1
|
Ghaempour M, Hassanli K, Abiri E. An approach to detect and predict epileptic seizures with high accuracy using convolutional neural networks and single-lead-ECG signal. Biomed Phys Eng Express 2024; 10:025041. [PMID: 38359446 DOI: 10.1088/2057-1976/ad29a3] [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: 09/22/2023] [Accepted: 02/15/2024] [Indexed: 02/17/2024]
Abstract
One of the epileptic patients' challenges is to detect the time of seizures and the possibility of predicting. This research aims to provide an algorithm based on deep learning to detect and predict the time of seizure from one to two minutes before its occurrence. The proposed Convolutional Neural Network (CNN) can detect and predict the occurrence of focal epilepsy seizures through single-lead-ECG signal processing instead of using EEG signals. The structure of the proposed CNN for seizure detection and prediction is the same. Considering the requirements of a wearable system, after a few light pre-processing steps, the ECG signal can be used as input to the neural network without any manual feature extraction step. The desired neural network learns purposeful features according to the labelled ECG signals and then performs the classification of these signals. Training of 39-layer CNN for seizure detection and prediction has been done separately. The proposed method can detect seizures with an accuracy of 98.84% and predict them with an accuracy of 94.29%. With this approach, the ECG signal can be a promising indicator for the construction of portable systems for monitoring the status of epileptic patients.
Collapse
Affiliation(s)
- Mostafa Ghaempour
- Department of Electrical Engineering, Shiraz University of Technology, Shiraz, Iran
| | - Kourosh Hassanli
- Department of Electrical Engineering, Shiraz University of Technology, Shiraz, Iran
| | - Ebrahim Abiri
- Department of Electrical Engineering, Shiraz University of Technology, Shiraz, Iran
| |
Collapse
|
2
|
Neuhaus E, Bitzer F, Held NR, Bauer T, Gaubatz J, von Wrede R, Baumgartner T, Rácz A, Becker V, Surges R, Rüber T. Volumetric gray matter findings in autonomic network regions of people with focal epilepsy. J Neuroimaging 2024; 34:55-60. [PMID: 37840190 DOI: 10.1111/jon.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND AND PURPOSE Voxel-based morphometry (VBM) studies of people with focal epilepsies revealed gray matter (GM) alterations in brain regions involved in cardiorespiratory regulation, which have been linked to the risk of sudden unexpected death in epilepsy (SUDEP). It remains unclear whether the type and localization of epileptogenic lesions influence the occurrence of such alterations. METHODS To test the hypothesis that VBM alterations of autonomic network regions are independent of epileptogenic lesions and that they reveal structural underpinnings of SUDEP risk, VBM was performed in 100 people with focal epilepsies without an epileptogenic lesion identifiable on MRI (mean age ± standard deviation = 35 ± 11 years, 56 female). The group was further stratified in high (sample size n = 29) and low risk of SUDEP (n = 71). GM volumes were compared between these two subgroups and to 100 matched controls. RESULTS People with epilepsy displayed higher GM volume in both amygdalae and parahippocampal gyri and lower GM volume in the cerebellum and occipital (p<.05, familywise error corrected). There were no significant volumetric differences between high and low SUDEP risk subgroups. CONCLUSION Our findings confirm that autonomic networks are structurally altered in people with focal epilepsy and they question VBM as a suitable method to show structural correlates of the SUDEP risk score.
Collapse
Affiliation(s)
- Elisabeth Neuhaus
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Bitzer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Nina R Held
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Jennifer Gaubatz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Atilla Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Vitali Becker
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
3
|
Sharma S, Rana AK, Rahmatkar SN, Patial V, Singh D. Protective effect of Nardostachys jatamansi extract against lithium-pilocarpine-induced spontaneous recurrent seizures and associated cardiac irregularities in a rat model. JOURNAL OF ETHNOPHARMACOLOGY 2023; 308:116280. [PMID: 36813245 DOI: 10.1016/j.jep.2023.116280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Nardostachys jatamansi (D.Don) DC. is a perennial herbaceous medicinal plant widely used for the ethnomedical treatment of various ailments. The underground parts of the plants are used in traditional medicine to manage epilepsy and other cardiovascular conditions. AIM OF THE STUDY The present study was undertaken to investigate the efficacy of a characterized hydroalcoholic extract (NJET) of Nardostachys jatamansi in the lithium-pilocarpine rat model of spontaneous recurrent seizures (SRS) and associated cardiac irregularities. MATERIALS AND METHODS NJET was prepared by percolation using 80% ethanol. The dried NEJT was subjected to UHPLC-qTOF-MS/MS for chemical characterization. Molecular docking studies were performed using the characterized compounds to understand mTOR interactions. The animals showing SRS following lithium-pilocarpine administration were treated with NJET for 6 weeks. Afterward, seizure severity, cardiac parameters, serum biochemistry, and histopathological parameters were studied. The cardiac tissue was processed for specific protein and gene expression studies. RESULTS The UHPLC-qTOF-MS/MS characterized 13 compounds in NJET. The identified compounds subjected to molecular docking showed promising binding affinities toward mTOR. There was a dose-dependent decrease in the severity of SRS following the extract administration. A reduction in mean arterial pressure and serum biochemical markers (lactate dehydrogenase and creatine kinase) was also observed following NJET treatment in epileptic animals. Histopathological investigations revealed reduced degenerative changes and decreased fibrosis following the extract treatment. The cardiac mRNA level of Mtor, Rps6, Hif1a, and Tgfb3 was reduced in the extract-treated groups. Further, a similar reduction in the protein expression of p-mTOR and HIF-1α was also observed following NJET treatment in the cardiac tissue. CONCLUSIONS The results concluded that NJET treatment reduces lithium-pilocarpine-induced recurrent seizures and associated cardiac irregularities via downregulation of the mTOR signalling pathway.
Collapse
Affiliation(s)
- Supriya Sharma
- Pharmacology and Toxicology Laboratory, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, 176061, Himachal Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Anil Kumar Rana
- Pharmacology and Toxicology Laboratory, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, 176061, Himachal Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Shubham Nilkanth Rahmatkar
- Pharmacology and Toxicology Laboratory, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, 176061, Himachal Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Vikram Patial
- Pharmacology and Toxicology Laboratory, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, 176061, Himachal Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Damanpreet Singh
- Pharmacology and Toxicology Laboratory, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, 176061, Himachal Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
| |
Collapse
|
4
|
Sasaki R, Osugi N, Nakagawa I. Generalized Epilepsy With Repetitive Sinus Pauses Following Generalized Tonic-Clonic Seizures Due to Reduced Baroreflex Sensitivity. Cureus 2023; 15:e39392. [PMID: 37378111 PMCID: PMC10292006 DOI: 10.7759/cureus.39392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Epilepsy and syncope are sometimes difficult to differentiate, and they often occur together. We report here a unique case of severe neuromodulatory syncope associated with generalized epilepsy. A 24-year-old right-handed female with no remarkable history had her first epileptic seizure when she was 15 years old and was diagnosed with epilepsy. However, she had epileptic seizures or fainting spells every few months and was referred to Nara Medical Center at the age of 23 years. No obvious neurological abnormality was present, and no organic abnormality was found on head magnetic resonance imaging. The seizures were symmetrical generalized tonic-clonic seizures (GTCS) without aura, and the patient was unable to stand up for several hours after the seizure. Long-term video electroencephalogram monitoring revealed two types of seizures: (1) GTCS starting with generalized polyspikes and waves and (2) fainting with sinus arrest for up to 10 seconds when the patient tried to stand up after GTCS. After the addition of valproic acid following the diagnosis of generalized epilepsy, her epileptic seizures improved, but syncope remained. We consulted the cardiology department of our hospital and diagnosed mixed neuromodulatory syncope after performing the tilt test. She underwent catheter ablation for cardioneuromodulation, and her syncope improved. Several reports have described reduced baroreflex sensitivity during the interictal period in epilepsy, and seizure-related autonomic dysfunction has been implicated in sudden unexpected death in epilepsy (SUDEP). In addition to suppression of epileptic seizures, when autonomic nervous system symptoms associated with epilepsy are severe, as in this case, a thorough cardiovascular examination should be performed, and the patient should be treated with the goal of preventing SUDEP.
Collapse
Affiliation(s)
- Ryota Sasaki
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| | - Nahomi Osugi
- Department of Clinical Laboratory, National Hospital Organization Nara Medical Center, Nara, JPN
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| |
Collapse
|
5
|
Nunes KZ, Scorza FA, Cavalheiro EA, Vassallo DV. Reduction of vascular reactivity in rat aortas following pilocarpine-induced status epilepticus. Clinics (Sao Paulo) 2023; 78:100195. [PMID: 37099815 PMCID: PMC10149400 DOI: 10.1016/j.clinsp.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
OBJECTIVE The authors investigated changes in vascular reactivity in rats following pilocarpine-induced status epilepticus. METHOD Male Wistar rats weighing between 250g and 300g were used. Status epilepticus was induced using 385 mg/kg i.p. pilocarpine. After 40 days the thoracic aorta was dissected and divided into 4 mm rings and the vascular smooth muscle reactivity to phenylephrine was evaluated. RESULTS Epilepsy decreased the contractile responses of the aortic rings to phenylephrine (0.1 nM-300 mM). To investigate if this reduction was induced by increasing NO production with/or hydrogen peroxide L-NAME and Catalase were used. L-NAME (N-nitro-L arginine methyl ester) increased vascular reactivity but the contractile response to phenylephrine increased in the epileptic group. Catalase administration decreased the contractile responses only in the rings of rats with epilepsy. CONCLUSIONS Our findings demonstrated for the first time that epilepsy is capable of causing a reduction of vascular reactivity in rat aortas. These results suggest that vascular reactivity reduction is associated with increased production of Nitric Oxide (NO) as an organic attempt to avoid hypertension produced by excessive sympathetic activation.
Collapse
Affiliation(s)
- Karolini Zuqui Nunes
- Postgraduate Program in Nutrition and Health, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
| | - Fulvio Alexandre Scorza
- Discipline of Neuroscience, Universidade Federal de São Paulo/Escola Paulista de Medicina, São PauloSP, Brazil
| | - Esper Abrão Cavalheiro
- Discipline of Neuroscience, Universidade Federal de São Paulo/Escola Paulista de Medicina, São PauloSP, Brazil
| | - Dalton Valentim Vassallo
- Graduate Program in Physiological Sciences, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| |
Collapse
|
6
|
Viloria-Alebesque A, Bellosta-Diago E, Navarro-Pérez MP, Santos-Lasaosa S, Mauri-Llerda JÁ. Circadian rhythm of blood pressure in patients with drug-resistant mesial temporal lobe epilepsy. Seizure 2023; 108:43-48. [PMID: 37080123 DOI: 10.1016/j.seizure.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE To determine whether patients with drug-resistant mesial temporal lobe epilepsy present with an alteration in the autonomic circadian regulation of blood pressure. METHODS A prospective case‒control study was designed, with a case group comprising patients with drug-resistant mesial temporal lobe epilepsy and a control group comprising healthy volunteers. Twenty-four-hour outpatient blood pressure monitoring was performed to assess the existence of a normal (dipping) or altered (non-dipping) circadian pattern. In addition, analytical and ultrasound parameters (carotid intima-media thickness) of vascular risk and sleep quality were evaluated. RESULTS Twenty-four subjects were recruited in each study group, amongst whom no demographic differences or history of vascular risk were observed. A higher percentage of participants with a non-dipping pattern was observed in the group of patients with epilepsy (62.5% vs. 12.5, p = 0.001). In the case group, significant differences were also observed in carotid intima-media thickness, with a greater probability of presenting with pathological values (p = 0.022). CONCLUSION The results suggest a disorder of the central autonomic control of blood pressure in patients with drug-resistant mesial temporal lobe epilepsy, with a greater probability of developing an alteration of the circadian rhythm of blood pressure. This dysfunction may be a factor involved in the increased cardiovascular risk in this population.
Collapse
Affiliation(s)
- Alejandro Viloria-Alebesque
- Neurology Department, Hospital Universitario Miguel Servet- Hospital General de la Defensa, P.º de Isabel la Católica 1-3, Zaragoza 50009, Spain; Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain.
| | - Elena Bellosta-Diago
- Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain; Neurology Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, Zaragoza 50009, Spain
| | - María Pilar Navarro-Pérez
- Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain; Neurology Department, Hospital Obispo Polanco, Av/ Ruiz Jarabo s/n, Teruel 44002, Spain
| | - Sonia Santos-Lasaosa
- Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain; Neurology Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, Zaragoza 50009, Spain
| | - José Ángel Mauri-Llerda
- Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain; Neurology Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, Zaragoza 50009, Spain
| |
Collapse
|
7
|
Assessing epilepsy-related autonomic manifestations: Beyond cardiac and respiratory investigations. Neurophysiol Clin 2023; 53:102850. [PMID: 36913775 DOI: 10.1016/j.neucli.2023.102850] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/13/2023] Open
Abstract
The Autonomic Nervous System (ANS) regulates many critical physiological functions. Its control relies on cortical input, especially limbic areas, which are often involved in epilepsy. Peri-ictal autonomic dysfunction is now well documented, but inter-ictal dysregulation is less studied. In this review, we discuss the available data on epilepsy-related autonomic dysfunction and the objective tests available. Epilepsy is associated with sympathetic-parasympathetic imbalance and a shift towards sympathetic dominance. Objective tests report alterations in heart rate, baroreflex function, cerebral autoregulation, sweat glands activity, thermoregulation, gastrointestinal and urinary function. However, some tests have found contradictory results and many tests suffer from a lack of sensitivity and reproducibility. Further study on interictal ANS function is required to further understand autonomic dysregulation and the potential association with clinically-relevant complications, including risk of Sudden Unexpected Death In Epilepsy (SUDEP).
Collapse
|
8
|
Liu Z, Thergarajan P, Antonic-Baker A, Chen Z, Sparks PB, Lannin NA, Kwan P, Jones NC, Casillas-Espinosa PM, Perucca P, O'Brien TJ, Sivathamboo S. Cardiac structural and functional abnormalities in epilepsy: A systematic review and meta-analysis. Epilepsia Open 2023; 8:46-59. [PMID: 36648338 PMCID: PMC9977759 DOI: 10.1002/epi4.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Epilepsy is associated with an increased risk of cardiovascular disease and mortality. Whether cardiac structure and function are altered in epilepsy remains unclear. To address this, we conducted a systematic review and meta-analysis of studies evaluating cardiac structure and function in patients with epilepsy. METHODS We searched the electronic databases MEDLINE, PubMed, COCHRANE, and Web of Science from inception to 31 December 2021. Primary outcomes of interest included left ventricular ejection fraction (LVEF) for studies reporting echocardiogram findings and cardiac weight and fibrosis for postmortem investigations. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) assessment tools. RESULTS Among the 10 case-control studies with epilepsy patients (n = 515) and healthy controls (n = 445), LVEF was significantly decreased in epilepsy group compared with controls (MD: -1.80; 95% confidence interval [CI]: -3.56 to -0.04; P = 0.045), whereas A-wave velocity (MD: 4.73; 95% CI: 1.87-7.60; P = 0.001), E/e' ratio (MD: 0.39; 95% CI: 0.06-0.71; P = 0.019), and isovolumic relaxation time (MD: 10.18; 95% CI: 2.05-18.32; P = 0.014) were increased in epilepsy, compared with controls. A pooled analysis was performed in sudden unexpected death in epilepsy (SUDEP) cases with autopsy data (n = 714). Among SUDEP cases, the prevalence of cardiac hypertrophy was 16% (95% CI: 9%-23%); cardiac fibrosis was 20% (95% CI: 15%-26%). We found no marked differences in cardiac hypertrophy, heart weight, or cardiac fibrosis between SUDEP cases and epilepsy controls. SIGNIFICANCE Our findings suggest that epilepsy is associated with altered diastolic and systolic echocardiogram parameters compared with healthy controls. Notably, SUDEP does not appear to be associated with a higher incidence of structural cardiac abnormalities, compared with non-SUDEP epilepsy controls. Longitudinal studies are needed to understand the prognostic significance of such changes. Echocardiography may be a useful noninvasive diagnostic test in epilepsy population.
Collapse
Affiliation(s)
- Zining Liu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peravina Thergarajan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul B Sparks
- Department of Cardiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nigel C Jones
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Pablo M Casillas-Espinosa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine (Austin Health), Epilepsy Research Centre, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Shobi Sivathamboo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| |
Collapse
|
9
|
Sanchez-Larsen A, Principe A, Ley M, Vaquerizo B, Langohr K, Rocamora R. Insular Role in Blood Pressure and Systemic Vascular Resistance Regulation. Neuromodulation 2023:S1094-7159(23)00006-5. [PMID: 36682902 DOI: 10.1016/j.neurom.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The insula is a brain area involved in the modulation of autonomic responses. Previous studies have focused mainly on its heart rate regulatory function, but its role in vascular control is not well defined. Ictal/postictal blood pressure (BP) fluctuations may have a role in the pathogenesis of sudden unexpected death in epilepsy. This study aims to characterize the insular influence on vascular regulation through direct high-frequency electrical stimulation (E-stim) of different insular regions during stereo-electroencephalographic studies. MATERIALS AND METHODS An observational, prospective study was conducted, involving people with epilepsy who underwent E-stim of depth electrodes implanted in the insular cortex. Patients with anatomical or electrophysiological insular abnormalities, E-stim producing after discharges, or any elicited symptoms were excluded. Variations of BP and systemic vascular resistance (SVR) during the insular stimuli were analyzed, comparing them with those observed during E-stim of control contacts implanted in cortical noneloquent regions and sham stimulations. RESULTS Fourteen patients were included, five implanted in the right insula and nine in the left. We analyzed 14 stimulations in the right insula, 18 in the left insula, 18 in control electrodes, and 13 sham stimulations. Most right insular responses were hypertensive, whereas most left ones were hypotensive. E-stim of the right insula produced a significant BP and SVR increase, whereas the left insula induced a significant BP decrease without SVR changes. The most remarkable changes were elicited in both posterior insulas, although the magnitude of BP changes was generally low. Control and sham stimulations did not induce BP or SVR changes. CONCLUSION Our findings on insular stimulation suggest an interhemispheric difference in its vascular regulatory function, with a vasopressor effect of the right insula and a vasodilator effect of the left one.
Collapse
Affiliation(s)
- Alvaro Sanchez-Larsen
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Alessandro Principe
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Miguel Ley
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Epilepsy Monitoring Unit, Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Beatriz Vaquerizo
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Klaus Langohr
- Integrative Pharmacology and Systems Neuroscience Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Statistics and Operations Research, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona, Spain
| | - Rodrigo Rocamora
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain
| |
Collapse
|
10
|
Zambrana-Vinaroz D, Vicente-Samper JM, Manrique-Cordoba J, Sabater-Navarro JM. Wearable Epileptic Seizure Prediction System Based on Machine Learning Techniques Using ECG, PPG and EEG Signals. SENSORS (BASEL, SWITZERLAND) 2022; 22:9372. [PMID: 36502071 PMCID: PMC9736525 DOI: 10.3390/s22239372] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Epileptic seizures have a great impact on the quality of life of people who suffer from them and further limit their independence. For this reason, a device that would be able to monitor patients' health status and warn them for a possible epileptic seizure would improve their quality of life. With this aim, this article proposes the first seizure predictive model based on Ear EEG, ECG and PPG signals obtained by means of a device that can be used in a static and outpatient setting. This device has been tested with epileptic people in a clinical environment. By processing these data and using supervised machine learning techniques, different predictive models capable of classifying the state of the epileptic person into normal, pre-seizure and seizure have been developed. Subsequently, a reduced model based on Boosted Trees has been validated, obtaining a prediction accuracy of 91.5% and a sensitivity of 85.4%. Thus, based on the accuracy of the predictive model obtained, it can potentially serve as a support tool to determine the status epilepticus and prevent a seizure, thereby improving the quality of life of these people.
Collapse
Affiliation(s)
- David Zambrana-Vinaroz
- Neuroengineering Biomedical Research Group, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Jose Maria Vicente-Samper
- Neuroengineering Biomedical Research Group, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Juliana Manrique-Cordoba
- Neuroengineering Biomedical Research Group, Miguel Hernández University of Elche, 03202 Elche, Spain
| | | |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Talavera B, Hupp NJ, Melius S, Lhatoo SD, Lacuey N. Protocols for multimodal polygraphy for cardiorespiratory monitoring in the epilepsy monitoring unit. Part I: Clinical acquisition. Epilepsy Res 2022; 185:106990. [PMID: 35930940 DOI: 10.1016/j.eplepsyres.2022.106990] [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] [Indexed: 11/03/2022]
Abstract
Multimodal polygraphy including cardiorespiratory monitoring in the Epilepsy Monitoring is becoming increasingly important. In addition to simultaneous recording of video and EEG, the combination of these techniques not only improves seizure detection, it enhances patient safety and provides information on autonomic clinical symptoms, which may be contributory to localization of seizure foci. However, there are currently no consensus guidelines, nor adequate information on devices available for multimodal polygraphy for cardiorespiratory monitoring in the Epilepsy Monitoring Unit. Our purpose here is to provide protocols and information on devices for such monitoring. Suggested parameters include respiratory inductance plethysmography (thoraco-abdominal belts for respiratory rate), pulse oximetry and four-lead electrocardiography. Detailed knowledge of devices, their operability and acquisition optimization enables accurate interpretation of signal and differentiation of abnormalities from artifacts. Multimodal polygraphy brings new opportunities for identification of peri-ictal cardiorespiratory abnormalities, and may identify high SUDEP risk individuals.
Collapse
Affiliation(s)
- Blanca Talavera
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, TX, USA.
| | - Norma J Hupp
- 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
| | - Samden D Lhatoo
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, TX, USA
| | - Nuria Lacuey
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, TX, USA
| |
Collapse
|
13
|
Ferlini L, Nonclercq A, Su F, Creteur J, Taccone FS, Gaspard N. Sepsis modulates cortical excitability and alters the local and systemic hemodynamic response to seizures. Sci Rep 2022; 12:11336. [PMID: 35790848 PMCID: PMC9256588 DOI: 10.1038/s41598-022-15426-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 11/09/2022] Open
Abstract
Non-convulsive seizures and status epilepticus are frequent and associated with increased mortality in septic patients. However, the mechanism through which seizures impact outcome in these patients is unclear. As previous studies yielded an alteration of neurovascular coupling (NVC) during sepsis, we hypothesized that non-convulsive seizures, might further impair NVC, leading to brain tissue hypoxia. We used a previously developed ovine model of sepsis. Animals were allocated to sham procedure or sepsis; septic animals were studied either during the hyperdynamic phase (sepsis group) or after septic shock occurrence (septic shock group). After allocation, seizures were induced by cortical application of penicillin. We recorded a greater seizure-induced increase in the EEG gamma power in the sepsis group than in sham. Using a neural mass model, we also found that the theoretical activity of the modeled inhibitory interneurons, thought to be important to reproduce gamma oscillations, were relatively greater in the sepsis group. However, the NVC was impaired in sepsis animals, despite a normal brain tissue oxygenation. In septic shock animals, it was not possible to induce seizures. Cortical activity declined in case of septic shock, but it did not differ between sham or sepsis animals. As the alteration in NVC preceded cortical activity reduction, we suggest that, during sepsis progression, the NVC inefficiency could be partially responsible for the alteration of brain function, which might prevent seizure occurrence during septic shock. Moreover, we showed that cardiac output decreased during seizures in sepsis animals instead of increasing as in shams. The alteration of the seizure-induced systemic hemodynamic variations in sepsis might further affect cerebrovascular response to neuronal activation. Our findings support the hypothesis that anomalies in the cerebral blood flow regulation may contribute to the sepsis-associated encephalopathy and that seizures might be dangerous in such a vulnerable setting.
Collapse
Affiliation(s)
- Lorenzo Ferlini
- Department of Neurology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Antoine Nonclercq
- Bio-, Electro- And Mechanical Systems (BEAMS), Université Libre de Bruxelles, Avenue F.D. Roosevelt 50 CP165/56, 1050, Brussels, Belgium
| | - Fuhong Su
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
| |
Collapse
|
14
|
Validation of Continuous Monitoring System for Epileptic Users in Outpatient Settings. SENSORS 2022; 22:s22082900. [PMID: 35458883 PMCID: PMC9025176 DOI: 10.3390/s22082900] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 12/24/2022]
Abstract
Epilepsy is a chronic disease with a significant social impact, given that the patients and their families often live conditioned by the possibility of an epileptic seizure and its possible consequences, such as accidents, injuries, or even sudden unexplained death. In this context, ambulatory monitoring allows the collection of biomedical data about the patients’ health, thus gaining more knowledge about the physiological state and daily activities of each patient in a more personalized manner. For this reason, this article proposes a novel monitoring system composed of different sensors capable of synchronously recording electrocardiogram (ECG), photoplethysmogram (PPG), and ear electroencephalogram (EEG) signals and storing them for further processing and analysis in a microSD card. This system can be used in a static and/or ambulatory way, providing information about the health state through features extracted from the ear EEG signal and the calculation of the heart rate variability (HRV) and pulse travel time (PTT). The different applied processing techniques to improve the quality of these signals are described in this work. A novel algorithm used to compute HRV and PTT robustly and accurately in ambulatory settings is also described. The developed device has also been validated and compared with other commercial systems obtaining similar results. In this way, based on the quality of the obtained signals and the low variability of the computed parameters, even in ambulatory conditions, the developed device can potentially serve as a support tool for clinical decision-taking stages.
Collapse
|
15
|
Vargiami E, Stabouli S, Sidira C, Kyriazi M, Anastasiou A, Notopoulos A, Zafeiriou D. Blood pressure and glomerular filtration rate in youth with tuberous sclerosis complex. Eur J Pediatr 2022; 181:1465-1472. [PMID: 34988664 DOI: 10.1007/s00431-021-04333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Abstract
UNLABELLED Renal involvement is very common in tuberous sclerosis complex (TSC) and is characterized by the development of angiomyolipoma and cysts. The aims of the present study were to assess kidney function and clinical features of renal involvement in TSC, including kidney function and blood pressure (BP) levels in children, adolescents and young adults. Non-selected patients with a definite diagnosis of TSC attending the paediatric neurology outpatient department of a tertiary hospital were included in a cross-sectional study. All participants had a renal imaging study within 6 months of ambulatory blood pressure (BP) and glomerular filtration rate (GFR) assessment. Data on demographics, history, genotype, kidney function at diagnosis and last imaging were collected. Twenty patients were enrolled in this study with a median age of 15 years (IQR range 9 to 18). About 23.5% of the participants had ambulatory hypertension. Systolic BP levels correlated significantly with GFRDTPA values despite the absence of hyperfiltration. Patients that developed hypertension and possibly those with angiomyolipoma or cysts had higher GFR levels in childhood and adolescence. All the patients with ambulatory hypertension had angiomyolipoma or cysts on renal imaging studies. CONCLUSIONS Hypertension may present with increased frequency in young patients with kidney disease associated with TSC. Routine ambulatory BP measurement should be part of the annual clinical assessment in patients with TSC. WHAT IS KNOWN • Nearly half of the patients with TSC have a premature decline in their renal function in their fifth decade of life. • Hypertension and hyperfiltration have been proposed as modifiable factors of progression of renal decline in patients with TSC-related renal disease. WHAT IS NEW • Hypertension is prevalent in youth with tuberous sclerosis complex. • SBP levels have a positive relation with GFR levels within the normal range of GFRDTPA values.
Collapse
Affiliation(s)
- Efthymia Vargiami
- First Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | - Stella Stabouli
- First Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece.
| | - Christina Sidira
- First Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | - Maria Kyriazi
- First Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | | | | | - Dimitrios Zafeiriou
- First Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| |
Collapse
|
16
|
Ghazale PP, dos Santos Borges K, Gomes KP, Quintino C, Braga PPP, de Castro CH, Mendes EP, Scorza FA, Colugnati DB, Pansani AP. Alterations in aortic vasorelaxation in rats with epilepsy induced by the electrical amygdala kindling model. Epilepsy Res 2022; 182:106920. [DOI: 10.1016/j.eplepsyres.2022.106920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 11/03/2022]
|
17
|
Ferlini L, Su F, Creteur J, Taccone FS, Gaspard N. Cerebral and systemic hemodynamic effect of recurring seizures. Sci Rep 2021; 11:22209. [PMID: 34782705 PMCID: PMC8593180 DOI: 10.1038/s41598-021-01704-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
The increase in neuronal activity induced by a single seizure is supported by a rise in the cerebral blood flow and tissue oxygenation, a mechanism called neurovascular coupling (NVC). Whether cerebral and systemic hemodynamics are able to match neuronal activity during recurring seizures is unclear, as data from rodent models are at odds with human studies. In order to clarify this issue, we used an invasive brain and systemic monitoring to study the effects of chemically induced non-convulsive seizures in sheep. Despite an increase in neuronal activity as seizures repeat (Spearman’s ρ coefficient 0.31, P < 0.001), ictal variations of cerebral blood flow remained stable while it progressively increased in the inter-ictal intervals (ρ = 0.06, P = 0.44 and ρ = 0.22; P = 0.008). We also observed a progressive reduction in the inter-ictal brain tissue oxygenation (ρ = − 0.18; P = 0.04), suggesting that NVC was unable to compensate for the metabolic demand of these closely repeating seizures. At the systemic level, there was a progressive reduction in blood pressure and a progressive rise in cardiac output (ρ = − 0.22; P = 0.01 and ρ = 0.22; P = 0.01, respectively), suggesting seizure-induced autonomic dysfunction.
Collapse
Affiliation(s)
- Lorenzo Ferlini
- Department of Neurology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - Fuhong Su
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Erasme Hospital, Free University of Brussels, Brussels, Belgium.
| |
Collapse
|
18
|
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.
Collapse
|
19
|
Husein N, Josephson CB, Keezer MR. Understanding cardiovascular disease in older adults with epilepsy. Epilepsia 2021; 62:2060-2071. [PMID: 34245013 DOI: 10.1111/epi.16991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/06/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was undertaken to investigate the distribution of social, lifestyle/behavior, and chronic disease risk factors for cardiovascular disease (CVD) in people with epilepsy as compared to the general population. We also measured the cross-sectional association between epilepsy and CVD in older adults, with and without adjustments for a history of stroke. METHODS We analyzed data for 44 817 participants in the Canadian Longitudinal Study on Aging, including 751 individuals with a lifetime history of epilepsy. We modeled associations using ordinal and binomial logistic regression, as well as log-binomial regression, with multiple imputation for missing data. We measured the attributable fraction of CVD burden due to stroke. RESULTS The majority of the CVD risk factors were significantly more prevalent in people with epilepsy as compared to the general population without epilepsy, independent of age and sex. After adjusting for a history of stroke, people with epilepsy had a significantly higher prevalence of heart disease (prevalence ratio [PR] = 1.27, 95% confidence interval [CI] = 1.02-1.57) and peripheral vascular disease (PR = 1.88, 95% CI = 1.50-2.36). Stroke accounted for 36% (95% CI = 19.85-48.76) of the increased prevalence of any CVD among people with epilepsy, similar to the 32% (95% CI = 27.82-36.25) among people without epilepsy. After adjustment for all other CVD risk factors, peripheral vascular disease remained significantly more prevalent (PR = 1.65, 95% CI = 1.28-2.12) in people with epilepsy as compared to those without. SIGNIFICANCE CVD risk factors are more prevalent in people with epilepsy, independent of age and sex, and the association between epilepsy and CVD is independent of the association between epilepsy and stroke. The association between peripheral vascular disease and epilepsy may differ from the associations with other types of CVD. These findings are important steps in more comprehensively understanding the origins of CVD in people with epilepsy.
Collapse
Affiliation(s)
- Nafisa Husein
- Research Centre of the University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mark R Keezer
- Research Centre of the University of Montreal Hospital Centre, Montreal, Quebec, Canada.,Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada.,School of Public Health, University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
20
|
Cardiometabolic Factors in Pediatric Patients with Chronic Diseases. Arch Med Res 2021; 52:535-543. [DOI: 10.1016/j.arcmed.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/08/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022]
|
21
|
Akyüz E, Üner AK, Köklü B, Arulsamy A, Shaikh MF. Cardiorespiratory findings in epilepsy: A recent review on outcomes and pathophysiology. J Neurosci Res 2021; 99:2059-2073. [PMID: 34109651 DOI: 10.1002/jnr.24861] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
Epilepsy is a debilitating disorder of uncontrollable recurrent seizures that occurs as a result of imbalances in the brain excitatory and inhibitory neuronal signals, that could stem from a range of functional and structural neuronal impairments. Globally, nearly 70 million people are negatively impacted by epilepsy and its comorbidities. One such comorbidity is the effect epilepsy has on the autonomic nervous system (ANS), which plays a role in the control of blood circulation, respiration and gastrointestinal function. These epilepsy-induced impairments in the circulatory and respiratory systems may contribute toward sudden unexpected death in epilepsy (SUDEP). Although, various hypotheses have been proposed regarding the role of epilepsy on ANS, the linking pathological mechanism still remains unclear. Channelopathies and seizure-induced damages in ANS-control brain structures were some of the causal/pathological candidates of cardiorespiratory comorbidities in epilepsy patients, especially in those who were drug resistant. However, emerging preclinical research suggest that neurotransmitter/receptor dysfunction and synaptic changes in the ANS may also contribute to the epilepsy-related autonomic disorders. Thus, pathological mechanisms of cardiorespiratory dysfunction should be elucidated by considering the modifications in anatomy and physiology of the autonomic system caused by seizures. In this regard, we present a comprehensive review of the current literature, both clinical and preclinical animal studies, on the cardiorespiratory findings in epilepsy and elucidate the possible pathological mechanisms of these findings, in hopes to prevent SUDEP especially in patients who are drug resistant.
Collapse
Affiliation(s)
- Enes Akyüz
- Department of Biophysics, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Arda Kaan Üner
- Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Betül Köklü
- Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Alina Arulsamy
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| |
Collapse
|
22
|
Ma S, Fan X, Zhao X, Wang K, Wang H, Yang Y. Risk factors for early-onset seizures after stroke: A systematicreview and meta-analysis of 18 observational studies. Brain Behav 2021; 11:e02142. [PMID: 33942550 PMCID: PMC8213649 DOI: 10.1002/brb3.2142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To systematically evaluate the risk factors of early-onset seizures after stroke, in order to better provide evidence-based results for early detection, identification, targeted prevention, and treatment of this disease. METHODS PubMed, EMBASE, The Cochrane Library, CNKI, and WanFang databases were searched to collect relevant studies on the risk factors of early-onset seizures after stroke from January 2010 to January 2020. Meta-analysis of all included studies was performed by using RevMan version 5.3 and Stata version 14.0 software. RESULTS Eighteen case-control studies with a total sample size of 13,289 cases, including 813 cases with early-onset seizures after stroke, and 12,476 cases with non-early-onset seizures after stroke were included. The results of meta-analysis showed that cortical involvement [Odds Ratio (OR) = 5.00, 95%Confidence Interval (CI) (2.85, 8.74), p < .00001], cerebral infarction with hemorrhagic transformation [OR = 2.77, 95%CI (1.87, 4.11), p < .00001] and intracerebral hemorrhage [OR = 1.83, 95%CI (1.13, 2.97), p = .01]-related factors showed greater association with the occurrence of early-onset seizures after stroke. CONCLUSIONS These findings suggest that cortical involvement, intracerebral hemorrhage, and cerebral infarction with hemorrhagic transformation are important predictors and risk factors for early seizures after stroke, while the patient's gender, age, NHISS score, alcoholism, smoking, high blood pressure, diabetes, atrial fibrillation, dyslipidemia, receiving surgical treatment, and reperfusion therapy showed no association with the occurrence of early-onset seizures after stroke.
Collapse
Affiliation(s)
- Sitian Ma
- Shaanxi University of Chinese Medicine, Shaanxi, China
| | - Xiaoxuan Fan
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Shaanxi, China
| | - Xiaoping Zhao
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Shaanxi, China
| | - Kai Wang
- Shaanxi University of Chinese Medicine, Shaanxi, China
| | - Huan Wang
- Shaanxi University of Chinese Medicine, Shaanxi, China
| | - Yongfeng Yang
- Shaanxi University of Chinese Medicine, Shaanxi, China
| |
Collapse
|
23
|
Mehdi SMA, Devanand DP, Hirsch IA, Gao K. Safe Electroconvulsive Therapy in a Patient with Underlying Hypertension and an Unruptured and Unsecured Cerebral Artery Aneurysm. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210506-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
24
|
Abstract
PURPOSE OF REVIEW Epilepsy is associated with autonomic dysfunction. Here, we provide an up-to-date review on measures of interictal autonomic function, focusing on heart rate variability (HRV), baroreflex sensitivity (BRS) and electrodermal activity (EDA). RECENT FINDINGS Resting HRV, BRS and EDA are altered in patients with epilepsy compared with healthy controls. A larger body of work is available for HRV compared with BRS and EDA, and points to interictal HRV derangements across a wide range of epilepsies, including focal, generalized, and combined generalized and focal epilepsies. HRV alterations are most pronounced in temporal lobe epilepsy, Dravet syndrome and drug-resistant and chronic epilepsies. There are conflicting data on the effect of antiseizure medications on measures of interictal autonomic function. However, carbamazepine has been associated with decreased HRV. Epilepsy surgery and vagus nerve stimulation do not appear to have substantial impact on measures of interictal autonomic function but well designed studies are lacking. SUMMARY Patients with epilepsy, particularly those with longstanding uncontrolled seizures, have measurable alterations of resting autonomic function. These alterations may be relevant to the increased risk of premature mortality in epilepsy, including sudden unexpected death in epilepsy, which warrants investigation in future research.
Collapse
|
25
|
Patodia S, Tan I, Ellis M, Somani A, Scheffer IE, Sisodiya SM, Thom M. Medullary tyrosine hydroxylase catecholaminergic neuronal populations in sudden unexpected death in epilepsy. Brain Pathol 2020; 31:133-143. [PMID: 32852867 PMCID: PMC8018054 DOI: 10.1111/bpa.12891] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 12/26/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is mechanistically complex and one probable cause is seizure‐related respiratory dysfunction. Medullary respiratory regulatory nuclei include the pre‐Bötzinger complex (pre‐BötC) in the ventrolateral medulla (VLM), the medullary raphé nuclei (MR) and nucleus of solitary tract in the dorsomedial medulla (DMM). The region of the VLM also contains intermingled tyrosine hydroxylase (TH) catecholaminergic neurones which directly project to the pre‐BötC and regulate breathing under hypoxic conditions and our aim was to evaluate these neurones in SUDEP cases. In post‐mortem cases from three groups [SUDEP (18), epilepsy controls (8) and non‐epilepsy controls (16)] serial sections of medulla (obex + 2 to + 13 mm) were immunolabeled for TH. Three regions of interest (ROI) were outlined (VLM, DMM and MR) and TH‐immunoreactive (TH‐IR) neurones were evaluated using automated detection for overall labeling index (neurones and processes) and neuronal densities and compared between groups and relative to obex level. C‐fos immunoreactivity was also semi‐quantitatively evaluated in these regions. We found no significant difference in the density of TH‐IR neurones or labeling index between the groups in all regions. Significantly more TH‐IR neurones were present in the DMM region than VLM in non‐epilepsy cases only (P < 0.01). Regional variations in TH‐IR neurones with obex level were seen in all groups except SUDEP. We also identified occasional TH neurones in the MR region in all groups. There was significantly less c‐fos labeling in the VLM and MR in SUDEP than non‐epilepsy controls but no difference with epilepsy controls. In conclusion, in this series we found no evidence for alteration of total medullary TH‐IR neuronal numbers in SUDEP but noted some differences in their relative distribution in the medulla and c‐fos neurones compared to control groups which may be relevant to the mechanism of death.
Collapse
Affiliation(s)
- Smriti Patodia
- Department of Clinical and Experimental epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 2BG, UK
| | - Ian Tan
- Department of Clinical and Experimental epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 2BG, UK
| | - Matthew Ellis
- School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Alyma Somani
- Department of Clinical and Experimental epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 2BG, UK
| | - Ingrid E Scheffer
- Epilepsy Research Centre, Department of Medicine (Neurology), University of Melbourne, Victoria, 3052, Australia
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 2BG, UK.,Chalfont Centre for Epilepsy, Bucks, SL9 0RJ, UK
| | - Maria Thom
- Department of Clinical and Experimental epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 2BG, UK.,School of Cancer Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
ILUŢ S, NISTOR C, NEMES B, DUDEA MS. Therapeutic difficulties in vegetative epileptic seizures as a sign of acute viral encephalitis: case presentation. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acute encephalitis is a severe pathology represented by the inflammation of the brain parenchyma associated with neurological dysfunction. The etiology is predominantly viral or autoimmune, with different therapeutic approach. The typical manifestations include fever, epileptic seizures and neurological focal signs. The treatment consists in specific drug therapies regarding the etiology and rehabilitation therapies in case of incomplete recovery.
We present a case of a 43-year-old woman with occipital cephalalgia and dizziness, associated with vesperal high blood pressure levels at the same hour daily. The brain MRI described possible acute encephalitis, with FLAIR and T2 hypersignal area on right parietal region and diffusion restriction. The lumbar puncture revealed no modifications and the EEG recordings showed irritative patterns. The acyclovir intravenous treatment and an antiepileptic drug were initiated. The repeated MRI revealed laminar necrosis which explained the vegetative epileptic seizures manifested with high blood pressure. The clinical status of the patient majorly improved due to specific treatment including rehabilitation interventions.
Key words: acute viral encephalitis, vegetative epileptic seizures, laminar necrosis, cephalalgia, rehabilitation,
Collapse
Affiliation(s)
- Silvina ILUŢ
- “Iuliu Hațieganu”, University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Cristina NISTOR
- “Iuliu Hațieganu”, University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Bianca NEMES
- “Iuliu Hațieganu”, University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - M. Sorin DUDEA
- “Iuliu Hațieganu”, University of Medicine and Pharmacy , Cluj-Napoca, Romania
| |
Collapse
|
28
|
Cardiac stress after electroconvulsive therapy and spontaneous generalized convulsive seizures: A prospective echocardiographic and blood biomarker study. Epilepsy Behav 2019; 101:106565. [PMID: 31675603 DOI: 10.1016/j.yebeh.2019.106565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/21/2022]
Abstract
AIM Knowledge about cardiac stress related to seizures in electroconvulsive therapy (ECT) and spontaneously occurring generalized convulsive seizures (GCS) is limited. The aim of the present study was to analyze cardiac function and circulating markers of cardiac stress in the early postictal period after ECT and GCS. METHODS Patients undergoing ECT in the Department of Psychiatry, Psychotherapy and Psychosomatics and patients undergoing diagnostic video-EEG monitoring (VEM) in the Department of Neurology were prospectively enrolled between November 2017 and November 2018. Cardiac function was examined twice using transthoracic echocardiography within 60 min and >4 h after ECT or GCS. Established blood markers (troponin T high-sensitive, N-terminal pro brain natriuretic peptide) of cardiac stress or injury were collected within 30 min, 4 to 6 h, and 24 h after ECT or GCS. In the ECT group, the troponin T values were also correlated with periprocedural heart rate and blood pressure values. Because of organizational or technical reasons, the measurement was not performed in all patients. RESULTS Twenty patients undergoing ECT and 6 patients with epilepsy with a GCS during VEM were included. Postictal echocardiography showed no wall motion disorders and no change in left ventricular and right ventricular functions. Four of 17 patients displayed a transient increase in high-sensitive cardiac troponin T 4-6 h after the seizure (3 patients with ECT-induced seizure). None of these 4 patients had signs of an acute cardiac event, and periprocedural blood pressure or heart rate peaks during ECT did not significantly differ in patients with and without troponin T elevation. CONCLUSIONS Signs of mild cardiac stress can occur in some patients following ECT or GCS without clinical complications, probably related to excessive catecholamine release during the seizure.
Collapse
|