1
|
Nuñez Ponasso G, McSweeney RC, Wartman WA, Lai P, Haueisen J, Maess B, Knösche TR, Weise K, Noetscher GM, Raij T, Makaroff SN. Accuracy of dipole source reconstruction in the 3-layer BEM model against the 5-layer BEM-FMM model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.17.594750. [PMID: 38826206 PMCID: PMC11142039 DOI: 10.1101/2024.05.17.594750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Objective To compare cortical dipole fitting spatial accuracy between the widely used yet highly simplified 3-layer and modern more realistic 5-layer BEM-FMM models with and without adaptive mesh refinement (AMR) methods. Methods We generate simulated noiseless 256-channel EEG data from 5-layer (7-compartment) meshes of 15 subjects from the Connectome Young Adult dataset. For each subject, we test four dipole positions, three sets of conductivity values, and two types of head segmentation. We use the boundary element method (BEM) with fast multipole method (FMM) acceleration, with or without (AMR), for forward modeling. Dipole fitting is carried out with the FieldTrip MATLAB toolbox. Results The average position error (across all tested dipoles, subjects, and models) is ~4 mm, with a standard deviation of ~2 mm. The orientation error is ~20° on average, with a standard deviation of ~15°. Without AMR, the numerical inaccuracies produce a larger disagreement between the 3- and 5-layer models, with an average position error of ~8 mm (6 mm standard deviation), and an orientation error of 28° (28° standard deviation). Conclusions The low-resolution 3-layer models provide excellent accuracy in dipole localization. On the other hand, dipole orientation is retrieved less accurately. Therefore, certain applications may require more realistic models for practical source reconstruction. AMR is a critical component for improving the accuracy of forward EEG computations using a high-resolution 5-layer volume conduction model. Significance Improving EEG source reconstruction accuracy is important for several clinical applications, including epilepsy and other seizure-inducing conditions.
Collapse
Affiliation(s)
- Guillermo Nuñez Ponasso
- Dept. of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Ryan C. McSweeney
- Dept. of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - William A. Wartman
- Dept. of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Peiyao Lai
- Dept. of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Burkhard Maess
- Max Plank Insititute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Thomas R. Knösche
- Max Plank Insititute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Konstantin Weise
- Max Plank Insititute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Gregory M. Noetscher
- Dept. of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Tommi Raij
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sergey N. Makaroff
- Dept. of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Koutsouras GW, Hall WA. Surgery for pediatric drug resistant epilepsy: a narrative review of its history, surgical implications, and treatment strategies. Transl Pediatr 2023; 12:245-259. [PMID: 36891373 PMCID: PMC9986775 DOI: 10.21037/tp-22-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/26/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Drug-resistant epilepsy (DRE), also known as medically refractory epilepsy, is a disorder of high prevalence and negatively impacts a patients quality of life, neurodevelopment, and life expectancy. Pediatric epilepsy surgery has been conducted since the late 1800s, and randomized controlled trials have demonstrated the marked effectiveness of surgery on seizure reduction and the potential for cure. Despite the strong evidence for pediatric epilepsy surgery, there is also strong evidence describing its underutilization. The objective of this narrative review is to describe the history, strength, and limitations in the evidence of surgery for pediatric drug resistant epilepsy. METHODS This narrative review was conducted utilizing standard search engines to include the relevant articles on the topic of surgery for drug resistant epilepsy in children, with main keywords including surgery in pediatric epilepsy and drug-refractory epilepsy. KEY CONTENT AND FINDINGS The first components describe the historical perspective of pediatric epilepsy surgery and the evidence that highlight the strengths and limitations of epilepsy surgery. We then highlight the importance of presurgical referral and evaluation, followed by a section detailing the surgical options for children with DRE. Lastly, we provide a perspective on the future of pediatric epilepsy surgery. CONCLUSIONS Evidence supports the role for surgery in pediatric medically refractory epilepsy in seizure frequency reduction, improved curative rates, and improvements in neurodevelopment and quality of life.
Collapse
Affiliation(s)
- George W Koutsouras
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Walter A Hall
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
3
|
Affiliation(s)
- Gerald A. Dienel
- Department of Neurology University of Arkansas for Medical Sciences Little Rock Arkansas USA
- Department of Cell Biology and Physiology University of New Mexico School of Medicine Albuquerque New Mexico USA
| | - Lisa Gillinder
- Mater Hospital South Brisbane Queensland Australia
- Faculty of Medicine Mater Research Institute, University of Queensland St Lucia Queensland Australia
| | - Aileen McGonigal
- Mater Hospital South Brisbane Queensland Australia
- Faculty of Medicine Mater Research Institute, University of Queensland St Lucia Queensland Australia
| | - Karin Borges
- Faculty of Medicine School of Biomedical Sciences, University of Queensland St Lucia Queensland Australia
| |
Collapse
|
4
|
Dienel GA, Gillinder L, McGonigal A, Borges K. Potential new roles for glycogen in epilepsy. Epilepsia 2023; 64:29-53. [PMID: 36117414 PMCID: PMC10952408 DOI: 10.1111/epi.17412] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 01/21/2023]
Abstract
Seizures often originate in epileptogenic foci. Between seizures (interictally), these foci and some of the surrounding tissue often show low signals with 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in many epileptic patients, even when there are no radiologically detectable structural abnormalities. Low FDG-PET signals are thought to reflect glucose hypometabolism. Here, we review knowledge about metabolism of glucose and glycogen and oxidative stress in people with epilepsy and in acute and chronic rodent seizure models. Interictal brain glucose levels are normal and do not cause apparent glucose hypometabolism, which remains unexplained. During seizures, high amounts of fuel are needed to satisfy increased energy demands. Astrocytes consume glycogen as an additional emergency fuel to supplement glucose during high metabolic demand, such as during brain stimulation, stress, and seizures. In rodents, brain glycogen levels drop during induced seizures and increase to higher levels thereafter. Interictally, in people with epilepsy and in chronic epilepsy models, normal glucose but high glycogen levels have been found in the presumed brain areas involved in seizure generation. We present our new hypothesis that as an adaptive response to repeated episodes of high metabolic demand, high interictal glycogen levels in epileptogenic brain areas are used to support energy metabolism and potentially interictal neuronal activity. Glycogenolysis, which can be triggered by stress or oxidative stress, leads to decreased utilization of plasma glucose in epileptogenic brain areas, resulting in low FDG signals that are related to functional changes underlying seizure onset and propagation. This is (partially) reversible after successful surgery. Last, we propose that potential interictal glycogen depletion in epileptogenic and surrounding areas may cause energy shortages in astrocytes, which may impair potassium buffering and contribute to seizure generation. Based on these hypotheses, auxiliary fuels or treatments that support glycogen metabolism may be useful to treat epilepsy.
Collapse
Affiliation(s)
- Gerald A. Dienel
- Department of NeurologyUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
- Department of Cell Biology and PhysiologyUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
| | - Lisa Gillinder
- Mater HospitalSouth BrisbaneQueenslandAustralia
- Faculty of MedicineMater Research Institute, University of QueenslandSt LuciaQueenslandAustralia
| | - Aileen McGonigal
- Mater HospitalSouth BrisbaneQueenslandAustralia
- Faculty of MedicineMater Research Institute, University of QueenslandSt LuciaQueenslandAustralia
| | - Karin Borges
- Faculty of MedicineSchool of Biomedical Sciences, University of QueenslandSt LuciaQueenslandAustralia
| |
Collapse
|
5
|
Pedersen M, Abbott DF, Jackson GD. Wearable OPM-MEG: A changing landscape for epilepsy. Epilepsia 2022; 63:2745-2753. [PMID: 35841260 PMCID: PMC9805039 DOI: 10.1111/epi.17368] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 01/09/2023]
Abstract
Magnetoencephalography with optically pumped magnometers (OPM-MEG) is an emerging and novel, cost-effective wearable system that can simultaneously record neuronal activity with high temporal resolution ("when" neuronal activity occurs) and spatial resolution ("where" neuronal activity occurs). This paper will first outline recent methodological advances in OPM-MEG compared to conventional superconducting quantum interference device (SQUID)-MEG before discussing how OPM-MEG can become a valuable and noninvasive clinical support tool in epilepsy surgery evaluation. Although OPM-MEG and SQUID-MEG share similar data features, OPM-MEG is a wearable design that fits children and adults, and it is also robust to head motion within a magnetically shielded room. This means that OPM-MEG can potentially extend the application of MEG into the neurobiology of severe childhood epilepsies with intellectual disabilities (e.g., epileptic encephalopathies) without sedation. It is worth noting that most OPM-MEG sensors are heated, which may become an issue with large OPM sensor arrays (OPM-MEG currently has fewer sensors than SQUID-MEG). Future implementation of triaxial sensors may alleviate the need for large OPM sensor arrays. OPM-MEG designs allowing both awake and sleep recording are essential for potential long-term epilepsy monitoring.
Collapse
Affiliation(s)
- Mangor Pedersen
- Department of Psychology and NeuroscienceAuckland University of TechnologyAucklandNew Zealand
| | - David F. Abbott
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia,Department of Medicine, Austin Health and Florey Department of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia,Department of Medicine, Austin Health and Florey Department of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| |
Collapse
|
6
|
Matsuo K, Kono K, Yasui-Furukori N, Shimoda K, Kaji Y, Akiyama K. HomotopicLI: Rationale, characteristics, and implications of a new threshold-free lateralization index of functional magnetic resonance imaging. Laterality 2022; 27:513-543. [PMID: 35948519 DOI: 10.1080/1357650x.2022.2109655] [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] [Indexed: 02/07/2023]
Abstract
The reliable preoperative estimation of brain hemispheric asymmetry may be achieved through multiple lateralization indices using functional magnetic resonance imaging. Adding to our previously developed AveLI, we devised a novel threshold-free lateralization index, HomotopicLI, which computes a basic formula, (Left - Right) / (Left + Right), using voxel values of pairs located symmetrically in relation to the midsagittal line as the terms Left and Right, and averages them within the regions-of-interest. The study aimed to evaluate HomotopicLI before clinical applications. Data were collected from 56 healthy participants who performed four language tasks. We compared seven index types, including HomotopicLI, AveLI, and BaseLI; BaseLI was calculated using the sums of voxel values as the terms. Contrary to our expectations, HomotopicLI performed similarly to AveLI but better than BaseLI in detecting right dominance. A detailed analysis of unilaterally activated voxels of the homotopic pairs revealed that unilateral activation occurred more frequently on the right than on the left when HomotopicLI indicated right dominance. The voxel values during right unilateral activation were smaller than those in the left, causing right dominances in the homotopic pairs by HomotopicLI. These unique features provide an advantage in detecting residual, compensative functions spreading weakly in the non-dominant hemisphere.
Collapse
Affiliation(s)
- Kayako Matsuo
- Center for Research Collaboration and Support, Dokkyo Medical University School of Medicine, Tochigi, Japan.,Graduate School of Informatics and Engineering, The University of Electro-Communications, Chofu, Japan
| | - Kenta Kono
- Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yasushi Kaji
- Department of Radiology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Tochigi, Japan.,Kawada Hospital, Okayama, Japan
| |
Collapse
|
7
|
Multimodal Presurgical Evaluation of Medically Refractory Focal Epilepsy in Adults: An Update for Radiologists. AJR Am J Roentgenol 2022; 219:488-500. [PMID: 35441531 DOI: 10.2214/ajr.22.27588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surgery is a potentially curative treatment option for patients with medically refractory focal epilepsy. Advanced neuroimaging modalities often improve surgical outcomes by contributing key information during the highly individualized surgical planning process and intraoperative localization. Hence, neuroradiologists play an integral role as part of the multidisciplinary management team. In this review, we initially present the conceptual background and practical framework of the presurgical evaluation process, including a description of the surgical treatment approaches in medically refractory focal epilepsy in adults. This background is followed by an overview of the advanced modalities commonly used during the presurgical workup at level IV epilepsy centers including diffusion imaging techniques, blood oxygen level dependent (BOLD) functional MRI (fMRI), PET, SPECT, and subtraction ictal SPECT, as well as by introductions to 7-T MRI and electrophysiologic techniques including electroencephalography (EEG) and magnetoencephalography (MEG). We also provide illustrative case examples of multimodal neuroimaging including PET/MRI, PET/MRI-DTI, subtraction ictal SPECT, and image-guided stereotactic planning with fMRI-DTI.
Collapse
|
8
|
Siriratnam P, Foster E, Shakhatreh L, Neal A, Carney PW, Jackson GD, O'Brien TJ, Kwan P, Chen Z, Ademi Z. The effect of epilepsy surgery on productivity: A systematic review and meta-analysis. Epilepsia 2022; 63:789-811. [PMID: 35088411 DOI: 10.1111/epi.17172] [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: 11/02/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES An important but understudied benefit of resective epilepsy surgery is improvement in productivity; that is, people's ability to contribute to society through participation in the workforce and in unpaid roles such as carer duties. Here, we aimed to evaluate productivity in adults with drug-resistant epilepsy (DRE) pre- and post-resective epilepsy surgery, and to explore the factors that positively influence productivity outcomes. METHODS We conducted a systematic review and meta-analysis using four electronic databases: Medline (Ovid), EMBASE (Ovid), EBM Reviews - Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Library. All studies over the past 30 years reporting on pre- and post-resective epilepsy surgical outcomes in adults with DRE were eligible for inclusion. Meta-analysis was performed to assess the post-surgery change in employment outcomes. RESULTS A total of 1005 titles and abstracts were reviewed. Seventeen studies, comprising 2056 unique patients, were suitable for the final quantitative synthesis and meta-analysis. Resective epilepsy surgery resulted in a 22% improvement in overall productivity (95% confidence interval [CI]: 1.07-1.40). The factors associated with increased post-surgery employment risk ratios were lower pre-surgical employment in the workforce (relative risk ratio [RRR] =0.34; 95% CI: 0.15-0.74), shorter follow-up duration (RRR = 0.95; 95% CI: 0.90-0.99), and lower mean age at time of surgery (RRR= 0.97; 95% CI: 0.94-0.99). The risk of bias of the included studies was assessed using Risk Of Bias In Non-randomised Studies - of Interventions and was low for most variables except "measurement of exposure." SIGNIFICANCE There is clear evidence that resective surgery in eligible surgical DRE patients results in improved productivity. Future work may include implementing a standardized method for collecting and reporting productivity in epilepsy cohorts and focusing on ways to reprioritize health care resource allocation to allow suitable candidates to access surgery earlier. This will ultimately benefit individuals with DRE, their families, our communities, and the wider health care system.
Collapse
Affiliation(s)
- Pakeeran Siriratnam
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Neurology Department, Eastern Health, Box Hill, Victoria, Australia
| | - Emma Foster
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lubna Shakhatreh
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrew Neal
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Patrick W Carney
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Terence J O'Brien
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
9
|
Mirandola L, Ballotta D, Talami F, Giovannini G, Pavesi G, Vaudano AE, Meletti S. Temporal Lobe Spikes Affect Distant Intrinsic Connectivity Networks. Front Neurol 2021; 12:746468. [PMID: 34975714 PMCID: PMC8718871 DOI: 10.3389/fneur.2021.746468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate local and distant blood oxygen level dependent (BOLD) signal changes related to interictal epileptiform discharges (IED) in drug-resistant temporal lobe epilepsy (TLE). Methods: Thirty-three TLE patients undergoing EEG–functional Magnetic Resonance Imaging (fMRI) as part of the presurgical workup were consecutively enrolled. First, a single-subject spike-related analysis was performed: (a) to verify the BOLD concordance with the presumed Epileptogenic Zone (EZ); and (b) to investigate the Intrinsic Connectivity Networks (ICN) involvement. Then, a group analysis was performed to search for common BOLD changes in TLE. Results: Interictal epileptiform discharges were recorded in 25 patients and in 19 (58%), a BOLD response was obtained at the single-subject level. In 42% of the cases, BOLD changes were observed in the temporal lobe, although only one patient had a pure concordant finding, with a single fMRI cluster overlapping (and limited to) the EZ identified by anatomo-electro-clinical correlations. In the remaining 58% of the cases, BOLD responses were localized outside the temporal lobe and the presumed EZ. In every patient, with a spike-related fMRI map, at least one ICN appeared to be involved. Four main ICNs were preferentially involved, namely, motor, visual, auditory/motor speech, and the default mode network. At the single-subject level, EEG–fMRI proved to have high specificity (above 65%) in detecting engagement of an ICN and the corresponding ictal/postictal symptom, and good positive predictive value (above 67%) in all networks except the visual one. Finally, in the group analysis of BOLD changes related to IED revealed common activations at the right precentral gyrus, supplementary motor area, and middle cingulate gyrus. Significance: Interictal temporal spikes affect several distant extra-temporal areas, and specifically the motor/premotor cortex. EEG–fMRI in patients with TLE eligible for surgery is recommended not for strictly localizing purposes rather it might be useful to investigate ICNs alterations at the single-subject level.
Collapse
Affiliation(s)
- Laura Mirandola
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, “San Giovanni Bosco” Hospital, Torino, Italy
- *Correspondence: Laura Mirandola ; ; orcid.org/0000-0002-1626-2932
| | - Daniela Ballotta
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Talami
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giada Giovannini
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile Baggiovara (OCB) Hospital, Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Pavesi
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Neurosurgery Unit, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile Baggiovara (OCB) Hospital, Modena, Italy
| | - Anna Elisabetta Vaudano
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile Baggiovara (OCB) Hospital, Modena, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile Baggiovara (OCB) Hospital, Modena, Italy
- Stefano Meletti ; orcid.org/0000-0003-0334-539X
| |
Collapse
|
10
|
Automatic Diagnosis of Epileptic Seizures in EEG Signals Using Fractal Dimension Features and Convolutional Autoencoder Method. BIG DATA AND COGNITIVE COMPUTING 2021. [DOI: 10.3390/bdcc5040078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper proposes a new method for epileptic seizure detection in electroencephalography (EEG) signals using nonlinear features based on fractal dimension (FD) and a deep learning (DL) model. Firstly, Bonn and Freiburg datasets were used to perform experiments. The Bonn dataset consists of binary and multi-class classification problems, and the Freiburg dataset consists of two-class EEG classification problems. In the preprocessing step, all datasets were prepossessed using a Butterworth band pass filter with 0.5–60 Hz cut-off frequency. Then, the EEG signals of the datasets were segmented into different time windows. In this section, dual-tree complex wavelet transform (DT-CWT) was used to decompose the EEG signals into the different sub-bands. In the following section, in order to feature extraction, various FD techniques were used, including Higuchi (HFD), Katz (KFD), Petrosian (PFD), Hurst exponent (HE), detrended fluctuation analysis (DFA), Sevcik, box counting (BC), multiresolution box-counting (MBC), Margaos-Sun (MSFD), multifractal DFA (MF-DFA), and recurrence quantification analysis (RQA). In the next step, the minimum redundancy maximum relevance (mRMR) technique was used for feature selection. Finally, the k-nearest neighbors (KNN), support vector machine (SVM), and convolutional autoencoder (CNN-AE) were used for the classification step. In the classification step, the K-fold cross-validation with k = 10 was employed to demonstrate the effectiveness of the classifier methods. The experiment results show that the proposed CNN-AE method achieved an accuracy of 99.736% and 99.176% for the Bonn and Freiburg datasets, respectively.
Collapse
|
11
|
Vibholm AK, Dietz MJ, Beniczky S, Christensen J, Højlund A, Jacobsen J, Bender D, Møller A, Brooks DJ. Activated N-methyl-D-aspartate receptor ion channels detected in focal epilepsy with [ 18 F]GE-179 positron emission tomography. Epilepsia 2021; 62:2899-2908. [PMID: 34558066 DOI: 10.1111/epi.17074] [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: 04/12/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Imaging activated glutamate N-methyl-D-aspartate receptor ion channels (NMDAR-ICs) using positron emission tomography (PET) has proved challenging due to low brain uptake, poor affinity and selectivity, and high metabolism and dissociation rates of candidate radioligands. The radioligand [18 F]GE-179 is a known use-dependent marker of NMDAR-ICs. We studied whether interictal [18 F]GE-179 PET would detect foci of abnormal NMDAR-IC activation in patients with refractory focal epilepsy. METHODS Ten patients with refractory focal epilepsy and 18 healthy controls had structural magnetic resonance imaging (MRI) followed by a 90-min dynamic [18 F]GE-179 PET scan with simultaneous electroencephalography (EEG). PET and EEG findings were compared with MRI and previous EEGs. Standard uptake value (SUV) images of [18 F]GE-179 were generated and global gray matter uptake was measured for each individual. To localize focal increases in uptake of [18 F]GE-179, the individual SUV images were interrogated with statistical parametric mapping in comparison to a normal database. Additionally, individual healthy control SUV images were compared with the rest of the control database to determine their prevalence of increased focal [18 F]GE-179 uptake. RESULTS Interictal [18 F]GE-179 PET detected clusters of significantly increased binding in eight of 10 patients with focal epilepsy but none of the controls. The number of clusters of raised [18 F]GE-179 uptake in the patients with epilepsy exceeded the focal abnormalities revealed by the simultaneously recorded EEG. Patients with extensive clusters of raised [18 F]GE-179 uptake showed the most abnormal EEGs. SIGNIFICANCE Detection of multiple foci of abnormal NMDAR-IC activation in 80% of our patients with refractory focal epilepsy using interictal [18 F]GE-179 PET could reflect enhanced neuronal excitability due to chronic seizure activity. This indicates that chronic epileptic activity is associated with abnormal NMDAR ion channel activation beyond the initial irritative zones. [18 F]GE-179 PET could be a candidate marker for identifying pathological brain areas in patients with treatment-resistant focal epilepsy.
Collapse
Affiliation(s)
- Ali K Vibholm
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Martin J Dietz
- Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center and Aarhus University, Dianalund, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,National Center for Register-Based Research, Department of Economics and Business Economics, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Andreas Højlund
- Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Jacobsen
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Dirk Bender
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Arne Møller
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark.,Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David J Brooks
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark.,Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
12
|
Characteristic changes in EEG spectral powers of patients with opioid-use disorder as compared with those with methamphetamine- and alcohol-use disorders. PLoS One 2021; 16:e0248794. [PMID: 34506492 PMCID: PMC8432824 DOI: 10.1371/journal.pone.0248794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Electroencephalography (EEG) likely reflects activity of cortical neurocircuits, making it an insightful estimation for mental health in patients with substance use disorder (SUD). EEG signals are recorded as sinusoidal waves, containing spectral amplitudes across several frequency bands with high spatio-temporal resolution. Prior work on EEG signal analysis has been made mainly at individual electrodes. These signals can be evaluated from advanced aspects, including sub-regional and hemispheric analyses. Due to limitation of computational techniques, few studies in earlier work could conduct data analyses from these aspects. Therefore, EEG in patients with SUD is not fully understood. In the present retrospective study, spectral powers from a data house containing opioid (OUD), methamphetamine/stimulants (MUD), and alcohol use disorder (AUD) were extracted, and then converted into five distinct topographic data (i.e., electrode-based, cortical subregion-based, left-right hemispheric, anterior-posterior based, and total cortex-based analyses). We found that data conversion and reorganization in the topographic way had an impact on EEG spectral powers in patients with OUD significantly different from those with MUD or AUD. Differential changes were observed from multiple perspectives, including individual electrodes, subregions, hemispheres, anterior-posterior cortices, and across the cortex as a whole. Understanding the differential changes in EEG signals may be useful for future work with machine learning and artificial intelligence (AI), not only for diagnostic but also for prognostic purposes in patients with SUD.
Collapse
|
13
|
Wang X, Hu T, Yang Q, Jiao D, Yan Y, Liu L. Graph-theory based degree centrality combined with machine learning algorithms can predict response to treatment with antiepileptic medications in children with epilepsy. J Clin Neurosci 2021; 91:276-282. [PMID: 34373040 DOI: 10.1016/j.jocn.2021.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of the current study is to detect changes of graph-theory-based degree centrality (DC) and their relationship with the clinical treatment effects of anti-epileptic drugs (AEDs) for patients with childhood absence epilepsy (CAE) using resting-state functional MRI (RS-fMRI). METHODS RS-fMRI data from 35 CAE patients were collected and compared with findings from 35 age and gender matched healthy controls (HCs). The patients were treated with AEDs for 46.03 weeks before undergoing a second RS-fMRI scan. RESULTS CAE children at baseline showed increased DC in thalamus, postcentral and precentral and reduced DC in medial frontal cortex, superior frontal cortex, middle temporal cortex, angular and precuneus. However, those abnormalities showed a clear renormalization after AEDs treatments. We then explored the viability of graph-theory-based degree centrality to accurately classify effectiveness to AEDs. Support Vector Machine analysis using leave-one-out cross-validation achieved a correct classification rate of 84.22% [sensitivity 78.76%, specificity 89.65%, and area under the receiver operating characteristic curve (AUC) 0.96] for differentiating effective subjects from ineffective subjects. Brain areas that contributed most to the classification model were mainly located within the right thalamus, bilateral middle temporal gyrus, right medial frontal gyrus, right inferior frontal gyrus, left precuneus, bilateral angular right precentral and left postcentral. Furthermore, the DC change within the bilateral angular are positively correlated with the symptom improvements after AEDs treatment. CONCLUSION These findings suggest that graph-theory-based measures, such as DC, combined with machine-learning algorithms, can provide crucial insights into pathophysiological mechanisms and the effectiveness of AEDs.
Collapse
Affiliation(s)
- Xueyu Wang
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
| | - Tian Hu
- Department of Radiology, Yanan University Affiliated Hospital, China
| | - Qi Yang
- Department of Radiology, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, China
| | - Dongmei Jiao
- Department of Internal Medicine, The Second Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan, China
| | - Yibing Yan
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Libo Liu
- Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China.
| |
Collapse
|
14
|
Abstract
Pediatric epilepsy is a highly variable condition due to age-related expression of syndromes that require specific diagnosis, evaluations, and treatments. Children with epilepsy differ from their adult counterparts in many important ways, mostly related to the age-related expression of specific epilepsy syndromes. This results in many important considerations related to the epilepsy diagnosis, classification, evaluations to determine an etiology, as well as treatment guidelines. A good understanding of these factors will help to establish an accurate epilepsy diagnosis, which in turn will guide appropriate testing and treatment decisions. In this way, patients will have improved seizure outcomes, and families will be educated appropriately and provided with the most accurate prognostic information available. The purpose of this article is to review the diagnosis, work-up, and management of pediatric epilepsy.
Collapse
Affiliation(s)
- Jeffrey R Tenney
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
15
|
Vorderwülbecke BJ, Carboni M, Tourbier S, Brunet D, Seeber M, Spinelli L, Seeck M, Vulliemoz S. High-density Electric Source Imaging of interictal epileptic discharges: How many electrodes and which time point? Clin Neurophysiol 2020; 131:2795-2803. [PMID: 33137569 DOI: 10.1016/j.clinph.2020.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the value of caudal EEG electrodes over cheeks and neck for high-density electric source imaging (ESI) in presurgical epilepsy evaluation, and to identify the best time point during averaged interictal epileptic discharges (IEDs) for optimal ESI accuracy. METHODS We retrospectively examined presurgical 257-channel EEG recordings of 45 patients with pharmacoresistant focal epilepsy. By stepwise removal of cheek and neck electrodes, averaged IEDs were downsampled to 219, 204, and 156 EEG channels. Additionally, ESI at the IED's half-rise was compared to other time points. The respective sources of maximum activity were compared to the resected brain area and postsurgical outcome. RESULTS Caudal channels had disproportionately more artefacts. In 30 patients with favourable outcome, the 204-channel array yielded the most accurate results with ESI maxima < 10 mm from the resection in 67% and inside affected sublobes in 83%. Neither in temporal nor in extratemporal cases did the full 257-channel setup improve ESI accuracy. ESI was most accurate at 50% of the IED's rising phase. CONCLUSION Information from cheeks and neck electrodes did not improve high-density ESI accuracy, probably due to higher artefact load and suboptimal biophysical modelling. SIGNIFICANCE Very caudal EEG electrodes should be used for ESI with caution.
Collapse
Affiliation(s)
- Bernd J Vorderwülbecke
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Margherita Carboni
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; Functional Brain Mapping Lab, Department of Basic Neurosciences, University of Geneva, Campus Biotech, 9 Chemin des Mines, 1202 Geneva, Switzerland.
| | - Sebastien Tourbier
- Connectomics Lab, Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Denis Brunet
- Functional Brain Mapping Lab, Department of Basic Neurosciences, University of Geneva, Campus Biotech, 9 Chemin des Mines, 1202 Geneva, Switzerland.
| | - Martin Seeber
- Functional Brain Mapping Lab, Department of Basic Neurosciences, University of Geneva, Campus Biotech, 9 Chemin des Mines, 1202 Geneva, Switzerland.
| | - Laurent Spinelli
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Margitta Seeck
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| |
Collapse
|
16
|
Rossi Sebastiano D, Tassi L, Spreafico R, Panzica F. Reply to "Maximizing non-invasive investigations in the quest for identifying the epileptogenic zone". Clin Neurophysiol 2020; 131:2779-2780. [PMID: 33012639 DOI: 10.1016/j.clinph.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
Affiliation(s)
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Roberto Spreafico
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ferruccio Panzica
- Clinical Engineering Service, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
17
|
Luria G, Duran D, Visani E, Rossi Sebastiano D, Sorrentino A, Tassi L, Granvillano A, Franceschetti S, Panzica F. Towards the Automatic Localization of the Irritative Zone Through Magnetic Source Imaging. Brain Topogr 2020; 33:651-663. [PMID: 32770321 PMCID: PMC7429532 DOI: 10.1007/s10548-020-00789-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/24/2020] [Indexed: 10/29/2022]
Abstract
The present work aims at validating a Bayesian multi-dipole modeling algorithm (SESAME) in the clinical scenario consisting of localizing the generators of single interictal epileptiform discharges from resting state magnetoencephalographic recordings. We use the results of Equivalent Current Dipole fitting, performed by an expert user, as a benchmark, and compare the results of SESAME with those of two widely used source localization methods, RAP-MUSIC and wMNE. In addition, we investigate the relation between post-surgical outcome and concordance of the surgical plan with the cerebral lobes singled out by the methods. Unlike dipole fitting, the tested algorithms do not rely on any subjective channel selection and thus contribute towards making source localization more unbiased and automatic. We show that the two dipolar methods, SESAME and RAP-MUSIC, generally agree with dipole fitting in terms of identified cerebral lobes and that the results of the former are closer to the fitted equivalent current dipoles than those of the latter. In addition, for all the tested methods and particularly for SESAME, concordance with surgical plan is a good predictor of seizure freedom while discordance is not a good predictor of poor post-surgical outcome. The results suggest that the dipolar methods, especially SESAME, represent a reliable and more objective alternative to manual dipole fitting for clinical applications in the field of epilepsy surgery.
Collapse
Affiliation(s)
- Gianvittorio Luria
- Department of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy.
- Department of Mathematics, University of Genoa, Genoa, Italy.
| | - Dunja Duran
- Department of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Elisa Visani
- Department of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Davide Rossi Sebastiano
- Department of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Alberto Sorrentino
- Department of Mathematics, University of Genoa, Genoa, Italy
- CNR - SPIN, Genoa, Italy
| | - Laura Tassi
- Epilepsy Surgery Center, Ospedale Niguarda, Milan, Italy
| | - Alice Granvillano
- Department of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Silvana Franceschetti
- Department of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Ferruccio Panzica
- Department of Neurophysiology and Diagnostic Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| |
Collapse
|
18
|
Lapinlampi N, Andrade P, Paananen T, Hämäläinen E, Ekolle Ndode-Ekane X, Puhakka N, Pitkänen A. Postinjury weight rather than cognitive or behavioral impairment predicts development of posttraumatic epilepsy after lateral fluid-percussion injury in rats. Epilepsia 2020; 61:2035-2052. [PMID: 32786029 DOI: 10.1111/epi.16632] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify postinjury physiologic, behavioral, and cognitive biomarkers for posttraumatic epilepsy to enrich study populations for long-term antiepileptogenesis studies. METHODS The EPITARGET cohort with behavioral follow-up and 1-month 24/7 video-electroencephalography (vEEG) monitoring included 115 adult male Sprague-Dawley rats with lateral fluid-percussion-induced traumatic brain injury (TBI), 23 sham-operated controls, and 13 naive rats. Animals underwent assessment of somatomotor performance (composite neuroscore), anxiety-like behavior (elevated plus maze, open field), spatial memory (Morris water maze), and depression-like behavior (Porsolt forced swim, sucrose preference). Impact force, postimpact apnea time, postimpact seizure-like behavior, and body weight were monitored. RESULTS TBI rats were impaired in the composite neuroscore (P < .001) on days (D) 2-14 and in the spatial memory test (P < .001) on D35-39 post-TBI. Differences in the elevated plus-maze (D28 and D126) and in the open field (D29 and D127) between TBI rats and controls were meager. No differences were observed in the Porsolt forced swim and sucrose preference tests as compared with sham-operated controls. Epilepsy developed in 27% of rats by the end of the sixth month. None of the behavioral or cognitive outcome measures discriminated rats with or without epilepsy. The receiver-operating characteristic analysis indicated that a decrease in body weight between D0 and D4 differentiated TBI rats with epilepsy from TBI rats without epilepsy (48% sensitivity, 83% specificity, area under the curve [AUC] 0.679, confidence interval [CI] 95% 0.56-0.80, P < .01). A 16% body weight decrease during D0-D4 could be used as a biomarker to enrich the study population from 27% (observed) to 50%. SIGNIFICANCE Single behavioral and cognitive outcome measures showed no power as prognostic/diagnostic biomarkers for posttraumatic epilepsy. A reduction in body weight during the first postinjury week showed some prognostic value for posttraumatic epileptogenesis and could serve as a subacute measure for selectively enriching the study population for long-term preclinical biomarker and therapy discovery studies of posttraumatic epileptogenesis.
Collapse
Affiliation(s)
- Niina Lapinlampi
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Pedro Andrade
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tomi Paananen
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Elina Hämäläinen
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Noora Puhakka
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Asla Pitkänen
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
19
|
Rossi Sebastiano D, Tassi L, Duran D, Visani E, Gozzo F, Cardinale F, Nobili L, Del Sole A, Rubino A, Dotta S, Schiaffi E, Garbelli R, Franceschetti S, Spreafico R, Panzica F. Identifying the epileptogenic zone by four non-invasive imaging techniques versus stereo-EEG in MRI-negative pre-surgery epilepsy patients. Clin Neurophysiol 2020; 131:1815-1823. [PMID: 32544836 DOI: 10.1016/j.clinph.2020.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We evaluated four imaging techniques, i.e. Electroencephalography (EEG)-functional Magnetic Resonance Imaging (MRI) (EEG-fMRI), High-resolution EEG (HR-EEG), Magnetoencephalography (MEG) and 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (PET), for the identification of the epileptogenic zone (EZ) in 41 patients with negative MRI, candidate to neurosurgery. METHODS For each technique, results were compared to the Stereo-EEG. Diagnostic measures were calculated with respect to the post-surgical outcome, either for all the patients (39/41, two patients excluded) and for the subgroup of patients with the EZ involving more than one lobe (20/41). RESULTS When considered individually, each functional technique showed accuracy values ranging 54,6%-63,2%, having PET, MEG and HR-EEG higher sensitivity, and EEG-fMRI higher specificity. In patients with multilobar epileptogenic zone, functional techniques achieved the best accuracies (up to 80%) when three techniques, including EEG-fMRI, were considered together. CONCLUSIONS The study highlights the accuracy of a combination of functional imaging techniques in the identification of EZ in MRI negative focal epilepsy. The best diagnostic yield was obtained if the combination of PET, MEG (or HR-EEG as alternative), EEG-fMRI were considered together. SIGNIFICANCE The functional imaging techniques may improve the presurgical workup of MRI negative focal epilepsy, if epileptogenic zone involves more than one lobe.
Collapse
Affiliation(s)
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Dunja Duran
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Visani
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Gozzo
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | | | - Lino Nobili
- DINOGMI, University of Genoa, and Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Angelo Del Sole
- Department of Health Sciences, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy
| | - Annalisa Rubino
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Sara Dotta
- Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Schiaffi
- Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Roberto Spreafico
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ferruccio Panzica
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
20
|
Berger A, Cohen N, Fahoum F, Medvedovsky M, Meller A, Ekstein D, Benifla M, Aizenstein O, Fried I, Gazit T, Strauss I. Preoperative localization of seizure onset zones by magnetic source imaging, EEG-correlated functional MRI, and their combination. J Neurosurg 2020; 134:1037-1043. [PMID: 32413858 DOI: 10.3171/2020.3.jns192794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Preoperative localization of seizure onset zones (SOZs) is an evolving field in the treatment of refractory epilepsy. Both magnetic source imaging (MSI), and the more recent EEG-correlated functional MRI (EEG-fMRI), have shown applicability in assisting surgical planning. The purpose of this study was to evaluate the capability of each method and their combination in localizing the seizure onset lobe (SL). METHODS The study included 14 patients who underwent both MSI and EEG-fMRI before undergoing implantation of intracranial EEG (icEEG) as part of the presurgical planning of the resection of an epileptogenic zone (EZ) during the years 2012-2018. The estimated location of the SL by each method was compared with the location determined by icEEG. Identification rates of the SL were compared between the different methods. RESULTS MSI and EEG-fMRI showed similar identification rates of SL locations in relation to icEEG results (88% ± 31% and 73% ± 42%, respectively; p = 0.281). The additive use of the coverage lobes of both methods correctly identified 100% of the SL, significantly higher than EEG-fMRI alone (p = 0.039) and nonsignificantly higher than MSI (p = 0.180). False-identification rates of the additive coverage lobes were significantly higher than MSI (p = 0.026) and EEG-fMRI (p = 0.027). The intersecting lobes of both methods showed the lowest false identification rate (13% ± 6%, p = 0.01). CONCLUSIONS Both MSI and EEG-fMRI can assist in the presurgical evaluation of patients with refractory epilepsy. The additive use of both tests confers a high identification rate in finding the SL. This combination can help in focusing implantation of icEEG electrodes targeting the SOZ.
Collapse
Affiliation(s)
- Assaf Berger
- 1Department of Neurosurgery.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Noa Cohen
- 2Sagol Brain Institute.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Firas Fahoum
- 3Department of Neurology, and.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Mordekhay Medvedovsky
- 4Department of Neurology, Hadassah Medical Center, Jerusalem.,8Hebrew University Hadassah Medical School, Jerusalem; and
| | - Aaron Meller
- 2Sagol Brain Institute.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Dana Ekstein
- 4Department of Neurology, Hadassah Medical Center, Jerusalem.,8Hebrew University Hadassah Medical School, Jerusalem; and
| | - Mony Benifla
- 5Department of Neurosurgery, Rambam Health Care Campus, Haifa.,9Rappaport Faculty of Medicine-Technion, Haifa, Israel
| | - Orna Aizenstein
- 6Department of Radiology, Tel Aviv Medical Center, Tel Aviv.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Itzhak Fried
- 1Department of Neurosurgery.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Tomer Gazit
- 2Sagol Brain Institute.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| | - Ido Strauss
- 1Department of Neurosurgery.,7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
| |
Collapse
|
21
|
Armada-Moreira A, Gomes JI, Pina CC, Savchak OK, Gonçalves-Ribeiro J, Rei N, Pinto S, Morais TP, Martins RS, Ribeiro FF, Sebastião AM, Crunelli V, Vaz SH. Going the Extra (Synaptic) Mile: Excitotoxicity as the Road Toward Neurodegenerative Diseases. Front Cell Neurosci 2020; 14:90. [PMID: 32390802 PMCID: PMC7194075 DOI: 10.3389/fncel.2020.00090] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/26/2020] [Indexed: 12/13/2022] Open
Abstract
Excitotoxicity is a phenomenon that describes the toxic actions of excitatory neurotransmitters, primarily glutamate, where the exacerbated or prolonged activation of glutamate receptors starts a cascade of neurotoxicity that ultimately leads to the loss of neuronal function and cell death. In this process, the shift between normal physiological function and excitotoxicity is largely controlled by astrocytes since they can control the levels of glutamate on the synaptic cleft. This control is achieved through glutamate clearance from the synaptic cleft and its underlying recycling through the glutamate-glutamine cycle. The molecular mechanism that triggers excitotoxicity involves alterations in glutamate and calcium metabolism, dysfunction of glutamate transporters, and malfunction of glutamate receptors, particularly N-methyl-D-aspartic acid receptors (NMDAR). On the other hand, excitotoxicity can be regarded as a consequence of other cellular phenomena, such as mitochondrial dysfunction, physical neuronal damage, and oxidative stress. Regardless, it is known that the excessive activation of NMDAR results in the sustained influx of calcium into neurons and leads to several deleterious consequences, including mitochondrial dysfunction, reactive oxygen species (ROS) overproduction, impairment of calcium buffering, the release of pro-apoptotic factors, among others, that inevitably contribute to neuronal loss. A large body of evidence implicates NMDAR-mediated excitotoxicity as a central mechanism in the pathogenesis of many neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD), and epilepsy. In this review article, we explore different causes and consequences of excitotoxicity, discuss the involvement of NMDAR-mediated excitotoxicity and its downstream effects on several neurodegenerative disorders, and identify possible strategies to study new aspects of these diseases that may lead to the discovery of new therapeutic approaches. With the understanding that excitotoxicity is a common denominator in neurodegenerative diseases and other disorders, a new perspective on therapy can be considered, where the targets are not specific symptoms, but the underlying cellular phenomena of the disease.
Collapse
Affiliation(s)
- Adam Armada-Moreira
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark
| | - Joana I. Gomes
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Carolina Campos Pina
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Oksana K. Savchak
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Joana Gonçalves-Ribeiro
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Nádia Rei
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Sara Pinto
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Tatiana P. Morais
- Neuroscience Division, School of Bioscience, Cardiff University, Cardiff, United Kingdom
| | - Robertta Silva Martins
- Laboratório de Neurofarmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Filipa F. Ribeiro
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ana M. Sebastião
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Vincenzo Crunelli
- Neuroscience Division, School of Bioscience, Cardiff University, Cardiff, United Kingdom
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Sandra H. Vaz
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
22
|
Kwon CS, Chang EF, Jetté N. Cost-Effectiveness of Advanced Imaging Technologies in the Presurgical Workup of Epilepsy. Epilepsy Curr 2020; 20:7-11. [PMID: 31910665 PMCID: PMC7020533 DOI: 10.1177/1535759719894307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The cost-effectiveness and benefit of many diagnostic tests used in the presurgical evaluation for persons with epilepsy is for the most part uncertain as is their influence on decision-making. The options we have at our disposal are ever increasing. Advanced imaging modalities aim to improve surgical candidacy by helping us better define the epileptogenic zone and optimize surgical planning. However, judicious use is important. Randomized controlled trials delineating which mode of investigation is superior are lacking. Presurgical tests do have incremental value by increasing surgical candidacy and refining surgical planning. The yield of additional imaging will increase with complex localization. However, every case must be tailored by hypothesis, cost, and accessibility. Future studies using a quantitative cost–benefit framework are needed to determine the cost-effectiveness of advanced diagnostic tests (beyond magnetic resonance imaging) in the presurgical evaluation of those with epilepsy.
Collapse
Affiliation(s)
- Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Health Outcomes & Knowledge Translation Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edward F Chang
- Department of Neurosurgery, University of California, San Francisco, CA, USA.,Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Health Outcomes & Knowledge Translation Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
23
|
Brusko GD, Perez-Roman RJ, Tapamo H, Burks SS, Serafini AN, Wang MY. Preoperative SPECT imaging as a tool for surgical planning in patients with axial neck and back pain. Neurosurg Focus 2019; 47:E19. [PMID: 31786563 DOI: 10.3171/2019.9.focus19648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hybrid SPECT with CT imaging has been used to help elucidate pain generators in patients with axial neck and back pain, identifying potential sites for treatment. Few studies have examined its role in spine surgery and most literature focuses on its use postoperatively. The authors describe the largest series to date of patients with symptomatic spondylosis who underwent preoperative SPECT imaging for surgical planning. METHODS A retrospective medical and imaging record review was conducted to identify patients who underwent SPECT or SPECT/CT studies between January 2014 and May 2018. Patients who underwent spine surgical intervention for spondylosis with primary symptoms of axial neck or back pain and who had evidence of hypermetabolic foci on spinal SPECT imaging were included. Only those patients who subsequently underwent surgery on a spinal level associated with increased radiotracer uptake were included in the analysis. Patient baseline and demographic information, and data pertaining to SPECT imaging, surgical planning, and postoperative care were collected and analyzed. RESULTS A total of 23 patients with an average age at surgery of 60.0 ± 11.0 years were included. Fifteen patients (65.2%) were male. A total of 53 spinal levels were treated, with an average of 2.30 levels treated per patient. All patients underwent fusion surgery, either lumbar (n = 14), with interbody fusion most commonly used (64.2%); or cervical (n = 9), with anterior cervical discectomy and fusion (66.6%) being the most common. The average length of hospital stay was 3.45 ± 2.32 days. One patient developed a wound infection postoperatively, requiring readmission. At the 3-month follow-up, 18 patients (78.3%) reported clinical improvement in pain. Eleven patients (47.8%) reported complete symptom resolution at the 6-month follow-up. At 1 year postoperatively, 19 patients (82.6%) reported significant relief of their symptoms following surgery. CONCLUSIONS This is the largest series to date describing patients with axial neck and back pain who underwent preoperative SPECT imaging and subsequent surgical intervention on the affected spinal levels. The results demonstrate that SPECT imaging may be a useful adjunct to guide surgical planning, resulting in substantial clinical improvement following surgery.
Collapse
Affiliation(s)
| | | | | | | | - Aldo N Serafini
- 2Division of Nuclear Medicine, Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | | |
Collapse
|
24
|
Shamshiri EA, Sheybani L, Vulliemoz S. The Role of EEG-fMRI in Studying Cognitive Network Alterations in Epilepsy. Front Neurol 2019; 10:1033. [PMID: 31608007 PMCID: PMC6771300 DOI: 10.3389/fneur.2019.01033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/11/2019] [Indexed: 02/01/2023] Open
Abstract
Brain functions do not arise from isolated brain regions, but from interactions in widespread networks necessary for both normal and pathological conditions. These Intrinsic Connectivity Networks (ICNs) support cognitive processes such as language, memory, or executive functions, but can be disrupted by epileptic activity. Simultaneous EEG-fMRI can help explore the hemodynamic changes associated with focal or generalized epileptic discharges, thus providing information about both transient and non-transient impairment of cognitive networks related to spatio-temporal overlap with epileptic activity. In the following review, we discuss the importance of interictal discharges and their impact on cognition in different epilepsy syndromes. We explore the cognitive impact of interictal activity in both animal models and human connectivity networks in order to confirm that this effect could have a possible clinical impact for prescribing medication and characterizing post-surgical outcome. Future work is needed to further investigate electrophysiological changes, such as amplitude/latency of single evoked responses or spontaneous epileptic activity in either scalp or intracranial EEG and determine its relative change in hemodynamic response with subsequent network modifications.
Collapse
Affiliation(s)
- Elhum A Shamshiri
- EEG and Epilepsy Unit, Neurology Department, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Laurent Sheybani
- Neurology Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, Neurology Department, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland.,Neurology Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| |
Collapse
|
25
|
Sone D, Maikusa N, Sato N, Kimura Y, Ota M, Matsuda H. Similar and Differing Distributions Between 18F-FDG-PET and Arterial Spin Labeling Imaging in Temporal Lobe Epilepsy. Front Neurol 2019; 10:318. [PMID: 31001198 PMCID: PMC6456651 DOI: 10.3389/fneur.2019.00318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/14/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Despite the increasing use of arterial spin labeling (ASL) in patients with epilepsy, little is known about its brain regional distribution pattern, including diaschisis, and its correspondence with FDG-PET. Here, we investigated the regional match and mismatch between FDG-PET and ASL in temporal lobe epilepsy (TLE). Methods: We recruited 27 patients with unilateral TLE, who underwent inter-ictal ASL and FDG-PET scans. These images were spatially normalized using Statistical Parametric Mapping 12, and the regional values in both ASL and FDG-PET were calculated using PMOD software within 20 volumes of interest (VOIs), including the temporal lobe, adjacent cortices, subcortical structures, and cerebellum. ASL images of 37 healthy controls were also analyzed and compared. Results: Whereas, ASL showed significant side differences, mainly in the temporal and frontal lobes, the significant abnormalities in FDG-PET were more widespread and included the insula and supramarginal gyrus. Ipsilateral thalamic reduction was found in FDG-PET only. The detectability of the focus side compared with the contralateral side was generally higher in FDG-PET. The discriminative values in ASL compared with healthy controls were higher in temporal neocortex and amygdala VOIs. Conclusions: There are similar and differing regional distributions between FDG-PET and ASL in TLE, possibly reflecting regional match and mismatch of cerebral blood flow and metabolism. At this stage, it seems that ASL couldn't present comparable clinical usefulness with FDG-PET. These findings deepen our knowledge of ASL imaging and are potentially useful for its further application.
Collapse
Affiliation(s)
- Daichi Sone
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Norihide Maikusa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Miho Ota
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Division of Clinical Medicine, Department of Neuropsychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| |
Collapse
|
26
|
Cahill V, Sinclair B, Malpas CB, McIntosh AM, Chen Z, Vivash LE, O'Shea MF, Wilson SJ, Desmond PM, Berlangieri SU, Hicks RJ, Rowe CC, Morokoff AP, King JA, Fabinyi GC, Kaye AH, Kwan P, Berkovic SF, O'Brien TJ. Metabolic patterns and seizure outcomes following anterior temporal lobectomy. Ann Neurol 2019; 85:241-250. [DOI: 10.1002/ana.25405] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Varduhi Cahill
- Departments of Medicine and Neurology; Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
- Manchester Centre for Clinical Neurosciences; Salford Royal NHS Foundation Trust; Salford United Kingdom
- Division of Neuroscience and Experimental Psychology; School of Biological Sciences, University of Manchester; Manchester United Kingdom
| | - Benjamin Sinclair
- Departments of Medicine and Radiology; University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
- Departments of Neuroscience and Neurology; Alfred Health, Central Clinical School, Monash University; Melbourne Victoria Australia
| | - Charles B. Malpas
- Departments of Medicine and Neurology; Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
- Departments of Neuroscience and Neurology; Alfred Health, Central Clinical School, Monash University; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Victoria Australia
| | - Anne M. McIntosh
- Departments of Medicine and Neurology; Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
- Departments of Neuroscience and Neurology; Alfred Health, Central Clinical School, Monash University; Melbourne Victoria Australia
- Epilepsy Research Centre; University of Melbourne, Austin Hospital; Melbourne Victoria Australia
| | - Zhibin Chen
- Departments of Medicine and Neurology; Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
- Departments of Neuroscience and Neurology; Alfred Health, Central Clinical School, Monash University; Melbourne Victoria Australia
| | - Lucy E. Vivash
- Departments of Medicine and Neurology; Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
- Departments of Neuroscience and Neurology; Alfred Health, Central Clinical School, Monash University; Melbourne Victoria Australia
| | - Marie F. O'Shea
- Comprehensive Epilepsy Program; Austin Hospital; Melbourne Victoria Australia
| | - Sarah J. Wilson
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Victoria Australia
- Comprehensive Epilepsy Program; Austin Hospital; Melbourne Victoria Australia
| | - Patricia M. Desmond
- Departments of Medicine and Radiology; University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
| | | | - Rodney J. Hicks
- Peter MacCallum Cancer Centre and the Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
| | - Christopher C. Rowe
- Epilepsy Research Centre; University of Melbourne, Austin Hospital; Melbourne Victoria Australia
- Florey Institute of Neuroscience and Mental Health; University of Melbourne; Melbourne Victoria Australia
| | - Andrew P. Morokoff
- Department of Surgery; University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
| | - James A. King
- Department of Surgery; University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Gavin C. Fabinyi
- Department of Surgery; University of Melbourne, Austin Hospital; Melbourne Victoria Australia
| | - Andrew H. Kaye
- Department of Surgery; University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Patrick Kwan
- Departments of Medicine and Neurology; Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
- Departments of Neuroscience and Neurology; Alfred Health, Central Clinical School, Monash University; Melbourne Victoria Australia
| | - Samuel F. Berkovic
- Epilepsy Research Centre; University of Melbourne, Austin Hospital; Melbourne Victoria Australia
- Comprehensive Epilepsy Program; Austin Hospital; Melbourne Victoria Australia
| | - Terence J. O'Brien
- Departments of Medicine and Neurology; Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital; Melbourne Victoria Australia
- Departments of Neuroscience and Neurology; Alfred Health, Central Clinical School, Monash University; Melbourne Victoria Australia
| |
Collapse
|
27
|
Kuo CC, Tucker DM, Luu P, Jenson K, Tsai JJ, Ojemann JG, Holmes MD. EEG source imaging of epileptic activity at seizure onset. Epilepsy Res 2018; 146:160-171. [DOI: 10.1016/j.eplepsyres.2018.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 01/16/2023]
|
28
|
Kang JW, Eom S, Hong W, Kwon HE, Park S, Ko A, Kang HC, Lee JS, Lee YM, Kim DS, Kim HD. Long-term Outcome of Resective Epilepsy Surgery in Patients With Lennox-Gastaut Syndrome. Pediatrics 2018; 142:peds.2018-0449. [PMID: 30194277 DOI: 10.1542/peds.2018-0449] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the long-term outcome of resective epilepsy surgery in patients with Lennox-Gastaut syndrome (LGS). METHODS We reviewed the case reports of 90 patients with LGS who had undergone resective surgery between 2003 and 2014 at the Severance Children's Hospital and managed them for a minimum period of 2 years. RESULTS At the time of surgery, the patients were between 3.0 and 23.5 years old (mean ± SD: 9.3 ± 4.4). The time from seizure onset to surgery ranged from 0.7 to 20.1 years (7.2 ± 4.3). On postoperative follow-up for an average period of 6.1 ± 2.2 years (range: 2.1-11.4 years), 45 patients (50.0%) had no seizures, and 15 (16.7%) reported infrequent seizures. Seizure-free outcomes were achieved in 15 of the 21 (71.4%) hemispherectomies, 23 of the 51 (45.1%) multilobar resections, and 7 of the 18 (38.9%) single lobar resections. On high-resolution MRIs, 20 patients (22.2%) had negative findings, 8 of whom (40.0%) became seizure-free after resective surgery. Malformation of cortical development was the most common pathologic finding and was noted in 57 patients (63.3%). Seizure-free patients achieved better adaptive behavior and social competence than did patients with persistent seizures at the second (2-3 years after surgery) and third (4-6 years after surgery) follow-ups, as indicated by social quotients (P < .05). CONCLUSIONS Resective surgery is a viable option in some patients to treat seizures that are associated with LGS, with a high probability of seizure control and better adaptive function.
Collapse
Affiliation(s)
- Joon Won Kang
- Departments of Pediatrics and Medical Science, Chungnam National University Hospital and College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Soyong Eom
- Epilepsy Research Institute, College of Medicine
| | - William Hong
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Hye Eun Kwon
- Department of Pediatrics, International St Mary's Hospital and College of Medicine, Catholic Kwandong University, Incheon, Republic of Korea; and
| | - Soyoung Park
- Department of Pediatrics, Soon Chun Hyang University Hospital and College of Medicine, Soonchunhyang University, Bucheon, Republic of Korea
| | - Ara Ko
- Epilepsy Research Institute, College of Medicine.,Pediatric Epilepsy Clinics, Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital
| | - Hoon-Chul Kang
- Epilepsy Research Institute, College of Medicine.,Pediatric Epilepsy Clinics, Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital
| | - Joon Soo Lee
- Epilepsy Research Institute, College of Medicine.,Pediatric Epilepsy Clinics, Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, and
| | - Dong Seok Kim
- Division of Pediatric Neurosurgery, Severance Hospital, Yonsei University, Seoul, Republic of Korea
| | - Heung Dong Kim
- Epilepsy Research Institute, College of Medicine, .,Pediatric Epilepsy Clinics, Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital
| |
Collapse
|
29
|
Polyanskaya MV, Demushkina AA, Vasiliev IG, Gazdieva HS, Kholin AA, Zavadenko NN, Alikhanov AA. Role of contrast-free MR-perfusion in the diagnosis of potential epileptogenic foci in children with focal epilepsia. ACTA ACUST UNITED AC 2018. [DOI: 10.17749/2077-8333.2018.10.2.006-018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ASL (Arterial Spin Labeling) – a novel modality of MR angiography – is based on radio-frequency labeling of aqueous protons in the arterial blood; the method is used to monitor blood supply to organs, including the brain. So far there has been little information on the use of ASL in children with focal epilepsy, especially in the pre-surgery period.Aim:to evaluate the perfusion patterns in seizure-free children with drug resistant focal epilepsy (FE) using the ASL mode of MRI.Materials and methods.We studied the ASL data of 54 (23-boys/31 girls) patients with FE treated in the Dpt. of Neurology at the Russian State Children Hospital from 2015 to 2018. The patients’ age varied from 4 months to 17 years. All images were produced with a 3T GE Discovery 750W system.Results. We found several brain perfusion patterns in children with FE; among other factors, those patterns depended on the clinical status of the patient, i. e. the interictal period or the early post- seizure period. The main pattern of the interictal period was characterized by a focal decrease in perfusion located around a structural focus identified on MRI scans. In the early post-seizure period, there was an increase in the arterial perfusion in the area of a structural epileptogenic lesion.Conclusion.ASL-MRI is an effective diagnostic method providing more information on children with FE during their pre-surgery phase. The ASL modality needs further research to rationalize its wider use as a preferred diagnostic tool or as a combination with the more complex PET and SPECT.
Collapse
|
30
|
Malkov A, Ivanov AI, Buldakova S, Waseem T, Popova I, Zilberter M, Zilberter Y. Seizure-induced reduction in glucose utilization promotes brain hypometabolism during epileptogenesis. Neurobiol Dis 2018; 116:28-38. [DOI: 10.1016/j.nbd.2018.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022] Open
|
31
|
Markoula S, Chaudhary UJ, Perani S, De Ciantis A, Yadee T, Duncan JS, Diehl B, McEvoy AW, Lemieux L. The impact of mapping interictal discharges using EEG-fMRI on the epilepsy presurgical clinical decision making process: A prospective study. Seizure 2018; 61:30-37. [PMID: 30059825 DOI: 10.1016/j.seizure.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/27/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE We set out to establish the clinical utility of EEG-correlated fMRI as part of the presurgical evaluation, by measuring prospectively its effects on the clinical decision. METHODS Patients with refractory extra-temporal focal epilepsy, referred for presurgical evaluation were recruited in a period of 18 months. The EEG-fMRI based localization was presented during a multi-disciplinary meeting after the team had defined the presumed RESULTS: Sixteen patients (six women), with a median age of 28 years, were recruited. Interpretable EEG-fMRI results were available in 13: interictal epileptic discharges (IEDs) were recorded in eleven patients and seizures were recorded in two patients. In three patients, no epileptic activity was captured during EEG-fMRI acquisition and in two of those an IED topographic map correlation was performed (between EEG recorded inside the scanner and long-term video EEG monitoring). EEG-fMRI results presentation had no impact on the initial clinical decision in three patients (23%) of the thirteen and resulted in a modification of the initial surgical plan in ten patients (77%) of the thirteen finally presented in MDT; in eight patients the impact was on the planned placement of invasive electrodes and in two patients the EEG-fMRI led to additional non-invasive tests before proceeding further with surgery. CONCLUSION The study is a prospective observational cohort study specifically designed to assess the impact of EEG-fMRI on the clinical decision making process, suggesting a significant influence of EEG-fMRI on epilepsy surgery planning.
Collapse
Affiliation(s)
- Sofia Markoula
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK; Neurology Department, University Hospital of Ioannina, Ioannina, Greece.
| | - Umair J Chaudhary
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK; Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Suejen Perani
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Alessio De Ciantis
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| | - Tinonkorn Yadee
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| |
Collapse
|
32
|
Adaptive optimal basis set for BCG artifact removal in simultaneous EEG-fMRI. Sci Rep 2018; 8:8902. [PMID: 29891929 PMCID: PMC5995808 DOI: 10.1038/s41598-018-27187-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/30/2018] [Indexed: 11/13/2022] Open
Abstract
Electroencephalography (EEG) signals recorded during simultaneous functional magnetic resonance imaging (fMRI) are contaminated by strong artifacts. Among these, the ballistocardiographic (BCG) artifact is the most challenging, due to its complex spatio-temporal dynamics associated with ongoing cardiac activity. The presence of BCG residuals in EEG data may hide true, or generate spurious correlations between EEG and fMRI time-courses. Here, we propose an adaptive Optimal Basis Set (aOBS) method for BCG artifact removal. Our method is adaptive, as it can estimate the delay between cardiac activity and BCG occurrence on a beat-to-beat basis. The effective creation of an optimal basis set by principal component analysis (PCA) is therefore ensured by a more accurate alignment of BCG occurrences. Furthermore, aOBS can automatically estimate which components produced by PCA are likely to be BCG artifact-related and therefore need to be removed. The aOBS performance was evaluated on high-density EEG data acquired with simultaneous fMRI in healthy subjects during visual stimulation. As aOBS enables effective reduction of BCG residuals while preserving brain signals, we suggest it may find wide application in simultaneous EEG-fMRI studies.
Collapse
|
33
|
Abramovici S, Antony A, Baldwin ME, Urban A, Ghearing G, Pan J, Sun T, Krafty RT, Richardson RM, Bagic A. Features of Simultaneous Scalp and Intracranial EEG That Predict Localization of Ictal Onset Zone. Clin EEG Neurosci 2018; 49:206-212. [PMID: 29067832 DOI: 10.1177/1550059417738688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the utility of simultaneous scalp EEG in patients with focal epilepsy undergoing intracranial EEG evaluation after a detailed presurgical testing, including an inpatient scalp video EEG evaluation. METHODS Patients who underwent simultaneous scalp and intracranial EEG (SSIEEG) monitoring were classified into group 1 or 2 depending on whether the seizure onset zone was delineated or not. Seizures were analyzed using the following 3 EEG features at the onset of seizures latency, location, and pattern. RESULTS The criteria showed at least one of the following features when comparing SSIEEG: prolonged latency, absence of anatomical congruence, lack of concordance of EEG pattern in 11.11% (1/9) of the patients in group 1 and 75 % (3/4) of the patients in group 2. These 3 features were not present in any of the 5 patients who had Engel class I outcome compared with 1 of the 2 patients (50%) who had seizure recurrence after resective surgery. The mean latency of seizure onset in scalp EEG compared with intracranial EEG of patients in group 1 was 17.48 seconds (SD = 16.07) compared with 4.33 seconds (SD = 11.24) in group 2 ( P = .03). None of the seizures recorded in patients in group 1 had a discordant EEG pattern in SSIEEG. CONCLUSION Concordance in EEG features like latency, location, and EEG pattern, at the onset of seizures in SSIEEG is associated with a favorable outcome after epilepsy surgery in patients with intractable focal epilepsy. SIGNIFICANCE Simultaneous scalp EEG complements intracranial EEG evaluation even after a detailed inpatient scalp video EEG evaluation and could be part of standard intracranial EEG studies in patients with intractable focal epilepsy.
Collapse
Affiliation(s)
| | - Arun Antony
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Maria Elizabeth Baldwin
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alexandra Urban
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gena Ghearing
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Julie Pan
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tao Sun
- 3 Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Todd Krafty
- 3 Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Mark Richardson
- 4 Department of Neurosurgery, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, PA, USA
| | - Anto Bagic
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
34
|
Janca R, Krsek P, Jezdik P, Cmejla R, Tomasek M, Komarek V, Marusic P, Jiruska P. The Sub-Regional Functional Organization of Neocortical Irritative Epileptic Networks in Pediatric Epilepsy. Front Neurol 2018; 9:184. [PMID: 29628910 PMCID: PMC5876241 DOI: 10.3389/fneur.2018.00184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/09/2018] [Indexed: 11/13/2022] Open
Abstract
Between seizures, irritative network generates frequent brief synchronous activity, which manifests on the EEG as interictal epileptiform discharges (IEDs). Recent insights into the mechanism of IEDs at the microscopic level have demonstrated a high variance in the recruitment of neuronal populations generating IEDs and a high variability in the trajectories through which IEDs propagate across the brain. These phenomena represent one of the major constraints for precise characterization of network organization and for the utilization of IEDs during presurgical evaluations. We have developed a new approach to dissect human neocortical irritative networks and quantify their properties. We have demonstrated that irritative network has modular nature and it is composed of multiple independent sub-regions, each with specific IED propagation trajectories and differing in the extent of IED activity generated. The global activity of the irritative network is determined by long-term and circadian fluctuations in sub-region spatiotemporal properties. Also, the most active sub-region co-localizes with the seizure onset zone in 12/14 cases. This study demonstrates that principles of recruitment variability and propagation are conserved at the macroscopic level and that they determine irritative network properties in humans. Functional stratification of the irritative network increases the diagnostic yield of intracranial investigations with the potential to improve the outcomes of surgical treatment of neocortical epilepsy.
Collapse
Affiliation(s)
- Radek Janca
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Pavel Krsek
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - Petr Jezdik
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Roman Cmejla
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Martin Tomasek
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - Vladimir Komarek
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - Petr Marusic
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - Premysl Jiruska
- Department of Developmental Epileptology, Institute of Physiology, The Czech Academy of Sciences, Prague, Czechia
| |
Collapse
|
35
|
Exploring the origins of EEG motion artefacts during simultaneous fMRI acquisition: Implications for motion artefact correction. Neuroimage 2018; 173:188-198. [PMID: 29486322 PMCID: PMC5929889 DOI: 10.1016/j.neuroimage.2018.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/16/2018] [Indexed: 11/24/2022] Open
Abstract
Motion artefacts (MAs) are induced within EEG data collected simultaneously with fMRI when the subject's head rotates relative to the magnetic field. The effects of these artefacts have generally been ameliorated by removing periods of data during which large artefact voltages appear in the EEG traces. However, even when combined with other standard post-processing methods, this strategy does not remove smaller MAs which can dominate the neuronal signals of interest. A number of methods are therefore being developed to characterise the MA by measuring reference signals and then using these in artefact correction. These methods generally assume that the head and EEG cap, plus any attached sensors, form a rigid body which can be characterised by a standard set of six motion parameters. Here we investigate the motion of the head/EEG cap system to provide a better understanding of MAs. We focus on the reference layer artefact subtraction (RLAS) approach, as this allows measurement of a separate reference signal for each electrode that is being used to measure brain activity. Through a series of experiments on phantoms and subjects, we find that movement of the EEG cap relative to the phantom and skin on the forehead is relatively small and that this non-rigid body movement does not appear to cause considerable discrepancy in artefacts between the scalp and reference signals. However, differences in the amplitude of these signals is observed which may be due to differences in geometry of the system from which the reference signals are measured compared with the brain signals. In addition, we find that there is non-rigid body movement of the skull and skin which produces an additional MA component for a head shake, which is not present for a head nod. This results in a large discrepancy in the amplitude and temporal profile of the MA measured on the scalp and reference layer, reducing the efficacy of MA correction based on the reference signals. Together our data suggest that the efficacy of the correction of MA using any reference-based system is likely to differ for different types of head movement with head shake being the hardest to correct. This provides new information to inform the development of hardware and post-processing methods for removing MAs from EEG data acquired simultaneously with fMRI data.
Collapse
|
36
|
Chiang CC, Wei X, Ananthakrishnan AK, Shivacharan RS, Gonzalez-Reyes LE, Zhang M, Durand DM. Slow moving neural source in the epileptic hippocampus can mimic progression of human seizures. Sci Rep 2018; 8:1564. [PMID: 29367722 PMCID: PMC5784157 DOI: 10.1038/s41598-018-19925-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/10/2018] [Indexed: 11/23/2022] Open
Abstract
Fast and slow neural waves have been observed to propagate in the human brain during seizures. Yet the nature of these waves is difficult to study in a surgical setting. Here, we report an observation of two different traveling waves propagating in the in-vitro epileptic hippocampus at speeds similar to those in the human brain. A fast traveling spike and a slow moving wave were recorded simultaneously with a genetically encoded voltage sensitive fluorescent protein (VSFP Butterfly 1.2) and a high speed camera. The results of this study indicate that the fast traveling spike is NMDA-sensitive but the slow moving wave is not. Image analysis and model simulation demonstrate that the slow moving wave is moving slowly, generating the fast traveling spike and is, therefore, a moving source of the epileptiform activity. This slow moving wave is associated with a propagating neural calcium wave detected with calcium dye (OGB-1) but is independent of NMDA receptors, not related to ATP release, and much faster than those previously recorded potassium waves. Computer modeling suggests that the slow moving wave can propagate by the ephaptic effect like epileptiform activity. These findings provide an alternative explanation for slow propagation seizure wavefronts associated with fast propagating spikes.
Collapse
Affiliation(s)
- Chia-Chu Chiang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Xile Wei
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
- School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072, China
| | | | - Rajat S Shivacharan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Luis E Gonzalez-Reyes
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Mingming Zhang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Dominique M Durand
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA.
| |
Collapse
|
37
|
Pellegrino G, Hedrich T, Chowdhury RA, Hall JA, Dubeau F, Lina JM, Kobayashi E, Grova C. Clinical yield of magnetoencephalography distributed source imaging in epilepsy: A comparison with equivalent current dipole method. Hum Brain Mapp 2017; 39:218-231. [PMID: 29024165 DOI: 10.1002/hbm.23837] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/25/2017] [Accepted: 09/25/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Source localization of interictal epileptic discharges (IEDs) is clinically useful in the presurgical workup of epilepsy patients. It is usually obtained by equivalent current dipole (ECD) which localizes a point source and is the only inverse solution approved by clinical guidelines. In contrast, magnetic source imaging using distributed methods (dMSI) provides maps of the location and the extent of the generators, but its yield has not been clinically validated. We systematically compared ECD versus dMSI performed using coherent Maximum Entropy on the Mean (cMEM), a method sensitive to the spatial extent of the generators. METHODS 340 source localizations of IEDs derived from 49 focal epilepsy patients with foci well-defined through intracranial EEG, MRI lesions, and surgery were analyzed. The comparison was based on the assessment of the sublobar concordance with the focus and of the distance between the source and the focus. RESULTS dMSI sublobar concordance was significantly higher than ECD (81% vs 69%, P < 0.001), especially for extratemporal lobe sources (dMSI = 84%; ECD = 67%, P < 0.001) and for seizure free patients (dMSI = 83%; ECD = 70%, P < 0.001). The median distance from the focus was 4.88 mm for ECD and 3.44 mm for dMSI (P < 0.001). ECD dipoles were often wrongly localized in deep brain regions. CONCLUSIONS dMSI using cMEM exhibited better accuracy. dMSI also offered the advantage of recovering more realistic maps of the generator, which could be exploited for neuronavigation aimed at targeting invasive EEG and surgical resection. Therefore, dMSI may be preferred to ECD in clinical practice. Hum Brain Mapp 39:218-231, 2018. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Giovanni Pellegrino
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montreal, Quebec, Canada.,Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,IRCCS Fondazione San Camillo Hospital, Venice, Italy
| | - Tanguy Hedrich
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montreal, Quebec, Canada
| | - Rasheda Arman Chowdhury
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montreal, Quebec, Canada
| | - Jeffery A Hall
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Francois Dubeau
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jean-Marc Lina
- Departement de Génie Electrique, Ecole de Technologie Supérieure, Montreal, Quebec, Canada.,Centre De Recherches En Mathématiques, Montreal, Quebec, Canada.,Centre D'études Avancées En Médecine Du Sommeil, Centre De Recherche De L'hôpital Sacré-Coeur De Montréal, Montreal, Quebec, Canada
| | - Eliane Kobayashi
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Christophe Grova
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montreal, Quebec, Canada.,Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Centre De Recherches En Mathématiques, Montreal, Quebec, Canada.,Physics Department and PERFORM Centre, Concordia University, Montreal, Quebec, Canada
| |
Collapse
|
38
|
Seeck M, Koessler L, Bast T, Leijten F, Michel C, Baumgartner C, He B, Beniczky S. The standardized EEG electrode array of the IFCN. Clin Neurophysiol 2017; 128:2070-2077. [DOI: 10.1016/j.clinph.2017.06.254] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 05/10/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022]
|
39
|
Popova I, Malkov A, Ivanov AI, Samokhina E, Buldakova S, Gubkina O, Osypov A, Muhammadiev RS, Zilberter T, Molchanov M, Paskevich S, Zilberter M, Zilberter Y. Metabolic correction by pyruvate halts acquired epilepsy in multiple rodent models. Neurobiol Dis 2017; 106:244-254. [PMID: 28709994 DOI: 10.1016/j.nbd.2017.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 01/22/2023] Open
Abstract
Metabolic intervention strategy of epilepsy treatment has been gaining broader attention due to accumulated evidence that hypometabolism, manifested in humans as reduced brain glucose consumption, is a principal factor in acquired epilepsy. Therefore, targeting deficient energy metabolism may be an effective approach for treating epilepsy. To confront this pathology we utilized pyruvate, which besides being an anaplerotic mitochondrial fuel possesses a unique set of neuroprotective properties as it: (i) is a potent reactive oxygen species scavenger; (ii) abates overactivation of Poly [ADP-ribose] polymerase 1 (PARP-1); (iii) facilitates glutamate efflux from the brain; (iv) augments brain glycogen stores; (v) is anti-inflammatory; (vi) prevents neuronal hyperexcitability; and (vii) normalizes the cytosolic redox state. In vivo, chronic oral pyruvate administration completely abolished established epileptic phenotypes in three accepted and fundamentally different rodent acquired epilepsy models. Our study reports metabolic correction by pyruvate as a potentially highly effective treatment of acquired epilepsies.
Collapse
Affiliation(s)
- I Popova
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France; Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - A Malkov
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France; Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - A I Ivanov
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France
| | - E Samokhina
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - S Buldakova
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France
| | - O Gubkina
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France
| | - A Osypov
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - R S Muhammadiev
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | | | - M Molchanov
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - S Paskevich
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - M Zilberter
- Neuronal Oscillations Lab, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Y Zilberter
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France.
| |
Collapse
|
40
|
Abstract
Recent advances in connectomics have led to a synthesis of perspectives regarding the brain's functional organization that reconciles classical concepts of localized specialization with an appreciation for properties that emerge from interactions across distributed functional networks. This provides a more comprehensive framework for understanding neural mechanisms of normal cognition and disease. Although fMRI has not become a routine clinical tool, research has already had important influences on clinical concepts guiding diagnosis and patient management. Here we review illustrative examples. Studies demonstrating the network plasticity possible in adults and the global consequences of even focal brain injuries or disease both have had substantial impact on modern concepts of disease evolution and expression. Applications of functional connectomics in studies of clinical populations are challenging traditional disease classifications and helping to clarify biological relationships between clinical syndromes (and thus also ways of extending indications for, or "re-purposing," current treatments). Large datasets from prospective, longitudinal studies promise to enable the discovery and validation of functional connectomic biomarkers with the potential to identify people at high risk of disease before clinical onset, at a time when treatments may be most effective. Studies of pain and consciousness have catalyzed reconsiderations of approaches to clinical management, but also have stimulated debate about the clinical meaningfulness of differences in internal perceptual or cognitive states inferred from functional connectomics or other physiological correlates. By way of a closing summary, we offer a personal view of immediate challenges and potential opportunities for clinically relevant applications of fMRI-based functional connectomics.
Collapse
Affiliation(s)
- Paul M Matthews
- Division of Brain Sciences, Department of Medicine and Centre for Neurotechnology, Imperial College London, London WC12 0NN, UK.
| | - Adam Hampshire
- Division of Brain Sciences, Department of Medicine and Centre for Neurotechnology, Imperial College London, London WC12 0NN, UK
| |
Collapse
|
41
|
Hedrich T, Pellegrino G, Kobayashi E, Lina JM, Grova C. Comparison of the spatial resolution of source imaging techniques in high-density EEG and MEG. Neuroimage 2017; 157:531-544. [PMID: 28619655 DOI: 10.1016/j.neuroimage.2017.06.022] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/29/2017] [Accepted: 06/09/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The present study aims at evaluating and comparing electrical and magnetic distributed source imaging methods applied to high-density Electroencephalography (hdEEG) and Magnetoencephalography (MEG) data. We used resolution matrices to characterize spatial resolution properties of Minimum Norm Estimate (MNE), dynamic Statistical Parametric Mapping (dSPM), standardized Low-Resolution Electromagnetic Tomography (sLORETA) and coherent Maximum Entropy on the Mean (cMEM, an entropy-based technique). The resolution matrix provides information of the Point Spread Functions (PSF) and of the Crosstalk functions (CT), this latter being also called source leakage, as it reflects the influence of a source on its neighbors. METHODS The spatial resolution of the inverse operators was first evaluated theoretically and then with real data acquired using electrical median nerve stimulation on five healthy participants. We evaluated the Dipole Localization Error (DLE) and the Spatial Dispersion (SD) of each PSF and CT map. RESULTS cMEM showed the smallest spatial spread (SD) for both PSF and CT maps, whereas localization errors (DLE) were similar for all methods. Whereas cMEM SD values were lower in MEG compared to hdEEG, the other methods slightly favored hdEEG over MEG. In real data, cMEM provided similar localization error and significantly less spatial spread than other methods for both MEG and hdEEG. Whereas both MEG and hdEEG provided very accurate localizations, all the source imaging methods actually performed better in MEG compared to hdEEG according to all evaluation metrics, probably due to the higher signal-to-noise ratio of the data in MEG. CONCLUSION Our overall results show that all investigated methods provide similar localization errors, suggesting very accurate localization for both MEG and hdEEG when similar number of sensors are considered for both modalities. Intrinsic properties of source imaging methods as well as their behavior for well-controlled tasks, suggest an overall better performance of cMEM in regards to spatial resolution and spatial leakage for both hdEEG and MEG. This indicates that cMEM would be a good candidate for studying source localization of focal and extended generators as well as functional connectivity studies.
Collapse
Affiliation(s)
- T Hedrich
- Multimodal Functional Imaging Lab, Biomedical Engineering Dpt., McGill University, Montreal, Canada.
| | - G Pellegrino
- Multimodal Functional Imaging Lab, Biomedical Engineering Dpt., McGill University, Montreal, Canada; Neurology and Neurosurgery Department, Montreal Neurological Institute (MNI), McGill University, Montreal, Canada; San Camillo Hospital IRCCS, Venice, Italy
| | - E Kobayashi
- Neurology and Neurosurgery Department, Montreal Neurological Institute (MNI), McGill University, Montreal, Canada
| | - J M Lina
- Département de Génie Électrique, École de Technologie Supérieure, Canada; Centre de recherches mathémathiques, Université de Montréal, Montreal, Canada; Center for Advanced Research on Sleep Medecine (CEAMS), hôpital du Sacré-Coeur, Montreal, Canada
| | - C Grova
- Multimodal Functional Imaging Lab, Biomedical Engineering Dpt., McGill University, Montreal, Canada; Neurology and Neurosurgery Department, Montreal Neurological Institute (MNI), McGill University, Montreal, Canada; Physics Dpt., PERFORM Centre, Concordia University, Canada; Centre de recherches mathémathiques, Université de Montréal, Montreal, Canada
| |
Collapse
|
42
|
Zilberter Y, Zilberter M. The vicious circle of hypometabolism in neurodegenerative diseases: Ways and mechanisms of metabolic correction. J Neurosci Res 2017; 95:2217-2235. [PMID: 28463438 DOI: 10.1002/jnr.24064] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/17/2017] [Accepted: 03/17/2017] [Indexed: 12/13/2022]
Abstract
Hypometabolism, characterized by decreased brain glucose consumption, is a common feature of many neurodegenerative diseases. Initial hypometabolic brain state, created by characteristic risk factors, may predispose the brain to acquired epilepsy and sporadic Alzheimer's and Parkinson's diseases, which are the focus of this review. Analysis of available data suggests that deficient glucose metabolism is likely a primary initiating factor for these diseases, and that resulting neuronal dysfunction further promotes the metabolic imbalance, establishing an effective positive feedback loop and a downward spiral of disease progression. Therefore, metabolic correction leading to the normalization of abnormalities in glucose metabolism may be an efficient tool to treat the neurological disorders by counteracting their primary pathological mechanisms. Published and preliminary experimental results on this approach for treating Alzheimer's disease and epilepsy models support the efficacy of metabolic correction, confirming the highly promising nature of the strategy. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Yuri Zilberter
- Aix-Marseille Université, INSERM UMR1106, Institut de Neurosciences des Systèmes, Marseille, France
| | - Misha Zilberter
- Gladstone Institute of Neurological Disease, 1650 Owens Street, San Francisco, California, 94158, USA
| |
Collapse
|
43
|
Nemtsas P, Birot G, Pittau F, Michel CM, Schaller K, Vulliemoz S, Kimiskidis VK, Seeck M. Source localization of ictal epileptic activity based on high-density scalp EEG data. Epilepsia 2017; 58:1027-1036. [DOI: 10.1111/epi.13749] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Petros Nemtsas
- Laboratory of Clinical Neurophysiology; AHEPA Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Gwenael Birot
- Department of Fundamental Neurosciences; Functional Brain Mapping Lab; University of Geneva; Geneva Switzerland
| | - Francesca Pittau
- EEG & Epilepsy Unit; Department of Clinical Neurosciences; University Hospital of Geneva; Geneva Switzerland
| | - Christoph M. Michel
- Department of Fundamental Neurosciences; Functional Brain Mapping Lab; University of Geneva; Geneva Switzerland
- Center for Biomedical Imaging (CIBM) Lausanne; Geneva Switzerland
| | - Karl Schaller
- Department of Clinical Neurosciences; Neurosurgery Clinic; University Hospital of Geneva; Geneva Switzerland
| | - Serge Vulliemoz
- EEG & Epilepsy Unit; Department of Clinical Neurosciences; University Hospital of Geneva; Geneva Switzerland
| | - Vasilios K. Kimiskidis
- Laboratory of Clinical Neurophysiology; AHEPA Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Margitta Seeck
- EEG & Epilepsy Unit; Department of Clinical Neurosciences; University Hospital of Geneva; Geneva Switzerland
| |
Collapse
|
44
|
Pittau F, Ferri L, Fahoum F, Dubeau F, Gotman J. Contributions of EEG-fMRI to Assessing the Epileptogenicity of Focal Cortical Dysplasia. Front Comput Neurosci 2017; 11:8. [PMID: 28265244 PMCID: PMC5316536 DOI: 10.3389/fncom.2017.00008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/02/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose: To examine the ability of the BOLD response to EEG spikes to assess the epileptogenicity of the lesion in patients with focal cortical dysplasia (FCD). Method: Patients with focal epilepsy and FCD who underwent 3T EEG-fMRI from 2006 to 2010 were included. Diagnosis of FCD was based on neuroradiology (MRI+), or histopathology in MRI-negative cases (MRI−). Patients underwent 120 min EEG-fMRI recording session. Spikes similar to those recorded outside the scanner were marked in the filtered EEG. The lesion (in MRI+) or the removed cortex (in MRI−) was marked on the anatomical T1 sequence, blindly to the BOLD response, after reviewing the FLAIR images. For each BOLD response we assessed the concordance with the spike field and with the lesion in MRI+ or the removed cortex in MRI−. BOLD responses were considered “concordant” if the maximal t-value was inside the marking. Follow-up after resection was used as gold-standard. Results: Twenty patients were included (13 MRI+, 7 MRI−), but in seven the EEG was not active or there were artifacts during acquisition. In all 13 studied patients, at least one BOLD response was concordant with the spike field; in 9/13 (69%) at least one BOLD response was concordant with the lesion: in 6/7 (86%) MRI+ and in 3/6 (50%) MRI− patients. Conclusions: Our study shows a high level of concordance between FCD and BOLD response. This data could provide useful information especially for MRI negative patients. Moreover, it shows in almost all FCD patients, a metabolic involvement of remote cortical or subcortical structures, corroborating the concept of epileptic network.
Collapse
Affiliation(s)
- Francesca Pittau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill UniversityQuébec, QC, Canada; Neurology Department, Geneva University HospitalsGeneva, Switzerland
| | - Lorenzo Ferri
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Québec, QC, Canada
| | - Firas Fahoum
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Québec, QC, Canada
| | - François Dubeau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Québec, QC, Canada
| | - Jean Gotman
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Québec, QC, Canada
| |
Collapse
|
45
|
Curatolo P, Bjørnvold M, Dill PE, Ferreira JC, Feucht M, Hertzberg C, Jansen A, Jóźwiak S, Kingswood JC, Kotulska K, Macaya A, Moavero R, Nabbout R, Zonnenberg BA. The Role of mTOR Inhibitors in the Treatment of Patients with Tuberous Sclerosis Complex: Evidence-based and Expert Opinions. Drugs 2016; 76:551-65. [PMID: 26927950 DOI: 10.1007/s40265-016-0552-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Tuberous sclerosis complex (TSC) is a genetic disorder arising from mutations in the TSC1 or TSC2 genes. The resulting over-activation of the mammalian target of rapamycin (mTOR) signalling pathway leaves patients with TSC susceptible to the growth of non-malignant tumours in multiple organs. Previously, surgery was the main therapeutic option for TSC. However, pharmacological therapy with mTOR inhibitors such as everolimus and sirolimus is now emerging as an alternate approach. Everolimus and sirolimus have already been shown to be effective in treating subependymal giant cell astrocytoma (SEGA) and renal angiomyolipoma (AML), and everolimus is currently being evaluated in treating TSC-related epilepsy. In November 2013 a group of European experts convened to discuss the current options and practical considerations for treating various manifestations of TSC. This article provides evidence-based recommendations for the treatment of SEGA, TSC-related epilepsy and renal AML, with a focus on where mTOR inhibitor therapy may be considered alongside other treatment options. Safety considerations regarding mTOR inhibitor therapy are also reviewed. With evidence of beneficial effects in neurological and non-neurological TSC manifestations, mTOR inhibitors may represent a systemic treatment for TSC.
Collapse
Affiliation(s)
- Paolo Curatolo
- Department of Neurosciences, Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy.
| | - Marit Bjørnvold
- National Center for Rare Epilepsy-related Disorders, National Center of Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Patricia E Dill
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,INSERM Unité 1511, Paris, France
| | - José Carlos Ferreira
- Neuro Pediatra, Centro Hospitalar Lisboa Ocidental, Hospital São Francisco Xavier, Lisbon, Portugal
| | - Martha Feucht
- Department of Paediatrics, University Hospital Vienna, Vienna, Austria
| | - Christoph Hertzberg
- Diagnose und Behandlungszentrum für Kinder und Jugendliche, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Anna Jansen
- Pediatric Neurology Unit-UZ Brussel, Brussels, Belgium
| | - Sergiusz Jóźwiak
- Department of Child Neurology, Medical University of Warsaw, Warsaw, Poland
| | - J Christopher Kingswood
- Sussex Renal Unit, Royal Sussex County Hospital, Brighton, UK.,The Trafford Department of Renal Medicine, Royal Sussex County Hospital, Brighton, UK
| | - Katarzyna Kotulska
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Alfons Macaya
- Servei de Neurologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Romina Moavero
- Department of Neurosciences, Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy.,Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Centre for Rare Epilepsies and Tuberous Sclerosis Complex, Necker-Enfants Malades Hospital, University Paris Descartes, Paris, France
| | | |
Collapse
|
46
|
Berrigan P, Bardouille T, MacLellan M, Mohamed IS, Murthy M. Cost-utility analysis of magnetoencephalography used to inform intracranial electrode placement in patients with drug resistant epilepsy: a model based analysis. J Eval Clin Pract 2016; 22:938-945. [PMID: 27270644 DOI: 10.1111/jep.12567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We estimated the cost-effectiveness of adding magnetoencephalography to a standard assessment for epilepsy surgery consisting of neuropsychology, magnetic resonance imagining, scalp electroencephalography, video electroencephalography and intracranial electroencephalography, in the capacity of informing intracranial electroencephalography electrode placement. METHODS We used Microsoft Excel (2007) to construct a decision model. Discounted costs and quality adjusted life years are aggregated to calculate incremental cost-effectiveness ratios. Sensitivity analyses are conducted to assess robustness of findings. RESULTS Our base case analysis yielded a result of $14 300 per quality adjusted life year gained. A total of 82.7% of probabilistic sensitivity analysis iterations resulted in incremental cost-effectiveness ratios below $100 000 in 2014 Canadian dollars. CONCLUSIONS Our findings demonstrate that the inclusion of Magnetoencephalography in the assessment for epilepsy surgery in the capacity of informing intracranial electroencephalography electrode placement is likely not cost saving but does represent a reasonable allocation of resources from a value for money perspective.
Collapse
Affiliation(s)
- Patrick Berrigan
- Centre for Clinical Research, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Tim Bardouille
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, NS, Canada
| | - Matt MacLellan
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, NS, Canada
| | - Ismail S Mohamed
- Department of Paediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Manjari Murthy
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, NS, Canada
| |
Collapse
|
47
|
Sone D, Matsuda H, Ota M, Maikusa N, Kimura Y, Sumida K, Yokoyama K, Imabayashi E, Watanabe M, Watanabe Y, Okazaki M, Sato N. Impaired cerebral blood flow networks in temporal lobe epilepsy with hippocampal sclerosis: A graph theoretical approach. Epilepsy Behav 2016; 62:239-45. [PMID: 27497065 DOI: 10.1016/j.yebeh.2016.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 12/19/2022]
Abstract
Graph theory is an emerging method to investigate brain networks. Altered cerebral blood flow (CBF) has frequently been reported in temporal lobe epilepsy (TLE), but graph theoretical findings of CBF are poorly understood. Here, we explored graph theoretical networks of CBF in TLE using arterial spin labeling imaging. We recruited patients with TLE and unilateral hippocampal sclerosis (HS) (19 patients with left TLE, and 21 with right TLE) and 20 gender- and age-matched healthy control subjects. We obtained all participants' CBF maps using pseudo-continuous arterial spin labeling and analyzed them using the Graph Analysis Toolbox (GAT) software program. As a result, compared to the controls, the patients with left TLE showed a significantly low clustering coefficient (p=0.024), local efficiency (p=0.001), global efficiency (p=0.010), and high transitivity (p=0.015), whereas the patients with right TLE showed significantly high assortativity (p=0.046) and transitivity (p=0.011). The group with right TLE also had high characteristic path length values (p=0.085), low global efficiency (p=0.078), and low resilience to targeted attack (p=0.101) at a trend level. Lower normalized clustering coefficient (p=0.081) in the left TLE and higher normalized characteristic path length (p=0.089) in the right TLE were found also at a trend level. Both the patients with left and right TLE showed significantly decreased clustering in similar areas, i.e., the cingulate gyri, precuneus, and occipital lobe. Our findings revealed differing left-right network metrics in which an inefficient CBF network in left TLE and vulnerability to irritation in right TLE are suggested. The left-right common finding of regional decreased clustering might reflect impaired default-mode networks in TLE.
Collapse
Affiliation(s)
- Daichi Sone
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Norihide Maikusa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kaoru Sumida
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kota Yokoyama
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Etsuko Imabayashi
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masako Watanabe
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yutaka Watanabe
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mitsutoshi Okazaki
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan.
| |
Collapse
|
48
|
Diagnostic techniques to detect the epileptogenic zone: Pathophysiological and presurgical analysis of epilepsy in dogs and cats. Vet J 2016; 215:64-75. [DOI: 10.1016/j.tvjl.2016.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/24/2016] [Accepted: 03/05/2016] [Indexed: 12/17/2022]
|
49
|
Propagating Neural Source Revealed by Doppler Shift of Population Spiking Frequency. J Neurosci 2016; 36:3495-505. [PMID: 27013678 DOI: 10.1523/jneurosci.3525-15.2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/28/2016] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Electrical activity in the brain during normal and abnormal function is associated with propagating waves of various speeds and directions. It is unclear how both fast and slow traveling waves with sometime opposite directions can coexist in the same neural tissue. By recording population spikes simultaneously throughout the unfolded rodent hippocampus with a penetrating microelectrode array, we have shown that fast and slow waves are causally related, so a slowly moving neural source generates fast-propagating waves at ∼0.12 m/s. The source of the fast population spikes is limited in space and moving at ∼0.016 m/s based on both direct and Doppler measurements among 36 different spiking trains among eight different hippocampi. The fact that the source is itself moving can account for the surprising direction reversal of the wave. Therefore, these results indicate that a small neural focus can move and that this phenomenon could explain the apparent wave reflection at tissue edges or multiple foci observed at different locations in neural tissue. SIGNIFICANCE STATEMENT The use of novel techniques with an unfolded hippocampus and penetrating microelectrode array to record and analyze neural activity has revealed the existence of a source of neural signals that propagates throughout the hippocampus. The source itself is electrically silent, but its location can be inferred by building isochrone maps of population spikes that the source generates. The movement of the source can also be tracked by observing the Doppler frequency shift of these spikes. These results have general implications for how neural signals are generated and propagated in the hippocampus; moreover, they have important implications for the understanding of seizure generation and foci localization.
Collapse
|
50
|
The role of SISCOM in preoperative evaluation for patients with epilepsy surgery: A meta-analysis. Seizure 2016; 41:43-50. [PMID: 27458682 DOI: 10.1016/j.seizure.2016.06.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the specific value of subtraction ictal and inter-ictal SPECT co-registered to MRI (SISCOM) in identifying the epileptogenic zone (EZ) and predicting postoperative outcomes in epileptic surgical patients. METHOD A meta-analysis of studies published from January 1995 to June 2015 was conducted through a comprehensive literature search, and 11 studies were included. R software was first used to calculate a pooled positive rate, concordant rate and positive predictive value (PPV) for good outcomes. Stata software was then used to explore the relationship between SISCOM localization and surgical outcomes, including a subgroup analysis for extra-temporal lobe epilepsy. RESULTS The unweighted positive and concordant rates of SISCOM were 85.9% and 65.3%, respectively. In 142 MRI-negative patients, the SISCOM positive rate was 83.8%. The pooled PPV of 178 surgical patients with concordant SISCOM was 56%. In the meta-analysis of 275 surgical patients, the seizure-free odds ratio was 3.28-times higher in concordant than in non-concordant SISCOM patients [95%CI (1.90, 5.67)]. For extra-temporal lobe epilepsy, the seizure-free odds ratio was 2.44-times higher in concordant than in non-concordant SISCOM patients [95%CI (1.34, 4.43)]. CONCLUSION Our data indicate that SISCOM has moderate sensitivity in localizing the epileptogenic zone and can provide complementary information when MRI is negative. Furthermore, SISCOM localization concordant with the gold standard demonstrates slightly higher predictive value for good surgical outcomes. Further research is required to explore the influence of SISCOM localization results in temporal lobe versus extra-temporal lobe epilepsy.
Collapse
|