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Cohen Z, Steinbrenner M, Piper RJ, Tangwiriyasakul C, Richardson MP, Sharp DJ, Violante IR, Carmichael DW. Transcranial electrical stimulation during functional magnetic resonance imaging in patients with genetic generalized epilepsy: a pilot and feasibility study. Front Neurosci 2024; 18:1354523. [PMID: 38572149 PMCID: PMC10989273 DOI: 10.3389/fnins.2024.1354523] [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: 12/12/2023] [Accepted: 02/13/2024] [Indexed: 04/05/2024] Open
Abstract
Objective A third of patients with epilepsy continue to have seizures despite receiving adequate antiseizure medication. Transcranial direct current stimulation (tDCS) might be a viable adjunct treatment option, having been shown to reduce epileptic seizures in patients with focal epilepsy. Evidence for the use of tDCS in genetic generalized epilepsy (GGE) is scarce. We aimed to establish the feasibility of applying tDCS during fMRI in patients with GGE to study the acute neuromodulatory effects of tDCS, particularly on sensorimotor network activity. Methods Seven healthy controls and three patients with GGE received tDCS with simultaneous fMRI acquisition while watching a movie. Three tDCS conditions were applied: anodal, cathodal and sham. Periods of 60 s without stimulation were applied between each stimulation condition. Changes in sensorimotor cortex connectivity were evaluated by calculating the mean degree centrality across eight nodes of the sensorimotor cortex defined by the Automated Anatomical Labeling atlas (primary motor cortex (precentral left and right), supplementary motor area (left and right), mid-cingulum (left and right), postcentral gyrus (left and right)), across each of the conditions, for each participant. Results Simultaneous tDCS-fMRI was well tolerated in both healthy controls and patients without adverse effects. Anodal and cathodal stimulation reduced mean degree centrality of the sensorimotor network (Friedman's ANOVA with Dunn's multiple comparisons test; adjusted p = 0.02 and p = 0.03 respectively). Mean degree connectivity of the sensorimotor network during the sham condition was not different to the rest condition (adjusted p = 0.94). Conclusion Applying tDCS during fMRI was shown to be feasible and safe in a small group of patients with GGE. Anodal and cathodal stimulation caused a significant reduction in network connectivity of the sensorimotor cortex across participants. This initial research supports the feasibility of using fMRI to guide and understand network modulation by tDCS that might facilitate its clinical application in GGE in the future.
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Affiliation(s)
- Zachary Cohen
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mirja Steinbrenner
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Rory J. Piper
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Chayanin Tangwiriyasakul
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mark P. Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - David J. Sharp
- The Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - Ines R. Violante
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - David W. Carmichael
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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Thomschewski A, Giovannini G, Gaspard N, Steinbrenner M, Wickström R, Jacobs J. Editorial: Advances in diagnosing and treating new-onset refractory status epilepticus (NORSE). Front Neurol 2023; 14:1270702. [PMID: 37712084 PMCID: PMC10499399 DOI: 10.3389/fneur.2023.1270702] [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: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Aljoscha Thomschewski
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giada Giovannini
- Unitá di Neurologia, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Nicolas Gaspard
- Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mirja Steinbrenner
- Clinic for Neurology With Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Ronny Wickström
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - Julia Jacobs
- Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
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Steinbart D, Yaakub SN, Steinbrenner M, Guldin LS, Holtkamp M, Keller SS, Weber B, Rüber T, Heckemann RA, Ilyas-Feldmann M, Hammers A. Automatic and manual segmentation of the piriform cortex: Method development and validation in patients with temporal lobe epilepsy and Alzheimer's disease. Hum Brain Mapp 2023; 44:3196-3209. [PMID: 37052063 PMCID: PMC10171523 DOI: 10.1002/hbm.26274] [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: 07/16/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 04/14/2023] Open
Abstract
The piriform cortex (PC) is located at the junction of the temporal and frontal lobes. It is involved physiologically in olfaction as well as memory and plays an important role in epilepsy. Its study at scale is held back by the absence of automatic segmentation methods on MRI. We devised a manual segmentation protocol for PC volumes, integrated those manually derived images into the Hammers Atlas Database (n = 30) and used an extensively validated method (multi-atlas propagation with enhanced registration, MAPER) for automatic PC segmentation. We applied automated PC volumetry to patients with unilateral temporal lobe epilepsy with hippocampal sclerosis (TLE; n = 174 including n = 58 controls) and to the Alzheimer's Disease Neuroimaging Initiative cohort (ADNI; n = 151, of whom with mild cognitive impairment (MCI), n = 71; Alzheimer's disease (AD), n = 33; controls, n = 47). In controls, mean PC volume was 485 mm3 on the right and 461 mm3 on the left. Automatic and manual segmentations overlapped with a Jaccard coefficient (intersection/union) of ~0.5 and a mean absolute volume difference of ~22 mm3 in healthy controls, ~0.40/ ~28 mm3 in patients with TLE, and ~ 0.34/~29 mm3 in patients with AD. In patients with TLE, PC atrophy lateralised to the side of hippocampal sclerosis (p < .001). In patients with MCI and AD, PC volumes were lower than those of controls bilaterally (p < .001). Overall, we have validated automatic PC volumetry in healthy controls and two types of pathology. The novel finding of early atrophy of PC at the stage of MCI possibly adds a novel biomarker. PC volumetry can now be applied at scale.
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Affiliation(s)
- David Steinbart
- Charité - Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität zu Berlin, Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, UK
| | - Siti N Yaakub
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, UK
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Mirja Steinbrenner
- Charité - Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität zu Berlin, Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Lynn S Guldin
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, UK
| | - Martin Holtkamp
- Charité - Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität zu Berlin, Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Bernd Weber
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Rolf A Heckemann
- Department of Medical Radiation Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Maria Ilyas-Feldmann
- Charité - Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität zu Berlin, Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Alexander Hammers
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, UK
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Steinbrenner M, Tito T, Dehnicke C, Holtkamp M. Predictors and reasons for epilepsy patients to decline surgery: a prospective study. J Neurol 2023; 270:2302-2307. [PMID: 36473975 PMCID: PMC10025225 DOI: 10.1007/s00415-022-11510-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients with drug-resistant focal epilepsy, resective surgery is the most successful treatment option to achieve seizure freedom. However, a surprisingly high rate of patients declines their physicians' recommendation to undergo removal of the seizure focus or-if necessary-further video-EEG monitoring (VEM). METHODS In this prospective study, consecutive patients in presurgical assessment with at least one scalp VEM between 2016 and 2018 were included. We assessed both epilepsy-related and psychosocial variables as well as decision-making of physicians and patients, including reasons for decline in the latter. RESULTS Out of 116 patients with a total of 165 VEM, 20 patients were eventually found to be ineligible for resection, 51 declined, and 45 agreed on recommendations for resection or further VEM diagnostics. Patients most frequently declined due to general fear of brain surgery (n = 30, 59%) and currently lower seizure frequency (n = 11, 22%). An independent predictor of patients' decline was less epilepsy-related fear (OR 0.43; p = 0.02) assessed in a standardised questionnaire. CONCLUSION Half of the patients potentially eligible for resective surgery decline the operation or further VEM procedures. Patients who decline are more fearful of brain surgery than of ongoing disabling seizures. More insight is needed to improve counselling of patients.
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Affiliation(s)
- Mirja Steinbrenner
- Department of Neurology and Experimental Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Tabea Tito
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Christoph Dehnicke
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology and Experimental Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
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Steinbrenner M, McDowell A, Centeno M, Moeller F, Perani S, Lorio S, Maziero D, Carmichael DW. Camera-based Prospective Motion Correction in Paediatric Epilepsy Patients Enables EEG-fMRI Localization Even in High-motion States. Brain Topogr 2023; 36:319-337. [PMID: 36939987 PMCID: PMC10164016 DOI: 10.1007/s10548-023-00945-0] [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: 09/01/2022] [Accepted: 02/14/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND EEG-fMRI is a useful additional test to localize the epileptogenic zone (EZ) particularly in MRI negative cases. However subject motion presents a particular challenge owing to its large effects on both MRI and EEG signal. Traditionally it is assumed that prospective motion correction (PMC) of fMRI precludes EEG artifact correction. METHODS Children undergoing presurgical assessment at Great Ormond Street Hospital were included into the study. PMC of fMRI was done using a commercial system with a Moiré Phase Tracking marker and MR-compatible camera. For retrospective EEG correction both a standard and a motion educated EEG artefact correction (REEGMAS) were compared to each other. RESULTS Ten children underwent simultaneous EEG-fMRI. Overall head movement was high (mean RMS velocity < 1.5 mm/s) and showed high inter- and intra-individual variability. Comparing motion measured by the PMC camera and the (uncorrected residual) motion detected by realignment of fMRI images, there was a five-fold reduction in motion from its prospective correction. Retrospective EEG correction using both standard approaches and REEGMAS allowed the visualization and identification of physiological noise and epileptiform discharges. Seven of 10 children had significant maps, which were concordant with the clinical EZ hypothesis in 6 of these 7. CONCLUSION To our knowledge this is the first application of camera-based PMC for MRI in a pediatric clinical setting. Despite large amount of movement PMC in combination with retrospective EEG correction recovered data and obtained clinically meaningful results during high levels of subject motion. Practical limitations may currently limit the widespread use of this technology.
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Affiliation(s)
- Mirja Steinbrenner
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.,Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Amy McDowell
- Developmental Imaging and Biophysics, UCL Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, UK
| | - Maria Centeno
- Developmental Imaging and Biophysics, UCL Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, UK.,Epilepsy Unit, Neurology Department, Hospital Clinic Barcelona/IDIBAPS, Villarroel 170., Barcelona, 08036, Spain
| | - Friederike Moeller
- Department of Clinical Neurophysiology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Suejen Perani
- Department of Basic and Clinical Neuroscience, KCL Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sara Lorio
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Danilo Maziero
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego Health, San Diego, CA, USA
| | - David W Carmichael
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. .,Developmental Imaging and Biophysics, UCL Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, UK.
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Steinbrenner M, Duncan JS, Dickson J, Rathore C, Wächter B, Aygun N, Menon RN, Radhakrishnan A, Holtkamp M, Ilyas-Feldmann M. Utility of 18F-fluorodeoxyglucose positron emission tomography in presurgical evaluation of patients with epilepsy: A multicenter study. Epilepsia 2022; 63:1238-1252. [PMID: 35166379 DOI: 10.1111/epi.17194] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in presurgical assessment in patients with drug-resistant focal epilepsy (DRE) if magnetic resonance imaging (MRI) and scalp electroencephalography (EEG) do not localize the seizure onset zone or are discordant. METHODS In this multicenter, retrospective observational cohort study, we included consecutive patients with DRE who had undergone FDG-PET as part of their presurgical workup. We assessed the utility of FDG-PET, which was defined as contributing to the decision-making process to refer for resection or intracranial EEG (iEEG) or to conclude surgery was not feasible. RESULTS We included 951 patients in this study; 479 had temporal lobe epilepsy (TLE), 219 extratemporal epilepsy (ETLE), and 253 epilepsy of uncertain lobar origin. FDG-PET showed a distinct hypometabolism in 62% and was concordant with ictal EEG in 74% in TLE and in 56% in ETLE (p < .001). FDG-PET was useful in presurgical decision-making in 396 patients (47%) and most beneficial in TLE compared to ETLE (58% vs. 44%, p = .001). Overall, FDG-PET contributed to recommending resection in 78 cases (20%) and iEEG in 187 cases (47%); in 131 patients (33%), FDG-PET resulted in a conclusion that resection was not feasible. In TLE, seizure-freedom 1 year after surgery did not differ significantly (p = .48) between patients with negative MRI and EEG-PET concordance (n = 30, 65%) and those with positive MRI and concordant EEG (n = 46, 68%). In ETLE, half of patients with negative MRI and EEG-PET concordance and three quarters with positive MRI and concordant EEG were seizure-free postsurgery (n = 5 vs. n = 6, p = .28). SIGNIFICANCE This is the largest reported cohort of patients with DRE who received presurgical FDG-PET, showing that FDG-PET is a useful diagnostic tool. MRI-negative and MRI-positive cases with concordant FDG-PET results (with either EEG or MRI) had a comparable outcome after surgery. These findings confirm the significance of FDG-PET in presurgical epilepsy diagnostics.
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Affiliation(s)
- Mirja Steinbrenner
- Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK
| | - John Dickson
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah (SBKS) Medical College, Sumandeep Vidyapeeth, Vadodara, India
| | - Bettina Wächter
- Epilepsy Center Berlin-Brandenburg, Evangelische Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Nafi Aygun
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Martin Holtkamp
- Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Epilepsy Center Berlin-Brandenburg, Evangelische Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Maria Ilyas-Feldmann
- Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Steinbart D, Steinbrenner M, Oltmanns F, Holtkamp M. P3. Significance of intracranial EEG parameters in prediction of seizure freedom. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Franke C, Ferse C, Kreye J, Reincke SM, Sanchez-Sendin E, Rocco A, Steinbrenner M, Angermair S, Treskatsch S, Zickler D, Eckardt KU, Dersch R, Hosp J, Audebert HJ, Endres M, Ploner JC, Prüß H. High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms. Brain Behav Immun 2021; 93:415-419. [PMID: 33359380 PMCID: PMC7834471 DOI: 10.1016/j.bbi.2020.12.022] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND COVID-19 intensive care patients can present with neurological syndromes, usually in the absence of SARS-CoV-2 in cerebrospinal fluid (CSF). The recent finding of some virus-neutralizing antibodies cross-reacting with brain tissue suggests the possible involvement of specific autoimmunity. DESIGN Blood and CSF samples from eleven critically ill COVID-19 patients presenting with unexplained neurological symptoms including myoclonus, oculomotor disturbance, delirium, dystonia and epileptic seizures, were analyzed for anti-neuronal and anti-glial autoantibodies. RESULTS Using cell-based assays and indirect immunofluorescence on unfixed murine brain sections, all patients showed anti-neuronal autoantibodies in serum or CSF. Antigens included intracellular and neuronal surface proteins, such as Yo or NMDA receptor, but also various specific undetermined epitopes, reminiscent of the brain tissue binding observed with certain human monoclonal SARS-CoV-2 antibodies. These included vessel endothelium, astrocytic proteins and neuropil of basal ganglia, hippocampus or olfactory bulb. CONCLUSION The high frequency of autoantibodies targeting the brain in the absence of other explanations suggests a causal relationship to clinical symptoms, in particular to hyperexcitability (myoclonus, seizures). Several underlying autoantigens and their potential molecular mimicry with SARS-CoV-2 still await identification. However, autoantibodies may already now explain some aspects of multi-organ disease in COVID-19 and can guide immunotherapy in selected cases.
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Affiliation(s)
- Christiana Franke
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Caroline Ferse
- Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Germany
| | - Jakob Kreye
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany,Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S. Momsen Reincke
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany,Berlin Institute of Health (BIH), Berlin 10178, Germany
| | | | - Andrea Rocco
- Department of Neurology, Ernst-von-Bergmann Klinikum, Potsdam, Germany
| | - Mirja Steinbrenner
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Angermair
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Germany
| | - Rick Dersch
- Clinic of Neurology and Neurophysiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jonas Hosp
- Clinic of Neurology and Neurophysiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Heinrich J. Audebert
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany,Center for Stroke Research Berlin, Berlin, Germany,Excellence Cluster NeuroCure, Berlin, Germany,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - J. Christoph Ploner
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Harald Prüß
- Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
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Steinbart D, Steinbrenner M, Oltmanns F, Holtkamp M. Prediction of seizure freedom after epilepsy surgery - Critical reappraisal of significance of intracranial EEG parameters. Clin Neurophysiol 2020; 131:2682-2690. [PMID: 33002730 DOI: 10.1016/j.clinph.2020.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To analyze the significance of intracranial electroencephalography (iEEG) parameters such as seizure onset patterns (SOP) and size of seizure onset zone (SOZ) with respect to prediction of seizure freedom after resective epilepsy surgery. METHODS All patients who underwent iEEG with subdural electrodes between January 2006 and December 2015 in our epilepsy-center were included. Various iEEG parameters were retrospectively analyzed regarding their predictive value to post-operative seizure freedom. Furthermore, associations of specific SOPs with underlying histopathology and brain regions of the SOZ were examined. RESULTS Eighty-one patients (34 female) with 324 seizures were assessed. Low-voltage fast activity (37%) and sharp activity <13 Hz (30%) were the most frequent SOPs. Focal SOZ (≤2 cm) was the only iEEG parameter independently associated with 1-year post-operative seizure freedom (OR 4.1, 95% CI 1.433-11.679). While no SOP was linked to specific histopathologies, some associations between SOPs and anatomical regions of SOZ were found. CONCLUSIONS A circumscribed SOZ, but no specific SOP was predictive for seizure freedom after epilepsy surgery. SIGNIFICANCE Intracranial EEG may be helpful to predict post-operative seizure freedom. Multicenter studies with larger numbers of patients are required to reliably assess the significance of specific SOPs for successful resective epilepsy surgery.
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Affiliation(s)
- David Steinbart
- Charité - Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
| | - Mirja Steinbrenner
- Charité - Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany.
| | - Frank Oltmanns
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Martin Holtkamp
- Charité - Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
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Steinbrenner M, Tangwiriyasakul C, Richardson M, Sharp D, Violante I, Carmichael D. P207 Transcranial electrical stimulation effects on sensorimotor network synchrony. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Steinbrenner M, Kowski AB, Holtkamp M. Referral to evaluation for epilepsy surgery: Reluctance by epileptologists and patients. Epilepsia 2019; 60:211-219. [DOI: 10.1111/epi.14641] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mirja Steinbrenner
- Epilepsy‐Center Berlin‐Brandenburg Department of Neurology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Alexander B. Kowski
- Epilepsy‐Center Berlin‐Brandenburg Department of Neurology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Martin Holtkamp
- Epilepsy‐Center Berlin‐Brandenburg Department of Neurology Charité–Universitätsmedizin Berlin Berlin Germany
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Steinbrenner M, Kowski AB, Schmitt FC, Holtkamp M. Hypothermia did not prevent epilepsy following experimental status epilepticus. Brain Res 2014; 1572:50-8. [PMID: 24854118 DOI: 10.1016/j.brainres.2014.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/05/2014] [Revised: 04/25/2014] [Accepted: 05/12/2014] [Indexed: 11/29/2022]
Abstract
In epilepsy research, one of the major challenges is to prevent or at least mitigate development of epilepsy following acquired brain insult by early therapeutic interventions. So far, all pharmacological antiepileptogenic treatment approaches were largely unsuccessful in clinical trials and in experimental animal studies. In a well-established rat model of chronic epilepsy following self-sustaining status epilepticus (SSSE), we assessed the antiepileptogenic properties of 3-h-cooling induced directly after the end of SSSE. Occurrence of spontaneous seizures and seizure severity up to 8 weeks after SSSE were compared with normothermic SSSE controls. Furthermore, electrophysiological parameters assessing inhibition and excitation in the dentate gyrus were assessed at multiple time points. Post SSSE hypothermia did not prevent the occurrence of seizures in any animal. Eight weeks after SSSE, Racine motor seizures trended to be less severe following cooling (4.0±0.6) compared with normothermic controls (4.8±0.2) but the difference was not significant when testing for multiple comparisons. Early loss of inhibition that is typically seen following SSSE was somewhat attenuated in cooled animals 3h after SSSE as expressed by smaller paired-pulse ratios (PPR; 0.16±0.21) compared with normothermic controls (0.54±0.21) but difference was not significant either. Latency between stimulus artefact and excitatory post-synaptic potential 3h after SSSE, reciprocally reflecting neuronal excitation, was higher in animals that underwent hypothermia (8.29±2.45 ms) compared with controls (4.82±0.66 ms), difference was not significant after correction for multiple comparisons. In summary, the current experiments were not able to demonstrate prevention or mitigation of epileptogenesis with immediate short-term cooling following SSSE.
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Affiliation(s)
- Mirja Steinbrenner
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Alexander B Kowski
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Friedhelm C Schmitt
- Department of Neurology, Universitätsklinik Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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Steinbrenner M, Häfer R, Gruhn B, Müller A, Fuchs D, Hermann J, Zintl F. T-cell independent production of salivary secretory IgA after hematopoietic stem cell transplantation in children. ACTA ACUST UNITED AC 2005; 20:282-8. [PMID: 16101963 DOI: 10.1111/j.1399-302x.2005.00226.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study examined the recovery of secretory IgA (S-IgA) in saliva after hematopoietic stem cell transplantation (HSCT) in 35 children and young people between the ages of 3 and 27 years (mean=13.6), and compared this recovery with that of serum immunologic constituents. Reference values for human salivary S-IgA in saliva were obtained from 77 healthy control subjects between the ages of 7 and 25 years (mean=11.4). In the 35 patients, a nadir of secretory IgA concentrations in saliva (S-IgA) was observed between the 3rd and the 4th month, and a return to normal values 1 year after HSCT. Serum IgA concentrations reached their nadir in the 6th month, and normalized in the 18 months after HSCT. The recovery of T-helper cells (CD4+/3+) was also delayed to beyond 18 months. We found a significant correlation between the reconstitution pattern of S-IgA and that of T-helper lymphocytes, but no correlation was found between the post-transplant evolutions of S-IgA and serum IgA, or between S-IgA and T-helper cells. The recovery of S-IgA was more rapid than that of serum IgA and appeared to be T-helper cell independent.
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Affiliation(s)
- M Steinbrenner
- Department of Pediatrics, University of Jena, Jena, Germany.
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