Clinical characteristics of patients with benign nonlesional temporal lobe epilepsy

A Study of Spontaneous Brain Activity on Resting-State Functional Magnetic Resonance Imaging in Adults with MRI-Negative Temporal Lobe Epilepsy

Purpose

Patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE-N) represent an important subgroup of temporal lobe epilepsy (TLE). Here, we aimed to combine three voxel-based local brain area analysis methods of resting-state functional MRI (rs-fMRI), to examine the TLE-N patients' resting brain function based on neural synchronization and intensity of local brain areas.

Methods

The study included 47 patients with TLE, including 28 cases of drug-controlled TLE (cTLE-N) and 19 cases of drug-resistant TLE-N (rTLE-N), as well as 30 participants in the healthy control (HC) group. To comprehensively assess the altered brain function associated with TLE-N patients, we analyzed three data-driven rs-fMRI algorithms for amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF) and regional homogeneity (ReHo).

Results

Compared to the HC group, the distribution of abnormal functional brain areas in cTLE-N patients was dominated by occipital lobe activation, as measured by increased fALFF values in the superior occipital gyrus (SOG) and increased ReHo values in the lingual gyrus (Lin), fusiform gyrus, and middle occipital gyrus. Patients with rTLE-N exhibited a diffuse distribution of abnormal functional brain areas, showing increased fALFF values in the SOG, Lin, superior temporal gyrus, and postcentral gyrus, and decreased fALFF values in the inferior frontal gyrus orbital, parahippocampal gyrus, and superior frontal gyrus orbital. The ReHo values were reduced in the orbital region of the middle frontal gyrus, the precuneus, and the parietal inferior angular gyrus; while ReHo values were elevated values in several frontal, temporal, occipital, and subcortical brain areas.

Conclusion

Patients with rTLE-N have local brain activity changes in the prefrontal limbic system and default model network dysfunction, while cTLE-N patients have local brain activity changes in the visual functional areas. Different epilepsy networks exist between cTLE-N and rTLE-N.

Expression of heat shock protein 70 and Annexin A1 in serum of patients with acutely severe traumatic brain injury

Trends of early expression levels of heat shock protein 70 (Hsp70) and Annexin A1 (ANXA1) in serum of patients with acutely severe traumatic brain injury and the effects on clinical prognosis were investigated. Eighty-four patients with severe traumatic brain injury admitted to Binzhou Center Hospital from June 2014 to July 2017 were selected as the experimental group. Glasgow coma scale and acute physiology and chronic health evaluation II (APACHE II) score were obtained after admission. A further 75 healthy subjects were selected as the control group. Serum expression of Hsp70 and ANXA1 in the two groups was detected by enzyme-linked immunosorbent assay on the 1st, 2nd, 3rd and 4th day after admission. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of Hsp70 and ANXA1 for the death of patients with acutely severe traumatic brain injury. Compared with the control group, expression of Hsp70 in the experimental group was significantly increased on the 1st, 2nd, 3rd and 4th day after admission (P<0.05), while expression of ANXA1 was significantly decreased (P<0.05). Expression levels of serum Hsp70 in the experimental group reached the peak on the 3rd day after admission, and the difference was statistically significant compared with the 1st, 2nd and 4th day (P<0.05). Expression of ANXA1 was the lowest on the 3rd day, and the difference was statistically significant compared with the 1st, 2nd and 4th day (P<0.05). The ROC curve analysis showed that the area under the curve of serum Hsp70 and ANXA1 was, respectively, 0.721 (95% CI: 0.611-0.829) and 0.684 (95% CI: 0.569-0.799). In conclusion, Hsp70 and ANXA1 may be involved in the occurrence and progression of acutely severe traumatic brain injury. The detection of serum Hsp70 and ANXA1 has certain diagnostic value for the death of patients with acutely severe traumatic brain injury.

An update of cyclooxygenase (COX)-inhibitors in epilepsy disorders

INTRODUCTION

Neuroinflammation has a critical role in brain disorders. Cyclooxygenase (COX) is one of the principal drug targets for the reduction of neuroinflammation; however, studies have yielded mixed results for COX-inhibitors in the treatment of diverse acute and chronic models of epilepsy.

AREAS COVERED

The article covers the effects of COX-inhibitors in epilepsy disorders. A considerable emphasis has been placed on the antiepileptic and 'disease-modifying' properties of COX-1 and COX-2 inhibitors in various preclinical epilepsy models.

EXPERT OPINION

The effect of COX-inhibitors on epilepsy is inconclusive. Studies have indicated beneficial effects in preclinical models; however, proconvulsant or no effects have also been observed. These molecules may have a bidirectional role with early neuroprotective and delayed neurotoxic effects. Further systematic preclinical studies to establish the use of COX-inhibitors in epilepsy are necessary.

The long-term prognosis of epilepsy patients with medically treated over a period of eight years in Turkey

Objective:

The aim of this study was to investigate the effect of demographic and clinical characteristics on temporal changes in seizure control and frequency in medically treated epilepsy patients to guide treatment modalities.

Methods:

We retrospectively analyzed the association between clinical and demographic characteristics and seizure frequency in 1329 epilepsy patients who were followed up at an outpatient clinic for one to eight years, 2008-2015..

Results:

Younger age at first seizure (p = 0.0465) and a long disease duration (p = 0.0406) had a negative effect on seizure control in all the epilepsy patients. Febrile convulsions (FCs) (p > 0.0001), perinatal risk (PNR) (p > 0.0002), a family history of epilepsy (FHE) (p > 0.0016), antiepileptic drug (AED) use (p > 0.001), mental retardation (MR) (p > 0.001), and psychiatric disorders (p > 0.0478) were prognostic indictors of temporal changes in seizure frequency. The presence of PNR (p = 0.0416), age at onset of epilepsy (p = 0.034), central nervous system infection (CNSI) (p = 0.04), and AEDs number (p = 0.0282) were prognostic indicators of not remaining seizure free for one year. In those with partial epilepsy, a trauma history (p = 0.05), a longer epilepsy duration (p = 0.0057), and FHE (p = 0.0466) increased the frequency of seizures, whereas cerebrovascular event (CVE) history decreased the seizure frequency (p = 0.0413). In addition, FHE (p = 0.0438) and psychotic disorders (p = 0.0416) increased generalized seizures frequency.

Conclusion:

In all the epilepsy patients, a younger age at onset and longer duration of epilepsy were associated with a poor prognosis. The presence of PNR, age at onset of epilepsy, CNSI, and AEDs numbers were prognostic indicators of not remaining seizure free for one year. Increasing AEDs number was not effective in controlling seizures in partial epilepsy, but it was effective in controlling seizures in generalized epilepsy.