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Okanishi T, Akiyama T, Mayo E, Honda Y, Ueda-Kawada C, Nakajima M, Homma Y, Ochi A, Go C, Widjaja E, Chuang SH, Rutka JT, Drake J, Snead OC, Otsubo H. Magnetoencephalography spike sources interrelate the extensive epileptogenic zone of tuberous sclerosis complex. Epilepsy Res 2016; 127:302-310. [PMID: 27693986 DOI: 10.1016/j.eplepsyres.2016.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/16/2016] [Accepted: 09/05/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We hypothesized that the extensive epileptic network in patients with tuberous sclerosis complex (TSC) manifests as clustered and scattered distributions of magnetoencephalography spike sources (MEGSS). METHODS We retrospectively analyzed pre-surgical MEG in 15 patients with TSC. We performed single moving dipole analysis to localize and classify clustered and scattered MEGSS. We compared the number of electrodes within the resected area (RA) and the proportions of clustered and scattered MEGSS within RA with the seizure outcome. RESULTS The number of electrodes within RA ranged from 29 to 83 (mean=51). The MEGSS were distributed over multiple lobes (3-8; mean=5.9) and bilaterally in 14 patients. Clusters of MEGSS ranged from 1 to 4 (mean=1.4). The number of MEGSS ranged in total from 28 to 139 (mean=70); in the clusters, 10-128 (mean=49); and in the scatters, 0-45 (mean=21). Four patients achieved an Engel class I surgical outcome, four, a class II outcome; five, a class III outcome; and two, a class IV outcome. The proportion of MEGSS ranged in total from 0 to 92% (mean=57%) within RA; 0-100% (mean=67%) in the resection hemisphere; 0-100% (mean=63%) in the clusters; and 0-81% (mean=28%) in the scatters. Univariate ordinal logistic regression analyses showed that the proportion of scattered MEGSS within RA (p=0.049) significantly correlated with seizure outcomes. Multivariate analyses using three covariates (number of electrodes, proportions of clustered and scattered MEGSS within RA) showed that only the proportion of scattered MEGSS within RA significantly correlated with seizure outcomes (p=0.016). SIGNIFICANCE MEG data showed a wide distribution of multilobar MEGSS in patients with TSC. The seizure outcome was not related to the clustered MEGSS within RA, since the grids were essentially planned to cover and resect the clustered MEGSS surrounding tubers. The maximal possible resection of scattered MEGSS correlated with improved seizure outcome in TSC. Some parts of the epileptogenic zone disrupted by multiple tubers did not have a sufficiently large area to produce clustered MEGSS. Although the wide distribution of scattered MEGSS is not interpreted as epileptogenic, they might be interrelated with clustered MEGSS to project a complex epilepsy network and be part of the extensive epileptogenic zones found in TSC.
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Affiliation(s)
- Tohru Okanishi
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada.
| | - Tomoyuki Akiyama
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada; Department of Child Neurology, Okayama University Hospital, PO Box 700, 0914 Okayama, Japan
| | - Ellen Mayo
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Yasunori Honda
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Chihiro Ueda-Kawada
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Midori Nakajima
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei-Hamamatsu General Hospital, PO Box 430, 8558, Hamamatsu, Shizuoka, Japan
| | - Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Cristina Go
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Division of Diagnostic Imaging, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Sylvester H Chuang
- Division of Diagnostic Imaging, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - James Drake
- Division of Neurosurgery, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
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2
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Hsieh DT, Whiteway SL, Rohena LO, Thiele EA. Tuberous sclerosis complex: Five new things. Neurol Clin Pract 2016; 6:339-347. [PMID: 29443126 DOI: 10.1212/cpj.0000000000000260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose of review Tuberous sclerosis complex (TSC) is a variably expressed neurocutaneous genetic disorder characterized by hamartomatous growths in multiple organ systems. Neurologic involvement often confers the most severe symptoms, and can include epilepsy, increased intracranial pressure from hydrocephalus, intellectual deficits, and autism. The purpose of this review is to provide a neurologically focused update in the diagnosis and treatment of these complications in patients with TSC. Recent findings We highlight 5 new areas of understanding in TSC: the neurobiology of TSC and its translation into clinical practice, vigabatrin in the treatment of infantile spasms, the role of tubers and epilepsy surgery, the treatment of subependymal giant cell astrocytomas, and TSC-related neuropsychiatric disorders. Summary These recent advances in diagnosis and treatment give our patients with TSC and their families hope for the future for improved care and possible preventive cures, to the end goal of improving quality of life.
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Affiliation(s)
- David T Hsieh
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
| | - Susan L Whiteway
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
| | - Luis O Rohena
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
| | - Elizabeth A Thiele
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
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3
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Lozovaya N, Gataullina S, Tsintsadze T, Tsintsadze V, Pallesi-Pocachard E, Minlebaev M, Goriounova NA, Buhler E, Watrin F, Shityakov S, Becker AJ, Bordey A, Milh M, Scavarda D, Bulteau C, Dorfmuller G, Delalande O, Represa A, Cardoso C, Dulac O, Ben-Ari Y, Burnashev N. Selective suppression of excessive GluN2C expression rescues early epilepsy in a tuberous sclerosis murine model. Nat Commun 2014; 5:4563. [PMID: 25081057 PMCID: PMC4143949 DOI: 10.1038/ncomms5563] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/30/2014] [Indexed: 01/06/2023] Open
Abstract
Tuberous sclerosis complex (TSC), caused by dominant mutations in either
TSC1 or
TSC2 tumour
suppressor genes is characterized by the presence of brain malformations, the
cortical tubers that are thought to contribute to the generation of
pharmacoresistant epilepsy. Here we report that tuberless heterozygote
Tsc1+/− mice show
functional upregulation of cortical GluN2C-containing N-methyl-D-aspartate receptors (NMDARs) in an
mTOR-dependent manner and exhibit recurrent, unprovoked seizures during early
postnatal life (<P19). Seizures are generated intracortically in the granular
layer of the neocortex. Slow kinetics of aberrant GluN2C-mediated currents in spiny stellate cells promotes
excessive temporal integration of persistent NMDAR-mediated recurrent excitation and
seizure generation. Accordingly, specific GluN2C/D antagonists block seizures in Tsc1+/− mice in vivo
and in vitro. Likewise, GluN2C expression is upregulated in TSC human surgical
resections, and a GluN2C/D
antagonist reduces paroxysmal hyperexcitability. Thus, GluN2C receptor constitutes a promising
molecular target to treat epilepsy in TSC patients. Tuberous sclerosis complex (TSC) is a rare genetic condition
characterized by epileptic seizures that start in infancy. Here, the authors show that
these seizures are modulated by GluN2C-containing NMDA receptors in the cortex of a
mouse model of TSC, and that suppressing their activity attenuates seizures.
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Affiliation(s)
- N Lozovaya
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France [3] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [4]
| | - S Gataullina
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France [3] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [4]
| | - T Tsintsadze
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France [3]
| | - V Tsintsadze
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - E Pallesi-Pocachard
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - M Minlebaev
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France [3] Laboratory of Neurobiology, Kazan Federal University, Kremlevskaya street 18, 420000 Kazan, Russia
| | - N A Goriounova
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - E Buhler
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - F Watrin
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - S Shityakov
- Department of Anaesthesia and Critical Care, University of Würzburg, Josef-Schneider-Street 2, 97080 Würzburg, Germany
| | - A J Becker
- Department of Neuropathology, University of Bonn Medical Center, Sigmund Freud Street 25, D-53105 Bonn, Germany
| | - A Bordey
- Neurosurgery, and Cellular and Molecular Physiology Departments, Yale University School of Medicine, PO Box 208082, New Haven, Connecticut 06520-8082, USA
| | - M Milh
- APHM, Department of Pediatric Neurosurgery and Neurology, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, France
| | - D Scavarda
- APHM, Department of Pediatric Neurosurgery and Neurology, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, France
| | - C Bulteau
- 1] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [2] Department of Pediatric Neurosurgery, Foundation Rothschild, 29 Rue Manin, 75019 Paris, France
| | - G Dorfmuller
- 1] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [2] Department of Pediatric Neurosurgery, Foundation Rothschild, 29 Rue Manin, 75019 Paris, France
| | - O Delalande
- Department of Pediatric Neurosurgery, Foundation Rothschild, 29 Rue Manin, 75019 Paris, France
| | - A Represa
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - C Cardoso
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - O Dulac
- 1] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [2] Department of Pediatric Neurosurgery, Foundation Rothschild, 29 Rue Manin, 75019 Paris, France [3] APHP, Necker Hospital, 149 Rue de Sèvres, 75015 Paris, France
| | - Y Ben-Ari
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - N Burnashev
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
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4
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Giannantoni NM, Restuccia D, Della Marca G, Alfano RM, Vollono C. A novel TSC2 mutation causing tuberless tuberous sclerosis. Seizure 2014; 23:580-2. [PMID: 24794161 DOI: 10.1016/j.seizure.2014.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/03/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Domenico Restuccia
- Institute of Neurology, Unit of Neurophysiology and Sleep Medicine, Catholic University, Rome, Italy
| | - Giacomo Della Marca
- Institute of Neurology, Unit of Neurophysiology and Sleep Medicine, Catholic University, Rome, Italy
| | - Rosa Maria Alfano
- Unit of Human Pathology, Department of Health Science San Paolo Hospital, Milan, Italy
| | - Catello Vollono
- Institute of Neurology, Unit of Neurophysiology and Sleep Medicine, Catholic University, Rome, Italy
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5
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Hunold A, Haueisen J, Ahtam B, Doshi C, Harini C, Camposano S, Warfield SK, Grant PE, Okada Y, Papadelis C. Localization of the epileptogenic foci in tuberous sclerosis complex: a pediatric case report. Front Hum Neurosci 2014; 8:175. [PMID: 24723876 PMCID: PMC3972469 DOI: 10.3389/fnhum.2014.00175] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/10/2014] [Indexed: 12/20/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare disorder of tissue growth and differentiation, characterized by benign hamartomas in the brain and other organs. Up to 90% of TSC patients develop epilepsy and 50% become medically intractable requiring resective surgery. The surgical outcome of TSC patients depends on the accurate identification of the epileptogenic zone consisting of tubers and the surrounding epileptogenic tissue. There is conflicting evidence whether the epileptogenic zone is in the tuber itself or in abnormally developed surrounding cortex. Here, we report the localization of the epileptiform activity among the many cortical tubers in a 4-year-old patient with TSC-related refractory epilepsy undergoing magnetoencephalography (MEG), electroencephalography (EEG), and diffusion tensor imaging (DTI). For MEG, we used a prototype system that offers higher spatial resolution and sensitivity compared to the conventional adult systems. The generators of interictal activity were localized using both EEG and MEG with equivalent current dipole (ECD) and minimum norm estimation (MNE) methods according to the current clinical standards. For DTI, we calculated four diffusion scalar parameters for the fibers passing through four ROIs defined: (i) at a large cortical tuber identified at the right quadrant, (ii) at the normal appearing tissue contralateral to the tuber, (iii) at the cluster formed by ECDs fitted at the peak of interictal spikes, and (iv) at the normal appearing tissue contralateral to the cluster. ECDs were consistently clustered at the vicinity of the large calcified cortical tuber. MNE and ECDs indicated epileptiform activity in the same areas. DTI analysis showed differences between the scalar values of the tracks passing through the tuber and the ECD cluster. In this illustrative case, we provide evidence from different neuroimaging modalities, which support the view that epileptiform activity may derive from abnormally developed tissue surrounding the tuber rather than the tuber itself.
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Affiliation(s)
- Alexander Hunold
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology , Ilmenau , Germany
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology , Ilmenau , Germany
| | - Banu Ahtam
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Newborn Medicine, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Chiran Doshi
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Chellamani Harini
- Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Susana Camposano
- Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Patricia Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Newborn Medicine, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Radiology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Yoshio Okada
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Christos Papadelis
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
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6
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Abstract
Tuberous Sclerosis Complex (TSC) is an autosomal dominant multisystem disorder, characterized by the presence of hamartomatous lesions involving different organ systems, including the brain. Epilepsy is the most common presenting symptom, representing a major source of morbidity and mortality. Despite multiple antiepileptic drug combinations, in about two thirds of cases the patients present high-frequency drug-resistant epilepsy, and nonpharmacologic options may be considered. The aim of this work was to point out the current knowledge on epileptogenesis in TSC, the available medical therapies and diagnostic tools, and possible surgical strategies, with the intent to better understand the actual difficulties in controlling seizures and the results reported in the literature. There is also a section dedicated to the common association with cognitive impairment and the role of epilepsy control on its outcome.
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Affiliation(s)
- Federica Novegno
- Department of Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy.
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7
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Affiliation(s)
- Paolo Curatolo
- Department of Neuroscience, Pediatric Neurology Unit, Tor Vergata University of Rome, Rome, Italy
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8
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Epilepsy secondary to tuberous sclerosis: lessons learned and current challenges. Childs Nerv Syst 2010; 26:1495-504. [PMID: 20358377 DOI: 10.1007/s00381-010-1128-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND In tuberous sclerosis complex (TSC), a substantially increased risk of developing epilepsy is present as a result of a disruption of a TSC gene expression in the brain and secondary abnormal cellular differentiation, migration, and proliferation. Dysregulated excitation probably has its roots in the disruption of GABAergic interneuron development. There is an age-dependent electroclinical expression of seizures, and epilepsy is often quite severe and unremitting. DISCUSSION The majority of patients (>60%) who are candidates for surgery remain seizure-free after tuberectomy. During the recent years technical advances in the localization of the epileptogenic zone during the recent years have lead to a 63% of Engel class I status after surgery compared with a previous 52%. In medically refractory patients not suitable for surgery, vagus nerve stimulation has proved efficacy in significantly reducing seizure frequency in more than 50% of cases. New evidence suggests that mTOR inhibitors may be helpful in the management of intractable epilepsy for individuals with TSC.
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Curatolo P, Moavero R. Tubers, epileptogenic foci, and epileptogenic networks in tuberous sclerosis. Epilepsia 2010; 51:2357-9. [DOI: 10.1111/j.1528-1167.2010.02713.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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10
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Current World Literature. Curr Opin Neurol 2010; 23:194-201. [DOI: 10.1097/wco.0b013e328338cade] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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