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Yang H, Wei X, Huang K, Wu Z, Zhang Q, Wen S, Wang Q, Feng L. Features of attention network impairment in patients with temporal lobe epilepsy: Evidence from eye-tracking and electroencephalogram. Epilepsy Behav 2024; 157:109887. [PMID: 38905916 DOI: 10.1016/j.yebeh.2024.109887] [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: 01/07/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 06/23/2024]
Abstract
AIM To explore multiple features of attention impairments in patients with temporal lobe epilepsy (TLE). METHODS A total of 93 patients diagnosed with TLE at Xiangya Hospital during May 2022 and December 2022 and 85 healthy controls were included in this study. Participants were asked to complete neuropsychological scales and attention network test (ANT) with recording of eye-tracking and electroencephalogram. RESULTS All means of evaluation showed impaired attention functions in TLE patients. ANT results showed impaired orienting (p < 0.001) and executive control (p = 0.041) networks. Longer mean first saccade time (p = 0.046) and more total saccadic counts (p = 0.035) were found in eye-tracking results, indicating abnormal alerting and orienting networks. Both alerting, orienting and executive control networks were abnormal, manifesting as decreased amplitudes (N1 & P3, p < 0.001) and extended latency (P3, p = 0.002). The energy of theta, alpha and beta were all sensitive to the changes of alerting and executive control network with time, but only beta power was sensitive to the changes of orienting network. CONCLUSION Our findings are helpful for early identification of patients with TLE combined with attention impairments, which have strong clinical guiding significance for long-term monitoring and intervention.
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Affiliation(s)
- Haojun Yang
- Department of Anesthesiology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaojie Wei
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi'an 710119, China; Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi'an 710119, China; University of Chinese Academy of Sciences, Beijing 101400, China
| | - Kailing Huang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongling Wu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Clinical Nursing Teaching and Research Section, Xiangya Hospital, Central South University, Changsha, China
| | - Qiong Zhang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shirui Wen
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Quan Wang
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi'an 710119, China; Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi'an 710119, China.
| | - Li Feng
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Buainain RP, Sodré AR, dos Santos JS, Takazaki KAG, Queiroz LDS, de Oliveira CTP, de Aguiar PHP, Marson FAL, Ortega MM. Single-Base Gene Variants in MIR-146A and SCN1A Genes Related to the Epileptogenic Process in Drug-Responsive and Drug-Resistant Temporal Lobe Epilepsy-A Preliminary Study in a Brazilian Cohort Sample. Int J Mol Sci 2024; 25:6005. [PMID: 38892194 PMCID: PMC11172889 DOI: 10.3390/ijms25116005] [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: 03/17/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
The drug-resistant temporal lobe epilepsy (TLE) has recently been associated with single nucleotide variants (SNVs) in microRNA(miR)-146a (MIR-146A) (rs2910164) and Sodium Voltage-Gated Channel Alpha Subunit 1 (SCN1A) (rs2298771 and rs3812718) genes. Moreover, no studies have shown an association between these SNVs and susceptibility to drug-resistant and drug-responsive TLE in Brazil. Thus, deoxyribonucleic acid (DNA) samples from 120 patients with TLE (55 drug-responsive and 65 drug-resistant) were evaluated by real-time polymerase chain reaction (RT-PCR). A total of 1171 healthy blood donor individuals from the Online Archive of Brazilian Mutations (ABraOM, from Portuguese Arquivo Brasileiro On-line de Mutações), a repository containing genomic variants of the Brazilian population, were added as a control population for the studied SNVs. MIR-146A and SCN1A relative expression was performed by quantitative RT-PCR (qRT-PCR). The statistical analysis protocol was performed using an alpha error of 0.05. TLE patient samples and ABraOM control samples were in Hardy-Weinberg equilibrium for all studied SNVs. For rs2910164, the frequencies of the homozygous genotype (CC) (15.00% vs. 9.65%) and C allele (37.80% vs. 29.97%) were superior in patients with TLE compared to controls with a higher risk for TLE disease [odds ratio (OR) = 1.89 (95% confidence interval (95%CI) = 1.06-3.37); OR = 1.38 (95%CI = 1.04-1.82), respectively]. Drug-responsive patients also presented higher frequencies of the CC genotype [21.81% vs. 9.65%; OR = 2.58 (95%CI = 1.25-5.30)] and C allele [39.09% vs. 29.97%; OR = 1.50 (95%CI = 1.01-2.22)] compared to controls. For rs2298771, the frequency of the heterozygous genotype (AG) (51.67% vs. 40.40%) was superior in patients with TLE compared to controls with a higher risk for TLE disease [OR = 2.42 (95%CI = 1.08-5.41)]. Drug-resistant patients presented a higher AG frequency [56.92% vs. 40.40%; OR = 3.36 (95%CI = 1.04-17.30)] compared to the control group. For rs3812718, the prevalence of genotypes and alleles were similar in both studied groups. The MIR-146A relative expression level was lower in drug-resistant compared to drug-responsive patients for GC (1.6 vs. 0.1, p-value = 0.049) and CC (1.8 vs. 0.6, p-value = 0.039). Also, the SCN1A relative expression levels in samples from TLE patients were significantly higher in AG [2.09 vs. 1.10, p-value = 0.038] and GG (3.19 vs. 1.10, p-value < 0.001) compared to the AA genotype. In conclusion, the rs2910164-CC and rs2298771-AG genotypes are exerting significant risk influence, respectively, on responsive disease and resistant disease, probably due to an upregulated nuclear factor kappa B (NF-kB) and SCN1A loss of function.
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Affiliation(s)
- Renata Parissi Buainain
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista 12916-900, SP, Brazil or (F.A.L.M.)
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista 12916-900, SP, Brazil
| | - André Rodrigues Sodré
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista 12916-900, SP, Brazil or (F.A.L.M.)
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista 12916-900, SP, Brazil
| | - Jéssica Silva dos Santos
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista 12916-900, SP, Brazil or (F.A.L.M.)
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista 12916-900, SP, Brazil
| | - Karen Antonia Girotto Takazaki
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista 12916-900, SP, Brazil or (F.A.L.M.)
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista 12916-900, SP, Brazil
| | - Luciano de Souza Queiroz
- Department of Pathology, Faculty of Medical Science, University of Campinas, Campinas 13083-970, SP, Brazil;
| | - Carlos Tadeu Parisi de Oliveira
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista 12916-900, SP, Brazil or (F.A.L.M.)
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista 12916-900, SP, Brazil
- São Francisco University Hospital, São Francisco University, Bragança Paulista 20210-030, SP, Brazil
| | - Paulo Henrique Pires de Aguiar
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista 12916-900, SP, Brazil or (F.A.L.M.)
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista 12916-900, SP, Brazil
- Department of Neurosurgery, Hospital Santa Paula, São Paulo 04556-100, SP, Brazil
| | - Fernando Augusto Lima Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista 12916-900, SP, Brazil or (F.A.L.M.)
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista 12916-900, SP, Brazil
| | - Manoela Marques Ortega
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista 12916-900, SP, Brazil or (F.A.L.M.)
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista 12916-900, SP, Brazil
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Huang Y, Wang N, Li W, Feng T, Zhang H, Fan X, Chen S, Wang Y, Shan Y, Wei P, Zhao G. Aberrant individual structure covariance network in patients with mesial temporal lobe epilepsy. Front Neurosci 2024; 18:1381385. [PMID: 38784092 PMCID: PMC11112066 DOI: 10.3389/fnins.2024.1381385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
Objective Mesial temporal lobe epilepsy (mTLE) is a complex neurological disorder that has been recognized as a widespread global network disorder. The group-level structural covariance network (SCN) could reveal the structural connectivity disruption of the mTLE but could not reflect the heterogeneity at the individual level. Methods This study adopted a recently proposed individual structural covariance network (IDSCN) method to clarify the alternated structural covariance connection mode in mTLE and to associate IDSCN features with the clinical manifestations and regional brain atrophy. Results We found significant IDSCN abnormalities in the ipsilesional hippocampus, ipsilesional precentral gyrus, bilateral caudate, and putamen in mTLE patients than in healthy controls. Moreover, the IDSCNs of these areas were positively correlated with the gray matter atrophy rate. Finally, we identified several connectivities with weak associations with disease duration, frequency, and surgery outcome. Significance Our research highlights the role of hippo-thalamic-basal-cortical circuits in the pathophysiologic process of disrupted whole-brain morphological covariance networks in mTLE, and builds a bridge between brain-wide covariance network changes and regional brain atrophy.
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Affiliation(s)
- Yuda Huang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ningrui Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Wei Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tao Feng
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Huaqiang Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Sichang Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yihe Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, China
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Englot DJ. Chronicles of Change: The Shrinking Brain in Epilepsy. Epilepsy Curr 2024; 24:159-161. [PMID: 38898902 PMCID: PMC11185202 DOI: 10.1177/15357597241228475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Identification of Different MRI Atrophy Progression Trajectories in Epilepsy by Subtype and Stage Inference Xiao F, Caciagli L, Wandschneider B, Sone D, Young AL, Vos SB, Winston GP, Zhang Y, Liu W, An D, Kanber B, Zhou D, Sander JW, Thom M, Duncan JS, Alexander DC, Galovic M, Koepp MJ. Brain . 2023;146(11):4702-4716. doi:10.1093/brain/awad284 Artificial intelligence (AI)-based tools are widely employed, but their use for diagnosis and prognosis of neurological disorders is still evolving. Here we analyse a cross-sectional multicentre structural MRI dataset of 696 people with epilepsy and 118 control subjects. We use an innovative machine-learning algorithm, Subtype and Stage Inference, to develop a novel data-driven disease taxonomy, whereby epilepsy subtypes correspond to distinct patterns of spatiotemporal progression of brain atrophy. In a discovery cohort of 814 individuals, we identify two subtypes common to focal and idiopathic generalized epilepsies, characterized by progression of grey matter atrophy driven by the cortex or the basal ganglia. A third subtype, only detected in focal epilepsies, was characterized by hippocampal atrophy. We corroborate external validity via an independent cohort of 254 people and confirm that the basal ganglia subtype is associated with the most severe epilepsy. Our findings suggest fundamental processes underlying the progression of epilepsy-related brain atrophy. We deliver a novel MRI- and AI-guided epilepsy taxonomy, which could be used for individualized prognostics and targeted therapeutics.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center
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Li Z, Zhao X, Zhang G, Xi C, Yang L. Efficacy of levetiracetam combined with oxcarbazepine in the treatment of adults with temporal lobe epilepsy and its impact on memory and cognitive function. Am J Transl Res 2024; 16:1009-1017. [PMID: 38586112 PMCID: PMC10994801 DOI: 10.62347/knte8578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To explore the effect of levetiracetam combined with oxcarbazepine on the memory and cognitive function of adult patients with temporal lobe epilepsy. METHODS This retrospective analysis included 91 adult patients with temporal lobe epilepsy treated at Xianyang Hospital from June 2020 to December 2022. Based on their medication regimen, patients were categorized into an observation group (n=51) receiving levetiracetam plus oxcarbazepine and a control group (n=40) receiving only levetiracetam. Both groups underwent 3 months of continuous treatment. Therapeutic efficacy, pre- and post-treatment memory function (assessed using the Clinical Memory Scale, CMS), cognitive function (evaluated with the Wechsler Adult Intelligence Scale-Revised in China, WAISRC), anxiety and depression levels (measured by the Hamilton Anxiety Scale, HAMA, and Hamilton Depression Scale, HAMD), as well as adverse reactions, were compared between the two groups. Independent factors influencing treatment efficacy were also analyzed. RESULTS CMS and WAISRC scores significantly increased in both groups after treatment (both P=0.001), with the observation group showing more significant improvements than the control group (P=0.001). The improvements in HAMA and HAMD scores in the observation group were significantly better than the control group (all P<0.001). Adverse reaction occurrence showed no significant difference between the two groups (P>0.05). Prognostic analysis identified seizure frequency and treatment regimen as independent factors influencing efficacy. CONCLUSION Levetiracetam combined with oxcarbazepine effectively improves cognitive dysfunction in adults with temporal lobe epilepsy, with superior efficacy to levetiracetam alone, and good safety.
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Affiliation(s)
- Zhangxia Li
- Ward 15, Department of Neurology, Xianyang Hospital, Yan’an UniversityXianyang 712000, Shaanxi, China
| | - Xiongfei Zhao
- Ward 15, Department of Neurology, Xianyang Hospital, Yan’an UniversityXianyang 712000, Shaanxi, China
| | - Guoxun Zhang
- Ward 15, Department of Neurology, Xianyang Hospital, Yan’an UniversityXianyang 712000, Shaanxi, China
| | - Cong Xi
- Department of Neurology, Baoji City People’s HospitalBaoji 721001, Shaanxi, China
| | - Liying Yang
- Department of Neurology, Baoji City People’s HospitalBaoji 721001, Shaanxi, China
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Huang H, Chen L, Yuan J, Zhang H, Yang J, Xu Z, Chen Y. Role and mechanism of EphB3 in epileptic seizures and epileptogenesis through Kalirin. Mol Cell Neurosci 2024; 128:103915. [PMID: 38143048 DOI: 10.1016/j.mcn.2023.103915] [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: 10/22/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND The EphB receptor tyrosine kinase family participates in intricate signaling pathways that orchestrate neural networks, guide neuronal axon development, and modulate synaptic plasticity through interactions with surface-bound ephrinB ligands. Additionally, Kalirin, a Rho guanine nucleotide exchange factor, is notably expressed in the postsynaptic membrane of excitatory neurons and plays a role in synaptic morphogenesis. This study postulates that Kalirin may act as a downstream effector of EphB3 in epilepsy. This investigation focuses on understanding the link between EphB3 and epilepsy. MATERIALS AND METHODS Chronic seizure models using LiCl-pilocarpine (LiCl/Pilo) and pentylenetetrazol were developed in rats. Neuronal excitability was gauged through whole-cell patch clamp recordings on rat hippocampal slices. Real-time PCR determined Kalirin's mRNA expression, and Western blotting was employed to quantify EphB3 and Kalirin protein levels. Moreover, dendritic spine density in epileptic rats was evaluated using Golgi staining. RESULTS Modulation of EphB3 functionality influenced acute seizure severity, latency duration, and frequency of spontaneous recurrent seizures. Golgi staining disclosed an EphB3-driven alteration in dendritic spine density within the hippocampus of epileptic rats, underscoring its pivotal role in the reconfiguration of hippocampal neural circuits. Furthermore, our data propose Kalirin as a prospective downstream mediator of the EphB3 receptor. CONCLUSIONS Our findings elucidate that EphB3 impacts the action potential dynamics in isolated rat hippocampal slices and alters dendritic spine density in the inner molecular layer of epileptic rat hippocampi, likely through Kalirin-mediated pathways. This hints at EphB3's significant role in shaping excitatory circuit loops and recurrent seizure activity via Kalirin.
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Affiliation(s)
- Hao Huang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Road, Chongqing 400010, China; Department of Neurology, The Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi 563003, Guizhou Province, China
| | - Ling Chen
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi 563003, Guizhou Province, China
| | - Jinxian Yuan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Road, Chongqing 400010, China
| | - Haiqing Zhang
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi 563003, Guizhou Province, China
| | - Juan Yang
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi 563003, Guizhou Province, China
| | - Zucai Xu
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi 563003, Guizhou Province, China.
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Road, Chongqing 400010, China.
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Tang Y, Xiao L, Deng C, Zhu H, Gao X, Li J, Yang Z, Liu D, Feng L, Hu S. [ 18F]FDG PET metabolic patterns in mesial temporal lobe epilepsy with different pathological types. Eur Radiol 2024; 34:887-898. [PMID: 37581655 DOI: 10.1007/s00330-023-10089-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To investigate [18F]FDG PET patterns of mesial temporal lobe epilepsy (MTLE) patients with distinct pathologic types and provide possible guidance for predicting long-term prognoses of patients undergoing epilepsy surgery. METHODS This was a retrospective review of MTLE patients who underwent anterior temporal lobectomy between 2016 and 2021. Patients were classified as having chronic inflammation and gliosis (gliosis, n = 44), hippocampal sclerosis (HS, n = 43), or focal cortical dysplasia plus HS (FCD-HS, n = 13) based on the postoperative pathological diagnosis. Metabolic patterns and the severity of metabolic abnormalities were investigated among MTLE patients and healthy controls (HCs). The standardized uptake value (SUV), SUV ratio (SUVr), and asymmetry index (AI) of regions of interest were applied to evaluate the severity of metabolic abnormalities. Imaging processing was performed with statistical parametric mapping (SPM12). RESULTS With a mean follow-up of 2.8 years, the seizure freedom (Engel class IA) rates of gliosis, HS, and FCD-HS were 54.55%, 62.79%, and 69.23%, respectively. The patients in the gliosis group presented a metabolic pattern with a larger involvement of extratemporal areas, including the ipsilateral insula. SUV, SUVr, and AI in ROIs were decreased for patients in all three MTLE groups compared with those of HCs, but the differences among all three MTLE groups were not significant. CONCLUSIONS MTLE patients with isolated gliosis had the worst prognosis and hypometabolism in the insula, but the degree of metabolic decrease did not differ from the other two groups. Hypometabolic regions should be prioritized for [18F]FDG PET presurgical evaluation rather than [18F]FDG uptake values. CLINICAL RELEVANCE STATEMENT This study proposes guidance for optimizing the operation scheme in patients with refractory MTLE and emphasizes the potential of molecular neuroimaging with PET using selected tracers to predict the postsurgical histology of patients with refractory MTLE epilepsy. KEY POINTS • MTLE patients with gliosis had poor surgical outcomes and showed a distinct pattern of decreased metabolism in the ipsilateral insula. • In the preoperative assessment of MTLE, it is recommended to prioritize the evaluation of glucose hypometabolism areas over [18F]FDG uptake values. • The degree of glucose hypometabolism in the epileptogenic focus was not associated with the surgical outcomes of MTLE.
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Affiliation(s)
- Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Chijun Deng
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaomei Gao
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Department of Neurology, Xiangya Hospital, Central South University (Jiangxi Branch), Nanchang, Jiangxi, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Roshan JHN, Chamanabad AG, Mashhadi A, Motamedi M. Cathodal HD-tDCS and attention: A study on patients with intractable left lateral frontal lobe epilepsy. Epilepsy Res 2024; 199:107265. [PMID: 38071911 DOI: 10.1016/j.eplepsyres.2023.107265] [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: 09/14/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Defects in the attentional network in patients with epilepsy are influenced by factors such as the location of epileptic foci. Examining the impact of cathodal high-definition transcranial direct current stimulation (HD-tDCS) on attention components could provide insights into potential attention-related side effects of tDCS. This study aimed to investigate the effect of cathodal HD-tDCS on interictal epileptiform discharges (IEDs), auditory/visual (A/V) attention components, and reaction time (RT) in patients with intractable focal left lateral frontal lobe epilepsy (LFLE). METHODS To control for variations in individual epilepsy syndrome, 12 adult participants diagnosed with drug-resistant left LFLE with focal cortical IEDs on C3 underwent repeated measurements at pretest, posttest, and follow-up steps. 4 × 1 ring electrodes (cathode on C3 and four anodes on F3, P3, T3, and Cz) delivered 2 mA DC for 20 min per session for 10 consecutive days. The integrated visual and auditory continuous performance test (IVA+) assessed the A/V attention components and RT. One-way repeated-measure ANOVA was used. RESULTS The findings suggest a significant effect in reducing IEDs. The IVA+ results showed a significant improvement in auditory divided attention and visual selective and focused attention (p < 0.05). In the follow-up, these changes demonstrated lasting efficacy. A/V speed scales increased (p < 0.05), showing a significant decrease in reaction time. CONCLUSIONS Cathodal HD-tDCS significantly reduced IEDs and improved the components of auditory divided attention, visual focused attention, and visual selective attention, with a reduction in patient reaction time. A significant lasting, side-effect-free positive effect was observed for up to one month after the intervention.
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Affiliation(s)
| | - Ali Ghanaei Chamanabad
- Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran; Cognitive Science Research Center, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Ali Mashhadi
- Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran; Cognitive Science Research Center, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mahmoud Motamedi
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
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Wen S, Zhang H, Huang K, Wei X, Yang K, Wang Q, Feng L. Impaired orienting function detected through eye movements in patients with temporal lobe epilepsy. Front Neurosci 2023; 17:1290959. [PMID: 38188032 PMCID: PMC10770870 DOI: 10.3389/fnins.2023.1290959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Patients with temporal lobe epilepsy (TLE) often exhibit attention function impairment. The orienting network is the subsystem of the attention network that has not been fully studied. In this study, we used eye-tracking technology with an attention network test (ANT)-based task to assess the orienting function of TLE patients, aiming to characterize their eye movement patterns. Methods A total of 37 TLE patients and 29 healthy controls (HCs) completed the ANT task based on eye-tracking technology. Orienting function damage was mainly assessed by the ANT orienting effect. Eye movement metrics, such as mean first goal-directed saccade latency (MGSL), total saccades, and saccade amplitudes, were compared between groups. Results The TLE patients had a significantly lower ANT orienting effect (HC, 54.05 ± 34.05; TLE, 32.29 ± 39.54) and lower eye-tracking orienting effect (HC, 116.98 ± 56.59; TLE, 86.72 ± 59.10) than those of the HCs. The larger orienting effects indicate that orienting responses are faster when receiving a spatial cue compared with a center cue. In the spatial cue condition, compared with HCs, the TLE group showed a longer first goal-directed saccade latency (HC, 76.77 ± 58.87 ms; TLE, 115.14 ± 59.15 ms), more total saccades (HC, 28.46 ± 12.30; TLE, 36.69 ± 15.13), and larger saccade amplitudes (HC, 0.75° ± 0.60°; TLE, 1.36° ± 0.89°). Furthermore, there was a positive correlation of the orienting-effect score between the ANT task and eye-tracking metrics (r = 0.58, p < 0.05). Conclusion We innovatively developed a new detection method using eye-tracking technology in combination with an ANT-based task to detect the orienting function in TLE patients. The current research demonstrated that TLE patients had a significant orienting dysfunction with a specific saccade pattern characterized by a longer first goal-directed saccade latency, more total saccades, and larger saccade amplitudes. These oculomotor metrics are likely to be a better indicator of orienting function and may potentially be used for behavioral-based interventions and long-term cognition monitoring in TLE patients.
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Affiliation(s)
- Shirui Wen
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huangyemin Zhang
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
- University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
| | - Kailing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaojie Wei
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
- University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
| | - Ke Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Quan Wang
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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10
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Xiao L, Tang Y, Deng C, Li J, Li R, Zhu H, Guo D, Yang Z, Long H, Feng L, Hu S. Differences in whole-brain metabolism are associated with the expression of genes related to neurovascular unit integrity and synaptic plasticity in temporal lobe epilepsy. Eur J Nucl Med Mol Imaging 2023; 51:168-179. [PMID: 37707571 DOI: 10.1007/s00259-023-06433-8] [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: 03/08/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Temporal lobe epilepsy (TLE) is a common, polygenic epilepsy syndrome that involves glucose hypometabolism in the epileptogenic zone. However, the transcriptional and cellular signatures underlying the metabolism in TLE remain unclear. METHODS In this retrospective study, 2-[18F]-fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography (PET) scans of TLE patients (n = 104) who underwent anterior temporal lobectomy were consecutively collected between 2016 and 2021. The transcriptional profiles of TLE risk genes across the brain were identified by the gene expression analyses from six TLE patients and twelve postmortem donors (six from the Allen Human Brain Atlas). Integrating the neuroimaging and transcriptomic data, we examined the relationship between the expression of TLE-associated genes and metabolic alterations in TLE. Furthermore, we performed functional enrichment analyses of the genes with higher weight in partial least squares regression using Metascape. RESULTS A total of 104 patients with TLE (mean age 29 ± 9 years, 50% male) and 30 healthy controls (HCs) (mean age 31 ± 6 years, 53% male) were enrolled. Compared to that of HCs, patients with TLE showed hypometabolism in the temporal lobes and adjacent structures but hypermetabolism in the thalamus and basal ganglia. The cortical map of inter-group differences in cerebral metabolism was spatially correlated with the expression of a weighted combination of genes enriched in ontology terms and pathways related to neurovascular unit (NVU) integrity and synaptic plasticity. DISCUSSION Our findings, combined with the analysis of neuroimaging and transcriptional data, suggest that genes related to NVU integrity and synaptic plasticity may drive alterations to brain metabolism that mediate the genetic risk of TLE.
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Affiliation(s)
- Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008, Hunan, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008, Hunan, China
| | - Chijun Deng
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jian Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008, Hunan, China
| | - Rong Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008, Hunan, China
| | - Danni Guo
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008, Hunan, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hongyu Long
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008, Hunan, China.
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008, Hunan, China.
- Department of Neurology, Xiangya Hospital, Central South University (Jiangxi Branch), Nanchang, Jiangxi, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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11
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Di Giacomo R, Burini A, Visani E, Doniselli FM, Cuccarini V, Garbelli R, Marucci G, De Santis D, Didato G, Deleo F, Pastori C, Stabile A, Villani F, Rizzi M, Girardi L, de Curtis M. Distinctive electro-clinical, neuroimaging and histopathological features of temporal encephaloceles associated to epilepsy. Neurol Sci 2023; 44:4451-4463. [PMID: 37458845 DOI: 10.1007/s10072-023-06939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/30/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Encephaloceles (ENCs) may cause clinical complications, including drug-resistant epilepsy that can be cured with epilepsy surgery. METHODS We describe clinical, diagnostic, and neuropathological findings of 12 patients with temporal ENC and epilepsy evaluated for surgery and compare them with a control group of 26 temporal lobe epilepsy (TLE) patients. RESULTS Six patients had unilateral and 6 bilateral temporal ENCs. Compared to TLEs, ENCs showed i) later epilepsy onset, ii) higher prevalence of psychiatric comorbidities, iii) no history of febrile convulsions, and iv) ictal semiology differences. Seven patients had MRI signs of gliosis, and 9 of intracranial hypertension. Interictal EEG analysis in ENCs demonstrated significant differences with controls: prominent activity in the beta/gamma frequency bands in frontal regions, interictal short sequences of low-voltage fast activity, and less frequent and more localized interictal epileptiform discharges. Ictal EEG patterns analyzed in 9 ENCs showed delayed and slower contralateral spread compared to TLEs. All ENCs that underwent surgery (7 lobectomies and 1 lesionectomy) are in Engel class I. Neuropathological examination revealed 4 patterns: herniated brain fragments, focal layer I distortion, white matter septa extending into the cortex, and altered gyral profile. CONCLUSIONS AND SIGNIFICANCE The described peculiarities might help clinicians to suspect the presence of largely underdiagnosed ENCs.
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Affiliation(s)
- Roberta Di Giacomo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Alessandra Burini
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Medicine (DAME), Neurology Unit, University of Udine, Udine, Italy
| | - Elisa Visani
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Valeria Cuccarini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianluca Marucci
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Dalia De Santis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Deleo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pastori
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Stabile
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Flavio Villani
- Clinical Neurophysiology Unit and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Rizzi
- Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Girardi
- Department of Enviromental System Science, Swiss Federal Institute (ETH) Zürich, Zurich, Switzerland
| | - Marco de Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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12
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Bijlenga D, Fronczek R, Gorter EJ, Thijs RD. Vigilance and circadian function in daytime and nocturnal epilepsy compared to controls. Epilepsy Res 2023; 197:107238. [PMID: 37839340 DOI: 10.1016/j.eplepsyres.2023.107238] [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: 06/28/2023] [Revised: 09/21/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND People with epilepsy often experience daytime vigilance problems and fatigue. This may be related to disturbed sleep due to nocturnal seizures. AIM To compare subjective and objective markers of vigilance and circadian function in adults with epilepsy with nocturnal seizures to those with daytime seizures and healthy controls and to identify determinants of impaired daytime vigilance in epilepsy in an explorative study. METHODS We included 30 adults with epilepsy (15 with daytime seizures and 15 with nocturnal seizures), and 15 healthy controls. All participants filled out the Epworth sleepiness scale (ESS), fatigue severity scale (FSS), Pittsburgh sleep quality index (PSQI) and the Munich chronotype questionnaire (MCTQ). Each participant performed two trials of the sustained attention to response task (SART) as a measure of vigilance, and had a post-illumination pupil response (PIPR) assessment as a marker for the circadian function. RESULTS Both epilepsy groups reported more fatigue on the FSS than healthy controls (p < .001) and had higher SART error scores (p = .026). The poorer FSS and SART scores were most prominent among those with nocturnal seizures. The ESS, PSQI, MCTQ and the primary PIPR outcome did not differ between groups. Having nocturnal seizures (p = .010) and using more antiseizure medications (p = .004) were related to increased SART error scores. CONCLUSIONS Nocturnal epilepsy is associated with poorer vigilance, indicating lower quality of wake time. We could not relate this to circadian dysfunction. Further studies should focus on vigilance problems in people with nocturnal epilepsy and explore interventions to improve the quality of wake time.
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Affiliation(s)
- Denise Bijlenga
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, Netherlands; Leiden University Medical Center (LUMC), dept. Neurology, Leiden, Netherlands
| | - Rolf Fronczek
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, Netherlands; Leiden University Medical Center (LUMC), dept. Neurology, Leiden, Netherlands
| | - Evelyn J Gorter
- Stichting Epilepsie Instellingen Nederland (SEIN), Epilepsy Centre, Heemstede, Netherlands
| | - Roland D Thijs
- Leiden University Medical Center (LUMC), dept. Neurology, Leiden, Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Epilepsy Centre, Heemstede, Netherlands.
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13
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Jiang JW, Narasimhan S, Johnson GW, González HFJ, Doss DJ, Shless JS, Paulo DL, Terry DP, Chang C, Morgan VL, Englot DJ. Abnormal functional connectivity of the posterior hypothalamus and other arousal regions in surgical temporal lobe epilepsy. J Neurosurg 2023; 139:640-650. [PMID: 36807210 PMCID: PMC10432570 DOI: 10.3171/2023.1.jns221452] [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: 07/28/2022] [Accepted: 01/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE This study sought to characterize resting-state functional MRI (fMRI) connectivity patterns of the posterior hypothalamus (pHTH) and the nucleus basalis of Meynert (NBM) in surgical patients with mesial temporal lobe epilepsy (mTLE), and to investigate potential correlations between functional connectivity of these arousal regions and neurocognitive performance. METHODS The study evaluated resting-state fMRI in 60 patients with preoperative mTLE and in 95 healthy controls. The authors first conducted voxel-wise connectivity analyses seeded from the pHTH, combined anterior and tuberal hypothalamus (atHTH; i.e., the rest of the hypothalamus), and the NBM ipsilateral (ipsiNBM) and contralateral (contraNBM) to the epileptogenic zone. Based on these results, the authors included the pHTH, ipsiNBM, and frontoparietal neocortex in a network-based statistic (NBS) analysis to elucidate a network that best distinguishes patients from controls. The connections involving the pHTH and ipsiNBM from this network were included in age-corrected pairwise region of interest (ROI) analysis, along with connections between arousal structures, including the pHTH, ipsiNBM, and brainstem arousal regions. Finally, patient functional connectivity was correlated with clinical neurocognitive testing scores for IQ as well as attention and concentration tests. RESULTS The voxel-wise analysis demonstrated that the pHTH, when compared with the atHTH, showed more widespread functional connectivity decreases in surgical mTLE patients when compared with controls. It was also observed that the ipsiNBM, but not the contraNBM, showed decreased functional connectivity in mTLE. The NBS analysis uncovered a perturbed network of frontoparietal regions, the pHTH, and ipsiNBM that distinguishes patients from controls. Age-corrected ROI analysis revealed functional connectivity decreases between the pHTH and bilateral superior frontal gyri, medial orbitofrontal cortices, rostral anterior cingulate cortices, and inferior parietal cortices in mTLE when compared with controls. For the ipsiNBM, there was reduced connectivity with bilateral medial orbitofrontal and rostral anterior cingulate cortices. Age-corrected ROI analysis also demonstrated upstream connectivity decreases from controls between the pHTH and the brainstem arousal regions, cuneiform/subcuneiform (CSC) nuclei, and ventral tegmental area, as well as the ipsiNBM and CSC nuclei. Reduced functional connectivity was also detected between the pHTH and ipsiNBM. Lastly, neurocognitive test scores for attention and concentration were found to be positively correlated with the functional connectivity between the pHTH and ipsiNBM, suggesting worse performance associated with connectivity perturbations. CONCLUSIONS This study demonstrated perturbed resting-state functional connectivity of arousal regions in surgical mTLE and is one of the first investigations to demonstrate decreased functional connectivity of the pHTH with frontoparietal regions and other arousal regions. Connectivity disturbances in arousal regions may contribute to neurocognitive deficits in surgical mTLE patients.
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Affiliation(s)
- Jasmine W. Jiang
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Saramati Narasimhan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Graham W. Johnson
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Hernán F. J. González
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Derek J. Doss
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Jared S. Shless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Danika L. Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Douglas P. Terry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | - Catie Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Victoria L. Morgan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Neurology, Vanderbilt University Medical Center, Nashville
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville
| | - Dario J. Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
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14
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Englot DJ. Networks Inhibited and Networks Excited: Loss of Consciousness in Epilepsy. Epilepsy Curr 2023; 23:217-219. [PMID: 37662463 PMCID: PMC10470105 DOI: 10.1177/15357597231166203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Distinct Signatures of Loss of Consciousness in Focal Impaired Awareness Versus Tonic-Clonic Seizures Juan E, Górska U, Kozma C, Papantonatos C, Bugnon T, Denis C, Kremen V, Worrell G, Struck AF, Bateman LM, Merricks EM, Blumenfeld H, Tononi G, Schevon C, Boly M. Brain . 20235;146(1):109-123. doi:10.1093/brain/awac291 Loss of consciousness is a hallmark of many epileptic seizures and carries risks of serious injury and sudden death. While cortical sleep-like activities accompany loss of consciousness during focal impaired awareness seizures, the mechanisms of loss of consciousness during focal to bilateral tonic-clonic seizures remain unclear. Quantifying differences in markers of cortical activation and ictal recruitment between focal impaired awareness and focal to bilateral tonic-clonic seizures may also help us to understand their different consequences for clinical outcomes and to optimize neuromodulation therapies. We quantified clinical signs of loss of consciousness and intracranial EEG activity during 129 focal impaired awareness and 50 focal to bilateral tonic-clonic from 41 patients. We characterized intracranial EEG changes both in the seizure onset zone and in areas remote from the seizure onset zone with a total of 3386 electrodes distributed across brain areas. First, we compared the dynamics of intracranial EEG sleep-like activities: slow-wave activity (1-4 Hz) and beta/delta ratio (a validated marker of cortical activation) during focal impaired awareness versus focal to bilateral tonic-clonic. Second, we quantified differences between focal to bilateral tonic-clonic and focal impaired awareness for a marker validated to detect ictal cross-frequency coupling: phase-locked high gamma (high-gamma phased-locked to low frequencies) and a marker of ictal recruitment: the epileptogenicity index. Third, we assessed changes in intracranial EEG activity preceding and accompanying behavioural generalization onset and their correlation with electromyogram channels. In addition, we analysed human cortical multi-unit activity recorded with Utah arrays during three focal to bilateral tonic-clonic seizures. Compared to focal impaired awareness, focal to bilateral tonic-clonic seizures were characterized by deeper loss of consciousness, even before generalization occurred. Unlike during focal impaired awareness, early loss of consciousness before generalization was accompanied by paradoxical decreases in slow-wave activity and by increases in high-gamma activity in parieto-occipital and temporal cortex. After generalization, when all patients displayed loss of consciousness, stronger increases in slow-wave activity were observed in parieto-occipital cortex, while more widespread increases in cortical activation (beta/delta ratio), ictal cross-frequency coupling (phase-locked high gamma) and ictal recruitment (epileptogenicity index). Behavioural generalization coincided with a whole-brain increase in high-gamma activity, which was especially synchronous in deep sources and could not be explained by EMG. Similarly, multi-unit activity analysis of focal to bilateral tonic-clonic revealed sustained increases in cortical firing rates during and after generalization onset in areas remote from the seizure onset zone. Overall, these results indicate that unlike during focal impaired awareness, the neural signatures of loss of consciousness during focal to bilateral tonic-clonic consist of paradoxical increases in cortical activation and neuronal firing found most consistently in posterior brain regions. These findings suggest differences in the mechanisms of ictal loss of consciousness between focal impaired awareness and focal to bilateral tonic-clonic and may account for the more negative prognostic consequences of focal to bilateral tonic-clonic.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center
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15
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Garcia-Ramos C, Adluru N, Chu DY, Nair V, Adluru A, Nencka A, Maganti R, Mathis J, Conant LL, Alexander AL, Prabhakaran V, Binder JR, Meyerand ME, Hermann B, Struck AF. Multi-shell connectome DWI-based graph theory measures for the prediction of temporal lobe epilepsy and cognition. Cereb Cortex 2023; 33:8056-8065. [PMID: 37067514 PMCID: PMC10267614 DOI: 10.1093/cercor/bhad098] [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: 11/11/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common epilepsy syndrome that empirically represents a network disorder, which makes graph theory (GT) a practical approach to understand it. Multi-shell diffusion-weighted imaging (DWI) was obtained from 89 TLE and 50 controls. GT measures extracted from harmonized DWI matrices were used as factors in a support vector machine (SVM) analysis to discriminate between groups, and in a k-means algorithm to find intrinsic structural phenotypes within TLE. SVM was able to predict group membership (mean accuracy = 0.70, area under the curve (AUC) = 0.747, Brier score (BS) = 0.264) using 10-fold cross-validation. In addition, k-means clustering identified 2 TLE clusters: 1 similar to controls, and 1 dissimilar. Clusters were significantly different in their distribution of cognitive phenotypes, with the Dissimilar cluster containing the majority of TLE with cognitive impairment (χ2 = 6.641, P = 0.036). In addition, cluster membership showed significant correlations between GT measures and clinical variables. Given that SVM classification seemed driven by the Dissimilar cluster, SVM analysis was repeated to classify Dissimilar versus Similar + Controls with a mean accuracy of 0.91 (AUC = 0.957, BS = 0.189). Altogether, the pattern of results shows that GT measures based on connectome DWI could be significant factors in the search for clinical and neurobehavioral biomarkers in TLE.
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Affiliation(s)
- Camille Garcia-Ramos
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
| | - Nagesh Adluru
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53705, United States
| | - Daniel Y Chu
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
| | - Veena Nair
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
| | - Anusha Adluru
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
| | - Andrew Nencka
- Department of Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave. Milwaukee, WI 53226, United States
| | - Rama Maganti
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
| | - Jedidiah Mathis
- Department of Neurology, Medical College of Wisconsin, 9200 W. Wisconsin Ave. Milwaukee, WI 53226, United States
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, 9200 W. Wisconsin Ave. Milwaukee, WI 53226, United States
| | - Andrew L Alexander
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53705, United States
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Rm 1005, Madison, WI 53705-2275, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, 9200 W. Wisconsin Ave. Milwaukee, WI 53226, United States
| | - Mary E Meyerand
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Rm 1005, Madison, WI 53705-2275, United States
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
- William S. Middleton VA Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States
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16
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Abstract
Prevalence and Risk Factors for Pharmacoresistance in Children With Focal Cortical Dysplasia-Related Epilepsy Cohen NT, Chang P, You X, Zhang A, Havens KA, Oluigbo CO, Whitehead MT, Gholipour T, Gaillard WD. Neurology . 2022;99(18):e2006-e2013. doi:10.1212/WNL.0000000000201033 Background and objectives: Focal cortical dysplasia is the most common cause of surgically-remediable epilepsy in children. Little is known about the risk factors for the timing and development of pharmacoresistance in this population. This study sought to evaluate the prevalence and risk factors for pharmacoresistance in pediatric FCD-related epilepsy. Methods: In this retrospective single-center cohort design, patients were identified from search of centralized radiology report database and a central epilepsy surgical database. Inclusion criteria consisted of: 3T MRI-confirmed FCD from January, 2011 to January, 2020; ages 0 days to 22 years at MRI; at least 18 months of documented follow-up after MRI, unless had single seizure or incidentally discovered FCD. Records were excluded if there was dual pathology (except for mesial temporal sclerosis), hemimegalencephaly, or tuberous sclerosis complex present in imaging or history. Results: One hundred forty-three patients with confirmed FCD met inclusion criteria. One hundred twenty-four children had epilepsy (87% of FCD patients) with median age of seizure onset 2.7 years (IQR 0.75-6 years, range 0 to 17 years). Twelve children (8.5%) had a single lifetime seizure (provoked or unprovoked) or recurrent provoked seizures. Seven children (4.9%) had incidental FCD. Ninety-two patients (74%) of those with epilepsy met criteria for pharmacoresistance. Of children with epilepsy of all types, 93 children (75%) were seizure-free at the last visit. Eighty-two patients underwent epilepsy surgery, of whom 59 (72%) achieved seizure freedom. 7% (9/124) achieved seizure freedom with a second ASM, and 5.6% (7/124) with a third or more ASMs. Failure of only one antiseizure medication is associated with enormous increased incidence and earlier development of pharmacoresistance (OR 346, 95% CI 19.6-6100). Cox regression showed FCD lobar location, pathologic subtype, and age of seizure onset are not. Conclusions: Failure of one antiseizure medication is associated with substantial risk of pharmacoresistance. These data support an operational re-definition of pharmacoresistance, for surgical planning, in FCD-related epilepsy to the failure of one antiseizure medication, and support early, potentially curative surgery to improve outcomes in this patient population.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery Vanderbilt University Medical Center
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17
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Cumbres-Vargas IM, Zamudio SR, Pichardo-Macías LA, Ramírez-San Juan E. Thalidomide Attenuates Epileptogenesis and Seizures by Decreasing Brain Inflammation in Lithium Pilocarpine Rat Model. Int J Mol Sci 2023; 24:ijms24076488. [PMID: 37047461 PMCID: PMC10094940 DOI: 10.3390/ijms24076488] [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: 02/28/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
Thalidomide (TAL) has shown potential therapeutic effects in neurological diseases like epilepsy. Both clinical and preclinical studies show that TAL may act as an antiepileptic drug and as a possible treatment against disease development. However, the evidence for these effects is limited. Therefore, the antiepileptogenic and anti-inflammatory effects of TAL were evaluated herein. Sprague Dawley male rats were randomly allocated to one of five groups (n = 18 per group): control (C); status epilepticus (SE); SE-TAL (25 mg/kg); SE-TAL (50 mg/kg); and SE-topiramate (TOP; 60mg/kg). The lithium-pilocarpine model was used, and one day after SE induction the rats received pharmacological treatment for one week. The brain was obtained, and the hippocampus was micro-dissected 8, 18, and 28 days after SE. TNF-α, IL-6, and IL-1β concentrations were quantified. TOP and TAL (50 mg/kg) increased the latency to the first of many spontaneous recurrent seizures (SRS) and decreased SRS frequency, as well as decreasing TNF-α and IL-1β concentrations in the hippocampus. In conclusion, the results showed that both TAL (50 mg/kg) and TOP have anti-ictogenic and antiepileptogenic effects, possibly by decreasing neuroinflammation.
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Affiliation(s)
- Irán M Cumbres-Vargas
- Departamento de Fisiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 07738, Mexico
| | - Sergio R Zamudio
- Departamento de Fisiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 07738, Mexico
| | - Luz A Pichardo-Macías
- Departamento de Fisiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 07738, Mexico
| | - Eduardo Ramírez-San Juan
- Departamento de Fisiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 07738, Mexico
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18
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González HFJ, Narasimhan S, Goodale SE, Johnson GW, Doss DJ, Paulo DL, Morgan VL, Chang C, Englot DJ. Arousal and salience network connectivity alterations in surgical temporal lobe epilepsy. J Neurosurg 2023; 138:810-820. [PMID: 35901709 PMCID: PMC10127440 DOI: 10.3171/2022.5.jns22837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is poorly understood why patients with mesial temporal lobe epilepsy (TLE) have cognitive deficits and brain network changes that extend beyond the temporal lobe, including altered extratemporal intrinsic connectivity networks (ICNs). However, subcortical arousal structures project broadly to the neocortex, are affected by TLE, and thus may contribute to these widespread network effects. The authors' objective was to examine functional connectivity (FC) patterns between subcortical arousal structures and neocortical ICNs, possible neurocognitive relationships, and FC changes after epilepsy surgery. METHODS The authors obtained resting-state functional magnetic resonance imaging (fMRI) in 50 adults with TLE and 50 controls. They compared nondirected FC (correlation) and directed FC (Granger causality laterality index) within the salience network, default mode network, and central executive network, as well as between subcortical arousal structures; these 3 ICNs were also compared between patients and controls. They also used an fMRI-based vigilance index to relate alertness to arousal center FC. Finally, fMRI was repeated in 29 patients > 12 months after temporal lobe resection. RESULTS Nondirected FC within the salience (p = 0.042) and default mode (p = 0.0008) networks, but not the central executive network (p = 0.79), was decreased in patients in comparison with controls (t-tests, corrected). Nondirected FC between the salience network and subcortical arousal structures (nucleus basalis of Meynert, thalamic centromedian nucleus, and brainstem pedunculopontine nucleus) was reduced in patients in comparison with controls (p = 0.0028-0.015, t-tests, corrected), and some of these connectivity abnormalities were associated with lower processing speed index, verbal comprehension, and full-scale IQ. Interestingly, directed connectivity measures suggested a loss of top-down influence from the salience network to the arousal nuclei in patients. After resection, certain FC patterns between the arousal nuclei and salience network moved toward control values in the patients, suggesting that some postoperative recovery may be possible. Although an fMRI-based vigilance measure suggested that patients exhibited reduced alertness over time, FC abnormalities between the salience network and arousal structures were not influenced by the alertness levels during the scans. CONCLUSIONS FC abnormalities between subcortical arousal structures and ICNs, such as the salience network, may be related to certain neurocognitive deficits in TLE patients. Although TLE patients demonstrated vigilance abnormalities, baseline FC perturbations between the arousal and salience networks are unlikely to be driven solely by alertness level, and some may improve after surgery. Examination of the arousal network and ICN disturbances may improve our understanding of the downstream clinical effects of TLE.
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Affiliation(s)
- Hernán F. J. González
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saramati Narasimhan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah E. Goodale
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Graham W. Johnson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Derek J. Doss
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Danika L. Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Victoria L. Morgan
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Departments of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Catie Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Departments of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dario J. Englot
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Departments of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Departments of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
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19
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Yi TT, Zhang LM, Huang XN. Glycyrrhizic acid protects against temporal lobe epilepsy in young rats by regulating neuronal ferroptosis through the miR-194-5p/PTGS2 axis. Kaohsiung J Med Sci 2023; 39:154-165. [PMID: 36647717 DOI: 10.1002/kjm2.12642] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 01/18/2023] Open
Abstract
Temporal lobe epilepsy (TLE) leads to extensive degradation of the quality of life of patients. Glycyrrhizic acid (GA) has been reported to exert neuroprotective effects on status epilepticus. Herein, the current study set out to explore the functional mechanism of GA in TLE young rats. Firstly, TLE young rat models were established using the lithium chloride and pilocarpine regimen and then subjected to treatment with different doses of GA, miR-194-5p-antagomir, or/and sh-prostaglandin-endoperoxide synthase 2 (PTGS2) to observe changes in iron content, glutathione and malondialdehyde levels, and GPX4 (glutathione peroxidase 4) and PTGS2 protein levels in the hippocampus. Neuronal injury and apoptosis were assessed through HE, Nissl, and TUNEL staining. Additionally, the expression patterns of miR-194-5p were detected. The binding site of miR-194-5p and PTGS2 was verified with a dual-luciferase assay. Briefly, different doses of GA (20, 40, and 60 mg/kg) reduced the epileptic score, frequency, and duration in TLE young rats, along with reductions in iron content, lipid peroxidation, neuronal injury, and apoptosis in the hippocampus. Silencing of miR-194-5p partly annulled the action of GA on inhibiting ferroptosis and attenuating neuronal injury in TLE young rats. Additionally, PTGS2 was validated as a target of miR-194-5p. GA inhibited ferroptosis and ameliorated neuronal injury in TLE young rats via the miR-194-5p/PTGS2 axis. Overall, our findings indicated that GA exerts protective effects on TLE young rats against neuronal injury by inhibiting ferroptosis through the miR-194-5p/PTGS2 axis.
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Affiliation(s)
- Ting-Ting Yi
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Li-Mei Zhang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiang-Nan Huang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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20
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Bauer J, Devinsky O, Rothermel M, Koch H. Autonomic dysfunction in epilepsy mouse models with implications for SUDEP research. Front Neurol 2023; 13:1040648. [PMID: 36686527 PMCID: PMC9853197 DOI: 10.3389/fneur.2022.1040648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Epilepsy has a high prevalence and can severely impair quality of life and increase the risk of premature death. Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in drug-resistant epilepsy and most often results from respiratory and cardiac impairments due to brainstem dysfunction. Epileptic activity can spread widely, influencing neuronal activity in regions outside the epileptic network. The brainstem controls cardiorespiratory activity and arousal and reciprocally connects to cortical, diencephalic, and spinal cord areas. Epileptic activity can propagate trans-synaptically or via spreading depression (SD) to alter brainstem functions and cause cardiorespiratory dysfunction. The mechanisms by which seizures propagate to or otherwise impair brainstem function and trigger the cascading effects that cause SUDEP are poorly understood. We review insights from mouse models combined with new techniques to understand the pathophysiology of epilepsy and SUDEP. These techniques include in vivo, ex vivo, invasive and non-invasive methods in anesthetized and awake mice. Optogenetics combined with electrophysiological and optical manipulation and recording methods offer unique opportunities to study neuronal mechanisms under normal conditions, during and after non-fatal seizures, and in SUDEP. These combined approaches can advance our understanding of brainstem pathophysiology associated with seizures and SUDEP and may suggest strategies to prevent SUDEP.
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Affiliation(s)
- Jennifer Bauer
- Department of Epileptology and Neurology, RWTH Aachen University, Aachen, Germany,Institute for Physiology and Cell Biology, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Orrin Devinsky
- Departments of Neurology, Neurosurgery and Psychiatry, NYU Langone School of Medicine, New York, NY, United States
| | - Markus Rothermel
- Institute for Physiology and Cell Biology, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Henner Koch
- Department of Epileptology and Neurology, RWTH Aachen University, Aachen, Germany,*Correspondence: Henner Koch ✉
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21
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Wang L, Li C, Han Z, Wu Q, Sun L, Zhang X, Go R, Wu J, Yan T. Spatiotemporal and sensory modality attention processing with domain-specific representations in frontoparietal areas. Cereb Cortex 2022; 32:5489-5502. [PMID: 35136999 DOI: 10.1093/cercor/bhac029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/10/2022] [Accepted: 02/12/2022] [Indexed: 01/25/2023] Open
Abstract
The frontoparietal network (FPN), including bilateral frontal eye field, inferior parietal sulcus, and supplementary motor area, has been linked to attention processing, including spatiotemporal and sensory modality domains. However, it is unclear whether FPN encodes representations of these domains that are generalizable across subdomains. We decomposed multivariate patterns of functional magnetic resonance imaging activity from 20 participants into domain-specific components and identified latent multivariate representations that generalized across subdomains. The 30 experimental conditions were organized into unimodal-bimodal and spatial-temporal models. We found that brain areas in the FPN, form the primary network that modulated during attention across domains. However, the activation patterns of areas within the FPN were reorganized according to the specific attentional demand, especially when pay attention to different sensory, suggesting distinct regional neural representations associated with specific attentional processes within FPN. In addition, there were also other domain-specific areas outside the FPN, such as the dorsolateral prefrontal cortex. Our conclusion is that, according to the results of the analysis of representation similarity, 2 types of activated brain regions, related to attention domain detailed information processing and general information processing, can be revealed.
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Affiliation(s)
- Luyao Wang
- School of Life Science, Shanghai University, Shanghai 200444, China
| | - Chunlin Li
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, China
| | - Ziteng Han
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Qiong Wu
- Department of Psychology, Suzhou University of Science and Technology, Suzhou 215009, China.,Cognitive Neuroscience Lab, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama 700-0084, Japan
| | - Liwei Sun
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, China
| | - Xu Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, China
| | - Ritsu Go
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Jinglong Wu
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China.,Cognitive Neuroscience Lab, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama 700-0084, Japan
| | - Tianyi Yan
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
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22
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Wang L, Duan C, Wang R, Chen L, Wang Y. Inflammation-related genes and immune infiltration landscape identified in kainite-induced temporal lobe epilepsy based on integrated bioinformatics analysis. Front Neurosci 2022; 16:996368. [PMID: 36389252 PMCID: PMC9648357 DOI: 10.3389/fnins.2022.996368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/06/2022] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Temporal lobe epilepsy (TLE) is a common brain disease. However, the pathogenesis of TLE and its relationship with immune infiltration remains unclear. We attempted to identify inflammation-related genes (IRGs) and the immune cell infiltration pattern involved in the pathological process of TLE via bioinformatics analysis. MATERIALS AND METHODS The GSE88992 dataset was downloaded from the Gene Expression Omnibus (GEO) database to perform differentially expressed genes screening and weighted gene co-expression network analysis (WGCNA). Subsequently, the functional enrichment analysis was performed to explore the biological function of the differentially expressed IRGs (DEIRGs). The hub genes were further identified by the CytoHubba algorithm and validated by an external dataset (GSE60772). Furthermore, the CIBERSORT algorithm was applied to assess the differential immune cell infiltration between control and TLE groups. Finally, we used the DGIbd database to screen the candidate drugs for TLE. RESULTS 34 DEIRGs (33 up-regulated and 1 down-regulated gene) were identified, and they were significantly enriched in inflammation- and immune-related pathways. Subsequently, 4 hub DEIRGs (Ptgs2, Jun, Icam1, Il6) were further identified. Immune cell infiltration analysis revealed that T cells CD4 memory resting, NK cells activated, Monocytes and Dendritic cells activated were involved in the TLE development. Besides, there was a significant correlation between hub DEIRGs and some of the specific immune cells. CONCLUSION 4 hub DEIRGs (Ptgs2, Jun, Icam1, Il6) were associated with the pathogenesis of TLE via regulation of immune cell functions, which provided a novel perspective for the understanding of TLE.
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Affiliation(s)
| | | | | | | | - Yue Wang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
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23
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Sarkis R. Memories in Persons with Epilepsy: They Are More Fragile Than You Think. Epilepsy Curr 2022; 22:282-284. [PMID: 36285204 PMCID: PMC9549231 DOI: 10.1177/15357597221108026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
“Hidden Objective Memory Deficits Behind Subjective Memory Complaints in
Patients with Temporal Lobe Epilepsy” Lemesle B, Barbeau EJ, Milongo Rigal E, Denuelle M, Valton L, Pariente J, Curot J.
Neurology. 2022 Feb 22;98(8):e818-e828. doi: 10.1212/WNL.0000000000013212. Epub 2021 Dec 14. PMID: 34906979. “Background and objectives: The aim of this work was to test the hypothesis that patients with temporal lobe
epilepsy (TLE) with subjective initial memory complaints (not confirmed by an
objective standard assessment) and various phenotypes also show objective very
long-term memory deficit with accelerated long-term forgetting. We tested patients
with TLE with 2 surprise memory tests after 3 weeks: the standard Free and Cued
Selective Reminding Test (FCSRT) and Epireal, a new test specifically designed to
capture more ecologic aspects of autobiographical memory. Methods: Forty-seven patients with TLE (12 with hippocampal sclerosis, 12 with amygdala
enlargement, 11 with extensive lesions, 12 with normal MRI) who complained about
their memory, but for whom the standard neuropsychological assessment did not reveal
any memory impairment after a standard delay of 20 minutes, underwent 2 surprise
memory tests after 3 weeks. They were compared to 35 healthy controls. Results: After 3 weeks, FCSRT and Epireal recall scores were significantly lower in patients
than in controls (P < .001). There was no significant
correlation between FCSRT and Epireal scores (P = .99). Seventy-six
percent of patients with TLE had objective impairment on at least 1 of these very
long-term memory tests, regardless of the existence and type of lesion or response
to antiseizure medication. Easily applicable, Epireal had a higher effect size,
detected deficits in 28% more patients, and is a useful addition to the standard
workup. Discussion: Assessing long-term memory should be broadened to a wide spectrum of patients with
TLE with a memory complaint, regardless of the epileptic syndrome, regardless of
whether it is associated with a lesion. This could lead to rethinking TLE nosology
associated with memory.”
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Affiliation(s)
- Rani Sarkis
- Brigham and Women's Hospital, Boston, MA, USA
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24
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Gan CL, Zou Y, Chen D, Shui X, Hu L, Li R, Zhang T, Wang J, Mei Y, Wang L, Zhang M, Tian Y, Gu X, Lee TH. Blocking ERK-DAPK1 Axis Attenuates Glutamate Excitotoxicity in Epilepsy. Int J Mol Sci 2022; 23:ijms23126370. [PMID: 35742817 PMCID: PMC9223430 DOI: 10.3390/ijms23126370] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 12/01/2022] Open
Abstract
Glutamate excitotoxicity induces neuronal cell death during epileptic seizures. Death-associated protein kinase 1 (DAPK1) expression is highly increased in the brains of epilepsy patients; however, the underlying mechanisms by which DAPK1 influences neuronal injury and its therapeutic effect on glutamate excitotoxicity have not been determined. We assessed multiple electroencephalograms and seizure grades and performed biochemical and cell death analyses with cellular and animal models. We applied small molecules and peptides and knocked out and mutated genes to evaluate the therapeutic efficacy of kainic acid (KA), an analog of glutamate-induced neuronal damage. KA administration increased DAPK1 activity by promoting its phosphorylation by activated extracellular signal-regulated kinase (ERK). DAPK1 activation increased seizure severity and neuronal cell death in mice. Selective ERK antagonist treatment, DAPK1 gene ablation, and uncoupling of DAPK1 and ERK peptides led to potent anti-seizure and anti-apoptotic effects in vitro and in vivo. Moreover, a DAPK1 phosphorylation-deficient mutant alleviated glutamate-induced neuronal apoptosis. These results provide novel insight into the pathogenesis of epilepsy and indicate that targeting DAPK1 may be a potential therapeutic strategy for treating epilepsy.
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Affiliation(s)
- Chen-Ling Gan
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
- Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, Institute of Materia Medica, School of Pharmacy, Fujian Medical University, Fuzhou 350122, China
| | - Yulian Zou
- Immunotherapy Institute, Fujian Medical University, Fuzhou 350122, China;
| | - Dongmei Chen
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Xindong Shui
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Li Hu
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Ruomeng Li
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Tao Zhang
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Junhao Wang
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Yingxue Mei
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Long Wang
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Mi Zhang
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Yuan Tian
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Xi Gu
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
| | - Tae Ho Lee
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China; (C.-L.G.); (D.C.); (X.S.); (L.H.); (R.L.); (T.Z.); (J.W.); (Y.M.); (L.W.); (M.Z.); (Y.T.); (X.G.)
- Correspondence: ; Tel.: +86-591-2286-2498; Fax: +86-591-2286-2320
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Chacón LMM, García LG, García-Ramón KB, Báez Martin MM, Bayard JB, Alfonso MA, Batista SB, Bermudez TDLP, González JG, Coroneaux AS, Ruiz ÁÁ, Roque MP, Matamoro LM. Common ictal and interictal perfusion patterns. A window into the epileptogenic network and SUDEP mechanism in Drug Resistant Focal Epilepsy? Curr Pharm Des 2022; 28:1198-1209. [PMID: 35658889 DOI: 10.2174/1381612828666220603125328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Focal epilepsies have been described as network disease. Noninvasive investigative techniques have been used to characterize epileptogenic networks. OBJETIVE To describe ictal and interictal cortical and subcortical perfusion patterns using single photon emission computed tomography (SPECT), in patients with drug-resistant epilepsy (DRE). METHODS Thirty-five interictal- ictal SPECT scans were obtained from 15 patients with DRE. A methodology was developed to get a relative perfusion index (PI) of 74 cortical and sub-cortical brain structures. K-means algorithm together with a modified v-fold cross-validation were used to identify the two regions of interest (ROI's) that represent hypoperfused and hyperperfused areas. RESULTS In common with the individual analysis, the statistical analysis evidenced that the hyperperfusion ROIs resulting from group analysis during interictal, and ictal involved mainly the cingulate gyrus, cuneus, the lingual gyrus, gyrus rectus as well as the putamen. ROIs hypoperfused included the red nucleus, the substantia nigra, and the medulla. The medians of the group analysis of the hypoperfusion and hyperperfusion ROIs were 0.601-0.565 and 1,133 - 1,119 for the ictal and interictal states, correspondingly. A group of mostly cortical structures involved in the hyperperfused ROIs in both interictal and ictal states showed no change or negative change in the transition from interictal to ictal state (mean change of -0.002). On the other hand, the brain stem, basal ganglia, red nucleus, and thalamus revealed a mean global change of 0.19, indicating a mild increase in the PI. However, some of these structures (red nucleus, substantia nigra, and medulla oblongata) remained hypoperfused during the interictal to ictal transition. CONCLUSION The methodology employed made it possible to identify common cortical and subcortical perfusion patterns not directly linked to epileptogenicity, but open a window for the epileptogenic network and sudden unexpected death (SUDEP) mechanism in DRE .
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Affiliation(s)
| | - Lidice Galan García
- Clinical Neurophysiology International Center of Neurologic Restoration Cuba
| | | | | | - Jorge Bosch Bayard
- Clinical Neurophysiology International Center of Neurologic Restoration Cuba
| | | | | | | | | | | | - Ángel Águila Ruiz
- Clinical Neurophysiology International Center of Neurologic Restoration Cuba
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Su Z, Li Y, Chen S, Liu X, Zhao K, Peng Y, Zhou L. Identification of Ion Channel-Related Genes and miRNA-mRNA Networks in Mesial Temporal Lobe Epilepsy. Front Genet 2022; 13:853529. [PMID: 35422840 PMCID: PMC9001885 DOI: 10.3389/fgene.2022.853529] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 01/10/2023] Open
Abstract
Objective: It aimed to construct the miRNA-mRNA regulatory network related to ion channel genes in mesial temporal lobe epilepsy (mTLE), and further identify the vital node in the network. Methods: Firstly, we identified ion channel-related differentially expressed genes (DEGs) in mTLE using the IUPHAR/BPS Guide to Pharmacology (GTP) database, neXtProt database, GeneCards database, and the high-throughput sequencing dataset. Then the STRING online database was used to construct a protein-protein interaction (PPI) network of DEGs, and the hub module in the PPI network was identified using the cytoHubba plug-in of Cytoscape software. In addition, the Single Cell Portal database was used to distinguish genes expression in different cell types. Based on the TarBase database, EpimiRBase database and the high-throughput sequencing dataset GSE99455, miRNA-mRNA regulatory network was constructed from selected miRNAs and their corresponding target genes from the identified DEGs. Finally, the rats were selected to construct chronic li-pilocarpine epilepsy model for the next stage experimental verification, and the miR-27a-3p mimic was used to regulate the miRNA expression level in PC12 cells. The relative expression of miR-27a-3p and its targeting mRNAs were determined by RT-qPCR. Results: 80 mTLE ion channel-related DEGs had been screened. The functional enrichment analysis results of these genes were highly enriched in voltage-gated channel activation and ion transport across membranes. In addition, the hub module, consisting of the Top20 genes in the protein-protein interaction (PPI) network, was identified, which was mainly enriched in excitatory neurons in the CA3 region of the hippocampus. Besides, 14 miRNAs targeting hub module genes were screened, especially the miR-27a-3p deserving particular attention. miR-27a-3p was capable of regulating multiple mTLE ion channel-related DEGs. Moreover, in Li–pilocarpine-induced epilepsy models, the expression level of miR-27a-3p was increased and the mRNAs expression level of KCNB1, SCN1B and KCNQ2 was decreased significantly. The mRNAs expression level of KCNB1 and KCNQ2 was decreased significantly following PC12 cells transfection with miR-27a-3p mimics. Conclusion: The hub ion channel-related DEGs in mTLE and the miRNA-mRNA regulatory networks had been identified. Moreover, the network of miR-27a-3p regulating ion channel genes will be of great value in mTLE.
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Affiliation(s)
- Zhengwei Su
- Department of Neurology, The Seven Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinchao Li
- Department of Neurology, The Seven Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Shuda Chen
- Department of Neurology, The Seven Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xianyue Liu
- Department of Neurology, The Seven Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Ke Zhao
- Department of Neurology, The Seven Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Ying Peng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liemin Zhou
- Department of Neurology, The Seven Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Marinho AMDN, Lobão-Soares B, Targino HAS, Vasconcellos YJF, Guarnieri R, Carlotti CG. Decreased hippocampal serotonin 5HT 1A expression in mesial temporal lobe of epilepsy patients. Epilepsy Behav 2022; 129:108574. [PMID: 35189481 DOI: 10.1016/j.yebeh.2022.108574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) is a surgically remediable epilepsy with a relatively high prevalence and psychiatric comorbidities. Depressive disorders may occur in up to 25% of MTLE-HS patients suggesting a common molecular mechanism underlying both conditions. OBJECTIVE To compare the gene expression comprising serotonin 5HT1A and 5HT2A, noradrenaline (NA) ADRA1A, and ADRA2A receptors in the hippocampus of MTLE-HS patients with and without major depression. METHODS A cross-sectional study allocated 31 patients in three groups: MTLE-HS without psychiatric diagnosis (MTLE-HS group), MTLE-HS with major depression (MTLE-HS-D group) and a control group consisting of healthy volunteers without any neurological or psychiatric disorders. Demographic and clinical characteristics were compared among groups. Gene expression of receptors were analyzed using general linear mixed models (GLMM), with an unstructured matrix, normal link. RESULTS The three groups showed a similar distribution regarding age, gender (p > 0.16), history of initial precipitating injury, family history of epilepsy, monthly frequency of seizures, side of hippocampal sclerosis, interictal spike distribution and anti-seizure medications did not differ between MTLE-HS and MTLE-HS-D groups (p > 0.05). We observed a greater expression of the 5HT1A receptor in the control group when compared to the MTLE-HS (P = .004) and MTLE-HS-D (P = .007). Nevertheless, we did not observe any difference when MTLE-HS and MTLE-HS-D groups were compared to the controls for the ADRA1A (P = .931; P = .931), ADRA2A (P = .120; P = .121) and 5HT2A (P = .638; P = .318, respectively) gene expression. CONCLUSION Mesial temporal lobe epilepsy related to hippocampal sclerosis and MTLE-HS-D patients showed a lowered expression of the 5HT1A receptors when compared with the controls adjusted for age and schooling. Data suggest that temporal lobe epilepsy plasticity may affect serotonin receptors, which may lead to more frequent cases of major depression in this population. More studies comprising wider samples are necessary to confirm these results; they also should investigate serotonin reuptake drugs as an adjuvant therapeutic option for MTLE-HS disorder.
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Affiliation(s)
| | - Bruno Lobão-Soares
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte (DBF - UFRN), Brazil.
| | | | | | | | - Carlos Gilberto Carlotti
- Department of Surgery, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, (FMRP-USP), Brazil
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Adotevi N, Kapur J. Focal impaired awareness seizures in a rodent model: A functional anatomy. Epilepsia Open 2022; 7:110-123. [PMID: 34822222 PMCID: PMC8886100 DOI: 10.1002/epi4.12563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients with temporal lobe epilepsy (TLE) frequently report debilitating comorbidities such as memory impairments, anxiety, and depression. An extensive neuronal network generates epileptic seizures and associated comorbidities, but a detailed description of this network is unavailable, which requires the generation of neuronal activation maps in experimental animals. METHODS We recorded electrographic seizures from the hippocampi during a kindling-evoked focal impaired awareness seizure with observed freezing, facial twitching, and involuntary head bobbing. We mapped seizure circuits activated during these seizures by permanently tagging neurons through activity-induced immediate early genes, combined with immunohistochemical approaches. RESULTS There was bilateral activation of circuits necessary for memory consolidation, including the hippocampal complex, entorhinal cortex, cingulate gyrus, retrosplenial cortex, piriform cortex, and septohippocampal complex in kindled animals compared with unstimulated awake behaving mice. Neuronal circuits in the ventral hippocampus, amygdala, and anterior cingulate cortex, which regulate the stress response of hypothalamic-pituitary-adrenal axis, were also markedly activated during a focal impaired awareness seizure. SIGNIFICANCE This study highlights neuronal circuits preferentially activated during a focal awareness impaired seizure in a rodent model. Many of the seizure-activated neuronal circuits are critical modulators of memory consolidation and long-term stress/depression response. The hijack of these memory and depression regulatory systems by a focal seizure could account for the frequent reports of comorbidities such as memory impairment and depression in many TLE patients.
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Affiliation(s)
- Nadia Adotevi
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Jaideep Kapur
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
- UVA Brain InstituteUniversity of VirginiaCharlottesvilleVirginiaUSA
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29
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Brodovskaya A, Batabyal T, Shiono S, Sun H, Kapur J. Distinct roles of rodent thalamus and corpus callosum in seizure generalization. Ann Neurol 2022; 91:682-696. [PMID: 35226367 PMCID: PMC9315027 DOI: 10.1002/ana.26338] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
Objective Bilateral synchronous cortical activity occurs during sleep, attention, and seizures. Canonical models place the thalamus at the center of bilateral cortical synchronization because it generates bilateral sleep spindle oscillations and primarily generalized absence seizures. However, classical studies suggest that the corpus callosum mediates bilateral cortical synchronization. Methods We mapped the spread of right frontal lobe‐onset, focal to bilateral seizures in mice and modified it using chemo and optogenetic suppression of motor thalamic nucleus and corpus callosotomy. Results Seizures from the right cortex spread faster to the left cortex than to the left thalamus. The 2 thalami have minimal monosynaptic commissural connections compared to the massive commissure corpus callosum. Chemogenetic and closed‐loop optogenetic inhibition of the right ventrolateral thalamic nucleus did not alter inter‐hemispheric seizure spread. However, anterior callosotomy delayed bilateral seizure oscillations. Interpretation Thalamocortical oscillations amplify focal onset motor seizures, and corpus callosum spreads them bilaterally. ANN NEUROL 2022;91:682–696
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Affiliation(s)
- Anastasia Brodovskaya
- Department of Neurology, University of Virginia, Charlottesville, Virginia, 22908, USA
| | - Tamal Batabyal
- Department of Neurology, University of Virginia, Charlottesville, Virginia, 22908, USA
| | - Shinnosuke Shiono
- Department of Neurology, University of Virginia, Charlottesville, Virginia, 22908, USA
| | - Huayu Sun
- Department of Neurology, University of Virginia, Charlottesville, Virginia, 22908, USA
| | - Jaideep Kapur
- Department of Neurology, University of Virginia, Charlottesville, Virginia, 22908, USA.,UVA Brain Institute, University of Virginia, Charlottesville, Virginia, 22908, USA
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30
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Sainburg LE, Little AA, Johnson GW, Janson AP, Levine KK, González HFJ, Rogers BP, Chang C, Englot DJ, Morgan VL. Characterization of resting functional MRI activity alterations across epileptic foci and networks. Cereb Cortex 2022; 32:5555-5568. [PMID: 35149867 PMCID: PMC9753043 DOI: 10.1093/cercor/bhac035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 01/25/2023] Open
Abstract
Brain network alterations have been studied extensively in patients with mesial temporal lobe epilepsy (mTLE) and other focal epilepsies using resting-state functional magnetic resonance imaging (fMRI). However, little has been done to characterize the basic fMRI signal alterations caused by focal epilepsy. Here, we characterize how mTLE affects the fMRI signal in epileptic foci and networks. Resting-state fMRI and diffusion MRI were collected from 47 unilateral mTLE patients and 96 healthy controls. FMRI activity, quantified by amplitude of low-frequency fluctuations, was increased in the epileptic focus and connected regions in mTLE. Evidence for spread of this epileptic fMRI activity was found through linear relationships of regional activity across subjects, the association of these relationships with functional connectivity, and increased activity along white matter tracts. These fMRI activity increases were found to be dependent on the epileptic focus, where the activity was related to disease severity, suggesting the focus to be the origin of these pathological alterations. Furthermore, we found fMRI activity decreases in the default mode network of right mTLE patients with different properties than the activity increases found in the epileptic focus. This work provides insights into basic fMRI signal alterations and their potential spread across networks in focal epilepsy.
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Affiliation(s)
- Lucas E Sainburg
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA,Department of Radiology and Radiological Sciences, Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Aubrey A Little
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Graham W Johnson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA,Department of Radiology and Radiological Sciences, Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Andrew P Janson
- Department of Radiology and Radiological Sciences, Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Kaela K Levine
- Department of Radiology and Radiological Sciences, Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Hernán F J González
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA,Department of Radiology and Radiological Sciences, Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Baxter P Rogers
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA,Department of Radiology and Radiological Sciences, Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Catie Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA,Department of Radiology and Radiological Sciences, Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37212, USA,Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Dario J Englot
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA,Department of Radiology and Radiological Sciences, Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37212, USA,Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37212, USA,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Victoria L Morgan
- Corresponding author: Department of Radiology and Radiological Sciences, Institute of Imaging Science, Vanderbilt University Medical Center, R0102 Medical Center North, 1161 21st Ave South, Nashville, TN 37232, USA.
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Wang Y, Wei P, Yan F, Luo Y, Zhao G. Animal Models of Epilepsy: A Phenotype-oriented Review. Aging Dis 2022; 13:215-231. [PMID: 35111370 PMCID: PMC8782545 DOI: 10.14336/ad.2021.0723] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/23/2021] [Indexed: 12/26/2022] Open
Abstract
Epilepsy is a serious neurological disorder characterized by abnormal, recurrent, and synchronous discharges in the brain. Long-term recurrent seizure attacks can cause serious damage to brain function, which is usually observed in patients with temporal lobe epilepsy. Controlling seizure attacks is vital for the treatment and prognosis of epilepsy. Animal models, such as the kindling model, which was the most widely used model in the past, allow the understanding of the potential epileptogenic mechanisms and selection of antiepileptic drugs. In recent years, various animal models of epilepsy have been established to mimic different seizure types, without clear merits and demerits. Accordingly, this review provides a summary of the views mentioned above, aiming to provide a reference for animal model selection.
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Affiliation(s)
- Yilin Wang
- 2Institute of Cerebrovascular Diseases Research and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Penghu Wei
- 1Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China.,4Clinical Research Center for Epilepsy Capital Medical University, Beijing, China
| | - Feng Yan
- 2Institute of Cerebrovascular Diseases Research and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yumin Luo
- 2Institute of Cerebrovascular Diseases Research and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,3Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,4Clinical Research Center for Epilepsy Capital Medical University, Beijing, China
| | - Guoguang Zhao
- 1Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China.,3Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,4Clinical Research Center for Epilepsy Capital Medical University, Beijing, China
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Samson S, Denos M. Neuropsychology of temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:519-529. [PMID: 35964990 DOI: 10.1016/b978-0-12-823493-8.00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This chapter focuses on the neuropsychology of adults with temporal lobe epilepsy (TLE). First, a thorough description of the brain-behavior relationship characterizing focal TLE with and without hippocampal sclerosis is presented. Then, the aim and the specificity of the NPA in the care of epilepsy are described. Considering the high frequency of medically intractable TLE that can be treated by surgery, an assessment carried out in the context of pre- and postoperative evaluation is presented and discussed in light of insights from functional neuroimaging findings. Finally, we propose concluding remarks about the place of neuropsychology in the care of epilepsy in improving our understanding of the cognitive and emotional phenotypes associated with TLE.
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Affiliation(s)
- Séverine Samson
- Department of Psychology, University of Lille, Lille, France; Epilepsy Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France.
| | - Marisa Denos
- Rehabilitation Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France
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Turek G, Skjei K. Seizure semiology, localization, and the 2017 ILAE seizure classification. Epilepsy Behav 2022; 126:108455. [PMID: 34894624 DOI: 10.1016/j.yebeh.2021.108455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
In the study of epilepsy, the term semiology is used to comprise the clinical characteristics of a seizure, both subjective symptoms and objective phenomena. It is produced by activation of the symptomagenic zone, and an accurate and comprehensive understanding of the localizing value of seizure semiology is crucial for presurgical evaluation and planning. Myriad publications in epilepsy journals detail correlations between various semiological features and activation of specific cortical regions. Traditionally these studies involved scalp EEG recorded in epilepsy monitoring units. The increasing use of invasive monitoring, and specifically the use of depth electrodes and stereo-electroencephalography, has advanced our understanding of the characteristics of seizures arising from ictal foci deep to the scalp, including the cingulate, insula and operculum. However, the distinction between seizure onset and symptomogenic zones is not always clear. In 2017 the International League Against Epilepsy (ILAE) published an operational classification of seizure types based heavily on seizure semiology. The current paper provides an updated review of the current body of knowledge relating to seizure semiology, incorporating both scalp EEG studies and more recent stereo-electroencephalography discoveries in the framework of the 2017 ILAE classification.
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Affiliation(s)
- Grant Turek
- Department of Neurology, University of Louisville, 401 E. Chestnut St. Unit 510, Louisville, KY 40202-5710, United States.
| | - Karen Skjei
- Department of Neurology, University of Texas at Austin, Dell Medical School, 1601 Trinity St., Bldg B, Strop Z0700, Austin, TX 78712, United States
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High prevalence of pathological alertness and wakefulness on maintenance of wakefulness test in adults with focal-onset epilepsy. Epilepsy Behav 2021; 125:108400. [PMID: 34800802 DOI: 10.1016/j.yebeh.2021.108400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a common complaint in adults with epilepsy (AWE), but objective evaluation is lacking. We used the maintenance of wakefulness test (MWT) to objectively measure the ability of adults with focal-onset epilepsy to maintain wakefulness in soporific conditions. METHODS Adults with epilepsy participating in a study investigating the effects of lacosamide on sleep and wakefulness underwent baseline ambulatory polysomnography (PSG)/EEG followed by MWT. Mean sleep latency (MSL) and mean percent sleep time (MST, mean percentage of non-wake EEG scored in 3-sec bins from lights out to sleep onset averaged over the 4 MWT trials) were quantified. Subjective sleepiness was assessed by the Epworth Sleepiness Scale (ESS). Spearman correlation and linear regression assessed relationships between MWT parameters, ESS and relevant sleep and epilepsy-related variables. RESULTS Maintenance of wakefulness test MSL in 51 AWE (mean age 43.5 ± 13 years, 69% female, mean BMI 24.6 ± 11.2 kg/m2) was 21.7 ± 11.9 min; 45.1% had an abnormally short MSL <19.4 min and 15.7% <8 min. MST was 9.3% [3.3, 19.1]. Mean ESS score was 8.8 ± 5.7; 39% had elevated ESS (>10). No correlation between subjective ESS and objective MSL (p = 0.67) or MST (p = 0.61) was found. MSL was significantly shorter in subjects with focal to bilateral tonic-clonic seizures (FBTCS; 7.9 min [13.6, 22.3]) compared to those without (27.4 min [21.2, 33.6], p = 0.013). Younger subjects had shorter MSL; MSL increased 3.2 min for every 10-year increase in age. CONCLUSION We found a high prevalence of objective sleepiness/difficulty maintaining wakefulness on the MWT and subjective sleepiness using the ESS in AWE without a correlation between the two. More severe objective sleepiness was found in subjects with a history of FBTCS and younger age. Further research is needed to determine mechanistic underpinnings and optimal measurements of pathological sleepiness in people with epilepsy given the burden of it on quality of life.
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Impaired awareness in mesial temporal lobe epilepsy: Network analysis of foramen ovale and scalp EEG. Clin Neurophysiol 2021; 132:3084-3094. [PMID: 34717226 DOI: 10.1016/j.clinph.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We use co-registration of foramen-ovale and scalp-EEG to investigate network alterations in temporal-lobe epilepsy during focal seizures without (aura) or with impairment of awareness (SIA). METHODS One aura and one SIA were selected from six patients. Temporal dynamic among 4 epochs, as well as the differences between aura and SIA, were analyzed through partial directed coherence and graph theory-based indices of centrality. RESULTS Regarding the auras temporal evolution, fronto-parietal (FP) regions showed decreased connectivity with respect to the interictal period, in both epileptogenic (EH) and non-epileptogenic hemisphere (nEH). During SIAs, temporal dynamic showed more changes than auras: centrality of mesial temporal (mT) regions changes during all conditions, and nEH FP centrality showed the same dynamic trend of the aura (decreased centrality), until the last epoch, close to the impaired awareness, when showed increased centrality. Comparing SIA with aura, in proximity of impaired awareness, increased centrality was found in all the regions, except in nEH mT. CONCLUSIONS Our findings suggested that the impairment of awareness is related to network alterations occurring first in neocortical regions and when awareness is still retained. SIGNIFICANCE The analysis of 'hub' alteration can represent a suitable biomarker for scalp EEG-based prediction of awareness impairment.
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Zhong Y, Wang Y, He Z, Lin Z, Pang N, Niu L, Guo Y, Pan M, Meng L. Closed-loop wearable ultrasound deep brain stimulation system based on EEG in mice. J Neural Eng 2021; 18. [PMID: 34388739 DOI: 10.1088/1741-2552/ac1d5c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/13/2021] [Indexed: 01/19/2023]
Abstract
Objective. Epilepsy is one of the most common severe brain disorders. Ultrasound deep brain stimulation (UDBS) has shown a potential capability to suppress seizures. However, because seizures occur sporadically, it is necessary to develop a closed-loop system to suppress them. Therefore, we developed a closed-loop wearable UDBS system that delivers ultrasound to the hippocampus to suppress epileptic seizures.Approach.Mice were intraperitoneally injected with 10 mg kg-1kainic acid and divided into sham and UDBS groups. Epileptic seizures were detected by applying both long short-term memory (LSTM) and bidirectional LSTM (BILSTM) networks according to EEG signal characteristics. When epileptic seizures were detected, the closed-loop UDBS system automatically activated a trigger switch to stimulate the hippocampus for 10 min and continuously record EEG signals until 20 min after ultrasonic stimulation. EEG signals were analyzed using the MATLAB software. After EEG recording, we observed the survival rate of the experimental mice for 72 h.Main results.The BiLSTM network was found to have preferable classification performance over the LSTM network. The closed-loop UDBS system with BiLSTM could automatically detect epileptic seizures using EEG signals and effectively reduce epileptic EEG power spectral density and seizure duration by 10.73%, eventually improving the survival rate of early epileptic mice from 67.57% in the sham group to 88.89% in the UDBS group.Significance.The closed-loop UDBS system developed in this study could be an effective clinical tool for the control of epilepsy.
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Affiliation(s)
- Yongsheng Zhong
- Neurosurgery Center, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China.,Institute of Biomedical and Health engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Yibo Wang
- Institute of Biomedical and Health engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Zhuoyi He
- Neurosurgery Center, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
| | - Zhengrong Lin
- Institute of Biomedical and Health engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Na Pang
- Institute of Biomedical and Health engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Lili Niu
- Institute of Biomedical and Health engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Yanwu Guo
- Neurosurgery Center, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China
| | - Min Pan
- Department of Ultrasound, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518034, People's Republic of China
| | - Long Meng
- Institute of Biomedical and Health engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
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Yu Y, Du L, Zhang J. Febrile seizure-related miR-148a-3p exerts neuroprotection by promoting the proliferation of hippocampal neurons in children with temporal lobe epilepsy. Dev Neurosci 2021; 43:312-320. [PMID: 34348296 DOI: 10.1159/000518352] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yanhui Yu
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, China
| | - Linjun Du
- Department of Pediatrics, Liaocheng Third People's Hospital, Liaocheng, China
| | - Jinxu Zhang
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, China
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Yan WW, Xia M, Chiang J, Levitt A, Hawkins N, Kearney J, Swanson GT, Chetkovich D, Nobis WP. Enhanced Synaptic Transmission in the Extended Amygdala and Altered Excitability in an Extended Amygdala to Brainstem Circuit in a Dravet Syndrome Mouse Model. eNeuro 2021; 8:ENEURO.0306-20.2021. [PMID: 34045209 PMCID: PMC8213443 DOI: 10.1523/eneuro.0306-20.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022] Open
Abstract
Dravet syndrome (DS) is a developmental and epileptic encephalopathy with an increased incidence of sudden death. Evidence of interictal breathing deficits in DS suggests that alterations in subcortical projections to brainstem nuclei may exist, which might be driving comorbidities in DS. The aim of this study was to determine whether a subcortical structure, the bed nucleus of the stria terminalis (BNST) in the extended amygdala, is activated by seizures, exhibits changes in excitability, and expresses any alterations in neurons projecting to a brainstem nucleus associated with respiration, stress response, and homeostasis. Experiments were conducted using F1 mice generated by breeding 129.Scn1a+/- mice with wild-type C57BL/6J mice. Immunohistochemistry was performed to quantify neuronal c-fos activation in DS mice after observed spontaneous seizures. Whole-cell patch-clamp and current-clamp electrophysiology recordings were conducted to evaluate changes in intrinsic and synaptic excitability in the BNST. Spontaneous seizures in DS mice significantly enhanced neuronal c-fos expression in the BNST. Further, the BNST had altered AMPA/NMDA postsynaptic receptor composition and showed changes in spontaneous neurotransmission, with greater excitation and decreased inhibition. BNST to parabrachial nucleus (PBN) projection neurons exhibited intrinsic excitability in wild-type mice, while these projection neurons were hypoexcitable in DS mice. The findings suggest that there is altered excitability in neurons of the BNST, including BNST-to-PBN projection neurons, in DS mice. These alterations could potentially be driving comorbid aspects of DS outside of seizures, including respiratory dysfunction and sudden death.
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Affiliation(s)
- Wen Wei Yan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - Maya Xia
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - Jeremy Chiang
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - Alyssa Levitt
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - Nicole Hawkins
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - Jennifer Kearney
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - Geoffrey T Swanson
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - Dane Chetkovich
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - William P Nobis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
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He J, Xiao B, Liu C, Wang K, Tan L, Long L. Feature of cognitive dysfunction in patients with temporal lobe epilepsy and its clinical influencing factors. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2021; 46:240-248. [PMID: 33927070 PMCID: PMC10929927 DOI: 10.11817/j.issn.1672-7347.2021.200770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To comprehensively analyze the characteristics of cognitive impairment of temporal lobe epilepsy (TLE), and to explore the effects of different lateral patients' cognitive impairment and different clinical factors on cognitive impairment of TLE. METHODS A total of 84 patients, who met the diagnostic criteria for TLE in the Department of Neurology, Xiangya Hospital, were collected as a patient group, with 36 cases of left TLE and 48 cases of right TLE. A total of 79 healthy volunteers with matching gender, age and education level were selected as a control group. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the scores of Arithmetic Test, Information Test, Digit Symbol Substitution Test (DSST), Block Design Test (BDT), Hayling Test and Verbal Fluency Test (VFT) of the revised Chinese Adult Wechsler Intelligence scale were retrospectively analyzed in the 2 groups.Multiple regression analysis was used to analyze the relationship between the clinical factors and the cognitive impairment score. RESULTS Compared with the control group, the TLE patient group had low scores in all neuropsychological tests, with significant difference (all P<0.05). Compared with the control group, there was significant difference in different neuropsychological tests in the patients with TLE on different sides (all P<0.05). In the left TLE, there were low scores in Information Test, arithmetic, VFT, the completion time of Hayling Test part A, the completion time of Hayling Test part B, the correct number of Hayling Test part A, the correct number of Hayling Test part B, BDT, Forward Digit Span Test (FDST) and Backward Digit Span Test (BDST). While in the right TLE, there were low scores in Information Test, arithmetic, DSST, VFT, the completion time of Hayling Test part A, the correct number of Hayling Test part A, the completion time of Hayling Test part B, the correct number of Hayling Test part B, BDT, FDST and BDST. CONCLUSIONS There are multiple cognitive domain dysfunctions in TLE, including language, short-term memory, long-term memory, attention, working memory, executive function and visual space function. Left TLE has greater impairment of executive function and right TLE has greater damage in working memory. Long pathography of disease, hippocampal sclerosis and a history of febrile convulsions may lead to more severe cognitive impairment. Earlier identification and earlier intervention are needed to improve prognosis of patients.
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Affiliation(s)
- Jialinzi He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chaorong Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Kangrun Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Langzi Tan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China.
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40
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Meisenhelter S, Quon RJ, Steimel SA, Testorf ME, Camp EJ, Moein P, Culler GW, Gross RE, Lega BC, Sperling MR, Kahana MJ, Jobst BC. Interictal Epileptiform Discharges are Task Dependent and are Associated with Lasting Electrocorticographic Changes. Cereb Cortex Commun 2021; 2:tgab019. [PMID: 34296164 PMCID: PMC8152941 DOI: 10.1093/texcom/tgab019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/24/2022] Open
Abstract
The factors that control the occurrence of interictal epileptiform discharges (IEDs) are not well understood. We suspected that this phenomenon reflects an attention-dependent suppression of interictal epileptiform activity. We hypothesized that IEDs would occur less frequently when a subject viewed a task-relevant stimulus compared with viewing a blank screen. Furthermore, IEDs have been shown to impair memory when they occur in certain regions during the encoding or recall phases of a memory task. Although these discharges have a short duration, their impact on memory suggests that they have longer lasting electrophysiological effects. We found that IEDs were associated with an increase in low-frequency power and a change in the balance between low- and high-frequency oscillations for several seconds. We found that the occurrence of IEDs is modified by whether a subject is attending to a word displayed on screen or is observing a blank screen. In addition, we found that discharges in brain regions in every lobe impair memory. These findings elucidate the relationship between IEDs and memory impairment and reveal the task dependence of the occurrence of IEDs.
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Affiliation(s)
- Stephen Meisenhelter
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
- Department of Neurology, Geisel School of Medicine at Dartmouth College Hanover, NH 03755, United States
| | - Robert J Quon
- Department of Neurology, Geisel School of Medicine at Dartmouth College Hanover, NH 03755, United States
| | - Sarah A Steimel
- Department of Neurology, Geisel School of Medicine at Dartmouth College Hanover, NH 03755, United States
| | - Markus E Testorf
- Thayer School of Engineering at Dartmouth College, Hanover, NH 03755, United States
| | - Edward J Camp
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Payam Moein
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - George W Culler
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University, Atlanta, GA 30322, United States
| | - Bradley C Lega
- Department of Neurosurgery, University of Texas-Southwestern, Dallas, TX 75390, United States
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19144, United States
| | - Michael J Kahana
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Barbara C Jobst
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
- Department of Neurology, Geisel School of Medicine at Dartmouth College Hanover, NH 03755, United States
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41
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Brodovskaya A, Shiono S, Kapur J. Activation of the basal ganglia and indirect pathway neurons during frontal lobe seizures. Brain 2021; 144:2074-2091. [PMID: 33730155 DOI: 10.1093/brain/awab119] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/12/2020] [Accepted: 01/04/2021] [Indexed: 12/27/2022] Open
Abstract
There are no detailed descriptions of neuronal circuit active during frontal lobe motor seizures. Using activity reporter mice, local field potential recordings, tissue clearing, viral tracing, and super-resolution microscopy, we found neuronal activation after focal motor to bilateral tonic-clonic seizures in the striatum, globus pallidus externus, subthalamic nucleus, substantia nigra pars reticulata and neurons of the indirect pathway. Seizures preferentially activated dopamine D2 receptor-expressing neurons over D1 in the striatum, which have different projections. Furthermore, the D2 receptor agonist infused into the striatum exerted an anticonvulsant effect. Seizures activate structures via short and long latency loops, and anatomical connections of the seizure focus determine the seizure circuit. These studies, for the first time, show activation of neurons in the striatum, globus pallidus, subthalamic nucleus, and substantia nigra during frontal lobe motor seizures on the cellular level, revealing a complex neuronal activation circuit subject to modulation by the basal ganglia.
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Affiliation(s)
- Anastasia Brodovskaya
- Neuroscience Graduate Program, University of Virginia, Charlottesville, Virginia 22908, USA
| | - Shinnosuke Shiono
- Department of Neurology, University of Virginia, Charlottesville, Virginia 22908, USA
| | - Jaideep Kapur
- Department of Neurology, University of Virginia, Charlottesville, Virginia 22908, USA.,UVA Brain Institute, University of Virginia, Charlottesville, Virginia 22908, USA
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42
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Muller LC, Mäder-Joaquim MJ, Terra VC, de Paola L, Hopker CDC, de Paula Souza L, Soares Silvado CE. Nonverbal fluency assessed by the five-point test in epilepsy patients with unilateral mesial temporal sclerosis-a Brazilian study. Clin Neuropsychol 2021; 35:S21-S31. [PMID: 33622173 DOI: 10.1080/13854046.2021.1887357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the performance of epilepsy patients diagnosed with unilateral mesial temporal sclerosis (MTS) on a nonverbal fluency measure using the five-point test (FPT). Our secondary aim was to investigate any differences in FPT and verbal fluency test (VFT) scores between left and right MTS. We hypothesized that scores on the FPT, commonly utilized in the assessment of individuals with presumed frontal lobe damage, would be lower in patients with temporal lobe dysfunction. METHOD One hundred eighty patients diagnosed with temporal lobe epilepsy (TLE) and 150 healthy controls (HCs) were included in this retrospective study. We analyzed correlations between scores obtained from FPT and phonemic and semantic VFT, and scores according to the lateralization of epileptogenic focus in the TLE group. RESULTS Overall, the TLE patients had lower performance than the HCs on the FPT, but no differences were observed on perseverance rates (p = 0.992). Statistically significant difference was found in both sections of the VFT in association with the lateralization of the epileptogenic zone (p < 0.001). As for the FPT, differences did not reach statistical significance (p = 0.0857). CONCLUSIONS Our results support the hypothesis of involvement of the temporal areas on tasks such as the FPT, despite the lack of a lateralizing effect. Our findings also contribute to better understanding of the role of the FPT in assessment of executive function in patients with unilateral MTS, and provide further psychometric data on a native Brazilian population.
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Affiliation(s)
- Luiza Cury Muller
- Epilepsy and EEG Center, Hospital de Clínicas-Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Maria Joana Mäder-Joaquim
- Epilepsy and EEG Center, Hospital de Clínicas-Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Vera Cristina Terra
- Epilepsy and EEG Center, Hospital de Clínicas-Federal University of Paraná, Curitiba, Paraná, Brazil.,Epicentro, Comprehensive Epilepsy Center, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
| | - Luciano de Paola
- Epilepsy and EEG Center, Hospital de Clínicas-Federal University of Paraná, Curitiba, Paraná, Brazil.,Epicentro, Comprehensive Epilepsy Center, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
| | | | - Luciana de Paula Souza
- Epilepsy and EEG Center, Hospital de Clínicas-Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Carlos Eduardo Soares Silvado
- Epilepsy and EEG Center, Hospital de Clínicas-Federal University of Paraná, Curitiba, Paraná, Brazil.,Epicentro, Comprehensive Epilepsy Center, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
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43
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Leeman-Markowski BA, Adams J, Martin SP, Devinsky O, Meador KJ. Methylphenidate for attention problems in epilepsy patients: Safety and efficacy. Epilepsy Behav 2021; 115:107627. [PMID: 33360744 PMCID: PMC7884102 DOI: 10.1016/j.yebeh.2020.107627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of seizures, and children with epilepsy have an increased prevalence of ADHD. Adults with epilepsy often have varying degrees of attentional dysfunction due to multiple factors, including anti-seizure medications, frequent seizures, interictal discharges, underlying lesions, and psychiatric comorbidities. Currently, there are no approved medications for the treatment of epilepsy-related attentional dysfunction. Methylphenidate (MPH) is a stimulant, FDA-approved for the treatment of ADHD, and often used for ADHD in the setting of pediatric epilepsy. Large database and registry studies indicate safety of MPH in children with ADHD and epilepsy, with no significant effect on seizure frequency. Small single-dose and open-label studies suggest efficacy of MPH in adults with epilepsy-related attention deficits. Methylphenidate represents a possible treatment for attentional dysfunction due to epilepsy, but large, randomized, placebo-controlled, double-blinded studies are needed.
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Affiliation(s)
- Beth A Leeman-Markowski
- Research Service, VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY 10010, United States; Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34th St., New York, NY 10016, United States.
| | - Jesse Adams
- Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305-5723, United States.
| | - Samantha P Martin
- Research Service, VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY 10010, United States; Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34th St., New York, NY 10016, United States.
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34th St., New York, NY 10016, United States; Department of Neurosurgery, New York University Langone Health, 660 1st Ave. #5, New York, NY 10016, United States; Department of Psychiatry, New York University Langone Health, 550 1st Ave., New York, NY 10016, United States.
| | - Kimford J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979 (room 2856), Palo Alto, CA 94304-5979, United States.
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González HFJ, Narasimhan S, Johnson GW, Wills KE, Haas KF, Konrad PE, Chang C, Morgan VL, Rubinov M, Englot DJ. Role of the Nucleus Basalis as a Key Network Node in Temporal Lobe Epilepsy. Neurology 2021; 96:e1334-e1346. [PMID: 33441453 DOI: 10.1212/wnl.0000000000011523] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether the nucleus basalis of Meynert (NBM) may be a key network structure of altered functional connectivity in temporal lobe epilepsy (TLE), we examined fMRI with network-based analyses. METHODS We acquired resting-state fMRI in 40 adults with TLE and 40 matched healthy control participants. We calculated functional connectivity of NBM and used multiple complementary network-based analyses to explore the importance of NBM in TLE networks without biasing our results by our approach. We compared patients to controls and examined associations of network properties with disease metrics and neurocognitive testing. RESULTS We observed marked decreases in connectivity between NBM and the rest of the brain in patients with TLE (0.91 ± 0.88, mean ± SD) vs controls (1.96 ± 1.13, p < 0.001, t test). Larger decreases in connectivity between NBM and fronto-parietal-insular regions were associated with higher frequency of consciousness-impairing seizures (r = -0.41, p = 0.008, Pearson). A core network of altered nodes in TLE included NBM ipsilateral to the epileptogenic side and bilateral limbic structures. Furthermore, normal community affiliation of ipsilateral NBM was lost in patients, and this structure displayed the most altered clustering coefficient of any node examined (3.46 ± 1.17 in controls vs 2.23 ± 0.93 in patients). Abnormal connectivity between NBM and subcortical arousal community was associated with modest neurocognitive deficits. Finally, a logistic regression model incorporating connectivity properties of ipsilateral NBM successfully distinguished patients from control datasets with moderately high accuracy (78%). CONCLUSIONS These results suggest that while NBM is rarely studied in epilepsy, it may be one of the most perturbed network nodes in TLE, contributing to widespread neural effects in this disabling disorder.
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Affiliation(s)
- Hernán F J González
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA.
| | - Saramati Narasimhan
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Graham W Johnson
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Kristin E Wills
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Kevin F Haas
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Peter E Konrad
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Catie Chang
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Victoria L Morgan
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Mikail Rubinov
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Dario J Englot
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
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Lagogianni C, Gatzonis S, Patrikelis P. Fatigue and cognitive functions in epilepsy: A review of the literature. Epilepsy Behav 2021; 114:107541. [PMID: 33243688 DOI: 10.1016/j.yebeh.2020.107541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
Epilepsy is a common neurological disorder affecting people of all ages and inducing cognitive impairments. While research has advanced in terms of neuropsychological enquiries of the various epileptic syndromes, the understanding of more complex and ill-defined phenomena such as fatigue is still unclear for epilepsy. It is suggested that fatigue is not just physical, but there can also be a cognitive element to it. Although studies in other conditions have been able to identify a relationship between fatigue and particular cognitive components, similar evidence is sparse in patients with epilepsy. This review is an attempt to gather, analyze, integrate, and critically discuss available information on fatigue and its rapport with various aspects of epilepsy, particularly focusing on cognition. Future directions are discussed urging researchers to target cognitive components of fatigue.
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Affiliation(s)
- Christodouli Lagogianni
- Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece; ICPS College for Humanistic Sciences, Athens, Greece.
| | - Stylianos Gatzonis
- Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece
| | - Panayiotis Patrikelis
- Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece
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People with mesial temporal lobe epilepsy have altered thalamo-occipital brain networks. Epilepsy Behav 2020; 115:107645. [PMID: 33334720 PMCID: PMC7882020 DOI: 10.1016/j.yebeh.2020.107645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
While temporal lobe epilepsy (TLE) is a focal epilepsy, previous work demonstrates that TLE causes widespread brain-network disruptions. Impaired visuospatial attention and learning in TLE may be related to thalamic arousal nuclei connectivity. Our prior preliminary work in a smaller patient cohort suggests that patients with TLE demonstrate abnormal functional connectivity between central lateral (CL) thalamic nucleus and medial occipital lobe. Others have shown pulvinar connectivity disturbances in TLE, but it is incompletely understood how TLE affects pulvinar subnuclei. Also, the effects of epilepsy surgery on thalamic functional connectivity remains poorly understood. In this study, we examine the effects of TLE on functional connectivity of two key thalamic arousal-nuclei: lateral pulvinar (PuL) and CL. We evaluate resting-state functional connectivity of the PuL and CL in 40 patients with TLE and 40 controls using fMRI. In 25 patients, postoperative images (>1 year) were also compared with preoperative images. Compared to controls, patients with TLE exhibit loss of normal positive connectivity between PuL and lateral occipital lobe (p < 0.05), and a loss of normal negative connectivity between CL and medial occipital lobe (p < 0.01, paired t-tests). FMRI amplitude of low-frequency fluctuation (ALFF) in TLE trended higher in ipsilateral PuL (p = 0.06), but was lower in the lateral occipital (p < 0.01) and medial occipital lobe in patients versus controls (p < 0.05, paired t-tests). More abnormal ALFF in the ipsilateral lateral occipital lobe is associated with worse preoperative performance on Rey Complex Figure Test Immediate (p < 0.05, r = 0.381) and Delayed scores (p < 0.05, r = 0.413, Pearson's Correlations). After surgery, connectivity between PuL and lateral occipital lobe remains abnormal in patients (p < 0.01), but connectivity between CL and medial occipital lobe improves and is no longer different from control values (p > 0.05, ANOVA, post hoc Fischer's LSD). In conclusion, thalamic arousal nuclei exhibit abnormal connectivity with occipital lobe in TLE, and some connections may improve after surgery. Studying thalamic arousal centers may help explain distal network disturbances in TLE.
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Nenert R, Allendorfer JB, Bebin EM, Gaston TE, Grayson LE, Houston JT, Szaflarski JP. Cannabidiol normalizes resting-state functional connectivity in treatment-resistant epilepsy. Epilepsy Behav 2020; 112:107297. [PMID: 32745959 DOI: 10.1016/j.yebeh.2020.107297] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Resting-state (rs) network dysfunction is a contributing factor to treatment resistance in epilepsy. In treatment-resistant epilepsy (TRE), pharmacological and nonpharmacological therapies have been shown to improve such dysfunction. In this study, our goal was to prospectively evaluate the effect of highly purified plant-derived cannabidiol (CBD; Epidiolex®) on rs functional magnetic resonance imaging (fMRI) functional connectivity (rs-FC). We hypothesized that CBD would change and potentially normalize the rs-FC in TRE. METHODS Twenty-two of 27 participants with TRE completed all study procedures including longitudinal pre-/on-CBD rs-fMRI (8M/14F, mean age = 36.2 ± 15.9 years, TRE duration = 18.3 ± 12.6 years); there were no differences in age (p = 0.99) or sex (p = 0.15) between groups. Assessments collected included seizure frequency (SF), Chalfont Seizure Severity Scale (CSSS), Columbia Suicide Severity Rating Scale (C-SSRS), Adverse Events Profile (AEP), and Profile of Mood States (POMS). Twenty-three healthy controls (HCs) received rs-fMRI and POMS once. RESULTS Participants with TRE showed average decrease of 71.7% in SF (p < 0.0001) and improved CSSS, AEP, and POMS confusion, depression, and fatigue subscores (all p < 0.05) on-CBD with POMS scores becoming similar to those of HCs. Paired t-tests showed significant pre-/on-CBD changes in rs-FC in cerebellum, frontal areas, temporal areas, hippocampus, and amygdala with some of them correlating with improvement in behavioral measures. Significant differences in rs-FC between pre-CBD and HCs were found in cerebellum, frontal, and occipital regions. After controlling for changes in SF with CBD, these differences were no longer present when comparing on-CBD to HCs. SIGNIFICANCE This study indicates that highly purified CBD modulates and potentially normalizes rs-FC in the epileptic brain. This effect may underlie its efficacy. This study provides Class III evidence for CBD's normalizing effect on rs-FC in TRE.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jane B Allendorfer
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Martina Bebin
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tyler E Gaston
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Leslie E Grayson
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - James T Houston
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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