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Gavriilaki M, Chatzikyriakou E, Moschou M, Arnaoutoglou M, Sakellari I, Kimiskidis VK. Therapeutic Biomarkers in Friedreich's Ataxia: a Systematic Review and Meta-analysis. Cerebellum 2024; 23:1184-1203. [PMID: 37889470 DOI: 10.1007/s12311-023-01621-6] [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] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 10/28/2023]
Abstract
Although a large array of biomarkers have been investigated in Friedreich's ataxia (FRDA) trials, the optimal biomarker for assessing disease progression or therapeutic benefit has yet to be identified. We searched PubMed, MEDLINE, and EMBASE databases up to June 2023 for any original study (with ≥ 5 participants and ≥ 2 months' follow-up) reporting the effect of therapeutic interventions on any clinical, cardiac, biochemical, patient-reported outcome measures, imaging, or neurophysiologic biomarker. We also explored the biomarkers' ability to detect subtle disease progression in untreated patients. The pooled standardized mean difference (SMD) was calculated using a random-effects model. The study's protocol was registered in PROSPERO (CRD42022319196). In total, 43 studies with 1409 FRDA patients were included in the qualitative synthesis. A statistically significant improvement was observed in Friedreich Ataxia Rating Scale scores [combining Friedreich Ataxia Rating Scale (FARS) and modified FARS (mFARS): SMD = - 0.32 (- 0.62 to - 0.02)] following drugs that augment mitochondrial function in a sensitivity analysis. Left ventricular mass index (LVMI) was improved significantly [SMD = - 0.34 (- 0.5 to - 0.18)] after 28.5 months of treatment with drugs that augment mitochondrial function. However, LVMI remained stable [SMD = 0.05 (- 0.3 to 0.41)] in untreated patients after 6-month follow-up. None of the remaining biomarkers changed significantly following any treatment intervention nor during the natural disease progression. Nevertheless, clinical implications of these results should be interpreted with caution because of low to very low quality of evidence. Further randomized controlled trials of at least 24 months' duration using a biomarker toolbox rather than a single biomarker are warranted.
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Affiliation(s)
- Maria Gavriilaki
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Evangelia Chatzikyriakou
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Maria Moschou
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Marianthi Arnaoutoglou
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Sakellari
- Hematology Department, Hematopoietic Cell Transplantation Unit, Gene and Cell Therapy Center, "George Papanikolaou" Hospital, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
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Vonck K, Biraben A, Bosak M, Jennum PJ, Kimiskidis VK, Marusic P, Mitchell JW, Ferreira LN, Ondrušová M, Pana A, Persson U, von Oertzen TJ, Lattanzi S. Usage and impact of patient-reported outcomes in epilepsy. Brain Behav 2023; 13:e3342. [PMID: 37997564 PMCID: PMC10726862 DOI: 10.1002/brb3.3342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The use of patient-reported outcomes (PRO) in clinical practice is gaining increasing attention. This study aimed to provide a critical assessment of the current state-of-the-art and beliefs about the use of PRO in the management of people with epilepsy across some European countries. METHODS Structured interviews were conducted with European experts to collect insights about (I) the personal experience with PRO; (II) the value and impact of PRO in the decision-making process at the national level; and (III) the interest for and use of PRO by national health authorities. RESULTS Nine neurologists (Austria, Belgium, Czechia, Denmark, France, Greece, Italy, Poland, and United Kingdom), three health economists (Portugal, Romania, and Sweden), and one epidemiologist (Slovakia) participated. They all stated that PRO are collected at their own countries in the context of clinical trials and/or specific projects. During everyday clinical practice, PRO are collected routinely/almost routinely in Austria and Sweden and only at the discretion of the treating physicians in Czechia, Denmark, France, Greece, and Portugal. There was complete consensus about the favorable impact that the PRO can have in terms of clinical outcomes, healthcare resources utilization, and general patient satisfaction. Only participants from Portugal and Sweden answered that the PRO are perceived as very important by the National Health Authorities of their respective countries. CONCLUSIONS Differences exist in attitudes and perspectives about PRO in epilepsy across Europe. An active plan is warranted to harmonize the measurement of PRO and ensure they can be relevant to people with epilepsy and health services.
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Affiliation(s)
- Kristl Vonck
- Department of Neurology, 4BrainGhent University HospitalGentBelgium
| | - Arnaud Biraben
- Unité d’épileptologie, CHU Pontchaillou RennesRennesFrance
| | - Magdalena Bosak
- Department of NeurologyMedical CollegeJagiellonian UniversityKrakowPoland
| | - Poul Jørgen Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep MedicineRigshospitaletDenmark
| | - Vasilios K Kimiskidis
- First Department of NeurologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Petr Marusic
- Department of NeurologySecond Faculty of Medicine and Motol University Hospital, Charles UniversityPragueCzech Republic
| | - James W. Mitchell
- Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Lara N. Ferreira
- Universidade do Algarve—ESGHTFaroPortugal
- Centre for Health Studies and Research of the University of Coimbra (CEISUC), Centre for Innovative Biomedicine and Biotechnology (CIBB)CoimbraPortugal
- Research Centre for TourismSustainability and Well‐Being (CinTurs), Universidade do AlgarveFaroPortugal
| | - Martina Ondrušová
- Department of Epidemiology and Biostatistics, Pharm‐In, Ltd.BratislavaSlovakia
- Faculty of Public HealthSlovak Medical UniversityBratislavaSlovakia
| | - Adrian Pana
- School of Public Health, Babes Bolyai University Cluj NapocaCenter for Health Outcomes & EvaluationCluj‐NapocaRomania
| | - Ulf Persson
- The Swedish Institute for Health EconomicsLundSweden
| | - Tim J. von Oertzen
- Center for Medicine of the Elderly, Kepler University HospitalJohannes Kepler UniversityLinzAustria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical MedicineMarche Polytechnic UniversityAnconaItaly
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Gavriilaki M, Papaliagkas V, Stamperna A, Moschou M, Notas K, Papagiannopoulos S, Arnaoutoglou M, Kimiskidis VK. Biomarkers of therapeutic efficacy in adolescents and adults with 5q spinal muscular atrophy: a systematic review. Acta Neurol Belg 2023; 123:1735-1745. [PMID: 35861914 DOI: 10.1007/s13760-022-02028-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The therapeutic landscape of spinal muscular atrophy (SMA) was dramatically transformed with the introduction of three disease-modifying therapies (DMTs). A systematic review was performed to assess available evidence regarding quantitative therapeutic biomarkers used in SMA patients older than 11 years under treatment with DMTs. METHODS Latest literature search in MEDLINE, EMBASE, Cochrane databases and gray literature resources was performed in June 2021. Studies reporting only motor function or muscle strength scales or pulmonary function tests were excluded. Primary outcome was the change from baseline score of any serum, cerebrospinal fluid (CSF) or neurophysiologic biomarker examined. RESULTS Database and gray literature search yielded a total of 8050 records. We identified 14 records published from 2019 until 2021 examining 18 putative serum, CSF or neurophysiologic biomarkers along with routine CSF parameters in 295 SMA nusinersen-treated type 2-4 patients older than 11 years of age. There is evidence based on real-world observational studies suggesting that serum creatinine, creatine kinase activity levels along with CSF Αβ42, glial fibrillary acidic protein concentration as well as ulnar compound motor action potential amplitude and single motor unit potential amplitude changes may depict therapeutic response in this population. CONCLUSION This systematic review explored for the first-time biomarkers used to monitor therapeutic efficacy in SMA adolescents and adults treated with DMTs. Research in this area is in its early stages, and our systematic review can facilitate selection of quantitative therapeutic biomarkers that may be used as surrogate measures of treatment efficacy in future trials. PROTOCOL REGISTRATION PROSPERO CRD42021245516.
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Affiliation(s)
- Maria Gavriilaki
- 1st Department of Neurology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kyriakidi Str. 1, 546 36, Thessaloniki, Greece.
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Alexandra Stamperna
- 2nd Department of Pediatrics, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Moschou
- 1st Department of Neurology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kyriakidi Str. 1, 546 36, Thessaloniki, Greece
| | - Konstantinos Notas
- Laboratory of Clinical Neurophysiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios Papagiannopoulos
- 3rd Department of Neurology, School of Medicine, G. Papanicolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianthi Arnaoutoglou
- Laboratory of Clinical Neurophysiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- 1st Department of Neurology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kyriakidi Str. 1, 546 36, Thessaloniki, Greece
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Liouta E, Poulidou V, Frontistis A, Moschou M, Fidani S, Papoulidis I, Spilioti M, Kimiskidis VK, Arnaoutoglou M. Charcot-Marie-Tooth Disease Type 2-Like Phenotype due to a Novel Variant in the Stalk Domain of KIF5A. Neurol India 2023; 71:577-579. [PMID: 37322770 DOI: 10.4103/0028-3886.378650] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Eleni Liouta
- First Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, Thessaloniki, Greece
| | - Vasiliki Poulidou
- First Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, Thessaloniki, Greece
| | - Antonios Frontistis
- First Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, Thessaloniki, Greece
| | - Maria Moschou
- First Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, Thessaloniki, Greece
| | - Styliani Fidani
- AHEPA Hospital and Department of Biology and Medical Genetics, Medical School, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, Thessaloniki, Greece
| | - Ioannis Papoulidis
- Third Department of Obstetrics and Gynaecology, Department of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49; Access to Genome - ATG, P.C., Ethnikis Antistaseos 33A, Thessaloniki, Greece
| | - Martha Spilioti
- First Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- First Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, Thessaloniki, Greece
| | - Marianthi Arnaoutoglou
- First Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital; Laboratory of Clinical Neurophysiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, Thessaloniki, Greece
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Papadopoulou E, Pepe G, Konitsiotis S, Chondrogiorgi M, Grigoriadis N, Kimiskidis VK, Tsivgoulis G, Mitsikostas DD, Chroni E, Domouzoglou E, Tsaousis G, Nasioulas G. The evolution of comprehensive genetic analysis in neurology: Implications for precision medicine. J Neurol Sci 2023; 447:120609. [PMID: 36905813 DOI: 10.1016/j.jns.2023.120609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
Technological advancements have facilitated the availability of reliable and thorough genetic analysis in many medical fields, including neurology. In this review, we focus on the importance of selecting the appropriate genetic test to aid in the accurate identification of disease utilizing currently employed technologies for analyzing monogenic neurological disorders. Moreover, the applicability of comprehensive analysis via NGS for various genetically heterogeneous neurological disorders is reviewed, revealing its efficiency in clarifying a frequently cloudy diagnostic picture and delivering a conclusive and solid diagnosis that is essential for the proper management of the patient. The feasibility and effectiveness of medical genetics in neurology require interdisciplinary cooperation among several medical specialties and geneticists, to select and perform the most relevant test according to each patient's medical history, using the most appropriate technological tools. The prerequisites for a comprehensive genetic analysis are discussed, highlighting the utility of appropriate gene selection, variant annotation, and classification. Moreover, genetic counseling and interdisciplinary collaboration could improve diagnostic yield further. Additionally, a sub-analysis is conducted on the 1,502,769 variation records with submitted interpretations in the Clinical Variation (ClinVar) database, with a focus on neurology-related genes, to clarify the value of suitable variant categorization. Finally, we review the current applications of genetic analysis in the diagnosis and personalized management of neurological patients and the advances in the research and scientific knowledge of hereditary neurological disorders that are evolving the utility of genetic analysis towards the individualization of the treatment strategy.
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Affiliation(s)
| | - Georgia Pepe
- GeneKor Medical SA, Spaton 52, Gerakas 15344, Greece
| | - Spiridon Konitsiotis
- Department of Neurology, University of Ioannina, Stavrou Niarchou Avenue, Ioannina 45500, Greece
| | - Maria Chondrogiorgi
- Department of Neurology, University of Ioannina, Stavrou Niarchou Avenue, Ioannina 45500, Greece
| | - Nikolaos Grigoriadis
- Second Department of Neurology, "AHEPA" University Hospital, Aristotle University of Thessaloniki, St. Kiriakidis 1, Thessaloniki 54636, Greece
| | - Vasilios K Kimiskidis
- First Department of Neurology, "AHEPA" University hospital, Aristotle University of Thessaloniki, St. Kiriakidis 1, Thessaloniki 54636, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Rio-Patras, Greece
| | - Eleni Domouzoglou
- Department of Pediatrics, University Hospital of Ioannina, Stavrou Niarchou Avenue, Ioannina 45500, Greece
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Julkunen P, Kimiskidis VK, Belardinelli P. Special issue on TMS-EEG methods, data analysis and processing. J Neurosci Methods 2023; 383:109735. [PMID: 36374722 DOI: 10.1016/j.jneumeth.2022.109735] [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: 11/07/2022]
Affiliation(s)
- Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Vasilios K Kimiskidis
- 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paolo Belardinelli
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Italy; Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
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Tzirini M, Roth Y, Harmelech T, Zibman S, Pell GS, Kimiskidis VK, Tendler A, Zangen A, Samaras T. Detailed measurements and simulations of electric field distribution of two TMS coils cleared for obsessive compulsive disorder in the brain and in specific regions associated with OCD. PLoS One 2022; 17:e0263145. [PMID: 36040972 PMCID: PMC9426893 DOI: 10.1371/journal.pone.0263145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
The FDA cleared deep transcranial magnetic stimulation (Deep TMS) with the H7 coil for obsessive-compulsive disorder (OCD) treatment, following a double-blinded placebo-controlled multicenter trial. Two years later the FDA cleared TMS with the D-B80 coil on the basis of substantial equivalence. In order to investigate the induced electric field characteristics of the two coils, these were placed at the treatment position for OCD over the prefrontal cortex of a head phantom, and the field distribution was measured. Additionally, numerical simulations were performed in eight Population Head Model repository models with two sets of conductivity values and three Virtual Population anatomical head models and their homogeneous versions. The H7 was found to induce significantly higher maximal electric fields (p<0.0001, t = 11.08) and to stimulate two to five times larger volumes in the brain (p<0.0001, t = 6.71). The rate of decay of electric field with distance is significantly slower for the H7 coil (p < 0.0001, Wilcoxon matched-pairs test). The field at the scalp is 306% of the field at a 3 cm depth with the D-B80, and 155% with the H7 coil. The H7 induces significantly higher intensities in broader volumes within the brain and in specific brain regions known to be implicated in OCD (dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (dlPFC), inferior frontal gyrus (IFG), orbitofrontal cortex (OFC) and pre-supplementary motor area (pre-SMA)) compared to the D-B80. Significant field ≥ 80 V/m is induced by the H7 (D-B80) in 15% (1%) of the dACC, 78% (29%) of the pre-SMA, 50% (20%) of the dlPFC, 30% (12%) of the OFC and 15% (1%) of the IFG. Considering the substantial differences between the two coils, the clinical efficacy in OCD should be tested and verified separately for each coil.
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Affiliation(s)
- Marietta Tzirini
- School of Physics, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- THESS, Thessaloniki Software Solution S.A., Thessaloniki, Greece
- * E-mail:
| | - Yiftach Roth
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- BrainsWay Ltd., Jerusalem, Israel
| | | | | | - Gaby S. Pell
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- BrainsWay Ltd., Jerusalem, Israel
| | - Vasilios K. Kimiskidis
- 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aron Tendler
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- BrainsWay Ltd., Jerusalem, Israel
- Advanced Mental Health Care Inc., United States of America
| | - Abraham Zangen
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Theodoros Samaras
- School of Physics, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Physics, University of Malta, Msida, Malta
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Mitkani CA, Tegos TT, Kimiskidis VK, Fountoulakis KN. Major depression precedes the first clinical manifestation of brain small vessel disease. Psychiatry Res 2022; 314:114681. [PMID: 35751999 DOI: 10.1016/j.psychres.2022.114681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/07/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Calypso A Mitkani
- Department of Neurology, Agios Pavlos General Hospital of Thessaloniki, Greece.
| | - Thomas T Tegos
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Poulidou V, Spilioti M, Moschou M, Papanikolaou N, Drevelegas A, Papagiannopoulos S, Kazis D, Kimiskidis VK. Multiple Sclerosis-Related Paroxysmal Kinesigenic Dyskinesia: Long Term, Favorable Response to Lacosamide. J Mov Disord 2022; 15:286-289. [PMID: 35880380 PMCID: PMC9536912 DOI: 10.14802/jmd.22016] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Vasiliki Poulidou
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martha Spilioti
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Moschou
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nickolas Papanikolaou
- Computational Clinical Imaging Group, Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal; Royal Marsden, London, UK; The Institute of Cancer Research, London, UK; Karolinska Institute, Sweden; Institute of Computer Science, The Foundation f
| | - Antonios Drevelegas
- Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece; Department of Radiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios Papagiannopoulos
- 3rd Department of Neurology, "G.Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Kazis
- 3rd Department of Neurology, "G.Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Notas K, Papaliagkas V, Spilioti M, Papagiannis I, Nemtsas P, Poulopoulos A, Kouskouras K, Diakogiannis I, Kimiskidis VK. Primary Sjögren's syndrome presenting with rapidly progressive dementia: a case report. Curr Alzheimer Res 2022; 19:479-484. [PMID: 35761497 DOI: 10.2174/1567205019666220627094707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rapidly progressive dementias (RPDs) are dementias that progress subacutely over a time period of weeks to months. Primary Sjögren's syndrome (pSS) is an autoimmune disease that can affect any organ system and may present with a wide range of clinical features that may mimic a plethora of medical conditions and in rare cases may manifest as RPD. We describe a unique case of pSS, in which rapidly progressive dementia (RPD) was the first disease manifestation and the patient's radiological and electroencephalogram findings were compatible with Creutzfeldt-Jakob disease (CJD). CASE PRESENTATION Here, we report a 58-year-old woman who presented with cognitive impairment rapidly deteriorating over the last 6 months prior to admission. Brain MRI and EEG were indicative of CJD. However, CSF 14-3-3 and tau/phospho tau ratio were within normal limits and therefore alternative diagnoses were considered. Blood tests were significant for positive antinuclear antibodies, anti-ENA and anti-SSA and a lip biopsy was consistent with pSS. The patient was started on intravenous steroids followed by oral prednisone taper, which prevented further deterioration. CONCLUSIONS This rare case expands the spectrum of neurological manifestations in pSS and highlights the importance of considering pSS in the differential diagnosis of RPDs in order to avoid misdiagnosis and provide appropriate treatment in a timely fashion.
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Affiliation(s)
- Konstantinos Notas
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Martha Spilioti
- 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Ioannis Papagiannis
- 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Petros Nemtsas
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Athanasios Poulopoulos
- Department of Oral Medicine and Maxillofacial Pathology, Dental School of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Kouskouras
- Department of Radiology, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Ioannis Diakogiannis
- 1st Department of Psychiatry, Aristotle University of Thessaloniki, General Hospital \'Papageorgiou\', Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636, Thessaloniki, Greece
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Papadopoulou M, Bakola E, Papapostolou A, Stefanou MI, Moschovos C, Salakou S, Zis P, Zouvelou V, Kimiskidis VK, Chroni E, Tsivgoulis G. Autonomic dysfunction in amyotrophic lateral sclerosis: A neurophysiological and neurosonology study. J Neuroimaging 2022; 32:710-719. [PMID: 35344230 DOI: 10.1111/jon.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting upper and lower motor neurons. Some ALS patients exhibit concomitant nonmotor signs, and thus ALS is considered a multisystem disorder. The aim of this study is to investigate autonomous nervous system involvement in ALS. METHODS We investigated 21 ALS patients and 28 age-matched controls. ALS patients were assessed for disease severity with the Revised-ALS Functional Rating Scale (ALSFSR) and for the presence of autonomic symptoms with the Composite Autonomic Symptom Score scale. Sympathetic nervous system was evaluated by sympathetic skin response (SSR) and parasympathetic nervous system by ultrasonography of vagus nerve (VN) at the level of the thyroid gland. RESULTS SSR latencies were shorter and SSR amplitudes were higher in controls compared to ALS patients. The cross-sectional area (CSA) of the VN was significantly smaller in ALS patients (mean CSA right/left: 1.73±0.62 mm2 /1.47±0.53 mm2 ) compared to controls (mean CSA right/left: 2.91±0.79 mm2 /2.30±0.80 mm2 ), right: p <. 001, left: p <. 001. There was a significant negative correlation between disease duration and CSA of left-VN (r = -0.493, p = .023). This correlation was attenuated between disease duration and CSA of right-VN (r = -0.419, p = .059). ALSFSR-R was positively correlated to CSA of right-VN (p = .006, r = 0.590). CSA of VN did not correlate with bulbar involvement. CONCLUSIONS This study confirms the presence of autonomic dysfunction in ALS patients and provides evidence of VN atrophy that correlates with disease severity and duration and is independent of bulbar involvement. Degeneration of dorsal nucleus neurons of the VN is hypothesized.
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Affiliation(s)
- Marianna Papadopoulou
- Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece.,Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Apostolos Papapostolou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Maria Ioanna Stefanou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Christos Moschovos
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Stavroula Salakou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Panagiotis Zis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.,Medical School, University of Cyprus, Nicosia, Cyprus.,Medical School, University of Sheffield, Sheffield, UK
| | - Vasiliki Zouvelou
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginitio University Hospital, Athens, Greece
| | - Vasilios K Kimiskidis
- First Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Rio-Patras, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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Zis P, Liampas A, Artemiadis A, Tsalamandris G, Neophytou P, Unwin Z, Kimiskidis VK, Hadjigeorgiou GM, Varrassi G, Zhao Y, Sarrigiannis PG. EEG Recordings as Biomarkers of Pain Perception: Where Do We Stand and Where to Go? Pain Ther 2022; 11:369-380. [PMID: 35322392 PMCID: PMC9098726 DOI: 10.1007/s40122-022-00372-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The universality and complexity of pain, which is highly prevalent, yield its significance to both patients and researchers. Developing a non-invasive tool that can objectively measure pain is of the utmost importance for clinical and research purposes. Traditionally electroencephalography (EEG) has been mostly used in epilepsy; however, over the recent years EEG has become an important non-invasive clinical tool that has helped increase our understanding of brain network complexities and for the identification of areas of dysfunction. This review aimed to investigate the role of EEG recordings as potential biomarkers of pain perception. Methods A systematic search of the PubMed database led to the identification of 938 papers, of which 919 were excluded as a result of not meeting the eligibility criteria, and one article was identified through screening of the reference lists of the 19 eligible studies. Ultimately, 20 papers were included in this systematic review. Results Changes of the cortical activation have potential, though the described changes are not always consistent. The most consistent finding is the increase in the delta and gamma power activity. Only a limited number of studies have looked into brain networks encoding pain perception. Conclusion Although no robust EEG biomarkers of pain perception have been identified yet, EEG has potential and future research should be attempted. Designing strong research protocols, controlling for potential risk of biases, as well as investigating brain networks rather than isolated cortical changes will be crucial in this attempt. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-022-00372-2.
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Affiliation(s)
- Panagiotis Zis
- Medical School, University of Cyprus, Nicosia, Cyprus
- Medical School, University of Sheffield, Sheffield, UK
- Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | - Andreas Liampas
- Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | - Artemios Artemiadis
- Medical School, University of Cyprus, Nicosia, Cyprus
- Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | | | - Zoe Unwin
- Department of Clinical Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Vasilios K. Kimiskidis
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios M. Hadjigeorgiou
- Medical School, University of Cyprus, Nicosia, Cyprus
- Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Yifan Zhao
- School of Aerospace, Transport and Manufacturing, Cranfield University, Cranfield, UK
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Gavriilaki M, Moschou M, Papaliagkas V, Notas K, Chatzikyriakou E, Papagiannopoulos S, Arnaoutoglou M, Kimiskidis VK. Nusinersen in Adults with 5q Spinal Muscular Atrophy: a Systematic Review and Meta-analysis. Neurotherapeutics 2022; 19:464-475. [PMID: 35178673 PMCID: PMC9226250 DOI: 10.1007/s13311-022-01200-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 01/18/2023] Open
Abstract
Evidence for nusinersen administration in adult 5q spinal muscular atrophy (5q-SMA) patients is scarce and based on real-world observational data. The present systematic review and meta-analysis aimed to explore the efficacy and safety of nusinersen in patients older than 12 years of age with 5q-SMA. We searched MEDLINE, EMBASE, the Cochrane Library, and grey literature through April 2021. Cross-sectional studies, case reports, review articles, and studies with follow-up less than 6 months were excluded. We included 12 records (seven case-series, five cohorts) representing 11 population cohorts and enrolling 428 SMA patients. We observed statistically significant improvements on motor function Hammersmith Functional Motor Scale Expanded (HFMSE) and Revised Upper Limb Module (RULM) scores at the longest follow-up assessments [SMD = 0.17(95% CI 0.01-0.33), SMD = 0.22(95% CI 0.06-0.38), respectively]. HFMSE and RULM significant improvements were also detected at the subgroup analysis during 10 and 14 months. HFMSE and RULM amelioration occurred earlier in patients with SMA type 3 or 4 during short-term analysis (≤ 6 months). 6-min walk tests (6MWT) and pulmonary function tests did not change. Minimal clinically important differences in HFMSE and RULM were observed in 43.3% (95% CI 34.5-52.3) and 38.9% (95% CI 27.7-50.7), respectively. Severe adverse events were reported in 2% (95% CI 0-5.8). Treatment withdrawal rate was 3% (95% CI 0.5-6.6). Despite the low quality of evidence and the unmet need for randomized data to establish the safety and efficacy of nusinersen in adults, our meta-analysis confirms that nusinersen is a valuable treatment option for older patients with longer-disease duration.Trial registration: PROSPERO database CRD42020223109.
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Affiliation(s)
- Maria Gavriilaki
- 1st Department of Neurology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- School of Medicine, University Campus, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Maria Moschou
- 1st Department of Neurology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, Nea Moudania, Greece
| | - Konstantinos Notas
- Laboratory of Clinical Neurophysiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Chatzikyriakou
- Laboratory of Clinical Neurophysiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios Papagiannopoulos
- 3rd Department of Neurology, School of Medicine, G. Papanicolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianthi Arnaoutoglou
- Laboratory of Clinical Neurophysiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- 1st Department of Neurology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Papaliagkas V, Foroglou N, Toulios P, Moschou M, Gavriilaki M, Notas K, Chatzikyriakou E, Zafeiridou G, Arnaoutoglou M, Kimiskidis VK. Intrathecal Administration of Nusinersen Using the Ommaya Reservoir in an Adult with 5q-Related Spinal Muscular Atrophy Type 1 and Severe Spinal Deformity. Case Rep Neurol 2021; 13:710-715. [PMID: 34950009 PMCID: PMC8647073 DOI: 10.1159/000519831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022] Open
Abstract
Spinal muscular atrophy (SMA) is a hereditary neuromuscular disorder, typically caused by survival motor neuron 1 (SMN1) gene deletion in chromosome 5q resulting in loss of SMN protein. SMA type 1 progresses rapidly leading to increased mortality usually before the age of 2 years. Nusinersen, the first approved disease-modifying treatment for all 5q-SMA types and ages, is an antisense oligonucleotide administered intrathecally via repeated lumbar punctures. However, adult SMA patients typically present with severe scoliosis and spinal deformity. We present a 28-year-old patient with SMA type 1 and severe spinal deformity, who received nusinersen via a subcutaneously implanted Ommaya reservoir connected with an intrathecal catheter at the thoracic level. The repetitive administrations were completed uneventfully, obviating the need for repeated laborious lumbar punctures and eliminating radiation exposure. In adult SMA patients, performing recurrent lumbar punctures can be technically challenging raising the need for an alternative route of administration. The use of Ommaya reservoirs is a viable, practical for repeated infusions, and safe option for the intrathecal delivery of nusinersen for select cases such as an adult SMA type 1 survivor with severe spinal deformity.
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Affiliation(s)
- Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Nikolaos Foroglou
- 1st Department of Neurosurgery, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Moschou
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Gavriilaki
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Notas
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Chatzikyriakou
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Zafeiridou
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianthi Arnaoutoglou
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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15
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Vlachos I, Kugiumtzis D, Tsalikakis DG, Kimiskidis VK. TMS-induced brain connectivity modulation in Genetic Generalized Epilepsy. Clin Neurophysiol 2021; 133:83-93. [PMID: 34814019 DOI: 10.1016/j.clinph.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/30/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In epilepsy patients, Transcranial Magnetic Stimulation (TMS) may result in the induction and modulation of epileptiform discharges (EDs). We hereby investigate the modulatory effects of TMS on brain connectivity in Genetic Generalized Epilepsy (GGE) and explore their potential as a diagnostic biomarker in GGE. METHODS Patients with GGE (n=18) and healthy controls (n=11) were investigated with a paired-pulse TMS-EEG protocol. The brain network was studied at local and at global levels using Coherence as an EEG connectivity measure. Comparison of patients vs controls was performed in a time-resolved manner by analyzing comparatively pre- vs post-TMS brain networks. RESULTS There was statistically significant TMS-induced modulation of connectivity at specific frequency bands within groups and difference in TMS-induced modulation between the two groups. The most significant difference between patients and controls related to connectivity modulation in the γ band at 1-3 sec post-TMS (p=0.004). CONCLUSIONS TMS modulates the healthy and epileptic brain connectivity in different ways. Our results indicate that TMS-EEG connectivity analysis can be a basis for a diagnostic biomarker of GGE. SIGNIFICANCE The analysis identifies specific time periods and frequency bands of interest of TMS-induced connectivity modulation and elucidates the effect of TMS on the healthy and epileptic brain connectivity.
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Affiliation(s)
- Ioannis Vlachos
- 1(st) Department of Clinical Neurology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece; Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
| | - Dimitris Kugiumtzis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
| | - Dimitris G Tsalikakis
- Department of Electrical and Computer Engineering, University of Western Macedonia, Kozani 50100, Greece.
| | - Vasilios K Kimiskidis
- 1(st) Department of Clinical Neurology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
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16
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Bourbouli M, Paraskevas GP, Rentzos M, Mathioudakis L, Zouvelou V, Bougea A, Tychalas A, Kimiskidis VK, Constantinides V, Zafeiris S, Tzagournissakis M, Papadimas G, Karadima G, Koutsis G, Kroupis C, Kartanou C, Kapaki E, Zaganas I. Genotyping and Plasma/Cerebrospinal Fluid Profiling of a Cohort of Frontotemporal Dementia-Amyotrophic Lateral Sclerosis Patients. Brain Sci 2021; 11:brainsci11091239. [PMID: 34573259 PMCID: PMC8472580 DOI: 10.3390/brainsci11091239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/05/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Abstract
Frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) are part of the same pathophysiological spectrum and have common genetic and cerebrospinal fluid (CSF) biomarkers. Our aim here was to identify causative gene variants in a cohort of Greek patients with FTD, ALS and FTD-ALS, to measure levels of CSF biomarkers and to investigate genotype-phenotype/CSF biomarker associations. In this cohort of 130 patients (56 FTD, 58 ALS and 16 FTD-ALS), we performed C9orf72 hexanucleotide repeat expansion analysis, whole exome sequencing and measurement of “classical” (Aβ42, total tau and phospho-tau) and novel (TDP-43) CSF biomarkers and plasma progranulin. Through these analyses, we identified 14 patients with C9orf72 repeat expansion and 11 patients with causative variants in other genes (three in TARDBP, three in GRN, three in VCP, one in FUS, one in SOD1). In ALS patients, we found that levels of phospho-tau were lower in C9orf72 repeat expansion and MAPT c.855C>T (p.Asp285Asp) carriers compared to non-carriers. Additionally, carriers of rare C9orf72 and APP variants had lower levels of total tau and Aβ42, respectively. Plasma progranulin levels were decreased in patients carrying GRN pathogenic variants. This study expands the genotypic and phenotypic spectrum of FTD/ALS and offers insights in possible genotypic/CSF biomarker associations.
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Affiliation(s)
- Mara Bourbouli
- Neurogenetics Laboratory, Neurology Department, Medical School, University of Crete, 71003 Heraklion, Greece; (M.B.); (L.M.); (S.Z.); (M.T.)
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - George P. Paraskevas
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece
| | - Mihail Rentzos
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - Lambros Mathioudakis
- Neurogenetics Laboratory, Neurology Department, Medical School, University of Crete, 71003 Heraklion, Greece; (M.B.); (L.M.); (S.Z.); (M.T.)
| | - Vasiliki Zouvelou
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - Anastasia Bougea
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - Athanasios Tychalas
- Department of Neurology, Papageorgiou General Hospital, 56403 Thessaloniki, Greece;
| | - Vasilios K. Kimiskidis
- 1st Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece;
| | - Vasilios Constantinides
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - Spiros Zafeiris
- Neurogenetics Laboratory, Neurology Department, Medical School, University of Crete, 71003 Heraklion, Greece; (M.B.); (L.M.); (S.Z.); (M.T.)
| | - Minas Tzagournissakis
- Neurogenetics Laboratory, Neurology Department, Medical School, University of Crete, 71003 Heraklion, Greece; (M.B.); (L.M.); (S.Z.); (M.T.)
| | - Georgios Papadimas
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - Georgia Karadima
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - Georgios Koutsis
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - Christos Kroupis
- Department of Clinical Biochemistry, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Chrisoula Kartanou
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - Elisabeth Kapaki
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (G.P.P.); (M.R.); (V.Z.); (A.B.); (V.C.); (G.P.); (G.K.); (G.K.); (C.K.); (E.K.)
| | - Ioannis Zaganas
- Neurogenetics Laboratory, Neurology Department, Medical School, University of Crete, 71003 Heraklion, Greece; (M.B.); (L.M.); (S.Z.); (M.T.)
- Correspondence: ; Tel.: +30-2810-394643
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Kimiskidis VK, Schachter S. Introduction. Int J Neural Syst 2021; 31:2103007. [PMID: 34423743 DOI: 10.1142/s0129065721030076] [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: 11/18/2022]
Affiliation(s)
- Vasilios K Kimiskidis
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Steven Schachter
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, 330 Brookline Ave., Boston, MA 02215, USA
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Doundoulakis I, Gavriilaki M, Tsiachris D, Arsenos P, Antoniou CK, Dimou S, Soulaidopoulos S, Farmakis I, Akrivos E, Stoiloudis P, Notas K, Kimiskidis VK, Giannakoulas G, Paraskevaidis S, Gatzoulis KA, Tsioufis K. Atrial High-Rate Episodes in Patients with Devices Without a History of Atrial Fibrillation: a Systematic Review and Meta-analysis. Cardiovasc Drugs Ther 2021; 36:951-958. [PMID: 34089429 DOI: 10.1007/s10557-021-07209-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Accepted: 05/25/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE Atrial high-rate episodes (AHREs) recorded with cardiac implantable electronic devices (CIEDs) have been associated with the development of clinical atrial fibrillation (AF) and increase in stroke and death risk. We sought to perform a systematic review with a meta-analysis to evaluate the prevalence of AHREs detected by CIEDs, their association with stroke risk, development of clinical AF, and mortality among patients without a documented history of AF. METHODS We searched several databases, ClinicalTrials.gov, references of reviews, and meeting abstract books without any language restrictions up to 9 September 2020. We studied patients with CIEDs in whom AHREs were detected. Exclusion criterion was AF history. Our primary outcome was the risk of ischemic stroke in patients with AHREs. RESULTS We deemed eligible eight studies for the meta-analysis enrolling a total of 4322 patients with CIED and without a documented AF history. The overall AHRE incidence ratio was estimated to be 17.56 (95% CI, 8.61 to 35.79) cases per 100 person-years. Evidence of moderate certainty suggests that patients with documented AHREs were 4.45 times (95% CI 2.87-6.91) more likely to develop clinical AF. Evidence of low confidence suggests that AHREs were associated with a 1.90-fold increased stroke risk (95% CI 1.19-3.05). AHREs were not associated with a statistically significant increased mortality risk. CONCLUSION The present systematic review and meta-analysis demonstrated that among patients without a documented history of AF, the detection of AHREs by CIEDs was associated with significant increased risk of clinical AF and stroke. REGISTRATION NUMBER (DOI) Available in https://doi.org/10.17605/OSF.IO/ZRF6M .
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Affiliation(s)
- Ioannis Doundoulakis
- First Department of Cardiology, University of Athens Medical School, Athens, Greece
- Department of Cardiology, 424 General Military Hospital, Thessaloniki, Greece
| | - Maria Gavriilaki
- First Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Petros Arsenos
- First Department of Cardiology, University of Athens Medical School, Athens, Greece
| | | | - Smaro Dimou
- Department of Cardiology, 424 General Military Hospital, Thessaloniki, Greece
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ioannis Farmakis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Akrivos
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Stoiloudis
- Second Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Notas
- First Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- First Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Paraskevaidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Chatzikonstantinou S, Gioula G, Kimiskidis VK, McKenna J, Mavroudis I, Kazis D. The gut microbiome in drug-resistant epilepsy. Epilepsia Open 2021; 6:28-37. [PMID: 33681645 PMCID: PMC7918308 DOI: 10.1002/epi4.12461] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/08/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022] Open
Abstract
Drug-resistant epileptic patients make up approximately one-third of the global epilepsy population. The pathophysiology of drug resistance has not been fully elucidated; however, current evidence suggests intestinal dysbiosis, as a possible etiopathogenic factor. Ketogenic diet, whose effect is considered to be mediated by alteration of gut microbiota synthesis, has long been administered in patients with medically refractory seizures, with positive outcomes. In this review, we present data derived from clinical studies regarding alterations of gut microbiome profile in drug-resistant epileptic patients. We further attempt to describe the mechanisms through which the gut microbiome modification methods (including ketogenic diet, pre- or probiotic administration) improve drug-resistant epilepsy, by reporting findings from preclinical and clinical studies. A comprehensive search of the published literature on the PubMed, Embase, and Web of science databases was performed. Overall, the role of gut microbiome in drug-resistant epilepsy is an area which shows promise for the development of targeted therapeutic interventions. More research is required to confirm the results from preliminary studies, as well as safety and effectiveness of altering gut bacterial composition, through the above-mentioned methods.
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Affiliation(s)
| | - Georgia Gioula
- Microbiology DepartmentMedical SchoolAristotle University of ThessalonikiThessalonikiGreece
| | - Vasilios K. Kimiskidis
- Laboratory of Clinical NeurophysiologyMedical SchoolAristotle University of ThessalonikiThessalonikiGreece
| | | | | | - Dimitrios Kazis
- Third Department of NeurologyAristotle University of ThessalonikiThessalonikiGreece
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20
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Kimiskidis VK. Thirty years of IJNS - A Clinician's View. Int J Neural Syst 2021; 31:2103003. [PMID: 33588714 DOI: 10.1142/s0129065721030039] [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: 11/18/2022]
Affiliation(s)
- Vasilios K Kimiskidis
- Professor of Neurology and Clinical Neurophysiology, 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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21
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Koutlis C, Kimiskidis VK, Kugiumtzis D. Comparison of Causality Network Estimation in the Sensor and Source Space: Simulation and Application on EEG. Front Netw Physiol 2021; 1:706487. [PMID: 36925583 PMCID: PMC10013050 DOI: 10.3389/fnetp.2021.706487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022]
Abstract
The usage of methods for the estimation of the true underlying connectivity among the observed variables of a system is increasing, especially in the domain of neuroscience. Granger causality and similar concepts are employed for the estimation of the brain network from electroencephalogram (EEG) data. Also source localization techniques, such as the standardized low resolution electromagnetic tomography (sLORETA), are widely used for obtaining more reliable data in the source space. In this work, connectivity structures are estimated in the sensor and in the source space making use of the sLORETA transformation for simulated and for EEG data with episodes of spontaneous epileptiform discharges (ED). From the comparative simulation study on high-dimensional coupled stochastic and deterministic systems originating in the sensor space, we conclude that the structure of the estimated causality networks differs in the sensor space and in the source space. Moreover, different network types, such as random, small-world and scale-free, can be better discriminated on the basis of the data in the original sensor space than on the transformed data in the source space. Similarly, in EEG epochs containing epileptiform discharges, the discriminative ability of network topological indices was significantly better in the sensor compared to the source level. In conclusion, causality networks constructed at the sensor and source level, for both simulated and empirical data, exhibit significant structural differences. These observations indicate that further studies are warranted in order to clarify the exact relationship between data registered in the sensor and source space.
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Affiliation(s)
- Christos Koutlis
- Information Technologies Institute, Centre of Research and Technology Hellas, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitris Kugiumtzis
- Division of Electronics and Computing, Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
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22
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Rossi S, Antal A, Bestmann S, Bikson M, Brewer C, Brockmöller J, Carpenter LL, Cincotta M, Chen R, Daskalakis JD, Di Lazzaro V, Fox MD, George MS, Gilbert D, Kimiskidis VK, Koch G, Ilmoniemi RJ, Lefaucheur JP, Leocani L, Lisanby SH, Miniussi C, Padberg F, Pascual-Leone A, Paulus W, Peterchev AV, Quartarone A, Rotenberg A, Rothwell J, Rossini PM, Santarnecchi E, Shafi MM, Siebner HR, Ugawa Y, Wassermann EM, Zangen A, Ziemann U, Hallett M. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clin Neurophysiol 2021; 132:269-306. [PMID: 33243615 PMCID: PMC9094636 DOI: 10.1016/j.clinph.2020.10.003] [Citation(s) in RCA: 446] [Impact Index Per Article: 148.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
This article is based on a consensus conference, promoted and supported by the International Federation of Clinical Neurophysiology (IFCN), which took place in Siena (Italy) in October 2018. The meeting intended to update the ten-year-old safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings (Rossi et al., 2009). Therefore, only emerging and new issues are covered in detail, leaving still valid the 2009 recommendations regarding the description of conventional or patterned TMS protocols, the screening of subjects/patients, the need of neurophysiological monitoring for new protocols, the utilization of reference thresholds of stimulation, the managing of seizures and the list of minor side effects. New issues discussed in detail from the meeting up to April 2020 are safety issues of recently developed stimulation devices and pulse configurations; duties and responsibility of device makers; novel scenarios of TMS applications such as in the neuroimaging context or imaging-guided and robot-guided TMS; TMS interleaved with transcranial electrical stimulation; safety during paired associative stimulation interventions; and risks of using TMS to induce therapeutic seizures (magnetic seizure therapy). An update on the possible induction of seizures, theoretically the most serious risk of TMS, is provided. It has become apparent that such a risk is low, even in patients taking drugs acting on the central nervous system, at least with the use of traditional stimulation parameters and focal coils for which large data sets are available. Finally, new operational guidelines are provided for safety in planning future trials based on traditional and patterned TMS protocols, as well as a summary of the minimal training requirements for operators, and a note on ethics of neuroenhancement.
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Affiliation(s)
- Simone Rossi
- Department of Scienze Mediche, Chirurgiche e Neuroscienze, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab (SI-BIN Lab), University of Siena, Italy.
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany; Institue of Medical Psychology, Otto-Guericke University Magdeburg, Germany
| | - Sven Bestmann
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Carmen Brewer
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jürgen Brockmöller
- Department of Clinical Pharmacology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Linda L Carpenter
- Butler Hospital, Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Massimo Cincotta
- Unit of Neurology of Florence - Central Tuscany Local Health Authority, Florence, Italy
| | - Robert Chen
- Krembil Research Institute and Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - Jeff D Daskalakis
- Center for Addiction and Mental Health (CAMH), University of Toronto, Canada
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico, Roma, Italy
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Mark S George
- Medical University of South Carolina, Charleston, SC, USA
| | - Donald Gilbert
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | | | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering (NBE), Aalto University School of Science, Aalto, Finland
| | - Jean Pascal Lefaucheur
- EA 4391, ENT Team, Faculty of Medicine, Paris Est Creteil University (UPEC), Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, (APHP), Créteil, France
| | - Letizia Leocani
- Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS-San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Sarah H Lisanby
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Spain
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Angel V Peterchev
- Departments of Psychiatry & Behavioral Sciences, Biomedical Engineering, Electrical & Computer Engineering, and Neurosurgery, Duke University, Durham, NC, USA
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alexander Rotenberg
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - John Rothwell
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Paolo M Rossini
- Department of Neuroscience and Rehabilitation, IRCCS San Raffaele-Pisana, Roma, Italy
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yoshikatzu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Eric M Wassermann
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Abraham Zangen
- Zlotowski Center of Neuroscience, Ben Gurion University, Beer Sheva, Israel
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.
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Kimiskidis VK, Schachter S. Introduction. Int J Neural Syst 2020; 30:2003008. [PMID: 33121323 DOI: 10.1142/s0129065720030082] [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: 11/18/2022]
Affiliation(s)
| | - Steven Schachter
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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Gavriilaki M, Kimiskidis VK, Gavriilaki E. Precision Medicine in Neurology: The Inspirational Paradigm of Complement Therapeutics. Pharmaceuticals (Basel) 2020; 13:E341. [PMID: 33114553 PMCID: PMC7693884 DOI: 10.3390/ph13110341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
Precision medicine has emerged as a central element of healthcare science. Complement, a component of innate immunity known for centuries, has been implicated in the pathophysiology of numerous incurable neurological diseases, emerging as a potential therapeutic target and predictive biomarker. In parallel, the innovative application of the first complement inhibitor in clinical practice as an approved treatment of myasthenia gravis (MG) and neuromyelitis optica spectrum disorders (NMOSD) related with specific antibodies raised hope for the implementation of personalized therapies in detrimental neurological diseases. A thorough literature search was conducted through May 2020 at MEDLINE, EMBASE, Cochrane Library and ClinicalTrials.gov databases based on medical terms (MeSH)" complement system proteins" and "neurologic disease". Complement's role in pathophysiology, monitoring of disease activity and therapy has been investigated in MG, multiple sclerosis, NMOSD, spinal muscular atrophy, amyotrophic lateral sclerosis, Parkinson, Alzheimer, Huntington disease, Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, stroke, and epilepsy. Given the complexity of complement diagnostics and therapeutics, this state-of-the-art review aims to provide a brief description of the complement system for the neurologist, an overview of novel complement inhibitors and updates of complement studies in a wide range of neurological disorders.
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Affiliation(s)
- Maria Gavriilaki
- Postgraduate Course, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Vasilios K. Kimiskidis
- Postgraduate Course, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Eleni Gavriilaki
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece;
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25
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Kouvatsou Z, Masoura E, Kiosseoglou G, Kimiskidis VK. Evaluating the relationship between working memory and information processing speed in multiple sclerosis. Appl Neuropsychol Adult 2020; 29:695-702. [PMID: 32813544 DOI: 10.1080/23279095.2020.1804911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the present study was to evaluate the effect of information processing speed on the functioning of specific working memory components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. Cognitive tasks that assess working memory ("word lists recall" for the phonological loop, "block recall" for the spatial component of visuospatial sketchpad, "listening recall" for the central executive and "immediate story recall" for the episodic buffer) and information processing speed (symbol digit modalities test- oral form) were administered to 38 patients with multiple sclerosis. Results showed that the central executive and episodic buffer components were significantly related to information processing speed. However, when age was included in the regression model, information processing speed significantly predicted only the episodic buffer scores. Further research on the relationship between the episodic buffer and information processing speed is recommended.
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Affiliation(s)
- Zoe Kouvatsou
- School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elvira Masoura
- School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigoris Kiosseoglou
- School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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26
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Pourzitaki C, Dardalas I, Poutoglidou F, Kouvelas D, Kimiskidis VK. The Combination of rTMS and Pharmacotherapy on In Vitro Models: A Mini-Review. CNS Neurol Disord Drug Targets 2020; 19:220-226. [PMID: 32418533 DOI: 10.2174/1871527319666200518100716] [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] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/05/2020] [Accepted: 04/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique that is being actively explored as a potential therapeutic modality in various neuropsychiatric disorders, such as depression, neuropathic pain, epilepsy, multiple sclerosis, and neurodegenerative disorders, including the Parkinson's and Alzheimer's disease. The Food and Drug Administration (FDA) approved rTMS for the treatment of major depression, migraine-associated headaches, and Obsessive Compulsive Disorder (OCD). The fact that a significant proportion of patients suffering from these disorders fail to respond to current pharmacological interventions indicates the need for alternative therapies like rTMS. OBJECTIVE The objective was to find and summarize all studies combining the use of rTMS and pharmacological interference in vitro, in order to facilitate future studies. METHODS The results of studies combining the use of rTMS with pharmacological interference in vitro were focused on. The PubMed database was searched using the terms "rTMS", "repetitive", "transcranial", "magnetic", "stimulation", "in vitro", "in vivo", "cell cultures" untilMarch 2019 and 7 eligible studies were found. RESULTS Overall results show a synergistic effect of rTMS and pharmacotherapy in vitro with additive effectiveness, better prognosis, and superior potential management. CONCLUSION The limited amount of knowledge denotes the need for additional in vitro studies on the combination of rTMS and pharmacotherapy, which could be extended to in vivo studies and ultimately help design clinical trials so as to improve the therapeutic management of patients with a wide array of neuropsychiatric disorders.
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Affiliation(s)
- Chryssa Pourzitaki
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ioannis Dardalas
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Frideriki Poutoglidou
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dimitrios Kouvelas
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54006, Thessaloniki, Greece
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27
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Tsolaki AC, Tsolaki M, Pandria N, Lazarou E, Gkatzima O, Zilidou V, Karagianni M, Iakovidou-Kritsi Z, Kimiskidis VK, Bamidis PD. Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study. J Med Internet Res 2020; 22:e14617. [PMID: 32379048 PMCID: PMC7243129 DOI: 10.2196/14617] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/19/2019] [Accepted: 12/15/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Apolipoprotein E (APOE) ε4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE ε4 carriers have never been studied before. OBJECTIVE The effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated. METHODS Using a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE ε4 carriers and non-APOE ε4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging. RESULTS All interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score-LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores-AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score-LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE ε4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE ε4+ cognitive AC training group. CONCLUSIONS None of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI ΑPOE ε4+ subgroup.
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Affiliation(s)
- Anthoula C Tsolaki
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Neurology, Agios Pavlos General Hospital, Thessaloniki, Greece
| | - Magda Tsolaki
- 1st Department of Neurology, American Hellenic Educational Progressive Association Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niki Pandria
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eftychia Lazarou
- 1st Department of Neurology, American Hellenic Educational Progressive Association Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Olymbia Gkatzima
- Panhellenic Institute of Neurodegenerative Diseases, Thessaloniki, Greece
| | - Vasiliki Zilidou
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Karagianni
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zafiroula Iakovidou-Kritsi
- Laboratory of Medical Biology-Genetics Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, American Hellenic Educational Progressive Association Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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28
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Markhus R, Henning O, Molteberg E, Hećimović H, Ujvari A, Hirsch E, Rheims S, Surges R, Malmgren K, Rüegg S, Gil-Nagel A, Roivainen R, Picard F, Steinhoff B, Marusic P, Mostacci B, Kimiskidis VK, Mindruta I, Jagella C, Mameniškienė R, Schulze-Bonhage A, Rosenow F, Kelemen A, Fabo D, Walker MC, Seeck M, Krämer G, Arsene OT, Krestel H, Lossius M. EEG in fitness to drive evaluations in people with epilepsy - Considerable variations across Europe. Seizure 2020; 79:56-60. [PMID: 32416569 DOI: 10.1016/j.seizure.2020.04.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Epilepsy patients consider driving issues to be one of their most serious concerns. Ideally, decisions regarding fitness to drive should be based upon thorough evaluations by specialists in epilepsy care. In 2009, an EU directive was published aiming to harmonize evaluation practices within European countries, but, despite these recommendations, whether all epileptologists use the same criteria is unclear. We therefore conducted this study to investigate routine practices on how epileptologists at European epilepsy centers evaluate fitness to drive. METHODS A questionnaire was sent to 63 contact persons identified through the European Epi-Care and the E-pilepsy network. The questionnaire addressed how fitness-to-drive evaluations were conducted, the involvement of different professionals, the use and interpretation of EEG, and opinions on existing regulations and guidelines. RESULTS The questionnaire was completed by 35 participants (56 % response rate). Results showed considerable variation regarding test routines and the emphasis placed on the occurrence and extent of epileptiform discharges revealed by EEG. 82 % of the responders agreed that there was a need for more research on how to better evaluate fitness-to-drive in people with epilepsy, and 89 % agreed that regulations on fitness to drive evaluations should be internationally coordinated. CONCLUSION Our survey showed considerable variations among European epileptologists regarding use of EEG and how findings of EEG pathology should be assessed in fitness-to-drive evaluations. There is a clear need for more research on this issue and international guidelines on how such evaluations should be carried out would be of value.
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Affiliation(s)
- Rune Markhus
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Norway.
| | - Oliver Henning
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Norway
| | - Ellen Molteberg
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Norway
| | | | - Akos Ujvari
- Juhász Pál Epilepsy Centrum, National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Edouard Hirsch
- Neurology Department, University Hospital Strasbourg, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon's Neurosciences Research Center, Lyon, France
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Germany
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, Switzerland
| | - Antonio Gil-Nagel
- Department of Neurology, Epilepsy Program, Hospital Ruber Internacional, Madrid, Spain
| | - Reina Roivainen
- Helsinki University Hospital, Neurocenter, Epilepsia Helsinki, Finland
| | - Fabienne Picard
- EEG and Epilepsy Unit, Department of Neurology, University Hospitals and Medical School of Geneva, Geneva, Switzerland
| | | | - Petr Marusic
- Department of Neurology, Charles University, Second Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Barbara Mostacci
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioana Mindruta
- University Emergency Hospital of Bucharest, Epilepsy Monitoring Unit, Neurology Department, Bucharest, Romania
| | | | - Rūta Mameniškienė
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrums der Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - Anna Kelemen
- Epilepsy Centrum, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Daniel Fabo
- Epilepsy Centrum, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Margitta Seeck
- Department for Clinical Neurosciences, HUG, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Oana Tarta Arsene
- Department of Pediatric Neuroloy, Al Obregia' Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Heinz Krestel
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt, Germany; Department of Neurology, Yale University School of Medicine, New Haven, USA
| | - Morten Lossius
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Norway
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Kouvatsou Z, Masoura E, Kiosseoglou G, Kimiskidis VK. Working memory profiles of patients with multiple sclerosis: Where does the impairment lie? J Clin Exp Neuropsychol 2019; 41:832-844. [PMID: 31204607 DOI: 10.1080/13803395.2019.1626805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Previous studies have mostly provided general estimations regarding Working Memory impairment in patients with Multiple Sclerosis. The aim of the present study was to investigate the relative degree of impairment in the four Working Memory components in Multiple Sclerosis. Method: Thirty-eight patients diagnosed with MS and 27 matched controls were assessed using 12 different cognitive tasks of the four components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. More precisely, Greek translated and adapted versions of the following tasks were administered: Digit recall, Word recall, Non-word recall, Block recall, Mazes recall, Visual Patterns recall, Backward Digit recall, Backward Block recall, Listening recall, Logical Memory I-Immediate Story recall and Greek Verbal Learning Test, which is based on the California Verbal Learning Test. Results: The phonological loop, the central executive and the spatial subcomponent of the visuospatial sketchpad were found to be equally disrupted in MS patients. The episodic buffer was found to be more heavily affected. On the other hand, the visual subcomponent of the visuospatial sketchpad proved to be preserved. Conclusions: WM subcomponents are differentially affected in patients with MS. This novel finding is discussed within the framework of existing knowledge regarding WM impairment in MS.
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Affiliation(s)
- Zoe Kouvatsou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Elvira Masoura
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Grigoris Kiosseoglou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Vasilios K Kimiskidis
- b Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Koutlis C, Kimiskidis VK, Kugiumtzis D. Identification of Hidden Sources by Estimating Instantaneous Causality in High-Dimensional Biomedical Time Series. Int J Neural Syst 2019; 29:1850051. [DOI: 10.1142/s012906571850051x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The study of connectivity patterns of a system’s variables, such as multi-channel electroencephalograms (EEG), is of utmost importance towards a better understanding of its internal evolutionary mechanisms. Here, the problem of estimating the connectivity network from multivariate time series in the presence of prominent unobserved variables is addressed. The causality measure of partial mutual information from mixed embedding (PMIME), designed to estimate direct lag-causal effects in the presence of many observed variables, is adapted to estimate also zero-lag effects, the so-called instantaneous causality. We term the proposed advanced method, PMIME0. The estimation of instantaneous causality by PMIME0 is a signature of the presence of hidden source in the observed system, as demonstrated analytically in a toy model. It is further demonstrated that the PMIME0 identifies the true instantaneous with great accuracy in a variety of high-dimensional dynamical systems. The method is applied to EEG data with epileptiform discharges (EDs), and the results imply a strong impact of unobserved confounders during the EDs. This finding comes as a possible explanation for the increased levels of causality during epileptic seizures estimated by some measures affected by the presence of a common source.
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Affiliation(s)
- Christos Koutlis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Vasilios K. Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Dimitris Kugiumtzis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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Tremblay S, Rogasch NC, Premoli I, Blumberger DM, Casarotto S, Chen R, Di Lazzaro V, Farzan F, Ferrarelli F, Fitzgerald PB, Hui J, Ilmoniemi RJ, Kimiskidis VK, Kugiumtzis D, Lioumis P, Pascual-Leone A, Pellicciari MC, Rajji T, Thut G, Zomorrodi R, Ziemann U, Daskalakis ZJ. Clinical utility and prospective of TMS–EEG. Clin Neurophysiol 2019; 130:802-844. [DOI: 10.1016/j.clinph.2019.01.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/15/2022]
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Kimiskidis VK, Schachter S. Introduction. Int J Neural Syst 2019; 29:1902001. [PMID: 30975004 DOI: 10.1142/s0129065719020015] [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: 11/18/2022]
Affiliation(s)
- Vasilios K Kimiskidis
- 1 Head, Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Steven Schachter
- 2 Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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Hughes R, Dalakas MC, Merkies I, Latov N, Léger JM, Nobile-Orazio E, Sobue G, Genge A, Cornblath D, Merschhemke M, Ervin CM, Agoropoulou C, Hartung HP, Day T, Spies J, Roberts L, Van Damme P, Van den Bergh PYK, Maertens de Noordhout A, Dionne A, Larue S, Massie R, Melanson M, Camu W, De Seze J, Le Masson G, Pouget J, Schmidt J, Kimiskidis VK, Chapman J, Drory VE, Fazio R, Gallia F, Kusunoki S, Mori M, Iijima M, Okamoto T, Baba M, Faber CG, van Schaik IN, Fryze W, Motta E, Selmaj K, Casasnovas C, Sola AG, Illa I, Holt J, Miller JAL, Lunn MP, Brannagan TH, Brown M, Kelemen J, Iyadurai S, Rezania K, Sharma KR, Tandan R, Gudesblatt M, Lawson V, Amato AA. Oral fingolimod for chronic inflammatory demyelinating polyradiculoneuropathy (FORCIDP Trial): a double-blind, multicentre, randomised controlled trial. Lancet Neurol 2018; 17:689-698. [DOI: 10.1016/s1474-4422(18)30202-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 12/17/2022]
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Kimiskidis VK, Papaliagkas V, Kazis DA, Geroukis T, Bostantjopoulou S. Central motor pathways in tropical spastic paraparesis: a combined transcranial magnetic stimulation and diffusion tensor imaging study. Hippokratia 2017; 21:191-193. [PMID: 30944510 PMCID: PMC6441342] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Previous transcranial magnetic stimulation (TMS) studies in patients with tropical spastic paraparesis (TSP) have focused on central motor conduction time measurements while other TMS parameters remained unexplored. From a neuroradiological point of view, pyramidal tract involvement with magnetic resonance imaging and diffusion tensor imaging (DTI) has been rarely reported in TSP. Accordingly, the present study investigated the mean threshold (MT) and silent period (SP) as well as DTI measurements in TSP. CASE DESCRIPTION A 35-year-old female patient presented with a 15-year history of spastic paraparesis with minimal upper-limb involvement. Serum and cerebrospinal fluid samples were positive for HTLV-I. TMS was performed with a figure-of-eight coil (recording, abductor hallucis and first dorsal interosseous muscles). Thr was measured at 1 % steps. SPs were elicited at 5 % increments from 0 to 100 % maximum stimulus intensity (SI), and data were used to construct a stimulus/response (S/R) curve of SI vs SP. The resulting S/R curves were fitted to a Boltzmann equation and statistically compared to control data. Voxel-based DTI analysis was performed with SPM 99. Corticospinal tractography was based on diffusion tensor data. The TMS examination disclosed that MT was significantly increased (54.5 ± 6.36 % vs 41.08 ± 7.85 % in a group of 82 controls, p=0.019). The patient's SP S/R curve had significantly reduced Max values compared to 13 age-matched controls (160.4 ± 0.91 ms vs 228.36 ± 38.69 ms, p <0.001). Fractional anisotropy was decreased in a cluster of voxels corresponding to the area of the pyramidal tract (0.388 ± 0.015 vs 0.506 ± 0.02 in 20 age-matched controls, p <0.001). CONCLUSION The described results provide novel neurophysiological and imaging evidence for central motor pathways malfunctioning in TSP. HIPPOKRATIA 2017, 21(4): 191-193.
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Affiliation(s)
- V K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Papaliagkas
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D A Kazis
- Department of Neurology III, G.Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Geroukis
- Department of Radiology, G.Papanikolaou Hospital, Thessaloniki, Greece
| | - S Bostantjopoulou
- Department of Neurology III, G.Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kugiumtzis D, Koutlis C, Tsimpiris A, Kimiskidis VK. Dynamics of Epileptiform Discharges Induced by Transcranial Magnetic Stimulation in Genetic Generalized Epilepsy. Int J Neural Syst 2017; 27:1750037. [DOI: 10.1142/s012906571750037x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: In patients with Genetic Generalized Epilepsy (GGE), transcranial magnetic stimulation (TMS) can induce epileptiform discharges (EDs) of varying duration. We hypothesized that (a) the ED duration is determined by the dynamic states of critical network nodes (brain areas) at the early post-TMS period, and (b) brain connectivity changes before, during and after the ED, as well as within the ED. Methods: EEG recordings from two GGE patients were analyzed. For hypothesis (a), the characteristics of the brain dynamics at the early ED stage are measured with univariate and multivariate EEG measures and the dependence of the ED duration on these measures is evaluated. For hypothesis (b), effective connectivity measures are combined with network indices so as to quantify the brain network characteristics and identify changes in brain connectivity. Results: A number of measures combined with specific channels computed on the first EEG segment post-TMS correlate with the ED duration. In addition, brain connectivity is altered from pre-ED to ED and post-ED and statistically significant changes were also detected across stages within the ED. Conclusion: ED duration is not purely stochastic, but depends on the dynamics of the post-TMS brain state. The brain network dynamics is significantly altered in the course of EDs.
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Affiliation(s)
- Dimitris Kugiumtzis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Christos Koutlis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Alkiviadis Tsimpiris
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Vasilios K. Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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Kimiskidis VK, Ryvlin P, Schachter S. Introduction. Int J Neural Syst 2017; 27:1702002. [PMID: 28820001 DOI: 10.1142/s0129065717020026] [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: 11/18/2022]
Affiliation(s)
- Vasilios K Kimiskidis
- 1 Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, Greece
| | - Philippe Ryvlin
- 2 Département des Neurosciences Cliniques, BH/10/137, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Steven Schachter
- 3 Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, 330 Brookline Ave., Boston, MA 02215, USA
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Nemtsas P, Birot G, Pittau F, Michel CM, Schaller K, Vulliemoz S, Kimiskidis VK, Seeck M. Source localization of ictal epileptic activity based on high-density scalp EEG data. Epilepsia 2017; 58:1027-1036. [DOI: 10.1111/epi.13749] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Petros Nemtsas
- Laboratory of Clinical Neurophysiology; AHEPA Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Gwenael Birot
- Department of Fundamental Neurosciences; Functional Brain Mapping Lab; University of Geneva; Geneva Switzerland
| | - Francesca Pittau
- EEG & Epilepsy Unit; Department of Clinical Neurosciences; University Hospital of Geneva; Geneva Switzerland
| | - Christoph M. Michel
- Department of Fundamental Neurosciences; Functional Brain Mapping Lab; University of Geneva; Geneva Switzerland
- Center for Biomedical Imaging (CIBM) Lausanne; Geneva Switzerland
| | - Karl Schaller
- Department of Clinical Neurosciences; Neurosurgery Clinic; University Hospital of Geneva; Geneva Switzerland
| | - Serge Vulliemoz
- EEG & Epilepsy Unit; Department of Clinical Neurosciences; University Hospital of Geneva; Geneva Switzerland
| | - Vasilios K. Kimiskidis
- Laboratory of Clinical Neurophysiology; AHEPA Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Margitta Seeck
- EEG & Epilepsy Unit; Department of Clinical Neurosciences; University Hospital of Geneva; Geneva Switzerland
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Kimiskidis VK, Papaliagkas V, Papagiannopoulos S, Zafeiriou D, Kazis D, Tsatsali-Foroglou E, Kouvatsou Z, Kapina V, Koutsonikolas D, Anogianakis G, Geroukis T, Bostantjopoulou S. Investigation of the motor system in two siblings with Canavan's disease: a combined transcranial magnetic stimulation (TMS) - diffusion tensor imaging (DTI) study. Metab Brain Dis 2017; 32:307-310. [PMID: 28130616 DOI: 10.1007/s11011-017-9955-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/18/2017] [Indexed: 12/11/2022]
Abstract
Canavan's disease (CD) is a hereditary leukodystrophy caused by mutations in the aspartoacylase gene (ASPA), leading to spongiform degeneration of the white matter and severe impairment of psychomotor development. We present the cases of two non-Jewish sisters with CD that have a milder and protracted clinical course compared to typical CD. MRI imaging revealed bilateral high-signal-intensity areas in the thalami and the internal capsule and MR spectroscopy showed typical findings for CD (a marked increase in N-acetylaspartate (NAA) levels). FA values of the right and left corticospinal tracts at the level of the posterior limb of the internal capsule, and the centrum semiovale were found to be significantly reduced compared to healthy controls. From a neurophysiological point of view, the peripheral motor system was normal. In contrast, cortical stimulation at maximal intensity failed to elicit facilitated or resting MEPs and silent periods (SPs) in upper and lower limbs, providing evidence for significant upper motor pathway dysfunction.
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Affiliation(s)
- V K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Vasileios Papaliagkas
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Thessaloniki, Greece.
| | - S Papagiannopoulos
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - D Zafeiriou
- First Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Kazis
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Z Kouvatsou
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - V Kapina
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - D Koutsonikolas
- Department of Experimental Physiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Anogianakis
- Department of Experimental Physiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Geroukis
- Department of Radiology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - S Bostantjopoulou
- Third Department of Neurology, G. Papanikolaou Hospital, Thessaloniki, Greece
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Kimiskidis VK, Sotirakoglou K, Kazis DA, Papaliagkas V, Chatzikyriakou E. The Hemiconvulsions-Hemiplegia-Epilepsy (HHE) syndrome: a transcranial magnetic stimulation-EEG study. Hippokratia 2017; 21:101. [PMID: 30455564 PMCID: PMC6239090] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Hemiconvulsions-Hemiplegia-Epilepsy (HHE) syndrome is currently regarded as an extremely rare condition. The etiological and pathophysiological mechanisms underlying this medical rarity as well as the optimal therapeutic approaches remain poorly defined and understood. We present the clinical, radiological and electroencephalography (EEG) findings of a patient with the HHE syndrome and describe the response of the continuously present epileptiform abnormalities to transcranial magnetic stimulation (TMS). CASE DESCRIPTION A 33-year old male patient was referred to our department for investigation and management of intractable epilepsy. His seizures began at the age of three months when, during the course of a common febrile illness, he developed repetitive clonic seizures involving the left upper and lower limbs, followed by permanent left hemiplegia. After extensive investigations, he was diagnosed with "idiopathic" HHE syndrome. Currently, he suffers from left hemiplegia, severe intellectual impairment [Intelligence Quotient (IQ) <30] and asymmetric, bilateral tonic seizures occurring 1-3 times daily despite treatment with valproate, topiramate, lamotrigine, rufinamide, and perampanel. Brain magnetic resonance imaging revealed atrophy of the right hemisphere and serial EEGs disclosed continuous sharp waves, the generators of which were localized by electrical source imaging (ESI) to two distinct sources within the right hemisphere. Repetitive TMS [210 stimuli of 1 Hz at 100 % corticomotor threshold applied with a circular coil over the generators of epileptic discharges (EDs)] resulted in a statistically significant decrease of ED counts compared to sham stimulation and the post-verum TMS period. CONCLUSION We present the clinical-laboratory profile and the long-term follow up of a patient with the HHE syndrome. Further, we describe the effects of TMS on EDs. The latter observation raises the possibility that TMS-EEG may be used in select cases with intractable epilepsy as a surrogate marker of responsiveness to more invasive modalities (i.e., cortical stimulation). HIPPOKRATIA 2017, 21(2): 101-104.
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Affiliation(s)
- V K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - K Sotirakoglou
- Laboratory of Mathematics and Statistics, Agricultural University of Athens, Greece
| | - D A Kazis
- 3 Department of Neurology, G.Papanikolaou Hospital, Aristotle University of Thessaloniki, Greece
| | - V Papaliagkas
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - E Chatzikyriakou
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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Kimiskidis VK, Tsimpiris A, Ryvlin P, Kalviainen R, Koutroumanidis M, Valentin A, Laskaris N, Kugiumtzis D. TMS combined with EEG in genetic generalized epilepsy: A phase II diagnostic accuracy study. Clin Neurophysiol 2017; 128:367-381. [DOI: 10.1016/j.clinph.2016.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/09/2016] [Accepted: 11/12/2016] [Indexed: 02/05/2023]
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Vogt VL, Äikiä M, Del Barrio A, Boon P, Borbély C, Bran E, Braun K, Carette E, Clark M, Cross JH, Dimova P, Fabo D, Foroglou N, Francione S, Gersamia A, Gil-Nagel A, Guekht A, Harrison S, Hecimovic H, Heminghyt E, Hirsch E, Javurkova A, Kälviäinen R, Kavan N, Kelemen A, Kimiskidis VK, Kirschner M, Kleitz C, Kobulashvili T, Kosmidis MH, Kurtish SY, Lesourd M, Ljunggren S, Lossius MI, Malmgren K, Mameniskiené R, Martin-Sanfilippo P, Marusic P, Miatton M, Özkara Ç, Pelle F, Rubboli G, Rudebeck S, Ryvlin P, van Schooneveld M, Schmid E, Schmidt PM, Seeck M, Steinhoff BJ, Shavel-Jessop S, Tarta-Arsene O, Trinka E, Viggedal G, Wendling AS, Witt JA, Helmstaedter C. Current standards of neuropsychological assessment in epilepsy surgery centers across Europe. Epilepsia 2017; 58:343-355. [PMID: 28067423 DOI: 10.1111/epi.13646] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 11/29/2022]
Abstract
We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe.
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Affiliation(s)
- Viola Lara Vogt
- Department of Epileptology, Medical Center, University of Bonn, Bonn, Germany
| | - Marja Äikiä
- Epilepsy Center/Neurocenter, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antonio Del Barrio
- Department of Neurology, Epilepsy Program, Hospital Ruber International, Madrid, Spain
| | - Paul Boon
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Csaba Borbély
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Ema Bran
- Department of Clinical Neurosciences, Pediatric Neurology Clinic, Carol Davila University of Medicine, Bucharest, Romania.,Alexandu Obregia Clinical Psychiatric Hospital, Pediatric Neurology Clinic, Bucharest, Romania
| | - Kees Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evelien Carette
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Maria Clark
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Judith Helen Cross
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Petia Dimova
- Clinic of Child Neurology, St Naum University Hospital of Neurology and Psychiatry, Sofia, Bulgaria
| | - Daniel Fabo
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Stefano Francione
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Anna Gersamia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Department of Neurology and Neurosurgery of the Russian National Research Medical University, Moscow, Russia
| | - Antonio Gil-Nagel
- Department of Neurology, Epilepsy Program, Hospital Ruber International, Madrid, Spain
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Department of Neurology and Neurosurgery of the Russian National Research Medical University, Moscow, Russia
| | - Sue Harrison
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Hrvoje Hecimovic
- Department of Neurology, Zagreb Epilepsy Center, University Hospital, Zagreb, Croatia
| | - Einar Heminghyt
- National Center for Epilepsy (SSE), Oslo University Hospital, Oslo, Norway
| | | | - Alena Javurkova
- 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | | | - Nicole Kavan
- EEG & Epilepsy Unit, Hospital of Geneva & Functional Neurology and Neurosurgery Program, University Hospitals of Geneva and Lausanne, Geneva, Switzerland
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Margarita Kirschner
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Selin Yagci Kurtish
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mathieu Lesourd
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Sofia Ljunggren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Kristina Malmgren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ruta Mameniskiené
- Faculty of Medicine, Clinic of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania.,Department of Neurology, Vilnius University Hospital Santariškių klinikos, Vilnius, Lithuania
| | - Patricia Martin-Sanfilippo
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Petr Marusic
- 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Marijke Miatton
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Çiğdem Özkara
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Federica Pelle
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Guido Rubboli
- Danish Epilepsy Center, Filadelfia/University of Copenhagen, EEMA (European Epilepsy Monitoring Unit Association), Dianalund, Denmark.,Epilepsy Institute, IDEE, Lyon, France
| | - Sarah Rudebeck
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,Epilepsy Institute, IDEE, Lyon, France
| | - Monique van Schooneveld
- Department of Pediatric Psychology, Sector of Neuropsychology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth Schmid
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Margitta Seeck
- EEG & Epilepsy Unit, Hospital of Geneva & Functional Neurology and Neurosurgery Program, University Hospitals of Geneva and Lausanne, Geneva, Switzerland
| | | | - Sara Shavel-Jessop
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Oana Tarta-Arsene
- Department of Clinical Neurosciences, Pediatric Neurology Clinic, Carol Davila University of Medicine, Bucharest, Romania.,Alexandu Obregia Clinical Psychiatric Hospital, Pediatric Neurology Clinic, Bucharest, Romania
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gerd Viggedal
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Juri-Alexander Witt
- Department of Epileptology, Medical Center, University of Bonn, Bonn, Germany
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Kimiskidis VK, Papadakis E, Papaliagkas V, Papagiannopoulos S, Galanakis DK. Dysfibrinogenemia and multiple sclerosis: spuriously associated or causally linked? Hippokratia 2017; 21:49-51. [PMID: 29904258 PMCID: PMC5997019] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The inherited dysfibrinogenemias comprise rare congenital coagulation disorders which are clinically characterized by bleeding diathesis and, in occasional patients, by thrombotic tendency or combined bleeding-thrombotic events. In recent years, accumulating evidence suggested that fibrinogen has a critical role in the pathogenesis of neuroinflammatory disorders, including multiple sclerosis. We describe the presentation and long-term follow-up of a patient with inherited dysfibrinogenemia and concomitant clinical and laboratory evidence of demyelinating disease. Case description: A 16-year-old male patient presented in 2003 with bilateral sensory symptomatology preceded by an episode of epistaxis. His past medical history included episodes of spontaneous nosebleeds as well as Duane syndrome and mild atrophy of the right upper limb. Coagulation testing of the patient and his asymptomatic father revealed in both the presence of a clotting defect, consistent with inherited dysfibrinogenemia (named Fibrinogen Thessaloniki). Within seven months, the patient presented with a new episode of motor semiology whereas serial brain magnetic resonance imaging (MRI) scans revealed T2 lesions with bilateral distribution, some of which with gadolinium enhancement. The cerebrospinal fluid examination disclosed the presence of oligoclonal bands in the central nervous system compartment. The patient was started on azathioprine (2.5 mg/kg/24h) which led to clinical and radiological stabilization for nine years. In 2013, the dose of azathioprine was reduced, due to an elevation of his amylase levels, resulting in radiological deterioration with an increased T2 lesion load. The reinstitution of azathioprine at therapeutic doses led to radiological improvement and clinical stability as of today. CONCLUSION The described case of inherited dysfibrinogenemia and concomitant multiple sclerosis provides speculative evidence for a causal link, rather than a chance association, between these two entities. Further studies are warranted to corroborate this hypothesis in experimental and clinical settings. HIPPOKRATIA 2017, 21(1): 49-51.
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Affiliation(s)
- V K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Papadakis
- Hematology Dept-Hemostasis Unit, Papageorgiou General Hospital, Thessaloniki, Greece
| | - V Papaliagkas
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Papagiannopoulos
- 3 Department of Neurology, G.Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D K Galanakis
- Pathology Department of Stony Brook University, Stony Brook, New York
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Dermitzakis EV, Kimiskidis VK, Lazaridis G, Alexopoulou Z, Timotheadou E, Papanikolaou A, Romanidou O, Georgiadis G, Kalogeras KT, Tsiptsios I, Tarlatzis B, Fountzilas G. The impact of paclitaxel and carboplatin chemotherapy on the autonomous nervous system of patients with ovarian cancer. BMC Neurol 2016; 16:190. [PMID: 27716097 PMCID: PMC5045633 DOI: 10.1186/s12883-016-0710-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 06/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Paclitaxel-based regimens are frequently associated with the development of peripheral neuropathy. The autonomous nervous system (ANS) effects, however, of this chemotherapeutic agent remain unexplored. Methods We investigated a group of 31 female patients with ovarian cancer receiving treatment with paclitaxel and carboplatin, as well as a group of 16 healthy age- and gender-matched healthy volunteers. All study participants completed a questionnaire and were assessed neurophysiologically at three time points (baseline, 3–4 months and 6–8 months following the onset of chemotherapy). The evaluation of the ANS included assessment of the adrenergic cardiovascular function (orthostatic hypotension-OH), parasympathetic heart innervation (30/15 ratio) and sympathetic skin response (SSR). Results At the 3–4 months ANS assessment, 19.2 % of the patients had systolic OH and the same percentage had diastolic OH, but at the 6–8 months evaluation no patient had systolic OH and only 13.8 % had diastolic OH. The values of the 30/15 ratio were significantly reduced at both time points, whereas the SSR was not affected. Conclusions Combined paclitaxel and carboplatin chemotherapy is associated with significant effects on the parasympathetic heart innervation and occasionally with effects on the adrenergic cardiovascular reaction. The SSR remained unaffected. Physicians should be alert to the possibility of these treatment-emergent side effects, so as to monitor ANS parameters and introduce treatment modifications accordingly. Our findings however, should be validated in larger cohorts. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0710-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emmanouil V Dermitzakis
- Laboratory of Clinical Neurophysiology, Department of Neurology, "Papageorgiou" Hospital, Thessaloniki, 564 03, Greece.
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, Faculty of Medicine, Thessaloniki, Greece
| | - George Lazaridis
- Department of Medical Oncology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zoi Alexopoulou
- Department of Biostatistics, Health Data Specialists Ltd, Athens, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Papanikolaou
- First Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ourania Romanidou
- Department of Medical Oncology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Georgiadis
- Neurological Department, "Hippocration" General Hospital, Thessaloniki, Greece
| | - Konstantine T Kalogeras
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.,Translational Research Section, Hellenic Cooperative Oncology Group, Data Office, Athens, Greece
| | - Iakovos Tsiptsios
- Laboratory of Clinical Neurophysiology, Department of Neurology, "Papageorgiou" Hospital, Thessaloniki, 564 03, Greece
| | - Basil Tarlatzis
- First Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kimiskidis VK, Papaliagkas V, Papagiannopoulos S, Giovos I, Lazaridis L, Kazis DA, Polychronakos C, Geroukis T, Bostantjopoulou S. Central nervous system involvement in multiple symmetric lipomatosis. J Neurol Sci 2016; 370:27-28. [PMID: 27772774 DOI: 10.1016/j.jns.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 12/25/2022]
Affiliation(s)
- V K Kimiskidis
- Department of Clinical Neurophysiology, AHEPA University Hospital, Greece
| | - V Papaliagkas
- Department of Clinical Neurophysiology, AHEPA University Hospital, Greece.
| | - S Papagiannopoulos
- C Department of Neurology, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Greece
| | - I Giovos
- 1st Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - L Lazaridis
- Department of Plastic Surgery, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - D A Kazis
- C Department of Neurology, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Greece
| | - C Polychronakos
- The Research Institute of the McGill University Health Centre, Montreal, Canada
| | - T Geroukis
- Department of Radiology, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - S Bostantjopoulou
- C Department of Neurology, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Greece
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Boulogne S, Andre-Obadia N, Kimiskidis VK, Ryvlin P, Rheims S. Cortico-cortical and motor evoked potentials to single and paired-pulse stimuli: An exploratory transcranial magnetic and intracranial electric brain stimulation study. Hum Brain Mapp 2016; 37:3767-3778. [PMID: 27312488 DOI: 10.1002/hbm.23274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Paired-pulse (PP) paradigms are commonly employed to assess in vivo cortical excitability using transcranial magnetic stimulation (TMS) to stimulate the primary motor cortex and modulate the induced motor evoked potential (MEP). Single-pulse cortical direct electrical stimulation (DES) during intracerebral EEG monitoring allows the investigation of brain connectivity by eliciting cortico-cortical evoked potentials (CCEPs). However, PP paradigm using intracerebral DES has rarely been reported and has never been previously compared with TMS. OBJECTIVE The work was intended (i) to verify that the well-established modulations of MEPs following PP TMS remain similar using DES in the motor cortex, and (ii) to evaluate if a similar pattern could be observed in distant cortico-cortical connections through modulations of CCEP. METHODS Three patients undergoing intracerebral EEG monitoring with electrodes implanted in the central region were studied. Single-pulse DES (1-3 mA, 1 ms, 0.2 Hz) and PP DES using six interstimulus intervals (5, 15, 30, 50, 100, and 200 ms) in the motor cortex with concomitant recording of CCEPs and MEPs in contralateral muscles were performed. Finally, a navigated PP TMS session targeted the intracranial stimulation site to record TMS-induced MEPs in two patients. RESULTS MEP modulations elicited by PP intracerebral DES proved similar among the three patients and to those obtained by PP TMS. CCEP modulations elicited by PP intracerebral DES usually showed a pattern comparable to that of MEP, although a different pattern could be observed occasionally. CONCLUSION PP intracerebral DES seems to involve excitatory and inhibitory mechanisms similar to PP TMS and allows the recording of intracortical inhibition and facilitation modulation on cortico-cortical connections. Hum Brain Mapp 37:3767-3778, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sébastien Boulogne
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon, 59 Boulevard Pinel, Bron, 69675, France. .,Lyon's Research Neuroscience Center, Institut National De La Santé Et De La Recherche Médicale U1028, Centre National De La Recherche Scientifique 5292, Lyon, France, CH Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, 69675 Bron, France. .,Lyon 1 University, 43 Boulevard Du 11 Novembre 1918, Villeurbanne, 69100, France.
| | - Nathalie Andre-Obadia
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon, 59 Boulevard Pinel, Bron, 69675, France
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - Philippe Ryvlin
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon, 59 Boulevard Pinel, Bron, 69675, France.,Lyon's Research Neuroscience Center, Institut National De La Santé Et De La Recherche Médicale U1028, Centre National De La Recherche Scientifique 5292, Lyon, France, CH Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, 69675 Bron, France.,Lyon 1 University, 43 Boulevard Du 11 Novembre 1918, Villeurbanne, 69100, France.,Department of Clinical neurosciences, CHU Vaudois, 46 Rue Du Bugnon, Lausanne, 1011, Switzerland
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon, 59 Boulevard Pinel, Bron, 69675, France.,Lyon's Research Neuroscience Center, Institut National De La Santé Et De La Recherche Médicale U1028, Centre National De La Recherche Scientifique 5292, Lyon, France, CH Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, 69675 Bron, France.,Lyon 1 University, 43 Boulevard Du 11 Novembre 1918, Villeurbanne, 69100, France
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Kobulashvili T, Höfler J, Dobesberger J, Ernst F, Ryvlin P, Cross JH, Braun K, Dimova P, Francione S, Hecimovic H, Helmstaedter C, Kimiskidis VK, Lossius MI, Malmgren K, Marusic P, Steinhoff BJ, Boon P, Craiu D, Delanty N, Fabo D, Gil-Nagel A, Guekht A, Hirsch E, Kalviainen R, Mameniskiené R, Özkara Ç, Seeck M, Rubboli G, Krsek P, Rheims S, Trinka E. Current practices in long-term video-EEG monitoring services: A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery. Seizure 2016; 38:38-45. [PMID: 27104922 DOI: 10.1016/j.seizure.2016.03.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The European Union-funded E-PILEPSY network aims to improve awareness of, and accessibility to, epilepsy surgery across Europe. In this study we assessed current clinical practices in epilepsy monitoring units (EMUs) in the participating centers. METHOD A 60-item web-based survey was distributed to 25 centers (27 EMUs) of the E-PILEPSY network across 22 European countries. The questionnaire was designed to evaluate the characteristics of EMUs, including organizational aspects, admission, and observation of patients, procedures performed, safety issues, cost, and reimbursement. RESULTS Complete responses were received from all (100%) EMUs surveyed. Continuous observation of patients was performed in 22 (81%) EMUs during regular working hours, and in 17 EMUs (63%) outside of regular working hours. Fifteen (56%) EMUs requested a signed informed consent before admission. All EMUs performed tapering/withdrawal of antiepileptic drugs, 14 (52%) prior to admission to an EMU. Specific protocols on antiepileptic drugs (AED) tapering were available in four (15%) EMUs. Standardized Operating Procedures (SOP) for the treatment of seizure clusters and status epilepticus were available in 16 (59%). Safety measures implemented by EMUs were: alarm seizure buttons in 21 (78%), restricted patient's ambulation in 19 (70%), guard rails in 16 (59%), and specially designated bathrooms in 7 (26%). Average costs for one inpatient day in EMU ranged between 100 and 2200 Euros. CONCLUSION This study shows a considerable diversity in the organization and practice patterns across European epilepsy monitoring units. The collected data may contribute to the development and implementation of evidence-based recommended practices in LTM services across Europe.
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Affiliation(s)
- Teia Kobulashvili
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Florian Ernst
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Philippe Ryvlin
- Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, France; European Epilepsy Monitoring Unit Association (EEMA), France
| | - J Helen Cross
- University College London Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Kees Braun
- Department of Child Neurology, University Medical Center, 3508 AB Utrecht, The Netherlands
| | - Petia Dimova
- Epilepsy Surgery Center, Neurosurgery department, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Stefano Francione
- Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Hrvoje Hecimovic
- Zagreb Epilepsy Center, Department of Neurology, University Hospital, Vinogradska cesta 29, 10000 Zagreb, Croatia
| | - Christoph Helmstaedter
- Department of Epileptology, University of Bonn, University Medical Center, Sigmund Freud Straße 25, 53105 Bonn, Germany
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Morten Ingvar Lossius
- Department of Complex Epilepsy, National Centre for Epilepsy (SSE), Oslo University Hospital, Oslo, Norway
| | - Kristina Malmgren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Petr Marusic
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, V Úvalu 84, Prague 5 CZ 150 06, Czech Republic
| | - Bernhard J Steinhoff
- Epilepsiezentrum Kork, Landstraße 1, 77694 Kehl-Kork, Germany; European Epilepsy Monitoring Unit Association (EEMA), France
| | - Paul Boon
- Institute for Neuroscience, Reference center for refractory epilepsy, Gehnt University Hospital, Belgium
| | - Dana Craiu
- "Carola Davila" University of Medicine Bucharest and Pediatric Neurology Clinic, "Alexandru Obregia" Clinical Psychiatric Hospital, Şos. Berceni 10-12, Sector 4, Bucharest, Romania
| | - Norman Delanty
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin 2, Ireland; Department of Neurology, Beaumont Hospital, Dublin 9, Ireland
| | - Daniel Fabo
- National Institute of Clinical Neurosciences, Amerikai ut 57, Budapest H-1145, Hungary
| | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional, La Maso 38, 28034 Madrid, Spain
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Ul. Donskaya 43, Moscow 115419, Russia; Department of Neurology and Neurosurgery of Russian National Research Medical University, Leninsky pr-t 8-8, Moscow 119049, Russia
| | - Edouard Hirsch
- Département de Neurologie, 1 Place de l'Hôpital, 67091 Strasbourg, France
| | - Reetta Kalviainen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ruta Mameniskiené
- Clinic of Neurology and neurosurgery, Medical Faculty (MF), Vilnius University, Vilnius, Lithuania; Epilepsy Center, Department of Neurology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Çiğdem Özkara
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Neurology, Division of Clinical Electro-Neurophysiology, 34098 Istanbul, Turkey
| | - Margitta Seeck
- Presurgical Epilepsy Evaluation Unit, Functional Neurology and Neurosurgery Program of the University Hospitals of Geneva and Lausanne, 1211 Geneva 14, Switzerland
| | - Guido Rubboli
- European Epilepsy Monitoring Unit Association (EEMA), France; Danish Epilepsy Center, Filadelfia/University of Copenhagen, Kolonivej 1, 4293 Dianalund, Denmark; IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Pavel Krsek
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, V Úvalu 84, Prague 5, CZ 150 06, Czech Republic
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria; European Epilepsy Monitoring Unit Association (EEMA), France.
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Siggiridou E, Koutlis C, Tsimpiris A, Kimiskidis VK, Kugiumtzis D. Causality networks from multivariate time series and application to epilepsy. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:4041-4. [PMID: 26737181 DOI: 10.1109/embc.2015.7319281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Granger causality and variants of this concept allow the study of complex dynamical systems as networks constructed from multivariate time series. In this work, a large number of Granger causality measures used to form causality networks from multivariate time series are assessed. For this, realizations on high dimensional coupled dynamical systems are considered and the performance of the Granger causality measures is evaluated, seeking for the measures that form networks closest to the true network of the dynamical system. In particular, the comparison focuses on Granger causality measures that reduce the state space dimension when many variables are observed. Further, the linear and nonlinear Granger causality measures of dimension reduction are compared to a standard Granger causality measure on electroencephalographic (EEG) recordings containing episodes of epileptiform discharges.
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Kugiumtzis D, Kimiskidis VK. Direct Causal Networks for the Study of Transcranial Magnetic Stimulation Effects on Focal Epileptiform Discharges. Int J Neural Syst 2015; 25:1550006. [DOI: 10.1142/s0129065715500069] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Transcranial magnetic stimulation (TMS) can have inhibitory effects on epileptiform discharges (EDs) of patients with focal seizures. However, the brain connectivity before, during and after EDs, with or without the administration of TMS, has not been extensively explored. Objective: To investigate the brain network of effective connectivity during ED with and without TMS in patients with focal seizures. Methods: For the effective connectivity a direct causality measure is applied termed partial mutual information from mixed embedding (PMIME). TMS-EEG data from two patients with focal seizures were analyzed. Each EEG record contained a number of EDs in the majority of which TMS was administered over the epileptic focus. As a control condition, sham stimulation over the epileptogenic zone or real TMS at a distance from the epileptic focus was also performed. The change in brain connectivity structure was investigated from the causal networks formed at each sliding window. Conclusion: The PMIME could detect distinct changes in the network structure before, within, and after ED. The administration of real TMS over the epileptic focus, in contrast to sham stimulation, terminated the ED prematurely in a node-specific manner and regained the network structure as if it would have terminated spontaneously.
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Affiliation(s)
- Dimitris Kugiumtzis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Vasilios K. Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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Kimiskidis VK, Lesser RP, Schachter S. Computational and Technological Innovations for Epilepsy Diagnosis and Control. Introduction. Int J Neural Syst 2015; 25:1503001. [PMID: 26058400 DOI: 10.1142/s012906571503001x] [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: 11/18/2022]
Affiliation(s)
| | - Ronald P Lesser
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21287-7247, USA
| | - Steven Schachter
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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Kimiskidis VK, Koutlis C, Tsimpiris A, Kälviäinen R, Ryvlin P, Kugiumtzis D. Transcranial Magnetic Stimulation Combined with EEG Reveals Covert States of Elevated Excitability in the Human Epileptic Brain. Int J Neural Syst 2015; 25:1550018. [PMID: 25986753 DOI: 10.1142/s0129065715500185] [Citation(s) in RCA: 21] [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] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation combined with electroencephalogram (TMS-EEG) can be used to explore the dynamical state of neuronal networks. In patients with epilepsy, TMS can induce epileptiform discharges (EDs) with a stochastic occurrence despite constant stimulation parameters. This observation raises the possibility that the pre-stimulation period contains multiple covert states of brain excitability some of which are associated with the generation of EDs. OBJECTIVE To investigate whether the interictal period contains "high excitability" states that upon brain stimulation produce EDs and can be differentiated from "low excitability" states producing normal appearing TMS-EEG responses. METHODS In a cohort of 25 patients with Genetic Generalized Epilepsies (GGE) we identified two subjects characterized by the intermittent development of TMS-induced EDs. The high-excitability in the pre-stimulation period was assessed using multiple measures of univariate time series analysis. Measures providing optimal discrimination were identified by feature selection techniques. The "high excitability" states emerged in multiple loci (indicating diffuse cortical hyperexcitability) and were clearly differentiated on the basis of 14 measures from "low excitability" states (accuracy = 0.7). CONCLUSION In GGE, the interictal period contains multiple, quasi-stable covert states of excitability a class of which is associated with the generation of TMS-induced EDs. The relevance of these findings to theoretical models of ictogenesis is discussed.
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Affiliation(s)
- Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Christos Koutlis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Alkiviadis Tsimpiris
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Reetta Kälviäinen
- Kuopio Epilepsy Center, Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Philippe Ryvlin
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France.,Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Dimitris Kugiumtzis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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