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Ventura R, Beltrán-Corbellini Á, Toledano R, Román ISM, García-Morales I, Gil-Nagel A. Epileptogenic focal lesions in Dravet syndrome: A warning to investigators. Epileptic Disord 2024; 26:173-180. [PMID: 38116874 DOI: 10.1002/epd2.20191] [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] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Most patients with Dravet syndrome (DS) have unremarkable neuroimaging studies. However, a small number of patients exhibit focal abnormalities that may modify the epilepsy phenotype. We report a case series of DS patients carrying SCN1A variants concurrent with additional focal brain lesions, aiming to provide details regarding their clinical course, electrographic findings, and imaging features. METHODS We reviewed the electronic medical records of patients with developmental and epileptic encephalopathies in our center, from January 2000 to December 2022, identifying 90 patients with DS resulting from SCN1A variants. Of these, patients displaying focal brain lesions were eligible. RESULTS Five patients (4 males and 1 female), with median age of 26 years, were included. All exhibited clinical and electroencephalographic features consistent with the DS spectrum. Sequencing analysis of the SCN1A gene identified pathogenic variants. Magnetic resonance imaging (MRI) revealed focal cortical dysplasia (FCD) in two patients, while the remaining three had cystic lesions. Three patients had previously undergone resective epilepsy surgery in other centers, with no improvement in seizure frequency. Neuropathology studies revealed the presence of FCD type IIA, intracranial teratomas, and dysembryoplastic neuroepithelial tumor (DNET). SIGNIFICANCE When an individual with an established diagnosis of genetic epilepsy and a focal lesion on MRI is undergoing preoperative evaluation, it is crucial to conduct a comprehensive analysis to understand the relevance of the focal finding for the patient's phenotype and thus anticipate potential surgical outcomes. In instances where epilepsy in DS patients is influenced by a specific focal structural lesion, resective surgery should be carefully considered after precise pharmacological treatment, acknowledging the persistent influence of an SCN1A variant on expected outcomes.
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Affiliation(s)
- Rita Ventura
- Hospital Egas Moniz - Neurology, Lisbon, Portugal
| | | | - Rafael Toledano
- Department of Neurology, Hospital Ruber Internacional Ringgold standard institution, Madrid, Spain
| | | | - Irene García-Morales
- Department of Neurology, Hospital Ruber Internacional Ringgold standard institution, Madrid, Spain
| | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional Ringgold standard institution, Madrid, Spain
- Fundación Iniciativa por las Neurociencias-(FINCE), Madrid, Spain
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Beltrán-Corbellini Á, Toledano R, Budke M, García-Morales I, Herráez E, Sánchez-Miranda Román I, Gil-Nagel A. Anterior midcingulate epilepsy: When semiology is of paramount importance to find the needle in the haystack. Epileptic Disord 2024; 26:161-163. [PMID: 37850932 DOI: 10.1002/epd2.20173] [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] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Abstract
Content available: Video
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Affiliation(s)
| | - Rafael Toledano
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Marcelo Budke
- Department of Neurosurgery, Hospital Ruber Internacional, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Erika Herráez
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | | | - Antonio Gil-Nagel
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
- Fundación Iniciativa por las Neurociencias (FINCE), Madrid, Spain
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Toledano R, Villanueva V, Toledo M, Sabaniego J, Pérez-Domper P. Clinical and economic implications of epilepsy management across treatment lines in Spain: a real-life database analysis. J Neurol 2023; 270:5945-5957. [PMID: 37626245 PMCID: PMC10632298 DOI: 10.1007/s00415-023-11958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Epilepsy is a chronic brain disease characterized by recurrent seizures. We investigated real-world management of epilepsy across treatment lines in Spain, including healthcare resource use (HRU) and associated costs. METHODS This was a retrospective study of real-life data from epilepsy patients prescribed antiseizure medication (ASM) between January 2016 and December 2021. Patients were grouped according to their line of treatment (1st, 2nd, 3rd and 4th +) during the recruitment period. Demographic and clinical characteristics, comorbidities and concomitant medications were analyzed during the baseline period (6 months before starting treatment line); antiepileptic treatments, concomitant medications, HRU and associated costs were analyzed during follow-up. RESULTS The study included 5006 patients. Treatment duration decreased as treatment lines progressed (mean ± SD progression time: 523.2 ± 279.1 days from 1st to 2nd line, 351.6 ± 194.4 days from 2nd to 3rd line; 272.7 ± 139.3 days from 3rd to 4th + line). Significant HRU differences were found with subsequent treatment lines, including an increase in hospital admissions and patients on sick leave. Mean (95% CI) adjusted total costs per patient were €2974/year (2773-3175) in the 1st line and €5735/year (5043-6428) in the 4th + line. There was an increase in adjusted direct and total costs with subsequent treatment lines; the mean difference in total costs between cohorts was €2761 (p < 0.001). The highest direct costs were associated with epilepsy medication, days at the hospital and specialist visits. CONCLUSION Our data revealed a progressive increase in the use of resources and associated costs across subsequent epilepsy treatment lines.
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Affiliation(s)
- Rafael Toledano
- Epilepsy Unit, Neurology Service, Hospital Universitario Ramón y Cajal and Hospital Ruber Internacional, Madrid, Spain.
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Member of ERN EpiCARE, Valencia, Spain
| | - Manuel Toledo
- Neurology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
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Beltrán-Corbellini Á, Romeral-Jiménez M, Mayo P, Sánchez-Miranda Román I, Iruzubieta P, Chico-García JL, Parra-Díaz P, García-Morales I, Toledano R, Aledo-Serrano Á, Gil-Nagel A. Cenobamate in patients with highly refractory focal epilepsy: A retrospective real-world study. Seizure 2023; 111:71-77. [PMID: 37549616 DOI: 10.1016/j.seizure.2023.07.026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE To determine the effectiveness and safety outcomes of cenobamate in a cohort of patients with highly refractory focal epilepsy in routine clinical practice. METHODS Observational, retrospective, phase 4 study on subjects receiving cenobamate in three Spanish centers. The primary endpoint was the retention rate at the last follow-up. The main secondary endpoints were the 50%-responder and seizure-free rates at three months and the last follow-up. Other secondary endpoints were Global Clinical Impressions-Improvement (CGI-I) scores and treatment-emergent adverse events (TEAEs). RESULTS Fifty-one patients with highly refractory focal epilepsy with 24.7 years of disease evolution, ten previously tried ASM, and a 23.5% of previous epilepsy surgery were included. The retention rate at the last follow-up was 80.4%. The 50% responder rate in focal seizures at three months was 56.5% (median reduction per month 51%, 0-74.6; p < 0.0001) and in focal to bilateral tonic-clonic seizures was 63.6% (median reduction per month 89%, 0-100; p = 0.022). A total of 54.3% of subjects reported a reduction in the intensity of focal seizures, and 66% manifested clinically significant satisfaction. Cenobamate allowed a significant decrease in concomitant ASM, especially sodium channel blockers. TEAEs were reported in 43.1% of individuals, 85% of whom resolved or improved, with no new safety findings. CONCLUSION In this analysis of patients with highly refractory focal epilepsy treated with cenobamate according to standard clinical practice, there was evidence of a high reduction in both seizure frequency and intensity, with a manageable safety profile.
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Affiliation(s)
| | - María Romeral-Jiménez
- Epilepsy Unit, Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Pablo Mayo
- Epilepsy Unit, Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Pablo Iruzubieta
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Juan Luis Chico-García
- Epilepsy Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Paloma Parra-Díaz
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Rafael Toledano
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ángel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Fundación Iniciativa por las Neurociencias (FINCE), Madrid, Spain
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Aledo-Serrano Á, Valls-Carbó A, Fenger CD, Groeppel G, Hartlieb T, Pascual I, Herraez E, Cabal B, García-Morales I, Toledano R, Budke M, Beltran-Corbellini Á, Baldassari S, Coras R, Kobow K, Herrera DM, Del Barrio A, Dahl HA, Del Pino I, Baulac S, Blumcke I, Møller RS, Gil-Nagel A. D-galactose Supplementation for the Treatment of Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia in Epilepsy (MOGHE): A Pilot Trial of Precision Medicine After Epilepsy Surgery. Neurotherapeutics 2023; 20:1294-1304. [PMID: 37278968 PMCID: PMC10480113 DOI: 10.1007/s13311-023-01395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
MOGHE is defined as mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy. Approximately half of the patients with histopathologically confirmed MOGHE carry a brain somatic variant in the SLC35A2 gene encoding a UDP-galactose transporter. Previous research showed that D-galactose supplementation results in clinical improvement in patients with a congenital disorder of glycosylation due to germline variants in SLC35A2. We aimed to evaluate the effects of D-galactose supplementation in patients with histopathologically confirmed MOGHE, with uncontrolled seizures or cognitive impairment and epileptiform activity at the EEG after epilepsy surgery (NCT04833322). Patients were orally supplemented with D-galactose for 6 months in doses up to 1.5 g/kg/day and monitored for seizure frequency including 24-h video-EEG recording, cognition and behavioral scores, i.e., WISC, BRIEF-2, SNAP-IV, and SCQ, and quality of life measures, before and 6 months after treatment. Global response was defined by > 50% improvement of seizure frequency and/or cognition and behavior (clinical global impression of "much improved" or better). Twelve patients (aged 5-28 years) were included from three different centers. Neurosurgical tissue samples were available in all patients and revealed a brain somatic variant in SLC35A2 in six patients (non-present in the blood). After 6 months of supplementation, D-galactose was well tolerated with just two patients presenting abdominal discomfort, solved after dose spacing or reduction. There was a 50% reduction or higher of seizure frequency in 3/6 patients, with an improvement at EEG in 2/5 patients. One patient became seizure-free. An improvement of cognitive/behavioral features encompassing impulsivity (mean SNAP-IV - 3.19 [- 0.84; - 5.6]), social communication (mean SCQ - 2.08 [- 0.63; - 4.90]), and executive function (BRIEF-2 inhibit - 5.2 [- 1.23; - 9.2]) was observed. Global responder rate was 9/12 (6/6 in SLC35A2-positive). Our results suggest that supplementation with D-galactose in patients with MOGHE is safe and well tolerated and, although the efficacy data warrant larger studies, it might build a rationale for precision medicine after epilepsy surgery.
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Affiliation(s)
- Ángel Aledo-Serrano
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain.
- Initiative for Neuroscience (INCE) Foundation, Madrid, Spain.
- Neuroscience Institute, Vithas Madrid La Milagrosa University Hospital, Vithas Hospital Group, Madrid, Spain.
| | - Adrián Valls-Carbó
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
- Initiative for Neuroscience (INCE) Foundation, Madrid, Spain
| | - Christina D Fenger
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
- Amplexa Genetics A/S (H.A.D.), Odense, Denmark
| | - Gudrun Groeppel
- Department of Paediatrics and Adolescent Medicine and Department of Neurology, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Till Hartlieb
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen Clinic, Vogtareuth, Germany
- Research Institute "Rehabilitation, " PMU Salzburg, Transition, PalliationSalzburg, Austria
| | - Irene Pascual
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
| | - Erika Herraez
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
- Department of Neurophysiology, Rey Juan Carlos University Hospital, Madrid, Spain
| | - Borja Cabal
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
- Department of Neurology, Puerta de Hierro University Hospital, Madrid, Spain
| | - Irene García-Morales
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
- Epilepsy Unit, Department of Neurology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Rafael Toledano
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
- Epilepsy Unit, Department of Neurology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Marcelo Budke
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
- Department of Neurosurgery, Niño Jesus University Hospital, Madrid, Spain
| | | | - Sara Baldassari
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
| | - Roland Coras
- Department of Neuropathology, University Hospital, Erlangen, Germany
| | - Katja Kobow
- Department of Neuropathology, University Hospital, Erlangen, Germany
| | - David M Herrera
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
- Epilepsy Unit, Department of Neurology, Kennedy University Hospital, Bogota, Colombia
| | - Antonio Del Barrio
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
| | | | - Isabel Del Pino
- Institute of Neurosciences (IN), Higher Council for Scientific Research-Miguel Hernandez University, Alicante, Spain
| | - Stéphanie Baulac
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
| | - Ingmar Blumcke
- Department of Neuropathology, University Hospital, Erlangen, Germany
| | - Rikke S Møller
- Neuroscience Institute, Vithas Madrid La Milagrosa University Hospital, Vithas Hospital Group, Madrid, Spain
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Antonio Gil-Nagel
- Epilepsy and Neurogenetics Program, Ruber Internacional Hospital, La Masó 34, 28034, Madrid, Spain
- Initiative for Neuroscience (INCE) Foundation, Madrid, Spain
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Celdran de Castro A, Nascimento FA, Beltran-Corbellini Á, Toledano R, Garcia-Morales I, Gil-Nagel A, Aledo-Serrano Á. Levetiracetam, from broad-spectrum use to precision prescription: A narrative review and expert opinion. Seizure 2023; 107:121-131. [PMID: 37023625 DOI: 10.1016/j.seizure.2023.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
Levetiracetam (LEV) is an antiseizure medication (ASM) whose mechanism of action involves the modulation of neurotransmitters release through binding to the synaptic vesicle glycoprotein 2A. It is a broad-spectrum ASM displaying favorable pharmacokinetic and tolerability profiles. Since its introduction in 1999, it has been widely prescribed, becoming the first-line treatment for numerous epilepsy syndromes and clinical scenarios. However, this might have resulted in overuse. Increasing evidence, including the recently published SANAD II trials, suggests that other ASMs are reasonable therapeutic options for generalized and focal epilepsies. Not infrequently, these ASMs show better safety and effectiveness profiles compared to LEV (partially due to the latter's well-known cognitive and behavioral adverse effects, present in up to 20% of patients). Moreover, it has been shown that the underlying etiology of epilepsy is significantly linked to ASMs response in particular scenarios, highlighting the importance of an etiology-based ASM choice. In the case of LEV, it has demonstrated an optimal effectiveness in Alzheimer's disease, Down syndrome, and PCDH19-related epilepsies whereas, in other etiologies such as malformations of cortical development, it may show negligible effects. This narrative review analyzes the current evidence related to the use of LEV for the treatment of seizures. Illustrative clinical scenarios and practical decision-making approaches are also addressed, therefore aiming to define a rational use of this ASM.
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Torres-Gaona G, Aledo-Serrano Á, García-Morales I, Toledano R, Valls J, Cosculluela B, Munsó L, Raurich X, Trejo A, Blanquez D, Gil-Nagel A. Artificial intelligence system, based on mjn-SERAS algorithm, for the early detection of seizures in patients with refractory focal epilepsy: a cross-sectional pilot study. Epilepsy Behav Rep 2023; 22:100600. [DOI: 10.1016/j.ebr.2023.100600] [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: 12/16/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
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Comino Garcia-Munoz A, Alemán-Gómez Y, Toledano R, Poch C, García-Morales I, Aledo-Serrano Á, Gil-Nagel A, Campo P. Morphometric and microstructural characteristics of hippocampal subfields in mesial temporal lobe epilepsy and their correlates with mnemonic discrimination. Front Neurol 2023; 14:1096873. [PMID: 36864916 PMCID: PMC9972498 DOI: 10.3389/fneur.2023.1096873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Pattern separation (PS) is a fundamental aspect of memory creation that defines the ability to transform similar memory representations into distinct ones, so they do not overlap when storing and retrieving them. Experimental evidence in animal models and the study of other human pathologies have demonstrated the role of the hippocampus in PS, in particular of the dentate gyrus (DG) and CA3. Patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HE) commonly report mnemonic deficits that have been associated with failures in PS. However, the link between these impairments and the integrity of the hippocampal subfields in these patients has not yet been determined. The aim of this work is to explore the association between the ability to perform mnemonic functions and the integrity of hippocampal CA1, CA3, and DG in patients with unilateral MTLE-HE. Method To reach this goal we evaluated the memory of patients with an improved object mnemonic similarity test. We then analyzed the hippocampal complex structural and microstructural integrity using diffusion weighted imaging. Results Our results indicate that patients with unilateral MTLE-HE present alterations in both volume and microstructural properties at the level of the hippocampal subfields DG, CA1, CA3, and the subiculum, that sometimes depend on the lateralization of their epileptic focus. However, none of the specific changes was found to be directly related to the performance of the patients in a pattern separation task, which might indicate a contribution of various alterations to the mnemonic deficits or the key contribution of other structures to the function. Discussion we established for the first time the alterations in both the volume and the microstructure at the level of the hippocampal subfields in a group of unilateral MTLE patients. We observed that these changes are greater in the DG and CA1 at the macrostructural level, and in CA3 and CA1 in the microstructural level. None of these changes had a direct relation to the performance of the patients in a pattern separation task, which suggests a contribution of various alterations to the loss of function.
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Affiliation(s)
- Alicia Comino Garcia-Munoz
- Centre de Résonance Magnétique Biologique et Médicale-Unité Mixte de Recherche 7339, Aix-Marseille Université, Marseille, France
| | - Yasser Alemán-Gómez
- Connectomics Lab, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Rafael Toledano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain,Epilepsy Unit, Neurology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Claudia Poch
- Facultad de Lenguas y Educación, Universidad de Nebrija, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain,Epilepsy Unit, Neurology Department, University Hospital of San Carlos, Madrid, Spain
| | - Ángel Aledo-Serrano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Pablo Campo
- Department of Basic Psychology, Autonoma University of Madrid, Madrid, Spain,*Correspondence: Pablo Campo ✉
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Aledo-Serrano Á, Cabal-Paz B, Gardella E, Gómez-Porro P, Martínez-Múgica O, Beltrán-Corbellini A, Toledano R, García-Morales I, Gil-Nagel A. Effect of Fenfluramine on Seizures and Comorbidities in SCN8A-Developmental and Epileptic Encephalopathy: A Case Series. Epilepsia Open 2022; 7:525-531. [PMID: 35802036 PMCID: PMC9436303 DOI: 10.1002/epi4.12623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/02/2022] [Indexed: 11/06/2022] Open
Abstract
SCN8A-developmental and epileptic encephalopathy is caused by mutations in the SCN8A gene encoding the Nav 1.6 sodium channel, and is characterized by intractable multivariate seizures and developmental regression. Fenfluramine is a repurposed drug with proven antiseizure efficacy in Dravet syndrome and Lennox-Gastaut syndrome. The effect of fenfluramine treatment was assessed in a retrospective series of three patients with intractable SCN8A epilepsy and severe neurodevelopmental comorbidity (n=2 females; age 2.8-13 years; 8-16 prior failed antiseizure medications (ASM); treatment duration: 0.75-4.2 years). In the 6 months prior to receiving fenfluramine, patients experienced multiple seizure types, including generalized tonic-clonic, focal and myoclonic seizures, and status epilepticus. Overall seizure reduction was 60%-90% in the last 3, 6, and 12 months of fenfluramine treatment. Clinically meaningful improvement was noted in ≥1 non-seizure comorbidity per patient after fenfluramine, as assessed by physician-ratings of ≥"Much Improved" on the Clinical Global Impression of Improvement scale. Improvements included ambulation in a previously non-ambulant patient and better attention, sleep, and language. One patient showed mild irritability which resolved; no other treatment-related adverse events were reported. There were no reports of valvular heart disease or pulmonary arterial hypertension. Fenfluramine may be a promising ASM for randomized clinical trials in SCN8A-related disorders.
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Affiliation(s)
- Ángel Aledo-Serrano
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
| | - Borja Cabal-Paz
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain.,Neurology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Elena Gardella
- Department of Epilepsy Genetics and Personalized Treatment, Danish Epilepsy Center, Dianalund, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Pablo Gómez-Porro
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain.,Neurology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Otilia Martínez-Múgica
- Pediatric Neurology Section, Pediatrics Department, Donostia University Hospital, San Sebastian, Spain
| | | | - Rafael Toledano
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain.,Epilepsy Unit, Neurology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain.,Epilepsy Unit, Neurology Department, Clínico San Carlos University Hospital, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
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Aledo-Serrano A, Hariramani R, Gonzalez-Martinez A, Álvarez-Troncoso J, Toledano R, Bayat A, Garcia-Morales I, Becerra JL, Villegas-Martínez I, Beltran-Corbellini A, Gil-Nagel A. Anakinra and tocilizumab in the chronic phase of febrile infection-related epilepsy syndrome (FIRES): Effectiveness and safety from a case-series. Seizure 2022; 100:51-55. [PMID: 35759951 DOI: 10.1016/j.seizure.2022.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 04/27/2022] [Revised: 05/29/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE There is scarce evidence of effective treatments for the chronic phase of Febrile infection-related epilepsy syndrome (FIRES). This study aimed to analyze the outcomes of treatment with anakinra and tocilizumab. METHODS Retrospective study including patients receiving either anti-interleukin-1 (anti-IL-1, anakinra) or anti-IL-6 (tocilizumab) during the chronic phase of FIRES. We evaluated seizure outcomes, non-seizure comorbidities, and adverse events. Additionally, an indirect control group including patients during the chronic phase of FIRES non-treated with-IL therapies was evaluated. RESULTS Five patients were included; three females. Median age at FIRES: 8 years (IQR: 6-10). Five patients received anakinra; one patient switched to tocilizumab after ineffectiveness. Median treatment duration was 9months (IQR: 7-20). While no patients became seizure-free, 20-50% reduction in seizure frequency was reported in 3/5 patients after 6 months with anakinra. Retention rate was 100% at 6 months and 40% at 12months. Three patients reported reduced seizure intensity and rescue medication needed, and better behavior/communication. Similar improvement was reported for the patient switching to tocilizumab. Patients with the best response received anti-IL a median of 9 years after acute phase. All discontinuations were due to ineffectiveness. There were none relevant adverse events apart from one patient presenting transient seizure aggravation. Nine patients were included in the control group; none of them showed relevant improvement in seizure outcomes or cognitive/behavioral comorbidities. Only one presented mild improvement in seizure frequency during the 6-months follow-up. CONCLUSION This study provides promising data on effectiveness/safety of anakinra and tocilizumab in the chronic phase of FIRES. These findings warrant prospective/larger studies.
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Affiliation(s)
- Angel Aledo-Serrano
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain.
| | - Roshan Hariramani
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain; Department of Neurology, Juan Ramon Jimenez Hospital, Huelva, Andalusia, Spain
| | - Alicia Gonzalez-Martinez
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain; Neurology & Immunology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria (IIS)-Princesa, Madrid, Spain
| | - Jorge Álvarez-Troncoso
- Division of autoimmune diseases, Department of Internal Medicine, La Paz University Hospital, Madrid, Spain
| | - Rafael Toledano
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain; Epilepsy Unit, Neurology Department, Ramon y Cajal University hospital, Madrid, Spain
| | - Allan Bayat
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark; Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
| | - Irene Garcia-Morales
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain; Epilepsy Unit, Neurology Department, Clinico San Carlos University Hospital Madrid, Spain
| | - Juan Luis Becerra
- Epilepsy Unit, Neurology Department, Germans Trias I Pujol University Hospital, Badalona, Spain
| | - Irene Villegas-Martínez
- Department of Neurology, Santa Lucía Hospital, Cartagena, Spain, Bio-Health Institute (IMIB-Arrixaca), Health Science Campus, Murcia, Spain
| | | | - Antonio Gil-Nagel
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
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11
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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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12
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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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13
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Beltrán-Corbellini Á, Aledo-Serrano Á, Møller RS, Pérez-Palma E, García-Morales I, Toledano R, Gil-Nagel A. Epilepsy Genetics and Precision Medicine in Adults: A New Landscape for Developmental and Epileptic Encephalopathies. Front Neurol 2022; 13:777115. [PMID: 35250806 PMCID: PMC8891166 DOI: 10.3389/fneur.2022.777115] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
This review aims to provide an updated perspective of epilepsy genetics and precision medicine in adult patients, with special focus on developmental and epileptic encephalopathies (DEEs), covering relevant and controversial issues, such as defining candidates for genetic testing, which genetic tests to request and how to interpret them. A literature review was conducted, including findings in the discussion and recommendations. DEEs are wide and phenotypically heterogeneous electroclinical syndromes. They generally have a pediatric presentation, but patients frequently reach adulthood still undiagnosed. Identifying the etiology is essential, because there lies the key for precision medicine. Phenotypes modify according to age, and although deep phenotyping has allowed to outline certain entities, genotype-phenotype correlations are still poor, commonly leading to long-lasting diagnostic odysseys and ineffective therapies. Recent adult series show that the target patients to be identified for genetic testing are those with epilepsy and different risk factors. The clinician should take active part in the assessment of the pathogenicity of the variants detected, especially concerning variants of uncertain significance. An accurate diagnosis implies precision medicine, meaning genetic counseling, prognosis, possible future therapies, and a reduction of iatrogeny. Up to date, there are a few tens of gene mutations with additional concrete treatments, including those with restrictive/substitutive therapies, those with therapies modifying signaling pathways, and channelopathies, that are worth to be assessed in adults. Further research is needed regarding phenotyping of adult syndromes, early diagnosis, and the development of targeted therapies.
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Affiliation(s)
| | - Ángel Aledo-Serrano
- Epilepsy Program, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
- *Correspondence: Ángel Aledo-Serrano
| | - Rikke S. Møller
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre, Dianalund, Denmark
| | - Eduardo Pérez-Palma
- Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Irene García-Morales
- Epilepsy Program, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
- Epilepsy Unit, Neurology Department, Clínico San Carlos University Hospital, Madrid, Spain
| | - Rafael Toledano
- Epilepsy Program, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
- Epilepsy Unit, Neurology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Program, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
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14
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Abstract
INTRODUCTION Perampanel (PER) is an antiepileptic drug approved in Europe as add-on therapy for patients with focal onset seizures (with or without secondary generalisation) from the age of 4 years, and for primary generalised tonic-clonic seizures from 7 years of age. OBJECTIVE Review current evidence on treatment with PER monotherapy after conversion from adjunctive therapy. DEVELOPMENT Two retrospective multicentre studies in which PER was used as monotherapy show that low doses (6-8 mg/day) of PER were effective and well tolerated in a subgroup of patients with less severe epilepsies than patients who participated in clinical trials (where PER was used as add-on therapy). In these studies, the retention rate exceeded 90% at 3 months, and 70% at 6, and 12 months. The responder rate was > 75% at 3 months, and the rate of seizure-free patients exceeded 50% at 3 and 6 months, and 37% at 12 months. Compared to other observational studies and clinical trials where PER was used as add-on therapy, no adverse effects other than those already known were observed. Four other studies examining the effects of conversion to PER monotherapy in a small number of patients support these results. CONCLUSIONS In routine clinical practice, conversion to PER monotherapy, at relatively low doses, is an effective and well-tolerated treatment for patients with focal and generalised tonic-clonic seizures.
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Affiliation(s)
- R Toledano
- Hospital Ruber Internacional, 28034 Madrid, España.,Hospital Ramón y Cajal, Madrid, España
| | - A Gil-Nagel
- Hospital Ruber Internacional, 28034 Madrid, España
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15
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Aledo-Serrano Á, Gómez-Iglesias P, Toledano R, Garcia-Peñas JJ, Garcia-Morales I, Anciones C, Soto-Insuga V, Benke TA, Del Pino I, Gil-Nagel A. Sodium channel blockers for the treatment of epilepsy in CDKL5 deficiency disorder: Findings from a multicenter cohort. Epilepsy Behav 2021; 118:107946. [PMID: 33848848 DOI: 10.1016/j.yebeh.2021.107946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study was aimed to analyze the effectiveness of sodium channel blockers (SCBs) in CDKL5 deficiency disorder (CDD)-related epilepsy. METHODS A retrospective, observational study was performed, including patients with CDD diagnosis evaluated between 2016 and 2019 at three tertiary Epilepsy Centers. Demographic, electroclinical and genetic features, as well as ASM treatments and their outcomes were analyzed, with special focus on SCBs. RESULTS Twenty-one patients evaluated at three tertiary Epilepsy Centers were included, of which 19 presented with epilepsy (90.5%); all had pathogenic mutations of CDKL5. Six patients (31.6%) were classified as SCB responders (more than 50% reduction), four being currently seizure free (mean seizure-free period of 8 years). Most frequent SCB drugs were oxcarbazepine (OXC), carbamazepine (CBZ), and lacosamide (LCM). None of them presented relevant adverse events. In contrast, three patients showed seizure aggravation in the non-responder group. When comparing both groups, responders had statistically significant younger age at SCB treatment and epilepsy onset, higher proportion of focal epileptiform activity and less frequent history of West syndrome. CONCLUSIONS The results of this study indicate that treatment with SCBs might be effective and safe in a subset of patients with CDD-related epilepsy.
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Affiliation(s)
- Ángel Aledo-Serrano
- Epilepsy Program. Neurology Department, Ruber Internacional Hospital, Madrid, Spain; Epilepsy Unit. Neuroscience Department, Corachan Clinic, Barcelona, Spain.
| | | | - Rafael Toledano
- Epilepsy Program. Neurology Department, Ruber Internacional Hospital, Madrid, Spain; Epilepsy Unit, Neurology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Juan Jose Garcia-Peñas
- Department of Pediatric Neurology, Niño Jesus University Children's Hospital, Madrid, Spain
| | - Irene Garcia-Morales
- Epilepsy Program. Neurology Department, Ruber Internacional Hospital, Madrid, Spain; Epilepsy Unit. Neurology Department, Clínico San Carlos University Hospital, Madrid, Spain
| | - Carla Anciones
- Epilepsy Program. Neurology Department, Ruber Internacional Hospital, Madrid, Spain
| | - Victor Soto-Insuga
- Department of Pediatric Neurology, Niño Jesus University Children's Hospital, Madrid, Spain
| | - Timothy A Benke
- Departments of Pediatrics, Neurology, and Pharmacology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Isabel Del Pino
- Principe Felipe Research Center (Centro de Investigación Principe Felipe, CIPF), Valencia, Spain
| | - Antonio Gil-Nagel
- Epilepsy Program. Neurology Department, Ruber Internacional Hospital, Madrid, Spain
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16
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Gutiérrez-Viedma Á, Sanz-Graciani I, Romeral-Jiménez M, Parejo-Carbonell B, Serrano-García I, Cuadrado ML, Aledo-Serrano Á, Gil-Nagel A, Toledano R, Pérez-De-Heredia-Torres M, Santamarina E, García-Morales I. Epidaily, a scale for comprehensive functional assessment of patients with epilepsy. Epilepsy Behav 2021; 114:107570. [PMID: 33234457 DOI: 10.1016/j.yebeh.2020.107570] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and validate an epilepsy-specific scale for comprehensive functional assessment of patients with epilepsy, named Epidaily. METHODS The multidisciplinary research group created through brainstorming a list of 47 items to explore the cognitive, social, basic and instrumental functionality of the patient. A group of epilepsy experts independent of the research group evaluated the suitability of all the items, which then were selected and reviewed by the research group to conform the Epidaily scale. On a sample of 102 patients, a reliability analysis was performed, as well as a validation one using as reference scale the score on the Activities of Daily Living Questionnaire (ADLQ), which evaluates basic and instrumental functionality. RESULTS Epidaily consisted of 10 items distributed in four dimensions, with a possible score from 0 to 100 (perfect functionality). Inter-observer reliability was excellent, with an intraclass correlation coefficient of 0.98 (95% confidence interval 0.97-0.99). Criterion validity was demonstrated by the high positive correlation of the Epidaily score with the ADLQ score (Spearman's rho coefficient 0.85, p < 0.001). Significant relation was found between ADLQ and Epidaily in the linear regression analysis (p < 001), which reported that Epidaily explains 85.5% of the variability of ADLQ (R-squared 0.85). Discriminant validity was also proved, as Epidaily allowed to classify epilepsy severity based on Cramer et al epilepsy severity classification. The median time to obtain the Epidaily score was 5 min (interquartile range 4-6). SIGNIFICANCE Epidaily is a brief and versatile scale, with excellent inter-observer reliability, which has been validated for comprehensive functional assessment of patients with epilepsy.
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Affiliation(s)
- Álvaro Gutiérrez-Viedma
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Servicio de Neurología, Hospital Universitario Fundación Jiménez Díaz, Avenida de los Reyes Católicos 2, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain.
| | - Isabel Sanz-Graciani
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - María Romeral-Jiménez
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Beatriz Parejo-Carbonell
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Irene Serrano-García
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Unidad de Metodología de Investigación y Epidemiología Clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - María-Luz Cuadrado
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Ángel Aledo-Serrano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Antonio Gil-Nagel
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Rafael Toledano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar Viejo 100, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Marta Pérez-De-Heredia-Torres
- Unidad de Epilepsia, Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar Viejo 100, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Estevo Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Vall D́Hebrón, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Irene García-Morales
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
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17
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Poch C, Toledano R, García-Morales I, Alemán-Gómez Y, Gil-Nagel A, Campo P. Contributions of left and right anterior temporal lobes to semantic cognition: Evidence from patients with small temporopolar lesions. Neuropsychologia 2020; 152:107738. [PMID: 33383038 DOI: 10.1016/j.neuropsychologia.2020.107738] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Abstract
Decades of research have increased the understanding of the contribution of the anterior temporal lobes (ATLs) to semantic cognition. Nonetheless, whether semantic processing of different types of information show a selective relationship with left and right ATLs, or whether semantic processing in the ATLs is independent of the modality of the input is currently unknown. There exists evidence supporting each of these alternatives. A fundamental objection to these findings is that they were obtained from studies with patients with brain damage affecting extensive regions, sometimes bilaterally. In the current study, we assessed a group of 38 temporal lobe epilepsy (TLE) patients with either left or right small epileptogenic lesions with a battery of commonly used semantic tasks that tested verbal and non-verbal semantic processing. We found that left TLE patients exhibited worse performance than controls on the verbal semantic tasks, as expected, but also on the non-verbal semantic task. On the other hand, performance of the right TLE group did not differ from controls on the non-verbal task, but was worse on a semantic fluency task. When performance between patient groups was compared, we found that left TLE not only did worse than right TLE on the naming task, but also on the non-verbal associative memory task. When considered together, current data do not support a strong view of input modality differences between left and right ATLs. Additionally, they provide evidence indicating that the left and right ATLs do not make similar contributions to a singular functional system for semantic representation.
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Affiliation(s)
- Claudia Poch
- Facultad de Lenguas y Educación, Universidad Nebrija, Spain
| | - Rafael Toledano
- Hospital Ruber Internacional, Epilepsy Unit, Neurology Department, Madrid, Spain; University Hospital of Ramón y Cajal, Epilepsy Unit, Neurology Department, Madrid, Spain
| | - Irene García-Morales
- Hospital Ruber Internacional, Epilepsy Unit, Neurology Department, Madrid, Spain; University Hospital of San Carlos, Epilepsy Unit, Neurology Department, Madrid, Spain
| | - Yasser Alemán-Gómez
- Center for Psychiatric Neuroscience, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland; Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland; Medical Image Analysis Laboratory (MIAL), Centre D'Imagerie BioMédicale (CIBM), Lausanne, Switzerland
| | - Antonio Gil-Nagel
- Hospital Ruber Internacional, Epilepsy Unit, Neurology Department, Madrid, Spain
| | - Pablo Campo
- Department of Basic Psychology, Autonoma University of Madrid, Madrid, Spain.
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18
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Monreal E, Maza S SDL, Gullón P, Natera-Villalba E, Chico-García JL, Beltrán-Corbellini Á, Martínez-Sanz J, García-Barragán N, Buisán J, Toledano R, Alonso-Canovas A, Pérez-Torre P, Matute-Lozano MC, López-Sendón JL, García-Ribas G, Corral Í, Fortún J, Montero-Errasquín B, Manzano L, Máiz-Carro L, Costa-Frossard L, Masjuan J. Non-severe immunosuppression might be associated with a lower risk of moderate-severe acute respiratory distress syndrome in COVID-19: A pilot study. J Med Virol 2020; 93:2243-2251. [PMID: 33165922 DOI: 10.1002/jmv.26656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
The role of immunosuppression among coronavirus disease 2019 (COVID-19) patients has not been elucidated and management may be challenging. This observational study included confirmed COVID-19 patients. The primary endpoint was the development of moderate-severe acute respiratory distress syndrome (ARDS). Time to moderate-severe ARDS, the need for mechanical or noninvasive ventilation (MV/NIV), death, and a composite of death or MV/NIV were secondary endpoints. Of 138 patients included, 27 (19.6%) were immunosuppressed (IS) and 95 (68.8%) were male, with a median (IQR) age of 68 (54-78) years. A significantly lower proportion of IS patients (25.9%) compared to non-IS patients (52.3%) developed moderate-severe ARDS, in both unadjusted (0.32; 95% CI, 0.13-0.83; p = .017) and adjusted (aOR, 0.25; 95% CI, 0.08-0.80; p = .019) analyses. After stratifying by pathologies, only IS patients with autoimmune diseases remained significant (aOR 0.25; 95% CI, 0.07-0.98; p = .046). Nonsignificant trends toward a longer time to moderate or severe ARDS, a lower need for MV/NIV, and a lower risk of death or MV/NIV were detected among IS. In our cohort of COVID-19 patients, nonsevere immunosuppression was associated with a lower risk of moderate-severe ARDS, especially among AD. This suggests a potential protective effect from a hypothesized hyper-inflammatory response.
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Affiliation(s)
- Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Sainz de la Maza S
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Pedro Gullón
- Public Health and Epidemiology Research Group, Universidad de Alcalá, Madrid, Spain
| | - Elena Natera-Villalba
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Juan Luis Chico-García
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Álvaro Beltrán-Corbellini
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Nuria García-Barragán
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Javier Buisán
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Rafael Toledano
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Araceli Alonso-Canovas
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Paula Pérez-Torre
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - María C Matute-Lozano
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Jose Luis López-Sendón
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Guillermo García-Ribas
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Íñigo Corral
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Jesús Fortún
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Beatriz Montero-Errasquín
- Department of Geriatrics, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Luis Manzano
- Department of Internal Medicine, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Luis Máiz-Carro
- Department of Neumology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Lucienne Costa-Frossard
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Jaime Masjuan
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
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19
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Toledano R, Campo P, Gil-Nagel A. Temporal pole epilepsy: Do not forget to look for occult encephaloceles. Epilepsia 2020; 61:2859-2860. [PMID: 33206995 DOI: 10.1111/epi.16760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rafael Toledano
- Epilepsy Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Pablo Campo
- Department of Basic Psychology, Autonoma University of Madrid, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
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20
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Martinez-Poles J, Toledano R, Jiménez-Huete A, García-Morales I, Aledo-Serrano Á, Anciones C, Campo P, Álvarez-Linera J, Gil-Nagel A. Epilepsy Associated with Temporal Pole Encephaloceles. Clin Neuroradiol 2020; 31:575-579. [DOI: 10.1007/s00062-020-00969-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/26/2020] [Indexed: 11/27/2022]
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21
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Aledo-Serrano A, García-Morales I, Toledano R, Jiménez-Huete A, Parejo B, Anciones C, Mingorance A, Ramos P, Gil-Nagel A. Diagnostic gap in genetic epilepsies: A matter of age. Epilepsy Behav 2020; 111:107266. [PMID: 32610249 DOI: 10.1016/j.yebeh.2020.107266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/15/2020] [Accepted: 06/09/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the access to advanced diagnostic tests in patients with epilepsy and intellectual disability, with special focus on genetics. METHODS Patients with epilepsy and intellectual disability evaluated between 2016 and 2018 at the Epilepsy Unit of two hospitals in Madrid, Spain were included. The main inclusion criterion was an undetermined etiological diagnosis after clinical assessment, neuroimaging, and electroencephalogram (EEG). RESULTS Two hundred and five patients with epilepsy and intellectual disability were evaluated, with 124 fulfilling the inclusion criteria (mean age: 33.9 years). Regarding the etiological workup, advanced neuroimaging, prolonged video-EEG, and any type of genetic test had been performed in 58%, 41%, and 40%, respectively. An etiological diagnosis was reached in 18.5%. The workup was considered incomplete in 67%. Variables that showed the strongest association with an incomplete diagnostic workup in the multivariate analysis were current age and seizure freedom. CONCLUSIONS Despite the multiple implications of modern diagnostic techniques, especially genetic testing, there is a large proportion of patients with epilepsy and intellectual disability who do not have access to them. Older age and seizure freedom seem to be associated with the highest diagnostic gap.
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Affiliation(s)
- Angel Aledo-Serrano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain.
| | - Irene García-Morales
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Rafael Toledano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Adolfo Jiménez-Huete
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Beatriz Parejo
- Epilepsy Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Carla Anciones
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | | | | | - Antonio Gil-Nagel
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
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22
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Martínez-Poles J, Toledano R, Aledo-Serrano Á, Korn K, Coras R, Blümcke I, García-Morales I, Álvarez-Linera J, Gil-Nagel A. Herpes simplex virus encephalitis after temporal lobe resection: an infrequent but treatable complication of epilepsy surgery. Eur J Neurol 2020; 27:e60-e61. [PMID: 32794613 DOI: 10.1111/ene.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- J Martínez-Poles
- Neurology Department, Hospital La Luz, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Clínico San Carlos, Health Research Institute of the Hospital Clinico San Carlos, Madrid, Spain
| | - R Toledano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Á Aledo-Serrano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - K Korn
- Institute of Virology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - R Coras
- Institute of Neuropathology, University Hospitals, Erlangen, Germany
| | - I Blümcke
- Institute of Neuropathology, University Hospitals, Erlangen, Germany
| | - I García-Morales
- Epilepsy Unit, Neurology Department, Hospital Clínico San Carlos, Health Research Institute of the Hospital Clinico San Carlos, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - J Álvarez-Linera
- Radiology Department, Hospital Ruber Internacional, Madrid, Spain
| | - A Gil-Nagel
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
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23
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Aledo-Serrano Á, Mingorance A, Jiménez-Huete A, Toledano R, García-Morales I, Anciones C, Gil-Nagel A. Genetic epilepsies and COVID-19 pandemic: Lessons from the caregiver perspective. Epilepsia 2020; 61:1312-1314. [PMID: 32420620 PMCID: PMC7276740 DOI: 10.1111/epi.16537] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Ángel Aledo-Serrano
- Epilepsy Unit, Department of Neurology, Ruber Internacional Hospital, Madrid, Spain.,Epilepsy Unit, Department of Neuroscience, Corachan Clinic, Barcelona, Spain
| | | | - Adolfo Jiménez-Huete
- Epilepsy Unit, Department of Neurology, Ruber Internacional Hospital, Madrid, Spain
| | - Rafael Toledano
- Epilepsy Unit, Department of Neurology, Ruber Internacional Hospital, Madrid, Spain.,Epilepsy Unit, Department of Neurology, Ramon y Cajal University Hospital, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Unit, Department of Neurology, Ruber Internacional Hospital, Madrid, Spain.,Epilepsy Unit, Department of Neurology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Carla Anciones
- Epilepsy Unit, Department of Neurology, Ruber Internacional Hospital, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Unit, Department of Neurology, Ruber Internacional Hospital, Madrid, Spain
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24
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Gutiérrez-Viedma Á, Sanz-Graciani I, Romeral-Jiménez M, Parejo-Carbonell B, Serrano-García I, Cuadrado ML, Aledo-Serrano Á, Gil-Nagel A, Toledano R, García-Morales I. Patients' knowledge on epilepsy and SUDEP improves after a semi-structured health interview. Epilepsy Behav 2019; 99:106467. [PMID: 31421520 DOI: 10.1016/j.yebeh.2019.106467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients' education is the most relevant contributor to patient self-management of epilepsy. We aimed to assess the acquisition of knowledge after a semi-structured interview. METHODS We performed a quasi-experimental prospective study with a cohort of patients with epilepsy admitted for prolonged video electroencephalogram (VEEG). We measured patients' baseline knowledge with a 10-item true-false test (test A). Then, a qualified nurse carried out a semi-structured interview. We measured acquired knowledge with another 10-item true-false exam (test B), prior to VEEG discharge and after a 3- to 5-month follow-up, and we compared the difference between the scores in test A and test B. Finally, we conducted a satisfaction and suitability survey on the interview at follow-up. RESULTS Thirty-two patients participated, half were women. Their median age was 39.5, and the median length of schooling was 14 years. The median time since epilepsy onset was 13 years, 75% had suffered tonic-clonic seizures. The median score on test A was 7, while the median score on test B was 8.5 (p < 0.001) both at VEEG discharge and after follow-up. After the interview, 84.4% of participants reported that they were very satisfied with the information received; 87.5% stated that they had not previously heard about SUDEP (sudden unexpected dead in epilepsy); and 93.8% considered it important to receive detailed information about SUDEP. CONCLUSIONS Patient education through a semi-structured comprehensive interview improves knowledge of patients with epilepsy about their disease. The calm atmosphere and the qualified nursing working at VEEG units make them an appropriate setting for talking about epilepsy and its risks, including SUDEP.
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Affiliation(s)
- Álvaro Gutiérrez-Viedma
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain.
| | - Isabel Sanz-Graciani
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - María Romeral-Jiménez
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Beatriz Parejo-Carbonell
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Irene Serrano-García
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Unidad de Metodología de Investigación y Epidemiología Clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - María-Luz Cuadrado
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Ángel Aledo-Serrano
- Unidad de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain
| | - Antonio Gil-Nagel
- Unidad de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain
| | - Rafael Toledano
- Unidad de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar Viejo 100, 28034 Madrid, Spain
| | - Irene García-Morales
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain
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25
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Espinosa‐Jovel C, Toledano R, Jiménez‐Huete A, Aledo‐Serrano Á, García‐Morales I, Campo P, Gil‐Nagel A. Olfactory function in focal epilepsies: Understanding mesial temporal lobe epilepsy beyond the hippocampus. Epilepsia Open 2019; 4:487-492. [PMID: 31440730 PMCID: PMC6698687 DOI: 10.1002/epi4.12343] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/12/2019] [Accepted: 05/28/2019] [Indexed: 11/06/2022] Open
Abstract
Several lines of research have linked olfactory regions with the pathophysiology of focal epilepsies. Among those regions, the piriform cortex represents the major part of the primary olfactory cortex. According to these data, we raised the hypothesis that in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis exists an interictal dysfunction of olfactory processing that could be more significant compared to patients with extra-hippocampal focal epilepsy and healthy controls. This could be the consequence of a dysfunctional epileptogenic network that extends beyond the hippocampus and affects other structures, including the piriform cortex. To test this hypothesis, we evaluated the olfactory function with the Sniffin' Sticks test in 32 patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis, 30 patients with extra-hippocampal focal epilepsy, and 22 healthy controls. Compared to the other study groups, patients with temporal lobe epilepsy due to hippocampal sclerosis showed a basal olfactory dysfunction characterized by an impairment in odor discrimination and odor identification. We also found that high seizure frequency had a strong correlation with the evaluated olfactory tasks. Our results are consistent with neuroimaging and neuropathological data that establish a link between olfactory regions and the pathophysiology of temporal lobe epilepsy.
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Affiliation(s)
- Camilo Espinosa‐Jovel
- Epilepsy Unit, Department of NeurologyHospital Occidente de KennedyBogotáColombia
- Epilepsy Unit, Department of NeurologyHospital Ruber InternacionalMadridSpain
| | - Rafael Toledano
- Epilepsy Unit, Department of NeurologyHospital Ruber InternacionalMadridSpain
- Epilepsy Unit, Department of NeurologyHospital Ramón y CajalMadridSpain
| | - Adolfo Jiménez‐Huete
- Clinical Neurology Unit, Department of NeurologyHospital Ruber InternacionalMadridSpain
| | - Ángel Aledo‐Serrano
- Epilepsy Unit, Department of NeurologyHospital Ruber InternacionalMadridSpain
| | - Irene García‐Morales
- Epilepsy Unit, Department of NeurologyHospital Ruber InternacionalMadridSpain
- Epilepsy Unit, Department of NeurologyHospital Clínico San CarlosMadridSpain
| | - Pablo Campo
- Department of Basic PsychologyAutonomous University of MadridMadridSpain
| | - Antonio Gil‐Nagel
- Epilepsy Unit, Department of NeurologyHospital Ruber InternacionalMadridSpain
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26
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Alemán-Gómez Y, Poch C, Toledano R, Jiménez-Huete A, García-Morales I, Gil-Nagel A, Campo P. Morphometric correlates of anomia in patients with small left temporopolar lesions. J Neuropsychol 2019; 14:260-282. [PMID: 31059211 DOI: 10.1111/jnp.12184] [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: 05/31/2018] [Revised: 03/06/2019] [Indexed: 10/26/2022]
Abstract
Visual object naming is a complex cognitive process that engages an interconnected network of cortical regions moving from occipitotemporal to anterior-inferior temporal cortices, and extending into the inferior frontal cortex. Naming can fail for diverse reasons, and different stages of the naming multi-step process appear to be reliant upon the integrity of different neuroanatomical locations. While the neural correlates of semantic errors have been extensively studied, the neural basis of omission errors remains relatively unspecified. Although a strong line of evidence supports an association between anterior temporal lobe damage and semantic errors, there are some studies suggesting that the anterior temporal lobe could be also associated with omissions. However, support for this hypothesis comes from studies with patients in whom damage affected extensive brain regions, sometimes bilaterally. Here, we availed of a group of 12 patients with epilepsy associated with a small lesion at the tip of the left temporal pole. Using an unbiased surface-based morphometry methodology, we correlated two morphological features with errors observed during visual naming. Analyses revealed a correlation between omission errors and reduced local gyrification index in three cortical clusters: one in the left anteromedial temporal lobe region (AMTL) and two in the left anterior cingulate cortex (ACC). Our findings support the view that regions in ACC and AMTL are critical structures within a network engaged in word selection from semantics.
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Affiliation(s)
- Yasser Alemán-Gómez
- Center for Psychiatric Neuroscience, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Switzerland.,Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Switzerland.,Medical Image Analysis Laboratory (MIAL), Centre d'Imagerie BioMédicale (CIBM), Lausanne, Switzerland
| | - Claudia Poch
- Department of Basic Psychology, University Complutense of Madrid, Spain.,Instituto Pluridisciplinar, University Complutense of Madrid, Spain.,Facultad de Lenguas y Educación, Universidad Nebrija, Madrid, Spain
| | - Rafael Toledano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain.,Epilepsy Unit, Neurology Department, University Hospital of Ramón y Cajal, Madrid, Spain
| | - Adolfo Jiménez-Huete
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain.,Epilepsy Unit, Neurology Department, University Hospital of San Carlos, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Pablo Campo
- Department of Basic Psychology, Autonoma University of Madrid, Spain
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Ros-Castelló V, Toledano R, Martínez-San-Millán JS, Alonso-Canovas A. Keeping Glucose Transporter Type 1 Deficiency Syndrome in Mind: A Late Diagnosis and Unusual Neuroimage Findings. Mov Disord Clin Pract 2019; 6:291-293. [PMID: 31061836 DOI: 10.1002/mdc3.12740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Rafael Toledano
- Neurology Department Ramón y Cajal University Hospital Madrid Spain
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Espinosa-Jovel C, Toledano R, García-Morales I, Álvarez-Linera J, Gil-Nagel A. Serial arterial spin labeling MRI in autonomic status epilepticus due to anti-LGI1 encephalitis. Neurology 2018; 87:443-4. [PMID: 27462038 DOI: 10.1212/wnl.0000000000002903] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Camilo Espinosa-Jovel
- From the Hospital Occidente de Kennedy (C.E.-J.), Bogotá, Colombia; Hospital Ruber International (R.T., I.G.-M., J.Á.-L., A.G.-N.); Hospital Ramón y Cajal (R.T.); and Hospital Clínico San Carlos (I.G.-M.), Madrid, Spain.
| | - Rafael Toledano
- From the Hospital Occidente de Kennedy (C.E.-J.), Bogotá, Colombia; Hospital Ruber International (R.T., I.G.-M., J.Á.-L., A.G.-N.); Hospital Ramón y Cajal (R.T.); and Hospital Clínico San Carlos (I.G.-M.), Madrid, Spain
| | - Irene García-Morales
- From the Hospital Occidente de Kennedy (C.E.-J.), Bogotá, Colombia; Hospital Ruber International (R.T., I.G.-M., J.Á.-L., A.G.-N.); Hospital Ramón y Cajal (R.T.); and Hospital Clínico San Carlos (I.G.-M.), Madrid, Spain
| | - Juan Álvarez-Linera
- From the Hospital Occidente de Kennedy (C.E.-J.), Bogotá, Colombia; Hospital Ruber International (R.T., I.G.-M., J.Á.-L., A.G.-N.); Hospital Ramón y Cajal (R.T.); and Hospital Clínico San Carlos (I.G.-M.), Madrid, Spain
| | - Antonio Gil-Nagel
- From the Hospital Occidente de Kennedy (C.E.-J.), Bogotá, Colombia; Hospital Ruber International (R.T., I.G.-M., J.Á.-L., A.G.-N.); Hospital Ramón y Cajal (R.T.); and Hospital Clínico San Carlos (I.G.-M.), Madrid, Spain
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29
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Gil-López FJ, Montoya J, Falip M, Aparicio J, López-González FJ, Toledano R, Gil-Nagel A, Molins A, García I, Serrano P, Domenech G, Torres F, Donaire A, Carreño M. Retrospective study of perampanel efficacy and tolerability in myoclonic seizures. Acta Neurol Scand 2018; 138:122-129. [PMID: 29573400 DOI: 10.1111/ane.12931] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Perampanel is an antiepileptic drug (AED) approved for add-on treatment of focal seizures (with or without generalization) and primary generalized tonic-clonic (GTC) seizures. Our objective was to explore the effectiveness and tolerability of adjunctive perampanel in patients with drug-resistant myoclonic seizures, after failure of other AEDs. MATERIALS AND METHODS Retrospective, multicenter, observational study. Data were collected from individual patient clinical files and analysed using appropriate descriptive statistics and inferential analyses. RESULTS Data are reported for 31 patients with mean age 36.4 years, who had an average epilepsy duration of 18 years, previously taken an average of 5.03 AEDs, and were taking an average of 2.4 AEDs on perampanel initiation. Patients exhibited myoclonic, GTC, absence, tonic and focal seizures, and most had associated cognitive decline and/or ataxia. Median time on perampanel was 6 months, most common dose was 6 mg, and overall retention rate was 84%. The responder rate for myoclonic seizures was defined via reduction of days with myoclonic seizures per month. At 6 months, 15 (48.4%) of the 31 patients were classed as myoclonic seizure responders, 10 (32.3%) were myoclonic seizure free, and 39% saw improvements in functional ability. Of 17 patients with GTC seizures at baseline, 9 (53%) were responders at 6 months, and 8 (47.1%) were seizure free. The most frequent side effects were psychiatric disorders, instability, dizziness and irritability, and mostly resolved with dose reduction. Five patients discontinued perampanel due to side effects. CONCLUSIONS Perampanel caused clinically meaningful improvements in patients with drug-resistant myoclonic seizures. It was generally well tolerated, but psychiatric and neurological side effects sometimes required follow-up and dose reduction.
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Affiliation(s)
- F. J. Gil-López
- Epilepsy Unit; Department of Neurology; Hospital Clínic de Barcelona; Barcelona Spain
| | - J. Montoya
- Department of Neurology; Hospital Lluis Alcanyís; Xàtiva Spain
| | - M. Falip
- Epilepsy Unit; Department of Neurology; Hospital Universitari de Bellvitge; Hospitalet de Llobregat; Barcelona Spain
| | - J. Aparicio
- Epilepsy Unit; Department of Neurology; Hospital Sant Joan de Déu; Barcelona Spain
| | - F. J. López-González
- Epilepsy Unit; Department of Neurology; Complexo Hospitalario Universitario de Santiago de Compostela; A Coruña Spain
| | - R. Toledano
- Epilepsy Unit; Department of Neurology; Hospital Ruber Internacional; Madrid Spain
| | - A. Gil-Nagel
- Epilepsy Unit; Department of Neurology; Hospital Ruber Internacional; Madrid Spain
| | - A. Molins
- Department of Neurology; Hospital Josep Trueta de Girona; Girona Spain
| | - I. García
- Epilepsy Unit; Hospital Clínico Universitario San Carlos; Madrid Spain
| | - P. Serrano
- Department of Neurology; Hospital Carlos Haya; Málaga Spain
| | - G. Domenech
- Medical Statistics Core Facility; IDIBAPS-Hospital Clínic; Barcelona Spain
| | - F. Torres
- Medical Statistics Core Facility; IDIBAPS-Hospital Clínic; Barcelona Spain
| | - A. Donaire
- Epilepsy Unit; Department of Neurology; Hospital Clínic de Barcelona; Barcelona Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - M. Carreño
- Epilepsy Unit; Department of Neurology; Hospital Clínic de Barcelona; Barcelona Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
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Gago-Veiga AB, Toledano R, García-Morales I, Pérez-Jiménez MA, Bernar J, Gil-Nagel A. Specificity of electroclinical features in the diagnosis of ring chromosome 20. Epilepsy Behav 2018; 80:215-220. [PMID: 29414555 DOI: 10.1016/j.yebeh.2017.12.001] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ring chromosome 20 (R20) syndrome is a chromosomal disorder characterized mainly by drug-resistant frontal lobe seizures, recurrent nonconvulsive status epilepticus (NCSE), and typical EEG features. The aim of this study was to investigate if this triad is common and specific to all patients with R20. METHODS In this cross-sectional study (from 2000 to 2011), we selected patients who fulfilled at least two out of three criteria: drug-resistant frontal lobe seizures, recurrent NCSE, and characteristic electroencephalography (EEG) features. In all patients, diagnosis was based on karyotype analysis of at least 100 metaphases. RESULTS We identified 36 patients who met at least two of the selected criteria: six patients (16.7%) with R20 and 30 (83.3%) without R20 (non-R20). All patients with R20 met all three criteria. Eleven (36.7%) patients without R20, however, also displayed the full triad. In 19 patients without R20 (63.3%), one of the three clinical features was missing: frontal lobe seizures were not resistant to antiepileptic drugs (AED) in four (13.3%), recurrent NCSE was missing in six (20%), and nine (30%) patients did not have typical EEG features. Based on this data, specificity was 63.3%, positive predictive value was 35.3%, and sensitivity and negative predictive values were 100%. Additionally, a review of all publications describing the R20 phenotype revealed that 81.98% of patients with R20 display the full electroclinical triad. CONCLUSIONS In our study, all patients with R20 displayed the three electroclinical characteristics. This is in line with previous reports (presenting high sensitivity and negative predictive value). However, these features can also be observed in other epilepsies and are not specific to R20. Our findings suggest that in the presence of the full triad of symptoms, karyotype analysis focused on chromosome 20 should be conducted.
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Affiliation(s)
- A B Gago-Veiga
- Epilepsy Unit, Department of Neurology, Hospital Universitario de La Princesa, Diego de León 62, 28006 Madrid, Spain
| | - R Toledano
- Epilepsy Program, Department of Neurology, Hospital Ruber International, La Masó 38, 28034 Madrid, Spain
| | - I García-Morales
- Epilepsy Program, Department of Neurology, Hospital Ruber International, La Masó 38, 28034 Madrid, Spain
| | - M A Pérez-Jiménez
- Epilepsy Monitoring Unit, Clinical Neurophysiology Department, Niño Jesús Pediatric University Hospital, Menendez Pelayo 65, 28009 Madrid, Spain
| | - J Bernar
- Department of Genetics, Hospital Ruber International, La Masó 38, 28034 Madrid, Spain
| | - A Gil-Nagel
- Epilepsy Program, Department of Neurology, Hospital Ruber International, La Masó 38, 28034 Madrid, Spain.
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Espinosa-Jovel C, Toledano R, Aledo-Serrano Á, García-Morales I, Gil-Nagel A. Epidemiological profile of epilepsy in low income populations. Seizure 2018; 56:67-72. [PMID: 29453113 DOI: 10.1016/j.seizure.2018.02.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/26/2017] [Accepted: 02/06/2018] [Indexed: 11/28/2022] Open
Abstract
Epilepsy is a global disease with an unequal distribution. About 80% of the affected individuals reside in low and middle income countries. The incidence and prevalence of epilepsy in low income populations is higher than in the rest of the world, this is partly explained by some risk factors such as head trauma, perinatal injury and CNS infections, which are more common in poor regions, especially in rural areas. Epilepsy is considered a treatable condition with high rates of therapeutic response. About three fourths of patients achieve control of the disease with the use of antiepileptic drugs, however, despite this benign prognosis, over 75% of patients from low income populations do not receive treatment at all. The cultural beliefs, the inequity in the distribution of public health services, the inadequate supply of antiepileptic drugs, the low number of neurologists involved in the attention of epilepsy, and the social stigma, are the main reasons that increase the treatment gap and the burden of disease in low income populations with epilepsy. We conducted a narrative review regarding the epidemiology of epilepsy in low income populations by searching PubMed, EMBASE, Google Scholar and thoroughly examining relevant bibliographies. This review aims to summarize the main epidemiological aspects of epilepsy in LMIC, emphasizing on incidence, prevalence, socio-demographic profile, TG, social stigma and QoL.
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Affiliation(s)
- Camilo Espinosa-Jovel
- Hospital Occidente de Kennedy, Servicio de Neurología, Bogotá, Colombia; Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain.
| | - Rafael Toledano
- Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain; Hospital Universitario Ramón y Cajal, Servicio de Neurología, Madrid, Spain
| | - Ángel Aledo-Serrano
- Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain
| | - Irene García-Morales
- Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain; Hospital Universitario Clínico San Carlos, Servicio de Neurología, Madrid, Spain
| | - Antonio Gil-Nagel
- Hospital Ruber Internacional, Servicio de Neurología, Programa de Epilepsia, Madrid, Spain
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Quintas S, Ródriguez-Carrillo JC, Toledano R, de Toledo M, Navacerrada Barrero FJ, Berbís MÁ, Gago-Veiga AB. When aphasia is due to aphasic status epilepticus: a diagnostic challenge. Neurol Sci 2017; 39:757-760. [DOI: 10.1007/s10072-017-3218-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022]
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33
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Abarrategui B, García-García ME, Toledano R, Parejo-Carbonell B, Gil-Nagel A, García-Morales I. Lacosamide for refractory generalized tonic-clonic seizures of non-focal origin in clinical practice: A clinical and VEEG study. Epilepsy Behav Case Rep 2017; 8:63-65. [PMID: 28948142 PMCID: PMC5602820 DOI: 10.1016/j.ebcr.2017.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/06/2017] [Accepted: 08/13/2017] [Indexed: 11/17/2022]
Abstract
7 of 9 patients with GGE reduced ≥ 50% their tonic–clonic seizure frequency on LCM. All 7 patients remained seizure free for > 1 year, and 2 of them for > 5 years. In 2 of the 9 patients, both with Juvenile Absence Epilepsy, absences aggravated. One aggravation consisted on a myoclonia and absence status, in a patient with no history of myoclonia. VEEG paralleled clinical improvement but didn't change in a case of absence worsening.
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Affiliation(s)
- Belén Abarrategui
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - María Eugenia García-García
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Rafael Toledano
- Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, La Masó 38, Mirasierra, 28034 Madrid, Spain.,Epilepsy Unit, Department of Neurology, Hospital Ramon y Cajal, Ctra M-607 Colmenar Viejo, 910, 28034 Madrid, Spain
| | - Beatriz Parejo-Carbonell
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, La Masó 38, Mirasierra, 28034 Madrid, Spain
| | - Irene García-Morales
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Profesor Martín Lagos s/n, 28040 Madrid, Spain.,Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, La Masó 38, Mirasierra, 28034 Madrid, Spain
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Jiménez-Huete A, Del Barrio A, Riva E, Campo P, Toledano R, Franch O. Subjective Evaluation of Mood and Cognitive Functions in a General Neurology Clinic: Patients versus Informants. J Clin Neurol 2017; 13:259-264. [PMID: 28748677 PMCID: PMC5532322 DOI: 10.3988/jcn.2017.13.3.259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/15/2016] [Revised: 04/11/2017] [Accepted: 04/11/2017] [Indexed: 12/01/2022] Open
Abstract
Background and Purpose We aimed to determine the correlation between subjective evaluations of mood and cognitive functions by patients and informants, and the findings of a battery of neuropsychological tests. Methods We analyzed 74 subjects recruited from a general neurology clinic, comprising 37 patients with cognitive complaints and 37 informants (either relatives or caregivers in close contact with the patients). Four ordinal scales concerning recent memory, verbal expression, initiative, and mood were correlated with the findings of a series of neuropsychological tests and questionnaires using the tau b coefficient. Results The scores for the patients on the scales were most strongly correlated with scores on the 15-item Geriatric Depression Scale (GDS-15), while the scores for the informants were most strongly correlated with scores on GDS-15, the Informant Questionnaire on Cognitive Decline, and the Functional Activities Questionnaire (FAQ). The most significant correlation was between the initiative scale from informants and FAQ (tau b=-0.591, p<0.001), and it was the only one that remained significant after correcting for multiple testing (p Holm=0.013). Conclusions Cognitive complaints from patients mainly reflect their mood, whilst informant reports mainly reflect both the functional ability and mood of the patients.
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Affiliation(s)
- Adolfo Jiménez-Huete
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain.
| | - Antonio Del Barrio
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Elena Riva
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Pablo Campo
- Department of Basic Psychology, Autonoma University of Madrid, Madrid, Spain
| | - Rafael Toledano
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Oriol Franch
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
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35
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Méndez-Bértolo C, Moratti S, Toledano R, Lopez-Sosa F, Martínez-Alvarez R, Mah YH, Vuilleumier P, Gil-Nagel A, Strange BA. A fast pathway for fear in human amygdala. Nat Neurosci 2016; 19:1041-9. [DOI: 10.1038/nn.4324] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/12/2016] [Indexed: 11/09/2022]
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36
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Toledano R, Jiménez-Huete A, Campo P, Poch C, García-Morales I, Gómez Angulo JC, Coras R, Blümcke I, Álvarez-Linera J, Gil-Nagel A. Small temporal pole encephalocele: A hidden cause of “normal” MRI temporal lobe epilepsy. Epilepsia 2016; 57:841-51. [DOI: 10.1111/epi.13371] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Rafael Toledano
- Epilepsy Unit; Department of Neurology; Hospital Ruber Internacional; Madrid Spain
- Epilepsy Unit; Department of Neurology; Hospital Ramon y Cajal; Madrid Spain
| | | | - Pablo Campo
- Department of Basic Psychology; Autonoma University of Madrid; Madrid Spain
| | - Claudia Poch
- Department of Biological and Health Psychology; Autonoma University of Madrid; Madrid Spain
| | - Irene García-Morales
- Epilepsy Unit; Department of Neurology; Hospital Ruber Internacional; Madrid Spain
- Epilepsy Unit; Department of Neurology; Hospital Clinico San Carlos; Madrid Spain
| | | | - Roland Coras
- Department of Neuropathology; University Hospital Erlangen; Erlangen Germany
| | - Ingmar Blümcke
- Department of Neuropathology; University Hospital Erlangen; Erlangen Germany
| | | | - Antonio Gil-Nagel
- Epilepsy Unit; Department of Neurology; Hospital Ruber Internacional; Madrid Spain
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37
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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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Poch C, Toledano R, Jiménez-Huete A, García-Morales I, Gil-Nagel A, Campo P. Differences in visual naming performance between patients with temporal lobe epilepsy associated with temporopolar lesions versus hippocampal sclerosis. Neuropsychology 2016; 30:841-52. [PMID: 26901171 DOI: 10.1037/neu0000269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Naming difficulties are frequently observed in patients with temporal lobe epilepsy (TLE). Although damage/removal of regions of the anterior temporal neocortex including the temporal pole is considered critical for those difficulties, 1 relevant hypothesis proposes that hippocampal damage also has a role. Our aim was to better understand the specific involvement of temporal pole and hippocampus in visual object naming. METHOD We assessed 2 types of patients with TLE on a visual confrontation-naming task: patients with hippocampal sclerosis (HS; n = 16) and patients with a lesion on the tip of the temporal pole that spared the hippocampus entirely (n = 18). A common battery of verbal and nonverbal semantic tasks was administered and used as a semantic memory background. Control group were 20 matched healthy participants. RESULTS Patients with lesions on their temporal poles differed from patients with HS and control group on naming ability, proportion and rate of error type, and influence of concept familiarity. Of note, naming performance was not affected by hippocampal damage. Using a Bayesian model averaging approach, we found that the number of omission errors distinguished patients with temporal pole damage from patients with HS and controls. This differential pattern occurred despite similar impairment on the semantic memory background in both clinical groups. CONCLUSION Current findings provide evidence that temporal pole damage produces or contributes to naming impairment in TLE, while also suggesting that the hippocampus is not critical for naming. They also highlight the importance of error-type analysis when evaluating visual naming in TLE. (PsycINFO Database Record
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Affiliation(s)
- Claudia Poch
- Department of Biological and Health Psychology, Autonoma University of Madrid
| | - Rafael Toledano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional
| | | | | | | | - Pablo Campo
- Department of Basic Psychology, Autonoma University of Madrid
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Schurr J, Coras R, Rössler K, Pieper T, Kudernatsch M, Holthausen H, Winkler P, Woermann F, Bien CG, Polster T, Schulz R, Kalbhenn T, Urbach H, Becker A, Grunwald T, Huppertz HJ, Gil-Nagel A, Toledano R, Feucht M, Mühlebner A, Czech T, Blümcke I. Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia in Frontal Lobe Epilepsy: A New Clinico-Pathological Entity. Brain Pathol 2016; 27:26-35. [PMID: 26748554 DOI: 10.1111/bpa.12347] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/21/2015] [Indexed: 01/06/2023] Open
Abstract
The histopathological spectrum of human epileptogenic brain lesions is widespread including common and rare variants of cortical malformations. However, 2-26% of epilepsy surgery specimens are histopathologically classified as nonlesional. We hypothesized that these specimens include also new diagnostic entities, in particular when presurgical magnetic resonance imaging (MRI) can identify abnormal signal intensities within the anatomical region of seizure onset. In our series of 1381 en bloc resected epilepsy surgery brain specimens, 52 cases could not be histopathologically classified and were considered nonlesional (3.7%). An increase of Olig2-, and PDGFR-alpha-immunoreactive oligodendroglia was observed in white matter and deep cortical layers in 22 of these patients (42%). Increased proliferation activity as well as heterotopic neurons in white matter were additional histopathological hallmarks. All patients suffered from frontal lobe epilepsy (FLE) with a median age of epilepsy onset at 4 years and 16 years at epilepsy surgery. Presurgical MRI suggested focal cortical dysplasia (FCD) in all patients. We suggest to classify this characteristic histopathology pattern as "mild malformation of cortical development with oligodendroglial hyperplasia (MOGHE)." Further insights into pathomechanisms of MOGHE may help to bridge the diagnostic gap in children and young adults with difficult-to-treat FLE.
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Affiliation(s)
- Johannes Schurr
- Department of Neuropathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Tom Pieper
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Vogtareuth, Germany
| | - Manfred Kudernatsch
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Vogtareuth, Germany
| | - Hans Holthausen
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Vogtareuth, Germany
| | - Peter Winkler
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Vogtareuth, Germany
| | | | | | - Tilman Polster
- Epilepsy Center Bethel, Hospital Mara, Bielefeld, Germany
| | | | - Thilo Kalbhenn
- Department of Neurosurgery, Evangelisches Krankenhaus Bielefeld, Kantensiek 11, 33617 Bielefeld, Germany
| | - Horst Urbach
- Department of Radiology, University Hospital Bonn, 53127 Bonn, Germany.,Department of Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, 53127 Bonn, Germany
| | | | | | - Antonio Gil-Nagel
- Servicio de Neurología, Hospital Ruber International, C/La Masó n 38, 28034 Madrid, Spain
| | - Rafael Toledano
- Servicio de Neurología, Hospital Ruber International, C/La Masó n 38, 28034 Madrid, Spain
| | - Martha Feucht
- Department of Pediatrics, Medical University Vienna, 1090 Vienna, Austria
| | - Angelika Mühlebner
- Department of Pediatrics, Medical University Vienna, 1090 Vienna, Austria.,Institute of Neurology, Medical University Vienna, 1090 Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University Vienna, 1090 Vienna, Austria
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Kurtis MM, Toledano R, García-Morales I, Gil-Nagel A. Immunomodulated parkinsonism as a presenting symptom of LGI1 antibody encephalitis. Parkinsonism Relat Disord 2015; 21:1286-7. [DOI: 10.1016/j.parkreldis.2015.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/19/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
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Giráldez BG, Toledano R, García-Morales I, Gil-Nagel A, López-González FJ, Tortosa D, Ojeda J, Serratosa JM. Long-term efficacy and safety of lacosamide monotherapy in the treatment of partial-onset seizures: A multicenter evaluation. Seizure 2015; 29:119-22. [DOI: 10.1016/j.seizure.2015.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 01/27/2023] Open
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Solana AB, Martínez K, Hernández-Tamames JA, San Antonio-Arce V, Toledano R, García-Morales I, Alvárez-Linera J, Gil-Nágel A, Del Pozo F. Altered brain rhythms and functional network disruptions involved in patients with generalized fixation-off epilepsy. Brain Imaging Behav 2015; 10:373-86. [PMID: 26001771 DOI: 10.1007/s11682-015-9404-6] [Citation(s) in RCA: 3] [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] [Indexed: 10/23/2022]
Abstract
Generalized Fixation-off Sensitivity (CGE-FoS) patients present abnormal EEG patterns when losing fixation. In the present work, we studied two CGE-FoS epileptic patients with simultaneous EEG-fMRI. We aim to identify brain areas that are specifically related to the pathology by identifying the brain networks that are related to the EEG brain altered rhythms. Three main analyses were performed: EEG standalone, where the voltage fluctuations in delta, alpha, and beta EEG bands were obtained; fMRI standalone, where resting-state fMRI ICA analyses for opened and closed eyes conditions were computed per subject; and, EEG-informed fMRI, where EEG delta, alpha and beta oscillations were used to analyze fMRI. Patient 1 showed EEG abnormalities for lower beta band EEG brain rhythm. Fluctuations of this rhythm were correlated with a brain network mainly composed by temporo-frontal areas only found in the closed eyes condition. Patient 2 presented alterations in all the EEG brain rhythms (delta, alpha, beta) under study when closing eyes. Several biologically relevant brain networks highly correlated (r > 0.7) to each other in the closed eyes condition were found. EEG-informed fMRI results in patient 2 showed hypersynchronized patterns in the fMRI correlation spatial maps. The obtained findings allow a differential diagnosis for each patient and different profiles with respect to healthy volunteers. The results suggest a different disruption in the functional brain networks of these patients that depends on their altered brain rhythms. This knowledge could be used to treat these patients by novel brain stimulation approaches targeting specific altered brain networks in each patient.
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Affiliation(s)
- Ana Beatriz Solana
- Department of Neuroimaging, Center for Biomedical Technology, Universidad Politécnica de Madrid, Autopista M40 Km.38, 28223, Pozuelo de Alarcón, Spain. .,GE Global Research, Freisinger Landstrasse 50, 85748, Garching bei Munich, Bayern, Germany.
| | - Kenia Martínez
- Research Unit, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón (IISGM), Calle Doctor Esquerdo, 46, 28007, Madrid, Spain
| | | | | | - Rafael Toledano
- Department of Neurology, Hospital Ruber Internacional, Calle de la Maso, 38, 28034, Madrid, Spain
| | - Irene García-Morales
- Department of Neurology, Hospital Ruber Internacional, Calle de la Maso, 38, 28034, Madrid, Spain
| | - Juan Alvárez-Linera
- Department of Neuroradiology, Hospital Ruber Internacional, Calle de la Maso, 38, 28034, Madrid, Spain
| | - Antonio Gil-Nágel
- Department of Neurology, Hospital Ruber Internacional, Calle de la Maso, 38, 28034, Madrid, Spain
| | - Francisco Del Pozo
- Department of Neuroimaging, Center for Biomedical Technology, Universidad Politécnica de Madrid, Autopista M40 Km.38, 28223, Pozuelo de Alarcón, Spain
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Vodonos A, Ostapenko I, Toledano R, Henkin Y, Zahger D, Wolak T, Sherf M, Novack V. Statin adherence and LDL cholesterol levels. Should we assess adherence prior to statin upgrade? Eur J Intern Med 2015; 26:268-72. [PMID: 25770073 DOI: 10.1016/j.ejim.2015.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/10/2015] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adherence to statin therapy has been shown to be suboptimal. In statin-treated patients with residual elevated low density lipoprotein cholesterol (LDL-C) levels the physician must decide whether to switch to a more potent statin or try and achieve better adherence. We examined the association between adherence and LDL-C within low, moderate and high intensity statin groups in a "real world" setting. METHODS We assessed annual adherence by the mean MPR (Medication Possession Ratio = number of purchased/prescribed daily doses) in unselected patient group. Statins were stratified (ACC/AHA Guideline) into low, moderate and high intensity groups. The impact of adherence on LDL levels was assessed by LOESS (locally weighted scatter plot smoothing). RESULTS Out of 1183 patients 173 (14.6%) were treated with low, 923 (78.0%) with moderate and 87 (7.4%) with high intensity statins. Statin intensity was inversely associated with adherence (MPR 77±21, 73±22 and 69±21% for low, moderate and high intensity respectively, p=0.018). Non-adjusted LDL levels decreased with higher adherence: a 10% adherence increase resulted in LDL decrease of 3.5, 5.8 and 7.1mg/dL in low, moderate and high intensity groups. Analysis of the adherence effect on LDL levels adjusted for age, DM and ischemic heart disease showed that MPR above 80% was associated with an additional decrease in LDL levels only in the high intensity group. CONCLUSIONS Increased adherence to statins beyond an MPR of 80% improves LDL levels only among patients given high intensity therapy. Switching from lower to higher intensity therapy may be more effective than further efforts to increase adherence.
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Affiliation(s)
- A Vodonos
- Public Health Department, Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - I Ostapenko
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - R Toledano
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Y Henkin
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - D Zahger
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - T Wolak
- Hypertension Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - M Sherf
- Medical Administration, Clalit Health Services, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - V Novack
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
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Jiménez-Huete A, Riva E, Toledano R, Campo P, Esteban J, Barrio AD, Franch O. Differential diagnosis of degenerative dementias using basic neuropsychological tests: multivariable logistic regression analysis of 301 patients. Am J Alzheimers Dis Other Demen 2014; 29:723-31. [PMID: 24838533 PMCID: PMC10852726 DOI: 10.1177/1533317514534954] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The validity of neuropsychological tests for the differential diagnosis of degenerative dementias may depend on the clinical context. We constructed a series of logistic models taking into account this factor. METHODS We retrospectively analyzed the demographic and neuropsychological data of 301 patients with probable Alzheimer's disease (AD), frontotemporal degeneration (FTLD), or dementia with Lewy bodies (DLB). Nine models were constructed taking into account the diagnostic question (eg, AD vs DLB) and subpopulation (incident vs prevalent). RESULTS The AD versus DLB model for all patients, including memory recovery and phonological fluency, was highly accurate (area under the curve = 0.919, sensitivity = 90%, and specificity = 80%). The results were comparable in incident and prevalent cases. The FTLD versus AD and DLB versus FTLD models were both inaccurate. CONCLUSION The models constructed from basic neuropsychological variables allowed an accurate differential diagnosis of AD versus DLB but not of FTLD versus AD or DLB.
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Affiliation(s)
- Adolfo Jiménez-Huete
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Elena Riva
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Rafael Toledano
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Pablo Campo
- Department of Basic Psychology, Autonoma University of Madrid, Madrid, Spain
| | - Jesús Esteban
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Antonio Del Barrio
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Oriol Franch
- Department of Neurology, General Neurology Unit, Hospital Ruber Internacional, Madrid, Spain
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Campo P, Poch C, Toledano R, Igoa JM, Belinchón M, García-Morales I, Gil-Nagel A. Visual object naming in patients with small lesions centered at the left temporopolar region. Brain Struct Funct 2014; 221:473-85. [DOI: 10.1007/s00429-014-0919-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
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Toledano R, Jiménez-Huete A, García-Morales I, Campo P, Poch C, Strange BA, Gil-Nagel A. Aphasic seizures in patients with temporopolar and anterior temporobasal lesions: a video-EEG study. Epilepsy Behav 2013. [PMID: 23973642] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Studies of patients with temporal lobe epilepsy provide few descriptions of seizures that arise in the temporopolar and the anterior temporobasal brain region. Based on connectivity, it might be assumed that the semiology of these seizures is similar to that of medial temporal lobe epilepsy. However, accumulating evidence suggests that the anterior temporobasal cortex may play an important role in the language system, which could account for particular features of seizures arising here. We studied the electroclinical features of seizures in patients with circumscribed temporopolar and temporobasal lesions in order to identify specific features that might differentiate them from seizures that originate in other temporal areas. Among 172 patients with temporal lobe seizures registered in our epilepsy unit in the last 15 years, 15 (8.7%) patients had seizures caused by temporopolar or anterior temporobasal lesions (11 left-sided lesions). The main finding in our study is that patients with left-sided lesions had aphasia during their seizures as the most prominent feature. In addition, while all patients showed normal to high intellectual functioning in standard neuropsychological testing, semantic impairment was found in a subset of 9 patients with left-sided lesions. This case series demonstrates that aphasic seizures without impairment of consciousness can result from small, circumscribed left anterior temporobasal and temporopolar lesions. Thus, the presence of speech manifestation during seizures should prompt detailed assessment of the structural integrity of the basal surface of the temporal lobe in addition to the evaluation of primary language areas.
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Affiliation(s)
- Rafael Toledano
- Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain.
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Campo P, Garrido MI, Moran RJ, García-Morales I, Poch C, Toledano R, Gil-Nagel A, Dolan RJ, Friston KJ. Network reconfiguration and working memory impairment in mesial temporal lobe epilepsy. Neuroimage 2013; 72:48-54. [PMID: 23370058 PMCID: PMC3610031 DOI: 10.1016/j.neuroimage.2013.01.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/22/2012] [Accepted: 01/22/2013] [Indexed: 11/25/2022] Open
Abstract
Mesial temporal lobe epilepsy (mTLE) is the most prevalent form of focal epilepsy, and hippocampal sclerosis (HS) is considered the most frequent associated pathological finding. Recent connectivity studies have shown that abnormalities, either structural or functional, are not confined to the affected hippocampus, but can be found in other connected structures within the same hemisphere, or even in the contralesional hemisphere. Despite the role of hippocampus in memory functions, most of these studies have explored network properties at resting state, and in some cases compared connectivity values with neuropsychological memory scores. Here, we measured magnetoencephalographic responses during verbal working memory (WM) encoding in left mTLE patients and controls, and compared their effective connectivity within a frontotemporal network using dynamic causal modelling. Bayesian model comparison indicated that the best model included bilateral, forward and backward connections, linking inferior temporal cortex (ITC), inferior frontal cortex (IFC), and the medial temporal lobe (MTL). Test for differences in effective connectivity revealed that patients exhibited decreased ipsilesional MTL-ITC backward connectivity, and increased bidirectional IFC-MTL connectivity in the contralesional hemisphere. Critically, a negative correlation was observed between these changes in patients, with decreases in ipsilesional coupling among temporal sources associated with increases contralesional frontotemporal interactions. Furthermore, contralesional frontotemporal interactions were inversely related to task performance and level of education. The results demonstrate that unilateral sclerosis induced local and remote changes in the dynamic organization of a distributed network supporting verbal WM. Crucially, pre-(peri) morbid factors (educational level) were reflected in both cognitive performance and (putative) compensatory changes in physiological coupling.
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Affiliation(s)
- Pablo Campo
- Faculty of Psychology, Autonoma University of Madrid, Madrid, Spain.
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Di Capua D, Garcia-Garcia ME, Reig-Ferrer A, Fuentes-Ferrer M, Toledano R, Gil-Nagel A, Garcia-Ptaceck S, Kurtis M, Kanner AM, Garcia-Morales I. Validation of the Spanish version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy Behav 2012; 24:493-6. [PMID: 22784672 DOI: 10.1016/j.yebeh.2012.06.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 06/05/2012] [Accepted: 06/07/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To translate and validate into Spanish (Spain) the screening instrument of major depressive episodes (MDEs), Neurological Disorders Depression Inventory in Epilepsy (NDDI-E), in patients with epilepsy. METHODS A total of 121 outpatients, aged 18 years and older, with a diagnosis of epilepsy were included. The diagnosis of a current major depressive episode (MDE) was established with the Mini International Neuropsychiatric Interview (MINI). RESULTS A diagnosis of current MDE was established in 20% of the patients with the MINI. Receiver operator characteristics (ROC) analysis showed an area under the curve of 0.89, with an internal consistency of 0.78. At a cutoff score >13, 22% of patients were considered to suffer from MDE with the NDDI-E (sensitivity: 84%; specificity: 78%; positive predictive value: 64.7%; and negative predictive value: 92.2%). DISCUSSION The Spanish-Spain version of the NDDI-E appears to be a good screening instrument to identify MDE.
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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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