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Yang Y, Han Y, Wang J, Zhou Y, Chen D, Wang M, Li T. Effects of altered excitation-inhibition imbalance by repetitive transcranial magnetic stimulation for self-limited epilepsy with centrotemporal spikes. Front Neurol 2023; 14:1164082. [PMID: 37305755 PMCID: PMC10250617 DOI: 10.3389/fneur.2023.1164082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Patients with self-limited epilepsy with centrotemporal spikes (SeLECTS) with electrical status epilepticus in sleep (ESES) have generalized cognitive impairment, yet treatment options are limited. Our study aimed to examine the therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on SeLECTS with ESES. In addition, we applied electroencephalography (EEG) aperiodic components (offset and slope) to investigate the improvement of rTMS on the excitation-inhibition imbalance (E-I imbalance) in the brain of this group of children. Methods Eight SeLECTS patients with ESES were included in this study. Low-frequency rTMS (≤1 Hz) was applied for 10 weekdays in each patient. To assess the clinical efficacy and changes in E-I imbalance, EEG recordings were performed both before and after rTMS. Seizure-reduction rate and spike-wave index (SWI) were measured to investigate the clinical effects of rTMS. The aperiodic offset and slope were calculated to explore the effect of rTMS on E-I imbalance. Results Five of the eight patients (62.5%) were seizure-free within 3 months after stimulation, with treatment effects decreasing with longer follow-ups. The SWI decreased significantly at 3 and 6 months after rTMS compared with the baseline (P = 0.0157 and P = 0.0060, respectively). The offset and slope were compared before rTMS and within 3 months after stimulation. The results showed a significant reduction in the offset after stimulation (P < 0.0001). There was a remarkable increase in slope after the stimulation (P < 0.0001). Conclusion Patients achieved favorable outcomes in the first 3 months after rTMS. The ameliorative effect of rTMS on SWI may last up to 6 months. Low-frequency rTMS could reduce firing rates in neuronal populations throughout the brain, which was most pronounced at the site of stimulation. A significant reduction in the slope after rTMS treatment suggested an improvement in the E-I imbalance in the SeLECTS.
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Affiliation(s)
- Yujiao Yang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yixian Han
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yongkang Zhou
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Dong Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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2
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Guo M, Xie P, Liu S, Luan G, Li T. Epilepsy and Autism Spectrum Disorder (ASD): The Underlying Mechanisms and Therapy Targets Related to Adenosine. Curr Neuropharmacol 2023; 21:54-66. [PMID: 35794774 PMCID: PMC10193761 DOI: 10.2174/1570159x20666220706100136] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/23/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
Epilepsy and autism spectrum disorder (ASD) are highly mutually comorbid, suggesting potential overlaps in genetic etiology, pathophysiology, and neurodevelopmental abnormalities. Adenosine, an endogenous anticonvulsant and neuroprotective neuromodulator of the brain, has been proved to affect the process of epilepsy and ASD. On the one hand, adenosine plays a crucial role in preventing the progression and development of epilepsy through adenosine receptordependent and -independent ways. On the other hand, adenosine signaling can not only regulate core symptoms but also improve comorbid disorders in ASD. Given the important role of adenosine in epilepsy and ASD, therapeutic strategies related to adenosine, including the ketogenic diet, neuromodulation therapy, and adenosine augmentation therapy, have been suggested for the arrangement of epilepsy and ASD. There are several proposals in this review. Firstly, it is necessary to further discuss the relationship between both diseases based on the comorbid symptoms and mechanisms of epilepsy and ASD. Secondly, it is important to explore the role of adenosine involved in epilepsy and ASD. Lastly, potential therapeutic value and clinical approaches of adenosine-related therapies in treating epilepsy and ASD need to be emphasized.
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Affiliation(s)
- Mengyi Guo
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Pandeng Xie
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Siqi Liu
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Guoming Luan
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Tianfu Li
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
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3
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Loring KE, Mattiske T, Lee K, Zysk A, Jackson MR, Noebels JL, Shoubridge C. Early 17β-estradiol treatment reduces seizures but not abnormal behaviour in mice with expanded polyalanine tracts in the Aristaless related homeobox gene (ARX). Neurobiol Dis 2021; 153:105329. [PMID: 33711494 DOI: 10.1016/j.nbd.2021.105329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 11/20/2022] Open
Abstract
Children with severe intellectual disability have an increased prevalence of refractory seizures. Steroid treatment may improve seizure outcomes, but the mechanism remains unknown. Here we demonstrate that short term, daily delivery of an exogenous steroid 17β-estradiol (40 ng/g) in early postnatal life significantly reduced the number and severity of seizures, but did not improve behavioural deficits, in mice modelling mutations in the Aristaless-related homeobox gene (ARX), expanding the first (PA1) or second (PA2) polyalanine tract. Frequency of observed seizures on handling (n = 14/treatment/genotype) were significantly reduced in PA1 (32% reduction) and more modestly reduced in PA2 mice (14% reduction) with steroid treatment compared to vehicle. Spontaneous seizures were assessed (n = 7/treatment/genotype) at 7 weeks of age coinciding with a peak of seizure activity in untreated mice. PA1 mice treated with steroids no longer present with the most severe category of prolonged myoclonic seizures. Treated PA2 mice had an earlier onset of seizures coupled with a subsequent reduction in seizures later in postnatal life, with a complete absence of any seizures during the analysis at 7 weeks of age. Despite the reduction in seizures, 17β-estradiol treated mice showed no improvement in behavioural or cognitive outcomes in adulthood. For the first time we show that these deficits due to mutations in Arx are already present before seizure onset and do not worsen with seizures. ARX is a transcription factor and Arx PA mutant mice have deregulated transcriptome profiles in the developing embryonic brain. At postnatal day 10, treatment completion, RNAseq identified 129 genes significantly deregulated (Log2FC > ± 0.5, P-value<0.05) in the frontal cortex of mutant compared to wild-type mice. This list reflects genes deregulated in disease and was particularly enriched for known genes in neurodevelopmental disorders and those involved in signalling and developmental pathways. 17β-estradiol treatment of mutant mice significantly deregulated 295 genes, with only 23 deregulated genes overlapping between vehicle and steroid treated mutant mice. We conclude that 17β-estradiol treatment recruits processes and pathways to reduce the frequency and severity of seizures in the Arx PA mutant mice but does not precisely correct the deregulated transcriptome nor improve mortality or behavioural and cognitive deficits.
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Affiliation(s)
- Karagh E Loring
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Tessa Mattiske
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Kristie Lee
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Aneta Zysk
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Matilda R Jackson
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | | | - Cheryl Shoubridge
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
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4
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Bar C, Kuchenbuch M, Barcia G, Schneider A, Jennesson M, Le Guyader G, Lesca G, Mignot C, Montomoli M, Parrini E, Isnard H, Rolland A, Keren B, Afenjar A, Dorison N, Sadleir LG, Breuillard D, Levy R, Rio M, Dupont S, Negrin S, Danieli A, Scalais E, De Saint Martin A, El Chehadeh S, Chelly J, Poisson A, Lebre A, Nica A, Odent S, Sekhara T, Brankovic V, Goldenberg A, Vrielynck P, Lederer D, Maurey H, Terrone G, Besmond C, Hubert L, Berquin P, Billette de Villemeur T, Isidor B, Freeman JL, Mefford HC, Myers CT, Howell KB, Rodríguez‐Sacristán Cascajo A, Meyer P, Genevieve D, Guët A, Doummar D, Durigneux J, van Dooren MF, de Wit MCY, Gerard M, Marey I, Munnich A, Guerrini R, Scheffer IE, Kabashi E, Nabbout R. Developmental and epilepsy spectrum of
KCNB1
encephalopathy with long‐term outcome. Epilepsia 2020; 61:2461-2473. [DOI: 10.1111/epi.16679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Claire Bar
- Department of Pediatric Neurology Reference Center for Rare Epilepsies Assistance Publique‐Hôpitaux de Paris (AP‐HP), Necker‐Enfants Malades Hospital Paris France
- Imagine Institute, Mixed Unit of Research 1163 University of ParisSorbonne University Paris France
| | - Mathieu Kuchenbuch
- Department of Pediatric Neurology Reference Center for Rare Epilepsies Assistance Publique‐Hôpitaux de Paris (AP‐HP), Necker‐Enfants Malades Hospital Paris France
- Imagine Institute, Mixed Unit of Research 1163 University of ParisSorbonne University Paris France
| | - Giulia Barcia
- Imagine Institute, Mixed Unit of Research 1163 University of ParisSorbonne University Paris France
- Department of Clinical Genetics AP‐HP, Necker‐Enfants Malades Hospital Paris France
| | - Amy Schneider
- Department of Medicine Epilepsy Research Centre Austin Health University of Melbourne Heidelberg Victoria Australia
| | | | - Gwenaël Le Guyader
- Department of Genetics Poitiers University Hospital CenterPoitiers Cedex France
- EA3808–NEUVACOD Neurovascular and Cognitive Disorders Unit University of Poitiers Poitiers France
| | - Gaetan Lesca
- Department of Genetics Lyon Civil Hospices Lyon France
- NeuroMyoGène Institute National Center for Scientific Research Mixed Unit of Research 5310, National Institute of Health and Medical Research U1217University of LyonClaude Bernard Lyon 1 University Villeurbanne France
| | - Cyril Mignot
- National Institute of Health and Medical Research, U1127 National Center for Scientific Research Mixed Unit of Research 7225 Pierre and Marie Curie University Paris 6 Mixed Unit of Research S1127 Brain and Spine Institute Sorbonne University Paris France
- Department of Genetics Rare Causes of Intellectual Disability Reference Center AP‐HP, Pitié‐Salpêtrière HospitalSorbonne University Paris France
| | - Martino Montomoli
- Pediatric Neurology, Neurogenetics, and Neurobiology Unit and Laboratories Neuroscience Department A. Meyer Children's HospitalUniversity of Florence Florence Italy
| | - Elena Parrini
- Pediatric Neurology, Neurogenetics, and Neurobiology Unit and Laboratories Neuroscience Department A. Meyer Children's HospitalUniversity of Florence Florence Italy
| | - Hervé Isnard
- Pediatric Neurologist Medical Office Lyon France
| | - Anne Rolland
- Department of Pediatrics Nantes University Hospital Center Nantes France
| | - Boris Keren
- Department of Genetics Rare Causes of Intellectual Disability Reference Center AP‐HP, Pitié‐Salpêtrière HospitalSorbonne University Paris France
| | - Alexandra Afenjar
- Department of Genetics and Medical Embryology Reference Center for Malformations and Congenital Diseases of the Cerebellum and Rare Causes of Intellectual Disabilities Sorbonne UniversityAP‐HP, Trousseau Hospital Paris France
| | - Nathalie Dorison
- Pediatric Neurosurgery Department Rothschild Foundation Hospital Paris France
- Department of Pediatric Neurology AP‐HP, Armand Trousseau HospitalSorbonne University Paris France
| | - Lynette G. Sadleir
- Department of Pediatrics and Child Health University of Otago Wellington New Zealand
| | - Delphine Breuillard
- Department of Pediatric Neurology Reference Center for Rare Epilepsies Assistance Publique‐Hôpitaux de Paris (AP‐HP), Necker‐Enfants Malades Hospital Paris France
- Imagine Institute, Mixed Unit of Research 1163 University of ParisSorbonne University Paris France
| | - Raphael Levy
- Department of Pediatric Radiology Necker‐Enfants Malades Hospital Paris France
| | - Marlène Rio
- Department of Clinical Genetics AP‐HP, Necker‐Enfants Malades Hospital Paris France
- Laboratory of Developmental Brain Disorders National Institute of Health and Medical Research Mixed Unit of Research 1163 Imagine InstituteSorbonne University Paris France
| | - Sophie Dupont
- National Institute of Health and Medical Research, U1127 National Center for Scientific Research Mixed Unit of Research 7225 Pierre and Marie Curie University Paris 6 Mixed Unit of Research S1127 Brain and Spine Institute Sorbonne University Paris France
- Epileptology Unit and Rehabilitation Unit AP‐HP, Pitie‐Salpêtrière‐Charles Foix Hospital Paris France
| | - Susanna Negrin
- Epilepsy and Clinical Neurophysiology Unit Scientific InstituteIRCCS E. Medea Treviso Italy
| | - Alberto Danieli
- Epilepsy and Clinical Neurophysiology Unit Scientific InstituteIRCCS E. Medea Treviso Italy
| | - Emmanuel Scalais
- Pediatric Neurology Unit Luxembourg Hospital Center Luxembourg City Luxembourg
| | - Anne De Saint Martin
- Department of Pediatric Neurology Strasbourg University HospitalHautepierre Hospital Strasbourg France
| | - Salima El Chehadeh
- Department of Medical Genetics Strasbourg University HospitalsHautepierre Hospital Strasbourg France
| | - Jamel Chelly
- Department of Medical Genetics Strasbourg University HospitalsHautepierre Hospital Strasbourg France
| | - Alice Poisson
- GénoPsy Reference Center for Diagnosis and Management of Genetic Psychiatric Disorders le Vinatier Hospital Center and EDR‐Psy Team (National Center for Scientific Research and Lyon 1 Claude Bernard University) Villeurbanne France
| | - Anne‐Sophie Lebre
- Reims University Hospital CenterMaison Blanche HospitalBiology Department Reims France
| | - Anca Nica
- Neurology Department Center for Clinical Research (CIC 1414) Rennes University Hospital Rennes France
- Laboratory of Signal ProcessingNational Institute of Health and Medical Research Mixed Unit of Research 1099 Rennes France
| | - Sylvie Odent
- Reference Center for Rare Developmental Abnormalities CLAD‐Ouest Rennes University Hospital Center Rennes France
- National Center for Scientific Research Mixed Unit of Research 6290, Institute of Genetics and Development of Rennes (IGDR)University of Rennes Rennes France
| | - Tayeb Sekhara
- Department of Pediatric Neurology C.H.I.R.E.C Brussels Belgium
| | | | - Alice Goldenberg
- Reference Center for Developmental Anomalies and Malformation Syndromes Rouen University Hospital Center Rouen France
| | - Pascal Vrielynck
- Reference Center for Refractory Epilepsy, Catholic University of Louvain William Lennox Neurological Hospital Ottignies Belgium
| | | | - Hélène Maurey
- Department of Pediatric Neurology AP‐HP, Bicêtre University Hospital Kremlin Bicêtre France
| | - Gaetano Terrone
- Department of Translational Medical Sciences Section of Pediatrics, Child Neurology Unit Federico II University Naples Italy
| | - Claude Besmond
- Translational Genetics National Institute of Health and Medical Research Mixed Unit of Research 1163Imagine InstituteUniversity of Paris Paris France
| | - Laurence Hubert
- Translational Genetics National Institute of Health and Medical Research Mixed Unit of Research 1163Imagine InstituteUniversity of Paris Paris France
| | - Patrick Berquin
- Department of Pediatric Neurology Amiens‐Picardie University Hospital CenterUniversity of Picardy Jules Verne Amiens France
| | | | - Bertrand Isidor
- Department of Clinical Genetics Nantes University Hospital Center Nantes France
| | - Jeremy L. Freeman
- Departments of Neurology and Paediatrics Royal Children's Hospital University of Melbourne Melbourne Victoria Australia
- Murdoch Children’s Research Institute Melbourne Victoria Australia
| | - Heather C. Mefford
- Department of Pediatrics Division of Genetic Medicine University of Washington Seattle Washington United States
| | - Candace T. Myers
- Department of Pediatrics Division of Genetic Medicine University of Washington Seattle Washington United States
| | - Katherine B. Howell
- Departments of Neurology and Paediatrics Royal Children's Hospital University of Melbourne Melbourne Victoria Australia
- Murdoch Children’s Research Institute Melbourne Victoria Australia
| | - Andrés Rodríguez‐Sacristán Cascajo
- Pediatric Neurology Unit Department of Pediatric Virgen Macarena Hospital Seville Spain
- Department of Pediatrics School of Medicine University of Seville Seville Spain
| | - Pierre Meyer
- Department of Pediatric Neurology Montpellier University Hospital Center Montpellier France
- PhyMedExp National Institute of Health and Medical Research, U1046National Center for Scientific Research Mixed Unit of Research 9214University of Montpellier Montpellier France
| | - David Genevieve
- Department of Medical Genetics, Rare Disease, and Personalized Medicine IRMBUniversity of MontpellierNational Institute of Health and Medical ResearchMontpellier University Hospital Center Montpellier France
| | - Agnès Guët
- Department of Pediatrics Louis‐Mourier Hospital Colombes France
| | - Diane Doummar
- Department of Pediatric Neurology AP‐HP, Armand Trousseau HospitalSorbonne University Paris France
| | - Julien Durigneux
- Departments of Neurology and Paediatrics Royal Children's Hospital University of Melbourne Melbourne Victoria Australia
| | - Marieke F. van Dooren
- Department of Clinical Genetics Erasmus University Medical Center Rotterdam the Netherlands
| | - Marie Claire Y. de Wit
- Department of Pediatric Neurology and ENCORE Expertise Center Erasmus University Medical Center Sophia Children’s Hospital Rotterdam the Netherlands
| | - Marion Gerard
- Clinical Genetics Côte de Nacre University Hospital Center Caen France
| | - Isabelle Marey
- Department of Genetics Rare Causes of Intellectual Disability Reference Center AP‐HP, Pitié‐Salpêtrière HospitalSorbonne University Paris France
| | - Arnold Munnich
- Imagine Institute, Mixed Unit of Research 1163 University of ParisSorbonne University Paris France
- Department of Clinical Genetics AP‐HP, Necker‐Enfants Malades Hospital Paris France
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics, and Neurobiology Unit and Laboratories Neuroscience Department A. Meyer Children's HospitalUniversity of Florence Florence Italy
| | - Ingrid E. Scheffer
- Department of Medicine Epilepsy Research Centre Austin Health University of Melbourne Heidelberg Victoria Australia
- Departments of Neurology and Paediatrics Royal Children's Hospital University of Melbourne Melbourne Victoria Australia
- Murdoch Children’s Research Institute Melbourne Victoria Australia
- Florey Institute of Neurosciences and Mental Health Heidelberg Victoria Australia
| | - Edor Kabashi
- Imagine Institute, Mixed Unit of Research 1163 University of ParisSorbonne University Paris France
| | - Rima Nabbout
- Department of Pediatric Neurology Reference Center for Rare Epilepsies Assistance Publique‐Hôpitaux de Paris (AP‐HP), Necker‐Enfants Malades Hospital Paris France
- Imagine Institute, Mixed Unit of Research 1163 University of ParisSorbonne University Paris France
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5
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Sullivan BJ, Ammanuel S, Kipnis PA, Araki Y, Huganir RL, Kadam SD. Low-Dose Perampanel Rescues Cortical Gamma Dysregulation Associated With Parvalbumin Interneuron GluA2 Upregulation in Epileptic Syngap1 +/- Mice. Biol Psychiatry 2020; 87:829-842. [PMID: 32107006 PMCID: PMC7166168 DOI: 10.1016/j.biopsych.2019.12.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Loss-of-function SYNGAP1 mutations cause a neurodevelopmental disorder characterized by intellectual disability and epilepsy. SYNGAP1 is a Ras GTPase-activating protein that underlies the formation and experience-dependent regulation of postsynaptic densities. The mechanisms that contribute to this proposed monogenic cause of intellectual disability and epilepsy remain unresolved. METHODS We established the phenotype of the epileptogenesis in a Syngap1+/- mouse model using 24-hour video electroencephalography (vEEG)/electromyography recordings at advancing ages. We administered an acute low dose of perampanel, a Food and Drug Administration-approved AMPA receptor (AMPAR) antagonist, during a follow-on 24-hour vEEG to investigate the role of AMPARs in Syngap1 haploinsufficiency. Immunohistochemistry was performed to determine the region- and location-specific differences in the expression of the GluA2 AMPAR subunit. RESULTS A progressive worsening of the epilepsy with emergence of multiple seizure phenotypes, interictal spike frequency, sleep dysfunction, and hyperactivity was identified in Syngap1+/- mice. Interictal spikes emerged predominantly during non-rapid eye movement sleep in 24-hour vEEG of Syngap1+/- mice. Myoclonic seizures occurred at behavioral-state transitions both in Syngap1+/- mice and during an overnight EEG from a child with SYNGAP1 haploinsufficiency. In Syngap1+/- mice, EEG spectral power analyses identified a significant loss of gamma power modulation during behavioral-state transitions. A significant region-specific increase of GluA2 AMPAR subunit expression in the somas of parvalbumin-positive interneurons was identified. CONCLUSIONS Acute dosing with perampanel significantly rescued behavioral state-dependent cortical gamma homeostasis, identifying a novel mechanism implicating Ca2+-impermeable AMPARs on parvalbumin-positive interneurons underlying circuit dysfunction in SYNGAP1 haploinsufficiency.
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Affiliation(s)
- Brennan J Sullivan
- Neuroscience Laboratory, Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, Maryland
| | - Simon Ammanuel
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Pavel A Kipnis
- Neuroscience Laboratory, Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, Maryland
| | - Yoichi Araki
- Department of Neuroscience, Kavli Neuroscience Discovery Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard L Huganir
- Department of Neuroscience, Kavli Neuroscience Discovery Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shilpa D Kadam
- Neuroscience Laboratory, Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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6
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Electrical Status Epilepticus During Sleep: a Case Report of Postmorbid Baseline Evaluation. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2020. [DOI: 10.1007/s40817-020-00077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Wang TS, Liu QZ, Liu M, Zhang Q, Wang RF, Wu CW, Zhang J, Wang W, Ji TY, Liu XY, Wang S, Cai LX, Jiang YW, Wu Y. Clinical features and surgical outcomes in young children with focal cortical dysplasia type II. CNS Neurosci Ther 2019; 26:270-277. [PMID: 31368639 PMCID: PMC6978260 DOI: 10.1111/cns.13205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/01/2022] Open
Abstract
AIMS To investigate clinical characteristics and surgery outcomes of young children with focal cortical dysplasia (FCD) type II. METHODS Young children (onset age ≤6 years) with FCDII who underwent epileptic surgery in Children Epilepsy Center of Peking University First Hospital in 2014-2018 were followed up for at least 6 months after surgery. RESULTS One hundred and twelve children with FCDII were included, with median age of onset 0.9 years (0.01-5.9), who underwent surgery at 4.1 years old (0.8-16.2). Focal seizures were most frequent (90.2%) and epileptic spasms presented in 23 (20.5%) cases. Epileptic encephalopathy was not uncommon (12.5%), associated with earlier epilepsy onset and higher rate of bilateral onset on ictal EEG (OR = 0.213, 9.059; P = .041, .004). At the last follow-up, 88.4% achieved seizure-free. Before surgery, 49.1% showed moderate/severe developmental delay, associated with earlier seizure onset and higher rate of history of epileptic encephalopathy (OR = 0.740, 5.160, P = .023, .042). For 48 children with preoperatively moderate/severe developmental delay, DQ rank at 6 months postsurgery was improved in only four cases. CONCLUSION For young children with FCDII, they tend to present with epileptic encephalopathies and show moderate/severe developmental delay before surgery. The seizure outcome was favorable after surgery. For children with preoperatively moderate/severe developmental delay, developmental outcome at 6 months after surgery was not satisfactory.
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Affiliation(s)
- Tian-Shuang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Qing-Zhu Liu
- Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Ming Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Qian Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Ruo-Fan Wang
- Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Chong-Wei Wu
- Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Jie Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Wen Wang
- Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Tao-Yun Ji
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Xiao-Yan Liu
- Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Shuang Wang
- Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Li-Xin Cai
- Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Yu-Wu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Children Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Children Epilepsy Center, Peking University First Hospital, Beijing, China
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8
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Wang Q, Liu Z, Lin Z, Zhang R, Lu Y, Su W, Li F, Xu X, Tu M, Lou Y, Zhao J, Zheng X. De Novo Germline Mutations in SEMA5A Associated With Infantile Spasms. Front Genet 2019; 10:605. [PMID: 31354784 PMCID: PMC6635550 DOI: 10.3389/fgene.2019.00605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/07/2019] [Indexed: 11/13/2022] Open
Abstract
Infantile spasm (IS) is an early-onset epileptic encephalopathy that usually presents with hypsarrhythmia on an electroencephalogram with developmental impairment or regression. In this study, whole-exome sequencing was performed to detect potential pathogenic de novo mutations, and finally we identified a novel damaging de novo mutation in SEMA5A and a compound heterozygous mutation in CLTCL1 in three sporadic trios with IS. The expression profiling of SEMA5A in the human brain showed that it was mainly highly expressed in the cerebral cortex, during the early brain development stage (8 to 9 post-conception weeks and 0 to 5 months after birth). In addition, we identified a close protein-protein interaction network between SEMA5A and candidate genes associated with epilepsy, autism spectrum disorder (ASD) or intellectual disability. Gene enrichment and function analysis demonstrated that genes interacting with SEMA5A were significantly enriched in several brain regions across early fetal development, including the cortex, cerebellum, striatum and thalamus (q < 0.05), and were involved in axonal, neuronal and synapse-associated processes. Furthermore, SEMA5A and its interacting genes were associated with ASD, epilepsy syndrome and developmental disorders of mental health. Our results provide insightful information indicating that SEMA5A may contribute to the development of the brain and is associated with IS. However, further genetic studies are still needed to evaluate the role of SEMA5A in IS to definitively establish the role of SEMA5A in this disorder.
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Affiliation(s)
- Qiongdan Wang
- Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zhenwei Liu
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zhongdong Lin
- Department of Pediatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ru Zhang
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Yutian Lu
- Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Weijue Su
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Feng Li
- Department of Pediatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xi Xu
- Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Mengyun Tu
- Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Yongliang Lou
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Laboratory Medicine, Ministry of Education, Wenzhou, Zhejiang, China
| | - Junzhao Zhao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiaoqun Zheng
- Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Laboratory Medicine, Ministry of Education, Wenzhou, Zhejiang, China
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9
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Epilepsy in Children with Autistic Spectrum Disorder. CHILDREN-BASEL 2019; 6:children6020015. [PMID: 30691036 PMCID: PMC6406948 DOI: 10.3390/children6020015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/21/2022]
Abstract
The comorbidity of autistic spectrum disorder (ASD) and epilepsy has been widely discussed but many questions still remain unanswered. The aim of this study was to establish the occurrence of epilepsy among children with ASD to define the type of epileptic seizures and syndromes, the age of onset of epilepsy, EEG abnormalities, the used antiepileptic drugs and the therapeutic responses for seizures and autistic behavior, as well as to find some correlations between epilepsy and gender, etiology and intellectual disability (ID). A retrospective study of medical files of 59 patients (aged 1–18 years) with ASD during a 5-year period was performed. ASD diagnosis was based on the DSM-5 diagnostic criteria. The patients were examined with a detailed medical history, physical and neurological examination, as well as some additional functional, imaging, laboratory and genetic investigations ASD etiology was syndromic in 9, probable syndromic in 9, and idiopathic in 41 children. ID was established in 90% of ASD children, and epilepsy in 44.4%. The onset of epilepsy prevailed before 7 years of age. The most common seizure types were focal with or without secondary generalization (53.4%). Focal epileptiform EEG abnormalities prevailed. Therapeutic response to seizures was good: 58% were seizure-free, while 27% had >50% seizure reduction but no improvement in autistic behavior. There was no correlation between epilepsy and either occurrence or degree of ID. There was a correlation between the frequency of epileptic seizures and the degree of ID. There was no significant difference among epilepsy rates in different etiologic, gender, and ID groups, probably because of the high percentage of ID and because this was a hospital-based study. Our study showed a significant percentage of epilepsy in ASD population and more than 1/4 were of symptomatic etiology. Those could be managed with specific treatments based on the pathophysiology of the gene defect.
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10
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Landi S, Petrucco L, Sicca F, Ratto GM. Transient Cognitive Impairment in Epilepsy. Front Mol Neurosci 2019; 11:458. [PMID: 30666185 PMCID: PMC6330286 DOI: 10.3389/fnmol.2018.00458] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 11/28/2018] [Indexed: 02/05/2023] Open
Abstract
Impairments of the dialog between excitation and inhibition (E/I) is commonly associated to neuropsychiatric disorders like autism, bipolar disorders and epilepsy. Moderate levels of hyperexcitability can lead to mild alterations of the EEG and are often associated with cognitive deficits even in the absence of overt seizures. Indeed, various testing paradigms have shown degraded performances in presence of acute or chronic non-ictal epileptiform activity. Evidences from both animal models and the clinics suggest that anomalous activity can cause cognitive deficits by transiently disrupting cortical processing, independently from the underlying etiology of the disease. Here, we will review our understanding of the influence of an abnormal EEG activity on brain computation in the context of the available clinical data and in genetic or pharmacological animal models.
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Affiliation(s)
- Silvia Landi
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Pisa, Italy
| | - Luigi Petrucco
- Graduate School of Systemic Neurosciences, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Federico Sicca
- Department of Developmental Neuroscience, Fondazione IRCCS Stella Maris, Pisa, Italy
| | - Gian Michele Ratto
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Pisa, Italy
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11
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Chemaly N, Nehlig A, Chiron C, Nabbout R. Electrocorticographic telemetric recording in unrestrained mouse pups. J Neurosci Methods 2018; 305:17-27. [DOI: 10.1016/j.jneumeth.2018.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
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12
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Jeong A, Wong M. Targeting the Mammalian Target of Rapamycin for Epileptic Encephalopathies and Malformations of Cortical Development. J Child Neurol 2018; 33:55-63. [PMID: 29246093 PMCID: PMC5739082 DOI: 10.1177/0883073817696814] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Malformations of cortical development represent a common cause of epileptic encephalopathies and drug-resistant epilepsy in children. As current treatments are often ineffective, new therapeutic targets are needed for epileptic encephalopathies associated with cortical malformations. The mechanistic/mammalian target of rapamycin (mTOR) pathway constitutes a signaling pathway that drives cellular and molecular mechanisms of epileptogenesis in a variety of focal cortical malformations. mTOR inhibitors prevent epilepsy and associated pathogenic mechanisms of epileptogenesis in mouse models of tuberous sclerosis complex and are currently in clinical trials for drug-resistant seizures in these patients. A recent explosion of genetic studies has linked mutations in various genes regulating the mTOR pathway to other cortical malformations, such as focal cortical dysplasia and hemimegalencephaly. Thus, mTOR inhibitors represent promising candidates as novel antiseizure and antiepileptogenic therapies for epilepsy associated with a spectrum of cortical malformations.
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Affiliation(s)
- Anna Jeong
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Wong
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
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13
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Barry JM, Holmes GL. Why Are Children With Epileptic Encephalopathies Encephalopathic? J Child Neurol 2016; 31:1495-1504. [PMID: 27515946 PMCID: PMC5410364 DOI: 10.1177/0883073816662140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/24/2016] [Indexed: 12/16/2022]
Abstract
The epileptic encephalopathies are devastating conditions characterized by frequent seizures, severely abnormal electroencephalograms (EEGs), and cognitive slowing or regression. The cognitive impairment in the epileptic encephalopathies may be more concerning to the patient and parents than the epilepsy itself. There is increasing recognition that the cognitive comorbidity can be both chronic, primarily due to the underlying etiology of the epilepsy, and dynamic or evolving because of recurrent seizures, interictal spikes, and antiepileptic drugs. Much of scholars' understanding of the neurophysiological underpinnings of cognitive dysfunction in the epileptic encephalopathies comes from rodent studies. Frequent seizures and interictal EEG discharges in rats lead to considerable spatial and social-cognitive deficits. Paralleling these cognitive deficits are dyscoordination of dynamic neural activity within and between the neural networks that subserve normal cognitive processes.
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Affiliation(s)
- Jeremy M Barry
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA
| | - Gregory L Holmes
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA
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14
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Shbarou R. Current Treatment Options for Early-Onset Pediatric Epileptic Encephalopathies. Curr Treat Options Neurol 2016; 18:44. [DOI: 10.1007/s11940-016-0428-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Sun QQ, Zhou C, Yang W, Petrus D. Continuous spike-waves during slow-wave sleep in a mouse model of focal cortical dysplasia. Epilepsia 2016; 57:1581-1593. [PMID: 27527919 DOI: 10.1111/epi.13501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine if mice with focal cortical dysplasia (FCD) develop spontaneous epileptic seizures and, if so, determine the key electroencephalography (EEG) features. METHODS Unilateral single freeze lesions to the S1 region (SFLS1R) were made in postnatal day 0-1 pups to induce a neocortical microgyrus in the right cortical hemisphere. Continuous 24-h recordings with intracranial EEG electrodes and behavioral tests were performed in adult SFLS1R and sham-control mice to assess neurologic status. RESULTS A high percentage of adult SFLS1R animals (89%, 40/45) exhibited at least one or more spontaneous nonconvulsive seizure events over the course of 24 h. Of these animals, 60% (27/45) presented with a chronic seizure state that was persistent throughout the recording session, consisting of bursts of rhythmic high-amplitude spike-wave activities and primarily occurring during periods of slow-wave sleep. In comparison, none of the control, age-matched, mice (0/12) developed seizures. The epileptic discharge pattern closely resembled a pattern of continuous spike-waves during slow-wave sleep (CSWS) of the human syndrome described as an electrical status epilepticus during slow-wave sleep (ESES). Key findings in the SFLS1R model indicated that the observed CSWS (1) were more prevalent in female (18/23) versus male (9/22, p < 0.05), (2) were strongest in the right S1 region although generalized to other brain regions, (3) were associated with significant cognitive and behavioral deficits, (4) were temporarily alleviated by ethosuximide treatment or optogenetic activation of cortical γ-aminobutyric acid (GABA)ergic neurons, and (5) theta and alpha band rhythms may play a key role in the generalization of spike-wave activities. SIGNIFICANCE This is the first report of an in vivo animal FCD model that induces chronic spontaneous electrographic brain seizures. Further characterization of the abnormal oscillations in this mouse model may lead to a better understanding of the mechanisms of CSWS/ESES.
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Affiliation(s)
- Qian-Quan Sun
- Department of Zoology and Physiology, University of Wyoming, Laramie, Wyoming, U.S.A.
| | - Chen Zhou
- Department of Zoology and Physiology, University of Wyoming, Laramie, Wyoming, U.S.A
| | - Weiguo Yang
- Department of Zoology and Physiology, University of Wyoming, Laramie, Wyoming, U.S.A
| | - Daniel Petrus
- Department of Zoology and Physiology, University of Wyoming, Laramie, Wyoming, U.S.A
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16
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Holmes GL, Noebels JL. The Epilepsy Spectrum: Targeting Future Research Challenges. Cold Spring Harb Perspect Med 2016; 6:6/7/a028043. [PMID: 27371672 DOI: 10.1101/cshperspect.a028043] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There have been tremendous recent advances in our understanding of the biological underpinnings of epilepsy and associated comorbidities that justify its representation as a spectrum disorder. Advances in genetics, electrophysiology, and neuroimaging have greatly improved our ability to differentiate, diagnose, and treat individuals with epilepsy. However, we have made little overall progress in preventing epilepsy, and the number of patients who are cured remains small. Likewise, the comorbidities of epilepsy are often underdiagnosed or not adequately treated. In this article, we suggest a few areas in which additional research will likely pay big dividends for patients and their families.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont 05405
| | - Jeffrey L Noebels
- Developmental Neurogenetics Laboratory, Departments of Neurology, Neuroscience, and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030
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17
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What is more harmful, seizures or epileptic EEG abnormalities? Is there any clinical data? Epileptic Disord 2016; 16 Spec No 1:S12-22. [PMID: 25323031 DOI: 10.1684/epd.2014.0686] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cognitive impairment is a common and often devastating co-morbidity of childhood epilepsy. While the aetiology of the epilepsy is a critical determinant of cognitive outcome, there is considerable evidence from both rodent and human studies that indicate that seizures and interictal epileptiform abnormalities can contribute to cognitive impairment. A critical feature of childhood epilepsy is that the seizures and epileptiform activity occur in a brain with developing, plastic neuronal circuits. The consequences of seizures and interictal epileptiform activity in the developing brain differ from similar paroxysmal events occurring in the relatively fixed circuitry of the mature brain. In animals, it is possible to study interictal spikes independently from seizures, and it has been demonstrated that interictal spikes are as detrimental as seizures during brain development. In the clinic, distinguishing the differences between interictal spikes and seizures is more difficult, since both typically occur together. However, both seizures and interictal spikes result in transient cognitive impairment. Recurrent seizures, particularly when frequent, can lead to cognitive regression. While the clinical data linking interictal spikes to persistent cognitive impairment is limited, interictal spikes occurring during the formation and stabilization of neuronal circuits likely contribute to aberrant connectivity. There is insufficient clinical literature to indicate whether interictal spikes are more detrimental than seizures during brain development.
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18
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Shbarou R, Mikati MA. The Expanding Clinical Spectrum of Genetic Pediatric Epileptic Encephalopathies. Semin Pediatr Neurol 2016; 23:134-42. [PMID: 27544470 DOI: 10.1016/j.spen.2016.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pediatric epileptic encephalopathies represent a clinically challenging and often devastating group of disorders that affect children at different stages of infancy and childhood. With the advances in genetic testing and neuroimaging, the etiologies of these epileptic syndromes are now better defined. The various encephalopathies that are reviewed in this article include the following: early infantile epileptic encephalopathy or Ohtahara syndrome, early myoclonic encephalopathy, epilepsy of infancy with migrating focal seizures, West syndrome, severe myoclonic epilepsy in infancy (Dravet syndrome), Landau-Kleffner syndrome, Lennox-Gastaut syndrome, and epileptic encephalopathy with continuous spike-and-wave during sleep. Their clinical features, prognosis as well as underlying genetic etiologies are presented and updated.
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Affiliation(s)
- Rolla Shbarou
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Lebanon
| | - Mohamad A Mikati
- Division of Pediatric Neurology, Children's Health Center, Duke University Medical Center, Durham, NC.
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19
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Abstract
Epilepsy is a complex disorder, which involves much more than seizures, encompassing a range of associated comorbid health conditions that can have significant health and quality-of-life implications. Of these comorbidities, cognitive impairment is one of the most common and distressing aspects of epilepsy. Clinical studies have demonstrated that refractory seizures, resistant to antiepileptic drugs, and occurring early in life have significant adverse effects on cognitive function. Much of what has been learned about the neurobiological underpinnings of cognitive impairment following early-life seizures has come from animal models. Although early-life seizures in rodents do not result in cell loss, seizures cause in changes in neurogenesis and synaptogenesis and alteration of excitatory or inhibitory balance, network connectivity and temporal coding. These morphological and physiological changes are accompanied by parallel impairment in cognitive skills. This increased understanding of the pathophysiological basis of seizure-induced cognitive deficits should allow investigators to develop novel targets for therapeutic interventions.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT.
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20
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Hwang SK, Kwon S. Early-onset epileptic encephalopathies and the diagnostic approach to underlying causes. KOREAN JOURNAL OF PEDIATRICS 2015; 58:407-14. [PMID: 26692875 PMCID: PMC4675920 DOI: 10.3345/kjp.2015.58.11.407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022]
Abstract
Early-onset epileptic encephalopathies are one of the most severe early onset epilepsies that can lead to progressive psychomotor impairment. These syndromes result from identifiable primary causes, such as structural, neurodegenerative, metabolic, or genetic defects, and an increasing number of novel genetic causes continue to be uncovered. A typical diagnostic approach includes documentation of anamnesis, determination of seizure semiology, electroencephalography, and neuroimaging. If primary biochemical investigations exclude precipitating conditions, a trial with the administration of a vitaminic compound (pyridoxine, pyridoxal-5-phosphate, or folinic acid) can then be initiated regardless of presumptive seizure causes. Patients with unclear etiologies should be considered for a further workup, which should include an evaluation for inherited metabolic defects and genetic analyses. Targeted next-generation sequencing panels showed a high diagnostic yield in patients with epileptic encephalopathy. Mutations associated with the emergence of epileptic encephalopathies can be identified in a targeted fashion by sequencing the most likely candidate genes. Next-generation sequencing technologies offer hope to a large number of patients with cryptogenic encephalopathies and will eventually lead to new therapeutic strategies and more favorable long-term outcomes.
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Affiliation(s)
- Su-Kyeong Hwang
- Department of Pediatrics, Kyungpook National University Children's Hospital, Daegu, Korea
| | - Soonhak Kwon
- Department of Pediatrics, Kyungpook National University Children's Hospital, Daegu, Korea
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21
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Ville D, Chiron C, Laschet J, Dulac O. The ketogenic diet can be used successfully in combination with corticosteroids for epileptic encephalopathies. Epilepsy Behav 2015; 48:61-5. [PMID: 26057351 DOI: 10.1016/j.yebeh.2015.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/20/2022]
Abstract
Hormonal therapy or ketogenic diet often permits overcoming the challenging periods of many epileptic encephalopathies (West and Lennox-Gastaut syndromes and encephalopathy with continuous spike-waves in slow sleep), but relapse affects over 20% of patients. We report here a monocenter pilot series of 42 consecutive patients in whom we combined oral steroids with the ketogenic diet for corticosteroid-resistant or -dependent epileptic encephalopathy. We retrospectively evaluated the effect on seizure frequency, interictal spike activity, neuropsychological course, and steroid treatment course. Twenty-three patients had West syndrome (WS), 13 had encephalopathy with continuous spike-waves in slow sleep (CSWS), and six others had miscellaneous epileptic encephalopathies. All patients succeeded to reach 0.8 to 1.6g/l ketone bodies in the urine following the usual KD regimen. For at least 6 months, 14/42 responded to the addition of the ketogenic diet: 4/23 with WS, 8/13 with CSWS, and 2/6 with miscellaneous epileptic encephalopathies. The addition of the KD allowed withdrawing steroids in all responders. Among them, 10/15 had been patients with steroid-dependent epileptic encephalopathy and 4/27 patients with steroid-resistant epileptic encephalopathy. Therefore, the ketogenic diet can be used successfully in combination with corticosteroids for epileptic encephalopathies. Patients presenting with steroid-dependent CSWS seem to be the best candidates.
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Affiliation(s)
- Dorothée Ville
- Hospices Civils de Lyon, HFME, Paediatric Neurology Department and Centre of Reference for Tuberous Sclerosis and Rare Epileptic Disorders, F-69677 Bron, France.
| | - Catherine Chiron
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; University Paris Descartes, PRES Sorbonne Paris Cité, CEA, Gif sur Yvette, France; Neuropaediatrics Department, Necker Hospital, APHP, Paris, France
| | - Jacques Laschet
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; University Paris Descartes, PRES Sorbonne Paris Cité, CEA, Gif sur Yvette, France
| | - Olivier Dulac
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; University Paris Descartes, PRES Sorbonne Paris Cité, CEA, Gif sur Yvette, France; Fondation Ophtalmologique Rothschild, Paris, France
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22
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Ghacibeh GA, Fields C. Interictal epileptiform activity and autism. Epilepsy Behav 2015; 47:158-62. [PMID: 25847431 DOI: 10.1016/j.yebeh.2015.02.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/18/2015] [Accepted: 02/20/2015] [Indexed: 01/16/2023]
Abstract
Many individuals with autism have epileptiform discharges on their EEG without having definite clinical seizures. The clinical significance of epileptiform activity in patients with autism is controversial. Some consider it an epiphenomenon of the underlying condition that should be ignored, and others believe that frequent spikes may contribute to the cognitive impairment and advocate treatment. Several studies have reported variable rates of epileptiform activity and variable response to treatment. There is an urgent need to conduct controlled clinical trials to assess the true incidence of epileptiform activity in children with autism, develop a risk assessment model, and study the effectiveness of treatment. This article is part of a Special Issue entitled "Autism and Epilepsy".
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Affiliation(s)
- Georges A Ghacibeh
- Comprehensive Epilepsy Center, Hackensack University Medical Center, USA; Progressive Neurology, 260 Old Hook Rd, Suite 200, Westwood, NJ 07675, USA.
| | - Cheryl Fields
- Comprehensive Epilepsy Center, Hackensack University Medical Center, USA; Progressive Neurology, 260 Old Hook Rd, Suite 200, Westwood, NJ 07675, USA
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23
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Sivaraju A, Nussbaum I, Cardoza CS, Mattson RH. Substantial and sustained seizure reduction with ketogenic diet in a patient with Ohtahara syndrome. EPILEPSY & BEHAVIOR CASE REPORTS 2015; 3:43-5. [PMID: 26005637 PMCID: PMC4436508 DOI: 10.1016/j.ebcr.2015.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 03/11/2015] [Accepted: 03/26/2015] [Indexed: 11/16/2022]
Abstract
Ketogenic diet has been shown to be efficacious in some epileptic encephalopathies but rarely reported as being useful in children with Ohtahara syndrome. This could possibly be attributed to the rarity of the disease and associated short survival period. We report on a 5-year-old child with Ohtahara syndrome, whose seizures failed to improve with all known medications, continued to show persistent suppression-burst pattern on the electroencephalography (EEG) and had substantial reduction in seizure frequency for one year post-initiation of ketogenic diet. He has not had a single visit to the emergency room because of seizures in the last one year, and more importantly, there has been a clear improvement noted in his level of interaction and temperament. Patients with Ohtahara syndrome invariably have medically intractable seizures and catastrophic neurodevelopmental outcome. Ketogenic diet is a treatment modality that might be worth considering even in this group of patients.
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Affiliation(s)
- Adithya Sivaraju
- Comprehensive Epilepsy Center, Department of Neurology, 15 York Street, LLCI 716, Yale University School of Medicine, Yale-New Haven Hospital, CT 06520, USA
| | - Ilisa Nussbaum
- Comprehensive Epilepsy Center, Department of Neurology, 15 York Street, LLCI 716, Yale University School of Medicine, Yale-New Haven Hospital, CT 06520, USA
| | - Candace S Cardoza
- Comprehensive Epilepsy Center, Department of Neurology, 15 York Street, LLCI 716, Yale University School of Medicine, Yale-New Haven Hospital, CT 06520, USA
| | - Richard H Mattson
- Comprehensive Epilepsy Center, Department of Neurology, 15 York Street, LLCI 716, Yale University School of Medicine, Yale-New Haven Hospital, CT 06520, USA
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24
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Kwong AKY, Ho ACC, Fung CW, Wong VCN. Analysis of mutations in 7 genes associated with neuronal excitability and synaptic transmission in a cohort of children with non-syndromic infantile epileptic encephalopathy. PLoS One 2015; 10:e0126446. [PMID: 25951140 PMCID: PMC4423861 DOI: 10.1371/journal.pone.0126446] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/02/2015] [Indexed: 11/23/2022] Open
Abstract
Epileptic Encephalopathy (EE) is a heterogeneous condition in which cognitive, sensory and/or motor functions deteriorate as a consequence of epileptic activity, which consists of frequent seizures and/or major interictal paroxysmal activity. There are various causes of EE and they may occur at any age in early childhood. Genetic mutations have been identified to contribute to an increasing number of children with early onset EE which had been previously considered as cryptogenic. We identified 26 patients with Infantile Epileptic Encephalopathy (IEE) of unknown etiology despite extensive workup and without any specific epilepsy syndromic phenotypes. We performed genetic analysis on a panel of 7 genes (ARX, CDKL5, KCNQ2, PCDH19, SCN1A, SCN2A, STXBP1) and identified 10 point mutations [ARX (1), CDKL5 (3), KCNQ2 (2), PCDH19 (1), SCN1A (1), STXBP1 (2)] as well as one microdeletion involving both SCN1A and SCN2A. The high rate (42%) of mutations suggested that genetic testing of this IEE panel of genes is recommended for cryptogenic IEE with no etiology identified. These 7 genes are associated with channelopathies or synaptic transmission and we recommend early genetic testing if possible to guide the treatment strategy.
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Affiliation(s)
- Anna Ka-Yee Kwong
- Division of Paediatric Neurology / Developmental Behavioural Paediatrics / Neurohabilitation, Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Alvin Chi-Chung Ho
- Division of Paediatric Neurology / Developmental Behavioural Paediatrics / Neurohabilitation, Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cheuk-Wing Fung
- Division of Paediatric Neurology / Developmental Behavioural Paediatrics / Neurohabilitation, Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Virginia Chun-Nei Wong
- Division of Paediatric Neurology / Developmental Behavioural Paediatrics / Neurohabilitation, Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Podsonnaya IV, Shumacher GI, Efremushkin GG, Gelobetskaya ED. Formation of paroxysmal brain activity in the liquidators of the consequences of the Chernobyl nuclear disaster. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:71-76. [DOI: 10.17116/jnevro201511510171-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Devinsky O, Goldberg R, Miles D, Bojko A, Riviello J. Episodic epileptic verbal auditory agnosia in Landau Kleffner syndrome treated with combination diazepam and corticosteroids. J Child Neurol 2014; 29:1291-8. [PMID: 24453158 DOI: 10.1177/0883073813516381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report 2 pediatric patients who presented initially with seizures followed by subacute language regression characterized by a verbal auditory agnosia. These previously normal children had no evidence of expressive aphasia during their symptomatic periods. Further, in both cases, auditory agnosia was associated with sleep-activated electroencephalographic (EEG) epileptiform activity, consistent with Landau-Kleffner syndrome. However, both cases are unique since the episodic auditory agnosia and sleep-activated EEG epileptiform activity rapidly responded to combination therapy with pulse benzodiazepine and corticosteroids. Further, in each case, recurrences were characterized by similar symptoms, EEG findings, and beneficial responses to the pulse benzodiazepine and corticosteroid therapy. These observations suggest that pulse combination high-dose corticosteroid and benzodiazepine therapy may be especially effective in Landau-Kleffner syndrome.
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Affiliation(s)
- Orrin Devinsky
- Department of Neurology, NYU Langone School of Medicine, New York, NY, USA Institute of Neurology, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Rina Goldberg
- Institute of Neurology, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Daniel Miles
- Department of Neurology, NYU Langone School of Medicine, New York, NY, USA
| | - Aviva Bojko
- Institute of Neurology, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - James Riviello
- Department of Neurology, NYU Langone School of Medicine, New York, NY, USA
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Abstract
This article focuses on the inflammatory processes in patients with generalized epilepsies. We specifically review the data regarding West, Lennox-Gastaut, and Landau-Kleffner syndromes as they have generalized clinical or electroencephalogram features. There is substantial evidence for a pathogenic implication of immune mechanisms in these epilepsies. Animal models and abnormalities in both cellular and humoral immunity support this hypothesis. They also appear to be particularly responsive to immunomodulatory therapies, which has raised the speculation that an unbalanced immune system may play an important role in the pathophysiology of these epileptic syndromes. In this article, we discuss clinical and experimental data that support the potential implication of immune mediated inflammation and immune response in the mechanism of these entities.
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Granata T, Matricardi S, Ragona F, Freri E, Casazza M, Villani F, Deleo F, Tringali G, Gobbi G, Tassi L, Lo Russo G, Marras CE, Specchio N, Vigevano F, Fusco L. Hemispherotomy in Rasmussen encephalitis: long-term outcome in an Italian series of 16 patients. Epilepsy Res 2014; 108:1106-19. [PMID: 24815913 DOI: 10.1016/j.eplepsyres.2014.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 03/13/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
Surgical disconnection of the affected hemisphere is considered the treatment of choice for Rasmussen encephalitis (RE), however few data on long-term outcomes after disconnective surgery are available. We report on long-term seizure, cognitive and motor outcomes after disconnective surgery in 16 (8 M, 8 F) RE patients. Pre- and post-operative evaluations included long-term video-EEG monitoring, MRI, assessment of motor function, and cognitive evaluation. Hemispherotomy, by various techniques was used to obtain functional disconnection of the affected hemisphere. The patients, of median current age 23.5 years, range 12-33, were operated on between 1993 and 2009. Median age at disease onset was 5.8 years (range 3-11.4). Median time from seizure onset to surgery was 3.8 years, range 8 months to 21 years. Post-surgical follow-up was a median of 9.5 years, range 3-20. At surgery all patients were receiving two or more antiepileptic drugs (AEDs). All but three patients were seizure-free at latest follow-up. AEDs had been stopped in ten patients; in the remaining six AEDs were markedly reduced. Postural control improved in all patients. Gain in cognitive functioning was significantly (p=0.002) related to disease duration. The long-term outcomes, in terms of seizure control, motor improvement, and cognitive improvement provide important support for disconnective surgery as first choice treatment for RE.
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Affiliation(s)
- Tiziana Granata
- Department of Pediatric Neuroscience, Carlo Besta Neurological Institute, Milan, Italy.
| | - Sara Matricardi
- Department of Pediatric Neuroscience, Carlo Besta Neurological Institute, Milan, Italy; Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Carlo Besta Neurological Institute, Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Carlo Besta Neurological Institute, Milan, Italy
| | - Marina Casazza
- Department of Neurophysiology, Carlo Besta Neurological Institute, Milan, Italy
| | - Flavio Villani
- Clinical Epileptology and Experimental Neurophysiology Unit, Carlo Besta Neurological Institute, Milan, Italy
| | - Francesco Deleo
- Clinical Epileptology and Experimental Neurophysiology Unit, Carlo Besta Neurological Institute, Milan, Italy
| | - Giovanni Tringali
- Department of Neurosurgery, Carlo Besta Neurological Institute, Milan, Italy
| | - Giuseppe Gobbi
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bellaria Hospital, Bologna, Italy
| | - Laura Tassi
- Epilepsy Surgery Centre C. Munari, Milan, Italy
| | | | | | - Nicola Specchio
- Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lucia Fusco
- Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
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Default mode network hypometabolism in epileptic encephalopathies with CSWS. Epilepsy Res 2014; 108:861-71. [PMID: 24746674 DOI: 10.1016/j.eplepsyres.2014.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/12/2014] [Accepted: 03/16/2014] [Indexed: 11/20/2022]
Abstract
Previous studies investigating cerebral metabolic changes associated with continuous spike-waves during sleep (CSWS) compared the metabolism of children with CSWS with that of healthy adults, precluding any assessment in brain areas showing physiologic age-related metabolic changes. Here, we investigated the metabolic and connectivity changes characterizing the acute phase of CSWS activity by comparing awake brain metabolism of children with CSWS with that of pediatric pseudo-controls. Positron emission tomography using [18F]-fluorodeoxyglucose (FDG-PET) was performed in 17 awake children with cryptogenic CSWS (5 girls, age: 5-11 years). Voxel-based analyses identified significant metabolic changes in CSWS patients compared with 18 pediatric pseudo-controls (12 girls, age: 6-11 years, non-CSWS focal cryptogenic epilepsy with normal FDG-PET). CSWS-induced changes in the contribution of brain areas displaying metabolic changes to the level of metabolic activity in other brain areas were investigated using pathophysiological interaction. Hypermetabolism in perisylvian regions bilaterally and hypometabolism in lateral and mesial prefrontal cortex, precuneus, posterior cingulate cortex and parahippocampal gyri characterized the acute phase of CSWS (p<0.05 FWE). No change in thalamic metabolism was disclosed. Altered functional connectivity was found between hyper- and hypometabolic regions in CSWS patients compared with pediatric pseudo-controls. This study demonstrates hypometabolism in key nodes of the default mode network (DMN) in awake patients with CSWS, in relation with a possible phenomenon of sustained remote inhibition from the epileptic foci. This hypometabolism might account for some of the acquired cognitive or behavioral features of CSWS epileptic encephalopathies. This study failed to find any evidence of thalamic metabolic changes, which supports the primary involvement of the cortex in CSWS genesis.
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Staba RJ, Worrell GA. What is the importance of abnormal "background" activity in seizure generation? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 813:43-54. [PMID: 25012365 DOI: 10.1007/978-94-017-8914-1_3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Investigations of interictal epileptiform spikes and seizures have played a central role in the study of epilepsy. The background EEG activity, however, has received less attention. In this chapter we discuss the characteristic features of the background activity of the brain when individuals are at rest and awake (resting wake) and during sleep. The characteristic rhythms of the background EEG are presented, and the presence of 1/f (β) behavior of the EEG power spectral density is discussed and its possible origin and functional significance. The interictal EEG findings of focal epilepsy and the impact of interictal epileptiform spikes on cognition are also discussed.
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Affiliation(s)
- Richard J Staba
- Department of Neurology, Reed Neurological Research Center, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, RNRC 2-155, Los Angeles, CA, 90095, USA,
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Park J, Yum MS, Choi HW, Kim EH, Kim HW, Ko TS. Determinants of intelligence in childhood-onset epilepsy: a single-center study. Epilepsy Behav 2013; 29:166-71. [PMID: 23973641 DOI: 10.1016/j.yebeh.2013.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/08/2013] [Accepted: 07/12/2013] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to quantify the intelligence of children with epilepsy and to determine the clinical factors associated with intellectual impairment. The medical records of patients diagnosed with childhood-onset epilepsy at a single tertiary medical center in Korea between 2006 and 2011 were retrospectively reviewed. The Korean Education Development Institute-Wechsler Intelligence Scale for Children or Korean Wechsler Intelligence Scale for adults was used to quantify the level of intelligence. Age at seizure onset, etiology, epilepsy duration, number of seizures in the last year, use of antiepileptic drugs, EEG/MRI findings, and epilepsy classification were recorded. The association between clinical factors and the intelligence was determined using logistic regression. Three hundred and twenty-two patients were included in the analysis. One hundred and seventy-six (54.7%) patients had low intelligence (intelligence quotient [IQ]<80) with 18 (5.6%) defined as borderline mental retardation (IQ 70-79), 47 (14.6%) as mild mental retardation (IQ 60-69), and 111 (34.5%) as moderate-to-severe mental retardation (IQ<60). Epilepsy duration, number of seizures in the last year, and epilepsy classification were significantly associated with low intelligence in multivariate logistic regression (p<0.05). However, when analyzed according to etiology, these factors were not associated with low intelligence in children with idiopathic epilepsy. The most important factors associated with low intelligence in childhood-onset epilepsy are the underlying etiology and, in cryptogenic and symptomatic epilepsy, seizure burden. The results of this study underscore the importance of seizure control to alleviate the harmful impact of epilepsy on cognition.
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Affiliation(s)
- Jungmee Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ramantani G, Kadish NE, Strobl K, Brandt A, Stathi A, Mayer H, Schubert-Bast S, Wiegand G, Korinthenberg R, Stephani U, van Velthoven V, Zentner J, Schulze-Bonhage A, Bast T. Seizure and cognitive outcomes of epilepsy surgery in infancy and early childhood. Eur J Paediatr Neurol 2013; 17:498-506. [PMID: 23602440 DOI: 10.1016/j.ejpn.2013.03.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/20/2013] [Accepted: 03/24/2013] [Indexed: 10/26/2022]
Abstract
AIMS To investigate seizure and developmental outcomes following epilepsy surgery in very young children and determine their predictive factors. METHODS We retrospectively reviewed the clinical data, surgical variables, and outcomes of 30 children under 3 years of age that underwent resection for refractory focal epilepsy in our institution in 2001-2011. RESULTS Seizure onset was in the first year of life in 27 (90%) cases and mean age at surgery was 20 months (range 5-33.6). Pathology consisted of cortical malformations in 24 (80%) cases, glioneuronal tumour and infarction with or without cortical dysplasia in three (10%) cases each. Morbidity was comparable with older paediatric cohorts. At 1-11.6 year follow-up (mean 4.1) 21 of 30 (70%) children achieved seizure freedom (Engel I), six (20%) demonstrated worthwhile improvement (Engel II/III) and three (10%) did not benefit from surgery (Engel IV). Intralobar lesionectomy more often resulted in seizure freedom than multilobar or hemispheric surgery. The abundance of non-regional interictal and ictal EEG findings did not preclude seizure freedom. Presurgical developmental impairment was established in 25 of 28 (89%) children; its severity correlated with longer epilepsy duration and determined postoperative developmental outcome. Developmental progress was established in 26 out of 28 (93%) children following surgery, showing stabilized trajectories rather than catch-up. CONCLUSIONS Resective surgery in very young children is safe and effective in terms of seizure control and developmental progress. Our findings underline the importance of early intervention in order to timely stop seizures and their deleterious effects on the developing brain.
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Affiliation(s)
- Georgia Ramantani
- Epilepsy Centre, University Hospital Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
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De Tiège X, Trotta N, Op de beeck M, Bourguignon M, Marty B, Wens V, Nonclercq A, Goldman S, Van Bogaert P. Neurophysiological activity underlying altered brain metabolism in epileptic encephalopathies with CSWS. Epilepsy Res 2013; 105:316-25. [DOI: 10.1016/j.eplepsyres.2013.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/03/2013] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
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Sharma S, Tripathi M. Ketogenic diet in epileptic encephalopathies. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:652052. [PMID: 23936641 PMCID: PMC3723152 DOI: 10.1155/2013/652052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/24/2013] [Indexed: 11/25/2022]
Abstract
The ketogenic diet is a medically supervised high-fat, low-carbohydrate diet that has been found useful in patients with refractory epilepsy. It has been shown to be effective in treating multiple seizure types and epilepsy syndromes. In this paper, we review the use of the ketogenic diet in epileptic encephalopathies such as Ohtahara syndrome, West syndrome, Dravet syndrome, epilepsy with myoclonic atonic seizures, and Lennox-Gastaut syndrome.
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Affiliation(s)
- Suvasini Sharma
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi 110001, India
| | - Manjari Tripathi
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India
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Abstract
BACKGROUND Infantile spasms (West's Syndrome) is a syndrome that includes a peculiar type of epileptic seizure-the spasms-and an electroencephalographic (EEG) abnormality often called hypsarrhythmia. Psychomotor retardation is frequently found at follow-up. Approximately two-thirds of affected infants will have a detectable underlying neurological abnormality, but still little is known about the pathophysiological basis for infantile spasms, and treatment remains problematic. OBJECTIVES To compare the effects of single pharmaceutical therapies used to treat infantile spasms in terms of control of the spasms, resolution of the EEG, relapse rates, psychomotor development, subsequent epilepsy, side effects, and mortality. SEARCH METHODS To identify published data, we searched the Cochrane Epilepsy Group Specialised Register (October 2012), CENTRAL (The Cochrane Library 2012, Issue 9), MEDLINE (1946 to September Week 4, 2012), EMBASE (1980 to March 2003), and the reference lists of all retrieved articles.To identify unpublished data, we searched the ISRCTN Register (www.controlled-trials.com), corresponded with colleagues and drug companies, and made requests at international conferences. SELECTION CRITERIA All randomised controlled trials (RCTs) of the administration of drug therapy to patients with infantile spasms. DATA COLLECTION AND ANALYSIS Data collection from all relevant publications was independently undertaken by three review authors (before 2010) or by two review authors using a standard proforma. Analysis included assessment of study quality and a search for sources of heterogeneity. MAIN RESULTS We found 16 small RCTs (fewer than 100 patients enrolled) and 2 larger RCTs (more than 100 patients enrolled). These 18 studies looked at a total of 916 patients treated with a total of 12 different pharmaceutical agents. Overall methodology of the studies was poor, in part because of ethical dilemmas such as giving placebo injections to children. Two studies showed that placebo was not as good as active treatment in resolving the spasms. The strongest evidence suggested that hormonal treatment (prednisolone or tetracosactide depot) leads to resolution of spasms faster and in more infants than does vigabatrin. Responses without subsequent relapse may be no different. The same study suggests that hormonal treatments might improve the long-term developmental outcome compared with vigabatrin in infants not found to have an underlying cause for their infantile spasms. AUTHORS' CONCLUSIONS To date, few well-designed RCTs have considered the treatment of infantile spasms, and the numbers of patients enrolled have been small. In the majority, methodology has been poor, hence it is not clear which treatment is optimal in the treatment of this epilepsy syndrome. Hormonal treatment resolves spasms in more infants than vigabatrin, but this may or may not translate into better long-term outcomes. If prednisolone or vigabatrin is used, high dosage is recommended. Vigabatrin may be the treatment of choice in tuberous sclerosis. Resolution of the EEG features may be important, but this has not been proven. Further research using large studies with robust methodology is required.
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Affiliation(s)
- Eleanor C Hancock
- c/o Cochrane Epilepsy Group, University of Liverpool, Liverpool, UK.
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Milh M, Falace A, Villeneuve N, Vanni N, Cacciagli P, Assereto S, Nabbout R, Benfenati F, Zara F, Chabrol B, Villard L, Fassio A. Novel compound heterozygous mutations in TBC1D24 cause familial malignant migrating partial seizures of infancy. Hum Mutat 2013; 34:869-72. [PMID: 23526554 DOI: 10.1002/humu.22318] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/07/2013] [Indexed: 11/08/2022]
Abstract
Early-onset epileptic encephalopathies (EOEEs) are a group of rare devastating epileptic syndromes of infancy characterized by severe drug-resistant seizures and electroencephalographic abnormalities. The current study aims to determine the genetic etiology of a familial form of EOEE fulfilling the diagnosis criteria for malignant migrating partial seizures of infancy (MMPSI). We identified two inherited novel mutations in TBC1D24 in two affected siblings. Mutations severely impaired TBC1D24 expression and function, which is critical for maturation of neuronal circuits. The screening of TBC1D24 in an additional set of eight MMPSI patients was negative. TBC1D24 loss of function has been associated to idiopathic infantile myoclonic epilepsy, as well as to drug-resistant early-onset epilepsy with intellectual disability. Here, we describe a familial form of MMPSI due to mutation in TBC1D24, revealing a devastating epileptic phenotype associated with TBC1D24 dysfunction.
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Sánchez Fernández I, Chapman KE, Peters J, Kothare SV, Nordli DR, Jensen FE, Berg AT, Loddenkemper T. The tower of Babel: survey on concepts and terminology in electrical status epilepticus in sleep and continuous spikes and waves during sleep in North America. Epilepsia 2013; 54:741-50. [PMID: 23163318 PMCID: PMC5030106 DOI: 10.1111/epi.12039] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The terms "electrical status epilepticus during sleep (ESES)" and "continuous spikes and waves during sleep (CSWS)" have been used interchangeably when referring to related but different concepts. In addition, the quantification of epileptiform activity has not been standardized, and different approaches to quantification have been used. The aim of this study was to evaluate the extent to which pediatric neurologists and epileptologists use a homogeneous terminology and conceptualization in CSWS and ESES and to characterize the current understanding of these conditions. METHODS A survey addressing the use of terminology in "ESES" and "CSWS" and the understanding of related concepts was distributed online to all members of the Child Neurology Society and the American Epilepsy Society mailing lists. Surveys were self-administered and collected using an online survey website (http://www.surveymonkey.com). KEY FINDINGS Two hundred nineteen surveys were completed, 137 from the Child Neurology Society mailing list and 82 from the American Epilepsy Society mailing list. ESES and CSWS were considered synonymous by 117 respondents, not synonymous by 61, 21 respondents did not know, and 20 did not respond. Most respondents (63.1%) considered CSWS as a devastating epileptic encephalopathy with severe sequelae even if treated correctly, but 25.1% of respondents indicated that it does not leave sequelae if epilepsy was treated early and another 11.8% noted that cognitive difficulties resolved with age. Cognitive and/or language regression were considered mandatory for the diagnosis of CSWS by only 27% of the respondents. The diagnosis of CSWS was based on electroencephalography (EEG) assessment alone by 31% of respondents. Respondents used different methods for calculation of the epileptiform activity, different EEG samples for calculation, and considered differently the lateralized epileptiform activity. The cut-off values for percentage of the sleep record occupied by spike-waves were variable depending on the respondent. There was no agreement on whether these cutoff values were mandatory for the diagnosis of ESES and CSWS. SIGNIFICANCE Our data show that the professionals caring for children with ESES and CSWS in North America use the terms, concepts, and defining features heterogeneously. The lack of a common language may complicate communication among clinicians and jeopardize research in this field. We anticipate that our data will fuel the development of much needed common terminology and conceptualization of ESES and CSWS.
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Affiliation(s)
- Iván Sánchez Fernández
- Children’s Hospital Boston, Department of Neurology, Harvard Medical School, Boston, MA, USA
- Hospital Sant Joan de Déu, Department of Child Neurology, Universidad de Barcelona, Barcelona, Spain
| | - Kevin E. Chapman
- Children’s Hospital Boston, Department of Neurology, Harvard Medical School, Boston, MA, USA
- Children’s Hospital Colorado, Department of Neurology, University of Colorado, CO, USA
| | - Jurriaan Peters
- Children’s Hospital Boston, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Sanjeev V. Kothare
- Children’s Hospital Boston, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Douglas R. Nordli
- Lurie Children’s Hospital, Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Frances E. Jensen
- Children’s Hospital Boston, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Anne T. Berg
- Lurie Children’s Hospital, Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Tobias Loddenkemper
- Children’s Hospital Boston, Department of Neurology, Harvard Medical School, Boston, MA, USA
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Abstract
The epileptic encephalopathies of infancy are a group of disorders characterized by intractable seizures, persistent abnormality of cortical function documented on EEG, and consequently impaired neuro-developmental outcomes. The etiologies vary and include; structural brain malformations, acquired brain insults, and inborn errors of metabolism in the majority of the affected patients. In a proportion of these cases no obvious etiology is identifiable on investigation. Recent advances in molecular diagnostics have led to the discovery of a number of gene defects that may be causal in many epileptic encephalopathies. Identification of the causative mutation is important for prognostic and genetic counseling, and may also carry treatment implications. The recently described genes include; Cyclin-Dependent Kinase-Like 5 gene (CDKL5), Protocadherin 19 (PCDH19), Sodium channel neuronal type 1a subunit gene (SCN1A), Aristaless-Related Homeobox Gene (ARX), and Syntaxin binding protein 1 gene (STXBP1), amongst others. Distinct electro-clinical syndromes are increasingly being identified amongst patients carrying the various mutations. In this review, we outline the approach to clinical evaluation and genetic testing of epileptic encephalopathies in infancy.
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Jambaqué I, Pinabiaux C, Lassonde M. Cognitive disorders in pediatric epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:691-5. [PMID: 23622216 DOI: 10.1016/b978-0-444-52891-9.00071-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Childhood epilepsy may cause cognitive disorders and the intellectual quotient is indeed not normally distributed in epileptic children, a fair proportion of whom show an IQ in the deficient range. Some epileptic syndromes happen during vulnerability periods of brain maturation and interfere with the development of specific cognitive functions. This is the case for the Landau-Kleffner syndrome, which generally appears during speech development and affects language. Similarly, West syndrome - or infantile spasms - is an epileptogenic encephalopathy appearing during the first years of life and induces a major delay in social and oculo-motor development. Specific impairments can also be identified in partial childhood epilepsies in relation with seizure focus localization. For instance, left temporal and frontal epilepsies are frequently associated with verbal impairments. Moreover, episodic memory disorders have been described in children suffering from temporal lobe epilepsy whereas executive deficits (planning, self-control, problem solving) have been reported in frontal lobe epilepsy. In most cases, including its mildest forms, childhood epilepsy induces attention deficits, which may affect academic achievement. These observations militate in favor of individual neuropsychological assessments as well as early interventions in order to provide the child with an optimal individualized treatment program.
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Affiliation(s)
- I Jambaqué
- INSERM U663; Université Paris Descartes, Institut de Psychologie, Paris, France; Fondation Rothschild, Unité de Neurochirurgie Pédiatrique, Paris, France.
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Valvo G, Novara F, Brovedani P, Ferrari AR, Guerrini R, Zuffardi O, Sicca F. 22q11.2 Microduplication syndrome and epilepsy with continuous spikes and waves during sleep (CSWS). A case report and review of the literature. Epilepsy Behav 2012; 25:567-72. [PMID: 23159380 DOI: 10.1016/j.yebeh.2012.09.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 12/21/2022]
Abstract
Chromosome 22q11.2 microduplication syndrome is characterized by a variable and usually mild phenotype and by incomplete penetrance. Neurological features of the syndrome may entail intellectual or learning disability, motor delay, and other neurodevelopmental disorders. However, seizures or abnormal EEG are reported in a few cases. We describe a 6-year-old girl with microduplication of chromosome 22q11.2 and epilepsy with continuous spikes and waves during sleep (CSWS). Her behavioral disorder, characterized by hyperactivity, impulsiveness, attention deficit, and aggressiveness, became progressively evident a few months after epilepsy onset, suggesting a link with the interictal epileptic activity characterizing CSWS. We hypothesize that, at least in some cases, the neurodevelopmental deficit seen in the 22q11.2 microduplication syndrome could be the consequence of a disorder of cerebral electrogenesis, suggesting the need for an EEG recording in affected individuals. Moreover, an array-CGH analysis should be performed in all individuals with cryptogenic epilepsy and CSWS.
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Affiliation(s)
- Giulia Valvo
- Epilepsy, Neurophysiology and Neurogenetics Unit, IRCCS Stella Maris Foundation, Via dei Giacinti 2, 56128 Calambrone, Pisa, Italy
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Fujikawa DG, Licht EA, Jacobsen RH. Chronic epileptic encephalopathy in adult patients with bilaterally synchronous frequent and/or prolonged subclinical epileptiform discharges. Epilepsy Behav 2012; 25:442-8. [PMID: 23021092 DOI: 10.1016/j.yebeh.2012.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 07/26/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
Abstract
We followed four patients with infrequent convulsive seizures for four to 10 years, with periodic EEGs and neuropsychological tests. All four had bursts of frontally predominant, bilaterally synchronous 1.5-3-Hz spike or polyspike and slow-wave discharges (SWDs) that initially comprised 15% to 88% but were reduced to 5% or less of total EEG time with appropriate antiepileptic drugs. Case 1 showed a 30-point improvement in his verbal WAIS-R score and Case 4 a 21-point improvement in his performance WAIS-R score, over nine- and five-year periods, respectively, with normalization of frontal executive function. Cases 2 and 3 showed no improvement in frontal executive dysfunction despite being free of SWDs for nine and five years, respectively. These patients had variable degrees of epileptic encephalopathy and subclinical SWDs. They illustrate the importance of minimizing the occurrence of SWDs with appropriate antiepileptic drugs and long-term monitoring with neuropsychological tests because chronic cognitive deficits are potentially reversible.
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Affiliation(s)
- Denson G Fujikawa
- Neurology Department, VA Greater Los Angeles Healthcare System, North Hills, CA, USA.
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Epileptic encephalopathies in adults and childhood. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:205131. [PMID: 23056934 PMCID: PMC3465907 DOI: 10.1155/2012/205131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/28/2012] [Accepted: 06/10/2012] [Indexed: 02/02/2023]
Abstract
Epileptic encephalopathies are motor-mental retardations or cognitive disorders secondary to epileptic seizures or epileptiform activities. Encephalopaties due to brain damage, medications, or systemic diseases are generally not in the scope of this definition, but they may rarely accompany the condition. Appropriate differential diagnosis of epileptic seizures as well as subclinical electroencephalographic discharges are crucial for management of seizures and epileptiform discharges and relative regression of cognitive deterioration in long-term followup. Proper antiepileptic drug, hormonal treatment, or i.v. immunoglobulin choice play major role in prognosis. In this paper, we evaluated the current treatment approaches by reviewing clinical electrophysiological characteristics of epileptic encephalopathies.
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Badawy RAB, Macdonell RAL, Vogrin SJ, Lai A, Cook MJ. Cortical excitability decreases in Lennox-Gastaut syndrome. Epilepsia 2012; 53:1546-53. [DOI: 10.1111/j.1528-1167.2012.03599.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kamien BA, Cardamone M, Lawson JA, Sachdev R. A genetic diagnostic approach to infantile epileptic encephalopathies. J Clin Neurosci 2012; 19:934-41. [PMID: 22617547 DOI: 10.1016/j.jocn.2012.01.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/12/2012] [Accepted: 01/19/2012] [Indexed: 12/29/2022]
Abstract
Epileptic encephalopathies are characterized by frequent severe seizures, and/or prominent interictal epileptiform discharges on the electroencephalogram, developmental delay or deterioration, and usually a poor prognosis. The epileptiform abnormalities themselves are believed to contribute to the progressive disturbance in cerebral function. Determining the underlying aetiology responsible for infantile epileptic encephalopathy is a clinical challenge worth undertaking to facilitate advice on the recurrence risk and to allow for the option of prenatal testing, as often this category of epilepsy is associated with devastating hardship for families. This review takes advantage of recently published studies that have identified new genes associated with epilepsy and focuses on known monogenic causes where detection is useful for the process of genetic counselling. Based on the review, we present a diagnostic work-up in order to triage specific genetic testing for infants presenting with an epileptic encephalopathy.
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Affiliation(s)
- Benjamin A Kamien
- Department of Medical Genetics, Sydney Children's Hospital, High St., Randwick, New South Wales 2031, Australia.
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Badawy RAB, Johnson KA, Cook MJ, Harvey AS. A mechanistic appraisal of cognitive dysfunction in epilepsy. Neurosci Biobehav Rev 2012; 36:1885-96. [PMID: 22617705 DOI: 10.1016/j.neubiorev.2012.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/24/2012] [Accepted: 05/13/2012] [Indexed: 12/14/2022]
Abstract
A strong relationship between the clinical characteristics of epilepsy and the nature of cognitive impairments associated with the condition has been found, but the nature of this relationship appears to be quite complex and not well understood. This review presents a summary of the research on the interaction between cognition and epilepsy, surveyed from a mechanistic perspective with the aim of clarifying factors that contribute to the co-existence of both disorders. The physiological basis underpinning cognitive processing is first reviewed. The physiology of epilepsy is reviewed, with emphasis placed on interictal discharges and seizures. The nature of the impact of epilepsy on cognition is described, with transient and prolonged effects distinguished. Finally, the complexity of the co-morbidity between cognitive dysfunction and epilepsy is discussed in relation to childhood and adult-onset epilepsy syndromes and severe epileptic encephalopathies. Structural and functional abnormalities exist in patients with epilepsy that may underpin both the cognitive dysfunction and epilepsy, highlighting the complexity of the association. Research, possibly of a longitudinal nature, is needed to elucidate this multifactorial relationship between cognitive dysfunction and epilepsy.
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Affiliation(s)
- Radwa A B Badawy
- Department of Clinical Neurosciences, St. Vincent's Hospital, Melbourne, Victoria, Australia; Department of Medicine, Melbourne, Victoria, Australia; Electrical and Electronic Engineering, Melbourne, Victoria, Australia. ,
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Abstract
Landau-Kleffner syndrome (LKS) is a childhood disorder characterized by an acquired aphasia that emerges in association with epileptiform electroencephalographic abnormalities. The language loss is often characterized by a severe disturbance of auditory language comprehension (verbal auditory agnosia) combined with a substantial disruption of expressive language. Comorbid behavioral disturbances commonly involve hyperactivity and attentional problems but sometimes encompass a more pervasive pattern of difficulties resembling an autism spectrum disorder. Now one the most frequently described forms of acquired aphasia in children, LKS has had a profound influence on both neurological practice and cognitive neuroscience. Here, we review current conceptualizations of LKS, consider its pleomorphic manifestations and discuss existing and future diagnostic issues and dilemmas. The potential relevance of LKS to understanding other disorders, including autistic regression, is considered.
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Affiliation(s)
- Gerry Stefanatos
- Communication Sciences & Disorders, Temple University, Philadelphia, PA 19122, USA.
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Pediatric epileptology. Epilepsy Behav 2011; 22:32-7. [PMID: 21530413 DOI: 10.1016/j.yebeh.2011.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 02/10/2011] [Indexed: 11/22/2022]
Abstract
Challenges facing children with epilepsy are understanding the neurobiology of pharmacoresistance of epileptic encephalopathies and the development of effective surgical treatment options for those with "non-lesional" epilepsy. Although, understanding the genetics of childhood epilepsy has advanced, an effective treatment intervention has not occurred. Recently, understanding the neurobiology of hamartin and tuberin in the development of epilepsy and cognitive impairment associated with tuberous sclerosis complex allowed the development of sirolimus and everolimus to be used in human clinical trials. In spite of these breakthroughs a large number of children are likely to be outside the scope of interventional therapies. For such patients the burden of seizures is onerous and psycho-social consequences debilitating. Surgical resective options are often limited by the lack of a well defined epileptic lesion. Co-registered synthesis of advanced functional, structural and electrographic seizure onset allows identification of a focus in patients thought to have "non-lesional" epilepsy. Developments of a Pipeline for prospective data sharing are likely to increase understanding and validation of the epileptogenic zone and offer the hope of seizure freedom. Two outstanding young investigators provide a review of their exciting research and its implications in pediatric epilepsy.
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Liang JS, Shimojima K, Takayama R, Natsume J, Shichiji M, Hirasawa K, Imai K, Okanishi T, Mizuno S, Okumura A, Sugawara M, Ito T, Ikeda H, Takahashi Y, Oguni H, Imai K, Osawa M, Yamamoto T. CDKL5 alterations lead to early epileptic encephalopathy in both genders. Epilepsia 2011; 52:1835-42. [DOI: 10.1111/j.1528-1167.2011.03174.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Mueller A, Boor R, Coppola G, Striano P, Dahlin M, von Stuelpnagel C, Lotte J, Staudt M, Kluger G. Low long-term efficacy and tolerability of add-on rufinamide in patients with Dravet syndrome. Epilepsy Behav 2011; 21:282-4. [PMID: 21620771 DOI: 10.1016/j.yebeh.2011.04.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
In this retrospective European multicenter study we evaluated the efficacy and tolerability of rufinamide in patients with Dravet syndrome and refractory seizures. Twenty patients were included; in 16 patients a SCN1A mutation was detected. The responder rate after 6 months was 20%, and after 34 months, 5%. The retention rate was 45% after 6 months and 5% after 34 months. Rufinamide treatment was stopped because of aggravation of seizures (30%), no effect (45%), and side effects (10%). The efficacy and long-term retention rate were low in our patients with Dravet syndrome and refractory seizures, far lower than in patients with Lennox-Gastaut syndrome; one-third of our patients experienced seizure aggravation. Therefore, rufinamide does not seem to be a suitable option for long-term treatment in patients with Dravet syndrome.
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Affiliation(s)
- A Mueller
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Vogtareuth, Germany
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Fendri-Kriaa N, Boujilbene S, Kammoun F, Mkaouar-Rebai E, Mahmoud AB, Hsairi I, Rebai A, Triki C, Fakhfakh F. A putative disease-associated haplotype within the SCN1A gene in Dravet syndrome. Biochem Biophys Res Commun 2011; 408:654-7. [DOI: 10.1016/j.bbrc.2011.04.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 04/17/2011] [Indexed: 10/18/2022]
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