1
|
Yıldırım F, Aydin Z, Sakcı Z, Yalçın AED. Investigation of Patients With Eye Closure Sensitive Epilepsy With Magnetic Resonance Spectroscopy. Clin EEG Neurosci 2022; 53:45-53. [PMID: 34558322 DOI: 10.1177/15500594211040953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction and aim: A proportion of patients diagnosed with genetic generalized epilepsy (GGE) experience eye-closure sensitivity (ECS), the underlying pathogenesis of which is unknown. In this study, we compare magnetic resonance spectroscopy (MRS) findings of healthy volunteers with patients diagnosed with GGE, with and without ECS, to detect possible explanatory differences between groups. Materials and methods: A total of 33 patients diagnosed with GGE: 17 with ECS and 16 without, and 12 healthy volunteers are included. MRS measurements of N-acetyl-aspartate (NAA), choline (Cho), and creatine (Cr) were made of bilateral occipital lobes and thalamus, and values of patients with GGE were compared with those of normal controls, and within subgroups with different clinical variables, using appropriate statistical tests. Results: Left occipital NAA and NAA/Cr levels were found to be significantly higher in the ECS group than in the control group. In the ECS epilepsy group, a significant moderate positive correlation was noted between left thalamic Cr and duration of drug therapy (r = .539, P = .047) and left thalamic Cr and age at epilepsy onset (r = .564, P = .036). Additionally, left thalamic NAA and NAA/Cr levels were observed to be lower in GGE patients compared to healthy subjects, although not to a statistically significant degree. Conclusion:The differences in MRS-measurable metabolites in the left occipital lobe in those with ECS epilepsy suggest an association between the ECS mechanism and the left occipital lobe. Our results also support the multifocal thalamocortical pathway disorder in the pathophysiology of GGE based on the observation of cellular dysfunction in the thalamus.
Collapse
Affiliation(s)
- Feyza Yıldırım
- University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Zeynep Aydin
- University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey.,52947Beykent University, İstanbul, Turkey
| | - Zakir Sakcı
- University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Ays E Destînâ Yalçın
- University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
2
|
Wang W, Wu Y, Li X, Li L, Sun K, Yan S. Altered plasma glutamate and glutamine levels in patients with drug-resistant and drug-responsive symptomatic focal epilepsy. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2021; 26:315-322. [PMID: 34663703 PMCID: PMC9037768 DOI: 10.17712/nsj.2021.4.20210041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare the levels of plasma glutamate and glutamine in drug-resistant or drug-responsive symptomatic focal epilepsy. Dysfunctional glutamate neurotransmission plays an essential role in epilepsy pathophysiology. METHODS This cross-sectional study included 80 drug-resistant and 42 drug-responsive symptomatic focal epileptic patients and 132 healthy controls from June 2017 to February 2018. Plasma glutamate and glutamine levels were assessed via high-performance liquid chromatography. RESULTS Patients with drug-resistant symptomatic focal epilepsy had significantly higher plasma glutamate levels than healthy controls, whereas those with the drug-responsive disease had higher plasma glutamine levels than healthy controls. These results indicate that plasma glutamate and glutamine levels can discriminate patients with drug-resistant and drug-responsive symptomatic focal epilepsy from control individuals with the areas under the curve values of 0.931 and 0.72, respectively. CONCLUSION Elevated plasma glutamate levels are associated with drug-resistant symptomatic focal epilepsy and may aid the diagnosis of drug-resistant symptomatic focal epilepsy.
Collapse
Affiliation(s)
- Wei Wang
- From the Department of Pharmacy (Wang, Li, Lin Li, Yan); from the Department of Central Laboratory (Wu); from the Department of Functional Neurosurgery (Sun); from the Beijing Institute of Functional Neurosurgery (Sun), Xuanwu Hospital, Capital Medical University, and from the Beijing Municipal Geriatric Medical Research Center (Wu), Beijing, China.
| | - Yanchuan Wu
- From the Department of Pharmacy (Wang, Li, Lin Li, Yan); from the Department of Central Laboratory (Wu); from the Department of Functional Neurosurgery (Sun); from the Beijing Institute of Functional Neurosurgery (Sun), Xuanwu Hospital, Capital Medical University, and from the Beijing Municipal Geriatric Medical Research Center (Wu), Beijing, China.
| | - Xiaoling Li
- From the Department of Pharmacy (Wang, Li, Lin Li, Yan); from the Department of Central Laboratory (Wu); from the Department of Functional Neurosurgery (Sun); from the Beijing Institute of Functional Neurosurgery (Sun), Xuanwu Hospital, Capital Medical University, and from the Beijing Municipal Geriatric Medical Research Center (Wu), Beijing, China.
| | - Lin Li
- From the Department of Pharmacy (Wang, Li, Lin Li, Yan); from the Department of Central Laboratory (Wu); from the Department of Functional Neurosurgery (Sun); from the Beijing Institute of Functional Neurosurgery (Sun), Xuanwu Hospital, Capital Medical University, and from the Beijing Municipal Geriatric Medical Research Center (Wu), Beijing, China.
| | - Ke Sun
- From the Department of Pharmacy (Wang, Li, Lin Li, Yan); from the Department of Central Laboratory (Wu); from the Department of Functional Neurosurgery (Sun); from the Beijing Institute of Functional Neurosurgery (Sun), Xuanwu Hospital, Capital Medical University, and from the Beijing Municipal Geriatric Medical Research Center (Wu), Beijing, China.
| | - Suying Yan
- From the Department of Pharmacy (Wang, Li, Lin Li, Yan); from the Department of Central Laboratory (Wu); from the Department of Functional Neurosurgery (Sun); from the Beijing Institute of Functional Neurosurgery (Sun), Xuanwu Hospital, Capital Medical University, and from the Beijing Municipal Geriatric Medical Research Center (Wu), Beijing, China.
- Address correspondence and reprint request to: Dr. Suying Yan, Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing, China. E-mail: ORCID ID: https://orcid.org/0000-0001-7223-6467
| |
Collapse
|
3
|
Sarlo GL, Holton KF. Brain concentrations of glutamate and GABA in human epilepsy: A review. Seizure 2021; 91:213-227. [PMID: 34233236 DOI: 10.1016/j.seizure.2021.06.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/27/2022] Open
Abstract
An imbalance between excitation and inhibition has been a longstanding proposed mechanism regarding ictogenesis and epileptogenesis. This imbalance is related to increased extracellular glutamate in the brain and/or reduction in GABA concentrations, leading to excitotoxicity, seizures, and cell death. This review aims to summarize the microdialysis and magnetic resonance spectroscopy (MRS) literature investigating glutamate and GABA concentrations in epilepsy patients, present limitations, and suggest future directions to help direct the search for novel epilepsy treatments. The majority of microdialysis studies demonstrated increased glutamate in epileptic regions either compared to control regions or to baseline levels; however, sample sizes were small, with some statistical comparisons missing. For the MRS research, two of six studies reported significant changes in glutamate levels compared to controls, though the results were mixed, with one reporting increased and the other reporting decreased glutamate levels. Eleven of 20 studies reported significant changes in Glx (glutamate + glutamine) or Glx ratios, with most reporting increased levels, except for a few epilepsy syndromes where reduced levels were reported. Few studies investigated GABA concentrations, with one microdialysis and four spectroscopy studies reporting increased GABA levels, and one study reporting decreased GABA in a different brain region. Based on this review, future research should account for medication use; include measurements of GABA, glutamate, and glutamine; use high-tesla strength MRI; and further evaluate the timing of microdialysis. Understanding the importance of brain glutamate and GABA levels in epilepsy may provide direction for future therapies and treatments.
Collapse
Affiliation(s)
- Gabrielle L Sarlo
- Department of Psychology, Behavior, Cognition and Neuroscience Program, American University, Washington DC, United States
| | - Kathleen F Holton
- Department of Health Studies, American University, Washington DC, United States; Center for Behavioral Neuroscience, American University, Washington DC, United States.
| |
Collapse
|
4
|
Muniz BC, Ribeiro BNDF, Ventura N, Gasparetto EL, Marchiori E. Isolated suprasellar involvement in tuberculosis: findings on magnetic resonance imaging. Radiol Bras 2019; 52:60-61. [PMID: 30804618 PMCID: PMC6383531 DOI: 10.1590/0100-3984.2017.0091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Bernardo Carvalho Muniz
- Instituto Estadual do Cérebro Paulo Niemeyer - Departamento de Radiologia, Rio de Janeiro, RJ, Brazil
| | | | - Nina Ventura
- Instituto Estadual do Cérebro Paulo Niemeyer - Departamento de Radiologia, Rio de Janeiro, RJ, Brazil
| | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|