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Wang D, Lu D, Zhang M, Dai A, Jin G, Wang Q, Zhang Y, Kahane P. Advances in epileptic network findings of hypothalamic hamartomas. J Cent Nerv Syst Dis 2024; 16:11795735241237627. [PMID: 38449707 PMCID: PMC10916467 DOI: 10.1177/11795735241237627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/16/2024] [Indexed: 03/08/2024] Open
Abstract
Hypothalamic hamartomas (HHs) are congenital developmental malformations located in the hypothalamus. They are associated with a characteristic clinical manifestation known as gelastic seizures (GS). However, the traditional understanding of HHs has been limited, resulting in insufficient treatment options and high recurrence rates of seizures after surgery. This is consistent with the network hypothesis of focal epilepsy that the epileptogenic zone is not only limited to HH but may also involve the distant cerebral cortex external to the HH mass. The epilepsy network theory, on the other hand, provides a new perspective. In this study, we aim to explore HH-related epilepsy as a network disease, challenging the conventional notion of being a focal lesional disease. We analyze various aspects of HHs, including genes and signaling pathways, local circuits, the whole-brain level, phenotypical expression in terms of seizure semiology, and comorbidities. By examining HHs through the lens of network theory, we can enhance our understanding of the condition and potentially identify novel approaches for more effective management and treatment of epilepsy associated with HHs.
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Affiliation(s)
- Di Wang
- School of Engineering Medicine, Beihang University, Beijing, China
| | - Di Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Mingtai Zhang
- School of Engineering Medicine, Beihang University, Beijing, China
| | - Anqi Dai
- School of Engineering Medicine, Beihang University, Beijing, China
| | - Guangyuan Jin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuyang Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Philippe Kahane
- Neurology Deparment, CHU Grenoble Alpes, University Grenoble Alpes, Grenoble Institute Neuroscience, Grenoble, France
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Guo ZH, Zhang JG, Shao XQ, Hu WH, Sang L, Zheng Z, Zhang C, Wang X, Li CD, Mo JJ, Zhang K. Neural network mapping of gelastic behavior in children with hypothalamus hamartoma. World J Pediatr 2023:10.1007/s12519-023-00763-1. [PMID: 37938453 DOI: 10.1007/s12519-023-00763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/17/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Hypothalamus hamartomas (HHs) are rare, congenital, tumor-like, and nonprogressive malformations resulting in drug-resistant epilepsy, mainly affecting children. Gelastic seizures (GS) are an early hallmark of epilepsy with HH. The aim of this study was to explore the disease progression and the underlying physiopathological mechanisms of pathological laughter in HH. METHODS We obtained clinical information and metabolic images of 56 HH patients and utilized ictal semiology evaluation to stratify the specimens into GS-only, GS-plus, and no-GS subgroups and then applied contrasted trajectories inference (cTI) to calculate the pseudotime value and evaluate GS progression. Ordinal logistic regression was performed to identify neuroimaging-clinical predictors of GS, and then voxelwise lesion network-symptom mapping (LNSM) was applied to explore GS-associated brain regions. RESULTS cTI inferred the specific metabolism trajectories of GS progression and revealed increased complexity from GS to other seizure types. This was further validated via actual disease duration (Pearson R = 0.532, P = 0.028). Male sex [odds ratio (OR) = 2.611, P = 0.013], low age at seizure onset (OR = 0.361, P = 0.005), high normalized HH metabolism (OR = - 1.971, P = 0.037) and severe seizure burden (OR = - 0.006, P = 0.032) were significant neuroimaging clinical predictors. LNSM revealed that the dysfunctional cortico-subcortico-cerebellar network of GS and the somatosensory cortex (S1) represented a negative correlation. CONCLUSIONS This study sheds light on the clinical characteristics and progression of GS in children with HH. We identified distinct subtypes of GS and demonstrated the involvement of specific brain regions at the cortical-subcortical-cerebellar level. These valuable results contribute to our understanding of the neural correlates of GS.
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Affiliation(s)
- Zhi-Hao Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chun-De Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Jia-Jie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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Amani H, Soltani Khaboushan A, Terwindt GM, Tafakhori A. Glia Signaling and Brain Microenvironment in Migraine. Mol Neurobiol 2023; 60:3911-3934. [PMID: 36995514 DOI: 10.1007/s12035-023-03300-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
Migraine is a complicated neurological disorder affecting 6% of men and 18% of women worldwide. Various mechanisms, including neuroinflammation, oxidative stress, altered mitochondrial function, neurotransmitter disturbances, cortical hyperexcitability, genetic factors, and endocrine system problems, are responsible for migraine. However, these mechanisms have not completely delineated the pathophysiology behind migraine, and they should be further studied. The brain microenvironment comprises neurons, glial cells, and vascular structures with complex interactions. Disruption of the brain microenvironment is the main culprit behind various neurological disorders. Neuron-glia crosstalk contributes to hyperalgesia in migraine. In the brain, microenvironment and related peripheral regulatory circuits, microglia, astrocytes, and satellite cells are necessary for proper function. These are the most important cells that could induce migraine headaches by disturbing the balance of the neurotransmitters in the nervous system. Neuroinflammation and oxidative stress are the prominent reactions glial cells drive during migraine. Understanding the role of cellular and molecular components of the brain microenvironment on the major neurotransmitters engaged in migraine pathophysiology facilitates the development of new therapeutic approaches with higher effectiveness for migraine headaches. Investigating the role of the brain microenvironment and neuroinflammation in migraine may help decipher its pathophysiology and provide an opportunity to develop novel therapeutic approaches for its management. This review aims to discuss the neuron-glia interactions in the brain microenvironment during migraine and their potential role as a therapeutic target for the treatment of migraine.
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Affiliation(s)
- Hanieh Amani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Soltani Khaboushan
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Neurology, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran.
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4
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Brito VN, Canton APM, Seraphim CE, Abreu AP, Macedo DB, Mendonca BB, Kaiser UB, Argente J, Latronico AC. The Congenital and Acquired Mechanisms Implicated in the Etiology of Central Precocious Puberty. Endocr Rev 2023; 44:193-221. [PMID: 35930274 PMCID: PMC9985412 DOI: 10.1210/endrev/bnac020] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Indexed: 01/20/2023]
Abstract
The etiology of central precocious puberty (CPP) is multiple and heterogeneous, including congenital and acquired causes that can be associated with structural or functional brain alterations. All causes of CPP culminate in the premature pulsatile secretion of hypothalamic GnRH and, consequently, in the premature reactivation of hypothalamic-pituitary-gonadal axis. The activation of excitatory factors or suppression of inhibitory factors during childhood represent the 2 major mechanisms of CPP, revealing a delicate balance of these opposing neuronal pathways. Hypothalamic hamartoma (HH) is the most well-known congenital cause of CPP with central nervous system abnormalities. Several mechanisms by which hamartoma causes CPP have been proposed, including an anatomical connection to the anterior hypothalamus, autonomous neuroendocrine activity in GnRH neurons, trophic factors secreted by HH, and mechanical pressure applied to the hypothalamus. The importance of genetic and/or epigenetic factors in the underlying mechanisms of CPP has grown significantly in the last decade, as demonstrated by the evidence of genetic abnormalities in hypothalamic structural lesions (eg, hamartomas, gliomas), syndromic disorders associated with CPP (Temple, Prader-Willi, Silver-Russell, and Rett syndromes), and isolated CPP from monogenic defects (MKRN3 and DLK1 loss-of-function mutations). Genetic and epigenetic discoveries involving the etiology of CPP have had influence on the diagnosis and familial counseling providing bases for potential prevention of premature sexual development and new treatment targets in the future. Global preventive actions inducing healthy lifestyle habits and less exposure to endocrine-disrupting chemicals during the lifespan are desirable because they are potentially associated with CPP.
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Affiliation(s)
- Vinicius N Brito
- Discipline of Endocrinology & Metabolism, Department of Internal
Medicine, University of Sao Paulo Medical School, University of Sao
Paulo, Sao Paulo 01246 903, Brazil
| | - Ana P M Canton
- Discipline of Endocrinology & Metabolism, Department of Internal
Medicine, University of Sao Paulo Medical School, University of Sao
Paulo, Sao Paulo 01246 903, Brazil
| | - Carlos Eduardo Seraphim
- Discipline of Endocrinology & Metabolism, Department of Internal
Medicine, University of Sao Paulo Medical School, University of Sao
Paulo, Sao Paulo 01246 903, Brazil
| | - Ana Paula Abreu
- Division of Endocrinology, Diabetes and Hypertension, Department of
Medicine, Brigham and Women’s Hospital, Harvard Medical School,
Boston, MA 02115, USA
| | - Delanie B Macedo
- Discipline of Endocrinology & Metabolism, Department of Internal
Medicine, University of Sao Paulo Medical School, University of Sao
Paulo, Sao Paulo 01246 903, Brazil
- Division of Endocrinology, Diabetes and Hypertension, Department of
Medicine, Brigham and Women’s Hospital, Harvard Medical School,
Boston, MA 02115, USA
- Núcleo de Atenção Médica Integrada, Centro de Ciências da Saúde,
Universidade de Fortaleza, Fortaleza 60811 905,
Brazil
| | - Berenice B Mendonca
- Discipline of Endocrinology & Metabolism, Department of Internal
Medicine, University of Sao Paulo Medical School, University of Sao
Paulo, Sao Paulo 01246 903, Brazil
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Department of
Medicine, Brigham and Women’s Hospital, Harvard Medical School,
Boston, MA 02115, USA
| | - Jesús Argente
- Hospital Infantil Universitario Niño Jesús, Department of Endocrinology and
Department of Pediatrics, Universidad Autónoma de Madrid, Spanish PUBERE Registry,
CIBER of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, IMDEA
Institute, Madrid 28009, Spain
| | - Ana Claudia Latronico
- Discipline of Endocrinology & Metabolism, Department of Internal
Medicine, University of Sao Paulo Medical School, University of Sao
Paulo, Sao Paulo 01246 903, Brazil
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5
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Xiao L, Zhou M, Tang Y, Hu S. 18 F-SynVesT-1 positron emission tomography in a hypothalamic hamartoma with abnormal uptake. Epilepsia 2023; 64:e43-e47. [PMID: 36745038 DOI: 10.1111/epi.17533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
Hypothalamic hamartomas (HHs) are uncommon benign lesions of neuronal and glial cells in the inferior hypothalamus. They have been linked to epilepsy, premature puberty, and cognitive and behavioral impairment. We report a 13-year-old patient who was referred to a multidisciplinary treatment team for epilepsy with 6 months of convulsive seizures. Sustained seizure control was not achieved despite the use of multiple antiepileptic agents. He had been plagued by unexplained paroxysmal bursts of laughter for >11 years. Video-electroencephalography showed diffuse epileptic discharges prominent in the right hemisphere in both interictal and ictal phases. Magnetic resonance imaging demonstrated an isointense gray matter mass on the right lateral walls of the third ventricle, with focal hypometabolism on 18 F-fluorodeoxyglucose positron emission tomography (PET). The patient subsequently was enrolled in a clinical trial of 18 F-SynVesT-1 PET in epilepsy, and an increased 18 F-SynVesT-1 uptake was noted in the mass. After excluding hormonal abnormalities, the patient underwent open resection targeting HHs. We used 18 F-SynVesT-1 as a specific PET tracer for synaptic vesicle glycoprotein 2A, which is ubiquitously expressed in brain synapses. 18 F-SynVesT-1 PET may hold promise as a supplementary tool in the presurgical localization and evaluation of HHs.
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Affiliation(s)
- Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Biological Nanotechnology of the National Health Commission, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
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6
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Cunningham MO. Rebuttal from Mark O. Cunningham. J Physiol 2022; 600:4579-4580. [PMID: 36149740 DOI: 10.1113/jp283576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Mark O Cunningham
- Discipline of Physiology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland.,FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
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Handoko M, Karakas C, Gadgil N, Wilfong A, Riviello J, Curry D, Ali I. Comparison of Surgical Outcomes in Individuals With Hypothalamic Hamartoma Alone or With Other Potentially Epileptogenic Focal Lesions. Pediatr Neurol 2022; 131:13-19. [PMID: 35461053 DOI: 10.1016/j.pediatrneurol.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/02/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hypothalamic hamartoma is a rare condition associated with refractory seizures. It can occur in isolation or with additional epileptogenic lesions. The aim of this study was to investigate the effects of additional potentially epileptogenic lesions on surgical outcomes in individuals with hypothalamic hamartoma. METHODS We conducted a chart review of 112 patients with hypothalamic hamartoma who underwent magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy targeted to the hypothalamic hamartoma. We compared surgical outcomes after at least six months of postoperative follow-up (N = 65) between patients with hypothalamic hamartoma alone and those with hypothalamic hamartoma plus additional potentially epileptogenic lesions. RESULTS Sixteen out of 112 (14%) patients had additional epileptogenic lesions, including focal cortical dysplasia, gray matter heterotopia, and polymicrogyria. Ten out of 16 patients with additional lesions and 55 out of 96 patients with hypothalamic hamartoma alone had more than six months of follow-up and are included in the outcome analysis. Mean follow-up in these patients is 21.5 ± 17.3 months (standard deviation, range: 7.3-76.8 months) for patients with hypothalamic hamartoma alone and 16.1 ± 15.0 months (standard deviation, range: 6.6-58.2 months) for those with hypothalamic hamartoma plus additional epileptogenic lesions. Fewer patients with hypothalamic hamartoma plus other lesions had Engel class I/II outcomes than patients with hypothalamic hamartoma alone (5/10 [50%] vs 46/55 [83.6%]; P = 0.031). CONCLUSIONS MRI-guided laser interstitial thermal therapy remains an effective treatment option for patients with hypothalamic hamartoma. However, the outcome of surgical procedures targeted to the hypothalamic hamartoma may be less favorable in patients who have hypothalamic hamartoma coexisting with other potentially epileptogenic focal lesions. Thus, an additional surgical workup is warranted for these patients who have failed surgical treatment of hypothalamic hamartoma.
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Affiliation(s)
- Maureen Handoko
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Cemal Karakas
- Norton Children's Medical Group, The University of Louisville, Louisville, Kentucky
| | - Nisha Gadgil
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Angus Wilfong
- Department Pediatric Neurology, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona
| | - James Riviello
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Daniel Curry
- Norton Children's Medical Group, The University of Louisville, Louisville, Kentucky
| | - Irfan Ali
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
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8
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Melikyan AG. [Surgical treatment of epilepsy in patients with hypothalamic hamartomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:83-88. [PMID: 35942841 DOI: 10.17116/neiro202286041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED The purpose of this review was to analyze the current ideas about various techniques and methods for treating epilepsy in patients with hypothalamic hamartomas including microsurgery, endoscopy, radiofrequency thermal destruction, stereotactic laser ablation and radiosurgery. Data characterizing their effectiveness, limitations and complications are considered. CONCLUSION When choosing the optimal treatment option, it is necessary to take into account patient age and course of disease, anatomical and topographic features of hamartoma location, previous attempts of treatment, opinion of the patient and his guardians, as well as surgical experience.
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9
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Yang C, Liu Z, Luan G, wang Q. The extension of epileptogenicity as the driving force of the epileptogenic network evolution and complex symptoms. Brain Res 2020; 1748:147073. [DOI: 10.1016/j.brainres.2020.147073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 01/04/2023]
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10
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Liu Z, Luan G, Yang C, Guan Y, Liu C, Wang J, Wang M, Wang Q. Distinguishing Dependent-Stage Secondary Epileptogenesis in a Complex Case of Giant Hypothalamic Hamartoma With Assistance of a Computational Method. Front Neurol 2020; 11:478. [PMID: 32587568 PMCID: PMC7297952 DOI: 10.3389/fneur.2020.00478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 05/01/2020] [Indexed: 11/18/2022] Open
Abstract
Besides gelastic seizures, hypothalamic hamartoma (HH) is also noted for its susceptibility to remote secondary epileptogenesis. Although clinical observations have demonstrated its existence, and a three-stage theory has been proposed, how to determine whether a remote symptom is spontaneous or dependent on epileptic activities of HH is difficult in some cases. Herein, we report a case of new non-gelastic seizures in a 9-year-old female associated with a postoperatively remaining HH. Electrophysiological examinations and stereo-electroencephalography (SEEG) demonstrated seizure onsets with slow-wave and fast activities on the outside of the HH. By using computational methodologies to calculate the network dynamic effective connectivities, the importance of HH in the epileptic network was revealed. After SEEG-guided thermal coagulation of the remaining HH, the patient finally was seizure-free at the 2-year follow-up. This case showed the ability of computational methods to reveal information underlying complex SEEG signals, and further demonstrated the dependent-stage secondary epileptogenesis, which has been rarely reported.
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Affiliation(s)
- Zhao Liu
- Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Epilepsy, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Epilepsy, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Chuanzuo Yang
- Department of Dynamics and Control, Beihang University, Beijing, China
| | - Yuguang Guan
- Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Changqing Liu
- Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Qingyun Wang
- Department of Dynamics and Control, Beihang University, Beijing, China
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11
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Conde Blanco E, Anciones Martín C, Manzanares I, Gil López F, Roldán P, Donaire A, Rumiá J, Carreño M. Hypothalamic hamartomas in adulthood: Clinical spectrum and treatment outcome-A unicenter experience. Brain Behav 2019; 9:e01412. [PMID: 31578831 PMCID: PMC6851795 DOI: 10.1002/brb3.1412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/01/2019] [Accepted: 07/28/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Clinical manifestations of the hypothalamic hamartoma-epilepsy syndrome (HH-ES) in adulthood are variable. Efficacy of therapeutic options and outcome are diverse. METHODS Retrospective study of adult patients diagnosed with a HH in magnetic resonance imaging and epilepsy who attended our tertiary Epilepsy Unit between 2003 and 2018. We report the clinical and electroencephalographic features of a series of adult patients with HH and related epilepsy seen in our center together with the treatments and seizure outcome. RESULTS We describe a series of eight patients. Five males (62.5%), median age at evaluation was 28.5 years (IQR: 15.5). Clinical manifestations included focal with preserved and impaired awareness emotional seizures (gelastic seizures [GS]) in six patients (75%), focal tonic, atonic with impaired awareness and focal to bilateral tonic-clonic seizures. Mild GS were the only symptom in one patient. Three patients (37.5%) had endocrinological disturbances such as obesity and hypothyroidism. Fifty percent of the patients showed psychiatric comorbidity such as anxiety disorder and aggressiveness, and two patients had psychomotor delay. Seven patients (87.7%) had drug-resistant seizures and three of them were treated with radiosurgery. Out of the treated group, only one (33.3%) became seizure-free 2 years after surgery but developed psychiatric problems. The other two patients had an Engel IV outcome and received a vagal nerve stimulation (VNS) implant. VNS did not lead to changes either in intensity nor in seizure frequency. CONCLUSIONS Hypothalamic hamartoma-epilepsy syndrome clinical manifestations in adult patients are as variable as at pediatric age. Outcome of therapeutic options such as radiosurgery or VNS may be poorer at this stage.
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Affiliation(s)
| | | | - Isabel Manzanares
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | | | - Pedro Roldán
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Jordi Rumiá
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clinic, Barcelona, Spain
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12
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Boerwinkle VL, Foldes ST, Torrisi SJ, Temkit H, Gaillard WD, Kerrigan JF, Desai VR, Raskin JS, Vedantam A, Jarrar R, Williams K, Lam S, Ranjan M, Broderson JS, Adelson D, Wilfong AA, Curry DJ. Subcentimeter epilepsy surgery targets by resting state functional magnetic resonance imaging can improve outcomes in hypothalamic hamartoma. Epilepsia 2018; 59:2284-2295. [DOI: 10.1111/epi.14583] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/10/2018] [Accepted: 09/24/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Varina L. Boerwinkle
- Division of Pediatric Neurology; Barrow Neurological Institute at Phoenix Children’s Hospital; Phoenix Arizona
| | - Stephen T. Foldes
- Neuroscience Research; Barrow Neurological Institute at Phoenix Children’s Hospital; Phoenix Arizona
| | - Salvatore J. Torrisi
- Section on the Neurobiology of Fear and Anxiety; National Institute of Mental Health; National Institutes of Health; Bethesda Maryland
| | - Hamy Temkit
- Department of Research; Phoenix Children’s Hospital; Phoenix Arizona
| | - William D. Gaillard
- Department of Neurology; Children’s National Medical Center; Washington District of Columbia
| | - John F. Kerrigan
- Division of Pediatric Neurology; Barrow Neurological Institute at Phoenix Children’s Hospital; Phoenix Arizona
| | - Virendra R. Desai
- Department of Neurosurgery; Houston Methodist Hospital; Houston Methodist Neurological Institute; Houston Texas
| | - Jeffrey S. Raskin
- Department of Pediatric Neurosurgery; Texas Children’s Hospital; Baylor College of Medicine; Houston Texas
| | - Aditya Vedantam
- Department of Pediatric Neurosurgery; Texas Children’s Hospital; Baylor College of Medicine; Houston Texas
| | - Randa Jarrar
- Division of Pediatric Neurology; Barrow Neurological Institute at Phoenix Children’s Hospital; Phoenix Arizona
| | - Korwyn Williams
- Division of Pediatric Neurology; Barrow Neurological Institute at Phoenix Children’s Hospital; Phoenix Arizona
| | - Sandi Lam
- Department of Pediatric Neurosurgery; Texas Children’s Hospital; Baylor College of Medicine; Houston Texas
| | - Manish Ranjan
- Division of Pediatric Neurosurgery; Barrow Neurological Institute at Phoenix Children’s Hospital; Phoenix Arizona
| | - Janna S. Broderson
- Division of Pediatric Neurology; Texas Children’s Hospital; Baylor College of Medicine; Houston Texas
| | - David Adelson
- Division of Pediatric Neurology; Barrow Neurological Institute at Phoenix Children’s Hospital; Phoenix Arizona
- Division of Pediatric Neurosurgery; Barrow Neurological Institute at Phoenix Children’s Hospital; Phoenix Arizona
| | - Angus A. Wilfong
- Division of Pediatric Neurology; Barrow Neurological Institute at Phoenix Children’s Hospital; Phoenix Arizona
| | - Daniel J. Curry
- Department of Pediatric Neurosurgery; Texas Children’s Hospital; Baylor College of Medicine; Houston Texas
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13
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Fox J, Hussain S, Sankar R, Kerrigan JF. Hypothalamic Hamartoma With Infantile Spasms: Case Report With Surgical Treatment. Semin Pediatr Neurol 2018; 26:115-118. [PMID: 29961499 DOI: 10.1016/j.spen.2017.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We report a 10-month-old boy with treatment-resistant infantile spasms associated with hypothalamic hamartoma (HH). Electroencephalography before surgical treatment showed modified hypsarrhythmia. Transventricular endoscopic resection and disconnection resulted in immediate and enduring disappearance of the epileptic spasms and improvement in the postoperative electroencephalography. After 8 years of treatment, the patient has nondisabling gelastic seizures associated with a small amount of residual HH but no other seizure types. He is not taking any antiepilepsy drugs. He is academically and socially successful. We are not aware of any prior reports of surgical treatment of HH with concurrent infantile spasms as an uncontrolled seizure type. The immediate disappearance of infantile spasms demonstrates that the HH lesion itself is an active and necessary component within the epileptic network responsible for spasms in this particular condition. This case contributes to the recognition that focal pathologies can be responsible for infantile spasms with hypsarrhythmia and respond successfully to surgical intervention.
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Affiliation(s)
- Jordana Fox
- Division of Pediatric Neurology, Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Shaun Hussain
- Division of Pediatric Neurology, Pediatric Epilepsy Program, Department of Pediatrics, UCLA School of Medicine, Mattel Children's Hospital, Los Angeles, CA
| | - Raman Sankar
- Division of Pediatric Neurology, Pediatric Epilepsy Program, Department of Pediatrics, UCLA School of Medicine, Mattel Children's Hospital, Los Angeles, CA
| | - John F Kerrigan
- Division of Pediatric Neurology, Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ.
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14
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Dupont S. Epilessie focali strutturali metaboliche o epilessie focali con eziologia identificata. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)85554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Harrison VS, Oatman O, Kerrigan JF. Hypothalamic hamartoma with epilepsy: Review of endocrine comorbidity. Epilepsia 2017; 58 Suppl 2:50-59. [PMID: 28591479 DOI: 10.1111/epi.13756] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/22/2022]
Abstract
The most common, and usually the only, endocrine disturbance in patients with hypothalamic hamartoma (HH) and epilepsy is central precocious puberty (CPP). The mechanism for CPP associated with HH may relate to ectopic generation and pulsatile release of gonadotropin-releasing hormone (GnRH) from the HH, but this remains an unproven hypothesis. Possible regulators of GnRH release that are intrinsic to HH tissue include the following: (1) glial factors (such as transforming growth factor α[TGFα) and (2) γ-aminobutyric acid (GABA)-mediated excitation. Both are known to be present in surgically-resected HH tissue, but are present in patients with and without a history of CPP, suggesting the possibility that symptoms related to HH are directly associated with the region of anatomic attachment of the HH to the hypothalamus, which determines functional network connections, rather than to differences in HH tissue expression or pathophysiology. CPP associated with HH presents with isosexual development prior to the age of 8 years in girls and 9 years in boys. It is not uncommon for CPP with HH to present in children at an earlier age in comparison to other causes of CPP, including in infancy. Surgical resection of the HH can be effective for treating CPP, but is reserved for patients with intractable epilepsy, since GnRH agonists are widely available and effective treatment. Other endocrine disturbances with HH are rare, but can include growth hormone deficiency, hypothyroidism, and adrenal insufficiency. Diabetes insipidus is commonly encountered postoperatively, but is not observed with HH prior to surgical intervention.
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Affiliation(s)
- Victor S Harrison
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Oliver Oatman
- Division of Endocrinology and Hypothalamic Hamartoma Program, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| | - John F Kerrigan
- Pediatric Neurology Division and Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
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16
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Kerrigan JF, Parsons A, Tsang C, Simeone K, Coons S, Wu J. Hypothalamic hamartoma: Neuropathology and epileptogenesis. Epilepsia 2017; 58 Suppl 2:22-31. [DOI: 10.1111/epi.13752] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 01/06/2023]
Affiliation(s)
- John F. Kerrigan
- Hypothalamic Hamartoma Program and Pediatric Neurology Division; Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix Children's Hospital; Phoenix Arizona U.S.A
- Hypothalamic Hamartoma Tissue Research Laboratory; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
| | - Angela Parsons
- Hypothalamic Hamartoma Tissue Research Laboratory; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
| | - Candy Tsang
- Hypothalamic Hamartoma Tissue Research Laboratory; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
| | - Kristina Simeone
- Department of Pharmacology; Creighton University School of Medicine; Omaha Nebraska U.S.A
| | - Stephen Coons
- Division of Neuropathology; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
| | - Jie Wu
- Hypothalamic Hamartoma Program and Division of Neurology; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona U.S.A
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17
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Wang B, Ma J. The diagnosis and management of hypothalamic hamartomas in children. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0047-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Aguila MER, Rebbeck T, Leaver AM, Lagopoulos J, Brennan PC, Hübscher M, Refshauge KM. The Association Between Clinical Characteristics of Migraine and Brain GABA Levels: An Exploratory Study. THE JOURNAL OF PAIN 2016; 17:1058-1067. [PMID: 27369186 DOI: 10.1016/j.jpain.2016.06.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 06/07/2016] [Accepted: 06/18/2016] [Indexed: 01/01/2023]
Abstract
UNLABELLED Migraine is prevalent and disabling yet is poorly understood. One way to better understand migraine is to examine its clinical characteristics and potential biomarkers such as gamma-aminobutyric acid (GABA). The primary objective of this study was to explore whether relevant disease characteristics of migraine are associated with brain GABA levels. Twenty adults fulfilling the established diagnostic criteria for migraine and 20 age- and gender-matched controls completed this cross-sectional study. Pain, central sensitization, negative emotional state, and perceived disability were measured using Short-form McGill Pain Questionnaire-2, Central Sensitization Inventory, Depression Anxiety Stress Scales-21, and Headache Impact Test-6, respectively. Secondary analysis of brain GABA levels of the same cohort measured using proton magnetic resonance spectroscopy was conducted. The migraine group had significantly higher scores than the control group on pain, central sensitization, and disability. Correlation analyses showed fair positive association between GABA levels and pain and central sensitization scores. No association was found between GABA levels and emotional state and disability. These findings are preliminary evidence supporting the use of questionnaires and GABA levels in characterizing migraine better and broadening the diagnostic process. These findings also strengthen the rationale for the role of GABA in migraine pathophysiology and corroborate the potential of GABA as a migraine biomarker. PERSPECTIVE Higher pain and central sensitization scores were associated with increased brain GABA levels in individuals with migraine. These findings offer preliminary evidence for the usefulness of measuring pain and central sensitization in migraine and provide some support for the possible role of GABA in migraine pathophysiology and its potential as a diagnostic marker.
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Affiliation(s)
- Maria-Eliza R Aguila
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia; University of the Philippines College of Allied Medical Professions, Manila, Philippines.
| | - Trudy Rebbeck
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - Andrew M Leaver
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - Jim Lagopoulos
- Brain and Mind Centre, Sydney Medical School, Camperdown, New South Wales, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Patrick C Brennan
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - Markus Hübscher
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia; Neuroscience Research Australia and The University of New South Wales, Randwick, New South Wales, Australia
| | - Kathryn M Refshauge
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
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19
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Wu J, Gao M, Rice SG, Tsang C, Beggs J, Turner D, Li G, Yang B, Xia K, Gao F, Qiu S, Liu Q, Kerrigan JF. Gap Junctions Contribute to Ictal/Interictal Genesis in Human Hypothalamic Hamartomas. EBioMedicine 2016; 8:96-102. [PMID: 27428422 PMCID: PMC4919609 DOI: 10.1016/j.ebiom.2016.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/28/2022] Open
Abstract
Human hypothalamic hamartoma (HH) is a rare subcortical lesion associated with treatment-resistant epilepsy. Cellular mechanisms responsible for epileptogenesis are unknown. We hypothesized that neuronal gap junctions contribute to epileptogenesis through synchronous activity within the neuron networks in HH tissue. We studied surgically resected HH tissue with Western-blot analysis, immunohistochemistry, electron microscopy, biocytin microinjection of recorded HH neurons, and microelectrode patch clamp recordings with and without pharmacological blockade of gap junctions. Normal human hypothalamus tissue was used as a control. Western blots showed increased expression of both connexin-36 (Cx36) and connexin-43 (Cx43) in HH tissue compared with normal human mammillary body tissue. Immunohistochemistry demonstrated that Cx36 and Cx43 are expressed in HH tissue, but Cx36 was mainly expressed within neuron clusters while Cx43 was mainly expressed outside of neuron clusters. Gap-junction profiles were observed between small HH neurons with electron microscopy. Biocytin injection into single recorded small HH neurons showed labeling of adjacent neurons, which was not observed in the presence of a neuronal gap-junction blocker, mefloquine. Microelectrode field recordings from freshly resected HH slices demonstrated spontaneous ictal/interictal-like discharges in most slices. Bath-application of gap-junction blockers significantly reduced ictal/interictal-like discharges in a concentration-dependent manner, while not affecting the action-potential firing of small gamma-aminobutyric acid (GABA) neurons observed with whole-cell patch-clamp recordings from the same patient's HH tissue. These results suggest that neuronal gap junctions between small GABAergic HH neurons participate in the genesis of epileptic-like discharges. Blockade of gap junctions may be a new therapeutic strategy for controlling seizure activity in HH patients. Neuronal-type functional gap junctions are present in HH tissue. Expression of neuronal-type gap junctions is more abundant in HH tissue relative to normal hypothalamus (mammillary body). In HH slices, pharmacological block of neuronal-type gap junctions significantly reduces seizure-like discharges.
This paper evaluates the role that gap junctions contribute to seizure activity utilized human hypothalamic hamartoma (HH) tissue after surgical resection. We find that 1) gap junctions are present in HH tissue, 2) gap junctions are more abundant in HH tissue relative to normal hypothalamus (mammillary body), and 3) pharmacological blockade of gap junctions in freshly-resected HH tissue slices can decrease the seizure-like discharges. These results provide evidence that gap junctions participate in the generation of seizures from HH tissue and suggest further research into the possibility that gap junction blocking medications may improve seizures in patients with HH.
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Affiliation(s)
- Jie Wu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA; Department of Pharmacology, Shantou University of Medical College, Guangdong, Shantou 815041, China.
| | - Ming Gao
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Stephen G Rice
- Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ 85016, USA
| | - Candy Tsang
- Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ 85016, USA
| | - John Beggs
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Dharshaun Turner
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Guohui Li
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Bo Yang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Kunkun Xia
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Fenfei Gao
- Department of Pharmacology, Shantou University of Medical College, Guangdong, Shantou 815041, China
| | - Shenfeng Qiu
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ 85004, USA
| | - Qiang Liu
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - John F Kerrigan
- Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ 85016, USA
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