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Di Gennaro G, Lattanzi S, Mecarelli O, Saverio Mennini F, Vigevano F. Current challenges in focal epilepsy treatment: An Italian Delphi consensus. Epilepsy Behav 2024; 155:109796. [PMID: 38643659 DOI: 10.1016/j.yebeh.2024.109796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Epilepsy, a globally prevalent neurological condition, presents distinct challenges in management, particularly for focal-onset types. This study aimed at addressing the current challenges and perspectives in focal epilepsy management, with focus on the Italian reality. METHODS Using the Delphi methodology, this research collected and analyzed the level of consensus of a panel of Italian epilepsy experts on key aspects of focal epilepsy care. Areas of focus included patient flow, treatment pathways, controlled versus uncontrolled epilepsy, follow-up protocols, and the relevance of patient-reported outcomes (PROs). This method allowed for a comprehensive assessment of consensus and divergences in clinical opinions and practices. RESULTS The study achieved consensus on 23 out of 26 statements, with three items failing to reach a consensus. There was strong agreement on the importance of timely intervention, individualized treatment plans, regular follow-ups at Epilepsy Centers, and the role of PROs in clinical practice. In cases of uncontrolled focal epilepsy, there was a clear inclination to pursue alternative treatment options following the failure of two previous therapies. Divergent views were evident on the inclusion of epilepsy surgery in treatment for uncontrolled epilepsy and the routine necessity of EEG evaluations in follow-ups. Other key findings included concerns about the lack of pediatric-specific research limiting current therapeutic options in this patient population, insufficient attention to the transition from pediatric to adult care, and need for improved communication. The results highlighted the complexities in managing epilepsy, with broad consensus on patient care aspects, yet notable divergences in specific treatment and management approaches. CONCLUSION The study offered valuable insights into the current state and complexities of managing focal-onset epilepsy. It highlighted many deficiencies in the therapeutic pathway of focal-onset epilepsy in the Italian reality, while it also underscored the importance of patient-centric care, the necessity of early and appropriate intervention, and individualized treatment approaches. The findings also called for continued research, policy development, and healthcare system improvements to enhance epilepsy management, highlighting the ongoing need for tailored healthcare solutions in this evolving field.
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Affiliation(s)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome (Retired) and Past President of LICE, Italian League Against Epilepsy, Rome, Italy
| | - Francesco Saverio Mennini
- Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome "Tor Vergata", Rome, Italy; Institute for Leadership and Management in Health, Kingston University London, London, UK.
| | - Federico Vigevano
- Head of Paediatric Neurorehabilitation Department, IRCCS San Raffaele, Rome, Italy.
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Granovetter MC, Maallo AMS, Patterson C, Glen D, Behrmann M. Morphometrics of the preserved post-surgical hemisphere in pediatric drug-resistant epilepsy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.24.559189. [PMID: 37808659 PMCID: PMC10557613 DOI: 10.1101/2023.09.24.559189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Importance Structural integrity of cortex following cortical resection for epilepsy management has been previously characterized, but only in adult patients. Objective This study sought to determine whether morphometrics of the preserved hemisphere in pediatric cortical resection patients differ from non-neurological controls. Design This was a case-control study, from 2013-2022. Setting This was a single-site study. Participants 32 patients with childhood epilepsy surgery and 51 age- and gender-matched controls participated. Main Measures We quantified morphometrics of the preserved hemisphere at the level of gross anatomy (lateral ventricle size, volume of gray and white matter). Additionally, cortical thickness, volume, and surface area were measured for 34 cortical regions segmented with the Desikan-Killiany atlas, and, last, volumes of nine subcortical regions were also quantified. Results 13 patients with left hemisphere (LH) surgery and a preserved right hemisphere (RH) (median age/median absolute deviation of age: 15.7/1.7 yr; 6 females, 7 males) and 19 patients with RH surgery and a preserved LH (15.4/3.7 yr; 11 females, 8 males) were compared to 51 controls (14.8/4.9 yr; 24 females, 27 males). Patient groups had larger ventricles and reduced total white matter volume relative to controls, and only patients with a preserved RH, but not patients with a preserved LH, had reduced total gray matter volume relative to controls. Furthermore, patients with a preserved RH had lower cortical thickness and volume and greater surface area of several cortical regions, relative to controls. Patients with a preserved LH had no differences in thickness, volume, or area, of any of the 34 cortical regions, relative to controls. Moreover, both LH and RH patients showed reduced volumes in select subcortical structures, relative to controls. Conclusions and Relevance That left-sided, but not right-sided, resection is associated with more pronounced reduction in cortical thickness and volume and increased cortical surface area relative to typically developing, age-matched controls suggests that the preserved RH undergoes structural plasticity to an extent not observed in cases of right-sided pediatric resection. Future work probing the association of the current findings with neuropsychological outcomes will be necessary to understand the implications of these structural findings for clinical practice.
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Affiliation(s)
- Michael C. Granovetter
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA 15213
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA 15213
| | - Anne Margarette S. Maallo
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA 15213
| | - Christina Patterson
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA 15213
| | - Daniel Glen
- Scientific and Statistical Computing Core, National Institute of Mental Health, Bethesda, MD, USA 20892
| | - Marlene Behrmann
- Department of Psychology and Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA 15213
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA 15213
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Orhan Varoglu A, Avarisli A, Keskin H, Garipbas N. Comparing neuropsychological functioning in Turkish patients with right and left temporal lobe epilepsy. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 38015648 DOI: 10.1080/23279095.2023.2286504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
We compared neuropsychiatric evaluations in temporal lobe epilepsy according to the lateralized hemisphere. Forty-one (68.3%) left-sided temporal lobe epilepsy (LTLE) were compared to 19 right-sided temporal lobe epilepsy (RTLE) (31.7%) (p < 0.001). RTLE mean age was 37 (22-46) years, and LTLE mean age 38 was (30-42). RTLE disease duration was 10 (6-20) years, and LTLE was 22 (10-33) (p < 0.013). Gender (man/woman) for RTLE was 7/12, and for LTLE was 18/23. LTLE scored poorer on the Wechsler Memory Scale (WMS)-III's Mental Control Months-error, WMS-V's "Forward Number Range" and "Backward Number Range" than RTLE (p < 0.017, p < 0.023, p < 0.004). There were differences between hemispheres for "Number of Items Remembered with a Hint" and "Total number of Recalled Items" (WMS-IV) (p < 0.038, p < 0.045). LTLE had lower scores in the Verbal Fluency -K-A-S letters words and WAIS (Wechsler Adult Intelligence Scale) similarity than RTLE (p < 0.019, p < 0.024, p < 0.033, p < 0.026). Oktem and Boston-number of Self-Named Items Tests were poorer in LTLE than RTLE (p < 0.05, p < 0.043). Mental Control Months-error (WMS-III), "Total Number of Recalled Items", "Number of Items Remembered with Hint" (WMS-IV), forward and backward number range (WMS-V), Oktem, Verbal Fluency -K,-A,-S letters words, WAIS similarity, and Boston-number of Self-Named Items tests, can help identify lateralization, particularly in LTLE.
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Affiliation(s)
- Asuman Orhan Varoglu
- Department of Neurology, Istanbul Medeniyet University, Goztepe Training, and Research Hospital, Istanbul,Turkey
| | - Aysenur Avarisli
- Department of Neurology, Istanbul Medeniyet University, Goztepe Training, and Research Hospital, Istanbul,Turkey
| | - Havva Keskin
- Department of Internal Medicine, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul,Turkey
| | - Nilay Garipbas
- Department of Psychiatry, Istanbul Medeniyet University, Goztepe Training, and Research Hospital, Istanbul,Turkey
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Lu D, Wang T, Yang Y, Fan X, Chen S, Wei P, Shan Y, Zhao G. Advances in hypothalamic hamartoma research over the past 30 years (1992-2021): a bibliometric analysis. Front Neurol 2023; 14:1176459. [PMID: 37416311 PMCID: PMC10322195 DOI: 10.3389/fneur.2023.1176459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023] Open
Abstract
Background Hypothalamic hamartoma (HH) is a rare intracranial disease whose manifestations include gelastic seizures and precocious puberty. The diagnosis and treatment of HH have changed substantially over the past three decades as medical care has improved. Bibliometrics can reveal the evolution and development of a scientific field. Methods Documents on HH were retrieved from the Web of Science Core Collection (WoSCC) database on September 8, 2022. The search terms were as follows: "hypothalamic hamartoma" or "hamartoma of the hypothalamus" or "hypothalamic hamartomas." The types of documents were restricted to articles, case reports, and reviews. VOSviewer, CiteSpace, and the R package "bibliometrix" were used for a bibliometric analysis. Results A total of 667 independent documents on HH were obtained from the WoSCC database. The most common types of documents were articles (n = 498, 75%) and reviews (n = 103, 15%). The number of annual publications fluctuated but showed an upward trend overall, and the annual growth rate was 6.85%. The cumulative publication data indicated that the most influential journals in the HH field include Epilepsia, Epileptic Disorders, Child's Nervous System, Neurosurgery, and the Journal of Neurosurgery. Kerrigan JF, Ng YT, Rekate HL, Regis J, and Kameyama S were among the most prominent authors in the field of HH, with numerous publications and citations. American research institutions, especially the Barrow Neurological Institute, occupied a pivotal position in HH research. Other countries and institutions were catching up and producing considerable research results. Research on HH has steadily switched its emphasis from Pallister-Hall syndrome (PHS) and precocious puberty to epilepsy and new diagnostic and therapeutic techniques, including Gamma Knife, laser ablation, and interstitial thermal therapy. Conclusion HH remains a special neurological disease with significant research prospects. The development of novel technologies, including MRI-guided laser-induced thermal therapy (MRg-LiTT) and stereotactic radiofrequency thermocoagulation (RF-TC), has enabled the efficient treatment of gelastic seizures in HH while minimizing the risks associated with craniotomies. Through bibliometric analysis, this study points out the direction for future HH research.
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Affiliation(s)
- Di Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Tianren Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Yanfeng Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Sichang Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
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Potes Y, Cachán-Vega C, Antuña E, García-González C, Menéndez-Coto N, Boga JA, Gutiérrez-Rodríguez J, Bermúdez M, Sierra V, Vega-Naredo I, Coto-Montes A, Caballero B. Benefits of the Neurogenic Potential of Melatonin for Treating Neurological and Neuropsychiatric Disorders. Int J Mol Sci 2023; 24:ijms24054803. [PMID: 36902233 PMCID: PMC10002978 DOI: 10.3390/ijms24054803] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
There are several neurological diseases under which processes related to adult brain neurogenesis, such cell proliferation, neural differentiation and neuronal maturation, are affected. Melatonin can exert a relevant benefit for treating neurological disorders, given its well-known antioxidant and anti-inflammatory properties as well as its pro-survival effects. In addition, melatonin is able to modulate cell proliferation and neural differentiation processes in neural stem/progenitor cells while improving neuronal maturation of neural precursor cells and newly created postmitotic neurons. Thus, melatonin shows relevant pro-neurogenic properties that may have benefits for neurological conditions associated with impairments in adult brain neurogenesis. For instance, the anti-aging properties of melatonin seem to be linked to its neurogenic properties. Modulation of neurogenesis by melatonin is beneficial under conditions of stress, anxiety and depression as well as for the ischemic brain or after a brain stroke. Pro-neurogenic actions of melatonin may also be beneficial for treating dementias, after a traumatic brain injury, and under conditions of epilepsy, schizophrenia and amyotrophic lateral sclerosis. Melatonin may represent a pro-neurogenic treatment effective for retarding the progression of neuropathology associated with Down syndrome. Finally, more studies are necessary to elucidate the benefits of melatonin treatments under brain disorders related to impairments in glucose and insulin homeostasis.
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Affiliation(s)
- Yaiza Potes
- Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Asturias, Spain
- Correspondence: (Y.P.); (B.C.); Tel.: +34-985102767 (Y.P.); +34-985102784 (B.C.)
| | - Cristina Cachán-Vega
- Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - Eduardo Antuña
- Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - Claudia García-González
- Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - Nerea Menéndez-Coto
- Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - Jose Antonio Boga
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - José Gutiérrez-Rodríguez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - Manuel Bermúdez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - Verónica Sierra
- Servicio Regional de Investigación y Desarrollo Agroalimentario (SERIDA), 33300 Villaviciosa, Asturias, Spain
| | - Ignacio Vega-Naredo
- Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Asturias, Spain
| | - Ana Coto-Montes
- Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Asturias, Spain
| | - Beatriz Caballero
- Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
- Instituto de Neurociencias del Principado de Asturias (INEUROPA), 33006 Oviedo, Asturias, Spain
- Correspondence: (Y.P.); (B.C.); Tel.: +34-985102767 (Y.P.); +34-985102784 (B.C.)
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Guo J, Guo M, Liu R, Kong Y, Hu X, Yao L, Lv S, Lv J, Wang X, Kong QX. Seizure Outcome After Surgery for Refractory Epilepsy Diagnosed by 18F-fluorodeoxyglucose positron emission tomography ( 18F-FDG PET/MRI): A Systematic Review and Meta-Analysis. World Neurosurg 2023; 173:34-43. [PMID: 36746239 DOI: 10.1016/j.wneu.2023.01.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE When magnetic resonance imaging (MRI) fails to detect an underlying epileptogenic lesion, the odds of a good outcome after epilepsy surgery are significantly lower (20%-65% compared with 60%-90% if a lesion is detected). We investigated the possible effects of introducing hybrid 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/MRI into the decision algorithm for patients with lesioned and nonlesioned drug-resistant epilepsy. METHODS Three databases were searched from January 1990 to October 2022. We registered the protocol with International Platform of Registered Systematic Review and Meta-analysis Protocols. Studies in which 18F-FDG PET/MRI was conducted with ≥12 months of postsurgical follow-up in patients with refractory epilepsy. Random-effects meta-analysis was used to calculate the proportion of patients with good outcomes. Metaregression was used to investigate sources of heterogeneity. RESULTS We identified 8105 studies, of which 23 (1292 patients in total) were included. The overall good postoperative outcome rate was 71% (95% confidence interval 63.6-74.9). Good outcome was associated with the location of the refractory epileptic lesion (temporal lobe or extratemporal; risk ratio 1.27 [95% confidence interval 1.01-1.52], P = 0.009); Length of postoperative follow-up ≥40 months included in the same study accounted for 0.6% of the observed heterogeneity. CONCLUSIONS Seventy-one percent of patients with refractory epilepsy and 18F-FDG PET/MRI epileptogenic lesion features had a good outcome of epilepsy after surgery. Our findings can be incorporated into routine preoperative consultations and emphasize the importance of the complete resection of the temporal lobe epileptogenic zone for 18F-FDG PET/MRI detection when safe and feasible.
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Affiliation(s)
- Jia Guo
- Clinical Medical College, Jining Medical University, Jining, China
| | - Mujie Guo
- Department of Imaging, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ruihan Liu
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China; Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yu Kong
- Department of Imaging, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xibin Hu
- Department of Imaging, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lei Yao
- Clinical Medical College, Jining Medical University, Jining, China
| | - Shaomin Lv
- Clinical Medical College, Jining Medical University, Jining, China
| | - Jiahua Lv
- Clinical Medical College, Jining Medical University, Jining, China
| | - Xinyu Wang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Qing-Xia Kong
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China.
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Wong ZW, Engel T. More than a drug target: Purinergic signalling as a source for diagnostic tools in epilepsy. Neuropharmacology 2023; 222:109303. [PMID: 36309046 DOI: 10.1016/j.neuropharm.2022.109303] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/15/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Epilepsy is one of the most common and disabling chronic neurological diseases affecting people of all ages. Major challenges of epilepsy management include the persistently high percentage of drug-refractoriness among patients, the absence of disease-modifying treatments, and its diagnosis and prognosis. To date, long-term video-electroencephalogram (EEG) recordings remain the gold standard for an epilepsy diagnosis. However, this is very costly, has low throughput, and in some instances has very limited availability. Therefore, much effort is put into the search for non-invasive diagnostic tests. Purinergic signalling, via extracellularly released adenosine triphosphate (ATP), is gaining increasing traction as a therapeutic strategy for epilepsy treatment which is supported by evidence from both experimental models and patients. This includes in particular the ionotropic P2X7 receptor. Besides that, other components from the ATPergic signalling cascade such as the metabotropic P2Y receptors (e.g., P2Y1 receptor) and ATP-release channels (e.g., pannexin-1), have also been shown to contribute to seizures and epilepsy. In addition to the therapeutic potential of purinergic signalling, emerging evidence has also shown its potential as a diagnostic tool. Following seizures and epilepsy, the concentration of purines in the blood and the expression of different compounds of the purinergic signalling cascade are significantly altered. Herein, this review will provide a detailed discussion of recent findings on the diagnostic potential of purinergic signalling for epilepsy management and the prospect of translating it for clinical application. This article is part of the Special Issue on 'Purinergic Signaling: 50 years'.
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Affiliation(s)
- Zheng Wei Wong
- School of Pharmacy, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, 43500, Semenyih, Selangor Darul Ehsan, Malaysia
| | - Tobias Engel
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland; FutureNeuro, Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland.
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8
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Mecarelli O, Di Gennaro G, Vigevano F. Unmet needs and perspectives in management of drug resistant focal epilepsy: An Italian study. Epilepsy Behav 2022; 137:108950. [PMID: 36347069 DOI: 10.1016/j.yebeh.2022.108950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
This study aimed to evaluate the consensus level between a representative group of Italian neurologists and people with Drug-Resistant Epilepsy (DRE) regarding a series of statements about different aspects involved in the management of epilepsy to identify the unmet needs of the People with Epilepsy (PwE) and the future perspectives for the management of this disease. This observational study was conducted using a classic Delphi technique. A 19-statement questionnaire was administered anonymously through an online platform to a panel of expert clinicians and a panel of PwE, analyzing three main topics of interest: drug resistance, access to care, and PwE's experience. The consensus was achieved on 8 of the 19 statements administered to the panel of medical experts and on 4 of the 14 submitted to the panel of PwE, particularly on the definition of DRE and its consequences on treatment, Quality of Life (QoL), and autonomy of PwE. Most of the items, however, did not reach a consensus and highlighted the lack of a shared univocal view on some topics, such as accessibility to care throughout the country and the role of emerging tools such as telemedicine, narrative medicine, and digital devices. In many cases, the two panels expressed different views on the statements. The results outlined many fields of possible intervention, such as the need for educational initiatives targeted at physicians and PwE - for example, regarding telemedicine, digital devices, and narrative medicine - as well as the spread of better knowledge about epilepsy among the general population, in order to reduce epilepsy stigma. Institutions, moreover, could take a cue from this survey to develop facilities aimed at enhancing PwE's autonomy and promoting more equal access to care throughout the country.
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Affiliation(s)
- Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome and Past President of LICE, Italian League Against Epilepsy, Rome, Italy.
| | | | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy.
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Imdad K, Abualait T, Kanwal A, AlGhannam ZT, Bashir S, Farrukh A, Khattak SH, Albaradie R, Bashir S. The Metabolic Role of Ketogenic Diets in Treating Epilepsy. Nutrients 2022; 14:5074. [PMID: 36501104 PMCID: PMC9738161 DOI: 10.3390/nu14235074] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
Epilepsy is a long-term neurological condition that results in recurrent seizures. Approximately 30% of patients with epilepsy have drug-resistant epilepsy (DRE). The ketogenic diet (KD) is considered an effective alternative treatment for epileptic patients. The aim of this study was to identify the metabolic role of the KD in epilepsy. Ketone bodies induce chemical messengers and alterations in neuronal metabolic activities to regulate neuroprotective mechanisms towards oxidative damage to decrease seizure rate. Here, we discuss the role of KD on epilepsy and related metabolic disorders, focusing on its mechanism of action, favorable effects, and limitations. We describe the significant role of the KD in managing epilepsy disorders.
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Affiliation(s)
- Kaleem Imdad
- Department of Biosciences, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Turki Abualait
- College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ammara Kanwal
- Department of Biosciences, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Ziyad Tareq AlGhannam
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Shahab Bashir
- Department of Biosciences, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Anum Farrukh
- Department of General Medicine, Fauji Foundation Hospital, Rawalpindi 45000, Pakistan
| | - Sahir Hameed Khattak
- National Institute for Genomics and Advanced Biotechnology (N.I.G.A.B.), National Agriculture Research Centre (NARC), Islamabad 44000, Pakistan
| | - Raidah Albaradie
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam 32253, Saudi Arabia
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam 32253, Saudi Arabia
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Djekidel M. Making the Case for Brain 18F-FDG PET Subtraction in Medically Refractory Epilepsy. A Novel, Useful Tool. Practical Points? J Nucl Med Technol 2022; 50:jnmt.122.264218. [PMID: 36041872 DOI: 10.2967/jnmt.122.264218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
18F-FDG PET plays a major role in the pre-surgical evaluation of medically refractory epilepsy patients. The current standard of care is performing interictal evaluations of glucose metabolism. This is mostly related to the tracer kinetics of 18F-FDG owing to a long uptake phase which would translate into ictal injections having low sensitivities and low specificity and demonstrating not only ictal but post-ictal changes. It has been reported that this limitation can be overcome in some status epilepticus scenarios where prolonged seizures can then correlate better with 18F-FDG uptake kinetics. In these cases, focal visual qualitative hot spots are suggestive of the seizure onset zone (SOZ). However, we note that by using advanced subtraction techniques, the prolonged 18F-FDG uptake phase can be overcome in a variety of other cases as well. This opens the door to a slightly larger set of patients that may benefit from this higher resolution PET method. We present 4 cases where a novel subtraction 18F-FDG PET technique was used and elucidate its impact in these specific cases.
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11
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Casciato S, Morano A, Ricci L, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, Consales A, de Palma L, Villani F, Zamponi N, Tassi L, Di Gennaro G, Beghi E, Marras CE. Knowledge and attitudes of neurologists toward epilepsy surgery: an Italian survey. Neurol Sci 2022; 43:4453-4461. [PMID: 35312881 PMCID: PMC8935880 DOI: 10.1007/s10072-022-06025-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
The current study, conceived with the contribution of the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) and the Epilepsy Study Group of the Italian Neurological Society (SIN), aimed to assess potential physician-related barriers to refer subjects for epilepsy surgery. All the members of SIN and LICE were invited by email to complete a 28-item online questionnaire. The survey items included: (1) individual and medical practice characteristics, (2) knowledge of current indications to select candidates for epilepsy surgery, (3) factors potentially affecting the attitude toward epilepsy surgery. Overall, 210 physicians completed the survey. More than half (63.3%) of the participants showed proper knowledge of the ILAE drug-resistance. Definition and almost two-thirds of them (71.9%) considered themselves adequately informed about indications, risks, and benefits of epilepsy surgery. Surgery was regarded as a valid option to be used as early as possible by 84.8% of the interviewees, and 71% of them estimated its complication rate to be low. However, more than half (63%) of the respondents reportedly referred patients for surgery only after the failure of 3–5 antiseizure medications. Overestimation of risks/complications of surgery and inadequate healthcare resources were identified as the main factor contrasting the patient referral for surgery by 43% and 40.5% of the participants, respectively. In conclusion, this survey confirms the existence of knowledge gap within both physicians and the healthcare system, as well as an educational need regarding epilepsy surgery. Further researches are warranted to define learning outcomes and optimize educational tools.
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Affiliation(s)
- Sara Casciato
- IRCCS NEUROMED, Via Atinense, 18, IS, 86170, Pozzilli, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Psychiatry and Neurology Unit, G. Salesi Hospital, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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12
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Governance of the clinical pathway and management of the patient suffering from epilepsy and drug-resistant epilepsy. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2022; 9:4-9. [PMID: 36628125 PMCID: PMC9796603 DOI: 10.33393/grhta.2022.2418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/30/2022] [Indexed: 01/13/2023] Open
Abstract
Epilepsy is a diffuse chronic neurological disease affecting around 50 million people worldwide. The diagnostic criteria by the International League against Epilepsy must be fulfilled to diagnose the disease, which is characterized by brief and transient episodes of abnormal neuronal activity involving one or both hemispheres, depending on the epilepsy type. The diagnosis of epilepsy should be properly and timely made because patients suffering from the disease are affected not only by seizure recurrence but also by epilepsy-related psychiatric and/or cognitive comorbidities that may have a huge impact with severe professional and social implications. It is of vital importance to define a specific governance model that has to be virtuously applied into the different phases of the clinical pathway of the patients with epilepsy in order to guarantee them the best model of care possible.
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13
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Sinha N, Johnson GW, Davis KA, Englot DJ. Integrating Network Neuroscience Into Epilepsy Care: Progress, Barriers, and Next Steps. Epilepsy Curr 2022; 22:272-278. [PMID: 36285209 PMCID: PMC9549227 DOI: 10.1177/15357597221101271] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Drug resistant epilepsy is a disorder involving widespread brain network
alterations. Recently, many groups have reported neuroimaging and
electrophysiology network analysis techniques to aid medical
management, support presurgical planning, and understand postsurgical
seizure persistence. While these approaches may supplement standard
tests to improve care, they are not yet used clinically or influencing
medical or surgical decisions. When will this change? Which approaches
have shown the most promise? What are the barriers to translating them
into clinical use? How do we facilitate this transition? In this
review, we will discuss progress, barriers, and next steps regarding
the integration of brain network analysis into the medical and
presurgical pipeline.
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Affiliation(s)
- Nishant Sinha
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia PA, USA
- Department of Neurology, Penn Epilepsy Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Graham W. Johnson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn A. Davis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia PA, USA
- Department of Neurology, Penn Epilepsy Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dario J. Englot
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Caccavella VM, Giordano M, Colicchio G, Izzo A, D’Ercole M, Rapisarda A, Polli FM, Fuggetta F, Olivi A, Montano N. Palliative surgery for drug resistant epilepsy in adult patients. A systematic review of the literature and a pooled analysis of outcomes. World Neurosurg 2022; 163:132-140.e1. [DOI: 10.1016/j.wneu.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
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15
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Tassi L, Specchio N, Mecarelli O, Tinuper P, Vigevano F, Perucca E. The 50th anniversary of the Italian League Against Epilepsy (Lega Italiana Contro l’Epilessia). Epilepsy Behav Rep 2022; 19:100553. [PMID: 35664663 PMCID: PMC9157453 DOI: 10.1016/j.ebr.2022.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022] Open
Abstract
We describe the 50-year history of the Italian League Against Epilepsy (LICE). LICE promotes high-quality epilepsy care, education and research into epilepsy. LICE maintains close relations with ILAE and other professional societies.
This article was prepared to outline the article collection submitted on behalf of Lega Italiana Contro l’Epilepsia, or LICE, for the 50th anniversary of the founding of the ILAE Italian Chapter, and provides a brief summary of the history, with its landmark achievements and challenges. LICE is a multidisciplinary, inclusive, educational, informative and multifaceted organization. Initially in 1955 and then formally in 1972, LICE was born in Milano, with the mission to devote itself to people suffering with epilepsy and by promoting appropriate treatment and care, integration into society, to promote and pursue all kinds of activities designed to achieve those aims. The LICE is currently composed of more than 1000 members including neurologists, pediatric neurologists, neurosurgeons, neurophysiologists, and neuropsychologists who function throughout Italy dealing mainly or exclusively with the diagnosis and treatment of people with epilepsy.
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Okanishi T, Fujimoto A. Corpus Callosotomy for Controlling Epileptic Spasms: A Proposal for Surgical Selection. Brain Sci 2021; 11:brainsci11121601. [PMID: 34942903 PMCID: PMC8699195 DOI: 10.3390/brainsci11121601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022] Open
Abstract
In 1940, van Wagenen and Herren first proposed the corpus callosotomy (CC) as a surgical procedure for epilepsy. CC has been mainly used to treat drop attacks, which are classified as generalized tonic or atonic seizures. Epileptic spasms (ESs) are a type of epileptic seizure characterized as brief muscle contractions with ictal polyphasic slow waves on an electroencephalogram and a main feature of West syndrome. Resection surgeries, including frontal/posterior disconnections and hemispherotomy, have been established for the treatment of medically intractable ES in patients with unilaterally localized epileptogenic regions. However, CC has also been adopted for ES treatment, with studies involving CC to treat ES having increased since 2010. In those studies, patients without lesions observed on magnetic resonance imaging or equally bilateral lesions predominated, in contrast to studies on resection surgeries. Here, we present a review of relevant literature concerning CC and relevant adaptations. We discuss history and adaptations of CC, and patient selection for epilepsy surgeries due to medically intractable ES, and compared resection surgeries with CC. We propose a surgical selection flow involving resection surgery or CC as first-line treatment for patients with ES who have been assessed as suitable candidates for surgery.
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Affiliation(s)
- Tohru Okanishi
- Division of Child Neurology, Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan;
- Correspondence: ; Tel.: +81-859-38-67721; Fax: +81-859-38-6770
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan;
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Brigo F, Di Gennaro G, Morano A, Sironi VA, Lorusso L. Camillo Negro (1861-1927) and Antonio Carle (1854-1927): Pioneers of non-resective surgical approach to epilepsy treatment. Epilepsy Behav 2021; 125:108360. [PMID: 34731720 DOI: 10.1016/j.yebeh.2021.108360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/25/2021] [Indexed: 11/17/2022]
Abstract
Epilepsy surgery developed following the clinical and experimental demonstration of the existence of the primary motor cortex in animals and humans. The first epilepsy surgery procedures were mainly performed to treat focal motor (Jacksonian) epilepsy, as the seizure semiology precisely pointed to the contralateral motor cortex (epileptogenic zone), guiding the surgical removal of the visible lesion found in that region. However, mainly in the absence of any visible alteration of brain tissue, the removal of the portion of the cortex supposed to be responsible for the seizures carried the risk of injuring healthy areas of the brain, often resulting in permanent neurological deficits. In 1891, the prominent Italian neurologist Camillo Negro (1861-1927) described a new technique to treat focal epilepsy using galvanic electrical stimulation of the motor cortex to induce selective cortical destruction. The procedure of "cortical electrolysis", initially performed by prof. Antonio Carle (1854-1927), chief surgeon at the Mauriziano Hospital of Turin, aimed at avoiding the risk of hemorrhage and neurological deficits due to the resective surgical procedures, without compromising asepsis. Camillo Negro deserves to be credited as the first to have envisioned a non-resective surgical approach to the treatment of epilepsy, which in its conceptual basis appears nowadays as extraordinarily modern and pioneering. Recent neurosurgical procedures, such as stereoelectroencephalography-guided radiofrequency thermocoagulation and MRI-guided laser-induced interstitial thermal ablation, although based on different technologies, share the same rationale, using minimally invasive epilepsy surgery to reduce tissue disruption and thus morbidity.
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Affiliation(s)
- Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
| | | | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Vittorio A Sironi
- Research Centre on History of Biomedical Thought, Centro Studi sulla Storia del Pensiero Biomedico (CESPEB), University of Milano Bicocca Monza, Italy
| | - Lorenzo Lorusso
- UOC Neurology and Stroke Unit, ASST Lecco, Merate, LC, Italy
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