1
|
Mueller SG, Garga N, Garcia P, Rossi S, Vu A, Neylan T, Laxer KD. The imprint of dissociative seizures on the brain. Neuroimage Clin 2024; 43:103664. [PMID: 39226702 DOI: 10.1016/j.nicl.2024.103664] [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: 07/08/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Increased resting state functional connectivity between regions involved in emotion control with regions with other specializations, e.g. motor control (emotional hyperconnectivity) is one of the most consistent imaging findings in persons suffering from dissociative seizures (DS). The overall goal of this study was to better characterize DS-related emotional hyperconnectivity using dynamic resting state analysis combined with brainstem volumetry to investigate 1. If emotional hyperconnectivity is restricted to a single state. 2. How volume losses within the modulatory and emotional motor subnetworks of the neuromodulatory system influence the expression of the emotional hyperconnectivity. METHODS 13 persons with dissociative seizures (PDS) (f/m:10/3, mean age (SD) 44.6 (11.5)) and 15 controls (CON) (f/m:10/5, mean age (SD) 41.7 (13.0)) underwent a mental health test battery and structural and functional imaging at 3 T. Deformation based morphometry was used to assess brain volume loss by extracting the mean Jacobian determinants from 457 brain, forebrain and brainstem structures. The bold signals from 445 brainstem and brain rois were extracted with CONN and a dynamic fMRI analysis combined with graph and hierarchical analysis was used to identify and characterize 9 different brain states. Welch's t tests and Kendall tau tests were used for group comparisons and correlation analyses. RESULTS The duration of Brain state 6 was longer in PDS than in CON (93.1(88.3) vs. 23.4(31.2), p = 0.01) and positively correlated with higher degrees of somatization, depression, PTSD severity and dissociation. Its global connectivity was higher in PDS than CON (90.4(3.2) vs 86.5(4.2) p = 0.01) which was caused by an increased connectivity between regions involved in emotion control and regions involved in sense of agency/body control. The brainstem and brainstem-forebrain modulatory and emotional motor subnetworks of the neuromodulatory system were atrophied in PDS. Atrophy severity within the brainstem-forebrain subnetworks was correlated with state 6 dwell time (modulatory: tau = -0.295, p = 0.03; emotional motor: tau = -0.343, p = 0.015) and atrophy severity within the brainstem subnetwork with somatization severity (modulatory: tau = -0.25, p = 0.036; emotional motor: tau = -0.256, p = 0.033). CONCLUSION DS-related emotional hyperconnectivity was restricted to state 6 episodes. The remaining states were not different between PDS and CON. The modulatory subnetwork synchronizes brain activity across brain regions. Atrophy and dysfunction within that subnetwork could facilitate the abnormal interaction between regions involved in emotion control with those controlling sense of agency/body ownership during state 6 and contribute to the tendency for somatization in PDS. The emotional motor subnetwork controls the activity of spinal motoneurons. Atrophy and dysfunction within this subnetwork could impair that control resulting in motor symptoms during DS. Taken together, these findings indicate that DS have a neurophysiological underpinning.
Collapse
Affiliation(s)
- S G Mueller
- Center for Imaging of Neurodegenerative Diseases, VAMC, San Francisco, CA, USA; Dept of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - N Garga
- VA Epilepsy Center of Excellence, VAMC, San Francisco, CA, USA; Dept. of Neurology, University of California, San Francisco, CA, USA
| | - P Garcia
- Dept. of Neurology, University of California, San Francisco, CA, USA
| | - S Rossi
- Center for Imaging of Neurodegenerative Diseases, VAMC, San Francisco, CA, USA
| | - A Vu
- Center for Imaging of Neurodegenerative Diseases, VAMC, San Francisco, CA, USA; Dept of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - T Neylan
- VA Mental Health, VAMC San Francisco, CA, USA
| | - K D Laxer
- Sutter Pacific Epilepsy Program, California Pacific Medical Center, San Francisco, CA, USA
| |
Collapse
|
2
|
Moya Quiros V, Adham A, Convers P, Lesca G, Mauguiere F, Soulier H, Arzimanoglou A, Bayat A, Braakman H, Camdessanche JP, Casenave P, Chaton L, Chaix Y, Chochoi M, Depienne C, Desportes V, De Ridder J, Dinkelacker V, Gardella E, Kluger GJ, Jung J, Lemesle Martin M, Mancardi MM, Mueller M, Poulat AL, Platzer K, Roubertie A, Stokman MF, Vulto-van Silfhout AT, Wiegand G, Mazzola L. Electro-Clinical Features and Functional Connectivity Analysis in SYN1-Related Epilepsy. Ann Neurol 2024. [PMID: 39177219 DOI: 10.1002/ana.27063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE There is currently scarce data on the electroclinical characteristics of epilepsy associated with synapsin 1 (SYN1) pathogenic variations. We examined clinical and electro-encephalographic (EEG) features in patients with epilepsy and SYN1 variants, with the aim of identifying a distinctive electroclinical pattern. METHODS In this retrospective multicenter study, we collected and reviewed demographic, genetic, and epilepsy data of 19 male patients with SYN1 variants. Specifically, we analyzed interictal EEG data for all patients, and electro-clinical data from 10 epileptic seizures in 5 patients, using prolonged video-EEG monitoring recordings. Inter-ictal EEG functional connectivity parameters and frequency spectrum of the 10 patients over 12 years of age, were computed and compared with those of 56 age- and sex-matched controls. RESULTS The main electroclinical features of epilepsy in patients with SYN1 were (1) EEG background and organization mainly normal; (2) interictal abnormalities are often rare or not visible on EEG; (3) more than 60% of patients had reflex seizures (cutaneous contact with water and defecation being the main triggers) isolated or associated with spontaneous seizures; (4) electro-clinical semiology of seizures was mainly temporal or temporo-insulo/perisylvian with a notable autonomic component; and (5) ictal EEG showed a characteristic rhythmic theta/delta activity predominating in temporo-perisylvian regions at the beginning of most seizures. Comparing patients with SYN1 to healthy subjects, we observed a shift to lower frequency bands in power spectrum of interictal EEG and an increased connectivity in both temporal regions. INTERPRETATION A distinct epilepsy syndrome emerges in patients with SYN1, with a rather characteristic clinical and EEG pattern suggesting predominant temporo-insular involvement. ANN NEUROL 2024.
Collapse
Affiliation(s)
| | - Ahmed Adham
- Physical Medicine and Rehabilitation Department, University Hospital of Saint-Étienne, Saint-Étienne, France
- CEA, LETI, CLINATEC, University Grenoble Alpes, Grenoble, France
| | - Philippe Convers
- Neurology Department, University Hospital, Saint-Etienne, France
- NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL-INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
| | - Gaetan Lesca
- Department of Genetics, Member of the ERN EpiCARE, Hospices Civils de Lyon, Bron, France
- Institute NeuroMyoGène, Laboratoire Physiopathologie et Génétique du Neurone et du Muscle, CNRS UMR 5261-INSERM U1315, Université de Lyon-Université Claude Bernard Lyon 1, Lyon, France
| | - François Mauguiere
- NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL-INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
- Department of Functional Neurology and Epileptology, Member of the ERN EpiCARE, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Hugo Soulier
- Neurology Department, University Hospital, Saint-Etienne, France
| | - Alexis Arzimanoglou
- Department of Clinical Epileptology, Sleep Disorders and Functional Pediatric Neurology, coordinating member of the ERN EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
- Sección Epilepsia, Sueño y Neurofisiología, Department of Neurology, coordinating member of the ERN EpiCARE, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Allan Bayat
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Member of the ERN EpiCARE, Dianalund, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hilde Braakman
- Department of Paediatric Neurology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | | | - Laurence Chaton
- Department of Neurology, Neurophysiology Unit, CHU Lille, Lille, France
| | - Yves Chaix
- Toulouse NeuroImaging Center, University of Toulouse, INSERM, Université Paul Sabatier, Toulouse, France
- Pediatric Neurology Unit, Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Maxime Chochoi
- Department of Neurology, Neurophysiology Unit, CHU Lille, Lille, France
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Vincent Desportes
- Hospices Civils de Lyon, Department of Pediatric Neurology, Member of the ERN EpiCARE, Hôpital Femme Mère Enfant, Lyon, France
| | - Jessie De Ridder
- Department of Neurology, Academic Center for Epileptology, Kempenhaeghe, Heeze, The Netherlands
| | - Vera Dinkelacker
- Department of Neurology, University Hospital Strasbourg, Strasbourg, France
| | - Elena Gardella
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Member of the ERN EpiCARE, Dianalund, Denmark
| | - Gerhard J Kluger
- Schön Klinik Vogtareuth, Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Collaborating Partner of the ERN EpiCARE, PMU, Vogtareuth, Salzburg, Germany
| | - Julien Jung
- Department of Functional Neurology and Epileptology, Member of the ERN EpiCARE, Hospices Civils de Lyon, Université de Lyon, Lyon, France
- Department of Neurology, University Hospital, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, Lyon, France
| | | | - Maria Margherita Mancardi
- Unit of Child Neuropsychiatry, Epilepsy Center, Member of the ERN EpiCARE, Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Markus Mueller
- Department of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Bielefeld University, Bielefeld, Germany
| | - Anne-Lise Poulat
- Hospices Civils de Lyon, Department of Pediatric Neurology, Member of the ERN EpiCARE, Hôpital Femme Mère Enfant, Lyon, France
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Agathe Roubertie
- Department of Pediatric Neurology, INSERM, University Hospital Montpellier, Montpellier, France
| | - Marijn F Stokman
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Gert Wiegand
- Division of Pediatric Neurology, Department of Pediatrics, Asklepios Klinik Nord-Heidberg, Hamburg, Germany
- Department of Pediatric and Adolescent Medicine II (Neuropediatrics, Social Pediatrics), University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Laure Mazzola
- Neurology Department, University Hospital, Saint-Etienne, France
- NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL-INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
| |
Collapse
|
3
|
Firouzabadi N, Asadi‐Pooya AA, Alimoradi N, Simani L, Asadollahi M. Polymorphism of glucocorticoid receptor gene (rs41423247) in functional seizures (psychogenic nonepileptic seizures/attacks). Epilepsia Open 2023; 8:1425-1431. [PMID: 37593891 PMCID: PMC10690659 DOI: 10.1002/epi4.12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE We investigated the association between the glucocorticoid receptor (GR) gene, also known as the nuclear receptor subfamily 3, group C, member 1 (NR3C1), rs41423247 polymorphism, and functional seizures (psychogenic nonepileptic seizures/attacks) in a case-control study. We hypothesized that the tested polymorphism has significant associations with functional seizures (psychogenic nonepileptic seizures/attacks) independent from comorbid depression. METHODS Seventy patients with functional seizures (psychogenic nonepileptic seizures/attacks), 70 with major depressive disorder (MDD), and 70 healthy controls (HCs) were studied. Their DNAs were analyzed for NR3C1 rs41423247 polymorphism. RESULTS Genotype and allele frequencies of rs41423247 were different between the three groups. G allele carriers were more frequent in patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD compared to HCs (p = 0.0001). However no significant difference was observed with respect to allele distributions between functional seizures (psychogenic nonepileptic seizures/attacks) and MDD groups (p = 0.391). CC genotype was less often associated with functional seizures (psychogenic nonepileptic seizures/attacks) versus HC: Codominant model; p = 0.001, OR = 0.11, 95% CI = 0.05-0.24, and -2loglilkelihood = 231.7. In comparison between functional seizures (psychogenic nonepileptic seizures/attacks) group and other (MDD + HC) groups, we observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks) (Codominant model; p = 0.001, OR = 5.63, 95% CI = 2.60-12.40 and -2loglikelihood = 245.99). SIGNIFICANCE Patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD were significantly more often G allele carriers in rs41423247 compared with HCs. We observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks). However, we could not exclude the possibility of confounding effects of depression. Future genetic studies of patients with functional seizures (psychogenic nonepileptic seizures/attacks) should include a comparison group with depression in addition to a comparison group of HCs.
Collapse
Affiliation(s)
- Negar Firouzabadi
- Department of Pharmacology and Toxicology, School of PharmacyShiraz University of Medical SciencesShirazIran
| | - Ali A. Asadi‐Pooya
- Epilepsy Research CenterShiraz University of Medical SciencesShirazIran
- Jefferson Comprehensive Epilepsy Center, Department of NeurologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Nahid Alimoradi
- Department of Pharmacology and Toxicology, School of PharmacyShiraz University of Medical SciencesShirazIran
| | - Leila Simani
- Brain Mapping Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Department of Pharmaceutical Sciences, College of PharmacyUniversity of KentuckyLexingtonKentuckyUSA
| | - Marjan Asadollahi
- Department of Epilepsy, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
| |
Collapse
|
4
|
Asadi-Pooya AA, Hallett M, Mirzaei Damabi N, Fazelian Dehkordi K. Genetics of Functional Seizures; A Scoping Systematic Review. Genes (Basel) 2023; 14:1537. [PMID: 37628589 PMCID: PMC10454456 DOI: 10.3390/genes14081537] [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: 07/07/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Evidence on the genetics of functional seizures is scarce, and the purpose of the current scoping systematic review is to examine the existing evidence and propose how to advance the field. METHODS Web of science and MEDLINE were searched, from their initiation until May 2023. The following key words were used: functional neurological disorder(s), psychogenic neurological disorder(s), functional movement disorder(s), psychogenic movement disorder(s), functional seizures(s), psychogenic seizure(s), nonepileptic seizure(s), dissociative seizure(s), or psychogenic nonepileptic seizure(s), AND, gene, genetic(s), polymorphism, genome, epigenetics, copy number variant, copy number variation(s), whole exome sequencing, or next-generation sequencing. RESULTS We identified three original studies. In one study, the authors observed that six (5.9%) patients with functional seizures carried pathogenic/likely pathogenic variants. In another study, the authors observed that, in functional seizures, there was a significant correlation with genes that are over-represented in adrenergic, serotonergic, oxytocin, opioid, and GABA receptor signaling pathways. In the third study, the authors observed that patients with functional seizures, as well as patients with depression, had significantly different genotypes in FKBP5 single nucleotide polymorphisms compared with controls. CONCLUSION Future genetic investigations of patients with functional seizures would increase our understanding of the pathophysiological and neurobiological problems underlying this common neuropsychological stress-associated condition.
Collapse
Affiliation(s)
- Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz 71438, Iran; (N.M.D.); (K.F.D.)
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Mark Hallett
- Division of Intramural Research, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD 20892, USA;
| | - Nafiseh Mirzaei Damabi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz 71438, Iran; (N.M.D.); (K.F.D.)
| | | |
Collapse
|
5
|
Malekpour M, Jafari A, Kashkooli M, Salarikia SR, Negahdaripour M. A systems biology approach for discovering the cellular and molecular aspects of psychogenic non-epileptic seizure. Front Psychiatry 2023; 14:1116892. [PMID: 37252132 PMCID: PMC10213457 DOI: 10.3389/fpsyt.2023.1116892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Psychogenic non-epileptic seizure (PNES) is the most common non-epileptic disorder in patients referring to epilepsy centers. Contrary to common beliefs about the disease's harmlessness, the death rate of PNES patients is similar to drug-resistant epilepsy. Meanwhile, the molecular pathomechanism of PNES is unknown with very limited related research. Thus, the aim of this in silico study was to find different proteins and hormones associated with PNES via a systems biology approach. Methods Different bioinformatics databases and literature review were used to find proteins associated with PNES. The protein-hormone interaction network of PNES was constructed to discover its most influential compartments. The pathways associated with PNES pathomechanism were found by enrichment analysis of the identified proteins. Besides, the relationship between PNES-related molecules and psychiatric diseases was discovered, and the brain regions that could express altered levels of blood proteins were discovered. Results Eight genes and three hormones were found associated with PNES through the review process. Proopiomelanocortin (POMC), neuropeptide Y (NPY), cortisol, norepinephrine, and brain-derived neurotrophic factor (BDNF) were identified to have a high impact on the disease pathogenesis network. Moreover, activation of Janus kinase-signaling transducer and activator of transcription (JAK-STAT) and JAK, as well as signaling of growth hormone receptor, phosphatidylinositol 3-kinase /protein kinase B (PI3K/AKT), and neurotrophin were found associated with PNES molecular mechanism. Several psychiatric diseases such as depression, schizophrenia, and alcohol-related disorders were shown to be associated with PNES predominantly through signaling molecules. Significance This study was the first to gather the biochemicals associated with PNES. Multiple components and pathways and several psychiatric diseases associated with PNES, and some brain regions that could be altered during PNES were suggested, which should be confirmed in further studies. Altogether, these findings could be used in future molecular research on PNES patients.
Collapse
Affiliation(s)
- Mahdi Malekpour
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Jafari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Kashkooli
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Manica Negahdaripour
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
6
|
Morphometric correlates in patients with functional seizures with and without comorbid epilepsy. Acta Neurol Belg 2023:10.1007/s13760-023-02208-y. [PMID: 36749466 DOI: 10.1007/s13760-023-02208-y] [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: 08/04/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Functional seizures (FS) or psychogenic, non-epileptic seizures (PNES) are episodic alterations of behaviour with similar semiology to epileptic seizures but which are not caused by epileptic brain activity. Epilepsy patients show a high risk in developing FS; therefore, the purpose of this study is to examine morphometric correlates in patients with FS as well as in epilepsy patients with FS by comparing them separately to healthy controls (HC). METHODS Twenty-one clinical three-dimensional (3D) T1-magnetic resonance imaging (MRI) scans of patients with FS (FS group) and 15 patients with FS and epilepsy (EFS group) were retrospectively compared with one control group of 21 age- and gender-matched HC. Two separate general linear model analyses were conducted via FreeSurfer version 6.0. RESULTS The study population consisted of 21 FS patients (66.7% females, n = 14) with a median age at the time of the scan of 24 years (range 17-44 years); 15 EFS patients (80% females, n = 12) with a median age at the time of the scan of 27 years (range 16-43 years); and 21 healthy subjects (66.7% females, n = 14) with a median age at the time of the scan of 24 years (range 19-38 years). Both patient groups showed an increased Cth in the right prefrontal lobe: in the FS group in the right superior frontal, rostral middle frontal gyri and the right orbitofrontal cortex and, in the EFS group, in the right superior frontal gyrus and the right orbitofrontal cortex. Decreases in Cth were present in the right lateral occipital lobe in the FS group, while also in both hemispheres in the EFS group, namely the left paracentral, superior frontal, caudal middle frontal, lateral occipital and right superior frontal gyri. Neither group showed changes in curvature. CONCLUSION These results suggest alterations in regions of emotional processing and executive control in patients with FS regardless of the presence of epilepsy.
Collapse
|
7
|
Yan HJ, He YY, Jin L, Guo Q, Zhou JH, Luo S. Expanding the phenotypic spectrum of KCNK4: From syndromic neurodevelopmental disorder to rolandic epilepsy. Front Mol Neurosci 2023; 15:1081097. [PMID: 36683851 PMCID: PMC9851069 DOI: 10.3389/fnmol.2022.1081097] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
The KCNK4 gene, predominantly distributed in neurons, plays an essential role in controlling the resting membrane potential and regulating cellular excitability. Previously, only two variants were identified to be associated with human disease, facial dysmorphism, hypertrichosis, epilepsy, intellectual/developmental delay, and gingival overgrowth (FHEIG) syndrome. In this study, we performed trio-based whole exon sequencing (WES) in a cohort of patients with epilepsy. Two de novo likely pathogenic variants were identified in two unrelated cases with heterogeneous phenotypes, including one with Rolandic epilepsy and one with the FHEIG syndrome. The two variants were predicted to be damaged by the majority of in silico algorithms. These variants showed no allele frequencies in controls and presented statistically higher frequencies in the case cohort than that in controls. The FHEIG syndrome-related variants were all located in the region with vital functions in stabilizing the conductive conformation, while the Rolandic epilepsy-related variant was distributed in the area with less impact on the conductive conformation. This study expanded the genetic and phenotypic spectrum of KCNK4. Phenotypic variations of KCNK4 are potentially associated with the molecular sub-regional effects. Carbamazepine/oxcarbazepine and valproate may be effective antiepileptic drugs for patients with KCNK4 variants.
Collapse
Affiliation(s)
- Hong-Jun Yan
- Epilepsy Center, Guangdong Brain Hospital, Guangzhou, China,Hong-Jun Yan,
| | - Yun-yan He
- Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China,Department of Neurology, Women and Children’s Hospital Affiliated to Qingdao University, Qingdao, China
| | - Liang Jin
- Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China,Department of Neurology, the Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Qiang Guo
- Epilepsy Center, Guangdong Brain Hospital, Guangzhou, China
| | - Jing-Hua Zhou
- Epilepsy Center, Guangdong Brain Hospital, Guangzhou, China
| | - Sheng Luo
- Epilepsy Center, Guangdong Brain Hospital, Guangzhou, China,Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China,*Correspondence: Sheng Luo,
| |
Collapse
|
8
|
Louis S, Busch RM, Lal D, Hockings J, Hogue O, Morita-Sherman M, Vegh D, Najm I, Ghosh C, Bazeley P, Eng C, Jehi L, Rotroff DM. Genetic and molecular features of seizure-freedom following surgical resections for focal epilepsy: A pilot study. Front Neurol 2022; 13:942643. [PMID: 36188379 PMCID: PMC9524264 DOI: 10.3389/fneur.2022.942643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Seizure outcomes after brain surgery for drug-resistant epilepsy (DRE) are very heterogeneous and difficult to predict with models utilizing the current clinical, imaging, and electrophysiological variables. In this pilot study, we investigated whether genetic and molecular biomarkers (e.g., genomic, transcriptomic) can provide additional insight into differential response to surgery. Methods Post-operative seizure-outcomes were collected at last follow-up (>6 months) for 201 adult patients with DRE who underwent surgery between 2004 and 2020. Resected tissue was sent for miRNA sequencing (n = 132) and mRNA sequencing (n = 135). Following the selection of 10 genes (SCN1A, NBEA, PTEN, GABRA1, LGL1, DEPDC5, IL1A, ABCB1, C3, CALHM1), we investigated SNPs in those 10 genes from previously acquired exome sequencing data (n = 106). Logistic regression was performed to test for associations between individual features (mRNAs, miRNAs, and SNPs) and post-operative seizure-outcome with an exploratory FDR P < 0.25 as the threshold for significance. Post-operative time-to-seizure analyses were performed for each SNP using a Cox proportional hazards model. Results The majority of patients (83%) had temporal lobe epilepsy. Mean age at surgery was 38.3 years, and 56% were female. Three SNPs (rs10276036, rs11975994, rs1128503) in multi-drug resistance gene, ABCB1, were associated with post-operative seizure outcomes. Patients with alternate alleles in ABCB1 were more likely to be seizure-free at last follow-up (52–56% reduction in seizure recurrence; FDR P = 0.24). All three SNPs were in linkage disequilibrium and highly correlated with each other. Median post-operative time-to-seizure was 63 months for patients with 2 alternate alleles, 24–33 months with 1 alternate allele, and 10–11 months with 0 alternate alleles. These SNPs improved outcome prediction beyond MRI and sex alone. No independent miRNAs or mRNAs were significantly associated with seizure-outcome (P > 0.05). However, pathway analysis identified “cancer drug resistance by drug efflux” (mir-154 and mir-379) as enriched (P = 0.02), supporting the role of drug response genes in post-operative seizure recurrence. Significance ABCB1 may have a role in epileptogenesis and surgery outcomes independent of its drug efflux activity necessitating further investigation. SNPs in ABCB1 may serve as independent predictors of post-operative outcome.
Collapse
Affiliation(s)
- Shreya Louis
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Robyn M. Busch
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Dennis Lal
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jennifer Hockings
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Center for Personalized Genetic Healthcare, Community Care and Population Health, Cleveland Clinic, Cleveland, OH, United States
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, United States
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Marcia Morita-Sherman
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Deborah Vegh
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Imad Najm
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Chaitali Ghosh
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Peter Bazeley
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Charis Eng
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Center for Personalized Genetic Healthcare, Community Care and Population Health, Cleveland Clinic, Cleveland, OH, United States
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Lara Jehi
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Lara Jehi
| | - Daniel M. Rotroff
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, United States
- *Correspondence: Daniel M. Rotroff
| |
Collapse
|
9
|
Partlow BH, Birkley EL. Cognitive Processing Therapy for Concurrent Posttraumatic Stress Disorder (PTSD) and Psychogenic Nonepileptic Seizures (PNES): A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
10
|
Nakken EI, Grinde F, Vaaler A, Drange OK, Brodtkorb E, Sæther SG. Epilepsy and other seizure disorders in acute psychiatric inpatients. BMC Psychiatry 2021; 21:626. [PMID: 34911471 PMCID: PMC8672464 DOI: 10.1186/s12888-021-03619-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well known that patients with epilepsy have a high rate of psychiatric comorbidity. However, studies exploring epilepsy in psychiatric cohorts are scarce. The aim of this study was to examine the prevalence of seizure disorders in acute psychiatric inpatients. METHODS This is a cross-sectional study performed in a catchment-area based acute psychiatric department. All patients (age > 18) admitted during September 2011 - March 2012 were eligible for inclusion. Consenting patients were screened for a life-time history of epilepsy or seizures using self-reported questionnaire data and diagnostic codes for epilepsy in hospital and National registries. Patients scoring positive to one or more of these screening criteria underwent a thorough diagnostic validation (chart review), and the seizure disorders were classified as epilepsy, acute symptomatic seizures and/or psychogenic non-epileptic seizures according to current definitions. RESULTS A total of 380 out of 591 (64.3%) consecutively admitted patients consented to participate in the study. Eighty-nine patients (23.4%) scored positive to one or more screening criteria. Fifteen (3.9%) were classified with epilepsy, 21 (5.5%) with acute symptomatic seizures and 9 (2.4%) with psychogenic non-epileptic seizures. CONCLUSIONS This is the first study to report on the prevalence of seizure disorders in acute psychiatric inpatients. The life-time prevalence of epilepsy in this cohort of patients is five - six times as high as reports in the general population. These findings underscore the need for the clinical psychiatrist to have comprehensive knowledge on the interface between epileptology and psychiatry. TRIALS REGISTRATION ClinicalTrials.gov identifier NCT01415323 .
Collapse
Affiliation(s)
- Erlend Iversen Nakken
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frithjof Grinde
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Vaaler
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Acute Psychiatry, Division of Mental Healthcare, St. Olavs University Hospital, Trondheim, Norway
| | - Ole Kristian Drange
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Acute Psychiatry, Division of Mental Healthcare, St. Olavs University Hospital, Trondheim, Norway ,grid.417290.90000 0004 0627 3712Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Eylert Brodtkorb
- grid.52522.320000 0004 0627 3560Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | |
Collapse
|
11
|
Immediate serial postoperative de novo psychogenic nonepileptic seizures after selective amygdalohippocampectomy. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
12
|
Deutsch CK, Patnaik PP, Greco FA. Is There a Characteristic Autonomic Response During Outbursts of Combative Behavior in Dementia Patients? J Alzheimers Dis Rep 2021; 5:389-394. [PMID: 34189410 PMCID: PMC8203282 DOI: 10.3233/adr-210007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We sought to determine whether skin conductance level could warn of outbursts of combative behavior in dementia patients by using a wristband device. Two outbursts were captured and are reported here. Although no physiologic parameter measured by the wristband gave advance warning, there is a common pattern of parasympathetic withdrawal (increased heart rate) followed approximately 30 seconds later by sympathetic activation (increased skin conductance). In the literature, a similar pattern occurs in psychogenic non-epileptic seizures. We hypothesize that similar autonomic responses reflect similarities in pathophysiology and that physical activity may partially account for the time course of skin conductance.
Collapse
Affiliation(s)
- Curtis K Deutsch
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Pooja P Patnaik
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Frank A Greco
- VA Bedford Healthcare System, Medical Research Service, Bedford, MA, USA
| |
Collapse
|