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Parnes M. Reply to: "Susceptibility-Weighted Imaging Reveals Subcortical Iron Deposition in PLAN: The "Double Cortex Sign"". Mov Disord 2023; 38:1973. [PMID: 37885407 DOI: 10.1002/mds.29592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Mered Parnes
- Pediatric Movement Disorders Clinic, Section of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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2
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Roeben B, Zeltner L, Hagberg GE, Scheffler K, Schöls L, Bender B. Reply to: "Susceptibility-Weighted Imaging Reveals Subcortical Iron Deposition in PLAN: The 'Double Cortex Sign'". Mov Disord 2023; 38:1973-1974. [PMID: 37885406 DOI: 10.1002/mds.29591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Benjamin Roeben
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Research Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Lena Zeltner
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Center of Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Gisela E Hagberg
- High Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Biomedical Magnetic Resonance, Eberhard Karl's University, Tübingen and University Hospital, Tübingen, Germany
| | - Klaus Scheffler
- High Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Biomedical Magnetic Resonance, Eberhard Karl's University, Tübingen and University Hospital, Tübingen, Germany
| | - Ludger Schöls
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Research Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
- Center of Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
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Kurzbuch AR, Cooper B, Israni A, Ellenbogen JR. Non-pharmacological treatment options of drug-resistant epilepsy in subcortical band heterotopia: systematic review and illustrative case. Childs Nerv Syst 2023; 39:451-462. [PMID: 35933521 DOI: 10.1007/s00381-022-05638-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Subcortical band heterotopia is a rare X-linked neuronal migration disorder primarily in females often associated with drug-resistant epilepsy. The aim of this study is to review the literature for non-pharmacological treatment options of drug-resistant epilepsy in subcortical band heterotopia. MATERIAL AND METHODS In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review. Entering the keywords "double cortex," "subcortical band heterotopia," and "subcortical laminar heterotopia," we searched Scopus and PubMed databases. We paid particular attention to type of invasive and non-invasive treatment, radiological presentation, and outcome. We also describe a related case report, managed at Alder Hey Children's Hospital, Liverpool. RESULTS The systematic literature review yielded 25 patients with subcortical band heterotopia and drug-resistant epilepsy who underwent non-pharmacological treatment. Including our patient, 26 patients were reported. The patients' mean age at seizure onset was 6.5 years (range 0.2-23) with a female sex predilection (5.25:1). The patients' mean age at invasive or non-invasive treatment was 21.5 years (range 6.5-51). The 26 patients underwent 29 non-pharmacological treatments. Ten patients underwent corpus callosotomy; 8 patients had a formal temporal lobectomy. Three patients had focal cortical resection. Two patients respectively had multiple subpial transections, insertion of a vagal nerve stimulator, or deep brain stimulation of the bilateral anterior nuclei of the thalamus. One patient underwent responsive focal neurostimulation. Another patient had transcutaneous stimulation of the vagal nerve. Sixteen patients reported a reduction or the disappearance of the seizures; 1 patient had no improvement. The outcome of 2 patients was classified class I, of 1 patient class II, of 1 patient class III, and of 5 patients class IV according to the Engel Epilepsy Surgery Outcome Scale. CONCLUSION Mainly corpus callosotomy and formal temporal lobectomy have been performed as non-pharmacological treatment with few cases published overall. Several other invasive procedures and one non-invasive technique are based on case reports. The small number of reported cases prevents drawing a firm conclusion as to which non-pharmacological treatment is the best treatment option for refractive epilepsy in patients with subcortical band heterotopia.
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Affiliation(s)
- Arthur R Kurzbuch
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - Ben Cooper
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Anil Israni
- Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jonathan R Ellenbogen
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Matsuhashi A, Matsuo T, Kumada S. Incremental changes in interhemispheric functional connectivity after two-stage corpus callosotomy in a patient with subcortical band heterotopia. Epilepsy Behav Rep 2022; 18:100525. [PMID: 35146404 PMCID: PMC8818921 DOI: 10.1016/j.ebr.2022.100525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Coherence calculated from scalp EEG may be utilized to evaluate functional connectivity. Functional connectivity decreased stepwise after anterior/posterior callosotomy. Correlation was seen between functional connectivity and seizure frequency change. Functional connectivity may reflect seizure outcome of callosotomy. Corpus callosotomy (CC) has been reported to be effective in reducing generalized seizures in patients with drug-resistant epilepsies. However, efficacy is measured only by seizure frequency, without any electrophysiological guidance. Herein, we conducted a quantitative analysis of interhemispheric functional connectivity using inter-electrode coherence of scalp electroencephalogram (EEG) in a clinical case of subcortical band heterotopia to evaluate its relationship with seizure frequency. In our case, seizure frequency decreased significantly after posterior CC but not after anterior CC. Inter-electrode coherence also decreased after posterior CC, suggesting it correlated with seizure frequency. This case study supports the use of inter-electrode coherence as an electrophysiological tool that is useful as predictive factor in evaluating the effectiveness of CC.
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Affiliation(s)
- Ako Matsuhashi
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-shi, Tokyo 183-0042, Japan
| | - Takeshi Matsuo
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-shi, Tokyo 183-0042, Japan
- Corresponding author.
| | - Satoko Kumada
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-shi, Tokyo 183-0042, Japan
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Gilliam FG, Ssentongo P, Sather M, Kawasawa YI. Case Report: PAFAH1B1 Mutation and Posterior Band Heterotopia With Focal Temporal Lobe Epilepsy Treated by Responsive Neurostimulation. Front Neurol 2021; 12:779113. [PMID: 34867768 PMCID: PMC8636682 DOI: 10.3389/fneur.2021.779113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/21/2021] [Indexed: 11/14/2022] Open
Abstract
Subcortical band heterotopia (SBH), also known as double cortex syndrome, is a malformation of cortical development caused by inherited or somatic gene variants. We present a case of a young adult with posterior SBH and electroclinical features of focal neocortical temporal lobe epilepsy. Genomic blood analysis identified a pathogenic somatic mosaicism duplication variant of the PAFAH1B1 gene. Despite bilateral cortical MRI abnormalities, the interictal and ictal EEG findings indicated a focal epileptogenic region in the left posterior temporal region. Chronic responsive cortical neurostimulation across two four-contact depth electrodes placed 5 mm on either side of the maximal interictal spiking identified during intraoperative electrocorticography resulted in a consistent 28% reduction in duration of electrographic seizures and as well as constricted propagation. Although electrographic seizures continued, the family reported no clinical seizures and a marked improvement in resistant behaviors. This observation supports that focal neocortical neuromodulation can control clinical seizures of consistently localized origin despite genetic etiology, bilateral structural brain abnormalities, and continuation of non-propagating electrographic seizures. We propose that a secondary somatic mutation may be the cause of the focal neocortical temporal lobe epilepsy.
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Affiliation(s)
- Frank G Gilliam
- Department of Neurology, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Paddy Ssentongo
- Department of Engineering Science and Mechanics, Penn State University, Hershey, PA, United States.,Department of Public Health Sciences, Penn State University, Hershey, PA, United States
| | - Michael Sather
- Department of Neurosurgery, Penn State University, Hershey, PA, United States
| | - Yuka I Kawasawa
- Department of Pharmacology and Biochemistry and Molecular Biology, Penn State University, Hershey, PA, United States
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Mahmud R. Subcortical Band Heterotopia Presented With Refractory Epilepsy and Reversible Aphasia. Cureus 2021; 13:e16990. [PMID: 34540393 PMCID: PMC8422252 DOI: 10.7759/cureus.16990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/11/2022] Open
Abstract
Subcortical band heterotopia (SBH) is a rare neurodevelopmental disorder due to mutation in the DCX or LIS1 gene. It is predominantly a disease of females. Its presentation varied widely, ranging from mild epilepsy and mental retardation to refractory epilepsy and severe mental retardation. Here, a case of a 22-year-old lady with refractory seizure is reported. She also had expressive aphasia which had reversed after adjustment of the anti-epileptic drugs and control of the seizure. Her MRI of the brain revealed a band of complete gray matter deep to the pachygyric cortex and an electroencephalogram (EEG) revealed bi-frontal slow waves.
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Affiliation(s)
- Reaz Mahmud
- Neurology, Dhaka Medical College, Dhaka, BGD
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Sahu S, Buhler E, Vermoyal JC, Watrin F, Represa A, Manent JB. Spontaneous epileptiform activity in a rat model of bilateral subcortical band heterotopia. Epilepsia 2018; 60:337-348. [PMID: 30597542 PMCID: PMC7027481 DOI: 10.1111/epi.14633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/20/2018] [Accepted: 12/07/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Malformations of cortical development are common causes of intellectual disability and epilepsy, yet there is a crucial lack of relevant preclinical models associating seizures and cortical malformations. Here, we describe a novel rat model with bilateral subcortical band heterotopia (SBH) and examine whether this model develops spontaneous epileptic seizures. METHODS To generate bilateral SBH in rats, we combined RNAi-mediated knockdown of Dcx and in utero electroporation with a tripolar electrode configuration enabling simultaneous transfection of the two brain hemispheres. To determine whether bilateral SBH leads to epileptiform activity, rats of various ages were implanted for telemetric electrocorticographic recordings and histopathological examination was carried out at the end of the recording sessions. RESULTS By 2 months, rats with bilateral SBH showed nonconvulsive spontaneous seizures consisting of spike-and-wave discharges (SWDs) with dominant frequencies in the alpha and theta bands and secondarily in higher-frequency bands. SWDs occurred during both the dark and the light period, but were more frequent during quiet awake state than during sleep. Also, SWDs were more frequent and lasted longer at older ages. No sex differences were found. Although frequencies and durations of SWDs were found to be uncorrelated with the size of SBH, SWDs were initiated in some occasions from brain hemispheres comprising a larger SBH. Lastly, SWDs exhibited absence-like pharmacological properties, being temporarily alleviated by ethosuximide administration. SIGNIFICANCE This novel model of bilateral SBH with spontaneous epilepsy may potentially provide valuable new insights into causality between cortical malformations and seizures, and help translational research aiming at designing novel treatment strategies for epilepsy.
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Affiliation(s)
- Surajit Sahu
- Neurobiology Institute of the Mediterranean (INMED), Aix-Marseille University, French National Institute of Health and Medical Research (INSERM) UMR1249, Marseille, France
| | - Emmanuelle Buhler
- Neurobiology Institute of the Mediterranean (INMED), Aix-Marseille University, French National Institute of Health and Medical Research (INSERM) UMR1249, Marseille, France
| | - Jean-Christophe Vermoyal
- Neurobiology Institute of the Mediterranean (INMED), Aix-Marseille University, French National Institute of Health and Medical Research (INSERM) UMR1249, Marseille, France
| | - Françoise Watrin
- Neurobiology Institute of the Mediterranean (INMED), Aix-Marseille University, French National Institute of Health and Medical Research (INSERM) UMR1249, Marseille, France
| | - Alfonso Represa
- Neurobiology Institute of the Mediterranean (INMED), Aix-Marseille University, French National Institute of Health and Medical Research (INSERM) UMR1249, Marseille, France
| | - Jean-Bernard Manent
- Neurobiology Institute of the Mediterranean (INMED), Aix-Marseille University, French National Institute of Health and Medical Research (INSERM) UMR1249, Marseille, France
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Tan AP, Chong WK, Mankad K. Comprehensive genotype-phenotype correlation in lissencephaly. Quant Imaging Med Surg 2018; 8:673-693. [PMID: 30211035 DOI: 10.21037/qims.2018.08.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Malformations of cortical development (MCD) are a heterogenous group of disorders with diverse genotypic and phenotypic variations. Lissencephaly is a subtype of MCD caused by defect in neuronal migration, which occurs between 12 and 24 weeks of gestation. The continuous advancement in the field of molecular genetics in the last decade has led to identification of at least 19 lissencephaly-related genes, most of which are related to microtubule structural proteins (tubulin) or microtubule-associated proteins (MAPs). The aim of this review article is to bring together current knowledge of gene mutations associated with lissencephaly and to provide a comprehensive genotype-phenotype correlation. Illustrative cases will be presented to facilitate the understanding of the described genotype-phenotype correlation.
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Affiliation(s)
- Ai Peng Tan
- Department of Diagnostic Imaging, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Wui Khean Chong
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Abstract
The genetic generalized epilepsies (GGEs) are mainly genetically determined disorders. Although inheritance in most cases appears to be complex, involving multiple genes, variants of a number of genes are known to contribute. Pathogenic variants of SLC2A1 leading to autosomal-dominant GLUT1 deficiency account for up to 1% of cases, increasing to 10% of those with absence seizures starting before age 4 years. Copy number variants are found in around 3% of cases, acting as risk alleles. Copy number variation is much more common in those with comorbid learning disability. Common variant associations are starting to emerge from genome-wide association studies but do not yet explain a large proportion of GGEs. Although currently genetic testing is not likely to yield a diagnosis for most patients with GGEs, it can be of great importance in specific clinical situations. Providers should consider the individual patient's history in determining the utility of genetic testing.
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Affiliation(s)
- Saul A Mullen
- Epilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Vic., Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Vic., Australia
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10
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Pittau F, Ferri L, Fahoum F, Dubeau F, Gotman J. Contributions of EEG-fMRI to Assessing the Epileptogenicity of Focal Cortical Dysplasia. Front Comput Neurosci 2017; 11:8. [PMID: 28265244 PMCID: PMC5316536 DOI: 10.3389/fncom.2017.00008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/02/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose: To examine the ability of the BOLD response to EEG spikes to assess the epileptogenicity of the lesion in patients with focal cortical dysplasia (FCD). Method: Patients with focal epilepsy and FCD who underwent 3T EEG-fMRI from 2006 to 2010 were included. Diagnosis of FCD was based on neuroradiology (MRI+), or histopathology in MRI-negative cases (MRI−). Patients underwent 120 min EEG-fMRI recording session. Spikes similar to those recorded outside the scanner were marked in the filtered EEG. The lesion (in MRI+) or the removed cortex (in MRI−) was marked on the anatomical T1 sequence, blindly to the BOLD response, after reviewing the FLAIR images. For each BOLD response we assessed the concordance with the spike field and with the lesion in MRI+ or the removed cortex in MRI−. BOLD responses were considered “concordant” if the maximal t-value was inside the marking. Follow-up after resection was used as gold-standard. Results: Twenty patients were included (13 MRI+, 7 MRI−), but in seven the EEG was not active or there were artifacts during acquisition. In all 13 studied patients, at least one BOLD response was concordant with the spike field; in 9/13 (69%) at least one BOLD response was concordant with the lesion: in 6/7 (86%) MRI+ and in 3/6 (50%) MRI− patients. Conclusions: Our study shows a high level of concordance between FCD and BOLD response. This data could provide useful information especially for MRI negative patients. Moreover, it shows in almost all FCD patients, a metabolic involvement of remote cortical or subcortical structures, corroborating the concept of epileptic network.
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Affiliation(s)
- Francesca Pittau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill UniversityQuébec, QC, Canada; Neurology Department, Geneva University HospitalsGeneva, Switzerland
| | - Lorenzo Ferri
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Québec, QC, Canada
| | - Firas Fahoum
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Québec, QC, Canada
| | - François Dubeau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Québec, QC, Canada
| | - Jean Gotman
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Québec, QC, Canada
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11
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Kim EH, Ko TS. Cognitive impairment in childhood onset epilepsy: up-to-date information about its causes. KOREAN JOURNAL OF PEDIATRICS 2016; 59:155-64. [PMID: 27186225 PMCID: PMC4865638 DOI: 10.3345/kjp.2016.59.4.155] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/02/2015] [Accepted: 11/16/2015] [Indexed: 11/27/2022]
Abstract
Cognitive impairment associated with childhood-onset epilepsy is an important consequence in the developing brain owing to its negative effects on neurodevelopmental and social outcomes. While the cause of cognitive impairment in epilepsy appears to be multifactorial, epilepsy-related factors such as type of epilepsy and underlying etiology, age at onset, frequency of seizures, duration of epilepsy, and its treatment are considered important. In recent studies, antecedent cognitive impairment before the first recognized seizure and microstructural and functional alteration of the brain at onset of epilepsy suggest the presence of a common neurobiological mechanism between epilepsy and cognitive comorbidity. However, the overall impact of cognitive comorbidity in children with epilepsy and the independent contribution of each of these factors to cognitive impairment have not been clearly delineated. This review article focuses on the significant contributors to cognitive impairment in children with epilepsy.
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Affiliation(s)
- Eun-Hee Kim
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Tae-Sung Ko
- Division of Pediatric Neurology, Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea
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12
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Are Ectopic Neurons a Red Herring in Localizing Seizure Foci? Epilepsy Curr 2015; 15:131-2. [DOI: 10.5698/1535-7597-15.3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ito K, Nakata Y, Matsuda H, Sugai K, Watanabe M, Kamiya K, Kimura Y, Shigemoto Y, Okazaki M, Sasaki M, Sato N. Evaluation of FDG-PET and ECD-SPECT in patients with subcortical band heterotopia. Brain Dev 2014; 36:578-84. [PMID: 23958594 DOI: 10.1016/j.braindev.2013.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/26/2013] [Accepted: 07/30/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to clarify the cellular activities of ectopic neurons in subcortical bands and to evaluate the imaging features of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and (99m)Tc ethyl cysteinate dimer (ECD) single-photon emission computed tomography (SPECT) in a series of patients with subcortical band heterotopia (SBH). MATERIALS AND METHODS The cases of 12 patients with SBH (3 men and 9 women; age range, 2-51 years) were evaluated on the basis of their MRI findings. Eight (18)F-FDG PET and 12 (99m)Tc-ECD SPECT images were obtained. The uptakes of these images were compared with electroencephalography (EEG) or MRI findings such as band thickness. In all patients, easy Z-score Imaging System (eZIS) software was used to statistically analyze the SPECT images. RESULTS Of the eight (18)F-FDG PET images, five showed higher uptake in the thick subcortical bands than in the overlying cortex. Of the 12 (99m)Tc-ECD SPECT examinations with eZIS images, nine indicated increased regional cerebral blood flow (rCBF) areas corresponding to the band locations. Of the eight (18)F-FDG PET examination findings, six were congruent with the rCBF distributions on the eZIS images. Eight of the 12 patients showed correspondence to the increased rCBF on the eZIS images, the band locations on MRI, and abnormal discharge sites on EEG. CONCLUSIONS Ectopic neurons in subcortical bands may have higher glucose metabolism and/or increased rCBF compared to the overlying cortex. (18)F-FDG PET and (99m)Tc-ECD SPECT using eZIS can be helpful to clearly detect the cellular activities of ectopic neurons in patients with SBH.
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Affiliation(s)
- Kimiteru Ito
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Yasuhiro Nakata
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenji Sugai
- Department of Child Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masako Watanabe
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kouhei Kamiya
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoko Shigemoto
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mitsutoshi Okazaki
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masayuki Sasaki
- Department of Child Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
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Fry AE, Cushion TD, Pilz DT. The genetics of lissencephaly. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2014; 166C:198-210. [DOI: 10.1002/ajmg.c.31402] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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15
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Hanáková P, Brázdil M, Novák Z, Hemza J, Chrastina J, Ošlejšková H, Hermanová M, Pažourková M, Rektor I, Kuba R. Long-term outcome and predictors of resective surgery prognosis in patients with refractory extratemporal epilepsy. Seizure 2013; 23:266-73. [PMID: 24378203 DOI: 10.1016/j.seizure.2013.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE We analyzed the long-term postoperative outcome and possible predictive factors of the outcome in surgically treated patients with refractory extratemporal epilepsy. METHODS We retrospectively analyzed 73 patients who had undergone resective surgery at the Epilepsy Center Brno between 1995 and 2010 and who had reached at least 1 year outcome after the surgery. The average age at surgery was 28.3±11.4 years. Magnetic resonance imaging (MRI) did not reveal any lesion in 24 patients (32.9%). Surgical outcome was assessed annually using Engel's modified classification until 5 years after surgery and at the latest follow-up visit. RESULTS Following the surgery, Engel Class I outcome was found in 52.1% of patients after 1 year, in 55.0% after 5 years, and in 50.7% at the last follow-up visit (average 6.15±3.84 years). Of the patients who reached the 5-year follow-up visit (average of the last follow-up 9.23 years), 37.5% were classified as Engel IA at each follow-up visit. Tumorous etiology and lesions seen in preoperative MRI were associated with significantly better outcome (p=0.035; p<0.01). Postoperatively, 9.6% patients had permanent neurological deficits. CONCLUSION Surgical treatment of refractory extratemporal epilepsy is an effective procedure. The presence of a visible MRI-detected lesion and tumorous etiology is associated with significantly better outcome than the absence of MRI-detected lesion or other etiology.
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Affiliation(s)
- Petra Hanáková
- Epilepsy Center Brno, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Milan Brázdil
- Epilepsy Center Brno, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Zdeněk Novák
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic; Epilepsy Center Brno, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Hemza
- Epilepsy Center Brno, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Chrastina
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic; Epilepsy Center Brno, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Hana Ošlejšková
- Epilepsy Center Brno, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Markéta Hermanová
- Department of Pathology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marta Pažourková
- Department of Radiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivan Rektor
- Epilepsy Center Brno, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Robert Kuba
- Epilepsy Center Brno, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Epilepsy Center Brno, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
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Bahi-Buisson N, Souville I, Fourniol FJ, Toussaint A, Moores CA, Houdusse A, Lemaitre JY, Poirier K, Khalaf-Nazzal R, Hully M, Leger PL, Elie C, Boddaert N, Beldjord C, Chelly J, Francis F. New insights into genotype-phenotype correlations for the doublecortin-related lissencephaly spectrum. ACTA ACUST UNITED AC 2013; 136:223-44. [PMID: 23365099 DOI: 10.1093/brain/aws323] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
X-linked isolated lissencephaly sequence and subcortical band heterotopia are allelic human disorders associated with mutations of doublecortin (DCX), giving both familial and sporadic forms. DCX encodes a microtubule-associated protein involved in neuronal migration during brain development. Structural data show that mutations can fall either in surface residues, likely to impair partner interactions, or in buried residues, likely to impair protein stability. Despite the progress in understanding the molecular basis of these disorders, the prognosis value of the location and impact of individual DCX mutations has largely remained unclear. To clarify this point, we investigated a cohort of 180 patients who were referred with the agyria-pachygyria subcortical band heterotopia spectrum. DCX mutations were identified in 136 individuals. Analysis of the parents' DNA revealed the de novo occurrence of DCX mutations in 76 cases [62 of 70 females screened (88.5%) and 14 of 60 males screened (23%)], whereas in the remaining cases, mutations were inherited from asymptomatic (n = 14) or symptomatic mothers (n = 11). This represents 100% of families screened. Female patients with DCX mutation demonstrated three degrees of clinical-radiological severity: a severe form with a thick band (n = 54), a milder form (n = 24) with either an anterior thin or an intermediate thickness band and asymptomatic carrier females (n = 14) with normal magnetic resonance imaging results. A higher proportion of nonsense and frameshift mutations were identified in patients with de novo mutations. An analysis of predicted effects of missense mutations showed that those destabilizing the structure of the protein were often associated with more severe phenotypes. We identified several severe- and mild-effect mutations affecting surface residues and observed that the substituted amino acid is also critical in determining severity. Recurrent mutations representing 34.5% of all DCX mutations often lead to similar phenotypes, for example, either severe in sporadic subcortical band heterotopia owing to Arg186 mutations or milder in familial cases owing to Arg196 mutations. Taken as a whole, these observations demonstrate that DCX-related disorders are clinically heterogeneous, with severe sporadic and milder familial subcortical band heterotopia, each associated with specific DCX mutations. There is a clear influence of the individual mutated residue and the substituted amino acid in determining phenotype severity.
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Affiliation(s)
- Nadia Bahi-Buisson
- Pediatric Neurology Hopital Necker Enfants Malades, Université Paris Descartes, APHP, 149 rue de Sevres 75015 Paris, France.
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17
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Chassoux F. Malformazioni dello sviluppo corticale. Neurologia 2012. [DOI: 10.1016/s1634-7072(12)62060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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18
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Gabel LA. Layer I neocortical ectopia: cellular organization and local cortical circuitry. Brain Res 2011; 1381:148-58. [PMID: 21256119 DOI: 10.1016/j.brainres.2011.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 01/11/2011] [Accepted: 01/12/2011] [Indexed: 12/31/2022]
Abstract
Focal cortical dysplasia (FCD) are associated with neurological disorders and cognitive impairments in humans. Molecular layer ectopia, clusters of misplaced cells in layer I of the neocortex, have been identified in patients with developmental dyslexia and psychomotor retardation. Mouse models of this developmental disorder display behavioral impairments and increased seizure susceptibility. Although there is a correlation between cortical malformations and neurological dysfunction, little is known about the morphological and physiological properties of cells within cortical malformations. In the present study we used electrophysiological and immunocytochemical analyses to examine the distribution of neuronal and non-neuronal cell types within and surrounding layer I neocortical ectopia in NXSMD/EiJ mice. We show that cells within ectopia have membrane properties of both pyramidal and a variety of non-pyramidal cell types, including fast-spiking cells. Immunocytochemical analysis for different interneuronal subtypes demonstrates that ectopia contain nonpyramidal cells immunoreactive for calbindin-D28K (CALB), parvalbumin (PARV), and calretinin (CR). Ectopia also contains astrocytes, positive for glial fibrillary acidic protein (GFAP) and oligodendrocyte precursor cells positive for NG2 proteoglycan (NG2). Lastly, we provide electrophysiological and morphological evidence to demonstrate that cells within ectopia receive input from cells within layers I, upper and deeper II/III, and V and provide outputs to cells within deep layer II/III and layer V, but not layers I and upper II/III. These results indicate that ectopia contain cells of different lineages with diverse morphological and physiological properties, and appear to cause disruptions in local cortical circuitry.
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Affiliation(s)
- Lisa Ann Gabel
- Department of Psychology and Program in Neuroscience, Lafayette College, Easton, PA 18042, USA.
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19
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Spencer-Smith M, Leventer R, Jacobs R, Luca CDE, Anderson V. Neuropsychological profile of children with subcortical band heterotopia. Dev Med Child Neurol 2009; 51:909-16. [PMID: 19416314 DOI: 10.1111/j.1469-8749.2009.03309.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Subcortical band heterotopia (SBH) or 'double cortex' is a malformation of cortical development resulting from impaired neuronal migration. So far, research has focused on the neurological, neuroimaging, and genetic correlates of SBH. More recently, clinical reports and small sample studies have documented neuropsychological dysfunction in patients with this malformation. This study aimed to characterize further the phenotype of patients with SBH by describing the neuropsychological profiles of children. METHOD Seven children (six females) aged 4 to 15 years were assessed for cognitive functioning (intellectual ability, processing speed, attention, working memory) and academic achievement (reading, spelling, arithmetic). Parents completed questionnaires examining their child's social skills and problem behaviours. Magnetic resonance images (MRI) conducted for routine clinical follow-up were coded by a paediatric neurologist. Genetic and seizure history were obtained from medical records. RESULTS There was variation in the neurological, neuroimaging, and genetic presentation of children in the sample. Impairments were observed in all areas of neuropsychological functioning examined. Intellectual ability was generally within the 'extremely low' range (full-scale IQ 44-74; performance IQ 45-72; verbal IQ 57-80). Generalized impairments in cognitive skills were typical, with severe impairments (scores greater than 2SD below the test mean) reported in processing speed, working memory, and arithmetic. Impairments in academic, social, and behavioural functioning were less generalized. No clear relationship between neuroimaging and neuropsychological impairments was found. INTERPRETATION Children with SBH demonstrate cognitive, academic, social, and behavioural problems, with the greatest difficulties in processing speed and complex cognitive skills.
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Morales Chacón L, Estupiñán B, Lorigados Pedre L, Trápaga Quincoses O, García Maeso I, Sanchez A, Bender del Busto J, Garcia M, Baez Martin M, Zaldivar M, Gómez A, Orozco S, Rocha Arrieta L. Microscopic mild focal cortical dysplasia in temporal lobe dual pathology: An electrocorticography study. Seizure 2009; 18:593-600. [DOI: 10.1016/j.seizure.2009.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 06/08/2009] [Accepted: 06/18/2009] [Indexed: 11/26/2022] Open
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22
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Saito Y, Sugai K, Nakagawa E, Sakuma H, Komaki H, Sasaki M, Maegaki Y, Ohno K, Sato N, Kaneko Y, Otsuki T. Treatment of epilepsy in severely disabled children with bilateral brain malformations. J Neurol Sci 2009; 277:37-49. [DOI: 10.1016/j.jns.2008.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 10/07/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
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23
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Campbell SL, Hablitz JJ. Decreased glutamate transport enhances excitability in a rat model of cortical dysplasia. Neurobiol Dis 2008; 32:254-61. [PMID: 18674619 DOI: 10.1016/j.nbd.2008.07.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 06/16/2008] [Accepted: 07/03/2008] [Indexed: 11/30/2022] Open
Abstract
Glutamate transporters function to maintain low levels of extracellular glutamate and play an important role in synaptic transmission at many synapses. Disruption of glutamate transporter function or expression can result in increased extracellular glutamate levels. Alterations in glutamate transporter expression have been reported in human epilepsy and animal seizure models. Functional electrophysiological changes that occur when transporter expression is disrupted in chronic epilepsy models have not been examined. Here, we used a freeze-induced model of cortical dysplasia to test the role of glutamate transporters in synaptic hyperexcitability. We report that inhibiting glutamate transporters with the non-selective antagonist, DL-threo-beta-benzylozyaspartic acid (TBOA) preferentially prolongs postsynaptic currents (PSCs) and decreases the threshold for evoking epileptiform activity in lesioned compared to control cortex. The effect of inhibiting uptake is mediated primarily by the glia glutamate transporter (GLT-1) since the selective antagonist dihydrokainate (DHK) mimicked the effects of TBOA. The effect of uptake inhibition is mediated by activation of N-methyl-D-aspartate (NMDA) receptors since D-(-)-2-amino-5-phosphonovaleric acid (APV) prevents TBOA-induced effects. Neurons in lesioned cortex also have a larger tonic NMDA current. These results indicate that chronic changes in glutamate transporters and NMDA receptors contribute to hyperexcitability in cortical dysplasia.
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Affiliation(s)
- Susan L Campbell
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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24
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Marshall CR, Young EJ, Pani AM, Freckmann ML, Lacassie Y, Howald C, Fitzgerald KK, Peippo M, Morris CA, Shane K, Priolo M, Morimoto M, Kondo I, Manguoglu E, Berker-Karauzum S, Edery P, Hobart HH, Mervis CB, Zuffardi O, Reymond A, Kaplan P, Tassabehji M, Gregg RG, Scherer SW, Osborne LR. Infantile spasms is associated with deletion of the MAGI2 gene on chromosome 7q11.23-q21.11. Am J Hum Genet 2008; 83:106-11. [PMID: 18565486 DOI: 10.1016/j.ajhg.2008.06.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 05/29/2008] [Accepted: 06/02/2008] [Indexed: 01/14/2023] Open
Abstract
Infantile spasms (IS) is the most severe and common form of epilepsy occurring in the first year of life. At least half of IS cases are idiopathic in origin, with others presumed to arise because of brain insult or malformation. Here, we identify a locus for IS by high-resolution mapping of 7q11.23-q21.1 interstitial deletions in patients. The breakpoints delineate a 500 kb interval within the MAGI2 gene (1.4 Mb in size) that is hemizygously disrupted in 15 of 16 participants with IS or childhood epilepsy, but remains intact in 11 of 12 participants with no seizure history. MAGI2 encodes the synaptic scaffolding protein membrane-associated guanylate kinase inverted-2 that interacts with Stargazin, a protein also associated with epilepsy in the stargazer mouse.
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Leventer RJ, Guerrini R, Dobyns WB. Malformations of cortical development and epilepsy. DIALOGUES IN CLINICAL NEUROSCIENCE 2008. [PMID: 18472484 PMCID: PMC3181860 DOI: 10.31887/dcns.2008.10.1/rjleventer] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Malformations of cortical development (MCDs) are macroscopic or microscopic abnormalities of the cerebral cortex that arise as a consequence of an interruption to the normal steps of formation of the cortical plate. The human cortex develops its basic structure during the first two trimesters of pregnancy as a series of overlapping steps, beginning with proliferation and differentiation of neurons, which then migrate before finally organizing themselves in the developing cortex. Abnormalities at any of these stages, be they environmental or genetic in origin, may cause disruption of neuronal circuitry and predispose to a variety of clinical consequences, the most common of which is epileptic seizures, A large number of MCDs have now been described, each with characteristic pathological, clinical, and imaging features. The causes of many of these MCDs have been determined through the study of affected individuals, with many MCDs now established as being secondary to mutations in cortical development genes. This review will highlight the best-known of the human cortical malformations associated with epilepsy. The pathological, clinical, imaging, and etioiogic features of each MCD will be summarized, with representative magnetic resonance imaging (MRI) images shown for each MCD, The malformations tuberous sclerosis, focal cortical dysplasia, hemimegalencephaiy, classical iissencephaly, subcortical band heterotopia, periventricular nodular heterotopia, polymicrogyria, and schizencephaly will be presented.
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Affiliation(s)
- Richard J Leventer
- Children's Neuroscience Centre & Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.
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Huppertz HJ, Wellmer J, Staack AM, Altenmüller DM, Urbach H, Kröll J. Voxel-based 3D MRI analysis helps to detect subtle forms of subcortical band heterotopia. Epilepsia 2008; 49:772-85. [DOI: 10.1111/j.1528-1167.2007.01436.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dericioglu N, Oguz KK, Ergun EL, Tezer FI, Saygi S. Ictal/interictal EEG patterns and functional neuroimaging findings in subcortical band heterotopia: report of three cases and review of the literature. Clin EEG Neurosci 2008; 39:43-9. [PMID: 18318419 DOI: 10.1177/155005940803900113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Subcortical band heterotopia (SBH) is a rare, genetic disorder of neuronal migration, which is seen almost exclusively in females. Little is known about the functionality of the band heterotopia, in terms of both physiology and pathology, in this malformation. Patients are reported to have several different types of seizures, which are usually drug resistant. Interictal EEG findings are known to correlate with the type of seizures, however less is known about the ictal EEG patterns. We present 3 female patients who were investigated at our center with video-scalp EEG monitoring, interictal single photon emission computed tomography (SPECT), functional magnetic resonance (MR) imaging (fMRI) and MR spectroscopy (MRS) besides routine MR imaging. They had several different types of seizures, and one of them reported also having circling seizures that have not been reported previously in patients with SBH. Ictal EEG recordings were remarkable for their unusual patterns of propagation. The findings in structural and functional neuroradiological investigations are discussed in light of the literature.
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Affiliation(s)
- Nese Dericioglu
- Hacettepe University School of Medicine, Department of Neurology, Ankara, Turkey.
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29
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Beaudoin BS, Hill JM, Ming SX. Brief Report: The Impact of Subcortical Band Heterotopia and Associated Complications on the Neuropsychological Functioning of a 13-year-old Child. J Autism Dev Disord 2006; 37:983-92. [PMID: 17160462 DOI: 10.1007/s10803-006-0236-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Motor impairment in children with Asperger syndrome (AS) or high functioning autism (HFA) has been reported previously. This study presents results of a quantitative assessment of neuromotor skills in 14-22 year old HFA/AS. Sixteen HFA/AS and 16 IQ-matched controls were assessed by the Zurich Neuromotor Assessment (ZNA). The HFA/AS group showed strongest impairments of dynamic balance skills and diadochokinesis. Motor abilities were associated with degree of social withdrawal in the full sample and severity of current autistic symptoms in the HFA/AS group. Similar motor patterns as in younger children were found in the older adolescents. The association of autistic symptoms with motor performance points towards an essential role of motor impairment in autism spectrum disorders.
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Affiliation(s)
- Beata S Beaudoin
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey at Newark, New Jersey Medical School, Newark, NJ, USA.
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30
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Lu MK, Chang FC, Yang YW, Lin YC, Lee CC, Tsai CH. Abnormal movement-related cortical potential in patients with subcortical heterotopia. Brain Dev 2006; 28:560-5. [PMID: 16682157 DOI: 10.1016/j.braindev.2006.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2005] [Revised: 03/16/2006] [Accepted: 03/20/2006] [Indexed: 11/15/2022]
Abstract
Movement-related cortical potential (MRCP) is recorded to investigate the cerebral motor preparation in two patients with subcortical heterotopia. Magnetic resonance imaging (MRI) studies were conducted in the two patients. Scalp MRCP elicited by self-paced voluntary extension of the wrist was recorded. The MRCP waveforms and the potential maps were compared to those of an age-matched normal subject. MRI reveals subcortical heterotopia in the right frontal area and bilateral centrum semiovale in one patient and in the left parietal lobe in the other. Both of the patients had history of early onset epilepsy and were hypersensitive to unexpected loud noises. Distinctly different from the normal MRCP, the waveforms of the patients are flattened in all scalp electrodes by moving either the right or the left hand. And the topographic potential map detects no evidence of preponderance of negativity on the hemisphere contralateral to the moving side in the patients. The ectopic neurons of the subcortical heterotopia may produce chaotic discharges, which can interrupt or cancel the well oriented dipole of the MRCP activities.
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Affiliation(s)
- Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
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31
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Jirsch JD, Bernasconi N, Villani F, Vitali P, Avanzini G, Bernasconi A. Sensorimotor organization in double cortex syndrome. Hum Brain Mapp 2006; 27:535-43. [PMID: 16124015 PMCID: PMC6871446 DOI: 10.1002/hbm.20197] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Subcortical band heterotopia is a diffuse malformation of cortical development related to pharmacologically intractable epilepsy. On magnetic resonance imaging (MRI), patients with "double cortex" syndrome (DCS) present with a band of heterotopic gray matter separated from the overlying cortex by a layer of white matter. The function and connectivity of the subcortical heterotopic band in humans is only partially understood. We studied six DCS patients with bilateral subcortical band heterotopias and six healthy controls using functional MRI (fMRI). In controls, simple motor task elicited contralateral activation of the primary motor cortex (M1) and ipsilateral activation of the cerebellum and left supplementary motor area (SMA). All DCS patients showed task-related contralateral activation of both M1 and the underlying heterotopic band. Ipsilateral motor activation was seen in 4/6 DCS patients. Furthermore, there were additional activations of nonprimary normotopic cortical areas. The sensory stimulus resulted in activation of the contralateral primary sensory cortex (SI) and the thalamus in all healthy subjects. The left sensory task also induced a contralateral activation of the insular cortex. Sensory activation of the contralateral SI was seen in all DCS patients and secondary somatosensory areas in 5/6. The heterotopic band beneath SI became activated in 3/6 DCS patients. Activations were also seen in subcortical structures for both paradigms. In DCS, motor and sensory tasks induce an activation of the subcortical heterotopic band. The recruitment of bilateral primary areas and higher-order association normotopic cortices indicates the need for a widespread network to perform simple tasks.
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Affiliation(s)
- Jeffrey D. Jirsch
- Montreal Neurological Institute and Hospital, Department of Neurology, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- Montreal Neurological Institute and Hospital, Department of Neurology, McGill University, Montreal, Quebec, Canada
| | | | - Paolo Vitali
- National Neurologic Institute Carlo Besta, Milan, Italy
| | | | - Andrea Bernasconi
- Montreal Neurological Institute and Hospital, Department of Neurology, McGill University, Montreal, Quebec, Canada
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Luat AF, Bernardi B, Chugani HT. Congenital perisylvian syndrome: MRI and glucose PET correlations. Pediatr Neurol 2006; 35:21-9. [PMID: 16814081 DOI: 10.1016/j.pediatrneurol.2005.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 07/28/2005] [Accepted: 11/14/2005] [Indexed: 11/26/2022]
Abstract
Congenital perisylvian syndromes are late migration/cortical organization disorders associated with distinctive clinical and imaging features. The clinical, magnetic resonance imaging, and 2-deoxy-2-[18F] fluoro-D-glucose (FDG) positron emission tomography scan findings of six children (age range: 3.2-16.7 years; 5 males) with congenital perisylvian syndrome were evaluated. The patients presented with heterogenous neurologic impairments, depending upon the involved hemisphere and the extension of perisylvian malformation. Two manifested bilateral malformation and four manifested unilateral. The characteristic MRI finding consisting of a vertically oriented sylvian fissure continuous with the central and postcentral sulcus was associated with variable extension of bordering polymicrogyric cortex. The positron emission tomography scans of all patients revealed perisylvian metabolic abnormalities corresponding to the magnetic resonance imaging-defined abnormality. Variable extent of abnormal glucose metabolism was also observed in areas with normal magnetic resonance imaging features. All patients with unilateral magnetic resonance imaging abnormality exhibited abnormal glucose metabolism also in the contralateral side. The two patients with bilateral malformation had more extensive positron emission tomography abnormalities than the morphologic anomalies on MRI. Although MRI remains the diagnostic gold standard to detect the lesion, positron emission tomography scan is helpful to evaluate the full functional extension of the cortical anomaly, thereby contributing to the definition of the clinical severity of the syndrome.
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Affiliation(s)
- Aimee F Luat
- The Carman and Ann Adams Department of Pediatrics, Childrens Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA
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Archer HL, Evans J, Edwards S, Colley J, Newbury-Ecob R, O'Callaghan F, Huyton M, O'Regan M, Tolmie J, Sampson J, Clarke A, Osborne J. CDKL5 mutations cause infantile spasms, early onset seizures, and severe mental retardation in female patients. J Med Genet 2006; 43:729-34. [PMID: 16611748 PMCID: PMC2564572 DOI: 10.1136/jmg.2006.041467] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the frequency of mutations in CDKL5 in both male and female patients with infantile spasms or early onset epilepsy of unknown cause, and to consider whether the breadth of the reported phenotype would be extended by studying a different patient group. METHODS Two groups of patients were investigated for CDKL5 mutations. Group 1 comprised 73 patients (57 female, 16 male) referred to Cardiff for CDKL5 analysis, of whom 49 (42 female, 7 male) had epileptic seizure onset in the first six months of life. Group 2 comprised 26 patients (11 female, 15 male) with infantile spasms previously recruited to a clinical trial, the UK Infantile Spasms Study. Where a likely pathogenic mutation was identified, further clinical data were reviewed. RESULTS Seven likely pathogenic mutations were found among female patients from group 1 with epileptic seizure onset in the first six months of life, accounting for seven of the 42 in this group (17%). No mutations other than the already published mutation were found in female patients from group 2, or in any male patient from either study group. All patients with mutations had early signs of developmental delay and most had made little developmental progress. Further clinical information was available for six patients: autistic features and tactile hypersensitivity were common but only one had suggestive Rett-like features. All had a severe epileptic seizure disorder, all but one of whom had myoclonic jerks. The EEG showed focal or generalised changes and in those with infantile spasms, hypsarrhythmia. Slow frequencies were seen frequently with a frontal or fronto-temporal predominance and high amplitudes. CONCLUSIONS The spectrum of the epileptic seizure disorder, and associated EEG changes, in those with CDKL5 mutations is broader than previously reported. CDKL5 mutations are a significant cause of infantile spasms and early epileptic seizures in female patients, and of a later intractable seizure disorder, irrespective of whether they have suspected Rett syndrome. Analysis should be considered in these patients in the clinical setting.
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Affiliation(s)
- H L Archer
- Department of Medical Genetics, Cardiff University, University Hospital of Wales, Cardiff, UK.
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Andermann F, Kobayashi E, Andermann E. Genetic Focal Epilepsies: State of the Art and Paths to the Future. Epilepsia 2005; 46 Suppl 10:61-7. [PMID: 16359475 DOI: 10.1111/j.1528-1167.2005.00361.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The concept of genetic focal epilepsies is relatively new as compared to awareness of the importance of genetic factors in the generalized epilepsies. However, in the past decade, there has been increasing recognition of families with dominantly inherited partial epilepsies. Better definition of the phenotypes allows identification of distinct syndromes. The main familial focal epilepsies are autosomal-dominant nocturnal frontal lobe epilepsy (ADNFLE), familial mesial TLE (FMTLE), familial lateral TLE (FLTLE), and familial partial epilepsy with variable foci (FPEVF). The only genes identified so far are those for ADNFLE and FLTLE. In these disorders, functional studies are the next step and could provide advances leading to clarification of the pathophysiology as well as to new therapeutic strategies. At present, we can provide genetic counseling and a more accurate prognosis for most of the familial focal epilepsies. Greater awareness of the genetic basis in this group of disorders by the treating physicians is essential for identification of new families. This will allow further linkage studies, candidate gene screening, and identification of new genes, which will hopefully result in genetically based prevention and treatment.
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Affiliation(s)
- Frederick Andermann
- Montreal Neurological Institute and Hospital McGill University, Montreal, Canada.
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Abstract
We reviewed the epileptogenic cortical malformations for which a causative gene has been cloned or a linkage obtained. X-linked bilateral periventricular nodular heterotopia (BPNH) consists of typical BPNH with epilepsy in female patients and prenatal lethality in most males. About 90% of patients have focal epilepsy. Filamin A mutations have been reported in all families and in approximately 20% of sporadic patients. A rare recessive form of BPNH also has been reported. Most cases of lissencephaly-pachygyria are caused by mutations of LIS1 and XLIS genes. LIS1 mutations cause a more severe malformation posteriorly. Most children have isolated lissencephaly, with severe developmental delay and infantile spasms, but milder phenotypes have been recorded. XLIS usually causes anteriorly predominant lissencephaly in male patients and subcortical band heterotopia (SBH) in female patients. Thickness of the band and severity of pachygyria correlate with the likelihood of developing Lennox-Gastaut syndrome. Mutations of the coding region of XLIS are found in all reported pedigrees and in 50% of sporadic female patients with SBH. Autosomal recessive lissencephaly with cerebellar hypoplasia; accompanied by severe delay, hypotonia, and seizures, has been associated with mutations of the RELN gene. Schizencephaly has a wide anatomoclinical spectrum, including focal epilepsy in most patients. Familial occurrence is rare. Initial reports of heterozygous mutations in the EMX2 gene need confirmation. Among several syndromes featuring polymicrogyria, bilateral perisylvian polymicrogyria shows genetic heterogeneity, including linkage to Xq28 in some pedigrees, autosomal recessive inheritance in others, and association with 22q11.2 deletion in some patients. About 65% of patients have severe epilepsy, often Lennox-Gastaut syndrome. Recessive bilateral frontal polymicrogyria has been linked to chromosome 16q12.2-21.
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Affiliation(s)
- Renzo Guerrini
- Epilepsy, Neurophysiology and Neurogenetics Unit, Division of Child Neurology and Psychiatry, University of Pisa and Research Institute Stella Maris Foundation, Pisa, Italy.
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36
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Clark GD. The classification of cortical dysplasias through molecular genetics. Brain Dev 2004; 26:351-62. [PMID: 15275695 DOI: 10.1016/s0387-7604(03)00093-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Revised: 12/02/2002] [Accepted: 12/25/2002] [Indexed: 11/29/2022]
Abstract
Recent genetic insight into the mechanisms of human brain malformation have allowed one to consider a classification of these disorders by the genetic disruption. In this article an attempt is made to classify human cortical dysplasias by the known genetic disruptions or insults that lead to them. The discussion of malformation is within the context of the embryologic processes that have thought to have gone awry. Human disorders of segmentation, cell proliferation, telencephalic cleavage, differentiation, and neuronal migration are discussed. As this is a rapidly changing area, the reader is encouraged to check online databases for updates on the genetic insights that have been gained since the publication of this article.
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Affiliation(s)
- Gary D Clark
- Departments of Pediatrics, Neurology, and Neuroscience, Cain Foundation Laboratories, Baylor College of Medicine, MC 3-6365, 6621 Fannin Street, Houston, TX 77030-2399, USA.
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Chang BS, Walsh CA. Mapping form and function in the human brain: the emerging field of functional neuroimaging in cortical malformations. Epilepsy Behav 2003; 4:618-25. [PMID: 14698694 DOI: 10.1016/j.yebeh.2003.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Malformations of cortical development (MCDs) are increasingly being recognized as a common cause of epilepsy in cases previously felt to be cryptogenic. MCDs occur when the normal process of cerebral cortical development is disrupted, and include disorders of neuronal proliferation, migration, and organization. Many have a genetic basis and the genes responsible for some MCDs have been identified. MCDs represent a unique and valuable substrate in functional brain mapping studies, since as developmental lesions they provide complementary information to studies performed on patients with acquired brain lesions. In recent years an increasing number of functional neuroimaging methods, including positron emission tomography, single photon emission computed tomography, magnetic resonance spectroscopy, and functional magnetic resonance imaging, have been applied to patients with MCDs. In this review we highlight some of the prominent findings in this emerging field by presenting the functional neuroimaging characteristics of selected MCDs.
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Affiliation(s)
- Bernard S Chang
- Comprehensive Epilepsy Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Degen R, Ebner A, Lahl R, Bartling S, Pannek HW, Tuxhorn I. MRI and EEG findings in surgically treated patients with partial seizures due to neuronal migration disorders, their relations to each other and to surgery outcome. Acta Neurol Scand 2003; 108:309-18. [PMID: 14616299 DOI: 10.1034/j.1600-0404.2003.00153.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate magnetic resonance imaging (MRI) and electro-encephalogram (EEG) findings of patients with therapy-resistant partial seizures due to neuronal migration disorders (NMD), and compare them with each other and with surgery outcome. MATERIAL AND METHODS The MRI, interictal and ictal EEG findings, and their relations to each other in 41 patients with NMD were compared with class IA surgery outcome. RESULTS The patients showed an MRI lesion in decreasing frequency from the frontal to the occipital areas. A predominantly extratemporal location of the interictal EEG foci (73.3%) and ictal patterns (82.4%) was therefore apparent, also showing a diminishing frequency from the anterior to the posterior areas. Comparing the EEG foci with the MRI lesions, the same location of the interictal foci was found in 68.4% and of the ictal foci in 52.7%, including several cases with a more widespread EEG focus or MRI lesion. The same location of interictal as well as ictal foci was evident in 85.7%. The most favourable surgery outcome (class IA) was, on average, apparent in patients with an MRI lesion (28.6% vs 25%), a main interictal EEG focus (50% vs 18%) and an ictal seizure pattern (37.5% vs 16.7%) located in the temporal area; likewise, if the interictal focus (30.8% vs 18.2%) and the ictal pattern (31.8% vs 12.5%) showed the same location as the MRI lesion, as well as when the interictal and ictal EEG changes had an equal location (30% vs 20%). CONCLUSION MRI and EEG recordings show relatively close relations to each other and might be important methods to predict surgery outcome in NMD patients.
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Affiliation(s)
- R Degen
- Telgter Str. 42, 33619 Bielefeld, Germany.
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Degen R, Ebner A, Lahl R, Leonhardt S, Pannek HW, Tuxhorn I. Various findings in surgically treated epilepsy patients with dysembryoplastic neuroepithelial tumors in comparison with those of patients with other low-grade brain tumors and other neuronal migration disorders. Epilepsia 2002; 43:1379-84. [PMID: 12423388 DOI: 10.1046/j.1528-1157.2002.15201.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine whether dysembryoplastic neuroepithelial tumors (DNTs) that belong to the neuronal migration disorders (NMDs) are to be classified with them or with "other low-grade brain tumors" regarding several etiologic, clinical, magnetic resonance imaging (MRI), and EEG findings. METHODS These findings of 21 DNT patients were compared with those of 13 consecutive patients with other low-grade brain tumors and 41 NMD patients. RESULTS The result is absolutely clear: nearly all findings in DNT patients (complications during pregnancy, birth, the newborn period and the postnatal period, age at first seizure, epileptic syndrome, seizure type, febrile seizures, retarded milestones, intellectual and neurologic deficits, MRI, interictal and ictal EEG findings) being similar or in agreement with those of other low-grade brain tumors, not with those of other NMDs. CONCLUSIONS Regarding various clinical features including surgery outcome, MRI, and EEG findings, DNTs should be classified with the other low-grade brain tumors, rather than with NMDs.
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Affiliation(s)
- Rolf Degen
- Epilepsy Centre Bethel, Bielefeld, Germany
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Abstract
The progress made in the understanding of the genetics of human brain malformations has lead to insight into the formation of brain and into mechanisms of disease affecting brain. It bears upon neurologists and geneticists to recognize the patterns of diseases of brain formation, to properly diagnose such disorders, to assess the recurrence risk of these malformations, and to guide families with appropriate expectations for outcomes. This article may serve as a guide to neurologists in their approach to these disorders. Because this area is one of rapid progress, the clinician is advised to seek more current information that may be available through on-line databases and other sources.
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Affiliation(s)
- Gary D Clark
- Departments of Pediatrics, Neurology, and Neuroscience, Cain Foundation Laboratories, 6621 Fannin Street, MC 3-6365, Houston, TX 77030-2399, USA.
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41
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Eriksson SH, Symms MR, Rugg-Gunn FJ, Boulby PA, Wheeler-Kingshott CAM, Barker GJ, Duncan JS, Parker GJM. Exploring white matter tracts in band heterotopia using diffusion tractography. Ann Neurol 2002; 52:327-34. [PMID: 12205645 DOI: 10.1002/ana.10295] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Band heterotopia is a malformation of cortical development characterized by bands of gray matter in the white matter parallel to the surface of the neocortex. Histopathological studies have suggested that small white matter tracts pass through the heterotopia, and functional magnetic resonance imaging studies have shown activation in the malformation. We used diffusion tractography to explore the anatomical connectivity of band heterotopia and, in particular, whether in vivo white matter tracts traverse the heterotopic gray matter. Five patients with band heterotopia and five control subjects were scanned with whole brain diffusion tensor imaging. Anisotropy maps were calculated. Using fast marching tractography, we produced maps of connectivity and tract traces from two seed points, in the splenium of the corpus callosum and the right parietal lobe. Eigenvectors were found to pass through the band heterotopia in an aligned fashion. Patterns for maps of connectivity were similar in patients and control subjects. Areas of high connectivity were found in the band heterotopia and in cortical areas on the far side of the malformation from the seed point. The tracts hence appeared to traverse or end within the band heterotopia. The results are in agreement with previous histopathological studies and indicate the structural basis of the functional connectivity and absence of focal deficits in these patients.
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Affiliation(s)
- Sofia H Eriksson
- MRI Unit, National Society for Epilepsy, Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College London, London, United Kingdom
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Bargalló N, Puerto B, De Juan C, Martinez-Crespo JM, Lourdes Olondo M. Hereditary subependymal heterotopia associated with mega cisterna magna: antenatal diagnosis with magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:86-89. [PMID: 12100426 DOI: 10.1046/j.1469-0705.2002.00741.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Bilateral nodular subependymal heterotopia has recently been identified as a hereditary disease linked to the X-chromosome. The sonographic findings are very subtle and difficult to observe during the second trimester when the germinal matrix is at its largest. Fetal magnetic resonance imaging facilitates visualization of the periventricular area. We report a case of bilateral nodular heterotopia associated with mega cisterna magna diagnosed by ultrasound and magnetic resonance imaging at 29 weeks' gestation. Magnetic resonance imaging of the brain of the mother revealed similar findings to those observed in the fetus and neonate. This case confirms the association between mega cisterna magna and bilateral periventricular nodular heterotopia and demonstrates that neuroimaging studies of the mother can contribute to the fetal diagnosis.
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Affiliation(s)
- N Bargalló
- Radiology Department, Centre de Diagnostic per la Imatge, Hospital Clínic I Provicial de Barcelona, Spain.
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43
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Abstract
Cortical dysplasias are associated with both epilepsy and cognitive impairments in humans. Similarly, several animal models of cortical dysplasia show that dysplasia causes increased seizure susceptibility and behavioral deficits in vivo and increased levels of excitability in vitro. As most current animal models involve either global disruptions in cortical architecture or the induction of lesions, it is not yet clear whether small spontaneous neocortical malformations are also associated with increased excitability or seizure susceptibility. Small groups of displaced neurons in layer I of the neocortex, ectopias, have been identified in patients with cognitive impairments, and similar malformations occur sporadically in some inbred lines of mice where they are associated with behavioral and sensory-processing deficits. In a previous study, we characterized the physiology of cells within neocortical ectopias, in one of the inbred lines (NXSM-D/Ei) and showed that the presence of multiple ectopias is associated with the generation of spontaneous epileptiform activity in slices. In this study, we use extracellular recordings from brain slices to show that even single-layer I ectopias are associated with higher excitability. Specifically, slices that contain single ectopias display epileptiform activity at significantly lower concentrations of the GABA(A) receptor antagonist bicuculline than do slices without ectopias (either from opposite hemispheres or animals without ectopias). Moreover, because removal of ectopias from slices does not restore normal excitability, enhanced excitability is not generated within the ectopia. Finally, we show that in vivo, mice with ectopias are more sensitive to the convulsant pentylenetetrazole than are mice without ectopias. Together these results suggest that alterations in cortical hemispheres containing focal layer I malformations increase cortical excitability and that even moderately small spontaneous cortical dysplasias are associated with increased excitability in vitro and in vivo.
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Affiliation(s)
- Lisa A Gabel
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, Connecticut 06269, USA
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Abstract
UNLABELLED Band heterotopia (BH) or "double cortex" syndrome is a neuronal migration disorder resulting in a diffuse band of subcortical grey matter and variable abnormality of the overlying cortex. Patients with BH have a spectrum of psychomotor delay and seizures. Associated epileptic syndromes and interictal EEG findings have been described, but ictal EEG patterns are lacking. METHODS We describe the clinical, interictal, and ictal EEG findings in two girls with BH and intractable seizures. RESULTS Ictal EEG patterns correlated well with clinical seizure types, and did not have features unique to BH. Similarly, seizure behaviors and interictal EEG findings were typical of those seen in symptomatic generalized epilepsies. CONCLUSIONS Despite evidence implicating the ectopic grey matter in seizure discharges, we conclude that seizure semiology and associated ictal EEG patterns in BH are no different from those seen in other causes of symptomatic generalized epilepsies.
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Affiliation(s)
- Arthur C Grant
- Comprehensive Epilepsy Program, Department of Neurology, University of California-Irvine, Neurodiagnostic Laboratory, Bldg. 22C, 101 The City Drive, Orange, CA 92868, U.S.A.
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Schottler F, Fabiato H, Leland JM, Chang LY, Lotfi P, Getachew F, Lee KS. Normotopic and heterotopic cortical representations of mystacial vibrissae in rats with subcortical band heterotopia. Neuroscience 2002; 108:217-35. [PMID: 11734356 DOI: 10.1016/s0306-4522(01)00395-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The tish rat is a neurological mutant exhibiting bilateral cortical heterotopia similar to those found in certain epileptic patients. Previous work has shown that thalamocortical fibers originating in the ventroposteromedial nucleus, which in normal animals segregate as 'barrel' representations for individual whiskers, terminate in both normotopic and heterotopic areas of the tish cortex (Schottler et al., 1998). Thalamocortical innervation terminates as barrels in layer IV and diffusely in layer VI of the normotopic area. Discrete patches of terminals are also observed in the underlying heterotopic area suggesting that representations of individual vibrissa may be present in the heterotopic somatosensory areas. The present study examines this issue by investigating the organization of the vibrissal somatosensory system in the tish cortex. Staining for cytochrome oxidase or Nissl substance reveals a normal complement of vibrissal barrels in the normotopic area of the tish cortex. Dense patches of cytochrome oxidase staining are also found in the underlying lateral portions of the heterotopic area (i.e. the same area that is innervated by the ventroposteromedial nucleus). Injections of retrograde tracers into vibrissal areas of either the normotopic or heterotopic area produce topographically organized labeling of neurons restricted to one or a small number of barreloids within the ventroposteromedial nucleus of the thalamus. Physical stimulation of a single whisker (D3 or E3) elicits enhanced uptake of [(14)C]2-deoxyglucose in restricted zones of both the normotopic and heterotopic areas, demonstrating that single whisker stimulation can increase functional activity in both normotopic and heterotopic neurons. These findings indicate that the barrels are intact in the normotopic area and are most consistent with the hypothesis that at least some of the individual vibrissae are 'dually' represented in normotopic and heterotopic positions in the primary somatosensory areas of the tish cortex.
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Affiliation(s)
- F Schottler
- Department of Neuroscience, University of Virginia, Box 801392, MR4 Annex, Charlottesville, VA 22098, USA
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46
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Guerrini R, Carrozzo R. Epilepsy and genetic malformations of the cerebral cortex. AMERICAN JOURNAL OF MEDICAL GENETICS 2002; 106:160-73. [PMID: 11579436 DOI: 10.1002/ajmg.1569] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Malformations of the cerebral cortex are an important cause of developmental disabilities and epilepsy. Here we review those malformations for which a genetic basis has been elucidated or is suspected and the types of associated epilepsy. Schizencephaly (cleft brain) has a wide anatomo-clinical spectrum, including partial epilepsy in most patients. Familial occurrence is rare. Heterozygous mutations in the EMX2 gene were reported in 13 patients. X-linked bilateral periventricular nodular heterotopia (BPNH) consists of typical BPNH with epilepsy in females and prenatal lethality in males. About 88% of patients have partial epilepsy. Filamin A mutations, all leading to a truncated protein, have been reported in three families and in sporadic patients. The most frequent forms of lissencephaly (agyria-pachygyria) are caused by mutations of LIS1. XLIS mutations cause classical lissencephaly in hemizygous males and subcortical band heterotopia (SBH) in heterozygous females. The thickness of the heterotopic band and the degree of pachygyria correlate with the likelihood of developing Lennox-Gastaut syndrome. Mutations of the coding region of XLIS were found in all reported pedigrees and in 38-91% of sporadic female patients with SBH. With few exceptions, children with LIS1 mutations have isolated lissencephaly, with severe developmental delay and infantile spasms. Autosomal recessive lissencephaly with cerebellar hypoplasia, accompanied by severe developmental delay, seizures, and hypotonia has been associated with mutations of the reelin gene. Fukuyama congenital muscular dystrophy is due to mutations of the fukutin gene and is accompanied by polymicrogyria. Febrile seizures and epilepsy with generalized tonic-convulsions appear in about 50% of children but are usually not severe. Tuberous sclerosis (TS) is caused by mutations in at least two genes, TSC1 and TSC2; 75% of cases are sporadic; 60% of patients have epilepsy, manifested in 50% of them as infantile spasms. TSC1 mutations seem to cause a milder disease with fewer cortical tubers and lower frequency of seizures. Among several syndromes featuring polymicrogyria, bilateral perisylvian polymicrogyria had familial occurrence on several occasions. Genetic heterogeneity is likely, including autosomal recessive, X-linked dominant, X-linked recessive inheritance, and association with 22q11.2 deletions. About 65% of patients have severe epilepsy, often Lennox-Gastaut syndrome.
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Affiliation(s)
- R Guerrini
- Pediatric Neurology, Institute of CHild Health and Great Ormond Street Hospital for Children, University College of London, UK.
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47
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Prayson RA, Spreafico R, Vinters HV. Pathologic characteristics of the cortical dysplasias. Neurosurg Clin N Am 2002; 13:17-25, vii. [PMID: 11754313 DOI: 10.1016/s1042-3680(02)80003-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The gross and microscopic features of cortical dysplasia (malformations caused by abnormalities of cortical development) are reviewed and illustrated in this article. The pathologic associations of neurocutaneous disorders, neoplasms, and hippocampal sclerosis with cortical dysplasia also are discussed.
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Affiliation(s)
- Richard A Prayson
- Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Abstract
The treatment of patients with hemispheric malformations of cortical development presents a challenging clinical problem that often requires surgical intervention. The development of a safe and effective treatment strategy for these patients requires an extensive work-up with a great deal of attention to a variety of multidisciplinary testing methods. In this article, the authors describe the presurgical evaluation of patients with hemispheric malformations of cortical development and epilepsy and review the surgical techniques currently available. They also detail some of the controversial issues regarding surgical treatment of these patients.
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Affiliation(s)
- Eldad J Hadar
- Assistant Professor and Head, Section of Epilepsy Surgery, Division of Neurosurgery, University of North Carolina at Chapel Hill, USA
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Montenegro MA, Li LM, Guerreiro MM, Cendes F. Neuroimaging characteristics of pseudosubcortical laminar heterotopia. J Neuroimaging 2002; 12:52-4. [PMID: 11826598 DOI: 10.1111/j.1552-6569.2002.tb00089.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Subcortical laminar heterotopia (SLH) is a subtype of malformation of cortical development characterized by laminar gray matter between the cortex and ventricles, which can vary in thickness and may be continuous or discontinuous. The objective of this study is to describe a normal finding of high-resolution magnetic resonance imaging that may simulate an SLH. SLH is isointense to cortex on both T1- and T2-weighted/FLAIR images, usually both anteriorly and posteriorly in location. Conversely, pseudo-SLH is a normal variant present only at the posterior aspect of the brain, and with dark signal on both T1- and T2-weighted/FLAIR images.
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50
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Palmini A, Lüders HO. Classification issues in malformations caused by abnormalities of cortical development. Neurosurg Clin N Am 2002; 13:1-16, vii. [PMID: 11754312 DOI: 10.1016/s1042-3680(02)80002-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Malformations caused by abnormalities of cortical development (MCDs) as a group are now widely recognized as a key cause of medically refractory epilepsies, often leading to a consideration of surgical treatment. A practical classification scheme including histopathologic, imaging, and, if possible, clinical-electrographic features of the various different types of MCDs, will be important to the delineation of surgical strategies and anticipation of medical and surgical prognoses. A proposal of such a scheme with emphasis on the focal cortical dysplasias is given in the hopes that it will reopen the debate on the best way to classify these disorders.
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Affiliation(s)
- André Palmini
- Porto Alegre Epilepsy Surgery Program, Neurology Service, Faculty of Medicine, and Hospital São Lucas, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
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