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Alkabie S, Gray MT, Lau JC, Barra L, Mandzia J, Zhang Q, Budhram A. Teaching NeuroImage: Unilateral Primary Angiitis of the CNS. Neurology 2024; 102:e208018. [PMID: 38175856 PMCID: PMC10834122 DOI: 10.1212/wnl.0000000000208018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/27/2023] [Indexed: 01/06/2024] Open
Abstract
A 48-year-old woman was referred with an 18-year history of focal-onset seizures. She also reported years-long slowly progressive right-sided weakness that was corroborated on examination. Repeated brain MRIs over 15 years showed multifocal left hemispheric T2 fluid-attenuated inversion recovery-hyperintense lesions with patchy enhancement and microhemorrhages, no diffusion restriction, and a left cerebellar infarct (Figure 1, A-F). Only 2 nonspecific white matter lesions were seen contralaterally, indicating largely unihemispheric disease. Differential diagnosis included unilateral primary angiitis of the CNS (PACNS), Rasmussen encephalitis, and myelin oligodendrocyte glycoprotein antibody-associated disease.1 Serum and CSF testing for autoimmune, infectious, and malignant etiologies and whole-body fluorodeoxyglucose-PET, whole-exome genetic sequencing, and MR vessel-wall imaging were nondiagnostic. Brain biopsy revealed vasculitis (Figure 2, A-F), and the patient was diagnosed with unilateral PACNS. Treatment with mycophenolate mofetil has been initiated. Unilateral PACNS is a rare unihemispheric disease characterized by an indolent course and seizures, recognition of which is critical to accurate diagnosis.1,2.
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Affiliation(s)
- Samir Alkabie
- From the Departments of Clinical Neurological Sciences (S.A., J.C.L., J.M., Q.Z., A.B.) and Pathology and Laboratory Medicine (M.T.G., Q.Z., A.B.), Western University, London Health Sciences Centre; and Division of Rheumatology, Department of Medicine (L.B.), Western University, St. Joseph's Health Care, London, Ontario, Canada
| | - Madison T Gray
- From the Departments of Clinical Neurological Sciences (S.A., J.C.L., J.M., Q.Z., A.B.) and Pathology and Laboratory Medicine (M.T.G., Q.Z., A.B.), Western University, London Health Sciences Centre; and Division of Rheumatology, Department of Medicine (L.B.), Western University, St. Joseph's Health Care, London, Ontario, Canada
| | - Jonathan C Lau
- From the Departments of Clinical Neurological Sciences (S.A., J.C.L., J.M., Q.Z., A.B.) and Pathology and Laboratory Medicine (M.T.G., Q.Z., A.B.), Western University, London Health Sciences Centre; and Division of Rheumatology, Department of Medicine (L.B.), Western University, St. Joseph's Health Care, London, Ontario, Canada
| | - Lillian Barra
- From the Departments of Clinical Neurological Sciences (S.A., J.C.L., J.M., Q.Z., A.B.) and Pathology and Laboratory Medicine (M.T.G., Q.Z., A.B.), Western University, London Health Sciences Centre; and Division of Rheumatology, Department of Medicine (L.B.), Western University, St. Joseph's Health Care, London, Ontario, Canada
| | - Jennifer Mandzia
- From the Departments of Clinical Neurological Sciences (S.A., J.C.L., J.M., Q.Z., A.B.) and Pathology and Laboratory Medicine (M.T.G., Q.Z., A.B.), Western University, London Health Sciences Centre; and Division of Rheumatology, Department of Medicine (L.B.), Western University, St. Joseph's Health Care, London, Ontario, Canada
| | - Qi Zhang
- From the Departments of Clinical Neurological Sciences (S.A., J.C.L., J.M., Q.Z., A.B.) and Pathology and Laboratory Medicine (M.T.G., Q.Z., A.B.), Western University, London Health Sciences Centre; and Division of Rheumatology, Department of Medicine (L.B.), Western University, St. Joseph's Health Care, London, Ontario, Canada
| | - Adrian Budhram
- From the Departments of Clinical Neurological Sciences (S.A., J.C.L., J.M., Q.Z., A.B.) and Pathology and Laboratory Medicine (M.T.G., Q.Z., A.B.), Western University, London Health Sciences Centre; and Division of Rheumatology, Department of Medicine (L.B.), Western University, St. Joseph's Health Care, London, Ontario, Canada
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Stredny CM, Blessing MM, Yi V, Ryan ME, Zhang B, Solomon IH, Prabhu SP, Alexandrescu S, Gorman MP. Mimics of Pediatric Small Vessel Primary Angiitis of the Central Nervous System. Ann Neurol 2023; 93:109-119. [PMID: 36254350 DOI: 10.1002/ana.26531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/14/2022] [Accepted: 10/05/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Small vessel primary angiitis of the central nervous system is a rare and often severe disease characterized by central nervous system-restricted inflammatory vasculitis on histopathology. Diagnosis requires brain biopsy for confirmation and is suggested prior to starting immunotherapy when feasible. However, emerging evidence suggests that other neuroinflammatory conditions may have a clinical and radiographic phenotype that mimics small vessel primary angiitis, at times with overlapping pathologic features as well. Such diagnoses, including myelin oligodendrocyte glycoprotein antibody-associated disease and central nervous system-restricted hemophagocytic lymphohistiocytosis, can be non-invasively diagnosed with serum antibody or genetic testing that would prompt different monitoring and treatment paradigms. To determine the ultimate diagnosis of patients who were suspected prior to biopsy to have small vessel primary angiitis, we reviewed the clinical, radiographic, and pathological features of a cohort of patients at a single center undergoing brain biopsy for non-oncologic indications. METHODS Clinical data were retrospectively extracted from the medical record. Pathology and neuroimaging review was conducted. RESULTS We identified 21 patients over a 19-year time-period, of whom 14 (66.7%) were ultimately diagnosed with entities other than small vessel primary angiitis that would have obviated the need for brain biopsy. Diagnoses included anti-myelin oligodendrocyte glycoprotein antibody associated disease (n = 9), central nervous system-restricted hemophagocytic lymphohistiocytosis (n = 3), anti-GABAA receptor encephalitis (n = 1), and Aicardi-Goutières syndrome (n = 1). INTERPRETATION This study highlights the importance of pursuing now readily available non-invasive testing for mimicking diagnoses before performing a brain biopsy for suspected small vessel primary angiitis of the central nervous system. ANN NEUROL 2023;93:109-119.
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Affiliation(s)
- Coral M Stredny
- Program in Neuroimmunology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa M Blessing
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Vivian Yi
- Program in Neuroimmunology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Morgan E Ryan
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Zhang
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Isaac H Solomon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanjay P Prabhu
- Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanda Alexandrescu
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark P Gorman
- Program in Neuroimmunology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Reiter JT, David B, Enders S, Prillwitz CC, Bauer T, Atalay D, Tietze A, Kaindl AM, Keil V, Radbruch A, Weber B, Becker AJ, Elger CE, Surges R, Rüber T. Infratentorial MRI Findings in Rasmussen Encephalitis Suggest Primary Cerebellar Involvement. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/6/e1058. [PMID: 34389659 PMCID: PMC8382488 DOI: 10.1212/nxi.0000000000001058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Background and Objective Rasmussen encephalitis (RE) is characterized by its unilateral cerebral involvement. However, both ipsi- and contralesional cerebellar atrophy have been anecdotally reported raising questions about the nature and extent of infratentorial findings. Using MRI, we morphometrically investigated the cerebellum and hypothesized abnormalities beyond the effects of secondary atrophy, implicating a primary involvement of the cerebellum by RE. Methods Voxel-based morphometry of the cerebellum and brainstem was conducted in 57 patients with RE and in 57 matched controls. Furthermore, patient-specific asymmetry indices (AIs) of cerebellar morphometry and fluid-attenuated inversion recovery (FLAIR) intensity were calculated. Using diffusion tensor imaging, the integrity of the cortico-ponto-cerebellar (CPC) tract was assessed. Finally, a spatial independent component analysis (ICA) was used to compare atrophy patterns between groups. Results Patients with RE showed bilateral cerebellar and predominantly ipsilesional mesencephalic atrophy (p < 0.01). Morphometric AIs revealed ipsilesional < contralesional asymmetry in 27 and ipsilesional > contralesional asymmetry in 30 patients. In patients with predominant ipsilesional atrophy, morphometric AIs strongly correlated with FLAIR intensity AIs (r = 0.86, p < 0.0001). Fractional anisotropy was lower for ipsilesional-to-contralesional CPC tracts than opposite tracts (T = 2.30, p < 0.05). ICA revealed bilateral and strictly ipsi- and contralesional atrophy components in patients with RE (p < 0.05). Discussion We demonstrated atrophy of the ipsilesional-to-contralesional CPC pathway and, consequently, interpret the loss of contralesional gray matter as secondary crossed cerebellar atrophy. The ipsilesional cerebellar atrophy, however, defies this explanation. Based on FLAIR hyperintensities, we interpret ipsilesional atrophy to be due to inflammation in the scope of a primary involvement of the cerebellum by RE.
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Affiliation(s)
- Johannes T Reiter
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Bastian David
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Selma Enders
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Conrad C Prillwitz
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Tobias Bauer
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Deniz Atalay
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Anna Tietze
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Angela M Kaindl
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Vera Keil
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Alexander Radbruch
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Bernd Weber
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Albert J Becker
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Christian E Elger
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Rainer Surges
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany
| | - Theodor Rüber
- From the Department of Epileptology (J.T.R., B.D., S.E., C.C.P., T.B., C.E.E., R.S., T.R.), University Hospital Bonn; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Department of Pediatric Neurology; Charité-Universitätsmedizin Berlin (D.A., A.M.K.), Center for Chronically Sick Children; Charité-Universitätsmedizin Berlin (A.T.), Institute of Neuroradiology; Charité-Universitätsmedizin Berlin (A.M.K.), Institute for Cell Biology and Neurobiology; Department of Neuroradiology (V.K., A.R.), University Hospital Bonn; Department of Radiology and Nuclear Medicine (V.K.), Vrije Universiteit Amsterdam Medisch Centrum, The Netherlands; Institute of Experimental Epileptology and Cognition Research (B.W.), University Hospital Bonn; and Section for Translational Epilepsy Research (A.J.B.), Department of Neuropathology, University Hospital Bonn, Germany.
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