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Helling RM, Shmuely S, Bauer PR, Tolner EA, Visser GH, Thijs RD. Tracking cortical excitability dynamics with transcranial magnetic stimulation in focal epilepsy. Ann Clin Transl Neurol 2022; 9:540-551. [PMID: 35297209 PMCID: PMC8994988 DOI: 10.1002/acn3.51535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The lack of reliable biomarkers constrain epilepsy management. We assessed the potential of repeated transcranial magnetic stimulation with electromyography (TMS-EMG) to track dynamical changes in cortical excitability on a within-subject basis. METHODS We recruited people with refractory focal epilepsy who underwent video-EEG monitoring and drug tapering as part of the presurgical evaluation. We performed daily TMS-EMG measurements with additional postictal assessments 1-6 h following seizures to assess resting motor threshold (rMT), and motor evoked potentials (MEPs) with single- and paired-pulse protocols. Anti-seizure medication (ASM) regimens were recorded for the day before each measurement and expressed in proportion to the dosage before tapering. Additional measurements were performed in healthy controls to evaluate day-to-day rMT variability. RESULTS We performed 77 (58 baseline, 19 postictal) measurements in 16 people with focal epilepsy and 35 in seven healthy controls. Controls showed minimal day-to-day rMT variation. Withdrawal of ASMs was associated with a lower rMT without affecting MEPs of single- and paired-pulse TMS-EMG paradigms. Postictal measurements following focal to bilateral tonic-clonic seizures demonstrated unaltered rMT and increased short interval intracortical inhibition, while measurements following focal seizures with impaired awareness showed decreased rMT's and reduced short and long interval intracortical inhibition. CONCLUSION Serial within-subject rMT measurements yielded reproducible, stable results in healthy controls. ASM tapering and seizures had distinct effects on TMS-EMG excitability indices in people with epilepsy. Drug tapering decreased rMT, indicating increased overall corticospinal excitability, whereas seizures affected intracortical inhibition with contrasting effects between seizure types.
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Affiliation(s)
- Robert M Helling
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Sharon Shmuely
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London, UK
| | - Prisca R Bauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Germany
| | - Else A Tolner
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gerhard H Visser
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London, UK.,Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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Pang S, D'Ambrosio S, Battaglia G, Jiménez-Jiménez D, Perulli M, Silvennoinen K, Zagaglia S, Sisodiya SM, Balestrini S. The impact of Transcranial Magnetic Stimulation (TMS) on seizure course in people with and without epilepsy. Clin Neurophysiol Pract 2022; 7:174-182. [PMID: 35800886 PMCID: PMC9254260 DOI: 10.1016/j.cnp.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
Abstract
Previous evidence on risk of TMS-induced seizures is anecdotal. There was no evidence that TMS caused changes in epileptiform activity. No seizures were induced by TMS in healthy subjects.
Objective To elucidate the effects of single and paired-pulse TMS on seizure activity at electrographic and clinical levels in people with and without epilepsy. Methods A cohort of 35 people with epilepsy, two people with alternating hemiplegia of childhood (AHC) with no epilepsy, and 16 healthy individuals underwent single or paired-pulse TMS combined with EEG. Clinical records and subject interviews were used to examine seizure frequency four weeks before and after TMS. Results There were no significant differences in seizure frequency in any subject after TMS exposure. There was no occurrence of seizures in healthy individuals, and no worsening of hemiplegic attacks in people with AHC. Conclusions No significant changes in seizure activity were found before or after TMS. Significance This study adds evidence on the safety of TMS in people with and without epilepsy with follow-up of four weeks after TMS.
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Are there differences in cortical excitability between akinetic-rigid and tremor-dominant subtypes of Parkinson's disease? Neurophysiol Clin 2021; 51:443-453. [PMID: 34588134 DOI: 10.1016/j.neucli.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess by transcranial magnetic stimulation (TMS) the excitability of various cortical circuits in akinetic-rigid and tremor-dominant subtypes of Parkinson's disease (PD). METHODS The study included 92 patients with PD according to UK Brain Bank criteria, with akinetic-rigid (n = 64) or tremor-dominant (n = 28) subtype. Cortical excitability study, including resting and active motor thresholds (rMT and aMT), input-output curve of motor evoked potentials, contralateral and ipsilateral silent periods (cSP and iSP), short and long-interval intracortical inhibition (SICI and LICI), and intracortical facilitation (ICF) were measured. The results obtained were compared to a control group of 30 age- and sex-matched healthy subjects. RESULTS The patients in the tremor group had significantly lower rMT and aMT compared to controls and akinetic-rigid patients and significantly shorter iSP duration compared to akinetic-rigid patients, while iSP latency tended to be longer in akinetic-rigid patients compared to controls. There were no significant differences between the two PD subgroups regarding other cortical excitability parameters, including paired-pulse TMS parameters. CONCLUSIONS Only subtle differences of cortical excitability were found between patients with akinetic-rigid vs. tremor-dominant subtype of PD. SIGNIFICANCE The clinical heterogeneity of PD patients probably has an impact on cortical excitability measures, far beyond the akinetic-rigid versus tremor-dominant profile.
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Sasaki R, Otsuru N, Miyaguchi S, Kojima S, Watanabe H, Ohno K, Sakurai N, Kodama N, Sato D, Onishi H. Influence of Brain-Derived Neurotrophic Factor Genotype on Short-Latency Afferent Inhibition and Motor Cortex Metabolites. Brain Sci 2021; 11:brainsci11030395. [PMID: 33804682 PMCID: PMC8003639 DOI: 10.3390/brainsci11030395] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
The Met allele of the brain-derived neurotrophic factor (BDNF) gene confers reduced cortical BDNF expression and associated neurobehavioral changes. BDNF signaling influences the survival, development, and synaptic function of cortical networks. Here, we compared gamma-aminobutyric acid (GABA)ergic network activity in the human primary motor cortex (M1) between the Met (Val/Met and Met/Met) and non-Met (Val/Val) genotype groups. Short- and long-interval intracortical inhibition, short-latency afferent inhibition (SAI), and long-latency afferent inhibition were measured using transcranial magnetic stimulation (TMS) as indices of GABAergic activity. Furthermore, the considerable inter-individual variability in inhibitory network activity typically measured by TMS may be affected not only by GABA but also by other pathways, including glutamatergic and cholinergic activities; therefore, we used 3-T magnetic resonance spectroscopy (MRS) to measure the dynamics of glutamate plus glutamine (Glx) and choline concentrations in the left M1, left somatosensory cortex, and right cerebellum. All inhibitory TMS conditions produced significantly smaller motor-evoked potentials than single-pulses. SAI was significantly stronger in the Met group than in the Val/Val group. Only the M1 Glx concentration was significantly lower in the Met group, while the BDNF genotype did not affect choline concentration in any region. Further, a positive correlation was observed between SAI and Glx concentrations only in M1. Our findings provide evidence that the BDNF genotype regulates both the inhibitory and excitatory circuits in human M1. In addition, lower Glx concentration in the M1 of Met carriers may alter specific inhibitory network on M1, thereby influencing the cortical signal processing required for neurobehavioral functions.
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Affiliation(s)
- Ryoki Sasaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (N.O.); (S.M.); (S.K.); (H.W.); (N.K.); (D.S.); (H.O.)
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia
- Correspondence: ; Tel.: +81-25-257-4445
| | - Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (N.O.); (S.M.); (S.K.); (H.W.); (N.K.); (D.S.); (H.O.)
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan
| | - Shota Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (N.O.); (S.M.); (S.K.); (H.W.); (N.K.); (D.S.); (H.O.)
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan
| | - Sho Kojima
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (N.O.); (S.M.); (S.K.); (H.W.); (N.K.); (D.S.); (H.O.)
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan
| | - Hiraku Watanabe
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (N.O.); (S.M.); (S.K.); (H.W.); (N.K.); (D.S.); (H.O.)
| | - Ken Ohno
- Department of Radiological Technology, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (K.O.); (N.S.)
| | - Noriko Sakurai
- Department of Radiological Technology, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (K.O.); (N.S.)
| | - Naoki Kodama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (N.O.); (S.M.); (S.K.); (H.W.); (N.K.); (D.S.); (H.O.)
- Department of Radiological Technology, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (K.O.); (N.S.)
| | - Daisuke Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (N.O.); (S.M.); (S.K.); (H.W.); (N.K.); (D.S.); (H.O.)
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan; (N.O.); (S.M.); (S.K.); (H.W.); (N.K.); (D.S.); (H.O.)
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata City, Niigata 950-3198, Japan
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Fatih P, Kucuker MU, Vande Voort JL, Doruk Camsari D, Farzan F, Croarkin PE. A Systematic Review of Long-Interval Intracortical Inhibition as a Biomarker in Neuropsychiatric Disorders. Front Psychiatry 2021; 12:678088. [PMID: 34149483 PMCID: PMC8206493 DOI: 10.3389/fpsyt.2021.678088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022] Open
Abstract
Long-interval intracortical inhibition (LICI) is a paired-pulse transcranial magnetic stimulation (TMS) paradigm mediated in part by gamma-aminobutyric acid receptor B (GABAB) inhibition. Prior work has examined LICI as a putative biomarker in an array of neuropsychiatric disorders. This review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) sought to examine existing literature focused on LICI as a biomarker in neuropsychiatric disorders. There were 113 articles that met the inclusion criteria. Existing literature suggests that LICI may have utility as a biomarker of GABAB functioning but more research with increased methodologic rigor is needed. The extant LICI literature has heterogenous methodology and inconsistencies in findings. Existing findings to date are also non-specific to disease. Future research should carefully consider existing methodological weaknesses and implement high-quality test-retest reliability studies.
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Affiliation(s)
- Parmis Fatih
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - M Utku Kucuker
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Jennifer L Vande Voort
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Deniz Doruk Camsari
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Centre for Engineering-Led Brain Research, Simon Fraser University, Surrey, BC, Canada
| | - Paul E Croarkin
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Madani N, O’Malley JA, Porter BE, Baumer FM. Lacosamide-Induced Dyskinesia in Children With Intractable Epilepsy. J Child Neurol 2020; 35:662-666. [PMID: 32524876 PMCID: PMC7415512 DOI: 10.1177/0883073820926634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lacosamide, an antiepileptic drug prescribed for children with refractory focal epilepsy, is generally well tolerated, with dose-dependent adverse effects. We describe 4 children who developed a movement disorder in conjunction with the initiation and/or uptitration of lacosamide. Three patients developed dyskinesias involving the face or upper extremity whereas the fourth had substantial worsening of chronic facial tics. The patients all had histories suggestive of opercular dysfunction: 3 had seizure semiologies including hypersalivation, facial and upper extremity clonus while the fourth underwent resection of polymicrogyria involving the opercula. Onset, severity, and resolution of dyskinesias correlated with lacosamide dosing. These cases suggest that pediatric patients with dysfunction of the opercular cortex are at increased risk for developing drug-induced dyskinesias on high-dose lacosamide therapy. Practitioners should be aware of this potential side effect and consider weaning lacosamide or video electroencephalography (EEG) for differential diagnosis, particularly in pediatric patients with underlying opercular dysfunction.
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Affiliation(s)
- Nadine Madani
- School of Medicine, The Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Jennifer A. O’Malley
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, 750 Welch Road, Palo Alto, California 94304
| | - Brenda E. Porter
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, 750 Welch Road, Palo Alto, California 94304
| | - Fiona M. Baumer
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, 750 Welch Road, Palo Alto, California 94304
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Silvennoinen K, Balestrini S, Rothwell JC, Sisodiya SM. Transcranial magnetic stimulation as a tool to understand genetic conditions associated with epilepsy. Epilepsia 2020; 61:1818-1839. [PMID: 32783192 PMCID: PMC8432162 DOI: 10.1111/epi.16634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/30/2022]
Abstract
Advances in genetics may enable a deeper understanding of disease mechanisms and promote a shift to more personalised medicine in the epilepsies. At present, understanding of consequences of genetic variants mainly relies on preclinical functional work; tools for acquiring similar data from the living human brain are needed. Transcranial magnetic stimulation (TMS), in particular paired-pulse TMS protocols which depend on the function of cortical GABAergic interneuron networks, has the potential to become such a tool. For this report, we identified and reviewed 23 publications on TMS studies of cortical excitability and inhibition in 15 different genes or conditions relevant to epilepsy. Reduced short-interval intracortical inhibition (SICI) and reduced cortical silent period (CSP) duration were the most commonly reported findings, suggesting abnormal GABAA - (SICI) or GABAB ergic (CSP) signalling. For several conditions, these findings are plausible based on established evidence of involvement of the GABAergic system; for some others, they may inform future research around such mechanisms. Challenges of TMS include lack of complete understanding of the neural underpinnings of the measures used: hypotheses and analyses should be based on existing clinical and preclinical data. Further pitfalls include gathering sufficient numbers of participants, and the effect of confounding factors, especially medications. TMS-EEG is a unique perturbational technique to study the intrinsic properties of the cortex with excellent temporal resolution; while it has the potential to provide further information of use in interpreting effects of genetic variants, currently the links between measures and neurophysiology are less established. Despite these challenges, TMS is a tool with potential for elucidating the system-level in vivo functional consequences of genetic variants in people carrying genetic changes of interest, providing unique insights.
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Affiliation(s)
- Katri Silvennoinen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St. Peter, UK
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St. Peter, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Department of UCL Queen Square, Institute of Neurology, London, UK
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St. Peter, UK
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Balestrini S, Sander JW. Transcranial magnetic stimulation as a biomarker of treatment response in children with epilepsy. Dev Med Child Neurol 2020; 62:770. [PMID: 32090314 DOI: 10.1111/dmcn.14496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Simona Balestrini
- NIHR Biomedical Research Centre at University College London Hospitals, UCL Queen Square Institute of Neurology, London, UK
| | - Josemir W Sander
- NIHR Biomedical Research Centre at University College London Hospitals, UCL Queen Square Institute of Neurology, London, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
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Hamed SA. Cortical excitability in epilepsy and the impact of antiepileptic drugs: transcranial magnetic stimulation applications. Expert Rev Neurother 2020; 20:707-723. [PMID: 3251028 DOI: 10.1080/14737175.2020.1780122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Epileptic conditions are characterized by impaired cortical excitation/inhibition balance and interneuronal disinhibition. Transcranial magnetic stimulation (TMS) is a neurophysiological method that assesses brain excitation/inhibition. AREA COVERED This review was written after a detailed search in PubMed, EMBASE, ISI web of science, SciELO, Scopus, and Cochrane Controlled Trials databases from 1990 to 2020. It summarizes TMS applications for diagnostic and therapeutic purposes in epilepsy. TMS studies help to distinguish different epilepsy conditions and explore the antiepileptic drugs' (AEDs') effects on neuronal microcircuits and plasticity mechanisms. Repetitive TMS studies showed that low-frequency rTMS (0.33-1 Hz) can reduce seizures' frequency in refractory epilepsy or pause ongoing seizures; however, there is no current approval for its use in such patients as adjunctive treatment to AEDs. EXPERT OPINION There are variable and conflicting TMS results which reflect the distinct pathogenic mechanisms of each epilepsy condition, the dynamic epileptogenic process over the long disease course resulting in the development of recurrent spontaneous seizures and/or progression of epilepsy after it is established, and the differential effect of AEDs on cortical excitability. Future epilepsy research should focus on combined TMS/functional connectivity studies that explore the complex cortical excitability circuits and networks using different TMS parameters and techniques.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut, Egypt
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10
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Huang HW, Tsai JJ, Su PF, Mau YL, Wu YJ, Wang WC, Lin CCK. Cortical Excitability by Transcranial Magnetic Stimulation as Biomarkers for Seizure Controllability in Temporal Lobe Epilepsy. Neuromodulation 2020; 23:399-406. [PMID: 31840383 DOI: 10.1111/ner.13093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether indicators of cortical excitability are good biomarkers of seizure controllability in temporal lobe epilepsy (TLE). MATERIALS AND METHODS Three groups of subjects were recruited: those with poorly controlled (PC) TLE (N = 41), well-controlled (WC) TLE (N = 71), and healthy controls (N = 44). Short- and long-latency recovery curves were obtained by paired-pulse transcranial magnetic stimulation. Linear mixed effect models were used to study the effects of group, interstimulus interval (ISI), and antiepileptic drugs on long-interval intracortical inhibition (LICI) and short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). RESULTS The mixed effect model that did not incorporate antiepileptic drugs showed that group and ISI were significant factors for LICI and SICI/ICF. LICI in the healthy control group was greater than in the two epilepsy groups, and the difference was significant at ISIs of 50, 150, and 200 msec. In contrast, SICI/ICF in the PC group was greater than in the healthy control and WC groups, and the difference was significant at an ISI of 15 msec. However, due to large variance, it was difficult to identify a cutoff value with both good sensitivity and good specificity. Incorporating the information of antiepileptic drugs to the mixed effect model did not change the overall results. CONCLUSIONS Although LICI and SICI/ICF parameters were significantly different at the group level, they may not be suitable biomarkers for the controllability of TLE at the subject level.
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Affiliation(s)
- Han-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jing-Jane Tsai
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Fang Su
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Lin Mau
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Jen Wu
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chi Wang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chou-Ching K Lin
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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12
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Shon YM, Lim SC, Lim SH. Therapeutic effect of repetitive transcranial magnetic stimulation on non-lesional focal refractory epilepsy. J Clin Neurosci 2019; 63:130-133. [PMID: 30711284 DOI: 10.1016/j.jocn.2019.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/04/2019] [Accepted: 01/18/2019] [Indexed: 02/01/2023]
Abstract
The effects of repetitive transcranial magnetic stimulation (rTMS) on epilepsy remain unclear. This study was performed to investigate the effects of low-frequency rTMS on non-lesional focal epilepsy. This was a prospective open-label longitudinal study with four patients with multi-drug-resistant non-lesional focal epilepsy and no control group. The patients received daily doses of 900 pulses of 0.5-Hz stimulation for 10 days over the epileptic foci in neocortical areas determined by electrical source analysis. The outcomes were measured in terms of seizure reduction. The incidences of seizures were measured at baseline (4 weeks), intervention (2 weeks), and follow up (8 weeks). Seizure reduction was observed in three of four subjects. The effects of rTMS persisted over a follow-up period of 8 weeks. One of the four patients did not respond to rTMS and showed no seizure reduction. The low frequency rTMS would be an effective treatment for non-lesional focal refractory epilepsy, may be an adjunctive treatment with conventional medical treatment for refractory epilepsy. These results are therefore useful for planning treatment strategies for patients with refractory epilepsy, as well as for treatment of epilepsy.
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Affiliation(s)
- Young-Min Shon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Chul Lim
- Department of Neurology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Bolden LB, Griffis JC, Nenert R, Allendorfer JB, Szaflarski JP. Cortical excitability and seizure control influence attention performance in patients with idiopathic generalized epilepsies (IGEs). Epilepsy Behav 2018; 89:135-142. [PMID: 30415135 DOI: 10.1016/j.yebeh.2018.10.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/08/2018] [Accepted: 10/21/2018] [Indexed: 02/05/2023]
Abstract
We recently found that higher cortical excitability is associated with poorer attention performance in healthy adults. While patients with idiopathic generalized epilepsies (IGEs), previously termed genetic generalized epilepsies, are known to demonstrate increased cortical excitability and cognitive deficits, a relationship between these variables in IGEs has not been investigated. Therefore, we aimed to characterize the effects of cortical excitability and seizure control on cognitive performance in IGEs. We studied 30 patients with IGEs (16 patients with controlled IGEs (cIGEs) and 14 patients with treatment-resistant IGEs (trIGEs)) and 24 healthy controls (HCs). Transcranial magnetic stimulation (TMS) was used to measure cortical excitability, including long-interval intracortical inhibition (LICI). Attention was assessed with the Digit Span Forwards, Digit Span Backwards, Trails A, and Flanker tasks. Executive functioning was assessed using Trails B, Stroop Color and Word, and the Wisconsin Card Sorting Task. Two-way multivariate analyses of variance (MANOVAs) were conducted to assess the influences of seizure control (HCs vs. cIGEs vs. trIGEs) and cortical excitability (inhibitory vs. excitatory) on composite measures of attention and executive functions. Attention performance was significantly affected by cortical excitability and seizure control. Participants with primarily excitatory LICI responses, indicating higher cortical excitability, performed worse than inhibitory responders on composite attention (Wilks' lambda = 0.748, F(4, 44) = 3.72, p = 0.011). While participants with cIGEs and trIGEs did not significantly differ in attention performance, participants with trIGEs performed worse on the Digit Forwards (False Discovery Rate (FDR)p < 0.001), Digit Backwards (FDRp = 0.015), and Flanker (FDRp = 0.0075) tasks compared with HCs. These results provide support for the relationship between cortical excitability and attention dysfunction in IGEs. Further investigation is needed to determine whether there is a causal relationship between these variables and whether intracortical gamma-aminobutyric acid (GABA)B networks may be targeted to improve attention deficits in clinical populations with decreased LICI. Findings also suggest that additional research directly comparing cognition in patients with cIGEs and trIGEs is warranted.
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Affiliation(s)
- Lauren B Bolden
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Joseph C Griffis
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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