1
|
Fateh AA, Smahi A, Hassan M, Mo T, Hu Z, Mohammed AAQ, Hu Y, Massé CC, Chen L, Chen Y, Liao J, Zeng H. From brain connectivity to cognitive function: Dissecting the salience network in pediatric BECTS-ESES. Prog Neuropsychopharmacol Biol Psychiatry 2024; 135:111110. [PMID: 39069247 DOI: 10.1016/j.pnpbp.2024.111110] [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: 03/25/2024] [Revised: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Benign childhood epilepsy with centrotemporal spikes (BECTS), a common pediatric epilepsy, may lead to cognitive decline when compounded by Electrical Status Epilepticus during Sleep (ESES). Emerging evidence suggests that disruptions in the Salience Network (SN) contribute significantly to the cognitive deficits observed in BECTS-ESES. Our study rigorously investigates the dynamic functional connectivity (dFC) within the SN and its correlation with cognitive impairments in BECTS-ESES, employing advanced neuroimaging and neuropsychological assessments. METHODS In this research, 45 patients diagnosed with BECTS-ESES and 55 age-matched healthy controls (HCs) participated. We utilized resting-state functional magnetic resonance imaging (fMRI) and Independent Component Analysis (ICA) to identify three fundamental SN nodes: the right Anterior Insula (rAI), left Anterior Insula (lAI), and the Anterior Cingulate Cortex (ACC). A two-sample t-test facilitated the comparison of dFC between these pivotal regions and other brain areas. RESULTS Significantly, the BECTS-ESES group demonstrated increased dFC, particularly between the ACC and the right Middle Occipital Gyrus, and from the rAI to the right Superior Parietal Gyrus and Cerebellum, and from the lAI to the left Postcentral Gyrus. Such dFC augmentations provide neural insights potentially explaining the neuropsychological deficits in BECTS-ESES children. Employing comprehensive neuropsychological evaluations, we mapped these dFC disruptions to specific cognitive impairments encompassing memory, executive functioning, language, and attention. Through multiple regression analysis and path analysis, a preliminary but compelling association was discovered linking dFC disturbances directly to cognitive impairments. These findings underscore the critical role of SN disruptions in BECTS-ESES cognitive dysfunctions. LIMITATION Our cross-sectional design and analytic methods preclude definitive mediation models and causal inferences, leaving the precise nature of dFC's mediating role and its direct impact by BECTS-ESES partially unresolved. Future longitudinal and confirmatory studies are needed to comprehensively delineate these associations. CONCLUSION Our study heralds dFC within the SN as a vital biomarker for cognitive impairment in pediatric epilepsy, advocating for targeted cognitive-specific interventions in managing BECTS-ESES. The preliminary nature of our findings invites further studies to substantiate these associations, offering profound implications for the prognosis and therapeutic strategies in BECTS-ESES, thereby underlining the importance of this research in the field of pediatric neurology and epilepsy management.
Collapse
Affiliation(s)
- Ahmed Ameen Fateh
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, China
| | - Abla Smahi
- Shenzhen Graduate School, Peking University, Shenzhen, China
| | - Muhammad Hassan
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, China
| | - Tong Mo
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, China
| | - Zhanqi Hu
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, China
| | - Adam A Q Mohammed
- School of Computer Science and Engineering, Southeast University, Nanjing 211189, China
| | - Yan Hu
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, China
| | - Cristina Cañete Massé
- Psychology, Sciences of Education and Sport, Blanquerna, Ramon Llull University, Barcelona, Spain; Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Li Chen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, China
| | - Yan Chen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, China
| | - Jianxiang Liao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, China.
| |
Collapse
|
2
|
Matsuura R, Hamano SI, Takeuchi H, Takeda R, Horita H, Hirata Y, Koichihara R, Kikuchi K, Oka A. Adrenocorticotropic hormone therapy alters Q-albumin ratios in patients with infantile epileptic spasms syndrome of unknown etiology. J Neurol Sci 2024; 465:123187. [PMID: 39173325 DOI: 10.1016/j.jns.2024.123187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/31/2024] [Accepted: 08/15/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Infantile epileptic spasms syndrome (IESS) with epileptic spasms as the main seizure type, is treated with adrenocorticotropic hormone (ACTH). This study, for the first time, examines the effects of epileptic spasms and ACTH on blood-brain barrier (BBB) permeability in patients with IESS of unknown etiology. METHODS We prospectively evaluated the changes in BBB permeability in patients with IESS of unknown etiology at the Saitama Children's Medical Center between February 2012 and February 2024. We compared the levels of serum-albumin, cerebrospinal fluid (CSF)-albumin, Q-albumin, and CSF-neuron-specific enolase (NSE) before and after ACTH therapy. We also assessed the correlation between the frequency of epileptic spasms and these markers. RESULTS Overall, 16 patients with IESS (8 males) were included in the study. The median age at IESS onset was 5 (range, 2-9) months. The median duration between the epileptic spasms onset and the serum and CSF sample examination before ACTH therapy was 26 (range, 1-154) days. After ACTH therapy, CSF-albumin and Q-albumin levels significantly decreased (CSF-albumin: 13.5 (9.0-32.0) mg/dL vs 11.0 (7.0-19.0) mg/dL, p = 0.001. Q-albumin: 3.7× 10-3 (2.2 × 10-3-7.3 × 10-3) vs 2.8× 10-3 (1.9 × 10-3-4.5 × 10-3), p = 0.003). No correlation was observed between the epileptic spasms frequency and levels of serum-albumin, CSF-albumin, Q-albumin, and CSF-NSE (Spearman's coefficient: r = 0.291, r = 0.141, r = 0.094, and r = -0.471, respectively). CONCLUSION ACTH therapy is one of the factors that play a role in restoring BBB permeability in patients with IESS of unknown etiology. Our findings may be useful in elucidating the mechanism of ACTH action and IESS pathophysiology.
Collapse
Affiliation(s)
- Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan.
| | - Hirokazu Takeuchi
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Rikako Takeda
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan
| | - Haruhito Horita
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Reiko Koichihara
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan.
| | - Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Akira Oka
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan.
| |
Collapse
|
3
|
Li S, Guo K, Wang Y, Wu D, Wang Y, Feng L, Wang J, Meng X, Ma L, He H, Kang F. Evaluating the Efficacy of CortexID Quantitative Analysis in Localization of the Epileptogenic Zone in Patients with Temporal Lobe Epilepsy. Neurol Ther 2024; 13:1403-1414. [PMID: 39093538 PMCID: PMC11393372 DOI: 10.1007/s40120-024-00646-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION There remains a critical need for precise localization of the epileptogenic foci in individuals with drug-resistant epilepsy (DRE). 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) imaging can reveal hypometabolic regions during the interval between seizures in patients with epilepsy. However, visual-based qualitative analysis is time-consuming and strongly influenced by physician experience. CortexID Suite is a quantitative analysis software that helps to evaluate PET imaging of the human brain. Therefore, we aimed to evaluate the efficacy of CortexID quantitative analysis in the localization of the epileptogenic zone in patients with temporal lobe epilepsy (TLE). METHODS A total of 102 patients with epilepsy who underwent 18F-FDG-PET examinations were included in this retrospective study. The PET visual analysis was interpreted by two nuclear medicine physicians, and the quantitative analysis was performed automatically using CortexID analysis software. The assumed epileptogenic zone was evaluated comprehensively by two skilled neurologists in the preoperative assessment of epilepsy. The accuracy of epileptogenic zone localization in PET visual analysis was compared with that in CortexID quantitative analysis. RESULTS The diagnostic threshold for the difference in the metabolic Z-score between the right and left sides of medial temporal lobe epilepsy (MTLE) was calculated as 0.87, and that for lateral temporal lobe epilepsy (LTLE) was 2.175. In patients with MTLE, the area under the curve (AUC) was 0.922 for PET visual analysis, 0.853 for CortexID quantitative analysis, and 0.971 for the combined diagnosis. In patients with LTLE, the AUC was 0.842 for PET visual analysis, 0.831 for CortexID quantitative analysis, and 0.897 for the combined diagnosis. These results indicate that the diagnostic efficacy of CortexID quantitative analysis is not inferior to PET visual analysis (p > 0.05), while combined analysis significantly increases diagnostic efficacy (p < 0.05). Among the 23 patients who underwent surgery, the sensitivity and specificity of PET visual analysis for localization were 95.4% and 66.7%, and the sensitivity and specificity of CortexID quantitative analysis were 100% and 50%. CONCLUSION The diagnostic efficacy of CortexID quantitative analysis is comparable to PET visual analysis in the localization of the epileptogenic zone in patients with TLE. CortexID quantitative analysis combined with visual analysis can further improve the accuracy of epileptogenic zone localization.
Collapse
Affiliation(s)
- Shuangshuang Li
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
- Medical School, Yan'an University, Yan'an, 716000, Shaanxi, China
| | - Kun Guo
- Department of Nuclear Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yuanyuan Wang
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Dianwei Wu
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yang Wang
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Lanlan Feng
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
- Medical School, Yan'an University, Yan'an, 716000, Shaanxi, China
| | - Junling Wang
- Department of Nuclear Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Xiaoli Meng
- Department of Nuclear Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Lei Ma
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Hua He
- Department of Ultrasound, Xijing 986 Hospital Department, Air Force Military Medical University, Xi'an, 710054, Shaanxi, China.
| | - Fei Kang
- Department of Nuclear Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China.
| |
Collapse
|
4
|
Gonzalez Stivala E, Wolfzun C, Sarudiansky M, Kochen S, Giagante B, Oddo S, Korman G, D'Alessio L. Psychiatric comorbid disorders and impulsivity in patients with drug-resistant temporal and extra-temporal focal epilepsies. Epilepsy Behav 2024; 159:109970. [PMID: 39121750 DOI: 10.1016/j.yebeh.2024.109970] [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: 02/19/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE To analyze patients with drug-resistant focal epilepsy from temporal (TLE) and extra-temporal origin (ETE) and to compare the prevalence of psychiatric comorbid disorders and impulsivity between them and a control group. METHODS Consecutively studied patients with TLE and ETE confirmed with Video-EEG were included. Standardized psychiatric assessment was conducted using the Structured Clinical Interview for Axis I and II diagnosis of DSM-IV (SCID I-II), the Barrat-11 scale for impulsivity, and Beck inventory for depression. Parametric and nonparametric tests were performed. RESULTS Seventy-three patients with temporal lobe epilepsy (TLE), 21 extra-temporal epilepsy (ETE) and 58 healthy control subjects were included. Both groups of patients showed a high frequency of Axis I comorbid psychiatric disorders: Depression was the most frequent disorder followed by Anxiety Disorders. Furthermore, Axis II (Personality disorders) were also diagnosed, similarly in both groups of patients (p > 0.05). In addition, both TLE and ETE groups presented higher impulsivity scores compared with the control group (p < 0.01). ETE showed a tendency to a higher impulsivity in the motor factor (p = 0.05). Among patients with TLE, a left laterality of the epileptogenic zone, and the presence of comorbid psychiatric disorders (depression), were found as independent factors associated with higher impulsivity (p < 0.05). CONCLUSION Comorbid depression associated with higher impulsivity are important issues to consider in behavioral and clinical evaluation of patients with drug-resistant focal epilepsies, with the aim to set up a prompt treatment.
Collapse
Affiliation(s)
- Ernesto Gonzalez Stivala
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias) - Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Camila Wolfzun
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Mercedes Sarudiansky
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Silvia Kochen
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Brenda Giagante
- Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Silvia Oddo
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Guido Korman
- Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Luciana D'Alessio
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias) - Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina.
| |
Collapse
|
5
|
Ke M, Luo X, Guo Y, Zhang J, Ren X, Liu G. Alterations in spatiotemporal characteristics of dynamic networks in juvenile myoclonic epilepsy. Neurol Sci 2024; 45:4983-4996. [PMID: 38704479 DOI: 10.1007/s10072-024-07506-8] [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: 11/23/2023] [Accepted: 03/27/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Juvenile myoclonic epilepsy (JME) is characterized by altered patterns of brain functional connectivity (FC). However, the nature and extent of alterations in the spatiotemporal characteristics of dynamic FC in JME patients remain elusive. Dynamic networks effectively encapsulate temporal variations in brain imaging data, offering insights into brain network abnormalities and contributing to our understanding of the seizure mechanisms and origins. METHODS Resting-state functional magnetic resonance imaging (rs-fMRI) data were procured from 37 JME patients and 37 healthy counterparts. Forty-seven network nodes were identified by group-independent component analysis (ICA) to construct the dynamic network. Ultimately, patients' and controls' spatiotemporal characteristics, encompassing temporal clustering and variability, were contrasted at the whole-brain, large-scale network, and regional levels. RESULTS Our findings reveal a marked reduction in temporal clustering and an elevation in temporal variability in JME patients at the whole-brain echelon. Perturbations were notably pronounced in the default mode network (DMN) and visual network (VN) at the large-scale level. Nodes exhibiting anomalous were predominantly situated within the DMN and VN. Additionally, there was a significant correlation between the severity of JME symptoms and the temporal clustering of the VN. CONCLUSIONS Our findings suggest that excessive temporal changes in brain FC may affect the temporal structure of dynamic brain networks, leading to disturbances in brain function in patients with JME. The DMN and VN play an important role in the dynamics of brain networks in patients, and their abnormal spatiotemporal properties may underlie abnormal brain function in patients with JME in the early stages of the disease.
Collapse
Affiliation(s)
- Ming Ke
- School of Computer and Communication, Lanzhou University of Technology, Lanzhou, 730050, China.
| | - Xiaofei Luo
- School of Computer and Communication, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Yi Guo
- School of Computer and Communication, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Juli Zhang
- School of Computer and Communication, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Xupeng Ren
- School of Computer and Communication, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Guangyao Liu
- Department of Nuclear Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, 730030, China.
| |
Collapse
|
6
|
Sánchez-Boluarte SS, Aguirre-Quispe W, De La Cruz Ramirez W, Tacunan-Cuellar J, Vergaray-Loayza A, Quintana-Garcia L, Alfaro-Olivera M, Nuñez Del Prado Murillo L, Caparó-Zamalloa C. Exploring seizure characteristics in individuals with autoimmune encephalitis: A comprehensive retrospective study in a low-middle-income country setting. Epilepsy Res 2024; 206:107439. [PMID: 39197377 DOI: 10.1016/j.eplepsyres.2024.107439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION Seizures and epilepsy are well-documented in association with autoimmune encephalitis. Despite this, a notable gap exists in understanding the persistence of seizures beyond the acute phase, particularly within the context of low- and low-middle-income settings. OBJECTIVE To evaluate the frequency, clinical characteristics, diagnosis, and potential factors associated with the occurrence and persistence of seizures in autoimmune encephalitis patients. METHODS This was a retrospective, cross-sectional study. Patients diagnosed with possible, probable or confirmed autoimmune encephalitis according to the Graus criteria at the "Instituto Nacional de Ciencias Neurológicas" in Lima, Peru, were included between January 2018 and April 2023. Demographic, clinical, diagnosis, and management information was recorded. A bivariate analysis was performed considering the persistence of seizures at one-year follow-up and a second analysis was performed to compare the groups according to the anti N-methyl-D-aspartate receptor (NMDAR) antibody results. RESULTS Sixty patients predominantly male (40; 66.7 %) were included. Only 36 (60 %) patients were tested for antibodies, 16 (44.4 %) were NMDAR positive. 46 (76.7 %) patients had at least one seizure and 13 (37.1 %) had seizures after 1 year of follow-up. Patients with seizure relapse were younger, 20 (IQR: 18-28) versus 29.5 years (IQR: 21-48), p=0.049. Four (44.4 %) patients with persistent seizures had positive NMDAR results. Similar sex distributions, no differences in seizure characteristics, and higher CSF cell count in the NMDAR-positive group were observed. Neuroimaging, EEG findings, and follow-up times were comparable between the groups. CONCLUSIONS We found a 37.1 % seizures rate after one year of follow-up, predominantly in younger patients.
Collapse
Affiliation(s)
- S S Sánchez-Boluarte
- School of Medicine, Universidad Cesar Vallejo, Trujillo-Perú; Epilepsy Department, Instituto Nacional de Ciencias Neurológicas, Lima-Perú
| | - W Aguirre-Quispe
- Grupo de Investigación Neurociencias, Metabolismo, Efectividad Clínica y Sanitaria (NEMECS), Universidad Científica del Sur, Lima-Perú.
| | | | - J Tacunan-Cuellar
- Education and Research Department, Instituto Nacional de Ciencias Neurológicas, Lima-Perú
| | | | | | - M Alfaro-Olivera
- Education and Research Department, Instituto Nacional de Ciencias Neurológicas, Lima-Perú
| | | | - C Caparó-Zamalloa
- Basic Research Center in Dementia and Central Nervous System Demyelinating Diseases, Instituto Nacional de Ciencias Neurológicas, Lima-Perú
| |
Collapse
|
7
|
Zhao C, Rollo B, Shahid Javaid M, Huang Z, He W, Xu H, Kwan P, Zhang C. An integrated in vitro human iPSCs-derived neuron and in vivo animal approach for preclinical screening of anti-seizure compounds. J Adv Res 2024; 64:249-262. [PMID: 37995945 DOI: 10.1016/j.jare.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION One-third of people with epilepsy continue to experience seizures despite treatment with existing anti-seizure medications (ASMs). The failure of modern ASMs to substantially improve epilepsy prognosis has been partly attributed to overreliance on acute rodent models in preclinical drug development as they do not adequately recapitulate the mechanisms of human epilepsy, are labor-intensive and unsuitable for high-throughput screening (HTS). There is an urgent need to find human-relevant HTS models in preclinical drug development to identify novel anti-seizure compounds. OBJECTIVES This paper developed high-throughput preclinical screening models to identify new ASMs. METHODS 14 natural compounds (α-asarone, curcumin, vinpocetine, magnolol, ligustrazine, osthole, tanshinone IIA, piperine, gastrodin, quercetin, berberine, chrysin, schizandrin A and resveratrol) were assessed for their ability to suppress epileptiform activity as measured by multi-electrode arrays (MEA) in neural cultures derived from human induced pluripotent stem cells (iPSCs). In parallel, they were tested for anti-seizure effects in zebrafish and mouse models, which have been widely used in development of modern ASMs. The effects of the compounds in these models were compared. Two approved ASMs were used as positive controls. RESULTS Epileptiform activity could be induced in iPSCs-derived neurons following treatment with 4-aminopyridine (4-AP) and inhibited by standard ASMs, carbamazepine, and phenytoin. Eight of the 14 natural compounds significantly inhibited the epileptiform activity in iPSCs-derived neurons. Among them, piperine, magnolol, α-asarone, and osthole showed significant anti-seizure effects both in zebrafish and mice. Comparative analysis showed that compounds ineffective in the iPSCs-derived neural model also showed no anti-seizure effects in the zebrafish or mouse models. CONCLUSION Our findings support the use of iPSCs-derived human neurons for first-line high-throughput screening to identify compounds with anti-seizure properties and exclude ineffective compounds. Effective compounds may then be selected for animal evaluation before clinical testing. This integrated approach may improve the efficiency of developing novel ASMs.
Collapse
Affiliation(s)
- Chunfang Zhao
- School of Pharmacy, Nanchang University, Nanchang 330006, PR China
| | - Ben Rollo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Muhammad Shahid Javaid
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Ziyu Huang
- School of Pharmacy, Nanchang University, Nanchang 330006, PR China
| | - Wen He
- School of Pharmacy, Nanchang University, Nanchang 330006, PR China
| | - Hong Xu
- Institute of Life Science, Nanchang University, Nanchang 330031, PR China
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing 400016, PR China; Departments of Neurology and Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia.
| | - Chunbo Zhang
- School of Pharmacy, Nanchang University, Nanchang 330006, PR China; Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia; Department of Pathology and Institute of Molecular Pathology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China.
| |
Collapse
|
8
|
Ramantani G, Wirrell E. Epilepsy surgery in developmental and epileptic encephalopathies. Epilepsy Behav 2024; 159:109985. [PMID: 39181112 DOI: 10.1016/j.yebeh.2024.109985] [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: 08/03/2024] [Accepted: 08/04/2024] [Indexed: 08/27/2024]
Abstract
Developmental and epileptic encephalopathies (DEEs) present significant treatment challenges due to frequent, drug-resistant seizures and comorbidities that impact quality of life. DEEs include both developmental encephalopathy from underlying pathology and epileptic encephalopathy where seizures exacerbate cognitive and behavioral impairments. Classification by syndrome and etiology is essential for therapy and prognosis, with common syndromes like infantile epileptic spasms syndrome and Dravet syndrome having specific first-line treatments. Etiologies are predominantly genetic, structural, or combined, with targeted therapies increasingly available. Surgery aims to improve seizure control but also may improve development, if the epileptic encephalopathy can be ameliorated. Timely intervention can reduce seizures and epileptiform discharges, maximizing developmental potential and allowing reduction in antiseizure medication. In cases requiring extensive resections, new deficits may be offset by developmental gains. Studies indicate that parents are generally willing to accept some deficits for significant seizure reduction.
Collapse
Affiliation(s)
- Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
9
|
Clemens B, Emri M, Dömötör J, Fekete I, Fekete K. Left hemispheric epilepsy is more frequent and has worse clinical course that right hemispheric epilepsy. Epilepsy Behav 2024; 159:110006. [PMID: 39181104 DOI: 10.1016/j.yebeh.2024.110006] [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: 03/04/2024] [Revised: 07/12/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Few studies demonstrated that focal epilepsy (FE) with left hemispheric (LH) seizure onset is more frequent than with right hemispheric (RH) seizure onset. In addition, patients with LH seizure onset show worse clinical course compared to those with RH seizure onset. The aim of our study was to investigate both issues in a great cohort of FE patients. METHODS In the retrospective study, we reviewed the clinical and paraclinical data of 682 patients with exclusively LH or RH seizure onset. We ascertained the laterality of seizure onset mainly by ictal and postictal semiology and ictal EEG findings. In the absence of ictal data, the basis of lateralization was the evidence of unilateral structural brain abnormality together with a corresponding interictal EEG finding. The endpoint of analysis of the clinical course was the presence/absence of five-year remission on drug treatment in the first ten years of treatment. RESULTS Out of the 682 patients, 378 (55.4 per cent) had LH and 304 (44.6 per cent) had RH seizure onset. The difference was statistically significant (p = 0.04). Out of them, 213 LH and 156 RH patients were eligible to evaluate prognosis. Five-years-remission was attained by 71 patients (33.3 per cent) in the LH, and 65 (41.7 per cent) in the RH group. The difference was statistically significant (p = 0.05). CONCLUSION We demonstrated the LH dominance of seizure onset and the worse clinical course of the patients with LH seizure onset. The findings are manifestations of the lateralized epileptic propensity of the brain. The dissimilar clinical course of the patient with LH and RH seizure onset may shape the general prognostic scheme in FE patients.
Collapse
Affiliation(s)
- Béla Clemens
- Department of Neurology, Kenézy Gyula Campus, Faculty of Medicine, University of Debrecen, Hungary
| | - Miklós Emri
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Hungary
| | - Johanna Dömötör
- Department of Neurology, Kenézy Gyula Campus, Faculty of Medicine, University of Debrecen, Hungary
| | - István Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Hungary
| | - Klára Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Hungary.
| |
Collapse
|
10
|
Wan Y, Kang Q, Wang Y, Lu X, Li J, Nie H, Chai W. Association of serum uric acid levels with risk of epilepsy: A national population-based study. Epilepsy Behav 2024; 159:109991. [PMID: 39181106 DOI: 10.1016/j.yebeh.2024.109991] [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: 03/19/2024] [Revised: 06/12/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Uric acid (UA) serves as a crucial endogenous antioxidant in the body, offering protection against oxidative stress, whichmaycontributetoepilepsypathogenesis. The association between serum UA levels and epilepsy remains uncertain. This study aimed to examine the potential connections between serum UA levels and epilepsy in US adults. METHODS Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2013-2018, a cross-sectional analysis was conducted. Weighted logistic regression analyses were employed to assess the potential link between serum UA levels and the risk of epilepsy. Additionally, sensitivity analyses were conducted to evaluate the reliability of the results. RESULTS We included 15,373 participants, of whom 136 (0.79 %) had epilepsy. Following adjustment for multiple variables, participants with serum UA levels <4.1 mg/dl had an odds ratio of 2.24 (95 % CI: 1.12-4.47, P = 0.023) for epilepsy compared to those with serum UA levels of 5.8-6.5 mg/dl. The results of the sensitivity analyses corroborated the initial findings. CONCLUSIONS Our study revealed a significant association between lower serum UA levels and heightened risks of epilepsy, suggesting that low UA levels may serve as an independent risk factor for epilepsy. A marginal increase in UA levels within the normal range may act as a protective factor against epilepsy.
Collapse
Affiliation(s)
- Yuehong Wan
- Department of Neurology, Jiangxi Provincial People's Hospital, Clinical College of Nanchang Medical College, First Affiliated Hospital of Nanchang Medical College, Xiangya Hospital of Central South University Jiangxi Hospital, National Regional Medical Center for Neurological Diseases, No. 266 Fenghe North Avenue, Honggutan District, Nanchang 330008, Jiangxi, China
| | - Qin Kang
- Department of Neurology, Jiangxi Provincial People's Hospital, Clinical College of Nanchang Medical College, First Affiliated Hospital of Nanchang Medical College, Xiangya Hospital of Central South University Jiangxi Hospital, National Regional Medical Center for Neurological Diseases, No. 266 Fenghe North Avenue, Honggutan District, Nanchang 330008, Jiangxi, China
| | - Yanmei Wang
- Department of Neurology, Jiangxi Provincial People's Hospital, Clinical College of Nanchang Medical College, First Affiliated Hospital of Nanchang Medical College, Xiangya Hospital of Central South University Jiangxi Hospital, National Regional Medical Center for Neurological Diseases, No. 266 Fenghe North Avenue, Honggutan District, Nanchang 330008, Jiangxi, China
| | - Xiaoqing Lu
- Department of Neurology, Jiangxi Provincial People's Hospital, Clinical College of Nanchang Medical College, First Affiliated Hospital of Nanchang Medical College, Xiangya Hospital of Central South University Jiangxi Hospital, National Regional Medical Center for Neurological Diseases, No. 266 Fenghe North Avenue, Honggutan District, Nanchang 330008, Jiangxi, China
| | - Jie Li
- Department of Neurology, Jiangxi Provincial People's Hospital, Clinical College of Nanchang Medical College, First Affiliated Hospital of Nanchang Medical College, Xiangya Hospital of Central South University Jiangxi Hospital, National Regional Medical Center for Neurological Diseases, No. 266 Fenghe North Avenue, Honggutan District, Nanchang 330008, Jiangxi, China
| | - Hongbing Nie
- Department of Neurology, Jiangxi Provincial People's Hospital, Clinical College of Nanchang Medical College, First Affiliated Hospital of Nanchang Medical College, Xiangya Hospital of Central South University Jiangxi Hospital, National Regional Medical Center for Neurological Diseases, No. 266 Fenghe North Avenue, Honggutan District, Nanchang 330008, Jiangxi, China
| | - Wen Chai
- Department of Neurology, Jiangxi Provincial People's Hospital, Clinical College of Nanchang Medical College, First Affiliated Hospital of Nanchang Medical College, Xiangya Hospital of Central South University Jiangxi Hospital, National Regional Medical Center for Neurological Diseases, No. 266 Fenghe North Avenue, Honggutan District, Nanchang 330008, Jiangxi, China.
| |
Collapse
|
11
|
Wirrell EC. Overview of clinical and physiologic aspects of status epilepticus in the developmental and epileptic encephalopathies. Epilepsy Behav 2024; 159:109950. [PMID: 39067356 DOI: 10.1016/j.yebeh.2024.109950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
The Developmental and Epileptic Encephalopathies are a group of severe epilepsies which onset in early life and are characterized by recurrent, drug-resistant seizures and multiple comorbidities including intellectual disability, behavior and sleep problems, gait concerns, amongst others. Both convulsive and nonconvulsive status epilepticus are frequently seen, however the exact risk and type of status epilepticus depends on the underlying syndrome or etiology. The baseline degree of developmental impairment and EEG features characterized by background slowing and persistent, and at times, near-continuous high-amplitude epileptiform discharges can make a clearcut diagnosis of nonconvulsive status epilepticus, in a timely manner, very challenging. Furthermore, there is limited guidance on best management of nonconvulsive status epilepticus, and success of therapy is often suboptimal.
Collapse
Affiliation(s)
- Elaine C Wirrell
- Division of Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First St SW, Rochester MN 55905, United States.
| |
Collapse
|
12
|
Carney PW, Brown H, Lewis AK, Taylor NF, Harding KE. Two thirds of patients may not need routine 12-month specialist review in an epilepsy clinic: A cross-sectional study of clinic appointments. Epilepsy Behav 2024; 159:110022. [PMID: 39216467 DOI: 10.1016/j.yebeh.2024.110022] [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: 06/18/2024] [Revised: 08/16/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Timely access to specialist outpatient clinics can be difficult to achieve as outpatient services are often oversubscribed leading to unacceptable wait times. New patients, or those with emergent issues may wait for appointments whilst existing patients are booked in for routine reviews "just in case" there is a problem, using considerable clinic resources. We investigated routine 12-month review appointments to assess whether these appointments changed patient management. METHODS The medical records of 100 randomly selected adult patients attending annual review appointments over 12 months at a publicly-funded specialist outpatient epilepsy clinic in Melbourne, Australia were audited. Demographic and clinical data as well as information about the content of each appointment were analysed to determine whether the appointment resulted in changes to epilepsy management (eg medication change), administrative actions (eg drivers license approval) or the provision of information or education. Logistic regression was performed to assess what clinical factors were associated with changes in patient care arising from the 12-month review appointment. RESULTS Almost half (47%) of appointments resulted in no change to patient care and 37% had only administrative outcomes, such as the completion of a regulatory driving report. Only 16% of appointments resulted in a change in medical management. The only factor that independently predicted a change in medical management was the occurrence of a seizure in the previous year. The only factor independently associated with not having any change in medical management or administrative action was having an unknown seizure type. CONCLUSIONS/ SIGNIFICANCE Only a small number of patients experience a change in medical management when attending a 12-month epilepsy clinic appointment, with a need for management change associated with the presence of ongoing seizure. Outpatient services should limit the use of routine annual follow up to those patients most likely to need intervention or support, creating "just in time" capacity for timely access to review as issues arise.
Collapse
Affiliation(s)
- Patrick W Carney
- Eastern Health Clinical School, Monash University, Box Hill, VIC, 3128; Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, VIC 3128, Australia; The Florey Institute for Neuroscience and Mental Health, Melbourne Brain Centre, Burgundy Street, Heidelberg, VIC 3084, Australia.
| | | | - Annie K Lewis
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| |
Collapse
|
13
|
Shan M, Mao H, Hu T, Xie H, Ye L, Cheng H. Deep brain stimulation of the subthalamic nucleus for a patient with drug resistant juvenile myoclonic epilepsy: 1 year follow-up. Neurol Sci 2024; 45:4997-5002. [PMID: 38740728 DOI: 10.1007/s10072-024-07553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Drug-resistant juvenile myoclonic epilepsy (DR-JME) remains a significant challenge in neurology. Traditional management strategies often fail to achieve satisfactory control, necessitating innovative treatments. OBJECTIVE This case report aims to evaluate the efficacy and safety of deep brain stimulation (DBS) targeting the subthalamic nucleus (STN-DBS) in a patient with DR-JME. METHODS We describe the treatment of a patient with DR-JME using STN-DBS. The patient underwent implantation and received high-frequency stimulation (HFS) at the STN. RESULTS One year post-implantation, the patient demonstrated a substantial reduction in motor seizure frequency by 87.5%, with improvements in quality of life and seizure severity by 52.0% and 46.7%, respectively. No adverse events were reported during the follow-up period. CONCLUSIONS This case represents the first report of favorable outcomes with STN-DBS in a patient with DR-JME, suggesting that long-term HFS of the STN may be a promising treatment option for patients suffering from this condition.
Collapse
Affiliation(s)
- Ming Shan
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, P.R. China
| | - Hongliang Mao
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, P.R. China
- First Clinical Medical College, Anhui Medical University, Meishan Road 81, Hefei, 230032, P.R. China
| | - Tianqi Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Hutao Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Lei Ye
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, P.R. China
| | - Hongwei Cheng
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, P.R. China.
| |
Collapse
|
14
|
Rahmati-Dehkordi F, Khanifar H, Najari N, Tamtaji Z, Talebi Taheri A, Aschner M, Shafiee Ardestani M, Mirzaei H, Dadgostar E, Nabavizadeh F, Tamtaji OR. Therapeutic Potential of Fingolimod on Psychological Symptoms and Cognitive Function in Neuropsychiatric and Neurological Disorders. Neurochem Res 2024; 49:2668-2681. [PMID: 38918332 DOI: 10.1007/s11064-024-04199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/04/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024]
Abstract
Neuropsychiatric and neurological disorders pose a significant global health burden, highlighting the need for innovative therapeutic approaches. Fingolimod (FTY720), a common drug to treat multiple sclerosis, has shown promising efficacy against various neuropsychiatric and neurological disorders. Fingolimod exerts its neuroprotective effects by targeting multiple cellular and molecular processes, such as apoptosis, oxidative stress, neuroinflammation, and autophagy. By modulating Sphingosine-1-Phosphate Receptor activity, a key regulator of immune cell trafficking and neuronal function, it also affects synaptic activity and strengthens memory formation. In the hippocampus, fingolimod decreases glutamate levels and increases GABA levels, suggesting a potential role in modulating synaptic transmission and neuronal excitability. Taken together, fingolimod has emerged as a promising neuroprotective agent for neuropsychiatric and neurological disorders. Its broad spectrum of cellular and molecular effects, including the modulation of apoptosis, oxidative stress, neuroinflammation, autophagy, and synaptic plasticity, provides a comprehensive therapeutic approach for these debilitating conditions. Further research is warranted to fully elucidate the mechanisms of action of fingolimod and optimize its use in the treatment of neuropsychiatric and neurological disorders.
Collapse
Affiliation(s)
- Fatemeh Rahmati-Dehkordi
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Khanifar
- Department of Internal Medicine, Shahre-kord University of Medical Sciences, Shahre-kord, Iran
| | - Nazanin Najari
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zeinab Tamtaji
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Abdolkarim Talebi Taheri
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Mehdi Shafiee Ardestani
- Department of Radio Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Dadgostar
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fatemeh Nabavizadeh
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Omid Reza Tamtaji
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
15
|
Engstrand H, Revdal E, Argren MB, Hagen K, Zwart JA, Brodtkorb E, Winsvold BS. Relationship between migraine and epilepsy in a large population-based cohort: The HUNT Study. Eur J Neurol 2024:e16496. [PMID: 39331386 DOI: 10.1111/ene.16496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/13/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND AND PURPOSE Several studies have reported substantial comorbidity between epilepsy and migraine. Most of these were based on clinical cohorts or used unvalidated diagnostic instruments. Our study re-examined this association in a large general population cohort using validated diagnoses for both disorders. METHODS A total of 65,407 participants (≥20 years old) from HUNT (the Trøndelag Health Study) were classified for migraine and nonmigraine headache using a validated questionnaire. Medical record review was used to validate and classify epilepsy in 364 participants (cases), who were compared with 63,298 participants without epilepsy (controls). The association between epilepsy and migraine was analysed using logistic regression adjusted for sex and age. RESULTS Patients with epilepsy had no increased prevalence of migraine (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.68-1.33) or nonmigraine headache (OR = 1.18, 95% CI = 0.93-1.50) compared to controls. When stratified by headache frequency, epilepsy was associated with a higher prevalence of migraine with highly frequent headache (≥7 days/month; OR = 1.73, 95% CI = 1.08-2.78). CONCLUSIONS Migraine was equally common in people with and without epilepsy. Patients with epilepsy who suffered from migraine were more prone to having highly frequent migraine.
Collapse
Affiliation(s)
- Helene Engstrand
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Neuromedicine and Movement, Norwegian Centre for Headache Research (NorHead), Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Eline Revdal
- Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Maria Bengtson Argren
- Department of Neuromedicine and Movement, Norwegian Centre for Headache Research (NorHead), Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement, Norwegian Centre for Headache Research (NorHead), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olav's University Hospital, Trondheim, Norway
| | - John-Anker Zwart
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Neuromedicine and Movement, Norwegian Centre for Headache Research (NorHead), Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bendik Slagsvold Winsvold
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Neuromedicine and Movement, Norwegian Centre for Headache Research (NorHead), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
16
|
Vatansever Pınar Z, Sağer SG, Çimen İD, Çağ Y. The Effect of Levetiracetam and Valproic Acid Treatment on Anger and Attention Deficit Hyperactivity Disorder Clinical Features in Children and Adolescents with Epilepsy: A Prospective Study. Paediatr Drugs 2024:10.1007/s40272-024-00652-8. [PMID: 39331340 DOI: 10.1007/s40272-024-00652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Antiseizure medications (ASMs) can potentially trigger psychobehavioral adverse events associated with the onset or exacerbation of psychiatric symptoms such as irritability, aggression, and hyperactivity. The objective of this study was to evaluate the effects of levetiracetam and valproic acid on changes in clinical features of anger, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The purpose was to furnish guidance on rational drug selection in children and adolescents with epilepsy to minimize psychiatric comorbidity in the treatment of epilepsy. METHOD This was a prospective, observational, cohort study involving treatment-naïve children aged 7-18 years with newly diagnosed generalized or focal epilepsy who were prescribed levetiracetam or valproic acid as monotherapy for a 6-month period and regularly followed up. Psychiatric assessment was conducted at the time of the new epilepsy diagnosis and at the six-month follow-up. These assessments were performed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Current and Lifetime Version (DSM-5), a structured psychiatric interview, as well as the State-Trait Anger Expression Style Inventory and Turgay DSM-IV Based Disruptive Behaviour Disorders Screening and Rating Scale. Anger subscores, ADHD symptoms, change in diagnosis, focal and generalized epilepsy groups, continuous seizures and seizure-free periods before and 6 months after treatment with valproic acid and levetiracetam were compared. RESULTS A total of 50 children, 25 in the valproic acid group and 25 in the levetiracetam group, with a mean age of 11.92 ± 3.08 years, were included in the study. There was a statistically significant increase in the ADHD subscale score post-treatment among patients receiving levetiracetam (p = 0.045) and valproic acid (p = 0.034) compared with pre-treatment. The change in both anger-in and anger-out expression scores with treatment was significantly higher in patients receiving levetiracetam (p = 0.035) compared with those receiving valproic acid (p = 0.026). Statistically, there was a significant difference in the diagnostic criteria of the levetiracetam group pre- and post-treatment (p = 0.026). The proportion of patients in whom the diagnostic criteria for ADHD+ODD were fulfilled increased from 16% before treatment to 48% after treatment, a statistically significant increase (p = 0.026). CONCLUSION This study found an increase in internalized anger features and ADHD symptom severity in children with epilepsy treated with valproic acid and levetiracetam. In those prescribed levetiracetam, there was a statistically significant rise in the proportion meeting the diagnostic criteria for ADHD + ODD. Our research is one of the first to prospectively examine the psychiatric assessment of children diagnosed with epilepsy. The remarkable results demonstrate changes in psychiatric diagnoses associated with the treatment of levetiracetam and valproic acid. Furthermore, a considerable rise in ADHD symptoms was observed in those treated with valproic acid.
Collapse
Affiliation(s)
- Zeynep Vatansever Pınar
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, İstanbul, Turkey.
| | - Safiye Güneş Sağer
- Department of Pediatric Neurology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - İrem Damla Çimen
- Department of Child and Adolescent Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Yakup Çağ
- Department of Pediatrics, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| |
Collapse
|
17
|
Zhao T, Cui J, Lan S, Chu L, Tian S, Zhou X. Causal role of peripheral immune cells in epilepsy: A large-scale genetic correlation study. Int Immunopharmacol 2024; 142:113238. [PMID: 39317048 DOI: 10.1016/j.intimp.2024.113238] [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: 06/03/2024] [Revised: 08/26/2024] [Accepted: 09/19/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND While an increasing number of researchers have focused on the correlation between the immune system and epilepsy, the precise causal role of immune cells in epilepsy continues to elude scientific understanding. The aim of the study was to examine the causal relationship between peripheral immune phenotypes and epilepsy. METHODS Mendelian randomization (MR) analysis and linkage disequilibrium score regression (LDSC) were utilized to determine the causal relationship between 731 immune cell traits and various types of epilepsy in this study. RESULTS LDSC revealed that 80 immunophenotypes showed genetic correlation with epilepsy, including 58 immunophenotypes associated with a single type of epilepsy (72.5 %),14 immunophenotypes associated with two types of epilepsy (17.5 %),7 immunophenotypes with 3 types of epilepsy (8.75 %) and 1 immunophenotype with 5 types of epilepsy (1.25 %). Although none of the types of epilepsy had a statistically significant effect on immunophenotypes, it is noteworthy that the MR revealed the protective effects of five immunophenotypes on epilepsy: CD45RA+CD8br AC (OR:0.86, 95 %CI:0.80-0.93), FSC-A on myeloid DC (OR:0.95, 95 %CI:0.91-0.98), CM CD8br AC (OR:0.69, 95 %CI:0.59--0.82), CD33 on CD66b++ Myeloid cell (OR:0.88, 95 %CI:0.83-0.93) and CD127 on CD28- CD8br (OR:0.97, 95 %CI:0.95-0.98). Additionally, harmful effects were observed for two immunophenotypes on epilepsy:CD4 Treg %CD4 (OR:1.04, 95 %CI:1.02-1.06) and SSC-A on plasmacytoid DC (OR:1.01, 95 %CI:1.00-1.02). CONCLUSION Our research has demonstrated the causal connections between immune cells and epilepsy, potentially providing valuable insights for future clinical studies.
Collapse
Affiliation(s)
- Ting Zhao
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province, PR China
| | - Junshuan Cui
- Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province, PR China
| | - Shengjiao Lan
- Department of Critical Care Medicine,The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province, PR China
| | - Liangzhao Chu
- Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province, PR China
| | - Shufen Tian
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province, PR China.
| | - Xingwang Zhou
- Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province, PR China.
| |
Collapse
|
18
|
Ueda T, Nishiyama M, Yamaguchi H, Soma K, Ishida Y, Maruyama A, Nozu K, Nagase H. Efficacy and safety of buccal midazolam for seizures outside the hospital: Real-world clinical experience. Brain Dev 2024:S0387-7604(24)00130-X. [PMID: 39317519 DOI: 10.1016/j.braindev.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/10/2024] [Accepted: 09/11/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION Buccal midazolam (buc MDL) is the first buccal mucosal delivery formulation applied for status epilepticus in Japan. Herein, we aimed to investigate the effectiveness and adverse events of buc MDL as a pre-hospital treatment for epileptic seizures in real-world clinical practice. METHODS This study involved a retrospective review based on medical records. We included children who received buc MDL as pre-hospital treatment for epileptic seizures and were subsequently transported to the emergency department between April 2021 and November 2023. RESULTS This study included 26 patients (136 episodes). The overall efficacy rate, which was defined as seizure cessation within 10 min after buc MDL administration with no recurrence within 30 min, was 43 %. Moreover, 70 % of the episodes did not require additional medications. None of the episodes required bag-mask ventilation or intubation following seizure cessation with buc MDL alone. The efficacy was decreased when buc MDL was administered longer than 15 min from seizure onset. Furthermore, the efficacy did not decrease as long as it was within 0.2-0.5 mg/kg, even if the dose was smaller than the appropriate dose for the specific age. CONCLUSIONS The response rate was significantly higher in episodes where buc MDL was administered within 15 min. Additionally, there was no concern regarding respiratory depression with buc MDL alone.
Collapse
Affiliation(s)
- Takuya Ueda
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Nishiyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Hiroshi Yamaguchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kento Soma
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
19
|
Li Y, Guo HL, Wang J, Zhang YY, Wang WJ, Huang J, Fan L, Hu YH, Lu XP, Chen F. CYP2C19 genotype and sodium channel blockers in lacosamide-treated children with epilepsy: two major determinants of trough lacosamide concentration or clinical response. Ther Adv Neurol Disord 2024; 17:17562864241273087. [PMID: 39314259 PMCID: PMC11418302 DOI: 10.1177/17562864241273087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 07/17/2024] [Indexed: 09/25/2024] Open
Abstract
Background The widespread clinical use of lacosamide (LCM) has revealed significant individual differences in clinical response, with various reported influencing factors. However, it remains unclear how genetic factors related to the disposition and clinical response of LCM, as well as drug-drug interactions (DDIs), exert their influence on pediatric patients with epilepsy. Objectives To evaluate the impact of genetic variations and DDIs on plasma LCM concentrations and clinical response. Design Patients with epilepsy treated with LCM from June 2021 to March 2023 in the Children's Hospital of Nanjing Medical University were included in the analysis. Methods The demographic information and laboratory examination data were obtained from the hospital information system. For the pharmacogenetic study, the left-over blood specimens, collected for routine plasma LCM concentration monitoring, were used to perform genotyping analysis for the selected 26 single nucleotide polymorphisms from 14 genes. The trough concentration/daily dose (C 0/D) ratio and efficacy outcomes were compared. Results Patients achieved 90.1% and 68.9% responder rates in LCM mono- and add-on therapy, respectively. The genetic variant in the CYP2C19 *2 (rs4244285) was associated with a better responsive treatment outcome (odds ratio: 1.82; 95% confidence interval: 1.05-3.15; p = 0.031). In monotherapy, 36% of patients were CYP2C19 normal metabolizers (NMs), 49% were intermediate metabolizers (IMs), and 15% were poor metabolizers (PMs) carrying CYP2C19 *2 or *3. Of note, the C 0/D ratios of IMs and PMs were 9.1% and 39.6% higher than those of NMs, respectively. Similar results were in the add-on therapy group, and we also observed a substantial decrease in the C 0/D ratio when patients were concomitant with sodium channel blockers (SCBs). Conclusion This study was the first to confirm that CYP2C19 *2 or *3 variants impact the disposition and treatment response of LCM in children with epilepsy. Moreover, concomitant with SCBs, particularly oxcarbazepine, also decreased plasma LCM concentration.
Collapse
Affiliation(s)
- Yue Li
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Hong-Li Guo
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Wang
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yuan-Yuan Zhang
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Jun Wang
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jian Huang
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Fan
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, China
| | - Xiao-Peng Lu
- Department of Neurology, Children’s Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, China
| | - Feng Chen
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, China
| |
Collapse
|
20
|
Dan J, Pale U, Amirshahi A, Cappelletti W, Ingolfsson TM, Wang X, Cossettini A, Bernini A, Benini L, Beniczky S, Atienza D, Ryvlin P. SzCORE: Seizure Community Open-Source Research Evaluation framework for the validation of electroencephalography-based automated seizure detection algorithms. Epilepsia 2024. [PMID: 39292446 DOI: 10.1111/epi.18113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024]
Abstract
The need for high-quality automated seizure detection algorithms based on electroencephalography (EEG) becomes ever more pressing with the increasing use of ambulatory and long-term EEG monitoring. Heterogeneity in validation methods of these algorithms influences the reported results and makes comprehensive evaluation and comparison challenging. This heterogeneity concerns in particular the choice of datasets, evaluation methodologies, and performance metrics. In this paper, we propose a unified framework designed to establish standardization in the validation of EEG-based seizure detection algorithms. Based on existing guidelines and recommendations, the framework introduces a set of recommendations and standards related to datasets, file formats, EEG data input content, seizure annotation input and output, cross-validation strategies, and performance metrics. We also propose the EEG 10-20 seizure detection benchmark, a machine-learning benchmark based on public datasets converted to a standardized format. This benchmark defines the machine-learning task as well as reporting metrics. We illustrate the use of the benchmark by evaluating a set of existing seizure detection algorithms. The SzCORE (Seizure Community Open-Source Research Evaluation) framework and benchmark are made publicly available along with an open-source software library to facilitate research use, while enabling rigorous evaluation of the clinical significance of the algorithms, fostering a collective effort to more optimally detect seizures to improve the lives of people with epilepsy.
Collapse
Affiliation(s)
- Jonathan Dan
- Embedded Systems Laboratory, EPFL, Lausanne, Switzerland
| | - Una Pale
- Embedded Systems Laboratory, EPFL, Lausanne, Switzerland
| | | | | | | | - Xiaying Wang
- Integrated Systems Laboratory, ETH Zürich, Zürich, Switzerland
- Research Department, Swiss University of Traditional Chinese Medicine, Zurzach, Switzerland
| | | | - Adriano Bernini
- Service of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Luca Benini
- Integrated Systems Laboratory, ETH Zürich, Zürich, Switzerland
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy
| | - Sándor Beniczky
- Aarhus University Hospital and Danish Epilepsy Center, Aarhus University, Dianalund, Denmark
| | - David Atienza
- Embedded Systems Laboratory, EPFL, Lausanne, Switzerland
| | - Philippe Ryvlin
- Service of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| |
Collapse
|
21
|
Surdi P, Trivisano M, De Dominicis A, Mercier M, Piscitello LM, Pavia GC, Calabrese C, Cappelletti S, Correale C, Mazzone L, Vigevano F, Specchio N. Unveiling the disease progression in developmental and epileptic encephalopathies: Insights from EEG and neuropsychology. Epilepsia 2024. [PMID: 39287605 DOI: 10.1111/epi.18127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 08/29/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE Developmental and epileptic encephalopathies (DEEs) are neurological disorders characterized by developmental impairment and epilepsy. Our study aims to assess disease progression by comparing clinical findings, electroencephalography (EEG), and neuropsychological data from seizure onset to the last follow-up evaluation. METHODS We retrospectively reviewed patients with genetic DEEs who were followed-up at the epilepsy unit of Bambino Gesù Children's Hospital, Rome. We collected information regarding gender, family history, genetic variant, age at onset and at last follow-up, neurological examination, type of seizure, drug resistance, occurrence of status epilepticus, and movement and cognitive and behavioral disorders. We compared EEG background activity, epileptiform abnormalities, and cognitive functions between seizure onset and the last follow-up evaluation using the McNemar-Bowker test (α = 5%). RESULTS A total of 160 patients (94 female) were included. Genetic analysis revealed a spectrum of pathogenic variants, with SCN1A being the most prevalent (25%). The median age at seizure onset and at the last follow-up was 0.37 (interquartile range [IQR]: 0.09-0.75) and 8.54 years (IQR: 4.32-14.55), respectively. We documented a statistically significant difference in EEG background activity (p = .017) and cognitive impairment (p = .01) from seizure onset to the last follow-up evaluation. No significant differences were detected for epileptiform abnormalities (p = .2). In addition, high prevalence rates were observed for drug resistance (81.9%), movement disorders (60.6%), behavioral and autism spectrum disorders (45%), neurological deficits (31.3%), and occurrence of status epilepticus (23.1%). SIGNIFICANCE Our study provides evidence that a clinical progression may appear in genetic DEEs, manifesting as development or worsening of cognitive impairment and disruption of EEG background activity. These results highlight the challenging clinical course and the importance of early intervention and personalized care in the management of patients with DEEs.
Collapse
Affiliation(s)
- Paolo Surdi
- Child Neurology and Psychiatry Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Marina Trivisano
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Angela De Dominicis
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Mattia Mercier
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Ludovica Maria Piscitello
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Giusy Carfì Pavia
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Costanza Calabrese
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Simona Cappelletti
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Cinzia Correale
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Federico Vigevano
- Pediatric Neurorehabilitation Department, IRCCS San Raffaele, Rome, Italy
| | - Nicola Specchio
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| |
Collapse
|
22
|
Fu Y, Shi F, Sha L, Yang X, Li R, Chen L. Effects of antiseizure medication withdrawal during the first trimester of pregnancy on seizure control and offspring outcomes. Epilepsia 2024. [PMID: 39287982 DOI: 10.1111/epi.18125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/29/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE To explore seizure control and offspring outcomes associated with antiseizure medication (ASM) withdrawal during the first trimester of pregnancy. METHODS Based on a prospective multicenter study in China, pregnancies followed up between 2009 and 2023 at the neurology outpatient clinic of 50 hospitals were included in this study. Information on demographics, epileptic characteristics, treatment during pregnancy, and offspring outcomes was collected. Pregnancies were categorized into an ASM withdrawal group and an ASM continuation group. Balance tests and univariate log-binomial regression analysis were conducted to identify imbalanced factors between groups and potential risk factors for seizure deterioration during pregnancy. Multivariate log-binomial regression was then used to estimate the adjusted effects of ASM withdrawal on seizure deterioration during pregnancy and fetal outcomes. In addition, exploratory subgroup analysis was conducted to identify high-risk patients who should avoid ASM withdrawal. RESULTS Of the 695 pregnancies enrolled, 14.2% withdrew ASMs in the first trimester of pregnancy. ASM withdrawal during this period was associated with a risk of seizure deterioration during pregnancy (adjusted risk ratio [aRR] 1.405, 95% confidence interval [CI] 1.009-1.876). Subgroup analysis revealed a significant risk of seizure deterioration in pregnancies with seizures in 9 months (aRR 1.590, 95% CI 1.079-2.344). After adjusting the folic acid dose, no evidence of protective effects on fetus after ASM withdrawal was observed compared to patients with continued treatment, whereas seizure deterioration during pregnancy increased the risk of fetal death (aRR 3.577, 95% CI 1.086-11.651). SIGNIFICANCE ASM withdrawal in the first trimester of pregnancy did not show a protective effect on fetal outcomes but rather resulted in increased seizure frequency during pregnancy. However, this finding requires a larger sample for validation. Furthermore, seizure deterioration during pregnancy was associated with an increased risk of fetal death.
Collapse
Affiliation(s)
- Yutong Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fanfan Shi
- Department of Clinical Research and Management, Center of Biostatistics, Design, Measurement and Evaluation (CBDME), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Leihao Sha
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ximeng Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Li
- Department of Neurology, The Affiliated YanAn Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Pazhou Lab, Guangzhou, China
| |
Collapse
|
23
|
Nguyen YTM, Vu BQ, Nguyen DK, Quach NV, Bui LT, Hong J, Bui CB. Genotype-driven therapeutics in DEE and metabolic epilepsy: navigating treatment efficacy and drug resistance. Sci Rep 2024; 14:21606. [PMID: 39285222 PMCID: PMC11405402 DOI: 10.1038/s41598-024-72683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
Neonatal intensive care unit (NICU), particularly in treating developmental and epileptic encephalopathy (DEE) and metabolic epilepsy (ME), requires a deep understanding of their complex etiologies and treatment responses. After excluding treatable cases such as infectious or autoimmune encephalitis, our focus shifted to a more challenging subgroup of 59 patients for in-depth genetic analysis using exome sequencing (ES). The ES analysis identified 40 genetic abnormalities, significantly including de novo variants. Notably, we found structural variation as duplications in regions 2q24.3, including SCN1A and SCN2A were observed in 7 cases. These genetic variants, impacting ion channels, glucose transport, transcription regulation, and kinases, play a crucial role in determining medication efficacy. More than one-third (34.2%) of patients with DEE had an unfavorable response to anti-seizure medications (ASMs) in the chronic phase. However, since the ketogenic supplementary diet showed a positive effect, more than three-quarters (80%) of these drug-resistant patients improved during a 3-month follow-up. In contrast, the ME had a lower adverse reaction rate of 9.1% (2/22) to specialized medications, yet there were 5 fatalities and 10 cases with unidentified genetic etiologies. This study suggests the potential of categorizing drug-resistant variants and that a ketogenic diet could be beneficial in managing DEE and ME. It also opens new perspectives on the mechanisms of the ketogenic diet on the discovered genetic variants.
Collapse
Affiliation(s)
- Yen Thi My Nguyen
- Department of Biotechnology, International University, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Unit of AI Genomics, DNA Medical Technology, Ho Chi Minh City, Vietnam
| | - Bao-Quoc Vu
- Institute of Food and Biotechnology, Can Tho University, Can Tho City, Vietnam
- Faculty of Computer Science, University of Information Technology, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Duy-Khai Nguyen
- Department of Neurology, City Children's Hospital, Ho Chi Minh City, Vietnam
| | - Ngoc-Vinh Quach
- Department of Neurology, City Children's Hospital, Ho Chi Minh City, Vietnam
| | - Liem Thanh Bui
- Institute of Food and Biotechnology, Can Tho University, Can Tho City, Vietnam
| | - Jeonghan Hong
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea
- HnB Genomics, Ulsan, South Korea
| | - Chi-Bao Bui
- University of Health Sciences, Vietnam National University Ho Chi Minh City, Ho Chi Minh, Vietnam.
- Unit of Molecular Biology, City Children's Hospital, Ho Chi Minh City, Vietnam.
| |
Collapse
|
24
|
Gunawan PI, Widianti N, Noviandi R, Samosir SM. N-methyl-D-aspartate receptor autoantibody levels in children with intractable and non-intractable epilepsy. Heliyon 2024; 10:e36734. [PMID: 39263117 PMCID: PMC11388750 DOI: 10.1016/j.heliyon.2024.e36734] [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: 05/07/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/13/2024] Open
Abstract
Objective Intractable epilepsy in children is a prevalent neurological disorder that can pose serious risks. The involvement of the autoimmune system is a significant factor in the pathogenesis of the disease. The N-methyl-D-aspartate-receptor (NMDAR) is a glutamate receptor and ion channel present in neurons and is associated with the mechanism of autoimmune etiology in epilepsy. This study aims to compare the levels of NMDAR auto antibodies in children with intractable and non-intractable epilepsy. Methods A prospective analytic study was conducted from June to September 2022. The study sample consisted of patients aged 1 month to 18 years diagnosed with epilepsy and receiving anti-seizure medication (ASM) therapy at Dr. Soetomo General Academic Hospital, Surabaya. The patients were divided into two groups, namely intractable epilepsy and non-intractable epilepsy. The NMDAR autoantibody levels were determined using enzyme-linked immunosorbent assay (ELISA). Statistical analysis employed the chi-squared and Wilcoxon-Mann-Whitney tests. Results Seventy-five subjects were included in the study. Of these patients, 41.3 % with intractable epilepsy and 33.4 % with non-intractable epilepsy presented NMDAR auto antibodies. Analysis of the patient characteristics revealed a correlation between seizure frequency and NMDAR autoantibody positivity (P = 0.002) but not between the number of ASM and NMDAR autoantibody positivity (P > 0.05). The NMDAR autoantibody levels were not significantly different in children with intractable and non-intractable epilepsy (P = 0.157). Conclusion The NMDAR autoantibody levels were numerically higher in children with intractable epilepsy compared with children with non-intractable epilepsy.
Collapse
Affiliation(s)
- Prastiya Indra Gunawan
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nurani Widianti
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Riza Noviandi
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Sunny Mariana Samosir
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| |
Collapse
|
25
|
Fonferko-Shadrach B, Strafford H, Jones C, Khan RA, Brown S, Edwards J, Hawken J, Shrimpton LE, White CP, Powell R, Sawhney IMS, Pickrell WO, Lacey AS. Annotation of epilepsy clinic letters for natural language processing. J Biomed Semantics 2024; 15:17. [PMID: 39277770 PMCID: PMC11402197 DOI: 10.1186/s13326-024-00316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/22/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND Natural language processing (NLP) is increasingly being used to extract structured information from unstructured text to assist clinical decision-making and aid healthcare research. The availability of expert-annotated documents for the development and validation of NLP applications is limited. We created synthetic clinical documents to address this, and to validate the Extraction of Epilepsy Clinical Text version 2 (ExECTv2) NLP pipeline. METHODS We created 200 synthetic clinic letters based on hospital outpatient consultations with epilepsy specialists. The letters were double annotated by trained clinicians and researchers according to agreed guidelines. We used the annotation tool, Markup, with an epilepsy concept list based on the Unified Medical Language System ontology. All annotations were reviewed, and a gold standard set of annotations was agreed and used to validate the performance of ExECTv2. RESULTS The overall inter-annotator agreement (IAA) between the two sets of annotations produced a per item F1 score of 0.73. Validating ExECTv2 using the gold standard gave an overall F1 score of 0.87 per item, and 0.90 per letter. CONCLUSION The synthetic letters, annotations, and annotation guidelines have been made freely available. To our knowledge, this is the first publicly available set of annotated epilepsy clinic letters and guidelines that can be used for NLP researchers with minimum epilepsy knowledge. The IAA results show that clinical text annotation tasks are difficult and require a gold standard to be arranged by researcher consensus. The results for ExECTv2, our automated epilepsy NLP pipeline, extracted detailed epilepsy information from unstructured epilepsy letters with more accuracy than human annotators, further confirming the utility of NLP for clinical and research applications.
Collapse
Affiliation(s)
| | - Huw Strafford
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
| | - Carys Jones
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
| | - Russell A Khan
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
| | - Sharon Brown
- Neurology Department, Swansea Bay University Health Board, Swansea, Wales, UK
| | - Jenny Edwards
- Neurology Department, Swansea Bay University Health Board, Swansea, Wales, UK
| | - Jonathan Hawken
- Neurology Department, Swansea Bay University Health Board, Swansea, Wales, UK
| | - Luke E Shrimpton
- Neurology Department, Swansea Bay University Health Board, Swansea, Wales, UK
| | - Catharine P White
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
- Paediatric Neurology Centre, Swansea Bay University Health Board, Swansea, Wales, UK
| | - Robert Powell
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
- Neurology Department, Swansea Bay University Health Board, Swansea, Wales, UK
| | - Inder M S Sawhney
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
- Neurology Department, Swansea Bay University Health Board, Swansea, Wales, UK
| | - William O Pickrell
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
- Neurology Department, Swansea Bay University Health Board, Swansea, Wales, UK
| | - Arron S Lacey
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
| |
Collapse
|
26
|
Park S, Permezel F, Agashe S, Osman G, Simpson HD, Miller KJ, Van Gompel JJ, Starnes K, Lundstrom BN, Worrell GA, Gregg NM. Centromedian thalamic deep brain stimulation for idiopathic generalized epilepsy: Connectivity and target optimization. Epilepsia 2024. [PMID: 39276007 DOI: 10.1111/epi.18122] [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: 05/14/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/16/2024]
Abstract
There are limited treatment options for individuals with drug-resistant idiopathic generalized epilepsy (IGE). Small, limited case series suggest that centromedian thalamus deep brain stimulation (CM-DBS) may be an effective treatment option. The optimal CM-DBS target for IGE is underexamined. Here, we present a retrospective analysis of CM-DBS targeting and efficacy for five patients with drug-resistant IGE. Volume of tissue activated (VTA) overlap with CM nucleus was performed using an open-source toolbox. Median follow-up time was 13 months. Median convulsive seizure frequency reduction was 66%. One patient had only absence seizures, with >99% reduction in absence seizure frequency. Four patients had electrode contacts positioned within the CM nucleus target, all of whom had >50% reduction in primary semiology seizure, with 85% median seizure reduction (p = .004, paired-sample t test). Volumetric "sweet-spot" mapping revealed that best outcomes were correlated with stimulation of the middle ventral CM nucleus. Connectivity strength between the sweet-spot region and central peri-Rolandic cortex was increased significantly relative to other cortical regions (p = 8.6 × 10-4, Mann-Whitney U test). Our findings indicate that CM-DBS can be an effective treatment for patients with IGE, highlight the importance of accurate targeting and targeting analysis, and within the context of prior work, suggest that ideal CM-DBS targets may be syndrome specific.
Collapse
Affiliation(s)
- Sihyeong Park
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Fiona Permezel
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shruti Agashe
- Department of Neurology, Duke University, Durham, North Carolina, USA
| | - Gamaleldin Osman
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Hugh D Simpson
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Kai J Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Keith Starnes
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | |
Collapse
|
27
|
Sulena S, Singh G, Padda P, Tyagi D. Epilepsy Among School-Children in a Rural District in Northwest India: Prevalence Estimates Using Three Different Approaches. Indian J Pediatr 2024:10.1007/s12098-024-05245-4. [PMID: 39271629 DOI: 10.1007/s12098-024-05245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 08/09/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVES To estimate and compare the prevalence of epilepsy during childhood using several approaches and also to determine whether school-based screening campaigns can capture epilepsy cases efficiently. METHODS Epilepsy prevalence determined from cases captured through the Rashtriya Bal Swasthya Karyakram (RBSK), a nationwide school-health screening framework, were compared with estimates derived from school- and community-based surveys in one Indian district. Level-1 screen comprised perusal of child health registers maintained by the RBSK teams over one year to estimate the documented number of children with epilepsy; Level-2 screen comprised a questionnaire-based school survey among 10,000 school children; and Level-3 screen-a door-to-door community-based survey among 10,000 children in the district. RESULTS Prevalence estimates of childhood epilepsy varied significantly across screening methods. The child health register identified lower crude and age-adjusted prevalences of 40 (95% CI, 24 to 55) and 36 (95% CI, 20 to 51)/1,00,000 vis-à-vis both the school survey [crude and age-adjusted prevalences of 354 (95% CI, 221 to 487) and 340 (95% CI, 181 to 517) per 100,000] and the community survey [crude and age-adjusted prevalences of 759 (95% CI, 591 to 927) and 746 (95% CI, 579 to 914) per 100,000]. The community survey identified 15 children with epilepsy (20%) who had dropped out of school. Also, it recaptured a small number of children previously identified by the school or child health register surveys. CONCLUSIONS The present findings underscore the need to scale up the capacity of public programs to screen epilepsy among school children and underline the high frequency of school dropouts among children with epilepsy in resource-limited settings.
Collapse
Affiliation(s)
- Sulena Sulena
- Division of Neurology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, 151203, India.
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Preeti Padda
- Department of Community Medicine, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Divesh Tyagi
- Division of Neurology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, 151203, India
| |
Collapse
|
28
|
Cioriceanu IH, Constantin DA, Zamfirescu B, Podasca PC, Marceanu LG, Rogozea L. Romanian Translation and Cultural Adaptation of the Seizure Severity Questionnaire. Neurol Int 2024; 16:1005-1013. [PMID: 39311349 PMCID: PMC11417800 DOI: 10.3390/neurolint16050076] [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: 07/29/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 09/26/2024] Open
Abstract
The aim of this study was to report the translation into Romanian of the Seizure Severity Questionnaire (SSQ), an instrument for the evaluation of the frequency and severity of epileptic seizures, and the results of applying it to a group of patients with epilepsy evaluated at a hospital in Romania. METHODS Four translators were involved in obtaining conceptual analogies and the cultural importance of the translated notions. The final version was obtained for the Romanian population, with the same appearance as the original instrument. Sixty-seven patients with epilepsy completed the SSQ and the Patient-Weighted Quality of Life in Epilepsy Inventory-QOLIE-31-P. RESULTS Females had a lower mean SSQ total score (TS) and perceived seizures less seriously than men. Patients with epilepsy with aura had a higher mean SSQ TS, with a more severe seizure perception, compared to those without aura. According to the frequency of seizures, patients with epilepsy with rare seizures had the lowest mean SSQ total score (TS) compared to those with frequent seizures. Patients who were on monotherapy had a less severe perception of epileptic seizures compared to those who were treated with two or more antiepileptic drugs. All QOLIE-31-P domains and TS correlated statistically significantly with the SSQ TS. CONCLUSIONS This study explored SSQ translation, evaluated preliminary results, and showed the correlation between seizure frequency and severity, clinical factors, and quality of life. This tool could be useful for measuring seizure severity in Romanian patients with epilepsy and conducting comparative studies.
Collapse
Affiliation(s)
- Ionut-Horia Cioriceanu
- Department of Neurology, Clinical Hospital of Psychiatry and Neurology Brasov, 500123 Brasov, Romania;
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania;
| | - Dan-Alexandru Constantin
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania;
| | - Bianca Zamfirescu
- Department of Social Work and Psychology, Dr. I.A. Sbarcea Clinical Hospital of Obstetrics and Gynecology Brasov, 500025 Brasov, Romania; (B.Z.); (P.C.P.)
| | - Petru Cezar Podasca
- Department of Social Work and Psychology, Dr. I.A. Sbarcea Clinical Hospital of Obstetrics and Gynecology Brasov, 500025 Brasov, Romania; (B.Z.); (P.C.P.)
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania
| | - Luigi Geo Marceanu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania
| | - Liliana Rogozea
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania;
| |
Collapse
|
29
|
Attia ZR, Labib ME, Kelany AK, Alnefaie RM, Twab HA, Wahsh E, Abd El Azeem RA, Shaaban EIA, Elsaid AM, Alalawy AI, Elshazli RM, El Tantawi N. Pharmacogenetic insights into ABCB1, ABCC2, CYP1A2, and CYP2B6 variants with epilepsy susceptibility among Egyptian Children: A retrospective case-control study. Int Immunopharmacol 2024; 142:113073. [PMID: 39265352 DOI: 10.1016/j.intimp.2024.113073] [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: 05/09/2024] [Revised: 08/23/2024] [Accepted: 09/01/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Pediatric epilepsy is a complicated neuropsychiatric disorder that is characterized by recurrent seizures and unusual synchronized electrical activities within brain tissues. It has a substantial effect on the quality of life of children, thus understanding of the hereditary considerations influencing epilepsy susceptibility and the response to antiepileptic medications is crucial. This study focuses on assessing the correlation of the ABCB1, ABCC2, CYP1A2, and CYP2B6 genetic polymorphisms with the susceptibility to epileptic seizures and their contributions to antiepileptic medication throughout the course of the disease. METHODS This study included 134 Egyptian epileptic children, comprising 67 drug-responsive and 67 drug-resistant patients, along with 124 healthy controls matching for age, gender, and geographical district. Genotyping of the rs2032582, rs717620, rs2273697, rs762551, and rs3745274 variants was performed using the PCR technique. Statistical analyses, including haplotype, multivariate, logistic regression, and bioinformatics approaches, were conducted to evaluate the associations within the disease. RESULTS The ABCC2*rs717620 (T allele) revealed an increased risk of epilepsy compared to healthy controls (OR = 2.12, p-value < 0.001), with the rs717620 (C/T + T/T genotypes) showing significant differences between drug-responsive and drug-resistant patients (p-value < 0.05). Moreover, the ABCC2*rs2273697 (A allele) indicated a decreased risk of epileptic seizures compared to healthy controls (OR = 0.51, p-value = 0.033), with the rs2273697 (G/A + A/A genotypes) indicating a significant association with drug-resistant patients (OR = 0.21, p-value = 0.002). The rs717620*T/rs2273697*G haplotype was significantly correlated with an elevated risk of epileptic seizures within drug-responsive patients (OR = 2.26, p-value = 0.019). Additionally, the CYP1A2*rs762551 (A allele) represented a protective effect against epilepsy susceptibility (OR = 0.50, p-value < 0.001), with the rs762551 (G/A + A/A genotypes) disclosing a substantial association with a decreased risk of epileptic seizures among drug-resistant patients compared to drug-responsive patients (OR = 0.07, p-value < 0.001). Conversely, the ABCB1*rs2032582 (G allele) and the CYP2B6*rs3745274 (T allele) did not attain a significant difference with the epilepsy risk compared to healthy controls (p-value > 0.05). CONCLUSIONS The findings of our study emphasize the importance of pharmacogenetic screening in epilepsy research, particularly regarding to drug-resistant patients. The ABCC2*rs717620 variant conferred a significant correlation with elevated risk of epileptic seizures, while the ABCC2*rs2273697 and CYP1A2*rs762551 variants confirmed their contributions as protective markers against epilepsy development. Conversely, the ABCB1*rs2032582 and CYP2B6*rs3745274 alleles were not considered as independent risk factors with the course of epilepsy disease.
Collapse
Affiliation(s)
- Zeinab R Attia
- Mansoura University Children's Hospital, Mansoura University, Mansoura 35516, Egypt
| | - Mariam E Labib
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Ayda K Kelany
- Department of Genomic Medicine, Cairo University Hospitals, Cairo University, Giza 12613, Egypt; Applied Science Research Center, Applied Science Private University, Amman 11831, Jordan; MEU Research Unit, Middle East University, Amman 11831, Jordan
| | - Rasha M Alnefaie
- Department of Biology, Faculty of Science, Al-Baha University, Al-Baha 65779, Saudi Arabia
| | - Hosam Abd Twab
- Clinical Immunology Unit, Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Eman Wahsh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Sinai University, Arish 45511, Egypt
| | - Rania A Abd El Azeem
- Mansoura University Children's Hospital, Mansoura University, Mansoura 35516, Egypt; Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 31991, Saudi Arabia
| | - Esraa Ibrahim A Shaaban
- Department of Drug Delivery and Nano Pharmaceutics, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya 467-8603, Japan
| | - Afaf M Elsaid
- Genetic Unit, Children's University Hospital, Mansoura University, Mansoura 35516, Egypt
| | - Adel I Alalawy
- Department of Biochemistry, Faculty of Science, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Rami M Elshazli
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA; Biochemistry and Molecular Genetics Unit, Department of Basic Sciences, Faculty of Physical Therapy, Horus University - Egypt, New Damietta 34517, Egypt.
| | - Noha El Tantawi
- Neurology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| |
Collapse
|
30
|
Zhong R, Li G, Zhao T, Zhang H, Zhang X, Lin W. Association of baseline sleep duration and sleep quality with seizure recurrence in newly treated patients with epilepsy. Epilepsia 2024. [PMID: 39258499 DOI: 10.1111/epi.18106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE Although sleep duration and sleep quality are considered to be significant factors associated with epilepsy and seizure risk, findings are inconsistent, and their joint association remains uncertain. This study aimed to determine independent and joint associations of these two modifiable sleep features with seizure recurrence risk in newly treated patients with epilepsy (PWE). METHODS This is a prospective cohort study of newly treated PWE at a comprehensive epilepsy center in northeast China between June 2020 and December 2023. Self-reported sleep duration and sleep quality were collected at baseline. All patients were followed for 12 months for recurrent seizures. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) of seizure recurrence. Models fitted with restricted cubic spline were conducted to test for linear and nonlinear shapes of each association. RESULTS A total of 209 patients were included, and 103 experienced seizure recurrence during follow-up. Baseline short sleep was significantly associated with greater risk of seizure recurrence (adjusted HR = 2.282, 95% confidence interval [CI] = 1.436-3.628, p < .001). Sleep duration (h/day) and recurrent seizure risk showed a significant nonlinear U-shaped association, with a nadir at 8 h/day. Baseline poor sleep quality was significantly associated with greater risk of seizure recurrence (adjusted HR = 1.985, 95% CI = 1.321-2.984, p < .001). Pittsburgh Sleep Quality Index score and seizure recurrence risk exhibited a positive linear association. Participants with a combination of poor quality-short sleep showed the highest risk of seizure recurrence (adjusted HR = 3.13, 95% CI = 1.779-5.507, p < .001) compared to the referent good quality-intermediate sleep group. SIGNIFICANCE Baseline sleep duration and sleep quality were independently and jointly associated with risk of seizure recurrence in newly treated PWE. Our results point to an important potential role of baseline sleep duration and sleep quality in shaping seizure risk.
Collapse
Affiliation(s)
- Rui Zhong
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guangjian Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Teng Zhao
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hanyu Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
31
|
Yang H, Liu W, Gao T, Liu Q, Zhang M, Liu Y, Ma X, Zhang N, Shi K, Duan M, Ma S, Zhang X, Cheng Y, Qu H, Chen M, Zhan S. Causal associations between gut microbiota, circulating inflammatory proteins, and epilepsy: a multivariable Mendelian randomization study. Front Immunol 2024; 15:1438645. [PMID: 39315097 PMCID: PMC11416947 DOI: 10.3389/fimmu.2024.1438645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Background Previous studies have suggested that gut microbiota (GM) may be involved in the pathogenesis of epilepsy through the microbiota-gut-brain axis (MGBA). However, the causal relationship between GM and different epilepsy subtypes and whether circulating inflammatory proteins act as mediators to participate in epileptogenesis through the MGBA remain unclear. Therefore, it is necessary to identify specific GM associated with epilepsy and its subtypes and explore their underlying inflammatory mechanisms for risk prediction, personalized treatment, and prognostic monitoring of epilepsy. Methods We hypothesized the existence of a pathway GM-inflammatory proteins-epilepsy. We found genetic variants strongly associated with GM, circulating inflammatory proteins, epilepsy and its subtypes, including generalized and partial seizures, from large-scale genome-wide association studies (GWAS) summary data and used Multivariate Mendelian Randomization to explore the causal relationship between the three and whether circulating inflammatory proteins play a mediating role in the pathway from GM to epilepsy, with inverse variance weighted (IVW) method as the primary statistical method, supplemented by four methods: MR-Egger, weighted median estimator (WME), Weighted mode and Simple mode. Results 16 positive and three negative causal associations were found between the genetic liability of GM and epilepsy and its subtypes. There were nine positive and nine negative causal associations between inflammatory proteins and epilepsy and its subtypes. Furthermore, we found that C-X-C motif chemokine 11 (CXCL11) levels mediated the causal association between Genus Family XIII AD3011 group and epilepsy. Conclusion Our study highlights the possible causal role of specific GM and specific inflammatory proteins in the development of epilepsy and suggests that circulating inflammatory proteins may mediate epileptogenesis through the MGBA.
Collapse
Affiliation(s)
- Han Yang
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wei Liu
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Tiantian Gao
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Qifan Liu
- Department of Transplant Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Mengyuan Zhang
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yixin Liu
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiaodong Ma
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Nan Zhang
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Kaili Shi
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Minyu Duan
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shuyin Ma
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiaodong Zhang
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yuxuan Cheng
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Huiyang Qu
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Mengying Chen
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shuqin Zhan
- Department of Neurology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| |
Collapse
|
32
|
Kalia LV, Berg D, Kordower JH, Shannon KM, Taylor JP, Cardoso F, Goldman JG, Jeon B, Meissner WG, Tijssen MAJ, Burn DJ, Fung VSC. Movement Disorders Society Viewpoint on Biological Frameworks of Parkinson's Disease: Current Status and Future Directions. Mov Disord 2024. [PMID: 39250594 DOI: 10.1002/mds.30007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/11/2024] Open
Affiliation(s)
- Lorraine V Kalia
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Christian Albrechts-University of Kiel, Kiel, Germany
| | - Jeffery H Kordower
- ASU-Banner Neurodegenerative Disease Research Center, Tempe, Arizona, USA
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Kathleen M Shannon
- Department of Neurology, University of Wisconsin School of Public Health, Madison, Wisconsin, USA
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, The Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jennifer G Goldman
- Barrow Neurological Institute, Phoenix, Arizona, USA
- JPG Enterprises LLC, Chicago, Illinois, USA
| | - Beomseok Jeon
- BJ Center for Comprehensive Parkinson Care and Rare Movement Disorders, Chung-Ang University Health Care System, Hyundae Hospital, Namyangju-si, South Korea
| | - Wassilos G Meissner
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, UMR5293, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Marina A J Tijssen
- Department of Neurology, Expertise Centre Movement Disorders, University Medical Centre Groningen, Groningen, The Netherlands
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
33
|
Charouf D, Miller D, Haddad L, White FA, Boustany RM, Obeid M. High Diagnostic Yield and Clinical Utility of Next-Generation Sequencing in Children with Epilepsy and Neurodevelopmental Delays: A Retrospective Study. Int J Mol Sci 2024; 25:9645. [PMID: 39273593 PMCID: PMC11395515 DOI: 10.3390/ijms25179645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/30/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
Advances in genetics led to the identification of hundreds of epilepsy-related genes, some of which are treatable with etiology-specific interventions. However, the diagnostic yield of next-generation sequencing (NGS) in unexplained epilepsy is highly variable (10-50%). We sought to determine the diagnostic yield and clinical utility of NGS in children with unexplained epilepsy that is accompanied by neurodevelopmental delays and/or is medically intractable. A 5-year retrospective review was conducted at the American University of Beirut Medical Center to identify children who underwent whole exome sequencing (WES) or whole genome sequencing (WGS). Data on patient demographics, neurodevelopment, seizures, and treatments were collected. Forty-nine children underwent NGS with an overall diagnostic rate of 68.9% (27/38 for WES, and 4/7 for WGS). Most children (42) had neurodevelopmental delays with (18) or without (24) refractory epilepsy, and only three had refractory epilepsy without delays. The diagnostic yield was 77.8% in consanguineous families (18), and 61.5% in non-consanguineous families (26); consanguinity information was not available for one family. Genetic test results led to anti-seizure medication optimization or dietary therapies in six children, with subsequent improvements in seizure control and neurodevelopmental trajectories. Not only is the diagnostic rate of NGS high in children with unexplained epilepsy and neurodevelopmental delays, but also genetic testing in this population may often lead to potentially life-altering interventions.
Collapse
Affiliation(s)
- Daniel Charouf
- Division of Child Neurology, Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut P.O. Box 11-0236, Lebanon
| | - Derryl Miller
- Division of Child Neurology, Department of Neurology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN 46202, USA
| | - Laith Haddad
- Division of Child Neurology, Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut P.O. Box 11-0236, Lebanon
| | - Fletcher A White
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Rose-Mary Boustany
- Division of Child Neurology, Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut P.O. Box 11-0236, Lebanon
- Department of Biochemistry, Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
| | - Makram Obeid
- Division of Child Neurology, Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut P.O. Box 11-0236, Lebanon
- Division of Child Neurology, Department of Neurology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN 46202, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| |
Collapse
|
34
|
Soboh H, Theitler J, Gandelman-Marton R. Primary treatment gap among adults with epilepsy: A cross-sectional analysis. Epileptic Disord 2024. [PMID: 39235824 DOI: 10.1002/epd2.20275] [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: 05/24/2024] [Revised: 08/03/2024] [Accepted: 08/15/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE Despite recommendations to initiate antiseizure medication treatment once the diagnosis of epilepsy is confirmed, a certain proportion of patients with epilepsy who should receive antiseizure medication treatment remain untreated. We aimed to evaluate the rate of and the reasons for the treatment gap in patients with epilepsy who were referred to their first visit in our epilepsy clinic. METHODS We retrospectively reviewed the computerized database and the medical records of all the patients with epilepsy who had their first visit in our outpatient epilepsy clinic during a 10-year period (2012-2021). RESULTS Forty-nine (6.5%) of 746 patients with epilepsy were not treated with antiseizure medications: 27 (3.6%) were nonadherent to treatment, 12 (1.6%) patients were not definitively diagnosed with epilepsy prior to their first epilepsy clinic visit, and in 10 (1.3%) patients antiseizure medication treatment was not recommended. Untreated patients had shorter epilepsy duration compared to patients treated with antiseizure medications (p = .003). At last follow-up, 77% of the untreated patients at first visit were receiving antiseizure medications compared to 97% of the initially treated group, and fewer were receiving antiseizure medication polytherapy (p = .0001). SIGNIFICANCE Although the rate of treatment gap was relatively low, we believe that it should be further reduced. Efforts may focus on addressing individual causes of nonadherence to antiseizure medication treatment and on promoting knowledge of diagnosis and treatment of epilepsy among healthcare professionals.
Collapse
Affiliation(s)
- Housam Soboh
- Neurology Department, Meir Medical Center, Kfar Saba, Israel
| | - Jacques Theitler
- Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Gandelman-Marton
- Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
35
|
Scheffer IE, Zuberi S, Mefford HC, Guerrini R, McTague A. Developmental and epileptic encephalopathies. Nat Rev Dis Primers 2024; 10:61. [PMID: 39237642 DOI: 10.1038/s41572-024-00546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/07/2024]
Abstract
Developmental and epileptic encephalopathies, the most severe group of epilepsies, are characterized by seizures and frequent epileptiform activity associated with developmental slowing or regression. Onset typically occurs in infancy or childhood and includes many well-defined epilepsy syndromes. Patients have wide-ranging comorbidities including intellectual disability, psychiatric features, such as autism spectrum disorder and behavioural problems, movement and musculoskeletal disorders, gastrointestinal and sleep problems, together with an increased mortality rate. Problems change with age and patients require substantial support throughout life, placing a high psychosocial burden on parents, carers and the community. In many patients, the aetiology can be identified, and a genetic cause is found in >50% of patients using next-generation sequencing technologies. More than 900 genes have been identified as monogenic causes of developmental and epileptic encephalopathies and many cell components and processes have been implicated in their pathophysiology, including ion channels and transporters, synaptic proteins, cell signalling and metabolism and epigenetic regulation. Polygenic risk score analyses have shown that common variants also contribute to phenotypic variability. Holistic management, which encompasses antiseizure therapies and care for multimorbidities, is determined both by epilepsy syndrome and aetiology. Identification of the underlying aetiology enables the development of precision medicines to improve the long-term outcome of patients with these devastating diseases.
Collapse
Affiliation(s)
- Ingrid E Scheffer
- Epilepsy Research Centre, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
- Florey and Murdoch Children's Research Institutes, Melbourne, Victoria, Australia.
- Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.
| | - Sameer Zuberi
- Paediatric Neurosciences Research Group, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
- Paediatric Neurosciences, Royal Hospital for Children, Glasgow, UK
| | - Heather C Mefford
- Center for Paediatric Neurological Disease Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital Meyer IRCCS, Florence, Italy
- University of Florence, Florence, Italy
| | - Amy McTague
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital, London, UK
| |
Collapse
|
36
|
Zhu X, Li P. GABA(A) Receptor Subunit (γ2, δ, β1-3) Variants in Genetic Epilepsy: A Comprehensive Summary of 206 Clinical Cases. J Child Neurol 2024:8830738241273437. [PMID: 39228214 DOI: 10.1177/08830738241273437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Epilepsy is identified in individuals who experienced 2 or more unprovoked seizures occurring over 24 hours apart, which can have a profound impact on a person's neurobiological, cognitive, psychological, and social well-being. Epilepsy is considerably diverse, with classifications such as genetic epilepsy that result directly from a known or presumed genetic variant with the core symptoms of seizures. The GABAA receptor primarily functions as a heteropentamer, containing 3 of 8 subunit types: α, β, γ, δ, ε, π, θ, and ρ. In the adult brain, the GABAA receptor is the primary inhibitory component in neural networks. The involvement of GABAA receptors in the pathogenesis of epilepsy has been proposed. We extensively reviewed all relevant clinical data of previously published cases of GABAA receptor subunit γ2, δ, β1-3 variants included in PubMed up to February 2024, including the variant types, loci, postulated mechanisms, their relevant regions, first onset ages, and phenotypes. We summarized the postulated mechanisms of epileptic pathogenesis. We also divided the collected 206 cases of epilepsy into 4 epileptic phenotypes: genetic generalized epilepsies, focal epilepsy, developmental and epileptic encephalopathies, and epilepsy with fever sensibility. We showed that there were significant differences in the likelihood of the γ2, β2, and β3 subunit variants causing genetic generalized epilepsies, focal epilepsy, developmental and epileptic encephalopathies, and epilepsy with fever sensibility. Patients with the β3 subunit variant seemed related to an earlier first onset age. Our review supports that GABAA receptor subunit variants are a crucial area of epilepsy research and treatment exploration.
Collapse
Affiliation(s)
- Xinyi Zhu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Peijun Li
- Shandong Institute of Brain Science and Brain-inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
37
|
Cubria T, Nairon EB, Landers J, Joseph S, Chandra M, Denbow ME, Hays R, Olson DM. Implementation of a Novel Seizure Assessment Tool for Unified Seizure Evaluation Improves Nurse Response. J Neurosci Nurs 2024:01376517-990000000-00107. [PMID: 39231436 DOI: 10.1097/jnn.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
ABSTRACT BACKGROUND: Ictal and postictal testing is an essential aspect of clinical care when diagnosing and treating seizures. The epilepsy monitoring unit (EMU) has standard operating procedures for nursing care during and after seizure events, but there is limited interrater reliability. Streamlining ictal and postictal testing processes may enhance care consistency for patients in the EMU unit. The purpose of this study was to create an ictal and postictal seizure assessment tool that would increase the consistency of nursing assessment for EMU patients. METHODS: This prospective study had 4 phases: baseline assessment, instrument development, staff education, and field testing. During baseline assessment, an advanced practice provider and an epilepsy fellow graded nurse ictal and postictal assessment via survey questions. After instrument development, education, and implementation, the same survey was administered to determine if nursing consistency in assessing seizure events improved. The tool used in this study was created by a team of clinical experts to ensure consistency in the assessment of seizure patients. RESULTS: A total of 58 first seizure events were collected over a 6-month intervention period; 27 in the pretest and 31 in the posttest. Paired t test analyses revealed significant improvement in the clinical testing domains of verbal language function (P < .005), motor function (P < .0005), and item assessment order (P < .005) postintervention. There was nonsignificant improvement in the domains of responsiveness (feeling [P = .597], using a code word [P = .093]) and visual language function (P = .602). CONCLUSION: The data captured in this study support the need for this instrument. There is strong need to increase consistency in assessing seizure events and to promote continued collaboration among clinical teams to enhance care to EMU patients. Validation of this instrument will further improve team collaboration by allowing nurses to contribute to their fullest extent.
Collapse
|
38
|
Ferretti A, Furlan M, Glinton KE, Fenger CD, Boschann F, Amlie-Wolf L, Zeidler S, Moretti R, Stoltenburg C, Tarquinio DC, Furia F, Parisi P, Rubboli G, Devinsky O, Mignot C, Gripp KW, Møller RS, Yang Y, Stankiewicz P, Gardella E. Epilepsy as a Novel Phenotype of BPTF-Related Disorders. Pediatr Neurol 2024; 158:17-25. [PMID: 38936258 DOI: 10.1016/j.pediatrneurol.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/15/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Neurodevelopmental disorder with dysmorphic facies and distal limb anomalies (NEDDFL) is associated to BPTF gene haploinsufficiency. Epilepsy was not included in the initial descriptions of NEDDFL, but emerging evidence indicates that epileptic seizures occur in some affected individuals. This study aims to investigate the electroclinical epilepsy features in individuals with NEDDFL. METHODS We enrolled individuals with BPTF-related seizures or interictal epileptiform discharges (IEDs) on electroencephalography (EEG). Demographic, clinical, genetic, raw EEG, and neuroimaging data as well as response to antiseizure medication were assessed. RESULTS We studied 11 individuals with a null variant in BPTF, including five previously unpublished ones. Median age at last observation was 9 years (range: 4 to 43 years). Eight individuals had epilepsy, one had a single unprovoked seizure, and two showed IEDs only. Key features included (1) early childhood epilepsy onset (median 4 years, range: 10 months to 7 years), (2) well-organized EEG background (all cases) and brief bursts of spikes and slow waves (50% of individuals), and (3) developmental delay preceding seizure onset. Spectrum of epilepsy severity varied from drug-resistant epilepsy (27%) to isolated IEDs without seizures (18%). Levetiracetam was widely used and reduced seizure frequency in 67% of the cases. CONCLUSIONS Our study provides the first characterization of BPTF-related epilepsy. Early-childhood-onset epilepsy occurs in 19% of subjects, all presenting with a well-organized EEG background associated with generalized interictal epileptiform abnormalities in half of these cases. Drug resistance is rare.
Collapse
Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Rome, Italy; Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark; Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
| | - Margherita Furlan
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark; Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Kevin E Glinton
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Christina D Fenger
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark; Amplexa Genetics A/S, Odense, Denmark
| | - Felix Boschann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Medizinische Genetik und Humangenetik, Berlin, Germany; Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Louise Amlie-Wolf
- Division of Medical Genetics, Nemours Children's Health, Wilmington, Delaware
| | - Shimriet Zeidler
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Raffaella Moretti
- APHP-Sorbonne Université, Département de Génétique, Hôpital Trousseau et Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Corinna Stoltenburg
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum Neuropädiatrie, Berlin, Germany
| | - Daniel C Tarquinio
- Rett Syndrome Clinic, Center for Rare Neurological Diseases, Norcross, Georgia
| | - Francesca Furia
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark; Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Pasquale Parisi
- Pediatrics Unit, Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Guido Rubboli
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Member of ERN EpiCARE
| | - Orrin Devinsky
- NYU Langone Epilepsy Center, Department of Neurology, NYU Grossman School of Medicine, New York City, New York
| | - Cyril Mignot
- APHP-Sorbonne Université, Département de Génétique, Hôpital Trousseau et Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Karen W Gripp
- Division of Medical Genetics, Nemours Children's Health, Wilmington, Delaware
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark; Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Member of ERN EpiCARE
| | - Yaping Yang
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas; AiLife Diagnostics, Pearland, Texas
| | - Pawel Stankiewicz
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Elena Gardella
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark; Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark; Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Member of ERN EpiCARE.
| |
Collapse
|
39
|
Adachi N, Kato M, Onuma T, Ito M, Okazaki M, Hara K, Adachi T, Matsubara R. Different psychopathological courses between chronic interictal psychosis and schizophrenia. Epilepsy Behav 2024; 158:109956. [PMID: 39059138 DOI: 10.1016/j.yebeh.2024.109956] [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: 05/06/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE The clinical course of interictal psychosis (IIP) has not yet been investigated. We aimed to compared the psychopathology and time-relevant indices between chronic IIP (CIIP) and schizophrenia (SC) METHODS: In this comprehensive psychopathological study, patients with chronic psychosis with and without epilepsy (127 with CIIP and 187 with SC) were compared. Psychopathology was measured using the Brief Psychiatric Rating Scale (BPRS): total, negative symptoms (NSs), positive symptoms (PSs), and anxiety-depressive symptoms (ADSs). Time-relevant indices included age at the time of evaluation, age at the onset of psychosis, and duration of psychosis. The psychopathology of psychosis types and time-relevant indices were analyzed using Pearson's correlation coefficient analysis of covariance. RESULTS Age at the time of evaluation was significantly correlated with NS, and ADS scores. Age-relevant trajectories significantly interacted with psychosis types. As age advanced, patients with SC exhibited increased scores, whereas patients with CIIP often exhibited decreased (or unchanged) scores. Age at onset of psychosis was significantly correlated with NS and ADS outcomes in patients with CIIP, whereas it was not correlated in patients with SC. There were significant interactions between age at onset and psychosis types. Patients with early-onset CIIP exhibited higher NS and lower ADS scores, whereas patients with SC exhibited no particular trajectory. The duration of psychosis significantly interacted with the psychosis types in the BPRS total, NSs and PSs. As duration increased, patients with CIIP exhibited no significant relationship, whereas patients with SC exhibited significantly higher psychotic scores. CONCLUSION Psychopathological courses differ between patients with CIIP and SC. Although patients with SC often exhibit deteriorations in psychotic symptoms, patients with CIIP exhibit no distinct deterioration. These findings can contribute psychiatric nosology, treatment strategies, and prediction outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Mitsutoshi Okazaki
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | | | | |
Collapse
|
40
|
Ribeiro LR, Dos Santos AMF, da Cruz Guedes E, Bezerra TLDS, de Souza TL, Filho JMB, de Almeida RN, Salvadori MGDSS. Effects of acute administration of 4-allyl-2,6-dimethoxyphenol in mouse models of seizures. Epilepsy Res 2024; 205:107421. [PMID: 39068729 DOI: 10.1016/j.eplepsyres.2024.107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 06/27/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024]
Abstract
Epilepsy, a chronic neurological disorder characterized by recurrent unprovoked seizures, presents a substantial challenge in approximately one-third of cases exhibiting resistance to conventional pharmacological treatments. This study investigated the effect of 4-allyl-2,6-dimethoxyphenol, a phenolic compound derived from various natural sources, in different models of induced seizures and its impact on animal electroencephalographic (EEG) recordings. Adult male Swiss albino mice were pre-treated (i.p.) with a dose curve of 4-allyl-2,6-dimethoxyphenol (50, 100, or 200 mg/kg), its vehicle (Tween), or standard antiepileptic drug (Diazepam; or Phenytoin). Subsequently, the mice were subjected to different seizure-inducing models - pentylenetetrazole (PTZ), 3-mercaptopropionic acid (3-MPA), pilocarpine (PILO), or maximal electroshock seizure (MES). EEG analysis was performed on other animals surgically implanted with electrodes to evaluate brain activity. Significant results revealed that animals treated with 4-allyl-2,6-dimethoxyphenol exhibited increased latency to the first myoclonic jerk in the PTZ and PILO models; prolonged latency to the first tonic-clonic seizure in the PTZ, 3-MPA, and PILO models; reduced total duration of tonic-clonic seizures in the PTZ and PILO models; decreased intensity of convulsive seizures in the PTZ and 3-MPA models; and diminished mortality in the 3-MPA, PILO, and MES models. EEG analysis indicated an increase in the percentage of total power attributed to beta waves following 4-allyl-2,6-dimethoxyphenol administration. Notably, the substance protected from behavioral and electrographic seizures in the PTZ model, preventing increases in the average amplitude of recording signals while also inducing an increase in the participation of theta and gamma waves. These findings suggest promising outcomes for the tested phenolic compound across diverse pre-clinical seizure models, highlighting the need for further comprehensive studies to elucidate its underlying mechanisms and validate its clinical relevance in epilepsy management.
Collapse
Affiliation(s)
- Leandro Rodrigo Ribeiro
- Laboratory of Psychopharmacology, Federal University of Paraíba, João Pessoa, Brazil; Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraíba, João Pessoa, Brazil; Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil; Institute of Research in Pharmaceuticals and Medicines, Federal University of Paraíba, João Pessoa, Brazil.
| | - Aline Matilde Ferreira Dos Santos
- Laboratory of Psychopharmacology, Federal University of Paraíba, João Pessoa, Brazil; Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraíba, João Pessoa, Brazil; Institute of Research in Pharmaceuticals and Medicines, Federal University of Paraíba, João Pessoa, Brazil
| | - Erika da Cruz Guedes
- Laboratory of Psychopharmacology, Federal University of Paraíba, João Pessoa, Brazil; Institute of Research in Pharmaceuticals and Medicines, Federal University of Paraíba, João Pessoa, Brazil; Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, Brazil
| | - Thamires Lucena da Silva Bezerra
- Laboratory of Psychopharmacology, Federal University of Paraíba, João Pessoa, Brazil; Institute of Research in Pharmaceuticals and Medicines, Federal University of Paraíba, João Pessoa, Brazil
| | - Thaíze Lopes de Souza
- Laboratory of Psychopharmacology, Federal University of Paraíba, João Pessoa, Brazil; Institute of Research in Pharmaceuticals and Medicines, Federal University of Paraíba, João Pessoa, Brazil
| | - José Maria Barbosa Filho
- Institute of Research in Pharmaceuticals and Medicines, Federal University of Paraíba, João Pessoa, Brazil; Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, Brazil; Department of Pharmaceutical Sciences, Federal University of Paraíba, João Pessoa, Brazil
| | - Reinaldo Nóbrega de Almeida
- Laboratory of Psychopharmacology, Federal University of Paraíba, João Pessoa, Brazil; Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraíba, João Pessoa, Brazil; Institute of Research in Pharmaceuticals and Medicines, Federal University of Paraíba, João Pessoa, Brazil; Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, Brazil; Department of Physiology and Pathology, Federal University of Paraíba, João Pessoa, Brazil
| | - Mirian Graciela da Silva Stiebbe Salvadori
- Laboratory of Psychopharmacology, Federal University of Paraíba, João Pessoa, Brazil; Graduate Program in Cognitive Neuroscience and Behavior, Federal University of Paraíba, João Pessoa, Brazil; Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil; Institute of Research in Pharmaceuticals and Medicines, Federal University of Paraíba, João Pessoa, Brazil; Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, Brazil
| |
Collapse
|
41
|
Wrzosek M, Banasik A, Czerwik A, Olszewska A, Płonek M, Stein V. Use of sedation-awakening electroencephalography in dogs with epilepsy. J Vet Intern Med 2024; 38:2578-2589. [PMID: 39133769 PMCID: PMC11423447 DOI: 10.1111/jvim.17153] [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: 01/15/2024] [Accepted: 07/17/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Electroencephalography (EEG) recording protocols have been standardized for humans. Although the utilization of techniques in veterinary medicine is increasing, a standard protocol has not yet been established. HYPOTHESIS Assessment of a sedation-awakening EEG protocol in dogs. ANIMALS Electroencephalography examination was performed in a research colony of 6 nonepileptic dogs (control [C]) and 12 dogs with epilepsy admitted to the clinic because of the epileptic seizures. METHODS It was a prospective study with retrospective control. Dogs with epilepsy were divided into 2 equal groups, wherein EEG acquisition was performed using a "sedation" protocol (IE-S, n = 6) and a "sedation-awakening" protocol (IE-SA, n = 6). All animals were sedated using medetomidine. In IE-SA group, sedation was reversed 5 minutes after commencing the EEG recording by injecting atipamezole IM. Type of background activity (BGA) and presence of EEG-defined epileptiform discharges (EDs) were evaluated blindly. Statistical significance was set at P > 0.05. RESULTS Epileptiform discharges were found in 1 of 6 of the dogs in group C, 4 of 6 of the dogs in IE-S group, and 5 of 6 of the dogs in IE-SA group. A significantly greater number of EDs (spikes, P = .0109; polyspikes, P = .0109; sharp waves, P = .01) were detected in Phase 2 in animals subjected to the "sedation-awakening" protocol, whereas there was no statistically significant greater number of discharges in sedated animals. CONCLUSIONS AND CLINICAL IMPORTANCE A "sedation-awakening" EEG protocol could be of value for ambulatory use if repeated EEG recordings and monitoring of epilepsy in dogs is needed.
Collapse
Affiliation(s)
- Marcin Wrzosek
- Department of Internal Diseases with a Clinic for Horses, Dogs and Cats, Faculty of Veterinary MedicineWrocław University of Environmental and Life SciencesWrocławPoland
- NeuroTeam Specialist Veterinary ClinicWrocławPoland
| | - Aleksandra Banasik
- Department of Internal Diseases with a Clinic for Horses, Dogs and Cats, Faculty of Veterinary MedicineWrocław University of Environmental and Life SciencesWrocławPoland
- NeuroTeam Specialist Veterinary ClinicWrocławPoland
| | - Adriana Czerwik
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐UniversityGiessenGermany
| | - Agnieszka Olszewska
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐UniversityGiessenGermany
| | - Marta Płonek
- Evidensia Small Animal HospitalArnhemThe Netherlands
| | - Veronika Stein
- Division of Clinical Neurology, Department for Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| |
Collapse
|
42
|
Feng T, Yang Y, Wang Y, Wei PH, Fan X, Zhang H, An Y, Wang T, Huang Y, Chen S, Piao Y, Xiao F, Duncan JS, Shan Y, Zhao G. Delineating structural and metabolic abnormalities in amygdala and hippocampal subfields for different seizure-onset patterns via stereotactic electroencephalography. CNS Neurosci Ther 2024; 30:e14905. [PMID: 39248455 PMCID: PMC11382356 DOI: 10.1111/cns.14905] [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: 05/01/2024] [Revised: 07/06/2024] [Accepted: 07/23/2024] [Indexed: 09/10/2024] Open
Abstract
AIMS We aimed to investigate mesial temporal lobe abnormalities in mesial temporal lobe epilepsy (MTLE) patients with hypersynchronous (HYP) and low-voltage fast rhythms (LVF) onset identified by stereotactic electroencephalography (SEEG) and evaluate their diagnostic and prognostic value. METHODS Fifty-one MTLE patients were categorized as HYP or LVF by SEEG. High-resolution MRI volume-based analysis and 18F-FDG-PET standard uptake values of hippocampal and amygdala subfields were quantified and compared with 57 matched controls. Further analyses were conducted to delineate the distinct pathological characteristics differentiating the two groups. Diagnostic and prognostic prediction performance of these biomarkers were assessed using receiver operating characteristic curves. RESULTS LVF-onset individuals demonstrated ipsilateral amygdala enlargement (p = 0.048) and contralateral hippocampus hypermetabolism (p = 0.042), pathological results often accompany abnormalities in the temporal lobe cortex, while HYP-onset subjects had significant atrophy (p < 0.001) and hypometabolism (p = 0.013) in ipsilateral hippocampus and its subfields, as well as amygdala atrophy (p < 0.001), pathological results are highly correlated with hippocampal sclerosis. Severe fimbria atrophy was observed in cases of HYP-onset MTLE with poor prognosis (AUC = 0.874). CONCLUSION Individuals with different seizure-onset patterns display specific morphological and metabolic abnormalities in the amygdala and hippocampus. Identifying these subfield abnormalities can improve diagnostic and prognostic precision, guiding surgical strategies for MTLE.
Collapse
Affiliation(s)
- Tao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yanfeng Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yihe Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Peng-Hu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Huaqiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yang An
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Tianren Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yuda Huang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Sichang Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yueshan Piao
- China International Neuroscience Institute (CHINA-INI), Beijing, China
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fenglai Xiao
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont Saint Peter, UK
| | - John S Duncan
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont Saint Peter, UK
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (CHINA-INI), Beijing, China
- Institute for Brain Disorder, Beijing, China
| |
Collapse
|
43
|
Yimenicioğlu S, Ekici A. Hot water epilepsy with alone and spontaneous seizures in childhood. Epilepsy Res 2024; 205:107418. [PMID: 39003967 DOI: 10.1016/j.eplepsyres.2024.107418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/10/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES Hot water epilepsy (HWE) is a type of epilepsy that primarily affects children. This study was aimed to evaluate the clinical, electroencephalogram (EEG), neuroimaging findings, and treatment options in children with HWE. METHODS The medical records of 24 patients who had HWE were evaluated retrospectively. RESULTS There were 2767 patients diagnosed with epilepsy during the seven-year period, and 0.86 % of the patients had HWE. The median age of the patients was three (range 1.2-7 years), with a male predominance (male/female ratio: 7.1). Six patients (25 %) had HWE with spontaneous seizures (HWESS) and 18 patients (75 %) had HWE alone (HWEA). 11 patients had focal onset seizures, 13 patients had generalized onset seizures. EEG abnormalities were found in 7 patients (29.2 %). Three patients (12.5 %) had nonspecific MRI findings. Developmental abnormalities (autism spectrum disorder, learning disability and speech disturbance.) were detected in 8 patients (33.3 %). Only one patient's (4.2 %) seizure could be controlled by changing bathroom habits. Twenty-three patients (95.8 %) were given antiepileptic drugs. 18 of 24 patients had come for follow-up visits for two years, nine of them used monotherapy and seizures did not recur. The treatment response was 55.5 %. Oxcarbazepine (8 patients, 33.3 %) and valproic acid (7 patients, 29.2 %) were the most chosen two drugs for HWE. The genetic tests performed were not accepted relevant to the patients' clinical conditions and epilepsy. CONCLUSION The frequency of the HWE was not as high in the literature. Male predominance, EEG abnormalities may be seen. Changing bath room habits did not improve the treatment as a first line management, all the patients except one used antiepileptic drug treatment. Until now, there has been no study in Turkey showing the frequency of HWE exclusively in children.
Collapse
Affiliation(s)
- Sevgi Yimenicioğlu
- Department of Pediatric Neurology, Health Ministry Eskisehir City Hospital, Eskisehir, Turkey.
| | - Arzu Ekici
- Department of Pediatric Neurology, Health Ministry Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
| |
Collapse
|
44
|
Baysal L, Ludolph AC, Wagner J. Clinical and paraclinical features of first unprovoked seizures in the elderly. Epilepsy Behav 2024; 158:109926. [PMID: 38959742 DOI: 10.1016/j.yebeh.2024.109926] [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: 04/14/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE The prevalence of unprovoked seizures and epilepsy rises significantly in later life stages. This study examines various factors in elderly patients (over 65 years) with their first unprovoked seizures, comparing findings with younger patients. METHODS We analyzed electronic medical records of individuals with first unprovoked seizures retrospectively. Diagnosis was based on patient history and witness accounts, and exclusion of other potential causes. Data included demographics, physical examination, seizure characteristics, neuroimaging, EEG findings, laboratory markers, potential causes, prescribed anti-seizure medications (ASMs) at diagnosis and follow-up, seizure-related injuries and hospital stay length. RESULTS We enrolled 391 patients (mean age 73.02 ± 16.5, 219 females). Most had late-onset (≥65 years) seizures (n = 295, 75.5 %). Status epilepticus was diagnosed in 10.2 %, more in the late-onset group. Elderly patients most often had focal seizures with impaired consciousness, while younger patients had focal to bilateral tonic-clonic seizures. (55.9 % vs 36.5 %). Late-onset seizures were linked to cerebrovascular diseases, small vessel disease, and cerebral atrophy, while early-onset cases were associated with brain tumors or unknown causes. Brain imaging revealed potentially epileptogenic abnormalities in 59.1 %. Positive paraneoplastic or autoimmune antibodies were found in 0.8 %. Abnormal EEGs were present in 25.9 %, more in the late-onset group. Most patients were discharged with levetiracetam (LEV) or lamotrigine (LTG) monotherapy. Nine patients with late-onset seizures died during in-hospital follow-up. CONCLUSION Our findings can contribute to the improved identification and characterization of patients with late-onset seizures, facilitating targeted diagnostics and appropriate treatment in this challenging patient population.
Collapse
Affiliation(s)
- Leyla Baysal
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany.
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany
| | - Jan Wagner
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany; Epilepsy Center Ulm, Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany
| |
Collapse
|
45
|
Klein P, Kaminski RM, Koepp M, Löscher W. New epilepsy therapies in development. Nat Rev Drug Discov 2024; 23:682-708. [PMID: 39039153 DOI: 10.1038/s41573-024-00981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/24/2024]
Abstract
Epilepsy is a common brain disorder, characterized by spontaneous recurrent seizures, with associated neuropsychiatric and cognitive comorbidities and increased mortality. Although people at risk can often be identified, interventions to prevent the development of the disorder are not available. Moreover, in at least 30% of patients, epilepsy cannot be controlled by current antiseizure medications (ASMs). As a result of considerable progress in epilepsy genetics and the development of novel disease models, drug screening technologies and innovative therapeutic modalities over the past 10 years, more than 200 novel epilepsy therapies are currently in the preclinical or clinical pipeline, including many treatments that act by new mechanisms. Assisted by diagnostic and predictive biomarkers, the treatment of epilepsy is undergoing paradigm shifts from symptom-only ASMs to disease prevention, and from broad trial-and-error treatments for seizures in general to mechanism-based treatments for specific epilepsy syndromes. In this Review, we assess recent progress in ASM development and outline future directions for the development of new therapies for the treatment and prevention of epilepsy.
Collapse
Affiliation(s)
- Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA.
| | | | - Matthias Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Wolfgang Löscher
- Translational Neuropharmacology Lab., NIFE, Department of Experimental Otology of the ENT Clinics, Hannover Medical School, Hannover, Germany.
- Center for Systems Neuroscience, Hannover, Germany.
| |
Collapse
|
46
|
Dong R, Jin R, Zhang H, Zhang H, Xue M, Li Y, Zhang K, Lv Y, Li X, Liu Y, Gai Z. Genotypic and phenotypic characteristics of sodium channel-associated epilepsy in Chinese population. J Hum Genet 2024; 69:441-453. [PMID: 38880818 DOI: 10.1038/s10038-024-01257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 06/18/2024]
Abstract
Variants in voltage-gated sodium channel (VGSC) genes are implicated in seizures, epilepsy, and neurodevelopmental disorders, constituting a significant aspect of hereditary epilepsy in the Chinese population. Through retrospective analysis utilizing next-generation sequencing (NGS), we examined the genotypes and phenotypes of VGSC-related epilepsy cases from a cohort of 691 epilepsy subjects. Our findings revealed that 5.1% of subjects harbored VGSC variants, specifically 22 with SCN1A, 9 with SCN2A, 1 with SCN8A, and 3 with SCN1B variants; no SCN3A variants were detected. Among these, 14 variants were previously reported, while 21 were newly identified. SCN1A variant carriers predominantly presented with Dravet Syndrome (DS) and Genetic Epilepsy with Febrile Seizures Plus (GEFS + ), featuring a heightened sensitivity to fever-induced seizures. Statistically significant disparities emerged between the SCN1A-DS and SCN1A-GEFS+ groups concerning seizure onset and genetic diagnosis age, incidence of status epilepticus, mental retardation, anti-seizure medication (ASM) responsiveness, and familial history. Notably, subjects with SCN1A variants affecting the protein's pore region experienced more frequent cluster seizures. All SCN2A variants were of de novo origin, and 88.9% of individuals with SCN2A variations exhibited cluster seizures. This research reveals a significant association between variations in VGSC-related genes and the clinical phenotype diversity of epilepsy subjects in China, emphasizing the pivotal role of NGS screening in establishing accurate disease diagnoses and guiding the selection of ASM.
Collapse
Affiliation(s)
- Rui Dong
- Pediatric Research Institute, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
| | - Ruifeng Jin
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
- Department of neurology, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China
| | - Hongwei Zhang
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
- Department of neurology, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China
| | - Haiyan Zhang
- Pediatric Research Institute, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
| | - Min Xue
- Pediatric Research Institute, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
| | - Yue Li
- Pediatric Research Institute, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
| | - Kaihui Zhang
- Pediatric Research Institute, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
| | - Yuqiang Lv
- Pediatric Research Institute, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
| | - Xiaoying Li
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China.
- Neonatology department, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China.
| | - Yi Liu
- Pediatric Research Institute, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China.
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China.
| | - Zhongtao Gai
- Pediatric Research Institute, Children's Hospital Affiliated to Shandong University (Jinan Children's Hospital), Jinan, China
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
| |
Collapse
|
47
|
Kaushik M, Mahajan S, Machahary N, Thakran S, Chopra S, Tomar RV, Kushwaha SS, Agarwal R, Sharma S, Kukreti R, Biswal B. Predicting efficacy of antiseizure medication treatment with machine learning algorithms in North Indian population. Epilepsy Res 2024; 205:107404. [PMID: 38996687 DOI: 10.1016/j.eplepsyres.2024.107404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE This study aimed to develop a classifier using supervised machine learning to effectively assess the impact of clinical, demographical, and biochemical factors in accurately predicting the antiseizure medications (ASMs) treatment response in people with epilepsy (PWE). METHODS Data was collected from 786 PWE at the Outpatient Department of Neurology, Institute of Human Behavior and Allied Sciences (IHBAS), New Delhi, India from 2005 to 2015. Patients were followed up at the 2nd, 4th, 8th, and 12th month over the span of 1 year for the drugs being administered and their dosage, the serum drug levels, the frequency of seizure control, drug efficacy, the adverse drug reactions (ADRs), and their compliance to ASMs. Several features, including demographic details, medical history, and auxiliary examinations electroencephalogram (EEG) or Computed Tomography (CT) were chosen to discern between patients with distinct remission outcomes. Remission outcomes were categorized into 'good responder (GR)' and 'poor responder (PR)' based on the number of seizures experienced by the patients over the study duration. Our dataset was utilized to train seven classical machine learning algorithms i.e Extreme Gradient Boost (XGB), K-Nearest Neighbor (KNN), Support Vector Classifier (SVC), Decision Tree (DT), Random Forest (RF), Naïve Bayes (NB) and Logistic Regression (LR) to construct classification models. RESULTS Our research findings indicate that 1) among the seven algorithms examined, XGB and SVC demonstrated superior predictive performances of ASM treatment outcomes with an accuracy of 0.66 each and ROC-AUC scores of 0.67 (XGB) and 0.66 (SVC) in distinguishing between PR and GR patients. 2) The most influential factor in discerning PR to GR patients is a family history of seizures (no), education (literate) and multitherapy with Chi-square (χ2) values of 12.1539, 8.7232 and 13.620 respectively and odds ratio (OR) of 2.2671, 0.4467, and 1.9453 each. 3). Furthermore, our surrogate analysis revealed that the null hypothesis for both XGB and SVC was rejected at a 100 % confidence level, underscoring the significance of their predictive performance. These findings underscore the robustness and reliability of XGB and SVC in our predictive modelling framework. SIGNIFICANCE Utilizing XG Boost and SVC-based machine learning classifier, we successfully forecasted the likelihood of a patient's response to ASM treatment, categorizing them as either PR or GR, post-completion of standard epilepsy examinations. The classifier's predictions were found to be statistically significant, suggesting their potential utility in improving treatment strategies, particularly in the personalized selection of ASM regimens for individual epilepsy patients.
Collapse
Affiliation(s)
- Mahima Kaushik
- Cluster Innovation Centre, University of Delhi, Delhi, India
| | | | - Nitin Machahary
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Sarita Thakran
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Saransh Chopra
- Cluster Innovation Centre, University of Delhi, Delhi, India
| | | | - Suman S Kushwaha
- Department. of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India
| | - Rachna Agarwal
- Department. of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India
| | - Sangeeta Sharma
- Department. of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India
| | - Ritushree Kukreti
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Bibhu Biswal
- Cluster Innovation Centre, University of Delhi, Delhi, India.
| |
Collapse
|
48
|
Wu Y, Zhang Q, Deng Y, Ding X, Xie H, Wang S, Liu C, Li M, Cai L, Jiang Y. Impact of epilepsy surgery on developmental trajectories of children under 3 years of age. Dev Med Child Neurol 2024; 66:1215-1225. [PMID: 38343043 DOI: 10.1111/dmcn.15873] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 08/03/2024]
Abstract
AIM To investigate the developmental effects of epilepsy surgery in young children. METHOD This study retrospectively reviewed 315 consecutive children under 3 years of age, and ultimately included 89 children (48 males, 41 females) with pre- and postsurgery developmental evaluations. RESULTS The mean general quotient before surgery was 46.7 (SD 24.7). Before surgery, the general quotient decreased in 77.6% of patients, while after surgery it increased in 55.1%. Furthermore, 70% of those 20 patients whose presurgical general quotient decreased by more than 10 points experienced positive changes. General quotient scores decreased in 15 out of the 22 patients classified in the normal/marginal presurgical category. Children who underwent surgery before the age of 12 months had a median gain in general quotient score by 7.6. Short-term general quotient scores were highly correlated with long-term scores (r = 0.909, p < 0.001). INTERPRETATION Surgical intervention was more inclined to positively impact developmental trajectories within a short postsurgical period, particularly among those affected by severe epileptic activity. However, in children with relatively typical development, certain developmental setbacks may arise. Postsurgical short-term developmental outcomes could predict longer-term outcomes.
Collapse
Affiliation(s)
- Yuan Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Qian Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yutong Deng
- Health Science Center, Peking University, Beijing, China
| | - Xiang Ding
- Health Science Center, Peking University, Beijing, China
| | - Han Xie
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Shuang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chang Liu
- Children's Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Ming Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Lixin Cai
- Children's Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Children's Epilepsy Center, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis and Study on Pediatric Genetic Diseases, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| |
Collapse
|
49
|
Ponisio MR, Zempel JM, Willie JT, Tomko SR, McEvoy SD, Roland JL, Williams JP. FDG-PET/MRI in the presurgical evaluation of pediatric epilepsy. Pediatr Radiol 2024; 54:1589-1602. [PMID: 39123082 DOI: 10.1007/s00247-024-06011-6] [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: 12/18/2023] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Abstract
In patients with drug-resistant epilepsy, difficulties in identifying the epileptogenic zone are well known to correlate with poorer clinical outcomes post-surgery. The integration of PET and MRI in the presurgical assessment of pediatric patients likely improves diagnostic precision by confirming or widening treatment targets. PET and MRI together offer superior insights compared to either modality alone. For instance, PET highlights abnormal glucose metabolism, while MRI precisely localizes structural anomalies, providing a comprehensive understanding of the epileptogenic zone. Furthermore, both methodologies, whether utilized through simultaneous PET/MRI scanning or the co-registration of separately acquired PET and MRI data, present unique advantages, having complementary roles in lesional and non-lesional cases. Simultaneous FDG-PET/MRI provides precise co-registration of functional (PET) and structural (MR) imaging in a convenient one-stop-shop approach, which minimizes sedation time and reduces radiation exposure in children. Commercially available fusion software that allows retrospective co-registration of separately acquired PET and MRI images is a commonly used alternative. This review provides an overview and illustrative cases that highlight the role of combining 18F-FDG-PET and MRI imaging and shares the authors' decade-long experience utilizing simultaneous PET/MRI in the presurgical evaluation of pediatric epilepsy.
Collapse
Affiliation(s)
- Maria R Ponisio
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, School of Medicine, Washington University in St Louis, MSC 8223-0019-10, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA.
| | - John M Zempel
- Department of Neurology, School of Medicine, Washington University in St Louis, St. Louis, MO, USA
| | - Jon T Willie
- Department of Neurosurgery, School of Medicine, Washington University in St Louis, St. Louis, MO, USA
| | - Stuart R Tomko
- Department of Neurology, School of Medicine, Washington University in St Louis, St. Louis, MO, USA
| | - Sean D McEvoy
- Department of Neurosurgery, School of Medicine, Washington University in St Louis, St. Louis, MO, USA
| | - Jarod L Roland
- Department of Neurosurgery, School of Medicine, Washington University in St Louis, St. Louis, MO, USA
| | - Jonathan P Williams
- Department of Neurology, School of Medicine, Washington University in St Louis, St. Louis, MO, USA
| |
Collapse
|
50
|
Castellotti B, Ragona F, Freri E, Messina G, Magri S, Previtali R, Solazzi R, Franceschetti S, Taroni F, Canafoglia L, Gellera C, Granata T, DiFrancesco JC. Next-generation sequencing in pediatric-onset epilepsies: Analysis with target panels and personalized therapeutic approach. Epilepsia Open 2024. [PMID: 39215763 DOI: 10.1002/epi4.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE The objective of this study is to report the results of the genetic analysis in a large and well-characterized population with pediatric-onset epilepsies and to identify those who could benefit from precision medicine treatments. METHODS In this retrospective observational study, we consecutively recruited patients with pediatric-onset epilepsy observed at a tertiary neurological center over a time span of 7 years, collecting clinical and laboratory findings. Following in-depth diagnostic process to exclude possible structural and metabolic causes of the disease, patients with a suspected genetically determined etiology underwent next-generation sequencing (NGS) screening with panels for the analysis of target genes causative of epilepsy. RESULTS We detected likely pathogenic or pathogenic variants (classes IV and V) in 24% of the 562 patients who underwent genetic investigations. By the evaluation of patients' data, we observed that some features (onset of epilepsy before one year old, presence of neurological deficits, psychomotor delay/cognitive disability, and malformative aspects at brain MRI) were significantly associated with class IV or V variants. Moreover, statistical analysis showed that the diagnostic yield resulted higher for patients affected by Progressive Myoclonic Epilepsy (PME) and with early onset developmental and epileptic encephalopathies (DEE), compared with focal epilepsies, genetic generalized epilepsies, DEE with onset at/after 1 y.o., and unclassified epileptic syndromes. According to the results of the genetic screening, up to 33% of patients carrying class IV or V variants resulted potentially eligible for precision medicine treatments. SIGNIFICANCE The large-scale application of NGS multigene panels of analysis is a useful tool for the molecular diagnosis of patients with pediatric-onset epilepsies, allowing the identification of those who could benefit from a personalized therapeutic approach. PLAIN LANGUAGE SUMMARY The analysis of patients with pediatric-onset epilepsy using advanced technologies for the screening of all the implicated genes allows the identification of the cause of diseases in an ever-increasing number of cases. Understanding the pathogenic mechanisms could, in some cases, guide the selection and optimization of appropriate treatment approaches for patients.
Collapse
Affiliation(s)
- Barbara Castellotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuliana Messina
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefania Magri
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Previtali
- Pediatric Neurology, Department of Biomedical and Clinical Sciences, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Roberta Solazzi
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvana Franceschetti
- Integrated Diagnostics for Epilepsy, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Franco Taroni
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Canafoglia
- Integrated Diagnostics for Epilepsy, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cinzia Gellera
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | |
Collapse
|