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Latorre A, Rocchi L, Paparella G, Manzo N, Bhatia KP, Rothwell JC. Changes in cerebellar output abnormally modulate cortical myoclonus sensorimotor hyperexcitability. Brain 2024; 147:1412-1422. [PMID: 37956080 PMCID: PMC10994547 DOI: 10.1093/brain/awad384] [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: 03/20/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Cortical myoclonus is produced by abnormal neuronal discharges within the sensorimotor cortex, as demonstrated by electrophysiology. Our hypothesis is that the loss of cerebellar inhibitory control over the motor cortex, via cerebello-thalamo-cortical connections, could induce the increased sensorimotor cortical excitability that eventually causes cortical myoclonus. To explore this hypothesis, in the present study we applied anodal transcranial direct current stimulation over the cerebellum of patients affected by cortical myoclonus and healthy controls and assessed its effect on sensorimotor cortex excitability. We expected that anodal cerebellar transcranial direct current stimulation would increase the inhibitory cerebellar drive to the motor cortex and therefore reduce the sensorimotor cortex hyperexcitability observed in cortical myoclonus. Ten patients affected by cortical myoclonus of various aetiology and 10 aged-matched healthy control subjects were included in the study. All participants underwent somatosensory evoked potentials, long-latency reflexes and short-interval intracortical inhibition recording at baseline and immediately after 20 min session of cerebellar anodal transcranial direct current stimulation. In patients, myoclonus was recorded by the means of surface EMG before and after the cerebellar stimulation. Anodal cerebellar transcranial direct current stimulation did not change the above variables in healthy controls, while it significantly increased the amplitude of somatosensory evoked potential cortical components, long-latency reflexes and decreased short-interval intracortical inhibition in patients; alongside, a trend towards worsening of the myoclonus after the cerebellar stimulation was observed. Interestingly, when dividing patients in those with and without giant somatosensory evoked potentials, the increment of the somatosensory evoked potential cortical components was observed mainly in those with giant potentials. Our data showed that anodal cerebellar transcranial direct current stimulation facilitates-and does not inhibit-sensorimotor cortex excitability in cortical myoclonus syndromes. This paradoxical response might be due to an abnormal homeostatic plasticity within the sensorimotor cortex, driven by dysfunctional cerebello-thalamo-cortical input to the motor cortex. We suggest that the cerebellum is implicated in the pathophysiology of cortical myoclonus and that these results could open the way to new forms of treatment or treatment targets.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari 09042, Italy
| | - Giulia Paparella
- Department of Neurology, IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Nicoletta Manzo
- Department of Neurology, IRCCS San Camillo Hospital, Venice 30126, Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
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Demura A, Demura Y, Sato K, Kinoshita M. Amplitude of Somatosensory Evoked Potentials (SEPs) Recorded in Short-Latency SEP Condition Is 80% of That in Giant SEP Condition. J Clin Neurophysiol 2024; 41:285-290. [PMID: 36173293 PMCID: PMC10898544 DOI: 10.1097/wnp.0000000000000966] [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] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Giant somatosensory evoked potentials (SEPs) with enhanced long-loop reflex (C-reflex) are useful to detect cortical motor hyperexcitability in patients with myoclonic epilepsy. The recording conditions of giant SEPs are different from those of short-latency SEPs (SSEPs). We investigated the waveform characteristics obtained for each condition. METHODS Forty-eight upper limbs of 24 adult normal subjects (12 men, age 35.5 ± 9.7 years [mean ± SD]) were investigated. Somatosensory evoked potentials of each subject were recorded in both conditions on the same day. The main differences in recording conditions were reference electrodes (SSEP: Fz vs. giant SEP: the earlobe electrode ipsilateral to the stimulated limb), stimulus rate (5 vs. 1 Hz), and bandpass filter (20 Hz-3 kHz vs. 1 Hz-1 kHz). Somatosensory evoked potentials were elicited by unilateral percutaneous electrical stimulation of the median nerve at the wrist with intensity of 110% of the movement threshold and recoded at C3'/C4'. RESULTS The amplitudes of N20 onset-N20 and N20-P25 were significantly larger in giant SEP condition than in SSEP condition ( p < 0.001). The mean + 3SD of N20-P25 amplitude was 10.0 μV in giant SEP condition and 7.8 μV in SSEP condition. The N20-P25 amplitude was significantly correlated between giant SEP condition and SSEP condition ( R = 0.64, p < 0.001). C-reflex was not elicited. CONCLUSIONS The amplitude of SEPs in SSEP condition is equivalent to 80% of that in giant SEP condition. The information is useful for detecting cortical hyperexcitability in various neurological disorders including myoclonic epilepsy.
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Affiliation(s)
- Ai Demura
- Sakurai Clinic, Otsu, Japan
- Department of Clinical Laboratory, National Hospital Organization Utano National Hospital, Kyoto, Japan
| | - Yutaka Demura
- Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan; and
| | - Kazuaki Sato
- Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
| | - Masako Kinoshita
- Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
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Sonoda Y, Fujita A, Torio M, Mukaino T, Sakata A, Matsukura M, Yonemoto K, Hatae K, Ichimiya Y, Chong PF, Ochiai M, Wada Y, Kadoya M, Okamoto N, Murakami Y, Suzuki T, Isobe N, Shigeto H, Matsumoto N, Sakai Y, Ohga S. Progressive myoclonic epilepsy as an expanding phenotype of NGLY1-associated congenital deglycosylation disorder: A case report and review of the literature. Eur J Med Genet 2024; 67:104895. [PMID: 38070824 DOI: 10.1016/j.ejmg.2023.104895] [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: 07/03/2023] [Revised: 11/25/2023] [Accepted: 12/03/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION NGLY1-associated congenital disorder of deglycosylation (CDDG1: OMIM #615273) is a rare autosomal recessive disorder caused by a functional impairment of endoplasmic reticulum in degradation of glycoproteins. Neurocognitive dysfunctions have been documented in patients with CDDG1; however, deteriorating phenotypes of affected individuals remain elusive. CASE PRESENTATION A Japanese boy with delayed psychomotor development showed ataxic movements from age 5 years and myoclonic seizures from age 12 years. Appetite loss, motor and cognitive decline became evident at age 12 years. Electrophysiological studies identified paroxysmal discharges on myoclonic seizure and a giant somatosensory evoked potential. Perampanel was effective for controlling myoclonic seizures. Exome sequencing revealed that the patient carried compound heterozygous variants in NGLY1, NM_018297.4: c.857G > A and c.-17_12del, which were inherited from mother and father, respectively. A literature review confirmed that myoclonic seizures were observed in 28.5% of patients with epilepsy. No other patients had progressive myoclonic epilepsy or cognitive decline in association with loss-of-function variations in NGLY1. CONCLUSION Our data provides evidence that a group of patients with CDDG1 manifest slowly progressive myoclonic epilepsy and cognitive decline during the long-term clinical course.
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Affiliation(s)
- Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Fujita
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Michiko Torio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiko Mukaino
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masaru Matsukura
- Department of Pediatrics, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Kousuke Yonemoto
- Department of Pediatrics, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Ken Hatae
- Department of Pediatrics, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Pin Fee Chong
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Wada
- Department of Obstetric Medicine, Osaka Women's and Children's Hospital, Osaka, Japan; Department of Molecular Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Machiko Kadoya
- Department of Molecular Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Nobuhiko Okamoto
- Department of Molecular Medicine, Osaka Women's and Children's Hospital, Osaka, Japan; Department of Medical Genetics, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yoshiko Murakami
- Research Institute for Microbial Diseases and WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Tadashi Suzuki
- Glycometabolic Biochemistry Laboratory, RIKEN Cluster for Pioneering Research, Saitama, Japan; Takeda-CiRA Joint Program (T-CiRA), Kanagawa, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Shigeto
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Medical Technology, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Latorre A, Belvisi D, Rothwell JC, Bhatia KP, Rocchi L. Rethinking the neurophysiological concept of cortical myoclonus. Clin Neurophysiol 2023; 156:125-139. [PMID: 37948946 DOI: 10.1016/j.clinph.2023.10.007] [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: 01/28/2023] [Revised: 09/04/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
Cortical myoclonus is thought to result from abnormal electrical discharges arising in the sensorimotor cortex. Given the ease of recording of cortical discharges, electrophysiological features of cortical myoclonus have been better characterized than those of subcortical forms, and electrophysiological criteria for cortical myoclonus have been proposed. These include the presence of giant somatosensory evoked potentials, enhanced long-latency reflexes, electroencephalographic discharges time-locked to individual myoclonic jerks and significant cortico-muscular connectivity. Other features that are assumed to support the cortical origin of myoclonus are short-duration electromyographic bursts, the presence of both positive and negative myoclonus and cranial-caudal progression of the jerks. While these criteria are widely used in clinical practice and research settings, their application can be difficult in practice and, as a result, they are fulfilled only by a minority of patients. In this review we reappraise the evidence that led to the definition of the electrophysiological criteria of cortical myoclonus, highlighting possible methodological incongruencies and misconceptions. We believe that, at present, the diagnostic accuracy of cortical myoclonus can be increased only by combining observations from multiple tests, according to their pathophysiological rationale; nevertheless, larger studies are needed to standardise the methods, to resolve methodological issues, to establish the diagnostic criteria sensitivity and specificity and to develop further methods that might be useful to clarify the pathophysiology of myoclonus.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom.
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Cuccurullo C, Striano P, Coppola A. Familial Adult Myoclonus Epilepsy: A Non-Coding Repeat Expansion Disorder of Cerebellar-Thalamic-Cortical Loop. Cells 2023; 12:1617. [PMID: 37371086 DOI: 10.3390/cells12121617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Familial adult myoclonus Epilepsy (FAME) is a non-coding repeat expansion disorder that has been reported under different acronyms and initially linked to four main loci: FAME1 (8q23.3-q24.1), FAME 2 (2p11.1-q12.1), FAME3 (5p15.31-p15.1), and FAME4 (3q26.32-3q28). To date, it is known that the genetic mechanism underlying FAME consists of the expansion of similar non-coding pentanucleotide repeats, TTTCA and TTTTA, in different genes. FAME is characterized by cortical tremor and myoclonus usually manifesting within the second decade of life, and infrequent seizures by the third or fourth decade. Cortical tremor is the core feature of FAME and is considered part of a spectrum of cortical myoclonus. Neurophysiological investigations as jerk-locked back averaging (JLBA) and corticomuscular coherence analysis, giant somatosensory evoked potentials (SEPs), and the presence of long-latency reflex I (or C reflex) at rest support cortical tremor as the result of the sensorimotor cortex hyperexcitability. Furthermore, the application of transcranial magnetic stimulation (TMS) protocols in FAME patients has recently shown that inhibitory circuits are also altered within the primary somatosensory cortex and the concomitant involvement of subcortical networks. Moreover, neuroimaging studies and postmortem autoptic studies indicate cerebellar alterations and abnormal functional connectivity between the cerebellum and cerebrum in FAME. Accordingly, the pathophysiological mechanism underlying FAME has been hypothesized to reside in decreased sensorimotor cortical inhibition through dysfunction of the cerebellar-thalamic-cortical loop, secondary to primary cerebellar pathology. In this context, the non-coding pentameric expansions have been proposed to cause cerebellar damage through an RNA-mediated toxicity mechanism. The elucidation of the underlying pathological mechanisms of FAME paves the way to novel therapeutic possibilities, such as RNA-targeting treatments, possibly applicable to other neurodegenerative non-coding disorders.
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Affiliation(s)
- Claudia Cuccurullo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16126 Genova, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy
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Alsallom F, Simon MV. Giant Somatosensory Evoked Potentials in Focal Epilepsy Secondary to Glioblastoma Multiforme. Neurohospitalist 2023; 13:202-203. [PMID: 37064925 PMCID: PMC10091443 DOI: 10.1177/19418744221133900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Faisal Alsallom
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mirela V. Simon
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Dubbioso R, Suppa A, Tijssen MAJ, Ikeda A. Familial adult myoclonus epilepsy: Neurophysiological investigations. Epilepsia 2023. [PMID: 36806000 DOI: 10.1111/epi.17553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/20/2023]
Abstract
Familial adult myoclonus epilepsy (FAME) also described as benign adult familial myoclonus epilepsy (BAFME) is a high-penetrant autosomal dominant condition featuring cortical myoclonus of varying frequency and occasional/rare convulsive seizures. In this update we provide a detailed overview of the main neurophysiological findings so far reported in patients with FAME/BAFME. After reviewing the diagnostic contribution of each neurophysiological technique, we discuss the possible mechanisms underlying cortical hyperexcitability and suggest the involvement of more complex circuits engaging cortical and subcortical structures, such as the cerebellum. We, thus, propose that FAME/BAFME clinical features should arise from an "abnormal neuronal network activity," where the cerebellum represents a possible common denominator. In the last part of the article, we suggest that future neurophysiological studies using more advanced transcranial magnetic stimulation (TMS) protocols could be used to evaluate the functional connectivity between the cerebellum and cortical structures. Finally, non-invasive brain stimulation techniques such as repetitive TMS or transcranial direct current stimulation could be assessed as potential therapeutic tools to ameliorate cortical excitability.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Napoli, Italy
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology Kyoto University Graduate School of Medicine Shogoin, Kyoto, Japan
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Peláez-Cruz R, Díaz-Baamonde A, Téllez MJ, Urriza J, Ghatan S, Ulkatan S. Unexpected median SEPs fluctuations during brain cavernous malformation resection with no post-operative deficit. J Clin Monit Comput 2023; 37:37-43. [PMID: 35357618 DOI: 10.1007/s10877-022-00852-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: 10/08/2021] [Accepted: 03/21/2022] [Indexed: 01/24/2023]
Abstract
Median nerve somatosensory evoked potentials (SEPs) may present changes during cavernous malformation (CM) resection unrelated to new post-operative sensory deficits. We performed intraoperative neurophysiological monitoring of median SEPs (m-SEPs) in three patients who underwent CM resection (surgery) near the sensory-motor cortex. The only preoperative clinical manifestations in all patients were seizures. All patients presented m-SEPs alterations on the side of the lesion during the procedure. Two patients presented permanent changes in the cortical potentials. In the third patient, the cortical and subcortical components suffered temporal fluctuations to return to baselines at the end of the surgery. None of these patients developed new post-operative clinical deficits. During brain cavernous malformation resection, significant fluctuations in the amplitude of different components of m-SEPs may occur. These changes may be due to excitability variations on m-SEP generators and do not translate into new post-operative neurological deficits.
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Affiliation(s)
- Roberto Peláez-Cruz
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, 1000, 10th Avenue, Suite 2B30, New York, NY, 10019, USA.
| | - Alba Díaz-Baamonde
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, 1000, 10th Avenue, Suite 2B30, New York, NY, 10019, USA
| | - Maria J Téllez
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, 1000, 10th Avenue, Suite 2B30, New York, NY, 10019, USA
| | - Javier Urriza
- Department of Clinical Neurophysiology, Complejo Hospitalario de Navarra, C/de Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Saadi Ghatan
- Department of Neurosurgery, Mount Sinai West and Mount Sinai Morningside, Pediatric Neurosurgery, Mount Sinai Health System, Mount Sinai West Hospital, 1000, 10th Avenue, New York, NY, USA
| | - Sedat Ulkatan
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, 1000, 10th Avenue, Suite 2B30, New York, NY, 10019, USA
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Significance and clinical suggestions for the somatosensory evoked potentials increased in amplitude revealed by a large sample of neurological patients. Neurol Sci 2022; 43:5553-5562. [DOI: 10.1007/s10072-022-06236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
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10
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Cavaliere S, Lori S, Bastianelli M, Cossu C, Gabbanini S, Dani C, Bertini G. Unilateral Transient Enhanced SEP during Integrated Multiparameter Neurophysiological Monitoring in a Newborn with Symptomatic Seizure. Pediatr Rep 2022; 14:254-261. [PMID: 35736655 PMCID: PMC9230835 DOI: 10.3390/pediatric14020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
During Integrated Multiparametric Neurophysiological Monitoring (IMNA), a newborn with suspected hypoxia at birth and microhaemorrhagic and ischaemic lesions presented some clonic-tonic episodes with specific EEG patterns characterized by rolandic and temporal spikes and the appearance of a unilateral enhanced Somatosensory Evoked Potential (SEP) (10.45 µv). Since the literature does not seem to describe cases of giant SEP in newborns, in this case report, we will discuss the hypotheses underlying this potential. It could be assumed that the ischaemic and haemorrhagic lesions presented by the newborn may have developed as a result of neurotransmitter balance failure. This may be the origin of the EEG picture, which, consequently, could have triggered a potential with high amplitude.
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Affiliation(s)
- Sara Cavaliere
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50134 Florence, Italy; (S.C.); (C.D.)
| | - Silvia Lori
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Maria Bastianelli
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Cesarina Cossu
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Simonetta Gabbanini
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50134 Florence, Italy; (S.C.); (C.D.)
| | - Giovanna Bertini
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50134 Florence, Italy; (S.C.); (C.D.)
- Correspondence:
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Suresh H, Mithani K, Brar K, Yan H, Strantzas S, Vandenberk M, Sharma R, Yau I, Go C, Pang E, Kerr E, Ochi A, Otsubo H, Jain P, Donner E, Snead OC, Ibrahim GM. Brainstem Associated Somatosensory Evoked Potentials and Response to Vagus Nerve Stimulation: An Investigation of the Vagus Afferent Network. Front Neurol 2022; 12:768539. [PMID: 35250790 PMCID: PMC8895499 DOI: 10.3389/fneur.2021.768539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/22/2021] [Indexed: 12/05/2022] Open
Abstract
Despite decades of clinical usage, selection of patients with drug resistant epilepsy who are most likely to benefit from vagus nerve stimulation (VNS) remains a challenge. The mechanism of action of VNS is dependent upon afferent brainstem circuitry, which comprises a critical component of the Vagus Afferent Network (VagAN). To evaluate the association between brainstem afferent circuitry and seizure response, we retrospectively collected intraoperative data from sub-cortical recordings of somatosensory evoked potentials (SSEP) in 7 children with focal drug resistant epilepsy who had failed epilepsy surgery and subsequently underwent VNS. Using multivariate linear regression, we demonstrate a robust negative association between SSEP amplitude (p < 0.01), and seizure reduction. There was no association between SSEP latency and seizure outcomes. Our findings provide novel insights into the mechanism of VNS and inform our understanding of the importance of brainstem afferent circuitry within the VagAN for seizure responsiveness following VNS.
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Affiliation(s)
- Hrishikesh Suresh
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Karim Mithani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Karanbir Brar
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Han Yan
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Samuel Strantzas
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mike Vandenberk
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Roy Sharma
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ivanna Yau
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christina Go
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pang
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Kerr
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Puneet Jain
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Donner
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - O. Carter Snead
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - George M. Ibrahim
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- *Correspondence: George M. Ibrahim
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12
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Dubbioso R, Striano P, Tomasevic L, Bilo L, Esposito M, Manganelli F, Coppola A. OUP accepted manuscript. Brain Commun 2022; 4:fcac037. [PMID: 35233526 PMCID: PMC8882005 DOI: 10.1093/braincomms/fcac037] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/26/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Familial adult myoclonic epilepsy type 2 is a hereditary condition characterized by cortical tremor, myoclonus and epilepsy. It belongs to the spectrum of cortical myoclonus and the sensorimotor cortex hyperexcitability represents an important pathogenic mechanism underlying this condition. Besides pericentral cortical structures, the impairment of subcortical networks seems also to play a pathogenetic role, mainly via the thalamo-cortical pathway. However, the mechanisms underlying cortical–subcortical circuits dysfunction, as well as their impact on clinical manifestations, are still unknown. Therefore, the main aims of our study were to systematically study with an extensive electrophysiological battery, the cortical sensorimotor, as well as thalamo-cortical networks in genetically confirmed familial adult myoclonic epilepsy patients and to establish reliable neurophysiological biomarkers for the diagnosis. In 26 familial myoclonic epilepsy subjects, harbouring the intronic ATTTC repeat expansion in the StAR-related lipid transfer domain-containing 7 gene, 17 juvenile myoclonic epilepsy patients and 22 healthy controls, we evaluated the facilitatory and inhibitory circuits within the primary motor cortex using single and paired-pulse transcranial magnetic stimulation paradigms. We also probed the excitability of the somatosensory, as well as the thalamo-somatosensory cortex connection by using ad hoc somatosensory evoked potential protocols. The sensitivity and specificity of transcranial magnetic stimulation and somatosensory evoked potential metrics were derived from receiver operating curve analysis. Familial adult myoclonic epilepsy patients displayed increased facilitation and decreased inhibition within the sensorimotor cortex compared with juvenile myoclonic epilepsy patients (all P < 0.05) and healthy controls (all P < 0.05). Somatosensory evoked potential protocols also displayed a significant reduction of early high-frequency oscillations and less inhibition at paired-pulse protocol, suggesting a concomitant failure of thalamo-somatosensory cortex circuits. Disease onset and duration and myoclonus severity did not correlate either with sensorimotor hyperexcitability or thalamo-cortical measures (all P > 0.05). Patients with a longer disease duration had more severe myoclonus (r = 0.467, P = 0.02) associated with a lower frequency (r = −0.607, P = 0.001) and higher power of tremor (r = 0.479, P = 0.02). Finally, familial adult myoclonic epilepsy was reliably diagnosed using transcranial magnetic stimulation, demonstrating its superiority as a diagnostic factor compared to somatosensory evoked potential measures. In conclusion, deficits of sensorimotor cortical and thalamo-cortical circuits are involved in the pathophysiology of familial adult myoclonic epilepsy even if these alterations are not associated with clinical severity. Transcranial magnetic stimulation-based measurements display an overall higher accuracy than somatosensory evoked potential parameters to reliably distinguish familial adult myoclonic epilepsy from juvenile myoclonic epilepsy and healthy controls.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
- Correspondence may also be addressed to: Dubbioso Raffaele MD PhD Department of Neurosciences Reproductive Sciences and Odontostomatology University Federico II of Napoli Via Sergio Pansini, 5. 80131 Napoli, Italy E-mail:
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Correspondence to: Striano Pasquale, MD, PhD Department of Neurosciences Rehabilitation, Ophthalmology, Genetics Maternal and Child Health (DiNOGMI) University of Genoa, Via Gaslini 5 padiglione 16, I piano, 16148 Genova, Italy E-mail: ;
| | - Leo Tomasevic
- Danish Research Centre for Magnetic Resonance (DRCMR), Copenhagen University, Kobenhavn, Denmark
| | - Leonilda Bilo
- Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
| | | | - Fiore Manganelli
- Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
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13
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Matsubara T, Ahlfors SP, Mima T, Hagiwara K, Shigeto H, Tobimatsu S, Goto Y, Stufflebeam S. Bilateral Representation of Sensorimotor Responses in Benign Adult Familial Myoclonus Epilepsy: An MEG Study. Front Neurol 2021; 12:759866. [PMID: 34764933 PMCID: PMC8577121 DOI: 10.3389/fneur.2021.759866] [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] [Received: 08/17/2021] [Accepted: 09/21/2021] [Indexed: 12/03/2022] Open
Abstract
Patients with cortical reflex myoclonus manifest typical neurophysiologic characteristics due to primary sensorimotor cortex (S1/M1) hyperexcitability, namely, contralateral giant somatosensory-evoked potentials/fields and a C-reflex (CR) in the stimulated arm. Some patients show a CR in both arms in response to unilateral stimulation, with about 10-ms delay in the non-stimulated compared with the stimulated arm. This bilateral C-reflex (BCR) may reflect strong involvement of bilateral S1/M1. However, the significance and exact pathophysiology of BCR within 50 ms are yet to be established because it is difficult to identify a true ipsilateral response in the presence of the giant component in the contralateral hemisphere. We hypothesized that in patients with BCR, bilateral S1/M1 activity will be detected using MEG source localization and interhemispheric connectivity will be stronger than in healthy controls (HCs) between S1/M1 cortices. We recruited five patients with cortical reflex myoclonus with BCR and 15 HCs. All patients had benign adult familial myoclonus epilepsy. The median nerve was electrically stimulated unilaterally. Ipsilateral activity was investigated in functional regions of interest that were determined by the N20m response to contralateral stimulation. Functional connectivity was investigated using weighted phase-lag index (wPLI) in the time-frequency window of 30–50 ms and 30–100 Hz. Among seven of the 10 arms of the patients who showed BCR, the average onset-to-onset delay between the stimulated and the non-stimulated arm was 8.4 ms. Ipsilateral S1/M1 activity was prominent in patients. The average time difference between bilateral cortical activities was 9.4 ms. The average wPLI was significantly higher in the patients compared with HCs in specific cortico-cortical connections. These connections included precentral-precentral, postcentral-precentral, inferior parietal (IP)-precentral, and IP-postcentral cortices interhemispherically (contralateral region-ipsilateral region), and precentral-IP and postcentral-IP intrahemispherically (contralateral region-contralateral region). The ipsilateral response in patients with BCR may be a pathologically enhanced motor response homologous to the giant component, which was too weak to be reliably detected in HCs. Bilateral representation of sensorimotor responses is associated with disinhibition of the transcallosal inhibitory pathway within homologous motor cortices, which is mediated by the IP. IP may play a role in suppressing the inappropriate movements seen in cortical myoclonus.
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Affiliation(s)
- Teppei Matsubara
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.,International University of Health and Welfare, Otawara, Japan
| | - Seppo P Ahlfors
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Tatsuya Mima
- Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Koichi Hagiwara
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Hiroshi Shigeto
- Division of Medical Technology, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shozo Tobimatsu
- Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Yoshinobu Goto
- Department of Physiology, School of Medicine, International University of Health and Welfare, Okawa, Japan
| | - Steven Stufflebeam
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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14
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Tojima M, Hitomi T, Matsuhashi M, Neshige S, Usami K, Oi K, Kobayashi K, Takeyama H, Shimotake A, Takahashi R, Ikeda A. A Biomarker for Benign Adult Familial Myoclonus Epilepsy: High-Frequency Activities in Giant Somatosensory Evoked Potentials. Mov Disord 2021; 36:2335-2345. [PMID: 34050549 DOI: 10.1002/mds.28666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/03/2021] [Accepted: 05/05/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Benign adult familial myoclonus epilepsy (BAFME) is one of the diseases that cause cortical myoclonus (CM) with giant somatosensory evoked potentials (SEPs). There are no useful diagnostic biomarkers differentiating BAFME from other CM diseases. OBJECTIVE To establish reliable biomarkers including high-frequency oscillations (HFOs) with giant SEPs for the diagnosis of BAFME. METHODS This retrospective case study included 49 consecutive CM patients (16 BAFME and 33 other CM patients) who exhibited giant P25 or N35 SEPs. SEPs were processed by a band-pass filter of 400-1000 Hz to analyze HFOs. Clinical and SEP findings were compared between (1) BAFME and other CM groups and (2) patients with presence and absence of P25-HFOs (HFOs superimposed on giant P25). The diagnostic power of each factor for BAFME was calculated. RESULTS All 16 BAFME patients showed SEP P25-HFOs with significantly higher occurrence (P < 0.0001) compared with that of other CM groups. The presence of P25-HFOs significantly correlated with a BAFME diagnosis (P < 0.0001) and high SEP P25 and N35 amplitudes (P = 0.01 and P < 0.0001, respectively). BAFME was reliably diagnosed using P25-HFOs with high sensitivity (100%), specificity (87.9%), positive predictive value (80%), and negative predictive value (100%), demonstrating its superiority as a diagnostic factor compared to other factors. CONCLUSIONS P25-HFOs with giant SEPs is a potential biomarker for BAFME diagnosis. P25-HFOs may reflect cortical hyperexcitability partly due to paroxysmal depolarizing shifts in epileptic neuronal activities and higher degrees of rhythmic tremulousness than those in ordinary CM. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Maya Tojima
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takefumi Hitomi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichiro Neshige
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kiyohide Usami
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuki Oi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirofumi Takeyama
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Shimotake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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15
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Roman-Pognuz E, Elmer J, Guyette FX, Poillucci G, Lucangelo U, Berlot G, Manganotti P, Peratoner A, Pellis T, Taccone F, Callaway C. Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C. J Clin Med 2021; 10:jcm10061331. [PMID: 33807041 PMCID: PMC8005130 DOI: 10.3390/jcm10061331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Early prediction of long-term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivity, somatosensory evoked potentials (SSEPs) cortical complex and Gray to White matter ratio (GWR) on brain computed tomography (CT) at different temperatures could predict survival and good outcome at hospital discharge and six months after the event. Methods: We performed a retrospective cohort study including consecutive adult, non-traumatic patients resuscitated from out-of-hospital CA who remained comatose on admission to our intensive care unit from 2013 to 2017. We acquired SSEPs and EEGs during the treatment at 36 °C and after rewarming at 37 °C, Gray to white matter ratio (GWR) was calculated on the brain computed tomography scan performed within six hours of the hospital admission. We primarily hypothesized that SSEP was associated with favor-able functional outcome at distance and secondarily that SSEP provides independent information from EEG and CT. Outcomes were evaluated using the Cerebral Performance Category (CPC) scale at six months from discharge. Results: Of 171 resuscitated patients, 75 were excluded due to missing data or uninterpretable neurophysiological findings. EEG reactivity at 37 °C has been shown the best single predictor of good out-come (AUC 0.803) while N20P25 was the best single predictor for survival at each time point. (AUC 0.775 at discharge and AUC 0.747 at six months follow up). The predictive value of a model including EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior (AUC 0.841 for survival and 0.920 for good out-come) to any combination of two tests or any single test. Conclusions: Our study, in which life-sustaining treatments were never suspended, suggests SSEP cortical complex N20P25, after normothermia and off sedation, is a reliable predictor for survival at any time. When SSEP cortical complex N20P25 is added into a model with GWR average and EEG reactivity, the predictivity for good outcome and survival at distance is superior than each single test alone.
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Affiliation(s)
- Erik Roman-Pognuz
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy; (U.L.); (G.B.); (A.P.)
- Correspondence: ; Tel.: +39-3394879119
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.E.); (F.X.G.); (C.C.)
| | - Frank X. Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.E.); (F.X.G.); (C.C.)
| | - Gabriele Poillucci
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina, 34128 Trieste, Italy;
| | - Umberto Lucangelo
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy; (U.L.); (G.B.); (A.P.)
| | - Giorgio Berlot
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy; (U.L.); (G.B.); (A.P.)
| | - Paolo Manganotti
- Department of Neurology, University of Trieste, 34100 Trieste, Italy;
| | - Alberto Peratoner
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Strada di Fiume 447, 34100 Trieste, Italy; (U.L.); (G.B.); (A.P.)
| | - Tommaso Pellis
- Department of Intensive Care, Azienda Sanitaria Friuli Occidentale Tommaso, 33170 Pordenone, Italy;
| | - Fabio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Bruxelles, Belgium;
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.E.); (F.X.G.); (C.C.)
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16
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Awake state-specific suppression of primary somatosensory evoked response correlated with duration of temporal lobe epilepsy. Sci Rep 2020; 10:15895. [PMID: 32985579 PMCID: PMC7523010 DOI: 10.1038/s41598-020-73051-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/10/2020] [Indexed: 11/08/2022] Open
Abstract
Epilepsy is a network disease. The primary somatosensory cortex (S1) is usually considered to be intact, but could be subclinically disturbed based on abnormal functional connectivity in patients with temporal lobe epilepsy (TLE). We aimed to investigate if the S1 of TLE is abnormally modulated. Somatosensory evoked magnetic fields (SEFs) evoked by median nerve stimulation were recorded in each hemisphere of 15 TLE patients and 28 normal subjects. All responses were separately averaged in the awake state and light sleep using background magnetoencephalography. Latency and strength of the equivalent current dipole (ECD) was compared between the groups for the first (M1) and second peaks. Latencies showed no significant differences between the groups in either wakefulness or light sleep. ECD strengths were significantly lower in TLE patients than in controls only during wakefulness. The reduction of M1 ECD strength in the awake state is significantly correlated with duration of epilepsy. SEFs of TLE patients showed pure ECD strength reduction without latency delay. The phenomenon occurred exclusively during wakefulness, suggesting that a wakefulness-specific modulator of S1 is abnormal in TLE. Repetitive seizures may gradually insult the modulator of S1 distant from the epileptogenic network.
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17
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Mure H, Toyoda N, Morigaki R, Fujita K, Takagi Y. Clinical Outcome and Intraoperative Neurophysiology of the Lance-Adams Syndrome Treated with Bilateral Deep Brain Stimulation of the Globus Pallidus Internus: A Case Report and Review of the Literature. Stereotact Funct Neurosurg 2020; 98:399-403. [PMID: 32894852 DOI: 10.1159/000509318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Lance-Adams syndrome (LAS) is a myoclonus syndrome caused by hypoxic-ischemic encephalopathy. LAS cases could be refractory to first-line medications, and the neuronal mechanism underlying LAS pathology remains unknown. OBJECTIVES To describe a patient with LAS who underwent bilateral globus pallidus internus (GPi) stimulation and discuss the pathophysiology of LAS with intraoperative electrophysiological findings. PATIENTS A 79-year-old woman presented with a history of cardiopulmonary arrest due to internal carotid artery rupture following carotid endarterectomy after successful cardiopulmonary resuscitation. However, within 1 month, the patient developed sensory stimulation-induced myoclonus in her face and extremities. Because her myoclonic symptoms were refractory to pharmacotherapy, deep brain stimulation of the GPi was performed 1 year after the hypoxic attack. RESULTS Continuous bilateral GPi stimulation with optimal parameter settings remarkably improved the patient's myoclonic symptoms. At the 2-year follow-up, her Unified Myoclonus Rating Scale score decreased from 90 to 24. In addition, we observed burst firing and interburst pause patterns on intraoperative microelectrode recordings of the bilateral GPi and stimulated this area as the therapeutic target. CONCLUSION Our results show that impairment in the basal ganglion circuitry might be involved in the pathogenesis of myoclonus in patients with LAS.
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Affiliation(s)
- Hideo Mure
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan, .,Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima, Japan,
| | - Naoto Toyoda
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima, Japan.,Department of Advanced Brain Research, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Koji Fujita
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima, Japan.,Department of Clinical Neuroscience, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Department of Advanced Brain Research, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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18
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Diagnosis and Management of Type 1 Sialidosis: Clinical Insights from Long-Term Care of Four Unrelated Patients. Brain Sci 2020; 10:brainsci10080506. [PMID: 32752208 PMCID: PMC7465165 DOI: 10.3390/brainsci10080506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Sialidosis is a rare autosomal recessive disease caused by NEU1 mutations, leading to neuraminidase deficiency and accumulation of sialic acid-containing oligosaccharides and glycopeptides into the tissues. Sialidosis is divided into two clinical entities, depending on residual enzyme activity, and can be distinguished according to age of onset, clinical features, and progression. Type 1 sialidosis is the milder, late-onset form, also known as non-dysmorphic sialidosis. It is commonly characterized by progressive myoclonus, ataxia, and a macular cherry-red spot. As a rare condition, the diagnosis is often only made after few years from onset, and the clinical management might prove difficult. Furthermore, the information in the literature on the long-term course is scarce. Case presentations: We describe a comprehensive clinical, neuroradiological, ophthalmological, and electrophysiological history of four unrelated patients affected by type 1 sialidosis. The long-term care and novel clinical and neuroradiological insights are discussed. Discussion and conclusions: We report the longest follow-up (up to 30 years) ever described in patients with type 1 sialidosis. During the course, we observed a high degree of motor and speech disability with preserved cognitive functions. Among the newest antiseizure medication, perampanel (PER) was proven to be effective in controlling myoclonus and tonic–clonic seizures, confirming it is a valid therapeutic option for these patients. Brain magnetic resonance imaging (MRI) disclosed new findings, including bilateral gliosis of cerebellar folia and of the occipital white matter. In addition, a newly reported variant (c.914G > A) is described.
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19
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Horlings CGC, Kofler M, Hotter A, Reiter E, Wanschitz JV, Löscher WN. The clinical meaning of giant somatosensory evoked potentials of the median nerve. Clin Neurophysiol 2020; 131:1495-1496. [PMID: 32388474 DOI: 10.1016/j.clinph.2020.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Markus Kofler
- Department of Neurology, Medical University Innsbruck, Austria; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Anna Hotter
- Department of Neurology, Medical University Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University Innsbruck, Austria
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20
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Assenza G, Lanzone J, Dubbioso R, Coppola A, Boscarino M, Ricci L, Insola A, Bilo L, Tombini M, Di Lazzaro V. Thalamic and cortical hyperexcitability in juvenile myoclonic epilepsy. Clin Neurophysiol 2020; 131:2041-2046. [PMID: 32487476 DOI: 10.1016/j.clinph.2020.04.164] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Juvenile myoclonic epilepsy (JME) is a genetic generalized epilepsy marked by cortical hyperexcitability. Recent neuroimaging data suggested also a thalamic role in sustaining epileptic propensity in JME. However, thalamic hyperexcitability was not demonstrated so far. Low-frequency (LF-SEPs) and high-frequency somatosensory evoked potentials (HF-SEPs) are very sensitive to thalamic (early HF-SEPs burst, eHFO) and cortical (late HF-SEPs burst, lHFO) excitability. The aim of our experiment was to explore and discern the role of thalamic and cortical excitability in epileptic susceptibility of JME through a LF-SEPs and HF-SEPs study. METHODS Twenty-three subjects with JME (11 females, 30.2 ± 9.8-year-old) and 23 healthy control subjects (12 females, age: 34.7 ± 7.7-year-old) underwent right median LF-SEPs scalp recordings. Cp3'-Fz traces were filtered (400-800 Hz) to reveal HF-SEPs. All JME patients were on drug treatment and seizure free, except for sporadic myoclonus. RESULTS N20 LF-SEPs amplitude (p < 0.009), areas of totHFO, eHFO and lHFO (all p < 0.005) and totHFO duration (p = 0.013) were increased in JME respect to healthy subjects. totHFO area was negatively correlated with the number of antiepileptic drugs (rho = -0.505, sig.: 0.027), while eHFO area was positively correlated with the myoclonus frequency (rho = 0.555, sig = 0.014). CONCLUSIONS We demonstrated that in JME the thalamic hyperexcitability assists the cortical one in sustaining epileptic susceptibility. SIGNIFICANCE Our results support the concept of JME as a network and genetic disorder.
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Affiliation(s)
- Giovanni Assenza
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Jacopo Lanzone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Napoli, Italy
| | - Antonietta Coppola
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Napoli, Italy
| | - Marilisa Boscarino
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Lorenzo Ricci
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Angelo Insola
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Leonilda Bilo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Napoli, Italy
| | - Mario Tombini
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
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De Novo Truncating Variants in the Last Exon of SEMA6B Cause Progressive Myoclonic Epilepsy. Am J Hum Genet 2020; 106:549-558. [PMID: 32169168 DOI: 10.1016/j.ajhg.2020.02.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/19/2020] [Indexed: 12/22/2022] Open
Abstract
De novo variants (DNVs) cause many genetic diseases. When DNVs are examined in the whole coding regions of genes in next-generation sequencing analyses, pathogenic DNVs often cluster in a specific region. One such region is the last exon and the last 50 bp of the penultimate exon, where truncating DNVs cause escape from nonsense-mediated mRNA decay [NMD(-) region]. Such variants can have dominant-negative or gain-of-function effects. Here, we first developed a resource of rates of truncating DNVs in NMD(-) regions under the null model of DNVs. Utilizing this resource, we performed enrichment analysis of truncating DNVs in NMD(-) regions in 346 developmental and epileptic encephalopathy (DEE) trios. We observed statistically significant enrichment of truncating DNVs in semaphorin 6B (SEMA6B) (p value: 2.8 × 10-8; exome-wide threshold: 2.5 × 10-6). The initial analysis of the 346 individuals and additional screening of 1,406 and 4,293 independent individuals affected by DEE and developmental disorders collectively identified four truncating DNVs in the SEMA6B NMD(-) region in five individuals who came from unrelated families (p value: 1.9 × 10-13) and consistently showed progressive myoclonic epilepsy. RNA analysis of lymphoblastoid cells established from an affected individual showed that the mutant allele escaped NMD, indicating stable production of the truncated protein. Importantly, heterozygous truncating variants in the NMD(+) region of SEMA6B are observed in general populations, and SEMA6B is most likely loss-of-function tolerant. Zebrafish expressing truncating variants in the NMD(-) region of SEMA6B orthologs displayed defective development of brain neurons and enhanced pentylenetetrazole-induced seizure behavior. In summary, we show that truncating DNVs in the final exon of SEMA6B cause progressive myoclonic epilepsy.
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Ionotropic Glutamate Receptors in Epilepsy: A Review Focusing on AMPA and NMDA Receptors. Biomolecules 2020; 10:biom10030464. [PMID: 32197322 PMCID: PMC7175173 DOI: 10.3390/biom10030464] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/22/2022] Open
Abstract
It is widely accepted that glutamate-mediated neuronal hyperexcitation plays a causative role in eliciting seizures. Among glutamate receptors, the roles of N-methyl-D-aspartate (NMDA) and α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptors in physiological and pathological conditions represent major clinical research targets. It is well known that agonists of NMDA or AMPA receptors can elicit seizures in animal or human subjects, while antagonists have been shown to inhibit seizures in animal models, suggesting a potential role for NMDA and AMPA receptor antagonists in anti-seizure drug development. Several such drugs have been evaluated in clinical studies; however, the majority, mainly NMDA-receptor antagonists, failed to demonstrate adequate efficacy and safety for therapeutic use, and only an AMPA-receptor antagonist, perampanel, has been approved for the treatment of some forms of epilepsy. These results suggest that a misunderstanding of the role of each glutamate receptor in the ictogenic process may underlie the failure of these drugs to demonstrate clinical efficacy and safety. Accumulating knowledge of both NMDA and AMPA receptors, including pathological gene mutations, roles in autoimmune epilepsy, and evidence from drug-discovery research and pharmacological studies, may provide valuable information enabling the roles of both receptors in ictogenesis to be reconsidered. This review aimed to integrate information from several studies in order to further elucidate the specific roles of NMDA and AMPA receptors in epilepsy.
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Kızıltan ME, Yeni SN, Aliş C, Gündüz A. Recovery function of somatosensory evoked potentials in juvenile myoclonic epilepsy*. Somatosens Mot Res 2019; 36:195-201. [DOI: 10.1080/08990220.2019.1644999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Meral E. Kızıltan
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C., Istanbul, Turkey
| | - S. Naz Yeni
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C., Istanbul, Turkey
| | - Ceren Aliş
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C., Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C., Istanbul, Turkey
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24
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Oi K, Neshige S, Hitomi T, Kobayashi K, Tojima M, Matsuhashi M, Shimotake A, Fujii D, Matsumoto R, Kasama S, Kanda M, Wada Y, Maruyama H, Takahashi R, Ikeda A. Low-dose perampanel improves refractory cortical myoclonus by the dispersed and suppressed paroxysmal depolarization shifts in the sensorimotor cortex. Clin Neurophysiol 2019; 130:1804-1812. [PMID: 31401489 DOI: 10.1016/j.clinph.2019.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/31/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To elucidate the effects of perampanel (PER) on refractory cortical myoclonus for dose, etiology and somatosensory-evoked potential (SEP) findings. METHODS We examined 18 epilepsy patients with seizure and cortical myoclonus. Based on data accumulated before and after PER treatment, correlations among clinical scores in myoclonus and activities of daily life (ADL); early cortical components of SEP; and PER blood concentration, were analyzed. RESULTS PER (mean dose: 3.2 ± 2.1 mg/day) significantly improved seizures, myoclonus and ADL and significantly decreased the amplitude of and prolonged latency of giant SEP components. The degree of P25 and N33 prolongations (23.8 ± 1.6 to 24.7 ± 1.7 ms and 32.1 ± 4.0 to 33.7 ± 3.4 ms) were significantly correlated with improved ADL score (p = 0.019 and p = 0.025) and blood PER concentration (p = 0.011 and p = 0.025), respectively. CONCLUSIONS Low-dose PER markedly improved myoclonus and ADL in patients with refractory cortical myoclonus. Our results suggest that SEP, particularly P25 latency, can be used as a potential biomarker for assessing the objective effects of PER on intractable cortical myoclonus. SIGNIFICANCE In this study, PER lessened the degree of synchronized discharges in the postsynaptic neurons in the primary motor cortex.
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Affiliation(s)
- Kazuki Oi
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Shuichiro Neshige
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan; Department of Futaba Emergency General Medicine Supportive Center, Fukushima Medical University, Japan
| | - Takefumi Hitomi
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Department of Laboratory Medicine, Kyoto University Graduate School of Medicine, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Maya Tojima
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Japan
| | - Akihiro Shimotake
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Japan
| | - Daiki Fujii
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Department of Neurology, Kurashiki Central Hospital, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Department of Neurology, Kobe University Graduate School of Medicine, Japan
| | - Shuhei Kasama
- Department of Neurology, Hyogo College of Medicine, Japan
| | | | - Yoshiaki Wada
- Department of Rehabilitation, Nissan Tamagawa Hospital, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Japan.
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25
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Pathophysiology of corticobasal degeneration: Insights from neurophysiological studies. J Clin Neurosci 2019; 60:17-23. [DOI: 10.1016/j.jocn.2018.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 10/05/2018] [Indexed: 11/20/2022]
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26
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Zutt R, Elting JW, van Zijl JC, van der Hoeven JH, Roosendaal CM, Gelauff JM, Peall KJ, Tijssen MAJ. Electrophysiologic testing aids diagnosis and subtyping of myoclonus. Neurology 2018; 90:e647-e657. [PMID: 29352095 PMCID: PMC5818165 DOI: 10.1212/wnl.0000000000004996] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/20/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the contribution of electrophysiologic testing in the diagnosis and anatomical classification of myoclonus. METHODS Participants with a clinical diagnosis of myoclonus were prospectively recruited, each undergoing a videotaped clinical examination and battery of electrophysiologic tests. The diagnosis of myoclonus and its subtype was reviewed after 6 months in the context of the electrophysiologic findings and specialist review of the videotaped clinical examination. RESULTS Seventy-two patients with myoclonus were recruited. Initial clinical anatomical classification included 25 patients with cortical myoclonus, 7 with subcortical myoclonus, 2 with spinal myoclonus, and 15 with functional myoclonic jerks. In 23 cases, clinical anatomical classification was not possible because of the complexity of the movement disorder. Electrophysiologic testing was completed in 66, with agreement of myoclonus in 60 (91%) and its subtype in 28 (47%) cases. Subsequent clinical review by a movement disorder specialist agreed with the electrophysiologic findings in 52 of 60; in the remaining 8, electrophysiologic testing was inconclusive. CONCLUSIONS Electrophysiologic testing is an important additional tool in the diagnosis and anatomical classification of myoclonus, also aiding in decision-making regarding therapeutic management. Further development of testing criteria is necessary to optimize its use in clinical practice.
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Affiliation(s)
- Rodi Zutt
- From the Department of Neurology (R.Z., J.W.E., J.C.v.Z., J.H.v.d.H., C.M.R., J.M.G., M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands; and Neuroscience and Mental Health Research Institute (K.J.P.), Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Jan W Elting
- From the Department of Neurology (R.Z., J.W.E., J.C.v.Z., J.H.v.d.H., C.M.R., J.M.G., M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands; and Neuroscience and Mental Health Research Institute (K.J.P.), Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Jonathan C van Zijl
- From the Department of Neurology (R.Z., J.W.E., J.C.v.Z., J.H.v.d.H., C.M.R., J.M.G., M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands; and Neuroscience and Mental Health Research Institute (K.J.P.), Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - J Han van der Hoeven
- From the Department of Neurology (R.Z., J.W.E., J.C.v.Z., J.H.v.d.H., C.M.R., J.M.G., M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands; and Neuroscience and Mental Health Research Institute (K.J.P.), Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Christiaan M Roosendaal
- From the Department of Neurology (R.Z., J.W.E., J.C.v.Z., J.H.v.d.H., C.M.R., J.M.G., M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands; and Neuroscience and Mental Health Research Institute (K.J.P.), Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Jeannette M Gelauff
- From the Department of Neurology (R.Z., J.W.E., J.C.v.Z., J.H.v.d.H., C.M.R., J.M.G., M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands; and Neuroscience and Mental Health Research Institute (K.J.P.), Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Kathryn J Peall
- From the Department of Neurology (R.Z., J.W.E., J.C.v.Z., J.H.v.d.H., C.M.R., J.M.G., M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands; and Neuroscience and Mental Health Research Institute (K.J.P.), Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Marina A J Tijssen
- From the Department of Neurology (R.Z., J.W.E., J.C.v.Z., J.H.v.d.H., C.M.R., J.M.G., M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands; and Neuroscience and Mental Health Research Institute (K.J.P.), Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK.
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27
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Huang Z, Zhan S, Chen C, Li N, Ding Y, Hou Y, Wang L, Wang Y. The Effect of Insomnia on Cortical Excitability in Patients With Generalized Anxiety Disorder. Front Psychiatry 2018; 9:755. [PMID: 30687140 PMCID: PMC6335338 DOI: 10.3389/fpsyt.2018.00755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/20/2018] [Indexed: 12/16/2022] Open
Abstract
The high rate of comorbidity between insomnia and anxiety disorders have been confirmed by previous studies. However, the underlying neurobiological correlates of the relationship between insomnia and anxiety disorders are largely unknown. The aim of the present study was to investigate the effect of insomnia on cortical excitability in patients with generalized anxiety disorder (GAD) by examining the recovery functions of median nerve somatosensory evoked potentials (SEPs) in patients with GAD without insomnia and patients with GAD comorbid with insomnia. We studied the recovery functions of median nerve SEPs in 12 medication-naive patients with GAD without insomnia, 15 medication-naive patients with GAD comorbid with insomnia, and 15 age and sex matched healthy controls. SEPs in response to single stimulus and paired stimuli at interstimulus intervals (ISIs) of 20, 60, 100, and 150 ms were recorded. The recovery function of the P25 component showed significantly reduced suppression in patients with GAD without insomnia as compared to patients with GAD comorbid with insomnia and healthy controls. There were no significant differences in the recovery functions of median nerve SEPs between patients with GAD comorbid with insomnia and healthy controls. The present study suggested that the cortical excitability of right parietal cortex increased in patients with GAD without insomnia, and cortical excitability in patients with GAD comorbid with insomnia was modulated by insomnia. Our findings provide new insights into the underlying neurobiological correlates of the effects of insomnia on GAD, which could ultimately be used to inform clinical intervention.
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Affiliation(s)
- Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Shuqin Zhan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Chao Chen
- Key Laboratory of Complex System Control Theory and Application, Tianjin University of Technology, Tianjin, China
| | - Ning Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Li Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
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28
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Pruvost M, Lépine M, Leonetti C, Etard O, Naveau M, Agin V, Docagne F, Maubert E, Ali C, Emery E, Vivien D. ADAMTS-4 in oligodendrocytes contributes to myelination with an impact on motor function. Glia 2017; 65:1961-1975. [PMID: 28850711 DOI: 10.1002/glia.23207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/06/2017] [Accepted: 08/02/2017] [Indexed: 12/30/2022]
Abstract
Myelination is a late developmental process regulated by a set of inhibitory and stimulatory factors, including extracellular matrix components. Accordingly, chondroitin sulfate proteoglycans (CSPGs) act as negative regulators of myelination processes. A disintegrin and metalloproteinase with thrombospondin motifs type 4 (ADAMTS-4) is an extracellular protease capable of degrading CSPGs. Although exogenous ADAMTS-4 has been proven to be beneficial in several models of central nervous system (CNS) injuries, the physiological functions of endogenous ADAMTS-4 remain poorly understood. We first used Adamts4/LacZ reporter mice to reveal that ADAMTS-4 is strongly expressed in the CNS, especially in the white matter, with a cellular profile restricted to mature oligodendrocytes. Interestingly, we evidenced an abnormal myelination in Adamts4-/- mice, characterized by a higher diameter of myelinated axons with a shifting g-ratio. Accordingly, lack of ADAMTS-4 is accompanied by motor deficits and disturbed nervous electrical activity. In conclusion, we demonstrate that ADAMTS-4 is a new marker of mature oligodendrocytes contributing to the myelination processes and thus to the control of motor capacities.
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Affiliation(s)
- Mathilde Pruvost
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France
| | - Matthieu Lépine
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France
| | - Camille Leonetti
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France
| | - Olivier Etard
- CHU de Caen, Laboratoire des Explorations Fonctionnelles du Système Nerveux, Avenue de la côte de Nacre, Caen F-14000, France.,Normandie Univ, UNICAEN, ISTS, 14000 Caen, France
| | - Mikaël Naveau
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France.,UMS 3408 Support Cyceron, CNR, Universite de Caen Normandie, CHU de Caen, GIP CYCERON, Caen, France
| | - Véronique Agin
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France
| | - Fabian Docagne
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France
| | - Eric Maubert
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France
| | - Carine Ali
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France
| | - Evelyne Emery
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France.,Department of neurosurgery, CHU de Caen, Avenue de la côte de Nacre, Caen F-14000, France
| | - Denis Vivien
- Normandie University, UNICAEN, INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Cyceron, Caen 14000, France.,Department of clinical research, CHU de Caen, Avenue de la côte de Nacre, Caen F-14000, France
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Neurophysiological and BOLD signal uncoupling of giant somatosensory evoked potentials in progressive myoclonic epilepsy: a case-series study. Sci Rep 2017; 7:44664. [PMID: 28294187 PMCID: PMC5353703 DOI: 10.1038/srep44664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/13/2017] [Indexed: 01/27/2023] Open
Abstract
In progressive myoclonic epilepsy (PME), a rare epileptic syndrome caused by a variety of genetic disorders, the combination of peripheral stimulation and functional magnetic resonance imaging (fMRI) can shed light on the mechanisms underlying cortical dysfunction. The aim of the study is to investigate sensorimotor network modifications in PME by assessing the relationship between neurophysiological findings and blood oxygen level dependent (BOLD) activation. Somatosensory-evoked potential (SSEP) obtained briefly before fMRI and BOLD activation during median-nerve electrical stimulation were recorded in four subjects with typical PME phenotype and compared with normative data. Giant scalp SSEPs with enlarger N20-P25 complex compared to normal data (mean amplitude of 26.2 ± 8.2 μV after right stimulation and 27.9 ± 3.7 μV after left stimulation) were detected. Statistical group analysis showed a reduced BOLD activation in response to median nerve stimulation in PMEs compared to controls over the sensorimotor (SM) areas and an increased response over subcortical regions (p < 0.01, Z > 2.3, corrected). PMEs show dissociation between neurophysiological and BOLD findings of SSEPs (giant SSEP with reduced BOLD activation over SM). A direct pathway connecting a highly restricted area of the somatosensory cortex with the thalamus can be hypothesized to support the higher excitability of these areas.
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30
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Cen Z, Huang C, Yin H, Ding X, Xie F, Lu X, Ouyang Z, Lou Y, Qiu X, Wang Z, Xiao J, Ding M, Luo W. Clinical and neurophysiological features of familial cortical myoclonic tremor with epilepsy. Mov Disord 2016; 31:1704-1710. [PMID: 27613677 DOI: 10.1002/mds.26756] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/24/2016] [Accepted: 07/27/2016] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Familial cortical myoclonic tremor with epilepsy is a rare epilepsy syndrome. Herein, we report on nine Chinese familial cortical myoclonic tremor with epilepsy pedigrees to delineate its clinical and neurophysiological features. METHODS Detailed clinical and neurophysiological data were obtained. Somatosensory evoked potential amplitudes and clinical profile were analyzed using multilevel statistical models. Age-at-onset anticipation was analyzed using Kaplan-Meier survival analysis. RESULTS Fifty-five patients were interviewed directly, whose mean age at onset of cortical tremor and generalized tonic-clonic seizures were 31.0 ± 8.3 and 36.0 ± 7.9 years. Giant somatosensory evoked potential was detected in 87.5% (28 of 32) of patients, and long-latency cortical reflex was detected in 93.5% (29 of 31). Cortical tremor severity was significantly higher in patients with longer disease duration of cortical tremor (P = 0.0061). Somatosensory evoked potential amplitudes were significant higher in patients with higher level of cortical tremor severity (P = 0.0003) and those using antiepileptic drugs (P = 0.0150). Age-at-onset anticipation of cortical tremor with paternal transmission was found with statistical significance (P = 0.022). CONCLUSION We provided the clinical and neurophysiological features of familial cortical myoclonic tremor with epilepsy patients. This study is reported for the presentation of this rare disease in a Chinese population with the largest single report on familial cortical myoclonic tremor with epilepsy worldwide. Age-at-onset anticipation of cortical tremor with paternal transmission was statistically significant, which further confirmed a possibility of unstable expanding repeat in the genetic mechanism of familial cortical myoclonic tremor with epilepsy. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Zhidong Cen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chunping Huang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Houmin Yin
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xueping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fei Xie
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xingjiao Lu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Neurology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Zhiyuan Ouyang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yuting Lou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xia Qiu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhongjin Wang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianfeng Xiao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Meiping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Luo
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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31
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Vidal-Dourado M, Nunes KF, Guaranha MSB, Giuliano LMP, Yacubian EMT, Manzano GM. Expression of praxis induction on cortical excitability in juvenile myoclonic epilepsy. Clin Neurophysiol 2016; 127:2551-60. [PMID: 27291873 DOI: 10.1016/j.clinph.2016.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effects of praxis induction on sensorimotor cortical and transcallosal excitability in juvenile myoclonic epilepsy (JME). METHODS A total of 36 subjects (18-62years) were included. The JME group was screened by video-electroencephalography neuropsychological protocol and divided into JME without praxis induction [JME-WI (n=12)], JME with praxis-induced seizures or epileptiform discharges [JME-PI (n=10)], and healthy controls (n=14). Motor and somatosensory cortical excitability and transcallosal pathways were evaluated through single-pulse transcranial magnetic stimulation (sTMS) and somatosensory evoked potentials (SEPs). RESULTS Motor and transcallosal excitabilities tested with sTMS were not different in the motor-dominant or non-dominant hemisphere among groups. Significant differences were found in cortical SEP amplitudes in the P27 component of the non-dominant hemisphere (p=0.03, Cohen's d=0.98), N35 in the dominant hemisphere (p=0.04, Cohen's d=0.96), and P27-35 interpeak amplitude in both somatosensory cortices of the JME-PI group (p=0.03, Cohen's d=0.96; p=0.02, Cohen's d=1.05) when compared with healthy controls. Giant SEPs were observed in two (16.7%) and five (50%) patients of the JME-WI and JME-PI groups, respectively. Cortical latencies did not reveal differences. CONCLUSIONS Praxis induction was associated with enhanced excitability in the somatosensory cortex of JME patients. SIGNIFICANCE These findings may help clarifying the less favorable therapeutic response in the JME-PI group and indicate identifying praxis induction as an important determinant in differentiating between JME patients.
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Affiliation(s)
- Marcos Vidal-Dourado
- Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Karlo Faria Nunes
- Department of Neurology and Neurosurgery, Division of Neurology, Section of Clinical Neurophysiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Lydia Maria Pereira Giuliano
- Department of Neurology and Neurosurgery, Division of Neurology, Section of Clinical Neurophysiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elza Márcia Targas Yacubian
- Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Gilberto Mastrocola Manzano
- Department of Neurology and Neurosurgery, Division of Neurology, Section of Clinical Neurophysiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Nakatani-Enomoto S, Hanajima R, Hamada M, Terao Y, Matsumoto H, Shirota Y, Ohminami S, Okabe S, Hirose M, Nakamura K, Furubayashi T, Groiss SJ, Kobayashi S, Mochizuki H, Enomoto H, Ugawa Y. Somatosensory-evoked potential modulation by quadripulse transcranial magnetic stimulation in patients with benign myoclonus epilepsy. Clin Neurophysiol 2016; 127:1560-1567. [DOI: 10.1016/j.clinph.2015.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
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Koepp MJ, Caciagli L, Pressler RM, Lehnertz K, Beniczky S. Reflex seizures, traits, and epilepsies: from physiology to pathology. Lancet Neurol 2015; 15:92-105. [PMID: 26627365 DOI: 10.1016/s1474-4422(15)00219-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 10/22/2022]
Abstract
Epileptic seizures are generally unpredictable and arise spontaneously. Patients often report non-specific triggers such as stress or sleep deprivation, but only rarely do seizures occur as a reflex event, in which they are objectively and consistently modulated, precipitated, or inhibited by external sensory stimuli or specific cognitive processes. The seizures triggered by such stimuli and processes in susceptible individuals can have different latencies. Once seizure-suppressing mechanisms fail and a critical mass (the so-called tipping point) of cortical activation is reached, reflex seizures stereotypically manifest with common motor features independent of the physiological network involved. The complexity of stimuli increases from simple sensory to complex cognitive-emotional with increasing age of onset. The topography of physiological networks involved follows the posterior-to-anterior trajectory of brain development, reflecting age-related changes in brain excitability. Reflex seizures and traits probably represent the extremes of a continuum, and understanding of their underlying mechanisms might help to elucidate the transition of normal physiological function to paroxysmal epileptic activity.
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Affiliation(s)
- Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, UK.
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, UK
| | - Ronit M Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital, London, UK; Clinical Neuroscience, UCL Institute of Child Health, London, UK
| | - Klaus Lehnertz
- Department of Epileptology, University Hospital of Bonn, Bonn, Germany
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark
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Zutt R, van Egmond ME, Elting JW, van Laar PJ, Brouwer OF, Sival DA, Kremer HP, de Koning TJ, Tijssen MA. A novel diagnostic approach to patients with myoclonus. Nat Rev Neurol 2015; 11:687-97. [PMID: 26553594 DOI: 10.1038/nrneurol.2015.198] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Myoclonus is a hyperkinetic movement disorder characterized by brief, involuntary muscular jerks. Recognition of myoclonus and determination of the underlying aetiology remains challenging given that both acquired and genetically determined disorders have varied manifestations. The diagnostic work-up in myoclonus is often time-consuming and costly, and a definitive diagnosis is reached in only a minority of patients. On the basis of a systematic literature review up to June 2015, we propose a novel diagnostic eight-step algorithm to help clinicians accurately, efficiently and cost-effectively diagnose myoclonus. The large number of genes implicated in myoclonus and the wide clinical variation of these genetic disorders emphasize the need for novel diagnostic techniques. Therefore, and for the first time, we incorporate next-generation sequencing (NGS) in a diagnostic algorithm for myoclonus. The initial step of the algorithm is to confirm whether the movement disorder phenotype is consistent with, myoclonus, and to define its anatomical subtype. The next steps are aimed at identification of both treatable acquired causes and those genetic causes of myoclonus that require a diagnostic approach other than NGS. Finally, other genetic diseases that could cause myoclonus can be investigated simultaneously by NGS techniques. To facilitate NGS diagnostics, we provide a comprehensive list of genes associated with myoclonus.
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Affiliation(s)
- Rodi Zutt
- Department of Neurology, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
| | - Martje E van Egmond
- Ommelander Ziekenhuisgroep, Department of Neurology, PO Box 30.000, 9670 RA Delfzijl and Winschoten, Netherlands
| | - Jan Willem Elting
- Department of Neurology, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
| | - Peter Jan van Laar
- Department of Radiology, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
| | - Oebele F Brouwer
- Department of Neurology, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
| | - Deborah A Sival
- Department of Neurology, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
| | - Hubertus P Kremer
- Department of Neurology, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
| | - Tom J de Koning
- Department of Neurology, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands.,Department of Genetics, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
| | - Marina A Tijssen
- Department of Neurology, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
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35
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Cen ZD, Xie F, Lou DN, Lu XJ, Ouyang ZY, Liu L, Cao J, Li D, Yin HM, Wang ZJ, Xiao JF, Luo W. Fine mapping and whole-exome sequencing of a familial cortical myoclonic tremor with epilepsy family. Am J Med Genet B Neuropsychiatr Genet 2015; 168:595-9. [PMID: 26130016 DOI: 10.1002/ajmg.b.32337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/16/2015] [Indexed: 02/05/2023]
Abstract
Familial cortical myoclonic tremor with epilepsy (FCMTE) is an autosomal dominant epilepsy syndrome. Four loci, including 8q24 (FCMTE1), 2p11.1-q12.2 (FCMTE2), 5p15.31-p15.1 (FCMTE3), and 3q26.32-3q28 (FCMTE4) were previously reported. Herein, we report a new FCMTE1 pedigree from Chinese population with its clinical and genetic study results. Whole genome scan was performed to identify the causative gene region and copy number variants. Whole-exome sequencing was used to identify the causative gene. There were twelve affected members alive in this FCMTE1 pedigree. Nine affected members had both cortical myoclonic tremor and epilepsy, while three affected members had only cortical myoclonic tremor. Electrophysiologic examinations manifested giant somatosensory evoked potentials and long-latency cortical reflex in some affected members. Whole genome scan identified a 20.4 Mb causative gene region at 8q22.3-q24.13. No copy number variants were identified as the causative mutation. Whole-exome sequencing identified a co-segregated mutation (c.206A>T; p.Y69F) in the SLC30A8 gene. However, the evidence supporting this gene as the causative gene of FCMTE1 is not enough. We report the first Chinese FCMTE1 pedigree. No copy number variants, point mutation or small insertion/deletion were detected in the identified region that showed an association with FCMTE1. Further studies could focus on other possible genetic mechanisms while the association between the SLC30A8 and FCMTE1 needs further evidence.
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Affiliation(s)
- Zhi-Dong Cen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fei Xie
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dan-Ning Lou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xing-Jiao Lu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhi-Yuan Ouyang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Cheng du, Sichuan, China
| | - Jin Cao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dan Li
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hou-Min Yin
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhong-Jin Wang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jian-Feng Xiao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Wei Luo
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Houdayer E, Comi G, Leocani L. The Neurophysiologist Perspective into MS Plasticity. Front Neurol 2015; 6:193. [PMID: 26388835 PMCID: PMC4558527 DOI: 10.3389/fneur.2015.00193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/18/2015] [Indexed: 01/17/2023] Open
Abstract
Multiple sclerosis (MS) is a frequent, highly debilitating inflammatory demyelinating disease, starting to manifest in early adulthood and presenting a wide variety of symptoms, which are often resistant to pharmacological treatments. Cortical dysfunctions have been demonstrated to be key components of MS condition, and plasticity of the corticospinal motor system is highly involved in major MS symptoms, such as fatigue, spasticity, or pain. Cortical dysfunction in MS can be studied with neurophysiological tools, such as electroencephalography (EEG) and related techniques (evoked potentials) or transcranial magnetic stimulation (TMS). These techniques are now widely used to provide essential elements of MS diagnosis and can also be used to modulate plasticity. Indeed, the recent development of non-invasive brain stimulation techniques able to induce cortical plasticity, such as repetitive TMS or transcranial direct current stimulation, has brought promising results as add-on treatments. In this review, we will focus on the use of these tools (EEG and TMS) to study plasticity in MS and on the major techniques used to modulate plasticity in MS.
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Affiliation(s)
- Elise Houdayer
- Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute , Milan , Italy
| | - Giancarlo Comi
- Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute , Milan , Italy ; University Vita-Salute San Raffaele, San Raffaele Scientific Institute , Milan , Italy
| | - Letizia Leocani
- Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute , Milan , Italy ; University Vita-Salute San Raffaele, San Raffaele Scientific Institute , Milan , Italy
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Lee CY, Cheng SJ, Chou CL. Myoclonus as the main presentation of Epstein-Barr virus encephalitis. Acta Neurol Belg 2015; 115:479-80. [PMID: 25027162 DOI: 10.1007/s13760-014-0329-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Chuo-Yu Lee
- Department of Neurology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan
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38
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Giant Somatosensory Evoked Potentials Coincident With Epileptiform Discharges in Acutely Comatose Patients. Can J Neurol Sci 2015; 42:317-23. [DOI: 10.1017/cjn.2015.237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundThe amplitude of the cortically generated somatosensory evoked potential (SSEP) is used to predict outcome in comatose patients. The relationship between epileptiform discharges and SSEP amplitude has not been elucidated in those patients.MethodsBilateral median nerve SSEP and electroencephalograph (EEG) studies were performed in a comatose patient (patient 1) 1 day after cardiac surgery and repeated 4 days later. He had tranexamic acid administered before and during surgery. Another comatose patient (patient 2) had the same studies performed 1 day after sustaining 10 minutes of pulseless electrical cardiac activity.ResultsBoth comatose patients had epileptiform discharges (on EEG) that were coincident with giant cortically generated SSEPs. In patient 1, the EEG and SSEP studies repeated 5 days postoperatively showed no epileptiform discharges, and the cortically generated SSEP amplitude was decreased (normalized) compared with that obtained one day postoperatively. He emerged from coma and had a good recovery. Patient 2 died shortly after EEG and SSEP testing.ConclusionsEpileptiform discharges were associated with giant cortically generated median nerve SSEP amplitude (tranexamic acid was implicated in patient 1 and anoxic brain injury in patient 2). Accordingly, those who use the amplitude of cortically generated SSEPs for predicting outcome in comatose patients should consider the presence of epileptiform discharges (detected by EEG) as a potential confounding factor.
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Canafoglia L, Gilioli I, Invernizzi F, Sofia V, Fugnanesi V, Morbin M, Chiapparini L, Granata T, Binelli S, Scaioli V, Garavaglia B, Nardocci N, Berkovic SF, Franceschetti S. Electroclinical spectrum of the neuronal ceroid lipofuscinoses associated with CLN6 mutations. Neurology 2015; 85:316-24. [PMID: 26115733 DOI: 10.1212/wnl.0000000000001784] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/31/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To describe the clinical and neurophysiologic patterns of patients with neuronal ceroid lipofuscinoses associated with CLN6 mutations. METHODS We reviewed the features of 11 patients with different ages at onset. RESULTS Clinical disease onset occurred within the first decade of life in 8 patients and in the second and third decades in 3. All children presented with progressive cognitive regression associated with ataxia and pyramidal and extrapyramidal signs. Recurrent seizures, visual loss, and myoclonus were mostly reported after a delay from onset; 7 children were chairbound and had severe dementia less than 4 years from onset. One child, with onset at 8 years, had a milder course. Three patients with a teenage/adult onset presented with a classic progressive myoclonic epilepsy phenotype that was preceded by learning disability in one. The EEG background was slow close to disease onset in 7 children, and later showed severe attenuation; a photoparoxysmal response (PPR) was present in all. The 3 teenage/adult patients had normal EEG background and an intense PPR. Early attenuation of the electroretinogram was seen only in children with onset younger than 5.5 years. Somatosensory evoked potentials were extremely enlarged in all patients. CONCLUSIONS In all patients, multifocal myoclonic jerks and seizures were a key feature, but myoclonic seizures were an early and prominent sign in the teenage/adult form only. Conversely, the childhood-onset form was characterized by initial and severe cognitive impairment coupled with electroretinogram and EEG attenuation. Cortical hyperexcitability, shown by the PPR and enlarged somatosensory evoked potentials, was a universal feature.
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Affiliation(s)
- Laura Canafoglia
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia.
| | - Isabella Gilioli
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Federica Invernizzi
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Vito Sofia
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Valeria Fugnanesi
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Michela Morbin
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Luisa Chiapparini
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Tiziana Granata
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Simona Binelli
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Vidmer Scaioli
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Barbara Garavaglia
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Nardo Nardocci
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Samuel F Berkovic
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Silvana Franceschetti
- From the Neurophysiopathology and Epilepsy Centre (L. Canafoglia, I.G., S.B., V. Scaioli, S.F.), Neuropathology-Neurology 5 (V.F., M.M.), Neuroradiology (L. Chiapparini), and Child Neurology and Psychiatry (T.G., N.N.), IRCCS Foundation C. Besta Neurological Institute, Milan; Molecular Neurogenetics (F.I., B.G.), IRCCS Foundation C. Besta Neurological Institute-Bicocca, Milan; G.F. Ingrassia Department (V. Sofia), University of Catania, Italy; and Epilepsy Research Center (S.F.B.), Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
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van Zijl JC, Beudel M, vd Hoeven HJ, Lange F, Tijssen MAJ, Elting JWJ. Electroencephalographic Findings in Posthypoxic Myoclonus. J Intensive Care Med 2015; 31:270-5. [PMID: 25670725 DOI: 10.1177/0885066615571533] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/17/2014] [Indexed: 11/17/2022]
Abstract
The physical examination findings of early posthypoxic myoclonus (PHM) are associated with poor prognosis. Recent findings indicate that patients with multifocal PHM, assumed to have a cortical origin, have a comparable outcome to resuscitated patients without PHM. Generalized PHM, assumed to have a subcortical myoclonus origin, is still associated with a bad clinical outcome. It is not known whether the electroencephalographic (EEG) findings differ between the multifocal and generalized myoclonus groups nor is the clinical significance clearly defined. Forty-three patients with PHM were retrospectively derived from an EEG database. Patients were categorized as having multifocal (i), generalized (ii), or undetermined (iii) PHM. Outcome was expressed in cerebral performance category scores. The EEG background was categorized into isoelectric (I), low voltage (II), burst suppression (III), status epilepticus (SE; IV), diffuse slowing (V), and mild encephalopathic or normal (VI). 17 patients had generalized PHM and 23 had multifocal PHM (3 undetermined). The EEG showed more SE in generalized compared to multifocal PHM (64% vs 13%, P< .001). Diffuse slowing was more often present in multifocal PHM (52% vs 17%, P < .05). Early-onset myoclonus occurred significantly more often in generalized PHM, and early generalized PHM was invariantly associated with poor outcome. In conclusion, patients with generalized PHM showed more SE. These EEG findings might be either subcortical corollaries or primarily cortical phenomena. Our retrospective results conflict with currently used clinical criteria for myoclonus classification, and we suggest that more refined difference may be needed for accurate assessment of PHM. To better understand PHM, prospective research with standardized clinical assessment and quantitative EEG analysis is needed.
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Affiliation(s)
- J C van Zijl
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - M Beudel
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - H J vd Hoeven
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands Department of Clinical Neurophysiology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - F Lange
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands Department of Clinical Neurophysiology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - J W J Elting
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands Department of Clinical Neurophysiology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
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Kobayashi K, Hitomi T, Matsumoto R, Kondo T, Kawamata J, Matsuhashi M, Hashimoto S, Ikeda H, Koide Y, Inoue Y, Takahashi R, Ikeda A. Long-term follow-up of cortical hyperexcitability in Japanese Unverricht–Lundborg disease. Seizure 2014; 23:746-50. [DOI: 10.1016/j.seizure.2014.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 05/06/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022] Open
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Cho JW, Lee JH. Suppression of myoclonus in corticobasal degeneration by levetiracetam. J Mov Disord 2014; 7:28-30. [PMID: 24926409 PMCID: PMC4051726 DOI: 10.14802/jmd.14007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/13/2012] [Accepted: 03/23/2014] [Indexed: 11/24/2022] Open
Abstract
Myoclonus in corticobasal degeneration (CBD) has often been associated with severe and difficult to treat disabilities. Levetiracetam is a new antiepileptic agent with antimyoclonic effects. Herein, we present a 72-year-old woman with clinically probable CBD and with spontaneous rhythmic myoclonus in the right foot, which was markedly ameliorated through treatment with levetiracetam. The effect of levetiracetam was associated with the decreased amplitude of enlarged cortical somatosensory evoked potentials. This result suggests that the antimyoclonic effect of levetiracetam might be mediated through the suppression of increased cortical excitability.
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Affiliation(s)
- Jae Wook Cho
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
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We were blind, so now we can see: The EP/ERP story in migraine. Clin Neurophysiol 2014; 125:433-4. [DOI: 10.1016/j.clinph.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 02/07/2023]
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Jadav RH, Sinha S, Yasha TC, Aravinda H, Gayathri N, Rao S, Bindu PS, Satishchandra P. Clinical, electrophysiological, imaging, and ultrastructural description in 68 patients with neuronal ceroid lipofuscinoses and its subtypes. Pediatr Neurol 2014; 50:85-95. [PMID: 24120650 DOI: 10.1016/j.pediatrneurol.2013.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We evaluated the clinical, electrophysiological, imaging, and ultrastructural features of neuronal ceroid lipofuscinoses and its subtypes. METHODS The clinical, electrophysiological, imaging, histopathological, and ultrastructural features of 68 (age at onset: 4.3 ± 5.4 years) neuronal ceroid lipofuscinoses and its subtypes (infantile neuronal ceroid lipofuscinoses [9], late infantile neuronal ceroid lipofuscinoses [34], juvenile neuronal ceroid lipofuscinoses [23], and adult neuronal ceroid lipofuscinoses [2] were evaluated. Skin (n = 56), brain (n = 12), muscle (n = 4) and nerve (n = 1) biopsies confirmed the diagnosis. RESULTS Clinical manifestations were milestone regression (93%), involuntary movements (92%), seizures (89%), myoclonus (79%), and visual impairment (68%). Response to anticonvulsants was unsatisfactory. Electroencephalography (n = 59) was abnormal in 90%: background slowing (90%); epileptiform discharges (71%), and photoparoxysmal response (4/21). Visual-evoked (n = 33) and somatosensory evoked (n = 40) potentials were abnormal in 62% and 63% of patients. Cranial computed tomography (n = 33) showed diffuse cerebral (61%) and cerebellar (27%) atrophy. Magnetic resonance imaging was abnormal in all 43 patients who were scanned: diffuse atrophy (100%), cerebellar atrophy (40%), leukoencephalopathy (65%), and thalamic T2 W hypointensity (33%). Dermal inclusions such as curvilinear inclusions were the most common abnormality: late infantile neuronal ceroid lipofuscinoses (97%), juvenile neuronal ceroid lipofuscinoses (100%), and infantile neuronal ceroid lipofuscinoses (88%). Additional fingerprint inclusions were noted: juvenile neuronal ceroid lipofuscinoses (43%), late infantile neuronal ceroid lipofuscinoses (15%), and infantile neuronal ceroid lipofuscinoses (13%). Granular osmiophilic deposits were noted in 50% of infantile neuronal ceroid lipofuscinoses. In 75% of patients, there was good correlation between the clinical subtype and ultrastructural inclusion pattern. In 27% of neuronal ceroid lipofuscinoses, multiple inclusions were noted. CONCLUSIONS The diagnosis of neuronal ceroid lipofuscinoses should be considered in individuals with characteristic clinical presentations and characteristic ultrastructural dermal inclusions. Three fourths showed morphological correlation of the inclusions with neuronal ceroid lipofuscinoses subtype.
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Affiliation(s)
- Rakesh H Jadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - T C Yasha
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - H Aravinda
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - N Gayathri
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - S Rao
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - P S Bindu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - P Satishchandra
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Inoue M, Kojima Y, Kinboshi M, Kanda M, Shibasaki H. [Case of post-anoxic reticular reflex myoclonus]. Rinsho Shinkeigaku 2013; 52:557-60. [PMID: 22975853 DOI: 10.5692/clinicalneurol.52.557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Reticular reflex myoclonus is a rare condition with only a few cases clearly documented on video. The purpose of this paper is to report a patient manifesting typical clinical picture documented on video and characteristic electrophysiological features of reticular reflex myoclonus. CASE A 60-year-old woman presented with spontaneous and stimulus-sensitive myoclonic jerks involving the face, neck and upper extremities following anoxic episode. The patient was investigated electrophysiologically. Surface electromyogram showed brief myoclonic activity starting from the sternocleidomastoid and spreading up to the orbicularis oculi as well as down to the upper limb muscles. Cortical somatosensory evoked potentials and long-latency reflex were not enhanced. CONCLUSION Clinical features and electrophysiological findings of this case are consistent with those of reticular reflex myoclonus originally reported by Hallett et al. in 1977.
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Affiliation(s)
- Manabu Inoue
- Department of Neurology, Ijinkai Takeda General Hospital
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Giant SEPs and SEP-recovery function in Unverricht–Lundborg disease. Clin Neurophysiol 2013; 124:1013-8. [DOI: 10.1016/j.clinph.2012.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/22/2012] [Accepted: 11/17/2012] [Indexed: 11/19/2022]
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Abstract
Epileptic myoclonus can be defined as an elementary electroclinical manifestation of epilepsy involving descending neurons, whose spatial (spread) or temporal (self-sustained repetition) amplification can trigger overt epileptic activity and can be classified as cortical (positive and negative), secondarily generalized, thalamo-cortical, and reticular. Cortical epileptic myoclonus represents a fragment of partial or symptomatic generalized epilepsy; thalamo-cortical epileptic myoclonus is a fragment of idiopathic generalized epilepsy. Reflex reticular myoclonus represents the clinical counterpart of fragments of hypersynchronous epileptic activity of neurons in the brainstem reticular formation. Epileptic myoclonus, in the setting of an epilepsy syndrome, can be only one component of a seizure, the only seizure manifestations, one of the multiple seizure types or a more stable condition that is manifested in a nonparoxysmal fashion and mimics a movement disorder. This complex correlation is more obvious in patients with epilepsia partialis continua in which cortical myoclonus and overt focal motor seizures usually start in the same somatic (and cortical) region. In patients with cortical tremor this correlation is less obvious and requires neurophysiological studies to be demonstrated.
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Affiliation(s)
- Renzo Guerrini
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer - University of Florence, Florence, Italy.
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Huang Z, Zhan S, Li N, Ding Y, Wang Y. Abnormal recovery function of somatosensory evoked potentials in patients with primary insomnia. Psychiatry Res 2012; 198:463-7. [PMID: 22424903 DOI: 10.1016/j.psychres.2011.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 11/13/2011] [Accepted: 11/26/2011] [Indexed: 11/24/2022]
Abstract
Neurobiological correlates underlying insomnia are poorly understood. The hyperarousal of the central nervous system indicates that cortical excitability may be abnormal in patients with insomnia. The purpose of the present study was to investigate changes in cortical excitability by examining the recovery function of median nerve somatosensory evoked potentials (SEPs) in patients with primary insomia (PI). We studied the recovery function of median nerve SEPs in 12 medication-naive PI patients and in 12 age- and sex-matched healthy subjects. SEPs in response to single stimulus and paired stimuli at interstimulus intervals (ISIs) of 20, 60, 100 and 150 ms were recorded. The recovery function of the cortical components of frontal P20 and parietal N20 showed significantly reduced suppression in PI patients as compared to healthy controls. In conclusion, this is the first study investigating changes in cortical excitability in PI patients by examining the recovery function of median nerve SEPs. The present study suggests that cortical excitability is increased in PI patients. Dysfunction of inhibitory GABAergic interneurons of the cerebral cortex might contribute to the increased cortical excitability in PI patients.
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Affiliation(s)
- Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchunjie Road, Beijing 100053, China
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Acute posthypoxic myoclonus after cardiopulmonary resuscitation. BMC Neurol 2012; 12:63. [PMID: 22853736 PMCID: PMC3482601 DOI: 10.1186/1471-2377-12-63] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 07/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of the study was to investigate whether acute PHM originates from cortical or subcortical structures, using somatosensory evoked potential (SEP) and electroencephalogram (EEG). Methods Patients with acute PHM (focal myoclonus or status myoclonus) within 72 hours after CPR were retrospectively selected from a multicenter cohort study. All patients were treated with hypothermia. Criteria for cortical origin of the myoclonus were: giant SEP potentials; or epileptic activity, status epilepticus, or generalized periodic discharges on the EEG (no back-averaging was used). Good outcome was defined as good recovery or moderate disability after 6 months. Results Acute PHM was reported in 79/391 patients (20%). SEPs were available in 51/79 patients and in 27 of them (53%) N20 potentials were present. Giant potentials were seen in 3 patients. EEGs were available in 36/79 patients with 23/36 (64%) patients fulfilling criteria for a cortical origin. Nine patients (12%) had a good outcome. A broad variety of drugs was used for treatment. Conclusions The results of this study show that acute PHM originates from subcortical, as well as cortical structures. Outcome of patients admitted after CPR who develop acute PHM in this cohort was better than previously reported in literature. The broad variety of drugs used for treatment shows the existing uncertainty about optimal treatment.
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Rubboli G, Franceschetti S, Berkovic SF, Canafoglia L, Gambardella A, Dibbens LM, Riguzzi P, Campieri C, Magaudda A, Tassinari CA, Michelucci R. Clinical and neurophysiologic features of progressive myoclonus epilepsy without renal failure caused by SCARB2 mutations. Epilepsia 2011; 52:2356-63. [PMID: 22050460 DOI: 10.1111/j.1528-1167.2011.03307.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Mutations of the SCARB2 gene cause action myoclonus renal failure syndrome (AMRF), a rare condition that combines progressive myoclonus epilepsy (PME) with severe renal dysfunction. We describe the clinical and neurophysiologic features of PME associated with SCARB2 mutations without renal impairment. METHODS Clinical and neurophysiologic investigations, including wakefulness and sleep electroencephalography (EEG), polygraphic recording (with jerk-locked back-averaging and analysis of the EEG-EMG (electromyography) relationship by coherence spectra and phase calculation), multimodal evoked potentials, and electromyography were performed on five Italian patients with SCARB2 mutations. KEY FINDINGS The main clinical features were adolescent-young adulthood onset, progressive action myoclonus, ataxia, absence of cognitive deterioration and, in most cases, epilepsy. The severity of the epilepsy could vary from uncontrolled seizures and status epilepticus in patients with adolescent onset to absent or rare seizures in patients with adult onset. Relevant neurophysiologic findings were a pronounced photosensitivity and massive action myoclonus associated with rhythmic myoclonic jerks at a frequency of 12-20 Hz, clinically resembling a postural tremor. The cortical origin of rhythmic myoclonus was demonstrated mainly by coherence and phase analysis of EEG-EMG signals indicating a significant EEG-EMG coupling and a direct corticospinal transfer. SIGNIFICANCE Our patients with SCARB2 mutations showed the clinical and neurophysiologic phenotype of PME, in which epilepsy could be extremely severe, extending the spectrum reported in the typical AMRF syndrome. Patients with PME of unknown origin of adolescent or young adult onset, with these neurophysiologic features, should be tested for SCARB2 mutations, even in the absence of renal impairment.
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Affiliation(s)
- Guido Rubboli
- Neurology Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy.
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