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Tang C, Luan G, Li T. Rasmussen's encephalitis: mechanisms update and potential therapy target. Ther Adv Chronic Dis 2020; 11:2040622320971413. [PMID: 33294146 PMCID: PMC7705182 DOI: 10.1177/2040622320971413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
Rasmussen’s encephalitis (RE) is rare neurological diseases characterized as epilepsia partialis continua, invariably hemiparesis, and cognitive impairment. This disease is encountered frequently in childhood and presents with progressive atrophy of the unilateral hemisphere, and there are also sustained neurological complications. Owing to uncertain pathogenesis, the most effective way to limit the influence of seizures currently is cerebral hemispherectomy. In this review, we focus on four main lines of pathogenesis: virus infection, antibody-mediated, cell-mediated immunity, and microglia activation. Although one or more antigenic epitopes may give rise to infiltrating T cell responses in RE brain tissue, no exact antigen was confirmed as the definite cause of the disease. On the other hand, the appearance of antibodies related with RE seem to be a secondary pathological process. Synthetic studies have suggested an adaptive immune mechanism mediated by CD8+ T cells and an innate immune mechanism mediated by activated microglia and neuroglia. Accordingly, opinions have been raised that immunomodulatory treatments aimed at initial damage to the brain that are induced by cytotoxic CD8+ T cell lymphocytes and microglia in the early stage of RE slow down disease progression. However, systematic exploration of the theory behind these therapeutic effects based on multicenter and large sample studies are needed. In addition, dysfunction of the adenosine system, including the main adenosine removing enzyme adenosine kinase and adenosine receptors, has been demonstrated in RE, which might provide a novel therapeutic target for treatment of RE in future.
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Affiliation(s)
- Chongyang Tang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Department of Neurology, SanBo Brain Hospital, Capital Medical University No. 50 Xiangshanyikesong Road, Haidian District, Beijing, 100093, China
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Ramantani G, Kadish NE, Mayer H, Anastasopoulos C, Wagner K, Reuner G, Strobl K, Schubert-Bast S, Wiegand G, Brandt A, Korinthenberg R, Mader I, van Velthoven V, Zentner J, Schulze-Bonhage A, Bast T. Frontal Lobe Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom, Overall Cognitive and Adaptive Functioning. Neurosurgery 2017; 83:93-103. [DOI: 10.1093/neuros/nyx340] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/16/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Although frontal lobe resections account for one-third of intralobar resections in pediatric epilepsy surgery, there is a dearth of information regarding long-term seizure freedom, overall cognitive and adaptive functioning.
OBJECTIVE
To identify outcome predictors and define the appropriate timing for surgery.
METHODS
We retrospectively analyzed the data of 75 consecutive patients aged 10.0 ± 4.9 yr at surgery that had an 8.1 yr mean follow-up.
RESULTS
Etiology comprised focal cortical dysplasia (FCD) in 71% and benign tumors in 16% cases. All patients but one had a magnetic resonance imaging-visible lesion. At last follow-up, 63% patients remained seizure-free and 37% had discontinued antiepileptic drugs. Presurgical predictors of seizure freedom were a shorter epilepsy duration, strictly regional epileptic discharges in electroencephalography (EEG), and an epileptogenic zone and/or lesion distant from eloquent cortex. Postsurgical predictors were the completeness of resection and the lack of early postoperative seizures or epileptic discharges in EEG. Higher presurgical overall cognitive and adaptive functioning was related to later epilepsy onset and to a sublobar epileptogenic zone and/or lesion. Following surgery, scores remained stable in the majority of patients. Postsurgical gains were determined by higher presurgical performance and tumors vs FCD.
CONCLUSION
Our findings highlight the favorable long-term outcomes following frontal lobe epilepsy surgery in childhood and adolescence and underline the importance of early surgical intervention in selected candidates. Early postsurgical relapses and epileptic discharges in EEG constitute key markers of treatment failure and should prompt timely reevaluation. Postsurgical overall cognitive and adaptive functioning is stable in most patients, whereas those with benign tumors have higher chances of improvement.
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Affiliation(s)
| | - Navah Ester Kadish
- Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Hans Mayer
- Epilepsy Centre Kork, Kehl-Kork, Germany
| | - Constantin Anastasopoulos
- Division of Neuropediatrics and Muscular Disorders, University Children's Hospital, Freiburg, Germany
| | - Kathrin Wagner
- Epilepsy Centre, University Hospital Freiburg, Freiburg, Germany
| | - Gitta Reuner
- Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany
| | | | - Susanne Schubert-Bast
- Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany
| | - Gert Wiegand
- Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Armin Brandt
- Epilepsy Centre, University Hospital Freiburg, Freiburg, Germany
| | - Rudolf Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, University Children's Hospital, Freiburg, Germany
| | - Irina Mader
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
| | - Vera van Velthoven
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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Rassner MP, Moser A, Follo M, Joseph K, van Velthoven-Wurster V, Feuerstein TJ. Neocortical GABA release at high intracellular sodium and low extracellular calcium: an anti-seizure mechanism. J Neurochem 2016; 137:177-89. [DOI: 10.1111/jnc.13555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/14/2016] [Accepted: 01/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Michael P. Rassner
- Section of Clinical Neuropharmacology of the Department of Neurosurgery; University of Freiburg; Freiburg Germany
| | - Andreas Moser
- Neurochemical Research Group; Department of Neurology; University of Lübeck; Lübeck Germany
- Freiburg Institute for Advanced Studies (FRIAS); University of Freiburg; Freiburg Germany
| | - Marie Follo
- Department of Medicine I; Medical Center - University of Freiburg; Freiburg Germany
| | - Kevin Joseph
- Section of Clinical Neuropharmacology of the Department of Neurosurgery; University of Freiburg; Freiburg Germany
- Section of Neuroelectronic Systems of the Department of Neurosurgery; University of Freiburg; Freiburg Germany
| | | | - Thomas J. Feuerstein
- Section of Clinical Neuropharmacology of the Department of Neurosurgery; University of Freiburg; Freiburg Germany
- Freiburg Institute for Advanced Studies (FRIAS); University of Freiburg; Freiburg Germany
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Raiteri L, Raiteri M. Multiple functions of neuronal plasma membrane neurotransmitter transporters. Prog Neurobiol 2015; 134:1-16. [PMID: 26300320 DOI: 10.1016/j.pneurobio.2015.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/09/2015] [Accepted: 08/18/2015] [Indexed: 12/11/2022]
Abstract
Removal from receptors of neurotransmitters just released into synapses is one of the major steps in neurotransmission. Transporters situated on the plasma membrane of nerve endings and glial cells perform the process of neurotransmitter (re)uptake. Because the density of transporters in the membranes can fluctuate, transporters can determine the transmitter concentrations at receptors, thus modulating indirectly the excitability of neighboring neurons. Evidence is accumulating that neurotransmitter transporters can exhibit multiple functions. Being bidirectional, neurotransmitter transporters can mediate transmitter release by working in reverse, most often under pathological conditions that cause ionic gradient dysregulations. Some transporters reverse to release transmitters, like dopamine or serotonin, when activated by 'indirectly acting' substrates, like the amphetamines. Some transporters exhibit as one major function the ability to capture transmitters into nerve terminals that perform insufficient synthesis. Transporter activation can generate conductances that regulate directly neuronal excitability. Synaptic and non-synaptic transporters play different roles. Cytosolic Na(+) elevations accompanying transport can interact with plasmalemmal or/and mitochondrial Na(+)/Ca(2+) exchangers thus generating calcium signals. Finally, neurotransmitter transporters can behave as receptors mediating releasing stimuli able to cause transmitter efflux through multiple mechanisms. Neurotransmitter transporters are therefore likely to play hitherto unknown roles in multiple therapeutic treatments.
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Affiliation(s)
- Luca Raiteri
- Department of Pharmacy, Pharmacology and Toxicology Section, University of Genoa, Genoa, Italy; Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; National Institute of Neuroscience, Genoa, Italy
| | - Maurizio Raiteri
- Department of Pharmacy, Pharmacology and Toxicology Section, University of Genoa, Genoa, Italy; Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; National Institute of Neuroscience, Genoa, Italy.
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Ramantani G, Kadish NE, Anastasopoulos C, Brandt A, Wagner K, Strobl K, Mayer H, Schubert-Bast S, Stathi A, Korinthenberg R, Feuerstein TJ, Mader I, van Velthoven V, Zentner J, Schulze-Bonhage A, Bast T. Epilepsy surgery for glioneuronal tumors in childhood: avoid loss of time. Neurosurgery 2015; 74:648-57; discussion 657. [PMID: 24584135 DOI: 10.1227/neu.0000000000000327] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In contrast to the abundance of seizure outcome reports in epilepsy surgery for glioneuronal tumors in childhood and adolescence, there is a dearth of information regarding cognitive outcomes. OBJECTIVE To investigate the seizure and cognitive outcome of children and adolescents that underwent resective surgery for glioneuronal tumor-associated refractory epilepsy and determine their predictive factors. METHODS We retrospectively analyzed the presurgical findings, resection types, and outcomes over 1.3 to 12.3 years (mean, 7.3) of 29 consecutive patients, who underwent resection in 2000 to 2011. The mean age at epilepsy onset was 7.9 years (range, 0-15.4), the mean age at surgery was 11.7 years (range, 2.6-17.3), and the mean epilepsy duration to surgery was 3.8 years (range, 0.3-15.3). Etiology comprised 13 dysembryoplastic neuroepithelial tumors and 16 gangliogliomas, with additional focal cortical dysplasia in 5 cases. RESULTS Eighty-six percent of children were seizure free 12 months after surgery; at final follow-up, 76% remained seizure free and 62% had discontinued antiepileptic drugs. Gross total resection was related to significantly higher rates of seizure freedom. Higher presurgical cognitive functioning (full-scale IQ, verbal IQ) was related to shorter epilepsy duration to surgery independent of age at epilepsy onset, thus determining postsurgical functioning. Improvements in verbal IQ, performance IQ, and visual memory as well as a trend toward improvement in full-scale IQ were established after surgery. Despite individual losses in full-scale IQ, verbal or visual memory, no deterioration was noted in any cognitive variable on a group level. CONCLUSION Completeness of resection predisposes to favorable outcomes regarding seizure alleviation. Whereas cognitive functioning deteriorates with time in glioneuronal tumor-related refractory epilepsy, surgery is linked to improvement rather than to deterioration on a group level.
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Affiliation(s)
- Georgia Ramantani
- *Epilepsy Centre, University Hospital Freiburg, Freiburg, Germany; ‡Department of General Pediatrics, Children's University Hospital, Heidelberg, Germany; §Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany; ¶Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany; ‖Epilepsy Centre Kork, Kehl-Kork, Germany; #Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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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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Ramantani G, Kadish NE, Brandt A, Strobl K, Stathi A, Wiegand G, Schubert-Bast S, Mayer H, Wagner K, Korinthenberg R, Stephani U, van Velthoven V, Zentner J, Schulze-Bonhage A, Bast T. Seizure control and developmental trajectories after hemispherotomy for refractory epilepsy in childhood and adolescence. Epilepsia 2013; 54:1046-55. [DOI: 10.1111/epi.12140] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/25/2022]
Affiliation(s)
| | - Navah Ester Kadish
- Department of General Pediatrics; University Children's Hospital; Heidelberg Germany
| | - Armin Brandt
- Epilepsy Center; University Hospital Freiburg; Freiburg Germany
| | | | - Angeliki Stathi
- Epilepsy Center; University Hospital Freiburg; Freiburg Germany
| | - Gert Wiegand
- Department of Neuropediatrics; University Medical Center Schleswig-Holstein; Kiel Germany
| | - Susanne Schubert-Bast
- Department of General Pediatrics; University Children's Hospital; Heidelberg Germany
| | | | - Kathrin Wagner
- Epilepsy Center; University Hospital Freiburg; Freiburg Germany
| | - Rudolf Korinthenberg
- Division of Neuropediatrics and Muscular Disorders; Department of Pediatrics and Adolescent Medicine; University Hospital Freiburg; Freiburg Germany
| | - Ulrich Stephani
- Department of Neuropediatrics; University Medical Center Schleswig-Holstein; Kiel Germany
| | - Vera van Velthoven
- Department of Neurosurgery; University Hospital Freiburg; Freiburg Germany
| | - Josef Zentner
- Department of Neurosurgery; University Hospital Freiburg; Freiburg Germany
| | | | - Thomas Bast
- Department of General Pediatrics; University Children's Hospital; Heidelberg Germany
- Epilepsy Center Kork; Kehl-Kork Germany
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