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Efremova D, Ciobanu N, Glavan D, Leahu P, Racila R, Bălănuță T, Matei A, Vasilieva M, Cheptea C, Bîtcă P, Damian C, Bondarciuc A, Bejenari I, Cojocaru A, Manea D, Ciocanu M, Zota E, Ciolac D, Groppa SA. Serum Urate Levels and Ultrasound Characteristics of Carotid Atherosclerosis across Obesity Phenotypes. Biomedicines 2023; 11:1897. [PMID: 37509536 PMCID: PMC10376805 DOI: 10.3390/biomedicines11071897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Existing evidence suggests a close link among high levels of serum urate (SU), obesity and carotid atherosclerosis. The aim of the present study was to evaluate the interrelations between SU levels and carotid atherosclerosis in subjects with different obesity phenotypes. METHODS In this study, a total of 2076 subjects (mean age 48.1 ± 13.1 years; 1307 women) were recruited: 59 with general obesity, 616 with central obesity, 715 with mixed (general-central) obesity and 686 non-obese. Anthropometric measurements, vascular risk factors, blood biochemistry analysis (including SU levels), and carotid ultrasound were performed. Ultrasound assessment included evaluation of intima-media thickness (IMT) and plaque characteristics, including number, total area and type (vulnerable vs. stable) of plaques. RESULTS After adjustment for potential confounders, the highest levels of SU were observed in subjects with mixed obesity, followed by subjects with central obesity, general obesity and the non-obese (309.4 ± 82.2 vs. 301.2 ± 73.1 vs. 272.9 ± 61.8 vs. 234.2 ± 59.8 μmol/L, respectively; F = 149.2, post hoc p < 0.001). Similarly, subjects with mixed and central obesity presented higher values of IMT compared to subjects with general obesity and the non-obese (0.68 ± 0.16 vs. 0.67 ± 0.16 vs. 0.62 ± 0.14 vs. 0.57 ± 0.13 mm, respectively; F = 54.2, post hoc p < 0.001). No difference in number, total area and type of plaques among obesity groups were attested (all p > 0.05). Significantly higher IMT values were observed in subjects with increased SU levels compared to subjects with normal SU levels (0.70 ± 0.10 vs. 0.62 ± 0.14 mm, p = 0.02) only within the central obesity group. Increasing levels of SU were associated with a higher frequency of increased IMT only in subjects with central obesity (OR 1.033, 95% CI 1.025-1.041). Similarly, SU levels yielded a satisfactory performance in detecting subjects with increased IMT (AUC 0.65, 95% CI 0.50-0.73, subjects with carotid plaques (0.62, 95% CI 0.55-0.68) and subjects with vulnerable plaque types (0.68, 0.59-0.76) only within the central obesity group. CONCLUSIONS Among the studied obesity types, the association between SU levels and markers of carotid atherosclerosis was of particular significance in subjects with central obesity.
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Affiliation(s)
- Daniela Efremova
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Natalia Ciobanu
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Danu Glavan
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Pavel Leahu
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Renata Racila
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Tatiana Bălănuță
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Alexandru Matei
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Maria Vasilieva
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Cristina Cheptea
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Paula Bîtcă
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Cristina Damian
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Ana Bondarciuc
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Irina Bejenari
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Adelina Cojocaru
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Diana Manea
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Mihail Ciocanu
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
| | - Eremei Zota
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Stanislav A Groppa
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
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2
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Vataman A, Ciolac D, Chiosa V, Aftene D, Leahu P, Winter Y, Groppa SA, Gonzalez-Escamilla G, Muthuraman M, Groppa S. Dynamic flexibility and controllability of network communities in juvenile myoclonic epilepsy. Neurobiol Dis 2023; 179:106055. [PMID: 36849015 DOI: 10.1016/j.nbd.2023.106055] [Citation(s) in RCA: 3] [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: 10/27/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
Juvenile myoclonic epilepsy (JME) is the most common syndrome within the idiopathic generalized epilepsy spectrum, manifested by myoclonic and generalized tonic-clonic seizures and spike-and-wave discharges (SWDs) on electroencephalography (EEG). Currently, the pathophysiological concepts addressing SWD generation in JME are still incomplete. In this work, we characterize the temporal and spatial organization of functional networks and their dynamic properties as derived from high-density EEG (hdEEG) recordings and MRI in 40 JME patients (25.4 ± 7.6 years, 25 females). The adopted approach allows for the construction of a precise dynamic model of ictal transformation in JME at the cortical and deep brain nuclei source levels. We implement Louvain algorithm to attribute brain regions with similar topological properties to modules during separate time windows before and during SWD generation. Afterwards, we quantify how modular assignments evolve and steer through different states towards the ictal state by measuring characteristics of flexibility and controllability. We find antagonistic dynamics of flexibility and controllability within network modules as they evolve towards and undergo ictal transformation. Prior to SWD generation, we observe concomitantly increasing flexibility (F(1,39) = 25.3, corrected p < 0.001) and decreasing controllability (F(1,39) = 55.3, p < 0.001) within the fronto-parietal module in γ-band. On a step further, during interictal SWDs as compared to preceding time windows, we notice decreasing flexibility (F(1,39) = 11.9, p < 0.001) and increasing controllability (F(1,39) = 10.1, p < 0.001) within the fronto-temporal module in γ-band. During ictal SWDs as compared to prior time windows, we demonstrate significantly decreasing flexibility (F(1,14) = 31.6; p < 0.001) and increasing controllability (F(1,14) = 44.7, p < 0.001) within the basal ganglia module. Furthermore, we show that flexibility and controllability within the fronto-temporal module of the interictal SWDs relate to seizure frequency and cognitive performance in JME patients. Our results demonstrate that detection of network modules and quantification of their dynamic properties is relevant to track the generation of SWDs. The observed flexibility and controllability dynamics reflect the reorganization of de-/synchronized connections and the ability of evolving network modules to reach a seizure-free state, respectively. These findings may advance the elaboration of network-based biomarkers and more targeted therapeutic neuromodulatory approaches in JME.
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Affiliation(s)
- Anatolie Vataman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldavia
| | - Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldavia
| | - Vitalie Chiosa
- Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldavia
| | - Daniela Aftene
- Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldavia
| | - Pavel Leahu
- Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldavia
| | - Yaroslav Winter
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stanislav A Groppa
- Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldavia
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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3
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Efremova D, Ciolac D, Zota E, Glavan D, Ciobanu N, Aulitzky W, Nics AM, Trinka E, Yamada C, Movila A, Groppa SA. Dissecting the Spectrum of Stroke Risk Factors in an Apparently Healthy Population: Paving the Roadmap to Primary Stroke Prevention. J Cardiovasc Dev Dis 2023; 10:35. [PMID: 36826531 PMCID: PMC9965290 DOI: 10.3390/jcdd10020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
We aimed to investigate, for the first time, the spectrum of stroke risk factors specific to the population of the Republic of Moldova. The subjects were examined according to a pre-established protocol of risk factor estimation. The study involved 300 subjects, including 60% women and 40% men, with a mean age of 49.9 ± 14.5 years. The most common risk factor was abdominal obesity, identified in 75% of subjects; general obesity was detected in 48%, while 32% of subjects were overweight and 20% were normally weighted. Hypertension was observed in 44%; 8% of those examined had atrial fibrillation, and 9% had diabetes mellitus. Left myocardial hypertrophy on ECG was present in 53% of subjects, and acute ischemic changes in 2%. Laboratory observations detected that glycosylated hemoglobin increased by 7%, and >50% had dyslipidemia. Total cholesterol was significantly elevated by 58%, LDL-cholesterol was increased by 32%, and HDL-cholesterol was decreased by 9%. Homocysteine was increased in 55% and high-sensitivity C-reactive protein in 28% of subjects. These results indicate the presence of modifiable risk factors and the necessity to elaborate on the primary prevention strategies aimed at minimizing the burden of stroke in the population of the Republic of Moldova.
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Affiliation(s)
- Daniela Efremova
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Eremei Zota
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Danu Glavan
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Natalia Ciobanu
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Wolfgang Aulitzky
- Open Medical Institute, American Austrian Foundation, 5020 Salzburg, Austria
| | - Anna Maria Nics
- Open Medical Institute, American Austrian Foundation, 5020 Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, 5020 Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria
| | - Chiaki Yamada
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Alexandru Movila
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Stanislav A. Groppa
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
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4
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Ciolac D, Gonzalez-Escamilla G, Winter Y, Melzer N, Luessi F, Radetz A, Fleischer V, Groppa SA, Kirsch M, Bittner S, Zipp F, Muthuraman M, Meuth SG, Grothe M, Groppa S. Altered grey matter integrity and network vulnerability relate to epilepsy occurrence in patients with multiple sclerosis. Eur J Neurol 2022; 29:2309-2320. [PMID: 35582936 DOI: 10.1111/ene.15405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/22/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND To investigate the relevance of compartmentalized grey matter (GM) pathology and network reorganization in MS patients with concomitant epilepsy. METHODS From 3T MRI scans of 30 MS patients with epilepsy (MSE; age 41±15 years, 21 females, disease duration 8±6 years, median Expanded Disability Status Scale (EDSS) 3), 60 MS patients without epilepsy (MS; age 41±12 years, 35 females, disease duration 6±4 years, EDSS 2), and 60 healthy subjects (HS; age 40±13 years, 27 females) regional volumes of GM lesions and of cortical, subcortical, and hippocampal structures were quantified. Network topology and vulnerability were modeled within the graph theoretical framework. The receiver operating characteristic (ROC) analysis was applied to assess the accuracy of GM pathology measures to discriminate between MSE and MS patients. RESULTS Higher lesion volumes within the hippocampus, mesiotemporal cortex, and amygdala were detected in MSE compared to MS (all p<0.05). MSE displayed lower cortical volumes mainly in temporal and parietal areas compared to MS and HS (all p<0.05). Lower volumes of hippocampal tail and presubiculum were identified in both MSE and MS patients compared to HS (all p<0.05). Network topology in MSE was characterized by higher transitivity and assortativity, and higher vulnerability compared to MS and HS (all p<0.05). Hippocampal lesion volume yielded the highest accuracy (area under the ROC curve 0.80 [0.67-0.91]) in discriminating between MSE and MS patients. CONCLUSIONS High lesion load, altered integrity of mesiotemporal GM structures, and network reorganization are associated with a greater propensity of epilepsy occurrence in MS.
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Affiliation(s)
- Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Yaroslav Winter
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Neurology, Philipps-University, Marburg, Germany
| | - Nico Melzer
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Angela Radetz
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stanislav A Groppa
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Michael Kirsch
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine of Greifswald, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sven G Meuth
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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5
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Ciolac D, Crivorucica I, Zota E, Manea D, Efremova D, Gușanu L, Crivorucica V, Ciocanu M, Groppa SA. Gray Matter-Restricted Whole Spinal Cord Involvement in a Young Woman with SARS-CoV-2 Infection. J Magn Reson Imaging 2021; 56:312-314. [PMID: 34739141 DOI: 10.1002/jmri.27986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova.,Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Igor Crivorucica
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Eremei Zota
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova.,Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Diana Manea
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Daniela Efremova
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Ludmila Gușanu
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Veaceslav Crivorucica
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Mihail Ciocanu
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Stanislav A Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova.,Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
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6
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Groppa SA, Ciolac D, Duarte C, Garcia C, Gasnaș D, Leahu P, Efremova D, Gasnaș A, Bălănuță T, Mîrzac D, Movila A. Molecular Mechanisms of SARS-CoV-2/COVID-19 Pathogenicity on the Central Nervous System: Bridging Experimental Probes to Clinical Evidence and Therapeutic Interventions. Adv Exp Med Biol 2021; 1376:1-27. [PMID: 34735712 DOI: 10.1007/5584_2021_675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has dramatically impacted the global healthcare systems, constantly challenging both research and clinical practice. Although it was initially believed that the SARS-CoV-2 infection is limited merely to the respiratory system, emerging evidence indicates that COVID-19 affects multiple other systems including the central nervous system (CNS). Furthermore, most of the published clinical studies indicate that the confirmed CNS inflammatory manifestations in COVID-19 patients are meningitis, encephalitis, acute necrotizing encephalopathy, acute transverse myelitis, and acute disseminated encephalomyelitis. In addition, the neuroinflammation along with accelerated neurosenescence and susceptible genetic signatures in COVID-19 patients might prime the CNS to neurodegeneration and precipitate the occurrence of neurodegenerative diseases, including Alzheimer's and Parkinson's diseases. Thus, this review provides a critical evaluation and interpretive analysis of existing published preclinical as well as clinical studies on the key molecular mechanisms modulating neuroinflammation and neurodegeneration induced by the SARS-CoV-2. In addition, the essential age- and gender-dependent impacts of SARS-CoV-2 on the CNS of COVID-19 patients are also discussed.
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Affiliation(s)
- Stanislav A Groppa
- Department of Neurology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Dumitru Ciolac
- Department of Neurology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Carolina Duarte
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Christopher Garcia
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Daniela Gasnaș
- Department of Neurology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Pavel Leahu
- Department of Neurology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Daniela Efremova
- Department of Neurology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova.,Laboratory of Cerebrovascular Diseases and Epilepsy, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Alexandru Gasnaș
- Department of Neurology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova.,Laboratory of Cerebrovascular Diseases and Epilepsy, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Tatiana Bălănuță
- Department of Neurology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova.,Laboratory of Cerebrovascular Diseases and Epilepsy, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Daniela Mîrzac
- Department of Neurology, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.,Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Alexandru Movila
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA. .,Institute of Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
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7
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Leahu P, Bange M, Ciolac D, Scheiter S, Matei A, Gonzalez-Escamilla G, Chirumamilla VC, Groppa SA, Muthuraman M, Groppa S. Increased migraine-free intervals with multifocal repetitive transcranial magnetic stimulation. Brain Stimul 2021; 14:1544-1552. [PMID: 34673259 DOI: 10.1016/j.brs.2021.10.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Episodic migraine is a debilitating condition associated with vast impairments of health, daily living, and life quality. Several prophylactic treatments exist, having a moderate ratio of action related to side effects and therapy costs. Repetitive transcranial magnetic stimulation (rTMS) is an evidence based therapy in several neuropsychiatric conditions, showing robust efficacy in alleviating specific symptoms. However, its efficacy in migraine disorders is unequivocal and might be tightly linked to the applied rTMS protocol. We hypothesized that multifocal rTMS paradigm could improve clinical outcomes in patients with episodic migraine by reducing the number of migraine days, frequency and intensity of migraine attacks, and improve the quality of life. METHODS We conducted an experimental, double-blind, randomized controlled study by applying a multifocal rTMS paradigm. Patients with episodic migraine with or without aura were enrolled in two centers from August 2018, to December 2019, and randomized to receive either real (n = 37) or sham (sham coil stimulation, n = 28) multifocal rTMS for six sessions over two weeks. Patients, physicians, and raters were blinded to the applied protocol. The experimental multifocal rTMS protocol included two components; first, swipe stimulation of 13 trains of 140 pulses/train, 67 Hz, 60% of RMT, and 2s intertrain interval and second, spot burst stimulation of 33 trains of 15 pulses/train, 67 Hz, 85% of RMT, and 8s intertrain interval. Reduction >50% from the baseline in migraine days (as primary outcome) and frequency and intensity of migraine attacks (as key secondary outcomes) over a 12-week period were assessed. To balance the baseline variables between the treatment arms, we applied the propensity score matching through the logistic regression. RESULTS Among 65 randomized patients, sixty (age 39.7 ± 11.6; 52 females; real rTMS n = 33 and sham rTMS n = 27) completed the trial and five patients dropped out. Over 12 weeks, the responder's rate in the number of migraine days was significantly higher in the real rTMS compared to the sham group (42% vs. 26%, p < 0.05). The mean migraine days per month decreased from 7.6 to 4.3 days in the real rTMS group and from 6.2 to 4.3 days in the sham rTMS group, resulting in a difference with real vs. sham rTMS of -3.2 days (p < 0.05). Similarly, over the 12-week period, the responder's rate in the reduction of migraine attacks frequency was higher in the real rTMS compared to the sham group (42% vs 33%, p < 0.05). No serious adverse events were observed. CONCLUSION Our pilot study shows compelling evidence in a double placebo-controlled trial that multifocal rTMS is an effective and well-tolerated preventive treatment in patients with episodic migraine.
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Affiliation(s)
- Pavel Leahu
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Manuel Bange
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Stefanie Scheiter
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexandru Matei
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Venkata C Chirumamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stanislav A Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Ciolac D, Crivorucica I, Zota E, Gorincioi N, Efremova D, Manea D, Crivorucica V, Ciocanu M, Groppa SA. Extensive cerebellar involvement and cognitive impairment in COVID-19-associated acute necrotizing encephalopathy. Ther Adv Neurol Disord 2021; 14:1756286420985175. [PMID: 33613691 PMCID: PMC7869150 DOI: 10.1177/1756286420985175] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022] Open
Abstract
Neurological complications of the newly appeared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly recognized. Here, we report a case of a young male presenting with a clinical and neuroimaging scenario of an acute necrotizing encephalopathy related to the coronavirus disease 2019 (COVID-19). This case is notable by its distinct pattern of magnetic resonance imaging findings of an extensive involvement of the cerebellum, and emergence of cognitive and behavioral impairment.
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Affiliation(s)
- Dumitru Ciolac
- Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | | | - Eremei Zota
- Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | | | | | - Diana Manea
- Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | | | - Mihail Ciocanu
- Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Stanislav A Groppa
- Department of Neurology, Institute of Emergency Medicine, Toma Ciorba Street 1, Chisinau, 2004, Republic of Moldova
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Mikulík R, Caso V, Bornstein NM, Svobodová V, Pezzella FR, Grecu A, Simsic S, Gdovinova Z, Członkowska A, Mishchenko TS, Flomin Y, Milanov IG, Andonova S, Tiu C, Arsovska A, Budinčević H, Groppa SA, Bereczki D, Kõrv J, Kharitonova T, Vosko MR. Enhancing and accelerating stroke treatment in Eastern European region: Methods and achievement of the ESO EAST program. Eur Stroke J 2020; 5:204-212. [PMID: 32637654 DOI: 10.1177/2396987319897156] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/03/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern Europe. Here, we describe its methods and milestones. Patients and methods The ESO EAST program is using an implementation strategy based on a 'detecting-understanding-reducing disparities' conceptual framework: stroke care quality is first measured (after developing a platform for data collection), gaps are identified in the current service delivery, and ultimately feedback is provided to participating hospitals, followed by the application of interventions to reduce disparities. The ESO EAST program is carried out by establishing a stroke quality registry, stroke management infrastructure, and creating education and training opportunities for healthcare professionals. Results Program management and leadership infrastructure has been established in 19 countries (Country Representatives in 22 countries, National Steering Committee in 19 countries). A software platform for data collection and analysis: Registry of Stroke Care Quality was developed, and launched in 2016, and has been used to collect data from over 90,000 patients from >750 hospitals and 56 countries between September 2016 and May 2019. Training in thrombolysis, nursing and research skills has been initiated. Discussion ESO EAST is the first pan-Eastern European (and beyond) multifaceted quality improvement intervention putting evidence-informed policies into practice. Continuous monitoring of stroke care quality allows hospital-to-hospital and country-to-country benchmarking and identification of the gaps and needs in health care.
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Affiliation(s)
- Robert Mikulík
- International Clinical Research Center and Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Valeria Caso
- Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Natan M Bornstein
- Shaare Zedek Medical center, Jerusalem, Tel Aviv University, Tel Aviv, Israel
| | - Veronika Svobodová
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | | | - Andreea Grecu
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Steven Simsic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Zuzana Gdovinova
- Faculty of Medicine, Department of Neurology, P.J. Šafárik University, University Hospital L. Pasteur, Košice, Slovakia
| | - Anna Członkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tamara S Mishchenko
- Department of Clinical Neurology, Psychiatry and Narcology, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Yuriy Flomin
- Comprehensive Stroke Unit, MC 'Universal Clinic 'Oberig', Kyiv, Ukraine
| | - Ivan G Milanov
- Neurology Clinic, Medical University of Sofia, Sofia, Bulgaria
| | - Silva Andonova
- Medical University - Varna, University Hospital "St. Marina" Second Clinic of Neurology with ICU and Stroke Unit, Varna, Bulgaria
| | - Cristina Tiu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Anita Arsovska
- University Clinic of Neurology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, North Macedonia
| | - Hrvoje Budinčević
- Department of Neurology, Stroke and Intensive Care Unit, Sveti Duh University Hospital, Zagreb, Croatia
| | - Stanislav A Groppa
- Department of Neurology and Neurosurgery, National Center of Epileptology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, State University of Medicine and Pharmacy "Nicolae Testemiţanu," Chisinau, Moldova
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tatiana Kharitonova
- Department of Acute Cerebrovascular Pathology and Emergency Neurology, Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze, Saint-Petersburg, Russia
| | - Milan R Vosko
- Department of Neurology, Med Campus III, Kepler University Hospital, Linz, Austria
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Chiosa V, Groppa SA, Ciolac D, Koirala N, Mişina L, Winter Y, Moldovanu M, Muthuraman M, Groppa S. Breakdown of Thalamo-Cortical Connectivity Precedes Spike Generation in Focal Epilepsies. Brain Connect 2017; 7:309-320. [DOI: 10.1089/brain.2017.0487] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vitalie Chiosa
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Neurology and Neurosurgery, National Center of Epileptology, Institute of Emergency Medicine, Chisinau, Moldova
- Laboratory of Neurobiology and Medical Genetics, State University of Medicine and Pharmacy “Nicolae Testemiţanu,” Chisinau, Moldova
| | - Stanislav A. Groppa
- Department of Neurology and Neurosurgery, National Center of Epileptology, Institute of Emergency Medicine, Chisinau, Moldova
- Laboratory of Neurobiology and Medical Genetics, State University of Medicine and Pharmacy “Nicolae Testemiţanu,” Chisinau, Moldova
| | - Dumitru Ciolac
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Neurology and Neurosurgery, National Center of Epileptology, Institute of Emergency Medicine, Chisinau, Moldova
- Laboratory of Neurobiology and Medical Genetics, State University of Medicine and Pharmacy “Nicolae Testemiţanu,” Chisinau, Moldova
| | - Nabin Koirala
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Liudmila Mişina
- Department of Neurology and Neurosurgery, National Center of Epileptology, Institute of Emergency Medicine, Chisinau, Moldova
- Laboratory of Neurobiology and Medical Genetics, State University of Medicine and Pharmacy “Nicolae Testemiţanu,” Chisinau, Moldova
| | - Yaroslav Winter
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Muthuraman Muthuraman
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Neuroimaging and Neurostimulation, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Hanganu A, Groppa SA, Deuschl G, Siebner H, Moeller F, Siniatchkin M, Stephani U, Groppa S. Cortical Thickness Changes Associated with Photoparoxysmal Response. Brain Topogr 2014; 28:702-709. [PMID: 24487625 DOI: 10.1007/s10548-014-0353-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 01/18/2014] [Indexed: 11/29/2022]
Abstract
Photoparoxysmal response (PPR) is an EEG trait of spike and spike-wave discharges in response to photic stimulation that is closely linked to idiopathic generalized epilepsy (IGE). In our previous studies we showed that PPR is associated with functional alterations in the occipital and frontal cortices. The aim of the present study was to determine structural changes associated with PPR. For this purpose we analysed the cortical thickness as derived from T1 MRI images in PPR-positive-subjects (n = 12; 15.5 ± 8.6 years; 4 males), PPR-positive-IGE-patients (n = 12; 14.9 ± 2.7 years; 4 males) and compared these groups with a group of PPR-negative-healthy-controls (HC, n = 17; 15.3 ± 3.6 years; 6 males). Our results revealed an increase of cortical thickness in the occipital, frontal and parietal cortices bilaterally in PPR-positive-subjects in comparison to HC. Moreover PPR-positive-subjects presented a significant decrease of cortical thickness in the temporal cortex in the same group contrast. IGE patients exhibited lower cortical thickness in the temporal lobe bilaterally and in the right paracentral region in comparison to PPR-positive-subjects. Our study demonstrates structural changes in the occipital lobe, frontoparietal regions and temporal lobe, which also show functional changes associated with PPR. Patients with epilepsy present changes in the temporal lobe and supplementary motor area.
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Affiliation(s)
- Alexandru Hanganu
- Clinic of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany.,Department of Neurology and Neurosurgery, National Scientifico-Practical Centre of Emergency Medicine, Medical and Pharmaceutical University Nicolae Testemiţanu, Chişinău, Moldova
| | - Stanislav A Groppa
- Department of Neurology and Neurosurgery, National Scientifico-Practical Centre of Emergency Medicine, Medical and Pharmaceutical University Nicolae Testemiţanu, Chişinău, Moldova
| | - Günther Deuschl
- Clinic of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Hartwig Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital of Hvidovre, Hvidovre, Denmark.,Institute of Neurology, Psychiatry and Senses, University of Copenhagen, Copenhagen, Denmark
| | - Friederike Moeller
- Clinic of Neuropediatrics, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Michael Siniatchkin
- Clinic of Neuropediatrics, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Ulrich Stephani
- Clinic of Neuropediatrics, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Sergiu Groppa
- Clinic of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany.
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Badalian LO, Morozov GV, Chekhonin VP, Groppa SA, Lebedev AS, Makhal'chuk LT. [Clinico-immunochemical study of late hereditary-degenerative diseases of the nervous system]. Klin Med (Mosk) 1991; 69:35-8. [PMID: 1839409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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