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Zeicu C, Legouhy A, Scott CA, Oliveira JFA, Winston GP, Duncan JS, Vos SB, Thom M, Lhatoo S, Zhang H, Harper RM, Diehl B. Altered amygdala volumes and microstructure in focal epilepsy patients with tonic-clonic seizures, ictal, and post-convulsive central apnea. Epilepsia 2023; 64:3307-3318. [PMID: 37857465 PMCID: PMC10952501 DOI: 10.1111/epi.17804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death for patients with epilepsy; however, the pathophysiology remains unclear. Focal-to-bilateral tonic-clonic seizures (FBTCS) are a major risk factor, and centrally-mediated respiratory depression may increase the risk further. Here, we determined the volume and microstructure of the amygdala, a key structure that can trigger apnea in people with focal epilepsy, stratified by the presence or absence of FBTCS, ictal central apnea (ICA), and post-convulsive central apnea (PCCA). METHODS Seventy-three patients with focal impaired awareness seizures without FBTC seizures (FBTCneg group) and 30 with FBTCS (FBTCpos group) recorded during video electroencephalography (VEEG) with respiratory monitoring were recruited prospectively during presurgical investigations. We acquired high-resolution T1-weighted anatomic and multi-shell diffusion images, and computed neurite orientation dispersion and density imaging (NODDI) metrics in all patients with epilepsy and 69 healthy controls. Amygdala volumetric and microstructure alterations were compared between three groups: healthy subjects, FBTCneg and FBTCpos groups. The FBTCpos group was further subdivided by the presence of ICA and PCCA, verified by VEEG. RESULTS Bilateral amygdala volumes were significantly increased in the FBTCpos cohort compared to healthy controls and the FBTCneg group. Patients with recorded PCCA had the highest increase in bilateral amygdala volume of the FBTCpos cohort. Amygdala neurite density index (NDI) values were decreased significantly in both the FBTCneg and FBTCpos groups relative to healthy controls, with values in the FBTCpos group being the lowest of the two. The presence of PCCA was associated with significantly lower NDI values vs the non-apnea FBTCpos group (p = 0.004). SIGNIFICANCE Individuals with FBTCpos and PCCA show significantly increased amygdala volumes and disrupted architecture bilaterally, with greater changes on the left side. The structural alterations reflected by NODDI and volume differences may be associated with inappropriate cardiorespiratory patterns mediated by the amygdala, particularly after FBTCS. Determination of amygdala volumetric and architectural changes may assist identification of individuals at risk.
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Affiliation(s)
- Claudia Zeicu
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Antoine Legouhy
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
| | - Catherine A. Scott
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of Clinical NeurophysiologyUniversity College London Hospitals NHS Foundation Trust National Hospital for Neurology and NeurosurgeryLondonUK
| | - Joana F. A. Oliveira
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of Clinical NeurophysiologyUniversity College London Hospitals NHS Foundation Trust National Hospital for Neurology and NeurosurgeryLondonUK
| | - Gavin P. Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Epilepsy Society MRI UnitChalfont St PeterUK
- Department of Medicine, Division of NeurologyQueen's UniversityKingstonOntarioCanada
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Sjoerd B. Vos
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
- Neuroradiological Academic Unit, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Centre for Microscopy, Characterisation, and AnalysisThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Samden Lhatoo
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTexasUSA
| | - Hui Zhang
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
| | - Ronald M. Harper
- Brain Research InstituteUniversity of California at Los AngelesLos AngelesCaliforniaUSA
- Department of Neurobiology, David Geffen School of MedicineUniversity of California at Los AngelesLos AngelesCaliforniaUSA
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of Clinical NeurophysiologyUniversity College London Hospitals NHS Foundation Trust National Hospital for Neurology and NeurosurgeryLondonUK
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Zeicu C, Legouhy A, Scott CA, Oliveira JFA, Winston G, Duncan JS, Vos SB, Thom M, Lhatoo S, Zhang H, Harper RM, Diehl B. Altered Amygdala Volumes and Microstructure in Focal Epilepsy Patients with Tonic-Clonic Seizures, Ictal and Post-Ictal Central Apnea. medRxiv 2023:2023.03.16.23287369. [PMID: 36993530 PMCID: PMC10055587 DOI: 10.1101/2023.03.16.23287369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objectives Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death for patients with epilepsy; however, the pathophysiology remains unclear. Focal-to-bilateral tonic-clonic seizures (FBTCS) are a major risk factor, and centrally-mediated respiratory depression may increase the risk further. Here, we determined volume and microstructure of the amygdala, a key structure that can trigger apnea in people with focal epilepsy, stratified by presence or absence of FBTCS, ictal central apnea (ICA) and post-ictal central apnea (PICA). Methods 73 patients with only-focal seizures and 30 with FBTCS recorded during video EEG (VEEG) with respiratory monitoring were recruited prospectively during presurgical investigations. We acquired high-resolution T1-weighted anatomical and multi-shell diffusion images, and computed neurite orientation dispersion and density imaging (NODDI) metrics in all epilepsy patients and 69 healthy controls. Amygdala volumetric and microstructure alterations were compared between healthy subjects, and patients with only-focal seizures or FBTCS The FBTCS group was further subdivided by presence of ICA and PICA, verified by VEEG. Results Bilateral amygdala volumes were significantly increased in the FBTCS cohort compared to healthy controls and the focal cohort. Patients with recorded PICA had the highest increase in bilateral amygdala volume of the FBTCS cohort.Amygdala neurite density index (NDI) values were significantly decreased in both the focal and FBTCS groups relative to healthy controls, with values in the FBTCS group being the lowest of the two. The presence of PICA was associated with significantly lower NDI values vs the non-apnea FBTCS group (p=0.004). Significance Individuals with FBTCS and PICA show significantly increased amygdala volumes and disrupted architecture bilaterally, with greater changes on the left side. The structural alterations reflected by NODDI and volume differences may be associated with inappropriate cardiorespiratory patterns mediated by the amygdala, particularly after FBTCS. Determination of amygdala volumetric and architectural changes may assist identification of individuals at risk.
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Affiliation(s)
- Claudia Zeicu
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Antoine Legouhy
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Catherine A. Scott
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Joana F. A. Oliveira
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Gavin Winston
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
- Division of Neurology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sjoerd B. Vos
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Samden Lhatoo
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Hui Zhang
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Ronald M. Harper
- Brain Research Institute, University of California at Los Angeles, California, USA
- Department of Neurobiology, David Geffen School of Medicine, University of California at Los Angeles, California, USA
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Scott CA, Li L, Rothwell PM. Diverging Temporal Trends in Stroke Incidence in Younger vs Older People: A Systematic Review and Meta-analysis. JAMA Neurol 2022; 79:1036-1048. [PMID: 35943738 PMCID: PMC9364236 DOI: 10.1001/jamaneurol.2022.1520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/15/2022] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Overall stroke incidence is falling in high-income countries, but data on time trends in incidence of young stroke (ie, stroke in individuals younger than 55 years) are conflicting. An age-specific divergence in incidence, with less favorable trends at younger vs older ages, might be a more consistent underlying finding across studies. OBJECTIVE To compare temporal trends in incidence of stroke at younger vs older ages in high-income countries. DATA SOURCES PubMed and EMBASE were searched from inception to February 2022. One additional population-based study (Oxford Vascular Study) was also included. STUDY SELECTION Studies reporting age-specific stroke incidence in high-income countries at more than 1 time point. DATA EXTRACTION AND SYNTHESIS For all retrieved studies, 2 authors independently reviewed the full text against the inclusion criteria to establish their eligibility. Meta-analysis was performed with the inverse variance-weighted random-effects model. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. MAIN OUTCOMES AND MEASURES The main outcome was age-specific divergence (<55 vs ≥55 years) in temporal trends in stroke incidence (relative temporal rate ratio [RTTR]) in studies extending to at least 2000. RTTRs were calculated for each study and pooled by random-effects meta-analysis, with stratification by administrative vs prospective population-based methodology, sex, stroke subtype (ischemic vs intracerebral hemorrhage vs subarachnoid hemorrhage) and geographical region. RESULTS Among 50 studies in 20 countries, 26 (13 prospective population-based and 13 administrative studies) reported data allowing calculation of the RTTR for stroke incidence at younger vs older ages across 2 or more periods, the latest extending beyond 2000. Reported trends in absolute incidence of young individuals with stroke were heterogeneous, but all studies showed a less favorable trend in incidence at younger vs older ages (pooled RTTR = 1.57 [95% CI, 1.42-1.74]). The overall RTTR was consistent by stroke subtype (ischemic, 1.62 [95% CI, 1.44-1.83]; intracerebral hemorrhage, 1.32 [95% CI, 0.91-1.92]; subarachnoid hemorrhage, 1.54 [95% CI, 1.00-2.35]); and by sex (men, 1.46 [95% CI, 1.34-1.60]; women, 1.41 [95% CI, 1.28-1.55]) but was greater in studies reporting trends solely after 2000 (1.51 [95% CI, 1.30-1.70]) vs solely before (1.18 [95% CI, 1.12-1.24]) and was highest in population-based studies in which the most recent reported period of ascertainment started after 2010 (1.87 [95% CI, 1.55-2.27]). CONCLUSIONS AND RELEVANCE Temporal trends in stroke incidence are diverging by age in high-income countries, with less favorable trends at younger vs older ages, highlighting the urgent need to better understand etiology and prevention of stroke at younger ages.
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Affiliation(s)
- Catherine A. Scott
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Peter M. Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
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Li L, Scott CA, Rothwell PM. Association of Younger vs Older Ages With Changes in Incidence of Stroke and Other Vascular Events, 2002-2018. JAMA 2022; 328:563-574. [PMID: 35943470 PMCID: PMC9364129 DOI: 10.1001/jama.2022.12759] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/08/2022] [Indexed: 12/22/2022]
Abstract
Importance Some studies have reported increasing stroke incidence at younger ages (<55 years) but have often relied only on administrative data, and more population-based studies of adjudicated stroke are required. An understanding of the drivers of any increase in incidence of young stroke also requires comparisons with stroke trends at older ages and with trends in incidence of other vascular events at younger ages. Objective To determine temporal changes in incidence of stroke and other major vascular events at younger vs older ages. Design, Setting, and Participants Prospective population-based incidence study conducted from April 2002 to March 2018 with a mean catchment population of 94 567 in Oxfordshire, England. Exposures Calendar time, premorbid vascular risk factors, and occupation. Main Outcomes and Measures Changes in incidence of stroke, transient ischemic attack (TIA), and other major vascular events (myocardial infarction, sudden cardiac death, and peripheral vascular events) stratified by age, sex, diagnostic workup, etiology, and severity. Results A total of 2429 incident strokes were ascertained (mean age, 73.6 [SD, 14.4] years; 51.3% female). From 2002-2010 to 2010-2018, stroke incidence increased significantly among participants younger than 55 years (incidence rate ratio [IRR], 1.67; 95% CI, 1.31-2.14) but fell significantly among participants aged 55 years or older (IRR, 0.85; 95% CI, 0.78-0.92; P < .001 for difference). The significant increase in incidence at younger than 55 years was independent of sex, stroke severity, pathological subtype, and changes in investigation and was also seen for TIA (IRR, 1.87; 95% CI, 1.36-2.57) but not for myocardial infarction and other major vascular events (IRR, 0.73; 95% CI, 0.58-0.93). Although TIA and stroke at younger than 55 years were significantly associated with diabetes (risk ratio [RR], 3.47; 95% CI, 2.54-4.74), hypertension (RR, 2.52; 95% CI, 2.04-3.12), current smoking (RR, 2.38; 95% CI, 1.92-2.94), and obesity (RR, 1.36; 95% CI, 1.07-1.72), the significant increase in incidence from 2002-2010 to 2010-2018 was still seen in individuals without these risk factors. The increase was greatest in professional/managerial occupations (IRR, 2.52; 95% CI, 1.75-3.62) and least in partially skilled/unskilled occupations (IRR, 1.17; 95% CI, 0.79-1.74). The proportion of TIAs and strokes among those younger than 55 years without known vascular risk factors increased significantly over time (45 [30.4%] vs 115 [42.4%]; absolute difference, 12.0%; 95% CI, 2.6-21.5), especially in patients with cryptogenic events (10 [18.5%] vs 63 [49.2%]; absolute difference, 30.7%; 95% CI, 17.2-44.2; P < .001; P = .002 for heterogeneity). Conclusions and Relevance Comparing persons living in Oxfordshire, England, in 2002-2010 vs 2010-2018, there was a significant increase in stroke incidence in those younger than 55 years, but a decrease in those aged 55 years or older. Given the absence of this divergence for other vascular events, further research is needed to understand the causes of this difference.
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Affiliation(s)
- Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Catherine A. Scott
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Peter M. Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Allen LA, Harper RM, Vos SB, Scott CA, Lacuey N, Vilella L, Winston JS, Whatley BP, Kumar R, Ogren J, Hampson JS, Rani S, Winston GP, Lemieux L, Lhatoo SD, Diehl B. Peri-ictal hypoxia is related to extent of regional brain volume loss accompanying generalized tonic-clonic seizures. Epilepsia 2020; 61:1570-1580. [PMID: 32683693 PMCID: PMC7496610 DOI: 10.1111/epi.16615] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Hypoxia, or abnormally low blood-oxygen levels, often accompanies seizures and may elicit brain structural changes in people with epilepsy which contribute to central processes underlying sudden unexpected death in epilepsy (SUDEP). The extent to which hypoxia may be related to brain structural alterations in this patient group remains unexplored. METHODS We analyzed high-resolution T1-weighted magnetic resonance imaging (MRI) to determine brain morphometric and volumetric alterations in people with generalized tonic-clonic seizures (GTCS) recorded during long-term video-electroencephalography (VEEG), recruited from two sites (n = 22), together with data from age- and sex-matched healthy controls (n = 43). Subjects were sub-divided into those with mild/moderate (GTCS-hypox-mild/moderate, n = 12) and severe (GTCS-hypox-severe, n = 10) hypoxia, measured by peripheral oxygen saturation (SpO2 ) during VEEG. Whole-brain voxel-based morphometry (VBM) and regional volumetry were used to assess group comparisons and correlations between brain structural measurements as well as the duration and extent of hypoxia during GTCS. RESULTS Morphometric and volumetric alterations appeared in association with peri-GTCS hypoxia, including volume loss in the periaqueductal gray (PAG), thalamus, hypothalamus, vermis, cerebellum, parabrachial pons, and medulla. Thalamic and PAG volume was significantly reduced in GTCS patients with severe hypoxia compared with GTCS patients with mild/moderate hypoxia. Brainstem volume loss appeared in both hypoxia groups, although it was more extensive in those with severe hypoxia. Significant negative partial correlations emerged between thalamic and hippocampal volume and extent of hypoxia, whereas vermis and accumbens volumes declined with increasing hypoxia duration. SIGNIFICANCE Brain structural alterations in patients with GTCS are related to the extent of hypoxia in brain sites that serve vital functions. Although the changes are associative only, they provide evidence of injury to regulatory brain sites related to respiratory manifestations of seizures.
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Affiliation(s)
- Luke A. Allen
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
- Epilepsy Society MRI UnitChalfont St PeterUK
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
| | - Ronald M. Harper
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- UCLA Brain Research InstituteLos AngelesCAUSA
- Department of NeurobiologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Sjoerd B. Vos
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Centre for Medical Image ComputingUniversity College LondonLondonUK
- Neuroradiological Academic UnitUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Catherine A. Scott
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of Clinical NeurophysiologyNational Hospital for Neurology and NeurosurgeryUCLHLondonUK
| | - Nuria Lacuey
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Laura Vilella
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Joel S. Winston
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Benjamin P. Whatley
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Rajesh Kumar
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of NeurobiologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
- Department of AnaesthesiologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Jennifer Ogren
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- UCLA Brain Research InstituteLos AngelesCAUSA
- Department of NeurobiologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Jaison S. Hampson
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Sandhya Rani
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
- Epilepsy Society MRI UnitChalfont St PeterUK
- Division of NeurologyDepartment of MedicineQueen's UniversityKingstonOntarioCanada
| | - Louis Lemieux
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Samden D. Lhatoo
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTXUSA
| | - Beate Diehl
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyUniversity College LondonLondonUK
- The Center for SUDEP ResearchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Department of Clinical NeurophysiologyNational Hospital for Neurology and NeurosurgeryUCLHLondonUK
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Abstract
Supplemental Digital Content is available in the text. Population-based studies provide the most reliable data on stroke incidence. A previous systematic review of population-based studies suggested that stroke incidence in high-income countries decreased by 42% between the 1970s and early 2000s. However, it is uncertain whether this trend of steady decline has been maintained in more recent periods.
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Affiliation(s)
- Linxin Li
- From the Nuffield Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Catherine A Scott
- From the Nuffield Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Peter M Rothwell
- From the Nuffield Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
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Allen LA, Vos SB, Kumar R, Ogren JA, Harper RK, Winston GP, Balestrini S, Wandschneider B, Scott CA, Ourselin S, Duncan JS, Lhatoo SD, Harper RM, Diehl B. Cerebellar, limbic, and midbrain volume alterations in sudden unexpected death in epilepsy. Epilepsia 2019; 60:718-729. [PMID: 30868560 DOI: 10.1111/epi.14689] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The processes underlying sudden unexpected death in epilepsy (SUDEP) remain elusive, but centrally mediated cardiovascular or respiratory collapse is suspected. Volume changes in brain areas mediating recovery from extreme cardiorespiratory challenges may indicate failure mechanisms and allow prospective identification of SUDEP risk. METHODS We retrospectively imaged SUDEP cases (n = 25), patients comparable for age, sex, epilepsy syndrome, localization, and disease duration who were high-risk (n = 25) or low-risk (n = 23), and age- and sex-matched healthy controls (n = 25) with identical high-resolution T1-weighted scans. Regional gray matter volume, determined by voxel-based morphometry, and segmentation-derived structure sizes were compared across groups, controlling for total intracranial volume, age, and sex. RESULTS Substantial bilateral gray matter loss appeared in SUDEP cases in the medial and lateral cerebellum. This was less prominent in high-risk subjects and absent in low-risk subjects. The periaqueductal gray, left posterior and medial thalamus, left hippocampus, and bilateral posterior cingulate also showed volume loss in SUDEP. High-risk subjects showed left thalamic volume reductions to a lesser extent. Bilateral amygdala, entorhinal, and parahippocampal volumes increased in SUDEP and high-risk patients, with the subcallosal cortex enlarged in SUDEP only. Disease duration correlated negatively with parahippocampal volume. Volumes of the bilateral anterior insula and midbrain in SUDEP cases were larger the closer to SUDEP from magnetic resonance imaging. SIGNIFICANCE SUDEP victims show significant tissue loss in areas essential for cardiorespiratory recovery and enhanced volumes in areas that trigger hypotension or impede respiratory patterning. Those changes may shed light on SUDEP pathogenesis and prospectively detect patterns identifying those at risk.
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Affiliation(s)
- Luke A Allen
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, London, UK.,Center for Sudden Unexpected Death in Epilepsy Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Sjoerd B Vos
- Magnetic Resonance Imaging Unit, Epilepsy Society, London, UK.,Center for Sudden Unexpected Death in Epilepsy Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, , UK.,Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Rajesh Kumar
- Center for Sudden Unexpected Death in Epilepsy Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Brain Research Institute, University of California, Los Angeles, Los Angeles, California.,Department of Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.,Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, California
| | - Jennifer A Ogren
- Center for Sudden Unexpected Death in Epilepsy Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Department of Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Rebecca K Harper
- Department of Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, London, UK
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, London, UK
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, London, UK
| | - Catherine A Scott
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK.,Center for Sudden Unexpected Death in Epilepsy Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Sebsatien Ourselin
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, London, UK
| | - Samden D Lhatoo
- Center for Sudden Unexpected Death in Epilepsy Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, Cleveland, Ohio.,Department of Neurology, University of Texas Health Sciences Center at Houston, United States
| | - Ronald M Harper
- Center for Sudden Unexpected Death in Epilepsy Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Brain Research Institute, University of California, Los Angeles, Los Angeles, California.,Department of Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, London, UK.,Center for Sudden Unexpected Death in Epilepsy Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
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Allen LA, Harper RM, Kumar R, Guye M, Ogren JA, Lhatoo SD, Lemieux L, Scott CA, Vos SB, Rani S, Diehl B. Dysfunctional Brain Networking among Autonomic Regulatory Structures in Temporal Lobe Epilepsy Patients at High Risk of Sudden Unexpected Death in Epilepsy. Front Neurol 2017; 8:544. [PMID: 29085330 PMCID: PMC5650686 DOI: 10.3389/fneur.2017.00544] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) is common among young people with epilepsy. Individuals who are at high risk of SUDEP exhibit regional brain structural and functional connectivity (FC) alterations compared with low-risk patients. However, less is known about network-based FC differences among critical cortical and subcortical autonomic regulatory brain structures in temporal lobe epilepsy (TLE) patients at high risk of SUDEP. METHODS 32 TLE patients were risk-stratified according to the following clinical criteria: age of epilepsy onset, duration of epilepsy, frequency of generalized tonic-clonic seizures, and presence of nocturnal seizures, resulting in 14 high-risk and 18 low-risk cases. Resting-state functional magnetic resonance imaging (rs-fMRI) signal time courses were extracted from 11 bilateral cortical and subcortical brain regions involved in autonomic and other regulatory processes. After computing all pairwise correlations, FC matrices were analyzed using the network-based statistic. FC strength among the 11 brain regions was compared between the high- and low-risk patients. Increases and decreases in FC were sought, using high-risk > low-risk and low-risk > high-risk contrasts (with covariates age, gender, lateralization of epilepsy, and presence of hippocampal sclerosis). RESULTS High-risk TLE patients showed a subnetwork with significantly reduced FC (t = 2.5, p = 0.029) involving the thalamus, brain stem, anterior cingulate, putamen and amygdala, and a second subnetwork with significantly elevated FC (t = 2.1, p = 0.031), which extended to medial/orbital frontal cortex, insula, hippocampus, amygdala, subcallosal cortex, brain stem, thalamus, caudate, and putamen. CONCLUSION TLE patients at high risk of SUDEP showed widespread FC differences between key autonomic regulatory brain regions compared to those at low risk. The altered FC revealed here may help to shed light on the functional correlates of autonomic disturbances in epilepsy and mechanisms involved in SUDEP. Furthermore, these findings represent possible objective biomarkers which could help to identify high-risk patients and enhance SUDEP risk stratification via the use of non-invasive neuroimaging, which would require validation in larger cohorts, with extension to patients with other epilepsies and subjects who succumb to SUDEP.
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Affiliation(s)
- Luke A Allen
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Ronald M Harper
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States
| | - Rajesh Kumar
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States.,Department of Anaesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Maxime Guye
- Aix Marseille University, CNRS, CRMBM UMR 7339, Marseille, France
| | - Jennifer A Ogren
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Samden D Lhatoo
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Louis Lemieux
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom
| | - Catherine A Scott
- Institute of Neurology, University College London, London, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Sjoerd B Vos
- Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Translational Imaging Group, University College London, London, United Kingdom
| | - Sandhya Rani
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Beate Diehl
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
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10
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Gollwitzer S, Scott CA, Farrell F, Bell GS, de Tisi J, Walker MC, Wehner T, Sander JW, Hamer HM, Diehl B. The long-term course of temporal lobe epilepsy: From unilateral to bilateral interictal epileptiform discharges in repeated video-EEG monitorings. Epilepsy Behav 2017; 68:17-21. [PMID: 28109984 DOI: 10.1016/j.yebeh.2016.12.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bilateral interictal epileptiform discharges (IED) and ictal patterns are common in temporal lobe epilepsy (TLE) and have been associated with decreased chances of seizure freedom after epilepsy surgery. It is unclear whether secondary epileptogenesis, although demonstrated in experimental models, exists in humans and may account for progression of epilepsy. MATERIAL AND METHODS We reviewed consecutive video-EEG recordings from 1992 to 2014 repeated at least two years apart (mean interval 6.14years) in 100 people diagnosed with TLE. RESULTS Ictal EEG patterns and IED remained restricted to one hemisphere in 36 people (group 1), 46 exhibited bilateral abnormalities from the first recording (group 2), 18 progressed from unilateral to bilateral EEG pathology over time (group 3). No significant differences between the three groups were seen with respect to age at epilepsy onset, duration, or underlying pathology. Extra-temporal IED during the first EEG recording were associated with an increased risk of developing bilateral epileptiform changes over time (hazard ratio 3.67; 95% CI 1.4, 9.4). CONCLUSION Our findings provide some support of progression in TLE and raise the possibility of secondary epileptogenesis in humans. The development of an independent contra-lateral epileptogenic focus is known to be associated with a less favorable surgical outcome. We defined reliable EEG markers for an increased risk of progression to more widespread or independent bitemporal epileptogenicity at an early stage, thus allowing for individualized pre-surgical counselling.
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Affiliation(s)
- Stephanie Gollwitzer
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
| | - Catherine A Scott
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Fiona Farrell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; Epilepsy Society, Chalfont St Peter SL9 0RJ, United Kingdom
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; Epilepsy Society, Chalfont St Peter SL9 0RJ, United Kingdom
| | - Jane de Tisi
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Matthew C Walker
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Tim Wehner
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; Epilepsy Society, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Beate Diehl
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
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Yang Z, Scott CA, Mao C, Tang J, Farmer AJ. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med 2014; 44:487-99. [PMID: 24297743 DOI: 10.1007/s40279-013-0128-8] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Resistance and aerobic exercises are both recommended as effective treatments for people with type 2 diabetes. However, the optimum type of exercise for the disease remains to be determined to inform clinical decision-making and facilitate personalized exercise prescription. OBJECTIVES Our objective was to investigate whether resistance exercise is comparable to aerobic exercise in terms of effectiveness and safety in people with type 2 diabetes. DATA SOURCES PubMed, EMBASE, CENTRAL, CINAHL, and SPORTdiscus were systematically searched up to March 2013. The reference lists of eligible studies and relevant reviews were also checked. STUDY SELECTION We used the following criteria to select studies for inclusion in the review: (i) the study was a randomized controlled trial; (ii) the participants were people with type 2 diabetes aged 18 years or more; (iii) the trial compared resistance exercise with aerobic exercise for a duration of at least 8 weeks, with pre-determined frequency, intensity, and duration; and (iv) the trial provided relevant data on at least one of the following: glycaemic control, blood lipids, anthropometric measures, blood pressure, fitness, health status, and adverse events. STUDY APPRAISAL AND SYNTHESIS METHODS The assessment of study quality was based on the Cochrane Risk of Bias tool. For effectiveness measures, differences (resistance group minus aerobic group) in the changes from baseline with the two exercises were combined, using a random-effects model wherever possible. For adverse events, the relative risks (resistance group vs. aerobic group) were combined. RESULTS Twelve trials (n = 626) were included. Following the exercise interventions, there was a greater reduction of glycosylated hemoglobin with aerobic exercise than with resistance exercise (difference 0.18% (1.97 mmol/mol), 95% confidence interval (CI) 0.01, 0.36). This difference became non-significant with sensitivity analysis (p = 0.14). The differences in changes from baseline were also statistically significant for body mass index (difference 0.22, 95% CI 0.06, 0.39), peak oxygen consumption (difference -1.84 mL/kg/min, 95% CI -3.07, -0.62), and maximum heart rate (difference 3.44 beats per minute, 95% CI 2.49, 4.39). Relative risks for adverse events (all) and serious adverse events were 1.17 (95% CI 0.77, 1.79) and 0.89 (95% CI 0.18, 4.39), respectively. LIMITATIONS Most included trials were short term (8 weeks to 6 months), and seven had important methodological limitations. Additionally, the meta-analyses for some of the secondary outcomes had a small number of participants or substantial statistical heterogeneity. CONCLUSIONS Although differences in some diabetic control and physical fitness measures between resistance exercise and aerobic exercise groups reached statistical significance, there is no evidence that they are of clinical importance. There is also no evidence that resistance exercise differs from aerobic exercise in impact on cardiovascular risk markers or safety. Using one or the other type of exercise for type 2 diabetes may be less important than doing some form of physical activity. Future long-term studies focusing on patient-relevant outcomes are warranted.
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Affiliation(s)
- Zuyao Yang
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China,
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12
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Kovac S, Rodionov R, Chinnasami S, Wehner T, Scott CA, McEvoy AW, Miserocchi A, Diehl B. Clinical significance of nonhabitual seizures during intracranial EEG monitoring. Epilepsia 2013; 55:e1-5. [PMID: 24299110 DOI: 10.1111/epi.12462] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 01/07/2023]
Abstract
This study sought to determine the frequency and clinical significance of nonhabitual seizures in 101 consecutive patients undergoing presurgical intracranial electroencephalography intracranial (icEEG) recording. We compared clinical data, recording details, and postsurgical outcome in patients with nonhabitual seizures to those without nonhabitual seizures during icEEG. In patients with nonhabitual seizures we compared icEEG recordings of nonhabitual seizures to recordings of habitual seizures. Nonhabitual seizures were recorded in 10% of patients. Those patients had a significantly higher rate of procedure-related complications compared to patients without nonhabitual seizures. Ultimate seizure outcome did not differ between the groups. Nonhabitual seizures often occurred within the first 3 days of icEEG recording and had larger seizure-onset zones compared to the patient's habitual seizures. Nonhabitual seizures have no effect on outcome of epilepsy surgery but may serve as important markers of procedure-related complications during icEEG.
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Affiliation(s)
- Stjepana Kovac
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology, University of Muenster, Muenster, Germany
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Scott CA, Atkinson SH, Sodha A, Tate C, Sadiq J, Lakhoo K, Pollard AJ. Management of lymphadenitis due to non-tuberculous mycobacterial infection in children. Pediatr Surg Int 2012; 28:461-6. [PMID: 22438045 DOI: 10.1007/s00383-012-3068-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE Non-tuberculous mycobacterial (NTM) infection is an important cause of cervico-facial lymph node enlargement in young children. The optimal treatment is thought to be early complete excision without chemotherapy. We compared management of patients referred to our centre to this "gold standard" and determined clinical outcomes by type of primary surgical intervention (complete excision vs. incomplete excision). METHODS Retrospective study of management and clinical outcomes of all children (<12 years) with NTM lymphadenitis referred to a single UK centre between May 1998 and May 2008. RESULTS We identified 43 children. Median time from onset of swelling to operation was 6 weeks. Management was: no operation (n = 1, 2 %), complete excision (n = 20, 47 %), incision and drainage (n = 17, 40 %) and fine needle aspirate (n = 5, 12 %). Children not treated by primary complete excision were more likely to have: re-operation (91 vs. 30 %; χ(2) = 16.48; p < 0.0001); persistent lymphadenitis (77 vs. 30 %; χ(2) = 9.45; p = 0.002); sinus formation (26 vs. 5 %; χ2 = 3.74; p = 0.05). CONCLUSION Failure to undertake primary complete excision leads to further morbidity. A high index of suspicion is required for timely appropriate management to avoid unnecessary morbidity and further intervention.
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Affiliation(s)
- Catherine A Scott
- Department of Paediatrics, Childrens Hospital, University of Oxford, Oxford, OX3 9DU, UK
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14
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Styles P, Soffe NF, Scott CA, Cragg DA, Row F, White DJ, White PCJ. A high-resolution NMR probe in which the coil and preamplifier are cooled with liquid helium. 1984. J Magn Reson 2011; 213:347-354. [PMID: 22152353 DOI: 10.1016/j.jmr.2011.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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15
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Strzelczyk A, Adjei P, Scott CA, Bauer S, Rosenow F, Walker MC, Surges R. Postictal increase in T-wave alternans after generalized tonic-clonic seizures. Epilepsia 2011; 52:2112-7. [DOI: 10.1111/j.1528-1167.2011.03266.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Surges R, Strzelczyk A, Scott CA, Walker MC, Sander JW. Postictal generalized electroencephalographic suppression is associated with generalized seizures. Epilepsy Behav 2011; 21:271-4. [PMID: 21570920 DOI: 10.1016/j.yebeh.2011.04.008] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/07/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
Abstract
Postictal generalized electroencephalographic suppression (PGES) may be involved in sudden unexpected death in epilepsy (SUDEP). We examined whether the occurrence of PGES depends on seizure type and whether PGES occurs more frequently in people with epilepsy who died suddenly. EEG recordings of people with pharmacoresistant focal epilepsies who died from SUDEP after presurgical video/EEG telemetry were compared with recordings of living controls. To test if PGES depends on seizure type, EEG recordings of people with temporal lobe epilepsy who had complex partial seizures (CPS) and secondarily generalized tonic-clonic seizures (GTCS) were reviewed. A total of 122 seizures in 57 individuals have been included. PGES was observed in 15% of all seizures in 26% of all individuals. Secondarily GTCS were significantly associated with PGES. Neither presence nor duration of PGES differed between the SUDEP and control groups. In conclusion, PGES is facilitated by secondarily GTCS, but does not seem to be an independent risk factor for SUDEP.
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Affiliation(s)
- Rainer Surges
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom.
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17
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Bell GS, Sinha S, Tisi JD, Stephani C, Scott CA, Harkness WF, McEvoy AW, Peacock JL, Walker MC, Smith SJ, Duncan JS, Sander JW. Premature mortality in refractory partial epilepsy: does surgical treatment make a difference? J Neurol Neurosurg Psychiatry 2010; 81:716-8. [PMID: 20478848 DOI: 10.1136/jnnp.2008.170837] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy. METHODS The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery). RESULTS There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8). CONCLUSION Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.
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Affiliation(s)
- G S Bell
- Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK
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Abstract
OBJECTIVE Generalized tonic-clonic seizures (GTCS) are a major risk factor for sudden unexpected death in epilepsy (SUDEP). We investigated whether ictal/postictal cardiac features were dependent on seizure type within individual patients. METHODS ECG data from patients with medically refractory temporal lobe epilepsy (TLE) undergoing presurgical investigation who had both complex partial seizures and secondarily GTCS during video-EEG telemetry were retrospectively reviewed. Peri-ictal heart rate (HR), corrected QT interval (QTc), HR variability, and cardiac rhythm were assessed. RESULTS Twenty-five patients were included in this study. Secondarily GTCS led to higher ictal HR, persistent postictal tachycardia, and decreased postictal HR variability. Moreover, abnormal shortening of QTc occurred in 17 patients mainly during the early postictal phase and significantly more often in secondarily GTCS. Abnormal QTc prolongation occurred in 3 patients with no significant association with GTCS. Benign cardiac arrhythmias occurred in 14 patients and were independent of seizure type. CONCLUSIONS Our data suggest a substantial disturbance of autonomic function following secondarily generalized tonic-clonic seizures (GTCS) in patients with medically refractory temporal lobe epilepsy. The observed alterations could potentially facilitate sudden cardiac death and might contribute to the association of sudden unexpected death in epilepsy with GTCS.
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Affiliation(s)
- Rainer Surges
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
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19
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Surges R, Adjei P, Kallis C, Erhuero J, Scott CA, Bell GS, Sander JW, Walker MC. Pathologic cardiac repolarization in pharmacoresistant epilepsy and its potential role in sudden unexpected death in epilepsy: A case-control study. Epilepsia 2010; 51:233-42. [DOI: 10.1111/j.1528-1167.2009.02330.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Adjei P, Surges R, Scott CA, Kallis C, Shorvon S, Walker MC. Do subclinical electrographic seizure patterns affect heart rate and its variability? Epilepsy Res 2009; 87:281-5. [DOI: 10.1016/j.eplepsyres.2009.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 08/11/2009] [Accepted: 08/22/2009] [Indexed: 10/20/2022]
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Surges R, Scott CA, Walker MC. Peri-ictal atrioventricular conduction block in a patient with a lesion in the left insula: case report and review of the literature. Epilepsy Behav 2009; 16:347-9. [PMID: 19700372 DOI: 10.1016/j.yebeh.2009.07.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 07/22/2009] [Accepted: 07/24/2009] [Indexed: 10/20/2022]
Abstract
Seizure-induced syncope is uncommon and is usually due to peri-ictal bradycardia and asystole. In contrast, peri-ictal atrioventricular conduction block (AV block) has been reported only rarely. Here, we review the literature on peri-ictal AV block and describe a patient with recurrent episodes of epigastric auras that were occasionally followed by a sensation of dizziness and syncope because of transient third-degree AV block. After installation of a cardiac pacemaker, epigastric auras persisted, whereas the sensation of dizziness and syncope stopped. MRI revealed a lesion in the left insula, leading to the notion that recurrent syncope was most likely due to ictal activity in central autonomic networks.
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Affiliation(s)
- Rainer Surges
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
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Borelli P, Shorvon SD, Stevens JM, Smith SJ, Scott CA, Walker MC. Extratemporal ictal clinical features in hippocampal sclerosis: Their relationship to the degree of hippocampal volume loss and to the outcome of temporal lobectomy. Epilepsia 2008; 49:1333-9. [DOI: 10.1111/j.1528-1167.2008.01694.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rac VE, Scott CA, Small C, Adamson SL, Rurak D, Challis JR, Lye SJ. Dose-dependent effects of meloxicam administration on cyclooxygenase-1 and cyclooxygenase-2 protein expression in intrauterine tissues and fetal tissues of a sheep model of preterm labor. Reprod Sci 2008; 14:750-64. [PMID: 18089593 DOI: 10.1177/1933719107309042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Meloxicam (MEL), a cyclooxygenase (COX)-2 inhibitor, decreases prostaglandin production and blocks preterm labor in sheep. The objective of this study is to investigate MEL dosage regimens on COX-1, COX-2, and prostaglandin dehydrogenase (PGDH) expression in ovine intrauterine and fetal tissues. Animals in preterm labor received maternal infusions of saline or MEL at maintained high or graded doses (study 1) or acute graded doses (study 2). MEL blocked preterm labor. In study 1, MEL decreased COX-2 expression in the endometrium, myometrium, and amnion but not placenta or fetal tissues. In study 2, COX-2 expression was unchanged. COX-1/PGDH expression was unaffected. While MEL is an effective tocolytic, reductions in COX-2 protein occurred only with maintained MEL exposure. MEL effects are tissue specific and do not affect COX-1 or PGDH expression. Maternal MEL does not affect fetal COX expression in the sheep, possibly contributing to its lack of fetal side effects.
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Affiliation(s)
- Valeria E Rac
- Research Centre for Women's and Infant's Health, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Jackson AC, Scott CA, Owen J, Weli SC, Rossiter JP. Human rabies therapy: lessons learned from experimental studies in mouse models. Dev Biol (Basel) 2008; 131:377-385. [PMID: 18634499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Ketamine was one of the therapeutic agents used as a therapy for a human rabies survivor who did not receive rabies vaccine. Ketamine therapy is re-examined here in infected mouse primary neuron cultures and in adult ICR mice using the CVS strain with both intracerebral and peripheral routes of inoculation with ketamine vs. vehicle given intraperitoneally. No significant beneficial therapeutic effects of ketamine in the cultures or mouse model were observed. This team does not recommend further widespread clinical use of ketamine on human rabies patients until further experimental work demonstrates therapeutic efficacy. Because of the potential neuroprotective and anti-apoptotic properties of minocycline, minocycline therapy was assessed in infected primary neuron cultures and in neonatal ICR mice infected by peripheral inoculation with a highly attenuated rabies virus strain. No beneficial effect of minocycline was observed in the primary neuron cultures. In the mouse model, minocycline therapy aggravated the clinical neurological disease and resulted in higher mortality. An anti-apoptotic effect of minocycline was noted in the brains of infected mice, which may have very mildly increased viral spread. An anti-inflammatory effect was also noted in the brain using a CD3 T cell marker. These effects likely aggravated the disease. This team recommends that empirical therapy with minocycline be avoided in the management of rabies and viral encephalitis in humans until more information becomes available.
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Affiliation(s)
- A C Jackson
- Department of Internal Medicine (Neurology), University of Manitoba, Winnipeg, Manitoba, Canada.
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Quartuccio L, De Marchi G, Scott CA, Ferraccioli G, Beltrami CA, De Vita S. Treatment of inclusion body myositis with cyclosporin-A or tacrolimus: successful long-term management in patients with earlier active disease and concomitant autoimmune features. Clin Exp Rheumatol 2007; 25:246-51. [PMID: 17543149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Sporadic inclusion body myositis (s-IBM) is a chronic, progressive, inflammatory myopathy of unknown aetiology, generally resistant to immunosuppressive therapy. Given that lymphocyte infiltrates in s-IBM muscle tissue are CD8+ T cells, targeting these cells may represent a valid approach. PATIENTS AND METHODS Three patients with biopsy-proven s-IBM, high creatine kinase levels at diagnosis, two of whom with associated immune disorders, were treated with either cyclosporin-A (CyA) or tacrolimus, in combination with high doses of corticosteroids (CS), followed by rapid CS tapering. Clinical assessment and laboratory evaluation were performed every three months for the first year and then every six months for the second year. RESULTS Based on muscle strength assessment and muscle enzyme serum levels, a major clinical response was observed at month +3 in two out of the three patients. A complete clinical response and major clinical response were obtained at month +6, in two and one patient, respectively. Normalization of serum muscle enzymes was observed in all. Steroids could be tapered to very low doses in all patients and were suspended early in one. Laboratory, but not clinical relapse occurred in one patient and was controlled by increasing the CyA dose. Treatment was well tolerated, with no serious adverse events occurring. All three patients are maintaining immunosuppressive therapy. CONCLUSION Calcineurin inhibitors may represent a useful option for the long-term management of s-IBM, possibly in a subset characterized by a short duration with high disease activity or associated autoimmune manifestations.
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Affiliation(s)
- L Quartuccio
- Clinic of Rheumatology, DPMSC, University of Udine, Italy
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Qaqundah PY, Sugerman RW, Ceruti E, Maspero JF, Kleha JF, Scott CA, Wu W, Mehta R, Crim C. Efficacy and safety of fluticasone propionate hydrofluoroalkane inhalation aerosol in pre-school-age children with asthma: a randomized, double-blind, placebo-controlled study. J Pediatr 2006; 149:663-670. [PMID: 17095339 DOI: 10.1016/j.jpeds.2006.07.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 05/09/2006] [Accepted: 07/28/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy and tolerability of fluticasone propionate (FP) hydrofluoroalkane (HFA) in children age 1 to < 4 years with asthma. STUDY DESIGN Children were assigned (2:1) to receive FP HFA 88 mug (n = 239) or placebo HFA (n = 120) twice daily through a metered-dose inhaler with a valved holding chamber and attached facemask for 12 weeks. The primary efficacy measure was mean percent change from baseline to endpoint in 24-hour daily (composite of daytime and nighttime) asthma symptom scores. RESULTS The FP-treated children had significantly greater (P < or = .05) reductions in 24-hour daily asthma symptom scores (-53.9% vs -44.1%) and nighttime symptom scores over the entire treatment period compared with the placebo group. Daytime asthma symptom scores and albuterol use were slightly more decreased with FP than with placebo; however, the differences were not statistically significant. Increases in the percentage of symptom-free days were comparable. The percentage of patients who experienced at least 1 adverse event was similar in the 2 groups. Baseline median urinary cortisol excretion values were comparable between the groups, and there was little change from baseline at endpoint. FP plasma concentrations demonstrated that systemic exposure was low. CONCLUSIONS FP HFA 88 mug twice daily was effective and well tolerated in pre-school-age children with asthma.
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Affiliation(s)
- Paul Y Qaqundah
- Pediatric Medical Care Group, Inc, Huntington Beach, CA, USA.
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Abstract
AIM To determine the effects of sleep and wakefulness on seizures in patients with refractory epilepsy recorded while undergoing video-electroencephalography (EEG) telemetry. METHODS The video-EEG data of patients who had two or more seizures during video-EEG telemetry (n = 270) were reviewed. Fifty seven patients who had seizures both in wakefulness and sleep were identified. The video and ictal EEG data were reviewed, paying specific attention to type of seizures, duration, semiology, lateralisation and number of seizures. RESULTS Three hundred and sixty two seizures were recorded; 237 seizures while awake and 125 while sleeping. Secondary generalisation occurred more often in sleep than in wakefulness (p < 0.01). Overall, there was no significant effect of sleep on the duration of seizures or ictal EEG change. Sleep and awake seizures differed in only eight patients. CONCLUSION Secondary generalisation occurred more often in sleep than in wakefulness, perhaps due to the facilitated spread of seizures during sleep. For the most part, however, seizures recorded during sleep did not differ from those recorded during wakefulness.
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Affiliation(s)
- S Sinha
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
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Rac VE, Small C, Scott CA, Adamson SL, Rurak D, Challis JR, Lye SJ. Meloxicam effectively inhibits preterm labor uterine contractions in a chronically catheterized pregnant sheep model: impact on fetal blood flow and fetal-maternal physiologic parameters. Am J Obstet Gynecol 2006; 195:528-34. [PMID: 16626612 DOI: 10.1016/j.ajog.2006.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 01/05/2006] [Accepted: 02/08/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Preterm birth occurs in 5% to 10% of all pregnancies and is associated with considerable neonatal mortality and morbidity. Effective and safe drugs to prevent preterm labor are not currently available. We have hypothesized that the nonsteroidal anti-inflammatory drug meloxicam, a more selective cyclooxygenase-2 inhibitor will successfully inhibit labor but avoid the complications associated with inhibition of cyclooxygenase-1. STUDY DESIGN Preterm labor was induced in chronically catheterized sheep by RU486 administration. Animals were then randomized to receive maternal infusions of saline (n = 5) or meloxicam (n = 4) for 48 hours or until delivery when the animals were killed and tissues and blood samples collected. RESULTS Maternal infusion of meloxicam inhibited uterine contractions, increasing contraction duration, and attenuating frequency and amplitude. Saline-treated animals progressed to delivery. Administration of meloxicam was not associated with any change in fetal or maternal blood gas status, osmolality, arterial pressure, heart rate, or fetal blood flows. CONCLUSION Meloxicam may represent a potentially safe and effective tocolytic agent.
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Affiliation(s)
- Valeria E Rac
- Research Centre for Women's and Infant's Health, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Wasserman RL, Baker JW, Kim KT, Blake KV, Scott CA, Wu W, Faris MA, Crim C. Efficacy and safety of inhaled fluticasone propionate chlorofluorocarbon in 2- to 4-year-old patients with asthma: results of a double-blind, placebo-controlled study. Ann Allergy Asthma Immunol 2006; 96:808-18. [PMID: 16802768 DOI: 10.1016/s1081-1206(10)61343-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current asthma guidelines recommend inhaled glucocorticoids administered via pressurized metered-dose inhaler (MDI) with a holding chamber as the preferred therapy for young children with asthma. OBJECTIVE To evaluate the efficacy and safety of fluticasone propionate chlorofluorocarbon MDI use in preschool-aged children with asthma. METHODS Randomized, double-blind, placebo-controlled, parallel-group study of 332 children aged 24 to 47 months with asthma. Fluticasone propionate chlorofluorocarbon, 44 or 88 microg twice daily, or placebo (chlorofluorocarbon propellant alone) administered for 12 weeks via MDI with a valved holding chamber and an attached face mask. The primary efficacy measure was average change in 24-hour daily asthma symptom scores. Safety assessments included adverse events, 12-hour urinary cortisol excretion, and growth. RESULTS Treatment failure (ie, asthma exacerbation) occurred in approximately half as many fluticasone propionate-treated patients (13%-14%) as placebo-treated patients (24%). Compared with placebo users, patients treated with fluticasone propionate, 88 microg twice daily, had a 13% greater improvement in the mean proportion of symptom- and albuterol-free days (P = .02); asthma symptom scores and albuterol use were also significantly reduced. Patients treated with fluticasone propionate, 44 microg twice daily, had greater improvements than placebo-treated patients; however, differences did not reach statistical significance. At end point, the growth velocities of fluticasone propionate-treated patients were within the range of those of placebo-treated patients. No clinically relevant changes in 12-hour overnight urinary cortisol excretion were observed. CONCLUSION Compared with placebo use, fluticasone propionate, 88 microg administered twice daily, significantly reduced asthma exacerbations, asthma symptoms, and rescue albuterol use and was well tolerated, with no clinically relevant systemic effects, as measured by growth velocity or 12-hour urinary cortisol excretion levels.
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Pinnas JL, Noonan MJ, Weinstein SF, Chervinsky P, Scott CA, Herje NE, Wu W, Crim C. Fluticasone propionate HFA-134a pressurized metered-dose inhaler in adolescents and adults with moderate to severe asthma. J Asthma 2006; 42:865-71. [PMID: 16393726 DOI: 10.1080/02770900500371294] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this randomized, double-blind, placebo-controlled trial, 397 patients with moderate to severe asthma, previously treated with bronchodilators alone, received fluticasone propionate 88, 220, or 440 microg twice daily, or placebo via metered dose inhaler (MDI) for 12 weeks. Mean change from baseline to endpoint in pre-dose percent predicted forced expiratory volume in one second (FEV1) was greater (p < 0.001) in each fluticasone propionate group (9.0%, 88 microg bid; 9.8%, 220 microg bid; 11.2%, 440 microg bid) versus placebo (3.4%). Morning and evening peak expiratory flow (PEF), asthma symptoms, and supplemental albuterol use also improved in all fluticasone propionate groups versus placebo. The incidence of adverse events and 24-hour urine cortisol excretion rates were similar between active treatments and placebo.
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Affiliation(s)
- Jacob L Pinnas
- University of Arizona School of Medicine, Tucson, Arizona, USA.
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31
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Lumry WR, Conway MM, LaForce CF, Pearlman DS, Scott CA, Herje NE, Wu WW, Crim C. Fluticasone propionate hydrofluoroalkane inhalation aerosol in patients receiving inhaled corticosteroids. Ann Allergy Asthma Immunol 2006; 96:51-9. [PMID: 16440533 DOI: 10.1016/s1081-1206(10)61040-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Inhaled corticosteroids (ICSs) delivered by metered-dose inhalers that contain chlorofluorocarbon propellants are being discontinued because of the harmful effects of chlorofluorocarbon on the ozone layer. Therefore, some metered-dose inhaler products are being reformulated with "ozone-friendly" hydrofluoroalkane propellants. OBJECTIVE To evaluate treatment with fluticasone propionate hydrofluoroalkane inhalation aerosol, 88, 220, and 440 microg twice daily, vs placebo in patients with asthma receiving an ICS. METHODS Randomized, double-blind, parallel-group, 12-week study. RESULTS Mean morning predose percent predicted forced expiratory volume in 1 second increased by 2.2%, 3.2%, and 4.6% in the fluticasone propionate, 88-, 220-, and 440-microg twice-daily, groups, respectively, compared with an 8.3% decrease for placebo (P < .001 vs placebo for all groups). Secondary pulmonary function end points and asthma symptoms showed similar improvements compared with placebo. Discontinuation from the study due to lack of efficacy was 50% in the placebo group and 11%, 10%, and 6% in the fluticasone propionate, 88-, 220-, and 440-microg twice-daily, groups, respectively. At week 12, the probability of remaining in the study was 0.89, 0.90, and 0.94 for the fluticasone propionate, 88-, 220-, and 440-microg twice-daily, groups, respectively, vs 0.45 for the placebo group (P < .001 for all). Changes in 24-hour urinary cortisol excretion rates were similar among treatment groups. CONCLUSIONS Fluticasone propionate hydrofluoroalkane, previously shown to be a clinically suitable alternative to fluticasone propionate chlorofluorocarbon, was effective and well tolerated. The ability to switch from fluticasone propionate chlorofluorocarbon and other chlorofluorocarbon-containing ICSs to fluticasone propionate hydrofluoroalkane without sacrificing asthma control or tolerability will facilitate a smooth transition to this nonchlorofluorocarbon-containing medicinal.
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Quartuccio L, Soardo G, Romano G, Zaja F, Scott CA, De Marchi G, Fabris M, Ferraccioli G, De Vita S. Rituximab treatment for glomerulonephritis in HCV-associated mixed cryoglobulinaemia: efficacy and safety in the absence of steroids. Rheumatology (Oxford) 2006; 45:842-6. [PMID: 16418196 DOI: 10.1093/rheumatology/kel004] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Rituximab, an anti-CD20 monoclonal antibody, has been used in lupus nephritis and membranous idiopathic nephropathy and has proved effective in non-renal manifestations of type II mixed cryoglobulinaemia (MC) syndrome. We investigated the possible efficacy and safety of rituximab in the treatment of cryoglobulinaemic nephritis. METHODS Five patients with active, biopsy-proven, glomerulonephritis in hepatitis C virus (HCV)-related type II MC syndrome were treated with four weekly infusions of rituximab (375 mg/m2) in monotherapy, without steroids whenever possible. Rituximab was the first-line therapy in three cases. RESULTS A rapid and sustained renal response was observed in all patients, in one of them without retreatment up to the last follow-up (month 21+). Renal biopsy was repeated after 6 months in one patient and histopathological improvement was documented. Three patients relapsed, at months +5, +7 and +12 of follow-up, respectively. Two of them were then retreated with rituximab and again presented a rapid improvement in renal function. Maintenance therapy with rituximab was performed in two patients: nephritis remission was maintained in both. Fc-gamma receptor 3a (FcgammaRIIIa) genotype characterization was consistent with the clinical response observed. Rituximab also proved effective against other active MC manifestations, when present. No major side-effects occurred and steroids were not required in the follow-up. CONCLUSIONS Rituximab may provide effective and safe therapy in type II MC-related glomerulonephritis, possibly as first-line therapy, avoiding steroids and hazardous immunosuppressive treatment.
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Affiliation(s)
- L Quartuccio
- Rheumatology Clinic, University of Udine, Piazzale Santa Maria della Misericordia 1, 33100 Udine, Italy
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Ahmad MD, Biggs T, Turral H, Scott CA. Application of SEBAL approach and MODIS time-series to map vegetation water use patterns in the data scarce Krishna river basin of India. Water Sci Technol 2006; 53:83-90. [PMID: 16838692 DOI: 10.2166/wst.2006.301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Evapotranspiration (ET) from irrigated land is one of the most useful indicators to explain whether the water is used as "intended". In this study, the Surface Energy Balance Algorithm for Land (SEBAL) was used to compute actual ET from a Landsat7 image of December 29, 2000 for diverse land use in the Krishna Basin in India. SEBAL ETa varies between 0 to 4.7 mm per day over the image and was quantified for identified land use classes. Seasonal/annual comparison of ETa from different land uses requires time series images, processed by SEBAL. In this study, the Landsat-derived snapshot SEBAL ETa result was interpreted using the cropping calendar and time series analysis of MODIS imagery. The wastewater irrigated area in the basin has the highest ETa in the image, partly due to its advanced growth stage compared to groundwater-irrigated rice. Shrub and forests in the senescence phase have similar ETa to vegetable/cash crops, and ETa from grasslands is a low 0.8 mm per day after the end of the monsoon. The results indicate that wastewater irrigation of fodder and rice is sufficient to meet crop water demand but there appears to be deficit irrigation of rice using groundwater.
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Affiliation(s)
- M D Ahmad
- International Water Management Institute, Global Research Division, P.O. Box 2075, Colombo, Sri Lanka.
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Goremychkin EA, Osborn R, Rainford BD, Costi TA, Murani AP, Scott CA, King PJC. Magnetic correlations and the anisotropic Kondo effect in Ce1-xLaxAl3. Phys Rev Lett 2002; 89:147201. [PMID: 12366072 DOI: 10.1103/physrevlett.89.147201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2001] [Indexed: 05/23/2023]
Abstract
By combining the results of muon spin relaxation and inelastic neutron scattering in the heavy fermion compounds Ce1-xLaxAl3 (0.0<or=x<or=0.2), we show that static magnetic correlations are suppressed above a characteristic temperature, T*, by electronic dissipation rather than by thermal disorder. Below T*, an energy gap opens in the single-ion magnetic response in agreement with the predictions of the anisotropic Kondo model. Scaling arguments suggest that similar behavior may underlie the "hidden order" in URu2Si2.
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Affiliation(s)
- E A Goremychkin
- Argonne National Laboratory, Argonne, Illinois 60439-4845, USA
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Pirisi M, Avellini C, Scott CA, Toniutto P, Intersimone D, Aprile G, Branca B, Fumo E. Recent advances in the pathophysiology, diagnosis and treatment of hereditary hemochromatosis and other iron overload syndromes. Adv Clin Path 2001; 5:121-31. [PMID: 17582936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Recent years have witnessed tremendous advances in the fields of pathophysiology, diagnosis and management of hereditary hemochromatosis (HH) and other iron overload syndromes, the dreadful consequences of which are fully preventable by early diagnosis and treatment. Missense mutations in HFE, a newly discovered gene encoding for a major histocompatibility class-I like molecule, have been found to be strictly associated with most cases of HH. The mechanisms by which a dysfunctional HFE molecule determines increased absorption of iron in HH are on the way to be fully clarified, due to the availability of a knockout mouse model. Epidemiologic studies have shown that HH is one of the most common human hereditary disorders. The possibility to identify HFE heterozygotes by means of a simple genetic test have prompted studies on the association between HFE mutations and iron overload syndromes different from HH. In the era of the historic completion of the human genome projects, genetic testing for HH may soon qualify for being adopted in universal population screening policies. In the present paper, the recent advances in the fields of genetics and pathophysiology of HH and other iron overload syndromes will be summarized. Furthermore, its clinical features, pathology and treatment will be reviewed, and the emerging issues of cost-effective diagnosis and of possible population screening strategies will be succintly discussed.
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Affiliation(s)
- M Pirisi
- Dipartimento di Scienze Mediche, Università degli Studi del Piemonte Orien- tale, 28100 Novara, Italy.
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Abstract
PURPOSE In limbic or mesial temporal lobe epilepsy, much attention has been given to specific regions or cell populations (e.g., the hippocampus or dentate granule cells). Epileptic seizures may involve broader changes in neural circuits, and evidence suggests that subcortical regions may play a role. In this study we examined the midline thalamic regions for involvement in limbic seizures, changes in anatomy and physiology, and the potential role for this region in limbic seizures and epilepsy. METHODS Using two rat models for limbic epilepsy (hippocampal kindled and chronic spontaneous limbic epilepsy) we examined the midline thalamus for evidence of involvement in seizure activity, alterations in structure, changes in the basic in vitro physiology of the thalamic neurons. We also explored how this region may influence limbic seizures. RESULTS The midline thalamus was consistently involved with seizure activity from the onset, and there was significant neuronal loss in the medial dorsal and reuniens/rhomboid nuclei. In addition, thalamic neurons had changes in synaptically mediated and voltage-gated responses. Infusion of lidocaine into the midline thalamus significantly shortened afterdischarge duration. CONCLUSIONS These observations suggest that this thalamic region is part of the neural circuitry of limbic epilepsy and may play a significant role in seizure modulation. Local neuronal changes can enhance the excitability of the thalamolimbic circuits.
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Affiliation(s)
- E H Bertram
- Department of Neurology, University of Virginia, Charlottesville, Virginia 22908, USA.
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Krakow K, Lemieux L, Messina D, Scott CA, Symms MR, Duncan JS, Fish DR. Spatio-temporal imaging of focal interictal epileptiform activity using EEG-triggered functional MRI. Epileptic Disord 2001; 3:67-74. [PMID: 11431168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
EEG-triggered, blood oxygen level-dependent functional MRI (BOLD-fMRI) was used in 24 patients with localization-related epilepsy and frequent interictal epileptiform discharges (spikes) to identify those brain areas involved in generating the spikes, and to study the evolution of the BOLD signal change over time. The location of the fMRI activation was compared with the scalp EEG spike focus and the structural MR abnormality. Twelve patients (50%) had an fMRI activation concordant with the EEG focus and structural brain abnormalities where present (n = 7). In 2 other patients, the fMRI activation was non-concordant with electroclinical findings. The remaining 10 patients (41.7%) showed no significant fMRI activation. These patients had significantly lower mean spike amplitudes compared to those with positive fMRI results (p = 0.03). The time course of the BOLD response was studied in 3 patients and this revealed a maximum signal change 1.5 to 7.5 sec after the spike. In conclusion, EEG-triggered fMRI can directly identify the generators of interictal epileptiform activity, with high spatial resolution, in selected patients with frequent spikes. The superior spatial resolution obtainable through EEG-triggered fMRI may provide an additional non-invasive tool in the presurgical evaluation of patients with intractable focal seizures.
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Affiliation(s)
- K Krakow
- MRI Unit, National Society for Epilepsy, Chalfont St. Peter, Buckinghamshire SL9 0RJ, UK
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Abstract
Video-electroencephalography (EEG) telemetry is a crucial component in the comprehensive evaluation of patients with epilepsy. The reasons for patients needing to be monitored fall broadly into three groups: presurgical assessment (36% of our patients), diagnostic assessment (52%), and sleep disorders (12%). Video EEG can be used to differentiate unusual epilepsies from pseudo seizures or other causes of paroxysmal neurological events. The design of a unit depends on the case mix of patients expected to be referred. The key elements to a successful unit are a reliable, flexible, easy-to-use recording system and a team of dedicated, experienced staff, both nursing and technical. The unit at the National Hospital is a six-bed ward with 7 nurses to provide 24-hour coverage, 5 technicians working in shifts, and physics support. A minimum of two staff are on duty at all times. It operates on a five-day week with a throughput of approximately 500 patients per year. It is vital that investigations are performed as efficiently and effectively as possible, and the patient's safety and wellbeing is paramount at all times. Drug reduction is likely to be used to precipitate seizures, especially in those being considered for epilepsy surgery, and this poses a risk of provoked secondary generalized seizures. Continuous supervision of patients, and the ability to respond rapidly to a seizure, are therefore essential. We adopt a standardized easy-to-follow drug-reduction protocol, similar to that used by other centers.
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Affiliation(s)
- C A Scott
- The National Hospital for Neurology and Neurosurgery, London, United Kingdom
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40
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Abstract
Limbic epilepsy is a chronic condition associated with a broad zone of seizure onset and pathology. Studies have focused mainly on the hippocampus, but there are indications that changes occur in other regions of the limbic system. This study used in vitro intracellular recording and histology to examine alterations to the physiology and anatomy of the basal nucleus of the amygdala in a rat model of chronic limbic epilepsy characterized by spontaneously recurring seizures. Epileptic pyramidal neuron responses evoked by stria terminalis stimulation revealed hyperexcitability characterized by multiple action potential bursts and no evident inhibitory potentials. In contrast, no hyperexcitability was observed in amygdalar neurons from kindled (included as a control for seizure activity) or control rats. Blockade of ionotropic glutamate receptors unmasked inhibitory postsynaptic potentials in epileptic pyramidal neurons. Control, kindled and epileptic inhibitory potentials were predominantly biphasic, with fast and slow components, but a few cells exhibited only the fast component (2/12 in controls, 0/3 in kindled, 3/10 in epileptic). Epileptic fast inhibitory potentials had a more rapid onset and shorter duration than control and kindled. Approximately 40% of control neurons exhibited spontaneous inhibitory potentials; no spontaneous inhibitory potentials were observed in neurons from kindled or epileptic rats. A preliminary histological examination revealed no gross alterations in the basal amygdala from epileptic animals. These results extend previous findings from this laboratory that hyperexcitability is found in multiple epileptic limbic regions and may be secondary to multiple alterations in excitatory and inhibitory efficacy. Because there were no differences between control and kindled animals, the changes observed in the epileptic animals are unlikely to be secondary to recurrent seizures.
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Affiliation(s)
- P S Mangan
- Department of Neurology, University of Virginia Health Sciences Center, Charlottesville, VA 22908,USA
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41
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Fabris C, Toniutto P, Scott CA, Falleti E, Avellini C, Del Forno M, Mattiuzzo M, Branca B, Pirisi M. Serum iron indices as a measure of iron deposits in chronic hepatitis C. Clin Chim Acta 2001; 304:49-55. [PMID: 11165198 DOI: 10.1016/s0009-8981(00)00397-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Serum iron indices are believed to be elevated in patients with hepatitis C virus (HCV) infection in connection to the presence of hepatic inflammation, though this hypothesis has never been formally tested. We studied 69 consecutive, unselected anti HCV antibody positive patients, aged 14 to 70 years. Iron, transferrin saturation and ferritin were measured in fasting serum samples. Histologically detectable iron (HDI) as well as histologic grading and staging were estimated semiquantitatively in liver biopsy samples. The median values for serum iron, transferrin saturation and serum ferritin were 24 micromol/l (range, 8-61), 29 percent (range, 6-77) and 170 microg/l (range, 1-954), respectively. At univariate analysis, all three serum iron indices were positively correlated with grading and staging scores, as well as with HDI in the liver; only serum iron was positively correlated with transaminases. At multivariate analysis, independent associations were found between serum iron and the grading score; ferritin and sinusoidal and portal HDI; transferrin saturation and total hepatic HDI. In conclusion, in hepatitis C, serum iron reflects the degree of current hepatic inflammation and necrosis, whereas the extent of progressive deposition of iron in sites of fibrosis is best reflected by serum ferritin. Transferrin saturation is the best predictor of the status of hepatic iron deposits.
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Affiliation(s)
- C Fabris
- Dipartimento di Patologia e Medicina Sperimentale e Clinica, University of Udine, 1 Piazzale Santa Maria della Misericordia, 33100 Udine, Italy
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42
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Walter MT, Parlange JY, Walter MF, Xin X, Scott CA. Modeling pollutant release from a surface source during rainfall runoff. J Environ Qual 2001; 30:151-159. [PMID: 11215647 DOI: 10.2134/jeq2001.301151x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Though runoff from manure spread fields is recognized as an important mode of nonpoint-source pollution, there are no models that mechanistically describe transport from a field-spread manure-type source. A mechanistic, physically based model for pollutant release from a surface source, such as field-spread manure, was hypothesized, laboratory tested, and field-applied. The primary objective of this study was to demonstrate the potential applicability of a mechanistic model to pollutant release from surface sources. The laboratory investigation used stable sources and a conservative "pollutant" (KCl) so that the dynamic effects of source dissolution and chemical transformations could be ignored and transport processes isolated. The field investigation used runoff and soluble reactive phosphorus (SP) data collected from a dairy-manure-spread field in the Cannonsville watershed in the Catskills region of New York State. The model predictions corroborated well with observations of runoff and pollutant delivery in both the laboratory and the field. "Pollutant" release from surface sources was generally predicted within 11% of laboratory KCl measurements and field SP observations. Laboratory flume runoff predictions with 15 and 26% errors for 25 and 15 mm h(-1) simulated rainfall intensity experiments, respectively, represented root mean square errors of less than 0.2 mLs(-1). A 26% error was calculated for overland flow predictions in the field, which translated into approximately a 39 mLs(-1) error. Results suggest that the hypothesized model satisfactorily represents the primary mechanisms in pollutant release from surface sources.
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Affiliation(s)
- M T Walter
- Environmental Science, Univ of Alaska Southeast, Juneau 99801, USA.
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43
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Selli C, Scott CA, Garbagnati F, De Antoni P, Moro U, Crisci A, Rossi S. Transurethral radiofrequency thermal ablation of prostatic tissue: a feasibility study in humans. Urology 2001; 57:78-82. [PMID: 11164148 DOI: 10.1016/s0090-4295(00)00871-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the feasibility and efficacy of ablating prostatic tissue by inducing thermal lesions using radiofrequency (RF) energy delivered transurethrally through electrodes mounted on a Foley-like catheter. METHODS Twenty male patients, candidates for radical cystoprostatectomy to treat bladder carcinoma, underwent RF prostate ablation 1 to 8 days before surgery (mean 2.8). Stainless steel, internally cooled, 2-cm-long electrodes mounted on a Foley-like catheter were used to deliver RF energy to the prostatic tissue. Semicircular electrodes were used in 10 patients (group A) and circular electrodes were used in the remaining 10 patients (group B). The urethral, rectal, and prostatic tissue temperatures were recorded. Histologic step sections were performed on whole mounts of the prostates to define the volume of the thermal lesions. RESULTS The mean RF energy delivered was 36.5 kJ (range 26.4 to 53.1) in group A and 82.3 kJ (range 38 to 149) in group B. The intraprostatic temperatures were between 44 degrees C and 80 degrees C in group A and between 60 degrees C and 119 degrees C in group B. The urethral and rectal temperatures never exceeded 42 degrees C. No major complications occurred. After the RF procedure, 5 patients who received more than 75 kJ of energy could not void and required catheterization. The mean prostate volume was 11.54 cm(3) for group A and 24.02 cm(3) for group B. The mean volumes of the thermal lesions and their relative percentages in relation to the whole prostate in groups A and B were, respectively, 1.69 cm(3) and 15% and 6.91 cm(3) and 29% (P = 0.049). Analysis of variance showed a significant correlation between the thermal lesion volume and the energy delivered, regardless of the electrode shape (P = 0.001). CONCLUSIONS Satisfactory thermal ablation of prostatic tissue can be achieved using RF electrodes mounted on a Foley-like catheter. The procedure is effective, simple, and safe and, therefore, can be used in pilot clinical studies on patients with benign prostatic hyperplasia.
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Affiliation(s)
- C Selli
- Department of Urology, University of Udine, Udine, Italy
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44
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Abstract
The ectoparasite fauna for island foxes (Urocyon littoralis) on Santa Cruz Island (California, USA) in April (wet season) and September (dry season) 1998 was evaluated. Three taxa of ectoparasites were identified. These were fleas (Pulex irritans), lice (Neotrichodectes mephitidis), and ticks (Ixodes pacificus). Ectoparasite abundances varied seasonally. Typical of insular endemic species, island foxes may be especially vulnerable to the introduction of novel disease organisms and their vectors.
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Affiliation(s)
- K R Crooks
- Department of Biology, University of California, Santa Cruz 95064, USA.
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45
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Krakow K, Baxendale SA, Maguire EA, Krishnamoorthy ES, Lemieux L, Scott CA, Smith SJ. Fixation-off sensitivity as a model of continuous epileptiform discharges: electroencephalographic, neuropsychological and functional MRI findings. Epilepsy Res 2000; 42:1-6. [PMID: 10996501 DOI: 10.1016/s0920-1211(00)00152-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A case of fixation-off sensitivity (FOS) in an asymptomatic adult is presented and studied as a model for continuous epileptiform discharges. Video-electroencephalographic (EEG) revealed continuous bilateral occipital spike wave discharges during elimination of central vision, which were shown to be associated with transitory cognitive impairment demonstrated by neuropsychological testing. Functional MRI showed activation of parieto-occipital and frontal brain areas during the fixation-off discharges. This localization was confirmed with 64-channel EEG source analysis. The applied methods provided additional information on the pathophysiology of epileptiform discharges.
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Affiliation(s)
- K Krakow
- Epilepsy Research Group, Department of Clinical Neurology, Institute of Neurology, University College London, London, UK.
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46
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Stratmann T, Apostolopoulos V, Mallet-Designe V, Corper AL, Scott CA, Wilson IA, Kang AS, Teyton L. The I-Ag7 MHC class II molecule linked to murine diabetes is a promiscuous peptide binder. J Immunol 2000; 165:3214-25. [PMID: 10975837 DOI: 10.4049/jimmunol.165.6.3214] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Susceptibility to insulin-dependent diabetes mellitus is linked to MHC class II genes. The only MHC class II molecule expressed by nonobese diabetic (NOD) mice, I-Ag7, shares a common alpha-chain with I-Ad but has a peculiar beta-chain. As with most beta-chain alleles linked to diabetes susceptibility, I-Ag7 contains a nonaspartic residue at position beta57. We have produced large amounts of empty I-Ag7 molecules using a fly expression system to characterize its biochemical properties and peptide binding by phage-displayed peptide libraries. The identification of a specific binding peptide derived from glutamic acid decarboxylase (GAD65) has allowed us to crystallize and obtain the three-dimensional structure of I-Ag7. Structural information was critical in evaluating the binding studies. I-Ag7, like I-Ad, appears to be very promiscuous in terms of peptide binding. Their binding motifs are degenerate and contain small and/or small hydrophobic residues at P4 and P6 of the peptide, a motif frequently found in most globular proteins. The degree of promiscuity is increased for I-Ag7 over I-Ad as a consequence of a larger P9 pocket that can specifically accommodate negatively charged residues, as well as possibly residues with bulky side chains. So, although I-Ad and I-Ag7 are structurally closely related, stable molecules and good peptide binders, they differ functionally in their ability to bind significantly different peptide repertoires that are heavily influenced by the presence or the absence of a negatively charged residue at position 57 of the beta-chain. These characteristics link I-Ag7 with autoimmune diseases, such as insulin-dependent diabetes mellitus.
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Affiliation(s)
- T Stratmann
- Departments of Immunology and Molecular Biology, and The Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
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47
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Behar TN, Schaffner AE, Scott CA, Greene CL, Barker JL. GABA receptor antagonists modulate postmitotic cell migration in slice cultures of embryonic rat cortex. Cereb Cortex 2000; 10:899-909. [PMID: 10982750 DOI: 10.1093/cercor/10.9.899] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Recent studies indicate that GABA acts as a chemoattractant during rat cortical histogenesis. In vivo, GABA localizes in appropriate locations for a chemoattractant, along migratory routes and near target destinations for migrating cortical neurons. In vitro, GABA induces dissociated embryonic cortical neurons to migrate. Here, embryonic rat cortical slices were cultured in the presence or absence of GABA receptor (GABA-R) antagonists to assess GABA's effects on neuronal migration in situ. Gestational day 18 (E18) cortical slices were incubated overnight in bromodeoxyuridine (BrdU)-containing medium to label ventricular zone (vz) cells as they underwent terminal mitosis. The slices were then cultured in BrdU-free medium with or without GABA-R antagonists. In control slices, most BrdU(+) cells were observed in the cortical plate (cp) after 48 h. In contrast, cultures maintained in either saclofen (a GABA(B)-R antagonist) or picrotoxin (a GABA(A/C)-R antagonist) had few BrdU-labeled cp cells. However, the effects of the two antagonists were distinct. In the picrotoxin-treated slices, nearly half of all BrdU(+) cells remained in the vz and subventricular zone (svz), whereas saclofen treatment resulted in an accumulation of BrdU(+) cells in the intermediate zone (iz). Bicuculline, a GABA(A)-R antagonist, did not block, but rather enhanced migration of BrdU(+) cells into the cp. These results provide evidence that picrotoxin-sensitive receptors promote the migration of vz/svz cells into the iz, while saclofen-sensitive receptors signal cells to migrate into the cp. Thus, as cortical cells differentiate, changing receptor expression appears to modulate migratory responses to GABA.
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Affiliation(s)
- T N Behar
- Laboratory of Neurophysiology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
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48
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Abstract
Telomerase activity was found to be elevated using a quantitative assay on snap-frozen protein extracts of exfoliated cells in urine and bladder washings and tumor tissue obtained from a male patient with small cell carcinoma of the bladder. To the best of our knowledge, this is the first demonstration of elevated values of telomerase activity in genitourinary small cell carcinoma and is in keeping with the findings in primary lung locations.
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Affiliation(s)
- C Selli
- Department of Urology, University of Udine, Udine, Italy
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49
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Abstract
We report a case of ureteral obstruction after kidney transplantation caused by localized bone metaplasia in the donor ureter. Surgical treatment consisted of removal of the involved ureteral segment, which was located 3 cm above the bladder and creation of a spatulated end-to-end anastomosis. Although bone metaplasia has been observed in the ureteral wall of some animal species secondary to experimental ischemia and microtrauma, it is exceedingly rare in humans and has never before been documented after kidney transplantation.
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Affiliation(s)
- C Selli
- Division of Urology, University of Udine, Udine, Italy
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50
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Abstract
Focal xanthogranulomatous pyelonephritis of the left lower pole was accidentally discovered in a 34-year-old woman at sonography. The patient had no history of stones and urinary tract infection and both conventional radiology and CT scan revealed radiated calcifications within a well-circumscribed mass. Surgical treatment consisted of enucleoresection of the lesion, and histopathology revealed a nucleus of bone metaplasia. To the best of our knowledge, metaplastic bone formation has never been documented before with xanthogranulomatous pyelonephritis.
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Affiliation(s)
- C Selli
- Department of Urology, University of Udine, Italy
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