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Monney J, Dallaire SE, Stoutah L, Fanda L, Mégevand P. Voxeloc: A time-saving graphical user interface for localizing and visualizing stereo-EEG electrodes. J Neurosci Methods 2024; 407:110154. [PMID: 38697518 DOI: 10.1016/j.jneumeth.2024.110154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/26/2024] [Accepted: 04/27/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Thanks to its unrivalled spatial and temporal resolutions and signal-to-noise ratio, intracranial EEG (iEEG) is becoming a valuable tool in neuroscience research. To attribute functional properties to cortical tissue, it is paramount to be able to determine precisely the localization of each electrode with respect to a patient's brain anatomy. Several software packages or pipelines offer the possibility to localize manually or semi-automatically iEEG electrodes. However, their reliability and ease of use may leave to be desired. NEW METHOD Voxeloc (voxel electrode locator) is a Matlab-based graphical user interface to localize and visualize stereo-EEG electrodes. Voxeloc adopts a semi-automated approach to determine the coordinates of each electrode contact, the user only needing to indicate the deep-most contact of each electrode shaft and another point more proximally. RESULTS With a deliberately streamlined functionality and intuitive graphical user interface, the main advantages of Voxeloc are ease of use and inter-user reliability. Additionally, oblique slices along the shaft of each electrode can be generated to facilitate the precise localization of each contact. Voxeloc is open-source software and is compatible with the open iEEG-BIDS (Brain Imaging Data Structure) format. COMPARISON WITH EXISTING METHODS Localizing full patients' iEEG implants was faster using Voxeloc than two comparable software packages, and the inter-user agreement was better. CONCLUSIONS Voxeloc offers an easy-to-use and reliable tool to localize and visualize stereo-EEG electrodes. This will contribute to democratizing neuroscience research using iEEG.
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Affiliation(s)
- Jonathan Monney
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Shannon E Dallaire
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Dalhousie University, Halifax, Canada
| | - Lydia Stoutah
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Université Paris-Saclay, Paris, France
| | - Lora Fanda
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre Mégevand
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Neurology division, Geneva University Hospitals, Geneva, Switzerland.
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Kishk N, Hosny H, Badry R, Elmenshawi I, Hamdy MM, Shaker E, Shehata HS, Magdy R, Ramzy GM, Hemeda M, Gaber A, Abdelhamed M, Abohagar A, Yassine IA, Abbas M, Shaheen HA, Abdel Moety M, Metwally HMH, Saeed MA, Essmat A, Abdou A, Soliman RH, Oraby MI, Morad AEN, Kasem SM, Aidaros M, El Heneedy Y, ElNemr A, Elkady A, Amin R, Abdel Ghany WA, Morsy AA, Hamdi H, Shamloul R. Consensus Guideline on the Management of Epilepsy in Egypt: A National Delphi Consensus Study. Epilepsia Open 2024. [PMID: 38790148 DOI: 10.1002/epi4.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. METHODS The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. RESULTS Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. SIGNIFICANCE With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. PLAIN LANGUAGE SUMMARY This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.
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Affiliation(s)
- Nirmeen Kishk
- Neurology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Hassan Hosny
- Neurology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Reda Badry
- Neurology Department, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Ibrahim Elmenshawi
- Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed M Hamdy
- Neurology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ehab Shaker
- Neurology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Hatem S Shehata
- Neurology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Rehab Magdy
- Neurology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Gihan M Ramzy
- Neurology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mahmoud Hemeda
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Gaber
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Abdelhamed
- Neurology Department, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Ahmed Abohagar
- Neurology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Imane A Yassine
- Neurology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohammed Abbas
- Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hala A Shaheen
- Neurology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mahmoud Abdel Moety
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Mohammad Ali Saeed
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Essmat
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ashraf Abdou
- Neurology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rasha Hassan Soliman
- Neurology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Mohammed I Oraby
- Neurology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Abd El-Naser Morad
- Neurology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | | | - Magdy Aidaros
- Neurology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Yasser El Heneedy
- Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed ElNemr
- Neurology Department, Maadi Military Hospital, Cairo, Egypt
| | - Ahmed Elkady
- Neurology Department, Mataria Teaching Hospital, El Matareya, Egypt
| | - Ramy Amin
- Neurosurgery Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Walid A Abdel Ghany
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed A Morsy
- Neurosurgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hussein Hamdi
- Neurosurgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Reham Shamloul
- Neurology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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Hajji EB, Traore B, Hassoune S, Bellakhdar S, Rafai MA, Lakhdar A. Antiseizure medication adherence and epilepsy surgery attitude in people with epilepsy in Morocco: A cross-sectional study. Epilepsy Behav Rep 2024; 26:100672. [PMID: 38770278 PMCID: PMC11103368 DOI: 10.1016/j.ebr.2024.100672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
We determine the proportion of non-Antiseizure Medication Adherence (non-AMA) and refusal attitude towards Epilepsy Surgery (ES) and their associated factors in Moroccan People With Epilepsy (PWE). A cross-sectional study was conducted (December 2021-December 2022) among adult Moroccan PWE. PWE were interviewed for their reactions to AMA and the ES attitude. Their medical files were processed to complete their sociodemographic and clinical data. Data were analyzed by the Statistical Package for Social Sciences (SPSS) software 21.0. A Chi-square test was performed to compare variables and multivariate logistic regression was used to highlight associations. Statistical tests were considered significant at a p-value ≤ 0.05 for a Confidence Interval (CI) of 95 %. The median age of our sample (n = 294) was 38 years (IQR: 25.00-55.00). Non-AMA was noted in 24.5 % with indifference as the main reason (55.6 %). ES refusal was found in 33.3 %, attributed mostly to apprehension (61.2 %). In the multivariate analysis, male sex (aOR = 1.94; 95 %CI: 1.03-3.64) and the existence of a family history of epilepsy (aOR = 1.96; 95 %CI: 1.02-3.75) were the factors associated with the non-AMA, whereas the use of allopathic treatments (aOR = 2.32; 95 %CI: 1.20-4.51), exclusively focal or generalized (not combined) seizures (aOR = 2.66; 95 %CI: 1.36-5.21) and the combination of a generic with the originator ASM (aOR = 2.64; 95 %CI: 1.12-6.18) were the predictive factors with the ES refusal attitude. The proportions found of non-AMA and ES refusal were relatively low compared to other studies, which may indicate the effort that medical staff have devoted recently to raising awareness of the importance of PWE's therapeutic involvement.
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Affiliation(s)
- El Bachir Hajji
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Boubacar Traore
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Direction de la Pharmacie et du Médicament (DPM), Bamako, Mali
| | - Samira Hassoune
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Laboratory of Cellular and Molecular Pathology, Team “Epidemiology and Histology of Chronic and Cancerous Diseases”, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Salma Bellakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Mohammed Abdoh Rafai
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Abdelhakim Lakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Neurosurgery, IBN ROCHD University Hospital, Casablanca, Morocco
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Ghosh A, Majie A, Karmakar V, Chatterjee K, Chakraborty S, Pandey M, Jain N, Roy Sarkar S, Nair AB, Gorain B. In-depth Mechanism, Challenges, and Opportunities of Delivering Therapeutics in Brain Using Intranasal Route. AAPS PharmSciTech 2024; 25:96. [PMID: 38710855 DOI: 10.1208/s12249-024-02810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024] Open
Abstract
Central nervous system-related disorders have become a continuing threat to human life and the current statistic indicates an increasing trend of such disorders worldwide. The primary therapeutic challenge, despite the availability of therapies for these disorders, is to sustain the drug's effective concentration in the brain while limiting its accumulation in non-targeted areas. This is attributed to the presence of the blood-brain barrier and first-pass metabolism which limits the transportation of drugs to the brain irrespective of popular and conventional routes of drug administration. Therefore, there is a demand to practice alternative routes for predictable drug delivery using advanced drug delivery carriers to overcome the said obstacles. Recent research attracted attention to intranasal-to-brain drug delivery for promising targeting therapeutics in the brain. This review emphasizes the mechanisms to deliver therapeutics via different pathways for nose-to-brain drug delivery with recent advancements in delivery and formulation aspects. Concurrently, for the benefit of future studies, the difficulties in administering medications by intranasal pathway have also been highlighted.
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Affiliation(s)
- Arya Ghosh
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Ankit Majie
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Varnita Karmakar
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Kaberi Chatterjee
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Swarup Chakraborty
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Manisha Pandey
- Department of Pharmaceutical Sciences, Central University of Haryana, Mahendergarh, 123031, India
| | - Neha Jain
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, U.P., India
| | - Suparna Roy Sarkar
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Anroop B Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
| | - Bapi Gorain
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India.
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Fatima H, Riaz F, Mustafa MS, Rangwala BS, Abbas SR, Rangwala HS. Compound 350: A New Hope for Individuals with Drug-resistant Epilepsy. Ann Neurosci 2024; 31:80-82. [PMID: 38694714 PMCID: PMC11060129 DOI: 10.1177/09727531231192758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Affiliation(s)
- Hareer Fatima
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Faiza Riaz
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | | | | | - Syed Raza Abbas
- Department of Medicine, Dow University of Health Sciences, Karachi, Sindh, Pakistan
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6
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Costa B, Vale N. Virus-Induced Epilepsy vs. Epilepsy Patients Acquiring Viral Infection: Unravelling the Complex Relationship for Precision Treatment. Int J Mol Sci 2024; 25:3730. [PMID: 38612542 PMCID: PMC11011490 DOI: 10.3390/ijms25073730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/04/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The intricate relationship between viruses and epilepsy involves a bidirectional interaction. Certain viruses can induce epilepsy by infecting the brain, leading to inflammation, damage, or abnormal electrical activity. Conversely, epilepsy patients may be more susceptible to viral infections due to factors, such as compromised immune systems, anticonvulsant drugs, or surgical interventions. Neuroinflammation, a common factor in both scenarios, exhibits onset, duration, intensity, and consequence variations. It can modulate epileptogenesis, increase seizure susceptibility, and impact anticonvulsant drug pharmacokinetics, immune system function, and brain physiology. Viral infections significantly impact the clinical management of epilepsy patients, necessitating a multidisciplinary approach encompassing diagnosis, prevention, and treatment of both conditions. We delved into the dual dynamics of viruses inducing epilepsy and epilepsy patients acquiring viruses, examining the unique features of each case. For virus-induced epilepsy, we specify virus types, elucidate mechanisms of epilepsy induction, emphasize neuroinflammation's impact, and analyze its effects on anticonvulsant drug pharmacokinetics. Conversely, in epilepsy patients acquiring viruses, we detail the acquired virus, its interaction with existing epilepsy, neuroinflammation effects, and changes in anticonvulsant drug pharmacokinetics. Understanding this interplay advances precision therapies for epilepsy during viral infections, providing mechanistic insights, identifying biomarkers and therapeutic targets, and supporting optimized dosing regimens. However, further studies are crucial to validate tools, discover new biomarkers and therapeutic targets, and evaluate targeted therapy safety and efficacy in diverse epilepsy and viral infection scenarios.
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Affiliation(s)
- Bárbara Costa
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Nuno Vale
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
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7
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Sharma A, Parfyonov M, Tiefenbach J, Hogue O, Nero N, Jehi L, Serletis D, Bingaman W, Gupta A, Rammo R. Predictors of therapeutic response following thalamic neuromodulation for drug-resistant pediatric epilepsy: A systematic review and individual patient data meta-analysis. Epilepsia 2024; 65:542-555. [PMID: 38265348 DOI: 10.1111/epi.17883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/02/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
We sought to perform a systematic review and individual participant data meta-analysis to identify predictors of treatment response following thalamic neuromodulation in pediatric patients with medically refractory epilepsy. Electronic databases (MEDLINE, Ovid, Embase, and Cochrane) were searched, with no language or data restriction, to identify studies reporting seizure outcomes in pediatric populations following deep brain stimulation (DBS) or responsive neurostimulation (RNS) implantation in thalamic nuclei. Studies featuring individual participant data of patients with primary or secondary generalized drug-resistant epilepsy were included. Response to therapy was defined as >50% reduction in seizure frequency from baseline. Of 417 citations, 21 articles reporting on 88 participants were eligible. Mean age at implantation was 13.07 ± 3.49 years. Fifty (57%) patients underwent DBS, and 38 (43%) RNS. Sixty (68%) patients were implanted in centromedian nucleus and 23 (26%) in anterior thalamic nucleus, and five (6%) had both targets implanted. Seventy-four (84%) patients were implanted bilaterally. The median time to last follow-up was 12 months (interquartile range = 6.75-26.25). Sixty-nine percent of patients achieved response to treatment. Age, target, modality, and laterality had no significant association with response in univariate logistic regression. Until thalamic neuromodulation gains widespread approval for use in pediatric patients, data on efficacy will continue to be limited to small retrospective cohorts and case series. The inherent bias of these studies can be overcome by using individual participant data. Thalamic neuromodulation appears to be a safe and effective treatment for epilepsy. Larger, prolonged prospective, multicenter studies are warranted to further evaluate the efficacy of DBS over RNS in this patient population where resection for curative intent is not a safe option.
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Affiliation(s)
- Akshay Sharma
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Maksim Parfyonov
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jakov Tiefenbach
- Center for Neurologic Restoration, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Neil Nero
- Education Institute, Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Demitre Serletis
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Bingaman
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ajay Gupta
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Richard Rammo
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Center for Neurologic Restoration, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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8
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Liu Y, Jia N, Tang C, Long H, Wang J. Microglia in Microbiota-Gut-Brain Axis: A Hub in Epilepsy. Mol Neurobiol 2024:10.1007/s12035-024-04022-w. [PMID: 38366306 DOI: 10.1007/s12035-024-04022-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
There is growing concern about the role of the microbiota-gut-brain axis in neurological illnesses, and it makes sense to consider microglia as a critical component of this axis in the context of epilepsy. Microglia, which reside in the central nervous system, are dynamic guardians that monitor brain homeostasis. Microglia receive information from the gut microbiota and function as hubs that may be involved in triggering epileptic seizures. Vagus nerve bridges the communication in the axis. Essential axis signaling molecules, such as gamma-aminobutyric acid, 5-hydroxytryptamin, and short-chain fatty acids, are currently under investigation for their participation in drug-resistant epilepsy (DRE). In this review, we explain how vagus nerve connects the gut microbiota to microglia in the brain and discuss the emerging concepts derived from this interaction. Understanding microbiota-gut-brain axis in epilepsy brings hope for DRE therapies. Future treatments can focus on the modulatory effect of the axis and target microglia in solving DRE.
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Affiliation(s)
- Yuyang Liu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, China
| | - Ningkang Jia
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, China
- The Second Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Chuqi Tang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, China
| | - Hao Long
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Jun Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China.
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, China.
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Lian X, Wang X, Xie Y, Sheng H, He J, Peng T, Xie N, Wang C, Lian Y. ATF5-regulated Mitochondrial Unfolded Protein Response Attenuates Neuronal Damage in Epileptic Rat by Reducing Endoplasmic Reticulum Stress Through Mitochondrial ROS. Neurochem Res 2024; 49:388-401. [PMID: 37847329 DOI: 10.1007/s11064-023-04042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
Endoplasmic reticulum (ER) dysfunction caused by excessive ER stress is a crucial mechanism underlying seizures-induced neuronal injury. Studies have shown that mitochondrial reactive oxygen species (ROS) are closely related to ER stress, and our previous study showed that activating transcription factor 5 (ATF5)-regulated mitochondrial unfolded protein response (mtUPR) modulated mitochondrial ROS generation in a hippocampal neuronal culture model of seizures. However, the effects of ATF5-regulated mtUPR on ER stress and the underlying mechanisms remain uncertain in epilepsy. In this study, ATF5 upregulation by lentivirus infection attenuated seizures-induced neuronal damage and apoptosis in a rat model of pilocarpine-induced epilepsy, whereas ATF5 downregulation by lentivirus infection had the opposite effects. ATF5 upregulation potentiated mtUPR by increasing the expression of mitochondrial chaperone heat shock protein 60 (HSP60) and caseinolytic protease proteolytic subunit (ClpP) and reducing mitochondrial ROS generation in pilocarpine-induced seizures in rats. Additionally, upregulation of ATF5 reduced the expression of glucose-regulated protein 78 (GRP78), protein kinase RNA-like endoplasmic reticulum kinase (PERK), activating transcription factor 4 (ATF4), and C/EBP homologous protein (CHOP), suggesting suppression of ER stress; Moreover, ATF5 upregulation attenuated apoptosis-related proteins such as B-cell lymphoma-2 (BCL2) downregulation, BCL2-associated X (BAX) and cleaved-caspase-3 upregulation. However, ATF5 downregulation exerted the opposite effects. Furthermore, pretreatment with the mitochondria-targeted antioxidant mito-TEMPO attenuated the harmful effects of ATF5 downregulation on ER stress and neuronal apoptosis by reducing mitochondrial ROS generation. Overall, our study suggested that ATF5-regulated mtUPR exerted neuroprotective effects against pilocarpine-induced seizures in rats and the underlying mechanisms might involve mitochondrial ROS-mediated ER stress.
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Affiliation(s)
- Xiaolei Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
- The Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaoyi Wang
- Institutes of Biological and Medical Sciences, Suzhou Medical College of Soochow University, Suzhou, 215123, Jiangsu, China
| | - Yinyin Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Hanqing Sheng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Jiao He
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Tingting Peng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Nanchang Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Cui Wang
- Department of Clinical Laboratory, Key Clinical Laboratory of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan, China.
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10
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Yu X, Yang H, Lv H, Lu H, Zhao H, Xu Z. Age-Dependent Phenomena of 6-Hz Corneal Kindling Model in Mice. Mol Neurobiol 2024:10.1007/s12035-024-03934-x. [PMID: 38214837 DOI: 10.1007/s12035-024-03934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
Although numerous studies have acknowledged disparities in epilepsy-related disease processes between young and aged animals, little is known about how epilepsy changes from young adulthood to middle age. This study investigates the impact of aging on 6-Hz corneal kindling in young-adult mice and middle-aged mice. We found that the kindling acquisition of the 6-Hz corneal kindling model was delayed in middle-aged mice when compared to young-adult mice. While the seizure stage and incidence of generalized seizures (GS) were similar between the two age groups, the duration of GS in the kindled middle-aged mice was shorter than that in the kindled young-adult mice. Besides, all kindled mice, regardless of age, were resistant to phenytoin sodium (PHT), valproate sodium (VPA), and lamotrigine (LGT), whereas middle-aged mice exhibited higher levetiracetam (LEV) resistance compared to young-adult mice. Both age groups of kindled mice displayed hyperactivity and impaired memory, which are common behavioral characteristics associated with epilepsy. Furthermore, middle-aged mice displayed more pronounced astrogliosis in the hippocampus. Additionally, the expression of Brain-Derived Neurotrophic Factor (BDNF) was lower in middle-aged mice than in young-adult mice prior to kindling. These data demonstrate that both the acquisition and expression of 6-Hz corneal kindling are attenuated in middle-aged mice, while hippocampal astrogliosis and pharmacological resistance are more pronounced in this age group. These results underscore the importance of considering age-related factors when utilizing the 6-Hz corneal kindling model in mice of varying age groups.
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Affiliation(s)
- Xiu Yu
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Han Yang
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - HongJie Lv
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haimei Lu
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huawei Zhao
- Department of Pharmacy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Zhenghao Xu
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China.
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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11
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Trofimova AM, Amakhin DV, Postnikova TY, Tiselko VS, Alekseev A, Podoliak E, Gordeliy VI, Chizhov AV, Zaitsev AV. Light-Driven Sodium Pump as a Potential Tool for the Control of Seizures in Epilepsy. Mol Neurobiol 2023:10.1007/s12035-023-03865-z. [PMID: 38114761 DOI: 10.1007/s12035-023-03865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
The marine flavobacterium Krokinobactereikastus light-driven sodium pump (KR2) generates an outward sodium ion current under 530 nm light stimulation, representing a promising optogenetic tool for seizure control. However, the specifics of KR2 application to suppress epileptic activity have not yet been addressed. In the present study, we investigated the possibility of KR2 photostimulation to suppress epileptiform activity in mouse brain slices using the 4-aminopyrindine (4-AP) model. We injected the adeno-associated viral vector (AAV-PHP.eB-hSyn-KR2-YFP) containing the KR2 sodium pump gene enhanced with appropriate trafficking tags. KR2 expression was observed in the lateral entorhinal cortex and CA1 hippocampus. Using whole-cell patch clamp in mouse brain slices, we show that KR2, when stimulated with LED light, induces a substantial hyperpolarization of entorhinal neurons. However, continuous photostimulation of KR2 does not interrupt ictal discharges in mouse entorhinal cortex slices induced by a solution containing 4-AP. KR2-induced hyperpolarization strongly activates neuronal HCN channels. Consequently, turning off photostimulation resulted in HCN channel-mediated rebound depolarization accompanied by a transient increase in spontaneous network activity. Using low-frequency pulsed photostimulation, we induced the generation of short HCN channel-mediated discharges that occurred in response to the light stimulus being turned off; these discharges reliably interrupt ictal activity. Thus, low-frequency pulsed photostimulation of KR2 can be considered as a potential tool for controlling epileptic seizures.
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Affiliation(s)
- Alina M Trofimova
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Saint Petersburg, Russia
| | - Dmitry V Amakhin
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Saint Petersburg, Russia
| | - Tatyana Y Postnikova
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Saint Petersburg, Russia
| | - Vasilii S Tiselko
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Saint Petersburg, Russia
| | - Alexey Alekseev
- Research Center for Molecular Mechanisms of Aging and Age-Related Diseases, Moscow Institute of Physics and Technology (National Research University), Dolgoprudny, Russia
- Institute for Auditory Neuroscience and InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| | - Elizaveta Podoliak
- Research Center for Molecular Mechanisms of Aging and Age-Related Diseases, Moscow Institute of Physics and Technology (National Research University), Dolgoprudny, Russia
- Department of Ophthalmology, Universitäts-Augenklinik Bonn, University of Bonn, Bonn, Germany
| | - Valentin I Gordeliy
- Research Center for Molecular Mechanisms of Aging and Age-Related Diseases, Moscow Institute of Physics and Technology (National Research University), Dolgoprudny, Russia
- Institut de Biologie Structurale (IBS), Université Grenoble Alpes, CEA, CNRS, Grenoble, France
| | - Anton V Chizhov
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Saint Petersburg, Russia
- MathNeuro Team, Inria Centre at Université Côte d'Azur, Sophia Antipolis, France
| | - Aleksey V Zaitsev
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Saint Petersburg, Russia.
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12
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Davletshin AI, Matveeva AA, Poletaeva II, Evgen'ev MB, Garbuz DG. The role of molecular chaperones in the mechanisms of epileptogenesis. Cell Stress Chaperones 2023; 28:599-619. [PMID: 37755620 PMCID: PMC10746656 DOI: 10.1007/s12192-023-01378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
Epilepsy is a group of neurological diseases which requires significant economic costs for the treatment and care of patients. The central point of epileptogenesis stems from the failure of synaptic signal transmission mechanisms, leading to excessive synchronous excitation of neurons and characteristic epileptic electroencephalogram activity, in typical cases being manifested as seizures and loss of consciousness. The causes of epilepsy are extremely diverse, which is one of the reasons for the complexity of selecting a treatment regimen for each individual case and the high frequency of pharmacoresistant cases. Therefore, the search for new drugs and methods of epilepsy treatment requires an advanced study of the molecular mechanisms of epileptogenesis. In this regard, the investigation of molecular chaperones as potential mediators of epileptogenesis seems promising because the chaperones are involved in the processing and regulation of the activity of many key proteins directly responsible for the generation of abnormal neuronal excitation in epilepsy. In this review, we try to systematize current data on the role of molecular chaperones in epileptogenesis and discuss the prospects for the use of chemical modulators of various chaperone groups' activity as promising antiepileptic drugs.
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Affiliation(s)
| | - Anna A Matveeva
- Engelhardt Institute of Molecular Biology RAS, 119991, Moscow, Russia
- Moscow Institute of Physics and Technology, 141700, Dolgoprudny, Moscow Region, Russia
| | - Inga I Poletaeva
- Biology Department, Lomonosov Moscow State University, 119991, Moscow, Russia
| | | | - David G Garbuz
- Engelhardt Institute of Molecular Biology RAS, 119991, Moscow, Russia
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Torres-Gaona G, Aledo-Serrano Á, García-Morales I, Toledano R, Valls J, Cosculluela B, Munsó L, Raurich X, Trejo A, Blanquez D, Gil-Nagel A. Artificial intelligence system, based on mjn-SERAS algorithm, for the early detection of seizures in patients with refractory focal epilepsy: a cross-sectional pilot study. Epilepsy Behav Rep 2023; 22:100600. [DOI: 10.1016/j.ebr.2023.100600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
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Zhao W, Li M, Wang S, Li Z, Li H, Li S. CircRNA SRRM4 affects glucose metabolism by regulating PKM alternative splicing via SRSF3 deubiquitination in epilepsy. Neuropathol Appl Neurobiol 2023; 49:e12850. [PMID: 36168302 DOI: 10.1111/nan.12850] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/10/2022] [Accepted: 07/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Several reports suggest that epigenetic therapy may be a potential method for treating epilepsy, and circular RNAs (circRNAs) play important roles in mediating the epigenetic mechanisms associated with epilepsy; however, currently there are no effective treatment methods to prevent the progression of epileptogenesis. The circRNA serine/arginine repetitive matrix 4 (circSRRM4) was found to exert regulatory effects in temporal lobe epilepsy (TLE); however, the mechanisms involved are still unknown. MATERIALS AND METHODS To elucidate the molecular mechanism of circSRRM4, we investigated human epileptic brain tissue, epileptic rats, neuron and astrocyte cell lines using RT-qPCR, western blot, fluorescence in situ hybridisation, immunofluorescence staining, Nissl stain, micro-PET-CT, RNA-pulldown, liquid chromatography-mass spectrometry, and RBP immunoprecipitation techniques. Furthermore, we evaluated the pyruvate kinase M1/2 (PKM) expression patterns in the human and rat models of TLE. RESULTS We detected the increased circSRRM4 expression in the hypometabolic lesions of patients with TLE and discovered that circSrrm4 has specific spatiotemporal characteristics in rats with kainic acid-induced epilepsy. The decreased PKM1 expression and increased PKM2 expression were similar to the Warburg effect in tumours. Notably, circSrrm4 silencing reduced the incidence and frequency of epilepsy, improved local hypometabolism, and prevented neuronal loss and astrocyte activation. CONCLUSION PKM2 promotes lactic acid production in the astrocytes by inducing glycolysis, thereby contributing to the energy source for epileptic seizures. Notably, circSRRM4 combines with and inhibits serine and arginine rich splicing factor 3 (SRSF3) from joining the ubiquitin-proteasome pathway, improving the SRSF3-regulated alternative splicing of PKM, and consequently stimulating glycolysis in cells.
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Affiliation(s)
- Wujun Zhao
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Miaomiao Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shuai Wang
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhuang Li
- The Third Department of Neurosurgery, The People's Hospital of Liaoning Province, Shenyang, China
| | - Han Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaoyi Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
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15
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Lima LSD, Loyola V, Bicca JVML, Faro L, Vale CLC, Lotufo Denucci B, Mortari MR. Innovative treatments for epilepsy: Venom peptides, cannabinoids, and neurostimulation. J Neurosci Res 2022; 100:1969-1986. [PMID: 35934922 DOI: 10.1002/jnr.25114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 11/07/2022]
Abstract
Antiepileptic drugs have been successfully treating epilepsy and providing individuals sustained seizure freedom. However, about 30% of the patients with epilepsy present drug resistance, which means they are not responsive to the pharmacological treatment. Considering this, it becomes extremely relevant to pursue alternative therapeutic approaches, in order to provide appropriate treatment for those patients and also improve their quality of life. In the light of that, this review aims to discuss some innovative options for the treatment of epilepsy, which are currently under investigation, addressing strategies that go from therapeutic compounds to clinical procedures. For instance, peptides derived from animal venoms, such as wasps, spiders, and scorpions, demonstrate to be promising antiepileptic molecules, acting on a variety of targets. Other options are cannabinoids and compounds that modulate the endocannabinoid system, since it is now known that this network is involved in the pathophysiology of epilepsy. Furthermore, neurostimulation is another strategy, being an alternative clinical procedure for drug-resistant patients who are not eligible for palliative surgeries.
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Affiliation(s)
- Larissa Silva de Lima
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasilia, Brazil
| | - Vinícius Loyola
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasilia, Brazil
| | - João Victor Montenegro Luzardo Bicca
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasilia, Brazil
| | - Lucas Faro
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasilia, Brazil
| | - Camilla Lepesqueur Costa Vale
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasilia, Brazil
| | - Bruna Lotufo Denucci
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasilia, Brazil
| | - Márcia Renata Mortari
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasilia, Brazil
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16
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Mohi-Ud-Din R, Mir RH, Mir PA, Banday N, Shah AJ, Sawhney G, Bhat MM, Batiha GE, Pottoo FH, Pottoo FH. Dysfunction of ABC Transporters at the Surface of BBB: Potential Implications in Intractable Epilepsy and Applications of Nanotechnology Enabled Drug Delivery. Curr Drug Metab 2022; 23:735-756. [PMID: 35980054 DOI: 10.2174/1389200223666220817115003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/10/2022] [Accepted: 05/31/2022] [Indexed: 01/05/2023]
Abstract
Epilepsy is a chronic neurological disorder affecting 70 million people globally. One of the fascinating attributes of brain microvasculature is the (BBB), which controls a chain of distinct features that securely regulate the molecules, ions, and cells movement between the blood and the parenchyma. The barrier's integrity is of paramount importance and essential for maintaining brain homeostasis, as it offers both physical and chemical barriers to counter pathogens and xenobiotics. Dysfunction of various transporters in the (BBB), mainly ATP binding cassette (ABC), is considered to play a vital role in hampering the availability of antiepileptic drugs into the brain. ABC (ATP-binding cassette) transporters constitute a most diverse protein superfamily, which plays an essential part in various biological processes, including cell homeostasis, cell signaling, uptake of nutrients, and drug metabolism. Moreover, it plays a crucial role in neuroprotection by out-flowing various internal and external toxic substances from the interior of a cell, thus decreasing their buildup inside the cell. In humans, forty-eight ABC transporters have been acknowledged and categorized into subfamilies A to G based on their phylogenetic analysis. ABC subfamilies B, C, and G, impart a vital role at the BBB in guarding the brain against the entrance of various xenobiotic and their buildup. The illnesses of the central nervous system have received a lot of attention lately Owing to the existence of the BBB, the penetration effectiveness of most CNS medicines into the brain parenchyma is very limited (BBB). In the development of neurological therapies, BBB crossing for medication delivery to the CNS continues to be a major barrier. Nanomaterials with BBB cross ability have indeed been extensively developed for the treatment of CNS diseases due to their advantageous properties. This review will focus on multiple possible factors like inflammation, oxidative stress, uncontrolled recurrent seizures, and genetic polymorphisms that result in the deregulation of ABC transporters in epilepsy and nanotechnology-enabled delivery across BBB in epilepsy.
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Affiliation(s)
- Roohi Mohi-Ud-Din
- Department of General Medicine, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu & Kashmir, 190011, India.,Department of Pharmaceutical Sciences, School of Applied Sciences & Technology, University of Kashmir, Hazratbal, Srinagar-190006, Jammu & Kashmir, India
| | - Reyaz Hassan Mir
- Pharmaceutical Chemistry Division, Chandigarh College of Pharmacy, Landran, Punjab-140301, India.,Department of Pharmaceutical Sciences, Pharmaceutical Chemistry Division, University of Kashmir, Hazratbal, Srinagar-190006, Kashmir, India
| | - Prince Ahad Mir
- Department of Pharmaceutical Sciences, Khalsa College of Pharmacy, G.T. Road, Amritsar-143002, Punjab, India
| | - Nazia Banday
- Department of Pharmaceutical Sciences, School of Applied Sciences & Technology, University of Kashmir, Hazratbal, Srinagar-190006, Jammu & Kashmir, India
| | - Abdul Jalil Shah
- Department of Pharmaceutical Sciences, Pharmaceutical Chemistry Division, University of Kashmir, Hazratbal, Srinagar-190006, Kashmir, India
| | - Gifty Sawhney
- Inflammation Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu-Tawi, Jammu 180001, India
| | - Mudasir Maqbool Bhat
- Department of Pharmaceutical Sciences, Pharmacy Practice Division, University of Kashmir, Hazratbal, Srinagar-190006, Jammu & Kashmir, India
| | - Gaber E Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, AlBeheira, Egypt
| | - Faheem Hyder Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Faheem Hyder Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, 31441, Dammam, Saudi Arabia
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17
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Shaimardanova AA, Chulpanova DS, Mullagulova AI, Afawi Z, Gamirova RG, Solovyeva VV, Rizvanov AA. Gene and Cell Therapy for Epilepsy: A Mini Review. Front Mol Neurosci 2022; 15:868531. [PMID: 35645733 PMCID: PMC9132249 DOI: 10.3389/fnmol.2022.868531] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is a chronic non-infectious disease of the brain, characterized primarily by recurrent unprovoked seizures, defined as an episode of disturbance of motor, sensory, autonomic, or mental functions resulting from excessive neuronal discharge. Despite the advances in the treatment achieved with the use of antiepileptic drugs and other non-pharmacological therapies, about 30% of patients suffer from uncontrolled seizures. This review summarizes the currently available methods of gene and cell therapy for epilepsy and discusses the development of these approaches. Currently, gene therapy for epilepsy is predominantly adeno-associated virus (AAV)-mediated delivery of genes encoding neuro-modulatory peptides, neurotrophic factors, enzymes, and potassium channels. Cell therapy for epilepsy is represented by the transplantation of several types of cells such as mesenchymal stem cells (MSCs), bone marrow mononuclear cells, neural stem cells, and MSC-derived exosomes. Another approach is encapsulated cell biodelivery, which is the transplantation of genetically modified cells placed in capsules and secreting various therapeutic agents. The use of gene and cell therapy approaches can significantly improve the condition of patient with epilepsy. Therefore, preclinical, and clinical studies have been actively conducted in recent years to prove the benefits and safety of these strategies.
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Affiliation(s)
| | - Daria S. Chulpanova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Aysilu I. Mullagulova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Zaid Afawi
- Center for Neuroscience, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Rimma G. Gamirova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Valeriya V. Solovyeva
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Albert A. Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- *Correspondence: Albert A. Rizvanov,
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Reorganization of Parvalbumin Immunopositive Perisomatic Innervation of Principal Cells in Focal Cortical Dysplasia Type IIB in Human Epileptic Patients. Int J Mol Sci 2022; 23:ijms23094746. [PMID: 35563137 PMCID: PMC9100614 DOI: 10.3390/ijms23094746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
Focal cortical dysplasia (FCD) is one of the most common causes of drug-resistant epilepsy. As several studies have revealed, the abnormal functioning of the perisomatic inhibitory system may play a role in the onset of seizures. Therefore, we wanted to investigate whether changes of perisomatic inhibitory inputs are present in FCD. Thus, the input properties of abnormal giant- and control-like principal cells were examined in FCD type IIB patients. Surgical samples were compared to controls from the same cortical regions with short postmortem intervals. For the study, six subjects were selected/each group. The perisomatic inhibitory terminals were quantified in parvalbumin and neuronal nuclei double immunostained sections using a confocal fluorescent microscope. The perisomatic input of giant neurons was extremely abundant, whereas control-like cells of the same samples had sparse inputs. A comparison of pooled data shows that the number of parvalbumin-immunopositive perisomatic terminals contacting principal cells was significantly larger in epileptic cases. The analysis showed some heterogeneity among epileptic samples. However, five out of six cases had significantly increased perisomatic input. Parameters of the control cells were homogenous. The reorganization of the perisomatic inhibitory system may increase the probability of seizure activity and might be a general mechanism of abnormal network activity.
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19
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Mueller JS, Tescarollo FC, Sun H. DREADDs in Epilepsy Research: Network-Based Review. Front Mol Neurosci 2022; 15:863003. [PMID: 35465094 PMCID: PMC9021489 DOI: 10.3389/fnmol.2022.863003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022] Open
Abstract
Epilepsy can be interpreted as altered brain rhythms from overexcitation or insufficient inhibition. Chemogenetic tools have revolutionized neuroscience research because they allow “on demand” excitation or inhibition of neurons with high cellular specificity. Designer Receptors Exclusively Activated by Designer Drugs (DREADDs) are the most frequently used chemogenetic techniques in epilepsy research. These engineered muscarinic receptors allow researchers to excite or inhibit targeted neurons with exogenous ligands. As a result, DREADDs have been applied to investigate the underlying cellular and network mechanisms of epilepsy. Here, we review the existing literature that has applied DREADDs to understand the pathophysiology of epilepsy. The aim of this review is to provide a general introduction to DREADDs with a focus on summarizing the current main findings in experimental epilepsy research using these techniques. Furthermore, we explore how DREADDs may be applied therapeutically as highly innovative treatments for epilepsy.
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20
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Desli E, Spilioti M, Evangeliou A, Styllas F, Magkos F, Dalamaga M. The Efficacy and Safety of Ketogenic Diets in Drug-Resistant Epilepsy in Children and Adolescents: a Systematic Review of Randomized Controlled Trials. Curr Nutr Rep 2022; 11:102-116. [PMID: 35303283 DOI: 10.1007/s13668-022-00405-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Drug-resistant epilepsy represents around one-quarter of epilepsies worldwide. Although ketogenic diets (KD) have been used for refractory epilepsy since 1921, the past 15 years have witnessed an explosion of KD use in the management of epilepsy. We aimed to review evidence from randomized controlled trials (RCTs) regarding the efficacy and safety of KD in drug-resistant epilepsy in children and adolescents. RECENT FINDINGS A literature search was performed in the Pubmed, Cohrane, Scopus, ClinicalTrials.gov, and Google Scholar databases. Predefined criteria were implemented regarding data extraction and study quality. Data were extracted from 14 RCTs in 1114 children and adolescents aged from 6 months to 18 years. Primary outcome was seizure reduction after the intervention. In 6 out of the 14 studies, there was a statistical significant seizure reduction by > 50% in the KD-treated group compared with the control group over a follow-up of 3-4 months. Secondary outcomes were adverse events, seizure severity, quality of life, and behavior. Gastrointestinal symptoms were the most frequent adverse events. Serious adverse events were rare. We conclude that the KD is an effective treatment for drug-resistant epilepsy in children and adolescents. Accordingly, RCTs investigating long-term impact, cognitive and behavioral effects, and cost-effectiveness are much anticipated.
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Affiliation(s)
- Evangelia Desli
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
| | - Martha Spilioti
- 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Athanasios Evangeliou
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Foteinos Styllas
- 1st Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Faidon Magkos
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian, University of Athens, Athens, Greece
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Batson S, Shankar R, Conry J, Boggs J, Radtke R, Mitchell S, Barion F, Murphy J, Danielson V. Efficacy and safety of VNS therapy or continued medication management for treatment of adults with drug-resistant epilepsy: systematic review and meta-analysis. J Neurol 2022; 269:2874-2891. [PMID: 35034187 PMCID: PMC9119900 DOI: 10.1007/s00415-022-10967-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people with drug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessful surgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted to determine the treatment effects of VNS Therapy as an adjunct to anti-seizure medications (ASMs) for the management of adults with DRE. A literature search was performed in August 2020 of the Medline®, Medline® Epub Ahead of Print, Embase, and the Cochrane library databases. Outcomes examined included reduction in seizure frequency, seizure freedom, ASM load, discontinuations, and serious adverse events (SAEs). Comparators included best medical practice, ASMs, low-stimulation or sham VNS Therapy. Four RCTs and six comparative observational studies were identified for inclusion. Against comparators, individuals treated with VNS had a significantly better odds of experiencing a ≥ 50% reduction in seizure frequency (OR: 2.27 [95% CI 1.47, 3.51]; p = 0.0002), a ≥ 75% reduction in seizure frequency (OR: 3.56 [95% CI 1.59, 7.98]; p = 0.002) and a reduced risk for increased ASM load (risk ratio: 0.36 [95% CI 0.21, 0.62]; p = 0.0002). There was no difference in the odds of discontinuation or the rate of SAEs between VNS versus comparators. This meta-analysis demonstrated the benefits of VNS Therapy in people with DRE, which included improvement in seizure frequency without an increase in the rate of SAEs or discontinuations, thereby supporting the consideration of VNS Therapy for people who are not responding to ASMs and those unsuitable or unwilling to undergo surgery.
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Affiliation(s)
- Sarah Batson
- Sarah Batson, Mtech Access Limited, 30 Murdock Road, Bicester, OX26 4PP, Oxfordshire, England.
| | - Rohit Shankar
- Neuropsychiatry, Peninsula School of Medicine, University of Plymouth, Plymouth, England
| | - Joan Conry
- Children's National, Washington, District of Columbia, USA
| | - Jane Boggs
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | - Stephen Mitchell
- Sarah Batson, Mtech Access Limited, 30 Murdock Road, Bicester, OX26 4PP, Oxfordshire, England
| | - Francesca Barion
- Pricing, Health Economics, Market Access and Reimbursement (PHEMAR), LivaNova, London, England
| | - Joanna Murphy
- Pricing, Health Economics, Market Access and Reimbursement (PHEMAR), LivaNova, London, England
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22
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Zhong R, Chen Q, Zhang X, Lin W. The Occurrence of Seizure Clusters in Patients With Epilepsy Is Partly Determined by Epilepsy Severity: A Single-Center Retrospective Observational Study. Front Neurol 2021; 12:794086. [PMID: 34956069 PMCID: PMC8695898 DOI: 10.3389/fneur.2021.794086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: This retrospective observational study aimed to investigate the self-reported prevalence of seizure clusters (SCs) in patients with epilepsy (PWE) and its relationship with clinical characteristics. Methods: We retrospectively analyzed data from consecutive PWE from our hospital in northeastern China. Data were collected from the databank of a tertiary epilepsy center. Logistic regression models were employed to investigate the relationships between the individual patient demographic/clinical variables and the occurrence of SC. Results: In total, 606 consecutive PWE were included in the final analysis, and 268 (44.2%) patients experienced at least one seizure cluster. In multivariate logistic regression models, age (OR: 1.014; 95% CI: 1.002–1.027; p = 0.02), seizure frequency (OR: 2.08; 95% CI: 1.555–2.783; p < 0.001), multiple seizure types (OR: 5.111; 95% CI: 1.737–15.043; p = 0.003), number of current anti-seizure medications (ASM) (OR: 1.533; 95% CI: 1.15–2.042; p = 0.004), drug-resistant epilepsy (OR: 1.987; 95% CI: 1.159–3.407; p = 0.013), and a history of status epilepticus (OR: 1.903; 95% CI: 1.24–2.922; p = 0.003) were independent variables associated with a history of SC in PWE. Conclusion: Seizure clusters (SCs) are common occurrences at our study center. The occurrence of SC in individuals with epilepsy, to some extent, is determined by the epilepsy severity.
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Affiliation(s)
- Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qingling Chen
- Department of Hepatology, Second People's Clinical College of Tianjin Medical University, Tianjin, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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Prophylactic Activation of Shh Signaling Attenuates TBI-Induced Seizures in Zebrafish by Modulating Glutamate Excitotoxicity through Eaat2a. Biomedicines 2021; 10:biomedicines10010032. [PMID: 35052712 PMCID: PMC8773121 DOI: 10.3390/biomedicines10010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Approximately 2 million individuals experience a traumatic brain injury (TBI) every year in the United States. Secondary injury begins within minutes after TBI, with alterations in cellular function and chemical signaling that contribute to excitotoxicity. Post-traumatic seizures (PTS) are experienced in an increasing number of TBI individuals that also display resistance to traditional anti-seizure medications (ASMs). Sonic hedgehog (Shh) is a signaling pathway that is upregulated following central nervous system damage in zebrafish and aids injury-induced regeneration. Using a modified Marmarou weight drop on adult zebrafish, we examined PTS following TBI and Shh modulation. We found that inhibiting Shh signaling by cyclopamine significantly increased PTS in TBI fish, prolonged the timeframe PTS was observed, and decreased survival across all TBI severities. Shh-inhibited TBI fish failed to respond to traditional ASMs, but were attenuated when treated with CNQX, which blocks ionotropic glutamate receptors. We found that the Smoothened agonist, purmorphamine, increased Eaat2a expression in undamaged brains compared to untreated controls, and purmorphamine treatment reduced glutamate excitotoxicity following TBI. Similarly, purmorphamine reduced PTS, edema, and cognitive deficits in TBI fish, while these pathologies were increased and/or prolonged in cyclopamine-treated TBI fish. However, the increased severity of TBI phenotypes with cyclopamine was reduced by cotreating fish with ceftriaxone, which induces Eaat2a expression. Collectively, these data suggest that Shh signaling induces Eaat2a expression and plays a role in regulating TBI-induced glutamate excitotoxicity and TBI sequelae.
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Aroor A, Brewster AL. Dendritic and Spine Loss in Epilepsy: What Seizures Got to Do With It? Epilepsy Curr 2021; 21:186-188. [PMID: 34867100 PMCID: PMC8609590 DOI: 10.1177/15357597211003096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
[Box: see text]
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25
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Vogel S, Kaltenhäuser M, Kim C, Müller-Voggel N, Rössler K, Dörfler A, Schwab S, Hamer H, Buchfelder M, Rampp S. MEG Node Degree Differences in Patients with Focal Epilepsy vs. Controls-Influence of Experimental Conditions. Brain Sci 2021; 11:1590. [PMID: 34942895 PMCID: PMC8699109 DOI: 10.3390/brainsci11121590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022] Open
Abstract
Drug-resistant epilepsy can be most limiting for patients, and surgery represents a viable therapy option. With the growing research on the human connectome and the evidence of epilepsy being a network disorder, connectivity analysis may be able to contribute to our understanding of epilepsy and may be potentially developed into clinical applications. In this magnetoencephalographic study, we determined the whole-brain node degree of connectivity levels in patients and controls. Resting-state activity was measured at five frequency bands in 15 healthy controls and 15 patients with focal epilepsy of different etiologies. The whole-brain all-to-all imaginary part of coherence in source space was then calculated. Node degree was determined and parcellated and was used for further statistical evaluation. In comparison to controls, we found a significantly higher overall node degree in patients with lesional and non-lesional epilepsy. Furthermore, we examined the conditions of high/reduced vigilance and open/closed eyes in controls, to analyze whether patient node degree levels can be achieved. We evaluated intraclass-correlation statistics (ICC) to evaluate the reproducibility. Connectivity and specifically node degree analysis could present new tools for one of the most common neurological diseases, with potential applications in epilepsy diagnostics.
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Affiliation(s)
- Stephan Vogel
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
- Friedrich Alexander University Erlangen Nürnberg (FAU), 91054 Erlangen, Germany
| | - Martin Kaltenhäuser
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
| | - Cora Kim
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
| | - Nadia Müller-Voggel
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, 1090 Vienna, Austria;
| | - Arnd Dörfler
- Department of Neuroradiology, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany; (S.S.); (H.H.)
| | - Hajo Hamer
- Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany; (S.S.); (H.H.)
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
- Department of Neurosurgery, University Hospital Halle (Saale), 06120 Halle (Saale), Germany
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Li N, Li J, Chen Y, Chu C, Lin W. Treatment Outcome and Risk Factors of Adult Newly Diagnosed Epilepsy: A Prospective Hospital-Based Study in Northeast China. Front Neurol 2021; 12:747958. [PMID: 34777218 PMCID: PMC8581653 DOI: 10.3389/fneur.2021.747958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/06/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: The study was conducted to summarize the treatment outcomes of newly diagnosed epilepsy (NDE) and analyse the risk factors for refractory epilepsy (RE) in Northeast China. Methods: A total of 466 adult patients with NDE were consecutively enrolled in this programme. Clinical data were collected at baseline and each follow-up. Several scales concerning recognition and mood were also completed at the first visit. Results: Seizure-free status was achieved by 52% (n = 244) of the patients; however, 15% (n = 68) manifested RE. A total of 286 (61%) patients continued with the first ASM as monotherapy, among which 186 (40%) patients became seizure-free. Fifteen (22%) patients with RE became seizure-free following ASM adjustment and 34 patients (14%) had breakthrough seizures after being classified as seizure-free. One patient developed RE after attaining seizure-free status. Breakthrough seizures during the first expected interictal interval [Odds ratio (OR) = 5.81, 95% CI: 2.70–12.50], high seizure frequency at baseline (OR = 1.24, 95% CI: 1.04–1.49), younger age of onset (OR = 1.42, 95% CI: 1.12–1.79), and male sex (OR = 2.64, 95% CI: 1.26–5.53) were risk factors for RE. Significance: Treatment outcomes of the majority of NDE cases are good. New risk factors could help physicians more promptly and accurately identify patients who are likely to develop RE. Seizure-free state is not long enough to commence the withdrawal of ASMs. RE is not permanent and seizure-free may be achieved subsequently by appropriate drug adjustment.
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Affiliation(s)
- Nan Li
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jing Li
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yanyan Chen
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neuroelectrophysiology, Changchun Six Hospital, Changchun, China
| | - Chaojia Chu
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
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Melatonin Pretreatment Protects Against Status epilepticus, Glutamate Transport, and Oxidative Stress Induced by Kainic Acid in Zebrafish. Mol Neurobiol 2021; 59:266-275. [PMID: 34665406 DOI: 10.1007/s12035-021-02579-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/24/2021] [Indexed: 02/07/2023]
Abstract
Status epilepticus (SE) develops from abnormal electrical discharges, resulting in neuronal damage. Current treatments include antiepileptic drugs. However, the most common drugs used to treat seizures may sometimes be ineffective and have many side effects. Melatonin is an endogenous physiological hormone that is considered an alternative treatment for neurological disorders because of its free radical scavenging property. Thus, this study aimed to determine the effects of melatonin pretreatment on SE by inducing glutamatergic hyperstimulation in zebrafish. Seizures were induced in zebrafish using kainic acid (KA), a glutamate analog, and the seizure intensity was recorded for 60 min. Melatonin treatment for 7 days showed a decrease in seizure intensity (28%), latency to reach score 5 (14 min), and duration of SE (29%). In addition, melatonin treatment attenuated glutamate transporter levels, which significantly decreased in the zebrafish brain after 12 h of KA-induced seizures. Melatonin treatment reduced the increase in oxidative stress by reactive oxygen species formation through thiobarbituric acid reactive substances and 2',7'-dichiorofluorescin, induced by KA-seizure. An imbalance of antioxidant enzyme activities such as superoxide dismutase and catalase was influenced by melatonin and KA-induced seizures. Our study indicates that melatonin promotes a neuroprotective response against the epileptic profile in zebrafish. These effects could be related to the modulation of glutamatergic neurotransmission, recovery of glutamate uptake, and oxidative stress parameters in the zebrafish brain.
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28
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Moriyama H, Nomura S, Imoto H, Inoue T, Fujiyama Y, Haji K, Maruta Y, Ishihara H, Suzuki M. Suppressive Effects of Transient Receptor Potential Melastatin 8 Agonist on Epileptiform Discharges and Epileptic Seizures. Front Pharmacol 2021; 12:766782. [PMID: 34658898 PMCID: PMC8517222 DOI: 10.3389/fphar.2021.766782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/16/2021] [Indexed: 01/12/2023] Open
Abstract
Epilepsy is a relatively common condition, but more than 30% of patients have refractory epilepsy that is inadequately controlled by or is resistant to multiple drug treatments. Thus, new antiepileptic drugs based on newly identified mechanisms are required. A previous report revealed the suppressive effects of transient receptor potential melastatin 8 (TRPM8) activation on penicillin G-induced epileptiform discharges (EDs). However, it is unclear whether TRPM8 agonists suppress epileptic seizures or affect EDs or epileptic seizures in TRPM8 knockout (TRPM8KO) mice. We investigated the effects of TRPM8 agonist and lack of TRPM8 channels on EDs and epileptic seizures. Mice were injected with TRPM8 agonist 90 min after or 30 min before epilepsy-inducer injection, and electrocorticograms (ECoGs) were recorded under anesthesia, while behavior was monitored when awake. TRPM8 agonist suppressed EDs and epileptic seizures in wildtype (WT) mice, but not in TRPM8KO mice. In addition, TRPM8KO mice had a shorter firing latency of EDs, and EDs and epileptic seizures were deteriorated by the epilepsy inducer compared with those in WT mice, with the EDs being more easily propagated to the contralateral side. These findings suggest that TRPM8 activation in epileptic regions has anti-epileptic effects.
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Affiliation(s)
- Hiroshi Moriyama
- Departments of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Sadahiro Nomura
- Departments of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan.,Epilepsy Center, Yamaguchi University Hospital, Ube, Japan
| | - Hirochika Imoto
- Departments of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan.,Epilepsy Center, Yamaguchi University Hospital, Ube, Japan
| | - Takao Inoue
- Departments of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yuichi Fujiyama
- Departments of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kohei Haji
- Departments of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yuichi Maruta
- Departments of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Hideyuki Ishihara
- Departments of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Michiyasu Suzuki
- Departments of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan
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Ding M, Lang Y, Shu H, Shao J, Cui L. Microbiota-Gut-Brain Axis and Epilepsy: A Review on Mechanisms and Potential Therapeutics. Front Immunol 2021; 12:742449. [PMID: 34707612 PMCID: PMC8542678 DOI: 10.3389/fimmu.2021.742449] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/17/2021] [Indexed: 12/16/2022] Open
Abstract
The gut-brain axis refers to the bidirectional communication between the gut and brain, and regulates intestinal homeostasis and the central nervous system via neural networks and neuroendocrine, immune, and inflammatory pathways. The development of sequencing technology has evidenced the key regulatory role of the gut microbiota in several neurological disorders, including Parkinson's disease, Alzheimer's disease, and multiple sclerosis. Epilepsy is a complex disease with multiple risk factors that affect more than 50 million people worldwide; nearly 30% of patients with epilepsy cannot be controlled with drugs. Interestingly, patients with inflammatory bowel disease are more susceptible to epilepsy, and a ketogenic diet is an effective treatment for patients with intractable epilepsy. Based on these clinical facts, the role of the microbiome and the gut-brain axis in epilepsy cannot be ignored. In this review, we discuss the relationship between the gut microbiota and epilepsy, summarize the possible pathogenic mechanisms of epilepsy from the perspective of the microbiota gut-brain axis, and discuss novel therapies targeting the gut microbiota. A better understanding of the role of the microbiota in the gut-brain axis, especially the intestinal one, would help investigate the mechanism, diagnosis, prognosis evaluation, and treatment of intractable epilepsy.
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Affiliation(s)
| | | | | | | | - Li Cui
- Department of Neurology, First Hospital of Jilin University, Changchun, China
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30
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Sturgeon ML, Langton R, Sharma S, Cornell RA, Glykys J, Bassuk AG. The opioid antagonist naltrexone decreases seizure-like activity in genetic and chemically induced epilepsy models. Epilepsia Open 2021; 6:528-538. [PMID: 34664432 PMCID: PMC8408599 DOI: 10.1002/epi4.12512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/23/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE A significant number of epileptic patients fail to respond to available anticonvulsive medications. To find new anticonvulsive medications, we evaluated FDA-approved drugs not known to be anticonvulsants. Using zebrafish larvae as an initial model system, we found that the opioid antagonist naltrexone exhibited an anticonvulsant effect. We validated this effect in three other epilepsy models and present naltrexone as a promising anticonvulsive candidate. METHODS Candidate anticonvulsant drugs, determined by our prior transcriptomics analysis of hippocampal tissue, were evaluated in a larval zebrafish model of human Dravet syndrome (scn1Lab mutants), in wild-type zebrafish larvae treated with the pro-convulsant drug pentylenetetrazole (PTZ), in wild-type C57bl/6J acute brain slices exposed to PTZ, and in wild-type mice treated with PTZ in vivo. Abnormal locomotion was determined behaviorally in zebrafish and mice and by field potential in neocortex layer IV/V and CA1 stratum pyramidale in the hippocampus. RESULTS The opioid antagonist naltrexone decreased abnormal locomotion in the larval zebrafish model of human Dravet syndrome (scn1Lab mutants) and wild-type larvae treated with the pro-convulsant drug PTZ. Naltrexone also decreased seizure-like events in acute brain slices of wild-type mice, and the duration and number of seizures in adult mice injected with PTZ. SIGNIFICANCE Our data reveal that naltrexone has anticonvulsive properties and is a candidate drug for seizure treatment.
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Affiliation(s)
| | - Rachel Langton
- Department of PediatricsDivision of Child NeurologyUniversity of IowaIowa CityIAUSA
- Iowa Neuroscience InstituteUniversity of IowaIowa CityIAUSA
| | | | - Robert A. Cornell
- Department of Anatomy and Cell BiologyUniversity of IowaIowa CityIAUSA
| | - Joseph Glykys
- Department of PediatricsDivision of Child NeurologyUniversity of IowaIowa CityIAUSA
- Iowa Neuroscience InstituteUniversity of IowaIowa CityIAUSA
- Department of NeurologyUniversity of IowaIowa CityIAUSA
| | - Alexander G. Bassuk
- Department of PediatricsDivision of Child NeurologyUniversity of IowaIowa CityIAUSA
- Iowa Neuroscience InstituteUniversity of IowaIowa CityIAUSA
- Department of NeurologyUniversity of IowaIowa CityIAUSA
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31
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Zummo L, Vitale AM, Caruso Bavisotto C, De Curtis M, Garbelli R, Giallonardo AT, Di Bonaventura C, Fanella M, Conway de Macario E, Cappello F, Macario AJL, Marino Gammazza A. Molecular Chaperones and miRNAs in Epilepsy: Pathogenic Implications and Therapeutic Prospects. Int J Mol Sci 2021; 22:ijms22168601. [PMID: 34445306 PMCID: PMC8395327 DOI: 10.3390/ijms22168601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is a pathologic condition with high prevalence and devastating consequences for the patient and its entourage. Means for accurate diagnosis of type, patient monitoring for predicting seizures and follow up, and efficacious treatment are desperately needed. To improve this adverse outcome, miRNAs and the chaperone system (CS) are promising targets to understand pathogenic mechanisms and for developing theranostics applications. miRNAs implicated in conditions known or suspected to favor seizures such as neuroinflammation, to promote epileptic tolerance and neuronal survival, to regulate seizures, and others showing variations in expression levels related to seizures are promising candidates as useful biomarkers for diagnosis and patient monitoring, and as targets for developing novel therapies. Components of the CS are also promising as biomarkers and as therapeutic targets, since they participate in epileptogenic pathways and in cytoprotective mechanisms in various epileptogenic brain areas, even if what they do and how is not yet clear. The data in this review should help in the identification of molecular targets among the discussed miRNAs and CS components for research aiming at understanding epileptogenic mechanisms and, subsequently, develop means for predicting/preventing seizures and treating the disease.
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Affiliation(s)
- Leila Zummo
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Department of Neurology and Stroke Unit, A.R.N.A.S. Ospedale Civico—Di Cristina Benfratelli, 90127 Palermo, Italy
| | - Alessandra Maria Vitale
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Celeste Caruso Bavisotto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Marco De Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (M.D.C.); (R.G.)
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (M.D.C.); (R.G.)
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences “Sapienza”, University of Rome, 00185 Rome, Italy; (A.T.G.); (C.D.B.); (M.F.)
- Policlinico Umberto I, 00161 Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences “Sapienza”, University of Rome, 00185 Rome, Italy; (A.T.G.); (C.D.B.); (M.F.)
- Policlinico Umberto I, 00161 Rome, Italy
| | - Martina Fanella
- Department of Human Neurosciences “Sapienza”, University of Rome, 00185 Rome, Italy; (A.T.G.); (C.D.B.); (M.F.)
- Policlinico Umberto I, 00161 Rome, Italy
| | - Everly Conway de Macario
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD 21202, USA;
| | - Francesco Cappello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Alberto J. L. Macario
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD 21202, USA;
| | - Antonella Marino Gammazza
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Correspondence:
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Evidences for a Role of Gut Microbiota in Pathogenesis and Management of Epilepsy. Int J Mol Sci 2021; 22:ijms22115576. [PMID: 34070389 PMCID: PMC8197531 DOI: 10.3390/ijms22115576] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Epilepsy as a chronic neurological disorder is characterized by recurrent, unprovoked epileptic seizures. In about half of the people who suffer from epilepsy, the root cause of the disorder is unknown. In the other cases, different factors can cause the onset of epilepsy. In recent years, the role of gut microbiota has been recognized in many neurological disorders, including epilepsy. These data are based on studies of the gut microbiota–brain axis, a relationship starting by a dysbiosis followed by an alteration of brain functions. Interestingly, epileptic patients may show signs of dysbiosis, therefore the normalization of the gut microbiota may lead to improvement of epilepsy and to greater efficacy of anticonvulsant drugs. In this descriptive review, we analyze the evidences for the role of gut microbiota in epilepsy and hypothesize a mechanism of action of these microorganisms in the pathogenesis and treatment of the disease. Human studies revealed an increased prevalence of Firmicutes in patients with refractory epilepsy. Exposure to various compounds can change microbiota composition, decreasing or exacerbating epileptic seizures. These include antibiotics, epileptic drugs, probiotics and ketogenic diet. Finally, we hypothesize that physical activity may play a role in epilepsy through the modulation of the gut microbiota.
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Fiani B, Jarrah R, Doan T, Shields J, Houston R, Sarno E. Stereoelectroencephalography versus Subdural Electrode Implantation to Determine Whether Patients with Drug-resistant Epilepsy Are Candidates for Epilepsy Surgery. Neurol Med Chir (Tokyo) 2021; 61:347-355. [PMID: 33967179 PMCID: PMC8258005 DOI: 10.2176/nmc.ra.2020-0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Epilepsy is a chronic condition that affects about 50 million individuals worldwide. While its challenges are profound, there are increasing instances where antiepileptic drugs (AEDs) fail to provide relief to epileptic manifestations. For these pharmacoresistant cases, epilepsy surgery often is an effective route for treatment. However, the complexity and challenges associated with presurgical evaluations have prevented more widespread utilization of epilepsy surgery in pharmacoresistant cases. While preliminary work-ups and non-invasive diagnostic imaging have allowed for limited identification of the epileptogenic zone (EZ), there is yet to be an established pre-determined algorithm for surgical evaluation of patients with epilepsy. However, two modalities are currently being used for localization of the EZ and in determining candidates for surgery: stereoelectroencephalography (SEEG) and subdural electrodes (SDEs). SDE has been used in the United States for decades; however, SEEG now provides a less invasive option for mapping brain regions. We seek to address which intracranial monitoring technique is superior. Through a review of the outcomes of various clinical studies, SEEG was found to have greater safety and efficiency benefits than SDE, such as lower morbidity rates, lower prevalence of neurological deficits, and shorter recovery times. Moreover, SEEG was also found to have further functional benefits by allowing for deeper targeting of cerebral tissue along with bilateral hemispheric monitoring. This has led to increased rates of seizure freedom and control among SEEG patients. Nevertheless, further studies on the limitations and advancements of SEEG and SDE are still required to provide a more comprehensive understanding regarding their application.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center
| | | | | | | | | | - Erika Sarno
- Michigan State University College of Osteopathic Medicine
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Synaptic Reshaping and Neuronal Outcomes in the Temporal Lobe Epilepsy. Int J Mol Sci 2021; 22:ijms22083860. [PMID: 33917911 PMCID: PMC8068229 DOI: 10.3390/ijms22083860] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 12/11/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is one of the most common types of focal epilepsy, characterized by recurrent spontaneous seizures originating in the temporal lobe(s), with mesial TLE (mTLE) as the worst form of TLE, often associated with hippocampal sclerosis. Abnormal epileptiform discharges are the result, among others, of altered cell-to-cell communication in both chemical and electrical transmissions. Current knowledge about the neurobiology of TLE in human patients emerges from pathological studies of biopsy specimens isolated from the epileptogenic zone or, in a few more recent investigations, from living subjects using positron emission tomography (PET). To overcome limitations related to the use of human tissue, animal models are of great help as they allow the selection of homogeneous samples still presenting a more various scenario of the epileptic syndrome, the presence of a comparable control group, and the availability of a greater amount of tissue for in vitro/ex vivo investigations. This review provides an overview of the structural and functional alterations of synaptic connections in the brain of TLE/mTLE patients and animal models.
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Xing H, Song Y, Zhang Z, Koch PD. Clinical Characteristics of BRAF V600E Gene Mutation in Patients of Epilepsy-Associated Brain Tumor: a Meta-analysis. J Mol Neurosci 2021; 71:1815-1824. [PMID: 33791912 DOI: 10.1007/s12031-021-01837-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/24/2021] [Indexed: 11/27/2022]
Abstract
Epilepsy-associated brain tumors (EATs) are usually slow-growing, with seizures as the primary and most dominant symptom. BRAF (v-raf murine sarcoma viral oncogene homolog B1) gene mutations have been found in several subsets of EATs; the V600E mutation is currently believed to contribute to the intrinsic epileptogenicity and tumor growth. However, the relationship between BRAF V600E gene mutation and clinical characteristics in EAT patients is not clear. In this study, we aimed to systematically review the frequency of BRAF V600E gene mutation, as well as the relationship between BRAF V600E gene mutation and clinical characteristics, which may help with the diagnosis and treatment of EATs. Cochrane Library, PubMed, Embase, CNKI, WanFang Data, CQVIP, and SinoMed databases were searched up to October 2020 to identify peer-reviewed human studies on assessing the relationship between BRAF V600E gene mutations and clinical characteristics in EATs. The following data were calculated: the frequency of BRAF V600E mutation and clinical feature comparison between BRAF V600E mutations and wild type in EATs, such as gender, age of seizure onset, duration of epilepsy, location of tumors, and Engel outcome. A total of 12 articles were included in the analysis. Five hundred and nine patients with epilepsy-associated brain tumors were screened for the BRAF V600E gene mutation. Among them, 193 patients had the BRAF V600E mutation (34.06%, 95% CI = 0.25 to 0.43). The subgroup analyses of BRAF V600E mutation showed positive frequency of 44.76% (95% CI = 0.36 to 0.54) in ganglioglioma, 24.75% (95% CI = 0.14 to 0.37) in gysembryoplastic neuroepithelial tumor, 2.15% (95% CI = 0 to 0.19) in angiocentric glioma, and 50.16% (95% CI = 0.33 to 0.68) in pleomorphic xanthoastrocytoma. Compared with the overall frequency, the BRAF V600E positive frequency in ganglioglioma was significantly higher (P = 0.0283). We also found that BRAF V600E gene mutation was significantly associated with age at seizure onset (MD = -2.37; 95% CI = -4.33 to -0.41; P = 0.02). There was no statistical difference between BRAF V600E mutations and wild type in gender, duration of epilepsy, tumor site, and Engel outcome comparison. In conclusion, our updated and comprehensive meta-analysis based on a large number of clinical data demonstrated that BRAF V600E mutation is a specific biomarker and could be a pharmacological target for ganglioglioma patients and an exclusion diagnostic criterion for angiocentric glioma. This meta-analysis suggested the critical role of BRAF V600E mutation in the occurrence and development of EATs. Our findings help to elucidate the progression mechanisms in EATs and develop future therapeutic strategies for EATs.
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Affiliation(s)
- Hang Xing
- Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Yi Song
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.
| | - Zhiqi Zhang
- Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Peter David Koch
- Center for Systems Biology, Massachusetts General Hospital, 185 Cambridge Street, CPZN 5206, Boston, MA, 02114, USA
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Keller LA, Merkel O, Popp A. Intranasal drug delivery: opportunities and toxicologic challenges during drug development. Drug Deliv Transl Res 2021; 12:735-757. [PMID: 33491126 PMCID: PMC7829061 DOI: 10.1007/s13346-020-00891-5] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Over the past 10 years, the interest in intranasal drug delivery in pharmaceutical R&D has increased. This review article summarises information on intranasal administration for local and systemic delivery, as well as for CNS indications. Nasal delivery offers many advantages over standard systemic delivery systems, such as its non-invasive character, a fast onset of action and in many cases reduced side effects due to a more targeted delivery. There are still formulation limitations and toxicological aspects to be optimised. Intranasal drug delivery in the field of drug development is an interesting delivery route for the treatment of neurological disorders. Systemic approaches often fail to efficiently supply the CNS with drugs. This review paper describes the anatomical, histological and physiological basis and summarises currently approved drugs for administration via intranasal delivery. Further, the review focuses on toxicological considerations of intranasally applied compounds and discusses formulation aspects that need to be considered for drug development.
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Affiliation(s)
- Lea-Adriana Keller
- Preclinical Safety, AbbVie Deutschland GmbH & Co. KG, Knollstrasse, 67061 Ludwigshafen, Germany
- Department of Pharmacy, Pharmaceutical Technology and Biopharmacy, Ludwig-Maximilians-University, Butenandtstraße 5-13, 81337 Munich, Germany
| | - Olivia Merkel
- Department of Pharmacy, Pharmaceutical Technology and Biopharmacy, Ludwig-Maximilians-University, Butenandtstraße 5-13, 81337 Munich, Germany
| | - Andreas Popp
- Preclinical Safety, AbbVie Deutschland GmbH & Co. KG, Knollstrasse, 67061 Ludwigshafen, Germany
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Zhang K, Yan Y, Su T. Treatment strategies for encephalopathy related to status epilepticus during slow sleep, a narrative review of the literature. Rev Neurosci 2020; 31:793-802. [PMID: 32678805 DOI: 10.1515/revneuro-2020-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/21/2020] [Indexed: 11/15/2022]
Abstract
Encephalopathy related to Status Epilepticus during slow Sleep (ESES) is an age-dependent syndrome characterized by the appearance of neuropsychological and behavioral disorders associated with extreme activation of epileptic activity during sleep. The major goal of therapy in ESES is to prevent neuropsychological deficits. Effective therapy to reduce seizures and resolve the EEG pattern of status epilepticus during sleep (SES) may be crucial to improve long-term prognosis. However, whether to improve neurodevelopmental deficits by suppressing or eliminating SES remains unknown. The purpose of this article is to review current therapeutic options in ESES, in order to provide better alternatives. Treatment options consist of antiepileptic drugs, steroids, immunoglobulins, the ketogenic diet, and surgery. Maybe therapy targeted mechanisms can be developed with deep insight into the etiology of ESES.
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Affiliation(s)
- Ke Zhang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Yu Yan
- Department of Neurology, People's Hospital of Dongxihu District, Wuhan, Hubei 430040, China
| | - Tangfeng Su
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
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Shringarpure M, Gharat S, Momin M, Omri A. Management of epileptic disorders using nanotechnology-based strategies for nose-to-brain drug delivery. Expert Opin Drug Deliv 2020; 18:169-185. [PMID: 32921169 DOI: 10.1080/17425247.2021.1823965] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Epilepsy, a major neurological disorder affects about 1% of the Indian population. The discovery of noninvasive strategies for epilepsy presents a challenge for the scientists. Different types of nose-to-brain dosage-forms have been studied for epilepsy management. It aims to give new perspectives for developing new and existing anti-epileptic drugs. Combining nanotechnology with nose-to-brain approach can help in promoting the treatment efficacy by site-specific delivery. Also, it will minimize the side-effects and patient noncompliance observed in conventional administration routes. Peptide delivery can be an interesting approach for the management of epilepsy. Drug-loaded intranasal nanoformulations exhibit diverse prospective potentials in the management of epilepsy. Considering that, nanotherapy using nose-to-brain delivery as a prospective technique for the efficient management of epilepsy is reviewed. AREAS COVERED The authors have compiled all recently available data pertaining to the nose-to-brain delivery of therapeutics using nanotechnological strategies. The fundamental mechanism of nose-to-brain delivery, claims for intranasal delivery and medical devices for epilepsy are discussed. EXPERT OPINION Drug-loaded intranasal nanoformulations exhibit different prospective potentials in the management of epilepsy. Considering the foregoing research done in the field of nanotechnology, globally, authors propose nose-to-brain delivery of nanoformulations as a potential technique for the efficient management of epilepsy.
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Affiliation(s)
- Mihika Shringarpure
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Mumbai, Maharashtra, India
| | - Sankalp Gharat
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Mumbai, Maharashtra, India
| | - Munira Momin
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Mumbai, Maharashtra, India.,SVKM's Shri C B Patel Research Center for Chemistry and Biological Sciences, Mumbai, Maharashtra, India
| | - Abdelwahab Omri
- The Novel Drug and Vaccine Delivery Systems Facility, Department of Chemistry and Biochemistry, Laurentian University, Sudbury, Canada
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Levetiracetam Reduced the Basal Excitability of the Dentate Gyrus without Restoring Impaired Synaptic Plasticity in Rats with Temporal Lobe Epilepsy. Brain Sci 2020; 10:brainsci10090634. [PMID: 32933015 PMCID: PMC7565946 DOI: 10.3390/brainsci10090634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022] Open
Abstract
Temporal lobe epilepsy (TLE), the most common type of focal epilepsy, affects learning and memory; these effects are thought to emerge from changes in synaptic plasticity. Levetiracetam (LEV) is a widely used antiepileptic drug that is also associated with the reversal of cognitive dysfunction. The long-lasting effect of LEV treatment and its participation in synaptic plasticity have not been explored in early chronic epilepsy. Therefore, through the measurement of evoked field potentials, this study aimed to comprehensively identify the alterations in the excitability and the short-term (depression/facilitation) and long-term synaptic plasticity (long-term potentiation, LTP) of the dentate gyrus of the hippocampus in a lithium–pilocarpine rat model of TLE, as well as their possible restoration by LEV (1 week; 300 mg/kg/day). TLE increased the population spike (PS) amplitude (input/output curve); interestingly, LEV treatment partially reduced this hyperexcitability. Furthermore, TLE augmented synaptic depression, suppressed paired-pulse facilitation, and reduced PS-LTP; however, LEV did not alleviate such alterations. Conversely, the excitatory postsynaptic potential (EPSP)-LTP of TLE rats was comparable to that of control rats and was decreased by LEV. LEV caused a long-lasting attenuation of basal hyperexcitability but did not restore impaired synaptic plasticity in the early chronic phase of TLE.
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Zhou M, Bian K, Hu F, Lai W. A New Method Based on CEEMD Combined With Iterative Feature Reduction for Aided Diagnosis of Epileptic EEG. Front Bioeng Biotechnol 2020; 8:669. [PMID: 32695761 PMCID: PMC7338793 DOI: 10.3389/fbioe.2020.00669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022] Open
Abstract
In the clinical diagnosis of epileptic diseases, the intelligent diagnosis of epileptic electroencephalogram (EEG) signals has become a research focus in the field of brain diseases. In order to solve the problem of time-consuming and easily influenced by human subjective factors, artificial intelligence pattern recognition algorithm has been applied to EEG signals recognition. However, at present, the common empirical mode decomposition (EMD) signal decomposition algorithm does not consider the problem of mode aliasing. The EEG features obtained by feature extraction may be mixed with some unimportant features that affect the classification accuracy. In this paper, we proposed a new method based on complementary ensemble empirical mode decomposition (CEEMD) combined with iterative feature reduction for aided diagnosis of epileptic EEG. First of all, the evaluation indexes of decomposing and reconstructing signals by several methods were compared. The CEEMD was selected as the decomposition method of the signals. Then, the support vector machine recursive elimination (SVM-RFE) was used to reduce 9 features extracted from EEG data. The support vector classification of the gray wolf optimizer (GWO-SVC) recognition model was established for different feature subsets. By comparing the classification accuracy of training set and test set of different feature subsets, and considering the complexity of the model reflected by the number of features selected by SVM-RFE, the analysis showed that the 6 feature subsets with fewer features and higher classification accuracy could reflect the key information of epileptic EEG. The accuracy of the training set classification was 99.38% and the test set was as high as 100%. The recognition time was only 1.6551 s. Finally, in order to verify the reliability of the algorithm proposed in this paper, the proposed algorithm compared with the classification model established by the raw EEG signals and the optimization model established by other intelligent optimization algorithms. It is found that the algorithm used in this paper has higher classification accuracy and faster recognition time than other processing methods. The experimental results show that CEEMD combined with SVM-RFE is feasible for rapid and accurate recognition of EEG signals, which provides a theoretical basis for the aided diagnosis of epilepsy.
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Affiliation(s)
- Mengran Zhou
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan, China.,State Key Laboratory of Mining Response and Disaster Prevention and Control in Deep Coal Mines, Anhui University of Science and Technology, Huainan, China
| | - Kai Bian
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan, China
| | - Feng Hu
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan, China
| | - Wenhao Lai
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan, China
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Abstract
Epilepsy is a neurological disorder that affects 50 million people worldwide. It is characterised by seizures that can vary in presentation, from short absences to protracted convulsions. Wearable electronic devices that detect seizures have the potential to hail timely assistance for individuals, inform their treatment, and assist care and self-management. This systematic review encompasses the literature relevant to the evaluation of wearable electronics for epilepsy. Devices and performance metrics are identified, and the evaluations, both quantitative and qualitative, are presented. Twelve primary studies comprising quantitative evaluations from 510 patients and participants were collated according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two studies (with 104 patients/participants) comprised both qualitative and quantitative evaluation components. Despite many works in the literature proposing and evaluating novel and incremental approaches to seizure detection, there is a lack of studies evaluating the devices available to consumers and researchers, and there is much scope for more complete evaluation data in quantitative studies. There is also scope for further qualitative evaluations amongst individuals, carers, and healthcare professionals regarding their use, experiences, and opinions of these devices.
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Bollard L, Moore E, Paff R. Epilepsy Surgery: A Paediatric Perspective. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2020. [DOI: 10.21307/ajon-2020-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rivadulla C, Aguilar J, Coletti M, Aguila J, Prieto S, Cudeiro J. Static magnetic fields reduce epileptiform activity in anesthetized rat and monkey. Sci Rep 2018; 8:15985. [PMID: 30375430 PMCID: PMC6207659 DOI: 10.1038/s41598-018-33808-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
Increasing evidence indicates that static magnetic fields (SMF) reduce cortical activity in both human and animal models. The aim of this work was to investigate the effect of SMF on epileptiform cortical activity, a condition related to an abnormal increase in neuronal excitability. The first experimental block included a Pilocarpine rat model of epilepsy, in which a magnetic neodymium nickel-plated cylinder, a magnetic field of 0.5 T, or “sham” were placed over the skull. In the second experimental block, we recorded epileptic-like activity in the visual cortex of a monkey (Macaca mulatta) under control conditions and in the presence of the magnet. Between 15 and 30 minutes after the second dose of Pilocarpine, EEG changes compatible with seizure like events induced by Pilocarpine were clearly observed in the control animals (sham stimulation). Similar effects were visible in the animals exposed to the real magnet after 1–2 hours. In the monkey, SMF over the cortical focus clearly reduced abnormal activity: the intensity threshold for visual induction increased and the severity and duration decreased. These results reinforce the view that static magnets modulate cortical activity and open the door to the future therapeutic use of SMF in epilepsy as a complement to current pharmacological treatments.
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Affiliation(s)
- Casto Rivadulla
- NEUROcom, School of Health Sciences University of A Coruna, and Agrupación estratégica CICA-INIBIC - UdC, A Coruna, Spain.
| | - Juan Aguilar
- Laboratorio de Neurofisiología Experimental, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla-La Mancha, Toledo, Spain.
| | - Marcos Coletti
- NEUROcom, School of Health Sciences University of A Coruna, and Agrupación estratégica CICA-INIBIC - UdC, A Coruna, Spain
| | - Jordi Aguila
- NEUROcom, School of Health Sciences University of A Coruna, and Agrupación estratégica CICA-INIBIC - UdC, A Coruna, Spain
| | - Sandra Prieto
- NEUROcom, School of Health Sciences University of A Coruna, and Agrupación estratégica CICA-INIBIC - UdC, A Coruna, Spain
| | - Javier Cudeiro
- NEUROcom, School of Health Sciences University of A Coruna, and Agrupación estratégica CICA-INIBIC - UdC, A Coruna, Spain.,Cerebral Stimulation Centre of Galicia, A Coruna, Spain
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