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Silvaieh S, Marko M, Trimmel K, Zulehner G, Berghoff A, Preusser M, Schmook M, Ulbrich L, Hainfellner JA, Widhalm G, Rössler K, Berger T, Pataraia E, Grisold A. P11.18.A Localizing value of EEG recordings in patients with glioblastoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Glioblastoma is associated with a high risk of epileptic seizures ranging from 40% to 60%. Before the advent of modern imaging techniques, electroencephalography (EEG) was a critical component in evaluating patients with space-occupying lesions. In this retrospective single-center study, we aimed (1) to characterize a cohort of patients with glioblastoma with regards to EEG monitoring, seizure frequency and the frequency of prescribed anti-seizure medications (ASM) and (2) to assess the value of EEG as a localizing technique in patients with glioblastoma.
Material and Methods
We reviewed the charts of 179 patients with glioblastomas between January 1st, 2020 and January 1st, 2022, treated at the Medical University of Vienna. The diagnosis was based on MRI and/or confirmed by biopsy according to the 2016 World Health Organization Classification of Tumors of the Central Nervous System. Patients who received an in-house EEG as part of their diagnostic work-up were included if an MRI/CT scan was available (within an average time of +/-60 days). For localization, focal slowing (theta/delta activity) and/or epileptiform discharges were considered. EEG rating was performed by a board-certified electrophysiologist blinded for the diagnosis and MRI/biopsy findings.
Results
We included 52 patients (29.05% of screened cohort) with at least one EEG and MRI or CT scan performed before or after EEG, following inclusion criteria (median: 2 days; mean: 6 days; range: -29 to 52), in the final analysis. Clinical seizure activity and/or epileptiform discharges on EEG were detected in 46 patients (88.46%), and 48 patients (92.31%) were on ASM.
An IDH-wildtype glioblastoma was diagnosed in 45 patients (86.54%), 4 had an IDH-mutant glioblastoma (7.69%), and in 3 patients, IDH-status was unknown (5.77%). In 22 patients (42.31%), biopsy revealed a positive MGMT promoter methylation status, while 28 were unmethylated (53.84%), and two patients had an unknown MGMT promoter methylation status (3.85%). Intermittent and/or continuous focal slow-wave activity was registered in 45 patients (86.54%). In comparison, epileptiform discharges could only be found in 13 patients (25%). When compared to MRI/CT scans, the hemispheric tumor localization could be determined in 42 cases (80.77%). Moreover, the affected brain lobe was accurately predicted in 35 patients (67.31%). Three patients had diffuse EEG changes (5.77%), and EEG was unremarkable in 7 patients (13.46%).
Conclusion
Overall, our presented data indicate that the hemispheric localization of glioblastoma can be reliably predicted by EEG recordings, while a precise (brain lobe-specific) localization was only possible in around two-thirds of cases.
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Affiliation(s)
- S Silvaieh
- Medical University of Vienna , Vienna , Austria
| | - M Marko
- Medical University of Vienna , Vienna , Austria
| | - K Trimmel
- Medical University of Vienna , Vienna , Austria
| | - G Zulehner
- Medical University of Vienna , Vienna , Austria
| | - A Berghoff
- Medical University of Vienna , Vienna , Austria
| | - M Preusser
- Medical University of Vienna , Vienna , Austria
| | - M Schmook
- Medical University of Vienna , Vienna , Austria
| | - L Ulbrich
- Medical University of Vienna , Vienna , Austria
| | | | - G Widhalm
- Medical University of Vienna , Vienna , Austria
| | - K Rössler
- Medical University of Vienna , Vienna , Austria
| | - T Berger
- Medical University of Vienna , Vienna , Austria
| | - E Pataraia
- Medical University of Vienna , Vienna , Austria
| | - A Grisold
- Medical University of Vienna , Vienna , Austria
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Krenn M, Gelpi E, Simonitsch-Klupp I, Kasprian G, Zulehner G, Grisold A, Zimprich F, Cetin H, Hülsmann M, Wohlfarth P. Muscle involvement in T-cell large granular lymphocytic leukemia presenting with asymmetric limb-girdle weakness and scapular winging. Muscle Nerve 2022; 66:E18-E21. [PMID: 35906958 DOI: 10.1002/mus.27690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gudun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Philipp Wohlfarth
- Division of Blood and Marrow Transplantation, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Krenn M, Tomschik M, Rath J, Cetin H, Grisold A, Zulehner G, Milenkovic I, Stogmann E, Zimprich A, Strom TM, Meitinger T, Wagner M, Zimprich F. Genotype-guided diagnostic reassessment after exome sequencing in neuromuscular disorders: experiences with a two-step approach. Eur J Neurol 2019; 27:51-61. [PMID: 31407473 PMCID: PMC6916592 DOI: 10.1111/ene.14033] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 02/11/2019] [Accepted: 07/05/2019] [Indexed: 01/03/2023]
Abstract
Background and purpose Next‐generation sequencing has greatly improved the diagnostic success rates for genetic neuromuscular disorders (NMDs). Nevertheless, most patients still remain undiagnosed, and there is a need to maximize the diagnostic yield. Methods A retrospective study was conducted on 72 patients with NMDs who underwent exome sequencing (ES), partly followed by genotype‐guided diagnostic reassessment and secondary investigations. The diagnostic yields that would have been achieved by appropriately chosen narrow and comprehensive gene panels were also analysed. Results The initial diagnostic yield of ES was 30.6% (n = 22/72 patients). In an additional 15.3% of patients (n = 11/72) ES results were of unknown clinical significance. After genotype‐guided diagnostic reassessment and complementary investigations, the yield was increased to 37.5% (n = 27/72). Compared to ES, targeted gene panels (<25 kilobases) reached a diagnostic yield of 22.2% (n = 16/72), whereas comprehensive gene panels achieved 34.7% (n = 25/72). Conclusion Exome sequencing allows the detection of pathogenic variants missed by (narrowly) targeted gene panel approaches. Diagnostic reassessment after genetic testing further enhances the diagnostic outcomes for NMDs.
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Affiliation(s)
- M Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Institute of Human Genetics, Technical University Munich, Munich, Germany
| | - M Tomschik
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - J Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - H Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - A Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - G Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - I Milenkovic
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - E Stogmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - A Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - T M Strom
- Institute of Human Genetics, Technical University Munich, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - T Meitinger
- Institute of Human Genetics, Technical University Munich, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - M Wagner
- Institute of Human Genetics, Technical University Munich, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany
| | - F Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Krenn M, Zulehner G, Hotzy C, Rath J, Stogmann E, Wagner M, Haack TB, Strom TM, Zimprich A, Zimprich F. Hereditary spastic paraplegia caused by compound heterozygous mutations outside the motor domain of the KIF1A
gene. Eur J Neurol 2017; 24:741-747. [DOI: 10.1111/ene.13279] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/07/2017] [Indexed: 01/08/2023]
Affiliation(s)
- M. Krenn
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - G. Zulehner
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - C. Hotzy
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - J. Rath
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - E. Stogmann
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - M. Wagner
- Institute of Human Genetics; Technical University Munich; Munich Germany
- Institute of Neurogenomics; Helmholtz Zentrum München; Neuherberg Germany
| | - T. B. Haack
- Institute of Human Genetics; Technical University Munich; Munich Germany
| | - T. M. Strom
- Institute of Human Genetics; Technical University Munich; Munich Germany
- Institute of Human Genetics; Helmholtz Zentrum München; Neuherberg Germany
| | - A. Zimprich
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - F. Zimprich
- Department of Neurology; Medical University of Vienna; Vienna Austria
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Cetin H, Wöhrer A, Rittelmeyer I, Gencik M, Zulehner G, Zimprich F, Ströbel T, Zimprich A. The c.65-2A>G splice site mutation is associated with a mild phenotype in Danon disease due to the transcription of normal LAMP2 mRNA. Clin Genet 2016; 90:366-71. [DOI: 10.1111/cge.12724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
- H. Cetin
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - A. Wöhrer
- Institute of Neurology; Medical University of Vienna; Vienna Austria
| | | | - M. Gencik
- Center for Human Genetics; Vienna Austria
| | - G. Zulehner
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - F. Zimprich
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - T. Ströbel
- Institute of Neurology; Medical University of Vienna; Vienna Austria
| | - A. Zimprich
- Department of Neurology; Medical University of Vienna; Vienna Austria
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van Zijl F, Mair M, Csiszar A, Schneller D, Zulehner G, Huber H, Eferl R, Beug H, Dolznig H, Mikulits W. Hepatic tumor-stroma crosstalk guides epithelial to mesenchymal transition at the tumor edge. Oncogene 2009; 28:4022-33. [PMID: 19718050 DOI: 10.1038/onc.2009.253] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The tumor-stroma crosstalk is a dynamic process fundamental in tumor development. In hepatocellular carcinoma (HCC), the progression of malignant hepatocytes frequently depends on transforming growth factor (TGF)-beta provided by stromal cells. TGF-beta induces an epithelial to mesenchymal transition (EMT) of oncogenic Ras-transformed hepatocytes and an upregulation of platelet-derived growth factor (PDGF) signaling. To analyse the influence of the hepatic tumor-stroma crosstalk onto tumor growth and progression, we co-injected malignant hepatocytes and myofibroblasts (MFBs). For this, we either used in vitro-activated p19(ARF) MFBs or in vivo-activated MFBs derived from physiologically inflamed livers of Mdr2/p19(ARF) double-null mice. We show that co-transplantation of MFBs with Ras-transformed hepatocytes strongly enhances tumor growth. Genetic interference with the PDGF signaling decreases tumor cell growth and maintains plasma membrane-located E-cadherin and beta-catenin at the tumor-host border, indicating a blockade of hepatocellular EMT. We further generated a collagen gel-based three dimensional HCC model in vitro to monitor the MFB-induced invasion of micro-organoid HCC spheroids. This invasion was diminished after inhibition of TGF-beta or PDGF signaling. These data suggest that the TGF-beta/PDGF axis is crucial during hepatic tumor-stroma crosstalk, regulating both tumor growth and cancer progression.
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Affiliation(s)
- F van Zijl
- Department of Medicine I, Division: Institute of Cancer Research, Medical University of Vienna, A-1090 Vienna, Austria
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Lahsnig C, Mikula M, Petz M, Zulehner G, Schneller D, van Zijl F, Huber H, Csiszar A, Beug H, Mikulits W. ILEI requires oncogenic Ras for the epithelial to mesenchymal transition of hepatocytes and liver carcinoma progression. Oncogene 2008; 28:638-50. [PMID: 19015638 DOI: 10.1038/onc.2008.418] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In human hepatocellular carcinoma (HCC), epithelial to mesenchymal transition (EMT) correlates with aggressiveness of tumors and poor survival. We employed a model of EMT based on immortalized p19(ARF) null hepatocytes (MIM), which display tumor growth upon expression of oncogenic Ras and undergo EMT through the synergism of Ras and transforming growth factor (TGF)-beta. Here, we show that the interleukin-related protein interleukin-like EMT inducer (ILEI), a novel EMT-, tumor- and metastasis-inducing protein, cooperates with oncogenic Ras to cause TGF-beta-independent EMT. Ras-transformed MIM hepatocytes overexpressing ILEI showed cytoplasmic E-cadherin, loss of ZO-1 and induction of alpha-smooth muscle actin as well as platelet-derived growth factor (PDGF)/PDGF-R isoforms. As shown by dominant-negative PDGF-R expression in these cells, ILEI-induced PDGF signaling was required for enhanced cell migration, nuclear accumulation of beta-catenin, nuclear pY-Stat3 and accelerated growth of lung metastases. In MIM hepatocytes expressing the Ras mutant V12-C40, ILEI collaborated with PI3K signaling resulting in tumor formation without EMT. Clinically, human HCC samples showed granular or cytoplasmic localization of ILEI correlating with well and poorly differentiated tumors, respectively. In conclusion, these data indicate that ILEI requires cooperation with oncogenic Ras to govern hepatocellular EMT through mechanisms involving PDGF-R/beta-catenin and PDGF-R/Stat3 signaling.
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Affiliation(s)
- C Lahsnig
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Borschke-Gasse 8a, Vienna, Austria
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