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Lee WC, Chen HH, Yang TF, Lee TH, Hsu TR, Chen C, Chang KP, Kwan SY, Lin WS. Early Surgery for Ohtahara Syndrome Associated With Cortical Dysplasia. Pediatr Neurol 2023; 148:28-31. [PMID: 37651974 DOI: 10.1016/j.pediatrneurol.2023.08.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Wei-Chen Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Hsin-Hung Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsui-Fen Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tse-Hao Lee
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Rong Hsu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kai-Ping Chang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, Wei-Gong Memorial Hospital, Miaoli, Taiwan
| | - Shang-Yeong Kwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Sheng Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Shih YC, Chou CC, Peng SJ, Yu HY, Hsu SPC, Lin CF, Lee CC, Yang HC, Chen YC, Kwan SY, Chen C, Wang SJ, Lin CJ, Lirng JF, Shih YH, Yen DJ, Liu YT. Clinical characteristics and long-term outcome of cerebral cavernous malformations-related epilepsy. Epilepsia 2022; 63:2056-2067. [PMID: 35593439 DOI: 10.1111/epi.17309] [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: 11/05/2021] [Revised: 05/06/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cerebral cavernous malformations (CCMs) present variably and epileptic seizures are the most common symptom. The factors contributing to cavernoma-related epilepsy (CRE) and drug resistance remain inconclusive. The outcomes of CRE after different treatment modalities have not yet been fully addressed. This study aimed to characterize the clinical features of patients with CRE and the long-term seizure outcomes of medical and surgical treatment strategies. METHODS This was a retrospective cohort of 135 patients with CCM who were diagnosed in 2007~2011 and followed up for 93.6 months on average. The patients were divided into drug-resistant epilepsy (DRE) (n = 29), non-DRE (NDRE) (n = 45), and no epilepsy (NE) (n = 61). RESULTS Temporal CCM was the factor most strongly associated with the development of both CRE and DRE. The majority of patients with single temporal CCMs had CRE (86.8%, n = 33) and 50% had DRE, whereas only 14.7% (n = 5) with a non-temporal supratentorial CCM had DRE (P < 0.05). The most common lesion site in the DRE group was the mesiotemporal lobe (50%). Multiple CCMs were more frequently observed in the CRE (29.2%) than the NE (11.5%) group (P < 0.05). In patients with CRE, multiple lesions were associated with a higher rebleeding rate (odds ratio: 11.1), particularly in those with DRE (odds ratio: 15.4). The majority of patients who underwent resective surgery for DRE (76.5%, n = 13) achieved ILAE class I and II seizure outcomes even after a long disease course. SIGNIFICANCE Temporal CCM not only predisposes to CRE but is also a major risk factor for drug resistance. The mesiotemporal lobe is the most epileptogenic zone. Multiple CCMs are another risk factor for CRE and increase the rebleeding risk in these patients. Surgical resection could provide beneficial long-term seizure outcomes in patients with DRE.
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Affiliation(s)
- Yen-Cheng Shih
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Chien-Chen Chou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Brain Research Centre, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Brain Research Centre, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Sanford P C Hsu
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Brain Research Centre, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chieh Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Chien Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Brain Research Centre, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Jung Lin
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Brain Research Centre, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yang-Hsin Shih
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Der-Jen Yen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Yo-Tsen Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Brain Research Centre, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Wu CI, Hsu PF, Lee IH, Lin YJ, Lin CF, Pan JP, Hsu TF, How CK, Kwan SY, Chung FP, Wu CH, Chen SA. Utilization of Amplitude-Integrated Electroencephalography to Predict Neurologic Function after Resuscitation in Adults with Cardiogenic Cardiac Arrest. Acta Cardiol Sin 2021; 37:632-642. [PMID: 34812237 PMCID: PMC8593491 DOI: 10.6515/acs.202111_37(6).20210630b] [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] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/20/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Amplitude-integrated electroencephalography (aEEG) has been used as a tool to recognize brain activity in children with hypoxic encephalopathy. OBJECTIVES To assess the prognostic value of aEEG during the post-resuscitation period of adult cardiogenic cardiac arrest, comatose survivors were monitored within 24 h of a return of spontaneous circulation using aEEG. METHODS Forty-two consecutive patients experiencing cardiac arrest were retrospectively enrolled, and a return of spontaneous circulation was achieved in all cases. These patients were admitted to the Coronary Intensive Care Unit due to cardiogenic cardiac arrest. The primary outcome was the best neurologic outcome within 6 months after resuscitation, and the registered patients were divided into two groups based on the Cerebral Performance Category (CPC) scale (CPC 1-2, good neurologic function group; CPC 3-5, poor neurologic function group). All patients received an aEEG examination within 24 h after a return of spontaneous circulation, and the parameters and patterns of aEEG recordings were compared. RESULTS Nineteen patients were in the good neurologic function group, and 23 were in the poor group. The four voltage parameters (minimum, maximum, span, average) of the aEEG recordings in the good neurologic function groups were significantly higher than in the poor group. Moreover, the continuous pattern, but not the status epilepticus or burst suppression patterns, could predict mid-term good neurologic function. CONCLUSIONS aEEG can be used to predict neurologic outcomes based on the recordings' parameters and patterns in unconscious adults who have experienced a cardiac collapse, resuscitation, and return of spontaneous circulation.
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Affiliation(s)
- Cheng-I Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Institute of Clinical Medicine, National Yang Ming Chiao Tung University
| | - Pai-Feng Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
,
Institute of Clinical Medicine, National Yang Ming Chiao Tung University;
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Director of Coronary Care Unit
| | | | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
,
Institute of Clinical Medicine, National Yang Ming Chiao Tung University
| | - Chun-Fu Lin
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei
| | - Ju-Pin Pan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | | | | | - Shang-Yeong Kwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Institute of Clinical Medicine, National Yang Ming Chiao Tung University
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Institute of Clinical Medicine, National Yang Ming Chiao Tung University
| | - Shih-Ann Chen
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University;
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Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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Chou CC, Lin PT, Yen DJ, Yu HY, Kwan SY, Chen C, Liu YT, Shih YC, Lin SY. Acute withdrawal of new-generation antiepileptic drugs in epilepsy monitoring units: Safety and efficacy. Epilepsy Behav 2021; 117:107846. [PMID: 33626492 DOI: 10.1016/j.yebeh.2021.107846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acute withdrawal of antiepileptic drugs (AEDs) is a safe and effective approach to provoking seizures in order to complete video-electroencephalogram (V-EEG) studies in a timely manner. Previous studies have focused only on withdrawal from conventional AEDs, and the effects of withdrawal from new-generation AEDs have not been extensively studied. MATERIALS AND METHODS This study examined adult patients with drug-resistant epilepsy admitted to an epilepsy monitoring unit between 2015 and 2018. Patients were classified according to whether they received conventional AEDs (Con; n = 13) or new-generation AEDs (N-Gen; n = 26). We then compared the effects of withdrawing these two types of AEDs over a period of one week in terms of efficacy (time to complete V-EEG monitoring) and safety, including the incidence of cluster seizures (CS), focal to bilateral tonic-clonic seizures (FBTCS) and status epilepticus (SE). RESULTS In both groups, approximately one week was required to complete V-EEG analysis: N-Gen group (5.6 days) and Con group (6.3 days). No differences were observed between the two groups in terms of the median number of seizures, the onset of the 1st seizure, the distribution of CS, FBTCS, or SE. Following acute withdrawal of medication, a high percentage of patients with a history of CS or FBTCS, respectively, presented CS or FBTCS. CONCLUSIONS We did not observe significant differences between patients taking new-generation AEDs and those taking conventional AEDs following withdrawal during V-EEG recording. In the current study, we employed a standard protocol for the rapid withdrawal of AEDs (daily dose reduction of 50%), which was sufficient for 80% of patients to complete V-EEG monitoring within one week.
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Affiliation(s)
- Chien-Chen Chou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
| | - Po-Tso Lin
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Der-Jen Yen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yo-Tsen Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Cheng Shih
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Szu-Ying Lin
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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Asafu-Adjaye EB, Wong SK, Arnason J, Betz J, Breakell K, Chen JX, Fitzloff J, Fong HHS, Kim CS, Kwan SY, Leung HW, Li GQ, Lin RC, Luo GA, Nicolidakis H, Park H, Suen E, Wang XR, Wang ZT, Wen KC, Yeung HW. Determination of Ginsenosides (Ginseng Saponins) in Dry Root Powder from Panax ginseng, Panax quinquefolius, and Selected Commercial Products by Liquid Chromatography: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.6.1112] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Twelve collaborating laboratories assayed 4 products, namely, Panax ginseng, Panax quinquefolius, and 2 ginseng products, for 6 ginsenosides: Rb1, Rb2, Rc, Rd, Re, andRg1. Collaborators also received a negative control for the recovery study. Pure ginsenosides were provided as reference standards for the liquid chromatography (LC) analysis and the system suitability tests. The LC analyses were performed on the methanol extract using UV detection at 203 nm. For P. ginseng, individual ginsenosides were consistent in their means; repeatability standard deviations (RSDr)rangedfrom4.17to5.09% and reproducibility standard deviations (RSDR) ranged from 7.27 to 11.3%. For P. quinquefolius, the Rb1 and Rb2 ginsenosides were higher and lower in concentration than P. ginseng, with RSDr values of 3.44 and 6.60% and RSDR values of 5.91 and 12.6% respectively, and other analytes at intermediate precisions. For ginseng commercial products, RSDr values ranged from 3.39 to 8.12%, andRSDR values ranged from 7.65 to 16.5%. A recovery study was also conducted for 3 ginsenosides: Rg1, Re, andRb1. The average recoveries were 99.9, 96.2, and 92.3%, respectively. The method is not applicable for the determination of Rg1 and Re in ginseng product at levels <300 mg/kg.
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Affiliation(s)
- Ebenezer B Asafu-Adjaye
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Product Quality Research Laboratory, HFD-941, NLRC Ste 2400, Rockville, MD 20857
| | - Siu Kay Wong
- Hong Kong Government Laboratory, Homantin Government Offices, 88 Chung Hau St, Hong Kong
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Peng SJ, Chou CC, Yu HY, Chen C, Yen DJ, Kwan SY, Hsu SPC, Lin CF, Chen HH, Lee CC. Ictal networks of temporal lobe epilepsy: views from high-frequency oscillations in stereoelectroencephalography. J Neurosurg 2018; 131:1086-1194. [PMID: 30544358 DOI: 10.3171/2018.6.jns172844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/27/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors investigated high-frequency oscillation (HFO) networks during seizures in order to determine how HFOs spread from the focal cerebral cortex and become synchronized across various areas of the brain. METHODS All data were obtained from stereoelectroencephalography (SEEG) signals in patients with drug-resistant temporal lobe epilepsy (TLE). The authors calculated intercontact cross-coefficients between all pairs of contacts to construct HFO networks in 20 seizures that occurred in 5 patients. They then calculated HFO network topology metrics (i.e., network density and component size) after normalizing seizure duration data by dividing each seizure into 10 intervals of equal length (labeled I1-I10). RESULTS From the perspective of the dynamic topologies of cortical and subcortical HFO networks, the authors observed a significant increase in network density during intervals I5-I10. A significant increase was also observed in overall energy during intervals I3-I8. The results of subnetwork analysis revealed that the number of components continuously decreased following the onset of seizures, and those results were statistically significant during intervals I3-I10. Furthermore, the majority of nodes were connected to a single dominant component during the propagation of seizures, and the percentage of nodes within the largest component grew significantly until seizure termination. CONCLUSIONS The consistent topological changes that the authors observed suggest that TLE is affected by common epileptogenic patterns. Indeed, the findings help to elucidate the epileptogenic network that characterizes TLE, which may be of interest to researchers and physicians working to improve treatment modalities for epilepsy, including resection, cortical stimulation, and neuromodulation treatments that are responsive to network topologies.
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Affiliation(s)
- Syu-Jyun Peng
- 1Biomedical Electronics Translational Research Center and
- 2Institute of Electronics, National Chiao-Tung University, Hsinchu
| | - Chien-Chen Chou
- Departments of3Neurology and
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- Departments of3Neurology and
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien Chen
- Departments of3Neurology and
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Der-Jen Yen
- Departments of3Neurology and
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Yeong Kwan
- Departments of3Neurology and
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sanford P C Hsu
- 4Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Fu Lin
- 4Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Hung Chen
- 4Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Chia Lee
- 4Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
- 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Liu YT, Chen YC, Kwan SY, Chou CC, Yu HY, Yen DJ, Liao KK, Chen WT, Lin YY, Chen RS, Jih KY, Lu SF, Wu YT, Wang PS, Hsiao FJ. Aberrant Sensory Gating of the Primary Somatosensory Cortex Contributes to the Motor Circuit Dysfunction in Paroxysmal Kinesigenic Dyskinesia. Front Neurol 2018; 9:831. [PMID: 30386286 PMCID: PMC6198142 DOI: 10.3389/fneur.2018.00831] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/18/2018] [Indexed: 12/19/2022] Open
Abstract
Paroxysmal kinesigenic dyskinesia (PKD) is conventionally regarded as a movement disorder (MD) and characterized by episodic hyperkinesia by sudden movements. However, patients of PKD often have sensory aura and respond excellently to antiepileptic agents. PRRT2 mutations, the most common genetic etiology of PKD, could cause epilepsy syndromes as well. Standing in the twilight zone between MDs and epilepsy, the pathogenesis of PKD is unclear. Gamma oscillations arise from the inhibitory interneurons which are crucial in the thalamocortical circuits. The role of synchronized gamma oscillations in sensory gating is an important mechanism of automatic cortical inhibition. The patterns of gamma oscillations have been used to characterize neurophysiological features of many neurological diseases, including epilepsy and MDs. This study was aimed to investigate the features of gamma synchronizations in PKD. In the paired-pulse electrical-stimulation task, we recorded the magnetoencephalographic data with distributed source modeling and time-frequency analysis in 19 patients of newly-diagnosed PKD without receiving pharmacotherapy and 18 healthy controls. In combination with the magnetic resonance imaging, the source of gamma oscillations was localized in the primary somatosensory cortex. Somatosensory evoked fields of PKD patients had a reduced peak frequency (p < 0.001 for the first and the second response) and a prolonged peak latency (the first response p = 0.02, the second response p = 0.002), indicating the synchronization of gamma oscillation is significantly attenuated. The power ratio between two responses was much higher in the PKD group (p = 0.013), indicating the incompetence of activity suppression. Aberrant gamma synchronizations revealed the defective sensory gating of the somatosensory area contributes the pathogenesis of PKD. Our findings documented disinhibited cortical function is a pathomechanism common to PKD and epilepsy, thus rationalized the clinical overlaps of these two diseases and the therapeutic effect of antiepileptic agents for PKD. There is a greater reduction of the peak gamma frequency in PRRT2-related PKD than the non-PRRT PKD group (p = 0.028 for the first response, p = 0.004 for the second response). Loss-of-function PRRT2 mutations could lead to synaptic dysfunction. The disinhibiton change on neurophysiology reflected the impacts of PRRT2 mutations on human neurophysiology.
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Affiliation(s)
- Yo-Tsen Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chieh Chen
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Chen Chou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Der-Jen Yen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kwong-Kum Liao
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Yang Lin
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Rou-Shayn Chen
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kang-Yang Jih
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Fen Lu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Te Wu
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Po-Shan Wang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.,Department of Neurology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Fu-Jung Hsiao
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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Su YC, Wu SC, Chen C, Chou CW, Hung SC, Lee Swindlehurst A, Kwan SY. Sample Entropy of High Frequency Oscillations for Epileptogenic Zone Localization. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:1-4. [PMID: 30440253 DOI: 10.1109/embc.2018.8512380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
For epileptic patients whose seizures are poorly controlled with medication, removing the brain region responsible for seizure onset is a treatment option. This requires the epileptogenic zone (EZ) to be accurately delineated. In this paper, a two-stage approach for EZ delineation is proposed. The algorithm starts by detecting events of high-frequency oscillations (HFOs) directly from the multi-channel intracranial electroencephalograms (iEEGs). The sample entropy is then computed for each of their channels that will be used for determining the channels correlated with the EZ. The performance of our proposed method is evaluated using the receiver operating characteristic curve analysis, and the results indicate that our proposed approach can provide an accurate estimation of the EZ.
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9
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Lu IL, Chen C, Tung CY, Chen HH, Pan JP, Chang CH, Cheng JS, Chen YA, Wang CH, Huang CW, Kang YN, Chang HY, Li LL, Chang KP, Shih YH, Lin CH, Kwan SY, Tsai JW. Identification of genes associated with cortical malformation using a transposon-mediated somatic mutagenesis screen in mice. Nat Commun 2018; 9:2498. [PMID: 29950674 PMCID: PMC6021418 DOI: 10.1038/s41467-018-04880-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/02/2018] [Accepted: 05/23/2018] [Indexed: 12/12/2022] Open
Abstract
Mutations in genes involved in the production, migration, or differentiation of cortical neurons often lead to malformations of cortical development (MCDs). However, many genetic mutations involved in MCD pathogenesis remain unidentified. Here we developed a genetic screening paradigm based on transposon-mediated somatic mutagenesis by in utero electroporation and the inability of mutant neuronal precursors to migrate to the cortex and identified 33 candidate MCD genes. Consistent with the screen, several genes have already been implicated in neural development and disorders. Functional disruption of the candidate genes by RNAi or CRISPR/Cas9 causes altered neuronal distributions that resemble human cortical dysplasia. To verify potential clinical relevance of these candidate genes, we analyzed somatic mutations in brain tissue from patients with focal cortical dysplasia and found that mutations are enriched in these candidate genes. These results demonstrate that this approach is able to identify potential mouse genes involved in cortical development and MCD pathogenesis. Cortical malformations have a variety of causes. Here the authors use transposon mutagenesis to insert mutations into neural stem cells in the developing mouse cortex to screen for new candidate genes for cortical malformation, and validate some targets in human brain tissue.
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Affiliation(s)
- I-Ling Lu
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Chien Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,National Yang-Ming University School of Medicine, Taipei, 112, Taiwan
| | - Chien-Yi Tung
- VYM Genome Research Center of National Yang-Ming University, Taipei, 112, Taiwan.,Institute of Microbiology and Immunology, National Yang-Ming University, Taipei, 112, Taiwan
| | - Hsin-Hung Chen
- National Yang-Ming University School of Medicine, Taipei, 112, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Jia-Ping Pan
- VYM Genome Research Center of National Yang-Ming University, Taipei, 112, Taiwan
| | - Chia-Hsiang Chang
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan.,Taiwan International Graduate Program (TIGP) in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, 112, Taiwan
| | - Jia-Shing Cheng
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Yi-An Chen
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Chun-Hung Wang
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Chia-Wei Huang
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Yi-Ning Kang
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Hsin-Yun Chang
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Lei-Li Li
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Kai-Ping Chang
- National Yang-Ming University School of Medicine, Taipei, 112, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Yang-Hsin Shih
- National Yang-Ming University School of Medicine, Taipei, 112, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Chi-Hung Lin
- VYM Genome Research Center of National Yang-Ming University, Taipei, 112, Taiwan.,Institute of Microbiology and Immunology, National Yang-Ming University, Taipei, 112, Taiwan.,Institute of Biophotonics, National Yang-Ming University, Taipei, 112, Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,National Yang-Ming University School of Medicine, Taipei, 112, Taiwan
| | - Jin-Wu Tsai
- Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan. .,Brain Research Center, National Yang-Ming University, Taipei, 112, Taiwan. .,Biophotonics and Molecular Imaging Research Center, National Yang-Ming University, Taipei, 112, Taiwan.
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10
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Wang IK, Liu CH, Yen TH, Jeng JS, Sung SF, Huang PH, Li JY, Sun Y, Wei CY, Lien LM, Tsai IJ, Sung FC, Hsu CY, Liu CH, Tsai CH, Huang WS, Lu CT, Tsai TC, Tseng CH, Lin KH, Shyu WC, Yang YW, Liu YL, Cho DY, Chen CC, Jeng JS, Tang SC, Tsai LK, Yeh SJ, Chen CH, Tsai HH, Li JY, Chen HJ, Lu K, Hsu SP, Kuo HC, Tsou JC, Wang YT, Tai YC, Hsieh MT, Liliang PC, Liang CL, Wang HK, Tsai YT, Wang KW, Chen JS, Chen PY, Wang YC, Chen CH, Sung PS, Hsieh HC, Su HC, Chiu HC, Lien LM, Chen WH, Bai CH, Huang TH, Lau CI, Wu YY, Yeh HL, Chang A, Lin CH, Yen CC, Lin RT, Chen CH, Khor GT, Chao AC, Lin HF, Huang P, Lin HJ, Ke DS, Chang CY, Yeh PS, Lin KC, Cheng TJ, Chou CH, Yang CM, Shen HC, Chen AC, Tsai SJ, Lu TM, Kung SL, Lee MJ, Chou HH, Chang WL, Chiu PY, Hsu MH, Chan PC, Pan CH, Shoung HM, Lo YC, Wang FH, Chang WC, Lai TC, Yin JH, Wang CJ, Wang KC, Chen LM, Denq JC, Sun Y, Lu CJ, Lin CH, Huang CC, Liu CH, Chan HF, Lee SP, Sun MH, Ke LY, Chen PL, Lee YS, Sung SF, Ong CT, Wu CS, Hsu YC, Su YH, Hung LC, Lee JT, Lin JC, Hsu YD, Denq JC, Peng GS, Hsu CH, Lin CC, Yen CH, Cheng CA, Sung YF, Chen YL, Lien MT, Chou CH, Liu CC, Yang FC, Wu YC, Tso AC, Lai YH, Chiang CI, Tsai CK, Liu MT, Lin YC, Hsu YC, Chiang TR, Huang PH, Liao PW, Lee MC, Chen JT, Lie SK, Sun MC, Hsiao PJ, Chen WL, Chen TC, Chang CS, Lai CH, Chuang CS, Chen YY, Lin SK, Su YC, Shiao JL, Yang FY, Liu CY, Chiang HL, Chen GC, Hsu PJ, Chang CY, Lin IS, Chien CH, Chang YC, Chen PK, Chiu PY, Hsiao YJ, Fang CW, Chen YW, Lee KY, Lin YY, Li CH, Tsai HF, Hsieh CF, Yang CD, Liaw SJ, Liao HC, Yeh SJ, Wu LL, Hsieh LP, Lee YH, Chen CW, Hsu CS, Jhih YJ, Zhuang HY, Pan YH, Shih SA, Chen CI, Sung JY, Weng HY, Teng HW, Lee JE, Huang CS, Chao SP, Yuan RY, Sheu JJ, Yu JM, Ho CS, Lin TC, Yu SC, Chen JR, Tsai SY, Wei CY, Hung CH, Lee CF, Yang SK, Chen CL, Lin W, Tseng HP, Liu CH, Lin CL, Lin HC, Chen PT, Hu CJ, Chan L, Chi NF, Chern CM, Lin CJ, Wang SJ, Hsu LC, Wong WJ, Lee IH, Yen DJ, Tsai CP, Kwan SY, Soong BW, Chen SP, Liao KK, Lin KP, Chen C, Shan DE, Fuh JL, Wang PN, Lee YC, Yu YH, Huang HC, Tsai JY, Wu MH, Chiang SY, Wang CY, Hsu MC, Chen CC, Yeh PY, Tsai YT, Wang KY, Chen TS, Hsieh CY, Chen WF, Yip PK, Wang V, Wang KC, Tsai CF, Chen CC, Chen CH, Liu YC, Chen SY, Zhao ZH, Wei ZP, Wu SL, Liu CK, Lin RH, Chu CH, Yan SH, Lin YC, Chen PY, Hsiao SH, Yip BS, Tsai PC, Chou PC, Kuo TM, Lee YC, Chiu YP, Tsai KC, Liao YS, Tsai MJ, Kao HY. Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke. Atherosclerosis 2018; 269:288-293. [PMID: 29254692 DOI: 10.1016/j.atherosclerosis.2017.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/26/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
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11
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Liu YT, Nian FS, Chou WJ, Tai CY, Kwan SY, Chen C, Kuo PW, Lin PH, Chen CY, Huang CW, Lee YC, Soong BW, Tsai JW. PRRT2 mutations lead to neuronal dysfunction and neurodevelopmental defects. Oncotarget 2018; 7:39184-39196. [PMID: 27172900 PMCID: PMC5129924 DOI: 10.18632/oncotarget.9258] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 02/05/2016] [Accepted: 04/26/2016] [Indexed: 11/25/2022] Open
Abstract
Mutations in the proline-rich transmembrane protein 2 (PRRT2) gene cause a wide spectrum of neurological diseases, ranging from paroxysmal kinesigenic dyskinesia (PKD) to mental retardation and epilepsy. Previously, seven PKD-related PRRT2 heterozygous mutations were identified in the Taiwanese population: P91QfsX, E199X, S202HfsX, R217PfsX, R217EfsX, R240X and R308C. This study aimed to investigate the disease-causing mechanisms of these PRRT2 mutations. We first documented that Prrt2 was localized at the pre- and post-synaptic membranes with a close spatial association with SNAP25 by synaptic membrane fractionation and immunostaining of the rat neurons. Our results then revealed that the six truncating Prrt2 mutants were accumulated in the cytoplasm and thus failed to target to the cell membrane; the R308C missense mutant had significantly reduced protein expression, suggesting loss-of function effects generated by these mutations. Using in utero electroporation of shRNA into cortical neurons, we further found that knocking down Prrt2 expression in vivo resulted in a delay in neuronal migration during embryonic development and a marked decrease in synaptic density after birth. These pathologic effects and novel disease-causing mechanisms may contribute to the severe clinical symptoms in PRRT2–related diseases.
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Affiliation(s)
- Yo-Tsen Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Fang-Shin Nian
- Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Wan-Ju Chou
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yin Tai
- Istitute of Pharmaceutics, Development Center for Biotechnology, New Taipei City, Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chien Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Pei-Wen Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Po-Hsi Lin
- Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chin-Yi Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Wei Huang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chung Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Bing-Wen Soong
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Wu Tsai
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Biophotonics and Molecular Imaging Research Center, National Yang-Ming University, Taipei, Taiwan
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12
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Wang HH, Kwan SY. Electroencephalographic periodic discharges in Metronidazoleinduced encephalopathy: a case report. Acta Neurol Taiwan 2017; 26:184-188. [PMID: 30315564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Hsing-Han Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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13
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Kim HD, Chi CS, Desudchit T, Nikanorova M, Visudtibhan A, Nabangchang C, Chan DWS, Fong CY, Chang KP, Kwan SY, Reyes FDL, Huang CC, Likasitwattanakul S, Lee WT, Yung A, Dash A. Review of clinical studies of perampanel in adolescent patients. Brain Behav 2016; 6:e00505. [PMID: 27688936 PMCID: PMC5036429 DOI: 10.1002/brb3.505] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 11/09/2022] Open
Abstract
AIM To assess the clinical trial and real-world data for adjunctive perampanel in adolescents and develop consensus recommendations to guide the use of perampanel in this population in clinical practice. METHODS In May 2015, 15 epilepsy experts attended a Consensus Development Meeting to assess the clinical trial data for perampanel, specific to the adolescent age group (12-17 years) and develop consensus treatment recommendations. RESULTS AND DISCUSSION Analysis of the adolescent subgroup data of three pivotal placebo-controlled, double-blind, phase 3 trials investigating perampanel in patients with ongoing focal epileptic seizures despite receiving one to three antiepileptic drugs found that perampanel 4-12 mg was superior to placebo. The tolerability profile of perampanel was generally acceptable. Adolescent patients receiving long-term treatment with perampanel in an open-label extension study maintained improvements in seizure control compared with baseline, with a favorable risk-benefit profile. A phase 2 study showed that perampanel had no clinically important effects on cognitive function, growth, and development. CONCLUSION Perampanel is a welcome addition to the armamentarium of existing antiepileptic drugs as it represents a new approach in the management of epilepsy, with a novel mechanism of action, and the potential to have a considerable impact on the treatment of adolescents with epilepsy.
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Affiliation(s)
- Heung Dong Kim
- Division of Pediatric Neurology Yonsei University Severance Children's Hospital Seoul Korea
| | - Ching-Shiang Chi
- Department of Pediatrics Tungs' Taichung Metro Harbor Hospital Taichung Taiwan
| | - Tayard Desudchit
- Department of Paediatric Neurology King Chulalongkorn Memorial Hospital Bangkok Thailand
| | - Marina Nikanorova
- Children's Department Danish Epilepsy Centre Filadelfia Dianalund Denmark
| | - Anannit Visudtibhan
- Division of Neurology Department of Pediatrics Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | | | - Derrick W S Chan
- Department of Paediatrics KK Women's and Children's Hospital Singapore City Singapore
| | - Choong Yi Fong
- Division of Paediatric Neurology Department of Paediatrics Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Kai-Ping Chang
- Department of Pediatrics Taipei Veterans General Hospital Taipei Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology Taipei Veterans General Hospital Taipei Taiwan
| | - Fe De Los Reyes
- Department of Pediatrics Mother Seton Hospital Camarines Sur Philippines
| | - Chao-Ching Huang
- Department of Pediatrics College of Medicine Taipei Medical University Taipei Taiwan
| | | | - Wang-Tso Lee
- Department of Pediatrics National Taiwan University Hospital Taipei Taiwan
| | - Ada Yung
- Department of Pediatrics The Duchess of Kent Children's Hospital Sandy Bay Hong Kong
| | - Amitabh Dash
- Eisai Pharmaceuticals India Pvt., Ltd. Mumbai India
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14
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Abstract
Zonisamide is an orally administered antiepileptic drug that was first approved for clinical use in Japan in 1989. Since then, it has been licensed in Korea for a broad spectrum of epilepsies in adults and children, and in the USA for adjunctive therapy of adults with partial seizures, and in Europe for monotherapy of adults with newly diagnosed partial seizures and adjunctive therapy of adults and adolescents and children aged ≥6 years with partial seizures with or without secondary generalization. Zonisamide is a benzisoxazole derivative with a unique chemical structure, predictable dose-dependent pharmacokinetics, and multiple complementary mechanisms of action. Treatment with zonisamide is well tolerated and is not known to be associated with clinically significant drug-drug interactions, including with oral contraceptives or other antiepileptic drugs. There have been >2 million patient-years of experience with zonisamide for treatment of epilepsy, and this drug has International League Against Epilepsy level A evidence for efficacy/effectiveness as initial monotherapy for adults with partial-onset seizures. This review presents the evidence for zonisamide across the spectrum of epilepsy, with emphasis on real-world clinical practice and special populations of patients (children, elderly patients, and women of childbearing age) who are likely to be treated in daily clinical practice.
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Affiliation(s)
- Shang-Yeong Kwan
- Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Chung Chuang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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15
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Hsiao FJ, Yu HY, Chen WT, Kwan SY, Chen C, Yen DJ, Yiu CH, Shih YH, Lin YY. Increased Intrinsic Connectivity of the Default Mode Network in Temporal Lobe Epilepsy: Evidence from Resting-State MEG Recordings. PLoS One 2015; 10:e0128787. [PMID: 26035750 PMCID: PMC4452781 DOI: 10.1371/journal.pone.0128787] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 04/30/2015] [Indexed: 11/23/2022] Open
Abstract
The electrophysiological signature of resting state oscillatory functional connectivity within the default mode network (DMN) during spike-free periods in temporal lobe epilepsy (TLE) remains unclear. Using magnetoencephalographic (MEG) recordings, this study investigated how the connectivity within the DMN was altered in TLE, and we examined the effect of lateralized TLE on functional connectivity. Sixteen medically intractable TLE patients and 22 controls participated in this study. Whole-scalp 306-channel MEG epochs without interictal spikes generated from both MEG and EEG data were analyzed using a minimum norm estimate (MNE) and source-based imaginary coherence analysis. With this processing, we obtained the cortical activation and functional connectivity within the DMN. The functional connectivity was increased between DMN and the right medial temporal (MT) region at the delta band and between DMN and the bilateral anterior cingulate cortex (ACC) regions at the theta band. The functional change was associated with the lateralization of TLE. The right TLE showed enhanced DMN connectivity with the right MT while the left TLE demonstrated increased DMN connectivity with the bilateral MT. There was no lateralization effect of TLE upon the DMN connectivity with ACC. These findings suggest that the resting-state functional connectivity within the DMN is reinforced in temporal lobe epilepsy during spike-free periods. Future studies are needed to examine if the altered functional connectivity can be used as a biomarker for treatment responses, cognitive dysfunction and prognosis in patients with TLE.
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Affiliation(s)
- Fu-Jung Hsiao
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Laboratory of Neurophysiology at Medical Research Division, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (FJH); (YYL)
| | - Hsiang-Yu Yu
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ta Chen
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Laboratory of Neurophysiology at Medical Research Division, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien Chen
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Der-Jen Yen
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Hing Yiu
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yang-Hsin Shih
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Yang Lin
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Laboratory of Neurophysiology at Medical Research Division, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (FJH); (YYL)
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16
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Wang WH, Shih YH, Yu HY, Yen DJ, Lin YY, Kwan SY, Chen C, Hua MS. Theory of mind and social functioning in patients with temporal lobe epilepsy. Epilepsia 2015; 56:1117-23. [DOI: 10.1111/epi.13023] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Wei-Han Wang
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
| | - Yang-Hsin Shih
- Department of Neurosurgery; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- National Yang-Ming University; Taipei Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- National Yang-Ming University; Taipei Taiwan
| | - Der-Jen Yen
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- National Yang-Ming University; Taipei Taiwan
| | - Yung-Yang Lin
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- National Yang-Ming University; Taipei Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- National Yang-Ming University; Taipei Taiwan
| | - Chien Chen
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- National Yang-Ming University; Taipei Taiwan
| | - Mau-Sun Hua
- Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
- Department of Psychiatry; National Taiwan University Hospital; Taipei Taiwan
- Neurobiology and Cognitive Science Center; National Taiwan University; Taipei Taiwan
- Graduate Institute of Brain and Mind Sciences; National Taiwan University; Taipei Taiwan
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17
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Chen HH, Chen C, Hung SC, Liang SY, Lin SC, Hsu TR, Yeh TC, Yu HY, Lin CF, Hsu SPC, Liang ML, Yang TF, Chu LS, Lin YY, Chang KP, Kwan SY, Ho DM, Wong TT, Shih YH. Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children: early intervention maybe better. Childs Nerv Syst 2014; 30:1885-95. [PMID: 25296550 DOI: 10.1007/s00381-014-2463-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/04/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Focal cortical dysplasia (FCD) is a specific malformation of cortical development harboring intrinsic epileptogenicity, and most of the patients develop drug-resistant epilepsy in early childhood. The detrimental effects of early and frequent seizures on cognitive function in children are significant clinical issues. In this study, we evaluate the effects of early surgical intervention of FCD on epilepsy outcome and cognitive development. METHODS From 2006 to 2013, 30 children younger than 18 years old underwent resective surgery for FCDs at Taipei Veterans General Hospital. The mean age at surgery was 10.0 years (range 1.7 to 17.6 years). There were 21 boys and 9 girls. In this retrospective clinical study, seizure outcome, cognitive function, and quality of life were evaluated. To evaluate the effects to outcomes on early interventions, the patients were categorized into four groups according to age of seizure onset, duration of seizure before surgery, and severity of cognitive deficits. RESULTS Eleven of 22 (50 %) patients demonstrated developmental delay preoperatively. The Engel seizure outcome achievements were class I in 21 (70 %), class II in 2 (7 %), class III in 6 (20 %), and class IV in 1 (3 %) patients. The locations of FCDs resected were in the frontal lobe in 18 cases, temporal lobe in 7, parietal lobe in 2, and in bilobes including frontoparietal lobe in 2 and parieto-occipital lobes in 1. Eight cases that had FCDs involved in the rolandic cortex presented hemiparesis before surgical resection. Motor function in four of them improved after operation. The histopathological types of FCDs were type Ia in 1, type Ib in 7, type IIa in 7, type IIb in 12, and type III in 3 patients. FCDs were completely resected in 20 patients. Eighteen (90 %) of them were seizure free (p < 0.001) with three patients that received more than one surgery to accomplish complete resection. The patients who had early seizure onset, no significant cognitive function deficit, and early surgical intervention with complete resection in less than 2 years of seizure duration showed best outcomes on seizure control, cognitive function, and quality of life. CONCLUSION Delay in cognitive development and poor quality of life is common in children treated for FCDs. Early surgical intervention and complete resection of the lesion help for a better seizure control, cognitive function development, and quality of life. FCDs involved eloquent cortex may not prohibit complete resection for better outcomes.
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Affiliation(s)
- Hsin-Hung Chen
- Department of Neurosurgery, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,
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Hsu WY, Kwan SY, Liao KK, Chen RS, Lin YY. Altered inhibitory modulation of somatosensory cortices in paroxysmal kinesigenic dyskinesia. Mov Disord 2013; 28:1728-31. [DOI: 10.1002/mds.25656] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/11/2013] [Accepted: 07/29/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Wan-Yu Hsu
- Institute of Brain Science; National Yang-Ming University; Taipei Taiwan
- Laboratory of Neurophysiology; Taipei Veterans General Hospital; Taipei Taiwan
- Integrated Brain Research Laboratory; Taipei Veterans General Hospital; Taipei Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology; National Yang-Ming University; Taipei Taiwan
- Department of Neurology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Kwong-Kum Liao
- Department of Neurology; National Yang-Ming University; Taipei Taiwan
- Department of Neurology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Rou-Shayn Chen
- Department of Neurology; Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Taipei Taiwan
| | - Yung-Yang Lin
- Institute of Brain Science; National Yang-Ming University; Taipei Taiwan
- Laboratory of Neurophysiology; Taipei Veterans General Hospital; Taipei Taiwan
- Integrated Brain Research Laboratory; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Neurology; National Yang-Ming University; Taipei Taiwan
- Department of Neurology; Taipei Veterans General Hospital; Taipei Taiwan. Institute of Physiology; National Yang-Ming University; Taipei Taiwan. Institute of Clinical Medicine; National Yang-Ming University; Taipei Taiwan
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Wang WH, Yu HY, Yen DJ, Lin YY, Kwan SY, Chen C, Hua MS. The Social and Occupational Functioning Scale for Epilepsy (SOFSE): A brief measure of functional status in a Taiwanese sample with epilepsy. Epilepsia 2013; 54:888-97. [DOI: 10.1111/epi.12141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Wei-Han Wang
- Department of Psychology; National Taiwan University; Taipei; Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital and National Yang-Ming University; Taipei; Taiwan
| | - Der-Jen Yen
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital and National Yang-Ming University; Taipei; Taiwan
| | - Yung-Yang Lin
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital and National Yang-Ming University; Taipei; Taiwan
| | - Shang-Yeong Kwan
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital and National Yang-Ming University; Taipei; Taiwan
| | - Chien Chen
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital and National Yang-Ming University; Taipei; Taiwan
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Kuan YC, Shih YH, Chen C, Yu HY, Yiu CH, Lin YY, Kwan SY, Yen DJ. Abdominal auras in patients with mesial temporal sclerosis. Epilepsy Behav 2012; 25:386-90. [PMID: 23103315 DOI: 10.1016/j.yebeh.2012.07.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 07/26/2012] [Accepted: 07/28/2012] [Indexed: 10/27/2022]
Abstract
To better clarify abdominal auras and their clinical correlates, we enrolled 331 temporal lobe epilepsy patients who received surgical treatment. Detailed descriptions of their auras were obtained before surgery and reconfirmed during postoperative outpatient follow-ups. Pathology revealed mesial temporal sclerosis (MTS) in 256 patients (77.3%) and 75 non-MTS. Of 214 MTS patients with auras, 78 (36.4%) reported abdominal auras (vs. 30.4% in non-MTS, p=0.439): 42 with left-sided seizure onset, and 36 with right-sided seizure onset. Moreover, 49 of the 78 MTS patients had abdominal auras accompanied by rising sensations (vs. 2 of 14 in non-MTS group, p=0.004). The "rising air" was initially described to locate to the epigastric (47.8%) or periumbilical area (45.7%) and mostly reached the chest (40.4%) or remained in the abdominal region (27.1%). An epigastric location of "rising air" favored a left-sided seizure onset, and non-epigastric areas favored right-sided seizure onset (p=0.018). Finally, we found that abdominal auras with or without rising sensations did not predict postoperative seizure outcomes.
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Affiliation(s)
- Yi-Chun Kuan
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
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21
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Chen CY, Lee HT, Chen CC, Kwan SY, Chen SJ, Hsieh LP, Tsai JD. Short-term results of vagus nerve stimulation in pediatric patients with refractory epilepsy. Pediatr Neonatol 2012; 53:184-7. [PMID: 22770107 DOI: 10.1016/j.pedneo.2012.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 06/14/2011] [Accepted: 06/27/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS), an alternative method to manage patients with medically intractable epilepsy, has shown favorable results in reducing seizure relapse and improvements in quality of life. In 1997, the U.S. Food and Drug Administration approved the use of this device as an adjunctive therapy for intractable seizure in adults and adolescents older than 12 years of age. METHODS We present a preliminary study of pediatric patients, who suffered from medically intractable seizure and underwent VNS implantation after observation of the baseline seizure frequency. Classification of epileptic syndrome, seizure patterns, age of onset, seizure frequency reduction and adverse effects were recorded. RESULTS Patients who underwent VNS implantation included four adolescents and four children. The follow-up duration ranged from 9-33 months. All the patients were responders after the beginning of the stimulation. Five of the eight patients responded to VNS with a seizure frequency reduction rate > 50%, and four of the eight patients experienced a ≥ 90% seizure reduction. No significant adverse effects were noted in all patients during the observation period. CONCLUSION The effective management of medically intractable seizure remains challenging to most clinical physicians. In addition to ketogenic diet and epilepsy surgery, VNS provides an alternative way to manage this issue. Our results suggest that VNS is well tolerated in pediatric patients, and is a favorable and safe method of treating intractable seizure in common clinical practice.
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Affiliation(s)
- Chih-Yi Chen
- Department of Pediatrics, Chung Shan Medical University and Hospital, Taiwan
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22
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Lin JH, Chen C, Shyu HY, Kwan SY, Yiu CH. Stimulus-induced rhythmic, periodic, or ictal discharges--a case report. Clin Neurol Neurosurg 2012; 114:1283-6. [PMID: 22445614 DOI: 10.1016/j.clineuro.2012.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 03/01/2012] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Ji-Ho Lin
- Department of Neurology, Taipei General Hospital, Department of Health, Executive Yuan, Taiwan, ROC
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Lin JH, Kwan SY. Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox–Gastaut syndrome. J Clin Neurosci 2012; 19:388-93. [DOI: 10.1016/j.jocn.2011.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 04/02/2011] [Indexed: 10/14/2022]
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Kwan SY. Sleep in patients with epilepsy. Acta Neurol Taiwan 2011; 20:229-231. [PMID: 22315172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Lin JH, Shyu HY, Chen C, Kwan SY, Wong TT, Chang KP, Yiu CH. Reflex absence epilepsy induced by gait. Epilepsy Behav 2011; 22:395-7. [PMID: 21813331 DOI: 10.1016/j.yebeh.2011.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 06/21/2011] [Indexed: 10/17/2022]
Abstract
Reflex epilepsy is characterized by seizures that are precipitated by a specific identifiable factor. We describe here the case of a 21-year-old man with notable absence epilepsy since the age of 11 who experienced generalized convulsions 2 years after onset (in the absence of antiepileptic therapy) and reflex absence seizures triggered by walking 7-10 steps. To our knowledge, this case report is the first describing reflex absence epilepsy seizures induced by gait.
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Affiliation(s)
- Ji-Ho Lin
- Department of Neurology, Taipei General Hospital, Department of Health, Executive Yuan, Taipei, Taiwan
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Yu HY, Yen DJ, Yiu CH, Lin YY, Kwan SY, Chen C, Hsu SPC, Shih YH. Postoperative interictal epileptiform discharge within 1 month is associated with seizure recurrence after anterior temporal lobectomy. Epilepsy Behav 2010; 19:436-40. [PMID: 20850385 DOI: 10.1016/j.yebeh.2010.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 08/07/2010] [Accepted: 08/09/2010] [Indexed: 11/18/2022]
Abstract
To investigate the relationship of interictal epileptiform discharges (IEDs) within 1 month of anterior temporal lobectomy (ATL) to seizure outcome, we reviewed data for 202 (107 left ATL, 95 right ATL) patients who had undergone ATL for mesial temporal epilepsy. Postoperative EEGs within 30 days and other preoperative variables were analyzed to examine the significant factors that determine freedom from disabling seizures. IEDs were noted in 29 (22.3%) of the 130 patients without seizures for 2 years after ATL compared with 31 (43.1%) of the 72 patients with recurrent seizures (P = 0.002). Postoperative IEDs remained an independent predictive factor for seizure outcome by logistic regression (adjusted OR = 2.38, 95% CI = 1.18-4.81, P = 0.016, 2 years postoperatively; adjusted OR = 2.22, 95% CI = 1.03-4.82, P = 0.043, 5 years postoperatively) and Cox hazard regression analysis (adjusted HR = 1.76, 95% CI = 1.18-2.62, P = 0.006) after controlling for other predicting factors (unilateral hippocampal atrophy, history of febrile seizures, and IQ scores). In this study, IEDs on the EEG obtained soon after surgery were associated with postoperative seizure recurrence. These results can be used in the assessment of risk of seizure recurrence after ATL.
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Affiliation(s)
- Hsiang-Yu Yu
- Department of Neurology, Taipei Veterans General Hospital, and National Yang-Ming University, Taiwan
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Yu HY, Shih YH, Su TP, Shan IK, Yiu CH, Lin YY, Kwan SY, Chen C, Yen DJ. The Wada memory test and prediction of outcome after anterior temporal lobectomy. J Clin Neurosci 2010; 17:857-61. [DOI: 10.1016/j.jocn.2009.11.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 11/12/2009] [Accepted: 11/17/2009] [Indexed: 11/15/2022]
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28
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Kwan SY. The role of intravenous valproate in convulsive status epilepticus in the future. Acta Neurol Taiwan 2010; 19:78-81. [PMID: 20830628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 05/31/2010] [Indexed: 05/29/2023]
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29
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Yu HY, Kwan SY, Lirng JF, Liao KK, Chu YK, Liao SQ. Epileptic negative myoclonus: SPECT, PET, and video/EEG studies and the dramatic effects of levetiracetam. Epilepsy Behav 2009; 14:687-90. [PMID: 19435576 DOI: 10.1016/j.yebeh.2009.01.025] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 01/27/2009] [Accepted: 01/29/2009] [Indexed: 11/30/2022]
Abstract
An 18-year-old woman presented with epileptic negative myoclonus (ENM) as her major seizure pattern for 4years. Her seizures were characterized by intermittent postural lapse of the right limbs for a period of hours to 2 days. Ictal electroencephalography (EEG)-electromyography showed a silent period that was time-locked to generalized spike-wave discharges. Video/EEG monitoring demonstrated marked improvement of ENM after oral administration of levetiracetam. Cranial magnetic resonance imaging was normal, but 2-deoxy-2-[(18)F]fluoro-d-glucose positron emission tomography during frequent ENM showed hypometabolism in the left frontoparietal cortex. Technetium-99m-ethyl cysteinate dimer single-photon emission computed tomography revealed hyperperfusion over the left parietal cortex and putamen. Here, we document the short-term effects of levetiracetam in this subject with nearly isolated ENM and the neuroimaging results during ENM. Long-term follow-up is in progress to evaluate the clinical evolution and long-term effects of levetiracetam on ENM.
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Affiliation(s)
- Hsiang-Yu Yu
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Lin JH, Kwan SY, Wu D. Mixed alien hand syndrome coexisting with left-sided extinction secondary to a left corpus callosal lesion: A case report. Mov Disord 2007; 22:248-51. [PMID: 17133516 DOI: 10.1002/mds.21241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Alien hand syndrome (AHS) is actually two distinct syndromes with distinct clinical and anatomic features, that is, a frontal type and a callosal type. Frontal AHS occurs in the dominant hand; is associated with reflexive grasping, groping, and compulsive manipulation of tools. Callosal AHS is characterized primarily by intermanual conflict. We report a case of right frontal AHS and left callosal AHS (mixed AHS) secondary to ischemic stroke of the left corpus callosum (lesion extending from the genu to splenium) and right corpus callosum (minimal lesion in the splenium) in a 67-year-old male patient who also presented with left-sided tactile extinction. To our knowledge, rare reports have documented mixed AHS coexisting with nondominant side extinction secondary only to unilateral (left) callosal lesion, as in our case.
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Affiliation(s)
- Ji-Ho Lin
- Department of Neurology, Tao-Yuan General Hospital, Department of Health, Taiwan.
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Abstract
A 38-year-old man had postictal global aphasia after generalized tonic-clonic seizure, but recovered within 1 day. There was a focal increase in the signal intensity of the left frontoparietal sulci on fluid-attenuated inversion recovery magnetic resonance (MR) sequence 6 hours after the seizure, which disappeared 1 month later. The transient seizure-induced MR hyperintensity was possibly caused by ictal or postictal hyperemia and breakdown of the blood-brain barrier. This report aims to increase awareness of this condition and avoid unnecessary management.
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Affiliation(s)
- Ji-Ho Lin
- Department of Neurology, Min-Sheng General Hospital, Taoyuan, Taiwan, R.O.C.
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Abstract
Leptomeningeal carcinomatosis is characterized by diffuse infiltration of the meninges by metastatic cancer. We report a rare case of leptomeningeal carcinomatosis with an initial presentation of isolated acute hearing loss. Progressive unsteady gait and multiple cranial nerve palsies ensued. Computed tomography of the chest with contrast revealed a 2 cm nodule over the right upper lung. Cytology of cerebrospinal fluid confirmed the diagnosis of adenocarcinoma. The patient was discharged after diagnosis. Isolated acute hearing loss is a rare initial presentation in leptomeningeal carcinomatosis, not necessarily with a known history of malignancy. A high index of suspicion is mandatory for accurate diagnosis.
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Affiliation(s)
- Tzu-Hsien Lai
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taiwan, R.O.C
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Kwan SY, Lin JH, Wong TT, Chang KP, Yiu CH. A comparison of seizure outcome after callosotomy in patients with Lennox-Gastaut syndrome and a positive or negative history for West syndrome. Seizure 2006; 15:552-7. [PMID: 16884930 DOI: 10.1016/j.seizure.2006.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2005] [Revised: 06/17/2006] [Accepted: 06/28/2006] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This retrospective study was designed to clarify the role of West syndrome in post-callosotomy seizure outcome in patients with Lennox-Gastaut syndrome. METHODS From September 1989 to May 1999, 74 patients diagnosed with Lennox-Gastaut syndrome received anterior corpus callosotomy at Taipei Veterans General Hospital, Taiwan. All patients were followed for more than 4 years after surgery. Among them, 21 (28.4%) patients had a history of West syndrome (Group A) whereas 53 (71.6%) patients did not have a history of West syndrome (Group B). Postoperative seizure outcome was compared for these two patient groups. RESULTS A total of 16 (76.2%) patients in Group A (positive history) and 29 (54.7%) patients in group B (negative history) achieved significant improvement in seizures after surgery (e.g., seizure reduction of more than 50%). There was no statistical significance (p=0.088) in the difference in outcome between the two groups. CONCLUSIONS A history of West syndrome does not appear to influence post-callosotomy seizure outcome in patients with Lennox-Gastaut syndrome.
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Affiliation(s)
- Shang-Yeong Kwan
- Pediatric Epilepsy Surgery Group, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Abstract
INTRODUCTION For children of medical resistant epilepsy without resectable epileptogenic zone, corpus callosotomy and vagus nerve stimulation (VNS) therapy are the two commonly used palliative epilepsy surgeries that can be considered. Although their routes and mechanisms to control epilepsy are different, both surgeries have shown their efficacy in selected candidates. The most common candidates for palliative surgery are in infants and children with organic encephalopathic types of epilepsy including infantile spasms/West syndrome, Lennox-Gastaut syndrome (LGS), severe epilepsy with multiple independent spike foci (SE-MISF) and selected symptomatic partial epilepsy to relief seizures and to stabilize co morbidities (Hirsch and Arzimanoglou, Revue Neurologique [Hirsch E and Arzimanoglou A, Rev Neurol (Paris). 160 Spec No 1:5S210-S219, (2004); Ohtahara S and Yamatogi Y, J Clin Neurophysiol 20(6):398-407, (2003); Wheless JW and Epilepsia 45(Suppl 5):17-22, (2004); Trevathan E, J Child Neurol 17 Suppl 2:2S9-2S22, (2002)]. DISCUSSION Callosotomy is a major and destructive but affordable surgical procedure as compare to the relative simple but costly extracranial procedure of VNS therapy. However, callosotomy is a safe and effective palliative operation in neurosurgeons familiar with the surgical procedure. Equipments for callosotomy can be as simple as headlight and binocular loupes, self-retention brain retractor, bipolar cauterization, and simple microinstruments.
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Affiliation(s)
- Tai-Tong Wong
- Pediatric Epilepsy Surgery Group, Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, VACRS, No. 210, Sec 2, Shih-Pai, 11217, Taipei, Taiwan, Republic of China.
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Abstract
We report the case of a 44-year-old man with superior sagittal and transverse sinus thrombi, who initially presented with venous subarachnoid hemorrhage over the right parietal sulci. After 7 days of intravenous anticoagulation therapy, his condition stabilized. Cerebral venous thrombosis can be difficult to diagnose and is further complicated when patients initially present with acute subarachnoid hemorrhage. A high index of clinical suspicion is needed to diagnose venous subarachnoid hemorrhage so that appropriate treatment can be initiated as promptly as possible.
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Affiliation(s)
- Ji-Ho Lin
- Department of Neurology, Tao-Yuan General Hospital, Taiwan, ROC.
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Chen SJ, Chang KP, Wong TT, Kwan SY, Hsu ML, Wang CC. Lamotrigine adjunctive therapy in children with refractory epilepsy: a medical center study. Acta Paediatr Taiwan 2006; 47:123-6. [PMID: 17078464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The aim of this study was to investigate the effects of adjunctive lamotrigine (LTG) in refractory epilepsy in Taiwan, especially including patients who had undergone ineffective epileptic surgeries. Totally, 27 recruited children and adolescents with refractory epilepsy were treated with LTG add-on therapy, but 23 were enrolled statistically during 2 years period trial. Ten of the 23 patients (43.5%), including 5 undergoing epileptic surgeries, before had a > 50% reduction in seizure frequency. Surprisingly, LTG was found to have excellent response in six patients with Lennox-Gastaut Syndrome (LGS), 5 of whom had received anterior 2/3 callosotomy prior to the trial. Non-seizure related positive effects were presented in 3 patients, including greater alertness and attentiveness in 2 patients and improvement in mood in one patient. This open trial found that LTG was an effective add-on anti-epileptic drug (AED) in Taiwanese children and adolescents with refractory epilepsy and in cases with LGS even after ineffective callosotomy.
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Affiliation(s)
- Shyi-Jou Chen
- Department of Pediatrics, Tri-Service General Hospital, No. 325, Section 2, Cheng-Kung Road, Nei-Hu 114, Taipei, Taiwan.
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Kwan SY, Lin JH, Wong TT, Chang KP, Yiu CH. Prognostic value of electrocorticography findings during callosotomy in children with Lennox–Gastaut syndrome. Seizure 2005; 14:470-5. [PMID: 16137897 DOI: 10.1016/j.seizure.2005.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2005] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To analyze findings and acute changes in electrocorticograms (ECoGs) obtained during corpus callosotomy in order to identify any relationships with the postoperative outcome of seizure activity. METHODS We retrospectively analyzed ECoGs obtained during anterior callosotomy (4-6 cm) in 48 patients with Lennox-Gastaut syndrome (32 boys and 16 girls, age 1-20 years, mean age 7.6 years) who underwent surgery between July 1993 and November 1996 to correlate recording findings with postoperative seizure activity. At the time of analysis, all patients had been followed postoperatively for more than 4 years. RESULTS Of 48 patients, 31 (64.6%) had significant improvement in seizure control after surgery. In pre-excisional ECoGs, 38 (79.2%) of 48 patients had bisynchronous epileptiform discharges. Patients (23 of 33 patients, 69.7%) with significant blockage of bisynchronous discharges recorded during callosotomy achieved the best postoperative seizure outcomes, but the difference did not reach statistical significance (P>0.05). CONCLUSIONS Based on our experience, changes in ECoG during callosotomy do not predict postoperative seizure outcome. Insignificant blockage of bisynchronous epileptiform discharges in ECoGs during callosotomy does not predict a worse prognosis than that associated with significant intraoperative blockage.
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Affiliation(s)
- Shang-Yeong Kwan
- Pediatric Epilepsy Surgery Group, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Lin JH, Kwan SY, Wu D, Su MS, Yiu CH. [Another seizure classification--Semiological Seizure Classification]. Acta Neurol Taiwan 2004; 13:136-48. [PMID: 15508941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The International League Against Epilepsy (ILAE) introduced in 1981 a seizure classification based on clinical semiology, interictal EEG findings, and ictal EEG patterns. Such classification depends heavily on detailed electroclinical correlation. After 20 years' progress in epileptology, many clinicians have found it difficult to make a "definite" seizure diagnosis clinically without a series of electrophysiological examinations, particularly in the infants, and further advancement in epileptology has findings have made the previous classification inefficient. Lüders and colleagues have proposed a classification, Semiological Seizure Classification (SSC), based exclusively on ictal semiology, which was published in the official journal of ILAE-EPILEPSIA in 1998. The EEG, neuroimaging and other laboratory results should be analyzed separately and then integrated to define the epileptic syndromes. The seizure diagnosis is thus made through a "what-you-see-is-what-you-get" way. It has also provoked an extensive discussion about the necessity of this new classification. In this review, we present the original guideline, which has been used at The Cleveland Clinic Foundation for years, to introduce another method of epileptic seizure classification.
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Affiliation(s)
- Ji-Ho Lin
- Department of Neurology, Min-Sheng General Hospital, Taoyuan, Taiwan.
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Affiliation(s)
- Chiao-Lin Chuang
- Division of Nephrology, Department of Medicine, Neurological Institute, Taipei Veterans General Hospital, No. 201 Sec. 2 Shih-Pai Road, Taipei 112, Taiwan.
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Lin YY, Chang KP, Hsieh JC, Yeh TC, Yu HY, Kwan SY, Yen DJ, Yiu CH, Hari R. Magnetoencephalographic analysis of bilaterally synchronous discharges in benign rolandic epilepsy of childhood. Seizure 2003; 12:448-55. [PMID: 12967572 DOI: 10.1016/s1059-1311(03)00002-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to examine the spatial and temporal relationship between bilateral foci of bilaterally synchronous discharges in benign rolandic epilepsy of childhood (BREC) using a whole-scalp neuromagnetometer. We simultaneously recorded interictal magnetoencephalographic (MEG) and electroencephalographic (EEG) signals in six children with BREC. Interictal spikes were classified into three groups: bilaterally synchronous discharges (BSDs), unilateral discharges on right side (UD-R), and unilateral discharges on left side (UD-L). We used equivalent current dipole (ECD) modelling to analyse the cortical sources of interictal spikes. Both BSDs and UDs were found in Patients 1-4, whereas only UDs were identified in Patients 5 and 6. The ECDs of interictal spikes were located in rolandic regions, 10-20mm anterior and lateral to hand somatosensory cortices. Multi-dipole analysis of BSDs showed two ECDs in homotopic motor areas of the hemispheres. During BSDs, the right-sided activation preceded the left-sided activation by 15-21 milliseconds in Patients 1 and 2. In Patients 3 and 4, the activation occurred 17-20 milliseconds earlier in the left than the right hemisphere. Within the same hemisphere, the sources of BSDs and UDs were located in similar areas. In conclusion, our results imply the cortical epileptogenicity in bilateral perirolandic areas in BREC. The sequential activation during BSDs in both hemispheres suggest the existence of synaptic connections, possibly via the corpus callosum, between bilateral irritative foci.
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Affiliation(s)
- Yung-Yang Lin
- Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, No 201, Sector 2, Shih-Pai Road, Taipei 11217, Taiwan, ROC.
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Lin YY, Shih YH, Hsieh JC, Yu HY, Yiu CH, Wong TT, Yeh TC, Kwan SY, Ho LT, Yen DJ, Wu ZA, Chang MS. Magnetoencephalographic yield of interictal spikes in temporal lobe epilepsy. Comparison with scalp EEG recordings. Neuroimage 2003; 19:1115-26. [PMID: 12880837 DOI: 10.1016/s1053-8119(03)00181-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
To compare magnetoencephalography (MEG) with scalp electroencephalography (EEG) in the detection of interictal spikes in temporal lobe epilepsy (TLE), we simultaneously recorded MEG and scalp EEG with a whole-scalp neuromagnetometer in 46 TLE patients. We visually searched interictal spikes on MEG and EEG channels and classified them into three types according to their presentation on MEG alone (M-spikes), EEG alone (E-spikes), or concomitantly on both modalities (M/E-spikes). The M-spikes and M/E-spikes were localized with MEG equivalent current dipole modeling. We analyzed the relative contribution of MEG and EEG in the overall yield of spike detection and also compared M-spikes with M/E-spikes in terms of dipole locations and strengths. During the 30- to 40-min MEG recordings, interictal spikes were obtained in 36 (78.3%) of the 46 patients. Among the 36 patients, most spikes were M/E-spikes (68.3%), some were M-spikes (22.1%), and some were E-spikes (9.7%). In comparison with EEG, MEG gave better spike yield in patients with lateral TLE. Sources of M/E- and M-spikes were situated in the same anatomical regions, whereas the average dipole strength was larger for M/E- than M-spikes. In conclusion, some interictal spikes appeared selectively on either MEG or EEG channels in TLE patients although more spikes were simultaneously identified on both modalities. Thus, simultaneous MEG and EEG recordings help to enhance spike detection. Identification of M-spikes would offer important localization of irritative foci, especially in patients with lateral TLE.
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Affiliation(s)
- Y Y Lin
- Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei 112, Taiwan.
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Yen DJ, Chen C, Shih YH, Guo YC, Liu LT, Yu HY, Kwan SY, Yiu CH. Antiepileptic Drug Withdrawal in Patients with Temporal Lobe Epilepsy Undergoing Presurgical Video-EEG Monitoring. Epilepsia 2003. [DOI: 10.1046/j.1528-1157.2001.4220251.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
We conducted a randomised controlled study to evaluate whether watching video compact discs intra-operatively using a liquid crystal display (LCD) unit decreased anxiety. Forty-four patients undergoing elective surgery under regional anaesthesia were assigned to either the LCD or control group. Anxiety was measured using the Chinese version of the State-Trait Anxiety Inventory (STAI) and visual analogue score (VAS). The mean (SD) anxiety trait scores were 46.15 (6.28) and 46.40 (7.32) in the control and LCD groups, respectively. The state anxiety of the LCD group [35.50 (7.96)] measured immediately postoperatively was significantly lower than the control group [41.50 (9.02); p = 0.03]. The median (range) reduction in VAS anxiety score was not significantly greater in the LCD group [20 (20 to 80) mm] compared with the control group [12.5 (70 to 60) mm]. Watching video intra-operatively reduces patient anxiety as measured by the STAI.
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Affiliation(s)
- A K Y Man
- Department of Anaesthesiology, Intensive Care and Operating Service, Alice Ho Miu Ling Nethersole Hospital, Tai Po, New Territories, Hong Kong
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Yang TF, Wong TT, Chang KP, Kwan SY, Kuo WY, Lee YC, Kuo TB. Power spectrum analysis of heart rate variability in children with epilepsy. Childs Nerv Syst 2001; 17:602-6. [PMID: 11685522 DOI: 10.1007/s003810100505] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2000] [Indexed: 10/27/2022]
Abstract
OBJECT Children with epilepsy have been found to be at increased risk of death during childhood. Sudden unexpected death (SUDEP) has accounted for at least 12% of deaths of children with epilepsy. The exact mechanisms of SUDEP are unknown; however, theories suggested have, to date, focused on autonomic instability. The purpose of this study was to investigate autonomic function in children with chronic epilepsy by means of power spectrum analysis of heart rate variability. METHODS Thirty patients with epilepsy and 30 control subjects, all between the ages of 4 and 10 years, were enrolled in this study. Power spectrum analysis of heart rate variability (HRV) was performed under standardized conditions after the patients had rested for 15 min. Each patient was tested in a supine position first and then again in a head-up tilted position, with 15 min between the two tests. RESULTS There was no significant difference between the low-frequency component (LF) and the high-frequency component (HF) of heart rate variability, or the LF/HF ratio, between the study and control groups, whether the test subjects were in the supine or the head-up tilt position. In the control group, however, the subjects showed a significantly greater LF component and a smaller HF component of heart rate variability, and a greater LF/HF ratio in the head-up position than in the supine position. This implies a normal sympathovagal balance. This phenomenon was not observed in the study group. This implies that the modulating effects on autonomic function deriving from the hemisphere were probably disturbed, owing to the brain lesions that each of the study group patients had already sustained. CONCLUSIONS A disturbed balance of activity between the sympathetic and parasympathetic nervous system might result from the loss of hemispheric influence in patients with epilepsy. Nevertheless, further investigation is clearly necessary to ascertain the possible association of this disturbed balance with SUDEP. Further investigation is also needed to establish the exact location of the region in the brain that gives rise to this modulating influence.
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Affiliation(s)
- T F Yang
- Department of Physical Therapy, National Yang-Ming University, Taipei, Taiwan.
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Mu PF, Wong TT, Chang KP, Kwan SY. Predictors of maternal depression for families having a child with epilepsy. J Nurs Res 2001; 9:116-26. [PMID: 11789131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
The purpose of this study was to use a descriptive correlational design to examine the relationship among maternal uncertainty, boundary ambiguity and depression in families having a child with epilepsy. Three hundred and twenty-four mothers from the child epilepsy day-clinics of three teaching hospitals in Taiwan participated in this study. Data collection was performed by well-trained research assistants who helped mothers fill out the well-developed Chinese version of the Parental Perception of Uncertainty Scale, the Boundary Ambiguity scale, and the Beck Depression Inventory. Uncertainty was positively associated with boundary ambiguity and depression. Boundary ambiguity was positively associated with depression. Stepwise regression analysis demonstrated that boundary ambiguity, uncertainty and mother's age are predictors of a mother's depression which account for 21.49% of the total variance of depression. The results provide a scientific knowledge base for nursing interventions that aim to provide clear information about the child's illness and help to establish appropriate patterns of parent-child interaction in terms of maintaining family boundary integrity and mothers' functional adaptability.
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Affiliation(s)
- P F Mu
- Institute of Clinical Nursing, National Yang Ming University, Taiwan, ROC.
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Yu HY, Yiu CH, Yen DJ, Chen C, Guo YC, Kwan SY, Lin YY, Shih YH. Lateralizing value of early head turning and ictal dystonia in temporal lobe seizures: a video-EEG study. Seizure 2001; 10:428-32. [PMID: 11700997 DOI: 10.1053/seiz.2001.0538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To investigate early head turning, we retrospectively studied videotapes of 262 seizures from 82 patients who were seizure free after temporal lobectomy. Early head movements were arbitrarily classified into non-tonic turning, tonic turning, and absence of turning. Among the 222 seizures which showed early head turning, 168 (75.7%) had non-tonic turning and 54 (24.3%) had tonic turning. The direction of the first head turning was ipsilateral to the epileptogenic foci in 132 (78.6%) seizures with non-tonic turning and in 35 (64.8%) seizures showing tonic head turning. The proportion of seizures with turning towards the ipsilateral side in the presence of tonic and non-tonic head turning were significantly different (P= 0.04). Seventy-four seizures (28.2%) evolved to secondary generalization, more frequently found in seizures with early head turning (P= 0.0015) and especially those showing tonic turning (P< 0.0001). The direction of head turning immediately preceding secondary generalization was contralateral to the lesion side in 53 seizures (82.8%). Dystonic upper limb posturing occurred in 86 seizures (32.8%), exclusively contralateral to the seizure focus, whereas 65 (75.6%) were associated with initial head turning ipsilateral to the focus. In summary, temporal lobe seizures with tonic head turning tends to secondarily generalize and the direction of head turning before secondarily generalized was contralateral to the seizure foci. Earlier in the seizures the direction of non-tonic head turning tends to be towards the epileptogenic hemisphere. In addition, dystonic posturing of the extremities is a significant lateralizing sign to the contralateral hemisphere in temporal lobe seizures.
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Affiliation(s)
- H Y Yu
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taiwan
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Affiliation(s)
- I H Lee
- Section of Epilepsy, The Neurological Institute, Taipei-Veterans General Hospital, and Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
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Yen DJ, Chen C, Shih YH, Guo YC, Liu LT, Yu HY, Kwan SY, Yiu CH. Antiepileptic drug withdrawal in patients with temporal lobe epilepsy undergoing presurgical video-EEG monitoring. Epilepsia 2001; 42:251-5. [PMID: 11240598 DOI: 10.1046/j.1528-1157.2001.15100.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate antiepileptic drug (AED) withdrawal during video-EEG monitoring in adult patients with temporal lobe epilepsy (TLE). METHODS Between 1995 and 1997, 102 consecutive patients with refractory TLE were admitted to the epilepsy monitoring unit for presurgical evaluation. Patients were monitored with ongoing AEDs being rapidly decreased and discontinued in 4-6 days. The monitoring was continued until sufficient numbers of seizures were recorded. Serum AED levels were checked at admission and after the first complex partial seizure (CPS). RESULTS In all, 89 patients had 429 CPSs (mean, 4.8 per patient), including 156 (36.4%) secondarily generalized. A mean of 153.8 h (16-451 h) was required for completing the monitoring in each patient. Forty-three (48.3%) patients experienced seizure clusters, and eight (9.0%) had generalized seizures that had never occurred or had been absent for years. However, none evolved to status epilepticus. Carbamazepine was the most commonly used AED in 71.9% of patients, followed by valproate and phenytoin. When the first CPS occurred, mean 77.2 h since the beginning of the monitoring, serum levels of these three AEDs were mostly subtherapeutic rather than minimal. CONCLUSIONS Acute AED withdrawal effectively provoked seizures in TLE patients undergoing presurgical video-EEG monitoring. However, nearly 50% of patients had seizure clusters or secondarily generalized seizures. Serum AED levels were mostly subtherapeutic when the first CPS occurred.
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Affiliation(s)
- D J Yen
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan 11217 (ROC).
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Kwan SY, Wong TT, Chang KP, Yang TF, Lee YC, Guo WY, Su MS. Seizure outcomes after anterior callosotomy in patients with posterior-dominant and with anterior-dominant epileptiform discharges. Childs Nerv Syst 2001; 17:71-5. [PMID: 11219628 DOI: 10.1007/pl00013725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTS We wished to find whether there was any difference in the postoperative seizure outcome between patients with bisynchronous anterior-dominant and those with posterior-dominant EDs after anterior callosotomy. METHODS Seizure outcomes after anterior callosotomy in 7 patients with bisynchronous posterior-dominant epileptiform discharges and in 54 patients with anterior-dominant seizures were compared. All 61 cases had been followed up for more than 2 years after operation. One patient (14.3%) had become seizure free. Two patients (28.6%) had more than 50% reduction in seizure frequency, but 4 patients (57.2%) showed no improvement at all. The percentage of cases with significant improvement (more than 50% reduction of seizure frequency) was 43% (3 in 7), which is lower than in the patients with bisynchronous anterior-dominant EDs (64.8%). CONCLUSIONS Our preliminary results suggest that anterior partial callosotomy could still be helpful in cases with bisynchronous posterior-dominant epileptiform discharges but the prognosis may be less optimistic than for those with anteriorly located discharges.
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Affiliation(s)
- S Y Kwan
- Section of Epilepsy, Neurological Institute, Taipei Veterans General Hospital, Taiwan, ROC.
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Abstract
An API-LC/MS/MS method was developed for the identification of the medicinal herb Podophyllum emodi based on the profile of its aryltetrahydronapthalene and related lignan marker compounds. This was done by matching the structural information from the tandem mass spectrometric data with those lignan marker compounds already reported for the herb. The method could be employed in the absence of reference standards for the markers and was particularly useful in view of the scarcity of supply of these chemical standards. It has been used successfully to differentiate Podophyllum emodi from two commonly used medicinal herbs of a different genus but having similar appearance, Radix clematidis and Radix gentiana, as well as a closely related herb, Podophyllum peltatum.
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Affiliation(s)
- S K Wong
- Government Laboratory, 88 Chung Hau Street, Homantin, Hong Kong SAR, People's Republic of China
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