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Roy B, Ogren JA, Allen LA, Diehl B, Sankar R, Lhatoo SD, Kumar R, Harper RM. Brain gray matter changes in children at risk for sudden unexpected death in epilepsy. Pediatr Res 2024:10.1038/s41390-024-03295-0. [PMID: 38992155 DOI: 10.1038/s41390-024-03295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 04/24/2024] [Accepted: 05/15/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Potential failing adult brain sites, stratified by risk, mediating Sudden Unexpected Death in Epilepsy (SUDEP) have been described, but are unknown in children. METHODS We examined regional brain volumes using T1-weighted MRI images in 21 children with epilepsy at high SUDEP risk and 62 healthy children, together with SUDEP risk scores, calculated from focal seizure frequency. Gray matter tissue type was partitioned, maps normalized, smoothed, and compared between groups (SPM12; ANCOVA; covariates, age, sex, and BMI). Partial correlations between regional volumes and seizure frequency were examined (SPM12, covariates, age, sex, and BMI); 67% were at high risk for SUDEP. RESULTS The cerebellar cortex, hippocampus, amygdala, putamen, cingulate, thalamus, and para-hippocampal gyrus showed increased gray matter volumes in epilepsy, and decreased volumes in the posterior thalamus, lingual gyrus, and temporal cortices. The cingulate, insula, and putamen showed significant positive relationships with focal seizure frequency indices using whole-brain voxel-by-voxel partial correlations. Tissue volume changes in selected sites differed in direction from adults; particularly, cerebellar sites, key for hypotensive recovery, increased rather than adult declines. CONCLUSION The volume increases may represent expansion by inflammatory or other processes that, with sustained repetitive seizure discharge, lead to tissue volume declines described earlier in adults. IMPACT Children with epilepsy, who are at risk for Sudden Unexplained Death, show changes in brain volume that often differ in direction of change from adults at risk for SUDEP. Sites of volume change play significant roles in mediating breathing and blood pressure, and include areas that serve recovery from prolonged apnea and marked loss of blood pressure. The extent of volume changes correlated with focal seizure frequency. Although the underlying processes contributing to regional volume changes remain speculative, regions of tissue swelling in pediatric brain areas may represent transitory conditions that later lead to tissue loss in the adult condition.
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Affiliation(s)
- Bhaswati Roy
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jennifer A Ogren
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA, 90095, USA
| | - Luke A Allen
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
| | - Raman Sankar
- Department of Neurology and Pediatrics, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Samden D Lhatoo
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rajesh Kumar
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Ronald M Harper
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA, 90095, USA
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA, 90095, USA
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van den Bongard F, Gowik JK, Coenen J, Jakobsmeyer R, Reinsberger C. Exercise-induced central and peripheral sympathetic activity in a community-based group of epilepsy patients differ from healthy controls. Exp Brain Res 2024; 242:1301-1310. [PMID: 38551692 PMCID: PMC11108887 DOI: 10.1007/s00221-024-06792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/22/2024] [Indexed: 05/23/2024]
Abstract
Ictal and interictal activity within the autonomic nervous system is characterized by a sympathetic overshoot in people with epilepsy. This autonomic dysfunction is assumed to be driven by alterations in the central autonomic network. In this study, exercise-induced changes of the interrelation of central and peripheral autonomic activity in patients with epilepsy was assessed. 21 patients with epilepsy (16 seizure-free), and 21 healthy matched controls performed an exhaustive bicycle ergometer test. Immediately before and after the exercise test, resting state electroencephalography measurements (Brain Products GmbH, 128-channel actiCHamp) of 5 min were carried out to investigate functional connectivity assessed by phase locking value in source space for whole brain, central autonomic network and visual network. Additionally, 1-lead ECG (Brain products GmbH) was performed to analyze parasympathetic (root mean square of successive differences (RMSSD) of the heart rate variability) and sympathetic activity (electrodermal activity (meanEDA)). MeanEDA increased (p < 0.001) and RMSSD decreased (p < 0.001) from pre to post-exercise in both groups. Correlation coefficients of meanEDA and central autonomic network functional connectivity differed significantly between the groups (p = 0.004) after exercise. Both patients with epilepsy and normal control subjects revealed the expected physiological peripheral autonomic responses to acute exhaustive exercise, but alterations of the correlation between central autonomic and peripheral sympathetic activity may indicate a different sympathetic reactivity after exercise in patients with epilepsy. The clinical relevance of this finding and its modulators (seizures, anti-seizure medication, etc.) still needs to be elucidated.
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Affiliation(s)
| | - Julia Kristin Gowik
- Institute of Sports Medicine, Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany
| | - Jessica Coenen
- Institute of Sports Medicine, Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany
| | - Rasmus Jakobsmeyer
- Institute of Sports Medicine, Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany.
- Division of Sports Neurology & Neurosciences, Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
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Zhao C, Tang Y, Xiao Y, Jiang P, Zhang Z, Gong Q, Zhou D. Asymmetrical cortical surface area decrease in epilepsy patients with postictal generalized electroencephalography suppression. Cereb Cortex 2024; 34:bhae026. [PMID: 38342683 DOI: 10.1093/cercor/bhae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 02/13/2024] Open
Abstract
Postictal generalized electroencephalographic suppression is a possible electroencephalographic marker for sudden unexpected death in epilepsy. We aimed to investigate the cortical surface area abnormalities in epilepsy patients with postictal generalized electroencephalographic suppression. We retrospectively included 30 epilepsy patients with postictal generalized electroencephalographic suppression (PGES+), 21 epilepsy patients without postictal generalized electroencephalographic suppression (PGES-), and 30 healthy controls. Surface-based analysis on high-resolution T1-weighted images was conducted and cortical surface areas were compared among the three groups, alongside correlation analyses with seizure-related clinical variables. Compared with PGES- group, we identified reduced surface area in the bilateral insula with more extensive distribution in the right hemisphere in PGES+ group. The reduced right insular surface area was associated with younger seizure-onset age. When compared with healthy controls, PGES- group presented reduced surface area in the left caudal middle frontal gyrus; PGES+ group presented more widespread surface area reductions in the right posterior cingulate gyrus, left postcentral gyrus, middle frontal gyrus, and middle temporal gyrus. Our results suggested cortical microstructural impairment in patients with postictal generalized electroencephalographic suppression. The significant surface area reductions in the insular cortex supported the autonomic network involvement in the pathology of postictal generalized electroencephalographic suppression, and its right-sided predominance suggested the potential shared abnormal brain network for postictal generalized electroencephalographic suppression and sudden unexpected death in epilepsy.
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Affiliation(s)
- Chenyang Zhao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Yingying Tang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Yuan Xiao
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Ping Jiang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- West China Medical Publishers, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, China
| | - Ziyi Zhang
- West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China
| | - Qiyong Gong
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
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Simeone KA, Martenz DM, Iyer SH, Booth CP, Herr SE, Matthews SA, Draves SB, Heinemann LL, Greenberg PL, Lhatoo SD, Donner E, Simeone TA. Personalization of SUDEP risk: A survey of transient subclinical comorbid changes. Epilepsy Res 2024; 199:107259. [PMID: 38086218 DOI: 10.1016/j.eplepsyres.2023.107259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Preclinical data report within subject modifiable ailments emerge weeks prior to SUDEP, including sleep disorders and cardiorespiratory changes; findings which support anecdotal clinical data. Here, we bridge preclinical findings with future clinical/preclinical studies, and survey whether caretakers or family members of victims noticed transient changes prior to SUDEP. The aim of this pilot study is to identify potential modifiable changes that may synergistically increase SUDEP risk for future research. METHODS A mobile electronic survey was posted on SUDEP community websites. The survey queried whether changes in seizures, sleep, physical well-being, emotional well-being, cognition, breathing, or heart rate were noticed before SUDEP. RESULTS The most profound finding was that 85% of victims had multiple transient ailments prior to SUDEP. Changes in seizures (28/54), and sleep (30/58) occurred in more than 50% of the victims and represent the most influential changes identified. The second and third most influential changes were a reduction in physical well-being (25/57) and emotional well-being (26/56). Changes were observed within the last two months of life in approximately one third of the cases, and more than four months prior to SUDEP in approximately one third of cases, indicating a potential time frame for proactive preventative strategies. Respondents also noted changes in cognition (16/55), breathing (9/54) or heart rate (8/55). Data indicate these changes may be associated with increased SUDEP risk within subject. Study limitations include the responses were based on memory, there was a potential for data to be over reported, and caretakers were not prompted to observe changes a priori, thus some existing changes may have gone unnoticed. SIGNIFICANCE Data support the preclinical findings that transient, subclinical (i.e., not severe enough to require medical intervention), modifiable ailments may increase risk of SUDEP. This suggests that just as an epilepsy type can change over a lifetime and epilepsy type-specific treatments can reduce SUDEP risk, further personalization of SUDEP risk will improve our understanding as to whether variables contribute to risk differently across lifespan. Thus, with a dynamic capacity to change, differing factors may contribute to the distribution of risk probability within an individual at any given time. Understanding whether different combinations of transient changes are specific to epilepsy type, age, or sex needs to be determined to move the field forward in hopes of developing a personalized approach to preventative strategies.
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Affiliation(s)
- Kristina A Simeone
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States.
| | | | - Shruthi H Iyer
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Cameron P Booth
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Shelby E Herr
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Stephanie A Matthews
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Samantha B Draves
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Laura L Heinemann
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Pierce L Greenberg
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Samden D Lhatoo
- Department of Neurology, University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, United States
| | - Elizabeth Donner
- Department of Paediatrics, Division of Neurology, Hospital for Sick Children, Canada
| | - Timothy A Simeone
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
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Misirocchi F, Vaudano AE, Florindo I, Zinno L, Zilioli A, Mannini E, Parrino L, Mutti C. Imaging biomarkers of sleep-related hypermotor epilepsy and sudden unexpected death in epilepsy: a review. Seizure 2024; 114:70-78. [PMID: 38088013 DOI: 10.1016/j.seizure.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024] Open
Abstract
In recent years, imaging has emerged as a promising source of several intriguing biomarkers in epilepsy, due to the impressive growth of imaging technology, supported by methodological advances and integrations of post-processing techniques. Bearing in mind the mutually influencing connection between sleep and epilepsy, we focused on sleep-related hypermotor epilepsy (SHE) and sudden unexpected death in epilepsy (SUDEP), aiming to make order and clarify possible clinical utility of emerging multimodal imaging biomarkers of these two epilepsy-related entities commonly occurring during sleep. Regarding SHE, advanced structural techniques might soon emerge as a promising source of diagnostic and predictive biomarkers, tailoring a targeted therapeutic (surgical) approach for MRI-negative subjects. Functional and metabolic imaging may instead unveil SHE's extensive and night-related altered brain networks, providing insights into distinctions and similarities with non-epileptic sleep phenomena, such as parasomnias. SUDEP is considered a storm that strikes without warning signals, but objective subtle structural and functional alterations in autonomic, cardiorespiratory, and arousal centers are present in patients eventually experiencing SUDEP. These alterations could be seen both as susceptibility and diagnostic biomarkers of the underlying pathological ongoing loop ultimately ending in death. Finally, given that SHE and SUDEP are rare phenomena, most evidence on the topic is derived from small single-center experiences with scarcely comparable results, hampering the possibility of performing any meta-analytic approach. Multicenter, longitudinal, well-designed studies are strongly encouraged.
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Affiliation(s)
| | - Anna Elisabetta Vaudano
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy; Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Irene Florindo
- Neurology Unit, University Hospital of Parma, Parma, Italy
| | - Lucia Zinno
- Neurology Unit, University Hospital of Parma, Parma, Italy
| | | | - Elisa Mannini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Liborio Parrino
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Neurology Unit, University Hospital of Parma, Parma, Italy; Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy.
| | - Carlotta Mutti
- Neurology Unit, University Hospital of Parma, Parma, Italy; Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
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Pai MS, Wang KC, Yeh KC, Wang SJ. Stabilization of mitochondrial function by chlorogenic acid protects against kainic acid-induced seizures and neuronal cell death in rats. Eur J Pharmacol 2023; 961:176197. [PMID: 38000721 DOI: 10.1016/j.ejphar.2023.176197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/21/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Abstract
The current study investigated the effect of chlorogenic acid, a polyphenolic compound found in numerous plant products, on a kainic acid-induced seizure rat model and its potential mechanism. Rats were administered chlorogenic acid (10 and 50 mg/kg) intraperitoneally for 30 min before kainic acid (15 mg/kg) intraperitoneal administration. Pretreatment with chlorogenic acid decreased the seizure score, increased the latency to onset of the first seizure, and decreased the mortality rate. Chlorogenic acid pretreatment also resulted in a significant reduction in glutamate elevation and neuronal death in the hippocampus of kainic acid-treated rats. In addition, electron microscopy revealed that kainic acid-induced changes in hippocampal mitochondrial structure were prevented by chlorogenic acid pretreatment. Additionally, the levels of mitochondrial function-related proteins, including sirtuin 3, Complex I, glutamate dehydrogenase 1 and ATP synthase, were increased, and the level of the mitochondrial damage marker cytochrome C was decreased in the hippocampus of chlorogenic acid/kainic acid rats. Furthermore, the expression of mitochondrial biogenesis-related proteins [AMP-activated protein kinase (AMPK), sirtuin1, and peroxisome proliferator-activated receptor γ-coactivator-1α (PGC-1α)] and mitophagy-related proteins [phosphatase and tensin homolog (PTEN)-induced putative kinase 1 (PINK1), Parkin, and microtubule-associated protein 1 light chain 3 (LC3)] was decreased in the hippocampus of kainic acid-treated rats, which was reversed by chlorogenic acid pretreatment. These observations reveal the marked neuroprotective potential of chlorogenic acid against kainic acid-induced neurotoxicity and seizures through prevention of glutamate increase and preservation of AMPK/sirtuin 1/PGC-1α-mediated mitochondrial biogenesis and PINK1/Parkin-induced mitophagy to maintain adequate mitochondrial homeostasis and function.
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Affiliation(s)
- Ming-Shang Pai
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; School of Medicine, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist, New Taipei City, 24205, Taiwan
| | - Kaw-Chen Wang
- School of Medicine, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist, New Taipei City, 24205, Taiwan; Department of Neurology, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Kun-Chieh Yeh
- School of Medicine, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist, New Taipei City, 24205, Taiwan; Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Su-Jane Wang
- School of Medicine, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist, New Taipei City, 24205, Taiwan; Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.
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Kiersnowski OC, Winston GP, Caciagli L, Biondetti E, Elbadri M, Buck S, Duncan JS, Thornton JS, Shmueli K, Vos SB. Quantitative susceptibility mapping identifies hippocampal and other subcortical grey matter tissue composition changes in temporal lobe epilepsy. Hum Brain Mapp 2023; 44:5047-5064. [PMID: 37493334 PMCID: PMC10502681 DOI: 10.1002/hbm.26432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is associated with widespread brain alterations. Using quantitative susceptibility mapping (QSM) alongside transverse relaxation rate (R 2 * ), we investigated regional brain susceptibility changes in 36 patients with left-sided (LTLE) or right-sided TLE (RTLE) secondary to hippocampal sclerosis, and 27 healthy controls (HC). We compared three susceptibility calculation methods to ensure image quality. Correlations of susceptibility andR 2 * with age of epilepsy onset, frequency of focal-to-bilateral tonic-clonic seizures (FBTCS), and neuropsychological test scores were examined. Weak-harmonic QSM (WH-QSM) successfully reduced noise and removed residual background field artefacts. Significant susceptibility increases were identified in the left putamen in the RTLE group compared to the LTLE group, the right putamen and right thalamus in the RTLE group compared to HC, and a significant susceptibility decrease in the left hippocampus in LTLE versus HC. LTLE patients who underwent epilepsy surgery showed significantly lower left-versus-right hippocampal susceptibility. SignificantR 2 * changes were found between TLE and HC groups in the amygdala, putamen, thalamus, and in the hippocampus. Specifically, decreased R2 * was found in the left and right hippocampus in LTLE and RTLE, respectively, compared to HC. Susceptibility andR 2 * were significantly correlated with cognitive test scores in the hippocampus, globus pallidus, and thalamus. FBTCS frequency correlated positively with ipsilateral thalamic and contralateral putamen susceptibility and withR 2 * in bilateral globi pallidi. Age of onset was correlated with susceptibility in the hippocampus and putamen, and withR 2 * in the caudate. Susceptibility andR 2 * changes observed in TLE groups suggest selective loss of low-myelinated neurons alongside iron redistribution in the hippocampi, predominantly ipsilaterally, indicating QSM's sensitivity to local pathology. Increased susceptibility andR 2 * in the thalamus and putamen suggest increased iron content and reflect disease severity.
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Affiliation(s)
- Oliver C. Kiersnowski
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- Department of Medicine, Division of NeurologyQueen's UniversityKingstonCanada
| | - Lorenzo Caciagli
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Emma Biondetti
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
- Department of Neuroscience, Imaging and Clinical SciencesInstitute for Advanced Biomedical Technologies, “D'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Maha Elbadri
- Department of NeurologyQueen Elizabeth HospitalBirminghamUK
| | - Sarah Buck
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
| | - John S. Thornton
- Neuroradiological Academic UnitUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Karin Shmueli
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Sjoerd B. Vos
- Neuroradiological Academic UnitUCL Queen Square Institute of Neurology, University College LondonLondonUK
- Centre for Microscopy, Characterisation, and AnalysisThe University of Western AustraliaNedlandsAustralia
- Centre for Medical Image Computing, Computer Science departmentUniversity College LondonLondonUK
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Kim W, Lee H, Lee KW, Yang E, Kim S. The Association of Nocturnal Seizures and Interictal Cardiac/Central Autonomic Function in Frontal Lobe Epilepsy: Heart Rate Variability and Central Autonomic Network Analysis. Neuropsychiatr Dis Treat 2023; 19:2081-2091. [PMID: 37810949 PMCID: PMC10559795 DOI: 10.2147/ndt.s426263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose Patients with epilepsy frequently experience autonomic dysfunction, closely related to sudden unexplained death in epilepsy (SUDEP). SUDEP occurs most often at night or during sleep, and frequent nocturnal seizures are an established risk factor. This study investigated the influence of nocturnal seizures on autonomic dysfunction in epilepsy. Patients and Methods This retrospective study enrolled frontal lobe epilepsy (FLE) patients who performed 24-hour EEG monitoring. All participants were divided into nocturnal FLE (NFLE, > 90% of seizures occurring during sleep) or diurnal FLE (DFLE) groups. EEG and ECG signals were simultaneously obtained during waking and sleep stages. EEG current density source and connectivity analysis of the autonomic network were performed. ECG was analyzed across time and frequency domains heart rate variability (HRV) analysis method was used. The obtained parameters were compared between the NFLE and DFLE groups. Results Fifteen NFLE and 16 DFLE patients were enrolled with no significant difference in age, sex, disease duration, seizure frequency, or the number of anti-seizure medications between the two groups. During sleep, a decrease in HRV parameters and an increase of the beta-1 (13-22 Hz) current source density power in the bilateral paracentral lobule (BA4,5,6), precuneus (BA7), and cingulate (BA31) were observed in the NFLE group compared to DFLE group. The NFLE group also showed hyperconnectivity in the central autonomic (12 edges distributed over 10 nodes), sympathetic (2 edges distributed over 3 nodes), and parasympathetic (4 edges distributed over 6 nodes) beta-1 frequency band networks during sleep. During wakefulness, central and cardiac autonomic variables were not significantly different between the NFLE and DFLE groups. Conclusion Interictal cardiac and central autonomic dysfunction occurred simultaneously and can be attributed to the brain-heart autonomic axis. Our findings suggest that nocturnal seizures may contribute to interictal autonomic dysfunction during sleep in people with epilepsy.
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Affiliation(s)
- Woojun Kim
- Department of Neurology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunjo Lee
- Department of Neurology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Kyung Won Lee
- Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunjin Yang
- Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seonghoon Kim
- Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lucas A, Cornblath EJ, Sinha N, Hadar P, Caciagli L, Keller SS, Bonilha L, Shinohara RT, Stein JM, Das S, Gleichgerrcht E, Davis KA. Resting state functional connectivity demonstrates increased segregation in bilateral temporal lobe epilepsy. Epilepsia 2023; 64:1305-1317. [PMID: 36855286 DOI: 10.1111/epi.17565] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy. An increasingly identified subset of patients with TLE consists of those who show bilaterally independent temporal lobe seizures. The purpose of this study was to leverage network neuroscience to better understand the interictal whole brain network of bilateral TLE (BiTLE). METHODS In this study, using a multicenter resting state functional magnetic resonance imaging (rs-fMRI) data set, we constructed whole-brain functional networks of 19 patients with BiTLE, and compared them to those of 75 patients with unilateral TLE (UTLE). We quantified resting-state, whole-brain topological properties using metrics derived from network theory, including clustering coefficient, global efficiency, participation coefficient, and modularity. For each metric, we computed an average across all brain regions, and iterated this process across network densities. Curves of network density vs each network metric were compared between groups. Finally, we derived a combined metric, which we term the "integration-segregation axis," by combining whole-brain average clustering coefficient and global efficiency curves, and applying principal component analysis (PCA)-based dimensionality reduction. RESULTS Compared to UTLE, BiTLE had decreased global efficiency (p = .031), and decreased whole brain average participation coefficient across a range of network densities (p = .019). Modularity maximization yielded a larger number of smaller communities in BiTLE than in UTLE (p = .020). Differences in network properties separate BiTLE and UTLE along the integration-segregation axis, with regions within the axis having a specificity of up to 0.87 for BiTLE. Along the integration-segregation axis, UTLE patients with poor surgical outcomes were distributed in the same regions as BiTLE, and network metrics confirmed similar patterns of increased segregation in both BiTLE and poor outcome UTLE. SIGNIFICANCE Increased interictal whole-brain network segregation, as measured by rs-fMRI, is specific to BiTLE, as well as poor surgical outcome UTLE, and may assist in non-invasively identifying this patient population prior to intracranial electroencephalography or device implantation.
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Affiliation(s)
- Alfredo Lucas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eli J Cornblath
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nishant Sinha
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter Hadar
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Leonardo Bonilha
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Russell T Shinohara
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joel M Stein
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sandhitsu Das
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ezequiel Gleichgerrcht
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn A Davis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Legouhy A, Allen LA, Vos SB, Oliveira JFA, Kassinopoulos M, Winston GP, Duncan JS, Ogren JA, Scott C, Kumar R, Lhatoo SD, Thom M, Lemieux L, Harper RM, Zhang H, Diehl B. Volumetric and microstructural abnormalities of the amygdala in focal epilepsy with varied levels of SUDEP risk. Epilepsy Res 2023; 192:107139. [PMID: 37068421 DOI: 10.1016/j.eplepsyres.2023.107139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/24/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
Although the mechanisms of sudden unexpected death in epilepsy (SUDEP) are not yet well understood, generalised- or focal-to-bilateral tonic-clonic seizures (TCS) are a major risk factor. Previous studies highlighted alterations in structures linked to cardio-respiratory regulation; one structure, the amygdala, was enlarged in people at high risk of SUDEP and those who subsequently died. We investigated volume changes and the microstructure of the amygdala in people with epilepsy at varied risk for SUDEP since that structure can play a key role in triggering apnea and mediating blood pressure. The study included 53 healthy subjects and 143 patients with epilepsy, the latter separated into two groups according to whether TCS occur in years before scan. We used amygdala volumetry, derived from structural MRI, and tissue microstructure, derived from diffusion MRI, to identify differences between the groups. The diffusion metrics were obtained by fitting diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) models. The analyses were performed at the whole amygdala level and at the scale of amygdaloid nuclei. Patients with epilepsy showed larger amygdala volumes and lower neurite density indices (NDI) than healthy subjects; the left amygdala volumes were especially enhanced. Microstructural changes, reflected by NDI differences, were more prominent on the left side and localized in the lateral, basal, central, accessory basal and paralaminar amygdala nuclei; basolateral NDI lowering appeared bilaterally. No significant microstructural differences appeared between epilepsy patients with and without current TCS. The central amygdala nuclei, with prominent interactions from surrounding nuclei of that structure, project to cardiovascular regions and respiratory phase switching areas of the parabrachial pons, as well as to the periaqueductal gray. Consequently, they have the potential to modify blood pressure and heart rate, and induce sustained apnea or apneusis. The findings here suggest that lowered NDI, indicative of reduced dendritic density, could reflect an impaired structural organization influencing descending inputs that modulate vital respiratory timing and drive sites and areas critical for blood pressure control.
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Affiliation(s)
- Antoine Legouhy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK.
| | - Luke A Allen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK; The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, UCL, London, UK; Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia
| | - Joana F A Oliveira
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Michalis Kassinopoulos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK; Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Jennifer A Ogren
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Brain Research Institute, UCLA, Los Angeles, CA, USA
| | - Catherine Scott
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Rajesh Kumar
- Brain Research Institute, UCLA, Los Angeles, CA, USA; Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Samden D Lhatoo
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Ronald M Harper
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Brain Research Institute, UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hui Zhang
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK; The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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11
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Legouhy A, Allen LA, Vos SB, Oliveira JFA, Kassinopoulos M, Winston GP, Duncan JS, Ogren JA, Scott C, Kumar R, Lhatoo SD, Thom M, Lemieux L, Harper RM, Zhang H, Diehl B. Volumetric and microstructural abnormalities of the amygdala in focal epilepsy with varied levels of SUDEP risk. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.13.23287045. [PMID: 36993394 PMCID: PMC10055456 DOI: 10.1101/2023.03.13.23287045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Although the mechanisms of sudden unexpected death in epilepsy (SUDEP) are not yet well understood, generalised- or focal-to-bilateral tonic-clonic seizures (TCS) are a major risk factor. Previous studies highlighted alterations in structures linked to cardio-respiratory regulation; one structure, the amygdala, was enlarged in people at high risk of SUDEP and those who subsequently died. We investigated volume changes and the microstructure of the amygdala in people with epilepsy at varied risk for SUDEP since that structure can play a key role in triggering apnea and mediating blood pressure. The study included 53 healthy subjects and 143 patients with epilepsy, the latter separated into two groups according to whether TCS occur in years before scan. We used amygdala volumetry, derived from structural MRI, and tissue microstructure, derived from diffusion MRI, to identify differences between the groups. The diffusion metrics were obtained by fitting diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) models. The analyses were performed at the whole amygdala level and at the scale of amygdaloid nuclei. Patients with epilepsy showed larger amygdala volumes and lower neurite density indices (NDI) than healthy subjects; the left amygdala volumes were especially enhanced. Microstructural changes, reflected by NDI differences, were more prominent on the left side and localized in the lateral, basal, central, accessory basal and paralaminar amygdala nuclei; basolateral NDI lowering appeared bilaterally. No significant microstructural differences appeared between epilepsy patients with and without current TCS. The central amygdala nuclei, with prominent interactions from surrounding nuclei of that structure, project to cardiovascular regions and respiratory phase switching areas of the parabrachial pons, as well as to the periaqueductal gray. Consequently, they have the potential to modify blood pressure and heart rate, and induce sustained apnea or apneusis. The findings here suggest that lowered NDI, indicative of reduced dendritic density, could reflect an impaired structural organization influencing descending inputs that modulate vital respiratory timing and drive sites and areas critical for blood pressure control.
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Affiliation(s)
- Antoine Legouhy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Luke A Allen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, UCL, London, UK
- Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia
| | - Joana F A Oliveira
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Michalis Kassinopoulos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
- Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John S Duncan
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Jennifer A Ogren
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Brain Research Institute, UCLA, Los Angeles, CA, USA
| | - Catherine Scott
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Rajesh Kumar
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Samden D Lhatoo
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Maria Thom
- Department of Neuropathology, Institute of Neurology, University College London, London, UK
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Ronald M Harper
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Brain Research Institute, UCLA, Los Angeles, CA, USA
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hui Zhang
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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12
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Faingold CL, Feng HJ. A unified hypothesis of SUDEP: Seizure-induced respiratory depression induced by adenosine may lead to SUDEP but can be prevented by autoresuscitation and other restorative respiratory response mechanisms mediated by the action of serotonin on the periaqueductal gray. Epilepsia 2023; 64:779-796. [PMID: 36715572 PMCID: PMC10673689 DOI: 10.1111/epi.17521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a major cause of death in people with epilepsy (PWE). Postictal apnea leading to cardiac arrest is the most common sequence of terminal events in witnessed cases of SUDEP, and postconvulsive central apnea has been proposed as a potential biomarker of SUDEP susceptibility. Research in SUDEP animal models has led to the serotonin and adenosine hypotheses of SUDEP. These neurotransmitters influence respiration, seizures, and lethality in animal models of SUDEP, and are implicated in human SUDEP cases. Adenosine released during seizures is proposed to be an important seizure termination mechanism. However, adenosine also depresses respiration, and this effect is mediated, in part, by inhibition of neuronal activity in subcortical structures that modulate respiration, including the periaqueductal gray (PAG). Drugs that enhance the action of adenosine increase postictal death in SUDEP models. Serotonin is also released during seizures, but enhances respiration in response to an elevated carbon dioxide level, which often occurs postictally. This effect of serotonin can potentially compensate, in part, for the adenosine-mediated respiratory depression, acting to facilitate autoresuscitation and other restorative respiratory response mechanisms. A number of drugs that enhance the action of serotonin prevent postictal death in several SUDEP models and reduce postictal respiratory depression in PWE. This effect of serotonergic drugs may be mediated, in part, by actions on brainstem sites that modulate respiration, including the PAG. Enhanced activity in the PAG increases respiration in response to hypoxia and other exigent conditions and can be activated by electrical stimulation. Thus, we propose the unifying hypothesis that seizure-induced adenosine release leads to respiratory depression. This can be reversed by serotonergic action on autoresuscitation and other restorative respiratory responses acting, in part, via the PAG. Therefore, we hypothesize that serotonergic or direct activation of this brainstem site may be a useful approach for SUDEP prevention.
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Affiliation(s)
- Carl L Faingold
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Hua-Jun Feng
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA
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13
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Dono F, Evangelista G, Consoli S, Venditti R, Russo M, De Angelis MV, Faustino M, Di Iorio A, Vollono C, Anzellotti F, Onofrj M, Sensi SL. Heart rate variability modifications in adult patients with early versus late-onset temporal lobe epilepsy: A comparative observational study. Neurophysiol Clin 2023; 53:102852. [PMID: 36966709 DOI: 10.1016/j.neucli.2023.102852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/25/2023] [Accepted: 02/25/2023] [Indexed: 03/28/2023] Open
Abstract
OBJECTIVES Temporal lobe epilepsy (TLE) is the most frequent form of focal epilepsy. TLE is associated with cardio-autonomic dysfunction and increased cardiovascular (CV) risk in patients over the fifth decade of age. In these subjects, TLE can be classified as early-onset (EOTLE; i.e., patients who had developed epilepsy in their youth) and late-onset (LOTLE; i.e., patients who developed epilepsy in adulthood). Heart rate variability (HRV) analysis is useful for assessing cardio-autonomic function and identifying patients with increased CV risk. This study compared changes in HRV occurring in patients over the age of 50, with EOTLE or LOTLE. METHODS We enrolled twenty-seven adults with LOTLE and 23 with EOTLE. Each patient underwent a EEG and EKG recording during 20-minutes of resting state and a 5-minutes hyperventilation (HV). Short-term HRV analysis was performed both in time and frequency domains. Linear Mixed Models (LMM) were used to analyze HRV parameters according to the condition (baseline and HV) and group (LOTLE and EOTLE groups). RESULTS Compared to the LOTLE group, the EOTLE group showed significantly decreased LnRMSSD (natural logarithm of the root mean square of the difference between contiguous RR intervals) (p-value=0.05), LnHF ms2 (natural logarithm of high frequency absolute power) (p-value=0.05), HF n.u. (high frequency power expressed in normalized units) (p-value=0.008) and HF% (high frequency power expressed in percentage) (p-value=0.01). In addition, EOTLE patients exhibited increased LF n.u. (low frequency power expressed in normalized units) (p-value=0.008) and LF/HF (low frequency/high frequency) ratio (p-value=0.007). During HV, the LOTLE group exhibited a multiplicative effect for the interaction between group and condition with increased LF n.u. (p = 0.003) and LF% (low frequency expressed in percentage) (p = 0.05) values. CONCLUSIONS EOTLE is associated with reduced vagal tone compared to LOTLE. Patients with EOTLE may have a higher risk of developing cardiac dysfunction or cardiac arrhythmia than LOTLE patients.
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Affiliation(s)
- Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology - CAST-, University G. d'Annunzio of Chieti-Pescara, Italy.
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Italy
| | - Stefano Consoli
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Italy
| | - Romina Venditti
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology - CAST-, University G. d'Annunzio of Chieti-Pescara, Italy
| | | | | | - Angelo Di Iorio
- Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, Italy
| | - Catello Vollono
- Unit of Neurophysiopathology and Sleep Medicine, Department of Geriatrics, Neurosciences and Orthopedics, IRCCS Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Francesca Anzellotti
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology - CAST-, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology - CAST-, University G. d'Annunzio of Chieti-Pescara, Italy; Institute for Advanced Biomedical Technology, ITAB, University G. d'Annunzio of Chieti-Pescara, Italy
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14
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Santos LEC, Almeida ACG, Silva SCB, Rodrigues AM, Cecílio SG, Scorza CA, Finsterer J, Moret M, Scorza FA. The amygdala lesioning due to status epilepticus - Changes in mechanisms controlling chloride homeostasis. Clinics (Sao Paulo) 2023; 78:100159. [PMID: 36774732 PMCID: PMC9945640 DOI: 10.1016/j.clinsp.2022.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE Amygdala has been demonstrated as one of the brain sites involved in the control of cardiorespiratory functioning. The structural and physiological alterations induced by epileptic activity are also present in the amygdala and reflect functional changes that may be directly associated with a sudden unexpected death. Seizures are always associated with neuronal damage and changes in the expression of cation-chloride cotransporters and Na/K pumps. In this study, the authors aimed to investigate if these changes are present in the amygdala after induction of status epilepticus with pilocarpine, which may be directly correlated with Sudden Unexpected Death in Epilepsy (SUDEP). METHODS Pilocarpine-treated wistar rats 60 days after Status Epilepticus (SE) were compared with control rats. Amygdala nuclei of brain slices immunostained for NKCC1, KCC2 and α1-Na+/K+-ATPase, were quantified by optical densitometry. RESULTS The amygdaloid complex of the animals submitted to SE had no significant difference in the NKCC1 immunoreactivity, but KCC2 immunoreactivity reduced drastically in the peri-somatic sites and in the dendritic-like processes. The α1-Na+/K+-ATPase peri-somatic immunoreactivity was intense in the rats submitted to pilocarpine SE when compared with control rats. The pilocarpine SE also promoted intense GFAP staining, specifically in the basolateral and baso-medial nuclei with astrogliosis and cellular debris deposition. INTERPRETATION The findings revealed that SE induces lesion changes in the expression of KCC2 and α1-Na+/K+-ATPase meaning intense change in the chloride regulation in the amygdaloid complex. These changes may contribute to cardiorespiratory dysfunction leading to SUDEP.
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Affiliation(s)
- Luiz E C Santos
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, MG, Brazil
| | - Antônio-Carlos G Almeida
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, MG, Brazil
| | - Sílvia C B Silva
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, MG, Brazil
| | - Antônio M Rodrigues
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, MG, Brazil
| | - Samyra G Cecílio
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, MG, Brazil
| | - Carla A Scorza
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina (Unifesp), São Paulo, SP, Brazil
| | | | - Marcelo Moret
- SENAI ‒ Departamento Regional da Bahia, Centro Integrado de Manufatura e Tecnologia, Bahia, BA, Brazil
| | - Fulvio A Scorza
- Disciplina de Neurologia Experimental, Escola Paulista de Medicina (Unifesp), São Paulo, SP, Brazil.
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15
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Rheims S, Sperling MR, Ryvlin P. Drug-resistant epilepsy and mortality-Why and when do neuromodulation and epilepsy surgery reduce overall mortality. Epilepsia 2022; 63:3020-3036. [PMID: 36114753 PMCID: PMC10092062 DOI: 10.1111/epi.17413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
Patients with drug-resistant epilepsy have an increased mortality rate, with the majority of deaths being epilepsy related and 40% due to sudden unexpected death in epilepsy (SUDEP). The impact of epilepsy surgery on mortality has been investigated since the 1970s, with increased interest in this field during the past 15 years. We systematically reviewed studies investigating mortality rate in patients undergoing epilepsy surgery or neuromodulation therapies. The quality of available evidence proved heterogenous and often limited by significant methodological issues. Perioperative mortality following epilepsy surgery was found to be <1%. Meta-analysis of studies that directly compared patients who underwent surgery to those not operated following presurgical evaluation showed that the former have a two-fold lower risk of death and a three-fold lower risk of SUDEP compared to the latter (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.29-0.56; p < .0001 for overall mortality and OR 0.32, 95% CI: 0.18-0.57; p < .001 for SUDEP). Limited data are available regarding the risk of death and SUDEP in patients undergoing neuromodulation therapies, although some evidence indicates that vagus nerve stimulation might be associated with a lower risk of SUDEP. Several key questions remain to be addressed in future studies, considering the need to better inform patients about the long-term benefit-risk ratio of epilepsy surgery. Dedicated long-term prospective studies will thus be required to provide more personalized information on the impact of surgery and/or neuromodulation on the risk of death and SUDEP.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Mickael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Vaudois University Hospital Center, Lausanne, Switzerland
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16
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Ciumas C, Rheims S, Ryvlin P. fMRI studies evaluating central respiratory control in humans. Front Neural Circuits 2022; 16:982963. [PMID: 36213203 PMCID: PMC9537466 DOI: 10.3389/fncir.2022.982963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
A plethora of neural centers in the central nervous system control the fundamental respiratory pattern. This control is ensured by neurons that act as pacemakers, modulating activity through chemical control driven by changes in the O2/CO2 balance. Most of the respiratory neural centers are located in the brainstem, but difficult to localize on magnetic resonance imaging (MRI) due to their small size, lack of visually-detectable borders with neighboring areas, and significant physiological noise hampering detection of its activity with functional MRI (fMRI). Yet, several approaches make it possible to study the normal response to different abnormal stimuli or conditions such as CO2 inhalation, induced hypercapnia, volitional apnea, induced hypoxia etc. This review provides a comprehensive overview of the majority of available studies on central respiratory control in humans.
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Affiliation(s)
- Carolina Ciumas
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Lyon Neuroscience Research Center, Institut National de la Santé et de la Recherche Médicale U1028/CNRS UMR 5292 Lyon 1 University, Bron, France
- IDEE Epilepsy Institute, Lyon, France
- *Correspondence: Carolina Ciumas
| | - Sylvain Rheims
- Lyon Neuroscience Research Center, Institut National de la Santé et de la Recherche Médicale U1028/CNRS UMR 5292 Lyon 1 University, Bron, France
- IDEE Epilepsy Institute, Lyon, France
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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17
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Hupp NJ, Talavera B, Melius S, Lacuey N, Lhatoo SD. Protocols for multimodal polygraphy for cardiorespiratory monitoring in the epilepsy monitoring unit. Part II - Research acquisition. Epilepsy Res 2022; 185:106987. [PMID: 35843018 DOI: 10.1016/j.eplepsyres.2022.106987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
Multimodal polygraphy including cardiorespiratory monitoring is a valuable tool for epilepsy and sudden unexpected death in epilepsy (SUDEP) research. Broader applications in research into stress, anxiety, mood and other domains exist. Polygraphy techniques used during video electroencephalogram (EEG) recordings provide information on cardiac and respiratory changes in the peri-ictal period. In addition, such monitoring in brain mapping during chronic intracranial EEG evaluations has helped the understanding of pathomechanisms that lead to seizure induced cardiorespiratory dysfunction. Our aim here is to provide protocols and information on devices that may be used in the Epilepsy Monitoring Unit, in addition to proposed standard of care data acquisition. These devices include oronasal thermistors, oronasal pressure transducers, capnography, transcutaneous CO2 sensors, and continuous noninvasive blood pressure monitoring. Standard protocols for cardiorespiratory monitoring simultaneously with video EEG recording, may be useful in the study of cardiorespiratory phenomena in persons with epilepsy.
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Affiliation(s)
- Norma J Hupp
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, TX, USA
| | - Blanca Talavera
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, TX, USA.
| | - Stephen Melius
- Memorial Hermann. Texas Medical Center, Houston, TX, USA
| | - Nuria Lacuey
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, TX, USA
| | - Samden D Lhatoo
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, TX, USA
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18
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Patodia S, Lim YM, Chung F, Stylianou I, El Hachami H, Thom M. Cortical neuronal hypertrophy and mTOR pathway activation in CAN regions in SUDEP. Epilepsia 2022; 63:2427-2438. [PMID: 35716147 PMCID: PMC9795893 DOI: 10.1111/epi.17335] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Dysfunctional connectivity and preexisting structural abnormalities of central autonomic network (CAN) regions have been shown on magnetic resonance imaging (MRI) in sudden unexpected death in epilepsy (SUDEP) and may be mechanistically relevant. In a previous postmortem study we reported increased microglia in CAN regions, including the superior temporal gyrus (STG) in SUDEP. In this current study we investigated mammalian target of rapamycin (mTOR) pathway activation and neuronal c-Fos activation in CAN regions in SUDEP compared to control groups. METHODS In a series of 59 postmortem cases (SUDEP, n = 26; epilepsy controls [EPCs], n = 14; and nonepilepsy controls [NECs], n = 19), we quantified pS6-240/4, pS6-235/6 (markers of mTOR activation) and c-Fos neuronal densities and labeling index in the STG, anterior cingulate, insula, frontobasal, and pulvinar regions using immunohistochemistry with whole-slide automated image analysis. RESULTS Significantly more pS6-positive neurons were present in the STG in cases with a history of recent seizures prior to death and also in SUDEP compared to other cause of death groups. No differences were noted for c-Fos neuronal labeling in any region between cause of death groups. Cortical neuronal hypertrophy in the STG was observed in some SUDEP cases and associated with pS6-240/4 expression. pS6-235/6 highlighted neuronal intranuclear inclusions, mainly in SUDEP cases and in the STG region. SIGNIFICANCE Neuronal labeling for pS6 in the STG correlated with both seizure activity in the period prior to death and SUDEP. Further investigations are required to explore the significance of this region in terms of autonomic network dysfunction that may increase the vulnerability for SUDEP.
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Affiliation(s)
- Smriti Patodia
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Yau Mun Lim
- Department of NeurodegenerationUCL Queen Square Institute of NeurologyLondonUK
| | - Freda Chung
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Irene Stylianou
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Hanaa El Hachami
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Maria Thom
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
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PAEDIATRIC SUDDEN UNEXPECTED DEATH IN EPILEPSY: FROM PATHOPHYSIOLOGY TO PREVENTION. Seizure 2022; 101:83-95. [DOI: 10.1016/j.seizure.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/22/2022] Open
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20
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Chacon LM, Garcia LG, Bosch-Bayard J, García-Ramo KB, Martin MMB, Alfonso MA, Batista SB, de la Paz Bermudez T, González JG, Coroneux AS. Relation of Brain Perfusion Patterns to Sudden Unexpected Death Risk Stratification: A Study in Drug Resistant Focal Epilepsy. Behav Sci (Basel) 2022; 12:207. [PMID: 35877277 PMCID: PMC9311833 DOI: 10.3390/bs12070207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
To explore the role of the interictal and ictal SPECT to identity functional neuroimaging biomarkers for SUDEP risk stratification in patients with drug-resistant focal epilepsy (DRFE). Twenty-nine interictal-ictal Single photon emission computed tomography (SPECT) scans were obtained from nine DRFE patients. A methodology for the relative quantification of cerebral blood flow of 74 cortical and sub-cortical structures was employed. The optimal number of clusters (K) was estimated using a modified v-fold cross-validation for the use of K means algorithm. The two regions of interest (ROIs) that represent the hypoperfused and hyperperfused areas were identified. To select the structures related to the SUDEP-7 inventory score, a data mining method that computes an automatic feature selection was used. During the interictal and ictal state, the hyperperfused ROIs in the largest part of patients were the bilateral rectus gyrus, putamen as well as globus pallidus ipsilateral to the seizure onset zone. The hypoperfused ROIs included the red nucleus, substantia nigra, medulla, and entorhinal area. The findings indicated that the nearly invariability in the perfusion pattern during the interictal to ictal transition observed in the ipsi-lateral putamen F = 12.60, p = 0.03, entorhinal area F = 25.80, p = 0.01, and temporal middle gyrus F = 12.60, p = 0.03 is a potential biomarker of SUDEP risk. The results presented in this paper allowed identifying hypo- and hyperperfused brain regions during the ictal and interictal state potentially related to SUDEP risk stratification.
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Affiliation(s)
- Lilia Morales Chacon
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Lidice Galan Garcia
- Cuban Neurosciences Center, 25th Ave, No 15202, Playa, Havana PC 11300, Cuba;
| | - Jorge Bosch-Bayard
- McGill Centre for Integrative Neuroscience, Ludmer Centre for Neuroinformatics and Mental Health, Montreal Neurological Institute, Montreal, QC H3A 0G4, Canada;
| | - Karla Batista García-Ramo
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Margarita Minou Báez Martin
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Maydelin Alfonso Alfonso
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Sheyla Berrillo Batista
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Tania de la Paz Bermudez
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Judith González González
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
| | - Abel Sánchez Coroneux
- International Center for Neurological Restoration, 25th Ave, No 15805, Playa, Havana PC 11300, Cuba; (K.B.G.-R.); (M.M.B.M.); (M.A.A.); (S.B.B.); (T.d.l.P.B.); (J.G.G.); (A.S.C.)
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21
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Chacón LMM, García LG, García-Ramón KB, Báez Martin MM, Bayard JB, Alfonso MA, Batista SB, Bermudez TDLP, González JG, Coroneaux AS, Ruiz ÁÁ, Roque MP, Matamoro LM. Common ictal and interictal perfusion patterns. A window into the epileptogenic network and SUDEP mechanism in Drug Resistant Focal Epilepsy? Curr Pharm Des 2022; 28:1198-1209. [PMID: 35658889 DOI: 10.2174/1381612828666220603125328] [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] [Received: 11/18/2021] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Focal epilepsies have been described as network disease. Noninvasive investigative techniques have been used to characterize epileptogenic networks. OBJETIVE To describe ictal and interictal cortical and subcortical perfusion patterns using single photon emission computed tomography (SPECT), in patients with drug-resistant epilepsy (DRE). METHODS Thirty-five interictal- ictal SPECT scans were obtained from 15 patients with DRE. A methodology was developed to get a relative perfusion index (PI) of 74 cortical and sub-cortical brain structures. K-means algorithm together with a modified v-fold cross-validation were used to identify the two regions of interest (ROI's) that represent hypoperfused and hyperperfused areas. RESULTS In common with the individual analysis, the statistical analysis evidenced that the hyperperfusion ROIs resulting from group analysis during interictal, and ictal involved mainly the cingulate gyrus, cuneus, the lingual gyrus, gyrus rectus as well as the putamen. ROIs hypoperfused included the red nucleus, the substantia nigra, and the medulla. The medians of the group analysis of the hypoperfusion and hyperperfusion ROIs were 0.601-0.565 and 1,133 - 1,119 for the ictal and interictal states, correspondingly. A group of mostly cortical structures involved in the hyperperfused ROIs in both interictal and ictal states showed no change or negative change in the transition from interictal to ictal state (mean change of -0.002). On the other hand, the brain stem, basal ganglia, red nucleus, and thalamus revealed a mean global change of 0.19, indicating a mild increase in the PI. However, some of these structures (red nucleus, substantia nigra, and medulla oblongata) remained hypoperfused during the interictal to ictal transition. CONCLUSION The methodology employed made it possible to identify common cortical and subcortical perfusion patterns not directly linked to epileptogenicity, but open a window for the epileptogenic network and sudden unexpected death (SUDEP) mechanism in DRE .
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Affiliation(s)
| | - Lidice Galan García
- Clinical Neurophysiology International Center of Neurologic Restoration Cuba
| | | | | | - Jorge Bosch Bayard
- Clinical Neurophysiology International Center of Neurologic Restoration Cuba
| | | | | | | | | | | | - Ángel Águila Ruiz
- Clinical Neurophysiology International Center of Neurologic Restoration Cuba
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22
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Gastrointestinal and Autonomic Symptoms—How to Improve the Diagnostic Process in Panayiotopoulos Syndrome? CHILDREN 2022; 9:children9060814. [PMID: 35740751 PMCID: PMC9222198 DOI: 10.3390/children9060814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
One of the most common epileptic disorders in the pediatric population is Panayiotopoulos syndrome. Clinical manifestations of this idiopathic illness include predominantly autonomic symptoms and dysfunction of the cardiorespiratory system. Another feature constitutes prolonged seizures that usually occur at sleep. It is crucial to differentiate the aforementioned disease from other forms of epilepsy, especially occipital and structural epilepsy and non-epileptic disorders. The diagnostic process is based on medical history, clinical examination, neuroimaging and electroencephalography—though results of the latter may be unspecific. Patients with Panayiotopoulos syndrome (PS) do not usually require treatment, as the course of the disease is, in most cases, mild, and the prognosis is good. The purpose of this review is to underline the role of central autonomic network dysfunction in the development of Panayiotopoulos syndrome, as well as the possibility of using functional imaging techniques, especially functional magnetic resonance imaging (fMRI), in the diagnostic process. These methods could be crucial for understanding the pathogenesis of PS. More data arerequired to create algorithms that will be able to predict the exposure to various complications of PS. It also concerns the importance of electroencephalography (EEG) as a tool to distinguish Panayiotopoulos syndrome from other childhood epileptic syndromes and non-epileptic disorders.
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23
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Patodia S, Somani A, Liu J, Cattaneo A, Paradiso B, Garcia M, Othman M, Diehl B, Devinsky O, Mills JD, Foong J, Thom M. Serotonin transporter in the temporal lobe, hippocampus and amygdala in SUDEP. Brain Pathol 2022; 32:e13074. [PMID: 35478467 PMCID: PMC9425018 DOI: 10.1111/bpa.13074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Several lines of evidence link deficient serotonin function and SUDEP. Chronic treatment with serotonin reuptake inhibitors (SRIs) reduces ictal central apnoea, a risk factor for SUDEP. Reduced medullary serotonergic neurones, modulators of respiration in response to hypercapnia, were reported in a SUDEP post‐mortem series. The amygdala and hippocampus have high serotonergic innervation and are functionally implicated in seizure‐related respiratory dysregulation. We explored serotonergic networks in mesial temporal lobe structures in a surgical and post‐mortem epilepsy series in relation to SUDEP risk. We stratified 75 temporal lobe epilepsy patients with hippocampal sclerosis (TLE/HS) into high (N = 16), medium (N = 11) and low risk (N = 48) groups for SUDEP based on generalised seizure frequency. We also included the amygdala in 35 post‐mortem cases, including SUDEP (N = 17), epilepsy controls (N = 10) and non‐epilepsy controls (N = 8). The immunohistochemistry labelling index (LI) and axonal length (AL) of serotonin transporter (SERT)‐positive axons were quantified in 13 regions of interest with image analysis. SERT LI was highest in amygdala and subiculum regions. In the surgical series, higher SERT LI was observed in high risk than low risk cases in the dentate gyrus, CA1 and subiculum (p < 0.05). In the post‐mortem cases higher SERT LI and AL was observed in the basal and accessory basal nuclei of the amygdala and peri‐amygdala cortex in SUDEP compared to epilepsy controls (p < 0.05). Patients on SRI showed higher SERT in the dentate gyrus (p < 0.005) and CA4 (p < 0.05) but there was no difference in patients with or without a psychiatric history. Higher SERT in hippocampal subfields in TLE/HS cases with SUDEP risk factors and higher amygdala SERT in post‐mortem SUDEP cases than epilepsy controls supports a role for altered serotonergic networks involving limbic regions in SUDEP. This may be of functional relevance through reduced 5‐HT availability.
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Affiliation(s)
- Smriti Patodia
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Alyma Somani
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Joan Liu
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Alice Cattaneo
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Beatrice Paradiso
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Maria Garcia
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Muhammad Othman
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Beate Diehl
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Departments of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Orrin Devinsky
- NYU Langone Comprehensive Epilepsy Center, New York University, New York City, New York, USA
| | - James D Mills
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jackie Foong
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Departments of Psychiatry, National Hospital for Neurology and Neurosurgery, London, UK
| | - Maria Thom
- Department of clinical and experimental epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Departments of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK
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Abstract
PURPOSE OF REVIEW Sudden unexpected death in epilepsy (SUDEP) is a major contributor to premature mortality in people with epilepsy. This review provides an update on recent findings on the epidemiology of SUDEP, clinical risk factors and potential mechanisms. RECENT FINDINGS The overall risk rate of SUDEP is approximately 1 per 1000 patients per year in the general epilepsy population and that children and older adults have a similar incidence. Generalized convulsive seizures (GCS), perhaps through their effects on brainstem cardiopulmonary networks, can cause significant postictal respiratory and autonomic dysfunction though other mechanisms likely exist as well. Work in animal models of SUDEP has identified multiple neurotransmitter systems, which may be future targets for pharmacological intervention. There are also chronic functional and structural changes in autonomic function in patients who subsequently die from SUDEP suggesting that some SUDEP risk is dynamic. Modifiable risks for SUDEP include GCS seizure frequency, medication adherence and nighttime supervision. SUMMARY Current knowledge of SUDEP risk factors has identified multiple targets for SUDEP prevention today as we await more specific therapeutic targets that are emerging from translational research studies.
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Affiliation(s)
- Daniel Friedman
- NYU Grossman School of Medicine, Department of Neurology, 223 East 34th Street, New York, New York, USA
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25
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Zhuravlev D, Lebedeva A, Lebedeva M, Guekht A. Current concepts about autonomic dysfunction in patients with epilepsy. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:131-138. [DOI: 10.17116/jnevro2022122031131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Whatley BP, Winston JS, Allen LA, Vos SB, Jha A, Scott CA, Smith AL, Chowdhury FA, Bomanji JB, Lhatoo SD, Harper RM, Diehl B. Distinct Patterns of Brain Metabolism in Patients at Risk of Sudden Unexpected Death in Epilepsy. Front Neurol 2021; 12:623358. [PMID: 34899550 PMCID: PMC8651549 DOI: 10.3389/fneur.2021.623358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/25/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: To characterize regional brain metabolic differences in patients at high risk of sudden unexpected death in epilepsy (SUDEP), using fluorine-18-fluorodeoxyglucose positron emission tomography (18FDG-PET). Methods: We studied patients with refractory focal epilepsy at high (n = 56) and low (n = 69) risk of SUDEP who underwent interictal 18FDG-PET as part of their pre-surgical evaluation. Binary SUDEP risk was ascertained by thresholding frequency of focal to bilateral tonic-clonic seizures (FBTCS). A whole brain analysis was employed to explore regional differences in interictal metabolic patterns. We contrasted these findings with regional brain metabolism more directly related to frequency of FBTCS. Results: Regions associated with cardiorespiratory and somatomotor regulation differed in interictal metabolism. In patients at relatively high risk of SUDEP, fluorodeoxyglucose (FDG) uptake was increased in the basal ganglia, ventral diencephalon, midbrain, pons, and deep cerebellar nuclei; uptake was decreased in the left planum temporale. These patterns were distinct from the effect of FBTCS frequency, where increasing frequency was associated with decreased uptake in bilateral medial superior frontal gyri, extending into the left dorsal anterior cingulate cortex. Significance: Regions critical to cardiorespiratory and somatomotor regulation and to recovery from vital challenges show altered interictal metabolic activity in patients with frequent FBTCS considered to be at relatively high-risk of SUDEP, and shed light on the processes that may predispose patients to SUDEP.
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Affiliation(s)
- Benjamin P Whatley
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,Division of Neurology, Dalhousie University, Halifax, NS, Canada
| | - Joel S Winston
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Wellcome Trust Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom
| | - Luke A Allen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom.,The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Sjoerd B Vos
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom.,The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States.,Neuroradiological Academic Unit, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Ashwani Jha
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Catherine A Scott
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - April-Louise Smith
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Fahmida A Chowdhury
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jamshed B Bomanji
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Samden D Lhatoo
- The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH, United States.,Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Ronald M Harper
- The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States.,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom.,The Center for SUDEP Research, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, United States
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Sivathamboo S, Friedman D, Laze J, Nightscales R, Chen Z, Kuhlmann L, Devore S, Macefield V, Kwan P, D'Souza W, Berkovic SF, Perucca P, O'Brien TJ, Devinsky O. Association of Short-term Heart Rate Variability and Sudden Unexpected Death in Epilepsy. Neurology 2021; 97:e2357-e2367. [PMID: 34649884 DOI: 10.1212/wnl.0000000000012946] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We compared heart rate variability (HRV) in sudden unexpected death in epilepsy (SUDEP) cases and living epilepsy controls. METHODS This international, multicenter, retrospective, nested case-control study examined patients admitted for video-EEG monitoring (VEM) between January 1, 2003, and December 31, 2014, and subsequently died of SUDEP. Time domain and frequency domain components were extracted from 5-minute interictal ECG recordings during sleep and wakefulness from SUDEP cases and controls. RESULTS We identified 31 SUDEP cases and 56 controls. Normalized low-frequency power (LFP) during wakefulness was lower in SUDEP cases (median 42.5, interquartile range [IQR] 32.6-52.6) than epilepsy controls (55.5, IQR 40.7-68.9; p = 0.015, critical value = 0.025). In the multivariable model, normalized LFP was lower in SUDEP cases compared to controls (contrast -11.01, 95% confidence interval [CI] -20.29 to 1.73; p = 0.020, critical value = 0.025). There was a negative correlation between LFP and the latency to SUDEP, where each 1% incremental reduction in normalized LFP conferred a 2.7% decrease in the latency to SUDEP (95% CI 0.95-0.995; p = 0.017, critical value = 0.025). Increased survival duration from VEM to SUDEP was associated with higher normalized high-frequency power (HFP; p = 0.002, critical value = 0.025). The survival model with normalized LFP was associated with SUDEP (c statistic 0.66, 95% CI 0.55-0.77), which nonsignificantly increased with the addition of normalized HFP (c statistic 0.70, 95% CI 0.59-0.81; p = 0.209). CONCLUSIONS Reduced short-term LFP, which is a validated biomarker for sudden death, was associated with SUDEP. Increased HFP was associated with longer survival and may be cardioprotective in SUDEP. HRV quantification may help stratify individual SUDEP risk. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in patients with epilepsy, some measures of HRV are associated with SUDEP.
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Affiliation(s)
- Shobi Sivathamboo
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Daniel Friedman
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Juliana Laze
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Russell Nightscales
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Zhibin Chen
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Levin Kuhlmann
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Sasha Devore
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Vaughan Macefield
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Patrick Kwan
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Wendyl D'Souza
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Samuel F Berkovic
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Piero Perucca
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Terence J O'Brien
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Orrin Devinsky
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia.
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Patodia S, Somani A, Thom M. Review: Neuropathology findings in autonomic brain regions in SUDEP and future research directions. Auton Neurosci 2021; 235:102862. [PMID: 34411885 PMCID: PMC8455454 DOI: 10.1016/j.autneu.2021.102862] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/16/2021] [Accepted: 07/24/2021] [Indexed: 12/21/2022]
Abstract
Autonomic dysfunction is implicated from clinical, neuroimaging and experimental studies in sudden and unexpected death in epilepsy (SUDEP). Neuropathological analysis in SUDEP series enable exploration of acquired, seizure-related cellular adaptations in autonomic and brainstem autonomic centres of relevance to dysfunction in the peri-ictal period. Alterations in SUDEP compared to control groups have been identified in the ventrolateral medulla, amygdala, hippocampus and central autonomic regions. These involve neuropeptidergic, serotonergic and adenosine systems, as well as specific regional astroglial and microglial populations, as potential neuronal modulators, orchestrating autonomic dysfunction. Future research studies need to extend to clinically and genetically characterized epilepsies, to explore if common or distinct pathways of autonomic dysfunction mediate SUDEP. The ultimate objective of SUDEP research is the identification of disease biomarkers for at risk patients, to improve post-mortem recognition and disease categorisation, but ultimately, for exposing potential treatment targets of pharmacologically modifiable and reversible cellular alterations.
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Affiliation(s)
- Smriti Patodia
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Alyma Somani
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.
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Autonomic manifestations of epilepsy: emerging pathways to sudden death? Nat Rev Neurol 2021; 17:774-788. [PMID: 34716432 DOI: 10.1038/s41582-021-00574-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
Epileptic networks are intimately connected with the autonomic nervous system, as exemplified by a plethora of ictal (during a seizure) autonomic manifestations, including epigastric sensations, palpitations, goosebumps and syncope (fainting). Ictal autonomic changes might serve as diagnostic clues, provide targets for seizure detection and help us to understand the mechanisms that underlie sudden unexpected death in epilepsy (SUDEP). Autonomic alterations are generally more prominent in focal seizures originating from the temporal lobe, demonstrating the importance of limbic structures to the autonomic nervous system, and are particularly pronounced in focal-to-bilateral and generalized tonic-clonic seizures. The presence, type and severity of autonomic features are determined by the seizure onset zone, propagation pathways, lateralization and timing of the seizures, and the presence of interictal autonomic dysfunction. Evidence is mounting that not all autonomic manifestations are linked to SUDEP. In addition, experimental and clinical data emphasize the heterogeneity of SUDEP and its infrequent overlap with sudden cardiac death. Here, we review the spectrum and diagnostic value of the mostly benign and self-limiting autonomic manifestations of epilepsy. In particular, we focus on presentations that are likely to contribute to SUDEP and discuss how wearable devices might help to prevent SUDEP.
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Transfer of SCN1A to the brain of adolescent mouse model of Dravet syndrome improves epileptic, motor, and behavioral manifestations. MOLECULAR THERAPY-NUCLEIC ACIDS 2021; 25:585-602. [PMID: 34589280 PMCID: PMC8463324 DOI: 10.1016/j.omtn.2021.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/13/2021] [Indexed: 12/02/2022]
Abstract
Dravet syndrome is a genetic encephalopathy characterized by severe epilepsy combined with motor, cognitive, and behavioral abnormalities. Current antiepileptic drugs achieve only partial control of seizures and provide little benefit on the patient’s neurological development. In >80% of cases, the disease is caused by haploinsufficiency of the SCN1A gene, which encodes the alpha subunit of the Nav1.1 voltage-gated sodium channel. Novel therapies aim to restore SCN1A expression in order to address all disease manifestations. We provide evidence that a high-capacity adenoviral vector harboring the 6-kb SCN1A cDNA is feasible and able to express functional Nav1.1 in neurons. In vivo, the best biodistribution was observed after intracerebral injection in basal ganglia, cerebellum, and prefrontal cortex. SCN1A A1783V knockin mice received the vector at 5 weeks of age, when most neurological alterations were present. Animals were protected from sudden death, and the epileptic phenotype was attenuated. Improvement of motor performance and interaction with the environment was observed. In contrast, hyperactivity persisted, and the impact on cognitive tests was variable (success in novel object recognition and failure in Morris water maze tests). These results provide proof of concept for gene supplementation in Dravet syndrome and indicate new directions for improvement.
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31
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Frontal lobe hypometabolism associated with Sudden Unexpected Death in Epilepsy (SUDEP) risk: An objective PET study. Epilepsy Behav 2021; 122:108185. [PMID: 34252829 DOI: 10.1016/j.yebeh.2021.108185] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Abnormalities of brain structures and neuronal networks have been identified in MRI studies of patients with Sudden Unexpected Death in Epilepsy (SUDEP) as well as in those at elevated risk. The goal of this study was to identify common patterns of objectively detected brain glucose metabolic abnormalities associated with SUDEP patients and those at high SUDEP risk. METHODS Patients with refractory epilepsy (n = 78, age: 16-61 years, 44 females), who underwent comprehensive presurgical evaluation, were assessed for their risk of SUDEP using the revised SUDEP-7 inventory. From the 57 patients with low SUDEP risk, 35 were selected to match their demographic and clinical characteristics to those with high SUDEP risk (n = 21). [18F]fluoro-deoxy-glucose positron emission tomography (FDG-PET) abnormalities were evaluated in the high- and low-SUDEP risk subgroups compared to FDG-PET scans of a healthy adult control group using statistical parametric mapping (SPM). Individual FDG-PET scans of 4 additional patients, who died from SUDEP, were also analyzed by SPM. RESULTS Mean SUDEP-7 score was 6.1 in the high and 2.7 in the low SUDEP risk group. MRI showed no lesion in 36 patients (64%). Statistical parametric mapping analysis of the high SUDEP risk subgroup showed bilateral medial frontal and inferior frontal hypometabolism as a common pattern. The low-risk group showed no specific common metabolic abnormalities on SPM group analysis. Individual PET scans of all 4 patients who died from SUDEP also showed bilateral frontal lobe hypometabolism. CONCLUSIONS These data show that bilateral frontal lobe involvement on FDG-PET, especially the medial and inferior frontal cortex, may be a common metabolic pattern associated with high SUDEP risk and SUDEP itself, in patients with refractory focal epilepsy.
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32
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Somani A, El-Hachami H, Patodia S, Sisodiya S, Thom M. Regional microglial populations in central autonomic brain regions in SUDEP. Epilepsia 2021; 62:1318-1328. [PMID: 33942290 DOI: 10.1111/epi.16904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) may arise as a result of autonomic dysfunction during a seizure. The central autonomic networks (CANs) modulate brainstem cardiorespiratory regulation. Recent magnetic resonance imaging (MRI) studies in SUDEP have shown cortical and subcortical volume changes and altered connectivity between CAN regions, but the pathological correlate is unknown. Because neuroinflammation is both a cause and a consequence of seizures and may relate to regional brain pathology, our aim was to evaluate microglial populations in CANs in SUDEP. METHODS In 55 postmortem cases, including SUDEP, epilepsy controls without SUDEP and nonepilepsy controls, we quantified Iba1-expressing microglia in 14 cortical and thalamic areas that included known CAN regions. RESULTS Mean Iba1 labeling across all brain regions was significantly higher in SUDEP cases compared to epilepsy and nonepilepsy controls. There was significant regional variation in Iba1 labeling in SUDEP cases only, with highest labeling in the medial thalamus. Significantly higher labeling in SUDEP cases than epilepsy and nonepilepsy controls was consistently noted in the superior temporal gyrus. In cases with documented seizures up to 10 days prior to death, significantly higher mean Iba1 labeling was observed in SUDEP compared to epilepsy controls. SIGNIFICANCE Our findings support microglial activation in SUDEP, including cortical and subcortical regions with known autonomic functions such as the thalamus and superior temporal gyrus. This may be relevant to cellular pathomechanisms underlying cardioregulatory failure during a seizure.
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Affiliation(s)
- Alyma Somani
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Hanna El-Hachami
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Smriti Patodia
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Sanjay Sisodiya
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK
| | - Maria Thom
- Departments of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Neuropathology, National Hospital for Neurology and Neurosurgery Queen Square, London, UK
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Chen SF, Pan HY, Huang CR, Huang JB, Tan TY, Chen NC, Hsu CY, Chuang YC. Autonomic Dysfunction Contributes to Impairment of Cerebral Autoregulation in Patients with Epilepsy. J Pers Med 2021; 11:jpm11040313. [PMID: 33920691 PMCID: PMC8073240 DOI: 10.3390/jpm11040313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 12/26/2022] Open
Abstract
Patients with epilepsy frequently experience autonomic dysfunction and impaired cerebral autoregulation. The present study investigates autonomic function and cerebral autoregulation in patients with epilepsy to determine whether these factors contribute to impaired autoregulation. A total of 81 patients with epilepsy and 45 healthy controls were evaluated, assessing their sudomotor, cardiovagal, and adrenergic functions using a battery of autonomic nervous system (ANS) function tests, including the deep breathing, Valsalva maneuver, head-up tilting, and Q-sweat tests. Cerebral autoregulation was measured by transcranial Doppler examination during the breath-holding test, the Valsalva maneuver, and the head-up tilting test. Autonomic functions were impaired during the interictal period in patients with epilepsy compared to healthy controls. The three indices of cerebral autoregulation—the breath-holding index (BHI), an autoregulation index calculated in phase II of the Valsalva maneuver (ASI), and cerebrovascular resistance measured in the second minute during the head-up tilting test (CVR2-min)—all decreased in patients with epilepsy. ANS dysfunction correlated significantly with impairment of cerebral autoregulation (measured by BHI, ASI, and CVR2-min), suggesting that the increased autonomic dysfunction in patients with epilepsy may augment the dysregulation of cerebral blood flow. Long-term epilepsy, a high frequency of seizures, and refractory epilepsy, particularly temporal lobe epilepsy, may contribute to advanced autonomic dysfunction and impaired cerebral autoregulation. These results have implications for therapeutic interventions that aim to correct central autonomic dysfunction and impairment of cerebral autoregulation, particularly in patients at high risk for sudden, unexplained death in epilepsy.
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Affiliation(s)
- Shu-Fang Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-F.C.); (H.-Y.P.); (C.-R.H.); (J.-B.H.); (T.-Y.T.); (N.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hsiu-Yung Pan
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-F.C.); (H.-Y.P.); (C.-R.H.); (J.-B.H.); (T.-Y.T.); (N.-C.C.)
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chi-Ren Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-F.C.); (H.-Y.P.); (C.-R.H.); (J.-B.H.); (T.-Y.T.); (N.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jyun-Bin Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-F.C.); (H.-Y.P.); (C.-R.H.); (J.-B.H.); (T.-Y.T.); (N.-C.C.)
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Teng-Yeow Tan
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-F.C.); (H.-Y.P.); (C.-R.H.); (J.-B.H.); (T.-Y.T.); (N.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Nai-Ching Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-F.C.); (H.-Y.P.); (C.-R.H.); (J.-B.H.); (T.-Y.T.); (N.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Yao-Chung Chuang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-F.C.); (H.-Y.P.); (C.-R.H.); (J.-B.H.); (T.-Y.T.); (N.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Institute for Translation Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Department of Biological Science, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Correspondence:
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Buchanan GF, Gluckman BJ, Kalume FK, Lhatoo S, Maganti RK, Noebels JL, Simeone KA, Quigg MS, Pavlova MK. Proceedings of the Sleep and Epilepsy Workshop: Section 3 Mortality: Sleep, Night, and SUDEP. Epilepsy Curr 2021; 21:15357597211004556. [PMID: 33787378 PMCID: PMC8609595 DOI: 10.1177/15357597211004556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy. Likely pathophysiological mechanisms include seizure-induced cardiac and respiratory dysregulation. A frequently identified feature in SUDEP cases is that they occur at night. This raises the question of a role for sleep state in regulating of SUDEP. An association with sleep has been identified in a number of studies with patients and in animal models. The focus of this section of the Sleep and Epilepsy Workshop was on identifying and understanding the role for sleep and time of day in the pathophysiology of SUDEP.
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Affiliation(s)
- Gordon F. Buchanan
- Department of Neurology and Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Bruce J. Gluckman
- Department of Engineering Science & Mechanics, Penn State University, University Park, PA, USA
- Department of Neurosurgery, Penn State University, University Park, PA, USA
- Department of Biomedical Engineering, Penn State University, University Park, PA, USA
| | - Franck K. Kalume
- Department of Neurological Surgery, University of Washington and Seattle Children’s Research Institute, Seattle, WA, USA
| | - Samden Lhatoo
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Rama K. Maganti
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jeffrey L. Noebels
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Kristina A. Simeone
- Department of Pharmacology & Neuroscience, Creighton University School of Medicine, Omaha, NE, USA
| | - Mark S. Quigg
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Milena K. Pavlova
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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Liu J, Peedicail JS, Gaxiola-Valdez I, Li E, Mosher V, Wilson W, Perera T, Singh S, Teskey GC, Federico P. Postictal brainstem hypoperfusion and risk factors for sudden unexpected death in epilepsy. Neurology 2020; 95:e1694-e1705. [PMID: 32675079 DOI: 10.1212/wnl.0000000000010360] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Since the strongest risk factor for sudden unexpected death in epilepsy (SUDEP) is frequent bilateral tonic-clonic seizures (BTCS), our aim was to determine whether postictal hypoperfusion in brainstem respiratory centers (BRCs) is more common following tonic-clonic seizures. METHODS We studied 21 patients with focal epilepsies who underwent perfusion imaging with arterial spin labeling MRI. Subtraction maps of cerebral blood flow were obtained from the postictal and baseline scans. We identified 6 regions of interest in the brainstem that contain key BRCs. Patients were considered to have postictal BRC hypoperfusion if any of the 6 regions of interest were significantly hypoperfused. RESULTS All 6 patients who experienced BTCS during the study had significant clusters of postictal hypoperfusion in BRCs compared to 7 who had focal impaired awareness seizures (7/15). The association between seizure type studied and the presence of BRC hypoperfusion was significant. Duration of epilepsy and frequency of BTCS were not associated with postictal brainstem hypoperfusion despite also being associated with risk for SUDEP. CONCLUSION Postictal hypoperfusion in brainstem respiratory centers occurs more often following BTCS than other seizure types, providing a possible explanation for the increased risk of SUDEP in patients who regularly experience BTCS.
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Affiliation(s)
- Jonathan Liu
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Joseph S Peedicail
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Ismael Gaxiola-Valdez
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Emmy Li
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Victoria Mosher
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - William Wilson
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Tefani Perera
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Shaily Singh
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - G Campbell Teskey
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada
| | - Paolo Federico
- From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada.
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Sisodiya SM, Whelan CD, Hatton SN, Huynh K, Altmann A, Ryten M, Vezzani A, Caligiuri ME, Labate A, Gambardella A, Ives‐Deliperi V, Meletti S, Munsell BC, Bonilha L, Tondelli M, Rebsamen M, Rummel C, Vaudano AE, Wiest R, Balachandra AR, Bargalló N, Bartolini E, Bernasconi A, Bernasconi N, Bernhardt B, Caldairou B, Carr SJ, Cavalleri GL, Cendes F, Concha L, Desmond PM, Domin M, Duncan JS, Focke NK, Guerrini R, Hamandi K, Jackson GD, Jahanshad N, Kälviäinen R, Keller SS, Kochunov P, Kowalczyk MA, Kreilkamp BA, Kwan P, Lariviere S, Lenge M, Lopez SM, Martin P, Mascalchi M, Moreira JC, Morita‐Sherman ME, Pardoe HR, Pariente JC, Raviteja K, Rocha CS, Rodríguez‐Cruces R, Seeck M, Semmelroch MK, Sinclair B, Soltanian‐Zadeh H, Stein DJ, Striano P, Taylor PN, Thomas RH, Thomopoulos SI, Velakoulis D, Vivash L, Weber B, Yasuda CL, Zhang J, Thompson PM, McDonald CR. The ENIGMA-Epilepsy working group: Mapping disease from large data sets. Hum Brain Mapp 2020; 43:113-128. [PMID: 32468614 PMCID: PMC8675408 DOI: 10.1002/hbm.25037] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 02/06/2023] Open
Abstract
Epilepsy is a common and serious neurological disorder, with many different constituent conditions characterized by their electro clinical, imaging, and genetic features. MRI has been fundamental in advancing our understanding of brain processes in the epilepsies. Smaller-scale studies have identified many interesting imaging phenomena, with implications both for understanding pathophysiology and improving clinical care. Through the infrastructure and concepts now well-established by the ENIGMA Consortium, ENIGMA-Epilepsy was established to strengthen epilepsy neuroscience by greatly increasing sample sizes, leveraging ideas and methods established in other ENIGMA projects, and generating a body of collaborating scientists and clinicians to drive forward robust research. Here we review published, current, and future projects, that include structural MRI, diffusion tensor imaging (DTI), and resting state functional MRI (rsfMRI), and that employ advanced methods including structural covariance, and event-based modeling analysis. We explore age of onset- and duration-related features, as well as phenomena-specific work focusing on particular epilepsy syndromes or phenotypes, multimodal analyses focused on understanding the biology of disease progression, and deep learning approaches. We encourage groups who may be interested in participating to make contact to further grow and develop ENIGMA-Epilepsy.
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Affiliation(s)
- Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyBucksUK
| | - Christopher D. Whelan
- Department of Molecular and Cellular TherapeuticsThe Royal College of Surgeons in IrelandDublinIreland
| | - Sean N. Hatton
- Center for Multimodal Imaging and GeneticsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Khoa Huynh
- Center for Multimodal Imaging and GeneticsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Andre Altmann
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Mina Ryten
- UCL Queen Square Institute of NeurologyLondonUK
| | - Annamaria Vezzani
- Department of NeuroscienceIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical SciencesUniversity “Magna Græcia" of CatanzaroCatanzaroItaly
| | - Angelo Labate
- Neuroscience Research Center, Department of Medical and Surgical SciencesUniversity “Magna Græcia" of CatanzaroCatanzaroItaly
- Institute of NeurologyUniversity “Magna Græcia" of CatanzaroCatanzaroItaly
| | - Antonio Gambardella
- Neuroscience Research Center, Department of Medical and Surgical SciencesUniversity “Magna Græcia" of CatanzaroCatanzaroItaly
- Institute of NeurologyUniversity “Magna Græcia" of CatanzaroCatanzaroItaly
| | | | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Neurology UnitOCB Hospital, AOU ModenaModenaItaly
| | - Brent C. Munsell
- Department of PsychiatryUniversity of North CarolinaChapel HillNorth CarolinaUSA
- Department of Computer ScienceUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Leonardo Bonilha
- Department of NeurologyMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | | | - Michael Rebsamen
- Support Center for Advanced NeuroimagingUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Christian Rummel
- Support Center for Advanced NeuroimagingUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Neurology UnitOCB Hospital, AOU ModenaModenaItaly
| | - Roland Wiest
- Support Center for Advanced NeuroimagingUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Akshara R. Balachandra
- Center for Multimodal Imaging and GeneticsUniversity of California San DiegoLa JollaCaliforniaUSA
- Boston University School of MedicineBostonMassachusettsUSA
| | - Núria Bargalló
- Magnetic Resonance Image Core FacilityInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de BarcelonaBarcelonaSpain
- Radiology Department of Center of Image DiagnosisHospital Clinic de BarcelonaBarcelonaSpain
| | - Emanuele Bartolini
- Neurology UnitUSL Centro Toscana, Nuovo Ospedale Santo StefanoPratoItaly
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy LaboratoryMontreal Neurological Institute, McGill UniversityMontrealQuébecCanada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy LaboratoryMontreal Neurological Institute, McGill UniversityMontrealQuébecCanada
| | - Boris Bernhardt
- McConnell Brain Imaging CenterMontreal Neurological Institute, McGill UniversityMontrealQuébecCanada
| | - Benoit Caldairou
- Neuroimaging of Epilepsy LaboratoryMontreal Neurological Institute, McGill UniversityMontrealQuébecCanada
| | - Sarah J.A. Carr
- NeuroscienceInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Gianpiero L. Cavalleri
- School of Pharmacy and Biomolecular SciencesThe Royal College of Surgeons in IrelandDublinIreland
- FutureNeuro SFI Research CentreDublinIreland
| | - Fernando Cendes
- Department of Neurology and Neuroimaging LaboratoryUniversity of Campinas – UNICAMPCampinasSão PauloBrazil
| | - Luis Concha
- Instituto de NeurobiologíaUniversidad Nacional Autónoma de MéxicoQuerétaroMexico
| | - Patricia M. Desmond
- Department of RadiologyRoyal Melbourne Hospital, University of MelbourneMelbourneVictoriaAustralia
| | - Martin Domin
- Functional Imaging Unit, Department of Diagnostic Radiology and NeuroradiologyUniversity Medicine GreifswaldGreifswaldGermany
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyBucksUK
| | - Niels K. Focke
- University Medicine GöttingenClinical NeurophysiologyGöttingenGermany
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and LaboratoriesChildren's Hospital A. Meyer‐University of FlorenceFlorenceItaly
| | - Khalid Hamandi
- The Wales Epilepsy Unit, Department of NeurologyUniversity Hospital of WalesCardiffUK
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
| | - Graeme D. Jackson
- Department of NeurologyAustin HealthHeidelbergVictoriaAustralia
- Florey Department of Neuroscience and Mental HealthUniversity of MelbourneVictoriaAustralia
| | - Neda Jahanshad
- Imaging Genetics CenterMark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Reetta Kälviäinen
- Kuopio University HospitalMember of EpiCARE ERNKuopioFinland
- Institute of Clinical MedicineNeurology, University of Eastern FinlandKuopioFinland
| | - Simon S. Keller
- Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
- The Walton CentreNHS Foundation TrustLiverpoolUK
| | - Peter Kochunov
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Magdalena A. Kowalczyk
- Florey Department of Neuroscience and Mental HealthUniversity of MelbourneVictoriaAustralia
| | - Barbara A.K. Kreilkamp
- Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
- The Walton CentreNHS Foundation TrustLiverpoolUK
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Sara Lariviere
- McConnell Brain Imaging CenterMontreal Neurological Institute, McGill UniversityMontrealQuébecCanada
| | - Matteo Lenge
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and LaboratoriesChildren's Hospital A. Meyer‐University of FlorenceFlorenceItaly
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery DepartmentChildren's Hospital A. Meyer‐University of FlorenceFlorenceItaly
| | - Seymour M. Lopez
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Pascal Martin
- Department of Neurology and EpileptologyHertie Institute for Clinical Brain Research, University Hospital TübingenTübingenGermany
| | - Mario Mascalchi
- 'Mario Serio' Department of Clinical and Experimental Medical SciencesUniversity of FlorenceFlorenceItaly
| | - José C.V. Moreira
- Department of Neurology and Neuroimaging LaboratoryUniversity of Campinas – UNICAMPCampinasSão PauloBrazil
| | - Marcia E. Morita‐Sherman
- Department of Neurology and Neuroimaging LaboratoryUniversity of Campinas – UNICAMPCampinasSão PauloBrazil
- Cleveland Clinic Neurological InstituteClevelandOhioUSA
| | - Heath R. Pardoe
- Department of NeurologyNew York University School of MedicineNew YorkNew YorkUSA
| | - Jose C. Pariente
- Magnetic Resonance Image Core FacilityInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de BarcelonaBarcelonaSpain
| | - Kotikalapudi Raviteja
- Department of Neurology and EpileptologyHertie Institute for Clinical Brain Research, University Hospital TübingenTübingenGermany
- Department of Diagnostic and Interventional NeuroradiologyUniversity Hospitals TübingenTübingenGermany
- Department of Clinical NeurophysiologyUniversity Hospital GöttingenGoettingenGermany
| | - Cristiane S. Rocha
- Department of Neurology and Neuroimaging LaboratoryUniversity of Campinas – UNICAMPCampinasSão PauloBrazil
| | - Raúl Rodríguez‐Cruces
- Instituto de NeurobiologíaUniversidad Nacional Autónoma de MéxicoQuerétaroMexico
- Montreal Neurological Institute and HospitalMcGill UniversityMontrealQuébecCanada
| | | | - Mira K.H.G. Semmelroch
- Florey Department of Neuroscience and Mental HealthUniversity of MelbourneVictoriaAustralia
- The Florey Institute of Neuroscience and Mental HealthAustin CampusHeidelbergVictoriaAustralia
| | - Benjamin Sinclair
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Alfred HealthMelbourneVictoriaAustralia
| | - Hamid Soltanian‐Zadeh
- Radiology and Research AdministrationHenry Ford Health SystemDetroitMichiganUSA
- School of Electrical and Computer EngineeringCollege of Engineering, University of TehranTehranIran
| | - Dan J. Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience InstituteUniversity of Cape Townon Risk & Resilience in Mental DisordersCape TownSouth Africa
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto 'G. Gaslini'GenovaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenovaItaly
| | - Peter N. Taylor
- School of ComputingNewcastle UniversityNewcastle upon TyneUK
| | - Rhys H. Thomas
- Institute of Translational and Clinical ResearchNewcastle UniversityNewcastle upon TyneUK
| | - Sophia I. Thomopoulos
- Imaging Genetics CenterMark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Dennis Velakoulis
- Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaUK
- Department of NeuropsychiatryRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Lucy Vivash
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition ResearchUniversity of BonnBonnGermany
| | - Clarissa Lin Yasuda
- Department of Neurology and Neuroimaging LaboratoryUniversity of Campinas – UNICAMPCampinasSão PauloBrazil
| | - Junsong Zhang
- Cognitive Science DepartmentSchool of Informatics, Xiamen UniversityXiamenChina
| | - Paul M. Thompson
- Imaging Genetics CenterMark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Carrie R. McDonald
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
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Pensel MC, Nass RD, Taubøll E, Aurlien D, Surges R. Prevention of sudden unexpected death in epilepsy: current status and future perspectives. Expert Rev Neurother 2020; 20:497-508. [PMID: 32270723 DOI: 10.1080/14737175.2020.1754195] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Sudden unexpected death in epilepsy (SUDEP) affects about 1 in 1000 people with epilepsy, and even more in medically refractory epilepsy. As most people are between 20 and 40 years when dying suddenly, SUDEP leads to a considerable loss of potential life years. The most important risk factors are nocturnal and tonic-clonic seizures, underscoring that supervision and effective seizure control are key elements for SUDEP prevention. The question of whether specific antiepileptic drugs are linked to SUDEP is still controversially discussed. Knowledge and education about SUDEP among health-care professionals, patients, and relatives are of outstanding importance for preventive measures to be taken, but still poor and widely neglected.Areas covered: This article reviews epidemiology, pathophysiology, risk factors, assessment of individual SUDEP risk and available measures for SUDEP prevention. Literature search was done using Medline and Pubmed in October 2019.Expert opinion: Significant advances in the understanding of SUDEP were made in the last decade which allow testing of novel strategies to prevent SUDEP. Promising current strategies target neuronal mechanisms of brain stem dysfunction, cardiac susceptibility for fatal arrhythmias, and reliable detection of tonic-clonic seizures using mobile health technologies.Abbreviations: AED, antiepileptic drug; CBZ, carbamazepine; cLQTS, congenital long QT syndrome; EMU, epilepsy monitoring unit; FBTCS, focal to bilateral tonic-clonic seizures; GTCS, generalized tonic-clonic seizures; ICA, ictal central apnea; LTG, lamotrigine; PCCA, postconvulsive central apnea; PGES, postictal generalized EEG suppression; SRI, serotonin reuptake inhibitor; SUDEP, sudden unexpected death in epilepsy; TCS, tonic-clonic seizures.
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Affiliation(s)
| | | | - Erik Taubøll
- Department of Neurology, Oslo University Hospital, Nydalen, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dag Aurlien
- Neuroscience Research Group and Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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38
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Patodia S, Paradiso B, Garcia M, Ellis M, Diehl B, Thom M, Devinsky O. Adenosine kinase and adenosine receptors A 1 R and A 2A R in temporal lobe epilepsy and hippocampal sclerosis and association with risk factors for SUDEP. Epilepsia 2020; 61:787-797. [PMID: 32243580 DOI: 10.1111/epi.16487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The "adenosine hypothesis of SUDEP" (sudden unexpected death in epilepsy) predicts that a seizure-induced adenosine surge combined with impaired metabolic clearance can foster lethal apnea or cardiac arrest. Changes in adenosine receptor density and adenosine kinase (ADK) occur in surgical epilepsy patients. Our aim was to correlate the distribution of ADK and adenosine A2A and A1 receptors (A2A R and A1 R) in surgical tissue from patients with temporal lobe epilepsy and hippocampal sclerosis (TLE/HS) with SUDEP risk factors. METHODS In 75 cases, patients were stratified into high-risk (n = 16), medium-risk (n = 11) and low-risk (n = 48) categories according to the frequency of generalized seizures before surgery. Using whole-slide scanning Definiens image analysis we quantified the labeling index (LI) for ADK, A2A R, and A1 R in seven regions of interest: temporal cortex, temporal lobe white matter, CA1, CA4, dentate gyrus, subiculum, and amygdala and relative to glial and neuronal densities with glial fibrillary acidic protein (GFAP) and neuronal nuclear antigen (NeuN). RESULTS A1 R showed predominant neuronal, A2A R astroglial, and ADK nuclear labeling in all regions but with significant variation. Compared with the low-risk group, the high-risk group had significantly lower A2A R LI in the temporal cortex. In HS cases with severe neuronal cell loss and gliosis predominantly in the CA1 and CA4 regions, significantly higher A1 R was present in the amygdala in high-risk than in low-risk cases. There was no significant difference in neuronal loss or gliosis between the risk groups or differences for ADK labeling. SIGNIFICANCE Reduced cortical A2A R suggests glial dysfunction and impaired adenosine modulation in response to seizures in patients at higher risk for SUDEP. Increased neuronal A1 R in the high-risk group could contribute to periictal amygdala dysfunction in SUDEP.
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Affiliation(s)
- Smriti Patodia
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Beatrice Paradiso
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Maria Garcia
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Matthew Ellis
- Neuropathology Division, National Hospital for Neurology and Neurosurgery, London, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,School of Cancer Sciences, University of Southampton, Southampton, UK.,Neuropathology Division, National Hospital for Neurology and Neurosurgery, London, UK
| | - Orrin Devinsky
- Langone Comprehensive Epilepsy Center, New York University, New York, New York
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Jefferys JGR, Ashby‐Lumsden A, Lovick TA. Cardiac effects of repeated focal seizures in rats induced by intrahippocampal tetanus toxin: Bradyarrhythmias, tachycardias, and prolonged interictal QT interval. Epilepsia 2020; 61:798-809. [DOI: 10.1111/epi.16479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- John G. R. Jefferys
- Department of Pharmacology Oxford University Oxford UK
- School of Clinical & Experimental Medicine The University of Birmingham Birmingham UK
- School of Biomedical Engineering Purdue University West Lafayette Indiana
- Department of Physiology 2nd Medical School Motol, Charles University Prague Czech Republic
| | - Alexander Ashby‐Lumsden
- Department of Pharmacology Oxford University Oxford UK
- School of Clinical & Experimental Medicine The University of Birmingham Birmingham UK
| | - Thelma A. Lovick
- School of Biomedical Engineering Purdue University West Lafayette Indiana
- School of Physiology, Pharmacology and Neuroscience The University of Bristol Bristol UK
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Jones JE, Asato MR, Brown MG, Doss JL, Felton EA, Kearney JA, Talos D, Dacks PA, Whittemore V, Poduri A. Epilepsy Benchmarks Area IV: Limit or Prevent Adverse Consequence of Seizures and Their Treatment Across the Life Span. Epilepsy Curr 2020; 20:31S-39S. [PMID: 31973592 PMCID: PMC7031803 DOI: 10.1177/1535759719895277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Epilepsy represents a complex spectrum disorder, with patients sharing seizures as a common symptom and manifesting a broad array of additional clinical phenotypes. To understand this disorder and treat individuals who live with epilepsy, it is important not only to identify pathogenic mechanisms underlying epilepsy but also to understand their relationships with other health-related factors. Benchmarks Area IV focuses on the impact of seizures and their treatment on quality of life, development, cognitive function, and other aspects and comorbidities that often affect individuals with epilepsy. Included in this review is a discussion on sudden unexpected death in epilepsy and other causes of mortality, a major area of research focus with still many unanswered questions. We also draw attention to special populations, such as individuals with nonepileptic seizures and pregnant women and their offspring. In this study, we review the progress made in these areas since the 2016 review of the Benchmarks Area IV and discuss challenges and opportunities for future study.
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Affiliation(s)
- Jana E Jones
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Miya R Asato
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, PA, USA
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Elizabeth A Felton
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | | | - Delia Talos
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Vicky Whittemore
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MA, USA.,Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Ming Q, Ma H, Li J, Yang F, Li J, Liang J, Li D, Lin W. Changes in autonomic nervous function and influencing factors in a rat insular cortex electrical kindling model. Neurosci Lett 2020; 721:134782. [PMID: 31978496 DOI: 10.1016/j.neulet.2020.134782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/26/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
In mammals, the insular cortex plays an important role in autonomic regulation. In patients with insular epilepsy, seizures are always accompanied by autonomic changes. Accordingly, we aimed to establish an electrical kindling model in autonomic-mediating areas of the insular cortex, and to conduct a long-term observation of epileptic genesis in these animals until sudden unexpected death. To establish this model in adult rats, we implanted stimulation electrodes in the granular cell layer of the insular cortex, which controls the heart rate (HR) and respiratory rate (RR). Subsequently, seizure was induced successfully in 92.3 % of the rats, and typical autonomic changes were observed during these seizures. Interestingly, the model was established more easily in older rats, and the rats in which electrical stimulation led to a greater reduction in the HR. Moreover, death occurred in 25 % of the kindled rats. In conclusion, our kindling model demonstrates the ability of insular cortex stimulation to generate epilepsy. Our model thus offers a practical tool for studies of the role of the insular cortex in sudden unexpected death in epilepsy.
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Affiliation(s)
- Qianwen Ming
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China
| | - Hongtao Ma
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China; Department of Neurological Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10021, USA; Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Jia Li
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China
| | - Fan Yang
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China
| | - Jing Li
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China
| | - Jianmin Liang
- Department of Pediatrics, First Hospital of Jilin University, Changchun 130021, China
| | - Dan Li
- Department of Radiology, First Hospital of Jilin University, Changchun 130021, China
| | - Weihong Lin
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China.
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Abstract
PURPOSE OF REVIEW The current review updates our knowledge regarding sudden unexpected death in epilepsy patient (SUDEP) risks, risk factors, and investigations of putative biomarkers based on suspected mechanisms of SUDEP. RECENT FINDINGS The overall incidence of SUDEP in adults with epilepsy is 1.2/1000 patient-years, with surprisingly comparable figures in children in recently published population-based studies. This risk was found to decrease over time in several cohorts at a rate of -7% per year, for unknown reasons. Well established risk factors include frequency of generalized tonic-clonic seizures, while adding antiepileptic treatment, nocturnal supervision and use of nocturnal listening device appear to be protective. In contrast, recent data failed to demonstrate the predictive value of heart rate variability, periictal cardiorespiratory dysfunction, and postictal generalized electroencephalography suppression. Preliminary findings suggest that brainstem and thalamic atrophy may be associated with a higher risk of SUDEP. Novel experimental and human data support the primary role of generalized tonic-clonic seizure-triggered respiratory dysfunction and the likely contribution of altered brainstem serotoninergic neurotransmission, in SUDEP pathophysiology. SUMMARY Although significant progress has been made during the past year in the understanding of SUDEP mechanisms and investigation of numerous potential biomarkers, we are still missing reliable predictors of SUDEP beyond the well established clinical risk factors.
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Abstract
Altered Brain Connectivity in Sudden Unexpected Death in Epilepsy (SUDEP) Revealed Using Resting-State fMRI Allen LA, Harper RM, Guye M, et al. Neuroimage Clin. 2019;24:102060. The circumstances surrounding sudden unexpected death in epilepsy (SUDEP) suggest autonomic or respiratory collapse, implying central failure of regulation or recovery. Characterization of the communication among brain areas mediating such processes may shed light on mechanisms and noninvasively indicate risk. We used rs-fMRI to examine network properties among brain structures in people with epilepsy who suffered SUDEP (n = 8) over an 8-year follow-up period, compared with matched high- and low-risk subjects (n = 16/group) who did not suffer SUDEP during that period and a group of healthy controls (n = 16). Network analysis was employed to explore connectivity within a “regulatory subnetwork” of brain regions involved in autonomic and respiratory regulation and over the whole brain. Modularity, the extent of network organization into separate modules, was significantly reduced in the regulatory subnetwork, and the whole-brain, in SUDEP and high-risk groups. Increased participation, a local measure of intermodular belonging, was evident in SUDEP and high-risk groups, particularly among thalamic structures. The medial prefrontal thalamus was increased in SUDEP compared with all other control groups, including high-risk group. Patterns of hub topology were similar in SUDEP and high-risk groups but were more extensive in low-risk patients who displayed greater hub prevalence and a radical reorganization of hubs in the subnetwork. Sudden unexpected death in epilepsy is associated with reduced functional organization among cortical and subcortical brain regions mediating autonomic and respiratory regulation. Living high-risk subjects demonstrated similar patterns, suggesting such network measures may provide prospective risk-indicating value, though a crucial difference between SUDEP and high-risk groups was altered connectivity of the medial thalamus in SUDEP, which was also elevated compared with all subgroups. Disturbed thalamic connectivity may reflect a potential noninvasive marker of elevated SUDEP risk.
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Yang H, Zhang R, Jia C, Chen M, Yin W, Wei L, Jiao H. Neuronal protective effect of Songling Xuemaikang capsules alone and in combination with carbamazepine on epilepsy in kainic acid-kindled rats. PHARMACEUTICAL BIOLOGY 2019; 57:22-28. [PMID: 30724642 PMCID: PMC6366425 DOI: 10.1080/13880209.2018.1563619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/19/2018] [Accepted: 12/12/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Epilepsy is a common life-threatening neurological disorder that is often drug-resistant and associated with cognitive impairment. The traditional Chinese patent medicine Songling Xuemaikang capsules (SXC) is clinically used for epilepsy therapy and alleviation of cognitive impairment. OBJECTIVE This study investigates the neuronal protective effect of SXC combined with carbamazepine (CBZ) on epilepsy and cognitive impairment in kainic acid-kindled SD rats. MATERIALS AND METHODS Kainic acid-kindled rats were established by injection of 0.45 μg kainic acid and randomly divided into 5 groups (n = 14): saline (sham-operated), control, CBZ, SXC and CBZ + SXC combined group. Rats in the treatment groups received CBZ (50 mg/kg/d), SXC (600 mg/kg/d) or combined CBZ (50 mg/kg/d) + SXC (600 mg/kg/d) via intragastric injection for 60 days. Epileptic behaviours, cognitive impairment, neuronal apoptosis and expression of p-Akt, Akt and caspase-9 were measured, and the alleviation of cognitive damage and neuronal apoptosis was analyzed. RESULTS The combined administration of SXC and CBZ significantly decreased the frequency of seizures (1.2 ± 0.3) and the number of episodes (1.3 ± 0.5) above stage III (p < 0.05). Neuronal apoptosis was improved (p < 0.01), and cognitive damage was ameliorated (p < 0.05).The level of p-Akt was enhanced (p < 0.01) whereas the expression of caspase-9 was evidently inhibited (p < 0.01) in the combined group. CONCLUSIONS The present findings confirm that the combined use of SXC with CBZ can effectively control epileptic seizures, alleviate damage to hippocampal neurons and protect against cognitive impairment. The mechanism of action might be related to the upregulation of p-Akt and inhibition of caspase-9 expression.
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Affiliation(s)
- Haiyan Yang
- Department of Pharmacy, Lanzhou University Second Hospital, Lanzhou, China
| | - Rui Zhang
- College of Pharmacy, Lanzhou University, Lanzhou, China
| | - Chen Jia
- Department of Pharmacy, Lanzhou University Second Hospital, Lanzhou, China
| | - Mengyu Chen
- College of Pharmacy, Lanzhou University, Lanzhou, China
| | - Wen Yin
- Department of Pharmacy, Lanzhou University Second Hospital, Lanzhou, China
| | - Liming Wei
- Department of Pharmacy, Lanzhou University Second Hospital, Lanzhou, China
| | - Haisheng Jiao
- Department of Pharmacy, Lanzhou University Second Hospital, Lanzhou, China
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LA A, Rm H, M G, R K, Ja O, Sb V, S O, Ca S, Sd L, L L, B D. Altered brain connectivity in sudden unexpected death in epilepsy (SUDEP) revealed using resting-state fMRI. NEUROIMAGE-CLINICAL 2019; 24:102060. [PMID: 31722289 PMCID: PMC6849487 DOI: 10.1016/j.nicl.2019.102060] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 01/12/2023]
Abstract
The functional architecture among regulatory structures, and the whole brain, is less modular in confirmed cases of SUDEP and those at high-risk. Altered functional organisation may mean potential impairment of communication among key regulatory circuits. SUDEP is associated with regional connectivity disruptions among cortical and sub-cortical regulatory sites. Medial thalamic connectivity was significantly altered in SUDEP compared with all control groups, including those at high-risk. Increases in the number, and a shift in organisation, of hubs appears to relate to lower mortality risk.
The circumstances surrounding SUDEP suggest autonomic or respiratory collapse, implying central failure of regulation or recovery. Characterisation of the communication among brain areas mediating such processes may shed light on mechanisms and noninvasively indicate risk. We used rs-fMRI to examine network properties among brain structures in people with epilepsy who suffered SUDEP (n = 8) over an 8-year follow-up period, compared with matched high- and low-risk subjects (n = 16/group) who did not suffer SUDEP during that period, and a group of healthy controls (n = 16). Network analysis was employed to explore connectivity within a ‘regulatory-subnetwork’ of brain regions involved in autonomic and respiratory regulation, and over the whole-brain. Modularity, the extent of network organization into separate modules, was significantly reduced in the regulatory-subnetwork, and the whole-brain, in SUDEP and high-risk. Increased participation, a local measure of inter-modular belonging, was evident in SUDEP and high-risk groups, particularly among thalamic structures. The medial prefrontal thalamus was increased in SUDEP compared with all other control groups, including high-risk. Patterns of hub topology were similar in SUDEP and high-risk, but were more extensive in low-risk patients, who displayed greater hub prevalence and a radical reorganization of hubs in the subnetwork. SUDEP is associated with reduced functional organization among cortical and sub-cortical brain regions mediating autonomic and respiratory regulation. Living high-risk subjects demonstrated similar patterns, suggesting such network measures may provide prospective risk-indicating value, though a crucial difference between SUDEP and high-risk was altered connectivity of the medial thalamus in SUDEP, which was also elevated compared with all sub-groups. Disturbed thalamic connectivity may reflect a potential non-invasive marker of elevated SUDEP risk.
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Affiliation(s)
- Allen LA
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK; The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Harper Rm
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; UCLA Brain Research Institute, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Guye M
- Aix Marseille University, CNRS, CRMBM UMR 7339, Marseille, France
| | - Kumar R
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ogren Ja
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; UCLA Brain Research Institute, Los Angeles, CA, USA
| | - Vos Sb
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; UCLA Brain Research Institute, Los Angeles, CA, USA; Wellcome / EPSRC Centre Interventional and Surgical Sciences, UCL, London, UK; Translational Imaging Group, Centre for Medical Image Computing, UCL, London, UK
| | - Ourselin S
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
| | - Scott Ca
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Lhatoo Sd
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Lemieux L
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK
| | - Diehl B
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Epilepsy Society MRI Unit, Chalfont St Peter, Buckinghamshire, UK; The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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Elmali AD, Bebek N, Baykan B. Let's talk SUDEP. ACTA ACUST UNITED AC 2019; 56:292-301. [PMID: 31903040 DOI: 10.29399/npa.23663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/21/2019] [Indexed: 01/17/2023]
Abstract
Sudden unexplained death in epilepsy (SUDEP) is a devastating complication of epilepsy which was under-recognized in the recent past despite its clear importance. In this review, we examine the definition of SUDEP, revise current pathophysiological theories, discuss risk factors and preventative measures, disclose tools for appraising the SUDEP risk, and last but not least dwell upon announcing and explaining the SUDEP risk to the patients and their caretakers. We aim to aid the clinicians in their responsibility of knowing SUDEP, explaining the SUDEP risk to their patients in a reasonable and sensible way and whenever possible, preventing SUDEP. Future studies are definitely needed to increase scientific knowledge and awareness related to this prioritized topic with malign consequences.
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Affiliation(s)
- Ayşe Deniz Elmali
- İstanbul University, İstanbul Faculty of Medicine, Department of Neurology, İstanbul, Turkey
| | - Nerses Bebek
- İstanbul University, İstanbul Faculty of Medicine, Department of Neurology, İstanbul, Turkey
| | - Betül Baykan
- İstanbul University, İstanbul Faculty of Medicine, Department of Neurology, İstanbul, Turkey
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47
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Lacuey N, Martins R, Vilella L, Hampson JP, Rani MRS, Strohl K, Zaremba A, Hampson JS, Sainju RK, Friedman D, Nei M, Scott C, Gehlbach BK, Hupp NJ, Schuele S, Ogren J, Harper RM, Allen L, Diehl B, Bateman LM, Devinsky O, Richerson GB, Lhatoo S. The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea. Epilepsy Behav 2019; 98:73-79. [PMID: 31301453 PMCID: PMC8975169 DOI: 10.1016/j.yebeh.2019.06.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy. METHODS Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group. RESULTS Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05). CONCLUSIONS Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.
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Affiliation(s)
- Nuria Lacuey
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Rita Martins
- Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Laura Vilella
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | - Johnson P. Hampson
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Kingman Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Medical Center, Cleveland, OH, USA
| | - Anita Zaremba
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | | | - Rup K. Sainju
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Daniel Friedman
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,NYU Langone School of Medicine, New York, NY, USA
| | - Maromi Nei
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Catherine Scott
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Institute of Neurology, University College London, London, UK
| | - Brian K Gehlbach
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Norma J. Hupp
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | - Stephan Schuele
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Northwestern University, Feinberg School of Medicine, Chicago
| | - Jennifer Ogren
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ronald M. Harper
- Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal,Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Luke Allen
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Institute of Neurology, University College London, London, UK
| | - Beate Diehl
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Institute of Neurology, University College London, London, UK
| | - Lisa M. Bateman
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Department of Neurology, Columbia University, New York, NY, USA
| | - Orrin Devinsky
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,NYU Langone School of Medicine, New York, NY, USA
| | - George B. Richerson
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Samden Lhatoo
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
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Insular resection may lead to autonomic function changes. Epilepsy Behav 2019; 97:260-264. [PMID: 31254846 PMCID: PMC6916254 DOI: 10.1016/j.yebeh.2019.04.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/16/2019] [Accepted: 04/19/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to determine if insular damage is associated with markers of autonomic dysfunction. METHODS We studied patients who underwent temporal lobe and/or insular resections for epilepsy surgery between April 2010 and June 2015 at University Hospitals Cleveland Medical Center (UHCMC). Presurgical T1-weighted MPRAGE, standard T1, T2 and FLAIR sequences were compared with postsurgical MRI by a neuroradiologist and classified as type 0 (no involvement of insula), type 1 (minimal involvement of insular margin), type 2 (insular involvement <25%), and type 3 (insular involvement ≥25%). Analysis of heart rate variability (HRV) was carried out in pre- and postoperative video-electroencephalography (vEEG) recording. Time-domain parameters were calculated: (mean of the RR intervals (MNN), root mean square difference of successive RR intervals (RMSSD), standard deviation of the RR intervals (SDNN), and coefficient of variation (CV)). In addition, frequency-domain parameters were calculated: low frequency (LF), high frequency (HF), and low frequency/high frequency (LF/HF). RESULTS Twenty-one patients (14 females) with mean age of 36.2 ± 14.4 years (30; 22-75) were studied. Insular involvement was classified as type 0 (4 patients [19%]), type 1 (9 [43%]), type 2 (7 [33%]), and type 3 (1 [5%]). Significant decrease in RMSSD (p = 0.025) and CV (p = 0.008) was seen in insular damage types 2 and 3 compared with no or minimal insular involvement (types 0 and 1). Right-sided resections were associated with increase in LF power (p = 0.010) and the LF/HF ratio (p = 0.017). CONCLUSIONS This study indicates that insular resection may lead to autonomic function changes.
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Li MCH, O'Brien TJ, Todaro M, Powell KL. Acquired cardiac channelopathies in epilepsy: Evidence, mechanisms, and clinical significance. Epilepsia 2019; 60:1753-1767. [PMID: 31353444 DOI: 10.1111/epi.16301] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/07/2019] [Accepted: 07/07/2019] [Indexed: 12/13/2022]
Abstract
There is growing evidence that cardiac dysfunction in patients with chronic epilepsy could play a pathogenic role in sudden unexpected death in epilepsy (SUDEP). Recent animal studies have revealed that epilepsy secondarily alters the expression of cardiac ion channels alongside abnormal cardiac electrophysiology and remodeling. These molecular findings represent novel evidence for an acquired cardiac channelopathy in epilepsy, distinct from inherited ion channels mutations associated with cardiocerebral phenotypes. Specifically, seizure activity has been shown to alter the messenger RNA (mRNA) and protein expression of voltage-gated sodium channels (Nav 1.1, Nav 1.5), voltage-gated potassium channels (Kv 4.2, Kv 4.3), sodium-calcium exchangers (NCX1), and nonspecific cation-conducting channels (HCN2, HCN4). The pathophysiology may involve autonomic dysfunction and structural cardiac disease, as both are independently associated with epilepsy and ion channel dysregulation. Indeed, in vivo and in vitro studies of cardiac pathology reveal a complex network of signaling pathways and transcription factors regulating ion channel expression in the setting of sympathetic overactivity, cardiac failure, and hypertrophy. Other mechanisms such as circulating inflammatory mediators or exogenous effects of antiepileptic medications lack evidence. Moreover, an acquired cardiac channelopathy may underlie the electrophysiologic cardiac abnormalities seen in chronic epilepsy, potentially contributing to the increased risk of malignant arrhythmias and sudden death. Therefore, further investigation is necessary to establish whether cardiac ion channel dysregulation similarly occurs in patients with epilepsy, and to characterize any pathogenic relationship with SUDEP.
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Affiliation(s)
- Michael C H Li
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Marian Todaro
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kim L Powell
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Somani A, Zborovschi AB, Liu Y, Patodia S, Michalak Z, Sisodiya SM, Thom M. Hippocampal morphometry in sudden and unexpected death in epilepsy. Neurology 2019; 93:e804-e814. [PMID: 31345959 DOI: 10.1212/wnl.0000000000007969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/01/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To determine hippocampal morphometric measures, including granule cell dispersion and features of malrotation, as potential biomarkers for sudden unexpected death in epilepsy (SUDEP) from an archival postmortem series. METHODS In a retrospective study of 187 archival postmortems from 3 groups, SUDEP (68; 14 with hippocampal sclerosis [HS]), non-SUDEP epilepsy controls (EP-C = 66; 25 with HS), and nonepilepsy controls (NEC = 53), Nissl/hematoxylin & eosin-stained sections from left and right hippocampus from 5 coronal levels were digitized. Image analysis was carried out for granule cell layer (GCL) thickness and measurements of hippocampal dimensions (HD) for shape (width [HD1], height [HD2]) and medial hippocampal positioning in relation to the parahippocampal gyrus (PHG) length (HD3). A qualitative evaluation of hippocampal malrotational (HMAL) features, dentate gyrus invaginations (DGI), and subicular/CA1 folds (SCF) was also made. RESULTS GCL thickness was increased in HS more than those without (p < 0.001). In non-HS cases, increased GCL thickness was noted in EP-C compared to NEC (p < 0.05) but not between SUDEP and NEC. There was no difference in the frequency of DGI, SCF, measurements of hippocampal shape (HD1, HD2, or ratio), or medial positioning among SUDEP, EP-C, and NEC groups, when factoring in HS, coronal level, and age at death. Comparison between left and right sides within cases showed greater PHG lengths (HD3) on the right side in the SUDEP group only (p = 0.018). CONCLUSIONS No hippocampal morphometric features were identified in support of either excessive granule cell dispersion or features of HMAL as definitive biomarkers for SUDEP. Asymmetries in PHG measurements in SUDEP warrant further investigation as they may indicate abnormal central autonomic networks.
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Affiliation(s)
- Alyma Somani
- From the Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Anita-Beatrix Zborovschi
- From the Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Yan Liu
- From the Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Smriti Patodia
- From the Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Zuzanna Michalak
- From the Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Sanjay M Sisodiya
- From the Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Maria Thom
- From the Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK.
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