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Freiman S, Hauser WA, Rider F, Gulyaeva N, Guekht A. Post-stroke epilepsy: From clinical predictors to possible mechanisms. Epilepsy Res 2024; 199:107282. [PMID: 38134643 DOI: 10.1016/j.eplepsyres.2023.107282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Stroke is the most common cause of newly diagnosed epilepsy in the elderly, ahead of degenerative disorders, brain tumors, and head trauma. Stroke accounts for 30-50% of unprovoked seizures in patients aged ≥ 60 years. This review discusses the current understanding of epidemiology, risk factors, mechanisms, prevention, and treatment opportunities for post-stroke epilepsy (PSE). METHODS We performed a literature search in the PubMed and Cochrane Library databases. The keywords "stroke, epilepsy", "stroke, seizure", "post-stroke seizure", "post-stroke epilepsy" were used to identify the clinical and experimental articles on PSE. All resulting titles and abstracts were evaluated, and any relevant article was considered. The reference lists of all selected papers and reference lists of selected review papers were manually analyzed to find other potentially eligible articles. RESULTS PSE occurs in about 6% of stroke patients within several years after the event. The main risk factors are cortical lesion, initial stroke severity, young age and seizures in acute stroke period (early seizures, ES). Other risk factors, such as a cardioembolic mechanism or circulation territory involvement, remain debated. The role of ES as a risk factor of PSE could be underestimated especially in young age. Mechanism of epileptogenesis may involve gliosis scarring, alteration in synaptic plasticity, etc.; and ES may enhance these processes. Statins especially in the acute period of stroke are possible agents for PSE prevention presumably due to their anticonvulsant and neuroprotection effects. Antiepileptic drugs (AED) monotherapy is enough for seizure prevention in most cases of PSE; but no evidence was found for its efficiency against epileptic foci formation. The growing interest in PSE has led to a notable increase in the number of published articles each year. To aid in navigating this expanding body of literature, several tables are included in the manuscript. CONCLUSION Further studies are needed for better understanding of the pathophysiology of PSE and searching the prevention strategies.
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Affiliation(s)
- Sofia Freiman
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation.
| | - W Allen Hauser
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, New York, USA
| | - Flora Rider
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation
| | - Natalia Gulyaeva
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Buyanov City Hospital of the Healthcare Department of Moscow, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Prevalence of seizures in brain tumor: A meta-analysis. Epilepsy Res 2022; 187:107033. [DOI: 10.1016/j.eplepsyres.2022.107033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022]
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Wolpert F, Lareida A, Terziev R, Grossenbacher B, Neidert MC, Roth P, Poryazova R, Imbach LL, Le Rhun E, Weller M. Risk factors for the development of epilepsy in patients with brain metastases. Neuro Oncol 2021; 22:718-728. [PMID: 31498867 DOI: 10.1093/neuonc/noz172] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current guidelines do not recommend primary prophylactic anti-epileptic drug (AED) therapy for patients with brain metastases (BM). Yet, subgroups of patients at high seizure risk might still benefit from prophylaxis. METHODS We identified 799 patients diagnosed with BM by retrospective screening of our electronic chart system. Candidate risk factors for the development of epilepsy were tested by univariate and multivariate Cox regression models. RESULTS Epilepsy was diagnosed in 226 of 799 patients (28%). Risk factors for epilepsy in non-operated patients were single BM (P = 0.002, hazard ratio [HR] 3.2, 95% CI: 1.5-6.6) and detection of tumoral hemorrhage (P = 0.008, HR 2.5, 95% CI: 1.3-4.9). Preoperative seizures occurred predominantly in patients with supratentorial BM (P = 0.003, HR 20.78, 95% CI: 2.8-153.4) and lung cancer (P = 0.022; HR 2.0, 95% CI: 1.1-3.6). Postoperative seizures were associated with supratentorial localization (P = 0.017, HR 5.8, 95% CI: 1.4-24.3), incomplete resection (P = 0.005, HR 4.6, 95% CI: 1.6-13.1), and by trend for multiple brain surgeries (P = 0.095, HR 1.9, 95% CI: 0.9-4.0). These risk factors were integrated into a predictive score model for postoperative epilepsy (score sum 0-8). A gradual increase of seizure rates along with higher sum score was confirmed post hoc (score 0 = no seizures; score 8 = 48% seizures). Receiver operating characteristic analysis supported diagnostic accuracy (P = 0.00001, area under the curve = 0.75). CONCLUSIONS Here we have defined risk profiles for the development of BM-related epilepsy and derived a score which might help to estimate the risk of postoperative seizures and identify individuals at risk who might benefit from primary prophylactic AED therapy.
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Affiliation(s)
- Fabian Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Anna Lareida
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Bettina Grossenbacher
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marian C Neidert
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Emilie Le Rhun
- Neuro-oncology, Department of Neurosurgery, University Hospital Lille, Salengro Hospital, Lille, France; Neurology, Department of Medical Oncology, Oscar Lambret Center, Lille, France and Inserm U-1192, Villeneuve d'Ascq, France
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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Ikawa A, Fujimoto A, Arai Y, Otsuki Y, Nozaki T, Baba S, Sato K, Enoki H. Case Report: Late-Onset Temporal Lobe Epilepsy Following Subarachnoid Hemorrhage: An Interplay Between Pre-existing Cortical Development Abnormality and Tissue Damage. Front Neurol 2021; 12:599130. [PMID: 33633663 PMCID: PMC7901922 DOI: 10.3389/fneur.2021.599130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
Epileptogenicity following brain insult depends on various factors including severity of the resulting lesion and extent of brain damage. We report a 54-year-old female patient who developed medically refractory epilepsy resulting from the interplay of pre-existing and post-insult pathologies. She presented with subarachnoid hemorrhage (SAH) due to a ruptured aneurysm and underwent clipping surgery. Seizures started 3 months post-operatively. MRI revealed cerebral ischemia and hemosiderin deposits in the left temporal lobes, and left hippocampal atrophy was suspected. As anti-seizure medications and vagus nerve stimulation failed to control her seizures, she underwent left temporal lobe resection and placement of a ventriculoperitoneal shunt for the post-operative complication of hydrocephalus. She remains seizure-free to date. Neuropathology revealed a previously undiagnosed focal cortical dysplasia (FCD) type 1a. Brain insult likely had a second hit effect in the late onset of epilepsy in this patient with pre-existing mild MCD, in whom secondary epilepsy can be attributed to the interplay of multiple underlying pathologies.
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Affiliation(s)
- Anna Ikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.,Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.,Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshifumi Arai
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Toshiki Nozaki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shimpei Baba
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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How does the COVID-19 cause seizure and epilepsy in patients? The potential mechanisms. Mult Scler Relat Disord 2020; 46:102535. [PMID: 33010584 PMCID: PMC7521932 DOI: 10.1016/j.msard.2020.102535] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 01/08/2023]
Abstract
The new coronavirus has spread throughout the world in a very short time and now has become a pandemic. Most infected people have symptoms such as dry cough, dyspnea, tiredness, and fever. However, the Covid-19 infection disrupts various organs, including the liver, kidney, and nervous system. Common neurological symptoms of the Covid-19 infection include delirium, confusion, headache, and loss of sense of smell and taste. In rare cases it can cause stroke and epilepsy. The virus enters the nervous system either directly through nerve pathways or indirectly through the ACE2 receptor. The neurological symptoms of a Covid-19 infection in the brain are mainly due to either the entry of pro-inflammatory cytokines into the nervous system or the production of these cytokines by microglia and astrocytes. Pro-inflammatory cytokines can cause blood-brain barrier disruption, increase in glutamate and aspartate and reduce GABA levels, impairs the function of ion channels, and finally, high levels of cytokines can cause epilepsy. Understanding the potential mechanisms is necessary to gain better insight into COVID-19 induced seizure pathogenesis and to design the correct treatment strategies to achieve appropriate treatment for seizure and epilepsy.
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Thakkar JP, Prabhu VC, Rouse S, Lukas RV. Acute Neurological Complications of Brain Tumors and Immune Therapies, a Guideline for the Neuro-hospitalist. Curr Neurol Neurosci Rep 2020; 20:32. [PMID: 32596758 DOI: 10.1007/s11910-020-01056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Patients with brain tumors presenting to the emergency room with acute neurologic complications may warrant urgent investigations and emergent management. As the neuro-hospitalist will likely encounter this complex patient population, an understanding of the acute neurologic issues will have value. RECENT FINDINGS We discuss updated information and management regarding various acute neurologic complications among neuro-oncology patients and neurologic complications of immunotherapy. Understanding of the acute neurologic complications associated with central nervous system tumors and with common contemporary cancer treatments will facilitate the neuro-hospitalist management of these patient populations. While there are aspects analogous to the diagnosis and management in the non-oncologic population, a number of unique features discussed in this review should be considered.
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Affiliation(s)
- Jigisha P Thakkar
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Bldg 105, Room 2700, Maywood, IL, 60153, USA. .,Department of Neurosurgery, Stritch School of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Bldg 105, Room 1900, Maywood, IL, 60153, USA.
| | - Vikram C Prabhu
- Department of Neurosurgery, Stritch School of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Bldg 105, Room 1900, Maywood, IL, 60153, USA
| | - Stasia Rouse
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Bldg 105, Room 2700, Maywood, IL, 60153, USA
| | - Rimas V Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Abbott Hall 1114, Chicago, IL, 60611, USA.,Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, 60611, USA
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van Leyen K, Roelcke U, Gruber P, Remonda L, Berberat J. Susceptibility and Tumor Size Changes During the Time Course of Standard Treatment in Recurrent Glioblastoma. J Neuroimaging 2019; 29:645-649. [PMID: 31112344 DOI: 10.1111/jon.12631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/09/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Susceptibility-weighted magnetic resonance imaging (SWI) yields information regarding tumor biology (e.g., hemorrhage) of growing gliomas. SWI changes can also be observed as a consequence of treatment, for example radiation therapy. The aim of our study was to investigate how susceptibility changes occur during the time course after completion of standard treatment in newly diagnosed glioblastoma (GBM). METHODS Eighteen GBM patients were retrospectively analyzed. After completion of therapy, imaging was performed every 3 months. MRI was analyzed at the following time points: after the third and sixth cycle of adjuvant temozolomide chemotherapy, thereafter in 3 month intervals and at recurrence. The number of SWI positive tumor pixels was quantified and compared with progression as defined by the RANO criteria on T2- and contrast-enhanced T1-weighted MRI sequences (T1-CE). RESULTS The MRI interval between completion of the sixth chemotherapy cycle and last MRI before progression was 390 ± 292 days. Between the last MRI before progression and at progression a significant increase in SWI positive tumor pixels was observed (P = .012), whereas tumor size remained unchanged (RANO T2: P = .385; RANO T1-CE: P = .165). The number of SWI positive pixels remained unchanged between last MRI before progression until progression (P = .149), whereas RANO T2 and T1-CE showed tumor progression (interval 128 ± 69 days). CONCLUSIONS SWI positive pixel count increases significantly prior to changes in tumor size (RANO). Our findings may be explained by microbleeds compatible with stimulation of angiogenesis and possibly serve as an early biomarker of tumor progression.
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Affiliation(s)
- K van Leyen
- Department of Neurosurgery, Cantonal Hospital St. Gallen, 9007, St. Gallen, Switzerland
| | - U Roelcke
- Department of Neurology and Brain Tumor Center, Cantonal Hospital Aarau, 5001, Aarau, Switzerland
| | - P Gruber
- Department of Neuroradiology, Cantonal Hospital Aarau, 5001, Aarau, Switzerland
| | - L Remonda
- Department of Neuroradiology, Cantonal Hospital Aarau, 5001, Aarau, Switzerland.,University of Bern, Bern, Switzerland
| | - J Berberat
- Department of Neuroradiology, Cantonal Hospital Aarau, 5001, Aarau, Switzerland
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Outcome and predictive factors in post-stroke seizures: A retrospective case-control study. Seizure 2018; 62:11-16. [PMID: 30245457 DOI: 10.1016/j.seizure.2018.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate clinical, radiographic, and electrophysiological features in the development and prognosis of ischemic post-stroke seizures (PSS). METHOD A retrospective study of 1119 patient records was performed between January 2006 and December 2016. After selection, 42 patients with seizures due to ischemic stroke were matched to a control group of 60 patients where seizures were absent. Stroke size and severity were analyzed using ASPECTS and NIHSS, respectively. Hemorrhagic transformation graded by ECASS III classification. Outcomes were assessed using the modified Rankin Scale. Fisher's exact test assessed categorical variables, and Mann-Whitney tested continuous variables. RESULTS Forty-two patients experienced PSS (22 females; median age 72.5 years) and were matched with 60 control subjects that had ischemic stroke without seizures. Focal seizures were present in 42.9% (18/42), and focal to bilateral convulsions in 57.1% (24/42). Stroke localization and severity did not differ (p = 0.6 and 0.21, respectively). Stroke size in anterior circulation was larger in PSS patients (median ASPECTS 6 vs 8 [p = 0.01]). Posterior circulation stroke size was similar in both groups. The presence of hemorrhage was the primary risk factor for PSS (61.9%) compared to controls (36.7%), p = 0.01. The presence of laminar necrosis (LN) (47.6% vs 21.6%, p = 0.005) and hemosiderin deposition (38.1% vs 18.3%, p = 0.02) were most predictive. PSS patients demonstrated worse outcomes than the controls (median mRS 3 vs 2, [p=<0.001]) with a median follow up of 14.8 and 20.7 months, respectively. CONCLUSIONS The size of anterior infarction, presence of blood products within the infarct bed, and especially LN predicted PSS.
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Tanaka T, Ihara M. Post-stroke epilepsy. Neurochem Int 2017; 107:219-228. [PMID: 28202284 DOI: 10.1016/j.neuint.2017.02.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 01/17/2023]
Abstract
Post-stroke epilepsy (PSE) is a common complication after stroke, yet treatment options remain limited. While many physicians prescribe antiepileptic drugs (AED) for secondary prevention of PSE, it is unclear which treatments are most effective in the prevention of recurrence of symptoms, or whether such therapy is needed for primary prevention. This review discusses the current understanding of epidemiology, diagnoses, mechanisms, risk factors, and treatments of PSE.
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Affiliation(s)
- Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Zou X, Jiang S, Wu Z, Shi Y, Cai S, Zhu R, Chen L. Effectiveness of deferoxamine on ferric chloride-induced epilepsy in rats. Brain Res 2017; 1658:25-30. [PMID: 28063856 DOI: 10.1016/j.brainres.2017.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/29/2016] [Accepted: 01/01/2017] [Indexed: 11/26/2022]
Abstract
Iron overload has been regarded as a common cause for refractory epilepsies in patients after hemorrhagic strokes. This study is to examine the potential epilepsy control effect of deferoxamine (DFO), an iron chelator, on a ferric chloride-induced epilepsy rat model. Twenty four rats were divided into 4 groups: group I is blank control group, group II is sham group with intracortical injection of saline, group III is epilepsy group with intracortical injection of iron and saline treatment, group IV is treatment group with intracortical injection of iron and DFO treatment. For the DFO intervention group, a daily dose of 100mg/kg DFO via peritoneal injection was applied for 14days. Outcomes were evaluated by behavioral study, electroencephalography (EEG), magnetic resonance imaging (MRI) scan and tissue analysis. Epilepsies according to behavioral observations and EEG analysis were significantly suppressed after intervention of DFO. Reduction of iron content in the brain cortex was proved by diminished low signal area on T2-MRI images (p=0.006) and tissue analysis (p<0.001), simultaneously the superoxide dismutase (SOD) activity increased (p<0.001). Western blot analysis demonstrated the decreasing of local transferrin after DFO treatment. DFO is efficient at Fe clearance, thus helpful in epilepsy control. This finding implies potential therapeutic value of DFO in patients with refractory epilepsy after hemorrhagic stroke.
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Affiliation(s)
- Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Wu Lu Mu Qi Road, No. 12, Shanghai 200040, China
| | - Shize Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Wu Lu Mu Qi Road, No. 12, Shanghai 200040, China
| | - Zehan Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Wu Lu Mu Qi Road, No. 12, Shanghai 200040, China
| | - Yimin Shi
- Department of Neurosurgery, Huashan Hospital, Fudan University, Wu Lu Mu Qi Road, No. 12, Shanghai 200040, China
| | - Shengyong Cai
- Department of Neurosurgery, Huashan Hospital, Fudan University, Wu Lu Mu Qi Road, No. 12, Shanghai 200040, China
| | - Renqing Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Wu Lu Mu Qi Road, No. 12, Shanghai 200040, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Wu Lu Mu Qi Road, No. 12, Shanghai 200040, China.
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Gillick BT, Krach LE, Feyma T, Rich TL, Moberg K, Menk J, Cassidy J, Kimberley T, Carey JR. Safety of primed repetitive transcranial magnetic stimulation and modified constraint-induced movement therapy in a randomized controlled trial in pediatric hemiparesis. Arch Phys Med Rehabil 2015; 96:S104-13. [PMID: 25283350 PMCID: PMC4380609 DOI: 10.1016/j.apmr.2014.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the safety of combining a 6-Hz primed low-frequency repetitive transcranial magnetic stimulation (rTMS) intervention in the contralesional hemisphere with a modified constraint-induced movement therapy (mCIMT) program in children with congenital hemiparesis. DESIGN Phase 1 randomized, double-blinded, placebo-controlled pretest/posttest trial. SETTING University academic facility and pediatric specialty hospital. PARTICIPANTS Subjects (N = 19; age range, 8-17 y) with congenital hemiparesis caused by ischemic stroke or periventricular leukomalacia. No subject withdrew because of adverse events. All subjects included completed the study. INTERVENTIONS Subjects were randomized to 1 of 2 groups: either real rTMS plus mCIMT (n = 10) or sham rTMS plus mCIMT (n = 9). MAIN OUTCOME MEASURES Adverse events, physician assessment, ipsilateral hand function, stereognosis, cognitive function, subject report of symptoms assessment, and subject questionnaire. RESULTS No major adverse events occurred. Minor adverse events were found in both groups. The most common events were headaches (real: 50%, sham: 89%; P = .14) and cast irritation (real: 30%, sham: 44%; P = .65). No differences between groups in secondary cognitive and unaffected hand motor measures were found. CONCLUSIONS Primed rTMS can be used safely with mCIMT in congenital hemiparesis. We provide new information on the use of rTMS in combination with mCIMT in children. These findings could be useful in research and future clinical applications in advancing function in congenital hemiparesis.
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Affiliation(s)
- Bernadette T Gillick
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN.
| | - Linda E Krach
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN; Gillette Children's Specialty Healthcare, St Paul, MN
| | - Tim Feyma
- Gillette Children's Specialty Healthcare, St Paul, MN
| | - Tonya L Rich
- Gillette Children's Specialty Healthcare, St Paul, MN
| | - Kelli Moberg
- Gillette Children's Specialty Healthcare, St Paul, MN
| | - Jeremiah Menk
- University of Minnesota Clinical and Translational Science Institute Biostatistical Design and Analysis Center, Minneapolis, MN
| | - Jessica Cassidy
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN
| | - Teresa Kimberley
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN
| | - James R Carey
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN
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Xia J, Xie N, Feng Y, Yin A, Liu P, Zhou R, Lin F, Teng G, Lei Y. Brain susceptibility weighted imaging signal changes in acute hemorrhagic anemia: an experimental study using a rabbit model. Med Sci Monit 2014; 20:1291-7. [PMID: 25060330 PMCID: PMC4116343 DOI: 10.12659/msm.890641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate susceptibility-weighted imaging (SWI) signal changes in different brain regions in a rabbit model of acute hemorrhagic anemia. Material/Methods Ten New Zealand white rabbits were used for construction of the model of acute hemorrhagic anemia. Signal intensities of SWI images of the bilateral frontal cortex, frontal white matter, temporal lobe, and thalamic nuclei were measured. In addition, the cerebral gray-white contrast and venous structures of the SWI images were evaluated by an experienced physician. Results Repeated bloodletting was associated with significant reductions in red blood cell count, hemoglobin concentration, hematocrit, pH, and PaCO2, and elevations of blood lactate and PaO2. In normal status, the SWI signal intensity was significantly higher in the frontal cortex than in the frontal white matter (63.10±22.82 vs. 52.50±20.29; P<0.05). Repeated bloodletting (5 occasions) caused significant (P<0.05) decreases in the SWI signals of the frontal cortex (from 63.10±22.82 to 37.70±4.32), temporal lobe (from 52.50±20.29 to 42.60±5.54), and thalamus (from 60.40±20.29 to 39.40±3.47), but was without effect in the frontal white matter. The cerebral white-gray contrast and venous structures were clearer after bloodletting than before bloodletting. Conclusions The effect of hemorrhage on the brain is reflected by SWI signal changes in the cerebral cortex and gray matter nuclei.
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Affiliation(s)
- Jun Xia
- Department of Rodiology, Second People's Hospital of Shenzhen City, First Affiliated Hospital of Shenzhen University, Shenzhen, China (mainland)
| | - Ni Xie
- Biobank, Second People's Hospital of Shenzhen City, First Affiliated Hospital of Shenzhen University, Shenzhen, China (mainland)
| | - Yuning Feng
- Department of Radiology, Second People's Hospital of Shenzhen City, First Affiliated Hospital of Shenzhen University, Shenzhen, China (mainland)
| | - Anyu Yin
- Department of Radiology, Second People's Hospital of Shenzhen City, First Affiliated Hospital of Shenzhen University, Shenzhen, China (mainland)
| | - Pinni Liu
- Department of Radiology, Second People's Hospital of Shenzhen City, First Affiliated Hospital of Shenzhen University, Shenzhen, China (mainland)
| | - Ruming Zhou
- Department of Interventional Radiology, Second People's Hospital of Shenzhen City, First Affiliated Hospital of Shenzhen University, Shenzhen, China (mainland)
| | - Fan Lin
- Department of Radiology, Second People's Hospital of Shenzhen City, First Affiliated Hospital of Shenzhen University, Shenzhen, China (mainland)
| | - Guozhao Teng
- Medical Record and Statisitic Room, Second People's Hospital of Shenzhen City. First Affiliated Hospital of Shenzhen University, Shenzhen, China (mainland)
| | - Yi Lei
- Department of Radiology, Second People's Hospital of Shenzhen City, First Affiliated Hospital of Shenzhen University, Shenzhen, China (mainland)
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