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Slinger G, Noorlag L, van Diessen E, Otte WM, Zijlmans M, Jansen FE, Braun KPJ. Clinical characteristics and diagnoses of 1213 children referred to a first seizure clinic. Epilepsia Open 2024; 9:548-557. [PMID: 38101810 PMCID: PMC10984297 DOI: 10.1002/epi4.12883] [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: 09/27/2023] [Revised: 11/15/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE New-onset seizure-like events (SLEs) are common in children, but differentiating between epilepsy and its mimics is challenging. This study provides an overview of the clinical characteristics, diagnoses, and corresponding etiologies of children evaluated at a first seizure clinic (FSC), which will be helpful for all physicians involved in the care of children with SLEs. METHODS We included 1213 children who were referred to the FSC of a Dutch tertiary children's hospital over a 13-year period and described their clinical characteristics, first routine EEG recording results, and the distribution and specification of their eventual epilepsy and non-epilepsy diagnoses. The time interval to correct diagnosis and the diagnostic accuracy of the FSC were evaluated. RESULTS "Epilepsy" was eventually diagnosed in 407 children (33.5%), "no epilepsy" in 737 (60.8%), and the diagnosis remained "unclear" in 69 (5.7%). Epileptiform abnormalities were seen in 60.9% of the EEG recordings in the "epilepsy" group, and in 5.7% and 11.6% of the "no epilepsy" and "unclear" group, respectively. Of all children with final "epilepsy" and "no epilepsy" diagnoses, 68.6% already received their diagnosis at FSC consultation, and 2.9% of the children were initially misdiagnosed. The mean time to final diagnosis was 2.0 months, and 91.3% of all children received their final diagnosis within 12 months after the FSC consultation. SIGNIFICANCE We describe the largest pediatric FSC cohort to date, which can serve as a clinical frame of reference. The experience and expertise built at FSCs will improve and accelerate diagnosis in children with SLEs. PLAIN LANGUAGE SUMMARY Many children experience events that resemble but not necessarily are seizures. Distinguishing between seizures and seizure mimics is important but challenging. Specialized first-seizure clinics can help with this. Here, we report data from 1213 children who were referred to the first seizure clinic of a Dutch children's hospital. One-third of them were diagnosed with epilepsy. In 68.8% of all children-with and without epilepsy-the diagnosis was made during the first consultation. Less than 3% were misdiagnosed. This study may help physicians in what to expect regarding the diagnoses in children who present with events that resemble seizures.
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Affiliation(s)
- Geertruida Slinger
- Department of Neurology and Neurosurgery, UMC Utrecht Brain CenterUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Lotte Noorlag
- Department of Neurology and Neurosurgery, UMC Utrecht Brain CenterUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Eric van Diessen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain CenterUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
- Department of Pediatrics, Franciscus Gasthuis & VlietlandRotterdamThe Netherlands
| | - Willem M. Otte
- Department of Neurology and Neurosurgery, UMC Utrecht Brain CenterUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, UMC Utrecht Brain CenterUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | - Floor E. Jansen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain CenterUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Kees P. J. Braun
- Department of Neurology and Neurosurgery, UMC Utrecht Brain CenterUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
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van Arnhem MML, van den Munckhof B, Arzimanoglou A, Perucca E, Metsähonkala L, Rubboli G, Søndergaard Khinchi M, de Saint-Martin A, Klotz KA, Jacobs J, Cross JH, Garcia Morales I, Otte WM, van Teeseling HC, Leijten FSS, Braun KPJ, Jansen FE. Corticosteroids versus clobazam for treatment of children with epileptic encephalopathy with spike-wave activation in sleep (RESCUE ESES): a multicentre randomised controlled trial. Lancet Neurol 2024; 23:147-156. [PMID: 38081201 DOI: 10.1016/s1474-4422(23)00409-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Epileptic encephalopathy with spike-wave activation in sleep (EE-SWAS) is a rare syndrome associated with cognitive and behavioural regression. On the basis of mostly small observational and retrospective studies, corticosteroids and clobazam are often considered the most effective treatments for this syndrome. We aimed to compare cognitive outcomes of children with EE-SWAS 6 months after starting treatment with either corticosteroids or clobazam. METHODS We did a multicentre, randomised controlled trial at eight tertiary referral centres for rare epilepsies in seven European countries. Children were eligible to participate if they were aged 2-12 years, were diagnosed with EE-SWAS within 6 months before inclusion, and had not been treated with corticosteroids or clobazam previously. Participants were randomly assigned (1:1) to treatment with corticosteroids (either continuous treatment with 1-2 mg/kg per day of prednisolone orally or pulse treatment with 20 mg/kg per day of methylprednisolone intravenously for 3 days every 4 weeks) or clobazam (0·5-1·2 mg/kg per day orally). The primary outcome was cognitive functioning after 6 months of treatment, which was assessed by either the intelligence quotient (IQ) responder rate (defined as improvement of ≥11·25 IQ points) or the cognitive sum score responder rate (defined as improvement of ≥0·75 points). Safety was assessed by number of adverse events and serious adverse events. Data were analysed in the intention-to-treat population, which included all children as randomised who had primary outcome data available at 6 months. The trial is registered with the Dutch Trial Register, Toetsingonline, NL43510.041.13, and the ISRCTN registry, ISRCTN42686094. The trial was terminated prematurely because enrolment of the predefined number of 130 participants was deemed not feasible. FINDINGS Between July 22, 2014, and Sept 3, 2022, 45 children were randomly assigned to either corticosteroids (n=22) or clobazam (n=23); two children assigned clobazam dropped out before 6 months and were excluded from the intention-to-treat analysis. At the 6-month assessment, an improvement of 11·25 IQ points or greater was reported for five (25%) of 20 children assigned corticosteroids versus zero (0%) of 18 assigned clobazam (risk ratio [RR] 10·0, 95% CI 1·2-1310·4; p=0·025). An improvement of 0·75 points or more in the cognitive sum score was recorded for one (5%) of 22 children assigned corticosteroids versus one (5%) of 21 children assigned clobazam (RR 1·0, 95% CI 0·1-11·7, p=0·97). Adverse events occurred in ten (45%) of 22 children who received corticosteroids, most frequently weight gain, and in 11 (52%) of 21 children who received clobazam, most often fatigue and behavioural disturbances. Occurrence of adverse events did not differ between groups (RR 0·8, 95% CI 0·4-1·4; p=0·65). Serious adverse events occurred in one child in the corticosteroid group (hospitalisation due to laryngitis) and in two children in the clobazam group (hospitalisation due to seizure aggravation, and respiratory tract infection). No deaths were reported. INTERPRETATION The trial was terminated prematurely, and the target sample size was not met, so our findings must be interpreted with caution. Our data indicated an improvement in IQ outcomes with corticosteroids compared with clobazam treatment, but no difference was seen in cognitive sum score. Our findings strengthen those from previous uncontrolled studies that support the early use of corticosteroids for children with EE-SWAS. FUNDING EpilepsieNL, WKZ fund, European Clinical Research Infrastructure Network, and Ming fund.
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Affiliation(s)
- Marleen M L van Arnhem
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon, Lyon, France
| | - Emilio Perucca
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia; Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Liisa Metsähonkala
- Department of Child Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Guido Rubboli
- Department of Epilepsy Genetics and Personalized Treatment, Danish Epilepsy Center, Dianalund, Denmark; Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne de Saint-Martin
- Department of Pediatric Neurology, Strasbourg University Hospital, Strasbourg, France
| | - Kerstin A Klotz
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Jacobs
- Department of Neuropediatrics and Muscle Disorders, University Hospital Freiburg, Freiburg, Germany; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - J Helen Cross
- Developmental Neurosciences Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK; Paediatric Neurosciences, Great Ormond Street Hospital for Children, London, UK
| | | | - Wim M Otte
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heleen C van Teeseling
- Department of Pediatric Psychology, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frans S S Leijten
- Department of Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands.
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Ramantani G, Cserpan D, Tisdall M, Otte WM, Dorfmüller G, Cross JH, van Schooneveld M, van Eijsden P, Nees F, Reuner G, Krayenbühl N, Zentner J, Bulteau C, Braun KPJ. Determinants of Functional Outcome after Pediatric Hemispherotomy. Ann Neurol 2024; 95:377-387. [PMID: 37962290 DOI: 10.1002/ana.26830] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE We aimed to evaluate determinants of functional outcome after pediatric hemispherotomy in a large and recent multicenter cohort. METHODS We retrospectively investigated the functional outcomes of 455 children who underwent hemispherotomy at 5 epilepsy centers in 2000-2016. We identified determinants of unaided walking, voluntary grasping with the hemiplegic hand, and speaking through Bayesian multivariable regression modeling using missing data imputation. RESULTS Seventy-five percent of children were seizure-free, and 44% stopped antiseizure medication at a 5.1-year mean follow-up (range = 1-17.1). Seventy-seven percent of children could walk unaided, 8% could grasp voluntarily, and 68% could speak at the last follow-up. Children were unlikely to walk when they had contralateral magnetic resonance imaging (MRI) abnormalities (40/73, p = 0.04), recurrent seizures following hemispherotomy (62/109, p = 0.04), and moderately (50/61, p = 0.03) or severely impaired (127/199, p = 0.001) postsurgical intellectual functioning, but were likely to walk when they were older at outcome determination (p = 0.01). Children were unlikely to grasp voluntarily with the hand contralateral to surgery when they had Rasmussen encephalitis (0/61, p = 0.001) or Sturge-Weber syndrome (0/32, p = 0.007). Children were unlikely to speak when they had contralateral MRI abnormalities (30/69, p = 0.002) and longer epilepsy duration (p = 0.01), but likely to speak when they had Sturge-Weber syndrome (29/35, p = 0.01), were older at surgery (p = 0.04), and were older at outcome determination (p < 0.001). INTERPRETATION Etiology and bilaterality of structural brain abnormalities were key determinants of functional outcome after hemispherotomy. Longer epilepsy duration affected language outcomes. Not surprisingly, walking and talking ability increased with older age at outcome evaluation. ANN NEUROL 2024;95:377-387.
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Affiliation(s)
- Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dorottya Cserpan
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Willem M Otte
- Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
| | - Georg Dorfmüller
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Member of European Reference Network EpiCARE, Paris, France
| | - J Helen Cross
- Department of Neurology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, Great Ormond Street and University College London National Institute for Health and Care Research Biomedical Research Centre Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Monique van Schooneveld
- Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
| | - Pieter van Eijsden
- Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
| | - Frauke Nees
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Gitta Reuner
- Institute of Education Studies, Faculty of Behavioral and Cultural Studies, University of Heidelberg, Heidelberg, Germany
| | - Niklaus Krayenbühl
- Department of Neurosurgery, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Josef Zentner
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christine Bulteau
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Member of European Reference Network EpiCARE, Paris, France
- University of Paris, MC2Lab, Institute of Psychology, Boulogne-Billancourt, France
| | - Kees P J Braun
- Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
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Terman SW, Slinger G, Koek A, Skvarce J, Springer MV, Ziobro JM, Burke JF, Otte WM, Thijs RD, Lossius MI, Marson AG, Bonnett LJ, Braun KPJ. Variation in seizure risk increases from antiseizure medication withdrawal among patients with well-controlled epilepsy: A pooled analysis. Epilepsia Open 2024; 9:333-344. [PMID: 38071463 PMCID: PMC10839298 DOI: 10.1002/epi4.12880] [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: 09/30/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE Guidelines suggest considering antiseizure medication (ASM) discontinuation in seizure-free patients with epilepsy. Past work has poorly explored how discontinuation effects vary between patients. We evaluated (1) what factors modify the influence of discontinuation on seizure risk; and (2) the range of seizure risk increase due to discontinuation across low- versus high-risk patients. METHODS We pooled three datasets including seizure-free patients who did and did not discontinue ASMs. We conducted time-to-first-seizure analyses. First, we evaluated what individual patient factors modified the relative effect of ASM discontinuation on seizure risk via interaction terms. Then, we assessed the distribution of 2-year risk increase as predicted by our adjusted logistic regressions. RESULTS We included 1626 patients, of whom 678 (42%) planned to discontinue all ASMs. The mean predicted 2-year seizure risk was 43% [95% confidence interval (CI) 39%-46%] for discontinuation versus 21% (95% CI 19%-24%) for continuation. The mean 2-year absolute seizure risk increase was 21% (95% CI 18%-26%). No individual interaction term was significant after correcting for multiple comparisons. The median [interquartile range (IQR)] risk increase across patients was 19% (IQR 14%-24%; range 7%-37%). Results were unchanged when restricting analyses to only the two RCTs. SIGNIFICANCE No single patient factor significantly modified the influence of discontinuation on seizure risk, although we captured how absolute risk increases change for patients that are at low versus high risk. Patients should likely continue ASMs if even a 7% 2-year increase in the chance of any more seizures would be too much and should likely discontinue ASMs if even a 37% risk increase would be too little. In between these extremes, individualized risk calculation and a careful understanding of patient preferences are critical. Future work will further develop a two-armed individualized seizure risk calculator and contextualize seizure risk thresholds below which to consider discontinuation. PLAIN LANGUAGE SUMMARY Understanding how much antiseizure medications (ASMs) decrease seizure risk is an important part of determining which patients with epilepsy should be treated, especially for patients who have not had a seizure in a while. We found that there was a wide range in the amount that ASM discontinuation increases seizure risk-between 7% and 37%. We found that no single patient factor modified that amount. Understanding what a patient's seizure risk might be if they discontinued versus continued ASM treatment is critical to making informed decisions about whether the benefit of treatment outweighs the downsides.
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Affiliation(s)
- Samuel W. Terman
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | - Geertruida Slinger
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's HospitalUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Adriana Koek
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
- Department of NeurologyUniversity of California San FranciscoSan FransiscoCaliforniaUSA
| | - Jeremy Skvarce
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | - Julie M. Ziobro
- Department of PediatricsUniversity of MichiganAnn ArborMichiganUSA
| | - James F. Burke
- Department of NeurologyThe Ohio State UniversityColumbusOhioUSA
| | - Willem M. Otte
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's HospitalUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Roland D. Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
- Department of NeurologyLeiden University Medical Centre (LUMC)LeidenThe Netherlands
- Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Morten I. Lossius
- Oslo University Hospital National Center for EpilepsyOsloNorway
- Institute of Clinical Medicine, University of OsloOsloNorway
| | - Anthony G. Marson
- Department of Pharmacology and TherapeuticsUniversity of LiverpoolLiverpoolUK
| | - Laura J. Bonnett
- Department of Health Data ScienceUniversity of LiverpoolLiverpoolUK
| | - Kees P. J. Braun
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's HospitalUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
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Woodfield J, Braun KPJ, van Schooneveld MMJ, Bastin ME, Chin RFM. Efficient organisation of the contralateral hemisphere connectome is associated with improvement in intelligence quotient after paediatric epilepsy surgery. Epilepsy Behav 2023; 149:109521. [PMID: 37944287 DOI: 10.1016/j.yebeh.2023.109521] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Aims of epilepsy surgery in childhood include optimising seizure control and facilitating cognitive development. Predicting which children will improve cognitively is challenging. We investigated the association of the pre-operative structural connectome of the contralateral non-operated hemisphere with improvement in intelligence quotient (IQ) post-operatively. METHODS Consecutive children who had undergone unilateral resective procedures for epilepsy at a single centre were retrospectively identified. We included those with pre-operative volume T1-weighted non-contrast brain magnetic resonance imaging (MRI), no visible contralateral MRI abnormalities, and both pre-operative and two years post-operative IQ assessment. The MRI of the hemisphere contralateral to the side of resection was anatomically parcellated into 34 cortical regions and the covariance of cortical thickness between regions was used to create binary and weighted group connectomes. RESULTS Eleven patients with a post-operative IQ increase of at least 10 points at two years were compared with twenty-four patients with no change in IQ score. Children who gained at least 10 IQ points post-operatively had a more efficiently structured contralateral hemisphere connectome with higher global efficiency (0.74) compared to those whose IQ did not change at two years (0.58, p = 0.014). This was consistent across thresholds and both binary and weighted networks. There were no statistically significant group differences in age, sex, age at onset of epilepsy, pre-operative IQ, mean cortical thickness, side or site of procedure, two year post-operative Engel scores or use of anti-seizure medications between the two groups. CONCLUSIONS Surgical procedures to reduce or stop seizures may allow children with an efficiently structured contralateral hemisphere to achieve their cognitive potential.
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Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom.
| | - Kees P J Braun
- Department of Paediatric Neurology, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Monique M J van Schooneveld
- Department of Paediatric Psychology, Sector of Neuropsychology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard F M Chin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
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Woodfield J, Chin RFM, van Schooneveld MMJ, van den Heuvel M, Bastin ME, Braun KPJ. The association of structural connectome efficiency with cognition in children with epilepsy. Epilepsy Behav 2023; 148:109462. [PMID: 37844437 DOI: 10.1016/j.yebeh.2023.109462] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Cognitive impairment is common in children with epilepsy (CWE), but understanding the underlying pathological processes is challenging. We aimed to investigate the association of structural brain network organisation with cognition. METHODS This was a retrospective cohort study of CWE without structural brain abnormalities, comparing whole brain network characteristics between those with cognitive impairment and those with intact cognition. We created structural whole-brain connectomes from anatomical and diffusion tensor magnetic resonance imaging using the number of streamlines and tract-averaged fractional anisotropy. We assessed the differences in average path length and global network efficiency between children with cognitive impairment and those without,using multivariable analyses to account for possible clinical group differences. RESULTS Twenty-eight CWE and cognitive impairment had lower whole brain network global efficiency compared with 34 children with intact cognition (0.54, standard deviation (SD):0.003 vs. 0.56, SD:0.002, p < 0.001), which is equivalent to longer normalized network average path lengths (1.14, SD:0.05 vs. 1.10, SD:0.02, p = 0.003). In multivariable logistic regression cognitive impairment was not significantly associated with age of onset, duration of epilepsy, or number of antiseizure medications, but was independently associated with daily seizures (p = 0.04) and normalized average path length (p = 0.007). CONCLUSIONS Higher structural network average path length and lower global network efficiency may be imaging biomarkers of cognitive impairment in epilepsy. Understanding what leads to changes in structural connectivity could aid identification of modifiable risk factors for cognitive impairment. These findings are only applicable to the specific cohort studied, and further confirmation in other cohorts is required.
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Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom.
| | - Richard F M Chin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | | | - Martijn van den Heuvel
- Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Kees P J Braun
- Department of Paediatric Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
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Defelippe VM, J M W van Thiel G, Otte WM, Schutgens REG, Stunnenberg B, Cross HJ, O'Callaghan F, De Giorgis V, Jansen FE, Perucca E, Brilstra EH, Braun KPJ. Toward responsible clinical n-of-1 strategies for rare diseases. Drug Discov Today 2023; 28:103688. [PMID: 37356616 DOI: 10.1016/j.drudis.2023.103688] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
N-of-1 strategies can provide high-quality evidence of treatment efficacy at the individual level and optimize evidence-based selection of off-label treatments for patients with rare diseases. Given their design characteristics, n-of-1 strategies are considered to lay at the intersection between medical research and clinical care. Therefore, whether n-of-1 strategies should be governed by research or care regulations remains a debated issue. Here, we delineate differences between medical research and optimized clinical care, and distinguish the regulations which apply to either. We also set standards for responsible optimized clinical n-of-1 strategies with (off-label) treatments for rare diseases. Implementing clinical n-of-1 strategies as defined here could aid in optimized treatment selection for such diseases.
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Affiliation(s)
- Victoria M Defelippe
- Department of Child Neurology, UMCU Brain Center, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands; European Reference Network for Rare and Complex Epilepsies (EpiCare), Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, c/o Pr Arzimanoglou, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 Bron, France.
| | - Ghislaine J M W van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Willem M Otte
- Department of Child Neurology, UMCU Brain Center, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Roger E G Schutgens
- Van Creveldkliniek, Benign Hematology Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; European Reference Network for Oncological and non-oncological Rare Hematological Diseases (EuroBloodNet), Hôpital St Louis / Université Paris 7, 1 Avenue Claude Vellefaux, 75475 Paris, France
| | - Bas Stunnenberg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands
| | - Helen J Cross
- European Reference Network for Rare and Complex Epilepsies (EpiCare), Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, c/o Pr Arzimanoglou, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 Bron, France; University College London (UCL) Great Ormond Street, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Finbar O'Callaghan
- European Reference Network for Rare and Complex Epilepsies (EpiCare), Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, c/o Pr Arzimanoglou, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 Bron, France; Paediatric Neuroscience, UCL Great Ormond Street, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Valentina De Giorgis
- European Reference Network for Rare and Complex Epilepsies (EpiCare), Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, c/o Pr Arzimanoglou, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 Bron, France; Fondazione Mondino National Institute of Neurology, University of Pavia, Via Mondino 2, 27100 Pavia, Italy
| | - Floor E Jansen
- Department of Child Neurology, UMCU Brain Center, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands; European Reference Network for Rare and Complex Epilepsies (EpiCare), Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, c/o Pr Arzimanoglou, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 Bron, France
| | - Emilio Perucca
- European Reference Network for Rare and Complex Epilepsies (EpiCare), Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, c/o Pr Arzimanoglou, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 Bron, France; Department of Medicine, University of Melbourne (Austin Health), Heidelberg, VIC 3084, Australia; Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Eva H Brilstra
- European Reference Network for Rare and Complex Epilepsies (EpiCare), Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, c/o Pr Arzimanoglou, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 Bron, France; Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Kees P J Braun
- European Reference Network for Rare and Complex Epilepsies (EpiCare), Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, c/o Pr Arzimanoglou, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 Bron, France; Department of Child Neurology, UMCU Brain Center, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
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Minderhoud CA, Postma A, Jansen FE, Verhoeven JS, Schrijver JJ, Goudswaard J, Andreae G, Otte WM, Braun KPJ, Brilstra EH. Gastrointestinal and eating problems in SCN1A-related seizure disorders. Epilepsy Behav 2023; 146:109361. [PMID: 37523795 DOI: 10.1016/j.yebeh.2023.109361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Our study aimed to describe the prevalence and characteristics of gastrointestinal and eating problems in Dravet syndrome (DS) and other SCN1A-related seizure disorders and to determine the association between the occurrence of gastrointestinal and eating problems and core features of DS. METHODS Gastrointestinal and eating problems were assessed with a questionnaire in a Dutch cohort of participants with an SCN1A-related seizure disorder. Associations between the number of gastrointestinal and eating problems and core features of DS, seizure severity, level of intellectual disability, impaired mobility, behavioral problems, and use of anti-seizure medication, were explored by multivariate ordinal regression analyses. Symptoms were divided into the categories dysphagia-related, behavioral, and gastrointestinal, and were assessed separately. RESULTS One hundred sixty-nine participants with an SCN1A-related seizure disorder, of whom 118 (69.8%) with DS and 51 (30.2%) with Generalized Epilepsy with Febrile Seizures Plus / Febrile Seizures (GEFS+/FS), the non-DS phenotype, were evaluated. Gastrointestinal and eating problems were highly prevalent in DS participants, 50.8% had more than three symptoms compared to 3.9% of non-DS participants. Of participants with DS, 17.8% were fully or partly fed by a gastric tube. Within the three different symptom categories, the most prevalent dysphagia-related symptom was drooling (60.7%), distraction during mealtimes (61.4%) the most prevalent behavioral symptom, and constipation and loss of appetite (both 50.4%) the most prevalent gastrointestinal symptoms. DS participants who use a wheelchair (odds ratio (OR) 4.9 95%CI (1.9-12.8) compared to walking without aid), who use ≥3 anti-seizure medications (ASM) (OR 5.9 95%CI (1.9-18.2) compared to <3 ASM) and who have behavioral problems (OR 3.0 95%CI (1.1-8.1) compared to no behavioral problems) had more gastrointestinal and eating problems. CONCLUSION Gastrointestinal and eating problems are frequently reported symptoms in DS. Distinguishing between symptom categories will lead to tailored management of patients at risk, will improve early detection, and enable a timely referral to a dietitian, behavioral expert, and/or speech therapist, ultimately aiming to improve the quality of life of both patients and caregivers.
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Affiliation(s)
- C A Minderhoud
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands.
| | - A Postma
- Department of Psychiatry, UMCU Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - F E Jansen
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - J S Verhoeven
- Department of Neurology, Academic Centre for Epileptology Kempenhaeghe, Heeze, the Netherlands
| | - J J Schrijver
- Department of Dietetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Goudswaard
- Speech Therapy, Stichting Epilepsie Instellingen Nederland, Postbus 540, 2130 AM Hoofddorp, the Netherlands
| | - G Andreae
- Speech Therapy, Stichting Epilepsie Instellingen Nederland, Postbus 540, 2130 AM Hoofddorp, the Netherlands
| | - W M Otte
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - K P J Braun
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - E H Brilstra
- Department of Genetics, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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Deckers PT, Siero JCW, Mensink MO, Kronenburg A, Braun KPJ, van der Zwan A, Bhogal AA. Anesthesia Depresses Cerebrovascular Reactivity to Acetazolamide in Pediatric Moyamoya Vasculopathy. J Clin Med 2023; 12:4393. [PMID: 37445429 DOI: 10.3390/jcm12134393] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Measurements of cerebrovascular reactivity (CVR) are essential for treatment decisions in moyamoya vasculopathy (MMV). Since MMV patients are often young or cognitively impaired, anesthesia is commonly used to limit motion artifacts. Our aim was to investigate the effect of anesthesia on the CVR in pediatric MMV. We compared the CVR with multidelay-ASL and BOLD MRI, using acetazolamide as a vascular stimulus, in all awake and anesthesia pediatric MMV scans at our institution. Since a heterogeneity in disease and treatment influences the CVR, we focused on the (unaffected) cerebellum. Ten awake and nine anesthetized patients were included. The post-acetazolamide CBF and ASL-CVR were significantly lower in anesthesia patients (47.1 ± 15.4 vs. 61.4 ± 12.1, p = 0.04; 12.3 ± 8.4 vs. 23.7 ± 12.2 mL/100 g/min, p = 0.03, respectively). The final BOLD-CVR increase (0.39 ± 0.58 vs. 3.6 ± 1.2% BOLD-change (mean/SD), p < 0.0001), maximum slope of increase (0.0050 ± 0.0040%/s vs. 0.017 ± 0.0059%, p < 0.0001), and time to maximum BOLD-increase (~463 ± 136 and ~697 ± 144 s, p = 0.0028) were all significantly lower in the anesthesia group. We conclude that the response to acetazolamide is distinctively different between awake and anesthetized MMV patients, and we hypothesize that these findings can also apply to other diseases and methods of measuring CVR under anesthesia. Considering that treatment decisions heavily depend on CVR status, caution is warranted when assessing CVR under anesthesia.
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Affiliation(s)
- Pieter T Deckers
- Department of Neurosurgery, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Radiology and Nuclear Medicine, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands
| | - Jeroen C W Siero
- Department of Radiology, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands
- Spinoza Center for Neuroimaging, 1105 BK Amsterdam, The Netherlands
| | - Maarten O Mensink
- Pediatric Anesthesiology, Prinses Máxima Centrum, 3584 CS Utrecht, The Netherlands
| | - Annick Kronenburg
- Department of Neurosurgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, 2512 VA The Hague, The Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Wilhelmina Children's Hospital, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands
| | - Albert van der Zwan
- Department of Neurosurgery, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands
| | - Alex A Bhogal
- Department of Radiology, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands
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Slinger G, Stevelink R, van Diessen E, Braun KPJ, Otte WM. The importance of discriminative power rather than significance when evaluating potential clinical biomarkers in epilepsy research. Epileptic Disord 2023; 25:285-296. [PMID: 37536951 DOI: 10.1002/epd2.20010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/20/2022] [Accepted: 10/05/2022] [Indexed: 08/05/2023]
Abstract
OBJECTIVE The quest for epilepsy biomarkers is on the rise. Variables with statistically significant group-level differences are often misinterpreted as biomarkers with sufficient discriminative power. This study aimed to demonstrate the relationship between significant group-level differences and a variable's power to discriminate between individuals. METHODS We simulated normal-distributed datasets from hypothetical populations with varying sample sizes (25-800), effect sizes (Cohen's d: .25-2.50), and variability (standard deviation: 10-35) to assess the impact of these parameters on significance and discriminative power. The simulation data were illustrated by assessing the discriminative power of a potential real-case biomarker-the EEG beta band power-to diagnose generalized epilepsy, using data from 66 children with generalized epilepsy and 385 controls. Additionally, we evaluated recently reported epilepsy biomarkers by comparing their effect sizes to our simulation-derived effect size criterion. RESULTS Group size affects significance but not discriminative power. Discriminative power is much more related to variability and effect size. Our real data example supported these simulation results by demonstrating that group-level significance does not translate, one to one, into discriminative power. Although we found a significant difference in the beta band power between children with and without epilepsy, the discriminative power was poor due to a small effect size. A Cohen's d of at least 1.25 is required to reach good discriminative power in univariable prediction modeling. Slightly over 60% of the biomarkers in our literature search met this criterion. SIGNIFICANCE Rather than statistical significance of group-level differences, effect size should be used as an indicator of a variable's biomarker potential. The minimal required effects size for individual biomarkers-a Cohen's d of 1.25-is large. This calls for multivariable approaches, in which combining multiple variables with smaller effect sizes could increase the overall effect size and discriminative power.
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Affiliation(s)
- Geertruida Slinger
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Remi Stevelink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eric van Diessen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Willem M Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Ramantani G, Bulteau C, Cserpan D, Otte WM, Dorfmüller G, Cross JH, Zentner J, Tisdall M, Braun KPJ. Not surgical technique, but etiology, contralateral MRI, prior surgery, and side of surgery determine seizure outcome after pediatric hemispherotomy. Epilepsia 2023; 64:1214-1224. [PMID: 36869851 DOI: 10.1111/epi.17574] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/06/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE We aimed to assess determinants of seizure outcome following pediatric hemispherotomy in a contemporary cohort. METHODS We retrospectively analyzed the seizure outcomes of 457 children who underwent hemispheric surgery in five European epilepsy centers between 2000 and 2016. We identified variables related to seizure outcome through multivariable regression modeling with missing data imputation and optimal group matching, and we further investigated the role of surgical technique by Bayes factor (BF) analysis. RESULTS One hundred seventy seven children (39%) underwent vertical and 280 children (61%) underwent lateral hemispherotomy. Three hundred forty-four children (75%) achieved seizure freedom at a mean follow-up of 5.1 years (range 1 to 17.1). We identified acquired etiology other than stroke (odds ratio [OR] 4.4, 95% confidence interval (CI) 1.1-18.0), hemimegalencephaly (OR 2.8, 95% CI 1.1-7.3), contralateral magnetic resonance imaging (MRI) findings (OR 5.5, 95% CI 2.7-11.1), prior resective surgery (OR 5.0, 95% CI 1.8-14.0), and left hemispherotomy (OR 2.3, 95% CI 1.3-3.9) as significant determinants of seizure recurrence. We found no evidence of an impact of the hemispherotomy technique on seizure outcome (the BF for a model including the hemispherotomy technique over the null model was 1.1), with comparable overall major complication rates for different approaches. SIGNIFICANCE Knowledge about the independent determinants of seizure outcome following pediatric hemispherotomy will improve the counseling of patients and families. In contrast to previous reports, we found no statistically relevant difference in seizure-freedom rates between the vertical and horizontal hemispherotomy techniques when accounting for different clinical features between groups.
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Affiliation(s)
- Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christine Bulteau
- Member of ERN EpiCare, Department of Pediatric Neurosurgery, Hospital Fondation Adolphe de Rothschild, Paris, France
| | - Dorottya Cserpan
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Willem M Otte
- Member of ERN EpiCare, Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands
| | - Georg Dorfmüller
- Member of ERN EpiCare, Department of Pediatric Neurosurgery, Hospital Fondation Adolphe de Rothschild, Paris, France
| | - J Helen Cross
- Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street & UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Josef Zentner
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kees P J Braun
- Member of ERN EpiCare, Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands
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12
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Terman SW, Slinger G, Rheaume CE, Haque AS, Smith SN, van Griethuysen R, van Asch CJJ, Otte WM, Burke JF, Braun KPJ. Antiseizure Medication Withdrawal Practice Patterns: A Survey Among Members of the American Academy of Neurology and EpiCARE. Neurol Clin Pract 2023; 13:e200109. [PMID: 37063781 PMCID: PMC10101711 DOI: 10.1212/cpj.0000000000200109] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/10/2022] [Indexed: 01/20/2023]
Abstract
Background and Objectives To describe neurologist practice patterns, challenges, and decision support needs pertaining to withdrawal of antiseizure medications (ASMs) in patients with well-controlled epilepsy. Methods We sent an electronic survey to (1) US and (2) European physician members of the American Academy of Neurology and (3) members of EpiCARE, a European Reference Network for rare and complex epilepsies. Analyses included frequencies and percentages, and we showed distributions through histograms and violin plots. Results We sent the survey to 4,923 individuals; 463 consented, 411 passed eligibility questions, and 287 responded to at least 1 of these questions. Most respondents indicated that they might ever consider ASM withdrawal, with respondents treating mostly children being more likely ever to consider withdrawal (e.g., medical monotherapy: children 96% vs adults 81%; p < 0.05). The most important factors when making decisions included seizure probability (83%), consequences of seizures (73%), and driving (74%). The top challenges when making decisions included unclear seizure probability (81%), inadequate guidelines (50%), and difficulty communicating probabilities (45%). Respondents would consider withdrawal after a median of 2-year seizure freedom, but also responded that they would begin withdrawal on average only when the postwithdrawal seizure relapse risk in the coming 2 years was less than 15%-30%. Wide variation existed in the use of words or numbers in respondents' counsel methods, for example, percentages vs frequencies or probability of seizure freedom vs seizure. The most highly rated point-of-care methods to inform providers of calculated risk were Kaplan-Meier curves and showing percentages only, rather than pictographs or text recommendations alone. Discussion Most surveyed neurologists would consider withdrawing ASMs in seizure-free individuals. Seizure probability was the largest factor driving decisions, yet estimating seizure probabilities was the greatest challenge. Respondents on average indicated that they may withdraw ASM after a minimum seizure-free duration of 2 years, yet also on average were willing to withdraw when seizure risk decreased below 15%-30%, which is lower than most patients' postwithdrawal risk at 2-year seizure freedom and lower than the equivalent even of a first seizure of life. These findings will inform future efforts at developing decision support tools aimed at optimizing ASM withdrawal decisions.
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Affiliation(s)
- Samuel W Terman
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
| | - Geertruida Slinger
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
| | - Carol E Rheaume
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
| | - Anisa S Haque
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
| | - Shawna N Smith
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
| | - Renate van Griethuysen
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
| | - Charlotte J J van Asch
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
| | - Willem M Otte
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
| | - James F Burke
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
| | - Kees P J Braun
- Department of Neurology (SWT), University of Michigan, Ann Arbor; Department of Child Neurology (GS, WMO, KB), UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, the Netherlands; American Academy of Neurology (CER), Minneapolis, MN; University of Michigan Medical School (ASH); Department of Health Management and Policy (SNS), School of Public Health, University of Michigan, Ann Arbor; Department of Clinical Neurophysiology and Sleep Centre SEIN Zwolle (RvG, CJJvA), the Netherlands; Department of Neurology (JFB), the Ohio State University, Columbus; and Member of the European Reference Network EpiCARE (KPJB)
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Terman SW, van Griethuysen R, Rheaume CE, Slinger G, Haque AS, Smith SN, Kerr WT, van Asch C, Otte WM, Ferreira-Atuesta C, Galovic M, Burke JF, Braun KPJ. Antiseizure medication withdrawal risk estimation and recommendations: A survey of American Academy of Neurology and EpiCARE members. Epilepsia Open 2023. [PMID: 36721311 DOI: 10.1002/epi4.12696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Choosing candidates for antiseizure medication (ASM) withdrawal in well-controlled epilepsy is challenging. We evaluated (a) the correlation between neurologists' seizure risk estimation ("clinician predictions") vs calculated predictions, (b) how viewing calculated predictions influenced recommendations, and (c) barriers to using risk calculation. METHODS We asked US and European neurologists to predict 2-year seizure risk after ASM withdrawal for hypothetical vignettes. We compared ASM withdrawal recommendations before vs after viewing calculated predictions, using generalized linear models. RESULTS Three-hundred and forty-six neurologists responded. There was moderate correlation between clinician and calculated predictions (Spearman coefficient 0.42). Clinician predictions varied widely, for example, predictions ranged 5%-100% for a 2-year seizure-free adult without epileptiform abnormalities. Mean clinician predictions exceeded calculated predictions for vignettes with epileptiform abnormalities (eg, childhood absence epilepsy: clinician 65%, 95% confidence interval [CI] 57%-74%; calculated 46%) and surgical vignettes (eg, focal cortical dysplasia 6-month seizure-free mean clinician 56%, 95% CI 52%-60%; calculated 28%). Clinicians overestimated the influence of epileptiform EEG findings on withdrawal risk (26%, 95% CI 24%-28%) compared with calculators (14%, 95% 13%-14%). Viewing calculated predictions slightly reduced willingness to withdraw (-0.8/10 change, 95% CI -1.0 to -0.7), particularly for vignettes without epileptiform abnormalities. The greatest barrier to calculator use was doubting its accuracy (44%). SIGNIFICANCE Clinicians overestimated the influence of abnormal EEGs particularly for low-risk patients and overestimated risk and the influence of seizure-free duration for surgical patients, compared with calculators. These data may question widespread ordering of EEGs or time-based seizure-free thresholds for surgical patients. Viewing calculated predictions reduced willingness to withdraw particularly without epileptiform abnormalities.
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Affiliation(s)
- Samuel W Terman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Geertruida Slinger
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, member of ERN EpiCARE, Utrecht University, Utrecht, The Netherlands
| | - Anisa S Haque
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shawna N Smith
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wesley T Kerr
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Charlotte van Asch
- Department of Clinical Neurophysiology and Sleep Centre, SEIN, Zwolle, The Netherlands
| | - Willem M Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, member of ERN EpiCARE, Utrecht University, Utrecht, The Netherlands
| | - Carolina Ferreira-Atuesta
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.,MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - James F Burke
- Department of Neurology, Ohio State University, Columbus, Ohio, USA
| | - Kees P J Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, member of ERN EpiCARE, Utrecht University, Utrecht, The Netherlands
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Terman SW, Slinger G, Koek A, Skvarce J, Springer MV, Ziobro JM, Burke JF, Otte WM, Thijs RD, Braun KPJ. Frequency of and factors associated with antiseizure medication discontinuation discussions and decisions in patients with epilepsy: A multicenter retrospective chart review. Epilepsia Open 2023. [PMID: 36693718 DOI: 10.1002/epi4.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/19/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Guidelines suggest considering antiseizure medication (ASM) discontinuation in patients with epilepsy who become seizure-free. Little is known about how discontinuation decisions are being made in practice. We measured the frequency of, and factors associated with, discussions and decisions surrounding ASM discontinuation. METHODS We performed a multicenter retrospective cohort study at the University of Michigan (UM) and two Dutch centers: Wilhelmina Children's Hospital (WCH) and Stichting Epilepsie Instellingen Nederland (SEIN). We screened all children and adults with outpatient epilepsy visits in January 2015 and included those with at least one visit during the subsequent 2 years where they were seizure-free for at least one year. We recorded whether charts documented (1) a discussion with the patient about possible ASM discontinuation and (2) any planned attempt to discontinue at least one ASM. We conducted multilevel logistic regressions to determine factors associated with each outcome. RESULTS We included 1058 visits from 463 patients. Of all patients who were seizure-free at least one year, 248/463 (53%) had documentation of any discussion and 98/463 (21%) planned to discontinue at least one ASM. Corresponding frequencies for patients who were seizure-free at least 2 years were 184/285 (65%) and 74/285 (26%). The probability of discussing or discontinuing increased with longer duration of seizure freedom. Still, even for patients who were 10 years seizure-free, our models predicated that in only 49% of visits was a discontinuation discussion documented, and in only 16% of visits was it decided to discontinue all ASMs. Provider-to-provider variation explained 18% of variation in whether patients discontinued any ASM. SIGNIFICANCE Only approximately half of patients with prolonged seizure freedom had a documented discussion about ASM discontinuation. Discontinuation was fairly rare even among low-risk patients. Future work should further explore barriers to and facilitators of counseling and discontinuation attempts.
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Affiliation(s)
- Samuel W Terman
- University of Michigan Department of Neurology, Ann Arbor, Michigan, USA
| | - Geertruida Slinger
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Adriana Koek
- University of Michigan Department of Neurology, Ann Arbor, Michigan, USA
| | - Jeremy Skvarce
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Julie M Ziobro
- University of Michigan Department of Pediatrics, Ann Arbor, Michigan, USA
| | - James F Burke
- Ohio State University Department of Neurology, Columbus, Ohio, USA
| | - Willem M Otte
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.,Queen Square Institute of Neurology, University College London, London, UK
| | - Kees P J Braun
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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Meijs TA, van Tuijl RJ, van den Brink H, Weaver NA, Siero JCW, van der Worp HB, Braun KPJ, Leiner T, de Jong PA, Zwanenburg JJM, Doevendans PA, Voskuil M, Grotenhuis HB. Assessment of aortic and cerebral haemodynamics and vascular brain injury with 3 and 7 T magnetic resonance imaging in patients with aortic coarctation. Eur Heart J Open 2023; 3:oead001. [PMID: 36751560 PMCID: PMC9898880 DOI: 10.1093/ehjopen/oead001] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
Aims Coarctation of the aorta (CoA) is characterized by a central arteriopathy resulting in increased arterial stiffness. The condition is associated with an increased risk of stroke. We aimed to assess the aortic and cerebral haemodynamics and the presence of vascular brain injury in patients with previous surgical CoA repair. Methods and results Twenty-seven patients with CoA (median age 22 years, range 12-72) and 25 age- and sex-matched controls (median age 24 years, range 12-64) underwent 3 T (heart, aorta, and brain) and 7 T (brain) magnetic resonance imaging scans. Haemodynamic parameters were measured using two-dimensional phase-contrast images of the ascending and descending aorta, internal carotid artery (ICA), basilar artery (BA), middle cerebral artery (MCA), and perforating arteries. Vascular brain injury was assessed by rating white matter hyperintensities, cortical microinfarcts, lacunes, and microbleeds. Pulse wave velocities in the aortic arch and descending aorta were increased and ascending aortic distensibility was decreased in patients with CoA vs. controls. Patients with CoA showed a higher mean flow velocity in the right ICA, left ICA, and BA and a reduced distensibility in the right ICA, BA, and left MCA. Haemodynamic parameters in the perforating arteries, total cerebral blood flow, intracranial volumes, and vascular brain injury were similar between the groups. Conclusion Patients with CoA show an increased flow velocity and reduced distensibility in the aorta and proximal cerebral arteries, which suggests the presence of a generalized arteriopathy that extends into the cerebral arterial tree. No substantial vascular brain injury was observed in this relatively young CoA population, although the study was inadequately powered regarding this endpoint.
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Affiliation(s)
| | - Rick J van Tuijl
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Hilde van den Brink
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Jeroen C W Siero
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands,Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands,Department of Cardiology, Central Military Hospital, Lundlaan 1, 3584 EZ Utrecht, The Netherlands
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16
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Kronenburg A, Deckers PT, van den Berg E, van Schooneveld MM, Vonken EJ, van der Zwan A, van Berckel BNM, Yaqub M, Otte W, Klijn CJM, Braun KPJ. The profile of cognitive impairment and hemodynamic compromise in moyamoya: a single-center prospective cohort study. J Neurosurg 2023; 138:173-184. [PMID: 35523260 DOI: 10.3171/2022.3.jns212844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/13/2021] [Accepted: 03/16/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Patients with moyamoya vasculopathy often experience cognitive impairments. In this prospective single-center study, the authors investigated the profile of neurocognitive impairment and its relation with the severity of ischemic brain lesions and hemodynamic compromise. METHODS Patients treated in a Dutch tertiary referral center were prospectively included. All patients underwent standardized neuropsychological evaluation, MRI, digital subtraction angiography, and [15O]H2O-PET (to measure cerebrovascular reactivity [CVR]). The authors determined z-scores for 7 cognitive domains and the proportion of patients with cognitive impairment (z-score < -1.5 SD in at least one domain). The authors explored associations between patient characteristics, imaging and CVR findings, and cognitive scores per domain by using multivariable linear regression and Bayesian regression analysis. RESULTS A total of 40 patients (22 children; 75% females) were included. The median age for children was 9 years (range 1-16 years); for adults it was 39 years (range 19-53 years). Thirty patients (75%) had an infarction, and 31 patients (78%) had impaired CVR (steal phenomenon). Six of 7 cognitive domains scored below the population norm. Twenty-nine patients (73%) had cognitive impairment. Adults performed better than children in the cognitive domain visuospatial functioning (p = 0.033, Bayes factor = 4.0), and children performed better in processing speed (p = 0.041, Bayes factor = 3.5). The authors did not find an association between infarction, white matter disease, or CVR and cognitive domains. CONCLUSIONS In this Western cohort, cognitive functioning in patients with moyamoya vasculopathy was below the population norm, and 73% had cognitive impairment in at least one domain. The cognitive profile differed between adults and children. The authors could not find an association with imaging findings.
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Affiliation(s)
- Annick Kronenburg
- 1Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht
| | - Pieter T Deckers
- 1Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht
| | | | | | | | - Albert van der Zwan
- 1Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht
| | | | - Maqsood Yaqub
- 5Department of Nuclear Medicine & PET Research, Amsterdam UMC, Amsterdam
| | - Willem Otte
- 6Department of Pediatric Neurology, UMC Utrecht Brain Center, Utrecht; and
| | - Catharina J M Klijn
- 1Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht.,7Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Center for Neuroscience, Radboud UMC, Nijmegen, The Netherlands
| | - Kees P J Braun
- 1Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht
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Deckers PT, Kronenburg A, van den Berg E, van Schooneveld MM, Vonken EJPA, Otte WM, van Berckel BNM, Yaqub M, Klijn CJM, van der Zwan A, Braun KPJ. Clinical Outcome, Cognition, and Cerebrovascular Reactivity after Surgical Treatment for Moyamoya Vasculopathy: A Dutch Prospective, Single-Center Cohort Study. J Clin Med 2022; 11:jcm11247427. [PMID: 36556043 PMCID: PMC9786028 DOI: 10.3390/jcm11247427] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background: It remains unclear whether revascularization of moyamoya vasculopathy (MMV) has a positive effect on cognitive function. In this prospective, single-center study, we investigated the effect of revascularization on cognitive function in patients with MMV. We report clinical and radiological outcome parameters and the associations between clinical determinants and change in neurocognitive functioning. Methods: We consecutively included all MMV patients at a Dutch tertiary referral hospital who underwent pre- and postoperative standardized neuropsychological evaluation, [15O]H2O-PET (including cerebrovascular reactivity (CVR)), MRI, cerebral angiography, and completed standardized questionnaires on clinical outcome and quality of life (QOL). To explore the association between patient characteristics, imaging findings, and change in the z-scores of the cognitive domains, we used multivariable linear- and Bayesian regression analysis. Results: We included 40 patients of whom 35 (27 females, 21 children) were treated surgically. One patient died after surgery, and two withdrew from the study. TIA- and headache frequency and modified Rankin scale (mRS) improved (resp. p = 0.001, 0.019, 0.039). Eleven patients (seven children) developed a new infarct during follow-up (31%), five of which were symptomatic. CVR-scores improved significantly (p < 0.0005). The language domain improved (p = 0.029); other domains remained stable. In adults, there was an improvement in QOL. We could not find an association between change in imaging and cognitive scores. Conclusion: In this cohort of Western MMV patients, TIA frequency, headache, CVR, and mRS improved significantly after revascularization. The language domain significantly improved, while others remained stable. We could not find an association between changes in CVR and cognitive scores.
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Affiliation(s)
- Pieter Thomas Deckers
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
- Department of Radiology and Nuclear Medicine, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands
- Correspondence:
| | - Annick Kronenburg
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | | | | | - Willem M. Otte
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
| | - Bart N. M. van Berckel
- Department of Nuclear Medicine & PET Research, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Nuclear Medicine & PET Research, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
| | - Catharina J. M. Klijn
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Center for Neuroscience, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Albert van der Zwan
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
| | - Kees P. J. Braun
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
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18
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Ferreira-Atuesta C, de Tisi J, McEvoy AW, Miserocchi A, Khoury J, Yardi R, Vegh DT, Butler J, Lee HJ, Deli-Peri V, Yao Y, Wang FP, Zhang XB, Shakhatreh L, Siriratnam P, Neal A, Sen A, Tristram M, Varghese E, Biney W, Gray WP, Peralta AR, Rainha-Campos A, Gonçalves-Ferreira AJC, Pimentel J, Arias JF, Terman S, Terziev R, Lamberink HJ, Braun KPJ, Otte WM, Rugg-Gunn FJ, Gonzalez W, Bentes C, Hamandi K, O'Brien TJ, Perucca P, Yao C, Burman RJ, Jehi L, Duncan JS, Sander JW, Koepp M, Galovic M. Predictive models for starting antiseizure medication withdrawal following epilepsy surgery in adults. Brain 2022:6841346. [DOI: 10.1093/brain/awac437] [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] [Received: 07/22/2022] [Revised: 10/20/2022] [Accepted: 11/06/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
More than half of adults with epilepsy undergoing resective epilepsy surgery achieve long-term seizure freedom and might consider withdrawing antiseizure medications (ASMs). We aimed to identify predictors of seizure recurrence after starting postoperative ASM withdrawal and develop and validate predictive models.
We performed an international multicentre observational cohort study in nine tertiary epilepsy referral centres. We included 850 adults who started ASM withdrawal following resective epilepsy surgery and were free of seizures other than focal non-motor aware seizures before starting ASM withdrawal. We developed a model predicting recurrent seizures, other than focal non-motor aware seizures, using Cox proportional hazards regression in a derivation cohort (n = 231). Independent predictors of seizure recurrence, other than focal non-motor aware seizures, following the start of ASM withdrawal were focal non motor-aware seizures after surgery and before withdrawal (adjusted hazards ratio [aHR] 5.5, 95% confidence interval [CI] 2.7-11.1), history of focal to bilateral tonic-clonic seizures before surgery (aHR 1.6, 95% CI 0.9-2.8), time from surgery to the start of ASM withdrawal (aHR 0.9, 95% CI 0.8-0.9), and number of ASMs at time of surgery (aHR 1.2, 95% CI 0.9-1.6). Model discrimination showed a concordance statistic of 0.67 (95% CI 0.63-0.71) in the external validation cohorts (n = 500). A secondary model predicting recurrence of any seizures (including focal non-motor aware seizures) was developed and validated in a subgroup that did not have focal non-motor aware seizures before withdrawal (n = 639), showing a concordance statistic of 0.68 (95% CI 0.64-0.72). Calibration plots indicated high agreement of predicted and observed outcomes for both models.
We show that simple algorithms, available as graphical nomograms and online tools (predictepilepsy.github.io), can provide probabilities of seizure outcomes after starting postoperative ASMs withdrawal. These multicentre-validated models may assist clinicians when discussing ASM withdrawal after surgery with their patients.
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Affiliation(s)
- Carolina Ferreira-Atuesta
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology , London, WC1N 3BG UK
- Chalfont Centre for Epilepsy , Chalfont St Peter SL9 0RJ , UK
- Department of Neurology, Icahn School of Medicine at Mount Sinai , New York , USA
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology , London, WC1N 3BG UK
- Chalfont Centre for Epilepsy , Chalfont St Peter SL9 0RJ , UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology , London, WC1N 3BG UK
- Chalfont Centre for Epilepsy , Chalfont St Peter SL9 0RJ , UK
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology , London, WC1N 3BG UK
- Chalfont Centre for Epilepsy , Chalfont St Peter SL9 0RJ , UK
| | - Jean Khoury
- Cleveland Clinic Epilepsy Center , Cleveland , USA
| | - Ruta Yardi
- Cleveland Clinic Epilepsy Center , Cleveland , USA
| | | | - James Butler
- Constantiaberg Mediclinic Hospital, Division of Neurology, Neuroscience Institute, University of Cape Town , South Africa
| | - Hamin J Lee
- Constantiaberg Mediclinic Hospital, Division of Neurology, Neuroscience Institute, University of Cape Town , South Africa
| | - Victoria Deli-Peri
- Constantiaberg Mediclinic Hospital, Division of Neurology, Neuroscience Institute, University of Cape Town , South Africa
| | - Yi Yao
- Department of Epilepsy Surgery, Shenzhen Children's Hospital , Shenzhen, Guangdong , China
- Department of Functional Neurosurgery, Xiamen Humanity Hospital , Xiamen, FuJian , China
| | - Feng-Peng Wang
- Department of Functional Neurosurgery, Xiamen Humanity Hospital , Xiamen, FuJian , China
| | - Xiao-Bin Zhang
- Department of Functional Neurosurgery, Xiamen Humanity Hospital , Xiamen, FuJian , China
| | - Lubna Shakhatreh
- Department of Neuroscience, Central Clinical School, Alfred Health, Monash University , Level 6, Melbourne VIC 3000 , Australia
- Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne , Parkville, VIC 3050 , Australia
- Neurology Department, Alfred Health , Melbourne, VIC 3000 , Australia
| | | | - Andrew Neal
- Department of Neuroscience, Central Clinical School, Alfred Health, Monash University , Level 6, Melbourne VIC 3000 , Australia
- Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne , Parkville, VIC 3050 , Australia
- Neurology Department, Alfred Health , Melbourne, VIC 3000 , Australia
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, University of Oxford , UK
- Department of Neurology, 3rd Floor, West Wing, John Radcliffe Hospital , Oxford OX3 9DU , UK
| | - Maggie Tristram
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, University of Oxford , UK
- Department of Neurology, 3rd Floor, West Wing, John Radcliffe Hospital , Oxford OX3 9DU , UK
| | - Elizabeth Varghese
- Department of Neurology, University Hospital of Wales , Cardiff, CF144XW , UK
| | - Wendy Biney
- Department of Neurology, University Hospital of Wales , Cardiff, CF144XW , UK
| | - William P Gray
- The Wales Epilepsy Unit, Department of Neurology, University Hospital of Wales and Division of Psychological Medicine and Clinical Neurosciences Cardiff, Cardiff University , Cardiff, CF144XW , UK
| | - Ana Rita Peralta
- Centro de Referência para Epilepsias Refratárias (member of EpiCare). Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa , Lisboa , Portugal
| | - Alexandre Rainha-Campos
- Centro de Referência para Epilepsias Refratárias (member of EpiCare). Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa , Lisboa , Portugal
| | - António J C Gonçalves-Ferreira
- Centro de Referência para Epilepsias Refratárias (member of EpiCare). Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa , Lisboa , Portugal
| | - José Pimentel
- Centro de Referência para Epilepsias Refratárias (member of EpiCare). Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa , Lisboa , Portugal
| | | | - Samuel Terman
- University of Michigan Department of Neurology , Ann Arbor, MI 48109 , USA
| | - Robert Terziev
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich , Zurich , Switzerland
| | - Herm J Lamberink
- Department of Neurology, Haaglanden Medical Center , The Hague , The Netherlands
- Department of Child Neurology, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Kees P J Braun
- Department of Child Neurology, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Willem M Otte
- Department of Child Neurology, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Fergus J Rugg-Gunn
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology , London, WC1N 3BG UK
- Chalfont Centre for Epilepsy , Chalfont St Peter SL9 0RJ , UK
| | | | - Carla Bentes
- Centro de Referência para Epilepsias Refratárias (member of EpiCare). Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa , Lisboa , Portugal
| | - Khalid Hamandi
- The Wales Epilepsy Unit, Department of Neurology, University Hospital of Wales and Division of Psychological Medicine and Clinical Neurosciences Cardiff, Cardiff University , Cardiff, CF144XW , UK
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Alfred Health, Monash University , Level 6, Melbourne VIC 3000 , Australia
- Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne , Parkville, VIC 3050 , Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Alfred Health, Monash University , Level 6, Melbourne VIC 3000 , Australia
- Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne , Parkville, VIC 3050 , Australia
- Neurology Department, Alfred Health , Melbourne, VIC 3000 , Australia
- Department of Medicine, Austin Health, The University of Melbourne; Comprehensive Epilepsy Program , Austin Health, Heidelberg, VIC 3084 , Australia
| | - Chen Yao
- Department of Neurosurgery, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital , Shenzhen, Guangdong , China
- Shenzhen Epilepsy Center (Shenzhen Children's Hospital and Shenzhen Second People's Hospital), Shenzhen , China
| | - Richard J Burman
- Constantiaberg Mediclinic Hospital, Division of Neurology, Neuroscience Institute, University of Cape Town , South Africa
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, University of Oxford , UK
- Department of Neurology, 3rd Floor, West Wing, John Radcliffe Hospital , Oxford OX3 9DU , UK
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center , Cleveland , USA
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology , London, WC1N 3BG UK
- Chalfont Centre for Epilepsy , Chalfont St Peter SL9 0RJ , UK
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology , London, WC1N 3BG UK
- Chalfont Centre for Epilepsy , Chalfont St Peter SL9 0RJ , UK
- Department of Neurology, West China Hospital, Sichuan University , Chengdu 610041 , China
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103SW , The Netherlands
| | - Matthias Koepp
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology , London, WC1N 3BG UK
- Chalfont Centre for Epilepsy , Chalfont St Peter SL9 0RJ , UK
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology , London, WC1N 3BG UK
- Chalfont Centre for Epilepsy , Chalfont St Peter SL9 0RJ , UK
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich , Zurich , Switzerland
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19
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Zweiphenning W, Klooster MAV', van Klink NEC, Leijten FSS, Ferrier CH, Gebbink T, Huiskamp G, van Zandvoort MJE, van Schooneveld MMJ, Bourez M, Goemans S, Straumann S, van Rijen PC, Gosselaar PH, van Eijsden P, Otte WM, van Diessen E, Braun KPJ, Zijlmans M. Intraoperative electrocorticography using high-frequency oscillations or spikes to tailor epilepsy surgery in the Netherlands (the HFO trial): a randomised, single-blind, adaptive non-inferiority trial. Lancet Neurol 2022; 21:982-993. [PMID: 36270309 PMCID: PMC9579052 DOI: 10.1016/s1474-4422(22)00311-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
Abstract
Background Intraoperative electrocorticography is used to tailor epilepsy surgery by analysing interictal spikes or spike patterns that can delineate epileptogenic tissue. High-frequency oscillations (HFOs) on intraoperative electrocorticography have been proposed as a new biomarker of epileptogenic tissue, with higher specificity than spikes. We prospectively tested the non-inferiority of HFO-guided tailoring of epilepsy surgery to spike-guided tailoring on seizure freedom at 1 year. Methods The HFO trial was a randomised, single-blind, adaptive non-inferiority trial at an epilepsy surgery centre (UMC Utrecht) in the Netherlands. We recruited children and adults (no age limits) who had been referred for intraoperative electrocorticography-tailored epilepsy surgery. Participants were randomly allocated (1:1) to either HFO-guided or spike-guided tailoring, using an online randomisation scheme with permuted blocks generated by an independent data manager, stratified by epilepsy type. Treatment allocation was masked to participants and clinicians who documented seizure outcome, but not to the study team or neurosurgeon. Ictiform spike patterns were always considered in surgical decision making. The primary endpoint was seizure outcome after 1 year (dichotomised as seizure freedom [defined as Engel 1A–B] vs seizure recurrence [Engel 1C–4]). We predefined a non-inferiority margin of 10% risk difference. Analysis was by intention to treat, with prespecified subgroup analyses by epilepsy type and for confounders. This completed trial is registered with the Dutch Trial Register, Toetsingonline ABR.NL44527.041.13, and ClinicalTrials.gov, NCT02207673. Findings Between Oct 10, 2014, and Jan 31, 2020, 78 individuals were enrolled to the study and randomly assigned (39 to HFO-guided tailoring and 39 to spike-guided tailoring). There was no loss to follow-up. Seizure freedom at 1 year occurred in 26 (67%) of 39 participants in the HFO-guided group and 35 (90%) of 39 in the spike-guided group (risk difference –23·5%, 90% CI –39·1 to –7·9; for the 48 patients with temporal lobe epilepsy, the risk difference was –25·5%, –45·1 to –6·0, and for the 30 patients with extratemporal lobe epilepsy it was –20·3%, –46·0 to 5·4). Pathology associated with poor prognosis was identified as a confounding factor, with an adjusted risk difference of –7·9% (90% CI –20·7 to 4·9; adjusted risk difference –12·5%, –31·0 to 5·9, for temporal lobe epilepsy and 5·8%, –7·7 to 19·5, for extratemporal lobe epilepsy). We recorded eight serious adverse events (five in the HFO-guided group and three in the spike-guided group) requiring hospitalisation. No patients died. Interpretation HFO-guided tailoring of epilepsy surgery was not non-inferior to spike-guided tailoring on intraoperative electrocorticography. After adjustment for confounders, HFOs show non-inferiority in extratemporal lobe epilepsy. This trial challenges the clinical value of HFOs as an epilepsy biomarker, especially in temporal lobe epilepsy. Further research is needed to establish whether HFO-guided intraoperative electrocorticography holds promise in extratemporal lobe epilepsy. Funding UMCU Alexandre Suerman, EpilepsieNL, RMI Talent Fellowship, European Research Council, and MING Fund.
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Affiliation(s)
- Willemiek Zweiphenning
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Maryse A van 't Klooster
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Nicole E C van Klink
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Frans S S Leijten
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Cyrille H Ferrier
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Tineke Gebbink
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Geertjan Huiskamp
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Monique M J van Schooneveld
- Department of Pediatric Psychology, Wilhelmina's Children Hospital, University Medical Center Utrecht, Netherlands
| | - M Bourez
- Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands
| | - Sophie Goemans
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Sven Straumann
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Peter C van Rijen
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Peter H Gosselaar
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Pieter van Eijsden
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Willem M Otte
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Eric van Diessen
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands; Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands.
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20
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Terman SW, Niznik JD, Slinger G, Otte WM, Braun KPJ, Aubert CE, Kerr WT, Boyd CM, Burke JF. Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study. BMC Neurol 2022; 22:328. [PMID: 36050646 PMCID: PMC9434838 DOI: 10.1186/s12883-022-02852-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND For the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We describe the incidence of and predictors for sustained ASM fill gaps to measure discontinuation in individuals potentially eligible for ASM withdrawal. METHODS This was a retrospective cohort of Medicare beneficiaries. We included patients with epilepsy by requiring International Classification of Diseases codes for epilepsy/convulsions plus at least one ASM prescription each year 2014-2016, and no acute visit for epilepsy 2014-2015 (i.e., potentially eligible for ASM discontinuation). The main outcome was the first day of a gap in ASM supply (30, 90, 180, or 360 days with no pills) in 2016-2018. We displayed cumulative incidence functions and identified predictors using Cox regressions. RESULTS Among 21,819 beneficiaries, 5191 (24%) had a 30-day gap, 1753 (8%) had a 90-day gap, 803 (4%) had a 180-day gap, and 381 (2%) had a 360-day gap. Predictors increasing the chance of a 180-day gap included number of unique medications in 2015 (hazard ratio [HR] 1.03 per medication, 95% confidence interval [CI] 1.01-1.05) and epileptologist prescribing physician (≥25% of that physician's visits for epilepsy; HR 2.37, 95% CI 1.39-4.03). Predictors decreasing the chance of a 180-day gap included Medicaid dual eligibility (HR 0.75, 95% CI 0.60-0.95), number of unique ASMs in 2015 (e.g., 2 versus 1: HR 0.37, 95% CI 0.30-0.45), and greater baseline adherence (> 80% versus ≤80% of days in 2015 with ASM pill supply: HR 0.38, 95% CI 0.32-0.44). CONCLUSIONS Sustained ASM gaps were rarer than current guidelines may suggest. Future work should further explore barriers and enablers of ASM discontinuation to understand the optimal discontinuation rate.
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Affiliation(s)
- Samuel W. Terman
- grid.214458.e0000000086837370Department of Neurology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Joshua D. Niznik
- grid.10698.360000000122483208Division of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC 27599 USA ,grid.10698.360000000122483208Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina At Chapel Hill, Chapel Hill, NC 27599 USA
| | - Geertruida Slinger
- grid.5477.10000000120346234Department of Child Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Willem M. Otte
- grid.5477.10000000120346234Department of Child Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees P. J. Braun
- grid.5477.10000000120346234Department of Child Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carole E. Aubert
- grid.5734.50000 0001 0726 5157Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Wesley T. Kerr
- grid.214458.e0000000086837370Department of Neurology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Cynthia M. Boyd
- grid.21107.350000 0001 2171 9311Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD 21224 USA
| | - James F. Burke
- grid.261331.40000 0001 2285 7943Department of Neurology, the Ohio State University, Columbus, OH 43210 USA
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21
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Touma L, Dansereau B, Chan AY, Jetté N, Kwon CS, Braun KPJ, Friedman D, Jehi L, Rolston JD, Vadera S, Wong-Kisiel LC, Englot DJ, Keezer MR. Neurostimulation in People with Drug-Resistant Epilepsy: Systematic Review and Meta-Analysis from the ILAE Surgical Therapies Commission. Epilepsia 2022; 63:1314-1329. [PMID: 35352349 DOI: 10.1111/epi.17243] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Summarize the current evidence on efficacy and tolerability of vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) through a systematic review and meta-analysis. METHODS We followed the PRISMA reporting standards and searched Ovid Medline, Ovid Embase, and the Cochrane Central Register of Controlled Trials. We included published randomized controlled trials (RCT) and their corresponding open-label extension studies, as well as prospective case series, with ≥ 20 participants (excluding studies limited to children). Our primary outcome was the mean (or median when unavailable) percentage decrease in frequency, as compared to baseline, of all epileptic seizures at last follow-up. Secondary outcomes included proportion of treatment responders and proportion with seizure freedom. RESULTS We identified 30 eligible studies, six of which were RCTs. At long-term follow-up (mean 1.3 years), five observational studies for VNS reported a pooled mean percentage decrease in seizure frequency of 34.7% (95% CI: -5.1, 74.5). In the open-label extension studies for RNS, the median seizure reduction was 53%, 66%, and 75% at two, five, and nine years of follow-up, respectively. For DBS, the median reduction was 56%, 65%, and 75% at two, five, and seven years, respectively. The proportion of individuals with seizure freedom at last follow-up increased significantly over time for DBS and RNS while a positive trend was observed for VNS. Quality of life was improved in all modalities. The most common complications included hoarseness, cough and throat pain for VNS and implant site pain, headache, and dysesthesia for DBS and RNS. SIGNIFICANCE Neurostimulation modalities are an effective treatment option for drug resistant epilepsy, with improving outcomes over time and few major complications. Seizure reduction rates among the three therapies were similar during the initial blinded phase. Recent long-term follow-up studies are encouraging for RNS and DBS but are lacking for VNS.
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Affiliation(s)
- Lahoud Touma
- Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Bénédicte Dansereau
- Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Alvin Y Chan
- Department of Neurological Surgery, School of Medicine, University of California, Irvine, Orange, CA, USA
| | - Nathalie Jetté
- Department of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Churl-Su Kwon
- Department of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Kees P J Braun
- Department of Child Neurology, University Medical Center Utrecht, member of ERN EpiCARE, Utrecht, Netherlands
| | - Daniel Friedman
- Department of Neurology, New York University Langone Health, NY, USA
| | - Lara Jehi
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Sumeet Vadera
- Department of Neurological Surgery, School of Medicine, University of California, Irvine, Orange, CA, USA
| | | | - Dario J Englot
- Departments of Neurological Surgery, Neurology, Radiological, Electrical Engineering, and Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark R Keezer
- Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada.,Honorary Researcher, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,School of Public Health, Université de Montréal, Montréal, QC, Canada
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22
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Slinger G, Otte WM, Braun KPJ, van Diessen E. An updated systematic review and meta-analysis of brain network organization in focal epilepsy: Looking back and forth. Neurosci Biobehav Rev 2021; 132:211-223. [PMID: 34813826 DOI: 10.1016/j.neubiorev.2021.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/21/2021] [Revised: 06/23/2021] [Accepted: 11/17/2021] [Indexed: 01/10/2023]
Abstract
Abnormalities of the brain network organization in focal epilepsy have been extensively quantified. However, the extent and directionality of abnormalities are highly variable and subtype insensitive. We conducted meta-analyses to obtain a more accurate and epilepsy type-specific quantification of the interictal global brain network organization in focal epilepsy. By using random-effects models, we estimated differences in average clustering coefficient, average path length, and modularity between patients with focal epilepsy and controls, based on 45 studies with a total sample size of 1,468 patients and 1,021 controls. Structural networks had a significant lower level of integration in patients with epilepsy as compared to controls, with a standardized mean difference of -0.334 (95 % confidence interval -0.631 to -0.038; p-value 0.027). Functional networks did not differ between patients and controls, except for the beta band clustering coefficient. Our meta-analyses show that differences in the brain network organization are not as well defined as individual studies often propose. We discuss potential pitfalls and suggestions to enhance the yield and clinical value of network studies.
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Affiliation(s)
- Geertruida Slinger
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - Willem M Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Kees P J Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Eric van Diessen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
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23
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Cloppenborg T, van Schooneveld M, Hagemann A, Hopf JL, Kalbhenn T, Otte WM, Polster T, Bien CG, Braun KPJ. Development and Validation of Prediction Models for Developmental and Intellectual Outcome Following Pediatric Epilepsy Surgery. Neurology 2021; 98:e225-e235. [PMID: 34795046 DOI: 10.1212/wnl.0000000000013065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/12/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To (1) identify predictors of postoperative intelligence and developmental quotients (IQ/DQ) and (2) develop and validate clinically applicable IQ/DQ prediction models. METHODS We retrospectively analyzed neuropsychological outcomes and their possible determinants for children treated in Bethel and Utrecht since 1990. We performed separate analyses for patients with IQ and those with only DQ available. We developed prediction models based on presurgical determinants to predict dichotomized levels of performance (IQ≥85, IQ≥70, DQ≥50). RESULTS IQ/DQ data before and two years after surgery were available for 492 patients (IQ n=365, DQ n=127). At a cutoff-level ±10 points, the chance of improvement was considerably higher than the chance of deterioration (IQ 37.3% vs. 6.6% and DQ 31.5% vs. 15.0%, respectively). Presurgical IQ/DQ was the strongest predictor of postoperative cognition (IQ r=0.85, p<.001, DQ: r=0.57, p<.001).Two IQ models were developed in the Bethel cohort (n=258) and externally validated in the Utrecht cohort (n=102). For DQ, we developed the model in the Bethel cohort and used 10-fold cross-validation. Models allowed good prediction at all three cutoff-levels (correct classification for IQ≥85=86%, IQ≥70=91%, DQ≥50=76%). External validation of the IQ models showed high accuracy (IQ≥85: 0.82, CI 0.75-0.91, IQ≥70: 0.84, CI 0.77-0.92) and excellent discrimination (ROC curves IQ≥85: AUC 0.90, CI 0.84-0.96; IQ≥70: AUC 0.92, CI 0.87-0.97). DISCUSSION After epilepsy surgery in children, the risk of cognitive deterioration is very low. Presurgical development has a strong impact on the postoperative trajectory. The presented models can improve presurgical counseling of patients and parents by reliably predicting cognitive outcomes. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for children undergoing epilepsy surgery presurgical IQ/DQ was the strongest predictor of postoperative cognition.
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Affiliation(s)
- Thomas Cloppenborg
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Bielefeld, Germany
| | - Monique van Schooneveld
- University Medical Center Utrecht, Department of Pediatric Neurology, The Netherlands, member of the ERN EpiCARE
| | | | - Johanna Lena Hopf
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Bielefeld, Germany
| | - Thilo Kalbhenn
- Bielefeld University, Medical School, Department of Neurosurgery (Evangelisches Klinikum Bethel), Bielefeld, Germany
| | - Willem M Otte
- University Medical Center Utrecht, Department of Pediatric Neurology, The Netherlands, member of the ERN EpiCARE
| | - Tilman Polster
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Bielefeld, Germany
| | - Christian G Bien
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Bielefeld, Germany
| | - Kees P J Braun
- University Medical Center Utrecht, Department of Pediatric Neurology, The Netherlands, member of the ERN EpiCARE
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24
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Terman SW, Lamberink HJ, Slinger G, Otte WM, Burke JF, Braun KPJ. Is the crystal ball broken? Another external validation of the post-withdrawal seizure-relapse prediction model. Epilepsia 2021; 62:3146-3147. [PMID: 34633078 DOI: 10.1111/epi.17096] [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: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Samuel W Terman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Herm J Lamberink
- Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands.,Department of Child Neurology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Geertruida Slinger
- Department of Child Neurology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Willem M Otte
- Department of Child Neurology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Kees P J Braun
- Department of Child Neurology, University Medical Center, Utrecht University, Utrecht, The Netherlands
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25
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Weuring WJ, Dilevska I, Hoekman J, van de Vondervoort J, Koetsier M, van 't Slot RH, Braun KPJ, Koeleman BPC. CRISPRa-Mediated Upregulation of scn1laa During Early Development Causes Epileptiform Activity and dCas9-Associated Toxicity. CRISPR J 2021; 4:575-582. [PMID: 34406040 DOI: 10.1089/crispr.2021.0013] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Dravet syndrome (DS) is a monogenic epileptic encephalopathy caused by loss-of-function mutations in the voltage-gated sodium channel (VGSC) gene SCN1A. DS has an age of onset within the first year of life and severe disease prognosis. In the past years, it has been shown that upregulation of endogenous SCN1A can be beneficial in animal models for DS, but a complete rescue was not observed. We hypothesized that upregulation during early development that precedes onset of first symptoms might improve disease outcome. To test this hypothesis, we first evaluated the CRISPR activating method for early upregulation of voltage gated sodium channels during early development. We injected CRISPRa components, which target the proximal or distal promoter region of the VGSC gene scn1Laa in the yolk of one-cell stage zebrafish embryos. The effect of both dCas9-VPR and dCas9-VP64 was evaluated. Both CRISPRa fusions showed toxicity in the majority of embryos, with or without guide RNAs. The few embryos that survived developed normally, and dCas9-VPR induces an upregulation of scn1Laa mRNA until 24 hours after fertilization. At 5 days post fertilization, CRISPRa-injected embryos showed an epileptic phenotype, including locomotor burst movements, hyperactivity, and epileptiform activity originating from the brain. In addition to previously published scn1Laa and scn1Lab loss-of-function models, we conclude that gain of scn1Laa function can have an equally severe phenotype. Upregulation of scn1Laa in the current zebrafish model for DS, scn1Lab-KO, aggravated the disease phenotype, highlighting that early-stage upregulation using CRISPRa can lead to both toxicity and a worsening of the disease phenotype.
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Affiliation(s)
- Wout J Weuring
- Department of Genetics, University Medical Center Utrecht Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands; and University Medical Centre Utrecht, Utrecht, The Netherlands; member of the ERN EpiCARE
| | - Ivana Dilevska
- Department of Genetics, University Medical Center Utrecht Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands; and University Medical Centre Utrecht, Utrecht, The Netherlands; member of the ERN EpiCARE
| | - Jos Hoekman
- Department of Genetics, University Medical Center Utrecht Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands; and University Medical Centre Utrecht, Utrecht, The Netherlands; member of the ERN EpiCARE
| | - Joep van de Vondervoort
- Department of Genetics, University Medical Center Utrecht Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands; and University Medical Centre Utrecht, Utrecht, The Netherlands; member of the ERN EpiCARE
| | - Martijn Koetsier
- Department of Genetics, University Medical Center Utrecht Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands; and University Medical Centre Utrecht, Utrecht, The Netherlands; member of the ERN EpiCARE
| | - Ruben H van 't Slot
- Department of Genetics, University Medical Center Utrecht Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands; and University Medical Centre Utrecht, Utrecht, The Netherlands; member of the ERN EpiCARE
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands; member of the ERN EpiCARE
| | - Bobby P C Koeleman
- Department of Genetics, University Medical Center Utrecht Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands; and University Medical Centre Utrecht, Utrecht, The Netherlands; member of the ERN EpiCARE
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Hulshof HM, Benova B, Krsek P, Kyncl M, Lequin MH, Belohlavkova A, Jezdik P, Braun KPJ, Jansen FE. The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia. Epilepsia Open 2021; 6:663-671. [PMID: 34328682 PMCID: PMC8633464 DOI: 10.1002/epi4.12529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/06/2020] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Patients with tuberous sclerosis complex (TSC) present with drug-resistant epilepsy in about 60% of cases, and evaluation for epilepsy surgery may be warranted. Correct delineation of the epileptogenic zone (EZ) among multiple dysplastic lesions on MRI represents a challenging step in pre-surgical evaluation. METHODS Two experienced neuroradiologists evaluated pre- and post-surgical MRIs of 28 epilepsy surgery patients with TSC, assessing characteristics of tubers, cysts, calcifications, and focal cortical dysplasia (FCD)-resembling lesions. Utilizing multiple metrics, we compared MRI features of the EZ-defined as the resected area in TSC patients who achieved seizure-freedom 2 years after epilepsy surgery-with features of other brain areas. Using combinatorial analysis, we identified combinations of dysplastic features that are most frequently observed in the epileptogenic zone in TSC patients. RESULTS All TSC-associated dysplastic features were more frequently observed in the EZ than in other brain areas (increased cortical thickness, gray-white matter blurring, transmantle sign, calcifications, and tubers; Kendal's tau 0.35, 0.25, 0.27, 0.26, and 0.23, respectively; P value <.001 in all). No single feature could reliably and independently indicate the EZ in all patients. Conversely, the EZ was indicated by the presence of the combination of three of the following features: tubers, transmantle sign, increased cortical thickness, calcifications, and the largest FCD-affected area. Out of these, the largest FCD-affected area emerged as the most reliable indicator of the EZ, combined either with calcifications or tubers. SIGNIFICANCE The epileptogenic zone in TSC patients harbors multiple dysplastic features, consistent with focal cortical dysplasia. A specific combination of these features can indicate the EZ and aid in pre-surgical MRI evaluation in epilepsy surgery candidates with TSC.
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Affiliation(s)
- Hanna M Hulshof
- Department of Pediatric Neurology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Barbora Benova
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Pavel Krsek
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Kyncl
- Department of Radiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Maarten H Lequin
- Department of Radiology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anezka Belohlavkova
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Jezdik
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
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Hulshof HM, Slot EMH, Lequin M, Breuillard D, Boddaert N, Jozwiak S, Kotulska K, Riney K, Feucht M, Samueli S, Scholl T, Krsek P, Benova B, Braun KPJ, Jansen FE, Nabbout R. Fetal Brain Magnetic Resonance Imaging Findings Predict Neurodevelopment in Children with Tuberous Sclerosis Complex. J Pediatr 2021; 233:156-162.e2. [PMID: 33640330 DOI: 10.1016/j.jpeds.2021.02.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/14/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To correlate fetal brain magnetic resonance imaging (MRI) findings with epilepsy characteristics and neurodevelopment at 2 years of age in children with tuberous sclerosis complex (TSC) to improve prenatal counseling. STUDY DESIGN This retrospective cohort study was performed in a collaboration between centers of the EPISTOP consortium. We included children with definite TSC, fetal MRIs, and available follow-up data at 2 years of age. A pediatric neuroradiologist masked to the patient's clinical characteristics evaluated all fetal MRIs. MRIs were categorized for each of the 10 brain lobes as score 0: no (sub)cortical lesions or doubt; score 1: a single small lesion; score 2: more than one small lesion or at least one large lesion (>5 mm). Neurologic manifestations were correlated to lesion sum scores. RESULTS Forty-one children were included. Median gestational age at MRI was 33.3 weeks; (sub)cortical lesions were detected in 97.6%. Mean lesion sum score was 4.5. At 2 years, 58.5% of patients had epilepsy and 22% had drug-resistant epilepsy. Cognitive, language, and motor development were delayed in 38%, 81%, and 50% of patients, respectively. Autism spectrum disorder (ASD) was diagnosed in 20.5%. Fetal MRI lesion sum scores were significantly associated with cognitive and motor development, and with ASD diagnosis, but not with epilepsy characteristics. CONCLUSIONS Fetal cerebral lesion scores correlate with neurodevelopment and ASD at 2 years in children with TSC.
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Affiliation(s)
- Hanna M Hulshof
- Department of Pediatric Neurology, University Medical Center, Utrecht Brain Center, Utrecht, the Netherlands (Member of the European Reference Network EpiCARE).
| | - Emma M H Slot
- Department of Pediatric Neurology, University Medical Center, Utrecht Brain Center, Utrecht, the Netherlands (Member of the European Reference Network EpiCARE)
| | - Maarten Lequin
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - Delphine Breuillard
- Department of Pediatric Neurology, Necker Enfants Maladies Hospital, Paris, France (Member of the European Reference Network EpiCARE)
| | - Nathalie Boddaert
- Department of Pediatric Radiology, Necker Enfants Maladies Hospital, Paris, France
| | - Sergiusz Jozwiak
- Instytut Pomnik-Centrum Zdrowia Dziecka, The Children's Memorial Health Institute, Warsaw, Poland (Member of the European Reference Network EpiCARE); Department of Child Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kotulska
- Instytut Pomnik-Centrum Zdrowia Dziecka, The Children's Memorial Health Institute, Warsaw, Poland (Member of the European Reference Network EpiCARE)
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital/University of Queensland School of Medicine, Brisbane, Australia
| | - Martha Feucht
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (Member of the European Reference Network EpiCARE)
| | - Sharon Samueli
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (Member of the European Reference Network EpiCARE)
| | - Theresa Scholl
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (Member of the European Reference Network EpiCARE)
| | - Pavel Krsek
- Department of Pediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Barbora Benova
- Department of Pediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Kees P J Braun
- Department of Pediatric Neurology, University Medical Center, Utrecht Brain Center, Utrecht, the Netherlands (Member of the European Reference Network EpiCARE)
| | - Floor E Jansen
- Department of Pediatric Neurology, University Medical Center, Utrecht Brain Center, Utrecht, the Netherlands (Member of the European Reference Network EpiCARE)
| | - Rima Nabbout
- Department of Pediatric Neurology, Necker Enfants Maladies Hospital, Paris, France (Member of the European Reference Network EpiCARE)
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28
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Stevelink R, Luykx JJ, Lin BD, Leu C, Lal D, Smith AW, Schijven D, Carpay JA, Rademaker K, Rodrigues Baldez RA, Devinsky O, Braun KPJ, Jansen FE, Smit DJA, Koeleman BPC. Shared genetic basis between genetic generalized epilepsy and background electroencephalographic oscillations. Epilepsia 2021; 62:1518-1527. [PMID: 34002374 PMCID: PMC8672363 DOI: 10.1111/epi.16922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/22/2021] [Indexed: 11/29/2022]
Abstract
Objective Paroxysmal epileptiform abnormalities on electroencephalography (EEG) are the hallmark of epilepsies, but it is uncertain to what extent epilepsy and background EEG oscillations share neurobiological underpinnings. Here, we aimed to assess the genetic correlation between epilepsy and background EEG oscillations. Methods Confounding factors, including the heterogeneous etiology of epilepsies and medication effects, hamper studies on background brain activity in people with epilepsy. To overcome this limitation, we compared genetic data from a genome‐wide association study (GWAS) on epilepsy (n = 12 803 people with epilepsy and 24 218 controls) with that from a GWAS on background EEG (n = 8425 subjects without epilepsy), in which background EEG oscillation power was quantified in four different frequency bands: alpha, beta, delta, and theta. We replicated our findings in an independent epilepsy replication dataset (n = 4851 people with epilepsy and 20 428 controls). To assess the genetic overlap between these phenotypes, we performed genetic correlation analyses using linkage disequilibrium score regression, polygenic risk scores, and Mendelian randomization analyses. Results Our analyses show strong genetic correlations of genetic generalized epilepsy (GGE) with background EEG oscillations, primarily in the beta frequency band. Furthermore, we show that subjects with higher beta and theta polygenic risk scores have a significantly higher risk of having generalized epilepsy. Mendelian randomization analyses suggest a causal effect of GGE genetic liability on beta oscillations. Significance Our results point to shared biological mechanisms underlying background EEG oscillations and the susceptibility for GGE, opening avenues to investigate the clinical utility of background EEG oscillations in the diagnostic workup of epilepsy.
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Affiliation(s)
- Remi Stevelink
- Department of Genetics, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,GGNet Mental Health, Apeldoorn, the Netherlands
| | - Bochao D Lin
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Costin Leu
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachussets, USA
| | - Dennis Lal
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachussets, USA
| | - Alexander W Smith
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachussets, USA
| | - Dick Schijven
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johannes A Carpay
- Department of Neurology, Tergooi Hospital, Hilversum, the Netherlands
| | - Koen Rademaker
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roiza A Rodrigues Baldez
- Clinical Research Laboratory on Neuroinfectious Diseases, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, New York, USA
| | - Kees P J Braun
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Floor E Jansen
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dirk J A Smit
- Psychiatry Department, Amsterdam Neuroscience, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Bobby P C Koeleman
- Department of Genetics, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Deckers PT, van Hoek W, Kronenburg A, Yaqub M, Siero JCW, Bhogal AA, van Berckel BNM, van der Zwan A, Braun KPJ. Contralateral improvement of cerebrovascular reactivity and TIA frequency after unilateral revascularization surgery in moyamoya vasculopathy. Neuroimage Clin 2021; 30:102684. [PMID: 34215154 PMCID: PMC8102652 DOI: 10.1016/j.nicl.2021.102684] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/24/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
Contralateral cerebrovascular reactivity may improve after unilateral surgery in moyamoya. TIA frequency from the contralateral hemisphere can decrease after unilateral moyamoya surgery. These findings support staged rather than direct bilateral surgery in moyamoya.
Objective Moyamoya vasculopathy is a rare, often bilateral disease characterized by progressive stenosis and occlusion of the distal internal carotid artery, leading to a progressive deterioration of cerebrovascular reactivity (CVR) and increased risk of transient ischemic attacks (TIAs), infarction and hemorrhage. Surgical revascularization is a widely accepted symptomatic treatment, often performed bilaterally in one or two stages. To possibly further optimize treatment strategy, we investigated the effect of unilateral revascularization surgery on the CVR of, and TIA frequency originating from, the contralateral hemisphere. Methods From our database of 143 moyamoya vasculopathy patients we selected those with bilateral disease, who underwent hemodynamic imaging ([15O]H2O positron emission tomography (PET)-CT with acetazolamide challenge) before and 14 months (median) after unilateral revascularization. We evaluated CVR in three regions per hemisphere, and averaged these per hemisphere for statistical comparison. Conservatively treated patients were showed as a comparison group. To examine TIA frequency, we selected patients who presented with TIAs that (also) originated from the contralateral – not to be operated – hemisphere. We scored changes in CVR and TIA frequency of the ipsilateral and contralateral hemisphere over time. Results Seven surgical and seven conservative patients were included for CVR comparison. Of the 20 scored contralateral regions in the surgical group, 15 showed improved CVR after unilateral revascularization, while 5 remained stable. The averaged scores improved significantly for both hemispheres. In conservatively treated patients, however, only 3 of the 20 scored regions improved in the least-affected (contralateral) hemispheres, and 9 deteriorated. From the 6 patients with contralateral TIAs at presentation, 4 had a decreased TIA frequency originating from the contralateral hemisphere after unilateral surgery, while 2 patients remained stable. Conclusion Both CVR and TIA frequency in the contralateral hemisphere can improve after unilateral revascularization surgery in bilateral MMV.
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Affiliation(s)
- Pieter T Deckers
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands.
| | - Wytse van Hoek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Annick Kronenburg
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Jeroen C W Siero
- Imaging Division, Department of Radiology, Utrecht Center for Image Sciences, University Medical Center Utrecht, Utrecht the Netherlands; Spinoza Centre for Neuroimaging, Amsterdam, the Netherlands
| | - Alex A Bhogal
- Imaging Division, Department of Radiology, Utrecht Center for Image Sciences, University Medical Center Utrecht, Utrecht the Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Albert van der Zwan
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
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30
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Noorlag L, van 't Klooster MA, van Huffelen AC, van Klink NEC, Benders MJNL, de Vries LS, Leijten FSS, Jansen FE, Braun KPJ, Zijlmans M. High-frequency oscillations recorded with surface EEG in neonates with seizures. Clin Neurophysiol 2021; 132:1452-1461. [PMID: 34023627 DOI: 10.1016/j.clinph.2021.02.400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Neonatal seizures are often the first symptom of perinatal brain injury. High-frequency oscillations (HFOs) are promising new biomarkers for epileptogenic tissue and can be found in intracranial and surface EEG. To date, we cannot reliably predict which neonates with seizures will develop childhood epilepsy. We questioned whether epileptic HFOs can be generated by the neonatal brain and potentially predict epilepsy. METHODS We selected 24 surface EEGs sampled at 2048 Hz with 175 seizures from 16 neonates and visually reviewed them for HFOs. Interictal epochs were also reviewed. RESULTS We found HFOs in thirteen seizures (7%) from four neonates (25%). 5025 ictal ripples (rate 10 to 1311/min; mean frequency 135 Hz; mean duration 66 ms) and 1427 fast ripples (rate 8 to 356/min; mean frequency 298 Hz; mean duration 25 ms) were marked. Two neonates (13%) showed interictal HFOs (285 ripples and 25 fast ripples). Almost all HFOs co-occurred with sharp transients. We could not find a relationship between neonatal HFOs and outcome yet. CONCLUSIONS Neonatal HFOs co-occur with ictal and interictal sharp transients. SIGNIFICANCE The neonatal brain can generate epileptic ripples and fast ripples, particularly during seizures, though their occurrence is not common and potential clinical value not evident yet.
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Affiliation(s)
- Lotte Noorlag
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands.
| | - Maryse A van 't Klooster
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Alexander C van Huffelen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Nicole E C van Klink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Frans S S Leijten
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Floor E Jansen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, the Netherlands
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Baumgartner T, Carreño M, Rocamora R, Bisulli F, Boni A, Brázdil M, Horak O, Craiu D, Pereira C, Guerrini R, San Antonio‐Arce V, Schulze‐Bonhage A, Zuberi SM, Hallböök T, Kalviainen R, Lagae L, Nguyen S, Quintas S, Franco A, Cross JH, Walker M, Arzimanoglou A, Rheims S, Granata T, Canafoglia L, Johannessen Landmark C, Sen A, Rattihalli R, Nabbout R, Tartara E, Santos M, Rangel R, Krsek P, Marusic P, Specchio N, Braun KPJ, Smeyers P, Villanueva V, Kotulska K, Surges R. A survey of the European Reference Network EpiCARE on clinical practice for selected rare epilepsies. Epilepsia Open 2021; 6:160-170. [PMID: 33681659 PMCID: PMC7918306 DOI: 10.1002/epi4.12459] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022] Open
Abstract
Objective Clinical care of rare and complex epilepsies is challenging, because evidence-based treatment guidelines are scarce, the experience of many physicians is limited, and interdisciplinary treatment of comorbidities is required. The pathomechanisms of rare epilepsies are, however, increasingly understood, which potentially fosters novel targeted therapies. The objectives of our survey were to obtain an overview of the clinical practice in European tertiary epilepsy centers treating patients with 5 arbitrarily selected rare epilepsies and to get an estimate of potentially available patients for future studies. Methods Members of the European Reference Network for rare and complex epilepsies (EpiCARE) were invited to participate in a web-based survey on clinical practice of patients with Dravet syndrome, tuberous sclerosis complex (TSC), autoimmune encephalitis, and progressive myoclonic epilepsies including Unverricht Lundborg and Unverricht-like diseases. A consensus-based questionnaire was generated for each disease. Results Twenty-six of 30 invited epilepsy centers participated. Cohorts were present in most responding centers for TSC (87%), Dravet syndrome (85%), and autoimmune encephalitis (71%). Patients with TSC and Dravet syndrome represented the largest cohorts in these centers. The antiseizure drug treatments were rather consistent across the centers especially with regard to Dravet syndrome, infantile spasms in TSC, and Unverricht Lundborg / Unverricht-like disease. Available, widely used targeted therapies included everolimus in TSC and immunosuppressive therapies in autoimmune encephalitis. Screening for comorbidities was routinely done, but specific treatment protocols were lacking in most centers. Significance The survey summarizes the current clinical practice for selected rare epilepsies in tertiary European epilepsy centers and demonstrates consistency as well as heterogeneity in the treatment, underscoring the need for controlled trials and recommendations. The survey also provides estimates for potential participants of clinical trials recruited via EpiCARE, emphasizing the great potential of Reference Networks for future studies to evaluate new targeted therapies and to identify novel biomarkers.
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Affiliation(s)
| | - Mar Carreño
- Epilepsy UnitChild Neurology DepartmentHospital San Juan de DiosBarcelonaSpain
- Hospital Clinic de BarcelonaBarcelonaSpain
| | - Rodrigo Rocamora
- Epilepsy CentreFaculty of Health and Life SciencesHospital del Mar‐IMIMUniversitat Pompeu FabraBarcelonaSpain
| | | | - Antonella Boni
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Milan Brázdil
- Brno Epilepsy CenterDepartment of NeurologySt. Anne´s University HospitalMedical Faculty of Masaryk UniversityBrnoCzech Republic
| | - Ondrej Horak
- Brno Epilepsy CenterDepartment of Child NeurologyBrno University HospitalMedical Faculty of Masaryk UniversityBrnoCzech Republic
| | - Dana Craiu
- Alexandru Obregia Clinical HospitalBucharestRomania
| | | | - Renzo Guerrini
- Children's Hospital A. Meyer‐University of FlorenceFlorenceItaly
| | - Victoria San Antonio‐Arce
- Epilepsy UnitChild Neurology DepartmentHospital San Juan de DiosBarcelonaSpain
- Epilepsy CenterFaculty of MedicineUniversity Medical CenterFreiburgGermany
| | | | | | - Tove Hallböök
- Department of PediatricsInstitute of Clinical SciencesSahlgrenska AcademyUniversity of Gothenburg and Queen Silvia Children’s HospitalSahlgrenska University HospitalGothenburgSweden
| | - Reetta Kalviainen
- Pohjois‐Savon SairaanhoitopiiriKuopio University Hospital, (KUH)KuopioFinland
| | - Lieven Lagae
- University Hospital Gasthuisberg KULeuvenBelgium
| | | | - Sofia Quintas
- Centro Hospitalar Universitário Lisboa Norte ‐ Hospital de Santa MariaLisboaPortugal
| | - Ana Franco
- Centro Hospitalar Universitário Lisboa Norte ‐ Hospital de Santa MariaLisboaPortugal
| | - J. Helen Cross
- Great Ormond Street Hospital for ChildrenNHS TrustLondonUK
| | - Matthew Walker
- University College London Hospitals NHS Foundation TrustLondonUK
| | - Alexis Arzimanoglou
- Epilepsy UnitChild Neurology DepartmentHospital San Juan de DiosBarcelonaSpain
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional NeurologyUniversity Hospitals of Lyon (HCL)LyonFrance
| | - Sylvain Rheims
- Department of Functional Neurology and EpileptologyHospices Civils de LyonUniversity of LyonLyonFrance
| | - Tiziana Granata
- Department of PediatricNeuroscience FondazioneIRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Laura Canafoglia
- Epilepsy UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Cecilie Johannessen Landmark
- Department of PharmacologyOslo University HospitalThe National Center for EpilepsyOslo Metropolitan UniversityOsloNorway
| | - Arjune Sen
- Oxford Epilepsy Research GroupNIHR Oxford Biomedical Research CentreNuffield Department of Clinical NeurosciencesJohn Radcliffe HospitalOxfordUK
| | - Rohini Rattihalli
- Department of Paediatric NeurologyChildren's HospitalJohn Radcliffe HospitalOxfordUK
| | - Rima Nabbout
- Department of Pediatric NeurologyAPHP, Imagine InstituteReference Centre for Rare EpilepsiesParis Descartes UniversityParisFrance
| | | | | | - Rui Rangel
- Centro Hospitalar Universitário do PortoPortoPortugal
| | - Pavel Krsek
- Departement of NeurologyCharles UniversitySecond Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Petr Marusic
- Departement of NeurologyCharles UniversitySecond Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Nicola Specchio
- Rare and Complex Epilepsy UnitDepartment of NeuroscienceBambino Gesu’ Children’s Hospital, IRCCSRomeItaly
| | - Kees P. J. Braun
- Department of Child NeurologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Patricia Smeyers
- Refractory Epilepsy Unit of Hospital Universitario y Politécnico La FeValenciaSpain
| | - Vicente Villanueva
- Refractory Epilepsy Unit of Hospital Universitario y Politécnico La FeValenciaSpain
| | | | - Rainer Surges
- Department of EpileptologyUniversity Hospital BonnBonnGermany
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van Klink NEC, Zweiphenning WJEM, Ferrier CH, Gosselaar PH, Miller KJ, Aronica E, Braun KPJ, Zijlmans M. Can we use intraoperative high-frequency oscillations to guide tumor-related epilepsy surgery? Epilepsia 2021; 62:997-1004. [PMID: 33617688 PMCID: PMC8248094 DOI: 10.1111/epi.16845] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 11/16/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 02/05/2023]
Abstract
Objective In people with low‐grade intrinsic brain tumors, an epileptic focus is often located close to the lesion. High‐frequency oscillations (HFOs) in electrocorticography (ECoG) might help to delineate this focus. We investigated the relationship between HFOs and low‐grade brain tumors and their potential value for tumor‐related epilepsy surgery. Methods We analyzed pre‐ and postresection intraoperative ECoG in 41 patients with refractory epilepsy and a low‐grade lesion. Electrodes were designated as overlying the tumor, adjacent resected tissue (peritumoral), or outside the resection bed using magnetic resonance imaging (MRI) and intraoperative photographs. We then used a semiautomated approach to detect HFOs as either ripples (80–250 Hz) or fast ripples (250–500 Hz). Results The rate of fast ripples was higher in electrodes covering tumor and peritumoral tissue than outside the resection (p = .04). Mesiotemporal tumors showed more ripples (p = .002), but not more fast ripples (p = .07), than superficial tumors. Rates of fast ripples were higher in glioma and extraventricular neurocytoma than in ganglioglioma or dysembryoplastic neuroepithelial tumor (DNET). The rate of ripples and fast ripples in postresection ECoG was not higher in patients with residual tumor tissue on MRI than those without. The rate of ripples in postresection ECoG was higher in patients with good than bad seizure outcome (p = .03). Fast ripples outside the resection and in post‐ECoG seem related to seizure recurrence. Significance Fast ripples in intraoperative ECoG can be used to help guide resection in tumor‐related epilepsy surgery. Preresection fast ripples occur predominantly in epileptogenic tumor and peritumoral tissue. Fast ripple rates are higher in glioma and extraventricular neurocytoma than in ganglioglioma and DNET.
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Affiliation(s)
- Nicole E C van Klink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Willemiek J E M Zweiphenning
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Cyrille H Ferrier
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Peter H Gosselaar
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Kai J Miller
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Epilepsy Institutes of the Netherlands Foundation (SEIN), Heemstede, the Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands.,Epilepsy Institutes of the Netherlands Foundation (SEIN), Heemstede, the Netherlands
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Benova B, Sanders MWCB, Uhrova-Meszarosova A, Belohlavkova A, Hermanovska B, Novak V, Stanek D, Vlckova M, Zamecnik J, Aronica E, Braun KPJ, Koeleman BPC, Jansen FE, Krsek P. GATOR1-related focal cortical dysplasia in epilepsy surgery patients and their families: A possible gradient in severity? Eur J Paediatr Neurol 2021; 30:88-96. [PMID: 33461085 DOI: 10.1016/j.ejpn.2020.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 07/28/2020] [Revised: 10/16/2020] [Accepted: 12/04/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Variants of GATOR1-genes represent a recognised cause of focal cortical dysplasia (FCD), the most common structural aetiology in paediatric drug-resistant focal epilepsy. Reports on familial cases of GATOR1-associated FCD are limited, especially with respect to epilepsy surgery outcomes. METHODS We present phenotypical manifestations of four unrelated patients with drug-resistant focal epilepsy, FCD and a first-degree relative with epilepsy. All patients underwent targeted gene panel sequencing as a part of the presurgical work up. Literature search was performed to compare our findings to previously published cases. RESULTS The children (probands) had a more severe phenotype than their parents, including drug-resistant epilepsy and developmental delay, and they failed to achieve seizure freedom post-surgically. All patients had histopathologically confirmed FCD (types IIa, IIb, Ia). In Patient 1 and her affected father, we detected a known pathogenic NPRL2 variant. In patients 2 and 3 and their affected parents, we found novel likely pathogenic germline DEPDC5 variants. In family 4, we detected a novel variant in NPRL3. We identified 15 additional cases who underwent epilepsy surgery for GATOR1-associated FCD, with a positive family history of epilepsy in the literature; in 8/13 tested, the variant was inherited from an asymptomatic parent. CONCLUSION The presented cases displayed a severity gradient in phenotype with children more severely affected than the parents. Although patients with GATOR1-associated FCD are considered good surgical candidates, post-surgical seizure outcome was poor in our familial cases, suggesting that accurate identification of the epileptogenic zone may be more challenging in this subgroup of patients.
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Affiliation(s)
- Barbora Benova
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic; Neurogenetics Laboratory of the Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague, 15006, Czech Republic.
| | - Maurits W C B Sanders
- Department of Child Neurology, Brain Center University Medical Center Utrecht, the Netherlands.
| | - Anna Uhrova-Meszarosova
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic; Neurogenetics Laboratory of the Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague, 15006, Czech Republic.
| | - Anezka Belohlavkova
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Barbora Hermanovska
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Vilem Novak
- Department of Paediatric Neurology, Ostrava Faculty Hospital, 17. Listopadu 1790, 708 00, Ostrava-Poruba, Czech Republic.
| | - David Stanek
- Neurogenetics Laboratory of the Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague, 15006, Czech Republic.
| | - Marketa Vlckova
- Department of Biology and Medical Genetics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Eleonora Aronica
- Amsterdam UMC, University of Amsterdam, Department of (Neuro)Pathology, Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 2, 2103, SW, Heemstede, the Netherlands.
| | - Kees P J Braun
- Department of Child Neurology, Brain Center University Medical Center Utrecht, the Netherlands.
| | - Bobby P C Koeleman
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Floor E Jansen
- Department of Child Neurology, Brain Center University Medical Center Utrecht, the Netherlands.
| | - Pavel Krsek
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
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van den Munckhof B, Arzimanoglou A, Perucca E, van Teeseling HC, Leijten FSS, Braun KPJ, Jansen FE. Corticosteroids versus clobazam in epileptic encephalopathy with ESES: a European multicentre randomised controlled clinical trial (RESCUE ESES*). Trials 2020; 21:957. [PMID: 33228736 PMCID: PMC7686710 DOI: 10.1186/s13063-020-04874-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/18/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epileptic encephalopathy with electrical status epilepticus in sleep (ESES) is an epilepsy syndrome occurring almost exclusively in children, usually at an age between 4 and 12 years. It is characterised by abundant sleep-induced epileptic activity in the electroencephalogram (EEG) and by acquired cognitive and behavioural deficits. The goal of treatment is to prevent further decline or even improve cognitive functioning. Based on mostly small and retrospective studies, corticosteroids and clobazam are regarded by many clinicians as the most effective pharmacological treatments. This European multicentre randomised controlled trial is designed to compare the effects of corticosteroids and clobazam on cognitive functioning after 6 months. Secondary outcomes include cognitive functioning after 18 months, EEG abnormalities in sleep, safety and tolerability, and seizure frequency. We also aimed at investigating whether treatment response in epileptic encephalopathy with ESES can be predicted by measurement of inflammatory mediators and autoantibodies in serum. METHODS The pragmatic study will be performed in centres with expertise in the treatment of rare paediatric epilepsy syndromes across Europe. A total of 130 patients, 2 to 12 years of age, with epileptic encephalopathy with ESES will be enrolled and randomised in a 1:1 ratio to receive either corticosteroids (monthly intravenous methylprednisolone pulses or daily oral prednisolone) or oral clobazam for 6 months according to an open-label parallel-group design. Follow-up visits with clinical assessment, EEGs, and neuropsychological testing are scheduled for up to 18 months. Blood samples for cytokine and autoantibody testing are obtained before treatment and 8 months after treatment initiation. DISCUSSION The treatment of epileptic encephalopathy with ESES aims at improving cognitive outcome. This randomised controlled study will compare the most frequently used treatments, i.e. corticosteroids and clobazam. If the study proves superiority of one treatment over the other or identifies biomarkers of treatment response, results will guide clinicians in the early treatment of this severe epilepsy syndrome. TRIAL REGISTRATION ISRCTN, ISRCTN42686094 . Registered on 24 May 2013.
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Affiliation(s)
- Bart van den Munckhof
- Department of Paediatric Neurology, Brain Center, University Medical Center Utrecht, Member of the European Reference Network EpiCARE, Utrecht University, KC 03.063.0, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Alexis Arzimanoglou
- Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology Department, University Hospitals of Lyon (HCL), Coordinator of the European Reference Network EpiCARE, Lyon Neurosciences Research Centre, Lyon, France.,Paediatric Epilepsy Unit, Child Neurology Department, Hospital San Juan de Dios, Universitat de Barcelona, Barcelona, Spain
| | - Emilio Perucca
- Clinical Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia and Clinical Trial Center, IRCCS Mondino Foundation, Member of the European Reference Network EpiCARE, Pavia, Italy
| | - Heleen C van Teeseling
- Department of Paediatric Neuropsychology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans S S Leijten
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Paediatric Neurology, Brain Center, University Medical Center Utrecht, Member of the European Reference Network EpiCARE, Utrecht University, KC 03.063.0, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Floor E Jansen
- Department of Paediatric Neurology, Brain Center, University Medical Center Utrecht, Member of the European Reference Network EpiCARE, Utrecht University, KC 03.063.0, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
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Gaillard WD, Jette N, Arnold ST, Arzimanoglou A, Braun KPJ, Cukiert A, Dick A, Harvey AS, Jacobs J, Rydenhag B, Udani V, Wilmshurst JM, Cross JH, Jayakar P. Establishing criteria for pediatric epilepsy surgery center levels of care: Report from the ILAE Pediatric Epilepsy Surgery Task Force. Epilepsia 2020; 61:2629-2642. [DOI: 10.1111/epi.16698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 02/04/2023]
Affiliation(s)
- William D. Gaillard
- Center for Neuroscience Research Children’s National Medical Center Washington DC USA
| | - Nathalie Jette
- Department of Neurology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Susan T. Arnold
- Division of Child Neurology University of Texas Southwestern Medical Center Dallas TX USA
| | - Alexis Arzimanoglou
- Department of Pediatric Epileptology and Functional Neurology University Hospitals of Lyon and Lyon Neuroscience Research Lyons France
- Epilepsy Unit Child Neurology Department Hospital San Juan de Dios Barcelona Spain
| | - Kees P. J. Braun
- Department of Child Neurology University Medical Center Utrecht the Netherlands
| | - Arthur Cukiert
- Department of Neurosurgery San Paolo Epilepsy Clinic San Paolo Brazil
| | - Alexander Dick
- Center for Neuroscience Research Children’s National Medical Center Washington DC USA
| | - A. Simon Harvey
- Department of Neurology Royal Children's Hospital Melbourne Victoria Australia
| | - Julia Jacobs
- Department of Pediatrics and Clinical Neuroscience Alberta Children’s HospitalUniversity of Calgary Calgary Alberta Canada
| | - Bertil Rydenhag
- Division of Neurosurgery Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Vrajesh Udani
- Department of Neurology P. D. Hinduja Hospital Mumbai India
| | - Jo M. Wilmshurst
- Department of Paediatric Neurology Red Cross War Memorial Children’s HospitalNeuroscience InstituteUniversity of Cape Town Cape Town South Africa
| | - J. Helen Cross
- Neurosciences Unit Great Ormond Street Institute of Child Health University College London London UK
| | - Prasanna Jayakar
- Department of Neurology Nicklaus Children’s Hospital Miami FL USA
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van den Munckhof B, Gefferie SR, van Noort SAM, van Teeseling HC, Schijvens MP, Smit W, Teunissen NW, Plate JDJ, Huiskamp GJM, Leijten FSS, Braun KPJ, Jansen FE, Bölsterli BK. Sleep slow-wave homeostasis and cognitive functioning in children with electrical status epilepticus in sleep. Sleep 2020; 43:5831237. [PMID: 32374855 DOI: 10.1093/sleep/zsaa088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/24/2019] [Revised: 03/03/2020] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVES Encephalopathy with electrical status epilepticus in sleep (ESES) is characterized by non-rapid eye movement (non-REM)-sleep-induced epileptiform activity and acquired cognitive deficits. The synaptic homeostasis hypothesis describes the process of daytime synaptic potentiation balanced by synaptic downscaling in non-REM-sleep and is considered crucial to retain an efficient cortical network. We aimed to study the overnight decline of slow waves, an indirect marker of synaptic downscaling, in patients with ESES and explore whether altered downscaling relates to neurodevelopmental and behavioral problems. METHODS Retrospective study of patients with ESES with at least one whole-night electroencephalogram (EEG) and neuropsychological assessment (NPA) within 4 months. Slow waves in the first and last hour of non-REM-sleep were analyzed. Differences in slow-wave slope (SWS) and overnight slope course between the epileptic focus and non-focus electrodes and relations to neurodevelopment and behavior were analyzed. RESULTS A total of 29 patients with 44 EEG ~ NPA combinations were included. Mean SWS decreased from 357 to 327 µV/s (-8%, p < 0.001) across the night and the overnight decrease was less pronounced in epileptic focus than in non-focus electrodes (-5.6% vs. -8.7%, p = 0.003). We found no relation between SWS and neurodevelopmental test results in cross-sectional and longitudinal analyses. Patients with behavioral problems showed less SWS decline than patients without and the difference was most striking in the epileptic focus (-0.9% vs. -8.8%, p = 0.006). CONCLUSIONS Slow-wave homeostasis-a marker of synaptic homeostasis-is disturbed by epileptiform activity in ESES. Behavioral problems, but not neurodevelopmental test results, were related to severity of this disturbance.
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Affiliation(s)
- Bart van den Munckhof
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Silvano R Gefferie
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Suus A M van Noort
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Heleen C van Teeseling
- Department of Pediatric Neuropsychology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mischa P Schijvens
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - William Smit
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico W Teunissen
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joost D J Plate
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert Jan M Huiskamp
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans S S Leijten
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bigna K Bölsterli
- Division of Clinical Neurophysiology, Department of Neurology, University Children's Hospital Zurich, Zurich, Switzerland
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Lamberink HJ, Otte WM, Blümcke I, Braun KPJ. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. Lancet Neurol 2020; 19:748-757. [PMID: 32822635 DOI: 10.1016/s1474-4422(20)30220-9] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgery is a widely accepted treatment option for drug-resistant focal epilepsy. A detailed analysis of longitudinal postoperative seizure outcomes and use of antiepileptic drugs for different brain lesions causing epilepsy is not available. We aimed to analyse the association between histopathology and seizure outcome and drug freedom up to 5 years after epilepsy surgery, to improve presurgical decision making and counselling. METHODS In this retrospective, multicentre, longitudinal, cohort study, patients who had epilepsy surgery between Jan 1, 2000, and Dec 31, 2012, at 37 collaborating tertiary referral centres across 18 European countries of the European Epilepsy Brain Bank consortium were assessed. We included patients of all ages with histopathology available after epilepsy surgery. Histopathological diagnoses and a minimal dataset of clinical variables were collected from existing local databases and patient records. The primary outcomes were freedom from disabling seizures (Engel class 1) and drug freedom at 1, 2, and 5 years after surgery. Proportions of individuals who were Engel class 1 and drug-free were reported for the 11 main categories of histopathological diagnosis. We analysed the association between histopathology, duration of epilepsy, and age at surgery, and the primary outcomes using random effects multivariable logistic regression to control for confounding. FINDINGS 9147 patients were included, of whom seizure outcomes were available for 8191 (89·5%) participants at 2 years, and for 5577 (61·0%) at 5 years. The diagnoses of low-grade epilepsy associated neuroepithelial tumour (LEAT), vascular malformation, and hippocampal sclerosis had the best seizure outcome at 2 years after surgery, with 77·5% (1027 of 1325) of patients free from disabling seizures for LEAT, 74·0% (328 of 443) for vascular malformation, and 71·5% (2108 of 2948) for hippocampal sclerosis. The worst seizure outcomes at 2 years were seen for patients with focal cortical dysplasia type I or mild malformation of cortical development (50·0%, 213 of 426 free from disabling seizures), those with malformation of cortical development-other (52·3%, 212 of 405 free from disabling seizures), and for those with no histopathological lesion (53·5%, 396 of 740 free from disabling seizures). The proportion of patients being both Engel class 1 and drug-free was 0-14% at 1 year and increased to 14-51% at 5 years. Children were more often drug-free; temporal lobe surgeries had the best seizure outcomes; and a longer duration of epilepsy was associated with reduced chance of favourable seizure outcomes and drug freedom. This effect of duration was evident for all lesions, except for hippocampal sclerosis. INTERPRETATION Histopathological diagnosis, age at surgery, and duration of epilepsy are important prognostic factors for outcomes of epilepsy surgery. In every patient with refractory focal epilepsy presumed to be lesional, evaluation for surgery should be considered. FUNDING None.
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Affiliation(s)
- Herm J Lamberink
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Willem M Otte
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Ingmar Blümcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany.
| | - Kees P J Braun
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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Affiliation(s)
| | - Herm J. Lamberink
- Brain Center Rudolf Magnus, Department of Child Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kees P. J. Braun
- Brain Center Rudolf Magnus, Department of Child Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
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Weuring WJ, Singh S, Volkers L, Rook MB, van ‘t Slot RH, Bosma M, Inserra M, Vetter I, Verhoeven-Duif NM, Braun KPJ, Rivara M, Koeleman BPC. NaV1.1 and NaV1.6 selective compounds reduce the behavior phenotype and epileptiform activity in a novel zebrafish model for Dravet Syndrome. PLoS One 2020; 15:e0219106. [PMID: 32134913 PMCID: PMC7058281 DOI: 10.1371/journal.pone.0219106] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/04/2020] [Indexed: 12/03/2022] Open
Abstract
Dravet syndrome is caused by dominant loss-of-function mutations in SCN1A which cause reduced activity of Nav1.1 leading to lack of neuronal inhibition. On the other hand, gain-of-function mutations in SCN8A can lead to a severe epileptic encephalopathy subtype by over activating NaV1.6 channels. These observations suggest that Nav1.1 and Nav1.6 represent two opposing sides of the neuronal balance between inhibition and activation. Here, we hypothesize that Dravet syndrome may be treated by either enhancing Nav1.1 or reducing Nav1.6 activity. To test this hypothesis we generated and characterized a novel DS zebrafish model and tested new compounds that selectively activate or inhibit the human NaV1.1 or NaV1.6 channel respectively. We used CRISPR/Cas9 to generate two separate Scn1Lab knockout lines as an alternative to previous zebrafish models generated by random mutagenesis or morpholino oligomers. Using an optimized locomotor assay, spontaneous burst movements were detected that were unique to Scn1Lab knockouts and disappear when introducing human SCN1A mRNA. Besides the behavioral phenotype, Scn1Lab knockouts show sudden, electrical discharges in the brain that indicate epileptic seizures in zebrafish. Scn1Lab knockouts showed increased sensitivity to the GABA antagonist pentylenetetrazole and a reduction in whole organism GABA levels. Drug screenings further validated a Dravet syndrome phenotype. We tested the NaV1.1 activator AA43279 and two novel NaV1.6 inhibitors MV1369 and MV1312 in the Scn1Lab knockouts. Both type of compounds significantly reduced the number of spontaneous burst movements and seizure activity. Our results show that selective inhibition of NaV1.6 could be just as efficient as selective activation of NaV1.1 and these approaches could prove to be novel potential treatment strategies for Dravet syndrome and other (genetic) epilepsies. Compounds tested in zebrafish however, should always be further validated in other model systems for efficacy in mammals and to screen for potential side effects.
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Affiliation(s)
- Wout J. Weuring
- Department of Genetics, Center for Molecular Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sakshi Singh
- Department of Genetics, Center for Molecular Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda Volkers
- Department of Cardiology, Laboratory of Experimental Cardiology, University Medical Centre Leiden, Leiden, the Netherlands
| | - Martin B. Rook
- Department of Medical Physiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ruben H. van ‘t Slot
- Department of Genetics, Center for Molecular Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjolein Bosma
- Department of Genetics, Center for Molecular Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marco Inserra
- Centre for Pain Research & School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Irina Vetter
- Centre for Pain Research & School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Nanda M. Verhoeven-Duif
- Department of Genetics, Center for Molecular Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees P. J. Braun
- Department of Neurology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mirko Rivara
- Food and Drug Department, University of Parma, Parma, Italy
| | - Bobby P. C. Koeleman
- Department of Genetics, Center for Molecular Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Hulshof HM, Brenner J, Overwater IE, Wit MCD, Braun KPJ, Jansen FE. Counselling in tuberous sclerosis complex: A survey on content and satisfaction in the Netherlands. Eur J Paediatr Neurol 2020; 25:113-119. [PMID: 31982306 DOI: 10.1016/j.ejpn.2020.01.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/22/2019] [Accepted: 01/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a highly variable condition and its clinical features cannot reliably be predicted from the genotype. Counselling of parents of a child with TSC is challenging because of the variability of the condition and the changing outlook due to new treatment options. This study explored current counselling strategies in TSC in the Netherlands, with the aim of developing a recommendation for counselling. METHOD We performed a nationwide survey using digital questionnaires. Questionnaires were sent to parents of children diagnosed with TSC, and to medical doctors involved in counselling, both no more than ten years prior to the study. Questions focused on general information about the child with TSC, medical doctors involved in counselling, type of information provided, mode of providing information, and recommendations for improvement of counselling. RESULTS Parents of 34 children diagnosed with TSC (7 prenatally) and 18 medical doctors from different departments responded to the questionnaires. Almost all parents were informed on the neurological and cardiac symptoms of TSC, other symptoms were mentioned less often. Satisfaction on counselling was higher when more information on the variability of TSC was provided, preferentially during a clinical visit, when emotional support was provided, and when parents were notified of the TSC patient society. CONCLUSIONS Information on the variability in expression and quality of life is highly demanded by (expecting) parents of a child with TSC. Furthermore, reference should be made to institutions such as the support organisation for patients and social services for questions and support.
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Affiliation(s)
- Hanna M Hulshof
- Department of Paediatric Neurology, UMC Utrecht Brain Center, Utrecht, the Netherlands.
| | - Juliette Brenner
- Department of Paediatric Neurology, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Iris E Overwater
- Department of Paediatric Neurology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Marie-Claire de Wit
- Department of Paediatric Neurology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Kees P J Braun
- Department of Paediatric Neurology, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Floor E Jansen
- Department of Paediatric Neurology, UMC Utrecht Brain Center, Utrecht, the Netherlands
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van den Munckhof B, Zwart AF, Weeke LC, Claessens NHP, Plate JDJ, Leemans A, Kuijf HJ, van Teeseling HC, Leijten FSS, Benders MJN, Braun KPJ, de Vries LS, Jansen FE. Perinatal thalamic injury: MRI predictors of electrical status epilepticus in sleep and long-term neurodevelopment. Neuroimage Clin 2020; 26:102227. [PMID: 32182576 PMCID: PMC7076143 DOI: 10.1016/j.nicl.2020.102227] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/05/2020] [Accepted: 02/23/2020] [Indexed: 01/26/2023]
Abstract
The majority of patients with perinatal thalamic injury, will develop epilepsy with ESES after the age of two years. ESES is associated with neurodevelopmental deficits. Larger residual thalamic volume at the three months MRI correlates to higher total IQ/DQ during follow-up. MRI at three months appears to be useful to predict neurodevelopmental outcome in this population.
Objective Perinatal thalamic injury is associated with epilepsy with electrical status epilepticus in sleep (ESES). The aim of this study was to prospectively quantify the risk of ESES and to assess neuroimaging predictors of neurodevelopment. Methods We included patients with perinatal thalamic injury. MRI scans were obtained in the neonatal period, around three months of age and during childhood. Thalamic and total brain volumes were obtained from the three months MRI. Diffusion characteristics were assessed. Sleep EEGs distinguished patients into ESES (spike-wave index (SWI) >85%), ESES-spectrum (SWI 50–85%) or no ESES (SWI < 50%). Serial Intelligence Quotient (IQ)/Developmental Quotient (DQ) scores were obtained during follow-up. Imaging and EEG findings were correlated to neurodevelopmental outcome. Results Thirty patients were included. Mean thalamic volume at three months was 8.11 (±1.67) ml and mean total brain volume 526.45 (±88.99) ml. In the prospective cohort (n = 23) 19 patients (83%) developed ESES (-spectrum) abnormalities after a mean follow-up of 96 months. In the univariate analysis, larger thalamic volume, larger total brain volume and lower SWI correlated with higher mean IQ/DQ after 2 years (Pearson's r = 0.74, p = 0.001; Pearson's r = 0.64, p = 0.005; and Spearman's rho -0.44, p = 0.03). In a multivariable mixed model analysis, thalamic volume was a significant predictor of IQ/DQ (coefficient 9.60 [p < 0.001], i.e., corrected for total brain volume and SWI and accounting for repeated measures within patients, a 1 ml higher thalamic volume was associated with a 9.6 points higher IQ). Diffusion characteristics during childhood correlated with IQ/DQ after 2 years. Significance Perinatal thalamic injury is followed by electrical status epilepticus in sleep in the majority of patients. Thalamic volume and diffusion characteristics correlate to neurodevelopmental outcome.
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Affiliation(s)
- Bart van den Munckhof
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Anne F Zwart
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joost D J Plate
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Heleen C van Teeseling
- Department of Pediatric Neuropsychology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frans S S Leijten
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Manon J N Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Sun D, van 't Klooster MA, van Schooneveld MMJ, Zweiphenning WJEM, van Klink NEC, Ferrier CH, Gosselaar PH, Braun KPJ, Zijlmans M. High frequency oscillations relate to cognitive improvement after epilepsy surgery in children. Clin Neurophysiol 2020; 131:1134-1141. [PMID: 32222614 DOI: 10.1016/j.clinph.2020.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/23/2019] [Revised: 12/19/2019] [Accepted: 01/12/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate how high frequency oscillations (HFOs; ripples 80-250 Hz, fast ripples (FRs) 250-500 Hz) and spikes in intra-operative electrocorticography (ioECoG) relate to cognitive outcome after epilepsy surgery in children. METHODS We retrospectively included 20 children who were seizure free after epilepsy surgery using ioECoG and determined their intelligence quotients (IQ) pre- and two years postoperatively. We analyzed whether the number of HFOs and spikes in pre- and postresection ioECoGs, and their change in the non-resected areas relate to cognitive improvement (with ≥ 5 IQ points increase considered to be clinically relevant (=IQ+ group) and < 5 IQ points as irrelevant (=IQ- group)). RESULTS The IQ+ group showed significantly more FRs in the resected tissue (p = 0.01) and less FRs in the postresection ioECoG (p = 0.045) compared to the IQ- group. Postresection decrease of ripples on spikes was correlated with postoperative cognitive improvement (correlation coefficient = -0.62 with p = 0.01). CONCLUSIONS Postoperative cognitive improvement was related to reduction of pathological HFOs signified by removing FR generating areas with subsequently less residual FRs, and decrease of ripples on spikes in the resection edge of the non-resected area. SIGNIFICANCE HFOs recorded in ioECoG could play a role as biomarkers in the prediction and understanding of cognitive outcome after epilepsy surgery.
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Affiliation(s)
- Dongqing Sun
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Maryse A van 't Klooster
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Monique M J van Schooneveld
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Department of Pediatric Psychology, Lundlaan 6, 3584 EA Utrecht, the Netherlands.
| | - Willemiek J E M Zweiphenning
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Nicole E C van Klink
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Cyrille H Ferrier
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Peter H Gosselaar
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Kees P J Braun
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Child Neurology, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Maeike Zijlmans
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Stichting Epilepsie Instellingen Nederland, Achterweg 2, 2103 SW Heemstede, the Netherlands.
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Abstract
Tuberous sclerosis complex (TSC) is a genetic neurocutaneous disorder with epilepsy as a common and early presenting symptom. The neurological phenotype, however, is variable and unpredictable. Early and refractory seizures, infantile spasms in particular, are associated with a poor neurological outcome. Preliminary data suggests early and aggressive seizure control may mitigate the detrimental neurodevelopmental effects of epilepsy. For infantile spasms, vigabatrin is the first line of treatment, and steroids and classic antiepileptic drugs (AEDs) are suitable for second line. Based on retrospective data, vigabatrin should be considered for other indications, especially in infants with focal seizures, as this may prevent infantile spasms, but also in children and adults with epileptic spasms and tonic seizures. Otherwise, for most seizure types, treatment is similar to that for patients without TSC, including the use of novel AEDs, although limited data are available. Three major developments are changing the field of epilepsy management in TSC. First, final recommendations on preventive treatment with vigabatrin will result from two multicenter trials in the US (PREVeNT, clinicaltrials.gov #NCT02849457) and Europe (EPISTOP, clinicaltrials.gov #NCT02098759). Second, treatment with everolimus, an inhibitor of the mechanistic target of rapamycin (mTOR), reduced seizures when compared to placebo. Further, mTOR inhibitors may have an overall disease-modifying effect. Third, the role of cannabidiol in the treatment of refractory seizures in TSC is yet to be established. With treatment recommendations in TSC, we keep an eye on the prize for the broader field of pediatric epilepsy: the lessons learned from TSC are likely applicable to other epileptic encephalopathies.
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Affiliation(s)
| | - Floor E Jansen
- Department of Child Neurology, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Child Neurology, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Jurriaan M Peters
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, FE9, Boston, 02115, USA.
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Abstract
Epilepsy surgery is the most effective treatment option for children with refractory focal lesional epilepsy, with seizure-freedom rates exceeding 70% two years after surgery. Although numbers of procedures in children are increasing over time, epilepsy surgery remains underutilized. Particularly in young children with developmental delay, arrest, or even regression, surgery can improve cognitive outcome. Many factors determine eventual developmental abilities, of which epilepsy duration is the most important modifiable predictor. Earlier surgery is not only associated with higher seizure-freedom rates, it also improves postoperative developmental outcomes. Every child with focal lesional epilepsy should therefore be referred early, to evaluate the possibilities of epilepsy surgery.
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Affiliation(s)
- Kees P J Braun
- University Medical Center Utrecht Brain Center (the UMC Utrecht is part of the ERN EpiCARE), Utrecht University, the Netherlands.
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Charbonnier L, Raemaekers MAH, Cornelisse PA, Verwoert M, Braun KPJ, Ramsey NF, Vansteensel MJ. A Functional Magnetic Resonance Imaging Approach for Language Laterality Assessment in Young Children. Front Pediatr 2020; 8:587593. [PMID: 33313027 PMCID: PMC7707083 DOI: 10.3389/fped.2020.587593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) is a usable technique to determine hemispheric dominance of language function, but high-quality fMRI images are difficult to acquire in young children. Here we aimed to develop and validate an fMRI approach to reliably determine hemispheric language dominance in young children. We designed two new tasks (story, SR; Letter picture matching, LPM) that aimed to match the interests and the levels of cognitive development of young children. We studied 32 healthy children (6-10 years old, median age 8.7 years) and seven children with epilepsy (7-11 years old, median age 8.6 years) and compared the lateralization index of the new tasks with those of a well-validated task (verb generation, VG) and with clinical measures of hemispheric language dominance. A conclusive assessment of hemispheric dominance (lateralization index ≤-0.2 or ≥0.2) was obtained for 94% of the healthy participants who performed both new tasks. At least one new task provided conclusive language laterality assessment in six out of seven participants with epilepsy. The new tasks may contribute to assessing language laterality in young and preliterate children and may benefit children who are scheduled for surgical treatment of disorders such as epilepsy.
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Affiliation(s)
- Lisette Charbonnier
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mathijs A H Raemaekers
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Philippe A Cornelisse
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maxime Verwoert
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kees P J Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nick F Ramsey
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mariska J Vansteensel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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Sanders MWCB, Lemmens CMC, Jansen FE, Brilstra EH, Koeleman BPC, Braun KPJ. Implications of genetic diagnostics in epilepsy surgery candidates: A single-center cohort study. Epilepsia Open 2019; 4:609-617. [PMID: 31819917 PMCID: PMC6885658 DOI: 10.1002/epi4.12366] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/14/2019] [Revised: 09/02/2019] [Accepted: 10/12/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Genetic causes are increasingly identified in patients with focal epilepsy. These genetic causes may be related to the effectiveness of epilepsy surgery. We aimed to assess the use and yield of genetic testing in a large cohort of patients who were evaluated for epilepsy surgery. METHODS We performed a retrospective single-center consecutive cohort study of patients who were evaluated for surgery between 1990 and 2016. Within this cohort, we assessed the use of genetic testing-either before or after presurgical decision-making. We evaluated genetic results as well as the outcome of presurgical decision-making and surgery, and compared these end points for different subgroups-especially MRI-positive vs MRI-negative patients. Patients with tuberous sclerosis (TSC) and KRIT1 mutations were excluded from analysis. RESULTS Of the 2385 epilepsy patients who were evaluated for surgery, 1280 (54%) received surgical treatment in our center. Of the entire cohort, 325 (14%) underwent genetic testing, comprising 156 of 450 MRI-negative patients (35%) vs 169 of 1935 MRI-positive patients (9%). A genetic cause of epilepsy was found in 40 of the 325 patients (12%, 2% of the entire cohort), mainly consisting of mutations in ion channel function and synaptic transmission genes, and mTOR pathway gene mutations. Three of the seven patients with mTOR pathway gene mutations underwent surgery; two achieved complete seizure freedom. One of the 17 patients with germline mutations in ion channel function and synaptic transmission genes received resective surgery but was not rendered seizure-free; two other patients underwent invasive intracranial EEG-monitoring before being rejected. SIGNIFICANCE This study shows that genetic testing is increasingly applied in focal epilepsy patients who are considered for epilepsy surgery. The diagnostic yield of genetic testing is highest in next generation sequencing techniques, and the outcome of genetic testing assists selecting eligible patients for invasive intracranial monitoring and resective surgery.
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Affiliation(s)
- Maurits W. C. B. Sanders
- Department of Child NeurologyBrain Center Rudolf MagnusUniversity Medical CenterUtrechtThe Netherlands
| | - Cynthia M. C. Lemmens
- Department of Child NeurologyBrain Center Rudolf MagnusUniversity Medical CenterUtrechtThe Netherlands
| | - Floor E. Jansen
- Department of Child NeurologyBrain Center Rudolf MagnusUniversity Medical CenterUtrechtThe Netherlands
| | - Eva H. Brilstra
- Department of GeneticsCenter for Molecular MedicineUniversity Medical CenterUtrechtThe Netherlands
| | - Bobby P. C. Koeleman
- Department of GeneticsCenter for Molecular MedicineUniversity Medical CenterUtrechtThe Netherlands
| | - Kees P. J. Braun
- Department of Child NeurologyBrain Center Rudolf MagnusUniversity Medical CenterUtrechtThe Netherlands
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Baumer FM, Peters JM, Clancy S, Prohl AK, Prabhu SP, Scherrer B, Jansen FE, Braun KPJ, Sahin M, Stamm A, Warfield SK. Corpus Callosum White Matter Diffusivity Reflects Cumulative Neurological Comorbidity in Tuberous Sclerosis Complex. Cereb Cortex 2019; 28:3665-3672. [PMID: 29939236 DOI: 10.1093/cercor/bhx247] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Neurological manifestations in Tuberous Sclerosis Complex (TSC) are highly variable. Diffusion tensor imaging (DTI) may reflect the neurological disease burden. We analyzed the association of autism spectrum disorder (ASD), intellectual disability (ID) and epilepsy with callosal DTI metrics in subjects with and without TSC. METHODS 186 children underwent 3T MRI DTI: 51 with TSC (19 with concurrent ASD), 46 with non-syndromic ASD and 89 healthy controls (HC). Subgroups were based on presence of TSC, ASD, ID, and epilepsy. Density-weighted DTI metrics obtained from tractography of the corpus callosum were fitted using a 2-parameter growth model. We estimated distributions using bootstrapping and calculated half-life and asymptote of the fitted curves. RESULTS TSC was associated with a lower callosal fractional anisotropy (FA) than ASD, and ASD with a lower FA than HC. ID, epilepsy and ASD diagnosis were each associated with lower FA values, demonstrating additive effects. In TSC, the largest change in FA was related to a comorbid diagnosis of ASD. Mean diffusivity (MD) showed an inverse relationship to FA. Some subgroups were too small for reliable data fitting. CONCLUSIONS Using a cross-disorder approach, this study demonstrates cumulative abnormality of callosal white matter diffusion with increasing neurological comorbidity.
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Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jurriaan M Peters
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Computational Radiology Laboratory, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Brain Center Rudolf Magnus, Department of Pediatric Neurology, University Medical Center Utrecht, The Netherlands
| | - Sean Clancy
- Computational Radiology Laboratory, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Anna K Prohl
- Computational Radiology Laboratory, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sanjay P Prabhu
- Computational Radiology Laboratory, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Benoit Scherrer
- Computational Radiology Laboratory, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Floor E Jansen
- Brain Center Rudolf Magnus, Department of Pediatric Neurology, University Medical Center Utrecht, The Netherlands
| | - Kees P J Braun
- Brain Center Rudolf Magnus, Department of Pediatric Neurology, University Medical Center Utrecht, The Netherlands
| | - Mustafa Sahin
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Aymeric Stamm
- Computational Radiology Laboratory, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Laboratory for Modeling and Scientific Computing (MOX), Dipartimento di Matematica, Politecnico di Milano, Italy
| | - Simon K Warfield
- Computational Radiology Laboratory, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Stevelink R, Pangilinan F, Jansen FE, Braun KPJ, Molloy AM, Brody LC, Koeleman BPC. Assessing the genetic association between vitamin B6 metabolism and genetic generalized epilepsy. Mol Genet Metab Rep 2019; 21:100518. [PMID: 31641590 PMCID: PMC6796782 DOI: 10.1016/j.ymgmr.2019.100518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 01/23/2023] Open
Abstract
Altered vitamin B6 metabolism due to pathogenic variants in the gene PNPO causes early onset epileptic encephalopathy, which can be treated with high doses of vitamin B6. We recently reported that single nucleotide polymorphisms (SNPs) that influence PNPO expression in the brain are associated with genetic generalized epilepsy (GGE). However, it is not known whether any of these GGE-associated SNPs influence vitamin B6 metabolite levels. Such an influence would suggest that vitamin B6 could play a role in GGE therapy. Here, we performed genome-wide association studies (GWAS) to assess the influence of GGE associated genetic variants on measures of vitamin B6 metabolism in blood plasma in 2232 healthy individuals. We also asked if SNPs that influence vitamin B6 were associated with GGE in 3122 affected individuals and 20,244 controls. Our GWAS of vitamin B6 metabolites reproduced a previous association and found a novel genome-wide significant locus. The SNPs in these loci were not associated with GGE. We found that 84 GGE-associated SNPs influence expression levels of PNPO in the brain as well as in blood. However, these SNPs were not associated with vitamin B6 metabolism in plasma. By leveraging polygenic risk scoring (PRS), we found suggestive evidence of higher catabolism and lower levels of the active and transport forms of vitamin B6 in GGE, although these findings require further replication.
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Affiliation(s)
- Remi Stevelink
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Faith Pangilinan
- National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Floor E Jansen
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kees P J Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lawrence C Brody
- National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Bobby P C Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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Zweiphenning WJEM, Keijzer HM, van Diessen E, van 't Klooster MA, van Klink NEC, Leijten FSS, van Rijen PC, van Putten MJAM, Braun KPJ, Zijlmans M. Increased gamma and decreased fast ripple connections of epileptic tissue: A high-frequency directed network approach. Epilepsia 2019; 60:1908-1920. [PMID: 31329277 PMCID: PMC6852371 DOI: 10.1111/epi.16296] [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: 12/23/2017] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE New insights into high-frequency electroencephalographic activity and network analysis provide potential tools to improve delineation of epileptic tissue and increase the chance of postoperative seizure freedom. Based on our observation of high-frequency oscillations "spreading outward" from the epileptic source, we hypothesize that measures of directed connectivity in the high-frequency range distinguish epileptic from healthy brain tissue. METHODS We retrospectively selected refractory epilepsy patients with a malformation of cortical development or tumor World Health Organization grade I/II who underwent epilepsy surgery with intraoperative electrocorticography for tailoring the resection based on spikes. We assessed directed functional connectivity in the theta (4-8 Hz), gamma (30-80 Hz), ripple (80-250 Hz), and fast ripple (FR; 250-500 Hz) bands using the short-time direct directed transfer function, and calculated the total, incoming, and outgoing propagation strength for each electrode. We compared network measures of electrodes covering the resected and nonresected areas separately for patients with good and poor outcome, and of electrodes with and without spikes, ripples, and FRs (group level: paired t test; patient level: Mann-Whitney U test). We selected the measure that could best identify the resected area and channels with epileptic events using the area under the receiver operating characteristic curve, and calculated the positive and negative predictive value, sensitivity, and specificity. RESULTS We found higher total and outstrength in the ripple and gamma bands in resected tissue in patients with good outcome (rippletotal : P = .01; rippleout : P = .04; gammatotal : P = .01; gammaout : P = .01). Channels with events showed lower total and instrength, and higher outstrength in the FR band, and higher total and outstrength in the ripple, gamma, and theta bands (FRtotal : P = .05; FRin : P < .01; FRout : P = .02; gammatotal : P < .01; gammain : P = .01; gammaout : P < .01; thetatotal : P = .01; thetaout : P = .01). The total strength in the gamma band was most distinctive at the channel level (positive predictive value [PPV]good = 74%, PPVpoor = 43%). SIGNIFICANCE Interictally, epileptic tissue is isolated in the FR band and acts as a driver up to the (fast) ripple frequency range. The gamma band total strength seems promising to delineate epileptic tissue intraoperatively.
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Affiliation(s)
- Willemiek J E M Zweiphenning
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Hanneke M Keijzer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, Clinical Neurophysiology Group, University of Twente, Enschede, the Netherlands
| | - Eric van Diessen
- Department of Pediatric Neurology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Maryse A van 't Klooster
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Nicole E C van Klink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Frans S S Leijten
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Peter C van Rijen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Michel J A M van Putten
- MIRA Institute for Biomedical Technology and Technical Medicine, Clinical Neurophysiology Group, University of Twente, Enschede, the Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.,Epilepsy Foundation of the Netherlands, Heemstede, the Netherlands
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van den Heuvel MP, Scholtens LH, van der Burgh HK, Agosta F, Alloza C, Arango C, Auyeung B, Baron-Cohen S, Basaia S, Benders MJNL, Beyer F, Booij L, Braun KPJ, Filho GB, Cahn W, Cannon DM, Chaim-Avancini TM, Chan SSM, Chen EYH, Crespo-Facorro B, Crone EA, Dannlowski U, de Zwarte SMC, Dietsche B, Donohoe G, Plessis SD, Durston S, Díaz-Caneja CM, Díaz-Zuluaga AM, Emsley R, Filippi M, Frodl T, Gorges M, Graff B, Grotegerd D, Gąsecki D, Hall JM, Holleran L, Holt R, Hopman HJ, Jansen A, Janssen J, Jodzio K, Jäncke L, Kaleda VG, Kassubek J, Masouleh SK, Kircher T, Koevoets MGJC, Kostic VS, Krug A, Lawrie SM, Lebedeva IS, Lee EHM, Lett TA, Lewis SJG, Liem F, Lombardo MV, Lopez-Jaramillo C, Margulies DS, Markett S, Marques P, Martínez-Zalacaín I, McDonald C, McIntosh AM, McPhilemy G, Meinert SL, Menchón JM, Montag C, Moreira PS, Morgado P, Mothersill DO, Mérillat S, Müller HP, Nabulsi L, Najt P, Narkiewicz K, Naumczyk P, Oranje B, Ortiz-Garcia de la Foz V, Peper JS, Pineda JA, Rasser PE, Redlich R, Repple J, Reuter M, Rosa PGP, Ruigrok ANV, Sabisz A, Schall U, Seedat S, Serpa MH, Skouras S, Soriano-Mas C, Sousa N, Szurowska E, Tomyshev AS, Tordesillas-Gutierrez D, Valk SL, van den Berg LH, van Erp TGM, van Haren NEM, van Leeuwen JMC, Villringer A, Vinkers CH, Vollmar C, Waller L, Walter H, Whalley HC, Witkowska M, Witte AV, Zanetti MV, Zhang R, de Lange SC. 10Kin1day: A Bottom-Up Neuroimaging Initiative. Front Neurol 2019; 10:425. [PMID: 31133958 PMCID: PMC6524614 DOI: 10.3389/fneur.2019.00425] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/08/2019] [Indexed: 01/11/2023] Open
Abstract
We organized 10Kin1day, a pop-up scientific event with the goal to bring together neuroimaging groups from around the world to jointly analyze 10,000+ existing MRI connectivity datasets during a 3-day workshop. In this report, we describe the motivation and principles of 10Kin1day, together with a public release of 8,000+ MRI connectome maps of the human brain.
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Affiliation(s)
- Martijn P. van den Heuvel
- Connectome Lab, CTG, CNCR, VU Amsterdam, Amsterdam, Netherlands
- UMC Utrecht Brain Center, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lianne H. Scholtens
- Connectome Lab, CTG, CNCR, VU Amsterdam, Amsterdam, Netherlands
- UMC Utrecht Brain Center, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hannelore K. van der Burgh
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Clara Alloza
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
- Department of Child and Adolescent Psychiatry, IiSGM, CIBERSAM, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, IiSGM, CIBERSAM, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Bonnie Auyeung
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Simon Baron-Cohen
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Silvia Basaia
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Manon J. N. L. Benders
- Department of Neonatology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frauke Beyer
- Department of Neurology, CRC “Obesity Mechanisms”, Subproject A1, Max Planck Institute for Human Cognitive and Brain Sciences, University of Leipzig, Leipzig, Germany
| | - Linda Booij
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Kees P. J. Braun
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Geraldo Busatto Filho
- Laboratory of Psychiatric Neuroimaging (LIM21), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Wiepke Cahn
- UMC Utrecht Brain Center, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dara M. Cannon
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics (NICOG), NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Tiffany M. Chaim-Avancini
- Laboratory of Psychiatric Neuroimaging (LIM21), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Sandra S. M. Chan
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Eric Y. H. Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Benedicto Crespo-Facorro
- Psychiatry Unit, Department of Medicine and Psychiatry, Hospital Universitario Marques de Valdecilla, IDIVAL, CIBERSAM, Hosptial Universitario Virgen del Rocío, Universidad de Seville, Seville, Spain
| | - Eveline A. Crone
- Brain and Development Research Center, Leiden University, Leiden, Netherlands
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Sonja M. C. de Zwarte
- UMC Utrecht Brain Center, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bruno Dietsche
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Gary Donohoe
- Cognitive Genetics and Cognitive Therapy Group, Neuroimaging and Cognitive Genomics Centre and NCBES Galway Neuroscience Centre, School of Psychology and Discipline of Biochemistry, National University of Ireland, Galway, Ireland
| | - Stefan Du Plessis
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sarah Durston
- UMC Utrecht Brain Center, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Covadonga M. Díaz-Caneja
- Department of Child and Adolescent Psychiatry, IiSGM, CIBERSAM, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Ana M. Díaz-Zuluaga
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Robin Emsley
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, University Hospital, Otto von Guericke University, Magdeburg, Germany
| | - Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Beata Graff
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Dariusz Gąsecki
- Department of Neurology of Adults, Medical University of Gdańsk, Gdańsk, Poland
| | - Julie M. Hall
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Laurena Holleran
- Cognitive Genetics and Cognitive Therapy Group, Neuroimaging and Cognitive Genomics Centre and NCBES Galway Neuroscience Centre, School of Psychology and Discipline of Biochemistry, National University of Ireland, Galway, Ireland
| | - Rosemary Holt
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Helene J. Hopman
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Andreas Jansen
- Department of Psychiatry and Center for Mind, Brain and Behaviour, University of Marburg, Marburg, Germany
| | - Joost Janssen
- Department of Child and Adolescent Psychiatry, IiSGM, CIBERSAM, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | - Lutz Jäncke
- Division of Neuropsychology, University of Zurich, Zurich, Switzerland
| | - Vasiliy G. Kaleda
- Department of Endogenous Mental Disorders, Mental Health Research Center, Moscow, Russia
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Tilo Kircher
- Department of Psychiatry and Center for Mind, Brain and Behaviour, University of Marburg, Marburg, Germany
| | - Martijn G. J. C. Koevoets
- UMC Utrecht Brain Center, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vladimir S. Kostic
- Clinic of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Axel Krug
- Department of Psychiatry and Center for Mind, Brain and Behaviour, University of Marburg, Marburg, Germany
| | - Stephen M. Lawrie
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Irina S. Lebedeva
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, Moscow, Russia
| | - Edwin H. M. Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Tristram A. Lett
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon J. G. Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Franziskus Liem
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Zurich, Switzerland
| | - Michael V. Lombardo
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Carlos Lopez-Jaramillo
- Mood Disorders Program, Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Hospital Universitario San Vicente Fundación, Universidad de Antioquia, Medellín, Colombia
| | - Daniel S. Margulies
- Frontlab, Centre National de la Recherche Scientifique, Institut du Cerveau et de la Moelle Épinière, UMR 7225, Paris, France
| | - Sebastian Markett
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Paulo Marques
- School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL and CIBERSAM, Barcelona, Spain
| | - Colm McDonald
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics (NICOG), NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Andrew M. McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Genevieve McPhilemy
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics (NICOG), NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | | | - José M. Menchón
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL and CIBERSAM, Barcelona, Spain
| | - Christian Montag
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Pedro S. Moreira
- School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
| | - Pedro Morgado
- School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
| | - David O. Mothersill
- Cognitive Genetics and Cognitive Therapy Group, Neuroimaging and Cognitive Genomics Centre and NCBES Galway Neuroscience Centre, School of Psychology and Discipline of Biochemistry, National University of Ireland, Galway, Ireland
| | - Susan Mérillat
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Zurich, Switzerland
| | | | - Leila Nabulsi
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics (NICOG), NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Pablo Najt
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics (NICOG), NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Bob Oranje
- UMC Utrecht Brain Center, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Victor Ortiz-Garcia de la Foz
- Psychiatry Unit, Department of Medicine and Psychiatry, IDIVAL, CIBERSAM, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jiska S. Peper
- Brain and Development Research Center, Leiden University, Leiden, Netherlands
| | - Julian A. Pineda
- Research Group, Instituto de Alta Tecnología Médica, Universidad de Antioquia, Medellín, Colombia
| | - Paul E. Rasser
- Priority Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, NSW, Australia
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Martin Reuter
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Pedro G. P. Rosa
- Laboratory of Psychiatric Neuroimaging (LIM21), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Amber N. V. Ruigrok
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Agnieszka Sabisz
- 2nd Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Ulrich Schall
- Priority Centre for Brain and Mental Health Research, The University of Newcastle, Newcastle, NSW, Australia
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Mauricio H. Serpa
- Laboratory of Psychiatric Neuroimaging (LIM21), Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Stavros Skouras
- BarcelonaBeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Carles Soriano-Mas
- Department of Psychiatry (IDIBELL and CIBERSAM) and Department of Psychobiology and Methodology in Health Sciences (UAB), Bellvitge Biomedical Research Institute-IDIBELL, CIBERSAM and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuno Sousa
- School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alexander S. Tomyshev
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, Moscow, Russia
| | - Diana Tordesillas-Gutierrez
- Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, CIBERSAM, Santander, Spain
| | - Sofie L. Valk
- Institute for Neuroscience and Medicine 7/Institute of Systems Neuroscience, Forschungszentrum Jülich - Heinrich Heine Universitaet Duesseldorf, Jülich, Germany
| | - Leonard H. van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Theo G. M. van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States
| | - Neeltje E. M. van Haren
- UMC Utrecht Brain Center, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Judith M. C. van Leeuwen
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Arno Villringer
- Departments of Neurology, Cognitive Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, University of Leipzig, Leipzig, Germany
| | - Christiaan H. Vinkers
- Departments of Psychiatry, Anatomy and Neurosciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Christian Vollmar
- Department of Neurology, Epilepsy Centre, University of Munich Hospital, Munich, Germany
| | - Lea Waller
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité Universitätsmedizin Berlin, Corporate Member of Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Heather C. Whalley
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Marta Witkowska
- Institute of Psychology, University of Gdańsk, Gdańsk, Poland
| | - A. Veronica Witte
- Department of Neurology, CRC “Obesity Mechanisms”, Subproject A1, Max Planck Institute for Human Cognitive and Brain Sciences, University of Leipzig, Leipzig, Germany
| | - Marcus V. Zanetti
- Laboratory of Psychiatric Neuroimaging (LIM21), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, São Paulo, Brazil
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, Universidade de São Paulo, São Paulo, Brazil
| | - Rui Zhang
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Siemon C. de Lange
- Connectome Lab, CTG, CNCR, VU Amsterdam, Amsterdam, Netherlands
- UMC Utrecht Brain Center, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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