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Toledano R, Martínez-Alvarez R, Jiménez-Huete A, García-Morales I, Aledo-Serrano Á, Cabrera W, Rey G, Campo P, Gómez-Angulo JC, Blumcke I, Álvarez-Linera J, Del Pozo JM, Gil-Nagel A. Stereoelectroencephalography in the preoperative assessment of patients with refractory focal epilepsy: experience at an epilepsy centre. Neurologia (Engl Ed) 2022; 37:334-345. [PMID: 35672120 DOI: 10.1016/j.nrleng.2019.05.006] [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: 03/04/2019] [Accepted: 05/20/2019] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE. MATERIAL AND METHODS In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure. RESULTS The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages. CONCLUSION SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.
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Affiliation(s)
- R Toledano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain; Programa de Epilepsia, Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - R Martínez-Alvarez
- Servicio de Neurocirugía Funcional y Radiocirugía, Hospital Ruber Internacional, Madrid, Spain
| | - A Jiménez-Huete
- Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain
| | - I García-Morales
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain; Programa de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - Á Aledo-Serrano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain
| | - W Cabrera
- Departamento de Anatomía y Embriología, Universidad Complutense de Madrid, Spain
| | - G Rey
- Servicio de Física Médica y Protección Radiológica, Hospital Ruber Internacional, Madrid, Spain
| | - P Campo
- Departamento de Psicología Básica, Universidad Autónoma de Madrid, Spain
| | - J C Gómez-Angulo
- Servicio de Neurocirugía, Hospital Universitario de Getafe, Spain; Servicio de Neurocirugía, Hospital Ruber Internacional, Madrid, Spain
| | - I Blumcke
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Alemania
| | - J Álvarez-Linera
- Servicio de Neuroradiología, Hospital Ruber Internacional, Madrid, Spain
| | - J M Del Pozo
- Servicio de Neurocirugía, Hospital Ruber Internacional, Madrid, Spain
| | - A Gil-Nagel
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain
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Toledano R, Martínez-Álvarez R, Jiménez-Huete A, García-Morales I, Aledo-Serrano Á, Cabrera W, Rey G, Campo P, Gómez-Angulo JC, Blumcke I, Álvarez-Linera J, Del Pozo JM, Gil-Nagel A. Stereoelectroencephalography in the preoperative assessment of patients with refractory focal epilepsy: Experience at an epilepsy centre. Neurologia 2022; 37:334-345. [PMID: 31337558 DOI: 10.1016/j.nrl.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE. MATERIAL AND METHODS In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure. RESULTS The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages. CONCLUSION SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.
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Affiliation(s)
- R Toledano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España; Programa de Epilepsia, Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - R Martínez-Álvarez
- Servicio de Neurocirugía Funcional y Radiocirugía, Hospital Ruber Internacional, Madrid, España
| | - A Jiménez-Huete
- Servicio de Neurología, Hospital Ruber Internacional, Madrid, España
| | - I García-Morales
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España; Programa de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - Á Aledo-Serrano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España
| | - W Cabrera
- Departamento de Anatomía y Embriología, Universidad Complutense de Madrid, España
| | - G Rey
- Servicio de Física Médica y Protección Radiológica, Hospital Ruber Internacional, Madrid, España
| | - P Campo
- Departamento de Psicología Básica, Universidad Autónoma de Madrid, España
| | - J C Gómez-Angulo
- Servicio de Neurocirugía, Hospital Universitario de Getafe, España; Servicio de Neurocirugía, Hospital Ruber Internacional, Madrid, España
| | - I Blumcke
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Alemania
| | - J Álvarez-Linera
- Servicio de Neurorradiología, Hospital Ruber Internacional, Madrid, España
| | - J M Del Pozo
- Servicio de Neurocirugía, Hospital Ruber Internacional, Madrid, España
| | - A Gil-Nagel
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España
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Álvarez-Linera Prado J, Jiménez-Huete A. Neuroimaging in dementia. Clinical-radiological correlation. Radiologia (Engl Ed) 2018; 61:66-81. [PMID: 30482502 DOI: 10.1016/j.rx.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 07/19/2018] [Accepted: 08/20/2018] [Indexed: 12/30/2022]
Abstract
Dementia is a syndrome characterised by chronic, multi-domain, acquired cognitive impairment that causes significant functional limitations. MRI is the standard imaging study for these cases, since it enables detection of the atrophy patterns of the various neurodegenerative diseases (Alzheimer's disease, frontotemporal degeneration, Lewy body dementia), the vascular lesions associated with vascular dementia, and various potentially reversible diseases (for example, tumours, hydrocephaly) or diseases that require special management measures (for example, prion diseases). In certain cases other imaging methods can be used, such as CT, functional MRI, HMPAO SPECT or dopaminergic markers and FDG PET, amyloid markers or dopaminergic markers. The indications for these methods have not yet been clearly established, and therefore should be used in multidisciplinary dementia units.
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Affiliation(s)
| | - A Jiménez-Huete
- Departamento de Neurología, Hospital Ruber Internacional, Madrid, España
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del Barrio A, Jiménez-Huete A, Toledano R, García-Morales I, Gil-Nagel A. Validez de las escalas clínicas y de contenido del Inventario Multifásico de Personalidad de Minnesota-2 para el diagnóstico de crisis no epilépticas psicógenas. Neurologia 2016; 31:106-12. [DOI: 10.1016/j.nrl.2013.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 12/05/2013] [Accepted: 12/11/2013] [Indexed: 11/30/2022] Open
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del Barrio A, Jiménez-Huete A, Toledano R, García-Morales I, Gil-Nagel A. Validity of the clinical and content scales of the Multiphasic Personality Inventory Minnesota 2 for the diagnosis of psychogenic non-epileptic seizures. Neurología (English Edition) 2016. [DOI: 10.1016/j.nrleng.2013.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Riva-Amarante E, Jiménez-Huete A, Toledano R, Calero M, Alvarez-Linera J, Escribano J, Sánchez Migallón M, Franch O. Usefulness of high b-value diffusion-weighted MRI in the diagnosis of Creutzfeldt-Jakob disease. Neurología (English Edition) 2011. [DOI: 10.1016/s2173-5808(11)70078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Cuadrado-Corrales N, Jiménez-Huete A, Albo C, Vega L, Hortigüela R, Cerrato L, Sierra-Moros M, Avellanal F, Rábano A, de Pedro-Cuesta J, Calero M. [Usefulness of the 14-3-3 test for the diagnosis of sCJD evaluated by a Spanish reference center]. Neurologia 2008; 23:91-97. [PMID: 18322827] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION The performance of the 14-3-3 protein test has been shown to be adequate for sporadic Creutzfeldt-Jakob disease (sCJD) diagnosis in selected populations, but its routine validity has been questioned. METHODS One thousand and sixty-eight patients with clinically suspected sCJD were analyzed in a Spanish reference center. In order to explore the influence of the clinical context on the performance of the immunoassay, the patients were classified at sample reception according to the World Health Organization (WHO) diagnostic criteria excluding the 14-3-3 test results. The yield of the immunoassay was evaluated in each subgroup with criteria of probable, possible sCJD or non-sCJD. RESULTS In the set of patients with suspicion of sCJD the inclusion of the 14-3-3 test produces a significant increase in the diagnosis certainty (positive likelihood ratio: 10.1) compared to the WHO's criteria, excluding the 14-3-3 test. For patients classified at sample reception as probable sCJD (n=166), possible sCJD (n=129) and non-sCJD (n=773), the positive predictive values for the test were 98.4%, 97.5% and 31%, and the negative predictive values were 22.2%, 73.4% and 100%, respectively. CONCLUSIONS The predictive values of the assay vary according to the previous diagnostic certainty. Therefore, in order to interpret correctly the test, it is necessary to evaluate the degree of initial clinical suspicion of the patient at the moment of the cerebrospinal fluid (CSF) extraction. This study offers up-to-date information, referenced to the Spanish population, and in useful format, and it is intended to serve as a guideline for 14-3-3 test results interpretation to the clinicians in our community.
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Affiliation(s)
- N Cuadrado-Corrales
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid
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Abstract
We report a SUNCT patient who showed both a precipitation and worsening of symptomatic periods after treatment with L-type calcium channel blockers. This pharmacological response may provide us with important clues for understanding the pathophysiology of SUNCT, and hopefully to find a remedy for the victims of this syndrome. This observation could also support a verapamil trial in SUNCT patients as a precipitating of attacks.
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Affiliation(s)
- A Jiménez-Huete
- Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain.
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Vidal R, Calero M, Piccardo P, Farlow MR, Unverzagt FW, Méndez E, Jiménez-Huete A, Beavis R, Gallo G, Gomez-Tortosa E, Ghiso J, Hyman BT, Frangione B, Ghetti B. Senile dementia associated with amyloid beta protein angiopathy and tau perivascular pathology but not neuritic plaques in patients homozygous for the APOE-epsilon4 allele. Acta Neuropathol 2000; 100:1-12. [PMID: 10912914 DOI: 10.1007/s004010051186] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Amyloid beta protein deposition in cortical and leptomeningeal vessels, causing the most common type of cerebral amyloid angiopathy, is found in sporadic and familial Alzheimer's disease (AD) and is the principal feature in the hereditary cerebral hemorrhage with amyloidosis, Dutch type. The presence of the Apolipopriotein E (APOE)-epsilon4 allele has been implicated as a risk factor for AD and the development of cerebral amyloid angiopathy in AD. We report clinical, pathological and biochemical studies on two APOE-epsilon4 homozygous subjects, who had senile dementia and whose main neuropathological feature was a severe and diffuse amyloid angiopathy associated with perivascular tau neurofibrillary pathology. Amyloid beta protein and ApoE immunoreactivity were observed in leptomeningeal vessels as well as in medium-sized and small vessels and capillaries in the parenchyma of the neocortex, hippocampus, thalamus, cerebellum, midbrain, pons, and medulla. The predominant peptide form of amyloid beta protein was that terminating at residue Val40, as determined by immunohistochemistry, amino acid sequence and mass spectrometry analysis. A crown of tau-immunopositive cell processes was consistently present around blood vessels. DNA sequence analysis of the Amyloid Precursor Protein gene and Presenilin-1 (PS-1) gene revealed no mutations. In these APOE-epsilon4 homozygous patients, the pathological process differed from that typically seen in AD in that they showed a heavy burden of perivascular tau-immunopositive cell processes associated with severe amyloid beta protein angiopathy, neurofibrillary tangles, some cortical Lewy bodies and an absence of neuritic plaques. These cases emphasize the concept that tau deposits may be pathogenetically related to amyloid beta protein deposition.
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Affiliation(s)
- R Vidal
- Department of Pathology, New York University School of Medicine, NY 10016, USA
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Jiménez-Huete A, Lievens PM, Vidal R, Piccardo P, Ghetti B, Tagliavini F, Frangione B, Prelli F. Endogenous proteolytic cleavage of normal and disease-associated isoforms of the human prion protein in neural and non-neural tissues. Am J Pathol 1998; 153:1561-72. [PMID: 9811348 PMCID: PMC1853409 DOI: 10.1016/s0002-9440(10)65744-6] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We have investigated the proteolytic cleavage of the cellular (PrPC) and pathological (PrPSc) isoforms of the human prion protein (PrP) in normal and prion-affected brains and in tonsils and platelets from neurologically intact individuals. The various PrP species were resolved after deglycosylation according to their electrophoretic mobility, immunoreactivity, Sarkosyl solubility, and, as a novel approach, resistance to endogenous proteases. First, our data show that PrPC proteolysis in brain originates amino-truncated peptides of 21 to 22 and 18 (C1) kd that are similar in different regions and are not modified by the PrP codon 129 genotype, a polymorphism that affects the expression of prion disorders. Second, this proteolytic cleavage of PrPC in brain is blocked by inhibitors of metalloproteases. Third, differences in PrPC proteolysis, and probably in Asn glycosylation and glycosylphosphatidylinositol anchor composition, exist between neural and non-neural tissues. Fourth, protease-resistant PrPSc cores in sporadic Creutzfeldt-Jakob disease (CJD) and Gerstmann-Sträussler-Scheinker F198S disease brains all have an intact C1 cleavage site (Met111-His112), which precludes disruption of a domain associated with toxicity and fibrillogenesis. Fifth, the profile of endogenous proteolytic PrPSc peptides is characteristic of each disorder studied, thus permitting the molecular classification of these prion diseases without the use of proteinase K and even a recognition of PrPSc heterogeneity within type 2 CJD patients having different codon 129 genotype and neuropathological phenotype. This does not exclude the role of additional factors in phenotypic expression; in particular, differences in glycosylation that may be especially relevant in the new variant CJD. Proteolytic processing of PrP may play an important role in the neurotropism and phenotypic expression of prion diseases, but it does not appear to participate in disease susceptibility.
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Affiliation(s)
- A Jiménez-Huete
- Department of Pathology, New York University Medical Center, New York 10016, USA
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