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Jensen KHR, Urdanibia-Centelles O, Dam VH, Köhler-Forsberg K, Frokjaer VG, Knudsen GM, Jørgensen MB, Ip CT. EEG abnormalities are not associated with poor antidepressant treatment outcome - A NeuroPharm study. Eur Neuropsychopharmacol 2024; 79:59-65. [PMID: 38128462 DOI: 10.1016/j.euroneuro.2023.11.004] [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: 06/06/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
EEG brain abnormalities, such as slowing and isolated epileptiform discharges (IEDs), has previously been associated with non-response to antidepressant treatment with escitalopram and venlafaxine, suggesting a potential need for treatment with anticonvulsant property in some patients. The current study aims to replicate the reported association of EEG abnormality and treatment outcomes in an open-label trial of escitalopram for major depressive disorder (MDD) and explore its relationship to mood and cognition. Pretreatment, 6 min eyes-closed resting-state 256-channel EEG was recorded in 91 patients with MDD (age 18-57) who were treated with 10-20 mg escitalopram for 12 weeks; patients could switch to duloxetine after four weeks. A certified clinical neurophysiologist rated the EEGs. IED and EEG slowing was seen in 13.2%, and in 6.6% there were findings with unclear significance (i.e., Wicket spikes and theta activity). We saw no group-difference in remission or response rates after 8 and 12 weeks of treatment or switching to duloxetine. Patients with EEG abnormalities had higher pretreatment mood disturbances driven by greater anger (p=.039) and poorer verbal memory (p=.012). However, EEG abnormality was not associated with improved mood or verbal memory after treatment. Our findings should be interpreted in light of the rarity of EEG abnormalities and the sample size. While we cannot confirm that EEG abnormalities are associated with non-response to treatment, including escitalopram, abnormal EEG activity is associated with poor mood and verbal memory. The clinical utility of EEG abnormality in antidepressant treatment selection needs careful evaluation before deciding if useful for clinical implementation.
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Affiliation(s)
- Kristian H Reveles Jensen
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Olalla Urdanibia-Centelles
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Vibeke H Dam
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Kristin Köhler-Forsberg
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Cognitive and Brain Sciences, University of Macau, Taipa, Macau SAR, China
| | - Martin B Jørgensen
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cheng T Ip
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark; Center for Cognitive and Brain Sciences, University of Macau, Taipa, Macau SAR, China
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2
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Ciliento R, Gjini K, Dabbs K, Hermann B, Riedner B, Jones S, Fatima S, Johnson S, Bendlin B, Lam AD, Boly M, Struck AF. Prevalence and localization of nocturnal epileptiform discharges in mild cognitive impairment. Brain Commun 2023; 5:fcad302. [PMID: 37965047 PMCID: PMC10642616 DOI: 10.1093/braincomms/fcad302] [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: 05/09/2023] [Revised: 09/18/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Recent evidence shows that identifying and treating epileptiform abnormalities in patients with Alzheimer's disease could represent a potential avenue to improve clinical outcome. Specifically, animal and human studies have revealed that in the early phase of Alzheimer's disease, there is an increased risk of seizures. It has also been demonstrated that the administration of anti-seizure medications can slow the functional progression of the disease only in patients with EEG signs of cortical hyperexcitability. In addition, although it is not known at what disease stage hyperexcitability emerges, there remains no consensus regarding the imaging and diagnostic methods best able to detect interictal events to further distinguish different phenotypes of Alzheimer's disease. In this exploratory work, we studied 13 subjects with amnestic mild cognitive impairment and 20 healthy controls using overnight high-density EEG with 256 channels. All participants also underwent MRI and neuropsychological assessment. Electronic source reconstruction was also used to better select and localize spikes. We found spikes in six of 13 (46%) amnestic mild cognitive impairment compared with two of 20 (10%) healthy control participants (P = 0.035), representing a spike prevalence similar to that detected in previous studies of patients with early-stage Alzheimer's disease. The interictal events were low-amplitude temporal spikes more prevalent during non-rapid eye movement sleep. No statistically significant differences were found in cognitive performance between amnestic mild cognitive impairment patients with and without spikes, but a trend in immediate and delayed memory was observed. Moreover, no imaging findings of cortical and subcortical atrophy were found between amnestic mild cognitive impairment participants with and without epileptiform spikes. In summary, our exploratory study shows that patients with amnestic mild cognitive impairment reveal EEG signs of hyperexcitability early in the disease course, while no other significant differences in neuropsychological or imaging features were observed among the subgroups. If confirmed with longitudinal data, these exploratory findings could represent one of the first signatures of a preclinical epileptiform phenotype of amnestic mild cognitive impairment and its progression.
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Affiliation(s)
- Rosario Ciliento
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Klevest Gjini
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Brady Riedner
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Stephanie Jones
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Safoora Fatima
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Sterling Johnson
- Department of Medicine, University of Wisconsin, Madison, WI 53705, USA
| | - Barbara Bendlin
- Department of Medicine, University of Wisconsin, Madison, WI 53705, USA
| | - Alice D Lam
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Melanie Boly
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
- Department of Neurology, William S. Middleton Veterans Administration Hospital, Madison, WI 53705, USA
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3
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Fazlollahi A, Zahmatyar M, Shamekh A, Motamedi A, Seyedi F, Seyedmirzaei H, Mousavi SE, Nejadghaderi SA, Sullman MJM, Kolahi AA, Arshi S, Safiri S. Electroencephalographic findings post-COVID-19 vaccination: A systematic review of case reports and case series. Rev Med Virol 2023; 33:e2484. [PMID: 37807809 DOI: 10.1002/rmv.2484] [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: 04/13/2023] [Revised: 08/14/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
A number of different neurological complications have been reported following vaccination against the coronavirus disease 2019 (COVID-19). Electroencephalogram (EEG) is one of the modalities used to evaluate the neurological complications of diseases. The aim of the present study was to identify the EEG changes in participants vaccinated against COVID-19. PubMed, Scopus, Web of Science, medRxiv, and Google Scholar were searched up to 1 September 2022, with terms related to COVID-19 vaccines, EEG, neurological signs/symptoms, or neurological disorders. All case reports and case series were included if the participants had received at least one dose of a COVID-19 vaccine and a post vaccination EEG report was also reported. We used the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for case reports and case series to appraise the methodological quality of the included studies. Thirty-one studies were included, which were comprised of 24 case reports and seven case series and a total of 36 participants. Generalised slowing and non-convulsive focal status epilepticus were the most common EEG findings post-COVID-19 vaccination. The most frequent symptoms were headache, fatigue, generalised weakness, and vomiting. In addition, the most common signs were encephalopathy, post-ictal phases, and confusion. Encephalitis, acute disseminated encephalomyelitis, and post-vaccinal encephalopathy were the most commonly diagnosed adverse events. Furthermore, most of the imaging studies appeared normal. The EEG reports mainly showed background slowing and epileptiform discharges, encephalitis, encephalopathies, and demyelinating disorders. Future studies with larger samples and more vaccine types may help to further unravel the potential neurological effects of COVID-19 vaccinations on recipients.
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Affiliation(s)
- Asra Fazlollahi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Zahmatyar
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Shamekh
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Motamedi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Seyedi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Homa Seyedmirzaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Interdisciplinary Neuroscience Research Program (INRP), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ehsan Mousavi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Tuberculosis and Lung Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahnam Arshi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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4
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Sarkis RA, Lam AD, Pavlova M, Locascio JJ, Putta S, Puri N, Pham J, Yih A, Marshall GA, Stickgold R. Epilepsy and sleep characteristics are associated with diminished 24-h memory retention in older adults with epilepsy. Epilepsia 2023; 64:2771-2780. [PMID: 37392445 PMCID: PMC10592425 DOI: 10.1111/epi.17707] [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: 05/16/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Individuals with epilepsy often have memory difficulties, and older adults with epilepsy are especially vulnerable, due to the additive effect of aging. The goal of this study was to assess factors that are associated with 24-h memory retention in older adults with epilepsy. METHODS Fifty-five adults with epilepsy, all aged >50 years, performed a declarative memory task involving the recall of the positions of 15 card pairs on a computer screen prior to a 24-h ambulatory electroencephalogram (EEG). We assessed the percentage of encoded card pairs that were correctly recalled after 24 h (24-h retention rate). EEGs were evaluated for the presence and frequency of scalp interictal epileptiform activity (IEA) and scored for total sleep. Global slow wave activity (SWA) power during non-rapid eye movement sleep was also calculated. RESULTS Forty-four participants successfully completed the memory task. Two were subsequently excluded due to seizures on EEG. The final cohort (n = 42) had a mean age of 64.3 ± 7.5 years, was 52% female, and had an average 24-h retention rate of 70.9% ± 30.2%. Predictors of 24-h retention based on multivariate regression analysis when controlling for age, sex, and education included number of antiseizure medications (β = -.20, p = .013), IEA frequency (β = -.08, p = .0094), and SWA power (β = +.002, p = .02). SIGNIFICANCE In older adults with epilepsy, greater frequency of IEA, reduced SWA power, and higher burden of antiseizure medications correlated with worse 24-h memory retention. These factors represent potential treatment targets to improve memory in older adults with epilepsy.
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Affiliation(s)
- Rani A Sarkis
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alice D Lam
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Milena Pavlova
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Swapna Putta
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nirajan Puri
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jonathan Pham
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alison Yih
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gad A Marshall
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert Stickgold
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Lemus HN, Sarkis RA. Interictal epileptiform discharges in Alzheimer's disease: prevalence, relevance, and controversies. Front Neurol 2023; 14:1261136. [PMID: 37808503 PMCID: PMC10551146 DOI: 10.3389/fneur.2023.1261136] [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: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Alzheimer's disease (AD) is the most common type of dementia and remains an incurable, progressive disease with limited disease-modifying interventions available. In patients with AD, interictal epileptiform discharges (IEDs) have been identified in up to 54% of combined cohorts of mild cognitive impairment (MCI) or mild dementia and are a marker of a more aggressive disease course. Studies assessing the role of IEDs in AD are limited by the lack of standardization in the definition of IEDs or the different neurophysiologic techniques used to capture them. IEDs are an appealing treatment target given the availability of EEG and anti-seizure medications. There remains uncertainty regarding when to treat IEDs, the optimal drug and dose for treatment, and the impact of treatment on disease course. This review covers the state of knowledge of the field of IEDs in AD, and the steps needed to move the field forward.
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Affiliation(s)
| | - Rani A. Sarkis
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
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6
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Forss N, Strbian D. Effect of epileptic activity on outcome for critically ill patients. Lancet Digit Health 2023:S2589-7500(23)00097-3. [PMID: 37295972 DOI: 10.1016/s2589-7500(23)00097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Nina Forss
- Department of Neurology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University, Aalto, Finland.
| | - Daniel Strbian
- Department of Neurology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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7
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Pasierski M, Kołba W, Szulczyk B. Guanfacine inhibits interictal epileptiform events and sodium currents in prefrontal cortex pyramidal neurons. Pharmacol Rep 2023; 75:331-341. [PMID: 36800106 DOI: 10.1007/s43440-023-00458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Guanfacine (an alpha-2A receptor agonist) is a commonly used drug with recognized efficacy in the treatment of attention deficit hyperactivity disorder (ADHD). This study aimed to assess the effects of guanfacine on short-lasting (interictal) epileptiform discharges in cortical neurons. Moreover, we assessed the effects of guanfacine on voltage-gated sodium currents. METHODS We conducted patch-clamp recordings in prefrontal cortex pyramidal neurons obtained from young rats. Interictal epileptiform events were evoked in cortical slices in a zero magnesium proepileptic extracellular solution with an elevated concentration of potassium ions. RESULTS Interictal epileptiform discharges were spontaneous depolarisations, which triggered action potentials. Guanfacine (10 and 100 µM) inhibited the frequency of epileptiform discharges. The effect of guanfacine on interictal events persisted in the presence of alpha-2 adrenergic receptor antagonist idazoxan. The tested drug inhibited neuronal excitability. Tonic NMDA currents were not influenced by guanfacine. Recordings from dispersed neurons showed that the tested drug (10 and 100 µM) inhibited persistent and fast inactivating voltage-gated sodium currents. CONCLUSIONS This study shows that guanfacine inhibits interictal discharges in cortical neurons independently of alpha-2A adrenergic receptors. This effect may be mediated by voltage-gated sodium currents. Inhibition of interictal activity by guanfacine may be of clinical importance because interictal events often occur in patients with ADHD and may contribute to symptoms of this disease.
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Affiliation(s)
- Michał Pasierski
- Department of Pharmacodynamics, The Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland
| | - Weronika Kołba
- Department of Pharmacodynamics, The Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland
| | - Bartłomiej Szulczyk
- Department of Pharmacodynamics, The Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland.
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8
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Operto FF, Pastorino GMG, Viggiano A, Dell’Isola GB, Dini G, Verrotti A, Coppola G. Epilepsy and Cognitive Impairment in Childhood and Adolescence: A Mini-Review. Curr Neuropharmacol 2023; 21:1646-1665. [PMID: 35794776 PMCID: PMC10514538 DOI: 10.2174/1570159x20666220706102708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
Managing epilepsy in people with an intellectual disability remains a therapeutic challenge and must take into account additional issues such as diagnostic difficulties and frequent drug resistance. Advances in genomic technologies improved our understanding of epilepsy and raised the possibility to develop patients-tailored treatments acting on the key molecular mechanisms involved in the development of the disease. In addition to conventional antiseizure medications (ASMs), ketogenic diet, hormone therapy and epilepsy surgery play an important role, especially in cases of drugresistance. This review aims to provide a comprehensive overview of the mainfactors influencing cognition in children and adolescents with epilepsy and the main therapeutic options available for the epilepsies associated with intellectual disability.
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Affiliation(s)
- Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Andrea Viggiano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, SA, Italy
| | | | - Gianluca Dini
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
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9
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Yu T, Teng ZT, Liu XY, Wang H. Effectiveness of perampanel in the treatment of pediatric patients with focal epilepsy and ESES: A single-center retrospective study. Front Pharmacol 2022; 13:1026836. [PMID: 36278197 PMCID: PMC9585220 DOI: 10.3389/fphar.2022.1026836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022] Open
Abstract
Objective: To investigate the therapeutic effect and influencing factors of perampanel (PER) on electrical status epilepticus during sleep (ESES). Methods: We retrospectively analyzed the clinical data of pediatric patients with focal epilepsy and ESES who were treated at the Epilepsy Center of Shengjing Hospital of China Medical University between January 2016 and March 2022. Changes in the spike wave index (SWI) after 24 weeks of PER add-on treatment were compared. Kaplan‒Meier survival analysis, the log-rank test and multivariate Cox regression analysis were performed. Results: A total of 54 pediatric patients met the inclusion criteria, including 33 males and 21 females. The mean age at the diagnosis of epilepsy was 6.41 ± 2.14 years and at ESES diagnosis was 7.58 ± 2.40 years. The mean ESES duration before add-on PER was 25.31 ± 15.12 months. The mean age of the patients at add-on PER initiation was 9.69 ± 2.12 years. The ESES resolved in 29 children after 6 months of PER add-on treatment, and the response rate was 53.7%. Univariate analysis with the log-rank test showed that the therapeutic effect of PER differed according to the age at ESES diagnosis and ESES duration before add-on PER treatment. Multivariate Cox regression analysis showed that only ESES duration before PER administration was a risk factor for PER treatment failure, and the other factors had no effect on the therapeutic effect. Conclusion: PER add-on treatment has a good therapeutic effect on ESES and can be used as an alternative to corticosteroid and benzodiazepines. The therapeutic effect of PER add-on treatment was not related to the dose. A longer ESES duration results in a worse therapeutic effect. Therefore, more aggressive treatment measures should be implemented for ESES.
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Kwon CS, Wirrell EC, Jetté N. Autism Spectrum Disorder and Epilepsy. Neurol Clin 2022; 40:831-847. [DOI: 10.1016/j.ncl.2022.03.011] [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]
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11
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Camarillo-Rodriguez L, Leenen I, Waldman Z, Serruya M, Wanda PA, Herweg NA, Kahana MJ, Rubinstein D, Orosz I, Lega B, Podkorytova I, Gross RE, Worrell G, Davis KA, Jobst BC, Sheth SA, Weiss SA, Sperling MR. Temporal lobe interictal spikes disrupt encoding and retrieval of verbal memory: A subregion analysis. Epilepsia 2022; 63:2325-2337. [PMID: 35708911 DOI: 10.1111/epi.17334] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The medial temporal lobe (MTL) encodes and recalls memories and can be a predominant site for interictal spikes (IS) in patients with focal epilepsy. It is unclear whether memory deficits are due to IS in the MTL producing a transient decline. Here, we investigated whether IS in the MTL subregions and lateral temporal cortex impact episodic memory encoding and recall. METHODS Seventy-eight participants undergoing presurgical evaluation for medically refractory focal epilepsy with depth electrodes placed in the temporal lobe participated in a verbal free recall task. IS were manually annotated during the pre-encoding, encoding, and recall epochs. We examined the effect of IS on word recall using mixed-effects logistic regression. RESULTS IS in the left hippocampus (odds ratio [OR] = .73, 95% confidence interval [CI] = .63-.84, p < .001) and left middle temporal gyrus (OR = .46, 95% CI = .27-.78, p < .05) during word encoding decreased subsequent recall performance. Within the left hippocampus, this effect was specific for area CA1 (OR = .76, 95% CI = .66-.88, p < .01) and dentate gyrus (OR = .74, 95% CI = .62-.89, p < .05). IS in other MTL subregions or inferior and superior temporal gyrus and IS occurring during the prestimulus window did not affect word encoding (p > .05). IS during retrieval in right hippocampal (OR = .22, 95% CI = .08-.63, p = .01) and parahippocampal regions (OR = .24, 95% CI = .07-.8, p < .05) reduced the probability of recalling a word. SIGNIFICANCE IS in medial and lateral temporal cortex contribute to transient memory decline during verbal episodic memory.
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Affiliation(s)
| | - Iwin Leenen
- Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Zachary Waldman
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mijail Serruya
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul A Wanda
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nora A Herweg
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J Kahana
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Rubinstein
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Iren Orosz
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | | | | | - Robert E Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | - Kathryn A Davis
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barbara C Jobst
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Shennan A Weiss
- Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, New York, USA.,Department of Physiology and Pharmacology, State University of New York Downstate Medical Center, Brooklyn, New York, USA.,Departments of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, New York, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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12
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Herlopian A, Barnett JR, Nascimento FA, Lee H, Thiele EA. Electroencephalographic changes in purified pharmaceutical cannabidiol therapy. Epilepsy Behav 2022; 128:108558. [PMID: 35078115 DOI: 10.1016/j.yebeh.2022.108558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evaluate electroencephalographic changes in patients receiving purified pharmaceutical cannabidiol (CBD). METHODS A total of 104 EEG studies from 52 patients with pediatric-onset refractory epilepsy, who were enrolled in the FDA-approved expanded access investigational new drug program, were retrospectively analyzed for electroencephalographic changes in the background, interictal epileptiform discharges (IEDs), ictal findings, and sleep architecture after CBD treatment. RESULTS Patients were between 18 months and 52 years of age. After CBD treatment, 88.4% (46/52) of patients had EEG changes. Eighty-nine percent of these patients had changes in their background, 74% in IEDs, 46% in ictal findings, and 17% in sleep architecture. Seven out of 52 patients had modified hypsarrhythmia on their pre-treatment EEG. The pattern resolved in 2/7 patients (29%), diminished in prevalence in 4/7 (57%) subjects, and remained unchanged in 1/7 (14%) cases. Electrographic improvement was seen in 70% (32/46) of the patients, and worsening in 7% (3/46) of the cases. At the post-CBD EEG, 83% had a reduction in the frequency of the most predominant seizure type, and 25% reported subjective cognitive improvement. Of these patients, 88% (p = 0.09) and 92% (p = 0.45) had corresponding EEG changes, respectively. CONCLUSION Our results revealed electrographic changes in association with the CBD treatment. Despite these changes, a substantial association between specific electrographic findings and clinical outcomes was not established.
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Affiliation(s)
- Aline Herlopian
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, 15 York St, LCI-7, New Haven, CT 06510, USA
| | - James R Barnett
- Pediatric Epilepsy, Program Department of Neurology, Massachusetts General Hospital Boston, MA 02114, USA
| | - Fábio A Nascimento
- Epilepsy Program, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hang Lee
- Massachusetts General Hospital Biostatistics, Harvard Medical School, 50 Staniford St, Boston, MA 02114, USA
| | - Elizabeth A Thiele
- Pediatric Epilepsy, Program Department of Neurology, Massachusetts General Hospital Boston, MA 02114, USA.
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13
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Nguyen YTK, Ha HTT, Nguyen TH, Nguyen LN. The role of SLC transporters for brain health and disease. Cell Mol Life Sci 2021; 79:20. [PMID: 34971415 PMCID: PMC11071821 DOI: 10.1007/s00018-021-04074-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/05/2021] [Accepted: 10/21/2021] [Indexed: 12/19/2022]
Abstract
The brain exchanges nutrients and small molecules with blood via the blood-brain barrier (BBB). Approximately 20% energy intake for the body is consumed by the brain. Glucose is known for its critical roles for energy production and provides substrates for biogenesis in neurons. The brain takes up glucose via glucose transporters GLUT1 and 3, which are expressed in several neural cell types. The brain is also equipped with various transport systems for acquiring amino acids, lactate, ketone bodies, lipids, and cofactors for neuronal functions. Unraveling the mechanisms by which the brain takes up and metabolizes these nutrients will be key in understanding the nutritional requirements in the brain. This could also offer opportunities for therapeutic interventions in several neurological disorders. For instance, emerging evidence suggests a critical role of lactate as an alternative energy source for neurons. Neuronal cells express monocarboxylic transporters to acquire lactate. As such, treatment of GLUT1-deficient patients with ketogenic diets to provide the brain with alternative sources of energy has been shown to improve the health of the patients. Many transporters are present in the brain, but only a small number has been characterized. In this review, we will discuss about the roles of solute carrier (SLC) transporters at the blood brain barrier (BBB) and neural cells, in transport of nutrients and metabolites in the brain.
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Affiliation(s)
- Yen T K Nguyen
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore
| | - Hoa T T Ha
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore
| | - Tra H Nguyen
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore
| | - Long N Nguyen
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore.
- SLING/Immunology Program, Life Sciences Institute, National University of Singapore, Singapore, 117456, Singapore.
- Immunology Translational and Cardiovascular Disease Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117545, Singapore.
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14
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Esmael A, Elsherbeny S, Abbas M. Association of epileptiform brain activity and specific language impairment (SLI) in preschool children. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Epileptiform activities can cause transient or permanent deficits that affect the children during development and may be accompanied by neurodevelopmental disorders like specific language impairment.
Objectives
The objective of this study was to find if there is a possible association and the impact of epilepsy and epileptiform activity in children with specific language impairment.
Patients and methods
The study was conducted on 80 children suffering from specific language impairment and 80 age and sex match healthy control children. Computed tomography brain was performed and electroencephalography was recorded for children. Intelligence quotient level, cognitive age, social, and phoniatric assessment were done for all patients.
Results
Eighty children with specific language impairment (51 males and 29 females) with a mean age of 4.11 ± 1.93. Patients with specific language impairment showed significantly higher rates of abnormal electroencephalography (P = 0.006) and epilepsy (P < 0.001) compared to the control group. Spearman correlation demonstrated a highly negative significant relationship linking the language, intelligence quotient with abnormal electroencephalography and epilepsy (r = − 0.91, P < 0.01 and r = − 0.91, P < 0.01 respectively). Also, there was a moderately inverse significant relationship linking the cognitive age, social with abnormal electroencephalography, and epilepsy (r = − 0.70, P < 0.05 and r = − 0.65, P < 0.05 respectively).
Conclusion
Epileptiform activities even without epilepsy in preschool children may alter normal language function. Specific language impairment was associated with lower intelligence quotient levels, social, and cognitive age.
Trial registration
ClinicalTrials.gov ID: NCT04141332
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15
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Duckrow RB, Ceolini E, Zaveri HP, Brooks C, Ghosh A. Artificial neural network trained on smartphone behavior can trace epileptiform activity in epilepsy. iScience 2021; 24:102538. [PMID: 34308281 PMCID: PMC8257969 DOI: 10.1016/j.isci.2021.102538] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022] Open
Abstract
A range of abnormal electrical activity patterns termed epileptiform discharges can occur in the brains of persons with epilepsy. These epileptiform discharges can be monitored and recorded with implanted devices that deliver therapeutic neurostimulation. These continuous recordings provide an opportunity to study the behavioral correlates of epileptiform discharges as the patients go about their daily lives. Here, we captured the smartphone touchscreen interactions in eight patients in conjunction with electrographic recordings (accumulating 35,714 h) and by using an artificial neural network model addressed if the behavior reflected the epileptiform discharges. The personalized model outputs based on smartphone behavioral inputs corresponded well with the observed electrographic data (R: 0.2-0.6, median 0.4). The realistic reconstructions of epileptiform activity based on smartphone use demonstrate how day-to-day digital behavior may be converted to personalized markers of disease activity in epilepsy.
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Affiliation(s)
| | - Enea Ceolini
- QuantActions GmbH, Lausanne, Switzerland
- Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden 2333 AK, The Netherlands
| | | | - Cornell Brooks
- Department of Neurology, Yale University, New Haven, CT, USA
- Amherst College, Amherst, MA, USA
| | - Arko Ghosh
- Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden 2333 AK, The Netherlands
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16
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Pellegrino G, Hedrich T, Sziklas V, Lina JM, Grova C, Kobayashi E. How cerebral cortex protects itself from interictal spikes: The alpha/beta inhibition mechanism. Hum Brain Mapp 2021; 42:3352-3365. [PMID: 34002916 PMCID: PMC8249896 DOI: 10.1002/hbm.25422] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
Interactions between interictal epileptiform discharges (IEDs) and distant cortical regions subserve potential effects on cognition of patients with focal epilepsy. We hypothesize that "healthy" brain areas at a distance from the epileptic focus may respond to the interference of IEDs by generating inhibitory alpha and beta oscillations. We predict that more prominent alpha-beta oscillations can be found in patients with less impaired neurocognitive profile. We performed a source imaging magnetoencephalography study, including 41 focal epilepsy patients: 21 with frontal lobe epilepsy (FLE) and 20 with mesial temporal lobe epilepsy. We investigated the effect of anterior (i.e., frontal and temporal) IEDs on the oscillatory pattern over posterior head regions. We compared cortical oscillations (5-80 Hz) temporally linked to 3,749 IEDs (1,945 frontal and 1,803 temporal) versus an equal number of IED-free segments. We correlated results from IED triggered oscillations to global neurocognitive performance. Only frontal IEDs triggered alpha-beta oscillations over posterior head regions. IEDs with higher amplitude triggered alpha-beta oscillations of higher magnitude. The intensity of posterior head region alpha-beta oscillations significantly correlated with a better neuropsychological profile. Our study demonstrated that cerebral cortex protects itself from IEDs with generation of inhibitory alpha-beta oscillations at distant cortical regions. The association of more prominent oscillations with a better cognitive status suggests that this mechanism might play a role in determining the cognitive resilience in patients with FLE.
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Affiliation(s)
- Giovanni Pellegrino
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Tanguy Hedrich
- Department of Biomedical Engineering, Multimodal Functional Imaging Lab, McGill University, Montreal, Quebec, Canada
| | - Viviane Sziklas
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jean-Marc Lina
- Departement de Genie Electrique, Ecole de Technologie Superieure, Montreal, Quebec, Canada.,Centre De Recherches En Mathematiques, Montreal, Quebec, Canada
| | - Christophe Grova
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Department of Biomedical Engineering, Multimodal Functional Imaging Lab, McGill University, Montreal, Quebec, Canada.,Centre De Recherches En Mathematiques, Montreal, Quebec, Canada.,Department of Physics and PERFORM Centre, Concordia University, Montreal, Quebec, Canada
| | - Eliane Kobayashi
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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17
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Karoly PJ, Rao VR, Gregg NM, Worrell GA, Bernard C, Cook MJ, Baud MO. Cycles in epilepsy. Nat Rev Neurol 2021; 17:267-284. [PMID: 33723459 DOI: 10.1038/s41582-021-00464-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 01/31/2023]
Abstract
Epilepsy is among the most dynamic disorders in neurology. A canonical view holds that seizures, the characteristic sign of epilepsy, occur at random, but, for centuries, humans have looked for patterns of temporal organization in seizure occurrence. Observations that seizures are cyclical date back to antiquity, but recent technological advances have, for the first time, enabled cycles of seizure occurrence to be quantitatively characterized with direct brain recordings. Chronic recordings of brain activity in humans and in animals have yielded converging evidence for the existence of cycles of epileptic brain activity that operate over diverse timescales: daily (circadian), multi-day (multidien) and yearly (circannual). Here, we review this evidence, synthesizing data from historical observational studies, modern implanted devices, electronic seizure diaries and laboratory-based animal neurophysiology. We discuss advances in our understanding of the mechanistic underpinnings of these cycles and highlight the knowledge gaps that remain. The potential clinical applications of a knowledge of cycles in epilepsy, including seizure forecasting and chronotherapy, are discussed in the context of the emerging concept of seizure risk. In essence, this Review addresses the broad question of why seizures occur when they occur.
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Affiliation(s)
- Philippa J Karoly
- Graeme Clark Institute, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Vikram R Rao
- Department of Neurology, University of California, San Francisco, CA, USA.,Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Nicholas M Gregg
- Bioelectronics, Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Gregory A Worrell
- Bioelectronics, Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Christophe Bernard
- Aix Marseille University, Inserm, Institut de Neurosciences des Systèmes, Marseille, France
| | - Mark J Cook
- Graeme Clark Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maxime O Baud
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland. .,Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland.
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18
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Peter‐Derex L, Klimes P, Latreille V, Bouhadoun S, Dubeau F, Frauscher B. Sleep Disruption in Epilepsy: Ictal and Interictal Epileptic Activity Matter. Ann Neurol 2020; 88:907-920. [DOI: 10.1002/ana.25884] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/27/2020] [Accepted: 08/16/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Laure Peter‐Derex
- Analytical Neurophysiology Lab Montreal Neurological Institute and Hospital, McGill University Montreal QC Canada
- Center for Sleep Medicine and Respiratory Diseases Lyon University Hospital, Lyon 1 University Lyon France
- Lyon Neuroscience Research Center, CNRS UMR5292 / INSERM, U1028 Lyon France
| | - Petr Klimes
- Analytical Neurophysiology Lab Montreal Neurological Institute and Hospital, McGill University Montreal QC Canada
- Institute of Scientific Instruments, The Czech Academy of Sciences Brno Czech Republic
| | - Véronique Latreille
- Analytical Neurophysiology Lab Montreal Neurological Institute and Hospital, McGill University Montreal QC Canada
| | - Sarah Bouhadoun
- Analytical Neurophysiology Lab Montreal Neurological Institute and Hospital, McGill University Montreal QC Canada
| | - François Dubeau
- Montreal Neurological Institute and Hospital, McGill University Montreal QC Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Lab Montreal Neurological Institute and Hospital, McGill University Montreal QC Canada
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19
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Precenzano F, Parisi L, Lanzara V, Vetri L, Operto FF, Pastorino GMG, Ruberto M, Messina G, Risoleo MC, Santoro C, Bitetti I, Marotta R. Electroencephalographic Abnormalities in Autism Spectrum Disorder: Characteristics and Therapeutic Implications. ACTA ACUST UNITED AC 2020; 56:medicina56090419. [PMID: 32825169 PMCID: PMC7559692 DOI: 10.3390/medicina56090419] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/03/2022]
Abstract
A large body of literature reports the higher prevalence of epilepsy in subjects with Autism Spectrum Disorder (ASD) compared to the general population. Similarly, several studies report an increased rate of Subclinical Electroencephalographic Abnormalities (SEAs) in seizure-free patients with ASD rather than healthy controls, although with varying percentages. SEAs include both several epileptiform discharges and different non-epileptiform electroencephalographic abnormalities. They are more frequently associated with lower intellectual functioning, more serious dysfunctional behaviors, and they are often sign of severer forms of autism. However, SEAs clinical implications remain controversial, and they could represent an epiphenomenon of the neurochemical alterations of autism etiology. This paper provides an overview of the major research findings with two main purposes: to better delineate the state-of-the-art about EEG abnormalities in ASD and to find evidence for or against appropriateness of SEAs pharmacological treatment in ASD.
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Affiliation(s)
- Francesco Precenzano
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
| | - Lucia Parisi
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Valentina Lanzara
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
| | - Luigi Vetri
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
- Correspondence: or ; Tel.: +39-328-643-4126
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Grazia Maria Giovanna Pastorino
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Maria Ruberto
- Centro Pro Juventute Minerva SRL, 80131 Napoli, Italy;
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Maria Cristina Risoleo
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Department of Medical and Surgical Science, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Claudia Santoro
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
| | - Ilaria Bitetti
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
| | - Rosa Marotta
- Department of Medical and Surgical Science, University “Magna Graecia”, 88100 Catanzaro, Italy;
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20
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Karami M, Nilipour R, Barekatain M, Gaillard WD. Language representation and presurgical language mapping in pediatric epilepsy: A narrative review. IRANIAN JOURNAL OF CHILD NEUROLOGY 2020; 14:7-18. [PMID: 32952578 PMCID: PMC7468084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 11/25/2022]
Abstract
As one of the most common neurological diseases in children, epilepsy affects 0.9-2% of children. Complex interactions among the etiologies of epilepsy, interictal discharges, seizures, and antiepileptic drugs lead to cognitive impairments in children with epilepsy. Since epilepsy is considered as a network disorder, in which seizures have a widespread impact on many parts of the brain, childhood epilepsy can even affect the normal development of language. About 25% of children with epilepsy do not respond to medications; therefore, brain surgery is considered as a treatment option for some of them. Presurgical neuropsychological evaluations including language mapping are recommended to preserve cognitive and language abilities of patients after surgery. Functional magnetic resonance imaging as a non-invasive technique for presurgical language mapping has been widely recommended in many epileptic centers. The present study reviewed language representation and presurgical language mapping in children with epilepsy. Mapping language in children with epilepsy helps to localize the epileptogenic zone, and also, to predict the cognitive outcome of epilepsy surgery and possible cognitive rehabilitation. This review collected information about language representation and language mapping in pediatric epilepsy settings.
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Affiliation(s)
- Mahdieh Karami
- PhD of Cognitive Science of Language, ICSS, Tehran, Iran
| | - Reza Nilipour
- Emeritus Professor of Neurolinguistics and Clinical Linguistics, Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Majid Barekatain
- Professor of Neuropsychiatry, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - William D Gaillard
- Professor of Neurology and Pediatrics, George Washington University, Center for Neuroscience and Behavioral Health, Children's National Medical Center, Washington DC. USA
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21
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Luz-Escamilla L, Morales-González JA. Association between Interictal Epileptiform Discharges and Autistic Spectrum Disorder. Brain Sci 2019; 9:brainsci9080185. [PMID: 31366163 PMCID: PMC6721430 DOI: 10.3390/brainsci9080185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023] Open
Abstract
It has been reported that bioelectric alterations in an electroencephalogram (EEG) may play an etiological role in neurodevelopmental disorders. The clinical impact of interictal epileptiform discharges (IEDs) in association with autistic spectrum disorder (ASD) is unknown. The Autism Diagnostic Interview-Revised (ADI-R) is one of the gold standards for the diagnosis of autistic spectrum disorder. Some studies have indicated high comorbidity of IED and ASD, while other studies have not supported an association between the central symptoms of autism and IED. This review examines the high comorbidity and clinical impact of IED; patients with epilepsy are excluded from the scope of this review. ASD can be disabling and is diagnosed at an average age of 5 years old, at which point the greatest neurological development has occurred. If an association between IED and ASD is identified, a clinical tool that entails an innocuous procedure could enable diagnosis in the first years of life. However, in the absence of reports that prove an association between IED and ASD, patients should not be subjected to expensive treatments, such as the administration of anticonvulsant therapies.
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Affiliation(s)
- Laura Luz-Escamilla
- Laboratorio de Medicina de Conservación y Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón S/N, Col. Casco de Santo Tomás, Alcaldía Miguel Hidalgo CP 11340, México.
- Departamento de Higiene Mental, Hospital General Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Distrito Federal CP 02990, México.
| | - José Antonio Morales-González
- Laboratorio de Medicina de Conservación y Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón S/N, Col. Casco de Santo Tomás, Alcaldía Miguel Hidalgo CP 11340, México.
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22
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Fattinger S, Heinzle BB, Ramantani G, Abela L, Schmitt B, Huber R. Closed-Loop Acoustic Stimulation During Sleep in Children With Epilepsy: A Hypothesis-Driven Novel Approach to Interact With Spike-Wave Activity and Pilot Data Assessing Feasibility. Front Hum Neurosci 2019; 13:166. [PMID: 31164813 PMCID: PMC6536690 DOI: 10.3389/fnhum.2019.00166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
Slow waves, the electroencephalographic (EEG) hallmark of deep sleep, can be systematically manipulated by acoustic stimulation: stimulation time-locked to the down phase of slow waves reduces, whereas stimulation time-locked to the up phase increases slow waves. Spike-waves during sleep seem to be related to slow waves, raising the question of whether spike-waves can be systematically influenced by such acoustic stimulation. In five pediatric patients, all-night EEG was recorded, combined with real-time slow wave detection. Throughout the night, acoustic stimulation was performed in a 3 × 5-min-block design (no stimulation—stimulation—no stimulation). Tones were applied time-locked either to the up or to the down phase of the detected slow waves in an alternating pattern. All patients tolerated the acoustic stimulation during sleep well. They showed high sleep quality and no signs of clinical or non-convulsive electrographic seizures. Our preliminary analysis shows no systematic effect of acoustic stimulation on spike-wave activity. Moreover, with our stimulation approach tones were distributed over a rather broad phase-range during the DOWN or UP stimulation and showed inter-individual differences in their distribution. In this study, we applied for the first time an acoustic closed-loop slow wave stimulation tool for a non-invasive manipulation of spike-wave activity. Thus, our pilot data show that closed-loop acoustic stimulation is feasible and well tolerated in children with spike wave activity during sleep. Improved precision in phase targeting and personalized stimulation parameters in a larger sample of subjects might be needed to show systematic effects.
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Affiliation(s)
- Sara Fattinger
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bigna Bölsterli Heinzle
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Georgia Ramantani
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lucia Abela
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bernhard Schmitt
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Abstract
PURPOSE OF REVIEW The estimation of seizure frequency is a cornerstone of clinical management of epilepsy and the evaluation of new therapies. Current estimation approaches are significantly limited by several factors. Comparing patient diaries and objective estimates (through both inpatient video-EEG monitoring of and long-term ambulatory EEG studies) reveal that patients document seizures inaccurately. So far, few practical alternative methods of estimation have been available. RECENT FINDINGS We review the systems of counting currently utilized and their limitations, as well as the limitations imposed by problems defining clinical events. Alternative methodologies that permit the volatility of seizure rates to be accommodated, and possible alternative measures of brain excitability will be outlined. Recent developments in technologies around data capture, such as wearable and implantable devices, as well as significant advances in the ability to analyse the large data-sets supplied by these systems have provided a wealth of information. SUMMARY There are now unprecedented opportunities to utilize and apply these insights in routine clinical management and assessment of therapies. The rapid adoption of long-term, wearable monitoring systems will permit major advances in our understanding of the natural history of epilepsy, and lead to more effective therapies and improved patient safety.
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Systad S, Bjørnvold M, Sørensen C, Lyster SAH. The Value of Electroencephalogram in Assessing Children With Speech and Language Impairments. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:153-168. [PMID: 30950754 DOI: 10.1044/2018_jslhr-l-17-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose We sought to estimate the prevalence of isolated epileptiform activity (IEA) in children with speech and language impairments and discuss the utility of an electroencephalogram (EEG) in assessing these children. Method We conducted a systematic review and searched for eligible studies in 8 databases. All languages were included, and meta-analyses were performed. Results We found 55 prevalence estimates (8 with control group). The odds of having IEA were 6 times greater for children with speech and language impairments than for typically developing children. The overall pooled prevalence of IEA was 27.3%. A wide variation between the prevalence estimates was, to a certain degree, explained by type of impairment (8.1% in speech impairments, 25.8% in language impairments, and 51.5% in language regression). Sleep EEGs detected a significantly higher prevalence than awake EEGs. Although the presence of epilepsy gave a significantly higher prevalence than if epilepsy was not present, 33.5% of children with language impairment but without epilepsy were found to have IEA in sleep EEGs. Conclusions This systematic review shows that IEA is 6 times more prevalent in children with speech and language impairment than in typically developing children. However, the prevalence rates vary to a great extent. Uncovering IEA will, in addition to information from other clinical assessments, provide a more comprehensive understanding of the child's impairments. We argue that, although EEG is of questionable value when assessing children with speech impairments, sleep EEG could be valuable when assessing children with language impairments and, in particular, children who experience language regression.
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Affiliation(s)
- Silje Systad
- Department of Special Needs Education, University of Oslo, Norway
- Solberg School, Akershus County, Norway
| | - Marit Bjørnvold
- Department of Refractory Epilepsy-SSE, Oslo University Hospital, Norway
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Epilepsy in Children with Autistic Spectrum Disorder. CHILDREN-BASEL 2019; 6:children6020015. [PMID: 30691036 PMCID: PMC6406948 DOI: 10.3390/children6020015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/21/2022]
Abstract
The comorbidity of autistic spectrum disorder (ASD) and epilepsy has been widely discussed but many questions still remain unanswered. The aim of this study was to establish the occurrence of epilepsy among children with ASD to define the type of epileptic seizures and syndromes, the age of onset of epilepsy, EEG abnormalities, the used antiepileptic drugs and the therapeutic responses for seizures and autistic behavior, as well as to find some correlations between epilepsy and gender, etiology and intellectual disability (ID). A retrospective study of medical files of 59 patients (aged 1–18 years) with ASD during a 5-year period was performed. ASD diagnosis was based on the DSM-5 diagnostic criteria. The patients were examined with a detailed medical history, physical and neurological examination, as well as some additional functional, imaging, laboratory and genetic investigations ASD etiology was syndromic in 9, probable syndromic in 9, and idiopathic in 41 children. ID was established in 90% of ASD children, and epilepsy in 44.4%. The onset of epilepsy prevailed before 7 years of age. The most common seizure types were focal with or without secondary generalization (53.4%). Focal epileptiform EEG abnormalities prevailed. Therapeutic response to seizures was good: 58% were seizure-free, while 27% had >50% seizure reduction but no improvement in autistic behavior. There was no correlation between epilepsy and either occurrence or degree of ID. There was a correlation between the frequency of epileptic seizures and the degree of ID. There was no significant difference among epilepsy rates in different etiologic, gender, and ID groups, probably because of the high percentage of ID and because this was a hospital-based study. Our study showed a significant percentage of epilepsy in ASD population and more than 1/4 were of symptomatic etiology. Those could be managed with specific treatments based on the pathophysiology of the gene defect.
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Landi S, Petrucco L, Sicca F, Ratto GM. Transient Cognitive Impairment in Epilepsy. Front Mol Neurosci 2019; 11:458. [PMID: 30666185 PMCID: PMC6330286 DOI: 10.3389/fnmol.2018.00458] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 11/28/2018] [Indexed: 02/05/2023] Open
Abstract
Impairments of the dialog between excitation and inhibition (E/I) is commonly associated to neuropsychiatric disorders like autism, bipolar disorders and epilepsy. Moderate levels of hyperexcitability can lead to mild alterations of the EEG and are often associated with cognitive deficits even in the absence of overt seizures. Indeed, various testing paradigms have shown degraded performances in presence of acute or chronic non-ictal epileptiform activity. Evidences from both animal models and the clinics suggest that anomalous activity can cause cognitive deficits by transiently disrupting cortical processing, independently from the underlying etiology of the disease. Here, we will review our understanding of the influence of an abnormal EEG activity on brain computation in the context of the available clinical data and in genetic or pharmacological animal models.
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Affiliation(s)
- Silvia Landi
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Pisa, Italy
| | - Luigi Petrucco
- Graduate School of Systemic Neurosciences, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Federico Sicca
- Department of Developmental Neuroscience, Fondazione IRCCS Stella Maris, Pisa, Italy
| | - Gian Michele Ratto
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Pisa, Italy
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Abstract
After more than 85 years of development and use in clinical practice, the electroencephalogram (EEG) remains a dependable, inexpensive, and useful diagnostic tool for the investigation of the electrophysiologic activity of the brain. The advent of digital technology has led to greater sophistication and multiple software applications to extend the utility of EEG beyond the confines of the laboratory. Despite the discovery of new waveforms, basic neurophysiologic principles remain essential to the clinical care of patients. Patterns in the interictal EEG make it possible to clarify the differential diagnosis of paroxysmal neurological events, classify seizure type and epilepsy syndromes, and characterize and quantify seizures when ictal recordings are obtained. EEG can also demonstrate cerebral dysfunction when structural imaging is normal to detect focal or lateralized abnormalities in patients with encephalopathy. High-density EEG with electrical source imaging has improved localization in candidates for epilepsy surgery. Quantitative EEG and broadband EEG are advancing our understanding of the functional processes of the brain itself.
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Affiliation(s)
- Anteneh M Feyissa
- Department of Neurology, Mayo Clinic College of Medicine and Health Sciences, Jacksonville, FL, United States.
| | - William O Tatum
- Department of Neurology, Mayo Clinic College of Medicine and Health Sciences, Jacksonville, FL, United States
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Kanemura H, Sano F, Ohyama T, Aihara M. Efficacy of levetiracetam for reducing rolandic discharges in comparison with carbamazepine and valproate sodium in rolandic epilepsy. Seizure 2018; 62:79-83. [PMID: 30308427 DOI: 10.1016/j.seizure.2018.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The main purpose of this study was to compare the efficacy of levetiracetam (LEV) with the older antiepileptic drugs (AEDs) for preventing atypical evolution in children with Rolandic epilepsy (RE). Accordingly, the present study compared the efficacy of older AEDs (carbamazepine (CBZ) and valproate sodium (VPA)) with LEV in reducing rolandic discharges (RDs) on interictal electroencephalogram (EEG) in children with RE. METHODS Patients in this heterogenous study were subdivided into CBZ, VPA and LEV groups in accordance with the initial monotherapy. The CBZ and VPA groups were studied retrospectively, but the LEV group was studied prospectively. Appearances of discharges were counted and these rates were computed. In comparison with the baseline RD frequency, EEG response to AED treatment was classified such as complete disappearance and response (≥50% reduction in RD frequency). The time taken to attain complete disappearance or response in EEG responders was assessed for each AED treatment group. RESULTS Responders comprised 10 (11.2%) of the 89 patients treated with CBZ, 41 (56.2%) of the 73 patients with VPA, and 25 (71.4%) of the 35 patients with LEV. Mean interval to achievement of EEG response in the CBZ, VPA, and LEV groups were 36.3, 23.1, and 14.7 months, respectively. EEG response was achieved significantly more rapidly with LEV than with CBZ (p < 0.001) or VPA (p < 0.005). Seizure control was not significantly different in all 3 investigated drugs. CONCLUSIONS LEV seems to be superior to CBZ and VPA in its ability to suppress RDs in children with RE.
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Affiliation(s)
- Hideaki Kanemura
- Department of Paediatrics, Faculty of Medicine, Graduate School, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan.
| | - Fumikazu Sano
- Department of Paediatrics, Faculty of Medicine, Graduate School, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
| | - Tetsuo Ohyama
- Department of Paediatrics, Faculty of Medicine, Graduate School, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
| | - Masao Aihara
- Graduate Faculty of Interdisciplinary Research, Graduate School, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
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Gogolou A, Tsandilas T, Palpanas T, Bezerianos A. Comparing Similarity Perception in Time Series Visualizations. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2018; 25:523-533. [PMID: 30136982 DOI: 10.1109/tvcg.2018.2865077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A common challenge faced by many domain experts working with time series data is how to identify and compare similar patterns. This operation is fundamental in high-level tasks, such as detecting recurring phenomena or creating clusters of similar temporal sequences. While automatic measures exist to compute time series similarity, human intervention is often required to visually inspect these automatically generated results. The visualization literature has examined similarity perception and its relation to automatic similarity measures for line charts, but has not yet considered if alternative visual representations, such as horizon graphs and colorfields, alter this perception. Motivated by how neuroscientists evaluate epileptiform patterns, we conducted two experiments that study how these three visualization techniques affect similarity perception in EEG signals. We seek to understand if the time series results returned from automatic similarity measures are perceived in a similar manner, irrespective of the visualization technique; and if what people perceive as similar with each visualization aligns with different automatic measures and their similarity constraints. Our findings indicate that horizon graphs align with similarity measures that allow local variations in temporal position or speed (i.e., dynamic time warping) more than the two other techniques. On the other hand, horizon graphs do not align with measures that are insensitive to amplitude and y-offset scaling (i.e., measures based on z-normalization), but the inverse seems to be the case for line charts and colorfields. Overall, our work indicates that the choice of visualization affects what temporal patterns we consider as similar, i.e., the notion of similarity in time series is not visualization independent.
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Abstract
PURPOSE OF REVIEW Cognitive impairments are common in children with epilepsy. They may already be present before the onset of epilepsy or occur - and even progress - during its course. Many variables contribute to cognitive dysfunction. Those that can be targeted to prevent (further) cognitive impairment will be highlighted in this review. RECENT FINDINGS Ideally, but not yet realistically, epileptogenesis is prevented to avert seizures and cognitive impairments in high-risk patients. New and targeted treatments of progressive epileptogenic disorders and precision medicine approaches in genetic epilepsies are increasingly applied. Cognitive outcome benefits from early diagnosis and treatment of epileptic encephalopathy. Ongoing seizures may cause permanent and progressive changes in brain structure and connectivity, suggesting that early seizure control optimizes eventual cognitive functioning. Frequent interictal epileptiform discharges justify treatment in children with cognitive impairments that are otherwise unexplained. Cognitive adverse effects of antiepileptic drugs should be closely monitored and balanced against potential benefits. Finally, early surgical treatment in selected candidates will improve their cognitive outcome. SUMMARY Although important determinants of intellectual functioning - including the child's genetic and environmental background and the epileptogenic pathology - may not be modifiable, several variables that contribute to cognitive impairment can be targeted to improve outcome. Early etiological diagnosis, personalized therapies, presurgical evaluation, and strict control of seizures - or in some patients interictal discharges - can prevent (further) cognitive impairments.
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31
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Baumer FM, Cardon AL, Porter BE. Language Dysfunction in Pediatric Epilepsy. J Pediatr 2018; 194:13-21. [PMID: 29241678 PMCID: PMC5826845 DOI: 10.1016/j.jpeds.2017.10.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA.
| | - Aaron L Cardon
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Brenda E Porter
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
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Vega C, Sánchez Fernández I, Peters J, Thome-Souza MS, Jackson M, Takeoka M, Wilkening GN, Pearl PL, Chapman K, Loddenkemper T. Response to clobazam in continuous spike-wave during sleep. Dev Med Child Neurol 2018; 60:283-289. [PMID: 29168169 DOI: 10.1111/dmcn.13607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the efficacy of clobazam treatment in reducing epileptiform discharges and modifying neuropsychological function in continuous spike-wave during slow wave sleep. METHOD We performed a prospective clinical trial in patients with continuous spike-wave during sleep aged 4 to 10 years. Patients underwent neuropsychological assessment and overnight electroencephalographic monitoring before treatment, and subsequent repeat assessment and overnight electroencephalographic monitoring 3 months after treatment. Treatment consisted of 1mg/kg clobazam up to a maximum dose of 30mg during the first night, followed by 0.5mg/kg nightly for 3 months. RESULTS Nine patients completed the study and had pre- and post-neuropsychological evaluation. There was a qualitative reduction in median (p25 -p75 ) spike percentage after 3 months (72.2 [68.0-75.8] vs 32.7 [4.7-81.7]). There were no marked changes in median (p25 -p75 ) IQ comparing pre- and post-clobazam treatment (80.0 [74.0-88.0] vs 80.0 [67.0-89.0]). There was a qualitative increase in Verbal IQ (83.0 [69.0-92.0] vs 95.0 [83.0-99.0]) and a qualitative decrease in Non-verbal IQ (84.0 [74.0-87.0] vs 71.0 [60.0-84.0]). INTERPRETATION Qualitative improvements in epileptiform activity and cognition occurred in patients treated with clobazam for 3 months and the relationship between epileptiform activity and cognitive outcome should be studied in larger studies. WHAT THIS PAPER ADDS Verbal IQ in patients with continuous spike-wave during sleep improved following short-term treatment with clobazam. Other neuropsychological improvements were observed, but varied by patient. Cognitive improvement was observed despite some worsening of epileptiform discharges.
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Affiliation(s)
- Clemente Vega
- Neurology/Psychiatry, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Ivan Sánchez Fernández
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA.,Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Jurriaan Peters
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Maria S Thome-Souza
- Departments of Neurology and Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Michele Jackson
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Masanori Takeoka
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Greta N Wilkening
- Pediatrics and Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Phillip L Pearl
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Kevin Chapman
- Pediatrics and Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Tobias Loddenkemper
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
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Hirosawa T, Kikuchi M, Fukai M, Hino S, Kitamura T, An KM, Sowman P, Takahashi T, Yoshimura Y, Miyagishi Y, Minabe Y. Association Between Magnetoencephalographic Interictal Epileptiform Discharge and Cognitive Function in Young Children With Typical Development and With Autism Spectrum Disorders. Front Psychiatry 2018; 9:568. [PMID: 30510521 PMCID: PMC6254014 DOI: 10.3389/fpsyt.2018.00568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/18/2018] [Indexed: 12/23/2022] Open
Abstract
Electroencephalograms of individuals with autism spectrum disorders (ASD) show higher rates of interictal epileptiform discharges (IEDs), which are known to have an inverse association with cognitive function in typically developed (TD) children. Nevertheless, that phenomenon has not been investigated adequately in children with ASD. From university and affiliated hospitals, 163 TD children (84 male, 79 female, aged 32-89 months) and 107 children (85 male, 22 female, aged 36-98 months) with ASD without clinical seizure were recruited. We assessed their cognitive function using the Kaufman Assessment Battery for Children (K-ABC) and recorded 10 min of MEG. Original waveforms were visually inspected. Then a linear regression model was applied to evaluate the association between the IED frequency and level of their cognitive function. Significantly higher rates of IEDs were found in the ASD group than in the TD group. In the TD group, we found significant negative correlation between mental processing scale scores (MPS) and the IED frequency. However, for the ASD group, we found significant positive correlation between MPS scores and the IED frequency. In terms of the achievement scale, correlation was not significant in either group. Although we found a correlative rather than a causal effect, typically developed children with higher IED frequency might better be followed up carefully. Furthermore, for children with ASD without clinical seizure, clinicians might consider IEDs as less harmful than those observed in TD children.
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Affiliation(s)
- Tetsu Hirosawa
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.,Department of Cognitive Science, Australian Hearing Hub, Macquarie University, Sydney, NSW, Australia
| | - Mitsuru Kikuchi
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.,Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
| | - Mina Fukai
- Department of Neuropsychiatry, Ishikawa Prefectural Takamatsu Hospital, Ishikawa, Japan
| | - Shoryoku Hino
- Department of Neuropsychiatry, Ishikawa Prefectural Takamatsu Hospital, Ishikawa, Japan
| | - Tatsuru Kitamura
- Department of Neuropsychiatry, Ishikawa Prefectural Takamatsu Hospital, Ishikawa, Japan
| | - Kyung-Min An
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
| | - Paul Sowman
- Department of Cognitive Science, Australian Hearing Hub, Macquarie University, Sydney, NSW, Australia
| | | | - Yuko Yoshimura
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
| | - Yoshiaki Miyagishi
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yoshio Minabe
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.,Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
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Kanner AM, Scharfman H, Jette N, Anagnostou E, Bernard C, Camfield C, Camfield P, Legg K, Dinstein I, Giacobe P, Friedman A, Pohlmann-Eden B. Epilepsy as a Network Disorder (1): What can we learn from other network disorders such as autistic spectrum disorder and mood disorders? Epilepsy Behav 2017; 77:106-113. [PMID: 29107450 PMCID: PMC9835466 DOI: 10.1016/j.yebeh.2017.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/16/2017] [Indexed: 01/16/2023]
Abstract
Epilepsy is a neurologic condition which often occurs with other neurologic and psychiatric disorders. The relation between epilepsy and these conditions is complex. Some population-based studies have identified a bidirectional relation, whereby not only patients with epilepsy are at increased risk of suffering from some of these neurologic and psychiatric disorders (migraine, stroke, dementia, autism, depression, anxiety disorders, Attention deficit hyperactivity disorder (ADHD), and psychosis), but also patients with these conditions are at increased risk of suffering from epilepsy. The existence of common pathogenic mechanisms has been postulated as a potential explanation of this phenomenon. To reassess the relationships between neurological and psychiatric conditions in general, and specifically autism, depression, Alzheimer's disease, schizophrenia, and epilepsy, a recent meeting brought together basic researchers and clinician scientists entitled "Epilepsy as a Network Disorder." This was the fourth in a series of conferences, the "Fourth International Halifax Conference and Retreat". This manuscript summarizes the proceedings on potential relations between Epilepsy on the one hand and autism and depression on the other. A companion manuscript provides a summary of the proceedings about the relation between epilepsy and Alzheimer's disease and schizophrenia, closed by the role of translational research in clarifying these relationships. The review of the topics in these two manuscripts will provide a better understanding of the mechanisms operant in some of the common neurologic and psychiatric comorbidities of epilepsy.
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Affiliation(s)
- Andres M. Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW 14th Street, Room #1324, Miami, FL 33136, USA,Corresponding author. (A.M. Kanner)
| | - Helen Scharfman
- New York University Langone Medical Center, New York, NY 10016, USA,The Nathan Kline Institute, Orangeburg, NY, USA
| | - Nathalie Jette
- Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, NY, USA,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Evdokia Anagnostou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
| | - Christophe Bernard
- NS – Institute de Neurosciences des Systemes, UMR INSERM 1106, Aix-Marseille Université, Equipe Physionet, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Carol Camfield
- Department of Pediatrics, Dalhousie University Halifax, Nova Scotia, Canada
| | - Peter Camfield
- Department of Pediatrics, Dalhousie University Halifax, Nova Scotia, Canada
| | - Karen Legg
- Division of Neurology, Department of Medicine, Halifax Infirmary, Halifax B3H4R2, Nova Scotia, Canada
| | - Ilan Dinstein
- Departments of Psychology and Brain & Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Peter Giacobe
- Centre for Mental Health, University of Toronto, University Health Network, Canada
| | - Alon Friedman
- Departments of Physiology and Cell Biology, Brain & Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel,Departments of Medical Neuroscience and Pediatrics, Faculty of Medicine, Dalhousie University Halifax, NS, Canada
| | - Bernd Pohlmann-Eden
- Brain Repair Center, Life Science Research Institute, Dalhousie University, Room 229, PO Box 15000, Halifax, Nova Scotia B3H4R2, Canada
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Nissenkorn A, Pappo A, Feldmann Y, Heimer G, Bar-Yosef O, Tzadok M, Polack O, Bord A, Levav M, Ben-Zeev B. Influence of epileptic activity during sleep on cognitive performance in benign childhood epilepsy with centrotemporal spikes. Eur J Paediatr Neurol 2017; 21:858-863. [PMID: 28734769 DOI: 10.1016/j.ejpn.2017.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 04/27/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Benign childhood epilepsy with centrotemporal spikes is benign childhood epilepsy, presenting between 4 and 10 years of age, characterized by typical clinical and EEG findings. Despite excellent prognosis, there are reports of mild cognitive, language, fine motor and behavioral difficulties. In its atypical form - electrical status epilepticus during slow wave sleep, continuous epileptiform activity during sleep lead to severe neurocognitive deterioration. Our objective was to investigate the influence of abundant sleep epileptiform activity, not fulfilling the criteria for electrical status epilepticus during Slow Wave Sleep, discovered randomly in children without overt intellectual impairment. METHODS We retrospectively reviewed the charts and EEG's of 34 children with benign childhood epilepsy with centrotemporal spikes, who underwent neurocognitive evaluation. The neurocognitive battery included items in the following domains: attention span, memory, language, fine motor and behavior. Patients were divided into two groups according to the spike wave index on sleep EEG, with a cut-off point of 50%. The groups were compared regarding to neurocognitive performance. OUTCOMES Children with epileptiform activity of more than 50%, were diagnosed at a significantly younger age (5.13 ± 1.94 years vs. 7.17 ± 2.45, p = 0.014 T test), had less controlled seizures and received more antiepileptic drugs. However, there was no difference in neurocognitive performance, except in fine motor tasks (Pegboard), where children with more abundant activity were scored lower (-0.79 ± 0.96 vs. 0.20 ± 1.05, p = 0.011, T test). CONCLUSION Our study did not show negative cognitive effect of abundant epileptiform activity discovered randomly in children with benign childhood epilepsy with centrotemporal spikes, warranting aggressive treatment.
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Affiliation(s)
- Andreea Nissenkorn
- Service for Rare Disorders, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel; Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Adi Pappo
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics C, Schneider Children's Medical Center, Petah Tiqva, Israel
| | - Yael Feldmann
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel
| | - Gali Heimer
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Ha Shomer, Israel
| | - Omer Bar-Yosef
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel
| | - Michal Tzadok
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel
| | - Orli Polack
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel
| | - Ayelet Bord
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel
| | - Miriam Levav
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel
| | - Bruria Ben-Zeev
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Boly M, Jones B, Findlay G, Plumley E, Mensen A, Hermann B, Tononi G, Maganti R. Altered sleep homeostasis correlates with cognitive impairment in patients with focal epilepsy. Brain 2017; 140:1026-1040. [PMID: 28334879 DOI: 10.1093/brain/awx017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 12/20/2016] [Indexed: 11/13/2022] Open
Abstract
In animal studies, both seizures and interictal spikes induce synaptic potentiation. Recent evidence suggests that electroencephalogram slow wave activity during sleep reflects synaptic potentiation during wake, and that its homeostatic decrease during the night is associated with synaptic renormalization and its beneficial effects. Here we asked whether epileptic activity induces plastic changes that can be revealed by high-density electroencephalography recordings during sleep in 15 patients with focal epilepsy and 15 control subjects. Compared to controls, patients with epilepsy displayed increased slow wave activity power during non-rapid eye movement sleep over widespread, bilateral scalp regions. This global increase in slow wave activity power was positively correlated with the frequency of secondarily generalized seizures in the 3-5 days preceding the recordings. Individual patients also showed local increases in sleep slow wave activity power at scalp locations matching their seizure focus. This local increase in slow wave activity power was positively correlated with the frequency of interictal spikes during the last hour of wakefulness preceding sleep. By contrast, frequent interictal spikes during non-rapid eye movement sleep predicted a reduced homeostatic decrease in the slope of sleep slow waves during the night, which in turn predicted reduced daytime learning. Patients also showed an increase in sleep spindle power, which was negatively correlated with intelligence quotient. Altogether, these findings suggest that both seizures and interictal spikes may induce long-lasting changes in the human brain that can be sensitively detected by electroencephalographic markers of sleep homeostasis. Furthermore, abnormalities in sleep markers are correlated with cognitive impairment, suggesting that not only seizures, but also interictal spikes can have negative consequences.
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Affiliation(s)
- Melanie Boly
- Department of Neurology, University of Wisconsin, Madison, USA.,Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Benjamin Jones
- Department of Neurology, University of Wisconsin, Madison, USA.,Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Graham Findlay
- Department of Neurology, University of Wisconsin, Madison, USA.,Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Erin Plumley
- Department of Neurology, University of Wisconsin, Madison, USA
| | - Armand Mensen
- Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin, Madison, USA
| | - Guilio Tononi
- Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Rama Maganti
- Department of Neurology, University of Wisconsin, Madison, USA
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37
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Bosl WJ, Loddenkemper T, Nelson CA. Nonlinear EEG biomarker profiles for autism and absence epilepsy. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40810-017-0023-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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38
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Mintz M. Evolution in the Understanding of Autism Spectrum Disorder: Historical Perspective. Indian J Pediatr 2017; 84:44-52. [PMID: 27053182 DOI: 10.1007/s12098-016-2080-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/24/2016] [Indexed: 01/19/2023]
Abstract
The study of the evolution in the diagnosis and treatment of autism is a lesson in the dangers of medical beliefs or doctrines that are not grounded in medical science. The early descriptions of autism suggested that it was the result of childhood psychoses or psychodynamic disturbances of parent-child relationships. This flawed conceptualization of autism spectrum disorders (ASD) gave way to advances in medical science, which have established ASD as a neurobiological disorder of early brain development. There are many genetic, epigenetic, metabolic, hormonal, immunological, neuroanatomical and neurophysiological etiologies of ASD, as well as an array of gastrointestinal and other systemic co-morbid disorders. Thus, ASD are a biologically heterogeneous population with extensive neurodiversity. Early identification and understanding of ASD is crucial; interventions at younger ages are associated with improved outcomes. The advent of understanding the biological sub-phenotypes of ASD, along with targeted medical therapies, coupled with a multimodal therapeutic approach that encompasses behavioral, educational, social, speech, occupational, creative arts, and other forms of therapies has created a new and exciting era for individuals with ASD and their families: "personalized" and "precision" medical care based upon underlying biological sub-phenotypes and clinical profiles. For many individuals and their families dealing with the scourge of autism, their long and frustrating diagnostic journey is beginning to come to an end, with a hope for improved outcomes and quality of life.
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Affiliation(s)
- Mark Mintz
- The Center for Neurological and Neurodevelopmental Health, Voorhees, NJ, USA.
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39
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Ravizza T, Onat FY, Brooks-Kayal AR, Depaulis A, Galanopoulou AS, Mazarati A, Numis AL, Sankar R, Friedman A. WONOEP appraisal: Biomarkers of epilepsy-associated comorbidities. Epilepsia 2016; 58:331-342. [PMID: 28035782 DOI: 10.1111/epi.13652] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 01/04/2023]
Abstract
Neurologic and psychiatric comorbidities are common in patients with epilepsy. Diagnostic, predictive, and pharmacodynamic biomarkers of such comorbidities do not exist. They may share pathogenetic mechanisms with epileptogenesis/ictogenesis, and as such are an unmet clinical need. The objectives of the subgroup on biomarkers of comorbidities at the XIII Workshop on the Neurobiology of Epilepsy (WONOEP) were to present the state-of-the-art recent research findings in the field that highlighting potential biomarkers for comorbidities in epilepsy. We review recent progress in the field, including molecular, imaging, and genetic biomarkers of comorbidities as discussed during the WONOEP meeting on August 31-September 4, 2015, in Heybeliada Island (Istanbul, Turkey). We further highlight new directions and concepts from studies on comorbidities and potential new biomarkers for the prediction, diagnosis, and treatment of epilepsy-associated comorbidities. The activation of various molecular signaling pathways such as the "Janus Kinase/Signal Transducer and Activator of Transcription," "mammalian Target of Rapamycin," and oxidative stress have been shown to correlate with the presence and severity of subsequent cognitive abnormalities. Furthermore, dysfunction in serotonergic transmission, hyperactivity of the hypothalamic-pituitary-adrenocortical axis, the role of the inflammatory cytokines, and the contributions of genetic factors have all recently been regarded as relevant for understanding epilepsy-associated depression and cognitive deficits. Recent evidence supports the utility of imaging studies as potential biomarkers. The role of such biomarker may be far beyond the diagnosis of comorbidities, as accumulating clinical data indicate that comorbidities can predict epilepsy outcomes. Future research is required to reveal whether molecular changes in specific signaling pathways or advanced imaging techniques could be detected in the clinical settings and correlate with epilepsy-associated comorbidities. A reliable biomarker will allow a more accurate diagnosis and improved treatment of epilepsy-associated comorbidities.
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Affiliation(s)
- Teresa Ravizza
- Department of Neuroscience, IRCCS-"Mario Negri" Institute for Pharmacological Research, Milano, Italy
| | - Filiz Y Onat
- Department of Medical Pharmacology, Epilepsy Research Center, School of Medicine Marmara University, Istanbul, Turkey
| | - Amy R Brooks-Kayal
- Department of Pediatrics, Neurology and Pharmaceutical Sciences, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Aurora, Colorado, U.S.A
| | | | - Aristea S Galanopoulou
- Laboratory of Developmental Neuroscience, Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Montefiore/Einstein Comprehensive Epilepsy Center, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Andrey Mazarati
- Neurology Division, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Adam L Numis
- Neurology Division, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Raman Sankar
- Neurology Division, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.,Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Alon Friedman
- Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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40
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Epilepsy beyond seizures: Predicting enduring cognitive dysfunction in genetic generalized epilepsies. Epilepsy Behav 2016; 62:297-303. [PMID: 27544704 DOI: 10.1016/j.yebeh.2016.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022]
Abstract
Reduced cognitive functioning has been documented in the genetic generalized epilepsies (GGE). Among a number of hypothesized causal mechanisms, some evidence from other epilepsy syndromes suggests the impact of epileptiform discharges. This study investigates the relationship between cognitive function in GGE and burden of epileptiform discharges within a 24-hour EEG recording, controlling for variables relevant to cognitive function in epilepsy. As part of a larger prospective cohort study, 69 patients with EEG-confirmed GGE (11-58years) underwent 24-hour EEG and detailed neuropsychological assessment using the Woodcock Johnson III Tests. Ten-second pages of the EEG were marked manually page-by-page on longitudinal bipolar montage with 0.5 to 70Hz bandwidth by an experienced EEG reader. Multiple regression analyses were conducted. Epileptiform discharges were detected in 90% of patients. Less than 0.01% of electrophysiological events of two or more seconds were recognized by patients. Regression analysis demonstrated that the cumulative duration of epileptiform discharges over a 24-hour period predicted overall cognitive ability and memory function, accounting for 9.6% and 11.8% of adjusted variance, respectively. None of the epilepsy covariates included in multiple regression analysis added significantly to the model. Duration of epileptiform discharges negatively predicts overall cognitive ability and memory function, even after accounting for other known determinants of cognition. Prolonged epileptiform discharges are common and remain unreported by patients, raising important questions regarding the management of GGE syndromes and their associated comorbidities. Further research is required to investigate causal mechanisms if we are to improve cognitive outcomes in this common group of epilepsies.
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41
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Shamshiri EA, Tierney TM, Centeno M, St Pier K, Pressler RM, Sharp DJ, Perani S, Cross JH, Carmichael DW. Interictal activity is an important contributor to abnormal intrinsic network connectivity in paediatric focal epilepsy. Hum Brain Mapp 2016; 38:221-236. [PMID: 27543883 DOI: 10.1002/hbm.23356] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/26/2016] [Accepted: 08/11/2016] [Indexed: 01/01/2023] Open
Abstract
Patients with focal epilepsy have been shown to have reduced functional connectivity in intrinsic connectivity networks (ICNs), which has been related to neurocognitive development and outcome. However, the relationship between interictal epileptiform discharges (IEDs) and changes in ICNs remains unclear, with evidence both for and against their influence. EEG-fMRI data was obtained in 27 children with focal epilepsy (mixed localisation and aetiologies) and 17 controls. A natural stimulus task (cartoon blocks verses blocks where the subject was told "please wait") was used to enhance the connectivity within networks corresponding to ICNs while reducing potential confounds of vigilance and motion. Our primary hypothesis was that the functional connectivity within visual and attention networks would be reduced in patients with epilepsy. We further hypothesized that controlling for the effects of IEDs would increase the connectivity in the patient group. The key findings were: (1) Patients with mixed epileptic foci showed a common connectivity reduction in lateral visual and attentional networks compared with controls. (2) Having controlled for the effects of IEDs there were no connectivity differences between patients and controls. (3) A comparison within patients revealed reduced connectivity between the attentional network and basal ganglia associated with interictal epileptiform discharges. We also found that the task activations were reduced in epilepsy patients but that this was unrelated to IED occurrence. Unexpectedly, connectivity changes in ICNs were strongly associated with the transient effects of interictal epileptiform discharges. Interictal epileptiform discharges were shown to have a pervasive transient influence on the brain's functional organisation. Hum Brain Mapp 38:221-236, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Elhum A Shamshiri
- Developmental Imaging and Biophysics Section, UCL Institute of Child Health, London, United Kingdom
| | - Tim M Tierney
- Developmental Imaging and Biophysics Section, UCL Institute of Child Health, London, United Kingdom
| | - Maria Centeno
- Developmental Imaging and Biophysics Section, UCL Institute of Child Health, London, United Kingdom
| | - Kelly St Pier
- Telemetry Unit, Department of Neurophysiology, Great Ormond Street Hospital, London, United Kingdom
| | - Ronit M Pressler
- Neuroscience Medicine, Great Ormond Street Hospital, London, United Kingdom.,Clinical Neurosciences, UCL Institute of Child Health, London, United Kingdom
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Suejen Perani
- Developmental Imaging and Biophysics Section, UCL Institute of Child Health, London, United Kingdom.,Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - J Helen Cross
- Neuroscience Medicine, Great Ormond Street Hospital, London, United Kingdom.,Clinical Neurosciences, UCL Institute of Child Health, London, United Kingdom
| | - David W Carmichael
- Developmental Imaging and Biophysics Section, UCL Institute of Child Health, London, United Kingdom
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42
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Glennon JM, Weiss-Croft L, Harrison S, Cross JH, Boyd SG, Baldeweg T. Interictal epileptiform discharges have an independent association with cognitive impairment in children with lesional epilepsy. Epilepsia 2016; 57:1436-42. [PMID: 27503785 DOI: 10.1111/epi.13479] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The relative contribution of interictal epileptiform discharges (IEDs) to cognitive dysfunction in comparison with the underlying brain pathology is not yet understood in children with lesional focal epilepsy. METHODS The current study investigated the association of IEDs with intellectual functioning in 103 children with medication-resistant focal epilepsy. Hierarchical multiple regression analyses were used to determine the independent contribution of IED features on intellectual functioning, after controlling for effects of lesional pathology, epilepsy duration, and medication. Exploratory analyses were conducted for language and memory scores as well as academic skills available in a subset of participants. RESULTS The results reveal that IEDs have a negative association with IQ with independent, additive effects documented for frequent and bilaterally distributed IEDs as well as discharge enhancement in sleep. Left-lateralized IEDs had a prominent effect on verbal intelligence, in excess of the influence of left-sided brain pathology. These effects extended to other cognitive functions, most prominently for sleep-enhanced IEDs to be associated with deficits in expressive and receptive language, reading, spelling and numerical skills. SIGNIFICANCE Overall, IED effects on cognition were of a magnitude similar to lesional influences or drug effects (topiramate use). This study demonstrates an association between IEDs and cognitive dysfunction, independent of the underlying focal brain pathology.
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Affiliation(s)
- Jennifer M Glennon
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom
| | - Louise Weiss-Croft
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital NHS Trust, London, United Kingdom
| | - Sue Harrison
- Great Ormond Street Hospital NHS Trust, London, United Kingdom
| | - J Helen Cross
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital NHS Trust, London, United Kingdom
| | - Stewart G Boyd
- Great Ormond Street Hospital NHS Trust, London, United Kingdom
| | - Torsten Baldeweg
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital NHS Trust, London, United Kingdom
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43
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Rheims S, Herbillon V, Villeneuve N, Auvin S, Napuri S, Cances C, Berquin P, Castelneau P, Nguyen The Tich S, Villega F, Isnard H, Nabbout R, Gaillard S, Mercier C, Kassai B, Arzimanoglou A. ADHD in childhood epilepsy: Clinical determinants of severity and of the response to methylphenidate. Epilepsia 2016; 57:1069-77. [PMID: 27237724 DOI: 10.1111/epi.13420] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is commonly observed in children with epilepsy. However, factors associated with the development of ADHD and which might help to guide its therapeutic management, remain an issue of debate. METHODS We conducted a multicenter prospective observational study that included children, aged 6-16 years, with both epilepsy and ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. After inclusion, patients entered a 12-16 week follow-up period during which they were either treated with methylphenidate or they did not receive specific ADHD treatment. ADHD was evaluated with the ADHD Rating Scale-IV. RESULTS One hundred sixty-seven patients were included, of which 91 were seizure-free during the preinclusion baseline period. At inclusion, the ADHD Rating Scale-IV total score was 30.4 ± (standard deviation) 9.2, the inattentive subscore was 17.3 ± 4.4, and the hyperactive subscore was 13.2 ± 6.6. We did not detect any difference of ADHD Rating Scale-IV scores across patients' age or gender, age at epilepsy onset, epilepsy syndrome, seizure frequency, or number of ongoing antiepileptic drugs. Methylphenidate was initiated in 61 patients, including 55 in whom a follow-up evaluation was available. At the last follow-up, 41 patients (75%) treated with methylphenidate and 39 (42%) of those who did not received ADHD therapy demonstrated ≥25% decrease of ADHD Rating Scale-IV total score (p < 0.001). Response to methylphenidate was greater in girls but was not influenced by any epilepsy-related variables. SIGNIFICANCE We did not detect any epilepsy-related factor associated with the severity of ADHD. Twenty-five percent of patients did not respond to methylphenidate. A better understanding of the pathologic process that underlies ADHD development in childhood epilepsy might be required to improve therapeutic strategies.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology and Epilepsy Institute (IDEE), Hospices Civils de Lyon and Lyon 1 University, Lyon, France.,Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France
| | - Vania Herbillon
- Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy, Sleep and Pediatric Neurophysiology Department, Hospices Civils de Lyon, Lyon, France
| | | | - Stéphane Auvin
- AP-HP, Department of Pediatric Neurology, Robert Debré Hospital, Paris, France
| | - Silvia Napuri
- Department of Pediatric Neurology, Rennes University Hospital, Rennes, France
| | - Claude Cances
- Department of Pediatric Neurology, Children Hospital, Toulouse, France
| | - Patrick Berquin
- Department of Pediatric Neurology, INSERM U1105 CURS, Amiens, France
| | - Pierre Castelneau
- Department of Pediatric Neurology, University Hospital of Tours, Tours, France
| | | | - Frédéric Villega
- Department of Pediatric Neurology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Rima Nabbout
- Pediatric Neurology Department, Reference Center for Rare Epilepsies, Necker Hospital, Paris, France
| | - Ségolène Gaillard
- Department of Clinical Pharmacology, EPICIME-CIC 1407 Inserm, Hospices Civils de Lyon, Lyon, France
| | | | - Behrouz Kassai
- Department of Clinical Pharmacology, EPICIME-CIC 1407 Inserm, Hospices Civils de Lyon, Lyon, France
| | - Alexis Arzimanoglou
- Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy, Sleep and Pediatric Neurophysiology Department, Hospices Civils de Lyon, Lyon, France
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44
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Marteau C, Mutschler V. EEG dans le bilan étiologique des troubles du spectre autistique : série rétrospective de 18 cas enregistrés entre janvier 2015 et mars 2016 aux hôpitaux universitaires de Strasbourg. Neurophysiol Clin 2016. [DOI: 10.1016/j.neucli.2016.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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45
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Howell KB, Harvey AS, Archer JS. Epileptic encephalopathy: Use and misuse of a clinically and conceptually important concept. Epilepsia 2016; 57:343-7. [DOI: 10.1111/epi.13306] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Katherine B. Howell
- Department of Neurology; The Royal Children's Hospital; Parkville Victoria Australia
- Department of Paediatrics; The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children Research Institute; Parkville Victoria Australia
| | - A. Simon Harvey
- Department of Neurology; The Royal Children's Hospital; Parkville Victoria Australia
- Department of Paediatrics; The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children Research Institute; Parkville Victoria Australia
| | - John S. Archer
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- The Florey Institute of Neuroscience and Mental Health; Parkville Victoria Australia
- Austin Health; Melbourne Victoria Australia
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