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Diamond JM, Chapeton JI, Xie W, Jackson SN, Inati SK, Zaghloul KA. Focal seizures induce spatiotemporally organized spiking activity in the human cortex. Nat Commun 2024; 15:7075. [PMID: 39152115 PMCID: PMC11329741 DOI: 10.1038/s41467-024-51338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 08/05/2024] [Indexed: 08/19/2024] Open
Abstract
Epileptic seizures are debilitating because of the clinical symptoms they produce. These symptoms, in turn, may stem directly from disruptions in neural coding. Recent evidence has suggested that the specific temporal order, or sequence, of spiking across a population of cortical neurons may encode information. Here, we investigate how seizures disrupt neuronal spiking sequences in the human brain by recording multi-unit activity from the cerebral cortex in five male participants undergoing monitoring for seizures. We find that pathological discharges during seizures are associated with bursts of spiking activity across a population of cortical neurons. These bursts are organized into highly consistent and stereotyped temporal sequences. As the seizure evolves, spiking sequences diverge from the sequences observed at baseline and become more spatially organized. The direction of this spatial organization matches the direction of the ictal discharges, which spread over the cortex as traveling waves. Our data therefore suggest that seizures can entrain cortical spiking sequences by changing the spatial organization of neuronal firing, providing a possible mechanism by which seizures create symptoms.
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Affiliation(s)
- Joshua M Diamond
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Julio I Chapeton
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Weizhen Xie
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - Samantha N Jackson
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sara K Inati
- Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA.
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2
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Dudley P, Marquez JP, Farrell F, Benson J, Rugg-Gunn F, Sidhu MK, O'Sullivan S, Walker M, Yogarajah M. Functional seizures and their mimics: a retrospective service review of cases from a tertiary video telemetry database. BMJ Neurol Open 2024; 6:e000738. [PMID: 39119525 PMCID: PMC11308881 DOI: 10.1136/bmjno-2024-000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/01/2024] [Indexed: 08/10/2024] Open
Abstract
ABSTRACT Objective Identify the proportion of patients referred with putative functional seizures (FS) that were subsequently re-diagnosed as epileptic seizures (ES), or an alternative diagnosis, following video telemetry EEG (VTEEG). In addition, describe the characteristics of those seizures. Methods The VTEEG reports from patients admitted to the Chalfont Centre for Epilepsy between 2019 and 2022 were reviewed. Pre-VTEEG and post-VTEEG diagnoses were compared to identify whether a diagnostic revision was made from suspected FS to ES or another diagnosis. Diagnostic revision cases were then grouped into cohorts with associated features and reviewed to characterise and describe FS mimics. Results 444 VTEEG reports where patients had habitual events were identified. 4.7% of patients were referred with FS and were subsequently diagnosed with ES or another diagnosis. In this group, several cohorts could be identified including frontal lobe epileptic seizures, ES with functional overlay, insular or temporal lobe epileptic seizures associated with autonomic or marked experiential peri-ictal symptoms, and individuals who had both ES and FS but whose ES were revealed on medication withdrawal. Conclusion In patients referred to a tertiary epilepsy unit, a small minority of cases had seizures diagnosed as functional and reclassified as epileptic or an alternative diagnosis. It is clinically important to be aware of these FS mimics.
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Affiliation(s)
- Peter Dudley
- Department of Epilepsy, Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - Jan Paul Marquez
- Department of Epilepsy, Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - Fiona Farrell
- Department of Epilepsy, Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - Jennifer Benson
- Department of Epilepsy, Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - Fergus Rugg-Gunn
- Department of Epilepsy, Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Meneka K Sidhu
- Department of Epilepsy, Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Suzanne O'Sullivan
- Department of Epilepsy, Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Matthew Walker
- Department of Epilepsy, Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Mahinda Yogarajah
- Department of Epilepsy, Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College London, London, UK
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3
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Hata M, Satake Y, Miyazaki Y, Omori H, Hirashima A, Kanemoto H, Yoshiyama K, Takahashi S, Ikeda M. Hidden cases of epilepsy in cognitive impairment clinics: Exploring the use of a portable device for simplified electroencephalography testing. Epilepsy Behav Rep 2024; 27:100701. [PMID: 39184193 PMCID: PMC11342905 DOI: 10.1016/j.ebr.2024.100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/16/2024] [Accepted: 07/27/2024] [Indexed: 08/27/2024] Open
Abstract
Late-onset epilepsy, particularly focal impaired awareness seizures, often present without convulsions and can cause memory impairment. This can lead patients to initially seek consultation at memory clinics, potentially delaying referral to epilepsy specialists. We report on three patients, aged 40s to 70s, admitted for cognitive evaluation who were finally diagnosed with epileptic seizures as the underlying cause of their symptoms. Notably, all initially presented to local clinics with symptoms suggesting cognitive impairment. Despite initial diagnostic uncertainty, all patients exhibited epileptic activity on electroencephalography (EEG) and responded positively to antiepileptic drugs, suggesting epileptic mechanisms were involved in their symptoms. Both traditional clinical EEG systems and newly developed, one-minute portable EEG devices were used in their evaluations. The portable device, medically approved in Japan, successfully captured sharp-waves like activities with the same durations, amplitudes, and shapes as traditional devices. This highlights its potential to improve epilepsy diagnosis and future screening due to its portability and ease of use. Implementing portable EEG devices could promote timely and appropriate treatment, preventing misdiagnosis of neurological conditions.
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Affiliation(s)
- Masahiro Hata
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Miyazaki
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisaki Omori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
- Shichiyama Hospital, Osaka, Japan
| | - Atsuya Hirashima
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
- Osaka Psychiatric Medical Center, Osaka, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
- Health and Counseling Center, Osaka University, Osaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shun Takahashi
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Occupational Therapy, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
- Clinical Research and Education Center, Asakayama General Hospital, Osaka, Japan
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
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4
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Vogrig A, Bellizzi F, Burini A, Gigli GL, Girardi L, Honnorat J, Valente M. Sudden unexpected death in epilepsy and ictal asystole in patients with autoimmune encephalitis: a systematic review. Neurol Sci 2024; 45:2811-2823. [PMID: 38194197 PMCID: PMC11081980 DOI: 10.1007/s10072-023-07280-z] [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: 07/27/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE As autoimmune encephalitis (AE) often involves the mesial temporal structures which are known to be involved in both sudden unexpected death in epilepsy (SUDEP) and ictal asystole (IA), it may represent a good model to study the physiopathology of these phenomena. Herein, we systematically reviewed the occurrence of SUDEP and IA in AE. METHODS We searched 4 databases (MEDLINE, Scopus, Embase, and Web of Science) for studies published between database inception and December 20, 2022, according to the PRISMA guidelines. We selected articles reporting cases of definite/probable/possible/near-SUDEP or IA in patients with possible/definite AE, or with histopathological signs of AE. RESULTS Of 230 records assessed, we included 11 cases: 7 SUDEP/near-SUDEP and 4 IA. All patients with IA were female. The median age at AE onset was 30 years (range: 15-65), and the median delay between AE onset and SUDEP was 11 months; 0.9 months for IA. All the patients presented new-onset seizures, and 10/11 also manifested psychiatric, cognitive, or amnesic disorders. In patients with SUDEP, 2/7 were antibody-positive (1 anti-LGI1, 1 anti-GABABR); all IA cases were antibody-positive (3 anti-NMDAR, 1 anti-GAD65). Six patients received steroid bolus, 3 intravenous immunoglobulin, and 3 plasmapheresis. A pacemaker was implanted in 3 patients with IA. The 6 survivors improved after treatment. DISCUSSION SUDEP and IA can be linked to AE, suggesting a role of the limbic system in their pathogenesis. IA tends to manifest in female patients with temporal lobe seizures early in AE, highlighting the importance of early diagnosis and treatment.
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Affiliation(s)
- Alberto Vogrig
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy.
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy.
| | - Fabrizio Bellizzi
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Alessandra Burini
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Luca Girardi
- Department of Environmental Systems Science, Swiss Federal Institute of Technology (ETH) Zürich, Zurich, Switzerland
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon University Hospital, Lyon, France
- MeLiS Institute - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Mariarosaria Valente
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy
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5
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Mulkerrin G, Hennessy MJ. Nonsense mutation in DEPDC5 gene in a patient with carbamazepine-responsive focal epilepsy. Epilepsy Behav Rep 2024; 27:100683. [PMID: 38983576 PMCID: PMC11231713 DOI: 10.1016/j.ebr.2024.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
•DEPDC-5 is a negative regulator of the mTOR pathway.•DEPDC-5 mutations can cause sleep-related hypermotor epilepsy.•Drug-refractory epilepsy is common in this cohort.•Carbamazepine-responsiveness in DEPDC-5-related epilepsy is described here.
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Saridas F, Mesut G, Dinc Y, Bican Demir A, Bora I. Lateralizing value and clinicoradiological features of asymmetric last clonic jerks in temporal and extratemporal epilepsy. Sci Rep 2024; 14:11578. [PMID: 38773166 PMCID: PMC11109186 DOI: 10.1038/s41598-024-61401-y] [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: 01/05/2024] [Accepted: 05/06/2024] [Indexed: 05/23/2024] Open
Abstract
Seizure semiology and electroencephalograph (EEG) are very important for determining seizure type, hemisphere lateralization, or localization. Clinical symptoms of focal seizures, as well as findings at the onset or end of a focal to bilateral tonic-clonic seizure (FBTCS), are highly informative for lateralization. This study aimed to investigate the relationship of asymmetric last clonic jerk in patients with temporal or extratemporal lobe epilepsy with pathologies, localization, lateralization, or other semiological findings detected in neuroimaging or neuro psychometric tests and its positive predictive value for the detection of hemisphere lateralization based on seizure onset ictal EEG activation. 44 patients with asymmetric last clonic jerks (aLCJ) who were followed up in our VEM unit were randomized 1:1 with epilepsy patients without. In patients with ipsilateral automatism and contralateral posture or gustatory and olfactory hallucinations aLCJ was less or absent. In patients with unilateral tonic activity, aLCJ was more common. The positive predictive value of aLCJ for ictal EEG activation lateralization was 86.36%. In conclusion, asymmetric last clonic beat is valuable for lateralization of FBTCS and should be considered. Its presence strongly and reliably lateralizes to the side of seizure onset.
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Affiliation(s)
- Furkan Saridas
- Department of Neurology, Bursa Uludağ University Medicine Faculty, Bursa, Türkiye.
| | - Gizem Mesut
- Department of Neurology, Bursa Uludağ University Medicine Faculty, Bursa, Türkiye
| | - Yasemin Dinc
- Department of Neurology, Bursa Uludağ University Medicine Faculty, Bursa, Türkiye
| | - Aylin Bican Demir
- Department of Neurology, Bursa Uludağ University Medicine Faculty, Bursa, Türkiye
| | - Ibrahim Bora
- Department of Neurology, Bursa Uludağ University Medicine Faculty, Bursa, Türkiye
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7
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Patel KH, Mitropanopoulos S, Kalamangalam G. Pearls & Oy-sters: Mesial Temporal Seizures in the Absence of the Mesial Temporal Lobe. Seizure Onset vs Seizure Network. Neurology 2024; 102:e208012. [PMID: 38165343 DOI: 10.1212/wnl.0000000000208012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
Seizure semiology represents the clinical expression of the activation of the several brain regions comprising an epileptic network. In mesial temporal lobe epilepsy (MTLE), this network includes the insular-opercular-neocortical temporal-hippocampal (IONTH) regions. In this study, we present the case of a patient with pharmacoresistant seizures characterized by nausea, lip-smacking, semipurposeful hand movements, and speechlessness, suggesting dominant hemisphere MTLE, with scalp video-EEG findings and left hippocampal sclerosis on brain MRI confirming the diagnosis. She underwent anterior temporal lobectomy with amygdalohippocampectomy and was seizure-free for 14 years before relapsing. Recurrent seizure semiology was similar to preoperative seizures, that is, consistent with left MTLE, despite the medial temporal lobe missing. Seizures were therefore assumed to arise from remnant portions of the IONTH network-the insula, operculum, and posterolateral temporal neocortex. Reinvestigation including MEG localization of spikes and acute MRI changes following a seizure cluster suggested a left opercular region epilepsy. Our patient thus demonstrated the principle that seizures with mesial temporal characteristics may arise from outside the mesial temporal lobe (MTL). MTLE semiology arises from the activation of a set of structures (the seizure network) associated with the MTL, which can be triggered by foci both within and outside the MTL itself, and indeed even in its absence. However, it is not necessary to resect the entire extended network to bring about extended periods of seizure freedom in patients with refractory MTLE.
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8
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Tye E, Baxendale S. Using the hospital anxiety and depression scale in people with epilepsy: Is overlapping symptomatology a problem? Epilepsy Behav Rep 2023; 25:100641. [PMID: 38235018 PMCID: PMC10792759 DOI: 10.1016/j.ebr.2023.100641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024] Open
Abstract
The Hospital Anxiety and Depression Scale (HADS) is designed to screen for anxiety and depression in clinical settings. However, some items on the HADS may reflect symptoms associated with epilepsy and antiseizure medications rather than anxiety and depression. This study examined whether these items on the HADS contributed disproportionately to the reporting of anxiety and depression on the HADS in people with epilepsy (PWE). As part of a routine clinical assessment, 546 adults with epilepsy completed the HADS. In our sample, 56.2% reported elevated levels of anxiety, and 27.3% reported symptoms of depression with a score of 8 or more on the respective subscales. Scores on the anxiety and depression subscales were not associated with age, sex or epilepsy type. We did not find a relationship between endorsement of items related to panic, feelings of dread or butterflies in the stomach and a diagnosis of temporal lobe epilepsy. The most frequently endorsed item on the anxiety subscale of the HADS in the sample as a whole related to worrying thoughts, rather than the more somatic manifestations of anxiety. The item 'I feel as if I am slowed down' was endorsed by the majority of people with epilepsy and may not reflect a symptom of depression in this group. Careful analyses of the pattern of endorsement of specific items on the HADS may improve the sensitivity of this screening measure to the presence of depression in people with epilepsy.
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Affiliation(s)
- Elisa Tye
- University College Hospital, London, United Kingdom
| | - Sallie Baxendale
- University College Hospital, London, United Kingdom
- UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, United Kingdom
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9
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Hall GR, Hutchings F, Horsley J, Simpson CM, Wang Y, de Tisi J, Miserocchi A, McEvoy AW, Vos SB, Winston GP, Duncan JS, Taylor PN. Epileptogenic networks in extra temporal lobe epilepsy. Netw Neurosci 2023; 7:1351-1362. [PMID: 38144694 PMCID: PMC10631792 DOI: 10.1162/netn_a_00327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/22/2023] [Indexed: 12/26/2023] Open
Abstract
Extra temporal lobe epilepsy (eTLE) may involve heterogenous widespread cerebral networks. We investigated the structural network of an eTLE cohort, at the postulated epileptogenic zone later surgically removed, as a network node: the resection zone (RZ). We hypothesized patients with an abnormal connection to/from the RZ to have proportionally increased abnormalities based on topological proximity to the RZ, in addition to poorer post-operative seizure outcome. Structural and diffusion MRI were collected for 22 eTLE patients pre- and post-surgery, and for 29 healthy controls. The structural connectivity of the RZ prior to surgery, measured via generalized fractional anisotropy (gFA), was compared with healthy controls. Abnormal connections were identified as those with substantially reduced gFA (z < -1.96). For patients with one or more abnormal connections to/from the RZ, connections with closer topological distance to the RZ had higher proportion of abnormalities. The minority of the seizure-free patients (3/11) had one or more abnormal connections, while most non-seizure-free patients (8/11) had abnormal connections to the RZ. Our data suggest that eTLE patients with one or more abnormal structural connections to/from the RZ had more proportional abnormal connections based on topological distance to the RZ and associated with reduced chance of seizure freedom post-surgery.
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Affiliation(s)
- Gerard R. Hall
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Frances Hutchings
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jonathan Horsley
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Callum M. Simpson
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yujiang Wang
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jane de Tisi
- Department of Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- UCL/UCLH NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Anna Miserocchi
- Department of Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Andrew W. McEvoy
- Department of Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Sjoerd B. Vos
- Centre for Microscopy, Characterisation, and Analysis, University of Western Australia, Nedlands, Australia
| | - Gavin P. Winston
- Department of Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, Canada
| | - John S. Duncan
- Department of Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- UCL/UCLH NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Peter N. Taylor
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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10
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Finkelstein SA, Popkirov S. Functional Neurological Disorder: Diagnostic Pitfalls and Differential Diagnostic Considerations. Neurol Clin 2023; 41:665-679. [PMID: 37775197 DOI: 10.1016/j.ncl.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Functional neurologic disorder (FND) is a "rule-in" diagnosis, characterized by positive examination signs or semiological features. Similar to other clinical diagnoses, providers should ideally see robustly present features, including if possible the identification of multiple features consistent with FND for the diagnosis to be made with a high degree of certainty. Diagnostic pitfalls need to be guarded against and vary depending on FND symptom subtype and the specific patient presentation. This perspective article aims to review pitfalls based on an FND symptom subtype, as well as discuss differential diagnostic considerations with respect to both neurologic and psychiatric entities.
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Affiliation(s)
- Sara A Finkelstein
- Department of Neurology, Functional Neurological Disorder Unit, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 20114, USA.
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, Bochum 44892, Germany.
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11
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Tran VD, Nguyen BT, Van Dong H, Lieber BA, Bista J, Van Vu H, Bui TN, Chu HT, Nguyen PX, Nguyen TA, Ono T, Trieu ST, Nhu SD. Temporal Lobe Surgery for Epilepsy in a Resource-Limited Vietnamese Cohort. World Neurosurg 2023; 178:e559-e565. [PMID: 37532017 DOI: 10.1016/j.wneu.2023.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Epilepsy surgery is traditionally difficult to pursue in resource-limited countries but is nevertheless essential in the treatment of medication-refractory, surgically amenable epilepsy. METHODS With the help of international collaboration, a successful epilepsy program was started in Vietnam. This article comprises a retrospective chart review, combined with prospective longitudinal follow-up of 35 cases of unilateral drug-resistant epilepsy in the temporal lobe who underwent temporal lobectomy, in Viet Duc University Hospital from May 2018 to September 2022. RESULTS The female/male ratio was 0.6:1, and focal seizures with impaired awareness accounted for 97.14% of patients. Of patients with focal awareness seizures, 51.41% were localized and detected by electroencephalography. Postoperatively, 80% of patients were seizure free (Engel I) at 1 year, and the remaining 20% had worthwhile seizure improvement (Engel II). Postoperative temporal lobe pathology was categorized as follows: mesial temporal sclerosis (48.57%), focal cortical dysplasia (25.71%), and low-grade neoplasms (25.71%). Of patients, 17.14% had postoperative complications (5 infections and 1 transient extremity paresis), and there were no deaths. CONCLUSIONS Even in low-resource environments, effective and safe surgical care can be provided for drug-resistant epilepsy caused by temporal lobe disease. This study serves as a model of international collaboration and support for future hospitals in low-resource environments to replicate.
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Affiliation(s)
- Van Dinh Tran
- Vietnam Military Medical University, Hanoi, Vietnam; Neurosurgery Center of Viet Duc Hospital, Hanoi, Vietnam
| | | | - He Van Dong
- Neurosurgery Center of Viet Duc Hospital, Hanoi, Vietnam
| | - Bryan A Lieber
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery, Dr. Kiran C. Patel College of Allopathic Medicine, Davie, Florida, USA.
| | - Jehan Bista
- The University of Queensland-Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Hoe Van Vu
- Vietnam Military Medical University, Hanoi, Vietnam
| | - Tien Ngoc Bui
- Neurosurgery Center of Viet Duc Hospital, Hanoi, Vietnam
| | - Hung Thanh Chu
- Department of Neurological Surgery, Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Tomonori Ono
- Epilepsy Center, Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | | | - Son Dinh Nhu
- Vietnam Military Medical University, Hanoi, Vietnam
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12
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Tai XY, Torzillo E, Lyall DM, Manohar S, Husain M, Sen A. Association of Dementia Risk With Focal Epilepsy and Modifiable Cardiovascular Risk Factors. JAMA Neurol 2023; 80:445-454. [PMID: 36972059 PMCID: PMC10043806 DOI: 10.1001/jamaneurol.2023.0339] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
Abstract
Importance Epilepsy has been associated with cognitive impairment and potentially dementia in older individuals. However, the extent to which epilepsy may increase dementia risk, how this compares with other neurological conditions, and how modifiable cardiovascular risk factors may affect this risk remain unclear. Objective To compare the differential risks of subsequent dementia for focal epilepsy compared with stroke and migraine as well as healthy controls, stratified by cardiovascular risk. Design, Setting, and Participants This cross-sectional study is based on data from the UK Biobank, a population-based cohort of more than 500 000 participants aged 38 to 72 years who underwent physiological measurements and cognitive testing and provided biological samples at 1 of 22 centers across the United Kingdom. Participants were eligible for this study if they were without dementia at baseline and had clinical data pertaining to a history of focal epilepsy, stroke, or migraine. The baseline assessment was performed from 2006 to 2010, and participants were followed up until 2021. Exposures Mutually exclusive groups of participants with epilepsy, stroke, and migraine at baseline assessment and controls (who had none of these conditions). Individuals were divided into low, moderate, or high cardiovascular risk groups based on factors that included waist to hip ratio, history of hypertension, hypercholesterolemia, diabetes, and smoking pack-years. Main Outcomes and Measures Incident all-cause dementia; measures of executive function; and brain total hippocampal, gray matter, and white matter hyperintensity volumes. Results Of 495 149 participants (225 481 [45.5%] men; mean [SD] age, 57.5 [8.1] years), 3864 had a diagnosis of focal epilepsy only, 6397 had a history of stroke only, and 14 518 had migraine only. Executive function was comparable between participants with epilepsy and stroke and worse than the control and migraine group. Focal epilepsy was associated with a higher risk of developing dementia (hazard ratio [HR], 4.02; 95% CI, 3.45 to 4.68; P < .001), compared with stroke (HR, 2.56; 95% CI, 2.28 to 2.87; P < .001), or migraine (HR, 1.02; 95% CI, 0.85 to 1.21; P = .94). Participants with focal epilepsy and high cardiovascular risk were more than 13 times more likely to develop dementia (HR, 13.66; 95% CI, 10.61 to 17.60; P < .001) compared with controls with low cardiovascular risk. The imaging subsample included 42 353 participants. Focal epilepsy was associated with lower hippocampal volume (mean difference, -0.17; 95% CI, -0.02 to -0.32; t = -2.18; P = .03) and lower total gray matter volume (mean difference, -0.33; 95% CI, -0.18 to -0.48; t = -4.29; P < .001) compared with controls. There was no significant difference in white matter hyperintensity volume (mean difference, 0.10; 95% CI, -0.07 to 0.26; t = 1.14; P = .26). Conclusions and Relevance In this study, focal epilepsy was associated with a significant risk of developing dementia, to a greater extent than stroke, which was magnified substantially in individuals with high cardiovascular risk. Further findings suggest that targeting modifiable cardiovascular risk factors may be an effective intervention to reduce dementia risk in individuals with epilepsy.
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Affiliation(s)
- Xin You Tai
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Emma Torzillo
- Epilepsy Department, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Donald M. Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sanjay Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
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Yoganathan K, Malek N, Torzillo E, Paranathala M, Greene J. Neurological update: structural and functional imaging in epilepsy surgery. J Neurol 2023; 270:2798-2808. [PMID: 36792721 PMCID: PMC10130132 DOI: 10.1007/s00415-023-11619-z] [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: 01/05/2023] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
Structural and functional imaging prior to surgery in drug-resistant focal epilepsy, has an important role to play alongside electroencephalography (EEG) techniques, in planning the surgical approach and predicting post-operative outcome. This paper reviews the role of structural and functional imaging of the brain, namely computed tomography (CT), magnetic resonance imaging (MRI), functional MRI (fMRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging in the preoperative work-up of people with medically refractory epilepsy. In MRI-negative patients, the precise localisation of the epileptogenic zone may be established by demonstrating hypometabolism on PET imaging or hyperperfusion on SPECT imaging in the area surrounding the seizure focus. These imaging modalities are far less invasive than intracranial EEG, which is the gold standard but requires surgical placement of electrodes or recording grids. Even when intracranial EEG is needed, PET or SPECT imaging can assist in the planning of EEG electrode placement, due to its' limited spatial sampling. Multimodal imaging techniques now allow the multidisciplinary epilepsy surgery team to identify and better characterise focal pathology, determine its' relationship to eloquent areas of the brain and the degree of interconnectedness within both physiological and pathological networks, as well as improve planning and surgical outcomes for patients. This paper will update the reader on this whole field and provide them with a practical guide, to aid them in the selection of appropriate investigations, interpretation of the findings and facilitating patient discussions in individuals with drug-resistant focal epilepsy.
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Affiliation(s)
- Katie Yoganathan
- University of Oxford and Oxford University Hospitals, Oxford, UK. .,Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Naveed Malek
- Department of Neurology, Queen's Hospital, Romford, UK
| | - Emma Torzillo
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - John Greene
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
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Khoo A, Alim-Marvasti A, de Tisi J, Diehl B, Walker MC, Miserocchi A, McEvoy AW, Chowdhury FA, Duncan JS. Value of semiology in predicting epileptogenic zone and surgical outcome following frontal lobe epilepsy surgery. Seizure 2023; 106:29-35. [PMID: 36736149 DOI: 10.1016/j.seizure.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/11/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To evaluate the ability of semiology alone in localising the epileptogenic zone (EZ) in people with frontal lobe epilepsy (FLE) who underwent resective surgery. METHODS We examined data on all individuals who had FLE surgery at our centre between January 01, 2011 and December 31, 2020. Descriptions of ictal semiology were obtained from video-EEG telemetry reports and presurgical multidisciplinary meeting summaries. The putative EZ was represented by the final site of resection. We assessed how well initial and combined set-of-semiologies correlated anatomically with the EZ, using a semiology visualisation tool to generate probabilistic cortical heatmaps of involvement in seizures. RESULTS Sixty-one individuals had FLE surgery over the study period. Twelve months following surgery, 28/61 (46%) were completely seizure-free, with a further eight experiencing only auras. Comparing the semiology database with the putative EZ, combined set-of-semiology correctly lateralised in 77% (95% CI: 69-85%), localised to the frontal lobe in 57% (95% CI: 48-67%), frontal lobe subregions in 52% (95% CI: 43-62%), and frontal gyri in 25% (95% CI: 16-33%). No difference in degree of correlation was seen comparing those with ongoing seizures 12 months after surgery to those seizure free. SIGNIFICANCE Semiology alone was able to correctly lateralize the putative EZ in 77%, and localise to a sublobar level in approximately half of individuals who had FLE surgery. Semiology is not adequate alone and must be combined with imaging and EEG data to identify the epileptogenic zone.
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Affiliation(s)
- Anthony Khoo
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Ali Alim-Marvasti
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Jane de Tisi
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Beate Diehl
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Matthew C Walker
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Anna Miserocchi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Andrew W McEvoy
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Fahmida A Chowdhury
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - John S Duncan
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
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Batista Tsukahara VH, de Oliveira Júnior JN, de Oliveira Barth VB, de Oliveira JC, Rosa Cota V, Maciel CD. Data-Driven Network Dynamical Model of Rat Brains During Acute Ictogenesis. Front Neural Circuits 2022; 16:747910. [PMID: 36034337 PMCID: PMC9399918 DOI: 10.3389/fncir.2022.747910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is one of the most common neurological disorders worldwide. Recent findings suggest that the brain is a complex system composed of a network of neurons, and seizure is considered an emergent property resulting from its interactions. Based on this perspective, network physiology has emerged as a promising approach to explore how brain areas coordinate, synchronize and integrate their dynamics, both under perfect health and critical illness conditions. Therefore, the objective of this paper is to present an application of (Dynamic) Bayesian Networks (DBN) to model Local Field Potentials (LFP) data on rats induced to epileptic seizures based on the number of arcs found using threshold analytics. Results showed that DBN analysis captured the dynamic nature of brain connectivity across ictogenesis and a significant correlation with neurobiology derived from pioneering studies employing techniques of pharmacological manipulation, lesion, and modern optogenetics. The arcs evaluated under the proposed approach achieved consistent results based on previous literature, in addition to demonstrating robustness regarding functional connectivity analysis. Moreover, it provided fascinating and novel insights, such as discontinuity between forelimb clonus and generalized tonic-clonic seizure (GTCS) dynamics. Thus, DBN coupled with threshold analytics may be an excellent tool for investigating brain circuitry and their dynamical interplay, both in homeostasis and dysfunction conditions.
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Affiliation(s)
- Victor Hugo Batista Tsukahara
- Signal Processing Laboratory, School of Engineering of São Carlos, Department of Electrical Engineering, University of São Paulo, São Carlos, Brazil
| | - Jordão Natal de Oliveira Júnior
- Signal Processing Laboratory, School of Engineering of São Carlos, Department of Electrical Engineering, University of São Paulo, São Carlos, Brazil
| | - Vitor Bruno de Oliveira Barth
- Signal Processing Laboratory, School of Engineering of São Carlos, Department of Electrical Engineering, University of São Paulo, São Carlos, Brazil
| | - Jasiara Carla de Oliveira
- Laboratory of Neuroengineering and Neuroscience, Department of Electrical Engineering, Federal University of São João Del-Rei, São João Del Rei, Brazil
| | - Vinicius Rosa Cota
- Laboratory of Neuroengineering and Neuroscience, Department of Electrical Engineering, Federal University of São João Del-Rei, São João Del Rei, Brazil
| | - Carlos Dias Maciel
- Signal Processing Laboratory, School of Engineering of São Carlos, Department of Electrical Engineering, University of São Paulo, São Carlos, Brazil
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Soare IL, Escudero J. Evaluation of EEG dynamic connectivity around seizure onset with principal component analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:40-43. [PMID: 36086271 DOI: 10.1109/embc48229.2022.9871650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Seizures represent a brain activity state charac-terised by extended synchronised firing in multiple regions that prevent normal brain functioning. It is important to develop methods to distinguish between normal and abnormal synchro-nisation in epilepsy, as well as to localise the networks involved in seizures. To this end, we perform a preliminary investigation in the use of principal components analysis (PCA) to assess the change in dynamic electroencephalogram (EEG) connectivity before and after seizure onset. Source estimation was performed for an openly available EEG dataset from 14 patients with epilepsy. By applying PCA onto the EEG data processed into dynamic connectivity (dFC) matrices, we identified a set of connectivity topologies (eigenconnectivities) that explain high levels of variance in the dynamic connectivity. We compare the dimensionality reduction results obtained on source-level vs. scalp-level connectivity. We identified eigenconnectivities with differences in preictal vs. ictal activity and the brain networks associated with these activations. The work illustrates a data-driven approach for identification of topologies of brain networks that change with seizure onset. Clinical relevance We identified networks that are signifi-cantly varying with preictal vs. ictal brain activity some of which verify preexistent epilepsy markers in a data-driven way.
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Gupta S, Kadam SD. Interictal Discharges: All Roads Lead to Rome? Epilepsy Curr 2022; 22:252-254. [PMID: 36187148 PMCID: PMC9483753 DOI: 10.1177/15357597221098809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Human Interictal Epileptiform Discharges Are Bidirectional Traveling Waves
Echoing Ictal Discharges Smith EH, Liou J-Y, Merricks EM, et al. Elife. 2022;11:e73541.
Published 2022 Jan 20. doi:10.7554/eLife.73541. Interictal epileptiform discharges (IEDs), also known as interictal spikes, are large
intermittent electrophysiological events observed between seizures in patients with
epilepsy. Although they occur far more often than seizures, IEDs are less studied, and
their relationship to seizures remains unclear. To better understand this
relationship, we examined multi-day recordings of microelectrode arrays implanted in
human epilepsy patients, allowing us to precisely observe the spatiotemporal
propagation of IEDs, spontaneous seizures, and how they relate. These recordings
showed that the majority of IEDs are traveling waves, traversing the same path as
ictal discharges during seizures, and with a fixed direction relative to seizure
propagation. Moreover, the majority of IEDs, like ictal discharges, were
bidirectional, with 1 predominant and a second, less frequent antipodal direction.
These results reveal a fundamental spatiotemporal similarity between IEDs and ictal
discharges. These results also imply that most IEDs arise in brain tissue outside the
site of seizure onset and propagate toward it, indicating that the propagation of IEDs
provides useful information for localizing the seizure focus.
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Attard Navarro G, Hamandi K. Lessons from the video-EEG telemetry unit. Pract Neurol 2022; 22:301-310. [PMID: 35418505 DOI: 10.1136/practneurol-2021-003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/04/2022]
Abstract
Epilepsy is a clinical diagnosis, based primarily on patient and witness histories. Where there is diagnostic uncertainty or when epilepsy surgery is being considered, long-term video-EEG monitoring in a telemetry unit remains the gold standard investigation for diagnostic clarification or presurgical localisation. We present six illustrative cases, highlighting important points that emerged during video-EEG review including potential pitfalls in video-EEG interpretation, and how the investigation helped with diagnosis and subsequent management. The diagnostic process strongly emphasises seizure semiology, more so than EEG.
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Affiliation(s)
- Giulia Attard Navarro
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Khalid Hamandi
- Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
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Smith KM, Alden EC, Simpson HD, Brinkmann BH, Gregg NM, Miller KJ, Lundstrom BN. Multimodal approach leads to seizure-freedom in a case of highly refractory drug-resistant focal epilepsy. Epilepsy Behav Rep 2022; 20:100570. [PMID: 36411878 PMCID: PMC9674497 DOI: 10.1016/j.ebr.2022.100570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/23/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Drug-resistant, nonlesional, extratemporal lobe focal epilepsy can be difficult to treat and may require a high degree of multidisciplinary teamwork to localize the seizure onset zone for resective surgery. Here, we describe a patient with longstanding drug-resistant, nonlesional, extratemporal focal epilepsy with a high seizure burden who became seizure-free after prolonged evaluation and eventual left frontal cortical resection. Prior evaluations included magnetoencephalography, invasive video-EEG monitoring, and implantation of a responsive neurostimulation (RNS) device for ongoing intracranial stimulation. Highly sophisticated techniques were utilized including stereotactic localization of prior evaluations to guide repeat stereo-EEG (SEEG), electrical stimulation mapping, SEEG-guided radiofrequency ablation, and awake resection with language and motor mapping using a cognitive testing platform . Incorporating a wide array of data from multiple centers and evaluation time periods was necessary to optimize seizure control and minimize the risk of neurological deficits from surgery.
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Affiliation(s)
- Kelsey M. Smith
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
- Corresponding author.
| | - Eva C. Alden
- Department of Psychology and Psychiatry, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Hugh D. Simpson
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Benjamin H. Brinkmann
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Nicholas M. Gregg
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Kai J. Miller
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Brian N. Lundstrom
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
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