1
|
Hanin A, Eschbach K, Gofton TE, Gopaul M, Howe CL, Lai YC, Koh S, Shen H, Hirsch LJ. New onset refractory status epilepticus: Summary of the NORSE Institute roundtable during the 2023 American Epilepsy Society meeting, Orlando, Florida. Epilepsia 2024; 65:1145-1146. [PMID: 38421053 DOI: 10.1111/epi.17934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Aurélie Hanin
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut, USA
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences, Epilepsy Unit and Department of Clinical Neurophysiology, Paris, France
| | - Krista Eschbach
- Department of Pediatrics, Section of Neurology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Teneille E Gofton
- University Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Margaret Gopaul
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Charles L Howe
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi-Chen Lai
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Sookyong Koh
- Children's Hospital and Medical Center, Department of Pediatrics, University of Nebraska, Omaha, Nebraska, USA
| | - Haying Shen
- Children's Hospital and Medical Center, Department of Pediatrics, University of Nebraska, Omaha, Nebraska, USA
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
2
|
Zhou DJ, Powers AM, Cave CA, Dickas EK, Rickard MC, Rathore G, Wright RR, Zabad RK, Koh S. Perplexing Initial Presentations of MOGAD in Two Children: Intracranial Hypertension and New-Onset Seizure. Neurohospitalist 2023; 13:438-444. [PMID: 37701249 PMCID: PMC10494829 DOI: 10.1177/19418744231192159] [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] [Indexed: 09/14/2023] Open
Abstract
We report two distinct challenging initial presentations of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Case 1 describes a 12-year-old boy who developed headaches refractory to pain medication followed by cranial neuropathies and intracranial hypertension, confirmed by lumbar puncture with an opening pressure >36 cm H2O. Case 2 describes a 3-year-old boy who developed new-onset seizures refractory to antiseizure medications, a presentation of FLAIR-hyperintense lesions in MOG-antibody associated encephalitis with seizures (FLAMES). On repeat magnetic resonance imaging, both patients were found to have cortical T2 hyperintensities, leptomeningeal contrast enhancement, and bilateral optic nerve enhancement. In the cerebrospinal fluid, both patients had CSF pleocytosis with neutrophilic predominance. The patients were treated with intravenous immunoglobulins, plasma exchange, and high-dose corticosteroids. The first patient achieved disease remission, whereas the second patient required the addition of rituximab for management of seizures. The two cases highlight the pleomorphic clinical phenotypes of MOGAD.
Collapse
Affiliation(s)
- Daniel J. Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andria M. Powers
- Department of Radiology, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Caleb A. Cave
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Emily K. Dickas
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Mary C. Rickard
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Geetanjali Rathore
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Rhonda R. Wright
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Rana K. Zabad
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sookyong Koh
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| |
Collapse
|
3
|
Zhou DJ, Darwish M, Ford JB, Patel S, Koh S, Rathore GS, Zabad RK. Pediatric CLIPPERS? Think again! J Neurol Sci 2023; 451:120698. [PMID: 37348249 DOI: 10.1016/j.jns.2023.120698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/28/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Daniel J Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Mohamed Darwish
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, United States of America.
| | - James B Ford
- Division of Pediatric Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Sachit Patel
- Division of Pediatric Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Sookyong Koh
- Division of Neurology, Children's Hospital and Medical Center, Omaha, NE, United States of America.
| | - Geetanjali S Rathore
- Division of Neurology, Children's Hospital and Medical Center, Omaha, NE, United States of America.
| | - Rana K Zabad
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States of America.
| |
Collapse
|
4
|
Hanin A, Cespedes J, Pulluru Y, Gopaul M, Aronica E, Decampo D, Helbig I, Howe CL, Huttner A, Koh S, Navarro V, Taraschenko O, Vezzani A, Wilson MR, Xian J, Gaspard N, Hirsch LJ. Review and standard operating procedures for collection of biospecimens and analysis of biomarkers in new onset refractory status epilepticus. Epilepsia 2023; 64:1444-1457. [PMID: 37039049 PMCID: PMC10756682 DOI: 10.1111/epi.17600] [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: 01/06/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
New onset refractory status epilepticus (NORSE), including its subtype with a preceding febrile illness known as febrile infection-related epilepsy syndrome (FIRES), is one of the most severe forms of status epilepticus. The exact causes of NORSE are currently unknown, and there is so far no disease-specific therapy. Identifying the underlying pathophysiology and discovering specific biomarkers, whether immunologic, infectious, genetic, or other, may help physicians in the management of patients with NORSE. A broad spectrum of biomarkers has been proposed for status epilepticus patients, some of which were evaluated for patients with NORSE. Nonetheless, none has been validated, due to significant variabilities in study cohorts, collected biospecimens, applied analytical methods, and defined outcome endpoints, and to small sample sizes. The NORSE Institute established an open NORSE/FIRES biorepository for health-related data and biological samples allowing the collection of biospecimens worldwide, promoting multicenter research and sharing of data and specimens. Here, we suggest standard operating procedures for biospecimen collection and biobanking in this rare condition. We also propose criteria for the appropriate use of previously collected biospecimens. We predict that the widespread use of standardized procedures will reduce heterogeneity, facilitate the future identification of validated biomarkers for NORSE, and provide a better understanding of the pathophysiology and best clinical management for these patients.
Collapse
Affiliation(s)
- Aurélie Hanin
- Department of Neurology and Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
- Sorbonne Université, Institut du Cerveau ICM, Paris Brain Institute, Inserm, CNRS, Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Epilepsy Unit and Department of Clinical Neurophysiology, Paris, France
| | - Jorge Cespedes
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Universidad Autonoma de Centro America, School of Medicine, San Jose, Costa Rica
| | - Yashwanth Pulluru
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Nebraska Medical Center, Omaha, Nebraska, USA
| | - Margaret Gopaul
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Danielle Decampo
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles L. Howe
- Division of Experimental Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anita Huttner
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sookyong Koh
- Department of Pediatrics, Children’s Hospital Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | - Vincent Navarro
- Sorbonne Université, Institut du Cerveau ICM, Paris Brain Institute, Inserm, CNRS, Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Epilepsy Unit and Department of Clinical Neurophysiology, Paris, France
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Annamaria Vezzani
- Department of Acute Brain Injury, Istituto di Recerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michael R. Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, California, San Francisco, USA
| | - Julie Xian
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nicolas Gaspard
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Lawrence J. Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
5
|
Koi Y, Koh S, Tajiri W, Kawasaki J, Akiyoshi S, Koga C, Nakamura Y, Taguchi K, Tokunaga E. P172 Different incidence of brain metastasis according to HER2 expression level in patients with triple negative breast cancer. Breast 2023. [DOI: 10.1016/s0960-9776(23)00289-8] [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: 03/17/2023] Open
|
6
|
Koh S, Koi Y, Tajiri W, Kawasaki J, Akiyoshi S, Nakamura Y, Koga C, Tokunaga E. P043 Characteristics and clinical outcomes of patients with HER2-low breast cancer. Breast 2023. [DOI: 10.1016/s0960-9776(23)00162-5] [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: 03/16/2023] Open
|
7
|
Jung J, Koh S, Lee K. 61P The cysteine-rich protein 61 (Cyr61) contributes to tumor proliferation and invasion via HGF-mediated NF-kB signaling pathway in human hepatocellular carcinoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100919] [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: 04/05/2023] Open
|
8
|
Ong S, Pasaribu S, Tan S, Aw T, Huang J, Woo M, Koh S, Khoo K. Quality Improvement at the Laboratory’s Specimen Reception Station. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
In our 1000-bed acute care tertiary hospital, physicians order laboratory tests via the computerized-provider-order-entry (CPOE) system and print barcode labels (patient demographics/tests ordered) at the computer-on-wheel printer. When tubes with unsuitable barcodes (misaligned, poor quality) are received at the laboratory specimen reception area a fresh barcode is re-printed by our laboratory staff. An incident involving a re- printed barcode label pasted on the wrong blood tube prompted an investigation into the quality of barcodes.
Methods/Case Report
We initiated ‘an opportunity for improvement (OFI) project’ at the laboratory specimen reception station. The OFI team involved Nursing, Information Technology (IT) and Pathology departments aimed to eliminate re-printing of barcode labels by 75% within 6 months. We collated and analyzed reasons for re-printing of barcodes on 3 separate 48-hour periods (27-28 April 2020, 24-25 June 2020, and 13-14 June 2022). A series of interventions and initiatives were implemented.
Results (if a Case Study enter NA)
Re-printed barcodes were from the Emergency Department (56%), Out-patient clinics (7%) and Wards (57%). Root cause analysis(RCA) using the “5 whys” technique categorized re-print causes into staff-related (misaligned barcodes) and printer-related (faint barcodes lines/truncated un-verifiable patient demographics). The team mass-emailed clinicians an educational “Do-You-Know” guide on proper pasting of barcodes on blood tubes and instructions on how to obtain help for printer rectification. These guide documents were placed in the hospital-wide document-sharing portal - Docupedia. Immediate close follow-up with sites that had poor barcodes was done in real-time. Barcode reprints decreased 83% within 2 months - from 174 (27-28 Apr 2020) to 30 (24-25 Jun 2020). A recent audit showed sustained elimination of barcode re-printing: 25 cases (13-14 Jun 2022).
Conclusion
The OFI project has successfully raised the quality of CPOE labels on specimen tubes contributing to process efficiency and safer patient care. Close communication with all care sites and their representatives on the OFI team are critical success factors.
Collapse
Affiliation(s)
- S Ong
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - S Pasaribu
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - S Tan
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - T Aw
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - J Huang
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - M Woo
- Information Technology, Sengkang General Hospital , Singapore , Singapore
| | - S Koh
- Nursing, Sengkang General Hospital , Singapore , Singapore
| | - K Khoo
- Nursing, Sengkang General Hospital , Singapore , Singapore
| |
Collapse
|
9
|
Yeom JS, Bernard H, Koh S. Gender differences in risk factors and psychosocial functioning in children with psychogenic nonepileptic seizures. Epilepsy Behav 2022; 136:108884. [PMID: 36195022 DOI: 10.1016/j.yebeh.2022.108884] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/12/2022] [Revised: 07/18/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Female predominance is evident in childhood-onset psychogenic nonepileptic seizures (PNES). Understanding gender-specific vulnerability to PNES may provide a unique insight into its cause and management. We aimed to investigate gender differences in demographic characteristics, triggering factors and psychosocial functioning in children and youth with PNES. METHODS We retrospectively reviewed patients who were evaluated in the PNES clinic at Children's Healthcare of Atlanta from July 2019 to March 2020 and completed questionnaires to assess adverse life events, psychosocial function (Pediatric Symptom Checklist-17 [PSC-17]), and somatic symptoms (Children's Somatic Symptom Inventory-8, [CSSI-8]). RESULTS Forty-nine consecutive patients (38 girls, 11 boys) with a median age of 15.0 (9-19) years were included in the study. We performed univariate analysis and evaluated significant variables related to PNES according to sex. Majority of both genders experienced daily to weekly PNES, came from dysfunctional families, scored high on PSC-17, were treated for neuropsychiatric illnesses, and experienced bothersome somatic symptoms. The variables significantly different between genders were suicidal thoughts, history of trauma, and learning disability. Suicidal thoughts and trauma, particularly sexual abuse, were significantly more prevalent in girls (p = 0.03) whereas learning disability was more common in boys (p = 0.03). CONCLUSION Females predominated in our PNES clinic (F:M = 3.5:1). Gender differences in predisposing factors were sexual abuse in females and learning disability in males. Our data highlight the gender-specific risk factors and vulnerability to PNES. The awareness of gender difference may guide more targeted intervention for children and youth with PNES.
Collapse
Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University Hospital, Jinju, South Korea; Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, South Korea; Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States
| | - Heather Bernard
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States; Children's Hospital & Medical Center, University of Nebraska, Omaha, NE, United States
| | - Sookyong Koh
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States; Children's Hospital & Medical Center, University of Nebraska, Omaha, NE, United States.
| |
Collapse
|
10
|
Chew NWS, Zhang A, Koh S, Ong JL, Kong G, Lim O, Kuntjoro I, Kong W, Low A, Lee CH, Chan MY, Yeo TC, Tan HC, Poh KK, Loh PH. Higher long-term mortality in patients with concomitant acute coronary syndrome and aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1417] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) and acute coronary syndrome (ACS) share similar cardiovascular risk factors, and their concomitant presentation is increasing in incidence with the aging population. Yet literature regarding the prognosis of patients with concomitant ACS and AS remains scarce.
Methods
This retrospective cohort study examined consecutive patients presenting with ACS (ST-segment elevation myocardial infarction [STEMI] and non-STEMI [NSTEMI]) and concomitant AS between 1 January 2011 and 31 March 2021 in a tertiary hospital. The cohort was divided into mild, moderate and severe AS based on index echocardiogram. The primary outcome was all-cause mortality. Kaplan-Meier curves were constructed to compare all-cause mortality among the three groups of patients, based on ACS type and left ventricular ejection fraction (LVEF). Multivariable Cox regression was performed to identify independent predictors of all-cause mortality.
Results
Of a total of 563 patients, 264 had mild (46.9%), 193 moderate (34.3%) and 106 severe AS (18.8%). The mean follow-up duration was 2.5 (± 2.4) years. Majority of patients (72.5%) presented with NSTEMI. Patients with moderate and severe AS had higher rates of all-cause mortality compared to those with mild AS (49.7% vs. 51.4% vs. 35.6% respectively, p=0.002). Concomitant moderate (HR 1.439, 95% CI 1.012–2.048, p=0.043) and severe AS (HR 1.844, 95% CI 1.159–2.933, p=0.010) were independent predictors of all-cause mortality after adjusting for age, gender, LVEF, ACS type, chronic kidney disease, diabetes, hypertension, coronary artery bypass grafting and aortic valve replacement as a time-dependent variable. The Kaplan-Meier curves demonstrated excess mortality in moderate and severe AS, compared to the mild AS group (p<0.001), with similar survival trends observed in the STEMI and the NSTEMI groups, as well as those with preserved LVEF.
Conclusion
Regardless of the ACS presentation type, long-term excess mortality in those with concomitant moderate or severe AS was observed. The adverse prognosis typically observed in patients with concomitant severe AS, in the setting of ACS, extends to patients with moderate AS.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - A Zhang
- National University Heart Centre , Singapore , Singapore
| | - S Koh
- National University Heart Centre , Singapore , Singapore
| | - J L Ong
- National University Heart Centre , Singapore , Singapore
| | - G Kong
- National University Heart Centre , Singapore , Singapore
| | - O Lim
- National University Heart Centre , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| |
Collapse
|
11
|
Erisken S, Nune G, Chung H, Kang JW, Koh S. Time and age dependent regulation of neuroinflammation in a rat model of mesial temporal lobe epilepsy: Correlation with human data. Front Cell Dev Biol 2022; 10:969364. [PMID: 36172274 PMCID: PMC9512631 DOI: 10.3389/fcell.2022.969364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Acute brain insults trigger diverse cellular and signaling responses and often precipitate epilepsy. The cellular, molecular and signaling events relevant to the emergence of the epileptic brain, however, remain poorly understood. These multiplex structural and functional alterations tend also to be opposing - some homeostatic and reparative while others disruptive; some associated with growth and proliferation while others, with cell death. To differentiate pathological from protective consequences, we compared seizure-induced changes in gene expression hours and days following kainic acid (KA)-induced status epilepticus (SE) in postnatal day (P) 30 and P15 rats by capitalizing on age-dependent differential physiologic responses to KA-SE; only mature rats, not immature rats, have been shown to develop spontaneous recurrent seizures after KA-SE. To correlate gene expression profiles in epileptic rats with epilepsy patients and demonstrate the clinical relevance of our findings, we performed gene analysis on four patient samples obtained from temporal lobectomy and compared to four control brains from NICHD Brain Bank. Pro-inflammatory gene expressions were at higher magnitudes and more sustained in P30. The inflammatory response was driven by the cytokines IL-1β, IL-6, and IL-18 in the acute period up to 72 h and by IL-18 in the subacute period through the 10-day time point. In addition, a panoply of other immune system genes was upregulated, including chemokines, glia markers and adhesion molecules. Genes associated with the mitogen activated protein kinase (MAPK) pathways comprised the largest functional group identified. Through the integration of multiple ontological databases, we analyzed genes belonging to 13 separate pathways linked to Classical MAPK ERK, as well as stress activated protein kinases (SAPKs) p38 and JNK. Interestingly, genes belonging to the Classical MAPK pathways were mostly transiently activated within the first 24 h, while genes in the SAPK pathways had divergent time courses of expression, showing sustained activation only in P30. Genes in P30 also had different regulatory functions than in P15: P30 animals showed marked increases in positive regulators of transcription, of signaling pathways as well as of MAPKKK cascades. Many of the same inflammation-related genes as in epileptic rats were significantly upregulated in human hippocampus, higher than in lateral temporal neocortex. They included glia-associated genes, cytokines, chemokines and adhesion molecules and MAPK pathway genes. Uniquely expressed in human hippocampus were adaptive immune system genes including immune receptors CDs and MHC II HLAs. In the brain, many immune molecules have additional roles in synaptic plasticity and the promotion of neurite outgrowth. We propose that persistent changes in inflammatory gene expression after SE leads not only to structural damage but also to aberrant synaptogenesis that may lead to epileptogenesis. Furthermore, the sustained pattern of inflammatory genes upregulated in the epileptic mature brain was distinct from that of the immature brain that show transient changes and are resistant to cell death and neuropathologic changes. Our data suggest that the epileptogenic process may be a result of failed cellular signaling mechanisms, where insults overwhelm the system beyond a homeostatic threshold.
Collapse
Affiliation(s)
- Sinem Erisken
- Department of Pediatrics, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University School of Medicine, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - George Nune
- Department of Pediatrics, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University School of Medicine, Chicago, IL, United States
- Department of Neurology, University of Southern California, Los Angeles, CA, United States
| | - Hyokwon Chung
- Department of Pediatrics, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University School of Medicine, Chicago, IL, United States
- Department of Pediatrics, Children’s Hospital & Medical Center, University of Nebraska, Omaha, NE, United States
| | - Joon Won Kang
- Department of Pediatrics, Children’s Hospital & Medical Center, University of Nebraska, Omaha, NE, United States
- Department of Pediatrics & Medical Science, Brain Research Institute, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Sookyong Koh
- Department of Pediatrics, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University School of Medicine, Chicago, IL, United States
- Department of Pediatrics, Children’s Hospital & Medical Center, University of Nebraska, Omaha, NE, United States
- *Correspondence: Sookyong Koh,
| |
Collapse
|
12
|
Lee K, Lee J, Choi J, Sim S, Kim J, Kim M, Park Y, Kim J, Koh S, Park K, Kang M, Ahn M, Lee KE, Kim H, Ahn H, Kim H, Park K, Park I. 241P Genomic analysis of plasma cell-free DNA in patients with heavily pretreated HER-2+ metastatic breast cancer (MBC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.280] [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: 11/26/2022] Open
|
13
|
Wickstrom R, Taraschenko O, Dilena R, Payne ET, Specchio N, Nabbout R, Koh S, Gaspard N, Hirsch LJ. International consensus recommendations for management of New Onset Refractory Status Epilepticus (NORSE) incl. Febrile Infection-Related Epilepsy Syndrome (FIRES): Statements and Supporting Evidence. Epilepsia 2022; 63:2840-2864. [PMID: 35997591 PMCID: PMC9828002 DOI: 10.1111/epi.17397] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/14/2022] [Accepted: 08/18/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To develop consensus-based recommendations for the management of adult and paediatric patients with NORSE/FIRES based on best evidence and experience. METHODS The Delphi methodology was followed. A facilitator group of 9 experts was established, who defined the scope, users and suggestions for recommendations. Following a review of the current literature, recommendation statements concerning diagnosis, treatment and research directions were generated which were then voted on a scale of 1 (strongly disagree) to 9 (strongly agree) by a panel of 48 experts in the field. Consensus that a statement was appropriate was reached if the median score was greater or equal to 7, and inappropriate if the median score was less than or equal to 3. The analysis of evidence was mapped to the results of each statement included in the Delphi survey. RESULTS Overall, 85 recommendation statements achieved consensus. The recommendations are divided into five sections: 1) disease characteristics, 2) diagnostic testing and sampling, 3) acute treatment, 4) treatment in the post-acute phase, and 5) research, registries and future directions in NORSE/FIRES. The detailed results and discussion of all 85 statements are outlined herein. A corresponding summary of findings and practical flowsheets are presented in a companion article. SIGNIFICANCE This detailed analysis offers insight into the supporting evidence and the current gaps in the literature that are associated with expert consensus statements related to NORSE/FIRES. The recommendations generated by this consensus can be used as a guide for the diagnosis, evaluation, and management of patients with NORSE/FIRES, and for planning of future research.
Collapse
Affiliation(s)
- Ronny Wickstrom
- Neuropaediatric UnitDepartment of Women's and Children's HealthKarolinska Institutet and Karolinska University HospitalStockholmSweden
| | - Olga Taraschenko
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Robertino Dilena
- Neuropathophysiology UnitFoundation IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Eric T. Payne
- Department of Pediatrics, Section of NeurologyAlberta Children's HospitalCalgaryAlbertaCanada
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of NeurosciencesBambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARERomeItaly
| | - Rima Nabbout
- Department of Pediatric Neurology, APHP, Member of EPICARE ERN, Centre de Reference Epilepsies RaresUniversite de Paris, Institut Imagine, INSERM 1163ParisFrance
| | - Sookyong Koh
- Department of Pediatrics, Children's Hospital and Medical CenterUniversity of NebraskaOmahaNebraskaUSA
| | | | - Lawrence J. Hirsch
- Department of Neurology, Comprehensive Epilepsy CenterYale UniversityNew HavenConnecticutUSA
| | | |
Collapse
|
14
|
Wickström R, Taraschenko O, Dilena R, Payne ET, Specchio N, Nabbout R, Koh S, Gaspard N, Hirsch LJ. International consensus recommendations for management of New Onset Refractory Status Epilepticus (NORSE) including Febrile Infection-Related Epilepsy Syndrome (FIRES): Summary and Clinical Tools. Epilepsia 2022; 63:2827-2839. [PMID: 35951466 PMCID: PMC9826478 DOI: 10.1111/epi.17391] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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: 04/28/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To develop consensus-based recommendations for the management of adult and pediatric patients with NORSE/FIRES based on best available evidence and expert opinion. METHODS The Delphi methodology was followed. A facilitator group of 9 experts was established, who defined the scope, users and suggestions for recommendations. Following a review of the current literature, recommendation statements concerning diagnosis, treatment and research directions were generated which were then voted on a scale of 1 (strongly disagree) to 9 (strongly agree) by a panel of 48 experts in the field. Consensus that a statement was appropriate was reached if the median score was greater than or equal to 7, and inappropriate if the median score was less than or equal to 3. RESULTS Overall, 85 recommendation statements achieved consensus. The recommendations are divided into five sections: 1) disease characteristics, 2) diagnostic testing and sampling, 3) acute treatment, 4) treatment in the post-acute phase, and 5) research, registries and future directions in NORSE/FIRES. These are summarized in this article along with two practical clinical flowsheets: one for diagnosis and evaluation and one for acute treatment. A corresponding evidence-based analysis of all 85 recommendations alongside responses by the Delphi panel is presented in a companion article. SIGNIFICANCE The recommendations generated by this consensus can be used as a guide for the diagnosis, evaluation, and management of patients with NORSE/FIRES, and for planning of future research.
Collapse
Affiliation(s)
- Ronny Wickström
- Neuropaediatric Unit, Department of Women's and Children's HealthKarolinska Institutet and Karolinska University HospitalStockholmSweden
| | - Olga Taraschenko
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Robertino Dilena
- Neuropathophysiology UnitFoundation IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Eric T. Payne
- Department of Pediatrics, Section of NeurologyAlberta Children's HospitalCalgaryAlbertaCanada
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of NeurosciencesBambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARERomeItaly
| | - Rima Nabbout
- Department of Pediatric Neurology, APHP, Member of EPICARE ERN, Centre de Reference Epilepsies RaresUniversite de Paris, Institut Imagine, INSERM 1163ParisFrance
| | - Sookyong Koh
- Department of Pediatrics, Children's Hospital and Medical CenterUniversity of NebraskaOmahaNebraskaUSA
| | - Nicolas Gaspard
- Hôpital Erasme, Université Libre de BruxellesBrusselsBelgium
| | - Lawrence J. Hirsch
- Department of Neurology, Comprehensive Epilepsy CenterYale UniversityNew HavenConnecticutUSA
| | | |
Collapse
|
15
|
Pavuluri S, Gumenyuk V, Koh S, Salehi A, Cathcart S, Taraschenko O. Child Neurology: Presurgical Evaluation of Dominant Hemisphere Function in a Child With Rasmussen Encephalitis Using Magnetoencephalography. Neurology 2022; 99:614-617. [PMID: 35918155 DOI: 10.1212/wnl.0000000000201085] [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: 03/14/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
Rasmussen's encephalitis (RE) is a devastating progressive inflammatory disorder that leads to debilitating neurological deficits and intractable epilepsy. Surgical treatment of the dominant hemisphere has been attempted with hesitation given the lack of effective diagnostic tools to determine the potential functional deficits from disconnection procedures.We present the case of a 15-year-old male with RE, right hemiparesis, profound aphasia, and recurrent status epilepticus, who underwent language assessment using magnetoencephalography (MEG) prior to urgent hemispherectomy for epilepsia partialis continua. Cortical responses in the passive auditory task were localized to the left and right hemispheres at latencies of 200 and 380 ms, respectively from the stimulation onset. The current density reconstruction analysis showed the sources at 380 and 200 ms in the right and left temporal-parietal junctions, respectively. These findings confirmed that the patient's language was represented bilaterally. Other tests conventionally used to assess cortical language function were not attempted given his poor functional status and ongoing seizures. The left functional hemispherectomy has resulted in seizure freedom and significantly improved language function.The MEG-based evaluation of the language function could provide valuable information regarding cortical language organization prior to hemispherectomy in patients with RE. Such approach of mapping the eloquent cortical functions can be used in other structural and autoinflammatory disorders of the brain, especially in patients who cannot participate in the conventional diagnostic modalities designed to assess critical brain functions like language and memory.
Collapse
Affiliation(s)
- Spriha Pavuluri
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE
| | - Valentina Gumenyuk
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE
| | - Sookyong Koh
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE
| | - Afshin Salehi
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha Children's & Medical Center, NE
| | - Sahara Cathcart
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
16
|
Koh S, Chung S, Yum Y, Joo H, Kim Y, Kim E. Comparison of cardiovascular prognosis between triglyceride variability and exposure estimate in diabetic patients. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
17
|
Kim S, Degrauw T, Berg AT, Koh S. Staring Spells: How to Distinguish Epileptic Seizures from Nonepileptic Staring. J Child Neurol 2022; 37:738-743. [PMID: 35746887 DOI: 10.1177/08830738221103090] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the nature of staring spells and factors distinguishing epileptic from nonepileptic staring spells, we studied the clinical and demographic features of children with staring spells referred to a regional new-onset seizure clinic. STUDY DESIGN Our retrospective chart review encompassed 2818 consecutive patients evaluated in the new-onset seizure clinic between September 22, 2015, and March 19, 2018. We identified 121 patients with newly presenting staring spells. RESULTS Sixty-two of 121 (51%) children were diagnosed with nonepileptic staring spells and 59 (49%) with epileptic seizures (24 with absence epilepsy, 35 with focal epilepsy). Patients with nonepileptic staring spells were younger (4.8 vs 7.1 years, P = .001) and more likely to have developmental delay (P = .005) than the seizure group. There was an 8.9-month delay on average from the onset of staring spells to the new-onset seizure clinic visit. The emergency department was a referral source for 80% (28/35) of focal seizures. In children with focal seizures, the staring spells typically lasted >1minute (29/35, 83%), whereas only 19 of 62 (31%) of children with nonepileptic staring spells had events lasting this long (P = .04). All children had a routine electroencephalography (EEG) on the day of new-onset seizure clinic visit. EEG was diagnostic in 100% (24/24) of absence seizures and 51% (18/35) of focal seizures. CONCLUSIONS In children presenting with staring spells, the differential diagnosis of epileptic staring spells vs nonepileptic staring spells can be made by history and routine EEG. Staring was as likely to be epileptic as nonepileptic spells. Younger children with developmental delay were more likely to have nonepileptic events. Our simple approach based on event duration, postictal symptoms, and EEG allowed identification of epileptic staring on first visit to new-onset seizure clinic but requires validation in future prospective studies including long-term video EEG monitoring and follow-up.
Collapse
Affiliation(s)
- Seunghyo Kim
- Department of Pediatrics, 138610Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, 37984Jeju National University School of Medicine, Jeju-si, Jeju, South Korea
| | - Ton Degrauw
- Department of Pediatrics, 138610Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Anne T Berg
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Sookyong Koh
- Department of Pediatrics, 138610Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, 12284University of Nebraska Medical Center and Children's Hospital & Medical Center, Omaha, NE, USA
| |
Collapse
|
18
|
Hood V, Berg AT, Knupp KG, Koh S, Laux L, Meskis MA, Zulfiqar‐Ali Q, Perry MS, Scheffer IE, Sullivan J, Wirrell E, Andrade DM. COVID-19 vaccine in patients with Dravet syndrome: Observations and real-world experiences. Epilepsia 2022; 63:1778-1786. [PMID: 35383912 PMCID: PMC9111612 DOI: 10.1111/epi.17250] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Vaccination against the SARS-CoV-2 virus is a primary tool to combat the COVID-19 pandemic. However, vaccination is a common seizure trigger in individuals with Dravet syndrome (DS). Information surrounding COVID-19 vaccine side effects in patients with DS would aid caregivers and providers in decisions for and management of COVID-19 vaccination. METHODS A survey was emailed to the Dravet Syndrome Foundation's Family Network and posted to the Dravet Parent & Caregiver Support Group on Facebook between May and August 2021. Deidentified information obtained included demographics and vaccination status for individuals with DS. Vaccine type, side effects, preventative measures, and changes in seizure activity following COVID-19 vaccination were recorded. For unvaccinated individuals, caregivers were asked about intent to vaccinate and reasons for their decision. RESULTS Of 278 survey responses, 120 represented vaccinated individuals with DS (median age = 19.5 years), with 50% reporting no side effects from COVID-19 vaccination. Increased seizures following COVID-19 vaccination were reported in 16 individuals, but none had status epilepticus. Of the 158 individuals who had not received a COVID-19 vaccination, 37 were older than 12 years (i.e., eligible at time of study), and only six of these caregivers indicated intent to seek vaccination. The remaining 121 responses were caregivers to children younger than 12 years, 60 of whom indicated they would not seek COVID-19 vaccination when their child with DS became eligible. Reasons for vaccine hesitancy were fear of increased seizure activity and concerns about vaccine safety. SIGNIFICANCE These results indicate COVID-19 vaccination is well tolerated by individuals with DS. One main reason for vaccine hesitancy was fear of increased seizure activity, which occurred in only 13% of vaccinated individuals, and none had status epilepticus. This study provides critical and reassuring insights for caregivers and health care providers making decisions about the safety of COVID-19 vaccinations for individuals with DS.
Collapse
Affiliation(s)
| | - Anne T. Berg
- Department of NeurologyNorthwestern Feinberg School of MedicineChicagoIllinoisUSA
| | - Kelly G. Knupp
- Department of Pediatrics and NeurologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Sookyong Koh
- Department of Pediatric Neurology at University of Nebraska Medical CenterOmahaNebraskaUSA
| | - Linda Laux
- Epilepsy CenterDepartment of PediatricsAnn & Robert H. Lurie Children’s HospitalChicagoIllinoisUSA
| | | | - Quratulain Zulfiqar‐Ali
- Adult Epilepsy Genetics ProgramKrembil Brain InstituteToronto Western HospitalTorontoOntarioCanada
| | - M. Scott Perry
- Jane and John Justin Neurosciences CenterCook Children’s Medical CenterFort WorthTexasUSA
| | - Ingrid E. Scheffer
- Epilepsy Research CentreUniversity of MelbourneAustin Health; Royal Children’s Hospital, Florey Institute; Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
| | - Joseph Sullivan
- Departments of Neurology and PediatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Elaine Wirrell
- Child and Adolescent NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Danielle M. Andrade
- Dravet Syndrome FoundationCherry HillNew JerseyUSA
- Division of NeurologyKrembil Brain InstituteToronto Western HospitalUniversity of TorontoTorontoOntarioCanada
- Adult Genetic Epilepsy ProgramUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
19
|
Camp CR, Shapiro L, Vlachos A, Perszyk RE, Shariatzadeh N, White J, Sanchez R, Koh S, Escayg A, McBain C, Pelkey K, Traynelis SF. The GluN2A Subunit of the NMDA Receptor Modulates the Rate of Functional Maturation in Parvalbumin‐positive Interneurons. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r6059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chad R. Camp
- Pharmacology and Chemical BiologyEmory UniversityAtlantaGA
| | | | - Anna Vlachos
- Section on Cellular and Synaptic PhysiologyNational Institutes of HealthBethesdaMD
| | | | | | | | | | - Sookyong Koh
- PediatricsUniversity of Nebraska Medical CenterOmahaNE
| | | | - Christopher McBain
- Section on Cellular and Synaptic PhysiologyNational Institutes of HealthBethesdaMD
| | - Kenneth Pelkey
- Section on Cellular and Synaptic PhysiologyNational Institutes of HealthBethesdaMD
| | | |
Collapse
|
20
|
Leal-Pardinas F, Truty R, McKnight DA, Johnson B, Morales A, Bristow SL, Pang TY, Cohen-Pfeffer J, Izzo E, Sankar R, Koh S, Wirrell EC, Millichap JJ, Aradhya S. Value of genetic testing for pediatric epilepsy: Driving earlier diagnosis of CLN2 Batten disease. Epilepsia 2022; 63:e68-e73. [PMID: 35474188 PMCID: PMC9545603 DOI: 10.1111/epi.17269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
This study assessed the effectiveness of genetic testing in shortening the time to diagnosis of late infantile neuronal ceroid lipofuscinosis type 2 (CLN2) disease. Individuals who received epilepsy gene panel testing through Behind the Seizure®, a sponsored genetic testing program (Cohort A), were compared to children outside of the sponsored testing program during the same period (Cohort B). Two cohorts were analyzed: children aged ≥24 to ≤60 months with unprovoked seizure onset at ≥24 months between December 2016 and January 2020 (Cohort 1) and children aged 0 to ≤60 months at time of testing with unprovoked seizure onset at any age between February 2019 and January 2020 (Cohort 2). The diagnostic yield in Cohort 1A (n = 1814) was 8.4% (n = 153). The TPP1 diagnostic yield within Cohort 1A was 2.9‐fold higher compared to Cohort 1B (1.0%, n = 18/1814 vs. .35%, n = 8/2303; p = .0157). The average time from first symptom to CLN2 disease diagnosis was significantly shorter than previously reported (9.8 vs. 22.7 months, p < .001). These findings indicate that facilitated access to early epilepsy gene panel testing helps to increase diagnostic yield for CLN2 disease and shortens the time to diagnosis, enabling earlier intervention.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sookyong Koh
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - John J Millichap
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | |
Collapse
|
21
|
Knupp KG, Coryell J, Singh RK, Gaillard WD, Shellhaas RA, Koh S, Mitchell WG, Harini C, Millichap JJ, May A, Dlugos D, Nickels K, Mytinger JR, Keator C, Yozawitz E, Singhal N, Lockrow J, Thomas JF, Juarez-Colunga E. Comparison of Cosyntropin, Vigabatrin, and Combination Therapy in New-Onset Infantile Spasms in a Prospective Randomized Trial. J Child Neurol 2022; 37:186-193. [PMID: 35044272 DOI: 10.1177/08830738211073400] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: In a randomized trial, we aimed to evaluate the efficacy of cosyntropin injectable suspension, 1 mg/mL, compared to vigabatrin for infantile spasms syndrome. An additional arm was included to assess the efficacy of combination therapy (cosyntropin and vigabatrin) compared with cosyntropin monotherapy. Methods: Children (2 months to 2 years) with new-onset infantile spasms syndrome and hypsarhythmia were randomized into 3 arms: cosyntropin, vigabatrin, and cosyntropin and vigabatrin combined. Daily seizures and adverse events were recorded, and EEG was repeated at day 14 to assess for resolution of hypsarhythmia. The primary outcome measure was the composite of resolution of hypsarhythmia and absence of clinical spasms at day 14. Fisher exact test was used to compare outcomes. Results: 37 children were enrolled and 34 were included in the final efficacy analysis (1 withdrew prior to treatment and 2 did not return seizure diaries). Resolution of both hypsarhythmia and clinical spasms was achieved in in 9 of 12 participants (75%) treated with cosyntropin, 1/9 (11%) vigabatrin, and 5/13 (38%) cosyntropin and vigabatrin combined. The primary comparison of cosyntropin versus vigabatrin was significant (64% [95% confidence interval 21, 82], P < .01). Adverse events were reported in all 3 treatment arms: 31 (86%) had an adverse event, 7 (19%) had a serious adverse event, and 15 (42%) had an adverse event of special interest with no difference between treatment arms. Significance: This randomized trial was underpowered because of incomplete enrollment, yet it demonstrated that cosyntropin was more effective for short-term outcomes than vigabatrin as initial treatment for infantile spasms.
Collapse
Affiliation(s)
- Kelly G Knupp
- Pediatrics and Neurology, 12225University of Colorado, Anschutz Campus, Aurora, CO, USA
| | - Jason Coryell
- Department of Pediatrics and Neurology, 89020Oregon Health and Sciences University, Portland, Oregon, USA
| | - Rani K Singh
- Department of Pediatrics, Division of Pediatric Neurology, Atrium Health/Levine Children's Hospital, Charlotte, NC, USA
| | - William D Gaillard
- Department of Pediatrics and Neurology, George Washington University, Washington, DC, USA
| | - Renée A Shellhaas
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sookyong Koh
- Department of Pediatrics, Children's Hospital, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Wendy G Mitchell
- Neurology Division, Keck School of Medicine, 8785University of Southern California and Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - John J Millichap
- Department of Pediatrics and Neurology, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Alison May
- Department of Neurology, Morgan Stanley Children's Hospital, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Dennis Dlugos
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Cynthia Keator
- Jane and John Justin Neurosciences, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, Department of Pediatrics, 550033Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Nilika Singhal
- Department of Neurology, Division of Epilepsy, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Jason Lockrow
- Division of Pediatric Neurology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jacob F Thomas
- School of Medicine, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
22
|
Dukkipati SS, Zhou DJ, Powers AM, Piccione EA, Koh S. Acute Bulbar Palsy-Plus Variant of Guillain-Barré Syndrome in a 3-Year-Old Girl. Child Neurol Open 2022; 9:2329048X221115476. [PMID: 35936111 PMCID: PMC9350509 DOI: 10.1177/2329048x221115476] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 3-year-old girl who rapidly developed bilateral facial
palsy, dysphagia, dysphonia, areflexia, and ataxia soon after receiving an
influenza vaccine. Brain and spine Magnetic resonance imaging (MRI) scans with
and without contrast showed enhancement of cranial nerves III, V, VII, and X, as
well as the anterior and posterior cervical spinal and cauda equina roots.
cerebrospinal fluid (CSF) studies showed white blood cell count of 19
cells/cm2, glucose 81 mg/dL, and protein 116 mg/dL, with negative
infectious and autoimmune labs. Serum IgM and IgG antibodies against GM1, GD1a,
GD1b, GM2, GT1A, GQ1b were negative. The patient was treated with intravenous
immunoglobulin, which led to a full recovery. Upon three-month follow-up, her
neurologic examination demonstrated normal cranial nerves, reflexes, and gait.
Her presentation was most consistent with the acute bulbar palsy plus (ABPp)
variant of Guillain-Barré syndrome (GBS), a rare and challenging diagnosis
especially in her age group.
Collapse
Affiliation(s)
- Saihari S. Dukkipati
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel J. Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andria M. Powers
- Department of Radiology, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Ezequiel A. Piccione
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sookyong Koh
- Division of Neurology, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE, USA
| |
Collapse
|
23
|
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has affected millions of people worldwide and is caused by infection from the severe acute respiratory syndrome coronavirus-2 pathogen. While COVID-19 most commonly affects the respiratory system, multiple neurological complications have been associated with this pathogen. We report a case of Wernicke encephalopathy in a young girl with poor oral intake secondary to anosmia and dysgeusia after a COVID-19 infection. CASE REPORT After a recent infection of COVID-19, a 15-year-old girl developed an overwhelming noxious metallic tase resulting in a 30 lb weight loss from being unable to tolerate oral foods. She presented to the hospital 3 months later with bilateral horizontal conjugate gaze palsies, up beating vertical nystagmus, difficulty with limb coordination and gait ataxia. She was found to have a thiamine level of 51 nmol/L (reference range: 70 to 180 nmol/L) and her brain magnetic resonance imaging showed fluid-attenuated inversion recovery and diffusion-weighted imaging changes in the periaqueductal gray and dorsomedial thalami suggestive of Wernicke encephalopathy. She was started on parenteral thiamine replacement and had significant neurological improvement. CONCLUSIONS As this pandemic continues to progress, more long-term neurological sequelae from COVID-19 such as Wernicke encephalopathy can be expected. Strong clinical suspicion for these complications is needed to allow for earlier diagnosis and faster treatment initiation.
Collapse
Affiliation(s)
- David Ross Landzberg
- Department of Neurology, Emory University School of Medicine/Grady Memorial Hospital
| | - Ekta Bery
- the Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Suhasini Chico
- the Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Sookyong Koh
- the Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Barbara Weissman
- the Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
24
|
Andrade DM, Berg AT, Hood V, Knupp KG, Koh S, Laux L, Meskis MA, Miller I, Perry MS, Scheffer IE, Sullivan J, Villas N, Wirrell E. Dravet syndrome: A quick transition guide for the adult neurologist. Epilepsy Res 2021; 177:106743. [PMID: 34624600 DOI: 10.1016/j.eplepsyres.2021.106743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/30/2021] [Revised: 08/02/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Dravet syndrome (DS) is still seen as a "pediatric disease", where patients receive excellent care in pediatric centers, but care is less than optimal in adult health care systems (HCS). This creates a barrier when young adults need to leave the family-centered pediatric system and enter the adult, patient-centered HCS. Here we create a guide to help with the transition from pediatric to adult for patients with DS. METHODS Experts in Dravet syndrome flagged the main barriers in caring for adults with DS and created a 2-page transition summary guide based on their expertise and a literature review. RESULTS The 2-page guide addresses: DS diagnosis in children and adults; clinical manifestations, including the differences in seizures types and frequencies between children and adults with DS; the natural history of intellectual disability, behavior, gait, motor disorders and dysautonomia; a review of optimal treatments (including medications not commonly used in adult epilepsy settings such as stiripentol and fenfluramine), as well as emergency seizure management; avoidance of triggers, preventive measures, and vaccine administration in adults with DS. CONCLUSION Several young adults with DS are still followed by their child neurologist. This 2-page transition guide should help facilitate the transition of patients with DS to the adult HCS and should be given to families as well as adult health care providers that may not be familiar with DS.
Collapse
Affiliation(s)
- Danielle M Andrade
- Adult Epilepsy Genetics Program, Division of Neurology, Krembil Brain Institute, Toronto Western Hospital, University of Toronto, Toronto, Canada.
| | - Anne T Berg
- Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Pediatrics and Neurological Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | | | - Kelly G Knupp
- Department of Pediatrics and Neurology, University of Colorado Anschutz Campus, Aurora, CO, USA
| | - Sookyong Koh
- Department of Pediatric Neurology at University of Nebraska Medical Center, Omaha, NE, USA
| | - Linda Laux
- Epilepsy Center, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | - Ian Miller
- Department of Neurology, Nicklaus Children's Hospital, Miami, FL, USA
| | - M Scott Perry
- Jane and John Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Ingrid E Scheffer
- Epilepsy Research Centre, The University of Melbourne, Austin Health, Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Joseph Sullivan
- Department of Neurology & Pediatrics, University of California, San Francisco, CA, USA
| | | | - Elaine Wirrell
- Child and Adolescent Neurology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
25
|
Abstract
Psychogenic nonepileptic seizures (PNES) is a neuropsychiatric condition that causes a transient alteration of consciousness and loss of self-control. PNES, which occur in vulnerable individuals who often have experienced trauma and are precipitated by overwhelming circumstances, are a body's expression of a distressed mind, a cry for help. PNES are misunderstood, mistreated, under-recognized, and underdiagnosed. The mindbody dichotomy, an artificial divide between physical and mental health and brain disorders into neurology and psychiatry, contributes to undue delays in the diagnosis and treatment of PNES. One of the major barriers in the effective diagnosis and treatment of PNES is the dissonance caused by different illness perceptions between patients and providers. While patients are bewildered by their experiences of disabling attacks beyond their control or comprehension, providers consider PNES trivial because they are not epileptic seizures and are caused by psychological stress. The belief that patients with PNES are feigning or controlling their symptoms leads to negative attitudes of healthcare providers, which in turn lead to a failure to provide the support and respect that patients with PNES so desperately need and deserve. A biopsychosocial perspective and better understanding of the neurobiology of PNES may help bridge this great divide between brain and behavior and improve our interaction with patients, thereby improving prognosis. Knowledge of dysregulated stress hormones, autonomic nervous system dysfunction, and altered brain connectivity in PNES will better prepare providers to communicate with patients how intangible emotional stressors could cause tangible involuntary movements and altered awareness.
Collapse
Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.,Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Heather Bernard
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| |
Collapse
|
26
|
Sanchez Russo R, Gambello MJ, Murphy MM, Aberizk K, Black E, Burrell TL, Carlock G, Cubells JF, Epstein MT, Espana R, Goines K, Guest RM, Klaiman C, Koh S, Leslie EJ, Li L, Novacek DM, Saulnier CA, Sefik E, Shultz S, Walker E, White SP, Mulle JG. Deep phenotyping in 3q29 deletion syndrome: recommendations for clinical care. Genet Med 2021; 23:872-880. [PMID: 33564151 PMCID: PMC8105170 DOI: 10.1038/s41436-020-01053-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 09/27/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To understand the consequences of the 3q29 deletion on medical, neurodevelopmental, psychiatric, brain structural, and neurological sequalae by systematic evaluation of affected individuals. To develop evidence-based recommendations using these data for effective clinical care. METHODS Thirty-two individuals with the 3q29 deletion were evaluated using a defined phenotyping protocol and standardized data collection instruments. RESULTS Medical manifestations were varied and reported across nearly every organ system. The most severe manifestations were congenital heart defects (25%) and the most common were gastrointestinal symptoms (81%). Physical examination revealed a high proportion of musculoskeletal findings (81%). Neurodevelopmental phenotypes represent a significant burden and include intellectual disability (34%), autism spectrum disorder (38%), executive function deficits (46%), and graphomotor weakness (78%). Psychiatric illness manifests across the lifespan with psychosis prodrome (15%), psychosis (20%), anxiety disorders (40%), and attention deficit-hyperactivity disorder (ADHD) (63%). Neuroimaging revealed structural anomalies of the posterior fossa, but on neurological exam study subjects displayed only mild or moderate motor vulnerabilities. CONCLUSION By direct evaluation of 3q29 deletion study subjects, we document common features of the syndrome, including a high burden of neurodevelopmental and neuropsychiatric phenotypes. Evidence-based recommendations for evaluation, referral, and management are provided to help guide clinicians in the care of 3q29 deletion patients.
Collapse
Affiliation(s)
| | - Michael J Gambello
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Melissa M Murphy
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Katrina Aberizk
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Emily Black
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - T Lindsey Burrell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Grace Carlock
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph F Cubells
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael T Epstein
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Roberto Espana
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Katrina Goines
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Ryan M Guest
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Cheryl Klaiman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth J Leslie
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Longchuan Li
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Derek M Novacek
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Desert Pacific Mental Illness, Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Celine A Saulnier
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Neurodevelopmental Assessment & Consulting Services, Atlanta, GA, USA
| | - Esra Sefik
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Sarah Shultz
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Elaine Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Stormi Pulver White
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer Gladys Mulle
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| |
Collapse
|
27
|
Park H, Jo U, Kim Y, Kim K, Yu S, Yoon H, Kwon S, Park J, Kim M, Lee J, Koh S. 686 A psoriasis mouse model with persistent skin lesions and comorbidities. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.716] [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: 11/25/2022]
|
28
|
Koh S, Wirrell E, Vezzani A, Nabbout R, Muscal E, Kaliakatsos M, Wickström R, Riviello JJ, Brunklaus A, Payne E, Valentin A, Wells E, Carpenter JL, Lee K, Lai Y, Eschbach K, Press CA, Gorman M, Stredny CM, Roche W, Mangum T. Proposal to optimize evaluation and treatment of Febrile infection-related epilepsy syndrome (FIRES): A Report from FIRES workshop. Epilepsia Open 2021; 6:62-72. [PMID: 33681649 PMCID: PMC7918329 DOI: 10.1002/epi4.12447] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 05/09/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/23/2022] Open
Abstract
Febrile infection-related epilepsy syndrome (FIRES) is a rare catastrophic epileptic encephalopathy that presents suddenly in otherwise normal children and young adults causing significant neurological disability, chronic epilepsy, and high rates of mortality. To suggest a therapy protocol to improve outcome of FIRES, workshops were held in conjunction with American Epilepsy Society annual meeting between 2017 and 2019. An international group of pediatric epileptologists, pediatric neurointensivists, rheumatologists and basic scientists with interest and expertise in FIRES convened to propose an algorithm for a standardized approach to the diagnosis and treatment of FIRES. The broad differential for refractory status epilepticus (RSE) should include FIRES, to allow empiric therapies to be started early in the clinical course. FIRES should be considered in all previously healthy patients older than two years of age who present with explosive onset of seizures rapidly progressing to RSE, following a febrile illness in the preceding two weeks. Once FIRES is suspected, early administrations of ketogenic diet and anakinra (the IL-1 receptor antagonist that blocks biologic activity of IL-1β) are recommended.
Collapse
Affiliation(s)
- Sookyong Koh
- Department of PediatricsEmory University School of MedicineAtlantaGAUSA
| | - Elaine Wirrell
- Child and Adolescent Neurology and EpilepsyMayo ClinicRochesterMNUSA
| | - Annamaria Vezzani
- Department of NeuroscienceInstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Rima Nabbout
- Reference Centre for Rare EpilepsiesDepartment of Pediatric NeurologyNecker Enfants Malades Hospital, APHPImagine InstituteParis Descartes UniversityParisFrance
| | - Eyal Muscal
- Department of PediatricsSection of Pediatric, RheumatologyBaylor College of MedicineHoustonTXUSA
| | - Marios Kaliakatsos
- Department of NeurologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - Ronny Wickström
- Neuropediatric UnitDepartment of Women's and Children's HealthKarolinska InstituteStockholmSweden
| | | | - Andreas Brunklaus
- Paediatric Neurosciences Research GroupRoyal Hospital for ChildrenGlasgowUK
| | - Eric Payne
- Child and Adolescent Neurology and EpilepsyMayo ClinicRochesterMNUSA
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, Psychology and NeuroscienceDepartment of Clinical NeurophysiologyKing's College Hospital NHS TrustLondonUK
| | - Elizabeth Wells
- Center for Neuroscience and Behavioral MedicineChildren’s National Health SystemWashingtonDCUSA
| | - Jessica L. Carpenter
- Center for Neuroscience and Behavioral MedicineChildren’s National Health SystemWashingtonDCUSA
| | - Kihyeong Lee
- Comprehensive Epilepsy CenterAdvent Health for ChildrenOrlandoFLUSA
| | - Yi‐Chen Lai
- Jan and Dan Duncan Neurological Research InstituteBaylor College of MedicineHoustonTXUSA
| | - Krista Eschbach
- Department of PediatricsSection of NeurologyUniversity of Colorado DenverDenverCOUSA
| | - Craig A. Press
- Department of PediatricsSection of NeurologyUniversity of Colorado DenverDenverCOUSA
| | - Mark Gorman
- Department of NeurologyBoston Children’s HospitalBostonMAUSA
| | | | - William Roche
- Department of PediatricsEmory University School of MedicineAtlantaGAUSA
| | - Tara Mangum
- Department of PediatricsPhoenix Children’s HospitalPhoenixAZUSA
| |
Collapse
|
29
|
Grinspan ZM, Patel AD, Shellhaas RA, Berg AT, Axeen ET, Bolton J, Clarke DF, Coryell J, Gaillard WD, Goodkin HP, Koh S, Kukla A, Mbwana JS, Morgan LA, Singhal NS, Storey MM, Yozawitz EG, Abend NS, Fitzgerald MP, Fridinger SE, Helbig I, Massey SL, Prelack MS, Buchhalter J. Design and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system. Epilepsia 2021; 62:198-216. [PMID: 33368200 PMCID: PMC10508354 DOI: 10.1111/epi.16733] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 08/22/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Common data elements (CDEs) are standardized questions and answer choices that allow aggregation, analysis, and comparison of observations from multiple sources. Clinical CDEs are foundational for learning health care systems, a data-driven approach to health care focused on continuous improvement of outcomes. We aimed to create clinical CDEs for pediatric epilepsy. METHODS A multiple stakeholder group (clinicians, researchers, parents, caregivers, advocates, and electronic health record [EHR] vendors) developed clinical CDEs for routine care of children with epilepsy. Initial drafts drew from clinical epilepsy note templates, CDEs created for clinical research, items in existing registries, consensus documents and guidelines, quality metrics, and outcomes needed for demonstration projects. The CDEs were refined through discussion and field testing. We describe the development process, rationale for CDE selection, findings from piloting, and the CDEs themselves. We also describe early implementation, including experience with EHR systems and compatibility with the International League Against Epilepsy classification of seizure types. RESULTS Common data elements were drafted in August 2017 and finalized in January 2020. Prioritized outcomes included seizure control, seizure freedom, American Academy of Neurology quality measures, presence of common comorbidities, and quality of life. The CDEs were piloted at 224 visits at 10 centers. The final CDEs included 36 questions in nine sections (number of questions): diagnosis (1), seizure frequency (9), quality of life (2), epilepsy history (6), etiology (8), comorbidities (2), treatment (2), process measures (5), and longitudinal history notes (1). Seizures are categorized as generalized tonic-clonic (regardless of onset), motor, nonmotor, and epileptic spasms. Focality is collected as epilepsy type rather than seizure type. Seizure frequency is measured in nine levels (all used during piloting). The CDEs were implemented in three vendor systems. Early clinical adoption included 1294 encounters at one center. SIGNIFICANCE We created, piloted, refined, finalized, and implemented a novel set of clinical CDEs for pediatric epilepsy.
Collapse
Affiliation(s)
- Zachary M Grinspan
- Departments of Population Health Sciences and Pediatrics, Weill Cornell Medicine, New York, NY
| | - Anup D Patel
- Division of Neurology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Renée A Shellhaas
- Department of Pediatrics (Pediatric Neurology), Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anne T Berg
- Division of Neurology, Epilepsy Center, Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern Feinberg School of Medicine, United States of America
| | - Erika T Axeen
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Jeffrey Bolton
- Harvard Medical School, Boston, MA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, U.S.A
| | - David F Clarke
- Division of Pediatric Neurology, Department of Neurology, Dell Medical School University of Texas at Austin, Austin, Texas
| | - Jason Coryell
- Departments of Pediatrics and Neurology, Oregon Health and Sciences University, Portland, Oregon
| | - William D Gaillard
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | - Howard P Goodkin
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Emory Children’s Center, 2015 Uppergate Drive NE, Atlanta, GA
| | | | - Juma S Mbwana
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | | | - Nilika S Singhal
- Departments of Pediatrics and Neurology, Seattle Children’s Hospital, University of Washington, and Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA
| | - Margaret M Storey
- Department of History, College of Liberal Arts & Social Sciences, DePaul University, Chicago, IL
| | - Elissa G Yozawitz
- Saul Korey Department of Neurology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Nicholas S Abend
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Mark P Fitzgerald
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Sara E Fridinger
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Shavonne L Massey
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Marisa S Prelack
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Jeffrey Buchhalter
- Department of Neurology, St Joseph’s Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
30
|
Lai Y, Muscal E, Wells E, Shukla N, Eschbach K, Hyeong Lee K, Kaliakatsos M, Desai N, Wickström R, Viri M, Freri E, Granata T, Nangia S, Dilena R, Brunklaus A, Wainwright MS, Gorman MP, Stredny CM, Asiri A, Hundallah K, Doja A, Payne E, Wirrell E, Koh S, Carpenter JL, Riviello J. Anakinra usage in febrile infection related epilepsy syndrome: an international cohort. Ann Clin Transl Neurol 2020; 7:2467-2474. [PMID: 33506622 PMCID: PMC7732241 DOI: 10.1002/acn3.51229] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/31/2022] Open
Abstract
Febrile-infection related epilepsy syndrome (FIRES) is a devastating neurological condition characterized by a febrile illness preceding new onset refractory status epilepticus (NORSE). Increasing evidence suggests innate immune dysfunction as a potential pathological mechanism. We report an international retrospective cohort of 25 children treated with anakinra, a recombinant interleukin-1 receptor antagonist, as an immunomodulator for FIRES. Anakinra was potentially safe with only one child discontinuing therapy due to infection. Earlier anakinra initiation was associated with shorter duration of mechanical ventilation, ICU and hospital length of stay. Our retrospective data lay the groundwork for prospective consensus-driven cohort studies of anakinra in FIRES.
Collapse
Affiliation(s)
- Yi‐Chen Lai
- Baylor College of Medicine/Texas Children's HospitalHoustonTexasUSA
| | - Eyal Muscal
- Baylor College of Medicine/Texas Children's HospitalHoustonTexasUSA
| | - Elizabeth Wells
- Children's National Health SystemWashingtonDistrict of ColumbiaUSA
| | - Nikita Shukla
- Baylor College of Medicine/Texas Children's HospitalHoustonTexasUSA
| | - Krista Eschbach
- Department of PediatricsSection of NeurologyChildren's Hospital ColoradoUniversity of ColoradoAuroraColoradoUSA
| | - Ki Hyeong Lee
- AdventHealthChild Neurology and Comprehensive Epilepsy CenterOrlandoFloridaUSA
| | | | - Nevedita Desai
- Neurosciences DepartmentGreat Ormond Street HospitalLondonUK
| | - Ronny Wickström
- Department of Women's and Children's HealthKarolinska University HospitalNeuropediatric UnitStockholmSweden
| | - Maurizio Viri
- Childhood Neuropsychiatric DepartmentUniversity Hospital Maggiore della CaritàNovaraItaly
| | - Elena Freri
- Department of Pediatric NeuroscienceFONDAZIONE IRCCS ISTITUTO NEUROLOGICO "CARLO BESTA"MilanItaly
| | - Tiziana Granata
- Department of Pediatric NeuroscienceFONDAZIONE IRCCS ISTITUTO NEUROLOGICO "CARLO BESTA"MilanItaly
| | - Srishti Nangia
- New York Presbyterian Hospital‐Weill Cornell Medical CollegeNYCNew YorkNew YorkUSA
| | - Robertino Dilena
- Clinical NeurophysiologyFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of NeurosciencesRehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenovaGenovaItaly
| | - Andreas Brunklaus
- Fraser of Allander Neurosciences UnitRoyal Hospital for ChildrenGlasgowUK
| | | | - Mark P. Gorman
- Department of NeurologyPediatric Multiple Sclerosis and Related Disorders ProgramBoston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Coral M. Stredny
- Department of NeurologyPediatric Multiple Sclerosis and Related Disorders ProgramBoston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Abdurhman Asiri
- Prince Sultan Medical Military City (PSMMC)RiyadhSaudi Arabia
| | | | - Asif Doja
- Division of NeurologyCHEO Research InstituteFaculty of MedicineUniversity of OttawaOttawaCanada
| | - Eric Payne
- Divisions of NeurologyDepartment of PediatricsAlberta Children’s HospitalCalgaryAlbertaCanada
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and EpilepsyDepartment of Pediatric NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Sookyong Koh
- Division of NeurologyDepartment of PediatricsEmory University School of MedicineAtlantaGeorgiaUSA
| | | | - James Riviello
- Baylor College of Medicine/Texas Children's HospitalHoustonTexasUSA
| |
Collapse
|
31
|
Kim S, DeGrauw T, Berg AT, Hass KB, Koh S. Evaluation of pediatric patients in new-onset seizure clinic (NOSc). Epilepsy Behav 2020; 112:107428. [PMID: 32920376 DOI: 10.1016/j.yebeh.2020.107428] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
Abstract
AIM We evaluated the clinical and demographic features of children presenting with unprovoked seizures at a regional new-onset seizure clinic (NOSc). METHODS We retrospectively reviewed charts of 492 consecutive patients evaluated in the NOSc at the Childrne's Healthcare of Atlanta RESULTS: Nonepileptic events (NEE) were diagnosed in 102 (24%) and epileptic seizures in the remaining 326 (76%). Patients with NEE were younger than patients with epileptic seizure (5.0 vs. 7.4 years). Except for headache which occurred more frequently in NEE (14% vs. 6%), frequencies of comorbidities were similar in groups with NEE and epileptic seizure. Electroencephalogram (EEG) was performed in 98%, and finding was abnormal in 51%. Brain magnetic resonance imaging (MRI) was performed in 55%, and finding was abnormal in 15%. An electroclinical epilepsy syndrome was diagnosed in 42%. Antiseizure medication was started in 25% with first seizure and in 77% with recurrent seizures. INTERPRETATION For children with newly-presenting seizures, a regional NOSc provided efficient, timely diagnosis and appropriate evaluations and treatment. Timely recognition of NEE resulted in fewer unnecessary evaluations and treatment for a quarter of referred patients whereas identification of the specific types of seizures and epilepsy allowed appropriate use, including deferral, of neuroimaging and guided treatment selection.
Collapse
Affiliation(s)
- Seunghyo Kim
- Department of Pediatrics, Jeju National University School of Medicine, Jeju-si, Jeju, South Korea; Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Ton DeGrauw
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Anne T Berg
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, United States of America
| | - Kristen B Hass
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Sookyong Koh
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States of America.
| |
Collapse
|
32
|
Koh S, Dupuis N, Auvin S. Ketogenic diet and Neuroinflammation. Epilepsy Res 2020; 167:106454. [DOI: 10.1016/j.eplepsyres.2020.106454] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/26/2020] [Accepted: 09/01/2020] [Indexed: 12/13/2022]
|
33
|
Kern-Smith E, Chen DF, Koh S, Dutt M. The cat's out of the bag: a rare case of new-onset refractory status epilepticus (NORSE) due to Bartonella henselae. Seizure 2020; 81:241-243. [DOI: 10.1016/j.seizure.2020.08.006] [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] [Received: 05/06/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022] Open
|
34
|
Ono KE, Bearden DJ, Adams E, Doescher J, Koh S, Eksioglu Y, Gross RE, Drane DL. Cognitive and behavioral outcome of stereotactic laser amydalohippocampotomy in a pediatric setting. Epilepsy Behav Rep 2020; 14:100370. [PMID: 32642637 PMCID: PMC7334373 DOI: 10.1016/j.ebr.2020.100370] [Citation(s) in RCA: 2] [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: 04/07/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022] Open
Abstract
We present neuropsychological and functional outcome data in a teenager undergoing stereotactic laser amygdalohippocampotomy (SLAH) who had drug-resistant mesial temporal lobe epilepsy due to left hippocampal sclerosis. Given strong baseline cognitive performance, there was concern for post-operative declines in language and verbal memory were this patient to undergo open resection. She was evaluated pre- and post-ablation with clinical and experimental neuropsychological measures including semantic memory, category-specific object/face recognition and naming, spatial learning, and socio-emotional processing. The patient became seizure-free following SLAH and experienced significant improvements in school performance and social engagement. She experienced improvement in recognition and naming of multiple object categories, memory functions, and verbal fluency. In contrast, the patient declined significantly in her ability to recognize emotional tone from facial expressions, a socio-emotional process that had been normal prior to surgery. We believe this decline was related to surgical disruption of the limbic system, an area highly involved in emotional processing, and suspect such deficits are an under-assessed and unrecognized risk for all surgeries involving the amygdalohippocampal complex and broader limbic system regions. We hope this positive SLAH outcome will serve as impetus for group level research to establish its safety and efficacy in the pediatric setting. Stereotactic laser ablation can be used successfully in pediatric epilepsy. At risk cognitive abilities did not decline after focal ablation in this teenager. Functional improvement was observed that paralleled gains in seizure status and cognition. Deficits still occurred in select areas related to focal structures ablated. Socio-emotional deficits can result from surgeries restricted to the amygdalohippocampal complex.
Collapse
Affiliation(s)
- Kim E Ono
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Donald J Bearden
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Elizabeth Adams
- Department of Neurology, Minnesota Epilepsy Group, Minneapolis, MN, USA
| | - Jason Doescher
- Department of Neurology, Minnesota Epilepsy Group, Minneapolis, MN, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Yaman Eksioglu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Coulter Department of Biomedical Engineering, Emory University, GA, USA
| | - Daniel L Drane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
35
|
Murphy MM, Burrell TL, Cubells JF, Epstein MT, Espana R, Gambello MJ, Goines K, Klaiman C, Koh S, Russo RS, Saulnier CA, Walker E, Mulle JG. Comprehensive phenotyping of neuropsychiatric traits in a multiplex 3q29 deletion family: a case report. BMC Psychiatry 2020; 20:184. [PMID: 32321479 PMCID: PMC7179007 DOI: 10.1186/s12888-020-02598-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 3q29 deletion syndrome is associated with a range of medical, neurodevelopmental, and psychiatric phenotypes. The deletion is usually de novo but cases have been reported where the deletion is inherited from apparently unaffected parents. The presence of these unaffected or mildly affected individuals suggests there may be an ascertainment bias for severely affected cases of 3q29 deletion syndrome, thus the more deleterious consequence of the 3q29 deletion may be overestimated. However, a substantial fraction of 3q29 deletion syndrome morbidity is due to psychiatric illness. In many case reports, probands and transmitting parents are not systematically evaluated for psychiatric traits. Here we report results from a systematic phenotyping protocol for neurodevelopmental and neuropsychiatric traits applied to all 3q29 deletion carriers in a multiplex family. CASE PRESENTATION Through the 3q29 registry at Emory University, a multiplex family was identified where three offspring had a paternally inherited 3q29 deletion. We evaluated all 4 3q29 deletion family members using our previously described standardized, systematic phenotyping protocol. The transmitting parent reported no psychiatric history, however upon evaluation he was discovered to meet criteria for multiple psychiatric diagnoses including previously undiagnosed schizoaffective disorder. All four 3q29 deletion individuals in the pedigree had multiple psychiatric diagnoses that interfered with quality of life and prohibited successful academic and occupational functioning. Cognitive ability for all individuals was average or below average, but within the normal range. CONCLUSIONS This is the first case report of inherited 3q29 deletion syndrome where all affected individuals in the pedigree have been comprehensively and systematically evaluated for neurodevelopmental and psychiatric symptoms, using a standard battery of normed instruments administered by expert clinicians. Our investigation reveals that individuals with 3q29 deletion syndrome may have psychiatric morbidity that is debilitating, but only apparent through specialized evaluation by an expert. In the absence of appropriate evaluation, individuals with 3q29 deletion syndrome may suffer from psychiatric illness but lack avenues for access to care. The individuals evaluated here all have cognition in the normal range alongside multiple psychiatric diagnoses each, suggesting that cognitive ability alone is not a representative proxy for 3q29 deletion-associated disability. These results require replication in a larger cohort of individuals with 3q29 deletion syndrome.
Collapse
Affiliation(s)
- Melissa M Murphy
- Department of Human Genetics, Emory University School of Medicine, Whitehead 305M, 615 Michael Street, Atlanta, GA, 30322, USA
| | - T Lindsey Burrell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, USA
| | - Joseph F Cubells
- Departments of Human Genetics and Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, USA
| | - Michael T Epstein
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, USA
| | - Roberto Espana
- Department of Psychology, Emory University, Atlanta, USA
| | - Michael J Gambello
- Department of Human Genetics, Emory University School of Medicine, Whitehead 305M, 615 Michael Street, Atlanta, GA, 30322, USA
| | - Katrina Goines
- Department of Psychology, Emory University, Atlanta, USA
| | - Cheryl Klaiman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
| | - Rossana Sanchez Russo
- Department of Human Genetics, Emory University School of Medicine, Whitehead 305M, 615 Michael Street, Atlanta, GA, 30322, USA
| | - Celine A Saulnier
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
- Neurodevelopmental Assessment & Consulting Services, Decatur, USA
| | - Elaine Walker
- Department of Psychology, Emory University, Atlanta, USA
| | - Jennifer Gladys Mulle
- Department of Human Genetics, Emory University School of Medicine, Whitehead 305M, 615 Michael Street, Atlanta, GA, 30322, USA.
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA.
| |
Collapse
|
36
|
Abstract
Febrile infection-related epilepsy syndrome (FIRES) is a rare and devastating epileptic encephalopathy with historically abysmal neurocognitive outcomes, including a high incidence of mortality. It tends to affect children and young adults and is characterized by superrefractory status epilepticus following a recent febrile illness. Growing evidence suggests a heterogeneous etiology resulting in fulminant nonantibody-mediated neuroinflammation. For some children with FIRES, this aberrant neuroinflammation appears secondary to a functional deficiency in the endogenous interleukin-1 receptor antagonist. A precise etiology has not been identified in all FIRES patients, and current treatments are not always successful. Limited treatment evidence exists to guide choice, dosing, and duration of therapies. However, the ketogenic diet and certain targeted immunomodulatory treatments, including anakinra, appear safe and have been associated with relatively excellent clinical outcomes in some FIRES patients. Future prospective multicenter collaborative studies are needed to further delineate the FIRES heterogeneous disease pathophysiology and to determine the safety and efficacy of treatment strategies through a robust measurement of neurocognitive outcomes.
Collapse
Affiliation(s)
- Eric T Payne
- Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sookyong Koh
- Division of Neurology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Elaine C Wirrell
- Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
37
|
Lee S, Park Y, Im SA, Jung K, Park I, Kang S, Kim J, Kim G, Lee KE, Ahn H, Lee M, Kim H, Koh S. Patient-reported outcomes of palbociclib plus exemestane with GnRH agonist versus capecitabine in premenopausal women with hormone receptor-positive metastatic breast cancer from the YoungPearl phase ll trial (KCSG-BR 15-10, NCT02592746). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.013] [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: 11/14/2022] Open
|
38
|
Dagan M, Dawson L, Stehli J, Koh S, Quine E, Walton A, Stub D, Htun N, Duffy S. Incidence, Predictors and Outcomes of Myocardial Injury Following Transcatheter Aortic Valve Implantation (TAVI). Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.637] [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: 10/26/2022]
|
39
|
Stehli J, Koh S, Duffy S, Dagan M, Quine E, Dick R, Htun N, Stub D, Marty C, Walton A. Long-term Survival and Valve Durability in Patients Undergoing Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.652] [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: 11/16/2022]
|
40
|
Dagan M, Dawson L, Stehli J, Koh S, Quine E, Walton A, Stub D, Htun N, Duffy S. Incidence, Management and Impact of Incidental Coronary Artery Disease on Outcomes Following Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.634] [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: 11/16/2022]
|
41
|
Bocaz JA, Barja P, Bonnar J, Daly L, Carrol A, Coutinho E, Goncalves M, Tsakok M, Koh S, Thomson JM, Poller L, Heady A, Holck S, Pinol A. Differences in Coagulation and Haemostatic Parameters in Normal Women of Childbearing Age from Different Ethnic Groups and Geographical Locations. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA comparative study of coagulation and fibrinolytic laboratory parameters was undertaken in four countries (Salvador, Brazil; Singapore; Santiago, Chile and Dublin, Ireland) among apparently healthy women of reproductive age. A continuous external quality control scheme of the laboratory measurements was employed to permit comparison among centres. Significant and consistent differences were found between the four centres. In Dublin, the prothrombin time and activated partial thromboplastin time (APTT) were accelerated, and the specific factor assays showed more activity, whereas the antiprotease levels were higher than in the other centres. In Salvador, a contrasting tendency was found with longer prothrombin times and APTT and lower Factor VII and antiprotease levels. The results from the other two centres were approximately midway between these two extremes. The study has revealed important differences in the coagulation and haemostatic tests between women from widely diverse geographical areas. It is not certain whether these are due to ethnic, nutritional or economic factors but they may be related to the apparent varying incidence of thrombosis in these ethnic groups.
Collapse
Affiliation(s)
- J A Bocaz
- The WHO Collaborating Centre for Research in Human Reproduction, Santiago, Chile
| | - P Barja
- The WHO Collaborating Centre for Research in Human Reproduction, Santiago, Chile
| | - J Bonnar
- The Dept. of Obstetrics and Gynaecology, Trinity College Medical School, St. James'and Rotunda Hospitals, University of Dublin, Dublin, Ireland
| | - L Daly
- The Dept. of Obstetrics and Gynaecology, Trinity College Medical School, St. James'and Rotunda Hospitals, University of Dublin, Dublin, Ireland
| | - A Carrol
- The Dept. of Obstetrics and Gynaecology, Trinity College Medical School, St. James'and Rotunda Hospitals, University of Dublin, Dublin, Ireland
| | - E Coutinho
- The WHO Collaborating Centre for Research in Human Reproduction, Salvador, Brazil
| | - M Goncalves
- The WHO Collaborating Centre for Research in Human Reproduction, Salvador, Brazil
| | - M Tsakok
- The WHO Collaborating Centre for Research in Human Reproduction, Singapore
| | - S Koh
- The WHO Collaborating Centre for Research in Human Reproduction, Singapore
| | - J M Thomson
- The UK Reference Laboratory for Anticoagulant Reagents and Control, Withington Hospital, University Hospital of South Manchester, Manchester, United Kingdom
| | - L Poller
- The UK Reference Laboratory for Anticoagulant Reagents and Control, Withington Hospital, University Hospital of South Manchester, Manchester, United Kingdom
| | - A Heady
- The Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - S Holck
- The Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - A Pinol
- The Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| |
Collapse
|
42
|
Koh S, Degerstedt S, Addicott B, Schenning R. 3:45 PM Abstract No. 146 The use of preprocedural educational videos to augment the consenting process and increase patient understanding and satisfaction in interventional radiology. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
43
|
Berg AT, Chakravorty S, Koh S, Grinspan ZM, Shellhaas RA, Saneto RP, Wirrell EC, Coryell J, Chu CJ, Mytinger JR, Gaillard WD, Valencia I, Knupp KG, Loddenkemper T, Sullivan JE, Poduri A, Millichap JJ, Keator C, Wusthoff C, Ryan N, Dobyns WB, Hegde M. Why West? Comparisons of clinical, genetic and molecular features of infants with and without spasms. PLoS One 2018. [PMID: 29518120 PMCID: PMC5843222 DOI: 10.1371/journal.pone.0193599] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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] [Indexed: 01/01/2023] Open
Abstract
Infantile spasms are the defining seizures of West syndrome, a severe form of early life epilepsy with poorly-understood pathophysiology. We present a novel comparative analysis of infants with spasms versus other seizure-types and identify clinical, etiological, and molecular-genetic factors preferentially predisposing to spasms. We compared ages, clinical etiologies, and associated-genes between spasms and non-spasms groups in a multicenter cohort of 509 infants (<12months) with newly-diagnosed epilepsy. Gene ontology and pathway enrichment analysis of clinical laboratory-confirmed pathogenic variant-harboring genes was performed. Pathways, functions, and cellular compartments between spasms and non-spasms groups were compared. Spasms onset age was similar in infants initially presenting with spasms (6.1 months) versus developing spasms as a later seizure type (6.9 months) but lower in the non-spasms group (4.7 months, p<0.0001). This pattern held across most etiological categories. Gestational age negatively correlated with spasms onset-age (r = -0.29, p<0.0001) but not with non-spasm seizure age. Spasms were significantly preferentially associated with broad developmental and regulatory pathways, whereas motor functions and pathways including cellular response to stimuli, cell motility and ion transport were preferentially enriched in non-spasms. Neuronal cell-body organelles preferentially associated with spasms, while, axonal, dendritic, and synaptic regions preferentially associated with other seizures. Spasms are a clinically and biologically distinct infantile seizure type. Comparative clinical-epidemiological analyses identify the middle of the first year as the time of peak expression regardless of etiology. The inverse association with gestational age suggests the preterm brain must reach a certain post-conceptional, not just chronological, neurodevelopmental stage before spasms manifest. Clear differences exist between the biological pathways leading to spasms versus other seizure types and suggest that spasms result from dysregulation of multiple developmental pathways and involve different cellular components than other seizure types. This deeper level of understanding may guide investigations into pathways most critical to target in future precision medicine efforts.
Collapse
Affiliation(s)
- Anne T. Berg
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- * E-mail:
| | - Samya Chakravorty
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Sookyong Koh
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, United States of America
| | - Zachary M. Grinspan
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, United States of America
- Department Pediatrics, Weill Cornell Medicine, New York, NY, United States of America
- New York Presbyterian Hospital, New York, NY, United States of America
| | - Renée A. Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America
| | - Russell P. Saneto
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, WA, United States of America
- Department of Neurology, University of Washington, Seattle, WA, United States of America
| | - Elaine C. Wirrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Jason Coryell
- Departments of Pediatrics & Neurology, Oregon Health & Sciences University, Portland, OR, United States of America
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - John R. Mytinger
- Department of Pediatrics, the Ohio State University, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - William D. Gaillard
- Department of Neurology, Children's National Health System, George Washington University School of Medicine, Washington, D.C., United States of America
| | - Ignacio Valencia
- Section of Neurology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Kelly G. Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Joseph E. Sullivan
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Annapurna Poduri
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - John J. Millichap
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Cynthia Keator
- Cook Children’s Health Care System, Jane and John Justin Neurosciences Center, Fort Worth, TX, United States of America
| | - Courtney Wusthoff
- Division of Child Neurology, Stanford University, Palo Alto, CA, United States of America
| | - Nicole Ryan
- Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - William B. Dobyns
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, WA, United States of America
- Department of Neurology, University of Washington, Seattle, WA, United States of America
- Center for Integrative Brain Research, University of Washington, Seattle, WA, United States of America
- Seattle Children's Research Institute, University of Washington, Seattle, WA, United States of America
- Pediatrics University of Washington, Seattle, WA, United States of America
| | - Madhuri Hegde
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States of America
| |
Collapse
|
44
|
Xu D, Robinson AP, Ishii T, Duncan DS, Alden TD, Goings GE, Ifergan I, Podojil JR, Penaloza-MacMaster P, Kearney JA, Swanson GT, Miller SD, Koh S. Peripherally derived T regulatory and γδ T cells have opposing roles in the pathogenesis of intractable pediatric epilepsy. J Exp Med 2018; 215:1169-1186. [PMID: 29487082 PMCID: PMC5881465 DOI: 10.1084/jem.20171285] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/08/2017] [Accepted: 01/26/2018] [Indexed: 12/14/2022] Open
Abstract
Xu et al. provide the first study in patients with intractable epilepsy showing a direct correlation between the phenotype, activation state, cytokine profiles, and ability to cause neuronal apoptosis of brain-infiltrating peripherally derived immune cells with seizure severity using an unbiased flow cytometric approach. The pathophysiology of drug-resistant pediatric epilepsy is unknown. Flow cytometric analysis of inflammatory leukocytes in resected brain tissues from 29 pediatric patients with genetic (focal cortical dysplasia) or acquired (encephalomalacia) epilepsy demonstrated significant brain infiltration of blood-borne inflammatory myeloid cells and memory CD4+ and CD8+ T cells. Significantly, proinflammatory (IL-17– and GM-CSF–producing) γδ T cells were concentrated in epileptogenic lesions, and their numbers positively correlated with disease severity. Conversely, numbers of regulatory T (T reg) cells inversely correlated with disease severity. Correspondingly, using the kainic acid model of status epilepticus, we show ameliorated seizure activity in both γδ T cell– and IL-17RA–deficient mice and in recipients of T reg cells, whereas T reg cell depletion heightened seizure severity. Moreover, both IL-17 and GM-CSF induced neuronal hyperexcitability in brain slice cultures. These studies support a major pathological role for peripherally derived innate and adaptive proinflammatory immune responses in the pathogenesis of intractable epilepsy and suggest testing of immunomodulatory therapies.
Collapse
Affiliation(s)
- Dan Xu
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Interdepartmental Immunobiology Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Andrew P Robinson
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Interdepartmental Immunobiology Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Toshiyuki Ishii
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Physiology, Nippon Medical School, Tokyo, Japan
| | - D'Anne S Duncan
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Interdepartmental Immunobiology Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tord D Alden
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gwendolyn E Goings
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Interdepartmental Immunobiology Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Igal Ifergan
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Interdepartmental Immunobiology Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Joseph R Podojil
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Interdepartmental Immunobiology Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pablo Penaloza-MacMaster
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Interdepartmental Immunobiology Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jennifer A Kearney
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Geoffrey T Swanson
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Stephen D Miller
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL .,Department of Interdepartmental Immunobiology Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sookyong Koh
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
45
|
Kruse CA, Pardo CA, Hartman AL, Jallo G, Vining EPG, Voros J, Gaillard WD, Liu J, Oluigbo C, Malone S, Bleasel AF, Dexter M, Micati A, Velasco TR, Machado HR, Martino AM, Huang A, Wheatley BM, Grant GA, Granata T, Freri E, Garbelli R, Koh S, Nordli DR, Campos AR, O'Neill B, Handler MH, Chapman KE, Wilfong AA, Curry DJ, Yaun A, Madsen JR, Smyth MD, Mercer D, Bingaman W, Harvey AS, Leventer RJ, Lockhart PJ, Gillies G, Pope K, Giller CA, Park YD, Rojiani AM, Sharma SJ, Jenkins P, Tung S, Huynh MN, Chirwa TW, Cepeda C, Levine MS, Chang JW, Owens GC, Vinters HV, Mathern GW. Rasmussen encephalitis tissue transfer program. Epilepsia 2018; 57:1005-7. [PMID: 27286752 DOI: 10.1111/epi.13383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Carol A Kruse
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.,Brain Research Institute, UCLA, Los Angeles, California, U.S.A
| | - Carlos A Pardo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Adam L Hartman
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - George Jallo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Eileen P G Vining
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Joe Voros
- Public Health Management, Los Angeles, California, U.S.A
| | - William D Gaillard
- Children's National Health System, Washington, DC, U.S.A.,George Washington University, Washington, DC, U.S.A
| | - Judy Liu
- Children's National Health System, Washington, DC, U.S.A.,George Washington University, Washington, DC, U.S.A
| | - Chima Oluigbo
- Children's National Health System, Washington, DC, U.S.A.,George Washington University, Washington, DC, U.S.A
| | - Stephen Malone
- Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew F Bleasel
- Westmead Hospital, Westmead, New South Wales, Australia.,The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mark Dexter
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Alex Micati
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Tonicarlo R Velasco
- Hospital Clinic of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.,University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Helio R Machado
- Hospital Clinic of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.,University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Adam Huang
- University of South Alabama, Mobile, Alabama, U.S.A
| | - B M Wheatley
- University of Alberta, Edmonton, Alberta, Canada
| | - Gerald A Grant
- Stanford University School of Medicine, Stanford, California, U.S.A.,Lucile Packard Children's Hospital, Stanford, California, U.S.A
| | - Tiziana Granata
- Carlo Besta, Neurological Institute Foundation, Milano, Lombardia, Italy
| | - Elena Freri
- Carlo Besta, Neurological Institute Foundation, Milano, Lombardia, Italy
| | - Rita Garbelli
- Carlo Besta, Neurological Institute Foundation, Milano, Lombardia, Italy
| | - Sookyong Koh
- Emory+Children's Pediatric Research Center, Atlanta, Georgia, U.S.A
| | - Douglas R Nordli
- Children's Memorial Hospital, Chicago, Illinois, U.S.A.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | | | - Brent O'Neill
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Michael H Handler
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A.,The Children's Hospital, Aurora, Colorado, U.S.A
| | - Kevin E Chapman
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Angus A Wilfong
- Texas Children's Hospital, Houston, Texas, U.S.A.,Baylor College of Medicine, Houston, Texas, U.S.A
| | - Daniel J Curry
- Texas Children's Hospital, Houston, Texas, U.S.A.,Baylor College of Medicine, Houston, Texas, U.S.A
| | - Amanda Yaun
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, U.S.A
| | - Joseph R Madsen
- Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Matthew D Smyth
- Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Deanna Mercer
- Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | | | - A S Harvey
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Richard J Leventer
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Paul J Lockhart
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Greta Gillies
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kate Pope
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Cole A Giller
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Yong D Park
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Amyn M Rojiani
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Suash J Sharma
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Patrick Jenkins
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Spencer Tung
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - My N Huynh
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Thabiso W Chirwa
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Carlos Cepeda
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Michael S Levine
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.,Brain Research Institute, UCLA, Los Angeles, California, U.S.A
| | - Julia W Chang
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Geoffrey C Owens
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Harry V Vinters
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Gary W Mathern
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.. .,Brain Research Institute, UCLA, Los Angeles, California, U.S.A..
| |
Collapse
|
46
|
Abstract
Until a decade ago, epilepsy research had focused mainly on alterations of neuronal activities and excitability. Such neurocentric emphasis has neglected the role of glia and involvement of inflammation in the pathogenesis of epilepsy. It is becoming clear that immune and inflammatory reactions do occur in the brain despite the brain's lack of conventional lymphatic drainage and graft acceptance and the presence of vascular brain barrier that tightly regulates infiltration of blood monocytes and lymphocytes. The critical roles of brain-resident immune mediators and of brain-infiltrating peripheral leukocytes are increasingly recognized. Inflammatory processes, including activation of microglia and astrocytes and production of proinflammatory cytokines and related molecules, occur in human epilepsy as well as in experimental models of epilepsy. Immune mechanism that underlies evolution of drug-resistant epilepsy and epileptic encephalopathy represents a new target and will aid in development of novel immunotherapeutic drugs and therapies against the key constituents in immune pathways.
Collapse
Affiliation(s)
- Sookyong Koh
- 1 Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
47
|
Berg AT, Coryell J, Saneto RP, Grinspan ZM, Alexander JJ, Kekis M, Sullivan JE, Wirrell EC, Shellhaas RA, Mytinger JR, Gaillard WD, Kossoff EH, Valencia I, Knupp KG, Wusthoff C, Keator C, Dobyns WB, Ryan N, Loddenkemper T, Chu CJ, Novotny EJ, Koh S. Early-Life Epilepsies and the Emerging Role of Genetic Testing. JAMA Pediatr 2017; 171:863-871. [PMID: 28759667 PMCID: PMC5710404 DOI: 10.1001/jamapediatrics.2017.1743] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Early-life epilepsies are often a consequence of numerous neurodevelopmental disorders, most of which are proving to have genetic origins. The role of genetic testing in the initial evaluation of these epilepsies is not established. OBJECTIVE To provide a contemporary account of the patterns of use and diagnostic yield of genetic testing for early-life epilepsies. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort, children with newly diagnosed epilepsy with an onset at less than 3 years of age were recruited from March 1, 2012, to April 30, 2015, from 17 US pediatric hospitals and followed up for 1 year. Of 795 families approached, 775 agreed to participate. Clinical diagnosis of the etiology of epilepsy were characterized based on information available before genetic testing was performed. Added contributions of cytogenetic and gene sequencing investigations were determined. EXPOSURES Genetic diagnostic testing. MAIN OUTCOMES AND MEASURES Laboratory-confirmed pathogenic variant. RESULTS Of the 775 patients in the study (367 girls and 408 boys; median age of onset, 7.5 months [interquartile range, 4.2-16.5 months]), 95 (12.3%) had acquired brain injuries. Of the remaining 680 patients, 327 (48.1%) underwent various forms of genetic testing, which identified pathogenic variants in 132 of 327 children (40.4%; 95% CI, 37%-44%): 26 of 59 (44.1%) with karyotyping, 32 of 188 (17.0%) with microarrays, 31 of 114 (27.2%) with epilepsy panels, 11 of 33 (33.3%) with whole exomes, 4 of 20 (20.0%) with mitochondrial panels, and 28 of 94 (29.8%) with other tests. Forty-four variants were identified before initial epilepsy presentation. Apart from dysmorphic syndromes, pathogenic yields were highest for children with tuberous sclerosis complex (9 of 11 [81.8%]), metabolic diseases (11 of 14 [78.6%]), and brain malformations (20 of 61 [32.8%]). A total of 180 of 446 children (40.4%), whose etiology would have remained unknown without genetic testing, underwent some testing. Pathogenic variants were identified in 48 of 180 children (26.7%; 95% CI, 18%-34%). Diagnostic yields were greater than 15% regardless of delay, spasms, and young age. Yields were greater for epilepsy panels (28 of 96 [29.2%]; P < .001) and whole exomes (5 of 18 [27.8%]; P = .02) than for chromosomal microarray (8 of 101 [7.9%]). CONCLUSIONS AND RELEVANCE Genetic investigations, particularly broad sequencing methods, have high diagnostic yields in newly diagnosed early-life epilepsies regardless of key clinical features. Thorough genetic investigation emphasizing sequencing tests should be incorporated into the initial evaluation of newly presenting early-life epilepsies and not just reserved for those with severe presentations and poor outcomes.
Collapse
Affiliation(s)
- Anne T. Berg
- Epilepsy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jason Coryell
- Department of Pediatrics, Oregon Health & Science University, Portland,Department of Neurology, Oregon Health & Science University, Portland
| | - Russell P. Saneto
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, Washington,Department of Neurology, University of Washington, Seattle
| | - Zachary M. Grinspan
- Department of Pediatrics, Weill Cornell Medicine, New York, New York,Department of Pediatrics, New York Presbyterian Hospital, New York, New York,Health Information Technology Evaluation Collaborative, New York, New York
| | | | - Mariana Kekis
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | | | | | | | - John R. Mytinger
- Department of Pediatrics, The Ohio State University, Columbus,Department of Neurology, Nationwide Children’s Hospital, Columbus, Ohio
| | - William D. Gaillard
- Department of Neurology, Children’s National Health System, George Washington University School of Medicine, Washington, DC
| | - Eric H. Kossoff
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland,Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ignacio Valencia
- Section of Neurology, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kelly G. Knupp
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora,Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Courtney Wusthoff
- Division of Child Neurology, Stanford University, Palo Alto, California
| | - Cynthia Keator
- Cook Children’s Health Care System, Jane and John Justin Neurosciences Center, Fort Worth, Texas
| | - William B. Dobyns
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, Washington,Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle
| | - Nicole Ryan
- Department of Neurology, The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Pediatrics, The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Edward J. Novotny
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, Washington,Department of Neurology, University of Washington, Seattle,Department of Pediatrics, University of Washington, Seattle,Center for Integrative Brain Research, University of Washington, Seattle,Seattle Children’s Research Institute, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle
| | - Sookyong Koh
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| |
Collapse
|
48
|
Aronica E, Bauer S, Bozzi Y, Caleo M, Dingledine R, Gorter JA, Henshall DC, Kaufer D, Koh S, Löscher W, Louboutin JP, Mishto M, Norwood BA, Palma E, Poulter MO, Terrone G, Vezzani A, Kaminski RM. Neuroinflammatory targets and treatments for epilepsy validated in experimental models. Epilepsia 2017; 58 Suppl 3:27-38. [PMID: 28675563 DOI: 10.1111/epi.13783] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 12/16/2022]
Abstract
A large body of evidence that has accumulated over the past decade strongly supports the role of inflammation in the pathophysiology of human epilepsy. Specific inflammatory molecules and pathways have been identified that influence various pathologic outcomes in different experimental models of epilepsy. Most importantly, the same inflammatory pathways have also been found in surgically resected brain tissue from patients with treatment-resistant epilepsy. New antiseizure therapies may be derived from these novel potential targets. An essential and crucial question is whether targeting these molecules and pathways may result in anti-ictogenesis, antiepileptogenesis, and/or disease-modification effects. Therefore, preclinical testing in models mimicking relevant aspects of epileptogenesis is needed to guide integrated experimental and clinical trial designs. We discuss the most recent preclinical proof-of-concept studies validating a number of therapeutic approaches against inflammatory mechanisms in animal models that could represent novel avenues for drug development in epilepsy. Finally, we suggest future directions to accelerate preclinical to clinical translation of these recent discoveries.
Collapse
Affiliation(s)
- Eleonora Aronica
- Department of (Neuro)Pathology, Academic Medical Center, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, Center for Neuroscience University of Amsterdam, Amsterdam, The Netherlands.,SEIN-Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Sebastian Bauer
- Department of Neurology, Philipps University, Marburg, Germany.,Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University, Frankfurt am Main, Germany
| | - Yuri Bozzi
- Neuroscience Institute, National Research Council (CNR), Pisa, Italy.,Laboratory of Molecular Neuropathology, Centre for Integrative Biology (CIBIO), University of Trento, Trento, Italy
| | - Matteo Caleo
- Neuroscience Institute, National Research Council (CNR), Pisa, Italy
| | - Raymond Dingledine
- Department of Pharmacology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Jan A Gorter
- Swammerdam Institute for Life Sciences, Center for Neuroscience University of Amsterdam, Amsterdam, The Netherlands
| | - David C Henshall
- Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Kaufer
- Helen Wills Neuroscience Institute, UC Berkeley, Berkeley, California, U.S.A
| | - Sookyong Koh
- Department of Pediatrics, Emory University, Atlanta, Georgia, U.S.A
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany
| | - Jean-Pierre Louboutin
- Department of Basic Medical Sciences, University of the West Indies, Kingston, Jamaica.,Gene Therapy Program, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Michele Mishto
- Charite University Medicine Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Braxton A Norwood
- Department of Neurology, Philipps University, Marburg, Germany.,Neuroscience Division, Expesicor LLC, Kalispell, Montana, U.S.A
| | - Eleonora Palma
- Department of Physiology and Pharmacology, University of Rome La Sapienza, Rome, Italy
| | - Michael O Poulter
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Gaetano Terrone
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Annamaria Vezzani
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | |
Collapse
|
49
|
Busch C, Koh S, Oie Y, Ichii M, Kanakura Y, Nishida K. Increased corneal densitometry as a subclinical corneal change associated with multiple myeloma. Eye (Lond) 2017; 31:1745-1746. [PMID: 28707673 DOI: 10.1038/eye.2017.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- C Busch
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.,University of Kansas School of Medicine, Kansas City, KS, USA
| | - S Koh
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Oie
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - M Ichii
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Kanakura
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - K Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
50
|
Hwang E, Lee S, Koh S. BARRIERS OF CREATING AGE FRIENDLY ENVIRONMENTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E. Hwang
- Virginia Tech, Blacksburg, Virginia,
| | - S. Lee
- Jeju Development Institute, Jeju, Korea (the Republic of)
| | - S. Koh
- Jeju Development Institute, Jeju, Korea (the Republic of)
| |
Collapse
|