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Czarnetzki C, Spinelli L, Huppertz HJ, Schaller K, Momjian S, Lobrinus J, Vargas MI, Garibotto V, Vulliemoz S, Seeck M. Yield of non-invasive imaging in MRI-negative focal epilepsy. J Neurol 2024; 271:995-1003. [PMID: 37907727 PMCID: PMC10827933 DOI: 10.1007/s00415-023-11987-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The absence of MRI-lesion reduces considerably the probability of having an excellent outcome (International League Against Epilepsies [ILAE] class I-II) after epilepsy surgery. Surgical success in magnetic-resonance imaging (MRI)-negative cases relies therefore mainly on non-invasive techniques such as positron-emission tomography (PET), subtraction ictal/inter-ictal single-photon-emission-computed-tomography co-registered to MRI (SISCOM), electric source imaging (ESI) and morphometric MRI analysis (MAP). We were interested in identifying the optimal imaging technique or combination to achieve post-operative class I-II in patients with MRI-negative focal epilepsy. METHODS We identified 168 epileptic patients without MRI lesion. Thirty-three (19.6%) were diagnosed with unifocal epilepsy, underwent surgical resection and follow-up ⩾ 2 years. Sensitivity, specificity, predictive values, and diagnostic odds ratio (OR) were calculated for each technique individually and in combination (after co-registration). RESULTS 23/33 (70%) were free of disabling seizures (75.0% with temporal and 61.5% extratemporal lobe epilepsy). None of the individual modalities presented an OR > 1.5, except ESI if only patients with interictal epileptiform discharges (IEDs) were considered (OR 3.2). On a dual combination, SISCOM with ESI presented the highest outcome (OR = 6). MAP contributed to detecting indistinguishable focal cortical dysplasia in particular in extratemporal epilepsies with a sensitivity of 75%. Concordance of PET, ESI on interictal epileptic discharges, and SISCOM was associated with the highest chance for post-operative seizure control (OR = 11). CONCLUSION If MRI is negative, the chances to benefit from epilepsy surgery are almost as high as in lesional epilepsy, provided that multiple established non-invasive imaging tools are rigorously applied and co-registered together.
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Affiliation(s)
- Christian Czarnetzki
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Laurent Spinelli
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | | | - Karl Schaller
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Shahan Momjian
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Johannes Lobrinus
- Department of Clinical Pathology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Maria-Isabel Vargas
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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Thamcharoenvipas T, Takahashi Y, Kimura N, Matsuda K, Usui N. Localizing and Lateralizing Value of Seizure Onset Pattern on Surface EEG in FCD Type II. Pediatr Neurol 2022; 129:48-54. [PMID: 35231790 DOI: 10.1016/j.pediatrneurol.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/26/2021] [Accepted: 01/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surface ictal electroencephalographic (EEG) monitoring has an important role in the presurgical evaluation of patients with focal cortical dysplasia (FCD). This study aimed to examine the characteristics of seizure onset pattern (SOP) on surface ictal EEG. This information will be useful for invasive monitoring planning. METHODS We reviewed 290 seizures from 31 patients with intractable seizures related to FCD type II (6 patients with FCD IIa and 25 patients with FCD IIb). We categorized the SOPs into five patterns and evaluated the relationships between the SOPs and the location and pathology of the FCD II subtype. RESULTS The most common SOP was no apparent change (39.0%), followed by rhythmic slow wave and repetitive spikes/sharp waves. The SOP of rhythmic slow wave was associated with FCD II in the temporal lobe (P < 0.001), and the SOP of no apparent change was associated with FCD II in the occipital lobe (P = 0.012). The SOPs of rhythmic slow waves and fast activity were most common in FCD IIa, P < 0.001 and 0.031, respectively. The repetitive spikes/sharp waves SOP was the most common pattern in FCD IIb (P < 0.001). The surface SOPs provided correct localization and lateralization of epileptic foci in FCD in 62.1% and 62.7%, respectively. In 61.3% of the patients, over 50% of the SOPs in each patient indicated accurate localization. CONCLUSIONS SOPs in surface EEG monitoring are beneficial for presurgical evaluation and lead to localization of epileptic foci and pathologic subtypes of FCD.
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Affiliation(s)
- Titaporn Thamcharoenvipas
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan; Division of Neurology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan; Department of Pediatrics, Gifu University School of Medicine, Gifu, Japan; School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan.
| | - Nobusuke Kimura
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Kazumi Matsuda
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Naotaka Usui
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
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Koenig JB, Dulla CG. Dysregulated Glucose Metabolism as a Therapeutic Target to Reduce Post-traumatic Epilepsy. Front Cell Neurosci 2018; 12:350. [PMID: 30459556 PMCID: PMC6232824 DOI: 10.3389/fncel.2018.00350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) is a significant cause of disability worldwide and can lead to post-traumatic epilepsy. Multiple molecular, cellular, and network pathologies occur following injury which may contribute to epileptogenesis. Efforts to identify mechanisms of disease progression and biomarkers which predict clinical outcomes have focused heavily on metabolic changes. Advances in imaging approaches, combined with well-established biochemical methodologies, have revealed a complex landscape of metabolic changes that occur acutely after TBI and then evolve in the days to weeks after. Based on this rich clinical and preclinical data, combined with the success of metabolic therapies like the ketogenic diet in treating epilepsy, interest has grown in determining whether manipulating metabolic activity following TBI may have therapeutic value to prevent post-traumatic epileptogenesis. Here, we focus on changes in glucose utilization and glycolytic activity in the brain following TBI and during seizures. We review relevant literature and outline potential paths forward to utilize glycolytic inhibitors as a disease-modifying therapy for post-traumatic epilepsy.
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Affiliation(s)
- Jenny B Koenig
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| | - Chris G Dulla
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
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Sakaguchi Y, Kidokoro H, Ogawa C, Okai Y, Ito Y, Yamamoto H, Ohno A, Nakata T, Tsuji T, Nakane T, Kawai H, Kato K, Naganawa S, Natsume J. Longitudinal Findings of MRI and PET in West Syndrome with Subtle Focal Cortical Dysplasia. AJNR Am J Neuroradiol 2018; 39:1932-1937. [PMID: 30213810 DOI: 10.3174/ajnr.a5772] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite the development of neuroimaging, identification of focal cortical dysplasia remains challenging. The purpose of this study was to show the longitudinal changes of MR imaging and FDG-PET in patients with West syndrome and subtle focal cortical dysplasia. MATERIALS AND METHODS Among 52 consecutive patients with West syndrome, 4 were diagnosed with subtle focal cortical dysplasia on 3T MR imaging. MR imaging and PET findings were evaluated longitudinally at onset and at 12 and 24 months of age. RESULTS At the onset of West syndrome, MR imaging demonstrated focal signal abnormalities of the subcortical white matter in 2 patients. In the other 2 patients, focal subcortical high-intensity signals became visible on follow-up T2WI as myelination progressed. PET at onset showed focal cortical hypometabolism in 3 patients, with 1 of these patients also having focal hypermetabolism and 1 having normal findings. On PET at 24 months, hypometabolism persisted in 2 patients and disappeared in 1, and hypermetabolism disappeared in 1. In 1 patient with normal MR imaging and PET findings at onset, focal hyperintensity and hypometabolism first appeared at 24 months of age. The findings on MR imaging and PET in these patients evolved differently with brain maturation and the clinical course. CONCLUSIONS Subtle focal cortical dysplasia can be undetectable on MR imaging at the onset of West syndrome and is not always accompanied by hypometabolism or hypermetabolism on PET. Longitudinal MR imaging and PET studies may be useful for detecting such lesions. Even in West syndrome with a congenital structural abnormality, PET findings evolve differently with brain maturation and the clinical condition.
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Affiliation(s)
- Y Sakaguchi
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - H Kidokoro
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - C Ogawa
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - Y Okai
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - Y Ito
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - H Yamamoto
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - A Ohno
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - T Nakata
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - T Tsuji
- Department of Pediatrics (T.T.), Okazaki City Hospital, Okazaki, Japan
| | - T Nakane
- Radiology (T. Nakane, H. Kawai, S.N.)
| | - H Kawai
- Radiology (T. Nakane, H. Kawai, S.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - K Kato
- Radiological and Medical Laboratory Sciences (K.K.)
| | - S Naganawa
- Radiology (T. Nakane, H. Kawai, S.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - J Natsume
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.) .,Developmental Disability Medicine (J.N.), Nagoya University Graduate School of Medicine, Nagoya, Japan.,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
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Lagarde S, Lepine A, Caietta E, Pelletier F, Boucraut J, Chabrol B, Milh M, Guedj E. Cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography in paediatric anti N-methyl-D-aspartate receptor encephalitis: A case series. Brain Dev 2016; 38:461-70. [PMID: 26542469 DOI: 10.1016/j.braindev.2015.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/15/2015] [Accepted: 10/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a frequent and severe cause of encephalitis in children with potential efficient treatment (immunotherapy). Suggestive clinical features are behavioural troubles, seizures and movement disorders. Prompt diagnosis and treatment initiation are needed to guarantee favourable outcome. Nevertheless, diagnosis may be challenging because of the classical ancillary test (magnetic resonance imaging (MRI), electroencephalogram, standard cerebro-spinal fluid analysis) have limited sensitivity. Currently, immunological analyses are needed for the diagnostic confirmation. In adult patients, some studies suggested a potential role of cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography (FDG-PET) in the evaluation of anti-NMDAR encephalitis. Nevertheless, almost no data exist in paediatric population. METHOD We report retrospectively clinical, ancillary tests and cerebral FDG-PET data in 6 young patients (median age=10.5 years, 4 girls) with immunologically confirmed anti-NMDAR encephalitis. RESULTS Our patients presented classical clinical features of anti-NMDAR encephalitis with severe course (notably four patients had normal MRI). Our series shows the feasibility and the good sensitivity of cerebral FDG-PET (6/6 patients with brain metabolism alteration) in paediatric population. We report some particular features in this population: extensive, symmetric cortical hypometabolism especially in posterior areas; asymmetric anterior focus of hypermetabolism; and basal ganglia hypermetabolism. We found also a good correlation between the clinical severity and the cerebral metabolism changes. Moreover, serial cerebral FDG-PET showed parallel brain metabolism and clinical improvement. CONCLUSION Our study reveals the existence of specific patterns of brain metabolism alteration in anti-NMDAR encephalitis in paediatric population.
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Affiliation(s)
- Stanislas Lagarde
- APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France.
| | - Anne Lepine
- APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France
| | - Emilie Caietta
- APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France
| | | | - José Boucraut
- Aix Marseille Université, CNRS, CRN2M UMR 7286, 13344 Marseille, France
| | - Brigitte Chabrol
- APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France
| | - Mathieu Milh
- APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France
| | - Eric Guedj
- APHM, Timone Hospital, Nuclear Medicine Department, 13005 Marseille, France
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