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Gennari AG, Bicciato G, Lo Biundo SP, Kottke R, Stefanos-Yakoub I, Cserpan D, O'Gorman Tuura R, Ramantani G. Lesion volume and spike frequency on EEG impact perfusion values in focal cortical dysplasia: a pediatric arterial spin labeling study. Sci Rep 2024; 14:7601. [PMID: 38556543 PMCID: PMC10982306 DOI: 10.1038/s41598-024-58352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
Arterial spin labelling (ASL), an MRI sequence non-invasively imaging brain perfusion, has yielded promising results in the presurgical workup of children with focal cortical dysplasia (FCD)-related epilepsy. However, the interpretation of ASL-derived perfusion patterns remains unclear. Hence, we compared ASL qualitative and quantitative findings to their clinical, EEG, and MRI counterparts. We included children with focal structural epilepsy related to an MRI-detectable FCD who underwent single delay pseudo-continuous ASL. ASL perfusion changes were assessed qualitatively by visual inspection and quantitatively by estimating the asymmetry index (AI). We considered 18 scans from 15 children. 16 of 18 (89%) scans showed FCD-related perfusion changes: 10 were hypoperfused, whereas six were hyperperfused. Nine scans had perfusion changes larger than and seven equal to the FCD extent on anatomical images. Hyperperfusion was associated with frequent interictal spikes on EEG (p = 0.047). Perfusion changes in ASL larger than the FCD corresponded to larger lesions (p = 0.017). Higher AI values were determined by frequent interictal spikes on EEG (p = 0.004). ASL showed FCD-related perfusion changes in most cases. Further, higher spike frequency on EEG may increase ASL changes in affected children. These observations may facilitate the interpretation of ASL findings, improving treatment management, counselling, and prognostication in children with FCD-related epilepsy.
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Affiliation(s)
- Antonio Giulio Gennari
- Department of Neuropediatrics, University Children's Hospital Zurich, 75, 8032, Zurich, Switzerland
- MR-Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Giulio Bicciato
- Department of Neuropediatrics, University Children's Hospital Zurich, 75, 8032, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Santo Pietro Lo Biundo
- Department of Neuropediatrics, University Children's Hospital Zurich, 75, 8032, Zurich, Switzerland
| | - Raimund Kottke
- Department of Radiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ilona Stefanos-Yakoub
- Department of Neuropediatrics, University Children's Hospital Zurich, 75, 8032, Zurich, Switzerland
| | - Dorottya Cserpan
- Department of Neuropediatrics, University Children's Hospital Zurich, 75, 8032, Zurich, Switzerland
| | - Ruth O'Gorman Tuura
- MR-Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, 75, 8032, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
- Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.
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Strýček O, Říha P, Kojan M, Řehák Z, Brázdil M. Metabolic connectivity as a predictor of surgical outcome in mesial temporal lobe epilepsy. Epilepsia Open 2024; 9:187-199. [PMID: 37881152 PMCID: PMC10839369 DOI: 10.1002/epi4.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE The study investigated metabolic connectivity (MC) differences between patients with unilateral drug-resistant mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS) and healthy controls (HCs), based on [18 F]-fluorodeoxyglucose (FDG)-PET data. We focused on the MC changes dependent on the lateralization of the epileptogenic lobe and on correlations with postoperative outcomes. METHODS FDG-PET scans of 47 patients with unilateral MTLE with histopathologically proven HS and 25 HC were included in the study. All the patients underwent a standard anterior temporal lobectomy and were more than 2 years after the surgery. MC changes were compared between the two HS groups (left HS, right HS) and HC. Differences between the metabolic network of seizure-free and non-seizure-free patients after surgery were depicted afterward. Network changes were correlated with clinical characteristics. RESULTS The study showed widespread metabolic network changes in the HS patients as compared to HC. The changes were more extensive in the right HS than in the left HS. Unfavorable surgical outcomes were found in patients with decreased MC within the network including both the lesional and contralesional hippocampus, ipsilesional frontal operculum, and contralesional insula. Favorable outcomes correlated with decreased MC within the network involving both orbitofrontal cortices and the ipsilesional temporal lobe. SIGNIFICANCE There are major differences in the metabolic networks of left and right HS, with more extensive changes in right HS. The changes within the metabolic network could help predict surgical outcomes in patients with HS. MC may identify patients with potentially unfavorable outcomes and direct them to a more detailed presurgical evaluation. PLAIN LANGUAGE SUMMARY Metabolic connectivity is a promising method for metabolic network mapping. Metabolic networks in mesial temporal lobe epilepsy are dependent on lateralization of the epileptogenic lobe and could predict surgical outcomes.
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Affiliation(s)
- Ondřej Strýček
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of MedicineMasaryk University, Member of ERN‐EpiCAREBrnoCzech Republic
- Central European Institute of Technology (CEITEC)Masaryk UniversityBrnoCzech Republic
| | - Pavel Říha
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of MedicineMasaryk University, Member of ERN‐EpiCAREBrnoCzech Republic
- Central European Institute of Technology (CEITEC)Masaryk UniversityBrnoCzech Republic
| | - Martin Kojan
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of MedicineMasaryk University, Member of ERN‐EpiCAREBrnoCzech Republic
- Central European Institute of Technology (CEITEC)Masaryk UniversityBrnoCzech Republic
| | - Zdeněk Řehák
- Department of Nuclear MedicineMasaryk Memorial Cancer InstituteBrnoCzech Republic
| | - Milan Brázdil
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of MedicineMasaryk University, Member of ERN‐EpiCAREBrnoCzech Republic
- Central European Institute of Technology (CEITEC)Masaryk UniversityBrnoCzech Republic
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Banerjee A, Kamboj P, Wyckoff SN, Sussman BL, Gupta SKS, Boerwinkle VL. Automated seizure onset zone locator from resting-state functional MRI in drug-resistant epilepsy. FRONTIERS IN NEUROIMAGING 2023; 1:1007668. [PMID: 37555141 PMCID: PMC10406253 DOI: 10.3389/fnimg.2022.1007668] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/24/2022] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Accurate localization of a seizure onset zone (SOZ) from independent components (IC) of resting-state functional magnetic resonance imaging (rs-fMRI) improves surgical outcomes in children with drug-resistant epilepsy (DRE). Automated IC sorting has limited success in identifying SOZ localizing ICs in adult normal rs-fMRI or uncategorized epilepsy. Children face unique challenges due to the developing brain and its associated surgical risks. This study proposes a novel SOZ localization algorithm (EPIK) for children with DRE. METHODS EPIK is developed in a phased approach, where fMRI noise-related biomarkers are used through high-fidelity image processing techniques to eliminate noise ICs. Then, the SOZ markers are used through a maximum likelihood-based classifier to determine SOZ localizing ICs. The performance of EPIK was evaluated on a unique pediatric DRE dataset (n = 52). A total of 24 children underwent surgical resection or ablation of an rs-fMRI identified SOZ, concurrently evaluated with an EEG and anatomical MRI. Two state-of-art techniques were used for comparison: (a) least squares support-vector machine and (b) convolutional neural networks. The performance was benchmarked against expert IC sorting and Engel outcomes for surgical SOZ resection or ablation. The analysis was stratified across age and sex. RESULTS EPIK outperformed state-of-art techniques for SOZ localizing IC identification with a mean accuracy of 84.7% (4% higher), a precision of 74.1% (22% higher), a specificity of 81.9% (3.2% higher), and a sensitivity of 88.6% (16.5% higher). EPIK showed consistent performance across age and sex with the best performance in those < 5 years of age. It helped achieve a ~5-fold reduction in the number of ICs to be potentially analyzed during pre-surgical screening. SIGNIFICANCE Automated SOZ localization from rs-fMRI, validated against surgical outcomes, indicates the potential for clinical feasibility. It eliminates the need for expert sorting, outperforms prior automated methods, and is consistent across age and sex.
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Affiliation(s)
- Ayan Banerjee
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, United States
| | - Payal Kamboj
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, United States
| | - Sarah N. Wyckoff
- Division of Neuroscience, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Bethany L. Sussman
- Division of Neuroscience, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Sandeep K. S. Gupta
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, United States
| | - Varina L. Boerwinkle
- Division of Child Neurology, University of North Carolina Department of Neurology, Chapel Hill, NC, United States
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4
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Mohanty D, Quach M. The Noninvasive Evaluation for Minimally Invasive Pediatric Epilepsy Surgery (MIPES): A Multimodal Exploration of the Localization-Based Hypothesis. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1760104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractMinimally invasive pediatric epilepsy surgery (MIPES) is a rising technique in the management of focal-onset drug-refractory epilepsy. Minimally invasive surgical techniques are based on small, focal interventions (such as parenchymal ablation or localized neuromodulation) leading to elimination of the seizure onset zone or interruption of the larger epileptic network. Precise localization of the seizure onset zone, demarcation of eloquent cortex, and mapping of the network leading to seizure propagation are required to achieve optimal outcomes. The toolbox for presurgical, noninvasive evaluation of focal epilepsy continues to expand rapidly, with a variety of options based on advanced imaging and electrophysiology. In this article, we will examine several of these diagnostic modalities from the standpoint of MIPES and discuss how each can contribute to the development of a localization-based hypothesis for potential surgical targets.
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Affiliation(s)
- Deepankar Mohanty
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Michael Quach
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Carvalho MS, Alvim MKM, Etchebehere E, Santos ADO, Ramos CD, Argenton JLP, Cendes F, Amorim BJ. Interictal and postictal 18F-FDG PET/CT in epileptogenic zone localization. Radiol Bras 2022; 55:273-279. [PMID: 36320375 PMCID: PMC9620847 DOI: 10.1590/0100-3984.2021.0141] [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: 09/21/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the performance of 18F-fluorodeoxyglucose
positron-emission tomography/computed tomography ( 18F-FDG
PET/CT) in localizing epileptogenic zones, comparing 18F-FDG
injection performed in the traditional interictal period with that performed
near the time of a seizure. Materials and Methods We evaluated patients with refractory epilepsy who underwent
18F-FDG PET/CT. The reference standards for localization of the
epileptogenic zone were histopathology and follow-up examinations (in
patients who underwent surgery) or serial electroencephalography (EEG)
recordings, long-term video EEG, and magnetic resonance imaging (in patients
who did not). The 18F-FDG injection was performed whether the
patient had an epileptic seizure during the EEG monitoring period or not.
The 18F-FDG PET/CT results were categorized as concordant or
discordant with the reference standards. Results Of the 110 patients evaluated, 10 were in a postictal group (FDG injection
after a seizure) and 100 were in the interictal group. The
18F-FDG PET/CT was concordant with the reference standards in
nine (90%) of the postictal group patients and in 60 (60%) of the interictal
group patients. Among the nine postictal group patients in whom the results
were concordant, the 18F-FDG PET/CT showed hypermetabolism and
hypometabolism in the epileptogenic zone in four (44.4%) and five (55.6%),
respectively. Conclusion Our data indicate that 18F-FDG PET/CT is a helpful tool for
localization of the epileptogenic zone and that EEG monitoring is an
important means of correlating the findings. In addition, postictal
18F-FDG PET/CT is able to identify the epileptogenic zone by
showing either hypometabolism or hypermetabolism.
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Kosugi K, Iijima K, Yokosako S, Takayama Y, Kimura Y, Kaneko Y, Sumitomo N, Saito T, Nakagawa E, Sato N, Iwasaki M. Low EEG Gamma Entropy and Glucose Hypometabolism After Corpus Callosotomy Predicts Seizure Outcome After Subsequent Surgery. Front Neurol 2022; 13:831126. [PMID: 35401399 PMCID: PMC8989433 DOI: 10.3389/fneur.2022.831126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with generalized epilepsy who had lateralized EEG abnormalities after corpus callosotomy (CC) occasionally undergo subsequent surgeries to control intractable epilepsy.ObjectivesThis study evaluated retrospectively the combination of EEG multiscale entropy (MSE) and FDG-PET for identifying lateralization of the epileptogenic zone after CC.MethodsThis study included 14 patients with pharmacoresistant epilepsy who underwent curative epilepsy surgery after CC. Interictal scalp EEG and FDG-PET obtained after CC were investigated to determine (1) whether the MSE calculated from the EEG and FDG-PET findings was lateralized to the surgical side, and (2) whether the lateralization was associated with seizure outcomes.ResultsSeizure reduction rate was higher in patients with lateralized findings to the surgical side than those without (MSE: p < 0.05, FDG-PET: p < 0.05, both: p < 0.01). Seizure free rate was higher in patients with lateralized findings in both MSE and FDG-PET than in those without (p < 0.05).ConclusionsThis study demonstrated that patients with lateralization of MSE and FDG-PET to the surgical side had better seizure outcomes. The combination of MSE and conventional FDG-PET may help to select surgical candidates for additional surgery after CC with good postoperative seizure outcomes.
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Affiliation(s)
- Kenzo Kosugi
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Suguru Yokosako
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuiko Kimura
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuu Kaneko
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
- *Correspondence: Masaki Iwasaki
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Zhang T, Li Y, Zhao S, Xu Y, Zhang X, Wu S, Dou X, Yu C, Feng J, Ding Y, Zhu J, Chen Z, Zhang H, Tian M. High-resolution pediatric age-specific 18F-FDG PET template: a pilot study in epileptogenic focus localization. Eur J Nucl Med Mol Imaging 2021; 49:1560-1573. [PMID: 34746970 PMCID: PMC8940757 DOI: 10.1007/s00259-021-05611-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022]
Abstract
Background PET imaging has been widely used in diagnosis of neurological disorders; however, its application to pediatric population is limited due to lacking pediatric age–specific PET template. This study aims to develop a pediatric age–specific PET template (PAPT) and conduct a pilot study of epileptogenic focus localization in pediatric epilepsy. Methods We recruited 130 pediatric patients with epilepsy and 102 age-matched controls who underwent 18F-FDG PET examination. High-resolution PAPT was developed by an iterative nonlinear registration-averaging optimization approach for two age ranges: 6–10 years (n = 17) and 11–18 years (n = 50), respectively. Spatial normalization to the PAPT was evaluated by registration similarities of 35 validation controls, followed by estimation of potential registration biases. In a pilot study, epileptogenic focus was localized by PAPT-based voxel-wise statistical analysis, compared with multi-disciplinary team (MDT) diagnosis, and validated by follow-up of patients who underwent epilepsy surgery. Furthermore, epileptogenic focus localization results were compared among three templates (PAPT, conventional adult template, and a previously reported pediatric linear template). Results Spatial normalization to the PAPT significantly improved registration similarities (P < 0.001), and nearly eliminated regions of potential biases (< 2% of whole brain volume). The PAPT-based epileptogenic focus localization achieved a substantial agreement with MDT diagnosis (Kappa = 0.757), significantly outperforming localization based on the adult template (Kappa = 0.496) and linear template (Kappa = 0.569) (P < 0.05). The PAPT-based localization achieved the highest detection rate (89.2%) and accuracy (80.0%). In postsurgical seizure-free patients (n = 40), the PAPT-based localization also achieved a substantial agreement with resection areas (Kappa = 0.743), and the highest detection rate (95%) and accuracy (80.0%). Conclusion The PAPT can significantly improve spatial normalization and epileptogenic focus localization in pediatric epilepsy. Future pediatric neuroimaging studies can also benefit from the unbiased spatial normalization by PAPT. Trial registration. NCT04725162: https://clinicaltrials.gov/ct2/show/NCT04725162 Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05611-w.
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Affiliation(s)
- Teng Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Yuting Li
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Shuilin Zhao
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Yuanfan Xu
- Hangzhou Universal Medical Imaging Diagnostic Center, Hangzhou, China
| | - Xiaohui Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Xiaofeng Dou
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Congcong Yu
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Jianhua Feng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Junming Zhu
- Department of Neurosurgery, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zexin Chen
- Center of Clinical Epidemiology & Biostatistics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. .,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China. .,The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.
| | - Mei Tian
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
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Kassab A, Hinnoutondji Toffa D, Robert M, Lesage F, Peng K, Khoa Nguyen D. Hemodynamic changes associated with common EEG patterns in critically ill patients: Pilot results from continuous EEG-fNIRS study. Neuroimage Clin 2021; 32:102880. [PMID: 34773798 PMCID: PMC8594770 DOI: 10.1016/j.nicl.2021.102880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022]
Abstract
Functional near-infrared spectroscopy (fNIRS) is currently the only non-invasive method allowing for continuous long-term assessment of cerebral hemodynamic. We evaluate the feasibility of using continueous electroencephalgraphy (cEEG)-fNIRS to study the cortical hemodynamic associated with status epilepticus (SE), burst suppression (BS) and periodic discharges (PDs). Eleven adult comatose patients admitted to the neuroICU for SE were recruited, and cEEG-fNIRS monitoring was performed to measure concentration changes in oxygenated (HbO) and deoxygenated hemoglobin (HbR). Seizures were associated with a large increase HbO and a decrease in HbR whose durations were positively correlated with the seizures' length. Similar observations were made for hemodynamic changes associated with bursts, showing overall increases in HbO and decreases in HbR relative to the suppression periods. PDs were seen to induce widespread HbO increases and HbR decreases. These results suggest that normal neurovascular coupling is partially retained with the hemodynamic response to the detected EEG patterns in these patients. However, the shape and distribution of the response were highly variable. This work highlighted the feasibility of conducting long-term cEEG-fNIRS to monitor hemodynamic changes over a large cortical area in critically ill patients, opening new routes for better understanding and management of abnormal EEG patterns in neuroICU.
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Affiliation(s)
- Ali Kassab
- Department of Neurological Sciences, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec H3C 3J7, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, 900 Saint Denis St., Montreal, Quebec H2X 0A9, Canada.
| | - Dènahin Hinnoutondji Toffa
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, 900 Saint Denis St., Montreal, Quebec H2X 0A9, Canada.
| | - Manon Robert
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, 900 Saint Denis St., Montreal, Quebec H2X 0A9, Canada.
| | - Frédéric Lesage
- Biomedical Engineering Institute, École Polytechnique de Montréal, 2500 Chemin de Polytechnique, Montréal, Quebec H3T 1J4, Canada; Research Center, Montreal Heart Institute, 5000 Rue Bélanger, Montreal, Quebec H1T 1C8, Canada.
| | - Ke Peng
- Department of Neurological Sciences, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec H3C 3J7, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, 900 Saint Denis St., Montreal, Quebec H2X 0A9, Canada.
| | - Dang Khoa Nguyen
- Department of Neurological Sciences, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec H3C 3J7, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, 900 Saint Denis St., Montreal, Quebec H2X 0A9, Canada; Division of Neurology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, 1000 Saint Denis St, Montreal, Quebec (H2X OC1), Canada.
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Bacon EJ, Jin C, He D, Hu S, Wang L, Li H, Qi S. Epileptogenic Zone Localization in Refractory Epilepsy by FDG-PET: The Comparison of SPM and SPM-CAT With Different Parameter Settings. Front Neurol 2021; 12:724680. [PMID: 34690915 PMCID: PMC8529991 DOI: 10.3389/fneur.2021.724680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Refractory epilepsy is a complex case of epileptic disease. The quantitative analysis of fluorodeoxyglucose positron emission tomography (FDG-PET) images complements visual assessment and helps localize the epileptogenic zone (EZ) for better curative treatment. Statistical parametric mapping (SPM) and its computational anatomy toolbox (SPM-CAT) are two commonly applied tools in neuroimaging analysis. This study compares SPM and SPM-CAT with different parameters to find the optimal approach for localizing EZ in refractory epilepsy. The current study enrolled 45 subjects, including 25 refractory epilepsy patients and 20 healthy controls. All of the 25 patients underwent surgical operations. Pathological results and the postoperative outcome evaluation by the Engel scale were likewise presented. SPM and SPM-CAT were used to assess FDG-PET images with three different uncorrected p-values and the corresponding cluster sizes (k), as in voxels in the cluster, namely p < 0.0002, k > 25; p < 0.001, k > 100; p < 0.005, and k > 200. When combining three settings, SPM and SPM-CAT yielded overall positive finding scores of 96.0% (24/25) and 100.0% (25/25) respectively. However, for the individual setting, SPM-CAT achieved the diverse positive finding scores of 96.0% (24/25), 96.0% (24/25), and 88.0% (22/24), which are higher than those of SPM [88.0% (22/25), 76.0% (19/25), and 72.0% (18/25)]. SPM and SPM-CAT localized EZ correctly with 28.0% (7/25) and 64.0% (16/25), respectively. SPM-CAT with parameter settings p < 0.0002 and k > 25 yielded a correct localization at 56.0% (14/25), which is slightly higher than that for the other two settings (48.0 and 20.0%). Moderate concordance was found between the confirmed and pre-surgical EZs, identified by SPM-CAT (kappa value = 0.5). Hence, SPM-CAT is more efficient than SPM in localizing EZ for refractory epilepsy by quantitative analysis of FDG-PET images. SPM-CAT with the setting of p < 0.0002 and k > 25 might perform as an objective complementary tool to the visual assessment for EZ localization.
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Affiliation(s)
- Eric Jacob Bacon
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.,Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
| | - Chaoyang Jin
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Dianning He
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Shuaishuai Hu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lanbo Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Han Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.,Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
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10
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Cheng L, Xing Y, Zhang H, Liu R, Lai H, Piao Y, Wang W, Yan X, Li X, Wang J, Li D, Loh HH, Yu T, Zhang G, Yang X. Mechanistic Analysis of Micro-Neurocircuits Underlying the Epileptogenic Zone in Focal Cortical Dysplasia Patients. Cereb Cortex 2021; 32:2216-2230. [PMID: 34664065 DOI: 10.1093/cercor/bhab350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
We aim to explore the microscopic neurophysiology of focal cortical dysplasia (FCD) induced epileptogenesis in specific macroscopic brain regions, therefore mapping a micro-macro neuronal network that potentially indicates the epileptogenic mechanism. Epileptic and relatively non-epileptic temporal neocortex specimens were resected from FCD and mesial temporal lobe epilepsy (mTLE) patients, respectively. Whole-cell patch-clamping was performed on cells from the seizure onset zone (SOZ) and non-SOZ inside the epileptogenic zone (EZ) of FCD patients, as well as the non-epileptic neocortex of mTLE patients. Microscopic data were recorded, including membrane characteristics, spontaneous synaptic activities, and evoked action potentials. Immunohistochemistry was also performed on parvalbumin-positive (PV+) interneurons. We found that SOZ interneurons exhibited abnormal neuronal expression and distribution as well as reduced overall function compared with non-SOZ and mTLE interneurons. The SOZ pyramidal cells experienced higher excitation but lower inhibition than the mTLE controls, whereas the non-SOZ pyramidal cells exhibited intermediate excitability. Action potential properties of both types of neurons also suggested more synchronized neuronal activity inside the EZ, particularly inside the SOZ. Together, our research provides evidence for a potential neurocircuit underlying SOZ epileptogenesis and non-SOZ seizure susceptibility. Further investigation of this microscopic network may promote understanding of the mechanism of FCD-induced epileptogenesis.
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Affiliation(s)
- Lipeng Cheng
- Center of Epilepsy, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China.,Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China.,Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yue Xing
- Center of Epilepsy, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China.,Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China.,Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Herui Zhang
- Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China
| | - Ru Liu
- Center of Epilepsy, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China.,Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China.,Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Huanling Lai
- Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China
| | - Yueshan Piao
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Wei Wang
- Center of Epilepsy, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China.,Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China.,Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiaoming Yan
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiaonan Li
- Center of Epilepsy, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China.,Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China.,Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jiaoyang Wang
- Center of Epilepsy, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China.,Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China.,Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Donghong Li
- Center of Epilepsy, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China.,Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China.,Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong 510635, China
| | - Horace H Loh
- Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China
| | - Tao Yu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Guojun Zhang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Functional Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Xiaofeng Yang
- Center of Epilepsy, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China.,Fundamental Research Department, Guangzhou Laboratory, Guangzhou 510700, China.,Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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11
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Starnes K, Depositario-Cabacar D, Wong-Kisiel L. Presurgical Evaluation Strategies for Intractable Epilepsy of Childhood. Semin Pediatr Neurol 2021; 39:100915. [PMID: 34620457 DOI: 10.1016/j.spen.2021.100915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
For children who continue to experience seizures despite treatment with antiseizure medications, epilepsy surgery can be considered. The goals of the presurgical evaluation are to determine the best surgical approach to render a good outcome. In patients with drug resistant focal epilepsy, the epileptogenic zone defines the minimal brain volume which must be resected for surgical success and to delineate the relationship of this region with functional cortex. A number of noninvasive tools for these tasks have emerged over the past decade, and existing technologies have been revised and improved. In this review, we examine the recent published evidence for these techniques, specifically as applied to the pediatric population. Discussed herein are the diagnostic value of methods such as video electroencephalography, magnetic resonance imaging, and supportive neuroimaging techniques including single photon emission tomography, photon emission tomography, and magnetoencephalography. Functional testing including functional magnetic resonance imaging, electrical stimulation mapping, and transcranial magnetic stimulation are considered in the context of pediatric epilepsy. The application of emerging techniques to preoperative testing such as source localization, image post-processing, and artificial intelligence is covered. We summarize the relative value of presurgical testing based on patient characteristics, including lesional or nonlesional MRI, temporal or extratemporal epilepsy, and other factors relevant in pediatric epilepsy such as pathological substrate and age.
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Affiliation(s)
| | | | - Lily Wong-Kisiel
- Department of Neurology and Pediatrics, Mayo Clinic, Rochester, MN.
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12
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Yan R, Zhang H, Wang J, Zheng Y, Luo Z, Zhang X, Xu Z. Application value of molecular imaging technology in epilepsy. IBRAIN 2021; 7:200-210. [PMID: 37786793 PMCID: PMC10528966 DOI: 10.1002/j.2769-2795.2021.tb00084.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 10/04/2023]
Abstract
Epilepsy is a common neurological disease with various seizure types, complicated etiologies, and unclear mechanisms. Its diagnosis mainly relies on clinical history, but an electroencephalogram is also a crucial auxiliary examination. Recently, brain imaging technology has gained increasing attention in the diagnosis of epilepsy, and conventional magnetic resonance imaging can detect epileptic foci in some patients with epilepsy. However, the results of brain magnetic resonance imaging are normal in some patients. New molecular imaging has gradually developed in recent years and has been applied in the diagnosis of epilepsy, leading to enhanced lesion detection rates. However, the application of these technologies in epilepsy patients with negative brain magnetic resonance must be clarified. Thus, we reviewed the relevant literature and summarized the information to improve the understanding of the molecular imaging application value of epilepsy.
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Affiliation(s)
- Rong Yan
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hai‐Qing Zhang
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Jing Wang
- Prevention and Health Care, The Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yong‐Su Zheng
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zhong Luo
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Xia Zhang
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zu‐Cai Xu
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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13
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Abstract
BACKGROUND A large number of patients have epilepsy that is intractable and adversely affects a child's lifelong experience with addition societal burden that is disabling and expensive. The last two decades have seen a major explosion of new antiseizure medication options. Despite these advances, children with epilepsy continue to have intractable seizures. An option that has been long available but little used is epilepsy surgery to control intractable epilepsy. METHODS This article is a review of the literature as well as published opinions. RESULTS Epilepsy surgery in pediatrics is an underused modality to effectively treat children with epilepsy. Adverse effects of medication should be weighed against risks of surgery as well as risks of nonefficacy. CONCLUSIONS We discuss an approach to selecting the appropriate pediatric patient for consideration, a detailed evaluation including necessary evaluation, and the creation of an algorithm to approach patients with both generalized and focal epilepsy. We then discuss surgical options available including outcome data. New modalities are also addressed including high-frequency ultrasound and co-registration techniques including magnetic resonance imaging-guided laser therapy.
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14
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Foundations of the Diagnosis and Surgical Treatment of Epilepsy. World Neurosurg 2020; 139:750-761. [DOI: 10.1016/j.wneu.2020.03.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/02/2020] [Indexed: 12/29/2022]
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15
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Curnow SR, Vogrin SJ, Barton S, Bailey CA, Harvey AS. Focal cortical hypermetabolism in atypical benign rolandic epilepsy. Epilepsy Res 2020; 161:106288. [PMID: 32086099 DOI: 10.1016/j.eplepsyres.2020.106288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Atypical benign rolandic epilepsy (BRE) is an underrecognized and poorly understood manifestation of a common epileptic syndrome. Most consider it a focal epileptic encephalopathy in which frequent, interictal, centrotemporal spikes lead to negative motor seizures and interfere with motor and sometimes speech and cognitive abilities. We observed focal cortical hypermetabolism on PET in three children with atypical BRE and investigated the spatial and temporal relationship with their centrotemporal spikes. METHODS EEG, MRI and PET were performed clinically in three children with atypical BRE. The frequency and source localization of centrotemporal spikes was determined and compared with the location of maximal metabolic activity on PET. RESULTS Cortical hypermetabolism on thresholded PET t-maps and current density reconstructions of centrotemporal spikes overlapped in each child, in the central sulcus region, the distances between the "centers of maxima" being 2 cm or less. Hypermetabolism was not due to recent seizures or frequent centrotemporal spikes at the time of FDG uptake. SIGNIFICANCE The findings suggest that localized, increased cortical activity, in the region of the EEG focus, underlies the negative clinical manifestations of atypical BRE. Similar findings are reported in the broader group of epileptic encephalopathies associated with electrical status epilepticus in sleep.
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Affiliation(s)
- Sarah R Curnow
- Department of Neurology, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Developmental Brain Imaging and Neuroscience Research Groups, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Simon J Vogrin
- Developmental Brain Imaging and Neuroscience Research Groups, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Sarah Barton
- Department of Neurology, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Developmental Brain Imaging and Neuroscience Research Groups, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Catherine A Bailey
- Department of Neurology, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - A Simon Harvey
- Department of Neurology, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Developmental Brain Imaging and Neuroscience Research Groups, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Pediatrics, The University of Melbourne, Grattan Street, Parkville, 3010, Australia.
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16
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Traub-Weidinger T, Muzik O, Sundar LKS, Aull-Watschinger S, Beyer T, Hacker M, Hahn A, Kasprian G, Klebermass EM, Lanzenberger R, Mitterhauser M, Pilz M, Rausch I, Rischka L, Wadsak W, Pataraia E. Utility of Absolute Quantification in Non-lesional Extratemporal Lobe Epilepsy Using FDG PET/MR Imaging. Front Neurol 2020; 11:54. [PMID: 32082251 PMCID: PMC7005011 DOI: 10.3389/fneur.2020.00054] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 01/14/2020] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to establish a non-invasive clinical PET/MR protocol using [18F]-labeled deoxyglucose (FDG) that provides physicians with regional metabolic rate of glucose (MRGlc) values and to clarify the contribution of absolute quantification to clinical management of patients with non-lesional extratemporal lobe epilepsy (ETLE). The study included a group of 15 patients with non-lesional ETLE who underwent a dynamic FDG PET study using a fully-integrated PET/MRI system (Siemens Biograph). FDG tracer uptake images were converted to MRGlc (μmol/100 g/min) maps using an image derived input function that was extracted based on the combined analysis of PET and MRI data. In addition, the same protocol was applied to a group of healthy controls, yielding a normative database. Abnormality maps for ETLE patients were created with respect to the normative database, defining significant hypo- or hyper-metabolic regions that exceeded ±2 SD of normal regional mean MRGlc values. Abnormality maps derived from MRGlc images of ETLE patients contributed to the localization of hypo-metabolic areas against visual readings in 53% and increased the confidence in the original clinical readings in 33% of all cases. Moreover, quantification allowed identification of hyper-metabolic areas that are associated with frequently spiking cortex, rarely acknowledged in clinical readings. Overall, besides providing some confirmatory information to visual readings, quantitative PET imaging demonstrated only a moderate impact on clinical management of patients with complex pathology that leads to epileptic seizures, failing to provide new decisive information that would have changed classification of patients from being rejected to being considered for surgical intervention.
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Affiliation(s)
- Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Otto Muzik
- Department of Pediatrics, The Detroit Medical Center, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, United States
| | - Lalith Kumar Shiyam Sundar
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Eva-Maria Klebermass
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Ludwig-Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Magdalena Pilz
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Lucas Rischka
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine, Graz, Austria
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17
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Abstract
Candidates for epilepsy surgery must undergo presurgical evaluation to establish whether and how surgical treatment can stop seizures without causing neurological deficits. Various techniques, including MRI, PET, single-photon emission CT, video-EEG, magnetoencephalography and invasive EEG, aim to identify the diseased brain tissue and the involved network. Recent technical and methodological developments, encompassing both advances in existing techniques and new combinations of technologies, are enhancing the ability to define the optimal resection strategy. Multimodal interpretation and predictive computer models are expected to aid surgical planning and patient counselling, and multimodal intraoperative guidance is likely to increase surgical precision. In this Review, we discuss how the knowledge derived from these new approaches is challenging our way of thinking about surgery to stop focal seizures. In particular, we highlight the importance of looking beyond the EEG seizure onset zone and considering focal epilepsy as a brain network disease in which long-range connections need to be taken into account. We also explore how new diagnostic techniques are revealing essential information in the brain that was previously hidden from view.
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18
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Altered Brain Glucose Metabolism Assessed by 18F-FDG PET Imaging Is Associated with the Cognitive Impairment of CADASIL. Neuroscience 2019; 417:35-44. [PMID: 31394195 DOI: 10.1016/j.neuroscience.2019.07.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022]
Abstract
Recurrent stroke and cognitive impairment are the primary features of patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The cognitive deficits in these patients are known to be correlated with structural brain changes, such as white matter lesions and lacunae, and resting-state functional connectivity in brain networks. However, the associations between changes in brain glucose metabolism based on 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) imaging and cognitive scores in CADASIL patients remain unclear. In the present study, 24 CADASIL patients and 24 matched healthy controls underwent 18F-FDG PET imaging. Brain glucose metabolism was measured in all subjects and Pearson's correlation analyses were performed to evaluate relationships between abnormal glucose metabolism in various brain areas and cognitive scores. Compared to controls, CADASIL patients exhibited significantly lower metabolism in the right cerebellar posterior lobe, left cerebellar anterior lobe, bilateral thalamus and left limbic lobe. Additionally, hypermetabolism was observed in the left precentral and postcentral gyri. Importantly, glucose metabolism in the left limbic lobe was positively associated with cognitive scores on the Mini-Mental State Examination (MMSE). Furthermore, glucose metabolism in the left precentral gyri was negatively correlated with cognitive scores on the Montreal Cognitive Assessment (MoCA). The present findings provide strong support for the presence of altered brain glucose metabolism in CADASIL patients as well as the associations between abnormal metabolism and cognitive scales in this population. The present findings suggest that patterns of brain glucose metabolism may become useful markers of cognitive impairment in CADASIL patients.
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19
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Guerriero RM, Gaillard WD. Imaging modalities to diagnose and localize status epilepticus. Seizure 2019; 68:46-51. [DOI: 10.1016/j.seizure.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 01/07/2023] Open
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20
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Koenig JB, Dulla CG. Dysregulated Glucose Metabolism as a Therapeutic Target to Reduce Post-traumatic Epilepsy. Front Cell Neurosci 2018; 12:350. [PMID: 30459556 PMCID: PMC6232824 DOI: 10.3389/fncel.2018.00350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) is a significant cause of disability worldwide and can lead to post-traumatic epilepsy. Multiple molecular, cellular, and network pathologies occur following injury which may contribute to epileptogenesis. Efforts to identify mechanisms of disease progression and biomarkers which predict clinical outcomes have focused heavily on metabolic changes. Advances in imaging approaches, combined with well-established biochemical methodologies, have revealed a complex landscape of metabolic changes that occur acutely after TBI and then evolve in the days to weeks after. Based on this rich clinical and preclinical data, combined with the success of metabolic therapies like the ketogenic diet in treating epilepsy, interest has grown in determining whether manipulating metabolic activity following TBI may have therapeutic value to prevent post-traumatic epileptogenesis. Here, we focus on changes in glucose utilization and glycolytic activity in the brain following TBI and during seizures. We review relevant literature and outline potential paths forward to utilize glycolytic inhibitors as a disease-modifying therapy for post-traumatic epilepsy.
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Affiliation(s)
- Jenny B Koenig
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| | - Chris G Dulla
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
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21
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Sakaguchi Y, Kidokoro H, Ogawa C, Okai Y, Ito Y, Yamamoto H, Ohno A, Nakata T, Tsuji T, Nakane T, Kawai H, Kato K, Naganawa S, Natsume J. Longitudinal Findings of MRI and PET in West Syndrome with Subtle Focal Cortical Dysplasia. AJNR Am J Neuroradiol 2018; 39:1932-1937. [PMID: 30213810 DOI: 10.3174/ajnr.a5772] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite the development of neuroimaging, identification of focal cortical dysplasia remains challenging. The purpose of this study was to show the longitudinal changes of MR imaging and FDG-PET in patients with West syndrome and subtle focal cortical dysplasia. MATERIALS AND METHODS Among 52 consecutive patients with West syndrome, 4 were diagnosed with subtle focal cortical dysplasia on 3T MR imaging. MR imaging and PET findings were evaluated longitudinally at onset and at 12 and 24 months of age. RESULTS At the onset of West syndrome, MR imaging demonstrated focal signal abnormalities of the subcortical white matter in 2 patients. In the other 2 patients, focal subcortical high-intensity signals became visible on follow-up T2WI as myelination progressed. PET at onset showed focal cortical hypometabolism in 3 patients, with 1 of these patients also having focal hypermetabolism and 1 having normal findings. On PET at 24 months, hypometabolism persisted in 2 patients and disappeared in 1, and hypermetabolism disappeared in 1. In 1 patient with normal MR imaging and PET findings at onset, focal hyperintensity and hypometabolism first appeared at 24 months of age. The findings on MR imaging and PET in these patients evolved differently with brain maturation and the clinical course. CONCLUSIONS Subtle focal cortical dysplasia can be undetectable on MR imaging at the onset of West syndrome and is not always accompanied by hypometabolism or hypermetabolism on PET. Longitudinal MR imaging and PET studies may be useful for detecting such lesions. Even in West syndrome with a congenital structural abnormality, PET findings evolve differently with brain maturation and the clinical condition.
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Affiliation(s)
- Y Sakaguchi
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - H Kidokoro
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - C Ogawa
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - Y Okai
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - Y Ito
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - H Yamamoto
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - A Ohno
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - T Nakata
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.)
| | - T Tsuji
- Department of Pediatrics (T.T.), Okazaki City Hospital, Okazaki, Japan
| | - T Nakane
- Radiology (T. Nakane, H. Kawai, S.N.)
| | - H Kawai
- Radiology (T. Nakane, H. Kawai, S.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - K Kato
- Radiological and Medical Laboratory Sciences (K.K.)
| | - S Naganawa
- Radiology (T. Nakane, H. Kawai, S.N.).,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
| | - J Natsume
- From the Departments of Pediatrics (Y.S., H. Kidokoro, C.O., Y.O., Y.I., H.Y., A.O., T. Nakata, J.N.) .,Developmental Disability Medicine (J.N.), Nagoya University Graduate School of Medicine, Nagoya, Japan.,Brain and Mind Research Center (H. Kidokoro, Y.I., H.Y., H. Kawai, S.N., J.N.), Nagoya University, Nagoya, Japan
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22
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Hu WH, Wang X, Liu LN, Shao XQ, Zhang K, Ma YS, Ai L, Li JJ, Zhang JG. Multimodality Image Post-processing in Detection of Extratemporal MRI-Negative Cortical Dysplasia. Front Neurol 2018; 9:450. [PMID: 29963006 PMCID: PMC6010529 DOI: 10.3389/fneur.2018.00450] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/28/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: To determine the diagnostic value of individual image post-processing techniques in a series of patients who underwent extratemporal operations for histologically proven, MRI-negative focal cortical dysplasia (FCD). Methods: The morphometric analysis program (MAP), PET/MRI co-registration and statistical parametric mapping (SPM) analysis of PET (SPM-PET) techniques were analyzed in 33 consecutive patients. The epileptogenic zone (EZ) assumed by MAP, PET/MRI, and SPM-PET was compared with the location of the FCD lesions determined by stereoelectroencephalography (SEEG) and histopathological study. The detection rate of each modality was statistically compared. Results: Three lesions were simultaneously detected by the three post-processing methods, while two lesions were only MAP positive, and 8 were only PET/MRI positive. The detection rate of MAP, PET/MRI, SPM-PET and the combination of the three modalities was 24.2, 90.9, 57.6, and 97.0%, respectively. Taking the pathological subtype into account, no type I lesions were detected by MAP, and PET/MRI was the most sensitive method for detecting FCD types II and IIA. During a mean follow-up period of 22.94 months, seizure freedom was attained in 26/33 patients (78.8%) after focal corticectomy. Conclusions: MAP, PET/MRI, and SPM-PET provide complementary information for FCD detection, intracranial electrode design, and lesion resection. PET/MRI was particularly useful, with the highest detection rate of extratemporal MRI-negative FCD.
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Affiliation(s)
- Wen-Han Hu
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Na Liu
- Department of Pathology, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan-Shan Ma
- Department of Epilepsy Center, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Lin Ai
- Department of Neuroimage, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun-Ju Li
- Department of Neurosurgery, Hainan General Hospital, Haikou, China
| | - Jian-Guo Zhang
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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23
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Tao H, Zhou X, Zhao B, Li K. Conflicting Effects of Methylglyoxal and Potential Significance of miRNAs for Seizure Treatment. Front Mol Neurosci 2018; 11:70. [PMID: 29556176 PMCID: PMC5845011 DOI: 10.3389/fnmol.2018.00070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/19/2018] [Indexed: 01/09/2023] Open
Abstract
According to an update from the World Health Organization, approximately 50 million people worldwide suffer from epilepsy, and nearly one-third of these individuals are resistant to the currently available antiepileptic drugs, which has resulted in an insistent pursuit of novel strategies for seizure treatment. Recently, methylglyoxal (MG) was demonstrated to serve as a partial agonist of the gamma-aminobutyric acid type A (GABAA) receptor and to play an inhibitory role in epileptic activities. However, MG is also a substrate in the generation of advanced glycation end products (AGEs) that function by activating the receptor of AGEs (RAGE). The AGE/RAGE axis is responsible for the transduction of inflammatory cascades and appears to be an adverse pathway in epilepsy. This study systematically reviewed the significance of GABAergic MG, glyoxalase I (GLO1; responsible for enzymatic catalysis of MG cleavage) and downstream RAGE signaling in epilepsy. This work also discussed the potential of miRNAs that target multiple mRNAs and introduced a preliminary scheme for screening and validating miRNA candidates with the goal of reconciling the conflicting effects of MG for the future development of seizure treatments.
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Affiliation(s)
- Hua Tao
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.,Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xu Zhou
- Clinical Research Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bin Zhao
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.,Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Keshen Li
- Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.,Stroke Center, Neurology & Neurosurgery Division, Clinical Medicine Research Institute & the First Affiliated Hospital, Jinan University, Guangzhou, China
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24
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García-García L, Fernández de la Rosa R, Delgado M, Silván Á, Bascuñana P, Bankstahl JP, Gomez F, Pozo MA. Metyrapone prevents acute glucose hypermetabolism and short-term brain damage induced by intrahippocampal administration of 4-aminopyridine in rats. Neurochem Int 2017; 113:92-106. [PMID: 29203398 DOI: 10.1016/j.neuint.2017.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/13/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Abstract
Intracerebral administration of the potassium channel blocker 4-aminopyridine (4-AP) triggers neuronal depolarization and intense acute seizure activity followed by neuronal damage. We have recently shown that, in the lithium-pilocarpine rat model of status epilepticus (SE), a single administration of metyrapone, an inhibitor of the 11β-hydroxylase enzyme, had protective properties of preventive nature against signs of brain damage and neuroinflammation. Herein, our aim was to investigate to which extent, pretreatment with metyrapone (150 mg/kg, i.p.) was also able to prevent eventual changes in the acute brain metabolism and short-term neuronal damage induced by intrahippocampal injection of 4-AP (7 μg/5 μl). To this end, regional brain metabolism was assessed by 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG) positron emission tomography (PET) during the ictal period. Three days later, markers of neuronal death and hippocampal integrity and apoptosis (Nissl staining, NeuN and active caspase-3 immunohistochemistry), neurodegeneration (Fluoro-Jade C labeling), astrogliosis (glial fibrillary acidic protein (GFAP) immunohistochemistry) and microglia-mediated neuroinflammation (in vitro [18F]GE180 autoradiography) were evaluated. 4-AP administration acutely triggered marked brain hypermetabolism within and around the site of injection as well as short-term signs of brain damage and inflammation. Most important, metyrapone pretreatment was able to reduce ictal hypermetabolism as well as all the markers of brain damage except microglia-mediated neuroinflammation. Overall, our study corroborates the neuroprotective effects of metyrapone against multiple signs of brain damage caused by seizures triggered by 4-AP. Ultimately, our data add up to the consistent protective effect of metyrapone pretreatment reported in other models of neurological disorders of different etiology.
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Affiliation(s)
- Luis García-García
- Unidad de Cartografía Cerebral, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Paseo Juan XXIII n° 1, 28040 Madrid, Spain; Departamento de Farmacología, Farmacognosia y Biología Vegetal, Facultad de Farmacia, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain.
| | - Rubén Fernández de la Rosa
- Unidad de Cartografía Cerebral, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Paseo Juan XXIII n° 1, 28040 Madrid, Spain
| | - Mercedes Delgado
- Unidad de Cartografía Cerebral, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Paseo Juan XXIII n° 1, 28040 Madrid, Spain
| | - Ágata Silván
- Unidad de Cartografía Cerebral, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Paseo Juan XXIII n° 1, 28040 Madrid, Spain
| | - Pablo Bascuñana
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany
| | - Jens P Bankstahl
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany
| | - Francisca Gomez
- Unidad de Cartografía Cerebral, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Paseo Juan XXIII n° 1, 28040 Madrid, Spain; Departamento de Farmacología, Farmacognosia y Biología Vegetal, Facultad de Farmacia, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Miguel A Pozo
- Unidad de Cartografía Cerebral, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Paseo Juan XXIII n° 1, 28040 Madrid, Spain; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto Tecnológico PET, C/ Manuel Bartolomé Cossío n° 10, 28040 Madrid, Spain
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25
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Barba C, Specchio N, Guerrini R, Tassi L, De Masi S, Cardinale F, Pellacani S, De Palma L, Battaglia D, Tamburrini G, Didato G, Freri E, Consales A, Nozza P, Zamponi N, Cesaroni E, Di Gennaro G, Esposito V, Giulioni M, Tinuper P, Colicchio G, Rocchi R, Rubboli G, Giordano F, Lo Russo G, Marras CE, Cossu M. Increasing volume and complexity of pediatric epilepsy surgery with stable seizure outcome between 2008 and 2014: A nationwide multicenter study. Epilepsy Behav 2017; 75:151-157. [PMID: 28866334 DOI: 10.1016/j.yebeh.2017.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to assess common practice in pediatric epilepsy surgery in Italy between 2008 and 2014. METHODS A survey was conducted among nine Italian epilepsy surgery centers to collect information on presurgical and postsurgical evaluation protocols, volumes and types of surgical interventions, and etiologies and seizure outcomes in pediatric epilepsy surgery between 2008 and 2014. RESULTS Retrospective data on 527 surgical procedures were collected. The most frequent surgical approaches were temporal lobe resections and disconnections (133, 25.2%) and extratemporal lesionectomies (128, 24.3%); the most frequent etiologies were FCD II (107, 20.3%) and glioneuronal tumors (105, 19.9%). Volumes of surgeries increased over time independently from the age at surgery and the epilepsy surgery center. Engel class I was achieved in 73.6% of patients (range: 54.8 to 91.7%), with no significant changes between 2008 and 2014. Univariate analyses showed a decrease in the proportion of temporal resections and tumors and an increase in the proportion of FCDII, while multivariate analyses revealed an increase in the proportion of extratemporal surgeries over time. A higher proportion of temporal surgeries and tumors and a lower proportion of extratemporal and multilobar surgeries and of FCD were observed in low (<50surgeries/year) versus high-volume centers. There was a high variability across centers concerning pre- and postsurgical evaluation protocols, depending on local expertise and facilities. SIGNIFICANCE This survey reveals an increase in volume and complexity of pediatric epilepsy surgery in Italy between 2008 and 2014, associated with a stable seizure outcome.
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Affiliation(s)
- Carmen Barba
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy.
| | - Nicola Specchio
- Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy; IRCCS Stella Maris, Pisa, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Salvatore De Masi
- Clinical Trial Office, Children's Hospital Anna Meyer, Florence, Italy
| | | | - Simona Pellacani
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy
| | - Luca De Palma
- Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Giuseppe Didato
- Clinical and Experimental Epileptology, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | | | - Paolo Nozza
- Anatomical Pathology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Nelia Zamponi
- Child Neurology and Psychiatry Unit, Children's Hospital G. Salesi-University of Ancona, Ancona, Italy
| | - Elisabetta Cesaroni
- Child Neurology and Psychiatry Unit, Children's Hospital G. Salesi-University of Ancona, Ancona, Italy
| | | | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Neurology and Psychiatry, University of Rome "La Sapienza", Rome, Italy
| | - Marco Giulioni
- Division of Neurosurgery, IRCCS - Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Paolo Tinuper
- Division of Neurology, IRCCS - Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | | | - Raffaele Rocchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Guido Rubboli
- Danish Epilepsy Centre, Filadelfia/University of Copenhagen, Dianalund, Denmark; IRCCS Institute of Neurological Sciences, Neurology Unit, Bellaria Hospital, Bologna, Italy
| | - Flavio Giordano
- Neurosurgery Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Efisio Marras
- Pediatric Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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26
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Zhu Y, Feng J, Wu S, Hou H, Ji J, Zhang K, Chen Q, Chen L, Cheng H, Gao L, Chen Z, Zhang H, Tian M. Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy. J Nucl Med 2017; 58:1293-1299. [PMID: 28104740 DOI: 10.2967/jnumed.116.187492] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
PET with 18F-FDG has been used for presurgical localization of epileptogenic foci; however, in nonsurgical patients, the correlation between cerebral glucose metabolism and clinical severity has not been fully understood. The aim of this study was to evaluate the glucose metabolic profile using 18F-FDG PET/CT imaging in patients with epilepsy. Methods: One hundred pediatric epilepsy patients who underwent 18F-FDG PET/CT, MRI, and electroencephalography examinations were included. Fifteen age-matched controls were also included. 18F-FDG PET images were analyzed by visual assessment combined with statistical parametric mapping (SPM) analysis. The absolute asymmetry index (|AI|) was calculated in patients with regional abnormal glucose metabolism. Results: Visual assessment combined with SPM analysis of 18F-FDG PET images detected more patients with abnormal glucose metabolism than visual assessment only. The |AI| significantly positively correlated with seizure frequency (P < 0.01) but negatively correlated with the time since last seizure (P < 0.01) in patients with abnormal glucose metabolism. The only significant contributing variable to the |AI| was the time since last seizure, in patients both with hypometabolism (P = 0.001) and with hypermetabolism (P = 0.005). For patients with either hypometabolism (P < 0.01) or hypermetabolism (P = 0.209), higher |AI| values were found in those with drug resistance than with seizure remission. In the post-1-y follow-up PET studies, a significant change of |AI| (%) was found in patients with clinical improvement compared with those with persistence or progression (P < 0.01). Conclusion:18F-FDG PET imaging with visual assessment combined with SPM analysis could provide cerebral glucose metabolic profiles in nonsurgical epilepsy patients. |AI| might be used for evaluation of clinical severity and progress in these patients. Patients with a prolonged period of seizure freedom may have more subtle (or no) metabolic abnormalities on PET. The clinical value of PET might be enhanced by timing the scan closer to clinical seizures.
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Affiliation(s)
- Yuankai Zhu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianhua Feng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Shuang Wu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Haifeng Hou
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianfeng Ji
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Kai Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Qing Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Lin Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Haiying Cheng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Liuyan Gao
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Zexin Chen
- Department of Clinical Epidemiology & Biostatistics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Mei Tian
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China .,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
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27
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Mountz JM, Patterson CM, Tamber MS. Pediatric Epilepsy: Neurology, Functional Imaging, and Neurosurgery. Semin Nucl Med 2016; 47:170-187. [PMID: 28237005 DOI: 10.1053/j.semnuclmed.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this chapter we provide a comprehensive review of the current role that functional imaging can have in the care of the pediatric epilepsy patient from the perspective of the epilepsy neurologist and the epilepsy neurosurgeon. In the neurology section, the diagnosis and classification of epilepsy adapted by the International League Against Epilepsy as well as the etiology and incidence of the disease is presented. The neuroimaging section describes how advanced nuclear medicine imaging methods can be synergized to provide a maximum opportunity to localize an epileptogenic focus. This section described the value of FDG-PET and regional cerebral blood flow SPECT in the identification of an epileptogenic focus. The imaging section also emphasizes the importance on developing a dedicated epilepsy management team, comprised of an epilepsy imaging specialist, epilepsy neurologist and epilepsy neurosurgeon, to provide the maximum benefit to each child with epilepsy. An emphasis is placed on preparation for ictal SPECT injection procedures, including the critical role of an automated injector well as the use of state-of-the-art dedicated nuclear medicine imaging and analysis protocols to correctly localize the epileptogenic focus location. In the final section, surgical options, approaches and expected outcomes for the different classes of epilepsy is presented.
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Affiliation(s)
- James M Mountz
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA.
| | - Christina M Patterson
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Mandeep S Tamber
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
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28
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Wang K, Liu T, Zhao X, Xia X, Zhang K, Qiao H, Zhang J, Meng F. Comparative Study of Voxel-Based Epileptic Foci Localization Accuracy between Statistical Parametric Mapping and Three-dimensional Stereotactic Surface Projection. Front Neurol 2016; 7:164. [PMID: 27729898 PMCID: PMC5037321 DOI: 10.3389/fneur.2016.00164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 09/15/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) is widely used to help localize the hypometabolic epileptogenic focus for presurgical evaluation of drug-refractory epilepsy patients. Two voxel-based brain mapping methods to interpret 18F-FDG-PET, statistical parametric mapping (SPM) and three-dimensional stereotactic surface projection (3D-SSP), improve the detection rate of seizure foci. This study aimed to compare the consistency of epileptic focus detection between SPM and 3D-SSP for 18F-FDG-PET brain mapping analysis. Methods We retrospectively reviewed the clinical, electroecephalographic, and brain imaging results of 35 patients with refractory epilepsy. 18F-FDG-PET studies were revaluated by SPM, 3D-SSP, and visual assessment, and the results were compared to the magnetic resonance imaging (MRI) lesion location and to the presumed epileptogenic zone (PEZ) defined by video-electroencephalogram and other clinical data. A second consistency study compared PET analyses to histopathology and surgical outcomes in the 19 patients who underwent lesion resection surgery. Results Of the 35 patients, consistency with the PEZ was 29/35 for SPM, 25/35 for 3D-SSP, 14/35 for visual assessment, and 10/35 for MRI. Concordance rates with the PEZ were significantly higher for SPM and 3D-SSP than for MRI (P < 0.05) and visual assessment (P < 0.05). Differences between SPM and 3D-SSP and between visual assessment and MRI were not significant. In the 19 surgical patients, concordance with histopathology/clinical outcome was 14/19 for SPM, 15/19 for 3D-SSP, 14/19 for visual assessment, and 9/19 for MRI (P > 0.05). A favorable Engel outcome (class I/II) was found in 16 of 19 cases (84%), and failure of seizure control was found in 3 of 19 patients (class III/IV). Conclusion Voxel-based 18F-FDG-PET brain mapping analysis using SPM or 3D-SSP can improve the detection rate of the epileptic focus compared to visual assessment and MRI. Consistency with PEZ was similar between SPM and 3D-SSP; according to their own characteristics, 3D-SSP is recommended for primary evaluation due to greater efficiency and operability of the software, while SPM is recommended for high-accuracy localization of complex lesions. Therefore, joint application of both software packages may be the best solution for FDG-PET analysis of epileptic focus localization.
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Affiliation(s)
- Kailiang Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Tinghong Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Xiaobin Zhao
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - XiaoTong Xia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - Kai Zhang
- Beijing Key Laboratory of Neurostimulation, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Qiao
- Beijing Neurosurgical Institute, Capital Medical University , Beijing , China
| | - Jianguo Zhang
- Beijing Key Laboratory of Neurostimulation, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
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