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Corrêa DG, Telles B, Freddi TDAL. The vigabatrin-associated brain abnormalities on MRI and their differential diagnosis. Clin Radiol 2024; 79:94-101. [PMID: 38092645 DOI: 10.1016/j.crad.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/12/2023] [Accepted: 11/14/2023] [Indexed: 01/02/2024]
Abstract
Vigabatrin is an anti-epileptic drug that inhibits the enzyme γ-aminobutyric acid (GABA)-transaminase. The anticonvulsant effect of vigabatrin involves increasing GABA levels and attenuating glutamate-glutamine cycling. Vigabatrin indications include infantile spasms and refractory focal seizures. Despite having a significant role in paediatric epileptology, vigabatrin has adverse effects, such as retinal toxicity, in up to 30% of patients after 1 year of use and brain abnormalities on magnetic resonance imaging (MRI). The percentage of patients with brain abnormalities on MRI varies between 22-32% of children using vigabatrin to treat infantile spasms. Risk factors for presenting these imaging abnormalities are cryptogenic infantile spasms, age <12 months old, high dosage, and possible concomitant hormonal therapy. Clinically, these abnormalities are usually asymptomatic. Histopathological analysis reveals white matter vacuolation and intramyelinic oedema. The typical findings of vigabatrin-associated brain abnormalities on MRI are bilateral and have a symmetrical hyperintense signal on T2-weighted imaging, with diffusion restriction, that often compromise the globi pallidi, thalami, subthalamic nuclei, cerebral peduncles, midbrain, dorsal brainstem, including the medial longitudinal fasciculi, and dentate nuclei of the cerebellum. In this article, the authors intend to review the clinical manifestations, histopathological features, imaging aspects, and differential diagnosis of vigabatrin-associated brain abnormalities on MRI.
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Affiliation(s)
- D G Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil; Department of Radiology, Rio de Janeiro State University, Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, RJ 20551-030, Brazil.
| | - B Telles
- Department of Radiology, Curitiba Institute of Neurology, Rua Jeremias Maciel Perretto, 300, Campo Comprido, Curitiba, PR 81210-310, Brazil; Department of Radiology, Hospital Pequeno Príncipe, Rua Desembargador Motta, 1070, Água Verde, Curitiba, PR 80250-060, Brazil
| | - T de A L Freddi
- Department of Radiology, Hcor, Rua Desembargador Eliseu Guilherme, 147, Paraíso, São Paulo, SP 04004-030, Brazil
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Warren AEL, Tobochnik S, Chua MMJ, Singh H, Stamm MA, Rolston JD. Neurostimulation for Generalized Epilepsy: Should Therapy be Syndrome-specific? Neurosurg Clin N Am 2024; 35:27-48. [PMID: 38000840 PMCID: PMC10676463 DOI: 10.1016/j.nec.2023.08.001] [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] [Indexed: 11/26/2023]
Abstract
Current applications of neurostimulation for generalized epilepsy use a one-target-fits-all approach that is agnostic to the specific epilepsy syndrome and seizure type being treated. The authors describe similarities and differences between the 2 "archetypes" of generalized epilepsy-Lennox-Gastaut syndrome and Idiopathic Generalized Epilepsy-and review recent neuroimaging evidence for syndrome-specific brain networks underlying seizures. Implications for stimulation targeting and programming are discussed using 5 clinical questions: What epilepsy syndrome does the patient have? What brain networks are involved? What is the optimal stimulation target? What is the optimal stimulation paradigm? What is the plan for adjusting stimulation over time?
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Affiliation(s)
- Aaron E L Warren
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa M J Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hargunbir Singh
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michaela A Stamm
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John D Rolston
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Wan L, Zhang CT, Zhu G, Chen J, Shi XY, Wang J, Zou LP, Zhang B, Shi WB, Yeh CH, Yang G. Integration of multiscale entropy and BASED scale of electroencephalography after adrenocorticotropic hormone therapy predict relapse of infantile spasms. World J Pediatr 2022; 18:761-770. [PMID: 35906344 DOI: 10.1007/s12519-022-00583-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Even though adrenocorticotropic hormone (ACTH) demonstrated powerful efficacy in the initially successful treatment of infantile spasms (IS), nearly half of patients have experienced a relapse. We sought to investigate whether features of electroencephalogram (EEG) predict relapse in those IS patients without structural brain abnormalities. METHODS We retrospectively reviewed data from children with IS who achieved initial response after ACTH treatment, along with EEG recorded within the last two days of treatment. The recurrence of epileptic spasms following treatment was tracked for 12 months. Subjects were categorized as either non-relapse or relapse groups. General clinical and EEG recordings were collected, burden of amplitudes and epileptiform discharges (BASED) score and multiscale entropy (MSE) were carefully explored for cross-group comparisons. RESULTS Forty-one patients were enrolled in the study, of which 26 (63.4%) experienced a relapse. The BASED score was significantly higher in the relapse group. MSE in the non-relapse group was significantly lower than the relapse group in the γ band but higher in the lower frequency range (δ, θ, α). Sensitivity and specificity were 85.71% and 92.31%, respectively, when combining MSE in the δ/γ frequency of the occipital region, plus BASED score were used to distinguish relapse from non-relapse groups. CONCLUSIONS BASED score and MSE of EEG after ACTH treatment could be used to predict relapse for IS patients without brain structural abnormalities. Patients with BASED score ≥ 3, MSE increased in higher frequency, and decreased in lower frequency had a high risk of relapse.
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Affiliation(s)
- Lin Wan
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese People's Liberation Army, Beijing, China
| | - Chu-Ting Zhang
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China
| | - Gang Zhu
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese People's Liberation Army, Beijing, China
| | - Jian Chen
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiu-Yu Shi
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese People's Liberation Army, Beijing, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jing Wang
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Li-Ping Zou
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese People's Liberation Army, Beijing, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wen-Bin Shi
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China
| | - Chien-Hung Yeh
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China.
| | - Guang Yang
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China. .,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China. .,Medical School of Chinese People's Liberation Army, Beijing, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Maki Y, Natsume J, Ito Y, Okai Y, Bagarinao E, Yamamoto H, Ogaya S, Takeuchi T, Fukasawa T, Sawamura F, Mitsumatsu T, Maesawa S, Saito R, Takahashi Y, Kidokoro H. Involvement of the Thalamus, Hippocampus, and Brainstem in Hypsarrhythmia of West Syndrome: Simultaneous Recordings of Electroencephalography and fMRI Study. AJNR Am J Neuroradiol 2022; 43:1502-1507. [PMID: 36137665 PMCID: PMC9575537 DOI: 10.3174/ajnr.a7646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE West syndrome is a developmental and epileptic encephalopathy characterized by epileptic spasms, neurodevelopmental regression, and a specific EEG pattern called hypsarrhythmia. Our aim was to investigate the brain activities related to hypsarrhythmia at onset and focal epileptiform discharges in the remote period in children with West syndrome using simultaneous electroencephalography and fMRI recordings. MATERIALS AND METHODS Fourteen children with West syndrome underwent simultaneous electroencephalography and fMRI at the onset of West syndrome. Statistically significant blood oxygen level-dependent responses related to hypsarrhythmia were analyzed using an event-related design of 4 hemodynamic response functions with peaks at 3, 5, 7, and 9 seconds after the onset of each event. Six of 14 children had focal epileptiform discharges after treatment and underwent simultaneous electroencephalography and fMRI from 12 to 25 months of age. RESULTS At onset, positive blood oxygen level-dependent responses were seen in the brainstem (14/14 patients), thalami (13/14), basal ganglia (13/14), and hippocampi (13/14), in addition to multiple cerebral cortices. Group analysis using hemodynamic response functions with peaks at 3, 5, and 7 seconds showed positive blood oxygen level-dependent responses in the brainstem, thalamus, and hippocampus, while positive blood oxygen level-dependent responses in multiple cerebral cortices were seen using hemodynamic response functions with peaks at 5 and 7 seconds. In the remote period, 3 of 6 children had focal epileptiform discharge-related positive blood oxygen level-dependent responses in the thalamus, hippocampus, and brainstem. CONCLUSIONS Positive blood oxygen level-dependent responses with hypsarrhythmia appeared in the brainstem, thalamus, and hippocampus on earlier hemodynamic response functions than the cerebral cortices, suggesting the propagation of epileptogenic activities from the deep brain structures to the neocortices. Activation of the hippocampus, thalamus, and brainstem was still seen in half of the patients with focal epileptiform discharges after adrenocorticotropic hormone therapy.
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Affiliation(s)
- Y Maki
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - J Natsume
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Developmental Disability Medicine (J.N.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - Y Ito
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
- Department of Pediatrics (Y.I.), Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center, Okazaki, Japan
| | - Y Okai
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
- Department of Pediatric Neurology (Y.O.), Toyota Municipal Child Development Center, Toyota, Japan
| | - E Bagarinao
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - H Yamamoto
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - S Ogaya
- Department of Pediatric Neurology (S.O.), Aichi Developmental Disability Center Central Hospital, Kasugai, Japan
| | - T Takeuchi
- Department of Pediatrics (T.T.), Japanese Red Cross Nagoya First Hospital
| | - T Fukasawa
- Nagoya, Japan; and Department of Pediatrics (T.F.), Anjo Kosei Hospital, Anjo, Japan
| | - F Sawamura
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - T Mitsumatsu
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - S Maesawa
- Neurosurgery (S.M., R.S.), Nagoya University Graduate School of Medicine, Nagoya, Japan
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - R Saito
- Neurosurgery (S.M., R.S.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Takahashi
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - H Kidokoro
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
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Wang Y, Li Y, Yang L, Huang W. Altered topological organization of resting-state functional networks in children with infantile spasms. Front Neurosci 2022; 16:952940. [PMID: 36248635 PMCID: PMC9562010 DOI: 10.3389/fnins.2022.952940] [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: 05/25/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
Covering neuroimaging evidence has demonstrated that epileptic symptoms are associated with the disrupted topological architecture of the brain network. Infantile spasms (IS) as an age-specific epileptic encephalopathy also showed abnormal structural or functional connectivity in specific brain regions or specific networks. However, little is known about the topological alterations of whole-brain functional networks in patients with IS. To fill this gap, we used the graph theoretical analysis to investigate the topological properties (whole-brain small-world property and modular interaction) in 17 patients with IS and 34 age- and gender-matched healthy controls. The functional networks in both groups showed efficient small-world architecture over the sparsity range from 0.05 to 0.4. While patients with IS showed abnormal global properties characterized by significantly decreased normalized clustering coefficient, normalized path length, small-worldness, local efficiency, and significantly increased global efficiency, implying a shift toward a randomized network. Modular analysis revealed decreased intra-modular connectivity within the default mode network (DMN) and fronto-parietal network but increased inter-modular connectivity between the cingulo-opercular network and occipital network. Moreover, the decreased intra-modular connectivity in DMN was significantly negatively correlated with seizure frequency. The inter-modular connectivity between the cingulo-opercular and occipital network also showed a significant correlation with epilepsy frequency. Together, the current study revealed the disrupted topological organization of the whole-brain functional network, which greatly advances our understanding of neuronal architecture in IS and may contribute to predict the prognosis of IS as disease biomarkers.
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Affiliation(s)
- Ya Wang
- School of Basic Medical Sciences, Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, Southern Medical University, Guangzhou, China
| | - Yongxin Li
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
- *Correspondence: Yongxin Li,
| | - Lin Yang
- Department of Anesthesiology, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Wenhua Huang
- School of Basic Medical Sciences, Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, Southern Medical University, Guangzhou, China
- Wenhua Huang,
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Liu X, Chen J, Wan L, Li Z, Liang Y, Yan H, Zhu G, Zhang B, Yang G. Interrater and Intrarater Agreement of Epileptic Encephalopathy Among Electroencephalographers for Children with Infantile Spasms Using the Burden of Amplitudes and Epileptiform Discharges (BASED) EEG Grading Scale: Study Design and Statistical Considerations. Neurol Ther 2022; 11:1427-1437. [PMID: 35809161 PMCID: PMC9338191 DOI: 10.1007/s40120-022-00382-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Infantile spasms are a serious epilepsy syndrome with a poor prognosis. Electroencephalography (EEG) has been a key component in the prognosis and treatment of infantile spasms. This multi-center study protocol is developed to investigate interrater and intrarater agreement of an electroencephalographic grading scale—the Burden of Amplitudes and Epileptiform Discharges (BASED) score among electroencephalographers. Methods Thirty children, aged 0–2 years, with infantile spasms who were hospitalized in the Chinese PLA General Hospital will be recruited into this study by stratified sampling. Seven electroencephalographers from different Class A tertiary hospitals will select a 5-min epoch with the most severe epileptiform discharge, score the EEG reports, and provide the basis for the scoring. The 420 (30 × 7 × 2) scoring results provided by electroencephalographers in two rounds can be analyzed statistically using weighted kappa (weighted \documentclass[12pt]{minimal}
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\begin{document}$$\kappa$$\end{document}κ) statistic, and intraclass correlation coefficient (ICC) to calculate the interrater and intrarater agreement. Discussion We will recruit more electroencephalographers than were included in previous studies to assess the interrater and intrarater agreement in the selection of 5-min EEG epochs, the BASED scores, and the basis for scoring. If the BASED score has an adequate interrater and intrarater agreement, the score will have more significance for guiding the clinical management and for predicting the prognosis of patients with infantile spasms. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00382-4.
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Affiliation(s)
- Xinting Liu
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Jian Chen
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Lin Wan
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Zhichao Li
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Yan Liang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Huimin Yan
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Guangyu Zhu
- Department of Computer Science and Statistics, University of Rhode Island, Kingston, RI, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Guang Yang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China.
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Dong Y, Xu R, Zhang Y, Shi Y, Du K, Jia T, Wang J, Wang F. Different Frequency Bands in Various Regions of the Brain Play Different Roles in the Onset and Wake-Sleep Stages of Infantile Spasms. Front Pediatr 2022; 10:878099. [PMID: 35633963 PMCID: PMC9135356 DOI: 10.3389/fped.2022.878099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study aimed to identify the signatures of brain networks using electroencephalogram (EEG) in patients with infantile spasms (IS). METHODS Scalp EEGs of subjects with IS were prospectively collected in the first year of life (n = 8; age range 4-8 months; 3 males, 5 females). Ten minutes of ictal and interictal EEGs were clipped and filtered into different EEG frequency bands. The values of each pair of EEG channels were directly compared between ictal with interictal onsets and the sleep-wake phase to calculate IS brain network attributes: characteristic path length (CPL), node degree (ND), clustering coefficient (CC), and betweenness centrality (BC). RESULTS CPL, ND, and CC of the fast waves decreased while BC increased. CPL and BC of the slow waves decreased, while ND and CC increased during the IS ictal onset (P < 0.05). CPL of the alpha decreased, and BC increased during the waking time (P < 0.05). CONCLUSION The transmission capability of the fast waves, the local connectivity, and the defense capability of the slow waves during the IS ictal onset were enhanced. The alpha band played the most important role in both the global and local networks during the waking time. These may represent the brain network signatures of IS.
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Affiliation(s)
- Yan Dong
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Ruijuan Xu
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Yaodong Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Henan Neurodevelopment Engineering Research Center for Children, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yali Shi
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Kaixian Du
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Tianming Jia
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Jun Wang
- Department of Children's Rehabilitation, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Fang Wang
- Department of Medical Record Management, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
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Rapid ictal transition of focal epilepsy to infantile spasms in neurofibromatosis type 1 captured with EEG. Epilepsy Behav Rep 2020; 14:100374. [PMID: 32642639 PMCID: PMC7334590 DOI: 10.1016/j.ebr.2020.100374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 11/21/2022] Open
Abstract
We report a novel case of an infant with neurofibromatosis type 1 (NF1) who presented with new onset presumed focal impaired awareness seizures with motor onset followed by rapid progression to infantile spasms (IS). Electroencephalography (EEG) captured evolution from focal epileptiform discharges to multifocal and generalized discharges, then to hypsarrhythmia over three days. Development of IS within days of focal seizure onset is rapid, and to our knowledge, has not been demonstrated electrographically. The pattern of rapid ictal transition to hypsarrhythmia is essential for neurologists to be able to recognize as it can help lead to early treatment, which is necessary for improved outcomes in IS.
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Hu DK, Mower A, Shrey DW, Lopour BA. Effect of interictal epileptiform discharges on EEG-based functional connectivity networks. Clin Neurophysiol 2020; 131:1087-1098. [PMID: 32199397 DOI: 10.1016/j.clinph.2020.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/22/2020] [Accepted: 02/04/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Functional connectivity networks (FCNs) based on interictal electroencephalography (EEG) can identify pathological brain networks associated with epilepsy. FCNs are altered by interictal epileptiform discharges (IEDs), but it is unknown whether this is due to the morphology of the IED or the underlying pathological activity. Therefore, we characterized the impact of IEDs on the FCN through simulations and EEG analysis. METHODS We introduced simulated IEDs to sleep EEG recordings of eight healthy controls and analyzed the effect of IED amplitude and rate on the FCN. We then generated FCNs based on epochs with and without IEDs and compared them to the analogous FCNs from eight subjects with infantile spasms (IS), based on 1340 visually marked IEDs. Differences in network structure and strength were assessed. RESULTS IEDs in IS subjects caused increased connectivity strength but no change in network structure. In controls, simulated IEDs with physiological amplitudes and rates did not alter network strength or structure. CONCLUSIONS Increases in connectivity strength in IS subjects are not artifacts caused by the interictal spike waveform and may be related to the underlying pathophysiology of IS. SIGNIFICANCE Dynamic changes in EEG-based FCNs during IEDs may be valuable for identification of pathological networks associated with epilepsy.
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Affiliation(s)
- Derek K Hu
- Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - Andrew Mower
- Division of Neurology, Children's Hospital Orange County, Orange, CA, USA; Department of Pediatrics, University of California, Irvine, CA, USA
| | - Daniel W Shrey
- Division of Neurology, Children's Hospital Orange County, Orange, CA, USA; Department of Pediatrics, University of California, Irvine, CA, USA
| | - Beth A Lopour
- Department of Biomedical Engineering, University of California, Irvine, CA, USA.
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Stacey W, Kramer M, Gunnarsdottir K, Gonzalez-Martinez J, Zaghloul K, Inati S, Sarma S, Stiso J, Khambhati AN, Bassett DS, Smith RJ, Liu VB, Lopour BA, Staba R. Emerging roles of network analysis for epilepsy. Epilepsy Res 2020; 159:106255. [PMID: 31855828 PMCID: PMC6990460 DOI: 10.1016/j.eplepsyres.2019.106255] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/08/2019] [Indexed: 11/29/2022]
Abstract
In recent years there has been increasing interest in applying network science tools to EEG data. At the 2018 American Epilepsy Society conference in New Orleans, LA, the yearly session of the Engineering and Neurostimulation Special Interest Group focused on emerging, translational technologies to analyze seizure networks. Each speaker demonstrated practical examples of how network tools can be utilized in clinical care and provide additional data to help care for patients with intractable epilepsy. The groups presented advances using tools from functional connectivity, control theory, and graph theory to analyze human EEG data. These tools have great potential to augment clinical interpretation of EEG signals.
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Affiliation(s)
- William Stacey
- Department of Neurology, Department of Biomedical Engineering, University of Michigan, United States.
| | - Mark Kramer
- Department of Mathematics and Statistics, Center of Systems Neuroscience, Boston University, United States
| | | | | | - Kareem Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, United States
| | - Sara Inati
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, NIH, United States
| | - Sridevi Sarma
- Department of Neurology, Department of Biomedical Engineering, University of Michigan, United States
| | - Jennifer Stiso
- Department of Bioengineering, University of Pennsylvania, United States
| | - Ankit N Khambhati
- Department of Bioengineering, University of Pennsylvania, United States
| | | | - Rachel J Smith
- Department of Biomedical Engineering, University of California, Irvine, United States
| | - Virginia B Liu
- Department of Pediatrics, University of California, Irvine, United States; Department of Child Neurology, Children's Hospital of Orange County, CA, United States
| | - Beth A Lopour
- Department of Biomedical Engineering, University of California, Irvine, United States
| | - Richard Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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11
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Baba S, Vakorin VA, Doesburg SM, Nagamori C, Cortez MA, Honda R, Ono T, Toda K, Nishimoto H, Ebihara T, Sakai K, Ochi A, Snead OC, Baba H, Otsubo H. EEG before and after total corpus callosotomy for pharmacoresistant infantile spasms: Fast oscillations and slow-wave connectivity in hypsarrhythmia. Epilepsia 2019; 60:1849-1860. [PMID: 31407333 DOI: 10.1111/epi.16295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE We analyzed the features of fast oscillations (FOs) and connectivity in hypsarrhythmia to identify biomarkers for predicting seizure outcomes after total corpus callosotomy (TCC) in children with pharmacoresistant infantile spasms (IS). We hypothesize that the power of FOs and connectivity of slow waves in hypsarrhythmia would indicate the prognosis of IS. METHOD We retrospectively identified 42 children with pharmacoresistant IS who underwent TCC from 2009 to 2014 at Nagasaki Medical Center. We collected preoperative hypsarrhythmia for 200 seconds from each child. Children were categorized into three groups with interictal epileptic discharges on EEG at 6 months after TCC: group A, no epileptic discharge; group B, lateralized epileptic discharges; and group C; bilateral epileptic discharges. We analyzed spectral power and phase synchronization in preoperative hypsarrhythmia among the three groups. RESULTS We found 10 children in group A, 10 children in group B, and 22 children in group C. All group A and 1 in group B achieved seizure freedom after TCC. Six (67%) of 9 group B children who underwent further surgeries achieved seizure freedom. Ten (45%) of group C children had seizure reduction >50% after TCC, and 13 (87%) of 15 children who underwent further surgeries had residual seizures. The clinical profiles of the three groups did not differ significantly. The power of FOs (≥45 Hz) in hypsarrhythmia was significantly stronger in group C at the midline and temporal regions than in groups B and A (P = .014). The connectivity of theta (4-9 Hz) and FOs (29-70 Hz) tended to increase in group C, compared with the increased connectivity of 1-2 Hz in group A (P = .08). SIGNIFICANCE The increased power and connectivity of FOs in hypsarrhythmia may correlate with pharmacoresistant and surgically resistant seizures in IS. The existence and connectivity of FOs are associated with unilateral/bilateral cortical epileptogenicity in hypsarrhythmia. Prominent slow waves and connectivity without FOs might correlate with seizure freedom after TCC. Modulation of the callosal system with subcortical/cortical epileptic discharges might play a role in generating hypsarrhythmia and IS.
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Affiliation(s)
- Shiro Baba
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada.,Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Vasily A Vakorin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada.,Behavioral and Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, Canada
| | - Sam M Doesburg
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada.,Behavioral and Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, Canada.,Department of Psychology, University of Toronto, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Chizuko Nagamori
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Miguel A Cortez
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Ryoko Honda
- Department of Paediatrics and Epilepsy Center, National Hospital Organization Nagasaki Medicine Center, Nagasaki, Japan
| | - Tomonori Ono
- Department of Neurosurgery and Epilepsy Center, National Hospital Organization Nagasaki Medicine Center, Nagasaki, Japan
| | - Keisuke Toda
- Department of Neurosurgery and Epilepsy Center, National Hospital Organization Nagasaki Medicine Center, Nagasaki, Japan
| | - Hanako Nishimoto
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Toshihiro Ebihara
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Kana Sakai
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Hiroshi Baba
- Department of Neurosurgery and Epilepsy Center, National Hospital Organization Nagasaki Medicine Center, Nagasaki, Japan
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
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12
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Meiron O, Gale R, Namestnic J, Bennet-Back O, Gebodh N, Esmaeilpour Z, Mandzhiyev V, Bikson M. Antiepileptic Effects of a Novel Non-invasive Neuromodulation Treatment in a Subject With Early-Onset Epileptic Encephalopathy: Case Report With 20 Sessions of HD-tDCS Intervention. Front Neurosci 2019; 13:547. [PMID: 31191235 PMCID: PMC6548848 DOI: 10.3389/fnins.2019.00547] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 05/13/2019] [Indexed: 01/30/2023] Open
Abstract
The current clinical investigation examined high-definition transcranial direct current stimulation (HD-tDCS) as a focal, non-invasive, anti-epileptic treatment in a child with early-onset epileptic encephalopathy. We investigated the clinical impact of repetitive (20 daily sessions) cathode-centered 4 × 1 HD-tDCS (1 mA, 20 min, 4 mm ring radius) over the dominant seizure-generating cortical zone in a 40-month-old child suffering from a severe neonatal epileptic syndrome known as Ohtahara syndrome (OS). Seizures and epileptiform activity were monitored and quantified using video-EEG over multiple days of baseline, intervention, and post-intervention periods. Primary outcome measures were changes in seizure frequency and duration on the last day of intervention versus the last baseline day, preceding the intervention. In particular, we examined changes in tonic spasms, tonic-myoclonic seizures (TM-S), and myoclonic seizures from baseline to post-intervention. A trend in TM-S frequency was observed indicating a reduction of 73% in TM-S frequency, which was non-significant [t(4) = 2.05, p = 0.1], and denoted a clinically significant change. Myoclonic seizure (M-S) frequency was significantly reduced [t(4) = 3.83, p = 0.019] by 68.42%, compared to baseline, and indicated a significant clinical change as well. A 73% decrease in interictal epileptic discharges (IEDs) frequency was also observed immediately after the intervention period, compared to IED frequency at 3 days prior to intervention. Post-intervention seizure-related peak delta desynchronization was reduced by 57%. Our findings represent a case-specific significant clinical response, reduction in IED, and change in seizure-related delta activity following the application of HD-tDCS. The clinical outcomes, as noted in the current study, encourage the further investigation of this focal, non-invasive neuromodulation procedure in other severe electroclinical syndromes (e.g., West syndrome) and in larger pediatric populations diagnosed with early-onset epileptic encephalopathy. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02960347, protocol ID: Meiron 2013-4.
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Affiliation(s)
- Oded Meiron
- The Clinical Research Center for Brain Sciences, Herzog Medical Center, Jerusalem, Israel
| | - Rena Gale
- Children Respiratory Unit, Herzog Medical Center, Jerusalem, Israel
| | - Julia Namestnic
- Children Respiratory Unit, Herzog Medical Center, Jerusalem, Israel
| | - Odeya Bennet-Back
- Pediatric Neurology Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nigel Gebodh
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, United States
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, United States
| | - Vladislav Mandzhiyev
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, United States
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, United States
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Landi S, Petrucco L, Sicca F, Ratto GM. Transient Cognitive Impairment in Epilepsy. Front Mol Neurosci 2019; 11:458. [PMID: 30666185 PMCID: PMC6330286 DOI: 10.3389/fnmol.2018.00458] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 11/28/2018] [Indexed: 02/05/2023] Open
Abstract
Impairments of the dialog between excitation and inhibition (E/I) is commonly associated to neuropsychiatric disorders like autism, bipolar disorders and epilepsy. Moderate levels of hyperexcitability can lead to mild alterations of the EEG and are often associated with cognitive deficits even in the absence of overt seizures. Indeed, various testing paradigms have shown degraded performances in presence of acute or chronic non-ictal epileptiform activity. Evidences from both animal models and the clinics suggest that anomalous activity can cause cognitive deficits by transiently disrupting cortical processing, independently from the underlying etiology of the disease. Here, we will review our understanding of the influence of an abnormal EEG activity on brain computation in the context of the available clinical data and in genetic or pharmacological animal models.
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Affiliation(s)
- Silvia Landi
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Pisa, Italy
| | - Luigi Petrucco
- Graduate School of Systemic Neurosciences, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Federico Sicca
- Department of Developmental Neuroscience, Fondazione IRCCS Stella Maris, Pisa, Italy
| | - Gian Michele Ratto
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Pisa, Italy
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14
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Shrey DW, Kim McManus O, Rajaraman R, Ombao H, Hussain SA, Lopour BA. Strength and stability of EEG functional connectivity predict treatment response in infants with epileptic spasms. Clin Neurophysiol 2018; 129:2137-2148. [PMID: 30114662 PMCID: PMC6193760 DOI: 10.1016/j.clinph.2018.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/21/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Epileptic spasms (ES) are associated with pathological neuronal networks, which may underlie characteristic EEG patterns such as hypsarrhythmia. Here we evaluate EEG functional connectivity as a quantitative marker of treatment response, in comparison to classic visual EEG features. METHODS We retrospectively identified 21 ES patients and 21 healthy controls. EEG data recorded before treatment and after ≥10 days of treatment underwent blinded visual assessment, and functional connectivity was measured using cross-correlation techniques. Short-term treatment response and long-term outcome data were collected. RESULTS Subjects with ES had stronger, more stable functional networks than controls. After treatment initiation, all responders (defined by cessation of spasms) exhibited decreases in functional connectivity strength, while an increase in connectivity strength occurred only in non-responders. There were six subjects with unusually strong pre-treatment functional connectivity, and all were responders. Visually assessed EEG features were not predictive of treatment response. CONCLUSIONS Changes in network connectivity and stability correlate to treatment response for ES, and high pre-treatment connectivity may predict favorable short-term treatment response. Quantitative measures outperform visual analysis of the EEG. SIGNIFICANCE Functional networks may have value as objective markers of treatment response in ES, with potential to facilitate rapid identification of personalized, effective treatments.
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Affiliation(s)
- Daniel W Shrey
- Division of Neurology, Children's Hospital Orange County, Orange, CA, USA; Department of Pediatrics, University of California, Irvine, CA, USA
| | - Olivia Kim McManus
- Division of Neurology, Children's Hospital Orange County, Orange, CA, USA; Division of Pediatric Neurology, University of California, San Diego, CA, USA
| | - Rajsekar Rajaraman
- Division of Pediatric Neurology, University of California, Los Angeles, CA, USA
| | - Hernando Ombao
- Department of Statistics, University of California, Irvine, CA, USA; Statistics Program, King Abdullah University of Science and Technology, Saudi Arabia
| | - Shaun A Hussain
- Division of Pediatric Neurology, University of California, Los Angeles, CA, USA
| | - Beth A Lopour
- Department of Biomedical Engineering, University of California, Irvine, CA, USA.
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15
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Smith RJ, Sugijoto A, Rismanchi N, Hussain SA, Shrey DW, Lopour BA. Long-Range Temporal Correlations Reflect Treatment Response in the Electroencephalogram of Patients with Infantile Spasms. Brain Topogr 2017; 30:810-821. [PMID: 28905146 PMCID: PMC6058722 DOI: 10.1007/s10548-017-0588-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
Infantile spasms syndrome is an epileptic encephalopathy in which prompt diagnosis and treatment initiation are critical to therapeutic response. Diagnosis of the disease heavily depends on the identification of characteristic electroencephalographic (EEG) patterns, including hypsarrhythmia. However, visual assessment of the presence and characteristics of hypsarrhythmia is challenging because multiple variants of the pattern exist, leading to poor inter-rater reliability. We investigated whether a quantitative measurement of the control of neural synchrony in the EEGs of infantile spasms patients could be used to reliably distinguish the presence of hypsarrhythmia and indicate successful treatment outcomes. We used autocorrelation and Detrended Fluctuation Analysis (DFA) to measure the strength of long-range temporal correlations in 21 infantile spasms patients before and after treatment and 21 control subjects. The strength of long-range temporal correlations was significantly lower in patients with hypsarrhythmia than control patients, indicating decreased control of neural synchrony. There was no difference between patients without hypsarrhythmia and control patients. Further, the presence of hypsarrhythmia could be classified based on the DFA exponent and intercept with 92% accuracy using a support vector machine. Successful treatment was marked by a larger increase in the DFA exponent compared to those in which spasms persisted. These results suggest that the strength of long-range temporal correlations is a marker of pathological cortical activity that correlates with treatment response. Combined with current clinical measures, this quantitative tool has the potential to aid objective identification of hypsarrhythmia and assessment of treatment efficacy to inform clinical decision-making.
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Affiliation(s)
- Rachel J Smith
- Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California, Irvine, CA, USA
| | - Amanda Sugijoto
- Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California, Irvine, CA, USA
| | - Neggy Rismanchi
- Division of Neurology, Children's Hospital Orange County, Orange, CA, USA
| | - Shaun A Hussain
- Division of Pediatric Neurology, University of California, Los Angeles, CA, USA
| | - Daniel W Shrey
- Division of Neurology, Children's Hospital Orange County, Orange, CA, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Beth A Lopour
- Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California, Irvine, CA, USA.
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16
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Japaridze N, Muthuraman M, Reinicke C, Moeller F, Anwar AR, Mideksa KG, Pressler R, Deuschl G, Stephani U, Siniatchkin M. Neuronal Networks during Burst Suppression as Revealed by Source Analysis. PLoS One 2015; 10:e0123807. [PMID: 25927439 PMCID: PMC4415810 DOI: 10.1371/journal.pone.0123807] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/06/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction Burst-suppression (BS) is an electroencephalography (EEG) pattern consisting of alternant periods of slow waves of high amplitude (burst) and periods of so called flat EEG (suppression). It is generally associated with coma of various etiologies (hypoxia, drug-related intoxication, hypothermia, and childhood encephalopathies, but also anesthesia). Animal studies suggest that both the cortex and the thalamus are involved in the generation of BS. However, very little is known about mechanisms of BS in humans. The aim of this study was to identify the neuronal network underlying both burst and suppression phases using source reconstruction and analysis of functional and effective connectivity in EEG. Material/Methods Dynamic imaging of coherent sources (DICS) was applied to EEG segments of 13 neonates and infants with burst and suppression EEG pattern. The brain area with the strongest power in the analyzed frequency (1–4 Hz) range was defined as the reference region. DICS was used to compute the coherence between this reference region and the entire brain. The renormalized partial directed coherence (RPDC) was used to describe the informational flow between the identified sources. Results/Conclusion Delta activity during the burst phases was associated with coherent sources in the thalamus and brainstem as well as bilateral sources in cortical regions mainly frontal and parietal, whereas suppression phases were associated with coherent sources only in cortical regions. Results of the RPDC analyses showed an upwards informational flow from the brainstem towards the thalamus and from the thalamus to cortical regions, which was absent during the suppression phases. These findings may support the theory that a “cortical deafferentiation” between the cortex and sub-cortical structures exists especially in suppression phases compared to burst phases in burst suppression EEGs. Such a deafferentiation may play a role in the poor neurological outcome of children with these encephalopathies.
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Affiliation(s)
- Natia Japaridze
- Department of Neuropediatrics, Christian-Albrechts-University, Kiel, Germany
- * E-mail:
| | | | - Christine Reinicke
- Department of Neuropediatrics, Christian-Albrechts-University, Kiel, Germany
| | - Friederike Moeller
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Abdul Rauf Anwar
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | | | - Ronit Pressler
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Günther Deuschl
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ulrich Stephani
- Department of Neuropediatrics, Christian-Albrechts-University, Kiel, Germany
| | - Michael Siniatchkin
- Institute of Medical Psychology and Medical Sociology, Christian-Albrechts-University of Kiel, Kiel, Germany
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17
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Resting-state activity in development and maintenance of normal brain function. Proc Natl Acad Sci U S A 2011; 108:11638-43. [PMID: 21709227 DOI: 10.1073/pnas.1109144108] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
One of the most intriguing recent discoveries concerning brain function is that intrinsic neuronal activity manifests as spontaneous fluctuations of the blood oxygen level-dependent (BOLD) functional MRI signal. These BOLD fluctuations exhibit temporal synchrony within widely distributed brain regions known as resting-state networks. Resting-state networks are present in the waking state, during sleep, and under general anesthesia, suggesting that spontaneous neuronal activity plays a fundamental role in brain function. Despite its ubiquitous presence, the physiological role of correlated, spontaneous neuronal activity remains poorly understood. One hypothesis is that this activity is critical for the development of synaptic connections and maintenance of synaptic homeostasis. We had a unique opportunity to test this hypothesis in a 5-y-old boy with severe epileptic encephalopathy. The child developed marked neurologic dysfunction in association with a seizure disorder, resulting in a 1-y period of behavioral regression and progressive loss of developmental milestones. His EEG showed a markedly abnormal pattern of high-amplitude, disorganized slow activity with frequent generalized and multifocal epileptiform discharges. Resting-state functional connectivity MRI showed reduced BOLD fluctuations and a pervasive lack of normal connectivity. The child underwent successful corpus callosotomy surgery for treatment of drop seizures. Postoperatively, the patient's behavior returned to baseline, and he resumed development of new skills. The waking EEG revealed a normal background, and functional connectivity MRI demonstrated restoration of functional connectivity architecture. These results provide evidence that intrinsic, coherent neuronal signaling may be essential to the development and maintenance of the brain's functional organization.
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Laufs H. Endogenous brain oscillations and related networks detected by surface EEG-combined fMRI. Hum Brain Mapp 2008; 29:762-9. [PMID: 18465797 DOI: 10.1002/hbm.20600] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
It is difficult to study the brain "at rest" with an approach generally pursued in science when external manipulation (independent variable) is used to obtain informative measurements (dependent variable) about the object of interest. External manipulation in its classic sense may suspend the resting state, and hence the object of interest will evade. Naturally, unless in a final and irreversible state, biological rest will always be an endogenously dynamic process. Combining two modalities, electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), to simultaneously measure the brain's activity from two angles, one can be chosen to be interpreted as the independent variable and the other as the dependent variable, and without external manipulation the brain's spontaneous dynamics can be studied. The EEG, for example, observes endogenous modulations of vigilance and detects spontaneous events such as sleep spindles or epileptic discharges and can be used as the independent variable, i.e., to form a regressor to interrogate the fMRI data (dependent variable). The opposite is possible as well, and data fusion attempts try using all data both as dependent and independent variables at the same time. This review limits itself to an exemplary discussion of simultaneous EEG/fMRI studies in humans, and among a variety of proposed resting state networks only discusses a few, especially those for which non-resting state literature has proposed a functional meaning: the "default mode" network and an attentional network. It will be shown that one EEG feature can correlate with different fMRI activation maps and that a single resting state network may be associated with a variety of EEG patterns giving insight into the function of different resting states and the relationship between the two modalities in themselves.
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Affiliation(s)
- Helmut Laufs
- Department of Neurology and Brain Imaging Center, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
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