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Song C, Zhang X, Zhang Y, Han S, Ma K, Mao X, Lian Y, Cheng J. Comparision of spontaneous brain activity between hippocampal sclerosis and MRI-negative temporal lobe epilepsy. Epilepsy Behav 2024; 157:109751. [PMID: 38820678 DOI: 10.1016/j.yebeh.2024.109751] [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: 12/27/2023] [Revised: 03/05/2024] [Accepted: 03/21/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Hippocampal sclerosis (HS) is a prevalent cause of temporal lobe epilepsy (TLE). However, up to 30% of individuals with TLE present negative magnetic resonance imaging (MRI) findings. A comprehensive grasp of the similarities and differences in brain activity among distinct TLE subtypes holds significant clinical and scientific importance. OBJECTIVE To comprehensively examine the similarities and differences between TLE with HS (TLE-HS) and MRI-negative TLE (TLE-N) regarding static and dynamic abnormalities in spontaneous brain activity (SBA). Furthermore, we aimed to determine whether these alterations correlate with epilepsy duration and cognition, and to determine a potential differential diagnostic index for clinical utility. METHODS We measured 12 SBA metrics in 38 patients with TLE-HS, 51 with TLE-N, and 53 healthy volunteers. Voxel-wise analysis of variance (ANOVA) and post-hoc comparisons were employed to compare these metrics. The six static metrics included amplitude of low-frequency fluctuations (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), voxel-mirrored homotopic connectivity (VMHC), degree centrality (DC), and global signal correlation (GSCorr). Additionally, six corresponding dynamic metrics were assessed: dynamic ALFF (dALFF), dynamic fALFF (dfALFF), dynamic ReHo (dReHo), dynamic DC (dDC), dynamic VMHC (dVMHC), and dynamic GSCorr (dGSCorr). Receiver operating characteristic (ROC) curve analysis of abnormal indices was employed. Spearman correlation analyses were also conducted to examine the relationship between the abnormal indices, epilepsy duration and cognition scores. RESULTS Both TLE-HS and TLE-N presented as extensive neural network disorders, sharing similar patterns of SBA alterations. The regions with increased fALFF, dALFF, and dfALFF levels were predominantly observed in the mesial temporal lobe, thalamus, basal ganglia, pons, and cerebellum, forming a previously proposed mesial temporal epilepsy network. Conversely, decreased SBA metrics (fALFF, ReHo, dReHo, DC, GSCorr, and VMHC) consistently appeared in the lateral temporal lobe ipsilateral to the epileptic foci. Notably, SBA alterations were more obvious in patients with TLE-HS than in those with TLE-N. Additionally, patients with TLE-HS exhibited reduced VMHC in both mesial and lateral temporal lobes compared with patients with TLE-N, with the hippocampus displaying moderate discriminatory power (AUC = 0.759). Correlation analysis suggested that alterations in SBA indicators may be associated with epilepsy duration and cognitive scores. CONCLUSIONS The simultaneous use of static and dynamic SBA metrics provides evidence supporting the characterisation of both TLE-HS and TLE-N as complex network diseases, facilitating the exploration of mechanisms underlying epileptic activity and cognitive impairment. Overall, SBA abnormality patterns were generally similar between the TLE-HS and TLE-N groups, encompassing networks related to TLE and auditory and occipital visual functions. These changes were more pronounced in the TLE-HS group, particularly within the mesial and lateral temporal lobes.
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Affiliation(s)
- Chengru Song
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China; Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China; Key Laboratory of Imaging Intelligence Research Medicine of Henan Province.
| | - Xiaonan Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China; Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China; Key Laboratory of Imaging Intelligence Research Medicine of Henan Province.
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China; Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China; Key Laboratory of Imaging Intelligence Research Medicine of Henan Province.
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China; Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China; Key Laboratory of Imaging Intelligence Research Medicine of Henan Province.
| | - Keran Ma
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China; Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China; Key Laboratory of Imaging Intelligence Research Medicine of Henan Province.
| | - Xinyue Mao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China; Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China; Key Laboratory of Imaging Intelligence Research Medicine of Henan Province.
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China; Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China; Key Laboratory of Imaging Intelligence Research Medicine of Henan Province.
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Krishnan B, Tousseyn S, Taylor K, Wu G, Serletis D, Najm I, Bulacio J, Alexopoulos AV. Measurable transitions during seizures in intracranial EEG: A stereoelectroencephalography and SPECT study. Clin Neurophysiol 2024; 161:80-92. [PMID: 38452427 DOI: 10.1016/j.clinph.2024.02.022] [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: 08/10/2023] [Revised: 02/05/2024] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Ictal Single Photon Emission Computed Tomography (SPECT) and stereo-electroencephalography (SEEG) are diagnostic techniques used for the management of patients with drug-resistant focal epilepsies. While hyperperfusion patterns in ictal SPECT studies reveal seizure onset and propagation pathways, the role of ictal hypoperfusion remains poorly understood. The goal of this study was to systematically characterize the spatio-temporal information flow dynamics between differently perfused brain regions using stereo-EEG recordings. METHODS We identified seizure-free patients after resective epilepsy surgery who had prior ictal SPECT and SEEG investigations. We estimated directional connectivity between the epileptogenic-zone (EZ), non-resected areas of hyperperfusion, hypoperfusion, and baseline perfusion during the interictal, preictal, ictal, and postictal periods. RESULTS Compared to the background, we noted significant information flow (1) during the preictal period from the EZ to the baseline and hyperperfused regions, (2) during the ictal onset from the EZ to all three regions, and (3) during the period of seizure evolution from the area of hypoperfusion to all three regions. CONCLUSIONS Hypoperfused brain regions were found to indirectly interact with the EZ during the ictal period. SIGNIFICANCE Our unique study, combining intracranial electrophysiology and perfusion imaging, presents compelling evidence of dynamic changes in directional connectivity between brain regions during the transition from interictal to ictal states.
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Affiliation(s)
- Balu Krishnan
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.
| | - Simon Tousseyn
- Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Heeze, The Netherlands; School for Mental Health and Neuroscience (MHeNs), University Maastricht (UM), Maastricht, The Netherlands
| | - Kenneth Taylor
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Guiyun Wu
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Demitre Serletis
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Imad Najm
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Bulacio
- Neurological Institute, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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Campora N, Princich JP, Nasimbera A, Cordisco S, Villanueva M, Oddo S, Giagante B, Kochen S. Stereo-EEG features of temporal and frontal lobe seizures with loss of consciousness. Neurosci Conscious 2024; 2024:niae003. [PMID: 38618487 PMCID: PMC11015893 DOI: 10.1093/nc/niae003] [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: 01/12/2023] [Revised: 12/11/2023] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
The loss of consciousness (LOC) during seizures is one of the most striking features that significantly impact the quality of life, even though the neuronal network involved is not fully comprehended. We analyzed the intracerebral patterns in patients with focal drug-resistant epilepsy, both with and without LOC. We assessed the localization, lateralization, stereo electroencephalography (SEEG) patterns, seizure duration, and the quantification of contacts exhibiting electrical discharge. The degree of LOC was quantified using the Consciousness Seizure Scale. Thirteen patients (40 seizures) with focal drug-resistant epilepsy underwent SEEG. In cases of temporal lobe epilepsy (TLE, 6 patients and 15 seizures), LOC occurred more frequently in seizures with mesial rather than lateral temporal lobe onset. On the other hand, in cases of frontal lobe epilepsy (7 patients; 25 seizures), LOC was associated with pre-frontal onset, a higher number of contacts with epileptic discharge compared to the onset count and longer seizure durations. Our study revealed distinct characteristics during LOC depending on the epileptogenic zone. For temporal lobe seizures, LOC was associated with mesial seizure onset, whereas in frontal lobe epilepsy, seizure with LOC has a significant increase in contact showing epileptiform discharge and a pre-frontal onset. This phenomenon may be correlated with the broad neural network required to maintain consciousness, which can be affected in different ways, resulting in LOC.
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Affiliation(s)
- Nuria Campora
- Neuroscience Department, El Cruce Hospital, Florencio Varela, Argentina
- Studies in Neuroscience and Complex Systems (ENyS), CONICET, Florencio Varela, Buenos Aires 1888, Argentina
| | - Juan Pablo Princich
- Neuroscience Department, El Cruce Hospital, Florencio Varela, Argentina
- Studies in Neuroscience and Complex Systems (ENyS), CONICET, Florencio Varela, Buenos Aires 1888, Argentina
| | - Alejandro Nasimbera
- Neuroscience Department, El Cruce Hospital, Florencio Varela, Argentina
- Studies in Neuroscience and Complex Systems (ENyS), CONICET, Florencio Varela, Buenos Aires 1888, Argentina
| | - Santiago Cordisco
- Studies in Neuroscience and Complex Systems (ENyS), CONICET, Florencio Varela, Buenos Aires 1888, Argentina
| | - Manuela Villanueva
- Studies in Neuroscience and Complex Systems (ENyS), CONICET, Florencio Varela, Buenos Aires 1888, Argentina
| | - Silvia Oddo
- Neuroscience Department, El Cruce Hospital, Florencio Varela, Argentina
- Studies in Neuroscience and Complex Systems (ENyS), CONICET, Florencio Varela, Buenos Aires 1888, Argentina
| | - Brenda Giagante
- Neuroscience Department, El Cruce Hospital, Florencio Varela, Argentina
| | - Silvia Kochen
- Neuroscience Department, El Cruce Hospital, Florencio Varela, Argentina
- Studies in Neuroscience and Complex Systems (ENyS), CONICET, Florencio Varela, Buenos Aires 1888, Argentina
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Song C, Xie S, Zhang X, Han S, Lian Y, Ma K, Mao X, Zhang Y, Cheng J. Similarities and differences of dynamic and static spontaneous brain activity between left and right temporal lobe epilepsy. Brain Imaging Behav 2024; 18:352-367. [PMID: 38087148 DOI: 10.1007/s11682-023-00835-w] [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] [Accepted: 12/01/2023] [Indexed: 06/07/2024]
Abstract
To comprehensively investigate the potential temporal dynamic and static abnormalities of spontaneous brain activity (SBA) in left temporal lobe epilepsy (LTLE) and right temporal lobe epilepsy (RTLE) and to detect whether these alterations correlate with cognition. Twelve SBA metrics, including ALFF, dALFF, fALFF, dfALFF, ReHo, dReHo, DC, dDC, GSCorr, dGSCorr, VMHC, and dVMHC, in 46 LTLE patients, 43 RTLE patients, and 53 healthy volunteers were compared in the voxel-wise analysis. Correlation analyses between metrics in regions showing statistic differences and epilepsy duration, epilepsy severity, and cognition scores were also performed. Compared with the healthy volunteers, the alteration of SBA was identified both in LTLE and RTLE patients. The ALFF, fALFF, and dALFF values in LTLE, as well as the fALFF values in RTLE, increased in the bilateral thalamus, basal ganglia, mesial temporal lobe, cerebellum, and vermis. Increased dfALFF in the bilateral basal ganglia, increased ReHo and dReHo in the bilateral thalamus in the LTLE group, increased ALFF and dALFF in the pons, and increased ReHo and dReHo in the right hippocampus in the RTLE group were also detected. However, the majority of deactivation clusters were in the ipsilateral lateral temporal lobe. For LTLE, the fALFF, DC, dDC, and GSCorr values in the left lateral temporal lobe and the ReHo and VMHC values in the bilateral lateral temporal lobe all decreased. For RTLE, the ALFF, fALFF, dfALFF, ReHo, dReHo, and DC values in the right lateral temporal lobe and the VMHC values in the bilateral lateral temporal lobe all decreased. Moreover, for both the LTLE and RTLE groups, the dVMHC values decreased in the calcarine cortex. The most significant difference between LTLE and RTLE was the higher activation in the cerebellum of the LTLE group. The alterations of many SBA metrics were correlated with cognition and epilepsy duration. The patterns of change in SBA abnormalities in the LTLE and RTLE patients were generally similar. The integrated application of temporal dynamic and static SBA metrics might aid in the investigation of the propagation and suppression pathways of seizure activity as well as the cognitive impairment mechanisms in TLE.
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Affiliation(s)
- Chengru Song
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052, China
| | - Shanshan Xie
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052, China
| | - Xiaonan Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Keran Ma
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052, China
| | - Xinyue Mao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052, China.
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052, China.
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Martino M, Magioncalda P. A three-dimensional model of neural activity and phenomenal-behavioral patterns. Mol Psychiatry 2024; 29:639-652. [PMID: 38114633 DOI: 10.1038/s41380-023-02356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
How phenomenal experience and behavior are related to neural activity in physiology and psychopathology represents a fundamental question in neuroscience and psychiatry. The phenomenal-behavior patterns may be deconstructed into basic dimensions, i.e., psychomotricity, affectivity, and thought, which might have distinct neural correlates. This work provides a data overview on the relationship of these phenomenal-behavioral dimensions with brain activity across physiological and pathological conditions (including major depressive disorder, bipolar disorder, schizophrenia, attention-deficit/hyperactivity disorder, anxiety disorders, addictive disorders, Parkinson's disease, Tourette syndrome, Alzheimer's disease, and frontotemporal dementia). Accordingly, we propose a three-dimensional model of neural activity and phenomenal-behavioral patterns. In this model, neural activity is organized into distinct units in accordance with connectivity patterns and related input/output processing, manifesting in the different phenomenal-behavioral dimensions. (1) An external neural unit, which involves the sensorimotor circuit/brain's sensorimotor network and is connected with the external environment, processes external inputs/outputs, manifesting in the psychomotor dimension (processing of exteroception/somatomotor activity). External unit hyperactivity manifests in psychomotor excitation (hyperactivity/hyperkinesia/catatonia), while external unit hypoactivity manifests in psychomotor inhibition (retardation/hypokinesia/catatonia). (2) An internal neural unit, which involves the interoceptive-autonomic circuit/brain's salience network and is connected with the internal/body environment, processes internal inputs/outputs, manifesting in the affective dimension (processing of interoception/autonomic activity). Internal unit hyperactivity manifests in affective excitation (anxiety/dysphoria-euphoria/panic), while internal unit hypoactivity manifests in affective inhibition (anhedonia/apathy/depersonalization). (3) An associative neural unit, which involves the brain's associative areas/default-mode network and is connected with the external/internal units (but not with the environment), processes associative inputs/outputs, manifesting in the thought dimension (processing of ideas). Associative unit hyperactivity manifests in thought excitation (mind-wandering/repetitive thinking/psychosis), while associative unit hypoactivity manifests in thought inhibition (inattention/cognitive deficit/consciousness loss). Finally, these neural units interplay and dynamically combine into various neural states, resulting in the complex phenomenal experience and behavior across physiology and neuropsychiatric disorders.
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Affiliation(s)
- Matteo Martino
- Graduate Institute of Mind Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.
| | - Paola Magioncalda
- Graduate Institute of Mind Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Radiology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
- Department of Medical Research, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
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Pang X, Liang X, Chang W, Lv Z, Zhao J, Wu P, Li X, Wei W, Zheng J. The role of the thalamus in modular functional networks in temporal lobe epilepsy with cognitive impairment. CNS Neurosci Ther 2024; 30:e14345. [PMID: 37424152 PMCID: PMC10848054 DOI: 10.1111/cns.14345] [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: 11/18/2021] [Revised: 06/04/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE Cognitive deficit is common in patients with temporal lobe epilepsy (TLE). Here, we aimed to investigate the modular architecture of functional networks associated with distinct cognitive states in TLE patients together with the role of the thalamus in modular networks. METHODS Resting-state functional magnetic resonance imaging scans were acquired from 53 TLE patients and 37 matched healthy controls. All patients received the Montreal Cognitive Assessment test and accordingly were divided into TLE patients with normal cognition (TLE-CN, n = 35) and TLE patients with cognitive impairment (TLE-CI, n = 18) groups. The modular properties of functional networks were calculated and compared including global modularity Q, modular segregation index, intramodular connections, and intermodular connections. Thalamic subdivisions corresponding to the modular networks were generated by applying a 'winner-take-all' strategy before analyzing the modular properties (participation coefficient and within-module degree z-score) of each thalamic subdivision to assess the contribution of the thalamus to modular functional networks. Relationships between network properties and cognitive performance were then further explored. RESULTS Both TLE-CN and TLE-CI patients showed lower global modularity, as well as lower modular segregation index values for the ventral attention network and the default mode network. However, different patterns of intramodular and intermodular connections existed for different cognitive states. In addition, both TLE-CN and TLE-CI patients exhibited anomalous modular properties of functional thalamic subdivisions, with TLE-CI patients presenting a broader range of abnormalities. Cognitive performance in TLE-CI patients was not related to the modular properties of functional network but rather to the modular properties of functional thalamic subdivisions. CONCLUSIONS The thalamus plays a prominent role in modular networks and potentially represents a key neural mechanism underlying cognitive impairment in TLE.
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Affiliation(s)
- Xiaomin Pang
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Xiulin Liang
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Weiwei Chang
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Zongxia Lv
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Jingyuan Zhao
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Peirong Wu
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Xinrong Li
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Wutong Wei
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Jinou Zheng
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
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Song C, Zhang X, Han S, Lian Y, Ma K, Wang K, Mao X, Zhang Y, Cheng J. Static and Temporal Dynamic Alteration of Intrinsic Brain Activity in MRI-negative Temporal Lobe Epilepsy. Seizure 2023; 108:33-42. [PMID: 37062236 DOI: 10.1016/j.seizure.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE To comprehensively explore the potential brain activity abnormalities affected by MRI-negative temporal lobe epilepsy (TLE) and to detect whether the changes were associated with cognition and help in the diagnosis or lateralization. METHOD Six static intrinsic brain activity (IBA) indicators (ALFF, fALFF, ReHo, DC, GSCorr, VMHC) and their corresponding six temporal dynamic indicators in 39 unilateral MRI-negative TLE patients and 42 healthy volunteers were compared. Correlation analyses were performed between these indicators in areas displaying group differences, cognitive function, and epilepsy duration. ROC analyses were performed to test the diagnostic and lateralization ability of the IBA parameters. RESULTS Considerable overlap was present among the abnormal brain regions detected by different static and dynamic indicators, including (1) alteration of fALFF, Reho, DC, VMHC, dfALFF, dReHo, and dDC in the temporal neocortex (predominately ipsilateral to the epileptogenic foci); (2) decreased dGSCorr and dVMHC in the occipital lobe. Meanwhile, the ReHo and VMHC values in the temporal neocortex correlated with the cognition scores or epilepsy duration (P < 0.01). The ROC analysis results revealed moderate diagnosis or lateralization efficiency of several IBA indicators (fALFF, dfALFF, ReHo, DC, dDC, and VMHC). CONCLUSION The abnormal condition of neuronal activity in the temporal neocortex, predominately lateralized to the epileptic side, was a crucial feature in patients with MRI-negative TLE and might offer diagnosis or lateralization information. The application of dynamic intrinsic brain activity indicators played a complementary role, further revealing the temporal variability decline of the occipital lobe in MRI-negative TLE patients.
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Krishnan B, Tousseyn S, Wang ZI, Murakami H, Wu G, Burgess R, Iasemidis L, Najm I, Alexopoulos AV. Novel noninvasive identification of patient-specific epileptic networks in focal epilepsies: Linking single-photon emission computed tomography perfusion during seizures with resting-state magnetoencephalography dynamics. Hum Brain Mapp 2023; 44:1695-1710. [PMID: 36480260 PMCID: PMC9921232 DOI: 10.1002/hbm.26168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/31/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Single-photon emission computed tomography (SPECT) during seizures and magnetoencephalography (MEG) during the interictal state are noninvasive modalities employed in the localization of the epileptogenic zone in patients with drug-resistant focal epilepsy (DRFE). The present study aims to investigate whether there exists a preferentially high MEG functional connectivity (FC) among those regions of the brain that exhibit hyperperfusion or hypoperfusion during seizures. We studied MEG and SPECT data in 30 consecutive DRFE patients who had resective epilepsy surgery. We parcellated each ictal perfusion map into 200 regions of interest (ROIs) and generated ROI time series using source modeling of MEG data. FC between ROIs was quantified using coherence and phase-locking value. We defined a generalized linear model to relate the connectivity of each ROI, ictal perfusion z score, and distance between ROIs. We compared the coefficients relating perfusion z score to FC of each ROI and estimated the connectivity within and between resected and unresected ROIs. We found that perfusion z scores were strongly correlated with the FC of hyper-, and separately, hypoperfused ROIs across patients. High interictal connectivity was observed between hyperperfused brain regions inside and outside the resected area. High connectivity was also observed between regions of ictal hypoperfusion. Importantly, the ictally hypoperfused regions had a low interictal connectivity to regions that became hyperperfused during seizures. We conclude that brain regions exhibiting hyperperfusion during seizures highlight a preferentially connected interictal network, whereas regions of ictal hypoperfusion highlight a separate, discrete and interconnected, interictal network.
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Affiliation(s)
- Balu Krishnan
- Neurological InstituteEpilepsy Center, Cleveland ClinicClevelandOhioUSA
| | - Simon Tousseyn
- Academic Center for EpileptologyKempenhaeghe and Maastricht UMC+HeezeThe Netherlands
| | - Zhong Irene Wang
- Neurological InstituteEpilepsy Center, Cleveland ClinicClevelandOhioUSA
| | - Hiroatsu Murakami
- Neurological InstituteEpilepsy Center, Cleveland ClinicClevelandOhioUSA
| | - Guiyun Wu
- Neurological InstituteEpilepsy Center, Cleveland ClinicClevelandOhioUSA
| | - Richard Burgess
- Neurological InstituteEpilepsy Center, Cleveland ClinicClevelandOhioUSA
| | - Leonidas Iasemidis
- Department of Translational NeuroscienceBarrow Neurological InstituteScottsdaleArizonaUSA
- Department of NeurologyBarrow Neurological InstituteScottsdaleArizonaUSA
| | - Imad Najm
- Neurological InstituteEpilepsy Center, Cleveland ClinicClevelandOhioUSA
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Zhao SZ, Zhao YX, Liao XH, Huo R, Li H, Jiao YM, Weng JC, Wang J, Liu B, Cao Y. Unruptured brain arteriovenous malformations causing seizures localize to one common brain network. J Neurosci Res 2023; 101:245-255. [PMID: 36345215 PMCID: PMC10100023 DOI: 10.1002/jnr.25142] [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: 05/29/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
Seizures are a frequent symptom of unruptured brain arteriovenous malformations (bAVMs). However, the brain regions responsible for these seizures remain unclear. To identify the brain regions causally involved in bAVM-related seizures, we retrospectively reviewed 220 patients with unruptured bAVMs. Using voxel-based lesion-symptom mapping (VLSM) analyses, we tested whether individual brain regions were associated with unruptured bAVM-related seizures. The result revealed that unruptured bAVMs causing seizures are anatomically heterogeneous at the voxel level. Subsequently, lesion network mapping (LNM) analyses was performed to determine whether bAVMs causing seizures belonged to a distributed brain network. LNM analyses indicated that these lesions were located in a functional network characterized by connectivity to the left caudate and precuneus. Moreover, the discrimination performance of the identified seizure network was evaluated in discovery set by calculating the individualized network damage score and was tested in validation set. Based on the calculated network damage scores, patients were divided into low-, medium-, and high-risk groups. The prevalence of seizures significantly differed among the three risk categories in both discovery (p = .003) and validation set (p = .004). Finally, we calculated the percentage of voxels in the canonical resting-state networks that overlapped with the seizure-susceptible brain regions to investigate the involvement of resting-state networks. With an involvement percentage over 50%, the frontoparietal control (82.9%), limbic function (76.7%), and default mode network (69.3%) were considered to be impacted in bAVM-related seizures. Our study identified the seizure-susceptible brain regions for unruptured bAVMs, which could be a plausible neuroimaging biomarker in predicting possible seizures.
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Affiliation(s)
- Shao-Zhi Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yu-Xin Zhao
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Xiao-Hua Liao
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Ran Huo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yu-Ming Jiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jian-Cong Weng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jie Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bing Liu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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10
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Bacon EJ, Jin C, He D, Hu S, Wang L, Li H, Qi S. Functional and effective connectivity analysis of drug-resistant epilepsy: a resting-state fMRI analysis. Front Neurosci 2023; 17:1163111. [PMID: 37152592 PMCID: PMC10157077 DOI: 10.3389/fnins.2023.1163111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Objective Epilepsy is considered as a neural network disorder. Seizure activity in epilepsy may disturb brain networks and damage brain functions. We propose using resting-state functional magnetic resonance imaging (rs-fMRI) data to characterize connectivity patterns in drug-resistant epilepsy. Methods This study enrolled 47 participants, including 28 with drug-resistant epilepsy and 19 healthy controls. Functional and effective connectivity was employed to assess drug-resistant epilepsy patients within resting state networks. The resting state functional connectivity (FC) analysis was performed to assess connectivity between each patient and healthy controls within the default mode network (DMN) and the dorsal attention network (DAN). In addition, dynamic causal modeling was used to compute effective connectivity (EC). Finally, a statistical analysis was performed to evaluate our findings. Results The FC analysis revealed significant connectivity changes in patients giving 64.3% (18/28) and 78.6% (22/28) for DMN and DAN, respectively. Statistical analysis of FC was significant between the medial prefrontal cortex, posterior cingulate cortex, and bilateral inferior parietal cortex for DMN. For DAN, it was significant between the left and the right intraparietal sulcus and the frontal eye field. For the DMN, the patient group showed significant EC connectivity in the right inferior parietal cortex and the medial prefrontal cortex for the DMN. There was also bilateral connectivity between the medial prefrontal cortex and the posterior cingulate cortex, as well as between the left and right inferior parietal cortex. For DAN, patients showed significant connectivity in the right frontal eye field and the right intraparietal sulcus. Bilateral connectivity was also found between the left frontal eye field and the left intraparietal sulcus, as well as between the right frontal eye field and the right intraparietal sulcus. The statistical analysis of the EC revealed a significant result in the medial prefrontal cortex and the right intraparietal cortex for the DMN. The DAN was found significant in the left frontal eye field, as well as the left and right intraparietal sulcus. Conclusion Our results provide preliminary evidence to support that the combination of functional and effective connectivity analysis of rs-fMRI can aid in diagnosing epilepsy in the DMN and DAN networks.
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Affiliation(s)
- Eric Jacob Bacon
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
| | - Chaoyang Jin
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Dianning He
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Shuaishuai Hu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lanbo Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Han Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Han Li,
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
- Shouliang Qi,
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11
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Akıncı T, Gündüz A, Özkara Ç, Kızıltan ME. The Thalamic and Intracortical Inhibitory Function of Somatosensory System Is Unchanged in Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis. J Clin Neurophysiol 2023; 40:45-52. [PMID: 33675312 DOI: 10.1097/wnp.0000000000000839] [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: 01/10/2023] Open
Abstract
PURPOSE In mesial temporal lobe epilepsy with hippocampal sclerosis, there is parietal atrophy and cognitive involvement in related domains. In this context, we hypothesized that inhibitory input into somatosensory cortex and thalamus may be increased in these patients, which could improve after epilepsy surgery. Thus, we analyzed the inhibitory function of somatosensory system by studying surround inhibition (SI) and recovery function of somatosensory evoked potentials in patients with mesial temporal lobe epilepsy with hippocampal sclerosis. METHODS Nine patients with unoperated mesial temporal lobe epilepsy with hippocampal sclerosis, 10 patients who underwent epilepsy surgery, and 12 healthy subjects were included. For SI of somatosensory evoked potentials, we recorded somatosensory evoked potentials after stimulating median or ulnar nerve at wrist separately and after median and ulnar nerves simultaneously and calculated SI% in all participants. For recovery function of somatosensory evoked potentials, paired stimulation of median nerve at 40- and 100-millisecond intervals was performed. We compared the findings among groups. As a secondary analysis, we determined the outliers in the patient group and analyzed the relation to the clinical findings. RESULTS The mean SI% or recovery function was similar among three groups. However, there were five patients with SI loss on normal side in the patient group, which was related to the antiseizure drugs. CONCLUSIONS In contrast to our hypothesis, both intracortical (SI) and thalamic/striatal (recovery function) inhibitory modulation of the somatosensory cortex was not altered in mesial temporal lobe epilepsy with hippocampal sclerosis and did not differ in surgical and nonsurgical groups.
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Affiliation(s)
- Tuba Akıncı
- Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa (I.U.C), Istanbul, Turkey
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12
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Bae S, Lim HK, Jeong Y, Kim SG, Park SM, Shon YM, Suh M. Deep brain stimulation of the anterior nuclei of the thalamus can alleviate seizure severity and induce hippocampal GABAergic neuronal changes in a pilocarpine-induced epileptic mouse brain. Cereb Cortex 2022; 32:5530-5543. [PMID: 35258078 DOI: 10.1093/cercor/bhac033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 01/25/2023] Open
Abstract
Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) has been widely used as an effective treatment for refractory temporal lobe epilepsy. Despite its promising clinical outcome, the exact mechanism of how ANT-DBS alleviates seizure severity has not been fully understood, especially at the cellular level. To assess effects of DBS, the present study examined electroencephalography (EEG) signals and locomotor behavior changes and conducted immunohistochemical analyses to examine changes in neuronal activity, number of neurons, and neurogenesis of inhibitory neurons in different hippocampal subregions. ANT-DBS alleviated seizure activity, abnormal locomotor behaviors, reduced theta-band, increased gamma-band EEG power in the interictal state, and increased the number of neurons in the dentate gyrus (DG). The number of parvalbumin- and somatostatin-expressing inhibitory neurons was recovered to the level in DG and CA1 of naïve mice. Notably, BrdU-positive inhibitory neurons were increased. In conclusion, ANT-DBS not only could reduce the number of seizures, but also could induce neuronal changes in the hippocampus, which is a key region involved in chronic epileptogenesis. Importantly, our results suggest that ANT-DBS may lead to hippocampal subregion-specific cellular recovery of GABAergic inhibitory neurons.
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Affiliation(s)
- Sungjun Bae
- 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
| | - Hyun-Kyoung Lim
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon 16419, South Korea.,Biomedical Institute for Convergence at SKKU (BICS), 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
| | - 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
| | - Sung-Min Park
- Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, South Korea
| | - Young-Min Shon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea.,Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Suwon 16419, South Korea
| | - Minah Suh
- 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.,Biomedical Institute for Convergence at SKKU (BICS), 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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He X, Caciagli L, Parkes L, Stiso J, Karrer TM, Kim JZ, Lu Z, Menara T, Pasqualetti F, Sperling MR, Tracy JI, Bassett DS. Uncovering the biological basis of control energy: Structural and metabolic correlates of energy inefficiency in temporal lobe epilepsy. SCIENCE ADVANCES 2022; 8:eabn2293. [PMID: 36351015 PMCID: PMC9645718 DOI: 10.1126/sciadv.abn2293] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 09/22/2022] [Indexed: 05/11/2023]
Abstract
Network control theory is increasingly used to profile the brain's energy landscape via simulations of neural dynamics. This approach estimates the control energy required to simulate the activation of brain circuits based on structural connectome measured using diffusion magnetic resonance imaging, thereby quantifying those circuits' energetic efficiency. The biological basis of control energy, however, remains unknown, hampering its further application. To fill this gap, investigating temporal lobe epilepsy as a lesion model, we show that patients require higher control energy to activate the limbic network than healthy volunteers, especially ipsilateral to the seizure focus. The energetic imbalance between ipsilateral and contralateral temporolimbic regions is tracked by asymmetric patterns of glucose metabolism measured using positron emission tomography, which, in turn, may be selectively explained by asymmetric gray matter loss as evidenced in the hippocampus. Our investigation provides the first theoretical framework unifying gray matter integrity, metabolism, and energetic generation of neural dynamics.
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Affiliation(s)
- Xiaosong He
- Department of Psychology, School of Humanities and Social Sciences, University of Science and Technology of China, Hefei, Anhui, China
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chesham Lane, Chalfont St Peter, Buckinghamshire, UK
| | - Linden Parkes
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Stiso
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Teresa M. Karrer
- Personalized Health Care, Product Development, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Jason Z. Kim
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhixin Lu
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Tommaso Menara
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, San Diego, CA, USA
| | - Fabio Pasqualetti
- Department of Mechanical Engineering, University of California, Riverside, Riverside, CA, USA
| | | | - Joseph I. Tracy
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dani S. Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Departments of Electrical and Systems Engineering, Physics and Astronomy, Psychiatry, and Neurology, University of Pennsylvania, Philadelphia, PA, USA
- Santa Fe Institute, Santa Fe, NM, USA
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14
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Song C, Zhang X, Han S, Ma K, Wang K, Mao X, Lian Y, Zhang X, Zhu J, Zhang Y, Cheng J. More than just statics: Static and temporal dynamic changes in intrinsic brain activity in unilateral temporal lobe epilepsy. Front Hum Neurosci 2022; 16:971062. [PMID: 36118964 PMCID: PMC9471141 DOI: 10.3389/fnhum.2022.971062] [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: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Temporal lobe epilepsy (TLE) is the most prevalent refractory focal epilepsy and is more likely accompanied by cognitive impairment. The fully understanding of the neuronal activity underlying TLE is of great significance. Objective This study aimed to comprehensively explore the potential brain activity abnormalities affected by TLE and detect whether the changes were associated with cognition. Methods Six static intrinsic brain activity (IBA) indicators [amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), degree centrality (DC), global signal correlation (GSCorr), and voxel-mirrored homotopic connectivity (VMHC)] and their corresponding dynamic indicators, such as dynamic ALFF (dALFF), dynamic fALFF (dfALFF), dynamic ReHo (dReHo), dynamic DC (dDC), dynamic VMHC (dVMHC), and dynamic GSCorr (dGSCorr), in 57 patients with unilateral TLE and 42 healthy volunteers were compared. Correlation analyses were also performed between these indicators in areas displaying group differences and cognitive function, epilepsy duration, and severity. Results Marked overlap was present among the abnormal brain regions detected using various static and dynamic indicators, primarily including increased ALFF/dALFF/fALFF in the bilateral medial temporal lobe and thalamus, decreased ALFF/dALFF/fALFF in the frontal lobe contralateral to the epileptogenic side, decreased fALFF, ReHo, dReHo, DC, dDC, GSCorr, dGSCorr, and VMHC in the temporal neocortex ipsilateral to the epileptogenic foci, decreased dReHo, dDC, dGSCorr, and dVMHC in the occipital lobe, and increased ALFF, fALFF, dfALFF, ReHo, and DC in the supplementary motor area ipsilateral to the epileptogenic foci. Furthermore, most IBA indicators in the abnormal brain region significantly correlated with the duration of epilepsy and several cognitive scale scores (P < 0.05). Conclusion The combined application of static and dynamic IBA indicators could comprehensively reveal more real abnormal neuronal activity and the impairment and compensatory mechanisms of cognitive function in TLE. Moreover, it might help in the lateralization of epileptogenic foci and exploration of the transmission and inhibition pathways of epileptic activity.
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Affiliation(s)
- Chengru Song
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Xiaonan Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Keran Ma
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Kefan Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Xinyue Mao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
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15
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Matsui T, Yamashita KI. Static and Dynamic Functional Connectivity Alterations in Alzheimer's Disease and Neuropsychiatric Diseases. Brain Connect 2022. [PMID: 35994384 DOI: 10.1089/brain.2022.0044] [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: 11/12/2022] Open
Abstract
To date, numerous studies have documented various alterations in resting brain activity in Alzheimer's disease (AD) and other neuropsychiatric diseases. In particular, disease-related alterations of functional connectivity (FC) in the resting state networks (RSN) have been documented. Altered FC in RSN is useful not only for interpreting the phenotype of diseases but also for diagnosing the diseases. More recently, several studies proposed the dynamics of resting-brain activity as a useful marker for detecting altered RSNs related to AD and other diseases. In contrast to previous studies, which focused on FC calculated using an entire fMRI scan (static FC), these newer studies focused the on temporal dynamics of FC within the scan (dynamic FC) to provide more sensitive measures to characterize RSNs. However, despite the increasing popularity of dFC, several studies cautioned that the results obtained in commonly used analyses for dFC require careful interpretation. In this mini-review, we review recent studies exploring alterations of static and dynamic functional connectivity in AD and other neuropsychiatric diseases. We then discuss how to utilize and interpret dFC for studying resting brain activity in diseases.
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Affiliation(s)
- Teppei Matsui
- Okayama University - Tsushima Campus, Tsushima-kita 1-1-1, Okayama, Japan, 700-8530;
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16
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Wang Y, Li Z, Zhang Y, Long Y, Xie X, Wu T. Classification of partial seizures based on functional connectivity: A MEG study with support vector machine. Front Neuroinform 2022; 16:934480. [PMID: 36059865 PMCID: PMC9435583 DOI: 10.3389/fninf.2022.934480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is a chronic neurological disorder that is divided into two subtypes, complex partial seizures (CPS) and simple partial seizures (SPS), based on clinical phenotypes. Revealing differences among the functional networks of different types of TLE can lead to a better understanding of the symbology of epilepsy. Whereas Although most studies had focused on differences between epileptic patients and healthy controls, the neural mechanisms behind the differences in clinical representations of CPS and SPS were unclear. In the context of the era of precision, medicine makes precise classification of CPS and SPS, which is crucial. To address the above issues, we aimed to investigate the functional network differences between CPS and SPS by constructing support vector machine (SVM) models. They mainly include magnetoencephalography (MEG) data acquisition and processing, construction of functional connectivity matrix of the brain network, and the use of SVM to identify differences in the resting state functional connectivity (RSFC). The obtained results showed that classification was effective and accuracy could be up to 82.69% (training) and 81.37% (test). The differences in functional connectivity between CPS and SPS were smaller in temporal and insula. The differences between the two groups were concentrated in the parietal, occipital, frontal, and limbic systems. Loss of consciousness and behavioral disturbances in patients with CPS might be caused by abnormal functional connectivity in extratemporal regions produced by post-epileptic discharges. This study not only contributed to the understanding of the cognitive-behavioral comorbidity of epilepsy but also improved the accuracy of epilepsy classification.
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Affiliation(s)
- Yingwei Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhongjie Li
- College of Intelligence and Computing, Tianjin Key Laboratory of Cognitive Computing and Application, Tianjin University, Tianjin, China
| | - Yujin Zhang
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Yingming Long
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinyan Xie
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ting Wu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Magnetoencephalography, Nanjing Brain Hospital, Affiliated to Nanjing Medical University, Nanjing, China
- *Correspondence: Ting Wu
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17
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Redinbaugh MJ, Afrasiabi M, Phillips JM, Kambi NA, Mohanta S, Raz A, Saalmann YB. Thalamic deep brain stimulation paradigm to reduce consciousness: Cortico-striatal dynamics implicated in mechanisms of consciousness. PLoS Comput Biol 2022; 18:e1010294. [PMID: 35816488 PMCID: PMC9321468 DOI: 10.1371/journal.pcbi.1010294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 07/26/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
Anesthetic manipulations provide much-needed causal evidence for neural correlates of consciousness, but non-specific drug effects complicate their interpretation. Evidence suggests that thalamic deep brain stimulation (DBS) can either increase or decrease consciousness, depending on the stimulation target and parameters. The putative role of the central lateral thalamus (CL) in consciousness makes it an ideal DBS target to manipulate circuit-level mechanisms in cortico-striato-thalamic (CST) systems, thereby influencing consciousness and related processes. We used multi-microelectrode DBS targeted to CL in macaques while recording from frontal, parietal, and striatal regions. DBS induced episodes of abnormally long, vacant staring with low-frequency oscillations here termed vacant, perturbed consciousness (VPC). DBS modulated VPC likelihood in a frequency-specific manner. VPC events corresponded to decreases in measures of neural complexity (entropy) and integration (Φ*), proposed indices of consciousness, and substantial changes to communication in CST circuits. During VPC, power spectral density and coherence at low frequencies increased across CST circuits, especially in thalamo-parietal and cortico-striatal pathways. Decreased consciousness and neural integration corresponded to shifts in cortico-striatal network configurations that dissociated parietal and subcortical structures. Overall, the features of VPC and implicated networks were similar to those of absence epilepsy. As this same multi-microelectrode DBS method–but at different stimulation frequencies–can also increase consciousness in anesthetized macaques, it can be used to flexibly address questions of consciousness with limited confounds, as well as inform clinical investigations of other consciousness disorders. Deep brain stimulation (DBS) is an effective treatment for a number of neurological and psychiatric disorders. Recent evidence shows that thalamic DBS can increase consciousness under general anesthesia, and has the potential to be an effective treatment for disorders of consciousness like coma. However, past studies also imply that thalamic DBS can decrease consciousness by producing periods of inactivity with vacant staring. In this study, we use thalamic DBS to induce vacant periods of perturbed consciousness (VPC) while recording from frontal, parietal and subcortical brain areas. Much of modern research on consciousness focuses on cortical contributions, debating if frontal or more posterior areas are more important. We show via machine learning, information theoretic and functional connectivity measures that VPC involves altered neural communication between parietal cortex and subcortical regions, challenging a cortico-centric focus. Further, these mechanisms resemble those associated with absence epilepsy, suggesting a link between this disorder of consciousness and VPC. Finally, occurrence of VPC in our study was stimulation frequency-dependent and influenced by the experimental history of DBS. This provides insight to mechanisms of thalamic DBS, informative for clinical manipulations of consciousness.
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Affiliation(s)
- Michelle J. Redinbaugh
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail: (YS); (MJR)
| | - Mohsen Afrasiabi
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jessica M. Phillips
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Niranjan A. Kambi
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Sounak Mohanta
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Aeyal Raz
- Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Yuri B. Saalmann
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, Madison, Wisconsin, United States of America
- * E-mail: (YS); (MJR)
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18
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Beniczky S, Tatum WO, Blumenfeld H, Stefan H, Mani J, Maillard L, Fahoum F, Vinayan KP, Mayor LC, Vlachou M, Seeck M, Ryvlin P, Kahane P. Seizure semiology: ILAE glossary of terms and their significance. Epileptic Disord 2022; 24:447-495. [PMID: 35770761 DOI: 10.1684/epd.2022.1430] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/19/2022] [Indexed: 11/17/2022]
Abstract
This educational topical review and Task Force report aims to address learning objectives of the International League Against Epilepsy (ILAE) curriculum. We sought to extract detailed features involving semiology from video recordings and interpret semiological signs and symptoms that reflect the likely localization for focal seizures in patients with epilepsy. This glossary was developed by a working group of the ILAE Commission on Diagnostic Methods incorporating the EEG Task Force. This paper identifies commonly used terms to describe seizure semiology, provides definitions, signs and symptoms, and summarizes their clinical value in localizing and lateralizing focal seizures based on consensus in the published literature. Video-EEG examples are included to illustrate important features of semiology in patients with epilepsy.
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19
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Duszyk-Bogorodzka A, Zieleniewska M, Jankowiak-Siuda K. Brain Activity Characteristics of Patients With Disorders of Consciousness in the EEG Resting State Paradigm: A Review. Front Syst Neurosci 2022; 16:654541. [PMID: 35720438 PMCID: PMC9198636 DOI: 10.3389/fnsys.2022.654541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
The assessment of the level of consciousness in disorders of consciousness (DoC) is still one of the most challenging problems in contemporary medicine. Nevertheless, based on the multitude of studies conducted over the last 20 years on resting states based on electroencephalography (EEG) in DoC, it is possible to outline the brain activity profiles related to both patients without preserved consciousness and minimally conscious ones. In the case of patients without preserved consciousness, the dominance of low, mostly delta, frequency, and the marginalization of the higher frequencies were observed, both in terms of the global power of brain activity and in functional connectivity patterns. In turn, the minimally conscious patients revealed the opposite brain activity pattern—the characteristics of higher frequency bands were preserved both in global power and in functional long-distance connections. In this short review, we summarize the state of the art of EEG-based research in the resting state paradigm, in the context of providing potential support to the traditional clinical assessment of the level of consciousness.
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Affiliation(s)
- Anna Duszyk-Bogorodzka
- Behavioural Neuroscience Lab, Institute of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
- *Correspondence: Anna Duszyk-Bogorodzka
| | | | - Kamila Jankowiak-Siuda
- Behavioural Neuroscience Lab, Institute of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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20
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Pathway-specific inhibition of critical projections from the mediodorsal thalamus to the frontal cortex controls kindled seizures. Prog Neurobiol 2022; 214:102286. [PMID: 35537572 DOI: 10.1016/j.pneurobio.2022.102286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/22/2022] [Accepted: 05/04/2022] [Indexed: 02/07/2023]
Abstract
There is a large unmet need for improved treatment for temporal lobe epilepsy (TLE); circuit-specific manipulation that disrupts the initiation and propagation of seizures is promising in this regard. The midline thalamus, including the mediodorsal nucleus (MD) is a critical distributor of seizure activity, but its afferent and efferent pathways that mediate seizure activity are unknown. Here, we used chemogenetics to silence input and output projections of the MD to discrete regions of the frontal cortex in the kindling model of TLE in rats. Chemogenetic inhibition of the projection from the amygdala to the MD abolished seizures, an effect that was replicated using optogenetic inhibition. Chemogenetic inhibition of projections from the MD to the prelimbic cortex likewise abolished seizures. By contrast, inhibition of projections from the MD to other frontal regions produced partial (orbitofrontal cortex, infralimbic cortex) or no (cingulate, insular cortex) attenuation of behavioral or electrographic seizure activity. These results highlight the particular importance of projections from MD to prelimbic cortex in the propagation of amygdala-kindled seizures.
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21
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Middlebrooks EH, He X, Grewal SS, Keller SS. Neuroimaging and thalamic connectomics in epilepsy neuromodulation. Epilepsy Res 2022; 182:106916. [PMID: 35367691 DOI: 10.1016/j.eplepsyres.2022.106916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/05/2022] [Accepted: 03/27/2022] [Indexed: 11/03/2022]
Abstract
Neuromodulation is an increasingly utilized therapy for the treatment of people with drug-resistant epilepsy. To date, the most common and effective target has been the thalamus, which is known to play a key role in multiple forms of epilepsy. Neuroimaging has facilitated rapid developments in the understanding of functional targets, surgical and programming techniques, and the effects of thalamic stimulation. In this review, the role of neuroimaging in neuromodulation is explored. First, the structural and functional changes of the thalamus in common epilepsy syndromes are discussed as the rationale for neuromodulation of the thalamus. Next, methods for imaging different thalamic nuclei are presented, as well as rationale for the need of direct surgical targeting rather than reliance on traditional stereotactic coordinates. Lastly, we discuss the potential role of neuroimaging in assessing the effects of thalamic stimulation and as a potential biomarker for neuromodulation outcomes.
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Affiliation(s)
- Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Xiaosong He
- Department of Psychology, University of Science and Technology of China, Hefei, Anhui, China
| | | | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK
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22
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Haemels M, Van Weehaeghe D, Cleeren E, Dupont P, van Loon J, Theys T, Van Laere K, Van Paesschen W, Goffin K. Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy. Acta Neurol Belg 2022; 122:325-335. [PMID: 33544336 DOI: 10.1007/s13760-020-01569-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/08/2020] [Indexed: 01/30/2023]
Abstract
The value of functional molecular changes outside the seizure onset zone as independent predictive factors of surgical outcome has been scarcely evaluated. The aim of this retrospective study was to evaluate relative metabolic and perfusion changes outside the seizure onset zone as predictors of postoperative outcome in patients with unifocal refractory focal epilepsy. Eighty-six unifocal epilepsy patients who underwent 18F-FDG PET prior to surgery were included. Ictal and interictal perfusion SPECT was available in 65 patients. Good postoperative outcome was defined as the International League against Epilepsy class 1. Using univariate statistical analysis, the predictive ability of volume-of-interest based relative metabolism/perfusion for outcome classification was quantified by AUC ROC-curve, using composite, unilateral cortical (frontal, orbitofrontal, temporal, parietal, occipital) and central volumes-of-interest. The results were cross-validated, and a false discovery rate (FDR) correction was applied. As a secondary objective, a subgroup analysis was performed on temporal lobe epilepsy patients (N = 64). Increased relative ictal perfusion in the contralateral central volume-of-interest was significantly associated with the good surgical outcome both in the total population (AUC 0.79, pFDR = 0.009) and the temporal lobe epilepsy subgroup (AUC 0.80, pFDR = 0.028). No other significant associations between functional molecular changes and postoperative outcome were found. Increased relative ictal perfusion in the contralateral central region significantly predicted outcome after epilepsy surgery in patients with refractory focal epilepsy. We postulate that these relative perfusion changes could be an expression of better preoperative neuronal network integration and centralization in the contralateral central structures, which is suggested to be associated with better postoperative outcome.
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23
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Hou J, Zhu H, Xiao L, Zhao CW, Liao G, Tang Y, Feng L. Alterations in Cortical-Subcortical Metabolism in Temporal Lobe Epilepsy With Impaired Awareness Seizures. Front Aging Neurosci 2022; 14:849774. [PMID: 35360210 PMCID: PMC8961434 DOI: 10.3389/fnagi.2022.849774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe features of cerebral metabolism associated with loss of consciousness in patients with temporal lobe epilepsy (TLE) have not been fully elucidated. We aim to investigate the alterations in cortical-subcortical metabolism in temporal lobe epilepsy with impaired awareness seizures (IAS).MethodsRegional cerebral metabolism was measured using fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in patients with TLE-IAS and healthy controls. All patients had a comprehensive evaluation to confirm their seizure origin and lateralization. Videos of all seizures were viewed and rated by at least two epileptologists to identify the state of consciousness when a seizure occurred. By synthesizing the seizure history, semeiology, and video EEG of all patients, as long as the patients had one seizure with impaired awareness, she/he will be included. 76 patients with TLE-IAS and 60 age-matched healthy controls were enrolled in this study. Regional cerebral metabolic patterns were analyzed for TLE-IAS and healthy control groups using statistical parametric mapping. Besides, we compared the MRI-negative patients and MRI-positive patients with healthy controls, respectively.ResultsThere were no significant differences in the age and sex of TLE-IAS patients and healthy control. TLE-IAS patients showed extensive bilateral hypermetabolism in the frontoparietal regions, cingulate gyrus, corpus callosum, occipital lobes, basal ganglia, thalamus, brainstem, and cerebellum. The region of metabolic change was more extensive in right TLE-IAS than that of the left, including extensive hypometabolism in the ipsilateral temporal, frontal, parietal, and insular lobes. And contralateral temporal lobe, bilateral frontoparietal regions, occipital lobes, the anterior and posterior regions of the cingulate gyrus, bilateral thalamus, bilateral basal ganglia, brainstem, and bilateral cerebellum showed hypermetabolism. The TLE patients with impaired awareness seizure showed hypermetabolism in the cortical-subcortical network including the arousal system. Additionally, 48 MRI-positive and 28 MRI-negative TLE-IAS patients were included in our study. TLE-IAS patients with MRI-negative and MRI-positive were both showed hypermetabolism in the cingulate gyrus. Hypometabolism in the bilateral temporal lobe was showed in the TLE-IAS with MRI-positive.ConclusionThese findings suggested that the repetitive consciousness impairing ictal events may have an accumulative effect on brain metabolism, resulting in abnormal interictal cortical-subcortical metabolic disturbance in TLE patients with impaired awareness seizure. Understanding these metabolic mechanisms may guide future clinical treatments to prevent seizure-related awareness deficits and improve quality of life in people with TLE.
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Affiliation(s)
- Jiale Hou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | | | - Guang Liao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Yongxiang Tang,
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders (XIANGYA), Xiangya Hospital, Central South University, Changsha, China
- Li Feng,
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24
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Ferguson MA, Schaper FL, Cohen A, Siddiqi S, Merrill SM, Nielsen JA, Grafman J, Urgesi C, Fabbro F, Fox MD. A Neural Circuit for Spirituality and Religiosity Derived From Patients With Brain Lesions. Biol Psychiatry 2022; 91:380-388. [PMID: 34454698 PMCID: PMC8714871 DOI: 10.1016/j.biopsych.2021.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/25/2021] [Accepted: 06/20/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Over 80% of the global population consider themselves religious, with even more identifying as spiritual, but the neural substrates of spirituality and religiosity remain unresolved. METHODS In two independent brain lesion datasets (N1 = 88; N2 = 105), we applied lesion network mapping to test whether lesion locations associated with spiritual and religious belief map to a specific human brain circuit. RESULTS We found that brain lesions associated with self-reported spirituality map to a brain circuit centered on the periaqueductal gray. Intersection of lesion locations with this same circuit aligned with self-reported religiosity in an independent dataset and previous reports of lesions associated with hyper-religiosity. Lesion locations causing delusions and alien limb syndrome also intersected this circuit. CONCLUSIONS These findings suggest that spirituality and religiosity map to a common brain circuit centered on the periaqueductal gray, a brainstem region previously implicated in fear conditioning, pain modulation, and altruistic behavior.
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Affiliation(s)
- Michael A. Ferguson
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, MA, 02115, USA
| | - Frederic L.W.V.J. Schaper
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, MA, 02115, USA,Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Alexander Cohen
- Harvard Medical School, Boston, MA, 02115, USA,Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Shan Siddiqi
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, MA, 02115, USA,Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah M. Merrill
- Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jared A. Nielsen
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Think + Speak Lab, Shirley Ryan Ability Lab, Chicago, Illinois, USA,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Cosimo Urgesi
- Cognitive Neuroscience Laboratory, Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Franco Fabbro
- Cognitive Neuroscience Laboratory, Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Michael D. Fox
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, MA, 02115, USA,Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA,Athinoula A. Martinos Centre for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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25
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Frazzini V, Cousyn L, Navarro V. Semiology, EEG, and neuroimaging findings in temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:489-518. [PMID: 35964989 DOI: 10.1016/b978-0-12-823493-8.00021-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy. First descriptions of TLE date back in time and detailed portraits of epileptic seizures of temporal origin can be found in early medical reports as well as in the works of various artists and dramatists. Depending on the seizure onset zone, several subtypes of TLE have been identified, each one associated with peculiar ictal semiology. TLE can result from multiple etiological causes, ranging from genetic to lesional ones. While the diagnosis of TLE relies on detailed analysis of clinical as well as electroencephalographic (EEG) features, the lesions responsible for seizure generation can be highlighted by multiple brain imaging modalities or, in selected cases, by genetic investigations. TLE is the most common cause of refractory epilepsy and despite the great advances in diagnostic tools, no lesion is found in around one-third of patients. Surgical treatment is a safe and effective option, requiring presurgical investigations to accurately identify the seizure onset zone (SOZ). In selected cases, presurgical investigations need intracerebral investigations (such as stereoelectroencephalography) or dedicated metabolic imaging techniques (interictal PET and ictal SPECT) to correctly identify the brain structures to be removed.
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Affiliation(s)
- Valerio Frazzini
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Louis Cousyn
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Vincent Navarro
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France.
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26
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Wang K, Zhang X, Song C, Ma K, Bai M, Zheng R, Wei Y, Chen J, Cheng J, Zhang Y, Han S. Decreased Intrinsic Neural Timescales in Mesial Temporal Lobe Epilepsy. Front Hum Neurosci 2021; 15:772365. [PMID: 34955790 PMCID: PMC8693765 DOI: 10.3389/fnhum.2021.772365] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/16/2021] [Indexed: 01/02/2023] Open
Abstract
It is well established that epilepsy is characterized by the destruction of the information capacity of brain network and the interference with information processing in regions outside the epileptogenic focus. However, the potential mechanism remains poorly understood. In the current study, we applied a recently proposed approach on the basis of resting-state fMRI data to measure altered local neural dynamics in mesial temporal lobe epilepsy (mTLE), which represents how long neural information is stored in a local brain area and reflect an ability of information integration. Using resting-state-fMRI data recorded from 36 subjects with mTLE and 36 healthy controls, we calculated the intrinsic neural timescales (INT) of neural signals by summing the positive magnitude of the autocorrelation of the resting-state brain activity. Compared to healthy controls, the INT values were significantly lower in patients in the right orbitofrontal cortices, right insula, and right posterior lobe of cerebellum. Whereas, we observed no statistically significant changes between patients with long- and short-term epilepsy duration or between left-mTLE and right-mTLE. Our study provides distinct insight into the brain abnormalities of mTLE from the perspective of the dynamics of the brain activity, highlighting the significant role of intrinsic timescale in understanding neurophysiological mechanisms. And we postulate that altered intrinsic timescales of neural signals in specific cortical brain areas may be the neurodynamic basis of cognitive impairment and emotional comorbidities in mTLE patients.
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Affiliation(s)
- Kefan Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
| | - Xiaonan Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Chengru Song
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Keran Ma
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Man Bai
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Ruiping Zheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Yarui Wei
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Jingli Chen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
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27
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Abstract
Impaired consciousness during seizures severely affects quality of life for people with
epilepsy but the mechanisms are just beginning to be understood. Consciousness is thought
to involve large-scale brain networks, so it is puzzling that focal seizures often impair
consciousness. Recent work investigating focal temporal lobe or limbic seizures in human
patients and experimental animal models suggests that impaired consciousness is caused by
active inhibition of subcortical arousal mechanisms. Focal limbic seizures exhibit
decreased neuronal firing in brainstem, basal forebrain, and thalamic arousal networks,
and cortical arousal can be restored when subcortical arousal circuits are stimulated
during seizures. These findings open the possibility of restoring arousal and
consciousness therapeutically during and following seizures by thalamic neurostimulation.
When seizures cannot be stopped by existing treatments, targeted subcortical stimulation
may improve arousal and consciousness, leading to improved safety and better psychosocial
function for people with epilepsy.
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Affiliation(s)
- Hal Blumenfeld
- Departments of Neurology, Neuroscience, Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
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Kumar A, Martin R, Chen W, Bauerschmidt A, Youngblood MW, Cunningham C, Si Y, Ezeani C, Kratochvil Z, Bronen J, Thomson J, Riordan K, Yoo JY, Shirka R, Manganas L, Krestel H, Hirsch LJ, Blumenfeld H. Simulated driving in the epilepsy monitoring unit: Effects of seizure type, consciousness, and motor impairment. Epilepsia 2021; 63:e30-e34. [PMID: 34816425 DOI: 10.1111/epi.17136] [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: 06/30/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
People with epilepsy face serious driving restrictions, determined using retrospective studies. To relate seizure characteristics to driving impairment, we aimed to study driving behavior during seizures with a simulator. Patients in the Yale New Haven Hospital undergoing video-electroencephalographic monitoring used a laptop-based driving simulator during ictal events. Driving function was evaluated by video review and analyzed in relation to seizure type, impairment of consciousness/responsiveness, or motor impairment during seizures. Fifty-one seizures in 30 patients were studied. In terms of seizure type, we found that focal to bilateral tonic-clonic or myoclonic seizures (5/5) and focal seizures with impaired consciousness/responsiveness (11/11) always led to driving impairment; focal seizures with spared consciousness/responsiveness (0/10) and generalized nonmotor (generalized spike-wave bursts; 1/19) usually did not lead to driving impairment. Regardless of seizure type, we found that seizures with impaired consciousness (15/15) or with motor involvement (13/13) always led to impaired driving, but those with spared consciousness (0/20) or spared motor function (5/38) usually did not. These results suggest that seizure types with impaired consciousness/responsiveness and abnormal motor function contribute to impaired driving. Expanding this work in a larger cohort could further determine how results with a driving simulator may translate into real world driving safety.
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Affiliation(s)
- Avisha Kumar
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Reese Martin
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - William Chen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew Bauerschmidt
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mark W Youngblood
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Courtney Cunningham
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yang Si
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Cel Ezeani
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zachary Kratochvil
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jared Bronen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James Thomson
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Katherine Riordan
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ji Yeoun Yoo
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Romina Shirka
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Louis Manganas
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Heinz Krestel
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.,Epilepsy Center of Frankfurt, Rhine-Main, Center for Personalized Translational Epilepsy Research, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Lawrence J Hirsch
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Arski ON, Wong SM, Warsi NM, Martire DJ, Ochi A, Otsubo H, Donner E, Jain P, Kerr EN, Smith ML, Ibrahim GM. Spectral changes following resective epilepsy surgery and neurocognitive function in children with epilepsy. J Neurophysiol 2021; 126:1614-1621. [PMID: 34550020 DOI: 10.1152/jn.00434.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Decelerated resting cortical oscillations, high-frequency activity, and enhanced cross-frequency interactions are features of focal epilepsy. The association between electrophysiological signal properties and neurocognitive function, particularly following resective surgery, is, however, unclear. In the current report, we studied intraoperative recordings from intracranial electrodes implanted in seven children with focal epilepsy and analyzed the spectral dynamics both before and after surgical resection of the hypothesized seizure focus. The associations between electrophysiological spectral signatures and each child's neurocognitive profiles were characterized using a partial least squares analysis. We find that extent of spectral alteration at the periphery of surgical resection, as indexed by slowed resting frequency and its acceleration following surgery, is associated with baseline cognitive deficits in children. The current report provides evidence supporting the relationship between altered spectral properties in focal epilepsy and neuropsychological deficits in children. In particular, these findings suggest a critical role of disrupted thalamocortical rhythms, which are believed to underlie the spectral alterations we describe, in both epileptogenicity and neurocognitive function.NEW & NOTEWORTHY Spectral alterations marked by decelerated resting oscillations and ectopic high-frequency activity have been noted in focal epilepsy. We leveraged intraoperative recordings from chronically implanted electrodes pre- and postresection to understand the association between these electrophysiological phenomena and neuropsychological function. We find that the extent of spectral alteration, indexed by slowed resting frequency and its acceleration following resection, is associated with baseline cognitive deficits. These findings provide novel insights into neurocognitive impairments in focal epilepsy.
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Affiliation(s)
- Olivia N Arski
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Simeon M Wong
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Nebras M Warsi
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Martire
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Donner
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Puneet Jain
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth N Kerr
- Division of Psychology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Division of Psychology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Impaired awareness in mesial temporal lobe epilepsy: Network analysis of foramen ovale and scalp EEG. Clin Neurophysiol 2021; 132:3084-3094. [PMID: 34717226 DOI: 10.1016/j.clinph.2021.09.011] [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: 05/04/2021] [Revised: 08/11/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We use co-registration of foramen-ovale and scalp-EEG to investigate network alterations in temporal-lobe epilepsy during focal seizures without (aura) or with impairment of awareness (SIA). METHODS One aura and one SIA were selected from six patients. Temporal dynamic among 4 epochs, as well as the differences between aura and SIA, were analyzed through partial directed coherence and graph theory-based indices of centrality. RESULTS Regarding the auras temporal evolution, fronto-parietal (FP) regions showed decreased connectivity with respect to the interictal period, in both epileptogenic (EH) and non-epileptogenic hemisphere (nEH). During SIAs, temporal dynamic showed more changes than auras: centrality of mesial temporal (mT) regions changes during all conditions, and nEH FP centrality showed the same dynamic trend of the aura (decreased centrality), until the last epoch, close to the impaired awareness, when showed increased centrality. Comparing SIA with aura, in proximity of impaired awareness, increased centrality was found in all the regions, except in nEH mT. CONCLUSIONS Our findings suggested that the impairment of awareness is related to network alterations occurring first in neocortical regions and when awareness is still retained. SIGNIFICANCE The analysis of 'hub' alteration can represent a suitable biomarker for scalp EEG-based prediction of awareness impairment.
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Taherpour J, Jaber M, Voges B, Apostolova I, Sauvigny T, House PM, Lanz M, Lindenau M, Klutmann S, Martens T, Stodieck S, Buchert R. Predicting the outcome of epilepsy surgery by covariance pattern analysis of ictal perfusion SPECT. J Nucl Med 2021; 63:925-930. [PMID: 34593599 DOI: 10.2967/jnumed.121.262702] [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: 06/07/2021] [Revised: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
Previous studies on the utility of specific perfusion patterns in ictal brain perfusion SPECT for predicting the outcome of temporal lobe epilepsy surgery used qualitative visual pattern classification, semi-quantitative region-of-interest analysis or conventional univariate voxel-based testing, which are limited by intra- and inter-rater variability and/or low sensitivity to capture functional interactions among brain regions. The present study performed covariance pattern analysis of ictal perfusion SPECT using the Scaled Subprofile Model for unbiased identification of predictive covariance patterns. Methods: The study retrospectively included 18 responders to temporal lobe epilepsy surgery (Engel I-A at 12 months follow-up) and 18 non-responders (≥ Engel I-B). Ictal SPECT images were analyzed with the Scaled Subprofile Model blinded to group membership for unbiased identification of the 16 covariance patterns explaining the highest proportion of variance in the whole data set. Individual expression scores of the covariance patterns were evaluated for predicting seizure freedom after temporal lobe surgery by ROC analysis. Kaplan-Meier analysis including all available follow-up data (up to 60 months after surgery) was also performed. Results: Amongst the 16 covariance patterns only one showed a different expression between responders and non-responders (P = 0.03). This 'favorable ictal perfusion pattern' resembled the typical ictal perfusion pattern in temporomesial epilepsy. The expression score of the pattern provided an area of 0.744 (95%-confidence interval 0.577-0.911, P = 0.004) under the ROC curve. Kaplan-Meier analysis revealed a statistical trend towards longer seizure freedom in patients with positive expression score (P = 0.06). The median estimated seizure free time was 48 months in patients with positive expression score versus 6 months in patients with negative expression score. Conclusion: The expression of the 'favorable ictal perfusion pattern' identified by covariance analysis of ictal brain perfusion SPECT provides independent (from demographical and clinical variables) information for the prediction of seizure freedom after temporal lobe epilepsy surgery. The expression of this pattern is easily computed for new ictal SPECT images and, therefore, might be used to support the decision for or against temporal lobe surgery in clinical patient care.
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Affiliation(s)
| | - Marian Jaber
- University Medical Center Hamburg-Eppendorf, Germany
| | | | | | | | | | | | | | | | | | | | - Ralph Buchert
- University Medical Center Hamburg-Eppendorf, Germany
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Gummadavelli A, Martin R, Goshay D, Sieu LA, Xu J, Gruenbaum BF, McCafferty C, Gerrard JL, Blumenfeld H. Cortical low-frequency power correlates with behavioral impairment in animal model of focal limbic seizures. Epilepsia 2021; 62:1960-1970. [PMID: 34240747 PMCID: PMC8349876 DOI: 10.1111/epi.16964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Impairment in consciousness is a debilitating symptom during and after seizures; however, its mechanism remains unclear. Limbic seizures have been shown to spread to arousal circuitry to result in a "network inhibition" phenomenon. However, prior animal model studies did not relate physiological network changes to behavioral responses during or following seizures. METHODS Focal onset limbic seizures were induced while rats were performing an operant conditioned behavioral task requiring response to an auditory stimulus to quantify how and when impairment of behavioral response occurs. Correct responses were rewarded with sucrose. Cortical and hippocampal electrophysiology measured by local field potential recordings was analyzed for changes in low- and high-frequency power in relation to behavioral responsiveness during seizures. RESULTS As seen in patients with seizures, ictal (p < .0001) and postictal (p = .0015) responsiveness was variably impaired. Analysis of cortical and hippocampal electrophysiology revealed that ictal (p = .002) and postictal (p = .009) frontal cortical low-frequency 3-6-Hz power was associated with poor behavioral performance. In contrast, the hippocampus showed increased power over a wide frequency range during seizures, and suppression postictally, neither of which were related to behavioral impairment. SIGNIFICANCE These findings support prior human studies of temporal lobe epilepsy as well as anesthetized animal models suggesting that focal limbic seizures depress consciousness through remote network effects on the cortex, rather than through local hippocampal involvement. By identifying the cortical physiological changes associated with impaired arousal and responsiveness in focal seizures, these results may help guide future therapies to restore ictal and postictal consciousness, improving quality of life for people with epilepsy.
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Affiliation(s)
- Abhijeet Gummadavelli
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Reese Martin
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Derek Goshay
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Lim-Anna Sieu
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Jingwen Xu
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Benjamin F. Gruenbaum
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Cian McCafferty
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Jason L. Gerrard
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
- Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
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Zanão TA, Lopes TM, de Campos BM, Yasuda CL, Cendes F. Patterns of default mode network in temporal lobe epilepsy with and without hippocampal sclerosis. Epilepsy Behav 2021; 121:106523. [PMID: 31645315 DOI: 10.1016/j.yebeh.2019.106523] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022]
Abstract
The default mode network (DMN) consists of the deactivation of specific regions during the performance of cognitive tasks and activation during resting or mind wandering. Several pieces of evidence indicate the impairment of DMN in patients with mesial temporal lobe epilepsy (MTLE). However, most of these studies combined different underlying etiologies, failing to disentangle the influence of seizures and presence and side of hippocampal sclerosis (HS). We included 119 patients with MTLE divided into right-HS (n = 42), left-HS (n = 46), and magnetic resonance imaging (MRI)-negative MTLE (n = 31) and controls (n = 59). All underwent resting-state seed-based functional connectivity (FC), with a seed placed at the posterior cingulate cortex (PCC), an essential node for the DMN. To access group inferences, we used an SPM (Statistical Parametric Mapping) full-factorial model to compare patterns of activation using pairwise comparisons among all groups. Our results indicate a different pattern of DMN FC when controlling for side and presence of HS. The group with right-HS had increased FC in the left angular gyrus and the left middle occipital gyrus, when compared to controls, and increased FC of the left hippocampus when compared to the group with left-HS. The MRI-negative group had increased FC of the left hippocampus, left ventral diencephalon, and left fusiform gyrus as compared to left-HS, but did not show any areas of reduced FC compared to controls. By contrast, the group with left-HS did not show areas of increased FC compared to controls or the right-HS and had reduced FC in the left hippocampus compared to controls. Hence, the right-HS presented increased FC in areas related to the DMN in the left hemisphere; the MRI-negative group also showed increased FC in left-sided structures close to temporal lobe when compared to left-HS, probably indicating engagement in a compensatory system. In a subanalysis considering only the MRI-negative with left-sided EEG (electroencephalogram) subgroup, we found differences against controls, with left angular gyrus more connected in the first group, but no significant differences when compared to the group with left-HS. We conclude that the origin of seizures on the left hemisphere seems to engender a less prominent capacity of recruiting other neighbor areas related to DMN as compared to right-HS and controls. Considering recent studies that have revealed the importance of DMN for cognitive skills and memory, our findings may indicate that deficiencies exhibited by patients with left-HS temporal lobe epilepsy (TLE) in connecting to the DMN could be a surrogate marker of their known worse neuropsychological performance. Further studies with direct comparisons between cognitive tests and FC within the DMN are needed to validate these findings, especially for MRI-negative patients. This article is part of the Special Issue "NEWroscience 2018".
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Affiliation(s)
- Tamires Araujo Zanão
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Tatila Martins Lopes
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Brunno Machado de Campos
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Clarissa Lin Yasuda
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Fernando Cendes
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, SP, Brazil.
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Fu C, Aisikaer A, Chen Z, Yu Q, Yin J, Yang W. Different Functional Network Connectivity Patterns in Epilepsy: A Rest-State fMRI Study on Mesial Temporal Lobe Epilepsy and Benign Epilepsy With Centrotemporal Spike. Front Neurol 2021; 12:668856. [PMID: 34122313 PMCID: PMC8193721 DOI: 10.3389/fneur.2021.668856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
The stark discrepancy in the prognosis of epilepsy is closely related to brain damage features and underlying mechanisms, which have not yet been unraveled. In this study, differences in the epileptic brain functional connectivity states were explored through a network-based connectivity analysis between intractable mesial temporal lobe epilepsy (MTLE) patients and benign epilepsy with centrotemporal spikes (BECT). Resting state fMRI imaging data were collected for 14 MTLE patients, 12 BECT patients and 16 healthy controls (HCs). Independent component analysis (ICA) was performed to identify the cortical functional networks. Subcortical nuclei of interest were extracted from the Harvard-Oxford probability atlas. Network-based statistics were used to detect functional connectivity (FC) alterations across intranetworks and internetworks, including the connectivity between cortical networks and subcortical nuclei. Compared with HCs, MTLE patients showed significant lower activity between the connectivity of cortical networks and subcortical nuclei (especially hippocampus) and lower internetwork FC involving the lateral temporal lobe; BECT patients showed normal cortical-subcortical FC with hyperconnectivity between cortical networks. Together, cortical-subcortical hypoconnectivity in MTLE suggested a low efficiency and collaborative network pattern, and this might be relevant to the final decompensatory state and the intractable prognosis. Conversely, cortical-subcortical region with normal connectivity remained well in global cooperativity, and compensatory internetwork hyperconnectivity caused by widespread cortical abnormal discharge, which might account for the self-limited clinical outcome in BECT. Based on the fMRI functional network study, different brain network patterns might provide a better explanation of mechanisms in different types of epilepsy.
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Affiliation(s)
- Cong Fu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Aikedan Aisikaer
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Zhijuan Chen
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing Yu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jianzhong Yin
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Weidong Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
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Li R, Hu C, Wang L, Liu D, Liu D, Liao W, Xiao B, Chen H, Feng L. Disruption of functional connectivity among subcortical arousal system and cortical networks in temporal lobe epilepsy. Brain Imaging Behav 2021; 14:762-771. [PMID: 30617780 DOI: 10.1007/s11682-018-0014-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Growing evidence has demonstrated widespread brain network alterations in temporal lobe epilepsy (TLE). However, the relatively accurate portrait of the subcortical-cortical relationship for impaired consciousness in TLE remains unclear. We proposed that consciousness-impairing seizures may invade subcortical arousal system and corresponding cortical regions, resulting in functional abnormalities and information flow disturbances between subcortical and cortical networks. We performed resting-state fMRI in 26 patients with TLE and 30 matched healthy controls. All included patients were diagnosed with impaired awareness during focal temporal lobe seizures. Functional connectivity density was adopted to determine whether local or distant network alterations occurred in TLE, and Granger causality analysis (GCA) was utilized to assess the direction and magnitude of causal influence among these altered brain networks further. Patients showed increased local functional connectivity in several arousal structures, such as the midbrain, thalamus, and cortical regions including bilateral prefrontal cortex (PFC), left superior temporal pole, left posterior insula, and cerebellum (P < 0.05, FDR corrected). GCA analysis revealed that the casual effects among these regions in patients were significantly sparser than those in controls (P < 0.05, uncorrected), including decreased excitatory and inhibitory effects among the midbrain, thalamus and PFC, and decreased inhibitory effect from the cerebellum to PFC. These findings suggested that consciousness-impairing seizures in TLE are associated with functional alterations and disruption of information process between the subcortical arousal system and cortical network. Understanding the functional networks and innervation pathway involved in TLE can provide insights into the mechanism underlying seizure-related loss of consciousness.
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Affiliation(s)
- Rong Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, People's Republic of China
| | - Chongyu Hu
- Department of Neurology, Hunan Provincial People's Hospital, Changsha, 410005, People's Republic of China
| | - Liangcheng Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, People's Republic of China
| | - Ding Liu
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, 410013, People's Republic of China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China
| | - Wei Liao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, People's Republic of China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, People's Republic of China.
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.
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Sattin D, Magnani FG, Bartesaghi L, Caputo M, Fittipaldo AV, Cacciatore M, Picozzi M, Leonardi M. Theoretical Models of Consciousness: A Scoping Review. Brain Sci 2021; 11:535. [PMID: 33923218 PMCID: PMC8146510 DOI: 10.3390/brainsci11050535] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022] Open
Abstract
The amount of knowledge on human consciousness has created a multitude of viewpoints and it is difficult to compare and synthesize all the recent scientific perspectives. Indeed, there are many definitions of consciousness and multiple approaches to study the neural correlates of consciousness (NCC). Therefore, the main aim of this article is to collect data on the various theories of consciousness published between 2007-2017 and to synthesize them to provide a general overview of this topic. To describe each theory, we developed a thematic grid called the dimensional model, which qualitatively and quantitatively analyzes how each article, related to one specific theory, debates/analyzes a specific issue. Among the 1130 articles assessed, 85 full texts were included in the prefinal step. Finally, this scoping review analyzed 68 articles that described 29 theories of consciousness. We found heterogeneous perspectives in the theories analyzed. Those with the highest grade of variability are as follows: subjectivity, NCC, and the consciousness/cognitive function. Among sub-cortical structures, thalamus, basal ganglia, and the hippocampus were the most indicated, whereas the cingulate, prefrontal, and temporal areas were the most reported for cortical ones also including the thalamo-cortical system. Moreover, we found several definitions of consciousness and 21 new sub-classifications.
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Affiliation(s)
- Davide Sattin
- Neurology, Public Health, Disability Unit—Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.G.M.); (L.B.); (M.C.); (M.C.); (M.L.)
- Experimental Medicine and Medical Humanities-PhD Program, Biotechnology and Life Sciences Department and Center for Clinical Ethics, Insubria University, 21100 Varese, Italy
| | - Francesca Giulia Magnani
- Neurology, Public Health, Disability Unit—Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.G.M.); (L.B.); (M.C.); (M.C.); (M.L.)
| | - Laura Bartesaghi
- Neurology, Public Health, Disability Unit—Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.G.M.); (L.B.); (M.C.); (M.C.); (M.L.)
| | - Milena Caputo
- Neurology, Public Health, Disability Unit—Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.G.M.); (L.B.); (M.C.); (M.C.); (M.L.)
| | | | - Martina Cacciatore
- Neurology, Public Health, Disability Unit—Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.G.M.); (L.B.); (M.C.); (M.C.); (M.L.)
| | - Mario Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit—Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.G.M.); (L.B.); (M.C.); (M.C.); (M.L.)
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Nishimura M, Okanishi T, Itamura S, Homma Y, Sakakura K, Ichikawa N, Limotai C, Yamada S, Baba S, Masuda Y, Enoki H, Fujimoto A. Seizure focus in the frontal interhemispheric fissure leads to ipsilateral isolated eye deviation. Epilepsy Behav 2021; 116:107772. [PMID: 33556862 DOI: 10.1016/j.yebeh.2021.107772] [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: 09/28/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Few studies have examined the localization of seizures presenting with ictal eye deviation (ED) in the absence of other motor symptoms. We aimed to investigate differences in the localization of the ictal onset zone (IOZ) between patients with isolated ED and those with ED plus head turning (HT) during focal seizures. METHODS We reviewed intracranial video-EEG data for 931 seizures in 80 patients with focal onset epilepsy in whom the IOZ could be confirmed. The 233 seizures in 49 patients with ED were classified into two semiological groups based on initial ED and the presence/absence of HT: (1) isolated ED (i.e., ED without HT), and (2) ED + HT (i.e., ED with HT). We analyzed the localization and lateralization of IOZs in each semiological group. We performed multivariate logistic regression analysis using a mixed-effects to determine the associations between IOZs and isolated ED/ED + HT. RESULTS A total of 183 IOZs in 24 patients were included in the isolated ED group, while a total of 143 IOZs in 31 patients were included in the ED + HT group. Sixty-eight IOZs of eight patients in the isolated ED group were located in the ipsilateral frontal interhemispheric fissure (F-IHF). Only ipsilateral F-IHF was significantly associated with isolated ED (odds ratio [OR], 2.43; 95% confidence interval [CI], 0.37-4.49; P = 0.021). The contralateral lateral frontal cortex (latF) (P = 0.007) and ipsilateral mesial temporal region (mT) (P = 0.029) were significantly associated with ED + HT. CONCLUSION The present study is the first to demonstrate that seizures with an F-IHF focus tend to present with initial ipsilateral isolated ED. This finding may aid in identifying the seizure focus in patients with isolated ED prior to resection.
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Affiliation(s)
- Mitsuyo Nishimura
- Department of Clinical Laboratory, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 3058576, Japan; Department of Clinical Laboratory, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Brain and Neuroscience, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan; Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan.
| | - Shinji Itamura
- Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan.
| | - Kazuki Sakakura
- Department of Epilepsy and Neurosurgery, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan
| | - Naoki Ichikawa
- Department of Epilepsy and Neurosurgery, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan
| | - Chusak Limotai
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Saki Yamada
- Department of Clinical Laboratory, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan. sk-
| | - Shimpei Baba
- Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan
| | - Yosuke Masuda
- Department of Neurosurgery, Comprehensive Epilepsy Center, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 3058576, Japan.
| | - Hideo Enoki
- Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan.
| | - Ayataka Fujimoto
- Department of Epilepsy and Neurosurgery, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 4308558, Japan.
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Krishnan B, Tousseyn S, Nayak CS, Aung T, Kheder A, Wang ZI, Wu G, Gonzalez-Martinez J, Nair D, Burgess R, Iasemidis L, Najm I, Bulacio J, Alexopoulos AV. Neurovascular networks in epilepsy: Correlating ictal blood perfusion with intracranial electrophysiology. Neuroimage 2021; 231:117838. [PMID: 33577938 DOI: 10.1016/j.neuroimage.2021.117838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/21/2020] [Accepted: 02/01/2021] [Indexed: 11/25/2022] Open
Abstract
Perfusion patterns observed in Subtraction Ictal SPECT Co-registered to MRI (SISCOM) assist in focus localization and surgical planning for patients with medically intractable focal epilepsy. While the localizing value of SISCOM has been widely investigated, its relationship to the underlying electrophysiology has not been extensively studied and is therefore not well understood. In the present study, we set to investigate this relationship in a cohort of 70 consecutive patients who underwent ictal and interictal SPECT studies and subsequent stereo-electroencephalography (SEEG) monitoring for localization of the epileptogenic focus and surgical intervention. Seizures recorded during SEEG evaluation (SEEG seizures) were matched to semiologically-similar seizures during the preoperative ictal SPECT evaluation (SPECT seizures) by comparing the semiological changes in the course of each seizure. The spectral changes of the ictal SEEG with respect to interictal ones over 7 traditional frequency bands (0.1 to 150Hz) were analyzed at each SEEG site. Neurovascular (SEEG/SPECT) relations were assessed by comparing the estimated spectral power density changes of the SEEG at each site with the perfusion changes (SISCOM z-scores) estimated from the acquired SISCOM map at that site. Across patients, a significant correlation (p<0.05) was observed between spectral changes during the SEEG seizure and SISCOM perfusion z-scores. Brain sites with high perfusion z-score exhibited higher increased SEEG power in theta to ripple frequency bands with concurrent suppression in delta and theta frequency bands compared to regions with lower perfusion z-score. The dynamics of the correlation of SISCOM perfusion and SEEG spectral power from ictal onset to seizure end and immediate postictal period were also derived. Forty-six (46) of the 70 patients underwent resective epilepsy surgery. SISCOM z-score and power increase in beta to ripple frequency bands were significantly higher in resected than non-resected sites in the patients who were seizure-free following surgery. This study provides for the first time concrete evidence that both hyper-perfusion and hypo-perfusion patterns observed in SISCOM maps have strong electrophysiological underpinnings, and that integration of the information from SISCOM and SEEG can shed light on the location and dynamics of the underlying epileptic brain networks, and thus advance our anatomo-electro-clinical understanding and approaches to targeted diagnostic and therapeutic interventions.
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Affiliation(s)
- Balu Krishnan
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA.
| | - Simon Tousseyn
- Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Heeze, The Netherlands
| | - Chetan Sateesh Nayak
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Thandar Aung
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Ammar Kheder
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Z Irene Wang
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Guiyun Wu
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Jorge Gonzalez-Martinez
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Dileep Nair
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Richard Burgess
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Leonidas Iasemidis
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Tech University, Ruston, LA, USA
| | - Imad Najm
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Juan Bulacio
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Andreas V Alexopoulos
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
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Li R, Wang H, Wang L, Zhang L, Zou T, Wang X, Liao W, Zhang Z, Lu G, Chen H. Shared and distinct global signal topography disturbances in subcortical and cortical networks in human epilepsy. Hum Brain Mapp 2021; 42:412-426. [PMID: 33073893 PMCID: PMC7776006 DOI: 10.1002/hbm.25231] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/08/2020] [Accepted: 09/29/2020] [Indexed: 01/21/2023] Open
Abstract
Epilepsy is a common brain network disorder associated with disrupted large-scale excitatory and inhibitory neural interactions. Recent resting-state fMRI evidence indicates that global signal (GS) fluctuations that have commonly been ignored are linked to neural activity. However, the mechanisms underlying the altered global pattern of fMRI spontaneous fluctuations in epilepsy remain unclear. Here, we quantified GS topography using beta weights obtained from a multiple regression model in a large group of epilepsy with different subtypes (98 focal temporal epilepsy; 116 generalized epilepsy) and healthy population (n = 151). We revealed that the nonuniformly distributed GS topography across association and sensory areas in healthy controls was significantly shifted in patients. Particularly, such shifts of GS topography disturbances were more widespread and bilaterally distributed in the midbrain, cerebellum, visual cortex, and medial and orbital cortex in generalized epilepsy, whereas in focal temporal epilepsy, these networks spread beyond the temporal areas but mainly remain lateralized. Moreover, we found that these abnormal GS topography patterns were likely to evolve over the course of a longer epilepsy disease. Our study demonstrates that epileptic processes can potentially affect global excitation/inhibition balance and shift the normal GS topological distribution. These progressive topographical GS disturbances in subcortical-cortical networks may underlie pathophysiological mechanisms of global fluctuations in human epilepsy.
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Affiliation(s)
- Rong Li
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Hongyu Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Liangcheng Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Leiyao Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Ting Zou
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Xuyang Wang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Wei Liao
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Zhiqiang Zhang
- Department of Medical ImagingJinling Hospital, Nanjing University School of MedicineNanjingChina
| | - Guangming Lu
- Department of Medical ImagingJinling Hospital, Nanjing University School of MedicineNanjingChina
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
- MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
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Neal EG, Schoenberg MR, Maciver S, Bezchlibnyk YB, Vale FL. Seizure Freedom After Epilepsy Surgery and Higher Baseline Cognition May Be Associated With a Negatively Correlated Epilepsy Network in Temporal Lobe Epilepsy. Front Neurosci 2021; 14:629667. [PMID: 33584184 PMCID: PMC7874020 DOI: 10.3389/fnins.2020.629667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Brain regions positively correlated with the epileptogenic zone in patients with temporal lobe epilepsy vary in spread across the brain and in the degree of correlation to the temporal lobes, thalamus, and limbic structures, and these parameters have been associated with pre-operative cognitive impairment and seizure freedom after epilepsy surgery, but negatively correlated regions have not been as well studied. We hypothesize that connectivity within a negatively correlated epilepsy network may predict which patients with temporal lobe epilepsy will respond best to surgery. Methods: Scalp EEG and resting state functional MRI (rsfMRI) were collected from 19 patients with temporal lobe epilepsy and used to estimate the irritative zone. Using patients' rsfMRI, the negatively correlated epilepsy network was mapped by determining all the brain voxels that were negatively correlated with the voxels in the epileptogenic zone and the spread and average connectivity within the network was determined. Results: Pre-operatively, connectivity within the negatively correlated network was inversely related to the spread (diffuseness) of that network and positively associated with higher baseline verbal and logical memory. Pre-operative connectivity within the negatively correlated network was also significantly higher in patients who would go on to be seizure free. Conclusion: Patients with higher connectivity within brain regions negatively correlated with the epilepsy network had higher baseline memory function, narrower network spread, and were more likely to be seizure free after surgery.
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Affiliation(s)
- Elliot G Neal
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Mike R Schoenberg
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States.,Department of Neurology, University of South Florida, Tampa, FL, United States
| | - Stephanie Maciver
- Department of Neurology, University of South Florida, Tampa, FL, United States
| | - Yarema B Bezchlibnyk
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Fernando L Vale
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, United States
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Gruenbaum BF. Comparison of anaesthetic- and seizure-induced states of unconsciousness: a narrative review. Br J Anaesth 2021; 126:219-229. [PMID: 32951841 PMCID: PMC7844374 DOI: 10.1016/j.bja.2020.07.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/23/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022] Open
Abstract
In order to understand general anaesthesia and certain seizures, a fundamental understanding of the neurobiology of unconsciousness is needed. This review article explores similarities in neuronal and network changes during general anaesthesia and seizure-induced unconsciousness. Both seizures and anaesthetics cause disruption in similar anatomical structures that presumably lead to impaired consciousness. Despite differences in behaviour and mechanisms, both of these conditions are associated with disruption of the functionality of subcortical structures that mediate neuronal activity in the frontoparietal cortex. These areas are all likely to be involved in maintaining normal consciousness. An assessment of the similarities in the brain network disruptions with certain seizures and general anaesthesia might provide fresh insights into the mechanisms of the alterations of consciousness seen in these particular unconscious states, allowing for innovative therapies for seizures and the development of anaesthetic approaches targeting specific networks.
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Ohtomo S, Otsubo H, Arai H, Shimoda Y, Homma Y, Tominaga T. Hyperperfusion in the thalamus on arterial spin labelling indicates non-convulsive status epilepticus. Brain Commun 2020; 3:fcaa223. [PMID: 33501426 PMCID: PMC7811763 DOI: 10.1093/braincomms/fcaa223] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
Non-convulsive status epilepticus describes the syndrome of unexplained impaired consciousness in critically ill patients. Non-convulsive status epilepticus is very likely to lead to delayed diagnosis and poor outcomes because of the absence of convulsive symptoms. EEG is essential for the diagnosis of non-convulsive status epilepticus to establish the association between periodic discharges and rhythmic delta activity in addition to ictal epileptiform discharges according to the Salzburg criteria. Arterial spin labelling, a type of perfusion MRI, has been applied for rapid and non-invasive evaluation of the ictal state. Ictal cerebral cortical hyperperfusion is the most common finding to demonstrate focal onset seizures. Hyperperfusion of the thalamus on single photon emission computed tomography was found in patients with impaired awareness seizures. We hypothesized that thalamocortical hyperperfusion on arterial spin labelling identifies non-convulsive status epilepticus and such thalamic hyperperfusion specifically associates with periodic/rhythmic discharges producing impaired consciousness without convulsion. We identified 27 patients (17 females; age, 39-91 years) who underwent both arterial spin labelling and EEG within 24 h of suspected non-convulsive status epilepticus. We analysed 28 episodes of suspected non-convulsive status epilepticus and compared hyperperfusion on arterial spin labelling with periodic/rhythmic discharges. We evaluated 21 episodes as a positive diagnosis of non-convulsive status epilepticus according to the Salzburg criteria. We identified periodic discharges in 15 (12 lateralized and 3 bilateral independent) episodes and rhythmic delta activity in 13 (10 lateralized, 1 bilateral independent and 2 generalized) episodes. Arterial spin labelling showed thalamic hyperperfusion in 16 (11 unilateral and 5 bilateral) episodes and cerebral cortical hyperperfusion in 24 (20 unilateral and 4 bilateral) episodes. Thalamic hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0007; sensitivity, 76.2%; specificity, 100%), periodic discharges (P < 0.0001; 93.3%; 84.6%), and rhythmic delta activity (P = 0.0006; 92.3%; 73.3%). Cerebral cortical hyperperfusion was significantly associated with non-convulsive status epilepticus (P = 0.0017; 100%; 57.1%) and periodic discharges (P = 0.0349; 100%; 30.8%), but not with rhythmic delta activity. Thalamocortical hyperperfusion could be a new biomarker of non-convulsive status epilepticus according to the Salzburg criteria in critically ill patients. Specific thalamic hyperexcitability might modulate the periodic discharges and rhythmic delta activity associated with non-convulsive status epilepticus. Impaired consciousness without convulsions could be caused by predominant thalamic hyperperfusion together with cortical hyperperfusion but without ictal epileptiform discharges.
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Affiliation(s)
- Satoru Ohtomo
- Department of Neurosurgery, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hiroaki Arai
- Department of Neurosurgery, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan
| | - Yoshiteru Shimoda
- Department of Neurosurgery, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Gernert M, Feja M. Bypassing the Blood-Brain Barrier: Direct Intracranial Drug Delivery in Epilepsies. Pharmaceutics 2020; 12:pharmaceutics12121134. [PMID: 33255396 PMCID: PMC7760299 DOI: 10.3390/pharmaceutics12121134] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
Epilepsies are common chronic neurological diseases characterized by recurrent unprovoked seizures of central origin. The mainstay of treatment involves symptomatic suppression of seizures with systemically applied antiseizure drugs (ASDs). Systemic pharmacotherapies for epilepsies are facing two main challenges. First, adverse effects from (often life-long) systemic drug treatment are common, and second, about one-third of patients with epilepsy have seizures refractory to systemic pharmacotherapy. Especially the drug resistance in epilepsies remains an unmet clinical need despite the recent introduction of new ASDs. Apart from other hypotheses, epilepsy-induced alterations of the blood-brain barrier (BBB) are thought to prevent ASDs from entering the brain parenchyma in necessary amounts, thereby being involved in causing drug-resistant epilepsy. Although an invasive procedure, bypassing the BBB by targeted intracranial drug delivery is an attractive approach to circumvent BBB-associated drug resistance mechanisms and to lower the risk of systemic and neurologic adverse effects. Additionally, it offers the possibility of reaching higher local drug concentrations in appropriate target regions while minimizing them in other brain or peripheral areas, as well as using otherwise toxic drugs not suitable for systemic administration. In our review, we give an overview of experimental and clinical studies conducted on direct intracranial drug delivery in epilepsies. We also discuss challenges associated with intracranial pharmacotherapy for epilepsies.
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Affiliation(s)
- Manuela Gernert
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, D-30559 Hannover, Germany;
- Center for Systems Neuroscience, D-30559 Hannover, Germany
- Correspondence: ; Tel.: +49-(0)511-953-8527
| | - Malte Feja
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, D-30559 Hannover, Germany;
- Center for Systems Neuroscience, D-30559 Hannover, Germany
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Masferrer L, Mancini AD, Caparrós B. Understanding the Relationship Between Complicated Grief Symptoms and Patterns of Personality Disorders in a Substance Users' Sample: A Network Analysis Approach. Front Psychol 2020; 11:566785. [PMID: 33250810 PMCID: PMC7673378 DOI: 10.3389/fpsyg.2020.566785] [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: 05/29/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The presence of personality disorders is greatly prevalent among substance users. Personality disorders could increase vulnerability to complicated grief symptoms. Bereavement is commonly overlooked among substance users. We used network analysis to estimate the structure of relations between patterns of personality disorders and complicated grief symptoms among a bereaved substance-using population. METHODS Complicated grief and personality disorders were assessed in a sample of 196 bereaved substance users. We use the graphical least absolute shrinkage selection operator (LASSO) to compute a regularized partial correlation network revealing associations among different patterns of personality disorders and complicated grief symptoms. RESULTS In a network involving nodes for personality disorders and symptomatology of complicated grief, patterns of depressive and paranoid personality disorder showed small relationships to complicated grief symptoms. All other personality disorders showed negligible to no relationship to complicated grief symptoms. Further, in the overall network, complicated grief showed the lowest level of centrality, suggesting that it is independent of personality disorders, whereas depressive and paranoid personality disorder symptoms showed the highest centrality. CONCLUSION Network analysis can be used to understand the relationships among higher-level constructs such as disorders. We found that complicated grief is largely independent of patterns of personality disorders with the exception of depressive and paranoid. Findings have implications for assessment and appropriate treatment of complicated grief symptoms and substance use disorder.
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Affiliation(s)
- Laura Masferrer
- CAS Girona, Mental Health and Addiction Research Group, Institutd’Assistència Sanitària (IAS), Institut d’Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Department of Psychology, University of Girona, Girona, Spain
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Gonen OM, Kwan P, O'Brien TJ, Lui E, Desmond PM. Resting-state functional MRI of the default mode network in epilepsy. Epilepsy Behav 2020; 111:107308. [PMID: 32698105 DOI: 10.1016/j.yebeh.2020.107308] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/28/2020] [Accepted: 06/28/2020] [Indexed: 02/09/2023]
Abstract
The default mode network (DMN) is a major neuronal network that deactivates during goal-directed tasks. Recent advances in neuroimaging have shed light on its structure and function. Alterations in the DMN are increasingly recognized in a range of neurological and psychiatric conditions including epilepsy. This review first describes the current understanding of the DMN in health, normal aging, and disease as it is acquired via resting-state functional magnetic resonance imaging (MRI), before focusing on how it is affected in various types of focal and generalized epilepsy. These findings support the potential use of DMN parameters as future biomarkers in epilepsy research, diagnosis, and management.
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Affiliation(s)
- Ofer M Gonen
- The Royal Melbourne Hospital, VIC, Australia; The University of Melbourne, VIC, Australia; The Alfred Hospital, VIC, Australia.
| | - Patrick Kwan
- The Royal Melbourne Hospital, VIC, Australia; The University of Melbourne, VIC, Australia; The Alfred Hospital, VIC, Australia; Monash University, VIC, Australia
| | - Terence J O'Brien
- The Royal Melbourne Hospital, VIC, Australia; The University of Melbourne, VIC, Australia; The Alfred Hospital, VIC, Australia; Monash University, VIC, Australia
| | - Elaine Lui
- The Royal Melbourne Hospital, VIC, Australia; The University of Melbourne, VIC, Australia
| | - Patricia M Desmond
- The Royal Melbourne Hospital, VIC, Australia; The University of Melbourne, VIC, Australia
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González HFJ, Goodale SE, Jacobs ML, Haas KF, Landman BA, Morgan VL, Englot DJ. Brainstem Functional Connectivity Disturbances in Epilepsy may Recover After Successful Surgery. Neurosurgery 2020; 86:417-428. [PMID: 31093673 DOI: 10.1093/neuros/nyz128] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/20/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Focal seizures in temporal lobe epilepsy (TLE) are associated with widespread brain network perturbations and neurocognitive problems. OBJECTIVE To determine whether brainstem connectivity disturbances improve with successful epilepsy surgery, as recent work has demonstrated decreased brainstem connectivity in TLE that is related to disease severity and neurocognitive profile. METHODS We evaluated 15 adult TLE patients before and after (>1 yr; mean, 3.4 yr) surgery, and 15 matched control subjects using magnetic resonance imaging to measure functional and structural connectivity of ascending reticular activating system (ARAS) structures, including cuneiform/subcuneiform nuclei (CSC), pedunculopontine nucleus (PPN), and ventral tegmental area (VTA). RESULTS TLE patients who achieved long-term postoperative seizure freedom (10 of 15) demonstrated increases in functional connectivity between ARAS structures and fronto-parietal-insular neocortex compared to preoperative baseline (P = .01, Kruskal-Wallis), with postoperative connectivity patterns resembling controls' connectivity. No functional connectivity changes were detected in 5 patients with persistent seizures after surgery (P = .9, Kruskal-Wallis). Among seizure-free postoperative patients, larger increases in CSC, PPN, and VTA functional connectivity were observed in individuals with more frequent seizures before surgery (P < .05 for each, Spearman's rho). Larger postoperative increases in PPN functional connectivity were seen in patients with lower baseline verbal IQ (P = .03, Spearman's rho) or verbal memory (P = .04, Mann-Whitney U). No changes in ARAS structural connectivity were detected after successful surgery. CONCLUSION ARAS functional connectivity disturbances are present in TLE but may recover after successful epilepsy surgery. Larger increases in postoperative connectivity may be seen in individuals with more severe disease at baseline.
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Affiliation(s)
- Hernán F J González
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee
| | - Sarah E Goodale
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Monica L Jacobs
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin F Haas
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bennett A Landman
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee.,Department of Electrical Engineering, Vanderbilt University, Nashville, Tennessee.,Department of Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Victoria L Morgan
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Electrical Engineering, Vanderbilt University, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dario J Englot
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Singh TB, Aisikaer A, He C, Wu Y, Chen H, Ni H, Song Y, Yin J. The Assessment of Brain Functional Changes in the Temporal Lobe Epilepsy Patient with Cognitive Impairment by Resting-state Functional Magnetic Resonance Imaging. J Clin Imaging Sci 2020; 10:50. [PMID: 32874755 PMCID: PMC7451150 DOI: 10.25259/jcis_55_2020] [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: 04/15/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives The objective of the study was to detect functional changes in the brain of cognitive impairment-temporal lobe epilepsy (CI-TLE) patient and to sort out the possible mechanism involved in CI in CI-TLE patients using resting-state functional magnetic resonance imaging (RS-fMRI). Material and Methods Fifty-eight TLE cases were included, which was divided into 44 TLE patients without CI (cognitive not impairment [CNI]-TLE) and 14 TLE patients with CI (CI-TLE). The normal control (NC) group consisted of 40 participants. RS-fMRI data preprocessing was carried out in statistical parametric mapping (SPM) software. The data were realigned, coregistered, normalized, and finally smoothened and then were taken for amplitude of low-frequency fluctuation (ALFF) calculation in RS-fMRI data analysis toolkit (REST) software. For data analysis, voxel-wise two-sample t-test was carried out between TLE group and NC group; CI-TLE group and cognitive not impairment-TLE (CNI-TLE) group in SPM software, a cluster >10 voxels and P < 0.01 was considered to be significant. Results Compared to NC, the TLE patients showed increased ALFF activation mostly in parahippocampal gyrus (PG), frontal lobe, midbrain, pons, insula, inferior temporal gyrus, and anterior cingulate gyrus (ACG) while decreased ALFF value was seen in posterior cingulate gyrus, cuneus, cerebellum posterior lobe, inferior parietal lobule (IPL), and superior temporal gyrus. Compared to CNI-TLE, CI-TLE patients showed increased ALFF in middle temporal gyrus (MTG), cuneus, ACG, IPL, middle frontal gyrus (MFG), superior frontal gyrus (SFG), cerebellum posterior lobe, and decreased ALFF cluster in the corpus callosum and MFG. Conclusion Between TLE and NC, we found increased ALFF activation in PG, frontal lobe, thalamus, insula, midbrain, and pons in TLE patient. Between CI and CNI TLE, area of executive control network and default model network, especially in MTG, ACG, IPL, MFG, and SFG, had increased ALFF value in CI-TLE patient. Activation of these areas should be because of the decompensation mechanism.
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Affiliation(s)
| | - Aikedan Aisikaer
- Department of Radiology, Tianjin First Central Hospital, Nankai, China
| | - Che He
- Department of Radiology, Tianjin First Central Hospital, Nankai, China
| | - Yalin Wu
- Department of Radiology, Tianjin First Central Hospital, Nankai, China
| | - Hong Chen
- Department of Radiology, Tianjin First Central Hospital, Nankai, China
| | - Hongyan Ni
- Department of Radiology, Tianjin First Central Hospital, Nankai, China
| | - Yijun Song
- Department of Radiology, Tianjin Medical University General Hospital, Heping, Tianjin
| | - Jianzhong Yin
- Department of Radiology, Tianjin First Central Hospital, Nankai, China
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48
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Kenchaiah R, Satishchandra P, Bhargava Goutham K, Dawn BR, Sain J, Kulanthaivelu K, Mundlamuri RC, Asranna A, Sinha S. Cortical-Subcortical morphometric signature of hot water epilepsy patients. Epilepsy Res 2020; 167:106436. [PMID: 32846313 DOI: 10.1016/j.eplepsyres.2020.106436] [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: 05/14/2020] [Revised: 07/20/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cortical and subcortical grey matter (GM) morphometric changes have been demonstrated Temporal Lobe Epilepsy (TLE) or Idiopathic Generalized Epilepsies (IGE). Hot Water Epilepsy (HWE) has not hitherto been studied in these perspectives. PURPOSE To investigate the cortical and subcortical grey matter in subjects with HWE in terms of thickness, volume, and surface area using Surface-Based Morphometry (SBM). To assess relationships of SBM-derived metrics with clinical variables. MATERIALS AND METHODS Ninety-nine people with HWE and 50 age-matched healthy controls underwent high resolution volumetric MRI brain. These were processed with FreeSurfer to obtain SBM parameters i:e cortical thickness, cortical volume, and Cortical surface area. Volumes of seven subcortical GM structures (hippocampus, globus pallidus, nucleus ambiguous(NA), caudate nucleus, putamen, thalamus, and amygdala) were computed. Intergroup morphometric differences and their correlation with epilepsy-specific clinical variables were calculated. RESULTS SBM revealed a global reduction in bihemispheric cortical thickness and left hemispheric cortical volume. Besides, a regional difference in the morphometric measures was noted in temporo-limbic, parietal, pre-cuneus, and the cingulate region. Reduced volume of thalami and left caudate alongside an increased volume of the bilateral amygdala, bilateral nucleus ambiguous (NA), right caudate, and putamen was the other cardinal observation. CONCLUSION HWE subjects show alterations in the morphometry of the cortical ribbon and the subcortical grey matter. The temporal semiology, 'reflex nature' pathophysiology correlates involvement of temporo-limbic structures/somatosensory cortex, while the involvement of structures like pre-cuneus, posterior cingulate, and frontal regions are in agreement with functional networks related loss of awareness. That bilateral amygdala swelling occurs in HWE is a novel observation and may signal that it could be a distinct variant of Mesial TLE.
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Affiliation(s)
- Raghavendra Kenchaiah
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - P Satishchandra
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - K Bhargava Goutham
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India; Departments of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - Bharath Rose Dawn
- Departments of Neuro-Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - Jitender Sain
- Departments of Neuro-Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - Karthik Kulanthaivelu
- Departments of Neuro-Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | | | - Ajay Asranna
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - Sanjib Sinha
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India.
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49
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He X, Chaitanya G, Asma B, Caciagli L, Bassett DS, Tracy JI, Sperling MR. Disrupted basal ganglia-thalamocortical loops in focal to bilateral tonic-clonic seizures. Brain 2020; 143:175-190. [PMID: 31860076 DOI: 10.1093/brain/awz361] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/16/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Focal to bilateral tonic-clonic seizures are associated with lower quality of life, higher risk of seizure-related injuries, increased chance of sudden unexpected death, and unfavourable treatment outcomes. Achieving greater understanding of their underlying circuitry offers better opportunity to control these seizures. Towards this goal, we provide a network science perspective of the interactive pathways among basal ganglia, thalamus and cortex, to explore the imprinting of secondary seizure generalization on the mesoscale brain network in temporal lobe epilepsy. Specifically, we parameterized the functional organization of both the thalamocortical network and the basal ganglia-thalamus network with resting state functional MRI in three groups of patients with different focal to bilateral tonic-clonic seizure histories. Using the participation coefficient to describe the pattern of thalamocortical connections among different cortical networks, we showed that, compared to patients with no previous history, those with positive histories of focal to bilateral tonic-clonic seizures, including both remote (none for >1 year) and current (within the past year) histories, presented more uniform distribution patterns of thalamocortical connections in the ipsilateral medial-dorsal thalamic nuclei. As a sign of greater thalamus-mediated cortico-cortical communication, this result comports with greater susceptibility to secondary seizure generalization from the epileptogenic temporal lobe to broader brain networks in these patients. Using interregional integration to characterize the functional interaction between basal ganglia and thalamus, we demonstrated that patients with current history presented increased interaction between putamen and globus pallidus internus, and decreased interaction between the latter and the thalamus, compared to the other two patient groups. Importantly, through a series of 'disconnection' simulations, we showed that these changes in interactive profiles of the basal ganglia-thalamus network in the current history group mainly depended upon the direct but not the indirect basal ganglia pathway. It is intuitively plausible that such disruption in the striatum-modulated tonic inhibition of the thalamus from the globus pallidus internus could lead to an under-suppressed thalamus, which in turn may account for their greater vulnerability to secondary seizure generalization. Collectively, these findings suggest that the broken balance between basal ganglia inhibition and thalamus synchronization can inform the presence and effective control of focal to bilateral tonic-clonic seizures. The mechanistic underpinnings we uncover may shed light on the development of new treatment strategies for patients with temporal lobe epilepsy.
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Affiliation(s)
- Xiaosong He
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ganne Chaitanya
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Burcu Asma
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Joseph I Tracy
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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50
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Functional imaging of the piriform cortex in focal epilepsy. Exp Neurol 2020; 330:113305. [DOI: 10.1016/j.expneurol.2020.113305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 01/26/2020] [Accepted: 04/08/2020] [Indexed: 11/19/2022]
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