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Ge Y, Chen C, Li H, Wang R, Yang Y, Ye L, He C, Chen R, Wang Z, Shao X, Gong Y, Yang L, Wang S, Zhou J, Wu X, Wang S, Ding Y. Altered structural network in temporal lobe epilepsy with focal to bilateral tonic-clonic seizures. Ann Clin Transl Neurol 2024. [PMID: 39152643 DOI: 10.1002/acn3.52135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVES This study aims to investigate whether alterations in white matter topological networks are associated with focal to bilateral tonic-clonic seizures (FBTCS) in temporal lobe epilepsy (TLE). Additionally, we investigated the variables contributing to memory impairment in TLE. METHODS This cross-sectional study included 88 unilateral people with TLE (45 left/43 right), and 42 healthy controls. Graph theory analysis was employed to compare the FBTCS (+) group (n = 51) with the FBTCS (-) group (n = 37). The FBTCS (+) group was subcategorized into current-FBTCS (n = 31) and remote-FBTCS (n = 20), based on the history of FBTCS within 1 year or longer than 1 year before scanning, respectively. We evaluated the discriminatory power of topological network properties by receiver operating characteristic (ROC) analysis. Generalized linear models (GLMs) were employed to investigate variables associated with memory impairment in TLE. RESULTS Global efficiency (Eg) was significantly reduced in the FBTCS (+) group, especially in the current-FBTCS subgroup. Greater disruption of regional properties in the ipsilateral occipital and temporal association cortices was observed in the FBTCS (+) group. ROC analysis revealed that Eg, normalized characteristic shortest path length, and nodal efficiency of the ipsilateral middle temporal gyrus could distinguish between FBTCS (+) and FBTCS (-) groups. Additionally, GLMs linked the occurrence of current FBTCS with poorer verbal memory outcomes in TLE. INTERPRETATION Our study suggests that abnormal networks could be the structural basis of seizure propagation in FBTCS. Strategies aimed at reducing the occurrence of FBTCS could potentially improve the memory outcomes in people with TLE.
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Affiliation(s)
- Yi Ge
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Chen
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Li
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ruyi Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuyu Yang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingqi Ye
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenmin He
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ruotong Chen
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zijian Wang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaotong Shao
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuting Gong
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linglin Yang
- Department of Psychiatry, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shan Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiping Zhou
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunyi Wu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Mardones MD, Rostam KD, Nickerson MC, Gupta K. Canonical Wnt activator Chir99021 prevents epileptogenesis in the intrahippocampal kainate mouse model of temporal lobe epilepsy. Exp Neurol 2024; 376:114767. [PMID: 38522659 PMCID: PMC11058011 DOI: 10.1016/j.expneurol.2024.114767] [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: 12/20/2023] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
The Wnt signaling pathway mediates the development of dentate granule cell neurons in the hippocampus. These neurons are central to the development of temporal lobe epilepsy and undergo structural and physiological remodeling during epileptogenesis, which results in the formation of epileptic circuits. The pathways responsible for granule cell remodeling during epileptogenesis have yet to be well defined, and represent therapeutic targets for the prevention of epilepsy. The current study explores Wnt signaling during epileptogenesis and for the first time describes the effect of Wnt activation using Wnt activator Chir99021 as a novel anti-epileptogenic therapeutic approach. Focal mesial temporal lobe epilepsy was induced by intrahippocampal kainate (IHK) injection in wild-type and POMC-eGFP transgenic mice. Wnt activator Chir99021 was administered daily, beginning 3 h after seizure induction, and continued up to 21-days. Immature granule cell morphology was quantified in the ipsilateral epileptogenic zone and the contralateral peri-ictal zone 14 days after IHK, targeting the end of the latent period. Bilateral hippocampal electrocorticographic recordings were performed for 28-days, 7-days beyond treatment cessation. Hippocampal behavioral tests were performed after completion of Chir99021 treatment. Consistent with previous studies, IHK resulted in the development of epilepsy after a 14 day latent period in this well-described mouse model. Activation of the canonical Wnt pathway with Chir99021 significantly reduced bilateral hippocampal seizure number and duration. Critically, this effect was retained after treatment cessation, suggesting a durable antiepileptogenic change in epileptic circuitry. Morphological analyses demonstrated that Wnt activation prevented pathological remodeling of the primary dendrite in both the epileptogenic zone and peri-ictal zone, changes in which may serve as a biomarker of epileptogenesis and anti-epileptogenic treatment response in pre-clinical studies. These findings were associated with improved object location memory with Chir99021 treatment after IHK. This study provides novel evidence that canonical Wnt activation prevents epileptogenesis in the IHK mouse model of mesial temporal lobe epilepsy, preventing pathological remodeling of dentate granule cells. Wnt signaling may therefore play a key role in mesial temporal lobe epileptogenesis, and Wnt modulation may represent a novel therapeutic strategy in the prevention of epilepsy.
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Affiliation(s)
- Muriel D Mardones
- Indiana University, Stark Neurosciences Research Institute, W 15th St, Indianapolis, IN 46202, United States of America; Indiana University, Department of Neurosurgery, W 16th St, Indianapolis, IN 46202, United States of America.
| | - Kevin D Rostam
- Indiana University, Stark Neurosciences Research Institute, W 15th St, Indianapolis, IN 46202, United States of America.
| | - Margaret C Nickerson
- Indiana University, Stark Neurosciences Research Institute, W 15th St, Indianapolis, IN 46202, United States of America.
| | - Kunal Gupta
- Medical College of Wisconsin, Department of Neurosurgery, 8701 Watertown Plank Rd, Milwaukee, WI 53226, United States of America; Medical College of Wisconsin, Neuroscience Research Center, 8701 Watertown Plank Rd, Milwaukee, WI 53226, United States of America; Indiana University, Stark Neurosciences Research Institute, W 15th St, Indianapolis, IN 46202, United States of America; Indiana University, Department of Neurosurgery, W 16th St, Indianapolis, IN 46202, United States of America.
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Duma GM, Pellegrino G, Rabuffo G, Danieli A, Antoniazzi L, Vitale V, Scotto Opipari R, Bonanni P, Sorrentino P. Altered spread of waves of activities at large scale is influenced by cortical thickness organization in temporal lobe epilepsy: a magnetic resonance imaging-high-density electroencephalography study. Brain Commun 2023; 6:fcad348. [PMID: 38162897 PMCID: PMC10754317 DOI: 10.1093/braincomms/fcad348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/11/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
Temporal lobe epilepsy is a brain network disorder characterized by alterations at both the structural and the functional levels. It remains unclear how structure and function are related and whether this has any clinical relevance. In the present work, we adopted a novel methodological approach investigating how network structural features influence the large-scale dynamics. The functional network was defined by the spatio-temporal spreading of aperiodic bursts of activations (neuronal avalanches), as observed utilizing high-density electroencephalography in patients with temporal lobe epilepsy. The structural network was modelled as the region-based thickness covariance. Loosely speaking, we quantified the similarity of the cortical thickness of any two brain regions, both across groups and at the individual level, the latter utilizing a novel approach to define the subject-wise structural covariance network. In order to compare the structural and functional networks (at the nodal level), we studied the correlation between the probability that a wave of activity would propagate from a source to a target region and the similarity of the source region thickness as compared with other target brain regions. Building on the recent evidence that large-waves of activities pathologically spread through the epileptogenic network in temporal lobe epilepsy, also during resting state, we hypothesize that the structural cortical organization might influence such altered spatio-temporal dynamics. We observed a stable cluster of structure-function correlation in the bilateral limbic areas across subjects, highlighting group-specific features for left, right and bilateral temporal epilepsy. The involvement of contralateral areas was observed in unilateral temporal lobe epilepsy. We showed that in temporal lobe epilepsy, alterations of structural and functional networks pair in the regions where seizures propagate and are linked to disease severity. In this study, we leveraged on a well-defined model of neurological disease and pushed forward personalization approaches potentially useful in clinical practice. Finally, the methods developed here could be exploited to investigate the relationship between structure-function networks at subject level in other neurological conditions.
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Affiliation(s)
- Gian Marco Duma
- Epilepsy Unit, IRCCS E. Medea Scientific Institute, Conegliano 31015, Italy
| | - Giovanni Pellegrino
- Epilepsy Program, Schulich School of Medicine and Dentistry, Western University, London N6A5C1, Canada
| | - Giovanni Rabuffo
- Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille 13005, France
| | - Alberto Danieli
- Epilepsy Unit, IRCCS E. Medea Scientific Institute, Conegliano 31015, Italy
| | - Lisa Antoniazzi
- Epilepsy Unit, IRCCS E. Medea Scientific Institute, Conegliano 31015, Italy
| | - Valerio Vitale
- Department of Neuroscience, Neuroradiology Unit, San Bortolo Hospital, Vicenza 36100, Italy
| | | | - Paolo Bonanni
- Epilepsy Unit, IRCCS E. Medea Scientific Institute, Conegliano 31015, Italy
| | - Pierpaolo Sorrentino
- Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille 13005, France
- Department of Biomedical Sciences, University of Sassari, Sassari 07100, Italy
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Arévalo-Astrada MA, Suller-Marti A, McLachlan RS, Paredes-Aragón E, Jones ML, Parrent AG, Mirsattari SM, Lau JC, Steven DA, Burneo JG. Involvement of the posterior cingulate gyrus in temporal lobe epilepsy: A study using stereo-EEG. Epilepsy Res 2023; 198:107237. [PMID: 37890266 DOI: 10.1016/j.eplepsyres.2023.107237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/22/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To analyze the involvement of the posterior cingulate gyrus (PCG) during mesial temporal lobe seizures (MTLS). METHODS We retrospectively reviewed the stereo-EEG (SEEG) recordings of patients with MTLS performed in our institution from February 2013 to December 2020. Only patients who had electrode implantation in the PCG were included. Patients with lesions that could potentially alter the seizure spread pathways were excluded. We assessed the propagation patterns of MTLS with respect to the different structures sampled. RESULTS Nine of 97 patients who had at least one seizure originating in the mesial temporal region met the inclusion criteria. A total of 174 seizures were analyzed. The PCG was the first site of propagation in most of the cases (8/9 patients and 77.5% of seizures, and 7/8 patients and 65.6% of seizures after excluding an outlier patient). The fastest propagation times were towards the contralateral mesial temporal region and ipsilateral PCG. Seven patients underwent standard anterior temporal lobectomy and, of these, all but one were Engel 1 at last follow up. CONCLUSION We found the PCG to be the first propagation site of MTLS in this group of patients. These results outline the relevance of the PCG in SEEG planning strategies. Further investigations are needed to corroborate whether fast propagation to the PCG predicts a good surgical outcome.
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Affiliation(s)
- Miguel A Arévalo-Astrada
- Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Box 511, Ottawa, Ontario K1H 8L6, Canada
| | - Ana Suller-Marti
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Richard S McLachlan
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Elma Paredes-Aragón
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Michelle-Lee Jones
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Andrew G Parrent
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Seyed M Mirsattari
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Jonathan C Lau
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - David A Steven
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Neuro-Epidemiology Unit, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada.
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Beltrán-Corbellini Á, Romeral-Jiménez M, Mayo P, Sánchez-Miranda Román I, Iruzubieta P, Chico-García JL, Parra-Díaz P, García-Morales I, Toledano R, Aledo-Serrano Á, Gil-Nagel A. Cenobamate in patients with highly refractory focal epilepsy: A retrospective real-world study. Seizure 2023; 111:71-77. [PMID: 37549616 DOI: 10.1016/j.seizure.2023.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE To determine the effectiveness and safety outcomes of cenobamate in a cohort of patients with highly refractory focal epilepsy in routine clinical practice. METHODS Observational, retrospective, phase 4 study on subjects receiving cenobamate in three Spanish centers. The primary endpoint was the retention rate at the last follow-up. The main secondary endpoints were the 50%-responder and seizure-free rates at three months and the last follow-up. Other secondary endpoints were Global Clinical Impressions-Improvement (CGI-I) scores and treatment-emergent adverse events (TEAEs). RESULTS Fifty-one patients with highly refractory focal epilepsy with 24.7 years of disease evolution, ten previously tried ASM, and a 23.5% of previous epilepsy surgery were included. The retention rate at the last follow-up was 80.4%. The 50% responder rate in focal seizures at three months was 56.5% (median reduction per month 51%, 0-74.6; p < 0.0001) and in focal to bilateral tonic-clonic seizures was 63.6% (median reduction per month 89%, 0-100; p = 0.022). A total of 54.3% of subjects reported a reduction in the intensity of focal seizures, and 66% manifested clinically significant satisfaction. Cenobamate allowed a significant decrease in concomitant ASM, especially sodium channel blockers. TEAEs were reported in 43.1% of individuals, 85% of whom resolved or improved, with no new safety findings. CONCLUSION In this analysis of patients with highly refractory focal epilepsy treated with cenobamate according to standard clinical practice, there was evidence of a high reduction in both seizure frequency and intensity, with a manageable safety profile.
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Affiliation(s)
| | - María Romeral-Jiménez
- Epilepsy Unit, Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Pablo Mayo
- Epilepsy Unit, Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Pablo Iruzubieta
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Juan Luis Chico-García
- Epilepsy Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Paloma Parra-Díaz
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Rafael Toledano
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ángel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Fundación Iniciativa por las Neurociencias (FINCE), Madrid, Spain
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Guo Z, Mo J, Zhang J, Hu W, Zhang C, Wang X, Zhao B, Zhang K. Altered Metabolic Networks in Mesial Temporal Lobe Epilepsy with Focal to Bilateral Seizures. Brain Sci 2023; 13:1239. [PMID: 37759840 PMCID: PMC10526398 DOI: 10.3390/brainsci13091239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
This study was designed to identify whether the metabolic network changes in mesial temporal lobe epilepsy (MTLE) patients with focal to bilateral tonic-clonic seizures (FBTCS) differ from changes in patients without FBTCS. This retrospective analysis enrolled 30 healthy controls and 54 total MTLE patients, of whom 27 had FBTCS. Fluorodeoxyglucose positron emission tomography (FDG-PET) data and graph theoretical analyses were used to examine metabolic connectivity. The differences in metabolic networks between the three groups were compared. Significant changes in both local and global network topology were evident in FBTCS+ patients as compared to healthy controls, with a lower assortative coefficient and altered betweenness centrality in 15 brain regions. While global network measures did not differ significantly when comparing FBTCS- patients to healthy controls, alterations in betweenness centrality were evident in 13 brain regions. Significantly altered betweenness centrality was also observed in four brain regions when comparing patients with and without FBTCS. The study revealed greater metabolic network abnormalities in MTLE patients with FBTCS as compared to FBTCS- patients, indicating the existence of distinct epileptogenic networks. These findings can provide insight into the pathophysiological basis of FBTCS.
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Affiliation(s)
- Zhihao Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Z.G.); (J.M.); (J.Z.); (W.H.); (C.Z.); (X.W.); (B.Z.)
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Z.G.); (J.M.); (J.Z.); (W.H.); (C.Z.); (X.W.); (B.Z.)
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Z.G.); (J.M.); (J.Z.); (W.H.); (C.Z.); (X.W.); (B.Z.)
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Z.G.); (J.M.); (J.Z.); (W.H.); (C.Z.); (X.W.); (B.Z.)
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Z.G.); (J.M.); (J.Z.); (W.H.); (C.Z.); (X.W.); (B.Z.)
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Z.G.); (J.M.); (J.Z.); (W.H.); (C.Z.); (X.W.); (B.Z.)
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Z.G.); (J.M.); (J.Z.); (W.H.); (C.Z.); (X.W.); (B.Z.)
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; (Z.G.); (J.M.); (J.Z.); (W.H.); (C.Z.); (X.W.); (B.Z.)
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
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Li X, Chen Q, Wang Z, Wang X, Zhang W, Lu J, Zhang X, Wang Z, Zhang B. Altered spontaneous brain activity as a potential imaging biomarker for generalized and focal to bilateral tonic-clonic seizures: A resting-state fMRI study. Epilepsy Behav 2023; 140:109100. [PMID: 36791632 DOI: 10.1016/j.yebeh.2023.109100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/21/2022] [Accepted: 01/14/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE We aimed to determine whether alterations in spontaneous regional brain activity in those with generalized tonic-clonic seizures (GTCS) and focal to bilateral tonic-clonic seizures (FBTCS) and explore whether the alterations could be used as biomarkers to classify disease subtypes through support vector machine analysis (SVM). METHODS The fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) from resting-state functional magnetic resonance imaging (rs-fMRI) data were extracted from 57 patients with GTCS, 35 patients with FBTCS, and 50 age-matched and sex-matched normal controls (NCs) using the DPARSF 5.0 toolbox. Between-group comparisons were adjusted for covariates (age, sex, and equipment). Correlation analyses between imaging biomarkers and the frequency or duration of seizure activity were calculated using partial correlations. The differential imaging indicators, age, and sex were considered as the discriminative features in the SVM to evaluate classification performance. RESULTS The patients with GTCS showed lower fALFF values (voxel p < 0.001, cluster p < 0.05, Gaussian random field corrected, GRF corrected) in the right postcentral gyrus and precentral gyrus and lower ReHo values (GRF corrected) in the middle temporal gyrus than the NCs. The patients with FBTCS showed higher fALFF (GRF corrected) values in the right postcentral and precentral gyrus and higher ReHo (GRF corrected) values in the right postcentral gyrus. Both fALFF (GRF corrected) and ReHo (GRF corrected) values were lower in the right postcentral gyrus and precentral gyrus in the GTCS group than in the FBTCS group. In patients with FBTCS, fALFF values in the right postcentral and precentral gyrus were positively correlated with duration (r = 0.655, p = 0.008, Bonferroni corrected) in the low-duration group, and ReHo values in the right postcentral gyrus were positively correlated with frequency (r = 0.486, p = 0.022, uncorrected) in the low-frequency group. SVM results showed receiver operating characteristic curves of 0.89, 0.87, and 0.76 for the classification between GTCS and NC, between FBTCS and NC, and GTCS and FBTCS, respectively. SIGNIFICANCE This study detected alterations in fALFF and ReHo in the postcentral gyrus and precentral gyrus in patients with GTCS and FBTCS, which might contribute to understanding the pathogenesis, disease classification, and clinical targeted therapy.
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Affiliation(s)
- Xin Li
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qian Chen
- Department of Radiology, the Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Zhongyuan Wang
- Department of Neurology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xiaoyun Wang
- Department of Neurology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Wen Zhang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jiaming Lu
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xin Zhang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zhengge Wang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China.
| | - Bing Zhang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China.
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Juan E, Górska U, Kozma C, Papantonatos C, Bugnon T, Denis C, Kremen V, Worrell G, Struck AF, Bateman LM, Merricks EM, Blumenfeld H, Tononi G, Schevon C, Boly M. Distinct signatures of loss of consciousness in focal impaired awareness versus tonic-clonic seizures. Brain 2023; 146:109-123. [PMID: 36383415 PMCID: PMC10582624 DOI: 10.1093/brain/awac291] [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: 10/06/2021] [Revised: 05/17/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022] Open
Abstract
Loss of consciousness is a hallmark of many epileptic seizures and carries risks of serious injury and sudden death. While cortical sleep-like activities accompany loss of consciousness during focal impaired awareness seizures, the mechanisms of loss of consciousness during focal to bilateral tonic-clonic seizures remain unclear. Quantifying differences in markers of cortical activation and ictal recruitment between focal impaired awareness and focal to bilateral tonic-clonic seizures may also help us to understand their different consequences for clinical outcomes and to optimize neuromodulation therapies. We quantified clinical signs of loss of consciousness and intracranial EEG activity during 129 focal impaired awareness and 50 focal to bilateral tonic-clonic from 41 patients. We characterized intracranial EEG changes both in the seizure onset zone and in areas remote from the seizure onset zone with a total of 3386 electrodes distributed across brain areas. First, we compared the dynamics of intracranial EEG sleep-like activities: slow-wave activity (1-4 Hz) and beta/delta ratio (a validated marker of cortical activation) during focal impaired awareness versus focal to bilateral tonic-clonic. Second, we quantified differences between focal to bilateral tonic-clonic and focal impaired awareness for a marker validated to detect ictal cross-frequency coupling: phase-locked high gamma (high-gamma phased-locked to low frequencies) and a marker of ictal recruitment: the epileptogenicity index. Third, we assessed changes in intracranial EEG activity preceding and accompanying behavioural generalization onset and their correlation with electromyogram channels. In addition, we analysed human cortical multi-unit activity recorded with Utah arrays during three focal to bilateral tonic-clonic seizures. Compared to focal impaired awareness, focal to bilateral tonic-clonic seizures were characterized by deeper loss of consciousness, even before generalization occurred. Unlike during focal impaired awareness, early loss of consciousness before generalization was accompanied by paradoxical decreases in slow-wave activity and by increases in high-gamma activity in parieto-occipital and temporal cortex. After generalization, when all patients displayed loss of consciousness, stronger increases in slow-wave activity were observed in parieto-occipital cortex, while more widespread increases in cortical activation (beta/delta ratio), ictal cross-frequency coupling (phase-locked high gamma) and ictal recruitment (epileptogenicity index). Behavioural generalization coincided with a whole-brain increase in high-gamma activity, which was especially synchronous in deep sources and could not be explained by EMG. Similarly, multi-unit activity analysis of focal to bilateral tonic-clonic revealed sustained increases in cortical firing rates during and after generalization onset in areas remote from the seizure onset zone. Overall, these results indicate that unlike during focal impaired awareness, the neural signatures of loss of consciousness during focal to bilateral tonic-clonic consist of paradoxical increases in cortical activation and neuronal firing found most consistently in posterior brain regions. These findings suggest differences in the mechanisms of ictal loss of consciousness between focal impaired awareness and focal to bilateral tonic-clonic and may account for the more negative prognostic consequences of focal to bilateral tonic-clonic.
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Affiliation(s)
- Elsa Juan
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Department of Psychology, University of Amsterdam, Amsterdam, 1018 WS, The Netherlands
| | - Urszula Górska
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Smoluchowski Institute of Physics, Jagiellonian University, 30-348 Krakow, Poland
| | - Csaba Kozma
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Cynthia Papantonatos
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Tom Bugnon
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Colin Denis
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Vaclav Kremen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, 16000, Czech Republic
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
- Department of Neurology, William S. Middleton Veterans Administration Hospital, Madison, WI 53705, USA
| | - Lisa M Bateman
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Edward M Merricks
- Department of Neurology, Columbia University, New York City, NY 10032, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale School of Medicine, New Haven, CT 06519, USA
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Catherine Schevon
- Department of Neurology, Columbia University, New York City, NY 10032, USA
| | - Melanie Boly
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
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9
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LeMonda BC, MacAllister W, Morrison C, Vaurio L, Blackmon K, Maiman M, Liu A, Liberta T, Bar WB. Is formal scoring better than just looking? A comparison of subjective and objective scoring methods of the Rey Complex Figure Test for lateralizing temporal lobe epilepsy. Clin Neuropsychol 2022; 36:1637-1652. [PMID: 33356888 PMCID: PMC8236070 DOI: 10.1080/13854046.2020.1865461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ObjectiveNeuropsychologists labor over scoring the Rey Complex Figure Test (RCFT), a measure of visuospatial functioning and nonverbal memory. Compelling arguments suggest that pathognomonic signs of the RCFT are observable to the "naked eye." Standard scoring systems are insensitive to lateralizing temporal lobe epilepsy (TLE) and alternative "qualitative" scoring systems are ineffective and time-consuming. Method: We examined accuracy of TLE lateralization using subjective classifications and standard scoring. Participants were 84 TLE patients (53 female; mean age=36yrs) and 46 controls (27 female; mean age = 27.5). The former were classified as right (n = 41) or left (n = 43) TLE by neurologists using EEG and MRI studies. RCFT were scored using standard scoring with cut-offs of z ≤ -2 classified as impaired and were rated as "characteristic" of RTLE (Ugly) or LTLE (Not Ugly) performance by neuropsychologists. Accuracy of seizure lateralization for both methods was examined. Results: Neuropsychologists' ratings accuracy were at or below chance. Standard scoring criteria showed chance or slightly better lateralization prediction. Standard scoring predicted RTLE laterality more accurately than subjective ratings for copy trials; standard scoring was no better at lateralizing RTLE with delays. Subjective ratings were better at distinguishing TLE patients from controls. Conclusion: Findings highlight concerns regarding the usefulness of the RCFT in TLE lateralization, regardless of scoring approach.
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Affiliation(s)
| | | | | | - Linnea Vaurio
- New York University Medical Center, New York, NY, USA
| | | | - Moshe Maiman
- University of Chicago Hospital, Chicago, IL, USA
| | - Anli Liu
- New York University Medical Center, New York, NY, USA
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10
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Wang Y, Li Z, Zhang Y, Long Y, Xie X, Wu T. Classification of partial seizures based on functional connectivity: A MEG study with support vector machine. Front Neuroinform 2022; 16:934480. [PMID: 36059865 PMCID: PMC9435583 DOI: 10.3389/fninf.2022.934480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is a chronic neurological disorder that is divided into two subtypes, complex partial seizures (CPS) and simple partial seizures (SPS), based on clinical phenotypes. Revealing differences among the functional networks of different types of TLE can lead to a better understanding of the symbology of epilepsy. Whereas Although most studies had focused on differences between epileptic patients and healthy controls, the neural mechanisms behind the differences in clinical representations of CPS and SPS were unclear. In the context of the era of precision, medicine makes precise classification of CPS and SPS, which is crucial. To address the above issues, we aimed to investigate the functional network differences between CPS and SPS by constructing support vector machine (SVM) models. They mainly include magnetoencephalography (MEG) data acquisition and processing, construction of functional connectivity matrix of the brain network, and the use of SVM to identify differences in the resting state functional connectivity (RSFC). The obtained results showed that classification was effective and accuracy could be up to 82.69% (training) and 81.37% (test). The differences in functional connectivity between CPS and SPS were smaller in temporal and insula. The differences between the two groups were concentrated in the parietal, occipital, frontal, and limbic systems. Loss of consciousness and behavioral disturbances in patients with CPS might be caused by abnormal functional connectivity in extratemporal regions produced by post-epileptic discharges. This study not only contributed to the understanding of the cognitive-behavioral comorbidity of epilepsy but also improved the accuracy of epilepsy classification.
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Affiliation(s)
- Yingwei Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhongjie Li
- College of Intelligence and Computing, Tianjin Key Laboratory of Cognitive Computing and Application, Tianjin University, Tianjin, China
| | - Yujin Zhang
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Yingming Long
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinyan Xie
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ting Wu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Magnetoencephalography, Nanjing Brain Hospital, Affiliated to Nanjing Medical University, Nanjing, China
- *Correspondence: Ting Wu
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11
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Zhang B, Wang J, Wang M, Wang X, Guan Y, Liu Z, Zhang Y, Liu C, Zhao M, Xie P, Zhu M, Li T, Luan G, Zhou J. Correlation Between Ictal Signs and Anatomical Subgroups in Temporal Lobe Seizures: A Stereoelectroencephalography Study. Front Neurol 2022; 13:917079. [PMID: 35756937 PMCID: PMC9226566 DOI: 10.3389/fneur.2022.917079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Ictal semiology is a fundamental part of the presurgical evaluation of patients with temporal lobe epilepsy. We aimed to identify different anatomical and semiologic subgroups in temporal lobe seizures, and investigate the correlation between them. Methods We enrolled 93 patients for whom stereoelectroencephalography exploration indicated that the seizure-onset zone was within the temporal lobe. Ictal signs and concomitant stereoelectroencephalography changes were carefully reviewed and quantified, and then cluster analysis and the Kendall correlation test were used to associate ictal signs with the temporal structures of patients. Results Clustering analysis identified two main groups of temporal structures. Group 1 consisted of the medial temporal lobe structures and the temporal pole, which were divided into two subgroups. Group 1A included the hippocampal head, hippocampal body, and amygdala, and this subgroup correlated significantly with oroalimentary automatisms, feeling of fear, and epigastric auras. Group 1B included the hippocampal tail, temporal pole, and parahippocampal gyrus, and this subgroup correlated significantly with manual and oroalimentary automatisms. Group 2 consisted of the cortical structures of the temporal lobe and was also divided into two subgroups. Group 2A included the superior and middle temporal gyrus, correlated significantly with bilateral rictus/facial contraction, generalized tonic-clonic seizure, and manual automatisms. Group 2B included Heschl's gyrus, the inferior temporal gyrus, and the fusiform gyrus, and this subgroup correlated significantly with auditory auras, focal hypokinetics, unilateral upper and lower limbs tonic posture/clonic signs, head/eye deviation, unilateral versive signs, and generalized tonic-clonic seizure. Significance The temporal structures can be categorized according to the level at which each structure participates in seizures, and different anatomical subgroups can be correlated with different ictal signs. Identifying specific semiologic features can help us localize the epileptogenic zone and thus develop stereoelectroencephalography electrode implantation and surgical resection protocols for patients with temporal lobe epilepsy.
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Affiliation(s)
- Bo Zhang
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiongfei Wang
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zhao Liu
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yao Zhang
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Changqing Liu
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Meng Zhao
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Pandeng Xie
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mingwang Zhu
- Department of Radiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,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, China
| | - Guoming Luan
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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12
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Khateb M, Bosak N, Herskovitz M. The Effect of Anti-seizure Medications on the Propagation of Epileptic Activity: A Review. Front Neurol 2021; 12:674182. [PMID: 34122318 PMCID: PMC8191738 DOI: 10.3389/fneur.2021.674182] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
The propagation of epileptiform events is a highly interesting phenomenon from the pathophysiological point of view, as it involves several mechanisms of recruitment of neural networks. Extensive in vivo and in vitro research has been performed, suggesting that multiple networks as well as cellular candidate mechanisms govern this process, including the co-existence of wave propagation, coupled oscillator dynamics, and more. The clinical importance of seizure propagation stems mainly from the fact that the epileptic manifestations cannot be attributed solely to the activity in the seizure focus itself, but rather to the propagation of epileptic activity to other brain structures. Propagation, especially when causing secondary generalizations, poses a risk to patients due to recurrent falls, traumatic injuries, and poor neurological outcome. Anti-seizure medications (ASMs) affect propagation in diverse ways and with different potencies. Importantly, for drug-resistant patients, targeting seizure propagation may improve the quality of life even without a major reduction in simple focal events. Motivated by the extensive impact of this phenomenon, we sought to review the literature regarding the propagation of epileptic activity and specifically the effect of commonly used ASMs on it. Based on this body of knowledge, we propose a novel classification of ASMs into three main categories: major, minor, and intermediate efficacy in reducing the propagation of epileptiform activity.
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Affiliation(s)
- Mohamed Khateb
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Noam Bosak
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Moshe Herskovitz
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel.,The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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13
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Gleichgerrcht E, Greenblatt AS, Kellermann TS, Rowland N, Vandergrift WA, Edwards J, Davis KA, Bonilha L. Patterns of seizure spread in temporal lobe epilepsy are associated with distinct white matter tracts. Epilepsy Res 2021; 171:106571. [PMID: 33582534 DOI: 10.1016/j.eplepsyres.2021.106571] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE It is commonly hypothesized that seizure spread patterns in patients with focal epilepsy are associated with structural brain pathways. However, this relationship is poorly understood and has not been fully demonstrated in patients with temporal lobe epilepsy. Here, we sought to determine whether directionality of seizure spread (DSS) is associated with specific cerebral white matter tracts in patients with temporal lobe epilepsy. METHODS Thirty-three adult patients with temporal lobe epilepsy who underwent stereoelectroencephalography (sEEG) and magnetic resonance diffusion tensor imaging (MR-DTI) as part of their standard-of-care clinical evaluation were included in the study. DSS was defined as anterior-posterior (AP) or medial-lateral (ML) spread based upon sEEG evaluation by two independent specialists who demonstrated excellent inter-rater agreement (Cohen's kappa = .92). DTI connectometry was used to assess differences between seizure spread pattern groups along major fiber pathways regarding fractional anisotropy (FA). RESULTS Twenty-four participants showed seizures with AP spread and nine participants showed seizures with ML spread. There were no significant differences between the groups on their demographic and clinical profile. Patients with ML seizures had higher FA along the corpus callosum and, to a lesser degree, some portions of the bilateral cingulate tracts. In contrast, patients with AP seizures had higher FA along several anterior-posterior white matter projections bundles, including the cingulate fasciculus and the inferior longitudinal, with significantly less involvement of the corpus callosum compared with ML seizures. SIGNIFICANCE This study confirms the hypothesis that the anatomical pattern of electrophysiological ictal propagation is associated with the structural reinforcement of supporting pathways in temporal lobe epilepsy. This observation can help elucidate mechanisms of ictal propagation and may guide future translational approaches to curtail seizure spread.
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Affiliation(s)
| | - Adam S Greenblatt
- Medical University of South Carolina, Charleston, SC, USA; University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nathan Rowland
- Medical University of South Carolina, Charleston, SC, USA
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14
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Changes in resting-state cerebral blood flow and its connectivity in patients with focal to bilateral tonic-clonic seizures. Epilepsy Behav 2021; 115:107687. [PMID: 33360175 DOI: 10.1016/j.yebeh.2020.107687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
Arterial spin labeling (ASL) is an important tool for understanding cerebral perfusion in epilepsy patients. The aim of this study was to explore patterns of change in cerebral blood flow (CBF) and CBF connectivity in patients with focal to bilateral tonic-clonic seizures (FBTCS). High-resolution three-dimensional (3-D) T1-weighted and 3-D pseudo-continuous ASL magnetic resonance imaging (MRI) was collected from 32 patients with FBTCS and 16 healthy volunteers using a 3.0 T MRI scanner. Cerebral blood flow and its connectivity were compared between the FBTCS and control group. Correlation analysis was used to explore relationships of CBF and its connectivity changes with clinical parameters. Cerebral blood flow data of spatial standardization and normalization were used to improve statistical power. Patients with FBTCS exhibited increased CBF in the bilateral thalamus, caudate nucleus, olfactory cortex, and gyrus rectus, but decreased CBF in the bilateral supplementary motor areas (SMA) and middle cingulate cortex (MCC). Patients with FBTCS showed significant positive correlation between CBF and gray matter volume (GMV) in bilateral SMA and MCC. No significant correlations between CBF and clinical parameters were found among FBTCS patients. The anterior cingulate cortex (ACC) showed positive CBF connectivity with the bilateral SMA and MCC, and these CBF connectivity measures differed significantly between groups (cluster-level, FWE-corrected, P < 0.001). These findings suggest that patients with FBTCS have changes in cerebral CBF and CBF connectivity, which may relate to the underlying neuropathology of FBTCS.
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15
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Guo Z, Zhao B, Hu W, Zhang C, Wang X, Wang Y, Liu C, Mo J, Sang L, Ma Y, Shao X, Zhang J, Zhang K. Effective connectivity among the hippocampus, amygdala, and temporal neocortex in epilepsy patients: A cortico-cortical evoked potential study. Epilepsy Behav 2021; 115:107661. [PMID: 33434884 DOI: 10.1016/j.yebeh.2020.107661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/08/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Mesial temporal lobe epilepsy (MTLE) is one of the most common types of intractable epilepsy. The hippocampus and amygdala are two crucial structures of the mesial temporal lobe and play important roles in the epileptogenic network of MTLE. This study aimed to explore the effective connectivity among the hippocampus, amygdala, and temporal neocortex and to determine whether differences in effective connectivity exist between MTLE patients and non-MTLE patients. METHODS This study recruited 20 patients from a large cohort of drug-resistant epilepsy patients, of whom 14 were MTLE patients. Single-pulse electrical stimulation (SPES) was performed to acquire cortico-cortical evoked potentials (CCEPs). The root mean square (RMS) was used as the metric of the magnitude of CCEP to represent the effective connectivity. We then conducted paired and independent sample t-tests to assess the directionality of the effective connectivity. RESULTS In both MTLE patients and non-MTLE patients, the directional connectivity from the amygdala to the hippocampus was stronger than that from the hippocampus to the amygdala (P < 0.01); the outward connectivity from the amygdala to the cortex was stronger than the inward connectivity from the cortex to the amygdala (P < 0.01); the amygdala had stronger connectivity to the neocortex than the hippocampus (P < 0.01). In MTLE patients, the neocortex had stronger connectivity to the hippocampus than to the amygdala (P < 0.01). No significant differences in directional connectivity were noted between the two groups. CONCLUSIONS A unique effective connectivity pattern among the hippocampus, amygdala, and temporal neocortex was identified through CCEPs analysis. This study may aid in our understanding of physiological and pathological networks in the brain and inspire neurostimulation protocols for neurological and psychiatric disorders.
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Affiliation(s)
- Zhihao Guo
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yao Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Yanshan Ma
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.
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16
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Sinha N, Peternell N, Schroeder GM, de Tisi J, Vos SB, Winston GP, Duncan JS, Wang Y, Taylor PN. Focal to bilateral tonic-clonic seizures are associated with widespread network abnormality in temporal lobe epilepsy. Epilepsia 2021; 62:729-741. [PMID: 33476430 PMCID: PMC8600951 DOI: 10.1111/epi.16819] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Our objective was to identify whether the whole-brain structural network alterations in patients with temporal lobe epilepsy (TLE) and focal to bilateral tonic-clonic seizures (FBTCS) differ from alterations in patients without FBTCS. METHODS We dichotomized a cohort of 83 drug-resistant patients with TLE into those with and without FBTCS and compared each group to 29 healthy controls. For each subject, we used diffusion-weighted magnetic resonance imaging to construct whole-brain structural networks. First, we measured the extent of alterations by performing FBTCS-negative (FBTCS-) versus control and FBTCS-positive (FBTCS+) versus control comparisons, thereby delineating altered subnetworks of the whole-brain structural network. Second, by standardizing each patient's networks using control networks, we measured the subject-specific abnormality at every brain region in the network, thereby quantifying the spatial localization and the amount of abnormality in every patient. RESULTS Both FBTCS+ and FBTCS- patient groups had altered subnetworks with reduced fractional anisotropy and increased mean diffusivity compared to controls. The altered subnetwork in FBTCS+ patients was more widespread than in FBTCS- patients (441 connections altered at t > 3, p < .001 in FBTCS+ compared to 21 connections altered at t > 3, p = .01 in FBTCS-). Significantly greater abnormalities-aggregated over the entire brain network as well as assessed at the resolution of individual brain areas-were present in FBTCS+ patients (p < .001, d = .82, 95% confidence interval = .32-1.3). In contrast, the fewer abnormalities present in FBTCS- patients were mainly localized to the temporal and frontal areas. SIGNIFICANCE The whole-brain structural network is altered to a greater and more widespread extent in patients with TLE and FBTCS. We suggest that these abnormal networks may serve as an underlying structural basis or consequence of the greater seizure spread observed in FBTCS.
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Affiliation(s)
- Nishant Sinha
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.,Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Natalie Peternell
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Gabrielle M Schroeder
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Jane de Tisi
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Sjoerd B Vos
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Centre for Medical Image Computing, University College London, London, UK.,Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Gavin P Winston
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - John S Duncan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chalfont St Peter, UK
| | - Yujiang Wang
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Peter N Taylor
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK
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Cortical Excitability in Temporal Lobe Epilepsy with Bilateral Tonic-Clonic Seizures. Can J Neurol Sci 2020; 48:648-654. [PMID: 33308332 DOI: 10.1017/cjn.2020.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We investigated motor cortical excitability (CE) in unilateral temporal lobe epilepsy (TLE) and its relationship to bilateral tonic-clonic seizure (BTCS) using paired-pulse transcranial magnetic stimulation (TMS). METHODS In this cross-sectional study, we enrolled 46 unilateral TLE patients and 16 age-and sex-matched healthy controls. Resting motor thresholds (RMT); short-interval intracortical inhibition (SICI, GABAA receptor-mediated); facilitation (ICF, glutamatergic-mediated) with interstimulus intervals (ISIs) of 2, 5, 10, and 15 ms; and long-interval intracortical inhibition (LICI, GABAB receptor-mediated) with ISIs of 200-400 ms were measured via paired-pulse TMS. Comparisons were made between controls and patients with TLE, and then among the TLE subgroups (no BTCS, infrequent BTCS and frequent BTCS subgroup). RESULTS Compared with controls, TLE patients had higher RMT, lower SICI and higher LICI in both hemispheres, and higher ICF in the ipsilateral hemisphere. In patients with frequent BTCS, cortical hyperexcitability in the ipsilateral hemisphere was found in a parameter-dependent manner (SICI decreased at a stimulation interval of 5 ms, and ICF increased at a stimulation interval of 15 ms) compared with patients with infrequent or no BTCS. CONCLUSIONS Our results demonstrate that motor cortical hyper-excitability in the ipsilateral hemisphere underlies the epileptogenic network of patients with active BTCS, which is more extensive than those with infrequent or no BTCS.
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Arterial spin-labelling and magnetic resonance spectroscopy as imaging biomarkers for detection of epileptogenic zone in non-lesional focal impaired awareness epilepsy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00326-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The proper identification of an epileptic focus is a pivotal diagnostic issue; particularly in non-lesional focal impaired awareness epilepsy (FIAE). Seizures are usually accompanied by alterations of regional cerebral blood flow (rCBF) and metabolism. Arterial spin labeling-MRI (ASL-MRI) and proton magnetic resonance spectroscopy (1H-MRS) are MRI techniques that can, non-invasively, define the regions of cerebral perfusion and metabolic changes, respectively. The aim of the current study was to recognize the epileptogenic zone in patients with non-lesional FIAE by evaluating the interictal changes in rCBF and cerebral metabolic alterations, using PASL-MRI and 1H-MRS.
Results
For identification of the epileptogenic zone, increased ASLAI% assessed by PASL-MRI (at a cut-off value ≥ 5.96%) showed 95.78% accuracy, and increased %AF (at a cut-off value ≥ 9.98%) showed 98.14% accuracy, while decreased NAA/(Cho + Cr) ratio estimated by multi-voxels (MV) 1H-MRS (at a cut-off value ≥ 0.59) showed 97.74% accuracy. Moreover, the combined use of PASL-MRI and MV 1H-MRS yielded 100% sensitivity, 98.45% specificity and 98.86% accuracy.
Conclusion
The combined use of PASL-MRI and MV 1H-MRS can be considered as in-vivo proficient bio-marker for proper identification of epileptogenic zone in patients with non-lesional FIAE.
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Wang Y, Wang X, Sang L, Zhang C, Zhao BT, Mo JJ, Hu WH, Shao XQ, Wang F, Ai L, Zhang JG, Zhang K. Network of ictal head version in mesial temporal lobe epilepsy. Brain Behav 2020; 10:e01820. [PMID: 32857475 PMCID: PMC7667364 DOI: 10.1002/brb3.1820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/29/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Ictal head version is a common clinical manifestation of mesial temporal lobe epilepsy (MTLE). Nevertheless, the location of the symptomatogenic zone and the network involved in head version remains unclear. We attempt to explain these problems by analyzing interictal 18 FDG-PET imaging and ictal stereo-electroencephalography (SEEG) recordings in MTLE patients. METHODS Fifty-eight patients with MTLE were retrospectively analyzed. The patients were divided into version (+) and (-) groups according to the occurrence of versive head movements. The interictal PET data were compared among 18 healthy controls and the (+) and (-) groups. Furthermore, epileptogenicity index (EI) values and correlations with the onset time of head version were analyzed with SEEG. RESULTS Intergroup comparisons showed that PET differences were observed in the middle temporal neocortex (MTN), posterior temporal neocortex (PTN), supramarginal gyrus (SMG), and inferior parietal lobe (IPL). The EI values in the SMG, MTN, and PTN were significantly higher in the version (+) group than in the version (-) group. A linear relationship was observed between head version onset and ipsilateral onset time in the SMG, orbitofrontal cortex (OFC), MTN, and PTN. A linear relationship was observed between EI, the difference between version onset and temporal neocortex onset, and the y-axis of the MNI coordinate. CONCLUSION The generation of ictal head version contributes to the propagation of ictal discharges to the intraparietal sulcus (IPS) area. The network of version originates from a mesial temporal lobe structure, passes through the MTN, PTN, and SMG, and likely ends at the IPS.
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Affiliation(s)
- Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Lin Sang
- Epilepsy Center, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Bao-Tian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia-Jie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Beijing Key Laboratory of Neurostimulation, Beijing, China.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Wang
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Ningxia, China
| | - Lin Ai
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
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20
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Andrews JP, Ammanuel S, Kleen J, Khambhati AN, Knowlton R, Chang EF. Early seizure spread and epilepsy surgery: A systematic review. Epilepsia 2020; 61:2163-2172. [PMID: 32944952 DOI: 10.1111/epi.16668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE A fundamental question in epilepsy surgery is how to delineate the margins of cortex that must be resected to result in seizure freedom. Whether and which areas showing seizure activity early in ictus must be removed to avoid postoperative recurrence of seizures is an area of ongoing research. Seizure spread dynamics in the initial seconds of ictus are often correlated with postoperative outcome; there is neither a consensus definition of early spread nor a concise summary of the existing literature linking seizure spread to postsurgical seizure outcomes. The present study is intended to summarize the literature that links seizure spread to postoperative seizure outcome and to provide a framework for quantitative assessment of early seizure spread. METHODS A systematic review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A Medline search identified clinical studies reporting data on seizure spread measured by intracranial electrodes, having at least 10 subjects and reporting at least 1-year postoperative outcome in the English literature from 1990 to 2019. Studies were evaluated regarding support for a primary hypothesis: Areas of early seizure spread represent cortex with seizure-generating potential. RESULTS The search yielded 4562 studies: 15 studies met inclusion criteria and 7 studies supported the primary hypothesis. The methods and metrics used to describe seizure spread were heterogenous. The timeframe of seizure spread associated with seizure outcome ranged from 1-14 seconds, with large, well-designed, retrospective studies pointing to 3-10 seconds as most likely to provide meaningful correlates of postoperative seizure freedom. SIGNIFICANCE The complex correlation between electrophysiologic seizure spread and the potential for seizure generation needs further elucidation. Prospective cohort studies or trials are needed to evaluate epilepsy surgery targeting cortex involved in the first 3-10 seconds of ictus.
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Affiliation(s)
- John P Andrews
- Department of Neurological Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Simon Ammanuel
- Department of Neurological Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Jonathan Kleen
- Department of Neurology, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Ankit N Khambhati
- Department of Neurological Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Robert Knowlton
- Department of Neurology, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Edward F Chang
- Department of Neurological Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
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21
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He X, Chaitanya G, Asma B, Caciagli L, Bassett DS, Tracy JI, Sperling MR. Disrupted basal ganglia-thalamocortical loops in focal to bilateral tonic-clonic seizures. Brain 2020; 143:175-190. [PMID: 31860076 DOI: 10.1093/brain/awz361] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/16/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Focal to bilateral tonic-clonic seizures are associated with lower quality of life, higher risk of seizure-related injuries, increased chance of sudden unexpected death, and unfavourable treatment outcomes. Achieving greater understanding of their underlying circuitry offers better opportunity to control these seizures. Towards this goal, we provide a network science perspective of the interactive pathways among basal ganglia, thalamus and cortex, to explore the imprinting of secondary seizure generalization on the mesoscale brain network in temporal lobe epilepsy. Specifically, we parameterized the functional organization of both the thalamocortical network and the basal ganglia-thalamus network with resting state functional MRI in three groups of patients with different focal to bilateral tonic-clonic seizure histories. Using the participation coefficient to describe the pattern of thalamocortical connections among different cortical networks, we showed that, compared to patients with no previous history, those with positive histories of focal to bilateral tonic-clonic seizures, including both remote (none for >1 year) and current (within the past year) histories, presented more uniform distribution patterns of thalamocortical connections in the ipsilateral medial-dorsal thalamic nuclei. As a sign of greater thalamus-mediated cortico-cortical communication, this result comports with greater susceptibility to secondary seizure generalization from the epileptogenic temporal lobe to broader brain networks in these patients. Using interregional integration to characterize the functional interaction between basal ganglia and thalamus, we demonstrated that patients with current history presented increased interaction between putamen and globus pallidus internus, and decreased interaction between the latter and the thalamus, compared to the other two patient groups. Importantly, through a series of 'disconnection' simulations, we showed that these changes in interactive profiles of the basal ganglia-thalamus network in the current history group mainly depended upon the direct but not the indirect basal ganglia pathway. It is intuitively plausible that such disruption in the striatum-modulated tonic inhibition of the thalamus from the globus pallidus internus could lead to an under-suppressed thalamus, which in turn may account for their greater vulnerability to secondary seizure generalization. Collectively, these findings suggest that the broken balance between basal ganglia inhibition and thalamus synchronization can inform the presence and effective control of focal to bilateral tonic-clonic seizures. The mechanistic underpinnings we uncover may shed light on the development of new treatment strategies for patients with temporal lobe epilepsy.
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Affiliation(s)
- Xiaosong He
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ganne Chaitanya
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Burcu Asma
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Joseph I Tracy
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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22
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Zhi D, Wu W, Xiao B, Qi S, Jiang R, Yang X, Yang J, Xiao W, Liu C, Long H, Calhoun VD, Long L, Sui J. NR4A1 Methylation Associated Multimodal Neuroimaging Patterns Impaired in Temporal Lobe Epilepsy. Front Neurosci 2020; 14:727. [PMID: 32760244 PMCID: PMC7372187 DOI: 10.3389/fnins.2020.00727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/18/2020] [Indexed: 11/25/2022] Open
Abstract
DNA hypermethylation has been widely observed in temporal lobe epilepsy (TLE), in which NR4A1 knockdown has been reported to be able to alleviate seizure severity in mouse model, while the underlying methylation-imaging pathway modulated by aberrant methylation levels of NR4A1 remains to be clarified in patients with TLE. Here, using multi-site canonical correlation analysis with reference, methylation levels of NR4A1 in blood were used as priori to guide fusion of three MRI features: functional connectivity (FC), fractional anisotropy (FA), and gray matter volume (GMV) for 56 TLE patients and 65 healthy controls. Post-hoc correlations were further evaluated between the identified NR4A1-associated brain components and disease onset. Results suggested that higher NR4A1 methylation levels in TLE were related with impaired temporal-cerebellar and occipital-cerebellar FC strength, lower FA in cingulum (hippocampus), and reduced GMV in putamen, temporal pole, and cerebellum. Moreover, findings were also replicated well in both patient subsets with either right TLE or left TLE only. Particularly, right TLE patients showed poorer cognitive abilities and more severe brain impairment than left TLE patients, especially more reduced GMV in thalamus. In summary, this work revealed a potential imaging-methylation pathway modulated by higher NR4A1 methylation in TLE via data mining, which may impact the above-mentioned multimodal brain circuits and was also associated with earlier disease onset and more cognitive deficits.
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Affiliation(s)
- Dongmei Zhi
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Wenyue Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Department of Neurology, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Shile Qi
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University - Emory University, Atlanta, GA, United States
| | - Rongtao Jiang
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xingdong Yang
- Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - Jian Yang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing, China
| | - Wenbiao Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Chaorong Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyu Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Vince D Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University - Emory University, Atlanta, GA, United States
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Sui
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University - Emory University, Atlanta, GA, United States.,CAS Centre for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing, China
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23
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Abstract
Temporal lobe epilepsy (TLE) is the most common type of drug-resistant focal epilepsy. Epilepsy can be conceptualized as a network disorder with the epileptogenic zone a critical node of the network. Temporal lobe networks can be identified on the microscale and macroscale, both during the interictal and ictal periods. This review summarizes the current understanding of TLE networks as studied by neurophysiological and imaging techniques discussing both functional and structural connectivity.
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Schönberger J, Birk N, Lachner-Piza D, Dümpelmann M, Schulze-Bonhage A, Jacobs J. High-frequency oscillations mirror severity of human temporal lobe seizures. Ann Clin Transl Neurol 2019; 6:2479-2488. [PMID: 31750633 PMCID: PMC6917313 DOI: 10.1002/acn3.50941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Objective Many patients with epilepsy have both focal and bilateral tonic‐clonic seizures (BTCSs), but it is largely unclear why ictal activity spreads only sometimes. Previous work indicates that interictal high‐frequency oscillations (HFOs), traditionally subdivided into ripples (80–250 Hz) and fast ripples (250–500 Hz), are a promising biomarker of epileptogenicity. We aimed to investigate whether HFOs correlate with the emergence of seizure activity and whether they differ between focal seizures (FSs) with impaired awareness and BTCSs. Methods We retrospectively analyzed 15 FSs and 13 BTCSs from seven patients with mesial temporal lobe epilepsy, each of them with at least one BTCS and at least one FS. Representative intervals of intracranial electroencephalography from the seizure onset zone (SOZ) and remote non‐SOZ areas were selected to compare pre‐ictal, complex focal, tonic‐clonic, and postictal periods. Ripples and fast ripples were visually identified and their density, that is, percentage of time occupied by the respective events, computed. Results Ripple and fast ripple densities increased inside the SOZ after seizure onset (P < 0.01) and in remote areas after progression to BTCSs (P < 0.01). Postictal SOZ ripple density dropped below pre‐ictal levels (P < 0.001). Prior to onset of bilateral tonic‐clonic movements, ripple density inside the SOZ is higher in BTCSs than in FSs (P < 0.05). Interpretation Ripples and fast ripples correlate with onset and spread of ictal activity. Abundant ripples inside the SOZ may reflect the activation of specific neuronal networks related to imminent spread of seizure activity.
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Affiliation(s)
- Jan Schönberger
- Universitätsklinikum Freiburg, Epilepsiezentrum, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Klinik für Neuropädiatrie und Muskelerkrankungen, Universitätsklinikum Freiburg, Mathildenstraße 1, 79106, Freiburg im Breisgau, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nadja Birk
- Universitätsklinikum Freiburg, Epilepsiezentrum, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Klinik für Neuropädiatrie und Muskelerkrankungen, Universitätsklinikum Freiburg, Mathildenstraße 1, 79106, Freiburg im Breisgau, Germany
| | - Daniel Lachner-Piza
- Universitätsklinikum Freiburg, Epilepsiezentrum, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany
| | - Matthias Dümpelmann
- Universitätsklinikum Freiburg, Epilepsiezentrum, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany
| | - Andreas Schulze-Bonhage
- Universitätsklinikum Freiburg, Epilepsiezentrum, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany
| | - Julia Jacobs
- Universitätsklinikum Freiburg, Epilepsiezentrum, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Klinik für Neuropädiatrie und Muskelerkrankungen, Universitätsklinikum Freiburg, Mathildenstraße 1, 79106, Freiburg im Breisgau, Germany
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25
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Stefanatou M, Gatzonis S, Peskostas A, Paraskevas G, Koutroumanidis M. Drug-responsive versus drug-refractory mesial temporal lobe epilepsy: a single-center prospective outcome study. Postgrad Med 2019; 131:479-485. [PMID: 31513436 DOI: 10.1080/00325481.2019.1663126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: To evaluate clinical, electrophysiological, and neuroradiological factors which correlate with the prognosis in patients with mesial temporal lobe epilepsy (MTLE). Methods: This was a single-center prospective outcome study in patients with MTLE. The patients' family history, clinical characteristics, neurophysiological data (electroencephalography - EEG), neuroimaging, antiepileptic therapy, and outcome were collected and analyzed. The population was divided into four groups depending on the frequency of the seizures when they attended their last follow up. All variables and outcome measures were compared between the four groups. Results: In total 83 consecutive patients were included within the four groups. Group 1 (seizure-free) consisted of 7 patients, (9%), Group 2 (rare seizures) consisted of 15 patients (18%), Group 3 (often seizures) consisted of 30 patients (36%), and Group 4 (very often seizures) consisted of 31 patients (37%). The groups did not differ significantly in demographic characteristics. There was a strong positive correlation between resistance to therapy and sleep activation on EEG (p = 0.005), occurrence of focal to bilateral seizures (p = 0.007), automatisms (p = 0.004), and the number of previously used antiepileptic drugs (AEDs) (p = 0.002). There was no association between febrile convulsions (FC), hippocampal sclerosis (HS), and the outcome that was found. Conclusion: MTLE is a heterogeneous syndrome. Establishing the factors responsible for, and associated with, drug resistance is important for optimal management and treatment, as early identification of drug resistance should then ensure a timely referral for surgical treatment is made. This prospective study shows that sleep activation on EEG, ictal automatisms, occurrence of focal to bilateral tonic-clonic seizures, and increased number of tried AEDs are negative prognostic factors.
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Affiliation(s)
- Maria Stefanatou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Aeginition Hospital , Athens , Greece.,Department of Clinical Neurophysiology and Epilepsies, Guy's and St. Thomas' NHS Foundation Trust , London , UK
| | - Stylianos Gatzonis
- 1st Department of Neurosurgery, Epilepsy Centre, National and Kapodistrian University of Athens, "Evangelismos" Hospital , Athens , Greece
| | - Antonis Peskostas
- Department of Statistics and Insurance Science, University of Piraeus , Piraeus , Greece
| | - George Paraskevas
- 1st Department of Neurology, National and Kapodistrian University of Athens, Aeginition Hospital , Athens , Greece
| | - Michael Koutroumanidis
- Department of Clinical Neurophysiology and Epilepsies, Guy's and St. Thomas' NHS Foundation Trust , London , UK
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26
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Wang Y, Wang X, Mo JJ, Sang L, Zhao BT, Zhang C, Hu WH, Zhang JG, Shao XQ, Zhang K. Symptomatogenic zone and network of oroalimentary automatisms in mesial temporal lobe epilepsy. Epilepsia 2019; 60:1150-1159. [PMID: 31095733 DOI: 10.1111/epi.15457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Oroalimentary automatisms (OAAs) are common clinical manifestations of medial temporal lobe epilepsy. Nevertheless, the location of the symptomatogenic zone of OAAs remains unclear. The generation mechanism of OAAs also has not been clarified. We attempt to explain these problems by analyzing interictal [18 F]-fluorodeoxyglucose positron emission tomography (18 FDG-PET) imaging and ictal stereo-electroencephalography (SEEG) recordings in patients with medial temporal lobe epilepsy. METHODS Fifty-seven patients with mesial temporal lobe epilepsy were analyzed retrospectively. All underwent anterior temporal lobectomy (ATL) and were seizure-free. The patients were divided into OAA (+) and OAA (-) groups according to the occurrence of consistent stereotyped OAAs. The interictal PET data were compared with those of 18 healthy controls and were then compared between groups using statistical parametric mapping (SPM). Functional connectivity using linear regression analysis was performed between the target brain regions. To clarify the network of OAAs, ictal epileptogenicity index (EI) values, and the nonlinear correlation method h2 were performed with SEEG on patients. RESULTS Compared to OAAs (-), the rolandic operculum was the only area with significant differences. Hippocampus and rolandic operculum showed significant correlations in the OAA (+) group (y = 0.758x+0.470, R2 = 0.456, P = 0.000). No correlation was found in the OAA (-) group (P = 0.486). The EI values of the OAA (+) group (median 0.20) were significantly higher (P < 0.0001) than those of the OAA (-) group (median 0). The h2 in the OAA (+) group (h2 = 0.23 ± 0.13) showed stronger functional connectivity (t = 6.166, P < 0.0001) than that of the OAA (-) group (h2 = 0.08 ± 0.05). SIGNIFICANCE The rolandic operculum is most likely to be the symptomatogenic zone of OAAs. In medial temporal lobe epilepsy, unilateral functional connection from the hippocampus to the rolandic operculum during seizure onset is the basis for the generation of OAAs.
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Affiliation(s)
- Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jia-Jie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Sang
- Epilepsy Center, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Bao-Tian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Wen-Han Hu
- Beijing Key Laboratory of Neurostimulation, Beijing, China.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
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Naftulin JS, Ahmed OJ, Piantoni G, Eichenlaub JB, Martinet LE, Kramer MA, Cash SS. Ictal and preictal power changes outside of the seizure focus correlate with seizure generalization. Epilepsia 2018; 59:1398-1409. [PMID: 29897628 DOI: 10.1111/epi.14449] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The treatment of focal epilepsies is largely predicated on the concept that there is a "focus" from which the seizure emanates. Yet, the physiological context that determines if and how ictal activity starts and propagates remains poorly understood. To delineate these phenomena more completely, we studied activity outside the seizure-onset zone prior to and during seizure initiation. METHODS Stereotactic depth electrodes were implanted in 17 patients with longstanding pharmacoresistant epilepsy for lateralization and localization of the seizure-onset zone. Only seizures with focal onset in mesial temporal structures were used for analysis. Spectral analyses were used to quantify changes in delta, theta, alpha, beta, gamma, and high gamma frequency power, in regions inside and outside the area of seizure onset during both preictal and seizure initiation periods. RESULTS In the 78 seizures examined, an average of 9.26% of the electrode contacts outside of the seizure focus demonstrated changes in power at seizure onset. Of interest, seizures that were secondarily generalized, on average, showed power changes in a greater number of extrafocus electrode contacts at seizure onset (16.7%) compared to seizures that remained focal (3.8%). The majority of these extrafocus changes occupied the delta and theta bands in electrodes placed in the ipsilateral, lateral temporal lobe. Preictally, we observed extrafocal high-frequency power decrements, which also correlated with seizure spread. SIGNIFICANCE This widespread activity at and prior to the seizure-onset time further extends the notion of the ictogenic focus and its relationship to seizure spread. Further understanding of these extrafocus, periictal changes might help identify the neuronal dynamics underlying the initiation of seizures and how therapies can be devised to control seizure activity.
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Affiliation(s)
- Jason S Naftulin
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Omar J Ahmed
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Giovanni Piantoni
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jean-Baptiste Eichenlaub
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Mark A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Karthick P, Tanaka H, Khoo HM, Gotman J. Prediction of secondary generalization from a focal onset seizure in intracerebral EEG. Clin Neurophysiol 2018; 129:1030-1040. [DOI: 10.1016/j.clinph.2018.02.122] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/01/2018] [Accepted: 02/08/2018] [Indexed: 01/06/2023]
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Mehvari J, Zare M, Andami R, Ghadimi K, Tabrizi N. Ictal and Interictal Electroencephalography of Mesial and Lateral Temporal Lobe Epilepsy; A Comparative Study. CASPIAN JOURNAL OF NEUROLOGICAL SCIENCES 2017. [DOI: 10.29252/nirp.cjns.3.11.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Focal cortical seizures start as standing waves and propagate respecting homotopic connectivity. Nat Commun 2017; 8:217. [PMID: 28794407 PMCID: PMC5550430 DOI: 10.1038/s41467-017-00159-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 06/02/2017] [Indexed: 01/27/2023] Open
Abstract
Focal epilepsy involves excessive cortical activity that propagates both locally and distally. Does this propagation follow the same routes as normal cortical activity? We pharmacologically induced focal seizures in primary visual cortex (V1) of awake mice, and compared their propagation to the retinotopic organization of V1 and higher visual areas. We used simultaneous local field potential recordings and widefield imaging of a genetically encoded calcium indicator to measure prolonged seizures (ictal events) and brief interictal events. Both types of event are orders of magnitude larger than normal visual responses, and both start as standing waves: synchronous elevated activity in the V1 focus and in homotopic locations in higher areas, i.e. locations with matching retinotopic preference. Following this common beginning, however, seizures persist and propagate both locally and into homotopic distal regions, and eventually invade all of visual cortex and beyond. We conclude that seizure initiation resembles the initiation of interictal events, and seizure propagation respects the connectivity underlying normal visual processing. Focal cortical seizures result from local and widespread propagation of excitatory activity. Here the authors employ widefield calcium imaging in mouse visual areas to demonstrate that these seizures start as local synchronous activation and then propagate along the connectivity that underlies normal sensory processing.
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Yang L, Li H, Zhu L, Yu X, Jin B, Chen C, Wang S, Ding M, Zhang M, Chen Z, Wang S. Localized shape abnormalities in the thalamus and pallidum are associated with secondarily generalized seizures in mesial temporal lobe epilepsy. Epilepsy Behav 2017; 70:259-264. [PMID: 28427841 DOI: 10.1016/j.yebeh.2017.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 01/16/2023]
Abstract
Mesial temporal lobe epilepsy (mTLE) is a common type of drug-resistant epilepsy and secondarily generalized tonic-clonic seizures (sGTCS) have devastating consequences for patients' safety and quality of life. To probe the mechanism underlying the genesis of sGTCS, we investigated the structural differences between patients with and without sGTCS in a cohort of mTLE with radiologically defined unilateral hippocampal sclerosis. We performed voxel-based morphometric analysis of cortex and vertex-wise shape analysis of subcortical structures (the basal ganglia and thalamus) on MRI of 39 patients (21 with and 18 without sGTCS). Comparisons were initially made between sGTCS and non-sGTCS groups, and subsequently made between uncontrolled-sGTCS and controlled-sGTCS subgroups. Regional atrophy of the ipsilateral ventral pallidum (cluster size=450 voxels, corrected p=0.047, Max voxel coordinate=107, 120, 65), medial thalamus (cluster size=1128 voxels, corrected p=0.049, Max voxel coordinate=107, 93, 67), middle frontal gyrus (cluster size=60 voxels, corrected p<0.05, Max voxel coordinate=-30, 49.5, 6), and contralateral posterior cingulate cortex (cluster size=130 voxels, corrected p<0.05, Max voxel coordinate=16.5, -57, 27) was found in the sGTCS group relative to the non-sGTCS group. Furthermore, the uncontrolled-sGTCS subgroup showed more pronounced atrophy of the ipsilateral medial thalamus (cluster size=1240 voxels, corrected p=0.014, Max voxel coordinate=107, 93, 67) than the controlled-sGTCS subgroup. These findings indicate a central role of thalamus and pallidum in the pathophysiology of sGTCS in mTLE.
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Affiliation(s)
- Linglin Yang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Li
- Departments of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lujia Zhu
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinfeng Yu
- Departments of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Jin
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shan Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Minming Zhang
- Departments of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhong Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Doucet GE, He X, Sperling M, Sharan A, Tracy JI. Gray Matter Abnormalities in Temporal Lobe Epilepsy: Relationships with Resting-State Functional Connectivity and Episodic Memory Performance. PLoS One 2016; 11:e0154660. [PMID: 27171178 PMCID: PMC4865085 DOI: 10.1371/journal.pone.0154660] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/15/2016] [Indexed: 11/19/2022] Open
Abstract
Temporal lobe epilepsy (TLE) affects multiple brain regions through evidence from both structural (gray matter; GM) and functional connectivity (FC) studies. We tested whether these structural abnormalities were associated with FC abnormalities, and assessed the ability of these measures to explain episodic memory impairments in this population. A resting-state and T1 sequences were acquired on 94 (45 with mesial temporal pathology) TLE patients and 50 controls, using magnetic resonance imaging (MRI) technique. A voxel-based morphometry analysis was computed to determine the GM volume differences between groups (right, left TLE, controls). Resting-state FC between the abnormal GM volume regions was computed, and compared between groups. Finally, we investigated the relation between EM, GM and FC findings. Patients with and without temporal pathology were analyzed separately. The results revealed reduced GM volume in multiple regions in the patients relative to the controls. Using FC, we found the abnormal GM regions did not display abnormal functional connectivity. Lastly, we found in left TLE patients, verbal episodic memory was associated with abnormal left posterior hippocampus volume, while in right TLE, non-verbal episodic memory was better predicted by resting-state FC measures. This study investigated TLE abnormalities using a multi-modal approach combining GM, FC and neurocognitive measures. We did not find that the GM abnormalities were functionally or abnormally connected during an inter-ictal resting state, which may reflect a weak sensitivity of functional connectivity to the epileptic network. We provided evidence that verbal and non-verbal episodic memory in left and right TLE patients may have distinct relationships with structural and functional measures. Lastly, we provide data suggesting that in the setting of occult, non-lesional right TLE pathology, a coupling of structural and functional abnormalities in extra-temporal/non-ictal regions is necessary to produce reductions in episodic memory recall. The latter, in particular, demonstrates the complex structure/function interactions at work when trying to understand cognition in TLE, suggesting that subtle network effects can emerge bearing specific relationships to hemisphere and the type of pathology.
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Affiliation(s)
- Gaelle E. Doucet
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Xiaosong He
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Michael Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Joseph I. Tracy
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States of America
- * E-mail:
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Edlow BL, McNab JA, Witzel T, Kinney HC. The Structural Connectome of the Human Central Homeostatic Network. Brain Connect 2016; 6:187-200. [PMID: 26530629 PMCID: PMC4827322 DOI: 10.1089/brain.2015.0378] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Homeostatic adaptations to stress are regulated by interactions between the brainstem and regions of the forebrain, including limbic sites related to respiratory, autonomic, affective, and cognitive processing. Neuroanatomic connections between these homeostatic regions, however, have not been thoroughly identified in the human brain. In this study, we perform diffusion spectrum imaging tractography using the MGH-USC Connectome MRI scanner to visualize structural connections in the human brain linking autonomic and cardiorespiratory nuclei in the midbrain, pons, and medulla oblongata with forebrain sites critical to homeostatic control. Probabilistic tractography analyses in six healthy adults revealed connections between six brainstem nuclei and seven forebrain regions, several over long distances between the caudal medulla and cerebral cortex. The strongest evidence for brainstem-homeostatic forebrain connectivity in this study was between the brainstem midline raphe and the medial temporal lobe. The subiculum and amygdala were the sampled forebrain nodes with the most extensive brainstem connections. Within the human brainstem-homeostatic forebrain connectome, we observed that a lateral forebrain bundle, whose connectivity is distinct from that of rodents and nonhuman primates, is the primary conduit for connections between the brainstem and medial temporal lobe. This study supports the concept that interconnected brainstem and forebrain nodes form an integrated central homeostatic network (CHN) in the human brain. Our findings provide an initial foundation for elucidating the neuroanatomic basis of homeostasis in the normal human brain, as well as for mapping CHN disconnections in patients with disorders of homeostasis, including sudden and unexpected death, and epilepsy.
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Affiliation(s)
- Brian L. Edlow
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Jennifer A. McNab
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Department of Radiology, R.M. Lucas Center for Imaging, Stanford University, Stanford, California
| | - Thomas Witzel
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Hannah C. Kinney
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Thyrion L, Raedt R, Portelli J, Van Loo P, Wadman WJ, Glorieux G, Lambrecht BN, Janssens S, Vonck K, Boon P. Uric acid is released in the brain during seizure activity and increases severity of seizures in a mouse model for acute limbic seizures. Exp Neurol 2016; 277:244-251. [PMID: 26774005 DOI: 10.1016/j.expneurol.2016.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/08/2022]
Abstract
Recent evidence points at an important role of endogenous cell-damage induced pro-inflammatory molecules in the generation of epileptic seizures. Uric acid, under the form of monosodium urate crystals, has shown to have pro-inflammatory properties in the body, but less is known about its role in seizure generation. This study aimed to unravel the contribution of uric acid to seizure generation in a mouse model for acute limbic seizures. We measured extracellular levels of uric acid in the brain and modulated them using complementary pharmacological and genetic tools. Local extracellular uric acid levels increased three to four times during acute limbic seizures and peaked between 50 and 100 min after kainic acid infusion. Manipulating uric acid levels through administration of allopurinol or knock-out of urate oxidase significantly altered the number of generalized seizures, decreasing and increasing them by a twofold respectively. Taken together, our results consistently show that uric acid is released during limbic seizures and suggest that uric acid facilitates seizure generalization.
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Affiliation(s)
- Lisa Thyrion
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Department of Neurology, Institute for Neuroscience, Ghent University Hospital, De Pintelaan 185, 2 Blok B, 9000 Ghent, Belgium.
| | - Robrecht Raedt
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Department of Neurology, Institute for Neuroscience, Ghent University Hospital, De Pintelaan 185, 2 Blok B, 9000 Ghent, Belgium.
| | - Jeanelle Portelli
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Department of Neurology, Institute for Neuroscience, Ghent University Hospital, De Pintelaan 185, 2 Blok B, 9000 Ghent, Belgium; Center for Neurosciences C4N, Department of Pharmaceutical Chemistry, Drug Analysis & Drug Information, Vrije Universiteit Brussel, Building G, Room G.103, Laarbeeklaan 103, 1090 Brussels, Belgium.
| | - Pieter Van Loo
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Department of Neurology, Institute for Neuroscience, Ghent University Hospital, De Pintelaan 185, 2 Blok B, 9000 Ghent, Belgium.
| | - Wytse J Wadman
- Swammerdam Institute of Life Sciences, University of Amsterdam, Sciencepark 904, 1098 XH Amsterdam, The Netherlands.
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 0K12, 9000 Ghent, Belgium.
| | - Bart N Lambrecht
- Unit Immunoregulation and Mucosal Immunology, VIB Inflammation Research Center, 'Fiers-Schell-Van Montagu' Building, Technologiepark 927, Zwijnaarde, 9052 Ghent, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Sophie Janssens
- Unit Immunoregulation and Mucosal Immunology, VIB Inflammation Research Center, 'Fiers-Schell-Van Montagu' Building, Technologiepark 927, Zwijnaarde, 9052 Ghent, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
| | - Kristl Vonck
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Department of Neurology, Institute for Neuroscience, Ghent University Hospital, De Pintelaan 185, 2 Blok B, 9000 Ghent, Belgium.
| | - Paul Boon
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Department of Neurology, Institute for Neuroscience, Ghent University Hospital, De Pintelaan 185, 2 Blok B, 9000 Ghent, Belgium.
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Evolution of Network Synchronization during Early Epileptogenesis Parallels Synaptic Circuit Alterations. J Neurosci 2015; 35:9920-34. [PMID: 26156993 DOI: 10.1523/jneurosci.4007-14.2015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In secondary epilepsy, a seizure-prone neural network evolves during the latent period between brain injury and the onset of spontaneous seizures. The nature of the evolution is largely unknown, and even its completeness at the onset of seizures has recently been challenged by measures of gradually decreasing intervals between subsequent seizures. Sequential calcium imaging of neuronal activity, in the pyramidal cell layer of mouse hippocampal in vitro preparations, during early post-traumatic epileptogenesis demonstrated rapid increases in the fraction of neurons that participate in interictal activity. This was followed by more gradual increases in the rate at which individual neurons join each developing seizure, the pairwise correlation of neuronal activities as a function of the distance separating the pair, and network-wide measures of functional connectivity. These data support the continued evolution of synaptic connectivity in epileptic networks beyond the latent period: early seizures occur when recurrent excitatory pathways are largely polysynaptic, while ongoing synaptic remodeling after the onset of epilepsy enhances intranetwork connectivity as well as the onset and spread of seizure activity.
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Baud MO, Vulliemoz S, Seeck M. Recurrent secondary generalization in frontal lobe epilepsy: Predictors and a potential link to surgical outcome? Epilepsia 2015. [DOI: 10.1111/epi.13086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maxime O. Baud
- Department of Neurology; University of California San Francisco; San Francisco California U.S.A
| | - Serge Vulliemoz
- Epilepsy Center; Geneva University Hospital; Geneva Switzerland
| | - Margitta Seeck
- Epilepsy Center; Geneva University Hospital; Geneva Switzerland
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Burns SP, Santaniello S, Yaffe RB, Jouny CC, Crone NE, Bergey GK, Anderson WS, Sarma SV. Network dynamics of the brain and influence of the epileptic seizure onset zone. Proc Natl Acad Sci U S A 2014; 111:E5321-30. [PMID: 25404339 PMCID: PMC4267355 DOI: 10.1073/pnas.1401752111] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The human brain is a dynamic networked system. Patients with partial epileptic seizures have focal regions that periodically diverge from normal brain network dynamics during seizures. We studied the evolution of brain connectivity before, during, and after seizures with graph-theoretic techniques on continuous electrocorticographic (ECoG) recordings (5.4 ± 1.7 d per patient, mean ± SD) from 12 patients with temporal, occipital, or frontal lobe partial onset seizures. Each electrode was considered a node in a graph, and edges between pairs of nodes were weighted by their coherence within a frequency band. The leading eigenvector of the connectivity matrix, which captures network structure, was tracked over time and clustered to uncover a finite set of brain network states. Across patients, we found that (i) the network connectivity is structured and defines a finite set of brain states, (ii) seizures are characterized by a consistent sequence of states, (iii) a subset of nodes is isolated from the network at seizure onset and becomes more connected with the network toward seizure termination, and (iv) the isolated nodes may identify the seizure onset zone with high specificity and sensitivity. To localize a seizure, clinicians visually inspect seizures recorded from multiple intracranial electrode contacts, a time-consuming process that may not always result in definitive localization. We show that network metrics computed from all ECoG channels capture the dynamics of the seizure onset zone as it diverges from normal overall network structure. This suggests that a state space model can be used to help localize the seizure onset zone in ECoG recordings.
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Affiliation(s)
| | | | - Robert B Yaffe
- Institute for Computational Medicine and Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD 21218; and
| | | | | | | | - William S Anderson
- Institute for Computational Medicine and Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, MD 21287
| | - Sridevi V Sarma
- Institute for Computational Medicine and Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD 21218; and
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Hemery C, Ryvlin P, Rheims S. Prevention of generalized tonic-clonic seizures in refractory focal epilepsy: a meta-analysis. Epilepsia 2014; 55:1789-99. [PMID: 25182978 DOI: 10.1111/epi.12765] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Secondary generalized tonic-clonic seizures (SGTCS) are among the most severe forms of seizures, and the main risk factor for sudden unexpected death in epilepsy (SUDEP). Whether some antiepileptic drugs (AEDs) might be more efficacious than others on SGTCS in patients with drug-resistant focal epilepsy thus represents an important clinical issue for which no data are currently available. METHODS We performed a meta-analysis of randomized controlled trials of adjunctive AED in which information on efficacy outcomes (i.e., responder rate and/or frequency per 28 days relative to baseline) were available both for all seizure types and for SGTCS. The primary analysis evaluated the efficacy of AEDs on all types of seizure and on SGTCS by comparing the responder rates for AED and for placebo. RESULTS Responder rate was available both for all seizure types and for SGTCS in 13 of the 72 eligible trials, evaluating 7 AEDs. Only three AEDs--lacosamide, perampanel and topiramate--showed greater efficacy than placebo. However, confidence intervals of relative risks overlapped for all AEDs but pregabalin, which demonstrated significantly lower efficacy than lacosamide, perampanel, and topiramate. Moreover, there was a nonsignificant trend toward a lower relative risk of responder rate for SGTCS than for all seizure types, which appeared related to a greater response to placebo for this outcome. SIGNIFICANCE Indirect comparison of AEDs using randomized placebo-controlled add-on trials does not support robust differences between AEDs to prevent SGTCS. Alternative designs for evaluation of therapeutic interventions in patients at risk for SGTCS-related complications are required.
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Affiliation(s)
- Claire Hemery
- Department of Functional Neurology and Epileptology, Institute of Epilepsies (IDEE), Hospices Civils de Lyon, Lyon, France
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