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Antal DC, Altenmüller DM, Dümpelmann M, Scheiwe C, Reinacher PC, Crihan ET, Ignat BE, Cuciureanu ID, Demerath T, Urbach H, Schulze-Bonhage A, Heers M. Semiautomated electric source imaging determines epileptogenicity of encephaloceles in temporal lobe epilepsy. Epilepsia 2024; 65:651-663. [PMID: 38258618 DOI: 10.1111/epi.17879] [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: 09/22/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE We aimed to assess the ability of semiautomated electric source imaging (ESI) from long-term video-electroencephalographic (EEG) monitoring (LTM) to determine the epileptogenicity of temporopolar encephaloceles (TEs) in patients with temporal lobe epilepsy. METHODS We conducted a retrospective study involving 32 temporal lobe epilepsy patients with TEs as potentially epileptogenic lesions in structural magnetic resonance imaging scans. Findings were validated through invasive intracerebral stereo-EEG in six of 32 patients and postsurgical outcome after tailored resection of the TE in 17 of 32 patients. LTM (mean duration = 6 days) was performed using the 10/20 system with additional T1/T2 for all patients and sphenoidal electrodes in 23 of 32 patients. Semiautomated detection and clustering of interictal epileptiform discharges (IEDs) were carried out to create IED types. ESI was performed on the averages of the two most frequent IED types per patient, utilizing individual head models, and two independent inverse methods (sLORETA [standardized low-resolution brain electromagnetic tomography], MUSIC [multiple signal classification]). ESI maxima concordance and propagation in spatial relation to TEs were quantified for sources with good signal quality (signal-to-noise ratio > 2, explained signal > 60%). RESULTS ESI maxima correctly colocalized with a TE in 20 of 32 patients (62.5%) either at the onset or half-rising flank of at least one IED type per patient. ESI maxima showed propagation from the temporal pole to other temporal or extratemporal regions in 14 of 32 patients (44%), confirming propagation originating in the area of the TE. The findings from both inverse methods validated each other in 14 of 20 patients (70%), and sphenoidal electrodes exhibited the highest signal amplitudes in 17 of 23 patients (74%). The concordance of ESI with the TE predicted a seizure-free postsurgical outcome (Engel I vs. >I) with a diagnostic odds ratio of 2.1. SIGNIFICANCE Semiautomated ESI from LTM often successfully identifies the epileptogenicity of TEs and the IED onset zone within the area of the TEs. Additionally, it shows potential predictive power for postsurgical outcomes in these patients.
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Affiliation(s)
- Dorin-Cristian Antal
- Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
- Neurology Clinic, Rehabilitation Clinical Hospital, Iași, Romania
- I Neurology Clinic, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, Iasi, Romania
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | | | - Matthias Dümpelmann
- Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for Laser Technology, Aachen, Germany
| | | | - Bogdan-Emilian Ignat
- Neurology Clinic, Rehabilitation Clinical Hospital, Iași, Romania
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Iulian-Dan Cuciureanu
- I Neurology Clinic, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, Iasi, Romania
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Theo Demerath
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Marcel Heers
- Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
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Chemogenetic attenuation of cortical seizures in nonhuman primates. Nat Commun 2023; 14:971. [PMID: 36854724 PMCID: PMC9975184 DOI: 10.1038/s41467-023-36642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
Epilepsy is a disorder in which abnormal neuronal hyperexcitation causes several types of seizures. Because pharmacological and surgical treatments occasionally interfere with normal brain function, a more focused and on-demand approach is desirable. Here we examined the efficacy of a chemogenetic tool-designer receptors exclusively activated by designer drugs (DREADDs)-for treating focal seizure in a nonhuman primate model. Acute infusion of the GABAA receptor antagonist bicuculline into the forelimb region of unilateral primary motor cortex caused paroxysmal discharges with twitching and stiffening of the contralateral arm, followed by recurrent cortical discharges with hemi- and whole-body clonic seizures in two male macaque monkeys. Expression of an inhibitory DREADD (hM4Di) throughout the seizure focus, and subsequent on-demand administration of a DREADD-selective agonist, rapidly suppressed the wide-spread seizures. These results demonstrate the efficacy of DREADDs for attenuating cortical seizure in a nonhuman primate model.
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Yacubian EÁ, Carrizosa J, Cavalheiro EA. Introduction to the special issue. Seizure 2021; 90:1-3. [PMID: 34215509 DOI: 10.1016/j.seizure.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Elza Árcia Yacubian
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Jaime Carrizosa
- Department of Pediatrics, Titular Professor University of Antioquia, Medellín, Colombia
| | - Esper A Cavalheiro
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.
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