1
|
Kamila G, Jauhari P, Gulati S, Jain S, Chakrabarty B, Kumar A, Sankar J, Pandey RM. 'Remote inhibition' of motor cortex in Epileptic encephalopathy with spike-wave activation in sleep (EE-SWAS): A TMS based cortical excitability study. Seizure 2024; 121:133-140. [PMID: 39163658 DOI: 10.1016/j.seizure.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/27/2024] [Accepted: 08/01/2024] [Indexed: 08/22/2024] Open
Abstract
OBJECTIVES The study compared real-time motor cortex excitability using transcranial magnetic stimulation (TMS)-derived parameters between children with epileptic encephalopathy with spike-wave activation in sleep (EE-SWAS) and age-matched neurotypical controls. The EE-SWAS group received steroids as standard of care and were longitudinally followed for three months. MATERIALS & METHODS Children aged 5-12 years with immunotherapy-naive EE-SWAS (spike-wave-index≥50 %) and neurotypical controls were enrolled. Cognitive and behavioral assessments were performed using valid psychometric tools. Real-time motor cortex excitability was assessed by measuring resting motor threshold (RMT), short intra-cortical inhibition (SICI) and long intra-cortical inhibition (LICI) in both groups. In EE-SWAS group, a follow up evaluation with TMS at 4- and 12-week intervals, EEG, and neurobehavioral assessments at 12-weeks were performed to assess the effect of steroids on cortical excitability and to determine electroclinical outcome. RESULTS Forty-eight children with suspected EE-SWAS and 26 neurotypical controls were screened; 20 were enrolled in each group. Children with EE-SWAS (mean age: 8.05 ± 1.76 years) had cognitive and behavioral problems (20/20), and ongoing seizures (12/20). At baseline, the dominant motor cortex was significantly inhibited in the EE-SWAS group compared to neurotypical children{RMT(%)[86.3 ± 6.96 vs 58.05 ± 4.71(p < 0.0001)]; LICI(%)[55.05 ± 4.39 vs 73.9 ± 3.75(p < 0.0001)]; SICI(%)[39.2 ± 4.36 vs 55.45 ± 4.78(p < 0.0001)]}. Reversal of motor cortex inhibition was sequentially observed in EE-SWAS group at 4- and 12-week follow-ups{(RMT[4, 12 weeks]: 71.45 ± 9.83, 63.45 ± 8.48); (LICI[4, 12 weeks]: 66.00 ± 6.26, 74.50 ± 5.36); (SICI[4, 12 weeks]: 49.35 ± 6.24, 56.05 ± 5.57)}[repeated-measures ANOVA: p < 0.0001]. CONCLUSION Motor cortex is remotely inhibited in EE-SWAS, which may contribute to neurobehavioral impairment. Steroids can disinhibit/reverse the epilepsy-induced motor cortex inhibition leading to improvement in neurobehavior.
Collapse
Affiliation(s)
- Gautam Kamila
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Jauhari
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Jain
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis & Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
Srivastava MK, Shaik AJ, Yareeda S, Nallapareddy K, Lingappa L, Moturi P, Gaddamonugu P, Kandadai RM, Borgohain R. Neurocognitive Profile and 18 F-Fluorodeoxyglucose Positron Emission Tomography Brain Imaging Correlation in Children with Electrical Status Epilepticus during Sleep. World J Nucl Med 2023; 22:174-182. [PMID: 37854089 PMCID: PMC10581755 DOI: 10.1055/s-0042-1757284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Objective Electrical status epilepticus in sleep (ESES) is defined by near-continuous epileptiform discharges during sleep along with cognitive, behavioral, and/or imaging abnormalities. We studied the neurocognitive profile and their correlation with 18 F fluorodeoxyglucose positron emission tomography (FDG PET) brain abnormalities in children with ESES. Methods Fourteen children with ESES with normal magnetic resonance imaging (MRI) from March to December 2019 were included. The intelligence quotient (IQ) and child behavior checklist (CBCL) scores were estimated using validated scales, and FDG PET brain was done at the same point of time to look for cerebral metabolic defects which was compared with a control group. Results Fourteen patients with a mean age of 8.2 ± 2.7 years were analyzed. The average duration of epilepsy was 6 ± 2.8 years. The mean IQ was 72.4 ± 18.2 and mean CBCL score was 37.3 ± 11.8. There was negative correlation between IQ and CBCL ( r = -0.55, p < 0.001). The duration of epilepsy also showed negative correlation with IQ ( r = -4.75, p < 0.001). FDG PET scan showed predominant thalamic hypometabolism in 12 of 14 patients (85.7%) on visual analysis with multiple other hypometabolic cortical and subcortical regions in the brain. The quantitative analysis showed significant difference in metabolism of basal ganglion when compared with control group. The total number of hypometabolic regions seen in the brain showed moderate positive correlation with CBCL score but no significant correlation with the IQ of cases. Conclusion This study demonstrates functional impairment of cerebral cortical, basal ganglia, and thalamic hypometabolism in a cohort of ESES patients with normal structural MRI brain study. There was a moderate correlation of extent and pattern of cerebral hypometabolism with the neuropsychological status of the child and duration of epilepsy.
Collapse
Affiliation(s)
- Madhur K. Srivastava
- Department of Nuclear Medicine, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Afshan J. Shaik
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Kavitha Nallapareddy
- Department of Nuclear Medicine, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Lokesh Lingappa
- Department of Pediatric Neurology, Rainbow Children Hospital, Banjara Hills, Hyderabad, Telangana, India
| | - Pallavi Moturi
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Padmaja Gaddamonugu
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Rukmini M. Kandadai
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| |
Collapse
|
3
|
Auvin S. Paediatric epilepsy and cognition. Dev Med Child Neurol 2022; 64:1444-1452. [PMID: 35801543 DOI: 10.1111/dmcn.15337] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 01/31/2023]
Abstract
Cognitive comorbidities are more frequent in children with epilepsy than in the general population. The cognitive function of children with epilepsy should be appropriately screened, and when there is an impairment, it must be diagnosed and managed. Several factors contribute to the occurrence of this comorbidity. The underlying aetiology and epilepsy syndrome are the major risk factors. Other factors also play a role, such as seizure recurrence, antiseizure medication, and interictal abnormalities. Recent evidence also suggested that cognitive involvement is an ongoing process that interacts with the normal maturation of cognitive function in children with epilepsy. Furthermore, some patients experience rapid cognitive deterioration related to epileptic activity, resulting in epileptic encephalopathy. Further research is needed to better understand how to prevent or modify factors that affect cognitive function in children with epilepsy. WHAT THIS PAPER ADDS: Cognitive comorbidities are more frequent in children with epilepsy than in the general population. The risk factors for cognitive impairment are the underlying aetiology/syndrome, seizure recurrence, antiseizure medication, and interictal abnormalities. Advanced genetic and neuroimaging studies are useful tools to better understand cognitive impairment in children with epilepsy.
Collapse
Affiliation(s)
- Stéphane Auvin
- Assistance Publique-Hôpitaux de Paris, Service de Neurologie Pédiatrique, Hôpital Robert Debré, Paris, France.,Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale NeuroDiderot, Paris, France.,Institut Universitaire de France, Paris, France
| |
Collapse
|
4
|
Alawadhi A, Appendino JP, Hader W, Rosenblatt B, Moreau JT, Dubeau F, Dudley RWR, Myers KA. Surgically Remediable Secondary Network Epileptic Encephalopathies With Continuous Spike Wave in Sleep: Lesions May Not Be Visible on Brain Magnetic Resonance Imaging (MRI). J Child Neurol 2022; 37:992-1002. [PMID: 36184927 DOI: 10.1177/08830738221129919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Continuous spike wave in sleep (CSWS) is an electroencephalogram (EEG) pattern associated with developmental and epileptic encephalopathy with spike-and-wave activation in sleep (DEE-SWAS). This etiologically heterogeneous syndrome may occur because of genetic factors and congenital or acquired brain lesions. We studied the pattern of clinical presentation and underlying etiologies in patients with DEE-SWAS that respond to resective surgery. METHODS We reviewed our clinical and research databases for patients who had resolution of CSWS following surgical resection of a focal lesion. RESULTS We identified 5 patients meeting inclusion criteria. In 3 of 5, an epileptogenic structural abnormality was not apparent on brain magnetic resonance imaging (MRI). In all 3 patients, focal cortical dysplasia was identified through intracranial EEG monitoring. SIGNIFICANCE DEE-SWAS may be a secondary bilateral network epilepsy syndrome, which can be treated with resection of the inciting focal lesion. In patients with drug-resistant CSWS, clinicians should consider a complete epilepsy presurgical workup, including intracranial EEG monitoring.
Collapse
Affiliation(s)
- Abdulla Alawadhi
- Division of Child Neurology, Department of Pediatrics, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada.,Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.,Dubai Health Authority, Dubai, United Arab Emirates
| | - Juan Pablo Appendino
- Section of Neurology, Department of Pediatrics, 9978Alberta Children's Hospital, Cumming School of Medicine, 70401University of Calgary, Calgary, Alberta, Canada
| | - Walter Hader
- Department of Clinical Neuroscience, Cumming School of Medicine, 70401University of Calgary, Calgary, Alberta, Canada
| | - Bernard Rosenblatt
- Division of Child Neurology, Department of Pediatrics, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada
| | - Jeremy T Moreau
- Cumming School of Medicine, 70401University of Calgary, Calgary, Alberta, Canada
| | - Francois Dubeau
- Department of Neurology & Neurosurgery, 55981Montreal Neurological Hospital, 5620McGill University, Montreal, Quebec, Canada
| | - Roy W R Dudley
- Department of Neurology & Neurosurgery, 55981Montreal Neurological Hospital, 5620McGill University, Montreal, Quebec, Canada.,Department of Neurology & Neurosurgery, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada.,5620Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Kenneth A Myers
- Division of Child Neurology, Department of Pediatrics, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada.,Department of Neurology & Neurosurgery, 10040Montreal Children's Hospital, 5620McGill University, Montreal, Quebec, Canada.,5620Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW To review the mutual interactions between sleep and epilepsy, including mechanisms of epileptogenesis, the relationship between sleep apnea and epilepsy, and potential strategies to treat seizures. RECENT FINDINGS Recent studies have highlighted the role of functional network systems underlying epileptiform activation in sleep in several epilepsy syndromes, including absence epilepsy, benign focal childhood epilepsy, and epileptic encephalopathy with spike-wave activation in sleep. Sleep disorders are common in epilepsy, and early recognition and treatment can improve seizure frequency and potentially reduce SUDEP risk. Additionally, epilepsy is associated with cyclical patterns, which has led to new treatment approaches including chronotherapy, seizure monitoring devices, and seizure forecasting. Adenosine kinase and orexin receptor antagonists are also promising new potential drug targets that could be used to treat seizures. Sleep and epilepsy have a bidirectional relationship that intersects with many aspects of clinical management. In this article, we identify new areas of research involving future therapeutic opportunities in the field of epilepsy.
Collapse
|
6
|
Puttaert D, Wens V, Fery P, Rovai A, Trotta N, Coquelet N, De Breucker S, Sadeghi N, Coolen T, Goldman S, Peigneux P, Bier JC, De Tiège X. Decreased Alpha Peak Frequency Is Linked to Episodic Memory Impairment in Pathological Aging. Front Aging Neurosci 2021; 13:711375. [PMID: 34475819 PMCID: PMC8406997 DOI: 10.3389/fnagi.2021.711375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/21/2021] [Indexed: 12/04/2022] Open
Abstract
The Free and Cued Selective Reminding Test (FCSRT) is a largely validated neuropsychological test for the identification of amnestic syndrome from the early stage of Alzheimer's disease (AD). Previous electrophysiological data suggested a slowing down of the alpha rhythm in the AD-continuum as well as a key role of this rhythmic brain activity for episodic memory processes. This study therefore investigates the link between alpha brain activity and alterations in episodic memory as assessed by the FCSRT. For that purpose, 37 patients with altered FCSRT performance underwent a comprehensive neuropsychological assessment, supplemented by 18F-fluorodeoxyglucose positron emission tomography/structural magnetic resonance imaging (18FDG-PET/MR), and 10 min of resting-state magnetoencephalography (MEG). The individual alpha peak frequency (APF) in MEG resting-state data was positively correlated with patients' encoding efficiency as well as with the efficacy of semantic cues in facilitating patients' retrieval of previous stored word. The APF also correlated positively with patients' hippocampal volume and their regional glucose consumption in the posterior cingulate cortex. Overall, this study demonstrates that alterations in the ability to learn and store new information for a relatively short-term period are related to a slowing down of alpha rhythmic activity, possibly due to altered interactions in the extended mnemonic system. As such, a decreased APF may be considered as an electrophysiological correlate of short-term episodic memory dysfunction accompanying pathological aging.
Collapse
Affiliation(s)
- Delphine Puttaert
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Wens
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Fery
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Service of Neuropsychology and Speech Therapy, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Antonin Rovai
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicola Trotta
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Coquelet
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Sandra De Breucker
- Department of Geriatrics, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Niloufar Sadeghi
- Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Tim Coolen
- Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Goldman
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Peigneux
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Christophe Bier
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Xavier De Tiège
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Clinic of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
7
|
Niesen M, Trotta N, Noel A, Coolen T, Fayad G, Leurkin-Sterk G, Delpierre I, Henrard S, Sadeghi N, Goffard JC, Goldman S, De Tiège X. Structural and metabolic brain abnormalities in COVID-19 patients with sudden loss of smell. Eur J Nucl Med Mol Imaging 2021; 48:1890-1901. [PMID: 33398411 PMCID: PMC7781559 DOI: 10.1007/s00259-020-05154-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Sudden loss of smell is a very common symptom of coronavirus disease 19 (COVID-19). This study characterizes the structural and metabolic cerebral correlates of dysosmia in patients with COVID-19. METHODS Structural brain magnetic resonance imaging (MRI) and positron emission tomography with [18F]-fluorodeoxyglucose (FDG-PET) were prospectively acquired simultaneously on a hybrid PET-MR in 12 patients (2 males, 10 females, mean age: 42.6 years, age range: 23-60 years) with sudden dysosmia and positive detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on nasopharyngeal swab specimens. FDG-PET data were analyzed using a voxel-based approach and compared with that of a group of healthy subjects. RESULTS Bilateral blocking of the olfactory cleft was observed in six patients, while subtle olfactory bulb asymmetry was found in three patients. No MRI signal abnormality downstream of the olfactory tract was observed. Decrease or increase in glucose metabolism abnormalities was observed (p < .001 uncorrected, k ≥ 50 voxels) in core olfactory and high-order neocortical areas. A modulation of regional cerebral glucose metabolism by the severity and the duration of COVID-19-related dysosmia was disclosed using correlation analyses. CONCLUSIONS This PET-MR study suggests that sudden loss of smell in COVID-19 is not related to central involvement due to SARS-CoV-2 neuroinvasiveness. Loss of smell is associated with subtle cerebral metabolic changes in core olfactory and high-order cortical areas likely related to combined processes of deafferentation and active functional reorganization secondary to the lack of olfactory stimulation.
Collapse
Affiliation(s)
- Maxime Niesen
- Department of Otorhinolaryngology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium.
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.
| | - Nicola Trotta
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Antoine Noel
- Department of Otorhinolaryngology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Tim Coolen
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Georges Fayad
- Department of Otorhinolaryngology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Gil Leurkin-Sterk
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Delpierre
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Sophie Henrard
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Internal Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Niloufar Sadeghi
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Christophe Goffard
- Department of Internal Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Goldman
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Xavier De Tiège
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI - ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
8
|
Burgos N, Cardoso MJ, Samper-González J, Habert MO, Durrleman S, Ourselin S, Colliot O. Anomaly detection for the individual analysis of brain PET images. J Med Imaging (Bellingham) 2021; 8:024003. [PMID: 33842668 PMCID: PMC8021015 DOI: 10.1117/1.jmi.8.2.024003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/12/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: In clinical practice, positron emission tomography (PET) images are mostly analyzed visually, but the sensitivity and specificity of this approach greatly depend on the observer's experience. Quantitative analysis of PET images would alleviate this problem by helping define an objective limit between normal and pathological findings. We present an anomaly detection framework for the individual analysis of PET images. Approach: We created subject-specific abnormality maps that summarize the pathology's topographical distribution in the brain by comparing the subject's PET image to a model of healthy PET appearance that is specific to the subject under investigation. This model was generated from demographically and morphologically matched PET scans from a control dataset. Results: We generated abnormality maps for healthy controls, patients at different stages of Alzheimer's disease and with different frontotemporal dementia syndromes. We showed that no anomalies were detected for the healthy controls and that the anomalies detected from the patients with dementia coincided with the regions where abnormal uptake was expected. We also validated the proposed framework using the abnormality maps as inputs of a classifier and obtained higher classification accuracies than when using the PET images themselves as inputs. Conclusions: The proposed method was able to automatically locate and characterize the areas characteristic of dementia from PET images. The abnormality maps are expected to (i) help clinicians in their diagnosis by highlighting, in a data-driven fashion, the pathological areas, and (ii) improve the interpretability of subsequent analyses, such as computer-aided diagnosis or spatiotemporal modeling.
Collapse
Affiliation(s)
- Ninon Burgos
- Paris Brain Institute, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, U 1127, Hôpital Pitié-Salpêtrière, Paris, France
- CNRS, UMR 7225, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Inria, Aramis Project-Team, Hôpital Pitié-Salpêtrière, Paris, France
| | - M. Jorge Cardoso
- King’s College London, Department of Imaging and Biomedical Engineering, London, United Kingdom
| | - Jorge Samper-González
- Paris Brain Institute, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, U 1127, Hôpital Pitié-Salpêtrière, Paris, France
- CNRS, UMR 7225, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Inria, Aramis Project-Team, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marie-Odile Habert
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Nuclear Medicine, Paris, France
- Laboratoire d’Imagerie Biomédicale, Sorbonne Université, Inserm U 1146, CNRS UMR 7371, Hôpital Pitié-Salpêtrière, Paris, France
- Centre Acquisition et Traitement des Images, Hôpital Pitié-Salpêtrière, Paris, France
| | - Stanley Durrleman
- Paris Brain Institute, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, U 1127, Hôpital Pitié-Salpêtrière, Paris, France
- CNRS, UMR 7225, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Inria, Aramis Project-Team, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sébastien Ourselin
- King’s College London, Department of Imaging and Biomedical Engineering, London, United Kingdom
| | - Olivier Colliot
- Paris Brain Institute, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, U 1127, Hôpital Pitié-Salpêtrière, Paris, France
- CNRS, UMR 7225, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Inria, Aramis Project-Team, Hôpital Pitié-Salpêtrière, Paris, France
| | | | | |
Collapse
|
9
|
Puttaert D, Coquelet N, Wens V, Peigneux P, Fery P, Rovai A, Trotta N, Sadeghi N, Coolen T, Bier JC, Goldman S, De Tiège X. Alterations in resting-state network dynamics along the Alzheimer's disease continuum. Sci Rep 2020; 10:21990. [PMID: 33319785 PMCID: PMC7738511 DOI: 10.1038/s41598-020-76201-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Human brain activity is intrinsically organized into resting-state networks (RSNs) that transiently activate or deactivate at the sub-second timescale. Few neuroimaging studies have addressed how Alzheimer's disease (AD) affects these fast temporal brain dynamics, and how they relate to the cognitive, structural and metabolic abnormalities characterizing AD. We aimed at closing this gap by investigating both brain structure and function using magnetoencephalography (MEG) and hybrid positron emission tomography-magnetic resonance (PET/MR) in 10 healthy elders, 10 patients with subjective cognitive decline (SCD), 10 patients with amnestic mild cognitive impairment (aMCI) and 10 patients with typical Alzheimer's disease with dementia (AD). The fast activation/deactivation state dynamics of RSNs were assessed using hidden Markov modeling (HMM) of power envelope fluctuations at rest measured with MEG. Correlations were sought between temporal properties of HMM states and participants' cognitive test scores, whole hippocampal grey matter volume and regional brain glucose metabolism. The posterior default-mode network (DMN) was less often activated and for shorter durations in AD patients than matched healthy elders. No significant difference was found in patients with SCD or aMCI. The time spent by participants in the activated posterior DMN state did not correlate significantly with cognitive scores, nor with the whole hippocampal volume. However, it correlated positively with the regional glucose consumption in the right dorsolateral prefrontal cortex (DLPFC). AD patients present alterations of posterior DMN power activation dynamics at rest that identify an additional electrophysiological correlate of AD-related synaptic and neural dysfunction. The right DLPFC may play a causal role in the activation of the posterior DMN, possibly linked to the occurrence of mind wandering episodes. As such, these data might suggest a neural correlate of the decrease in mind wandering episodes reported in pathological aging.
Collapse
Affiliation(s)
- D Puttaert
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium. .,Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.
| | - N Coquelet
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - V Wens
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - P Peigneux
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - P Fery
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Service of Neuropsychology and Speech Therapy, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - A Rovai
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - N Trotta
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - N Sadeghi
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - T Coolen
- Department of Radiology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - J-C Bier
- Department of Neurology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - S Goldman
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - X De Tiège
- Laboratoire de Cartographie fonctionnelle du Cerveau (LCFC), UNI-ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
10
|
Aeby A, Santalucia R, Van Hecke A, Nebbioso A, Vermeiren J, Deconinck N, De Tiège X, Van Bogaert P. A qualitative awake EEG score for the diagnosis of continuous spike and waves during sleep (CSWS) syndrome in self-limited focal epilepsy (SFE): A case-control study. Seizure 2020; 84:34-39. [PMID: 33276197 DOI: 10.1016/j.seizure.2020.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine whether awake EEG criteria can differentiate epileptic encephalopathy with continuous spike and waves during sleep (EE-CSWS) at the time of cognitive regression from typical, self-limited focal epilepsy (SFE). METHODS This retrospective case-control study was based on the analysis of awake EEGs and included 15 patients with EE-CSWS and 15 age-matched and sex-matched patients with typical SFE. The EEGs were anonymised and scored by four independent readers. The following qualitative and quantitative EEG indices were analysed: slow-wave index (SLWI), spike-wave index (SWI), spike-wave frequency (SWF), long spike-wave clusters (CLSW) and EEG score (between grades 0 and 4). Sensitivity and specificity were assessed using receiver operating characteristic (ROC) curves and their reproducibility with a kappa test. RESULTS Based on a highly sensitive cut-off, EE-CSWS patients were 8.4 times more likely than those with SFE to have an SLWI > 6%, 15 times more likely to have an SWI > 10 % and six times more likely to have a CLSW of ≥ 1 s. There was substantial agreement between readers (with kappa values of 0.64, 0.69 and 0.67). EE-CSWS patients were 13 times more likely to have an SWF of > 11 % and 149 times more likely to have an EEG score of ≥ 3 than typical SFE patients. Agreement about these ratings was almost perfect (kappa 0.91 and 0.86). CONCLUSION An EEG score of ≥ 3 on a 20-min awake EEG differentiates typical SFE from EE-CSWS at the time of cognitive regression, with good reliability across readers with different levels of expertise.
Collapse
Affiliation(s)
- Alec Aeby
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Roberto Santalucia
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium; Department of Paediatric Neurology, Hôpital Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Audrey Van Hecke
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Andrea Nebbioso
- Department of Paediatrics, Hôpital d'Ixelles-ULB, Brussels, Belgium
| | - Justine Vermeiren
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Deconinck
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Xavier De Tiège
- Department of Functional Neuroimaging, Nuclear Medicine Service, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Van Bogaert
- Unité de Neurologie et de Neurochirurgie de l'enfant, service de pédiatrie, CHU Angers, France; Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), University of Angers, France
| |
Collapse
|
11
|
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: 6] [Impact Index Per Article: 1.5] [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.
Collapse
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.
| |
Collapse
|
12
|
Epilepsy syndromes of childhood with sleep activation: Insights from functional imaging. Eur J Paediatr Neurol 2020; 24:58-60. [PMID: 31875835 DOI: 10.1016/j.ejpn.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/06/2019] [Indexed: 11/21/2022]
Abstract
In epilepsy syndromes of childhood with sleep activation, defined as the spectrum of epileptic conditions going from classical benign childhood epilepsy with centrotemporal spikes (BECTS) to epileptic encephalopathy (EE) with continuous spike and waves during slow-wave sleep (CSWS) including Landau-Kleffner syndrome (LKS), a lot of functional imaging studies have been performed so far, leading to results that are not always consistent, related to the technique of neuroimaging performed and to the variability of the clinical phenotype. Most consistent findings are, depending of the method used, activations or increased regional glucose metabolism in the epileptogenic regions, and deactivations, hypometabolism or decreased functional connectivity in cortical regions that belong to the default mode network. Functional changes are either transitory, temporally related to the occurrence of interictal epileptiform discharges (IED), or permanent, persisting across IED-free periods. Some studies have shown that the more severe phenotype, i.e. EE with CSWS, displays the more profound functional disturbances. Taken together, functional imaging studies support the concept that IED impact cognition in epilepsy syndromes of childhood with sleep activation. However, the precise chronology between the occurrence of IED and the functional disturbances, the neuropsychological correlates of the functional disturbances, and the effects of the anti-epileptic treatments on IED, functional disturbances and cognition need to be further studied.
Collapse
|
13
|
Personality profile and health-related quality of life in adults with previous continuous spike-waves during slow sleep syndrome. Brain Dev 2019; 41:522-530. [PMID: 30797668 DOI: 10.1016/j.braindev.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Epilepsy with continuous spike-waves during slow sleep syndrome (CSWSS) is characterized by various seizure types, a characteristic EEG pattern and neuropsychological disorders. The main purpose of this study was to evaluate the long-term outcome of CSWSS occurred in childhood and to evaluate the variables that could influence the quality of social adaptation and the personality profile. MATERIAL AND METHODS This is a prospective study on 24 young adults with previous CSWSS (median age 24.5 yrs) who were enrolled between January and July 2011 at the G. Gaslini Children's Hospital, Genoa, Italy. Patients were divided into two groups: twelve with previous spike-wave index (SWI > 85%) defined as typical CSWSS (T-CSWSS) and twelve with previous SWI = 50-85% defined as atypical CSWSS (A-CSWSS). All the subjects were submitted to Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Psychological General Well-Being Index (PGWBI), and to a structured interview. RESULTS A correlation was observed with the severity of EEG abnormalities expressed by the SWI and outcome. The T-CSWSS group showed a significantly lower perceived well-being. Similarly in the T-CSWSS group the percentage of MMPI-2 clinical scales with T-scores ≥65 was higher than in the A-CSWSS group. Finally, a significant lower schooling in the T-CSWSS group was observed. CONCLUSION There seem to be two forms of the same disease, with similar onset and clinical evolution but a different outcome regarding the social and psychological conditions. The outcome of the social adaptation and of the personality consciousness was related with the severity of the EEG abnormalities: more favorable in patients with less intense SWI activity (A-CSWSS) compared those with a more severe EEG impairment (T-CSWSS).
Collapse
|
14
|
Mathieu ML, de Bellescize J, Till M, Flurin V, Labalme A, Chatron N, Sanlaville D, Chemaly N, des Portes V, Ostrowsky K, Arzimanoglou A, Lesca G. Electrical status epilepticus in sleep, a constitutive feature of Christianson syndrome? Eur J Paediatr Neurol 2018; 22:1124-1132. [PMID: 30126759 DOI: 10.1016/j.ejpn.2018.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 06/25/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
Christianson syndrome (CS) is a X-linked neurodevelopmental disorder, including severe intellectual disability (ID), progressive microcephaly, ataxia, autistic behaviour (ASD), near absent speech, and epilepsy. Electrical status epilepticus in sleep (ESES) has been reported in two patients. We describe five male patients from three unrelated families with Christianson syndrome caused by a pathogenic nucleotide variation or a copy-number variation involving SLC9A6. ESES was present in three out of the five patients in the critical age window between 4 and 8 years. All patients presented with severe intellectual disability, autistic features, and hyperactivity. Epilepsy onset occurred within the first two years of life. Seizures were of various types. In the two boys with a 20-years follow-up, epilepsy was drug-resistant during childhood, and became less active in early adolescence. Psychomotor regression was noted in two patients presenting with ESES. It was difficult to assess to what extent ESES could have contributed to the pathophysiological process, leading to regression of the already very limited communication skills. The two published case reports and our observation suggests that ESES could be a constitutive feature of Christianson syndrome, as it has already been shown for other Mendelian epileptic disorders, such as GRIN2A and CNKSR2-related developmental epileptic encephalopathies. Sleep EEG should be performed in patients with Christianson syndrome between 4 and 8 years of age. ESES occurring in the context of ID, ASD and severe speech delay, could be helpful to make a diagnosis of CS.
Collapse
Affiliation(s)
- Marie-Laure Mathieu
- Neuropaediatrics Department, Femme Mère Enfant Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Julitta de Bellescize
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France
| | - Marianne Till
- Department of Medical Genetics, Lyon University Hospital, Lyon, France
| | - Vincent Flurin
- Department of Paediatric Intensive Care, Le Mans Hospital, Le Mans, France
| | - Audrey Labalme
- Department of Medical Genetics, Lyon University Hospital, Lyon, France
| | - Nicolas Chatron
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France
| | - Damien Sanlaville
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France
| | - Nicole Chemaly
- Reference Centre for Rare Epilepsies, APHP, Necker-Enfants Malades Hospital, Imagine Institute, Paris, France; INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif sur Yvette, France
| | - Vincent des Portes
- Neuropaediatrics Department, Femme Mère Enfant Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Karine Ostrowsky
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France; DYCOG Team, Lyon Neuroscience Research Centre (CRNL), INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Gaëtan Lesca
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France.
| |
Collapse
|
15
|
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: 12] [Impact Index Per Article: 2.0] [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.
Collapse
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
| |
Collapse
|
16
|
Bölsterli BK, Gardella E, Pavlidis E, Wehrle FM, Tassinari CA, Huber R, Rubboli G. Remission of encephalopathy with status epilepticus (ESES) during sleep renormalizes regulation of slow wave sleep. Epilepsia 2017; 58:1892-1901. [DOI: 10.1111/epi.13910] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Bigna K. Bölsterli
- Division of Clinical Neurophysiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
| | - Elena Gardella
- Department of Clinical Neurophysiology; Danish Epilepsy Center; Dianalund Denmark
- University of Southern Denmark; Odense Denmark
| | - Elena Pavlidis
- Danish Epilepsy Center; Dianalund Denmark
- Child Neuropsychiatry Unit; Department of Neuroscience; University of Parma; Parma Italy
| | - Flavia M. Wehrle
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
| | | | - Reto Huber
- Children's Research Center; University Children's Hospital Zurich; Zurich Switzerland
- Child Development Center; University Children's Hospital Zurich; Zurich Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy; Psychiatric Hospital; University of Zurich; Zurich Switzerland
| | - Guido Rubboli
- Danish Epilepsy Center; Filadelfia/University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
17
|
Clinical Correlates and Prognostic Significance of Lateralized Periodic Discharges in Patients Without Acute or Progressive Brain Injury: A Case-Control Study. J Clin Neurophysiol 2016. [PMID: 26200591 DOI: 10.1097/wnp.0000000000000206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Lateralized periodic discharges (LPDs, also known as periodic lateralized epileptiform discharges) in conjunction with acute brain injuries are known to be associated with worse prognosis but little is known about their importance in absence of such acute injuries. We studied the clinical correlates and outcome of patients with LPDs in the absence of acute or progressive brain injury. METHODS This is a case-control study of 74 patients with no acute brain injury undergoing continuous EEG monitoring, half with LPDs and half without, matched for age and etiology of remote brain injury, if any, or history of epilepsy. RESULTS Lateralized periodic discharges were found in 145/1785 (8.1%) of subjects; 37/145 (26%) had no radiologic evidence of acute or progressive brain injury. Those with LPDs were more likely to have abnormal consciousness (86% vs. 57%; P = 0.005), seizures (70% vs. 24%; P = 0.0002), and functional decline (62% vs. 27%; P = 0.005), and were less likely to be discharged home (24% vs. 62%; P = 0.002). On multivariate analysis, LPDs and status epilepticus were associated with abnormal consciousness (P = 0.009; odds ratio = 5.2, 95% CI = 1.60-20.00 and P = 0.017; odds ratio = 5.0, 95% CI = 1.4-21.4); and LPDs were independently associated with functional decline (P = 0.001; odds ratio = 4.8, 95% CI = 1.6-15.4) and lower likelihood of being discharged home (P = 0.009; odds ratio = 0.2, 95% CI = 0.04-0.6). CONCLUSIONS Despite absence of acute or progressive brain injury, LPDs were independently associated with abnormal consciousness and worse outcome at hospital discharge.
Collapse
|
18
|
Current understanding and neurobiology of epileptic encephalopathies. Neurobiol Dis 2016; 92:72-89. [DOI: 10.1016/j.nbd.2016.03.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 12/25/2022] Open
|
19
|
Bansal L, Miller I, Hyslop A, Bhatia S, Duchowny M, Jayakar P. PET hypermetabolism in medically resistant childhood epilepsy: Incidence, associations, and surgical outcome. Epilepsia 2016; 57:436-44. [DOI: 10.1111/epi.13311] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Lalit Bansal
- Department of Neurology; Nicklaus Children's Hospital; Miami Florida U.S.A
| | - Ian Miller
- Department of Neurology; Nicklaus Children's Hospital; Miami Florida U.S.A
- Brain Institute; Nicklaus Children's Hospital; Miami Florida U.S.A
- Department of Neurology; Miller School of Medicine; University of Miami; Miami Florida U.S.A
| | - Ann Hyslop
- Department of Neurology; Nicklaus Children's Hospital; Miami Florida U.S.A
- Brain Institute; Nicklaus Children's Hospital; Miami Florida U.S.A
- Department of Neurology; Miller School of Medicine; University of Miami; Miami Florida U.S.A
| | - Sanjiv Bhatia
- Brain Institute; Nicklaus Children's Hospital; Miami Florida U.S.A
- Department of Neurosurgery; Nicklaus Children's Hospital; Miller School of Medicine; University of Miami; Miami Florida U.S.A
| | - Michael Duchowny
- Department of Neurology; Nicklaus Children's Hospital; Miami Florida U.S.A
- Brain Institute; Nicklaus Children's Hospital; Miami Florida U.S.A
- Department of Neurology; Miller School of Medicine; University of Miami; Miami Florida U.S.A
| | - Prasanna Jayakar
- Department of Neurology; Nicklaus Children's Hospital; Miami Florida U.S.A
- Brain Institute; Nicklaus Children's Hospital; Miami Florida U.S.A
- Department of Neurology; Miller School of Medicine; University of Miami; Miami Florida U.S.A
| |
Collapse
|
20
|
Xiao F, An D, Lei D, Li L, Chen S, Wu X, Yang T, Ren J, Gong Q, Zhou D. Real-time effects of centrotemporal spikes on cognition in rolandic epilepsy. Neurology 2016; 86:544-51. [DOI: 10.1212/wnl.0000000000002358] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/12/2015] [Indexed: 11/15/2022] Open
|
21
|
Agarwal R, Kumar A, Tiwari VN, Chugani H. Thalamic abnormalities in children with continuous spike-wave during slow-wave sleep: An F-18-fluorodeoxyglucose positron emission tomography perspective. Epilepsia 2015; 57:263-71. [PMID: 26697846 DOI: 10.1111/epi.13278] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Thalamic injury has been implicated in the development of continuous spike-wave during slow-wave sleep (CSWS) in children with epilepsy. We studied thalamic abnormalities in children with CSWS using F-18-fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging. METHODS Twenty-three patients (12 male; mean age 9 years) with CSWS and normal thalami on brain magnetic resonance imaging (MRI) underwent FDG-PET. Thalamic glucose metabolism, represented by standardized uptake value normalized to whole brain (nSUV, RT for right thalamus and LT for left thalamus), and its asymmetry--absolute asymmetry index (AAI): ¦(RT-LT)¦*100/[(RT+LT)/2]--was calculated. These values were compared with those from 10 normal healthy controls (five female; mean age 11.1 years). RESULTS Thalamic glucose metabolism was abnormal in 18 patients (78.3%). Thalamic nSUV was decreased (n = 6) or increased (n = 1) bilaterally in seven children without any asymmetry. Abnormal thalamic symmetry [AAI = 3.7-31.5% (0.8-3.3% in controls)] was seen in 11 children. Of these, six children had a unilateral thalamic metabolic abnormality (increased metabolism, n = 3 and decreased metabolism, n = 3), whereas 5 of 14 children had abnormal asymmetry index with bilaterally normal (n = 4) or increased (n = 1) thalamic metabolism. No clear association of thalamic metabolic abnormalities was seen with the stage of evolution of CSWS (prodromal, acute, or residual) or with the cortical FDG abnormalities. SIGNIFICANCE Functional thalamic abnormalities, both unilateral and bilateral, are frequently seen in patients with CSWS. FDG-PET is a sensitive and quantifiable modality to detect these changes.
Collapse
Affiliation(s)
- Rajkumar Agarwal
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.,Division of Neurology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A
| | - Ajay Kumar
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.,Division of Neurology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.,Division of Radiology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.,PET Center, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A
| | - Vijay N Tiwari
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.,Division of Neurology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.,PET Center, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A
| | - Harry Chugani
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.,Division of Neurology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.,PET Center, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A
| |
Collapse
|
22
|
Ouyang G, Wang Y, Yang Z, Li X. Global Synchronization of Multichannel EEG in Patients With Electrical Status Epilepticus in Sleep. Clin EEG Neurosci 2015; 46:357-63. [PMID: 25392005 DOI: 10.1177/1550059414538807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 05/08/2014] [Indexed: 11/17/2022]
Abstract
In the research field of epilepsy, it is a challenge to understand the transition of brain activity to electrical status epilepticus in sleep (ESES). In this study, an S-estimator method is proposed to describe the course of global synchronization in multichannel electroencephalograph (EEG) from awake to sleep in 11 patients with ESES. The study confirms that there is a significant increase in spikes and global synchronization from awake to sleep. It is also found that global synchronization is strongly correlated with spikes. The proposed method has the potential of revealing the intrinsic features of EEG signals and the underlying brain dynamics in ESES.
Collapse
Affiliation(s)
- Gaoxiang Ouyang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China
| | - Yinghua Wang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China
| |
Collapse
|
23
|
Default mode network hypometabolism in epileptic encephalopathies with CSWS. Epilepsy Res 2014; 108:861-71. [PMID: 24746674 DOI: 10.1016/j.eplepsyres.2014.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/12/2014] [Accepted: 03/16/2014] [Indexed: 11/20/2022]
Abstract
Previous studies investigating cerebral metabolic changes associated with continuous spike-waves during sleep (CSWS) compared the metabolism of children with CSWS with that of healthy adults, precluding any assessment in brain areas showing physiologic age-related metabolic changes. Here, we investigated the metabolic and connectivity changes characterizing the acute phase of CSWS activity by comparing awake brain metabolism of children with CSWS with that of pediatric pseudo-controls. Positron emission tomography using [18F]-fluorodeoxyglucose (FDG-PET) was performed in 17 awake children with cryptogenic CSWS (5 girls, age: 5-11 years). Voxel-based analyses identified significant metabolic changes in CSWS patients compared with 18 pediatric pseudo-controls (12 girls, age: 6-11 years, non-CSWS focal cryptogenic epilepsy with normal FDG-PET). CSWS-induced changes in the contribution of brain areas displaying metabolic changes to the level of metabolic activity in other brain areas were investigated using pathophysiological interaction. Hypermetabolism in perisylvian regions bilaterally and hypometabolism in lateral and mesial prefrontal cortex, precuneus, posterior cingulate cortex and parahippocampal gyri characterized the acute phase of CSWS (p<0.05 FWE). No change in thalamic metabolism was disclosed. Altered functional connectivity was found between hyper- and hypometabolic regions in CSWS patients compared with pediatric pseudo-controls. This study demonstrates hypometabolism in key nodes of the default mode network (DMN) in awake patients with CSWS, in relation with a possible phenomenon of sustained remote inhibition from the epileptic foci. This hypometabolism might account for some of the acquired cognitive or behavioral features of CSWS epileptic encephalopathies. This study failed to find any evidence of thalamic metabolic changes, which supports the primary involvement of the cortex in CSWS genesis.
Collapse
|
24
|
Siniatchkin M, Capovilla G. Functional neuroimaging in epileptic encephalopathies. Epilepsia 2013; 54 Suppl 8:27-33. [DOI: 10.1111/epi.12420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Michael Siniatchkin
- Clinic of Child and Adolescents Psychiatry; Goethe-University of Frankfurt; Frankfurt Germany
| | - Giuseppe Capovilla
- Department of Child Neuropsychiatry; Epilepsy Center; C. Poma Hospital; Mantova Italy
| |
Collapse
|
25
|
Filippini M, Arzimanoglou A, Gobbi G. Neuropsychological approaches to epileptic encephalopathies. Epilepsia 2013; 54 Suppl 8:38-44. [DOI: 10.1111/epi.12422] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Melissa Filippini
- IRCCS, The Institute of Neurological Sciences of Bologna; Child Neurology Unit; Bologna Italy
| | - Alexis Arzimanoglou
- Department of Epilepsy, Sleep and Pediatric Neurophysiology; University Hospitals of Lyon (HCL); Lyon France
| | - Giuseppe Gobbi
- IRCCS, The Institute of Neurological Sciences of Bologna; Child Neurology Unit; Bologna Italy
| |
Collapse
|
26
|
Continuous Spikes and Waves during Sleep: Electroclinical Presentation and Suggestions for Management. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:583531. [PMID: 23991336 PMCID: PMC3748771 DOI: 10.1155/2013/583531] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/07/2013] [Indexed: 01/21/2023]
Abstract
Continuous spikes and waves during sleep (CSWS) is an epileptic encephalopathy characterized in most patients by (1) difficult to control seizures, (2) interictal epileptiform activity that becomes prominent during sleep leading to an electroencephalogram (EEG) pattern of electrical status epilepticus in sleep (ESES), and (3) neurocognitive regression. In this paper, we will summarize current epidemiological, clinical, and EEG knowledge on CSWS and will provide suggestions for treatment. CSWS typically presents with seizures around 2-4 years of age. Neurocognitive regression occurs around 5-6 years of age, and it is accompanied by subacute worsening of EEG abnormalities and seizures. At approximately 6-9 years of age, there is a gradual resolution of seizures and EEG abnormalities, but the neurocognitive deficits persist in most patients. The cause of CSWS is unknown, but early developmental lesions play a major role in approximately half of the patients, and genetic associations have recently been described. High-dose benzodiazepines and corticosteroids have been successfully used to treat clinical and electroencephalographic features. Corticosteroids are often reserved for refractory disease because of adverse events. Valproate, ethosuximide, levetiracetam, sulthiame, and lamotrigine have been also used with some success. Epilepsy surgery may be considered in a few selected patients.
Collapse
|
27
|
De Tiège X, Trotta N, Op de beeck M, Bourguignon M, Marty B, Wens V, Nonclercq A, Goldman S, Van Bogaert P. Neurophysiological activity underlying altered brain metabolism in epileptic encephalopathies with CSWS. Epilepsy Res 2013; 105:316-25. [DOI: 10.1016/j.eplepsyres.2013.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/03/2013] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
|
28
|
Changes in functional integration with the non-epileptic temporal lobe of patients with unilateral mesiotemporal epilepsy. PLoS One 2013; 8:e67053. [PMID: 23818976 PMCID: PMC3688582 DOI: 10.1371/journal.pone.0067053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/14/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate epilepsy-induced changes in effective connectivity between the non-epileptic amygdalo-hippocampal complex (AHC) and the rest of the brain in patients with unilateral mesiotemporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS). Methods Thirty-three patients with unilateral MTLE associated with HS (20 females, mean age: 36 years, 19 left HS) and 33 adult controls matched for age and gender underwent 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET). Right-HS patients' FDG-PET data were flipped to obtain a left–epileptic–focus–lateralized group of patients. Voxels of interest (VOI) were selected within the cytoarchitectonic probabilistic maps of the non-epileptic AHC (probability level = 100%, SPM8 Anatomy toolbox v1.7). Patients and controls were compared using VOI metabolic activity as covariate of interest to search for epilepsy-induced changes in the contribution of the non-epileptic AHC to the level of metabolic activity in other brain areas. Age, gender, duration of epilepsy, seizure type and frequency were used as covariates of no-interest for connectivity analyses. Key findings Significant decrease in effective connectivity was found between the non-epileptic AHC and ventral prefrontal cortical areas bilaterally, as well as with the temporal pole and the posterior cingulate cortex contralateral to HS. Significant increase in connectivity was found between the non-epileptic AHC and midline structures, such as the anterior cingulate and dorsal medial prefrontal cortices, as well as the temporo-parietal junction bilaterally. Connectivity analyses also revealed a preserved positive connectivity between the non-epileptic and the epileptic AHC in the patients' group. Significance This study evidences epilepsy-induced changes in connectivity between the non-epileptic AHC and some limbic and default mode network areas. These changes in connectivity probably account for emotional, cognitive and decision-making impairments frequently observed in MTLE patients. The preserved neurometabolic connectivity between the non-epileptic and the epileptic AHC in MTLE patients is pivotal to explain the epilepsy-induced changes found in this study.
Collapse
|
29
|
van Bogaert P, King MD, Paquier P, Wetzburger C, Labasse C, Dubru JM, Deonna T. Acquired auditory agnosia in childhood and normal sleep electroencephalography subsequently diagnosed as Landau-Kleffner syndrome: a report of three cases. Dev Med Child Neurol 2013; 55:575-9. [PMID: 23121226 DOI: 10.1111/dmcn.12025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM We report three cases of Landau-Kleffner syndrome (LKS) in children (two females, one male) in whom diagnosis was delayed because the sleep electroencephalography (EEG) was initially normal. METHOD Case histories including EEG, positron emission tomography findings, and long-term outcome were reviewed. RESULTS Auditory agnosia occurred between the age of 2 years and 3 years 6 months, after a period of normal language development. Initial awake and sleep EEG, recorded weeks to months after the onset of language regression, during a nap period in two cases and during a full night of sleep in the third case, was normal. Repeat EEG between 2 months and 2 years later showed epileptiform discharges during wakefulness and strongly activated by sleep, with a pattern of continuous spike-waves during slow-wave sleep in two patients. Patients were diagnosed with LKS and treated with various antiepileptic regimens, including corticosteroids. One patient in whom EEG became normal on hydrocortisone is making significant recovery. The other two patients did not exhibit a sustained response to treatment and remained severely impaired. INTERPRETATION Sleep EEG may be normal in the early phase of acquired auditory agnosia. EEG should be repeated frequently in individuals in whom a firm clinical diagnosis is made to facilitate early treatment.
Collapse
Affiliation(s)
- Patrick van Bogaert
- Department of Paediatric Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | |
Collapse
|
30
|
Archambaud F, Bouilleret V, Hertz-Pannier L, Chaumet-Riffaud P, Rodrigo S, Dulac O, Chassoux F, Chiron C. Optimizing statistical parametric mapping analysis of 18F-FDG PET in children. EJNMMI Res 2013; 3:2. [PMID: 23289862 PMCID: PMC3558387 DOI: 10.1186/2191-219x-3-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/27/2012] [Indexed: 01/18/2023] Open
Abstract
UNLABELLED BACKGROUND Statistical parametric mapping (SPM) procedure is an objective tool to analyze 18F-fluoro-2-deoxy-d-glucose-positron-emission tomography (FDG-PET) images and a useful complement to visual analysis. However, SPM requires a comparison to control data set that cannot be obtained in healthy children for ethical reasons. Using adults as controls showed some limitations. The purpose of the present study was to generate and validate a group of pseudo-normal children as a control group for FDG-PET studies in pediatrics. METHODS FDG-PET images of 47 children (mean ± SD age 10.2 ± 3.1 years) with refractory symptomatic (MRI-positive, n = 20) and cryptogenic (MRI-negative, n = 27) focal epilepsy planned for surgery were analyzed using visual and SPM analysis. Performances of SPM analysis were compared using two different control groups: (1) an adult control group consisting of healthy young adults (n = 25, 30.5 ± 5.8 years, adult PET template) and (2) a pediatric pseudo-control group consisting of patients (n = 24, 10.6 ± 3.1 years, children PET template) with refractory focal epilepsy but with negative MRI and with PET considered normal not only on visual analysis but also on SPM. RESULTS Among the 47 children, visual analysis succeeded detecting at least one hypometabolic area in 87% of the cases (interobserver kappa = 0.81). Regarding SPM analysis, the best compromise between sensitivity and specificity was obtained with a threshold of p less than 0.001 as an extent of more than 40 voxels. There was a significant concordance to detect hypometabolic areas between both SPM analyses [kappa (K) = 0.59; p < 0.005] and between both SPM and visual analyses (K = 0.45; p < 0.005), in symptomatic (K = 0.74; p < 0.005) as in cryptogenic patients (K = 0.26; p < 0.01). The pediatric pseudo-control group dramatically improved specificity (97% vs. 89%; p < 0.0001) by increasing the positive predictive value (86% vs. 65%). Sensitivity remained acceptable although it was not better (79% vs. 87%, p = 0.039). The main impact was to reduce by 41% the number of hypometabolic cortical artifacts detected by SPM, especially in the younger epileptic patients, which is a key point in clinical practice. CONCLUSIONS This age-matched pseudo-control group is a way to optimize SPM analysis of FDG-PET in children with epilepsy. It might also be considered for other brain pathologies in pediatrics in the future.
Collapse
Affiliation(s)
- Frederique Archambaud
- Inserm, U663, Service de Neurologie et Métabolisme, Hôpital Necker, 149 rue de Sèvres, Paris, 75015, France.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Van Bogaert P. Epileptic encephalopathy with continuous spike-waves during slow-wave sleep including Landau-Kleffner syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:635-40. [PMID: 23622211 DOI: 10.1016/b978-0-444-52891-9.00066-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epileptic encephalopathy with continuous spike-waves during slow-wave sleep (CSWS) is a spectrum of epileptic conditions best defined by the association of cognitive or behavioral impairment acquired during childhood and not related to another factor other than the presence of abundant interictal epileptiform discharges (IED) during sleep, which tend to diffuse over the whole scalp. It is part of the childhood focal epileptic syndromes, some cases being idiopathic and overlapping with benign rolandic epilepsy, and others being symptomatic of a structural brain lesion. Landau-Kleffner syndrome (LKS) is a particular presentation where acquired aphasia is the core symptom. Clinical, neurophysiological, and cerebral glucose metabolism data support the hypothesis that IED play a prominent role in the cognitive deficits by interfering with the neuronal networks at the site of the epileptic foci but also at distant connected areas. Therefore, the treatment should aim to suppress IED. This may be achieved using conventional antiepileptic drugs, but corticosteroids seem to have more pronounced and sustained efficacy. Outcome for epilepsy is usually good, CSWS being an age-dependent EEG pattern, whereas outcome for cognition, language, and behavior is variable. Rehabilitation represents an important part of the treatment and visual forms of language should be encouraged in children with LKS.
Collapse
|
32
|
Sánchez Fernández I, Loddenkemper T, Peters JM, Kothare SV. Electrical status epilepticus in sleep: clinical presentation and pathophysiology. Pediatr Neurol 2012; 47:390-410. [PMID: 23127259 DOI: 10.1016/j.pediatrneurol.2012.06.016] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/20/2012] [Indexed: 10/27/2022]
Abstract
Electrical status epilepticus in sleep involves an electroencephalographic pattern where interictal epileptiform activity is potentiated in the transition from wakefulness to sleep. Near-continuous spikes and waves that occupy a significant proportion of nonrapid eye movement sleep appear as a result of sleep-potentiated epileptiform activity. This electroencephalographic pattern appears in different electroclinical syndromes that present three common characteristics with different degrees of severity: seizures, sleep-potentiated epileptiform activity, and neuropsychologic regression. Continuous spikes and waves during sleep comprise the severest epileptic encephalopathy in the electroclinical spectrum. Landau-Kleffner syndrome presents with intermediate severity. Some "benign" pediatric focal epileptic syndromes represent the mildest end of this continuum. Based on published data, we provide a framework for clinical and electrical events. The underlying mechanisms leading to sleep potentiation of epileptiform activity in electrical status epilepticus in sleep are incompletely understood. A genetic basis or acquired early developmental insult may disrupt the normal maturation of neuronal networks. These factors may dynamically alter normal processes of brain development, leading to an age-related pattern of electroclinical expression of electrical status epilepticus in sleep.
Collapse
Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | |
Collapse
|
33
|
|
34
|
Impact of focal interictal epileptiform discharges on behaviour and cognition in children. Neurophysiol Clin 2011; 42:53-8. [PMID: 22200342 DOI: 10.1016/j.neucli.2011.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/29/2011] [Accepted: 11/01/2011] [Indexed: 11/23/2022] Open
Abstract
It is hypothesised that focal interictal epileptiform discharges (IED) may exert a deleterious effect on behaviour and cognition in children. This hypothesis is supported by the abnormally high prevalence of IED in several developmental disorders, like specific language impairment, and of cognitive and behavioural deficits in epileptic children after excluding confounding factors such as underlying structural brain lesions, drug effects, or the occurrence of frequent or prolonged epileptic seizures. Neurophysiological and functional neuroimaging evidence suggests that IED may impact cognition through either transient effects on brain processing mechanisms, or through more long-lasting effects leading to prolonged inhibition of brain areas distant from but connected with the epileptic focus (i.e. remote inhibition effect). Sustained IED may also impair sleep-related learning consolidation processes. Nowadays, the benefits of anti-epileptic treatment aimed at reducing IED are not established except in specific situations like epileptic encephalopathies with continuous spike and waves during slow-wave sleep. Well-designed pharmacological studies are still necessary to address this issue.
Collapse
|
35
|
Is sleep-related consolidation impaired in focal idiopathic epilepsies of childhood? A pilot study. Epilepsy Behav 2011; 22:380-4. [PMID: 21872533 DOI: 10.1016/j.yebeh.2011.07.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/29/2011] [Accepted: 07/18/2011] [Indexed: 11/20/2022]
Abstract
We investigated sleep-related declarative memory consolidation in four children with focal idiopathic epilepsy. In a population of healthy control children, recall of learned pairs of words was increased after a night of sleep, but not after a daytime wakefulness period. In children with epilepsy (1 case of benign epilepsy with centro-temporal spikes, 1 case of benign childhood epilepsy with occipital paroxysms, and 2 cases of epileptic encephalopathy (EE) with continuous spike and waves during slow-wave sleep, CSWS), recall performance significantly decreased overnight, suggesting impairment in sleep-related declarative memory consolidation. Hydrocortisone treatment in one patient with EE with CSWS resulted in normalization of the sleep EEG together with normalization of overnight memory performance, which was not the case in the other EE/CSWS patient whose sleep EEG was only partially improved. These preliminary results suggest that interictal epileptiform discharges in idiopathic focal epilepsies may disrupt the brain processes underlying sleep-related memory consolidation.
Collapse
|
36
|
Trotta N, Goldman S, Legros B, Ligot N, Guerry N, Baete K, Van Laere K, Van Bogaert P, De Tiège X. Metabolic evidence for episodic memory plasticity in the nonepileptic temporal lobe of patients with mesial temporal epilepsy. Epilepsia 2011; 52:2003-12. [PMID: 21933182 DOI: 10.1111/j.1528-1167.2011.03271.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Metabolic changes have been described in the nonepileptic temporal lobe of patients with unilateral mesiotemporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS). To better understand the functional correlate of this metabolic finding, we have sought to characterize brain regions in patients with MTLE that show correlation between unilateral episodic memory performances, as assessed by intracarotid amobarbital test (IAT), and interictal regional cerebral metabolism measured by [(18) F]-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS Resting FDG-PET was performed interictally in 26 patients with unilateral MTLE caused by HS (16 female, mean age: 36 years; 16 left HS). Using statistical parametric mapping (SPM8), we performed a group comparison analysis comparing brain metabolism in the patients and in 54 adult controls (27 female, mean age: 32 years), with FDG-PET data of right HS patients being flipped. IAT scores of nonepileptic hemisphere functions (amobarbital injection ipsilateral to HS) were used as covariates of interest in a correlation analysis with regional brain metabolism. KEY FINDINGS The group comparison analysis revealed significant hypometabolic areas in a widespread temporofrontal network ipsilateral to HS. In addition, a significant increase in metabolism was found in mesial and lateral temporal regions contralateral to HS. Significant positive correlations were found between IAT scores of nonepileptic hemisphere functions and mesial temporal metabolism in this hemisphere. SIGNIFICANCE This study demonstrates the existence of significant increase in relative regional cerebral glucose metabolism in mesial and lateral temporal regions contralateral to the epileptic focus in patients with unilateral MTLE associated with HS. The positive correlation in these brain regions between IAT scores and metabolism supports the role of disease-induced plasticity mechanisms contralateral to HS in the preservation of episodic memory processes.
Collapse
Affiliation(s)
- Nicola Trotta
- Laboratoire de Cartographie Fonctionnelle du Cerveau, Hpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Ligot N, Krystkowiak P, Simonin C, Goldman S, Peigneux P, Van Naemen J, Monclus M, Lacroix SF, Devos D, Dujardin K, Delmaire C, Bardinet E, Delval A, Delliaux M, Defebvre L, Yelnik J, Blond S, Destée A, De Tiège X. External globus pallidus stimulation modulates brain connectivity in Huntington's disease. J Cereb Blood Flow Metab 2011; 31:41-6. [PMID: 20959850 PMCID: PMC3049470 DOI: 10.1038/jcbfm.2010.186] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Positron emission tomography with O-15-labeled water was used to study at rest the neurophysiological effects of bilateral external globus pallidus (GPe) deep brain stimulation in patients with Huntington's disease (HD). Five patients were compared with a control group in the on and off states of the stimulator. External globus pallidus stimulation decreased neuronal activity and modulated cerebral connectivity within the basal ganglia-thalamocortical circuitry, the sensorimotor, and the default-mode networks. These data indicate that GPe stimulation modulates functional integration in HD patients in accordance with the basal ganglia-thalamocortical circuit model.
Collapse
Affiliation(s)
- Noémie Ligot
- Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Mazzuca M, Jambaque I, Hertz-Pannier L, Bouilleret V, Archambaud F, Caviness V, Rodrigo S, Dulac O, Chiron C. 18F-FDG PET Reveals Frontotemporal Dysfunction in Children with Fever-Induced Refractory Epileptic Encephalopathy. J Nucl Med 2010; 52:40-7. [DOI: 10.2967/jnumed.110.077214] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
|
39
|
Siniatchkin M, Groening K, Moehring J, Moeller F, Boor R, Brodbeck V, Michel CM, Rodionov R, Lemieux L, Stephani U. Neuronal networks in children with continuous spikes and waves during slow sleep. Brain 2010; 133:2798-813. [DOI: 10.1093/brain/awq183] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Brown ES. Effects of glucocorticoids on mood, memory, and the hippocampus. Treatment and preventive therapy. Ann N Y Acad Sci 2009; 1179:41-55. [PMID: 19906231 DOI: 10.1111/j.1749-6632.2009.04981.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Corticosteroids, such as prednisone and dexamethasone, are commonly prescribed medications that suppress the immune system and decrease inflammation. Common side effects of long-term treatment with corticosteroids include weight gain, osteoporosis, and diabetes mellitus. This paper reviews the literature on psychiatric and cognitive changes during corticosteroid therapy and potential treatment options. Hypomania and mania are the most common mood changes during acute corticosteroid therapy, although depression has also been reported. However, depression is reported to be more common than mania during long-term treatment with corticosteroids. A decline in declarative and working memory is also reported during corticosteroid therapy. Corticosteroids are associated with changes in the temporal lobe, detected by structural, functional, and spectroscopic imaging. The mood and cognitive symptoms are dose dependent and frequently occur during the first few weeks of therapy. Other risk factors are not well characterized. Controlled trials suggest that lithium and phenytoin can prevent mood symptoms associated with corticosteroids. Lamotrigine and memantine also have been shown to reverse, at least partially, the declarative memory effects of corticosteroids. Uncontrolled trials suggest that antipsychotics, anti-seizure medications, and perhaps some antidepressants can also be useful for normalizing mood changes associated with corticosteroids. Thus, both the symptoms and treatment response are similar to those of bipolar disorder. Moreover, corticosteroid-induced mood and cognitive alterations have been shown to be reversible with dose reduction or discontinuation of treatment.
Collapse
Affiliation(s)
- E Sherwood Brown
- Psychoneuroendocrine Research Program, Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
| |
Collapse
|
41
|
Paquier PF, Verheulpen D, De Tiège X, Van Bogaert P. Acquired cognitive dysfunction with focal sleep spiking activity. Epilepsia 2009; 50 Suppl 7:29-32. [DOI: 10.1111/j.1528-1167.2009.02215.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
De Tiège X, Goldman S, Van Bogaert P. Insights into the pathophysiology of psychomotor regression in CSWS syndromes from FDG-PET and EEG-fMRI. Epilepsia 2009; 50 Suppl 7:47-50. [DOI: 10.1111/j.1528-1167.2009.02219.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
43
|
Mascetti L, Foret A, Bonjean M, Matarazzo L, Dang-Vu T, Maquet P. Some facts about sleep relevant for Landau-Kleffner syndrome. Epilepsia 2009; 50 Suppl 7:43-6. [DOI: 10.1111/j.1528-1167.2009.02218.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
44
|
Hamed SA. The aspects and mechanisms of cognitive alterations in epilepsy: the role of antiepileptic medications. CNS Neurosci Ther 2009; 15:134-56. [PMID: 19254331 PMCID: PMC6494068 DOI: 10.1111/j.1755-5949.2008.00062.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Epilepsy is a major health problem. Several studies suggest a significant influence of epilepsy and its treatment on dynamic and functional properties of brain activity. Epilepsy can adversely affect mental development, cognition, and behavior. Epileptic patients may experience reduced intelligence, attention, and problems in memory, language, and frontal executive functions. Neuropsychological, functional, and quantitative neuroimaging studies revealed that epilepsy affect the brain as a whole. Mechanisms of epilepsy-related cognitive dysfunction are poorly delineated. Cognitive deficits with epilepsy may be transient, persistent, or progressive. Transient disruption of cognitive encoding processes may occur with paroxysmal focal or generalized epileptic discharges, whereas epileptogenesis-related neuronal plasticity, reorganization, sprouting, and impairment of cellular metabolism are fundamental determinants for progressive cognitive deterioration. Also antiepileptic drugs (AEDs) have differential, reversible, and sometimes cumulative cognitive adverse consequences. AEDs not only reduce neuronal irritability but also may impair neuronal excitability, neurotransmitter release, enzymes, and factors critical for information processing and memory. The present article serves as an overview of recent studies in adult and childhood epilepsy literatures present in PubMed that highlighted cognitive evaluation in epilepsy field (publications till 2008 were checked). We also checked the reference lists of the retrieved studies for additional reports of relevant studies, in addition to our experience in this field. Our search revealed that although the aspects of cognitive dysfunction, risk factors, and consequences have been explored in many studies; however, the mechanisms of contribution of epilepsy-related variables, including AEDs, to patients' cognition are largely unexplored. In this review, we discussed the differential effect of AEDs in mature and immature brains and the known mechanisms underlying epilepsy and AEDs adverse effects on cognition. The nature, timing, course, and mechanisms of cognitive alteration with epilepsy and its medications are of considerable clinical and research implications.
Collapse
Affiliation(s)
- Sherifa A Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
| |
Collapse
|
45
|
Cortical glucose metabolism positively correlates with gamma-oscillations in nonlesional focal epilepsy. Neuroimage 2008; 42:1275-84. [PMID: 18652902 DOI: 10.1016/j.neuroimage.2008.06.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 06/08/2008] [Accepted: 06/23/2008] [Indexed: 11/24/2022] Open
Abstract
Why do the epileptogenic foci appear hypometabolic on interictal glucose metabolism positron emission tomography (PET) in a substantial proportion of patients with focal epilepsy but appear normo- or even hyper-metabolic in others? Such observations on interictal PET have not been fully explained by the frequency of interictal spike discharges alone. In the present study using digital electrocorticography monitoring system with high-frequency sampling, we determined how well regression models using spectral ECoG measures and spike frequency derived from 651 intracranial electrode sites explained cortical glucose metabolic patterns in six children with nonlesional focal epilepsy. Univariate regression analysis demonstrated that spectral amplitudes at gamma ranges (32-64, 64-100, and 100-200 Hz) were tightly correlated with interictal glucose uptake in the given electrode site in all children. Spike frequency was negatively correlated with interictal glucose uptake in three patients, whose epileptogenic focus appeared hypometabolic and interictal epileptiform discharge often consisted of a spike followed by a subsequent delta-wave. Conversely, spike frequency was positively correlated with interictal glucose uptake in the other three patients, whose epileptogenic foci appeared more hypermetabolic compared to the surrounding regions and associated with frequent interictal spike bursts. The spatial pattern of interictal glucose metabolism in nonlesional focal epilepsy may be better explained by gamma-oscillations derived from epileptiform and physiological neuronal activities rather than the frequency of interictal epileptiform discharges alone.
Collapse
|
46
|
Abstract
Electrical status epilepticus in sleep (ESES) describes an electroencephalographic pattern showing significant activation of epileptiform discharges in sleep. The terms continuous spike wave in slow-wave sleep (CSWS) and Landau-Kleffner syndrome (LKS) describe the clinical epileptic syndromes seen with ESES. Although there is an overlap between these 2 syndromes, children with CSWS present with a more global regression have more problematic epilepsy and have EEG foci located predominantly in frontotemporal or frontocentral regions. In contrast, children with LKS present with an acquired auditory agnosia, fewer seizures, and EEG foci in the posterotemporal regions. ESES requires a high degree of clinical suspicion because slow-wave sleep must be recorded to confirm this diagnosis. Treatment of ESES extends beyond just control of the seizures; amelioration of the continuous epileptiform discharge must occur to improve neuropsychological outcome. Although there is little evidence to guide treatment, conventional antiepileptic drugs play only a minimal role. Steroid therapy and high-dose benzodiazepines are most commonly used, but other therapies including intravenous gamma-globulin, the ketogenic diet, and surgical therapy with multiple subpial transaction have shown efficacy in small case series. Although epilepsy resolves with time in most cases, many children are left with significant cognitive or language impairment. Longer duration of ESES appears to be the major predictor of poor outcome; markedly abnormal neuronal activity during a critical period for synaptogenesis may result in aberrant synapse formation, explaining the poorer neuropsychological outcome. Early recognition and effective therapy are necessary to improve long-term prognosis in this condition.
Collapse
|
47
|
Metabolic evidence for remote inhibition in epilepsies with continuous spike-waves during sleep. Neuroimage 2007; 40:802-810. [PMID: 18201907 DOI: 10.1016/j.neuroimage.2007.11.043] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 11/28/2007] [Accepted: 11/28/2007] [Indexed: 11/23/2022] Open
Abstract
Epileptic syndromes with continuous spikes and waves during sleep (CSWS) are characterized by an acute phase with the emergence of psychomotor deficits and CSWS activity and by a recovery phase in which patients' clinical condition improves together with the remission of CSWS activity. The pathophysiological mechanisms of how CSWS activity induces psychomotor regression are still poorly understood. PET studies using [18F]-fluorodeoxyglucose (FDG) were performed in 9 children during acute and recovery phases of CSWS. PET data were analyzed at individual and group levels using statistical parametric mapping via subtractive, exclusive masking and variance analyses. Pathophysiological interaction analyses were conducted to determine the evolution of changes in effective connectivity between hypermetabolic and hypometabolic brain areas. At the individual level, CSWS recovery was characterized by a complete or almost complete regression of both hypermetabolic and hypometabolic abnormalities observed during the acute phase. Similar evolution was observed at the group level. Indeed, altered effective connectivity between focal hypermetabolism (centro-parietal regions and right fusiform gyrus) and widespread hypometabolism (prefrontal and orbitofrontal cortices, temporal lobes, left parietal cortex, precuneus and cerebellum) was found at the acute phase and markedly regressed at recovery. This study shows that the neurophysiological effects of CSWS activity are not restricted to the epileptic foci but spread via the inhibition of remote neurons within connected brain areas. The present study suggests that these reversible remote effects participate to the psychomotor repercussions of CSWS activity.
Collapse
|
48
|
De Tiège X, Harrison S, Laufs H, Boyd SG, Clark CA, Allen P, Neville BG, Vargha-Khadem F, Cross JH. Impact of interictal epileptic activity on normal brain function in epileptic encephalopathy: an electroencephalography-functional magnetic resonance imaging study. Epilepsy Behav 2007; 11:460-5. [PMID: 17869185 DOI: 10.1016/j.yebeh.2007.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 05/31/2007] [Accepted: 06/02/2007] [Indexed: 10/22/2022]
Abstract
Using electroencephalography (EEG) in combination with functional magnetic resonance imaging (fMRI), we studied a 9.5-year-old girl who developed cognitive and behavioral regression in association with intense interictal bilaterally synchronous epileptic discharges (IBSEDs) both during the awake state and during sleep. During runs of IBSEDs, EEG-fMRI demonstrated deactivations in the lateral and medial frontoparietal cortices, posterior cingulate gyrus, and cerebellum together with focal relative activations in the right frontal, parietal, and temporal cortices. The deactivations probably reflect the repercussion of the interictal epileptic activity on normal brain function which might cause the neuropsychological regression by inducing repetitive interruptions of neurophysiological function resulting in a chronic state of specific psychomotor impairment. The relative activations could possibly indicate the source of epileptic activity rapidly spreading to other brain regions.
Collapse
Affiliation(s)
- X De Tiège
- Neuroscience Unit, UCL Institute of Child Health, London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Van Paesschen W, Porke K, Fannes K, Vandenberghe R, Palmini A, Van Laere K, Dupont P. Cognitive Deficits during Status Epilepticus and Time Course of Recovery: A Case Report. Epilepsia 2007; 48:1979-83. [PMID: 17561953 DOI: 10.1111/j.1528-1167.2007.01157.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe a young woman with progressive cognitive and neurological deficits during a parietal lobe status epilepticus (SE). Ictal FDG-PET showed left parietal lobe hypermetabolism and frontal lobe hypometabolism with concomitant EEG slowing. Cognitive and neurological deficits fully reversed more than 1 year after seizure remission, and were associated with normalization of FDG-PET and EEG. Our findings suggest that ictal hypometabolism and EEG delta activity at a distance from the epileptic focus were seizure-related phenomena, possibly representing inhibition in seizure propagation pathways, which could be responsible for the epileptic encephalopathy.
Collapse
Affiliation(s)
- Wim Van Paesschen
- Department of Neurology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
50
|
De Tiège X, Goldman S, Verheulpen D, Aeby A, Poznanski N, Van Bogaert P. Coexistence of Idiopathic Rolandic Epilepsy and CSWS in Two Families. Epilepsia 2006; 47:1723-7. [PMID: 17054694 DOI: 10.1111/j.1528-1167.2006.00644.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To report two families combining benign childhood epilepsy with centrotemporal spikes (BCECS) and cryptogenic epilepsy with continuous spike-waves during sleep (CSWS) in first-degree relatives. METHODS Clinical, EEG, and cerebral imaging data are described. RESULTS FAMILY 1: The proband was 3 years old at epilepsy onset. First seizures were convulsive, with centrotemporal spikes on EEG. At age 5 years, he had complex partial seizures, psychomotor regression, and centrotemporal CSWS. [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) showed left parietal hypermetabolism. After several antiepileptic drug (AED) trials, valproate (VPA) and ethosuximide (ESM) induced seizure remission, CSWS disappearance, and psychomotor improvement. Learning disabilities, however, persisted. Family history was remarkable for BCECS in his father. FAMILY 2: The proband was 2 years old at epilepsy onset. First seizures were convulsive, with centrotemporal CSWS on EEG. Despite several AED trials including corticosteroids, focal negative myoclonia, atypical absences, and psychomotor regression occurred, leading to severe mental retardation. FDG-PET showed bilateral parietal hypermetabolism. Vagus nerve stimulator was implanted. Her family history was remarkable for BCECS in her father and febrile convulsions in infancy in her mother. CONCLUSIONS These data suggest the existence of a common genetic basis between BCECS and cryptogenic epilepsies with CSWS. The higher expression in patients with CSWS could be related to other genetic or acquired factors. These data suggest that these epileptic syndromes constitute edges of a continuum.
Collapse
Affiliation(s)
- Xavier De Tiège
- Department of Pediatric Neurology, ULB-Hôspital Erasme, Université Libre de Brussels, Brussles, Belgium.
| | | | | | | | | | | |
Collapse
|