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Li X, Qu Z, Li Z, Su R, Yin B, Yin L. Effect of GABAa-receptors on neuronal discharge and ion activity in focal seizures. Cereb Cortex 2024; 34:bhae110. [PMID: 38518225 DOI: 10.1093/cercor/bhae110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024] Open
Abstract
Focal seizures are a type of epileptic event that has plagued the medical community for a long time, and the existing drug treatment is mainly based on the modulation of ${GABA}_a$-receptors to affect GABAergic signaling to achieve the therapeutic purpose. The majority of research currently focuses on the impact of ${GABA}_a$-receptors on neuronal firing, failing to analyze the molecular and ionic mechanisms involved. Specifically, the research on deeper-level mechanisms on how ${GABA}_a$-receptors affect neuronal firing by altering ion activity has not been addressed. This research aimed to study the effects of different ${GABA}_a$-receptor structures on ion activity in focal seizures model by adjusting parameters of the ${GABA}_a$-receptors: the rise time constant (${tau}_1$) and decay time constant (${tau}_2$). The research indicates that as the values of ${tau}_1$ and ${tau}_2$ of the ${GABA}_a$-receptor change, the ion concentration will vary based on the change of the ${GABA}_a$-receptor potential. To a certain extent, the duration of epileptic activity will also be affected to a certain extent. In conclusion, the alteration of ${GABA}_a$-receptor structure will affect the inhibitory effect of interneurons on pyramidal neurons, and different parameters of the ${GABA}_a$-receptor will directly impact the therapeutic effect.
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Affiliation(s)
- Xin Li
- School of Electrical Engineering, Yanshan University, Qinhuangdao, Hebei 066004, P.R. China
- Measurement Technology and Instrumentation Key Lab of Hebei Province, Qinhuangdao, Hebei 066004, P.R. China
| | - Zhongjie Qu
- School of Electrical Engineering, Yanshan University, Qinhuangdao, Hebei 066004, P.R. China
- Measurement Technology and Instrumentation Key Lab of Hebei Province, Qinhuangdao, Hebei 066004, P.R. China
| | - Zipeng Li
- School of Electrical Engineering, Yanshan University, Qinhuangdao, Hebei 066004, P.R. China
- Measurement Technology and Instrumentation Key Lab of Hebei Province, Qinhuangdao, Hebei 066004, P.R. China
| | - Rui Su
- School of Medical Imaging, Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Bowen Yin
- Department of Neurology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Liyong Yin
- Department of Neurology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
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Všianský V, Brázdil M, Rektor I, Doležalová I, Kočvarová J, Strýček O, Hemza J, Chrastina J, Brichtová E, Horák O, Mužlayová P, Hermanová M, Hendrych M, Pail M. Twenty-five years of epilepsy surgery at a Central European comprehensive epilepsy center-Trends in intervention delay and outcomes. Epilepsia Open 2023; 8:991-1001. [PMID: 37259787 PMCID: PMC10472383 DOI: 10.1002/epi4.12769] [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: 01/13/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE We analyzed trends in patients' characteristics, outcomes, and waiting times over the last 25 years at our epilepsy surgery center situated in Central Europe to highlight possible areas of improvement in our care for patients with drug-resistant epilepsy. METHODS A total of 704 patients who underwent surgery at the Brno Epilepsy Center were included in the study, 71 of those were children. Patients were separated into three time periods, 1996-2000 (n = 95), 2001-2010 (n = 295) and 2011-2022 (n = 314) based on first evaluation at the center. RESULTS The average duration of epilepsy before surgery in adults remained high over the last 25 years (20.1 years from 1996 to 2000, 21.3 from 2001 to 2010, and 21.3 from 2011 to 2020, P = 0.718). There has been a decrease in rate of surgeries for temporal lobe epilepsy in the most recent time period (67%-70%-52%, P < 0.001). Correspondingly, extratemporal resections have become more frequent with a significant increase in surgeries for focal cortical dysplasia (2%-8%-19%, P < 0.001). For resections, better outcomes (ILAE scores 1a-2) have been achieved in extratemporal lesional (0%-21%-61%, P = 0.01, at least 2-year follow-up) patients. In temporal lesional patients, outcomes remained unchanged (at least 77% success rate). A longer duration of epilepsy predicted a less favorable outcome for resective procedures (P = 0.024) in patients with disease duration of less than 25 years. SIGNIFICANCE The spectrum of epilepsy surgery is shifting toward nonlesional and extratemporal cases. While success rates of extratemporal resections at our center are getting better, the average duration of epilepsy before surgical intervention is still very long and is not improving. This underscores the need for stronger collaboration between epileptologists and outpatient neurologists to ensure prompt and effective treatment for patients with drug-resistant epilepsy.
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Affiliation(s)
- Vít Všianský
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Milan Brázdil
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Ivan Rektor
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Irena Doležalová
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Jitka Kočvarová
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Ondřej Strýček
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Jan Hemza
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Jan Chrastina
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Eva Brichtová
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Ondřej Horák
- Brno Epilepsy Center, Department of Pediatric Neurology, Brno University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Patrícia Mužlayová
- Brno Epilepsy Center, Department of Pediatric Neurology, Brno University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Markéta Hermanová
- Department of Pathology, St. Anne's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Michal Hendrych
- Department of Pathology, St. Anne's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Martin Pail
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
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3
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Hamblin MR. Could Photobiomodulation Therapy Be Helpful in Epilepsy? Photobiomodul Photomed Laser Surg 2023; 41:35-36. [PMID: 36695664 DOI: 10.1089/photob.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg-Doornfontein Campus, Doornfontein, South Africa
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4
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Levin LA, Patrick C, Choudry NB, Sharif NA, Goldberg JL. Neuroprotection in neurodegenerations of the brain and eye: Lessons from the past and directions for the future. Front Neurol 2022; 13:964197. [PMID: 36034312 PMCID: PMC9412944 DOI: 10.3389/fneur.2022.964197] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundNeurological and ophthalmological neurodegenerative diseases in large part share underlying biology and pathophysiology. Despite extensive preclinical research on neuroprotection that in many cases bridges and unifies both fields, only a handful of neuroprotective therapies have succeeded clinically in either.Main bodyUnderstanding the commonalities among brain and neuroretinal neurodegenerations can help develop innovative ways to improve translational success in neuroprotection research and emerging therapies. To do this, analysis of why translational research in neuroprotection fails necessitates addressing roadblocks at basic research and clinical trial levels. These include optimizing translational approaches with respect to biomarkers, therapeutic targets, treatments, animal models, and regulatory pathways.ConclusionThe common features of neurological and ophthalmological neurodegenerations are useful for outlining a path forward that should increase the likelihood of translational success in neuroprotective therapies.
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Affiliation(s)
- Leonard A. Levin
- Departments of Ophthalmology and Visual Sciences, Neurology & Neurosurgery, McGill University, Montreal, QC, Canada
- *Correspondence: Leonard A. Levin
| | | | - Nozhat B. Choudry
- Global Alliances and External Research, Ophthalmology Innovation Center, Santen Inc., Emeryville, CA, United States
| | - Najam A. Sharif
- Global Alliances and External Research, Ophthalmology Innovation Center, Santen Inc., Emeryville, CA, United States
| | - Jeffrey L. Goldberg
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
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5
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de Carvalho TS. Calorie restriction or dietary restriction: how far they can protect the brain against neurodegenerative diseases? Neural Regen Res 2022; 17:1640-1644. [PMID: 35017409 PMCID: PMC8820686 DOI: 10.4103/1673-5374.332126] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Finding the correct nutritional intervention is one of the biggest challenges in treating patients with neurodegenerative diseases. In general, these patients develop strong metabolic alterations, resulting in lower treatment efficacy and higher mortality rates. However, there are still many open questions regarding the effectiveness of dietary interventions in neurodiseases. Some studies have shown that a reduction in calorie intake activates key pathways that might be important for preventing or slowing down the progression of such diseases. However, it is still unclear whether these neuroprotective effects are associated with an overall reduction in calories (hypocaloric diet) or a specific nutrient restriction (diet restriction). Therefore, here we discuss how commonly or differently hypocaloric and restricted diets modulate signaling pathways and how these changes can protect the brain against neurodegenerative diseases.
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6
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Khuvis S, Hwang ST, Mehta AD. Intracranial EEG Biomarkers for Seizure Lateralization in Rapidly-Bisynchronous Epilepsy After Laser Corpus Callosotomy. Front Neurol 2021; 12:696492. [PMID: 34690909 PMCID: PMC8531267 DOI: 10.3389/fneur.2021.696492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: It has been asserted that high-frequency analysis of intracranial EEG (iEEG) data may yield information useful in localizing epileptogenic foci. Methods: We tested whether proposed biomarkers could predict lateralization based on iEEG data collected prior to corpus callosotomy (CC) in three patients with bisynchronous epilepsy, whose seizures lateralized definitively post-CC. Lateralization data derived from algorithmically-computed ictal phase-locked high gamma (PLHG), high gamma amplitude (HGA), and low-frequency (filtered) line length (LFLL), as well as interictal high-frequency oscillation (HFO) and interictal epileptiform discharge (IED) rate metrics were compared against ground-truth lateralization from post-CC ictal iEEG. Results: Pre-CC unilateral IEDs were more frequent on the more-pathologic side in all subjects. HFO rate predicted lateralization in one subject, but was sensitive to detection threshold. On pre-CC data, no ictal metric showed better predictive power than any other. All post-corpus callosotomy seizures lateralized to the pathological hemisphere using PLHG, HGA, and LFLL metrics. Conclusions: While quantitative metrics of IED rate and ictal HGA, PHLG, and LFLL all accurately lateralize based on post-CC iEEG, only IED rate consistently did so based on pre-CC data. Significance: Quantitative analysis of IEDs may be useful in lateralizing seizure pathology. More work is needed to develop reliable techniques for high-frequency iEEG analysis.
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Affiliation(s)
- Simon Khuvis
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.,Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Sean T Hwang
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Ashesh D Mehta
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.,Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
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Kaculini CM, Tate-Looney AJ, Seifi A. The History of Epilepsy: From Ancient Mystery to Modern Misconception. Cureus 2021; 13:e13953. [PMID: 33880289 PMCID: PMC8051941 DOI: 10.7759/cureus.13953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Epilepsy is an ancient disease, which has fascinated and frightened scientists and laymen alike. Before the working knowledge of the central nervous system, seizures were shrouded in mystery. In antiquity, this disease was accredited to gods and demonic possession, causing those with epilepsy to be feared and isolated. Epilepsy patients continued to face discrimination through the mid-20th century. This discrimination ranged from lack of access to health insurance, jobs, and marriage equality to forced sterilizations. Despite the strides that have been made, there are still many misconceptions globally regarding epilepsy. Studies show that patients with epilepsy in communities that understand the pathology and cause of seizures are generally more successful in social and educational environments. While there has been progress, there is more work which needs to be done to educate people across the globe about the pathology of epilepsy.
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Affiliation(s)
- Christian M Kaculini
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Amelia J Tate-Looney
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Ali Seifi
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
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8
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Cerebellar Degeneration in Epilepsy: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020473. [PMID: 33435567 PMCID: PMC7827978 DOI: 10.3390/ijerph18020473] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 01/03/2023]
Abstract
Introduction: Cerebellar degeneration has been associated in patients with epilepsy, though the exact pathogenic mechanisms are not understood. The aim of this systematic review was to identify the prevalence of cerebellar degeneration in patients with epilepsy and identify any pathogenic mechanisms. Methodology: A systematic computer-based literature search was conducted using the PubMed database. Data extracted included prevalence, clinical, neuroradiological, and neuropathological characteristics of patients with epilepsy and cerebellar degeneration. Results: We identified three consistent predictors of cerebellar degeneration in the context of epilepsy in our review: temporal lobe epilepsy, poor seizure control, and phenytoin as the treatment modality. Whole brain and hippocampal atrophy were also identified in patients with epilepsy. Conclusions: Cerebellar degeneration is prevalent in patients with epilepsy. Further prospective studies are required to confirm if the predictors identified in this review are indeed linked to cerebellar degeneration and to establish the pathogenic mechanisms that result in cerebellar insult.
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Abstract
Lennox-Gastaut syndrome (LGS), a childhood-onset severe developmental and epileptic encephalopathy (DEE), is an entity that encompasses a heterogenous group of aetiologies, with no single genetic cause. It is characterised by multiple seizure types, an abnormal EEG with generalised slow spike and wave discharges and cognitive impairment, associated with high morbidity and profound effects on the quality of life of patients and their families. Drug-refractory seizures are a hallmark and treatment is further complicated by its multiple morbidities, which evolve over the patient's lifetime. This review provides a comprehensive overview of the current and future options for the treatment of seizures associated with LGS. Six treatments are specifically indicated as adjunct therapies for the treatment of seizures associated with LGS in the US: lamotrigine, clobazam, rufinamide, topiramate, felbamate and most recently cannabidiol. These therapies have demonstrated reductions in drop seizures in 15%-68% of patients across trials, with responder rates (≥ 50% reduction in drop seizures) of 37%-78%. Valproate is still the preferred first-line treatment, generally in combination with lamotrigine or clobazam. Other treatments frequently used off-label include the broad spectrum anti-epileptic drugs (AED) levetiracetam, zonisamide and perampanel, while recent evidence from observational studies has indicated that a newer AED, the levetiracetam analogue brivaracetam, may be effective and well tolerated in LGS patients. Other treatments in clinical development include fenfluramine in late phase III, perampanel, soticlestat-OV953/TAK-953, carisbamate and ganaxolone. Non-pharmacologic interventions include the ketogenic diet, vagus nerve stimulation and surgical interventions; these are also expanding, with the potential for less invasive techniques for corpus callosotomy that have promise for reducing complications. However, despite these advancements, patients continue to experience a significant burden. Because LGS is not a single entity, tailoring of treatment is needed as opposed to a 'one size fits all' approach. Further research is needed into the underlying aetiologies and pathophysiology of LGS, together with advancements in treatments that encompass the spectrum of seizures associated with this complex syndrome.
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10
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Yamazaki M, Honda S, Tamaki K, Irie M, Mihara T. Effects of (+)-bicuculline, a GABAa receptor antagonist, on auditory steady state response in free-moving rats. PLoS One 2020; 15:e0236363. [PMID: 32706815 PMCID: PMC7380603 DOI: 10.1371/journal.pone.0236363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022] Open
Abstract
Auditory steady-state responses (ASSRs) are states in which the electrical activity of the brain reacts steadily to repeated auditory stimuli. They are known to be useful for testing the functional integrity of neural circuits in the cortex, as well as for their capacity to generate synchronous activity in both human and animal models. Furthermore, abnormal gamma oscillations on ASSR are typically observed in patients with schizophrenia (SZ). Changes in neural synchrony may reflect aberrations in cortical gamma-aminobutyric acid (GABA) neurotransmission. However, GABA’s impact and effects related to ASSR are still unclear. Here, we examined the effect of a GABAa receptor antagonist, (+)-bicuculline, on ASSR in free-moving rats. (+)-Bicuculline (1, 2 and 4 mg/kg, sc) markedly and dose-dependently reduced ASSR signals, consistent with current hypotheses. In particular, (+)-bicuculline significantly reduced event-related spectral perturbations (ERSPs) at 2 and 4 mg/kg between 10 and 30 minutes post-dose. Further, bicuculline (2 and 4 mg/kg) significantly and dose-dependently increased baseline gamma power. Furthermore, the occurrence of convulsions was consistent with the drug’s pharmacokinetics. For example, high doses of (+)-bicuculline such as those greater than 880 ng/g in the brain induced convulsion. Additionally, time-dependent changes in ERSP with (+)-bicuculline were observed in accordance with drug concentration. This study partially unraveled the contribution of GABAa receptor signals to the generation of ASSR.
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Affiliation(s)
- Mayako Yamazaki
- Department of Neuroscience, Drug Discovery Research, Astellas Pharma Inc., Tsukuba-shi, Ibaraki, Japan
- * E-mail:
| | - Sokichi Honda
- Department of Neuroscience, Drug Discovery Research, Astellas Pharma Inc., Tsukuba-shi, Ibaraki, Japan
| | - Keisuke Tamaki
- Department of Neuroscience, Drug Discovery Research, Astellas Pharma Inc., Tsukuba-shi, Ibaraki, Japan
| | - Megumi Irie
- Analysis & Pharmacokinetics Research Labs., Drug Discovery Research, Astellas Pharma Inc., Tsukuba-shi, Ibaraki, Japan
| | - Takuma Mihara
- Department of Neuroscience, Drug Discovery Research, Astellas Pharma Inc., Tsukuba-shi, Ibaraki, Japan
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Patel P, Moshé SL. The evolution of the concepts of seizures and epilepsy: What's in a name? Epilepsia Open 2020; 5:22-35. [PMID: 32140641 PMCID: PMC7049807 DOI: 10.1002/epi4.12375] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022] Open
Abstract
This review aims to highlight the historical hallmarks in the development of the concepts of seizures and epilepsy. It begins with a discussion of seizure semiology and terminology, followed by the pathophysiology of seizures. We then discuss the definition of epilepsy, its etiologies, and ultimately classification schemes. Each section starts with our current views and subsequently transports the reader back in time to understand how these views evolved and came to be what they are today. People living as early as in the prehistoric times may have been aware of the existence of seizures, and descriptions and terminology have been provided as early as 2500 BC. While names have been revised and updated through time, the meanings are seemingly unchanged. However, it is clearly evident that we have come a long way in understanding the pathophysiology and etiology of seizures and epilepsy, thus leading to our current classification schemes. No classification scheme will be perfect yet, until our understanding is advanced enough to create one based predominantly on scientific grounds. The goal is that it is relevant to clinical practice, leading to a more precise diagnosis to guide targeted treatments.
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Affiliation(s)
- Puja Patel
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of NeurologyDepartment of Pediatrics and Comprehensive Einstein/Montefiore Epilepsy CenterAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNYUSA
| | - Solomon L. Moshé
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of NeurologyDepartment of Pediatrics and Comprehensive Einstein/Montefiore Epilepsy CenterAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNYUSA
- Dominic P. Purpura Department of Neuroscience and Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNYUSA
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12
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Chirchiglia D, Chirchiglia P. Epilepsy over the centuries: a disease survived at the time. Neurol Sci 2020; 41:1309-1313. [DOI: 10.1007/s10072-019-04214-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
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13
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Al-Eitan LN, Al-Dalalah IM, Mustafa MM, Alghamdi MA, Elshammari AK, Khreisat WH, Al-Quasmi MN, Aljamal HA. Genetic polymorphisms of CYP3A5, CHRM2, and ZNF498 and their association with epilepsy susceptibility: a pharmacogenetic and case-control study. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:225-233. [PMID: 31564953 PMCID: PMC6732506 DOI: 10.2147/pgpm.s212433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/22/2019] [Indexed: 01/30/2023]
Abstract
Background A total of 50 million persons were diagnosed worldwide with epilepsy. One-third of them are experiencing debilitating seizures despite optimum anti-epileptic drugs (AEDs) treatment. Several studies have suggested that CYP3A5, CHRM2, and ZNF498 influence the pharmacokinetics of AEDs. Therefore, the severity of the disease as well as the degree of response to the AEDs could be affected by the genetic polymorphisms within these genes. Objectives In this study, we assessed the effect of certain single nucleotide polymorphisms (SNPs) within CYP3A5, CHRM2, and ZNF498 genes on the susceptibility to develop epilepsy and the responsiveness to AEDs treatment. Methods A case-control and pharmacogenetic study was conducted on samples of 299 healthy individuals in addition to 296 epileptic patients. Genotypic, allelic, and clinical data association were performed for the selected polymorphisms within the (rs324649, rs420817, rs15524, and rs1859690) in the Jordanian population. Results The analysis revealed no significant association of the investigated SNPs with epilepsy in general, partial and generalized epilepsy as well as drug responsiveness. CYP3A5 and ZNF498 were associated with family history (P=0.003 and P=0.002, respectively) and the classification of epilepsy for the ZNF498 variant (P=0.009). On the other hand, CHRM2 was not linked to either disease severity or treatment responsiveness. Conclusion Our results failed to confirm the association of CYP3A5, ZNF498, and CHRM2 variants with either disease development or treatment response. Clinical pharmacogenetic studies may contribute to treatment personalization, appropriate drug dose selection, minimizing drug adverse reactions, increasing drug efficacy, and reducing the costive burdens.
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Affiliation(s)
- Laith N Al-Eitan
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan.,Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Islam M Al-Dalalah
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamed M Mustafa
- Department of Neuroscience, Jordan University of Science and Technology, Irbid, Jordan
| | - Mansour A Alghamdi
- Anatomy Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Afrah K Elshammari
- Department of Pediatric Neurology, Queen Rania Hospital for Children, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Wael H Khreisat
- Department of Pediatric Neurology, Queen Rania Hospital for Children, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Mohammed N Al-Quasmi
- Department of Medical Laboratory, King Abdullah University Hospital, Irbid, Jordan
| | - Hanan A Aljamal
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Musumeci T, Bonaccorso A, Puglisi G. Epilepsy Disease and Nose-to-Brain Delivery of Polymeric Nanoparticles: An Overview. Pharmaceutics 2019; 11:E118. [PMID: 30871237 PMCID: PMC6471219 DOI: 10.3390/pharmaceutics11030118] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 02/07/2023] Open
Abstract
Epilepsy is the fourth most common global neurological problem, which can be considered a spectrum disorder because of its various causes, seizure types, its ability to vary in severity and the impact from person to person, as well as its range of co-existing conditions. The approaches to drug therapy of epilepsy are directed at the control of symptoms by chronic administration of antiepileptic drugs (AEDs). These AEDs are administered orally or intravenously but alternative routes of administration are needed to overcome some important limits. Intranasal (IN) administration represents an attractive route because it is possible to reach the brain bypassing the blood brain barrier while the drug avoids first-pass metabolism. It is possible to obtain an increase in patient compliance for the easy and non-invasive route of administration. This route, however, has some drawbacks such as mucociliary clearance and the small volume that can be administered, in fact, only drugs that are efficacious at low doses can be considered. The drug also needs excellent aqueous solubility or must be able to be formulated using solubilizing agents. The use of nanomedicine formulations able to encapsulate active molecules represents a good strategy to overcome several limitations of this route and of conventional drugs. The aim of this review is to discuss the innovative application of nanomedicine for epilepsy treatment using nose-to-brain delivery with particular attention focused on polymeric nanoparticles to load drugs.
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Affiliation(s)
- Teresa Musumeci
- Department of Drug Sciences, University of Catania; V.le Andrea Doria, 6, 95125 Catania, Italy.
| | - Angela Bonaccorso
- Department of Drug Sciences, University of Catania; V.le Andrea Doria, 6, 95125 Catania, Italy.
| | - Giovanni Puglisi
- Department of Drug Sciences, University of Catania; V.le Andrea Doria, 6, 95125 Catania, Italy.
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15
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Siewe JFN, Ngarka L, Tatah G, Mengnjo MK, Nfor LN, Chokote ES, Boullé C, Nkouonlack C, Dema F, Nkoro GA, Njamnshi WY, Tabah EN, Zoung-Kanyi Bissek AC, Colebunders R, Njamnshi AK. Clinical presentations of onchocerciasis-associated epilepsy (OAE) in Cameroon. Epilepsy Behav 2019; 90:70-78. [PMID: 30513438 DOI: 10.1016/j.yebeh.2018.11.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND A high prevalence of epilepsy has been observed in several onchocerciasis-endemic countries, including Cameroon. However, little is known on the clinical presentations of the affected persons with epilepsy (PWE). A community-based study was conducted with the aim of describing the spectrum of seizures in selected onchocerciasis-endemic villages in Cameroon and documenting relevant medical history in patients with onchocerciasis-associated epilepsy (OAE). METHODS We carried out door-to-door surveys in 5 onchocerciasis-endemic villages in Cameroon and recruited all consenting PWE. Epilepsy was diagnosed using a 2-step approach consisting of the administration of a standardized 5-item questionnaire followed by confirmation of the suspected cases by a neurologist. Onchocerciasis-associated epilepsy was defined as ≥2 seizures without an obvious cause, starting between the ages of 3-18 years in previously healthy persons having resided for at least 3 years in an onchocerciasis-endemic area. Ivermectin use by PWE was verified. Seizure history, relevant past medical, and family history, as well as neurological findings, were noted. RESULTS In all, 156 PWE were recruited in the 5 villages. The modal age group for epilepsy onset was 10-14 years. The diagnostic criteria for OAE were met by 93.2% of the PWE. Participants had one or more of the following seizure types: generalized tonic-clonic seizures (89.1%), absences (38.5%), nodding (21.8%), focal nonmotor (7.7%), and focal motor seizures (1.9%). One case (0.6%) with the "Nakalanga syndrome" was identified. More than half (56.4%) of PWE had at least one seizure per month. In one village, 56.2% of PWE had onchocercal skin lesions. CONCLUSION People with epilepsy in onchocerciasis-endemic villages in Cameroon present with a wide clinical spectrum including nodding seizures and Nakalanga features. A great majority of participants met the diagnostic criteria for OAE, suggesting that better onchocerciasis control could prevent new cases. Epilepsy management algorithms in these areas must be adjusted to reflect the varied seizure types.
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Affiliation(s)
| | - Leonard Ngarka
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon
| | - Godwin Tatah
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon; Neurology Department, CH Saint Nazaire, France
| | - Michel K Mengnjo
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon
| | - Leonard N Nfor
- Neurology Department, Yaoundé Central Hospital, Cameroon; Neurology Department, CHU Brugmann, Belgium
| | - Eric S Chokote
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon
| | - Charlotte Boullé
- Institut de Recherche pour le Développement, UMI 233-Inserm U1175-Montpellier University, France
| | | | | | - Grace A Nkoro
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon
| | - Wepnyu Y Njamnshi
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon; Faculty of Science and Medicine, University of Fribourg, Switzerland
| | | | | | | | - Alfred K Njamnshi
- Neurology Department, Yaoundé Central Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon.
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16
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Yee AS, Tharakan J, Idris Z, Bhaskar S, Halim SA, Razak SA, Hussin ZAM, Kandasamy R, Hassan WMNW, Mukmin L, Hassan MH, Chin TY, Idris B, Ghani ARI, Pal HK, George J, Sayuthi S, Awang MS, Abdullah JM. Epilepsy Surgery in Hospital Universiti Sains Malaysia: Our Experiences since 2004. Malays J Med Sci 2018; 24:97-102. [PMID: 29379392 DOI: 10.21315/mjms2017.24.6.12] [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: 08/06/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022] Open
Abstract
Epilepsy surgery has been performed by a few centres in Malaysia, including Hospital Universiti Sains Malaysia (HUSM). To date, a total of 15 patients have undergone epilepsy surgery in HUSM. The epilepsy surgery included anterior temporal lobectomy (ATL) with amygdalohippocampectomy (AH) and Vagal nerve stimulation (VNS). The surgical outcomes of the patients were assessed using the International League Against Epilepsy (ILAE) outcome scale. The ILAE scores for patients who underwent ATL with AH were comparatively better than those who underwent VNS. One of the patient who underwent ATL with AH and frontal lesionectomy was found to have psychosis during follow up. Epilepsy surgery has proven to be an important treatment for medically resistant epilepsy. Thus it is important to raise public awareness regarding epilepsy and its treatment.
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Affiliation(s)
- Ang Song Yee
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - John Tharakan
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Shalini Bhaskar
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Sanihah Abdul Halim
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Salmi Abd Razak
- Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zabidi Azhar Mohd Hussin
- Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Regunath Kandasamy
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Nazaruddin Wan Hassan
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Laila Mukmin
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohamad Hasyizan Hassan
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Tan Yew Chin
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Badrisyah Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Abdul Rahman Izaini Ghani
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Hillol Kanti Pal
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Jain George
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Sani Sayuthi
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohamed Saufi Awang
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
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17
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Tao H, Zhao J, Zhou X, Ma Z, Chen Y, Sun F, Cui L, Zhou H, Cai Y, Chen Y, Zhao S, Yao L, Zhao B, Li K. Promoter Variants of the ADAM10 Gene and Their Roles in Temporal Lobe Epilepsy. Front Neurol 2016; 7:108. [PMID: 27445971 PMCID: PMC4928100 DOI: 10.3389/fneur.2016.00108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/22/2016] [Indexed: 12/31/2022] Open
Abstract
Previous evidence has indicated that downregulated ADAM10 gives rise to epileptic seizures in Alzheimer's disease, and this study investigated the association of ADAM10 with temporal lobe epilepsy (TLE) from a genetic perspective. A total of 496 TLE patients and 528 healthy individuals were enrolled and genotyped for ADAM10 promoter variants (rs653765 G > A and rs514049 A > C). The alleles, genotypes, and haplotypes were then compared with clarify the association of these variants with TLE and their impacts upon age at onset, initial seizure types before treatments, and responses to drug treatments. In cohorts I, II, and I + II, the frequencies of the A allele and AA genotype at rs514049 were consistently increased in the cases compared with the controls (p = 0.020 and p = 0.009; p = 0.008 and p = 0.009; p = 0.000 and p = 0.000; q = 0.003 and q = 0.002, respectively). In contrast, the frequency of the AC haplotype (rs653765-rs514049) decreased in cohorts I + II (p = 0.013). Further analyses of the TLE patients indicated that the AA genotype functioned as a predisposing factor to drug-resistant TLE and the AC haplotype as a protective factor against generalized tonic-clonic seizures (GTCS) and drug-resistant TLE. This study is the first to demonstrate an association of the ADAM10 promoter variants with TLE. In particular, the AA genotype and AC haplotype showed their effects upon GTCS and drug-resistant TLE.
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Affiliation(s)
- Hua Tao
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China; Guangdong Key Laboratory of Age-related Cardiac and Cerebral Diseases, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Jianghao Zhao
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China; Guangdong Key Laboratory of Age-related Cardiac and Cerebral Diseases, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xu Zhou
- Clinical Research Center, Guangdong Medical University , Zhanjiang, Guangdong , China
| | - Zhonghua Ma
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University , Beijing , China
| | - Ying Chen
- Department of Neurology, Central People's Hospital of Zhanjiang , Zhanjiang, Guangdong , China
| | - Fuhai Sun
- Department of Neurology, The First People's Hospital of Pingdingshan , Pingdingshan, Hebei , China
| | - Lili Cui
- Guangdong Key Laboratory of Age-related Cardiac and Cerebral Diseases, Guangdong Medical University , Zhanjiang, Guangdong , China
| | - Haihong Zhou
- Department of Neurology, Affiliated Hospital of Guangdong Medical University , Zhanjiang, Guangdong , China
| | - Yujie Cai
- Guangdong Key Laboratory of Age-related Cardiac and Cerebral Diseases, Guangdong Medical University , Zhanjiang, Guangdong , China
| | - Yanyan Chen
- Guangdong Key Laboratory of Age-related Cardiac and Cerebral Diseases, Guangdong Medical University , Zhanjiang, Guangdong , China
| | - Shu Zhao
- Department of Neurology, Affiliated Hospital of Guangdong Medical University , Zhanjiang, Guangdong , China
| | - Lifen Yao
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University , Harbin, Heilongjiang , China
| | - Bin Zhao
- Guangdong Key Laboratory of Age-related Cardiac and Cerebral Diseases, Guangdong Medical University , Zhanjiang, Guangdong , China
| | - Keshen Li
- Guangdong Key Laboratory of Age-related Cardiac and Cerebral Diseases, Guangdong Medical University, Zhanjiang, Guangdong, China; Jinan University, Guangzhou, Guangdong, China
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18
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Mahmoudi Nezhad GS, Dalfardi B. Henri Gastaut (1915-1995). J Neurol 2015; 262:1999-2000. [PMID: 25929668 DOI: 10.1007/s00415-015-7765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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