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Tomas-Sanchez C, Blanco-Alvarez VM, Gonzalez-Barrios JA, Martinez-Fong D, Soto-Rodriguez G, Brambila E, Gonzalez-Vazquez A, Aguilar-Peralta AK, Limón DI, Vargas-Castro V, Cebada J, Alatriste-Bueno V, Leon-Chavez BA. Prophylactic zinc and therapeutic selenium administration in adult rats prevents long-term cognitive and behavioral sequelae by a transient ischemic attack. Heliyon 2024; 10:e30017. [PMID: 38707461 PMCID: PMC11068621 DOI: 10.1016/j.heliyon.2024.e30017] [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: 10/30/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
The transient hypoxic-ischemic attack, also known as a minor stroke, can result in long-term neurological issues such as memory loss, depression, and anxiety due to an increase in nitrosative stress. The individual or combined administration of chronic prophylactic zinc and therapeutic selenium is known to reduce nitrosative stress in the first seven days post-reperfusion and, due to an antioxidant effect, prevent cell death. Besides, zinc or selenium, individually administered, also causes antidepressant and anxiolytic effects. Therefore, this work evaluated whether combining zinc and selenium could prevent stroke-elicited cognition and behavior deficits after 30 days post-reperfusion. Accordingly, we assessed the expression of growth factors at 7 days post-reperfusion, a four-time course of memory (from 7 to 28 days post-learning test), and cell proliferation, depression, and anxiety-like behavior at 30 days post-reperfusion. Male Wistar rats with a weight between 190 and 240 g) were treated with chronic prophylactic zinc administration with a concentration of 0.2 mg/kg for 15 days before common carotid artery occlusion (10 min) and then with therapeutic selenium (6 μg/kg) for 7 days post-reperfusion. Compared with individual administrations, the administration combined of prophylactic zinc and therapeutic selenium decreased astrogliosis, increased growth factor expression, and improved cell proliferation and survival in two regions, the hippocampus, and cerebral cortex. These effects prevented memory loss, depression, and anxiety-like behaviors. In conclusion, these results demonstrate that the prophylactic zinc administration combined with therapeutic selenium can reduce the long-term sequelae caused by the transient ischemic attack. Significance statement. A minor stroke caused by a transient ischemic attack can result in psychomotor sequelae that affect not only the living conditions of patients and their families but also the economy. The incidence of these micro-events among young people has increased in the world. Nonetheless, there is no deep understanding of how this population group responds to regular treatments (Ekker and et al., 2018) [1]. On the basis that zinc and selenium have antioxidant, anti-inflammatory, and regenerative properties in stroke animal models, our work explored whether the chronic combined administration of prophylactic zinc and therapeutic selenium could prevent neurological sequelae in the long term in a stroke rat model of unilateral common carotid artery occlusion (CCAO) by 10-min. Our results showed that this combined treatment provided a long-term neuroprotective effect by decreasing astrogliosis, memory loss, anxiety, and depression-like behavior.
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Affiliation(s)
- Constantino Tomas-Sanchez
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, 14 sur y Av. San Claudio, 72570, Puebla, Mexico
| | - Victor Manuel Blanco-Alvarez
- Facultad de Enfermería, Benemérita Universidad Autónoma de Puebla, Av 25 Pte 1304, Colonia Volcanes, Puebla, Mexico
| | - Juan Antonio Gonzalez-Barrios
- Laboratorio de Medicina Genómica, Hospital regional 1° de Octubre, ISSSTE, Avenida Instituto Politécnico Nacional #1669, 07760, México D. F., Mexico
| | - Daniel Martinez-Fong
- Departamento de Fisiología, Biofísica y Neurociencias, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Apartado Postal 14-740, 07000, México D.F., Mexico
- Nanoparticle Therapy Institute, 404 Avenida Monte Blanco, Aguascalientes, 20120, Mexico
| | - Guadalupe Soto-Rodriguez
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, 13 Sur 2702, Col. Volcanes, 72410, Puebla, Mexico
| | - Eduardo Brambila
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, 14 sur y Av. San Claudio, 72570, Puebla, Mexico
| | - Alejandro Gonzalez-Vazquez
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, 13 Sur 2702, Col. Volcanes, 72410, Puebla, Mexico
| | - Ana Karina Aguilar-Peralta
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, 13 Sur 2702, Col. Volcanes, 72410, Puebla, Mexico
| | - Daniel I. Limón
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, 14 sur y Av. San Claudio, 72570, Puebla, Mexico
| | - Viridiana Vargas-Castro
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, 14 sur y Av. San Claudio, 72570, Puebla, Mexico
| | - Jorge Cebada
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, 13 Sur 2702, Col. Volcanes, 72410, Puebla, Mexico
| | - Victorino Alatriste-Bueno
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, 14 sur y Av. San Claudio, 72570, Puebla, Mexico
| | - Bertha Alicia Leon-Chavez
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, 14 sur y Av. San Claudio, 72570, Puebla, Mexico
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Delazer L, Bao H, Lauseker M, Stauner L, Nübling G, Conrad J, Noachtar S, Havla J, Kaufmann E. Association between retinal thickness and disease characteristics in adult epilepsy: A cross-sectional OCT evaluation. Epilepsia Open 2024; 9:236-249. [PMID: 37920967 PMCID: PMC10839337 DOI: 10.1002/epi4.12859] [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: 07/31/2023] [Accepted: 10/29/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Thinning of the peripapillary retinal nerve fiber layer (p-RNFL), as measured by optical coherence tomography (OCT), was recently introduced as a promising marker for cerebral neuronal loss in people with epilepsy (PwE). However, its clinical implication remains to be elucidated. We thus aimed to (1) systematically characterize the extent of the retinal neuroaxonal loss in a broad spectrum of unselected PwE and (2) to evaluate the main clinical determinants. METHODS In this prospective study, a spectral-domain OCT evaluation was performed on 98 well-characterized PwE and 85 healthy controls (HCs) (18-55 years of age). All inner retinal layers and the total macula volume were assessed. Group comparisons and linear regression analyses with stepwise backward selection were performed to identify relevant clinical and demographic modulators of the retinal neuroaxonal integrity. RESULTS PwE (age: 33.7 ± 10.6 years; 58.2% female) revealed a significant neuroaxonal loss across all assessed retinal layers (global pRNFL, P = 0.001, Δ = 4.24 μm; macular RNFL, P < 0.001, Δ = 0.05 mm3 ; ganglion cell inner plexiform layer, P < 0.001, Δ = 0.11 mm3 ; inner nuclear layer, INL, P = 0.03, Δ = 0.02 mm3 ) as well as significantly reduced total macula volumes (TMV, P < 0.001, Δ = 0.18 mm3 ) compared to HCs (age: 31.2 ± 9.0 years; 57.6% female). The extent of retinal neuroaxonal loss was associated with the occurrence and frequency of tonic-clonic seizures and the number of antiseizure medications, and was most pronounced in male patients. SIGNIFICANCE PwE presented an extensive retinal neuroaxonal loss, affecting not only the peripapillary but also macular structures. The noninvasive and economic measurement via OCT bears the potential to establish as a practical tool to inform patient management, as the extent of the retinal neuroaxonal loss reflects aspects of disease severity and sex-specific vulnerability. PLAIN LANGUAGE SUMMARY The retina is an extension of the brain and closely connected to it. Thus, cerebral alterations like atrophy reflect also on the retinal level. This is advantageous, as the retina is easily accessible and measureable with help of the optical coherence tomography. Here we report that adults with epilepsy have a significantly thinner retina than healthy persons. Especially people with many big seizures and a lot of medications have a thinner retina. We propose that measurement of the retina can be useful as a marker of disease severity and to inform patient management.
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Affiliation(s)
- Luisa Delazer
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| | - Han Bao
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig Maximilians UniversityMunichGermany
- Institute for StatisticsMunichGermany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig Maximilians UniversityMunichGermany
| | - Livia Stauner
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| | - Georg Nübling
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- German Center for Neurodegenerative DiseasesMunichGermany
| | - Julian Conrad
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- Division for Neurodegenerative DiseasesUniversitätsmedizin Mannheim, University of HeidelbergHeidelbergGermany
| | - Soheyl Noachtar
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| | - Joachim Havla
- Institute of Clinical NeuroimmunologyLMU HospitalLMU Hospital, Ludwig Maximilians UniversityMunichGermany
| | - Elisabeth Kaufmann
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
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Zeicu C, Legouhy A, Scott CA, Oliveira JFA, Winston GP, Duncan JS, Vos SB, Thom M, Lhatoo S, Zhang H, Harper RM, Diehl B. Altered amygdala volumes and microstructure in focal epilepsy patients with tonic-clonic seizures, ictal, and post-convulsive central apnea. Epilepsia 2023; 64:3307-3318. [PMID: 37857465 PMCID: PMC10952501 DOI: 10.1111/epi.17804] [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: 06/11/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death for patients with epilepsy; however, the pathophysiology remains unclear. Focal-to-bilateral tonic-clonic seizures (FBTCS) are a major risk factor, and centrally-mediated respiratory depression may increase the risk further. Here, we determined the volume and microstructure of the amygdala, a key structure that can trigger apnea in people with focal epilepsy, stratified by the presence or absence of FBTCS, ictal central apnea (ICA), and post-convulsive central apnea (PCCA). METHODS Seventy-three patients with focal impaired awareness seizures without FBTC seizures (FBTCneg group) and 30 with FBTCS (FBTCpos group) recorded during video electroencephalography (VEEG) with respiratory monitoring were recruited prospectively during presurgical investigations. We acquired high-resolution T1-weighted anatomic and multi-shell diffusion images, and computed neurite orientation dispersion and density imaging (NODDI) metrics in all patients with epilepsy and 69 healthy controls. Amygdala volumetric and microstructure alterations were compared between three groups: healthy subjects, FBTCneg and FBTCpos groups. The FBTCpos group was further subdivided by the presence of ICA and PCCA, verified by VEEG. RESULTS Bilateral amygdala volumes were significantly increased in the FBTCpos cohort compared to healthy controls and the FBTCneg group. Patients with recorded PCCA had the highest increase in bilateral amygdala volume of the FBTCpos cohort. Amygdala neurite density index (NDI) values were decreased significantly in both the FBTCneg and FBTCpos groups relative to healthy controls, with values in the FBTCpos group being the lowest of the two. The presence of PCCA was associated with significantly lower NDI values vs the non-apnea FBTCpos group (p = 0.004). SIGNIFICANCE Individuals with FBTCpos and PCCA show significantly increased amygdala volumes and disrupted architecture bilaterally, with greater changes on the left side. The structural alterations reflected by NODDI and volume differences may be associated with inappropriate cardiorespiratory patterns mediated by the amygdala, particularly after FBTCS. Determination of amygdala volumetric and architectural changes may assist identification of individuals at risk.
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Affiliation(s)
- Claudia Zeicu
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Antoine Legouhy
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
| | - Catherine A. Scott
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of Clinical NeurophysiologyUniversity College London Hospitals NHS Foundation Trust National Hospital for Neurology and NeurosurgeryLondonUK
| | - Joana F. A. Oliveira
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of Clinical NeurophysiologyUniversity College London Hospitals NHS Foundation Trust National Hospital for Neurology and NeurosurgeryLondonUK
| | - Gavin P. Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Epilepsy Society MRI UnitChalfont St PeterUK
- Department of Medicine, Division of NeurologyQueen's UniversityKingstonOntarioCanada
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Sjoerd B. Vos
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
- Neuroradiological Academic Unit, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Centre for Microscopy, Characterisation, and AnalysisThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Samden Lhatoo
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTexasUSA
| | - Hui Zhang
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
| | - Ronald M. Harper
- Brain Research InstituteUniversity of California at Los AngelesLos AngelesCaliforniaUSA
- Department of Neurobiology, David Geffen School of MedicineUniversity of California at Los AngelesLos AngelesCaliforniaUSA
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of Clinical NeurophysiologyUniversity College London Hospitals NHS Foundation Trust National Hospital for Neurology and NeurosurgeryLondonUK
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Pei H, Ma S, Yan W, Liu Z, Wang Y, Yang Z, Li Q, Yao D, Jiang S, Luo C, Yu L. Functional and structural networks decoupling in generalized tonic-clonic seizures and its reorganization by drugs. Epilepsia Open 2023; 8:1038-1048. [PMID: 37394869 PMCID: PMC10472403 DOI: 10.1002/epi4.12781] [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: 07/13/2022] [Accepted: 06/27/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE To investigate potential functional and structural large-scale network disturbances in untreated patients with generalized tonic-clonic seizures (GTCS) and the effects of antiseizure drugs. METHODS In this study, 41 patients with GTCS, comprising 21 untreated patients and 20 patients who received antiseizure medications (ASMs), and 29 healthy controls were recruited to construct large-scale brain networks based on resting-state functional magnetic resonance imaging and diffusion tensor imaging. Structural and functional connectivity and network-level weighted correlation probability (NWCP) were further investigated to identify network features that corresponded to response to ASMs. RESULTS Untreated patients showed more extensive enhancement of functional and structural connections than controls. Specifically, we observed abnormally enhanced connections between the default mode network (DMN) and the frontal-parietal network. In addition, treated patients showed similar functional connection strength to that of the control group. However, all patients exhibited similar structural network alterations. Moreover, the NWCP value was lower for connections within the DMN and between the DMN and other networks in the untreated patients; receiving ASMs could reverse this pattern. SIGNIFICANCE Our study identified alterations in structural and functional connectivity in patients with GTCS. The influence of ASMs may be more noticeable within the functional network; moreover, abnormalities in both the functional and structural coupling state may be improved by ASM treatment. Therefore, the coupling state of structural and functional connectivity may be used as an indicator of the efficacy of ASMs.
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Affiliation(s)
- Haonan Pei
- The Clinical Hospital of Chengdu Brain Science InstituteMOE Key Lab for NeuroinformationSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit of NeuroInformation (2019RU035)Chinese Academy of Medical SciencesChengduChina
| | - Shuai Ma
- The Clinical Hospital of Chengdu Brain Science InstituteMOE Key Lab for NeuroinformationSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit of NeuroInformation (2019RU035)Chinese Academy of Medical SciencesChengduChina
- Neurology DepartmentSichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, The Affiliated Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Wei Yan
- The Clinical Hospital of Chengdu Brain Science InstituteMOE Key Lab for NeuroinformationSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit of NeuroInformation (2019RU035)Chinese Academy of Medical SciencesChengduChina
| | - Zetao Liu
- The Clinical Hospital of Chengdu Brain Science InstituteMOE Key Lab for NeuroinformationSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit of NeuroInformation (2019RU035)Chinese Academy of Medical SciencesChengduChina
| | - Yuehan Wang
- The Clinical Hospital of Chengdu Brain Science InstituteMOE Key Lab for NeuroinformationSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit of NeuroInformation (2019RU035)Chinese Academy of Medical SciencesChengduChina
| | - Zhihuan Yang
- The Clinical Hospital of Chengdu Brain Science InstituteMOE Key Lab for NeuroinformationSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit of NeuroInformation (2019RU035)Chinese Academy of Medical SciencesChengduChina
| | - Qifu Li
- Department of NeurologyThe First Affiliated Hospital of Hainan Medical UniversityHaikouChina
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science InstituteMOE Key Lab for NeuroinformationSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit of NeuroInformation (2019RU035)Chinese Academy of Medical SciencesChengduChina
- Department of NeurologyThe First Affiliated Hospital of Hainan Medical UniversityHaikouChina
- High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Sisi Jiang
- The Clinical Hospital of Chengdu Brain Science InstituteMOE Key Lab for NeuroinformationSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit of NeuroInformation (2019RU035)Chinese Academy of Medical SciencesChengduChina
- High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science InstituteMOE Key Lab for NeuroinformationSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit of NeuroInformation (2019RU035)Chinese Academy of Medical SciencesChengduChina
- High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Liang Yu
- Neurology DepartmentSichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, The Affiliated Hospital of University of Electronic Science and Technology of ChinaChengduChina
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Li Y, Ran Y, Chen Q. Abnormal static and dynamic functional network connectivity of the whole-brain in children with generalized tonic-clonic seizures. Front Neurosci 2023; 17:1236696. [PMID: 37670842 PMCID: PMC10475552 DOI: 10.3389/fnins.2023.1236696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Generalized tonic-clonic seizures (GTCS) are a subtype of generalized seizures exhibiting bursts of bilaterally synchronous generalized spike-wave discharges. Numerous neuroimaging studies have reported aberrant functional activity and topological organization of brain network in epilepsy patients with GTCS, but most studies have focused on adults. However, the effect of GTCS on the spatial and temporal properties of brain function in children remains unclear. The present study aimed to explore whole-brain static (sFC) and dynamic functional connectivity (dFC) in children with GTCS. Methods Twenty-three children with GTCS and 32 matched healthy controls (HCs) were recruited for the present study. Resting-state functional magnetic resonance imaging (MRI) data were collected for each subject. The group independent component analysis method was used to obtain independent components (ICs). Then, sFC and dFC methods were applied and the differences in functional connectivity (FC) were compared between the children with GTCS and the HCs. Additionally, we investigated the correlations between the dFC indicators and epilepsy duration. Results Compared to HCs, GTCS patients exhibited a significant decrease in sFC strengths among most networks. The K-means clustering method was implemented for dFC analysis, and the optimal number of clusters was estimated: two discrete connectivity configurations, State 1 (strong connection) and State 2 (weak connection). The decreased dFC mainly occurred in State 1, especially the dFC between the visual network (VIS) and somatomotor network (SMN); but the increased dFC mainly occurred in State 2 among most networks in GTCS children. In addition, GTCS children showed significantly shorter mean dwell time and lower fractional windows in stronger connected State 1, while GTCS children showed significantly longer mean dwell time in weaker connected State 2. In addition, the dFC properties, including mean dwell time and fractional windows, were significantly correlated with epilepsy duration. Conclusion Our results indicated that GTCS epilepsy not only alters the connectivity strength but also changes the temporal properties of connectivity in networks in the whole brain. These findings also emphasized the differences in sFC and dFC in children with GTCS. Combining sFC and dFC methods may provide more comprehensive understanding of the abnormal changes in brain architecture in children with GTCS.
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Affiliation(s)
- Yongxin Li
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Yun Ran
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Qian Chen
- Department of Pediatric Neurosurgery, Shenzhen Children’s Hospital, Shenzhen, China
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Legouhy A, Allen LA, Vos SB, Oliveira JFA, Kassinopoulos M, Winston GP, Duncan JS, Ogren JA, Scott C, Kumar R, Lhatoo SD, Thom M, Lemieux L, Harper RM, Zhang H, Diehl B. Volumetric and microstructural abnormalities of the amygdala in focal epilepsy with varied levels of SUDEP risk. Epilepsy Res 2023; 192:107139. [PMID: 37068421 DOI: 10.1016/j.eplepsyres.2023.107139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/24/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
Although the mechanisms of sudden unexpected death in epilepsy (SUDEP) are not yet well understood, generalised- or focal-to-bilateral tonic-clonic seizures (TCS) are a major risk factor. Previous studies highlighted alterations in structures linked to cardio-respiratory regulation; one structure, the amygdala, was enlarged in people at high risk of SUDEP and those who subsequently died. We investigated volume changes and the microstructure of the amygdala in people with epilepsy at varied risk for SUDEP since that structure can play a key role in triggering apnea and mediating blood pressure. The study included 53 healthy subjects and 143 patients with epilepsy, the latter separated into two groups according to whether TCS occur in years before scan. We used amygdala volumetry, derived from structural MRI, and tissue microstructure, derived from diffusion MRI, to identify differences between the groups. The diffusion metrics were obtained by fitting diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) models. The analyses were performed at the whole amygdala level and at the scale of amygdaloid nuclei. Patients with epilepsy showed larger amygdala volumes and lower neurite density indices (NDI) than healthy subjects; the left amygdala volumes were especially enhanced. Microstructural changes, reflected by NDI differences, were more prominent on the left side and localized in the lateral, basal, central, accessory basal and paralaminar amygdala nuclei; basolateral NDI lowering appeared bilaterally. No significant microstructural differences appeared between epilepsy patients with and without current TCS. The central amygdala nuclei, with prominent interactions from surrounding nuclei of that structure, project to cardiovascular regions and respiratory phase switching areas of the parabrachial pons, as well as to the periaqueductal gray. Consequently, they have the potential to modify blood pressure and heart rate, and induce sustained apnea or apneusis. The findings here suggest that lowered NDI, indicative of reduced dendritic density, could reflect an impaired structural organization influencing descending inputs that modulate vital respiratory timing and drive sites and areas critical for blood pressure control.
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Affiliation(s)
- Antoine Legouhy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK.
| | - Luke A Allen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK; The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, UCL, London, UK; Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia
| | - Joana F A Oliveira
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Michalis Kassinopoulos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK; Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Jennifer A Ogren
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Brain Research Institute, UCLA, Los Angeles, CA, USA
| | - Catherine Scott
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Rajesh Kumar
- Brain Research Institute, UCLA, Los Angeles, CA, USA; Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Samden D Lhatoo
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Ronald M Harper
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Brain Research Institute, UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hui Zhang
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK; The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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Legouhy A, Allen LA, Vos SB, Oliveira JFA, Kassinopoulos M, Winston GP, Duncan JS, Ogren JA, Scott C, Kumar R, Lhatoo SD, Thom M, Lemieux L, Harper RM, Zhang H, Diehl B. Volumetric and microstructural abnormalities of the amygdala in focal epilepsy with varied levels of SUDEP risk. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.13.23287045. [PMID: 36993394 PMCID: PMC10055456 DOI: 10.1101/2023.03.13.23287045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Although the mechanisms of sudden unexpected death in epilepsy (SUDEP) are not yet well understood, generalised- or focal-to-bilateral tonic-clonic seizures (TCS) are a major risk factor. Previous studies highlighted alterations in structures linked to cardio-respiratory regulation; one structure, the amygdala, was enlarged in people at high risk of SUDEP and those who subsequently died. We investigated volume changes and the microstructure of the amygdala in people with epilepsy at varied risk for SUDEP since that structure can play a key role in triggering apnea and mediating blood pressure. The study included 53 healthy subjects and 143 patients with epilepsy, the latter separated into two groups according to whether TCS occur in years before scan. We used amygdala volumetry, derived from structural MRI, and tissue microstructure, derived from diffusion MRI, to identify differences between the groups. The diffusion metrics were obtained by fitting diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) models. The analyses were performed at the whole amygdala level and at the scale of amygdaloid nuclei. Patients with epilepsy showed larger amygdala volumes and lower neurite density indices (NDI) than healthy subjects; the left amygdala volumes were especially enhanced. Microstructural changes, reflected by NDI differences, were more prominent on the left side and localized in the lateral, basal, central, accessory basal and paralaminar amygdala nuclei; basolateral NDI lowering appeared bilaterally. No significant microstructural differences appeared between epilepsy patients with and without current TCS. The central amygdala nuclei, with prominent interactions from surrounding nuclei of that structure, project to cardiovascular regions and respiratory phase switching areas of the parabrachial pons, as well as to the periaqueductal gray. Consequently, they have the potential to modify blood pressure and heart rate, and induce sustained apnea or apneusis. The findings here suggest that lowered NDI, indicative of reduced dendritic density, could reflect an impaired structural organization influencing descending inputs that modulate vital respiratory timing and drive sites and areas critical for blood pressure control.
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Affiliation(s)
- Antoine Legouhy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Luke A Allen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, UCL, London, UK
- Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia
| | - Joana F A Oliveira
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Michalis Kassinopoulos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
- Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John S Duncan
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Jennifer A Ogren
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Brain Research Institute, UCLA, Los Angeles, CA, USA
| | - Catherine Scott
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Rajesh Kumar
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Samden D Lhatoo
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Maria Thom
- Department of Neuropathology, Institute of Neurology, University College London, London, UK
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Ronald M Harper
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Brain Research Institute, UCLA, Los Angeles, CA, USA
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hui Zhang
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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8
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Seizure duration predicts postictal electroencephalographic recovery after electroconvulsive therapy-induced seizures. Clin Neurophysiol 2023; 148:1-8. [PMID: 36773503 DOI: 10.1016/j.clinph.2023.01.008] [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: 10/17/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE We aim to provide a quantitative description of the relation between seizure duration and the postictal state using features extracted from the postictal electroencephalogram (EEG). METHODS Thirty patients with major depressive disorder treated with electroconvulsive therapy (ECT) were studied with continuous EEG before, during, and after ECT-induced seizures. EEG recovery was quantified as the spectral difference between postictal and baseline EEG using the temporal brain symmetry index (BSI). The postictal temporal EEG evolution was modeled with a single exponential. The parameters of the model, including the time constant τ, describe the change and speed of postictal EEG recovery. The change from baseline EEG at t = 60 minutes post-seizure (ΔBSI) was calculated from the exponential fit. Postictal clinical reorientation time (ROT) was clinically established. A multivariate generalized multi-level Bayesian model was estimated with seizure duration and ROT as predictors of τ and ΔBSI. RESULTS EEG features of 290 seizures and postictal states were used for analyses. The model faithfully described the dynamics of the postictal EEG in nearly all patients. Seizure duration was associated with the recovery time constant, τ, and ΔBSI. ROT was associated with τ, but not with ΔBSI. CONCLUSIONS Longer seizures are associated with slower postictal EEG recovery and more enduring EEG changes compared to baseline. SIGNIFICANCE Quantitative EEG allows objective assessment of the postictal state.
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9
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Zeicu C, Legouhy A, Scott CA, Oliveira JFA, Winston G, Duncan JS, Vos SB, Thom M, Lhatoo S, Zhang H, Harper RM, Diehl B. Altered Amygdala Volumes and Microstructure in Focal Epilepsy Patients with Tonic-Clonic Seizures, Ictal and Post-Ictal Central Apnea. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.16.23287369. [PMID: 36993530 PMCID: PMC10055587 DOI: 10.1101/2023.03.16.23287369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objectives Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death for patients with epilepsy; however, the pathophysiology remains unclear. Focal-to-bilateral tonic-clonic seizures (FBTCS) are a major risk factor, and centrally-mediated respiratory depression may increase the risk further. Here, we determined volume and microstructure of the amygdala, a key structure that can trigger apnea in people with focal epilepsy, stratified by presence or absence of FBTCS, ictal central apnea (ICA) and post-ictal central apnea (PICA). Methods 73 patients with only-focal seizures and 30 with FBTCS recorded during video EEG (VEEG) with respiratory monitoring were recruited prospectively during presurgical investigations. We acquired high-resolution T1-weighted anatomical and multi-shell diffusion images, and computed neurite orientation dispersion and density imaging (NODDI) metrics in all epilepsy patients and 69 healthy controls. Amygdala volumetric and microstructure alterations were compared between healthy subjects, and patients with only-focal seizures or FBTCS The FBTCS group was further subdivided by presence of ICA and PICA, verified by VEEG. Results Bilateral amygdala volumes were significantly increased in the FBTCS cohort compared to healthy controls and the focal cohort. Patients with recorded PICA had the highest increase in bilateral amygdala volume of the FBTCS cohort.Amygdala neurite density index (NDI) values were significantly decreased in both the focal and FBTCS groups relative to healthy controls, with values in the FBTCS group being the lowest of the two. The presence of PICA was associated with significantly lower NDI values vs the non-apnea FBTCS group (p=0.004). Significance Individuals with FBTCS and PICA show significantly increased amygdala volumes and disrupted architecture bilaterally, with greater changes on the left side. The structural alterations reflected by NODDI and volume differences may be associated with inappropriate cardiorespiratory patterns mediated by the amygdala, particularly after FBTCS. Determination of amygdala volumetric and architectural changes may assist identification of individuals at risk.
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Affiliation(s)
- Claudia Zeicu
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Antoine Legouhy
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Catherine A. Scott
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Joana F. A. Oliveira
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Gavin Winston
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
- Division of Neurology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sjoerd B. Vos
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Samden Lhatoo
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Hui Zhang
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Ronald M. Harper
- Brain Research Institute, University of California at Los Angeles, California, USA
- Department of Neurobiology, David Geffen School of Medicine, University of California at Los Angeles, California, USA
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, United Kingdom
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10
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Harper RM. Exploring the brain with sleep-related injuries, and fixing it. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad007. [PMID: 37193272 PMCID: PMC10148654 DOI: 10.1093/sleepadvances/zpad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Indexed: 05/18/2023]
Abstract
The focus of my research efforts rests with determining dysfunctional neural systems underlying disorders of sleep, and identifying interventions to overcome those disorders. Aberrant central and physiological control during sleep exerts serious consequences, including disruptions in breathing, motor control, blood pressure, mood, and cognition, and plays a major role in sudden infant death syndrome, congenital central hypoventilation, and sudden unexpected death in epilepsy, among other concerns. The disruptions can be traced to brain structural injury, leading to inappropriate outcomes. Identification of failing systems arose from the assessment of single neuron discharge in intact, freely moving and state-changing human and animal preparations within multiple systems, including serotonergic action and motor control sites. Optical imaging of chemosensitive, blood pressure and other breathing regulatory areas, especially during development, were useful to show integration of regional cellular action in modifying neural output. Identification of damaged neural sites in control and afflicted humans through structural and functional magnetic resonance imaging procedures helped to identify the sources of injury, and the nature of interactions between brain sites that compromise physiological systems and lead to failure. Interventions to overcome flawed regulatory processes were developed, and incorporate noninvasive neuromodulatory means to recruit ancient reflexes or provide peripheral sensory stimulation to assist breathing drive to overcome apnea, reduce the frequency of seizures, and support blood pressure in conditions where a failure to perfuse can lead to death.
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Affiliation(s)
- Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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11
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Rheims S, Sperling MR, Ryvlin P. Drug-resistant epilepsy and mortality-Why and when do neuromodulation and epilepsy surgery reduce overall mortality. Epilepsia 2022; 63:3020-3036. [PMID: 36114753 PMCID: PMC10092062 DOI: 10.1111/epi.17413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
Patients with drug-resistant epilepsy have an increased mortality rate, with the majority of deaths being epilepsy related and 40% due to sudden unexpected death in epilepsy (SUDEP). The impact of epilepsy surgery on mortality has been investigated since the 1970s, with increased interest in this field during the past 15 years. We systematically reviewed studies investigating mortality rate in patients undergoing epilepsy surgery or neuromodulation therapies. The quality of available evidence proved heterogenous and often limited by significant methodological issues. Perioperative mortality following epilepsy surgery was found to be <1%. Meta-analysis of studies that directly compared patients who underwent surgery to those not operated following presurgical evaluation showed that the former have a two-fold lower risk of death and a three-fold lower risk of SUDEP compared to the latter (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.29-0.56; p < .0001 for overall mortality and OR 0.32, 95% CI: 0.18-0.57; p < .001 for SUDEP). Limited data are available regarding the risk of death and SUDEP in patients undergoing neuromodulation therapies, although some evidence indicates that vagus nerve stimulation might be associated with a lower risk of SUDEP. Several key questions remain to be addressed in future studies, considering the need to better inform patients about the long-term benefit-risk ratio of epilepsy surgery. Dedicated long-term prospective studies will thus be required to provide more personalized information on the impact of surgery and/or neuromodulation on the risk of death and SUDEP.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Mickael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Vaudois University Hospital Center, Lausanne, Switzerland
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12
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Ogren JA, Allen LA, Roy B, Diehl B, Stern JM, Eliashiv DS, Lhatoo SD, Harper RM, Kumar R. Regional variation in brain tissue texture in patients with tonic-clonic seizures. PLoS One 2022; 17:e0274514. [PMID: 36137154 PMCID: PMC9499268 DOI: 10.1371/journal.pone.0274514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with epilepsy, who later succumb to sudden unexpected death, show altered brain tissue volumes in selected regions. It is unclear whether the alterations in brain tissue volume represent changes in neurons or glial properties, since volumetric procedures have limited sensitivity to assess the source of volume changes (e.g., neuronal loss or glial cell swelling). We assessed a measure, entropy, which can determine tissue homogeneity by evaluating tissue randomness, and thus, shows tissue integrity; the measure is easily calculated from T1-weighted images. T1-weighted images were collected with a 3.0-Tesla MRI from 53 patients with tonic-clonic (TC) seizures and 53 healthy controls; images were bias-corrected, entropy maps calculated, normalized to a common space, smoothed, and compared between groups (TC patients and controls using ANCOVA; covariates, age and sex; SPM12, family-wise error correction for multiple comparisons, p<0.01). Decreased entropy, indicative of increased tissue homogeneity, appeared in major autonomic (ventromedial prefrontal cortex, hippocampus, dorsal and ventral medulla, deep cerebellar nuclei), motor (sensory and motor cortex), or both motor and autonomic regulatory sites (basal-ganglia, ventral-basal cerebellum), and external surfaces of the pons. The anterior and posterior thalamus and midbrain also showed entropy declines. Only a few isolated regions showed increased entropy. Among the spared autonomic regions was the anterior cingulate and anterior insula; the posterior insula and cingulate were, however, affected. The entropy alterations overlapped areas of tissue changes found earlier with volumetric measures, but were more extensive, and indicate widespread injury to tissue within critical autonomic and breathing regulatory areas, as well as prominent damage to more-rostral sites that exert influences on both breathing and cardiovascular regulation. The entropy measures provide easily-collected supplementary information using only T1-weighted images, showing aspects of tissue integrity other than volume change that are important for assessing function.
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Affiliation(s)
- Jennifer A. Ogren
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Luke A. Allen
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - Bhaswati Roy
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - John M. Stern
- Department of Neurology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Dawn S. Eliashiv
- Department of Neurology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Samden D. Lhatoo
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Ronald M. Harper
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, United States of America
- Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Rajesh Kumar
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, United States of America
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13
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Patodia S, Lim YM, Chung F, Stylianou I, El Hachami H, Thom M. Cortical neuronal hypertrophy and mTOR pathway activation in CAN regions in SUDEP. Epilepsia 2022; 63:2427-2438. [PMID: 35716147 PMCID: PMC9795893 DOI: 10.1111/epi.17335] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Dysfunctional connectivity and preexisting structural abnormalities of central autonomic network (CAN) regions have been shown on magnetic resonance imaging (MRI) in sudden unexpected death in epilepsy (SUDEP) and may be mechanistically relevant. In a previous postmortem study we reported increased microglia in CAN regions, including the superior temporal gyrus (STG) in SUDEP. In this current study we investigated mammalian target of rapamycin (mTOR) pathway activation and neuronal c-Fos activation in CAN regions in SUDEP compared to control groups. METHODS In a series of 59 postmortem cases (SUDEP, n = 26; epilepsy controls [EPCs], n = 14; and nonepilepsy controls [NECs], n = 19), we quantified pS6-240/4, pS6-235/6 (markers of mTOR activation) and c-Fos neuronal densities and labeling index in the STG, anterior cingulate, insula, frontobasal, and pulvinar regions using immunohistochemistry with whole-slide automated image analysis. RESULTS Significantly more pS6-positive neurons were present in the STG in cases with a history of recent seizures prior to death and also in SUDEP compared to other cause of death groups. No differences were noted for c-Fos neuronal labeling in any region between cause of death groups. Cortical neuronal hypertrophy in the STG was observed in some SUDEP cases and associated with pS6-240/4 expression. pS6-235/6 highlighted neuronal intranuclear inclusions, mainly in SUDEP cases and in the STG region. SIGNIFICANCE Neuronal labeling for pS6 in the STG correlated with both seizure activity in the period prior to death and SUDEP. Further investigations are required to explore the significance of this region in terms of autonomic network dysfunction that may increase the vulnerability for SUDEP.
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Affiliation(s)
- Smriti Patodia
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Yau Mun Lim
- Department of NeurodegenerationUCL Queen Square Institute of NeurologyLondonUK
| | - Freda Chung
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Irene Stylianou
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Hanaa El Hachami
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Maria Thom
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
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14
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Chacon LM, Garcia LG, Bosch-Bayard J, García-Ramo KB, Martin MMB, Alfonso MA, Batista SB, de la Paz Bermudez T, González JG, Coroneux AS. Relation of Brain Perfusion Patterns to Sudden Unexpected Death Risk Stratification: A Study in Drug Resistant Focal Epilepsy. Behav Sci (Basel) 2022; 12:207. [PMID: 35877277 PMCID: PMC9311833 DOI: 10.3390/bs12070207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
To explore the role of the interictal and ictal SPECT to identity functional neuroimaging biomarkers for SUDEP risk stratification in patients with drug-resistant focal epilepsy (DRFE). Twenty-nine interictal-ictal Single photon emission computed tomography (SPECT) scans were obtained from nine DRFE patients. A methodology for the relative quantification of cerebral blood flow of 74 cortical and sub-cortical structures was employed. The optimal number of clusters (K) was estimated using a modified v-fold cross-validation for the use of K means algorithm. The two regions of interest (ROIs) that represent the hypoperfused and hyperperfused areas were identified. To select the structures related to the SUDEP-7 inventory score, a data mining method that computes an automatic feature selection was used. During the interictal and ictal state, the hyperperfused ROIs in the largest part of patients were the bilateral rectus gyrus, putamen as well as globus pallidus ipsilateral to the seizure onset zone. The hypoperfused ROIs included the red nucleus, substantia nigra, medulla, and entorhinal area. The findings indicated that the nearly invariability in the perfusion pattern during the interictal to ictal transition observed in the ipsi-lateral putamen F = 12.60, p = 0.03, entorhinal area F = 25.80, p = 0.01, and temporal middle gyrus F = 12.60, p = 0.03 is a potential biomarker of SUDEP risk. The results presented in this paper allowed identifying hypo- and hyperperfused brain regions during the ictal and interictal state potentially related to SUDEP risk stratification.
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Affiliation(s)
- Lilia Morales Chacon
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Lidice Galan Garcia
- Cuban Neurosciences Center, 25th Ave, No 15202, Playa, Havana PC 11300, Cuba;
| | - Jorge Bosch-Bayard
- McGill Centre for Integrative Neuroscience, Ludmer Centre for Neuroinformatics and Mental Health, Montreal Neurological Institute, Montreal, QC H3A 0G4, Canada;
| | - Karla Batista García-Ramo
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Margarita Minou Báez Martin
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Maydelin Alfonso Alfonso
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Sheyla Berrillo Batista
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Tania de la Paz Bermudez
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Judith González González
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Abel Sánchez Coroneux
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
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15
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Abstract
PURPOSE OF REVIEW Sudden unexpected death in epilepsy (SUDEP) is a major contributor to premature mortality in people with epilepsy. This review provides an update on recent findings on the epidemiology of SUDEP, clinical risk factors and potential mechanisms. RECENT FINDINGS The overall risk rate of SUDEP is approximately 1 per 1000 patients per year in the general epilepsy population and that children and older adults have a similar incidence. Generalized convulsive seizures (GCS), perhaps through their effects on brainstem cardiopulmonary networks, can cause significant postictal respiratory and autonomic dysfunction though other mechanisms likely exist as well. Work in animal models of SUDEP has identified multiple neurotransmitter systems, which may be future targets for pharmacological intervention. There are also chronic functional and structural changes in autonomic function in patients who subsequently die from SUDEP suggesting that some SUDEP risk is dynamic. Modifiable risks for SUDEP include GCS seizure frequency, medication adherence and nighttime supervision. SUMMARY Current knowledge of SUDEP risk factors has identified multiple targets for SUDEP prevention today as we await more specific therapeutic targets that are emerging from translational research studies.
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Affiliation(s)
- Daniel Friedman
- NYU Grossman School of Medicine, Department of Neurology, 223 East 34th Street, New York, New York, USA
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16
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Li T, Niu S, Qiu X, Zhai Z, Yang L, Chen L, Zhang XM. Altered Cerebral Blood Flow is Linked to Disease Duration in Patients with Generalized tonic‒clonic Seizures. Neuropsychiatr Dis Treat 2022; 18:2649-2659. [PMID: 36387946 PMCID: PMC9662018 DOI: 10.2147/ndt.s386509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate cerebral blood flow (CBF) characteristics in individuals with generalized tonic‒clonic seizures (GTCS) during the interictal phase using voxel-based analysis of 3D pseudocontinuous arterial spin labeling (PCASL). PATIENTS AND METHODS Patients with GTCS (GTCS group) (during the interictal period) and healthy volunteers (control group) underwent head MR imaging with a 3.0T MR scanner with a 3D PCASL sequence. CBF was compared between the two groups. Spearman correlations of CBF in regions of interest (ROIs) in GTCS patients with the duration of disease and age of onset were analyzed and corrected using the false discovery rate (FDR). RESULTS Twenty patients with GTCS (GTCS group) and twenty healthy volunteers (control group) were recruited for this study. On 3D PCASL, (1) GTCS patients had lower CBF in the brainstem, right cerebellum, right inferior temporal gyrus, parahippocampal gyrus, superior frontal gyrus, middle frontal gyrus, triangular part of inferior frontal gyrus, left temporal pole of superior temporal gyrus and thalamus and had higher CBF in the bilateral superior parietal gyri, precuneus, precentral gyri, postcentral gyri, and left dorsolateral superior frontal gyrus than controls. (2) The CBF of the right temporal pole of the middle temporal gyrus was negatively correlated with the duration of disease (PFDRcorrected<0.05), with a correlation coefficient r of -0.7333 and a PFDRcorrected value of 0.04. CONCLUSION Voxel-based analysis of 3D PCASL imaging can be used to sensitively detect brain perfusion differences in GTCS patients. The decrease in CBF in the right temporal pole of the middle temporal gyrus may be associated with disease onset. These findings may offer new perspectives on the pathogenesis of GTCS and the underlying pathophysiological changes associated with perfusion.
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Affiliation(s)
- Ting Li
- The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China.,Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Shaowei Niu
- Department of Infection, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Xiang Qiu
- Department of Radiology, Integrated TCM & Western Medicine Hospital Affiliated to Chengdu University of TCM, Chengdu First People's Hospital, Chengdu, People's Republic of China
| | - Zhaohua Zhai
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Lin Yang
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Li Chen
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Xiao Ming Zhang
- The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China.,Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
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17
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Patodia S, Somani A, Thom M. Review: Neuropathology findings in autonomic brain regions in SUDEP and future research directions. Auton Neurosci 2021; 235:102862. [PMID: 34411885 PMCID: PMC8455454 DOI: 10.1016/j.autneu.2021.102862] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/16/2021] [Accepted: 07/24/2021] [Indexed: 12/21/2022]
Abstract
Autonomic dysfunction is implicated from clinical, neuroimaging and experimental studies in sudden and unexpected death in epilepsy (SUDEP). Neuropathological analysis in SUDEP series enable exploration of acquired, seizure-related cellular adaptations in autonomic and brainstem autonomic centres of relevance to dysfunction in the peri-ictal period. Alterations in SUDEP compared to control groups have been identified in the ventrolateral medulla, amygdala, hippocampus and central autonomic regions. These involve neuropeptidergic, serotonergic and adenosine systems, as well as specific regional astroglial and microglial populations, as potential neuronal modulators, orchestrating autonomic dysfunction. Future research studies need to extend to clinically and genetically characterized epilepsies, to explore if common or distinct pathways of autonomic dysfunction mediate SUDEP. The ultimate objective of SUDEP research is the identification of disease biomarkers for at risk patients, to improve post-mortem recognition and disease categorisation, but ultimately, for exposing potential treatment targets of pharmacologically modifiable and reversible cellular alterations.
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Affiliation(s)
- Smriti Patodia
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Alyma Somani
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.
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18
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Autonomic manifestations of epilepsy: emerging pathways to sudden death? Nat Rev Neurol 2021; 17:774-788. [PMID: 34716432 DOI: 10.1038/s41582-021-00574-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
Epileptic networks are intimately connected with the autonomic nervous system, as exemplified by a plethora of ictal (during a seizure) autonomic manifestations, including epigastric sensations, palpitations, goosebumps and syncope (fainting). Ictal autonomic changes might serve as diagnostic clues, provide targets for seizure detection and help us to understand the mechanisms that underlie sudden unexpected death in epilepsy (SUDEP). Autonomic alterations are generally more prominent in focal seizures originating from the temporal lobe, demonstrating the importance of limbic structures to the autonomic nervous system, and are particularly pronounced in focal-to-bilateral and generalized tonic-clonic seizures. The presence, type and severity of autonomic features are determined by the seizure onset zone, propagation pathways, lateralization and timing of the seizures, and the presence of interictal autonomic dysfunction. Evidence is mounting that not all autonomic manifestations are linked to SUDEP. In addition, experimental and clinical data emphasize the heterogeneity of SUDEP and its infrequent overlap with sudden cardiac death. Here, we review the spectrum and diagnostic value of the mostly benign and self-limiting autonomic manifestations of epilepsy. In particular, we focus on presentations that are likely to contribute to SUDEP and discuss how wearable devices might help to prevent SUDEP.
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19
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Kassinopoulos M, Harper RM, Guye M, Lemieux L, Diehl B. Altered Relationship Between Heart Rate Variability and fMRI-Based Functional Connectivity in People With Epilepsy. Front Neurol 2021; 12:671890. [PMID: 34177777 PMCID: PMC8223068 DOI: 10.3389/fneur.2021.671890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Disruptions in central autonomic processes in people with epilepsy have been studied through evaluation of heart rate variability (HRV). Decreased HRV appears in epilepsy compared to healthy controls, suggesting a shift in autonomic balance toward sympathetic dominance; recent studies have associated HRV changes with seizure severity and outcome of interventions. However, the processes underlying these autonomic changes remain unclear. We examined the nature of these changes by assessing alterations in whole-brain functional connectivity, and relating those alterations to HRV. Methods: We examined regional brain activity and functional organization in 28 drug-resistant epilepsy patients and 16 healthy controls using resting-state functional magnetic resonance imaging (fMRI). We employed an HRV state-dependent functional connectivity (FC) framework with low and high HRV states derived from the following four cardiac-related variables: 1. RR interval, 2. root mean square of successive differences (RMSSD), 4. low-frequency HRV (0.04-0.15 Hz; LF-HRV) and high-frequency HRV (0.15-0.40 Hz; HF-HRV). The effect of group (epilepsy vs. controls), HRV state (low vs. high) and the interactions of group and state were assessed using a mixed analysis of variance (ANOVA). We assessed FC within and between 7 large-scale functional networks consisting of cortical regions and 4 subcortical networks, the amygdala, hippocampus, basal ganglia and thalamus networks. Results: Consistent with previous studies, decreased RR interval (increased heart rate) and decreased HF-HRV appeared in people with epilepsy compared to healthy controls. For both groups, fluctuations in heart rate were positively correlated with BOLD activity in bilateral thalamus and regions of the cerebellum, and negatively correlated with BOLD activity in the insula, putamen, superior temporal gyrus and inferior frontal gyrus. Connectivity strength in patients between right thalamus and ventral attention network (mainly insula) increased in the high LF-HRV state compared to low LF-HRV; the opposite trend appeared in healthy controls. A similar pattern emerged for connectivity between the thalamus and basal ganglia. Conclusion: The findings suggest that resting connectivity patterns between the thalamus and other structures underlying HRV expression are modified in people with drug-resistant epilepsy compared to healthy controls.
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Affiliation(s)
- Michalis Kassinopoulos
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Buckinghamshire, United Kingdom
| | - Ronald M. Harper
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Buckinghamshire, United Kingdom
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Buckinghamshire, United Kingdom
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20
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Somani A, El-Hachami H, Patodia S, Sisodiya S, Thom M. Regional microglial populations in central autonomic brain regions in SUDEP. Epilepsia 2021; 62:1318-1328. [PMID: 33942290 DOI: 10.1111/epi.16904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) may arise as a result of autonomic dysfunction during a seizure. The central autonomic networks (CANs) modulate brainstem cardiorespiratory regulation. Recent magnetic resonance imaging (MRI) studies in SUDEP have shown cortical and subcortical volume changes and altered connectivity between CAN regions, but the pathological correlate is unknown. Because neuroinflammation is both a cause and a consequence of seizures and may relate to regional brain pathology, our aim was to evaluate microglial populations in CANs in SUDEP. METHODS In 55 postmortem cases, including SUDEP, epilepsy controls without SUDEP and nonepilepsy controls, we quantified Iba1-expressing microglia in 14 cortical and thalamic areas that included known CAN regions. RESULTS Mean Iba1 labeling across all brain regions was significantly higher in SUDEP cases compared to epilepsy and nonepilepsy controls. There was significant regional variation in Iba1 labeling in SUDEP cases only, with highest labeling in the medial thalamus. Significantly higher labeling in SUDEP cases than epilepsy and nonepilepsy controls was consistently noted in the superior temporal gyrus. In cases with documented seizures up to 10 days prior to death, significantly higher mean Iba1 labeling was observed in SUDEP compared to epilepsy controls. SIGNIFICANCE Our findings support microglial activation in SUDEP, including cortical and subcortical regions with known autonomic functions such as the thalamus and superior temporal gyrus. This may be relevant to cellular pathomechanisms underlying cardioregulatory failure during a seizure.
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Affiliation(s)
- Alyma Somani
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Hanna El-Hachami
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Smriti Patodia
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Sanjay Sisodiya
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK
| | - Maria Thom
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Neuropathology, National Hospital for Neurology and Neurosurgery Queen Square, London, UK
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21
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Ochoa-Urrea M, Dayyani M, Sadeghirad B, Tandon N, Lacuey N, Lhatoo SD. Electrical Stimulation-Induced Seizures and Breathing Dysfunction: A Systematic Review of New Insights Into the Epileptogenic and Symptomatogenic Zones. Front Hum Neurosci 2021; 14:617061. [PMID: 33551780 PMCID: PMC7862564 DOI: 10.3389/fnhum.2020.617061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/18/2020] [Indexed: 12/29/2022] Open
Abstract
Objective: Electrical stimulation (ES) potentially delineates epileptogenic cortex through induction of typical seizures. Although frequently employed, its value for epilepsy surgery remains controversial. Similarly, ES is used to identify symptomatogenic zones, but with greater success and a long-standing evidence base. Recent work points to new seizure symptoms such as ictal central apnea (ICA) that may enhance presurgical hypotheses. The aims of this review are 2-fold: to determine the value of ES-induced seizures (ESIS) in epilepsy surgery and to analyze current evidence on ICA as a new surrogate of symptomatogenic cortex. Methods: Three databases were searched for ESIS. Investigators independently selected studies according to pre-specified criteria. Studies reporting postoperative outcome in patients with ESIS were included in a meta-analysis. For ES-induced apnea, a thorough search was performed and reference list searching was employed. Results: Of 6,314 articles identified for ESIS, 25 were considered eligible to be reviewed in full text. Fourteen studies were included in the qualitative synthesis (1,069 patients); six studies were included in the meta-analysis (530 patients). The meta-analysis showed that favorable outcome is associated with ESIS prior to surgery (OR: 2.02; 95% CI: 1.332–3.08). In addition, the overall estimation of the occurrence of favorable outcome among cases with ESIS is 68.13% (95% CI: 56.62–78.7). On the other hand, recent studies have shown that stimulation of exclusively mesial temporal lobe structures elicits central apnea and represents symptomatogenic anatomic substrates of ICA. This is in variance with traditional teaching that mesial temporal ES is non-symptomatogenic. Conclusions: ES is a tool highly likely to aid in the delineation of the epileptogenic zone, since ESIS is associated with favorable postoperative outcomes (Engel I). There is an urgent need for prospective evaluation of this technique, including effective stimulation parameters and surgical outcomes, that will provide knowledge base for practice. In addition, ES-induced apnea studies suggest that ICA, especially when it is the first or only clinical sign, is an important semiological feature in localizing the symptomatogenic zone to mesial temporal lobe structures, which must be considered in SEEG explorations where this is planned, and in surgical resection strategies.
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Affiliation(s)
- Manuela Ochoa-Urrea
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Mojtaba Dayyani
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nitin Tandon
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Nuria Lacuey
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Samden D Lhatoo
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, United States
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22
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Goldman AM. Peri-ictal Brainstem-Driven Posturing and Its Meaning. Neurology 2020; 96:89-90. [PMID: 33268564 DOI: 10.1212/wnl.0000000000011277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Patodia S, Tachrount M, Somani A, Scheffer I, Yousry T, Golay X, Sisodiya S, Thom M. In response to 'Volume loss and altered neuronal composition in the brainstem reticular zone may not cause sudden unexpected death in epilepsy'. Neuropathol Appl Neurobiol 2020; 47:173-175. [PMID: 32767838 DOI: 10.1111/nan.12653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022]
Affiliation(s)
- S Patodia
- Departments of Neuropathology, UCL Queen Square Institute of Neurology, London, United Kingdom.,Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - M Tachrount
- Neuroradiology Academic Unit, Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom.,Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford
| | - A Somani
- Departments of Neuropathology, UCL Queen Square Institute of Neurology, London, United Kingdom.,Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - I Scheffer
- Epilepsy Research Centre, Department of Medicine (Neurology), University of Melbourne Victoria, Australia
| | - T Yousry
- Neuroradiology Academic Unit, Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - X Golay
- Neuroradiology Academic Unit, Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - S Sisodiya
- Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,Chalfont Centre for Epilepsy, Bucks, Chalfont Saint Peter, United Kingdom
| | - M Thom
- Departments of Neuropathology, UCL Queen Square Institute of Neurology, London, United Kingdom.,Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
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24
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Allen LA, Harper RM, Vos SB, Scott CA, Lacuey N, Vilella L, Winston JS, Whatley BP, Kumar R, Ogren J, Hampson JS, Rani S, Winston GP, Lemieux L, Lhatoo SD, Diehl B. Peri-ictal hypoxia is related to extent of regional brain volume loss accompanying generalized tonic-clonic seizures. Epilepsia 2020; 61:1570-1580. [PMID: 32683693 PMCID: PMC7496610 DOI: 10.1111/epi.16615] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Hypoxia, or abnormally low blood-oxygen levels, often accompanies seizures and may elicit brain structural changes in people with epilepsy which contribute to central processes underlying sudden unexpected death in epilepsy (SUDEP). The extent to which hypoxia may be related to brain structural alterations in this patient group remains unexplored. METHODS We analyzed high-resolution T1-weighted magnetic resonance imaging (MRI) to determine brain morphometric and volumetric alterations in people with generalized tonic-clonic seizures (GTCS) recorded during long-term video-electroencephalography (VEEG), recruited from two sites (n = 22), together with data from age- and sex-matched healthy controls (n = 43). Subjects were sub-divided into those with mild/moderate (GTCS-hypox-mild/moderate, n = 12) and severe (GTCS-hypox-severe, n = 10) hypoxia, measured by peripheral oxygen saturation (SpO2 ) during VEEG. Whole-brain voxel-based morphometry (VBM) and regional volumetry were used to assess group comparisons and correlations between brain structural measurements as well as the duration and extent of hypoxia during GTCS. RESULTS Morphometric and volumetric alterations appeared in association with peri-GTCS hypoxia, including volume loss in the periaqueductal gray (PAG), thalamus, hypothalamus, vermis, cerebellum, parabrachial pons, and medulla. Thalamic and PAG volume was significantly reduced in GTCS patients with severe hypoxia compared with GTCS patients with mild/moderate hypoxia. Brainstem volume loss appeared in both hypoxia groups, although it was more extensive in those with severe hypoxia. Significant negative partial correlations emerged between thalamic and hippocampal volume and extent of hypoxia, whereas vermis and accumbens volumes declined with increasing hypoxia duration. SIGNIFICANCE Brain structural alterations in patients with GTCS are related to the extent of hypoxia in brain sites that serve vital functions. Although the changes are associative only, they provide evidence of injury to regulatory brain sites related to respiratory manifestations of seizures.
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Affiliation(s)
- Luke A. Allen
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
- Epilepsy Society MRI UnitChalfont St PeterUK
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
| | - Ronald M. Harper
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- UCLA Brain Research InstituteLos AngelesCAUSA
- Department of NeurobiologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Sjoerd B. Vos
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Centre for Medical Image ComputingUniversity College LondonLondonUK
- Neuroradiological Academic UnitUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Catherine A. Scott
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of Clinical NeurophysiologyNational Hospital for Neurology and NeurosurgeryUCLHLondonUK
| | - Nuria Lacuey
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Laura Vilella
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Joel S. Winston
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Benjamin P. Whatley
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Rajesh Kumar
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of NeurobiologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
- Department of AnaesthesiologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Jennifer Ogren
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- UCLA Brain Research InstituteLos AngelesCAUSA
- Department of NeurobiologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Jaison S. Hampson
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Sandhya Rani
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
- Epilepsy Society MRI UnitChalfont St PeterUK
- Division of NeurologyDepartment of MedicineQueen's UniversityKingstonOntarioCanada
| | - Louis Lemieux
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Samden D. Lhatoo
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Beate Diehl
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of Clinical NeurophysiologyNational Hospital for Neurology and NeurosurgeryUCLHLondonUK
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