuming. In this retrospective case series, we describe the findings of conventional MR imaging and 3D pseudocontinuous arterial spin-labeling in patients with autoimmune encephalitis confirmed by antibody testing. All patients with autoimmune encephalitis showed increased CBF in the affected area, even when some of them presented with normal or slightly abnormal findings on conventional MR imaging. Additionally, serial 3D pseudocontinuous arterial spin-labeling showed perfusion reduction in 1 patient after therapy. For patients with highly suspected autoimmune encephalitis, 3D pseudocontinuous arterial spin-labeling may be added to the clinical work-up. Further studies and longitudinal data are needed to corroborate whether and to what extent 3D pseudocontinuous arterial spin-labeling improves the diagnostic work-up in patients with autoimmune encephalitis compared with conventional MR imaging.
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Affiliation(s)
- R. Li
- From the Department of Medical Imaging (R.L., S.J.), Tianjin Huanhu Hospital, Tianjin, China,Department of Radiology (R.L., Y.W., J.-F.L., H.-F.X., Y.-L.W., L.M.), The First Medical Center of PLA General Hospital, Beijing, China,Department of Medical Imaging (R.L., S.J.), Affiliated Huanhu Hospital of Nankai University, Tianjin, China
| | - S. Jin
- From the Department of Medical Imaging (R.L., S.J.), Tianjin Huanhu Hospital, Tianjin, China,Department of Medical Imaging (R.L., S.J.), Affiliated Huanhu Hospital of Nankai University, Tianjin, China
| | - Y. Wang
- Department of Radiology (R.L., Y.W., J.-F.L., H.-F.X., Y.-L.W., L.M.), The First Medical Center of PLA General Hospital, Beijing, China
| | - J.-F. Li
- Department of Radiology (R.L., Y.W., J.-F.L., H.-F.X., Y.-L.W., L.M.), The First Medical Center of PLA General Hospital, Beijing, China
| | - H.-F. Xiao
- Department of Radiology (R.L., Y.W., J.-F.L., H.-F.X., Y.-L.W., L.M.), The First Medical Center of PLA General Hospital, Beijing, China
| | - Y.-L. Wang
- Department of Radiology (R.L., Y.W., J.-F.L., H.-F.X., Y.-L.W., L.M.), The First Medical Center of PLA General Hospital, Beijing, China
| | - L. Ma
- Department of Radiology (R.L., Y.W., J.-F.L., H.-F.X., Y.-L.W., L.M.), The First Medical Center of PLA General Hospital, Beijing, China
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22
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Kitajima M, Uetani H. Arterial Spin Labeling for Pediatric Central Nervous System Diseases: Techniques and Clinical Applications. Magn Reson Med Sci 2022; 22:27-43. [PMID: 35321984 PMCID: PMC9849418 DOI: 10.2463/mrms.rev.2021-0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL) are techniques used to evaluate brain perfusion using MRI. DSC requires dynamic image acquisition with a rapid administration of gadolinium-based contrast agent. In contrast, ASL obtains brain perfusion information using magnetically labeled blood water as an endogenous tracer. For the evaluation of brain perfusion in pediatric neurological diseases, ASL has a significant advantage compared to DSC, CT, and single-photon emission CT/positron emission tomography because of the lack of radiation exposure and contrast agent administration. However, in ASL, optimization of several parameters, including the type of labeling, image acquisition, background suppression, and postlabeling delay, is required, because they have a significant effect on the quantification of cerebral blood flow (CBF).In this article, we first review recent technical developments of ASL and age-dependent physiological characteristics in pediatric brain perfusion. We then review the clinical implementation of ASL in pediatric neurological diseases, including vascular diseases, brain tumors, acute encephalopathy with biphasic seizure and late reduced diffusion (AESD), and migraine. In moyamoya disease, ASL can be used for brain perfusion and vessel assessment in pre- and post-treatment. In arteriovenous malformations, ASL is sensitive to detect small degrees of shunt. Furthermore, in vascular diseases, the implementation of ASL-based time-resolved MR angiography is described. In neoplasms, ASL-derived CBF has a high diagnostic accuracy for differentiation between low- and high-grade pediatric brain tumors. In AESD and migraine, ASL may allow for accurate early diagnosis and provide pathophysiological information.
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Affiliation(s)
- Mika Kitajima
- Department of Medical Imaging Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan,Corresponding author: 4-24-1, Kuhonji, Chuo-ku, Kumamoto, Kumamoto 862-0976, Japan. Phone: +81-373-5483, Fax: +81-373-5519, E-mail:
| | - Hiroyuki Uetani
- Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
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23
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Alcohol abuse has a potential association with unfavourable clinical course and brain atrophy in patients with status epilepticus. Clin Radiol 2022; 77:e287-e294. [PMID: 35093234 DOI: 10.1016/j.crad.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/23/2021] [Indexed: 11/20/2022]
Abstract
AIM To evaluate chronological changes on serial magnetic resonance imaging (MRI) examinations and clinical prognosis in patients with status epilepticus (SE), as well as the effect of alcohol abuse and heavy alcohol use on clinicoradiological findings. MATERIALS AND METHODS This retrospective, single-centre study was approved by the institutional review board. Among 345 patients with seizures between January 2010 and October 2021, 27 patients with SE who had undergone both initial MRI (within a week after onset) and follow-up MRI (within 1 month after the initial MRI) were included. Five and three patients with concurrent or previous alcohol abuse and heavy alcohol-use history were included, respectively, and they were classified into the AL (Alcohol use) group. The remaining 19 patients were classified into the non-AL group. Two neuroradiologists independently evaluated both initial and follow-up MRI examinations of each patient; MRI findings were compared between the AL and non-AL groups using Fisher's exact test. In 15 patients, including four patients from the AL group, clinical information 6 months after the onset of SE was available; this information was compared between the two groups. RESULTS Brain atrophy (5/8 versus 2/19, p=0.011; odds ratio, 12.29 [95% confidence interval, 1.32-189.2]) and unfavourable clinical course with uncontrollable seizures (3/4 versus 1/11, p=0.033; odds ratio, 30[1.43-638.19]) were significantly more frequent in the AL group than in the non-AL group. CONCLUSION Among patients with SE, alcohol abuse and heavy alcohol-use history were associated with unfavourable seizure control and brain atrophy.
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24
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Li T, Niu S, Qiu X, Zhai Z, Yang L, Chen L, Zhang XM. Altered Cerebral Blood Flow is Linked to Disease Duration in Patients with Generalized tonic‒clonic Seizures. Neuropsychiatr Dis Treat 2022; 18:2649-2659. [PMID: 36387946 PMCID: PMC9662018 DOI: 10.2147/ndt.s386509] [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: 08/17/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate cerebral blood flow (CBF) characteristics in individuals with generalized tonic‒clonic seizures (GTCS) during the interictal phase using voxel-based analysis of 3D pseudocontinuous arterial spin labeling (PCASL). PATIENTS AND METHODS Patients with GTCS (GTCS group) (during the interictal period) and healthy volunteers (control group) underwent head MR imaging with a 3.0T MR scanner with a 3D PCASL sequence. CBF was compared between the two groups. Spearman correlations of CBF in regions of interest (ROIs) in GTCS patients with the duration of disease and age of onset were analyzed and corrected using the false discovery rate (FDR). RESULTS Twenty patients with GTCS (GTCS group) and twenty healthy volunteers (control group) were recruited for this study. On 3D PCASL, (1) GTCS patients had lower CBF in the brainstem, right cerebellum, right inferior temporal gyrus, parahippocampal gyrus, superior frontal gyrus, middle frontal gyrus, triangular part of inferior frontal gyrus, left temporal pole of superior temporal gyrus and thalamus and had higher CBF in the bilateral superior parietal gyri, precuneus, precentral gyri, postcentral gyri, and left dorsolateral superior frontal gyrus than controls. (2) The CBF of the right temporal pole of the middle temporal gyrus was negatively correlated with the duration of disease (PFDRcorrected<0.05), with a correlation coefficient r of -0.7333 and a PFDRcorrected value of 0.04. CONCLUSION Voxel-based analysis of 3D PCASL imaging can be used to sensitively detect brain perfusion differences in GTCS patients. The decrease in CBF in the right temporal pole of the middle temporal gyrus may be associated with disease onset. These findings may offer new perspectives on the pathogenesis of GTCS and the underlying pathophysiological changes associated with perfusion.
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Affiliation(s)
- Ting Li
- The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China.,Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Shaowei Niu
- Department of Infection, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Xiang Qiu
- Department of Radiology, Integrated TCM & Western Medicine Hospital Affiliated to Chengdu University of TCM, Chengdu First People's Hospital, Chengdu, People's Republic of China
| | - Zhaohua Zhai
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Lin Yang
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Li Chen
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Xiao Ming Zhang
- The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China.,Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
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25
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Kim TJ, Choi JW, Han M, Kim BG, Park SA, Huh K, Choi JY. Usefulness of arterial spin labeling perfusion as an initial evaluation of status epilepticus. Sci Rep 2021; 11:24218. [PMID: 34930959 PMCID: PMC8688435 DOI: 10.1038/s41598-021-03698-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/06/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to evaluate the sensitivity and prognostic value of arterial spin labeling (ASL) in a large group of status epilepticus (SE) patients and compare them with those of other magnetic resonance (MR) sequences, including dynamic susceptibility contrast (DSC) perfusion imaging. We retrospectively collected data of patients with SE in a tertiary center between September 2016 and March 2020. MR images were visually assessed, and the sensitivity for the detection of SE and prognostication was compared among multi-delay ASL, DSC, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). We included 51 SE patients and 46 patients with self-limiting seizures for comparison. Relevant changes in ASL were observed in 90.2% (46/51) of SE patients, a percentage higher than those for DSC, FLAIR, and DWI. ASL was the most sensitive method for initial differentiation between SE and self-limiting seizures. The sensitivity of ASL for detecting refractory SE (89.5%) or estimating poor outcomes (100%) was higher than those of other MR protocols or electroencephalography and comparable to those of clinical prognostic scores, although the specificity of ASL was very low as 9.4% and 15.6%, respectively. ASL showed a better ability to detect SE and predict the prognosis than other MR sequences, therefore it can be valuable for the initial evaluation of patients with SE.
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Affiliation(s)
- Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Miran Han
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Byung Gon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.,Departments of Brain Science and Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Sun Ah Park
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Anatomy, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyoon Huh
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jun Young Choi
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea. .,Departments of Brain Science and Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
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26
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Pasca L, Sanvito F, Ballante E, Totaro M, Paoletti M, Bergui A, Varesio C, Rognone E, De Giorgis V, Pichiecchio A. Arterial spin labelling qualitative assessment in paediatric patients with MRI-negative epilepsy. Clin Radiol 2021; 76:942.e15-942.e23. [PMID: 34645570 DOI: 10.1016/j.crad.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the usefulness of arterial spin labelling (ASL) qualitative analysis for the localisation of seizure-related perfusion abnormalities in paediatric patients with negative brain magnetic resonance imaging (MRI) epilepsy. MATERIALS AND METHODS Forty-two patients with a diagnosis of MRI-negative focal or generalised epilepsy, who underwent electroencephalogram (EEG) and MRI with ASL in the interictal phase were included. Perfusion abnormalities were evaluated through a qualitative assessment and then compared to EEG seizure focus. RESULTS Among the 42 patients, 26 had focal epilepsy and 16 had generalised epilepsy. Thirty-three patients (79%) showed a perfusion abnormality, mainly hypoperfusion (74.5% of all ASL alterations), whereas hyperperfused alterations were more represented in patients who experienced the last seizure either less than 48 hours prior to ASL acquisition or in the time interval from 1 week to 1 month prior to ASL acquisition (p=0.034). Concordance of ASL abnormality and EEG focus was found in 33 patients (78.5%), as complete in 17 (40.5%) and as partial in 16 (38%). A trend of higher concordance was found in focal epilepsies compared to generalised epilepsies (p=0.059). The concordance between ASL and EEG major alterations was higher for hyperperfused anomalies than for hypoperfused ones (p=0.009). Variables such as age, sedation, and time from last seizure were not significant contributors for concordance. CONCLUSIONS The combined use of qualitative ASL and brain MRI and scalp EEG could be a potential tool in daily clinical practice.
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Affiliation(s)
- L Pasca
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy; Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
| | - F Sanvito
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - E Ballante
- Department of Mathematics, University of Pavia, Pavia, Italy; BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - M Totaro
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy; Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
| | - M Paoletti
- Advanced Imaging and Radiomics, Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - A Bergui
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - C Varesio
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy
| | - E Rognone
- Advanced Imaging and Radiomics, Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - V De Giorgis
- Department of Child Neurology and Psychiatry, IRCSS Mondino Foundation, Pavia, Italy.
| | - A Pichiecchio
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy; Advanced Imaging and Radiomics, Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
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Farrell JS, Colangeli R, Dong A, George AG, Addo-Osafo K, Kingsley PJ, Morena M, Wolff MD, Dudok B, He K, Patrick TA, Sharkey KA, Patel S, Marnett LJ, Hill MN, Li Y, Teskey GC, Soltesz I. In vivo endocannabinoid dynamics at the timescale of physiological and pathological neural activity. Neuron 2021; 109:2398-2403.e4. [PMID: 34352214 PMCID: PMC8351909 DOI: 10.1016/j.neuron.2021.05.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/06/2021] [Accepted: 05/19/2021] [Indexed: 10/20/2022]
Abstract
The brain's endocannabinoid system is a powerful controller of neurotransmitter release, shaping synaptic communication under physiological and pathological conditions. However, our understanding of endocannabinoid signaling in vivo is limited by the inability to measure their changes at timescales commensurate with the high lability of lipid signals, leaving fundamental questions of whether, how, and which endocannabinoids fluctuate with neural activity unresolved. Using novel imaging approaches in awake behaving mice, we now demonstrate that the endocannabinoid 2-arachidonoylglycerol, not anandamide, is dynamically coupled to hippocampal neural activity with high spatiotemporal specificity. Furthermore, we show that seizures amplify the physiological endocannabinoid increase by orders of magnitude and drive the downstream synthesis of vasoactive prostaglandins that culminate in a prolonged stroke-like event. These results shed new light on normal and pathological endocannabinoid signaling in vivo.
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Affiliation(s)
- Jordan S Farrell
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Anatomy and Cell Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | - Roberto Colangeli
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Anatomy and Cell Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Ao Dong
- State Key Laboratory of Membrane Biology, School of Life Sciences, PKU-THU Center for Life Sciences, IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Antis G George
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Anatomy and Cell Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Kwaku Addo-Osafo
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Anatomy and Cell Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Philip J Kingsley
- A.B. Hancock Jr. Memorial Laboratory for Cancer Research, Departments of Biochemistry, Chemistry, and Pharmacology, Vanderbilt Institute of Chemical Biology, Center in Molecular Toxicology, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Maria Morena
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Anatomy and Cell Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Marshal D Wolff
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Anatomy and Cell Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Barna Dudok
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Kaikai He
- State Key Laboratory of Membrane Biology, School of Life Sciences, PKU-THU Center for Life Sciences, IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Toni A Patrick
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Keith A Sharkey
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Sachin Patel
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lawrence J Marnett
- A.B. Hancock Jr. Memorial Laboratory for Cancer Research, Departments of Biochemistry, Chemistry, and Pharmacology, Vanderbilt Institute of Chemical Biology, Center in Molecular Toxicology, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Matthew N Hill
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Anatomy and Cell Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Yulong Li
- State Key Laboratory of Membrane Biology, School of Life Sciences, PKU-THU Center for Life Sciences, IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - G Campbell Teskey
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Anatomy and Cell Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Ivan Soltesz
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
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28
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Zeng JY, Hu XQ, Xu JF, Zhu WJ, Wu HY, Dong FJ. Diagnostic Accuracy of Arterial Spin-Labeling MR Imaging in Detecting the Epileptogenic Zone: Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2021; 42:1052-1060. [PMID: 33766822 DOI: 10.3174/ajnr.a7061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND A noninvasive, safe, and economic imaging technique is required to identify epileptogenic lesions in the brain. PURPOSE Our aim was to perform a meta-analysis evaluating the accuracy of arterial spin-labeling in localizing the epileptic focus in the brain and the changes in the blood perfusion in these regions. DATA SOURCES Our sources were the PubMed and EMBASE data bases. STUDY SELECTION English language studies that assessed the diagnostic accuracy of arterial spin-labeling for detecting the epileptogenic zone up to July 2019 were included. DATA ANALYSIS The symptomatogenic foci of seizures in the brain were determined and used as the references. The relevant studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The outcomes were evaluated using the pooled sensitivity, pooled specificity, pooled accuracy, diagnostic odds ratio, area under the summary receiver operating characteristic curve, and likelihood ratio. DATA SYNTHESIS Six studies that included 174 patients qualified for this meta-analysis. The pooled sensitivity, pooled specificity, and area under the summary receiver operating characteristic curve were 0.74 (95% CI, 0.65-0.82), 0.35 (95% CI, 0.03-0.90), and 0.73 (95% CI, 0.69-0.76), respectively. The accuracy of arterial spin-labeling for localizing the epileptic focus was 0.88 (accuracy in arterial spin-labeling/all perfusion changes in arterial spin-labeling) in cases of a positive arterial spin-labeling result. The epileptogenic zone exhibited hyperperfusion or hypoperfusion. LIMITATIONS Only a few studies were enrolled due to the strict inclusion criteria. CONCLUSIONS Arterial spin-labeling can be used for assessing, monitoring, and reviewing, postoperatively, patients with epilepsy. Blood perfusion changes in the brain may be closely related to the seizure time and pattern.
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Affiliation(s)
- J Y Zeng
- From the Department of Ultrasound (J.Z., X.H., J.X., H.W., F.D.), First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - X Q Hu
- From the Department of Ultrasound (J.Z., X.H., J.X., H.W., F.D.), First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
- Integrated Chinese and Western Medicine Postdoctoral Research Station (X.H.), Jinan University, Guangzhou, China
| | - J F Xu
- From the Department of Ultrasound (J.Z., X.H., J.X., H.W., F.D.), First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - W J Zhu
- QQ Music Business group of Tencent Music Entertainment Group (W.Z.), Shenzhen People's Hospital, Shenzhen, China
| | - H Y Wu
- From the Department of Ultrasound (J.Z., X.H., J.X., H.W., F.D.), First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - F J Dong
- From the Department of Ultrasound (J.Z., X.H., J.X., H.W., F.D.), First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
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29
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Gajdoš M, Říha P, Kojan M, Doležalová I, Mutsaerts HJMM, Petr J, Rektor I. Epileptogenic zone detection in MRI negative epilepsy using adaptive thresholding of arterial spin labeling data. Sci Rep 2021; 11:10904. [PMID: 34035336 PMCID: PMC8149682 DOI: 10.1038/s41598-021-89774-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022] Open
Abstract
Drug-resistant epilepsy is a diagnostic and therapeutic challenge, mainly in patients with negative MRI findings. State-of-the-art imaging methods complement standard epilepsy protocols with new information and help epileptologists to increase the reliability of their decisions. In this study, we investigate whether arterial spin labeling (ASL) perfusion MRI can help localize the epileptogenic zone (EZ). To that end, we developed an image processing method to detect the EZ as an area with hypoperfusion relative to the contralateral unaffected side, using subject-specific thresholding of the asymmetry index in ASL images. We demonstrated three thresholding criteria (termed minimal product criterion, minimal distance criterion, and elbow criterion) on 29 patients with MRI-negative epilepsy (age 32.98 ± 10.4 years). The minimal product criterion showed optimal results in terms of positive predictive value (mean 0.12 in postoperative group and 0.22 in preoperative group) and true positive rate (mean 0.71 in postoperative group and 1.82 in preoperative group). Additionally, we found high accuracy in determining the EZ side (mean 0.86 in postoperative group and 0.73 in preoperative group out of 1.00). ASL can be easily incorporated into the standard presurgical MR protocol, and it provides an additional benefit in EZ localization.
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Affiliation(s)
- Martin Gajdoš
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic
| | - Pavel Říha
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic.,Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Medical Faculty of Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Martin Kojan
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic.,Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Medical Faculty of Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Irena Doležalová
- Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Medical Faculty of Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, University Hospital Ghent, Ghent, Belgium
| | - Jan Petr
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Ivan Rektor
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic. .,Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Medical Faculty of Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic.
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30
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Ictal hypoperfusion and iron deposition in the symptomatogenic zone of epilepsia partialis continua - A case report. Seizure 2021; 89:56-58. [PMID: 34015570 DOI: 10.1016/j.seizure.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022] Open
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31
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Ebrahimi T, Tafakhori A, Hashemi H, Ali Oghabian M. An interictal measurement of cerebral oxygen extraction fraction in MRI-negative refractory epilepsy using quantitative susceptibility mapping. Phys Med 2021; 85:87-97. [PMID: 33984822 DOI: 10.1016/j.ejmp.2021.03.039] [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: 01/08/2021] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Oxygen extraction fraction (OEF) can be a factor to identify brain tissue's disability in epileptic patients. This study aimed to assess the OEF's level measurement in refractory epileptic patients (REPs) using a quantitative susceptibility mapping (QSM) method and to determine whether the OEF parameters change. METHODS QSM-OEF maps of 26 REPs and 16 healthy subjects were acquired using 3T MRI with a 64-channel coil. Eighteen regions-of-interest (ROIs) were chosen around the cortex in one appropriate slice of the brain and the mean QSM-OEF for each ROI was obtained. The correlations of QSM-OEF among different clinical characteristics of the disease, as well as between the patients and normal subjects, were also investigated. RESULTS QSM-OEF was shown to be significantly higher in REPs (44.9 ± 5.8) than that in HS (41.9 ± 6.2) (p < 0.05). Mean QSM-OEF was statistically lower in the ipsilateral side (44.5 ± 6.6) compared to the contralateral side (46.4 ± 6.8) (P < 0.01). QSM-OEF was illustrated to have a strong positive correlation with the attack duration (r = 0.6), and a moderate negative correlation with the attack frequency (r = -0.3). Using an optimized support vector machine algorithm, we could predict the disease in subjects having abnormal OEF values in the brain-selected-ROIs with sensitivity, specificity, AUC, and the precision of 0.96, 1, 0.98, and 1, respectively. CONCLUSIONS The results of this study revealed that QSM-OEF of the REPs' brain is higher than that of HS, which indicates that QSM-OEF is associated with disease activity.
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Affiliation(s)
- Tayyebeh Ebrahimi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Tafakhori
- Iranian Center of Neurological Research (ICNR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hassan Hashemi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Oghabian
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Molecular and Cellular Imaging, Tehran University of Medical Science, Tehran, Iran.
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32
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Gom RC, Bhatt D, Villa BR, George AG, Lohman AW, Mychasiuk R, Rho JM, Teskey GC. The ketogenic diet raises brain oxygen levels, attenuates postictal hypoxia, and protects against learning impairments. Neurobiol Dis 2021; 154:105335. [PMID: 33741453 DOI: 10.1016/j.nbd.2021.105335] [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: 01/04/2021] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES A prolonged vasoconstriction/hypoperfusion/hypoxic event follows self-terminating focal seizures. The ketogenic diet (KD) has demonstrated efficacy as a metabolic treatment for intractable epilepsy and other disorders but its effect on local brain oxygen levels is completely unknown. This study investigated the effects of the KD on tissue oxygenation in the hippocampus before and after electrically elicited (kindled) seizures and whether it could protect against a seizure-induced learning impairment. We also examined the effects of the ketone β-hydroxybutyrate (BHB) as a potential underlying mechanism. METHODS Male and female rats were given access to one of three diet protocols 2 weeks prior to the initiation of seizures: KD, caloric restricted standard chow, and ad libitum standard chow. Dorsal hippocampal oxygen levels were measured prior to initiation of diets as well as before and after a 10-day kindling paradigm. Male rats were then tested on a novel object recognition task to assess postictal learning impairments. In a separate cohort, BHB was administered 30 min prior to seizure elicitation to determine whether it influenced oxygen dynamics. RESULTS The KD increased dorsal hippocampal oxygen levels, ameliorated postictal hypoxia, and prevented postictal learning impairments. Acute BHB administration did not alter oxygen levels before or after seizures. INTERPRETATION The ketogenic diet raised brain oxygen levels and attenuated severe postictal hypoxia likely through a mechanism independent of ketosis and shows promise as a non-pharmacological treatment to prevent the postictal state.
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Affiliation(s)
- Renaud C Gom
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, CA, Canada.
| | - Dhyey Bhatt
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, CA, Canada
| | - Bianca R Villa
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, CA, Canada
| | - Antis G George
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, CA, Canada
| | - Alexander W Lohman
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, CA, Canada
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Jong M Rho
- Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine University of Calgary, Calgary, CA, Canada; Departments of Neurosciences and Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, California, USA
| | - G Campbell Teskey
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, CA, Canada
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33
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Yoo HL, Choi YJ, Moon JH, Jo HJ, Park DW. Serial Perfusion and Vascular Changes after a Prolonged Seizure. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2020.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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34
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Lam J, Tomaszewski P, Gilbert G, Moreau JT, Guiot MC, Albrecht S, Farmer JP, Atkinson J, Saint-Martin C, Wintermark P, Bernhardt B, Baillet S, Dudley RWR. The utility of arterial spin labeling in the presurgical evaluation of poorly defined focal epilepsy in children. J Neurosurg Pediatr 2020; 27:243-252. [PMID: 33361483 DOI: 10.3171/2020.7.peds20397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to assess the utility of arterial spin labeling (ASL) perfusion 3T-MRI for the presurgical evaluation of poorly defined focal epilepsy in pediatric patients. METHODS Pseudocontinuous ASL perfusion 3T-MRI was performed in 25 consecutive children with poorly defined focal epilepsy. ASL perfusion abnormalities were detected qualitatively by visual inspection and quantitatively by calculating asymmetry index (AI) maps and significant z-score cluster maps based on successfully operated cases. ASL results were prospectively compared to scalp EEG, structural 3T-MRI, FDG-PET, ictal/interictal SPECT, magnetoencephalography (MEG), and intracranial recording results, as well as the final surgically proven epileptogenic zone (EZ) in operated patients who had at least 1 year of good (Engel class I/II) seizure outcome and positive histopathology results. RESULTS Qualitative ASL perfusion abnormalities were found in 17/25 cases (68%), specifically in 17/20 MRI-positive cases (85.0%) and in none of the 5 MRI-negative cases. ASL was concordant with localizing scalp EEG findings in 66.7%, structural 3T-MRI in 90%, FDG-PET in 75%, ictal/interictal SPECT in 62.5%, and MEG in 75% of cases, and with intracranial recording results in 40% of cases. Eleven patients underwent surgery; in all 11 cases the EZ was surgically proven by positive histopathology results and the patient having at least 1 year of good seizure outcome. ASL results were concordant with this final surgically proven EZ in 10/11 cases (sensitivity 91%, specificity 50%). All 10 ASL-positive patients who underwent surgery had positive surgical pathology results and good long-term postsurgical seizure outcome at a mean follow-up of 39 months. Retrospective quantitative analysis based on significant z-score clusters found 1 true-positive result that was missed by qualitative analysis and 3 additional false-positive results (sensitivity 100%, specificity 23%). CONCLUSIONS ASL supports the hypothesis regarding the EZ in poorly defined focal epilepsy cases in children. Due to its convenience and noninvasive nature, the authors recommend that ASL be added routinely to the presurgical MRI evaluation of epilepsy. Future optimized quantitative methods may improve the diagnostic yield of this technique.
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Affiliation(s)
- Jack Lam
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
| | - Patricia Tomaszewski
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
| | - Guillaume Gilbert
- 2Philips Canada, MRI Research Department, Montréal; and Departments of
| | - Jeremy T Moreau
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
| | | | | | | | | | | | - Pia Wintermark
- 6Neonatology, McGill University Health Network, Montréal, Quebec, Canada
| | - Boris Bernhardt
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
| | - Sylvain Baillet
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
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35
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Self-limited epilepsy with centro-temporal spikes: A study of 46 patients with unusual clinical manifestations. Epilepsy Res 2020; 169:106507. [PMID: 33296810 DOI: 10.1016/j.eplepsyres.2020.106507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE We retrospectively analyzed the seizure characteristics, EEG pattern, treatment, and outcome in a series of patients with self-limited epilepsy with centrotemporal spikes (SLECTS) who presented with unusual clinical manifestations. METHOD A retrospective, descriptive, multicenter study was conducted evaluating 46 patients with SLECTS who had seizures with an unusual semiology. We collected data from patients with SLECTS seen at eight Argentine centers between April 1998 and April 2018. RESULTS Thirteen patients (28.2 %) had seizures with affective symptoms characterized by sudden fright and autonomic disturbances and mild impairment of consciousness. Eleven patients (24.8 %) had frequent seizures characterized by unilateral facial sensorimotor symptoms, oropharyngolaryngeal manifestations, and speech arrest with sialorrhea only when awake. Seven patients (15.3 %) started with opercular epileptic status with unilateral or bilateral clonic seizures of the mouth with speech arrest and sialorrhea when awake and during sleep. Seven patients (15.3 %) had postictal Todd's paralysis after unilateral clonic seizures with facial and limb movements lasting between 60 min and 130 min. Six patients (13 %) had negative myoclonus, two in a unilateral upper limb, two in a unilateral lower limb, and the remaining two patients had frequent falls. One patient (2.1 %) had focal sensorimotor seizures characterized by unilateral numbness in the cheeks and one upper limb, additional to unilateral facial clonic seizures, speech arrest, and sialorrhea. The remaining patient (2.1 %) had sporadic focal tonic-dystonic seizures in the left upper limb only during sleep. CONCLUSION In our study, we found evidence of the existence of unusual clinical cases of SLECTS with typical EEG patterns and an excellent prognosis.
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Federico P, Wiebe S. Is bad brain worse than no brain? Salvaging the cerebral cortex in epilepsy. Brain 2020; 143:3172-3175. [DOI: 10.1093/brain/awaa330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This scientific commentary refers to ‘Resective surgery prevents progressive cortical thinning in temporal lobe epilepsy’, by Galovic et al. (doi:10.1093/brain/awaa284).
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Affiliation(s)
- Paolo Federico
- Department of Clinical Neurosciences, University of Calgary, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Canada
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Tran CHT, George AG, Teskey GC, Gordon GR. Seizures elevate gliovascular unit Ca2+ and cause sustained vasoconstriction. JCI Insight 2020; 5:136469. [PMID: 33004688 PMCID: PMC7566700 DOI: 10.1172/jci.insight.136469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/20/2020] [Indexed: 12/31/2022] Open
Abstract
Seizures can result in a severe hypoperfusion/hypoxic attack that causes postictal memory and behavioral impairments. However, neither postictal changes to microvasculature nor Ca2+ changes in key cell types controlling blood perfusion have been visualized in vivo, leaving essential components of the underlying cellular mechanisms unclear. Here, we use 2-photon microvascular and Ca2+ imaging in awake mice to show that seizures result in a robust vasoconstriction of cortical penetrating arterioles, which temporally mirrors the prolonged postictal hypoxia. The vascular effect was dependent on cyclooxygenase 2, as pretreatment with ibuprofen prevented postictal vasoconstriction. Moreover, seizures caused a rapid elevation in astrocyte endfoot Ca2+ that was confined to the seizure period, and vascular smooth muscle cells displayed a significant increase in Ca2+ both during and following seizures, lasting up to 75 minutes. Our data show enduring postictal vasoconstriction and temporal activities of 2 cell types within the neurovascular unit that are associated with seizure-induced hypoperfusion/hypoxia. These findings support prevention of this event may be a novel and tractable treatment strategy in patients with epilepsy who experience extended postseizure impairments. Seizures cause enduring microvascular constriction via long lasting calcium elevations in vascular smooth muscle cells.
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Affiliation(s)
- Cam Ha T Tran
- Hotchkiss Brain Institute and.,Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Antis G George
- Hotchkiss Brain Institute and.,Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - G Campbell Teskey
- Hotchkiss Brain Institute and.,Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Grant R Gordon
- Hotchkiss Brain Institute and.,Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Soldozy S, Galindo J, Snyder H, Ali Y, Norat P, Yağmurlu K, Sokolowski JD, Sharifi K, Tvrdik P, Park MS, Kalani MYS. Clinical utility of arterial spin labeling imaging in disorders of the nervous system. Neurosurg Focus 2020; 47:E5. [PMID: 31786550 DOI: 10.3171/2019.9.focus19567] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
Neuroimaging is an indispensable tool in the workup and management of patients with neurological disorders. Arterial spin labeling (ASL) is an imaging modality that permits the examination of blood flow and perfusion without the need for contrast injection. Noninvasive in nature, ASL provides a feasible alternative to existing vascular imaging techniques, including angiography and perfusion imaging. While promising, ASL has yet to be fully incorporated into the diagnosis and management of neurological disorders. This article presents a review of the most recent literature on ASL, with a special focus on its use in moyamoya disease, brain neoplasms, seizures, and migraines and a commentary on recent advances in ASL that make the imaging technique more attractive as a clinically useful tool.
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Farrell JS, Colangeli R, Dudok B, Wolff MD, Nguyen SL, Jackson J, Dickson CT, Soltesz I, Teskey GC. In vivo assessment of mechanisms underlying the neurovascular basis of postictal amnesia. Sci Rep 2020; 10:14992. [PMID: 32929133 PMCID: PMC7490395 DOI: 10.1038/s41598-020-71935-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/21/2020] [Indexed: 12/16/2022] Open
Abstract
Long-lasting confusion and memory difficulties during the postictal state remain a major unmet problem in epilepsy that lacks pathophysiological explanation and treatment. We previously identified that long-lasting periods of severe postictal hypoperfusion/hypoxia, not seizures per se, are associated with memory impairment after temporal lobe seizures. While this observation suggests a key pathophysiological role for insufficient energy delivery, it is unclear how the networks that underlie episodic memory respond to vascular constraints that ultimately give rise to amnesia. Here, we focused on cellular/network level analyses in the CA1 of hippocampus in vivo to determine if neural activity, network oscillations, synaptic transmission, and/or synaptic plasticity are impaired following kindled seizures. Importantly, the induction of severe postictal hypoperfusion/hypoxia was prevented in animals treated by a COX-2 inhibitor, which experimentally separated seizures from their vascular consequences. We observed complete activation of CA1 pyramidal neurons during brief seizures, followed by a short period of reduced activity and flattening of the local field potential that resolved within minutes. During the postictal state, constituting tens of minutes to hours, we observed no changes in neural activity, network oscillations, and synaptic transmission. However, long-term potentiation of the temporoammonic pathway to CA1 was impaired in the postictal period, but only when severe local hypoxia occurred. Lastly, we tested the ability of rats to perform object-context discrimination, which has been proposed to require temporoammonic input to differentiate between sensory experience and the stored representation of the expected object-context pairing. Deficits in this task following seizures were reversed by COX-2 inhibition, which prevented severe postictal hypoxia. These results support a key role for hypoperfusion/hypoxia in postictal memory impairments and identify that many aspects of hippocampal network function are resilient during severe hypoxia except for long-term synaptic plasticity.
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Affiliation(s)
- Jordan S Farrell
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| | - Roberto Colangeli
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Barna Dudok
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Marshal D Wolff
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Sarah L Nguyen
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Jesse Jackson
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Clayton T Dickson
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Ivan Soltesz
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - G Campbell Teskey
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Liu J, Peedicail JS, Gaxiola-Valdez I, Li E, Mosher V, Wilson W, Perera T, Singh S, Teskey GC, Federico P. Postictal brainstem hypoperfusion and risk factors for sudden unexpected death in epilepsy. Neurology 2020; 95:e1694-e1705. [PMID: 32675079 DOI: 10.1212/wnl.0000000000010360] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Since the strongest risk factor for sudden unexpected death in epilepsy (SUDEP) is frequent bilateral tonic-clonic seizures (BTCS), our aim was to determine whether postictal hypoperfusion in brainstem respiratory centers (BRCs) is more common following tonic-clonic seizures. METHODS We studied 21 patients with focal epilepsies who underwent perfusion imaging with arterial spin labeling MRI. Subtraction maps of cerebral blood flow were obtained from the postictal and baseline scans. We identified 6 regions of interest in the brainstem that contain key BRCs. Patients were considered to have postictal BRC hypoperfusion if any of the 6 regions of interest were significantly hypoperfused. RESULTS All 6 patients who experienced BTCS during the study had significant clusters of postictal hypoperfusion in BRCs compared to 7 who had focal impaired awareness seizures (7/15). The association between seizure type studied and the presence of BRC hypoperfusion was significant. Duration of epilepsy and frequency of BTCS were not associated with postictal brainstem hypoperfusion despite also being associated with risk for SUDEP. CONCLUSION Postictal hypoperfusion in brainstem respiratory centers occurs more often following BTCS than other seizure types, providing a possible explanation for the increased risk of SUDEP in patients who regularly experience BTCS.
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Affiliation(s)
- Jonathan Liu
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Joseph S Peedicail
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Ismael Gaxiola-Valdez
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Emmy Li
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Victoria Mosher
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - William Wilson
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Tefani Perera
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Shaily Singh
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - G Campbell Teskey
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Paolo Federico
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada.
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Wolff MD, Farrell JS, Scantlebury MH, Teskey GC. Dynamic oxygen changes during status epilepticus and subsequent endogenous kindling. Epilepsia 2020; 61:1515-1527. [PMID: 32478859 PMCID: PMC7496277 DOI: 10.1111/epi.16554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Brain tissue oxygen (partial oxygen pressure [pO2 ]) levels are tightly regulated to stay within the normoxic zone, with deviations on either side resulting in impaired brain function. Whereas pathological events such as ischemic attacks and brief seizures have previously been shown to result in pO2 levels well below the normoxic zone, oxygen levels during prolonged status epilepticus (SE) and the subsequent endogenous kindling period are unknown. METHODS We utilized two models of acquired temporal lobe epilepsy in rats: intrahippocampal kainic acid infusion and prolonged perforant pathway stimulation. Local tissue oxygen was measured in the dorsal hippocampus using an optode during and for several weeks following SE. RESULTS We observed hyperoxia in the hippocampus during induced SE in both models. Following termination of SE, 88% of rats initiated focal self-generated spiking activity in the hippocampus within the first 7 days, which was associated with dynamic oxygen changes. Self-generated and recurring epileptiform activity subsequently organized into higher-frequency bursts that became progressively longer and were ultimately associated with behavioral seizures that became more severe with time and led to postictal hypoxia. SIGNIFICANCE Induced SE and self-generated recurrent epileptiform activity can have profound and opposing effects on brain tissue oxygenation that may serve as a biomarker for ongoing pathological activity in the brain.
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Affiliation(s)
- Marshal D. Wolff
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Jordan S. Farrell
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of NeurosurgeryStanford UniversityStanfordCaliforniaUSA
| | - Morris H. Scantlebury
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Departments of Pediatrics and Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - G. Campbell Teskey
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
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Perera T, Gaxiola-Valdez I, Singh S, Peedicail J, Sandy S, Lebel RM, Li E, Milne-Ives M, Szostakiwskyj J, Federico P. Localizing the seizure onset zone by comparing patient postictal hypoperfusion to healthy controls. J Neurosci Res 2020; 98:1517-1531. [PMID: 32476173 DOI: 10.1002/jnr.24646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/23/2020] [Accepted: 05/03/2020] [Indexed: 11/10/2022]
Abstract
Arterial spin labeling (ASL) MRI can provide seizure onset zone (SOZ) localizing information in up to 80% of patients. Clinical implementation of this technique is limited by the need to obtain two scans per patient: a postictal scan that is subtracted from an interictal scan. We aimed to determine whether it is possible to limit the number of ASL scans to one per patient by comparing patient postictal ASL scans to baseline scans of 100 healthy controls. Eighteen patients aged 20-55 years underwent ASL MRI <90 min after a seizure and during the interictal period. Each postictal cerebral blood flow (CBF) map was statistically compared to average baseline CBF maps from 100 healthy controls (pvcASL; patient postictal CBF vs. control baseline CBF). The pvcASL maps were compared to subtraction ASL maps (sASL; patient baseline CBF minus patient postictal CBF). Postictal CBF reductions from pvcASL and sASL maps were seen in 17 of 18 (94.4%) and 14 of 18 (77.8%) patients, respectively. Maximal postictal hypoperfusion seen in pvcASL and sASL maps was concordant with the SOZ in 10 of 17 (59%) and 12 of 14 (86%) patients, respectively. In seven patients, both pvcASL and sASL maps showed similar results. In two patients, sASL showed no significant hypoperfusion, while pvcASL showed significant hypoperfusion concordant with the SOZ. We conclude that pvcASL is clinically useful and although it may have a lower overall concordance rate than sASL, pvcASL does provide localizing or lateralizing information for specific cases that would be otherwise missed through sASL.
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Affiliation(s)
- Tefani Perera
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | - Ismael Gaxiola-Valdez
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | - Shaily Singh
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph Peedicail
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sherry Sandy
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - R Marc Lebel
- GE Healthcare, Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Emmy Li
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | - Madison Milne-Ives
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | | | - Paolo Federico
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten MJAM. The postictal state - What do we know? Epilepsia 2020; 61:1045-1061. [PMID: 32396219 PMCID: PMC7317965 DOI: 10.1111/epi.16519] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
This narrative review provides a broad and comprehensive overview of the most important discoveries on the postictal state over the past decades as well as recent developments. After a description and definition of the postictal state, we discuss postictal sypmtoms, their clinical manifestations, and related findings. Moreover, pathophysiological advances are reviewed, followed by current treatment options.
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Affiliation(s)
- Julia C M Pottkämper
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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Abstract
Purpose of review Imaging constitutes one of the key pillars in the diagnostic workup after a first seizure as well as for the presurgical workup in epilepsy. The role of imaging in emergency situations, mainly to support the adequate diagnosis, as well as its role in planning of noninvasive image-guided therapies is less well established. Here, we provide an overview on peri-ictal imaging findings to support differential diagnosis in emergency situations and describe recent attempts toward minimal invasive therapy in the treatment of epilepsy and its comorbidities based on a combination of imaging techniques with ultrasound. Recent findings Peri-ictal perfusion changes can differentiate ictal stroke mimics from acute ischemic stroke if focal areas of increased perfusion are depicted by computed tomography or MRI. Postictal perfusion patterns in patients with persisting neurological symptoms are frequently normal and do not reach enough diagnostic sensitivity to differentiate between stroke and its mimics. Noninvasive magnetic resonance-techniques as arterial spin labeling may provide a higher sensitivity, especially in combination with diffusion-weighted and susceptibility-weighted MRI. Imaging guided focused ultrasound (FUS) bears the potential to ablate epileptogenic tissue and allows suppression of epileptic activity. Imaging guided blood–brain-barrier opening with FUS offers new options for local drug administration. Summary MRI should be considered the method of choice in the differential diagnosis of peri-ictal imaging findings and their differential diagnosis. A combination of various MRI techniques with FUS opens new avenues for treatment of epilepsy.
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Xu SY, Li ZX, Wu XW, Li L, Li CX. Frequency and Pathophysiology of Post-Seizure Todd's Paralysis. Med Sci Monit 2020; 26:e920751. [PMID: 32134903 PMCID: PMC7075081 DOI: 10.12659/msm.920751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Todd's paralysis, a neurological abnormality characterized by temporary limb weakness or hemiplegia, typically occurs following a seizure, without enduring consequences. Since limb weakness or hemiplegia can also be a common symptom of an acute ischemic stroke, it is often difficult to diagnose Todd's paralysis in individuals experiencing an acute ischemic stroke if they do not have a pre-existing history of epilepsy. Given that there is a limited understanding of Todd's paralysis, this review discusses the history, prevalence, clinical manifestations, duration, etiology, and diagnosis of Todd's paralysis. A few factors that may help clinicians distinguish Todd's paralysis from other clinical indications are as follows: (1) Todd's paralysis is commonly observed after partial seizures or generalized tonic-clonic seizures. (2) The incidence of Todd's paralysis is greater if the epilepsy is associated with old age or stroke history. (3) The duration of Todd's paralysis can range from minutes to days, depending on the type of seizure or whether the patient has experienced cortical structural damage. (4) The etiology of Todd's paralysis is associated with cerebral perfusion abnormality after seizures. Further research is needed to explore factors that distinguish Todd's paralysis from other indications that may lead to limb weakness in order to improve the diagnosis of Todd's paralysis.
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Affiliation(s)
- Sui-Yi Xu
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland).,Department of Neurology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China (mainland)
| | - Ze-Xing Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
| | - Xiao-Wei Wu
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
| | - Ling Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
| | - Chang-Xin Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
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Abstract
INTRODUCTION Stroke is a significant underlying cause of epilepsy. Seizures due to ischemic stroke (IS) are generally categorized into early seizures (ESs) and late seizures (LSs). Seizures in thrombolysis situations may raise the possibility of other etiology than IS. AIM We overtook a systematic review focusing on the pathogenesis, prevalence, risk factors, detection, management, and clinical outcome of ESs in IS and in stroke/thrombolysis situations. We also collected articles focusing on the association of recombinant tissue-type plasminogen activator (rt-PA) treatment and epileptic seizures. RESULTS We have identified 37 studies with 36,775 participants. ES rate was 3.8% overall in patients with IS with geographical differences. Cortical involvement, severe stroke, hemorrhagic transformation, age (<65 years), large lesion, and atrial fibrillation were the most important risk factors. Sixty-one percent of ESs were partial and 39% were general. Status epilepticus (SE) occurred in 16.3%. 73.6% had an onset within 24 h and 40% may present at the onset of stroke syndrome. Based on EEG findings seizure-like activity could be detected only in approximately 18% of ES patients. MRI diffusion-weighted imaging and multimodal brain imaging may help in the differentiation of ischemia vs. seizure. There are no specific recommendations with regard to the treatment of ES. CONCLUSION ESs are rare complications of acute stroke with substantial burden. A significant proportion can be presented at the onset of stroke requiring an extensive diagnostic workup.
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Abstract
Candidates for epilepsy surgery must undergo presurgical evaluation to establish whether and how surgical treatment can stop seizures without causing neurological deficits. Various techniques, including MRI, PET, single-photon emission CT, video-EEG, magnetoencephalography and invasive EEG, aim to identify the diseased brain tissue and the involved network. Recent technical and methodological developments, encompassing both advances in existing techniques and new combinations of technologies, are enhancing the ability to define the optimal resection strategy. Multimodal interpretation and predictive computer models are expected to aid surgical planning and patient counselling, and multimodal intraoperative guidance is likely to increase surgical precision. In this Review, we discuss how the knowledge derived from these new approaches is challenging our way of thinking about surgery to stop focal seizures. In particular, we highlight the importance of looking beyond the EEG seizure onset zone and considering focal epilepsy as a brain network disease in which long-range connections need to be taken into account. We also explore how new diagnostic techniques are revealing essential information in the brain that was previously hidden from view.
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Uetani H, Kitajima M, Sugahara T, Muto Y, Hirai K, Kuroki Y, Nakaura T, Tateishi M, Yamashita Y. Perfusion abnormality on three-dimensional arterial spin labeling in patients with acute encephalopathy with biphasic seizures and late reduced diffusion. J Neurol Sci 2020; 408:116558. [PMID: 31715327 DOI: 10.1016/j.jns.2019.116558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is the most common encephalopathy subtype in Japanese children. Few case reports have shown perfusion abnormality on arterial spin labeling (ASL) in patients with AESD. The present study aimed to review the chronological change of cerebral perfusion on three-dimensional (3D) ASL in patients with AESD. METHODS Twenty consecutive patients with AESD were enrolled; the patients underwent MRI including 3D ASL. The clinical course of AESD was divided into four phases according to the time from occurrence of seizures to MRI. Two neuroradiologists independently assessed presence or absence, distribution, and severity of perfusion abnormality using ASL and qualitatively scored perfusion abnormality using a five-point grading system. The level of interobserver agreement in the evaluation was analyzed using weighted κ statistics. Additionally, the signal ratio of abnormal perfusion region and peri-central sulcus region on ASL was semi-quantitatively evaluated. Moreover, we qualitatively compared the distribution between perfusion abnormality on ASL and bright tree appearance (BTA) on diffusion-weighted image (DWI). RESULTS ASL showed hypoperfusion from 8.5 to 22 h after early seizures (ESs) and hyperperfusion within 24 h after late seizures (LSs). Various perfusions were found >3 days after LSs. Interobserver agreement for qualitative scored perfusion abnormality was good (κ = 0.77). The distribution of abnormal perfusion was relatively consistent with BTA. CONCLUSION In AESD, cerebral perfusion changes with time. ASL showed hypoperfusion from 8.5 to 22 h after ESs, hyperperfusion within 24 h after LSs in patients with AESD.
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Affiliation(s)
- Hiroyuki Uetani
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Japan; Department of Radiology, Japanese Red Cross Kumamoto Hospital, Japan.
| | - Mika Kitajima
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Japan
| | - Takeshi Sugahara
- Department of Radiology, Japanese Red Cross Kumamoto Hospital, Japan
| | - Yuichiro Muto
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Japan
| | - Katsuki Hirai
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Japan
| | - Yohei Kuroki
- Department of Radiology, Japanese Red Cross Kumamoto Hospital, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Japan
| | - Machiko Tateishi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Japan
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Phillips TJ, Gom RC, Wolff MD, Teskey GC. Caffeine Exacerbates Postictal Hypoxia. Neuroscience 2019; 422:32-43. [PMID: 31678341 DOI: 10.1016/j.neuroscience.2019.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 12/11/2022]
Abstract
A stroke-like event follows seizures which may be responsible for the postictal state and a contributing factor to the development of seizure-induced brain abnormalities and behavioral dysfunction associated with epilepsy. Caffeine is the world's most popular drug with ∼85% of people in the USA consuming it daily. Thus, persons with epilepsy are likely to have caffeine in their body and brain during seizures. This preclinical study investigated the effects of acute caffeine on local hippocampal tissue oxygenation pre and post seizure. We continuously measured local oxygen levels in the CA1 region of the hippocampus and utilized the electrical kindling model in rats. Rats were acutely administered either caffeine, or one of its metabolites, or agonists and antagonists at adenosine sub-receptor types or ryanodine receptors prior to the elicitation of seizures. Acute caffeine administration caused a significant drop in pre-seizure hippocampal pO2. Following a seizure, caffeine, as well as two of its metabolites paraxanthine, and theophylline, increased the time below the severe hypoxic threshold (10 mmHg). Likewise, the specific A2A receptor antagonist, SCH-58261, mimicked caffeine by causing a significant drop in pre-seizure pO2 and the area and time below the severe hypoxic threshold. Moreover, the A2A receptor agonist, CGS-21680 was able to prevent the effect of both caffeine and SCH-58261 adding further evidence that caffeine is likely acting through the A2A receptor. Clinical tracking and investigations are needed to determine the effect of caffeine on postictal symptomology and blood flow in persons with epilepsy.
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Affiliation(s)
- Thomas J Phillips
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Renaud C Gom
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marshal D Wolff
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - G Campbell Teskey
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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50
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Rüber T, David B, Lüchters G, Nass RD, Friedman A, Surges R, Stöcker T, Weber B, Deichmann R, Schlaug G, Hattingen E, Elger CE. Evidence for peri-ictal blood-brain barrier dysfunction in patients with epilepsy. Brain 2019; 141:2952-2965. [PMID: 30239618 DOI: 10.1093/brain/awy242] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022] Open
Abstract
Epilepsy has been associated with a dysfunction of the blood-brain barrier. While there is ample evidence that a dysfunction of the blood-brain barrier contributes to epileptogenesis, blood-brain barrier dysfunction as a consequence of single epileptic seizures has not been systematically investigated. We hypothesized that blood-brain barrier dysfunction is temporally and anatomically associated with epileptic seizures in patients and used a newly-established quantitative MRI protocol to test our hypothesis. Twenty-three patients with epilepsy undergoing inpatient monitoring as part of their presurgical evaluation were included in this study (10 females, mean age ± standard deviation: 28.78 ± 8.45). For each patient, we acquired quantitative T1 relaxation time maps (qT1) after both ictal and interictal injection of gadolinium-based contrast agent. The postictal enhancement of contrast agent was quantified by subtracting postictal qT1 from interictal qT1 and the resulting ΔqT1 was used as a surrogate imaging marker of peri-ictal blood-brain barrier dysfunction. Additionally, the serum concentrations of MMP9 and S100, both considered biomarkers of blood-brain barrier dysfunction, were assessed in serum samples obtained prior to and after the index seizure. Fifteen patients exhibited secondarily generalized tonic-clonic seizures and eight patients exhibited focal seizures at ictal injection of contrast agent. By comparing ΔqT1 of the generalized tonic-clonic seizures and focal seizures groups, the anatomical association between ictal epileptic activity and postictal enhancement of contrast agent could be probed. The generalized tonic-clonic seizures group showed significantly higher ΔqT1 in the whole brain as compared to the focal seizures group. Specific analysis of scans acquired later than 3 h after the onset of the seizure revealed higher ΔqT1 in the generalized tonic-clonic seizures group as compared to the focal seizures group, which was strictly lateralized to the hemisphere of seizure onset. Both MMP9 and S100 showed a significantly increased postictal concentration. The current study provides evidence for the occurrence of a blood-brain barrier dysfunction, which is temporally and anatomically associated with epileptic seizures. qT1 after ictal contrast agent injection is rendered as valuable imaging marker of seizure-associated blood-brain barrier dysfunction and may be measured hours after the seizure. The observation of the strong anatomical association of peri-ictal blood-brain barrier dysfunction may spark the development of new functional imaging modalities for the post hoc visualization of brain areas affected by the seizure.
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Affiliation(s)
- Theodor Rüber
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Bastian David
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Guido Lüchters
- Center for Development Research, University of Bonn, Bonn, Germany
| | - Robert D Nass
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Alon Friedman
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Departments of Physiology and Cell Biology, Cognitive and Brain Sciences, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rainer Surges
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany.,Section of Epileptology, Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Tony Stöcker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Bernd Weber
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Gottfried Schlaug
- Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Elke Hattingen
- Department of Radiology, University of Bonn Medical Center, Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
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