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Wu S, Wang Q, Zhai H, Zhang Y, Xu D, Yan G, Wu R. γ-Aminobutyric acid as a biomarker of the lateralizing and monitoring drug effect in patients with magnetic resonance imaging-negative temporal lobe epilepsy. Front Neurosci 2023; 17:1184440. [PMID: 37255748 PMCID: PMC10225511 DOI: 10.3389/fnins.2023.1184440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Despite verifying proton magnetic resonance spectroscopy (1H-MRS) for focal localization in magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE), it is necessary to illustrate metabolic changes and screen for effective biomarkers for monitoring therapeutic effect. We used 1H-MRS to investigate the role of metabolic levels in MRI-negative TLE. Materials and methods Thirty-seven patients (n = 37, 14 women) and 20 healthy controls (n = 20, 11 women) were investigated by 1H-MRS. We compared the metabolite level changes in the epileptic and contralateral sides on the mesial temporal and dorsolateral prefrontal cortices and analyzed their association with clinical symptoms. Results γ-Aminobutyric acid (GABA) levels were significantly lower on the epileptic side (2.292 ± 0.890) than in the contralateral side (2.662 ± 0.742, p = 0.029*) in patients on the mesial temporal lobe. N-acetylaspartate (NAA) levels were significantly lower on the epileptic side (7.284 ± 1.314) than on the contralateral side (7.655 ± 1.549, p = 0.034*). NAA + N-acetylaspartylglutamate levels were significantly lower on the epileptic side (7.668 ± 1.406) than on the contralateral side (8.086 ± 1.675, p = 0.032*). Glutamate levels were significantly lower on the epileptic side (7.773 ± 1.428) than on the contralateral side (8.245 ± 1.616, p = 0.040*). Moreover, a significant negative correlation was found between GABA levels in the epileptic mesial temporal lobe and tonic-clonic seizure frequency (r = -0.338, p = 0.046*). Conclusion γ-Aminobutyric acid (GABA) is a potential biomarker for lateralization and monitoring seizure frequency in MRI-negative TLE.
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Affiliation(s)
- Shuohua Wu
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
- Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Qianqi Wang
- Department of Basic Medical Sciences, School of Medicine, Xiamen University, Xiamen, China
| | - Huige Zhai
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
| | - Yiwen Zhang
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Dongyuan Xu
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
| | - Gen Yan
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Renhua Wu
- Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
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Sillanpää M, Hermann B, Rinne JO, Parkkola R, Saarinen M, Karrasch M, Saunavaara J, Rissanen E, Joutsa J, Shinnar S. Differences in brain changes between adults with childhood-onset epilepsy and controls: A prospective population-based study. Acta Neurol Scand 2022; 145:322-331. [PMID: 34837220 PMCID: PMC9299133 DOI: 10.1111/ane.13560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022]
Abstract
Purpose To determine the impact of childhood‐onset uncomplicated epilepsy (COE) on brain aging over 50‐year prospective follow‐up. Methods A population‐based cohort of 41 aging subjects with COE and their 46 matched controls participated in a detailed in‐person prospective assessment in 2012 and 2017 to characterize ongoing changes in the aging brain. Results The mean age of the COE participants was 63.2 years (SD 4.14, median 63.2, range 55.8–70.6) and 63.0 years (mean, SD 4.13, median 63.3, range 56.0–69.9) years for controls. Neurologic signs were significantly more common in COE participants not in remission (p = .015), and the most frequent abnormalities were cerebellar signs (p < .001). Neurologic signs in general (p = .008) and cerebellar signs in particular (p = .018) were significantly more common in focal than in generalized epilepsies. MRI white matter abnormalities were significantly associated with absence of vocational education (p = .011), and MRI hippocampal atrophy in COE subjects was associated with arterial hypertension versus normal blood pressure (p = .017). In the combined study cohort of COE subjects and controls, presenting neurologic signs increased both in the subjects and in the controls from the 2012 to 2017 study. Conclusions At ultra‐long‐term follow‐up, clinical and neuroimaging findings show tendencies to brain aging that is more accelerated in COE participants with active adult childhood‐onset epilepsy, and particularly in focal epilepsy.
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Affiliation(s)
- Matti Sillanpää
- Departments of Child Neurology and General Practice University of Turku and Turku University Hospital University of Turku Turku Finland
| | - Bruce Hermann
- Department of Neurology School of Medicine and Public Health University of Wisconsin Madison Wisconsin USA
| | - Juha O. Rinne
- Turku PET Centre University of Turku and Turku University Hospital Turku Finland
- Division of Clinical Neurosciences University of Turku and Turku University Hospital Turku Finland
| | - Riitta Parkkola
- Department of Radiology University of Turku and Turku University Hospital Turku Finland
| | - Maiju M. Saarinen
- Departments of Child Neurology and General Practice University of Turku and Turku University Hospital University of Turku Turku Finland
| | - Mira Karrasch
- Department of Psychology Åbo Akademi University Turku Finland
| | - Jani Saunavaara
- Department of Medical Physics University of Turku and Turku University Hospital Turku Finland
| | - Eero Rissanen
- Turku PET Centre University of Turku and Turku University Hospital Turku Finland
- Division of Clinical Neurosciences University of Turku and Turku University Hospital Turku Finland
| | - Juho Joutsa
- Turku PET Centre University of Turku and Turku University Hospital Turku Finland
- Division of Clinical Neurosciences University of Turku and Turku University Hospital Turku Finland
- Turku Brain and Mind Center University of Turku Turku Finland
| | - Shlomo Shinnar
- Departments of Neurology, Pediatrics, Epidemiology & Population Health Montefiore Medical Center Albert Einstein College of Medicine Bronx New York USA
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Xu C, Gong Y, Wang Y, Chen Z. New advances in pharmacoresistant epilepsy towards precise management-from prognosis to treatments. Pharmacol Ther 2021; 233:108026. [PMID: 34718071 DOI: 10.1016/j.pharmthera.2021.108026] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
Epilepsy, one of the most severe neurological diseases, is characterized by abrupt recurrent seizures. Despite great progress in the development of antiseizure drugs (ASDs) based on diverse molecular targets, more than one third of epilepsy patients still show resistance to ASDs, a condition termed pharmacoresistant epilepsy. The management of pharmacoresistant epilepsy involves serious challenges. In the past decade, promising advances have been made in the use of interdisciplinary techniques involving biophysics, bioinformatics, biomaterials and biochemistry, which allow more precise prognosis and development of drug target for pharmacoresistant epilepsy. Notably, novel experimental tools such as viral vector gene delivery, optogenetics and chemogenetics have provided a framework for promising approaches to the precise treatment of pharmacoresistant epilepsy. In this review, historical achievements especially recent advances of the past decade in the prognosis and treatment of pharmacoresistant epilepsy from both clinical and laboratory settings are presented and summarized. We propose that the further development of novel experimental tools at cellular or molecular levels with both temporal and spatial precision are necessary to make improve the management and drug development for pharmacoresistant epilepsy in the clinical arena.
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Affiliation(s)
- Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yiwei Gong
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China; Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China; Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Longitudinal analysis of interictal electroencephalograms in patients with temporal lobe epilepsy with hippocampal sclerosis. Seizure 2021; 90:141-144. [DOI: 10.1016/j.seizure.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/14/2022] Open
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Brain functional and structural characteristics of patients with seizure recurrence following drug withdrawal. Neuroradiology 2021; 63:2087-2097. [PMID: 34195875 DOI: 10.1007/s00234-021-02755-2] [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: 02/18/2021] [Accepted: 06/16/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE We aimed to analyze the characteristics of brain function and microstructure linked to epilepsy relapse after drug withdrawal in patients with focal epilepsy. METHODS Resting-state functional magnetic resonance imaging and high-resolution T1-weighted images were acquired within 1 month prior to drug withdrawal from 15 patients who did not have epilepsy relapse (PER - group) and 16 patients who subsequently had epilepsy relapse (PER + group). Additionally, 23 healthy participants undergoing the same scanning protocol were included as controls. Fractional amplitude of low-frequency fluctuation (fALFF) and gray matter density (GMD) were compared among groups. Subgroup and correlation analyses were also performed. RESULTS There were no significant differences in fALFF between patient groups, but the PER + group showed lower GMD in the bilateral calcarine, left precuneus, and right superior temporal gyrus than the PER - group (Gaussian random field correction, voxel-level P < 0.001 and cluster-level P < 0.05). Both increased seizure number and polytherapy were associated with lower GMD; also, patients using other antiseizure medications showed lower GMD than those using only levetiracetam (Gaussian random field correction, voxel-level P < 0.001, and cluster-level P < 0.05). The active period and disease duration showed both positive and negative correlations with GMD, while the seizure-free period mainly showed positive correlations with GMD (uncorrected, P < 0.001). CONCLUSION Gray matter microstructure, but not local functional activity, showed distinct characteristics between patients with and without epilepsy relapse and may serve as a potential biomarker for predicting seizure recurrence upon drug withdrawal.
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Bando SY, Bertonha FB, Pimentel-Silva LR, de Oliveira JGM, Carneiro MAD, Oku MHM, Wen HT, Castro LHM, Moreira-Filho CA. Hippocampal CA3 transcriptional modules associated with granule cell alterations and cognitive impairment in refractory mesial temporal lobe epilepsy patients. Sci Rep 2021; 11:10257. [PMID: 33986407 PMCID: PMC8119682 DOI: 10.1038/s41598-021-89802-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/30/2021] [Indexed: 01/03/2023] Open
Abstract
In about a third of the patients with epilepsy the seizures are not drug-controlled. The current limitation of the antiepileptic drug therapy derives from an insufficient understanding of epilepsy pathophysiology. In order to overcome this situation, it is necessary to consider epilepsy as a disturbed network of interactions, instead of just looking for changes in single molecular components. Here, we studied CA3 transcriptional signatures and dentate gyrus histopathologic alterations in hippocampal explants surgically obtained from 57 RMTLE patients submitted to corticoamygdalohippocampectomy. By adopting a systems biology approach, integrating clinical, histopathological, and transcriptomic data (weighted gene co-expression network analysis), we were able to identify transcriptional modules highly correlated with age of disease onset, cognitive dysfunctions, and granule cell alterations. The enrichment analysis of transcriptional modules and the functional characterization of the highly connected genes in each trait-correlated module allowed us to unveil the modules’ main biological functions, paving the way for further investigations on their roles in RMTLE pathophysiology. Moreover, we found 15 genes with high gene significance values which have the potential to become novel biomarkers and/or therapeutic targets in RMTLE.
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Affiliation(s)
- Silvia Yumi Bando
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 05403-900, Brazil
| | - Fernanda Bernardi Bertonha
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 05403-900, Brazil
| | - Luciana Ramalho Pimentel-Silva
- Department of Neurology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, UNICAMP, Campinas, SP, 13083-887, Brazil
| | | | | | - Mariana Hiromi Manoel Oku
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 05403-900, Brazil
| | - Hung-Tzu Wen
- Epilepsy Surgery Group, Hospital das Clínicas da FMUSP, São Paulo, SP, 05403-900, Brazil
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Bryant L, McKinnon ET, Taylor JA, Jensen JH, Bonilha L, de Bezenac C, Kreilkamp BAK, Adan G, Wieshmann UC, Biswas S, Marson AG, Keller SS. Fiber ball white matter modeling in focal epilepsy. Hum Brain Mapp 2021; 42:2490-2507. [PMID: 33605514 PMCID: PMC8090772 DOI: 10.1002/hbm.25382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/15/2022] Open
Abstract
Multicompartment diffusion magnetic resonance imaging (MRI) approaches are increasingly being applied to estimate intra‐axonal and extra‐axonal diffusion characteristics in the human brain. Fiber ball imaging (FBI) and its extension fiber ball white matter modeling (FBWM) are such recently described multicompartment approaches. However, these particular approaches have yet to be applied in clinical cohorts. The modeling of several diffusion parameters with interpretable biological meaning may offer the development of new, noninvasive biomarkers of pharmacoresistance in epilepsy. In the present study, we used FBI and FBWM to evaluate intra‐axonal and extra‐axonal diffusion properties of white matter tracts in patients with longstanding focal epilepsy. FBI/FBWM diffusion parameters were calculated along the length of 50 white matter tract bundles and statistically compared between patients with refractory epilepsy, nonrefractory epilepsy and controls. We report that patients with chronic epilepsy had a widespread distribution of extra‐axonal diffusivity relative to controls, particularly in circumscribed regions along white matter tracts projecting to cerebral cortex from thalamic, striatal, brainstem, and peduncular regions. Patients with refractory epilepsy had significantly greater markers of extra‐axonal diffusivity compared to those with nonrefractory epilepsy. The extra‐axonal diffusivity alterations in patients with epilepsy observed in the present study could be markers of neuroinflammatory processes or a reflection of reduced axonal density, both of which have been histologically demonstrated in focal epilepsy. FBI is a clinically feasible MRI approach that provides the basis for more interpretive conclusions about the microstructural environment of the brain and may represent a unique biomarker of pharmacoresistance in epilepsy.
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Affiliation(s)
- Lorna Bryant
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK
| | - Emilie T McKinnon
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James A Taylor
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jens H Jensen
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christophe de Bezenac
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK
| | - Barbara A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK.,Department of Clinical Neurophysiology, University Medicine Göttingen, Göttingen, Germany
| | - Guleed Adan
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
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8
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Cerebellar Degeneration in Epilepsy: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020473. [PMID: 33435567 PMCID: PMC7827978 DOI: 10.3390/ijerph18020473] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 01/03/2023]
Abstract
Introduction: Cerebellar degeneration has been associated in patients with epilepsy, though the exact pathogenic mechanisms are not understood. The aim of this systematic review was to identify the prevalence of cerebellar degeneration in patients with epilepsy and identify any pathogenic mechanisms. Methodology: A systematic computer-based literature search was conducted using the PubMed database. Data extracted included prevalence, clinical, neuroradiological, and neuropathological characteristics of patients with epilepsy and cerebellar degeneration. Results: We identified three consistent predictors of cerebellar degeneration in the context of epilepsy in our review: temporal lobe epilepsy, poor seizure control, and phenytoin as the treatment modality. Whole brain and hippocampal atrophy were also identified in patients with epilepsy. Conclusions: Cerebellar degeneration is prevalent in patients with epilepsy. Further prospective studies are required to confirm if the predictors identified in this review are indeed linked to cerebellar degeneration and to establish the pathogenic mechanisms that result in cerebellar insult.
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Jber M, Habibabadi JM, Sharifpour R, Marzbani H, Hassanpour M, Seyfi M, Mobarakeh NM, Keihani A, Hashemi-Fesharaki SS, Ay M, Nazem-Zadeh MR. Temporal and extratemporal atrophic manifestation of temporal lobe epilepsy using voxel-based morphometry and corticometry: clinical application in lateralization of epileptogenic zone. Neurol Sci 2021; 42:3305-3325. [PMID: 33389247 DOI: 10.1007/s10072-020-05003-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/14/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Advances in MRI acquisition and data processing have become important for revealing brain structural changes. Previous studies have reported widespread structural brain abnormalities and cortical thinning in patients with temporal lobe epilepsy (TLE), as the most common form of focal epilepsy. METHODS In this research, healthy control cases (n = 20) and patients with left TLE (n = 19) and right TLE (n = 14) were recruited, all underwent 3.0 T MRI with magnetization-prepared rapid gradient echo sequence to acquire T1-weighted images. Morphometric alterations in gray matter were identified using voxel-based morphometry (VBM). Volumetric alterations in subcortical structures and cortical thinning were also determined. RESULTS Patients with left TLE demonstrated more prevailing and widespread changes in subcortical volumes and cortical thickness than right TLE, mainly in the left hemisphere, compared to the healthy group. Both VBM analysis and subcortical volumetry detected significant hippocampal atrophy in ipsilateral compared to contralateral side in TLE group. In addition to hippocampus, subcortical volumetry found the thalamus and pallidum bilaterally vulnerable to the TLE. Furthermore, the TLE patients underwent cortical thinning beyond the temporal lobe, affecting gray matter cortices in frontal, parietal, and occipital lobes in the majority of patients, more prevalently for left TLE cases. Exploiting volume changes in individual patients in the hippocampus alone led to 63.6% sensitivity and 100% specificity for lateralization of TLE. CONCLUSION Alteration of gray matter volumes in subcortical regions and neocortical temporal structures and also cortical gray matter thickness were evidenced as common effects of epileptogenicity, as manifested by the majority of cases in this study.
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Affiliation(s)
- Majdi Jber
- Medical School, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Roya Sharifpour
- Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Molecular and Cellular Imaging, Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences, Tehran, Iran
| | - Hengameh Marzbani
- Department of Biomedical Engineering, Amirkabir University of Technology (AUT), Tehran, Iran
| | - Masoud Hassanpour
- Research Center for Molecular and Cellular Imaging, Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Seyfi
- Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Molecular and Cellular Imaging, Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mohammadi Mobarakeh
- Research Center for Molecular and Cellular Imaging, Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmedreza Keihani
- Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammadreza Ay
- Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Molecular and Cellular Imaging, Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Nazem-Zadeh
- Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Molecular and Cellular Imaging, Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences, Tehran, Iran.
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Zaki MA, ElSherif LN, Shamloul RM. Assessment of the response to antiepileptic drugs in epileptic patients with structural lesion(s) on neuroimaging. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Focal epilepsy is the most common form of epilepsy in adults. Advances in brain imaging allowed better identification of different structural lesions underlying focal epilepsy. However, the response to antiepileptic drugs in lesional epilepsy is heterogeneous and difficult to anticipate. This study aimed to evaluate the response to antiepileptic drugs (AED) in patients with lesional epilepsy and to identify the predictors for poor seizure control.
Methods
One hundred and sixty-five patients with lesional epilepsy were included; the clinical diagnosis of epilepsy and seizure classification was based on the revised criteria of the International League Against Epilepsy (ILAE). Patients were subjected to full clinical assessment, MRI brain imaging epilepsy protocol, and EEG monitoring. All subjects were followed in the epilepsy clinic for at least 6 months.
Results
75.8% of patients with lesional epilepsy showed poor response to antiepileptic medications. Cerebromalatic lesions related to brain trauma was the most frequently encountered (21.8%). Malformations of cortical development were significantly associated with poor response to AED (p = 0.040). Polytherapy and the combined use of 1st- and 2nd-generation AED were higher in the poor response group. Logistic regression analysis revealed that younger age at seizure onset and abnormal EEG findings was 0.965 times and 2.5 times more associated with poor seizure control, respectively.
Conclusion
This study revealed that patients with lesional epilepsy who develop seizures in their early life, who suffer from malformations of cortical development, or who show abnormal EEG findings are more suspected to show poor response to AED.
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11
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Microstructural features of the cerebral cortex: Implications for predicting epilepsy relapse after drug withdrawal. Brain Res 2020; 1751:147200. [PMID: 33166509 DOI: 10.1016/j.brainres.2020.147200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023]
Abstract
A considerable portion of patients with well-controlled seizures and visually normal brain structures experience seizure recurrence after anti-seizure medication is withdrawn. Microstructural abnormalities of the cortex may play an essential role in epilepsy relapse. Patients with idiopathic/cryptogenic epilepsy were registered. At the follow-up endpoint, 18 patients with relapse (PR+ group), 20 patients without relapse (PR- group), and 30 healthy controls were included. High-resolution T1-weighted images were obtained at the time of drug withdrawal. Microstructural features including cortical thickness, surface area, cortical volume and mean curvature in 68 cortical areas were calculated. A general linear model was applied to investigate intergroup differences, and then post hoc analysis was performed. Additionally, factor analysis was conducted to extract components from imaging measures showing a difference between PR- and PR+ groups, and independent associations between components and epilepsy relapse were assessed using a logistic regression model. Cortical thickness of the left paracentral lobule, left temporal pole and right superior frontal gyrus; surface area of the bilateral lingual gyrus and bilateral pericalcarine cortex; and cortical volume of the bilateral pericalcarine cortex had significant intergroup differences (false discovery rate correction, P < 0.05). All measures, except for cortical thickness of the left temporal pole, showed differences between PR- and PR+ groups. Two dominant components were extracted from these measures, and both were independently associated with epilepsy relapse. In conclusion, epilepsy patients with relapse presented distinct microstructural features of cortex at the time of drug withdrawal, which may serve as a potential biomarker for predicting seizure recurrence.
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12
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Pimentel-Silva LR, Casseb RF, Cordeiro MM, Campos BAG, Alvim MKM, Rogerio F, Yasuda CL, Cendes F. Interactions between in vivo neuronal-glial markers, side of hippocampal sclerosis, and pharmacoresponse in temporal lobe epilepsy. Epilepsia 2020; 61:1008-1018. [PMID: 32347553 DOI: 10.1111/epi.16509] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/01/2020] [Accepted: 03/29/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the interactions of metabolic neuronal-glial changes with the presence and hemispheric-side of hippocampal sclerosis (HS) and its potential role in predicting pharmacoresistance in temporal lobe epilepsy (TLE). METHODS We included structural magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1 H-MRS) metabolic data for 91 patients with unilateral TLE and 50 healthy controls. We measured the values of total N-acetyl aspartate/total creatine (tNAA/tCr), glutamate/tCr (Glu/tCr), and myo-inositol/tCr (mIns/tCr). To assess the influence of the pharmacoresponse and hemispheric-side of HS on metabolic data, the relationship between clinical and MRI data, and the predictive value of NAA/Cr, we used analysis of variance/covariance and built a logistic regression model. We used bootstrap simulations to evaluate reproducibility. RESULTS Bilateral tNAA/tCr reduction was associated with pharmacoresistance and with left HS, a decrease of Glu/tCr ipsilateral to the seizure focus was associated with pharmacoresistance, and ipsilateral mIns/tCr increase was related to pharmacoresistance and the presence of left HS. The logistic regression model containing clinical and 1 H-MRS data discriminated pharmacoresistance (area under the curve [AUC] = 0.78). However, the reduction of tNAA/tCr was the main predictor, with the odds 2.48 greater for pharmacoresistance. SIGNIFICANCE Our study revealed a spectrum of neuronal-glial changes in TLE, which was associated with pharmacoresistance, being more severe in left-sided HS and less severe in MRI-negative TLE. These noninvasive, in vivo biomarkers provide valuable additional information about the interhemispheric differences in metabolic dysfunction, seizure burden, and HS, and may help to predict pharmacoresistance.
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Affiliation(s)
| | - Raphael F Casseb
- Department of Neurology, University of Campinas, Campinas, Brazil
| | | | - Bruno A G Campos
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Marina K M Alvim
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Fábio Rogerio
- Department of Pathology, University of Campinas, Campinas, Brazil
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
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Low-frequency Stimulation at the Subiculum is Anti-convulsant and Anti-drug-resistant in a Mouse Model of Lamotrigine-resistant Temporal Lobe Epilepsy. Neurosci Bull 2020; 36:654-658. [PMID: 32157502 DOI: 10.1007/s12264-020-00482-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/10/2019] [Indexed: 10/24/2022] Open
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Lee HJ, Park KM. Intrinsic hippocampal and thalamic networks in temporal lobe epilepsy with hippocampal sclerosis according to drug response. Seizure 2020; 76:32-38. [PMID: 31986443 DOI: 10.1016/j.seizure.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/31/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The aim of this study was to investigate whether intrinsic hippocampal or thalamic networks in patients with temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS) were different according to antiepileptic drug (AED) response. METHODS We enrolled 80 patients with TLE with HS and 40 healthy controls. Of the patients with TLE with HS, 43 were classified as a drug-resistant epilepsy (DRE) group, whereas 37 patients were enrolled as a drug-controlled epilepsy (DCE) group. We investigated the structural connectivity of the global brain, intrinsic hippocampal, and intrinsic thalamic networks based on structural volumes in the patients with DRE and DCE, and analyzed the differences between them. RESULTS There were significant alterations of the intrinsic hippocampal network compared with healthy controls. The average degree and the global efficiency were decreased, whereas the characteristic path length was increased in the patients with DRE compared with those in healthy controls. In the patients with DCE, only the small-worldness index was decreased compared with healthy controls. Compared to the patients with DCE, the mean clustering coefficient was increased in the patients with DRE. CONCLUSION We found that the intrinsic hippocampal network in patients with TLE with HS was different according to AED response. The patients with DRE had more severe disruptions of the intrinsic hippocampal network than those with DCE compared with healthy controls. These findings suggested that the hippocampal network might be related to AED response and could be a new biomarker of medical outcome in patients with TLE with HS.
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Affiliation(s)
- Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
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Zapata Barco AM, Restrepo-Martínez M, Restrepo D. Depression in People with Epilepsy. What is the Connection? REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:53-61. [PMID: 32081210 DOI: 10.1016/j.rcp.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/25/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Depression is the most common psychiatric comorbidity in people with epilepsy. It worsens the prognosis and quality of life of these patients. Despite this, depression is poorly diagnosed and when the treatment is given, it is frequently suboptimal. OBJECTIVE To perform a narrative review of the medical literature, seeking to collect useful information regarding the relationship between epilepsy and depression. RESULTS Narrative reviews, systematic reviews, meta-analyses, clinical trials, and follow-up studies were identified in English and Spanish with no time limit, including epidemiological, clinical, associated factors, etiological explanations, diagnostic and therapeutic approaches to comorbid depression in epilepsy. CONCLUSION The relationship between epilepsy and depression is complex. The available scientific evidence suggests the possibility of a bidirectional relationship that could be explained from common aetiopathogenic mechanisms. Despite the high prevalence of depression in epileptic patients, this mental disorder continues to be poorly identified by clinicians. To improve this, we have easy-to-apply instruments that routinely screen this patient population and contribute substantially to making the problem more visible and seek to improve the quality of life for this population.
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Yang SJ, He GN, Han X, Wang N, Chen Y, Zhu XR, Ma BQ, Li MM, Zhao P, Chen YN, Zhao T, Ma H. A scale for prediction of response to AEDs in patients with MRI-negative epilepsy. Epilepsy Behav 2019; 94:41-46. [PMID: 30884406 DOI: 10.1016/j.yebeh.2019.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Antiepileptic drugs (AEDs) are the first choice in magnetic resonance imaging (MRI)-negative patients with epilepsy, although the responses to AEDs are diverse. Preoperative evaluation and postoperative prognosis in MRI-negative epilepsy have been reported. However, there are few tools for predicting the response to AEDs. Herein, we developed an AED response scale based on clinical factors and video-electroencephalography (VEEG) in MRI-negative patients with epilepsy. METHODS A total of 132 consecutive patients with MRI-negative epilepsy at the Epilepsy Center of Henan Provincial People's Hospital between August 2016 and August 2018 were included. Patients were further divided into drug-responsive epilepsy ([DSE-MRI (-)]; n = 101) and drug-resistant epilepsy ([DRE-MRI (-)]; n = 31) groups. The clinical and VEEG factors were evaluated in univariate analyses and multivariate logistic regression analyses. A scale was derived and the scores categorized into 3 risk levels of DRE-MRI (-). RESULTS A scale was established based on 4 independent risk factors for DRE-MRI (-). The scale had a sensitivity of 83.87%, specificity of 80.20%, positive likelihood ratio of 4.24, negative likelihood ratio of 0.20, and showed good discrimination with the area under the curve (AUC) of 0.886 (0.826-0.946). The categorization of the risk score based on this scale was: low risk (0-3 points), medium risk (3-5 points), and high risk (>5 points). CONCLUSION We established a DRE-MRI (-) scale with a good sensitivity and specificity, which may be useful for clinicians when making medical decisions in patients with MRI-negative epilepsy.
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Affiliation(s)
- Shi-Jun Yang
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Gui-Nv He
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
| | - Na Wang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Yi Chen
- Clinical research service center, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Xue-Rui Zhu
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Bing-Qian Ma
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Ming-Min Li
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Pan Zhao
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Ya-Nan Chen
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Ting Zhao
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Huan Ma
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
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Pressl C, Brandner P, Schaffelhofer S, Blackmon K, Dugan P, Holmes M, Thesen T, Kuzniecky R, Devinsky O, Freiwald WA. Resting state functional connectivity patterns associated with pharmacological treatment resistance in temporal lobe epilepsy. Epilepsy Res 2018; 149:37-43. [PMID: 30472489 DOI: 10.1016/j.eplepsyres.2018.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/20/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022]
Abstract
There are no functional imaging based biomarkers for pharmacological treatment response in temporal lobe epilepsy (TLE). In this study, we investigated whether there is an association between resting state functional brain connectivity (RsFC) and seizure control in TLE. We screened a large database containing resting state functional magnetic resonance imaging (Rs-fMRI) data from 286 epilepsy patients. Patient medical records were screened for seizure characterization, EEG reports for lateralization and location of seizure foci to establish uniformity of seizure localization within patient groups. Rs-fMRI data from patients with well-controlled left TLE, patients with treatment-resistant left TLE, and healthy controls were analyzed. Healthy controls and cTLE showed similar functional connectivity patterns, whereas trTLE exhibited a significant bilateral decrease in thalamo-hippocampal functional connectivity. This work is the first to demonstrate differences in neural network connectivity between well-controlled and treatment-resistant TLE. These differences are spatially highly focused and suggest sites for the etiology and possibly treatment of TLE. Altered thalamo-hippocampal RsFC thus is a potential new biomarker for TLE treatment resistance.
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Affiliation(s)
- Christina Pressl
- Laboratory of Neural Systems, The Rockefeller University, New York, NY, USA; Department of Neurology, New York University, New York, NY, USA
| | - Philip Brandner
- Laboratory of Neural Systems, The Rockefeller University, New York, NY, USA
| | | | - Karen Blackmon
- Department of Neurology, New York University, New York, NY, USA; Department of Physiology, Neuroscience and Behavioral Sciences, St George's University, Grenada, West Indies
| | - Patricia Dugan
- Department of Neurology, New York University, New York, NY, USA
| | - Manisha Holmes
- Department of Neurology, New York University, New York, NY, USA
| | - Thomas Thesen
- Department of Neurology, New York University, New York, NY, USA; Department of Physiology, Neuroscience and Behavioral Sciences, St George's University, Grenada, West Indies
| | - Ruben Kuzniecky
- Department of Neurology, Hofstra-Northwell Medical School, New York, NY, USA
| | - Orrin Devinsky
- Department of Neurology, New York University, New York, NY, USA
| | - Winrich A Freiwald
- Laboratory of Neural Systems, The Rockefeller University, New York, NY, USA.
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Scharfman HE, Kanner AM, Friedman A, Blümcke I, Crocker CE, Cendes F, Diaz-Arrastia R, Förstl H, Fenton AA, Grace AA, Palop J, Morrison J, Nehlig A, Prasad A, Wilcox KS, Jette N, Pohlmann-Eden B. Epilepsy as a Network Disorder (2): What can we learn from other network disorders such as dementia and schizophrenia, and what are the implications for translational research? Epilepsy Behav 2018; 78:302-312. [PMID: 29097123 PMCID: PMC5756681 DOI: 10.1016/j.yebeh.2017.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
There is common agreement that many disorders of the central nervous system are 'complex', that is, there are many potential factors that influence the development of the disease, underlying mechanisms, and successful treatment. Most of these disorders, unfortunately, have no cure at the present time, and therapeutic strategies often have debilitating side effects. Interestingly, some of the 'complexities' of one disorder are found in another, and the similarities are often network defects. It seems likely that more discussions of these commonalities could advance our understanding and, therefore, have clinical implications or translational impact. With this in mind, the Fourth International Halifax Epilepsy Conference and Retreat was held as described in the prior paper, and this companion paper focuses on the second half of the meeting. Leaders in various subspecialties of epilepsy research were asked to address aging and dementia or psychosis in people with epilepsy (PWE). Commonalities between autism, depression, aging and dementia, psychosis, and epilepsy were the focus of the presentations and discussion. In the last session, additional experts commented on new conceptualization of translational epilepsy research efforts. Here, the presentations are reviewed, and salient points are highlighted.
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Affiliation(s)
- Helen E Scharfman
- Departments of Psychiatry, Neurosciences and Physiology, and the Neuroscience Institute, New York University Langone Medical Center, New York, NY 10016, USA.
| | - Andres M Kanner
- University of Miami, Miller School of Medicine, 1120 NW 14th Street, Room #1324, Miami, FL 33136, USA
| | - Alon Friedman
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ingmar Blümcke
- Neuropathological Institute, University Hospitals Erlangen, Germany
| | - Candice E Crocker
- Nova Scotia Early Psychosis Program, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Fernando Cendes
- Department of Neurology, University of Campinas, 13083-888 Campinas, Sao Paulo, Brazil
| | - Ramon Diaz-Arrastia
- Centre for Neuroscience & Regenerative Medicine, Uniformed Services University of the Health Sciences, 12725 Twinbrook Parkway, Rockville, MD 20852, USA
| | - Hans Förstl
- Department of Psychiatry, University of Munich, Klinikum rechts der Isar, Ismaninger Strabe 22, D-81675 Munich, Germany
| | - André A Fenton
- Centre for Neural Science, New York University, 4 Washington Place, Room 809, New York, NY 10003, USA
| | - Anthony A Grace
- University of Pittsburgh, 456 Langley Hall, 4200 Fifth Avenue, Pittsburgh, PA 15269, USA
| | - Jorge Palop
- Department of Neurology, Gladstone Institute, 1650 Owens Street, San Francisco, CA 94158-2261, USA
| | - Jason Morrison
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Astrid Nehlig
- INSERM U 1129, Hôpital Necker, Paris, Faculty of Medicine, Strasbourg, France
| | - Asuri Prasad
- Department of Pediatrics, Children's Hospital of Western Ontario, London, ON, Canada
| | - Karen S Wilcox
- Department of Pharmacology & Toxicology, Anticonvulsant Drug Development Program, University of Utah, Salt Lake City, UT, USA
| | - Nathalie Jette
- Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, NY, USA; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Bernd Pohlmann-Eden
- Brain Repair Center, Life Science Research Institute, Dalhousie University, Room 229, PO Box 15000, Halifax, NS B3H4R2, Canada.
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Kim HC, Kim SE, Lee BI, Park KM. Can we predict drug response by volumes of the corpus callosum in newly diagnosed focal epilepsy? Brain Behav 2017; 7:e00751. [PMID: 28828212 PMCID: PMC5561312 DOI: 10.1002/brb3.751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/08/2017] [Accepted: 05/15/2017] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate whether volumes of the corpus callosum could predict a response to antiepileptic drugs in patients with newly diagnosed focal epilepsy. METHODS Fifty-three patients with newly diagnosed focal epilepsy of unknown etiology and healthy subjects were enrolled in this study. First, we analyzed the differences in the volumes of the corpus callosum between patients with epilepsy and healthy subjects. Second, we divided patients with epilepsy into antiepileptic drug responders and drug nonresponders groups, according to their seizure controls, and evaluated the differences in the volumes of the corpus callosum between the groups. Third, we conducted correlation analyses between the volumes of the corpus callosum and mean diffusion measures in healthy subjects. RESULTS The volumes of the corpus callosum in patients with epilepsy were significantly lower than those in normal controls (p = .0001). Among epilepsy patients, the volumes of the corpus callosum were significantly lower in antiepileptic drug responders compared with nonresponders (p = .0481), which was the only independent variable for predicting antiepileptic drug response (OR = 10.07, p = .0434). In addition, we found that the volumes of the corpus callosum were significantly correlated with the mean diffusion measures (fractional anisotropy, r = .408, p = .0027; mean diffusivity, r = -0.403, p = .0028) in normal controls. CONCLUSIONS We demonstrated that the volumes of the corpus callosum were different according to antiepileptic drug responses in patients with newly diagnosed focal epilepsy, which might suggest that the volumes of the corpus callosum could be a new biomarker for predicting responses to antiepileptic drugs.
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Affiliation(s)
- Hyung Chan Kim
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Sung Eun Kim
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Byung In Lee
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Kang Min Park
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
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Kanner AM. Can Neurochemical Changes of Mood Disorders Explain the Increase Risk of Epilepsy or its Worse Seizure Control? Neurochem Res 2017; 42:2071-2076. [PMID: 28667464 DOI: 10.1007/s11064-017-2331-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 12/29/2022]
Abstract
The existence of a bidirectional relation between mood disorders and epilepsy has been suggested by six population-based studies. Furthermore, three studies have associated a higher risk of treatment-resistant epilepsy with a history of depression preceding the onset of epilepsy. Common pathogenic mechanisms operant in depression and epilepsy may provide a possible explanation of these observations. This article reviews some of the leading pathogenic mechanisms of depression with respect to potential proconvulsant properties that may provide explanations for these phenomena.
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Affiliation(s)
- Andres M Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW 14th Street, Room #1324, Miami, FL, 33136, USA.
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Park KM, Kim SE, Shin KJ, Ha SY, Park J, Kim TH, Mun CW, Lee BI, Kim SE. Effective connectivity in temporal lobe epilepsy with hippocampal sclerosis. Acta Neurol Scand 2017; 135:670-676. [PMID: 27558524 DOI: 10.1111/ane.12669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We hypothesized that temporal lobe epilepsy (TLE) patients with and without hippocampal sclerosis (HS) showed differences in their limbic networks. This study aimed to evaluate the role of the thalamus in TLE patients with HS. MATERIALS AND METHODS Twenty-nine TLE patients with HS and 30 controls were enrolled in this study. In addition, we included eight TLE patients without HS as a disease control group. Using whole-brain T1-weighted MRIs, we analyzed the volumes of the limbic structures, including the hippocampus, thalamus, and total cortex, with FreeSurfer 5.1. We also investigated the effective connectivity among these structures using SPSS Amos 21 based on these volumetric measures. Moreover, we quantified correlations between epilepsy duration and the volumes of these structures. RESULTS There was a statistically significant effective connectivity from the hippocampus to the thalamus in TLE patients with HS. Moreover, the volumes of the left and right thalamus were negatively correlated with epilepsy duration (r=-.42, P=.0315 and r=-.52, P=.0062, respectively). However, neither TLE patients without HS nor normal controls had a significant effective connectivity from the hippocampus to the thalamus. CONCLUSIONS The limbic networks of TLE patients with and without HS could be different, and the thalamus might play a critical role in TLE patients with HS.
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Affiliation(s)
- K. M. Park
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - S. E. Kim
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - K. J. Shin
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - S. Y. Ha
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - J. Park
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - T. H. Kim
- Department of Health Science and Technology; Inje University; Gimhae Korea
| | - C. W. Mun
- Department of Health Science and Technology; Inje University; Gimhae Korea
- Department of Biomedical Engineering/u-HARC; Inje University; Gimhae Korea
| | - B. I. Lee
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
| | - S. E. Kim
- Department of Neurology; Haeundae Paik Hospital; Inje University College of Medicine; Busan Korea
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Błaszczyk B, Czuczwar SJ. Epilepsy coexisting with depression. Pharmacol Rep 2017; 68:1084-92. [PMID: 27634589 DOI: 10.1016/j.pharep.2016.06.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022]
Abstract
Depression episodes in epilepsy is the most common commorbidity, affecting between 11% and 62% of patients with epilepsy. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. The manifestation of depression in epilepsy is a complex issue having many interacting neurobiological and psychosocial determinants, including clinical features of epilepsy (seizure frequency, type, foci, or lateralization of foci) and neurochemical or iatrogenic mechanisms. Other risk factors are a family history of psychiatric illness, particularly depression, a lack of control over the seizures and iatrogenic causes (pharmacologic and surgical). In addition, treatment with antiepileptic drugs (AEDs) as well as social coping and adaptation skills have also been recognised as risk factors of depression associated with epilepsy. Epilepsy may foster the development of depression through being exposed to chronic stress. The uncertainty and unpredictability of seizures may instigate sadness, loneliness, despair, low self-esteem, and self-reproach in patients with epilepsy and lead to social isolation, stigmatization, or disability. Often, depression is viewed as a reaction to epilepsy's stigma and the associated poor quality of life. Moreover, patients with epilepsy display a 4-5 higher rate of depression and suicide compared with healthy population.
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Affiliation(s)
- Barbara Błaszczyk
- Faculty of Health Sciences, High School of Economics, Law and Medical Sciences, Kielce, Poland; Private Neurological Practice, Kielce, Poland.
| | - Stanisław J Czuczwar
- Department of Pathophysiology, Medical University of Lublin, Lublin, Poland; Department of Physiopathology, Institute of Rural Health, Lublin, Poland.
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Pawley AD, Chowdhury FA, Tangwiriyasakul C, Ceronie B, Elwes RDC, Nashef L, Richardson MP. Cortical excitability correlates with seizure control and epilepsy duration in chronic epilepsy. Ann Clin Transl Neurol 2017; 4:87-97. [PMID: 28168208 PMCID: PMC5288462 DOI: 10.1002/acn3.383] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 11/30/2022] Open
Abstract
Objective Cortical excitability differs between treatment responders and nonresponders in new‐onset epilepsy. Moreover, during the first 3 years of epilepsy, cortical excitability becomes more abnormal in nonresponders but normalizes in responders. Here, we study chronic active epilepsy, to examine whether cortical excitability continues to evolve over time, in association with epilepsy duration and treatment response. Methods We studied 28 normal subjects, 28 patients with moderately controlled epilepsy (≤4 seizures per year) and 40 patients with poorly controlled epilepsy (≥20 or more seizures per year). Resting motor threshold (RMT), active motor threshold (AMT), short‐interval intracortical inhibition (SICI), intracortical facilitation (ICF) and cortical silent period (CSP) were measured, using transcranial magnetic stimulation (TMS). Disease and treatment covariates were collected (age at onset of epilepsy, epilepsy duration, number of drugs prescribed, total drug load, sodium channel drug load). Results RMT and AMT were higher in patients than in normal subjects; RMT and AMT were higher in poorly controlled than moderately controlled patients. ICF at 12 msec and 15 msec were lower in poorly controlled patients than in normal subjects. Long‐interval intracortical inhibition (LICI) at 50 msec was higher in poorly controlled compared to moderately controlled patients. These differences were not explained by antiepileptic drug (AED) treatment or duration of epilepsy. RMT and AMT increased with duration in the poorly controlled group, but did not increase with duration in the moderately controlled group. Interpretation Cortical excitability differs markedly between moderately controlled and poorly controlled patients with chronic epilepsy, not explained by disease or treatment variables. Moreover, the evolution of cortical excitability over time differs, becoming more abnormal in the poorly controlled group.
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Affiliation(s)
- Adam D Pawley
- Department of Basic and Clinical Neuroscience King's College London London United Kingdom
| | - Fahmida A Chowdhury
- Department of Basic and Clinical Neuroscience King's College London London United Kingdom
| | | | - Bryan Ceronie
- Department of Basic and Clinical Neuroscience King's College London London United Kingdom
| | - Robert D C Elwes
- Centre for Epilepsy King's College Hospital London United Kingdom
| | - Lina Nashef
- Centre for Epilepsy King's College Hospital London United Kingdom
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience King's College London London United Kingdom
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24
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Glenn GR, Jensen JH, Helpern JA, Spampinato MV, Kuzniecky R, Keller SS, Bonilha L. Epilepsy-related cytoarchitectonic abnormalities along white matter pathways. J Neurol Neurosurg Psychiatry 2016; 87:930-6. [PMID: 27076491 DOI: 10.1136/jnnp-2015-312980] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/28/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Temporal lobe epilepsy (TLE) is one of the most common forms of epilepsy. Unfortunately, the clinical outcomes of TLE cannot be determined based only on current diagnostic modalities. A better understanding of white matter (WM) connectivity changes in TLE may aid the identification of network abnormalities associated with TLE and the phenotypic characterisation of the disease. METHODS We implemented a novel approach for characterising microstructural changes along WM pathways using diffusional kurtosis imaging (DKI). Along-the-tract measures were compared for 32 subjects with left TLE and 36 age-matched and gender-matched controls along the left and right fimbria-fornix (FF), parahippocampal WM bundle (PWMB), arcuate fasciculus (AF), inferior longitudinal fasciculus (ILF), uncinate fasciculus (UF) and cingulum bundle (CB). Limbic pathways were investigated in relation to seizure burden and control with antiepileptic drugs. RESULTS By evaluating measures along each tract, it was possible to identify abnormalities localised to specific tract subregions. Compared with healthy controls, subjects with TLE demonstrated pathological changes in circumscribed regions of the FF, PWMB, UF, AF and ILF. Several of these abnormalities were detected only by kurtosis-based and not by diffusivity-based measures. Structural WM changes correlated with seizure burden in the bilateral PWMB and cingulum. CONCLUSIONS DKI improves the characterisation of network abnormalities associated with TLE by revealing connectivity abnormalities that are not disclosed by other modalities. Since TLE is a neuronal network disorder, DKI may be well suited to fully assess structural network abnormalities related to epilepsy and thus serve as a tool for phenotypic characterisation of epilepsy.
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Affiliation(s)
- G Russell Glenn
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jens H Jensen
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joseph A Helpern
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maria V Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ruben Kuzniecky
- Department of Neurology, New York University, New York City, New York, USA
| | - Simon S Keller
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, London, UK
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
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Mazarati A, Sankar R. Common Mechanisms Underlying Epileptogenesis and the Comorbidities of Epilepsy. Cold Spring Harb Perspect Med 2016; 6:6/7/a022798. [PMID: 27371669 DOI: 10.1101/cshperspect.a022798] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The importance of comorbidities in determining the quality of life of individuals with epilepsy and their families has received increasing attention in the past decade. Along with it has come a recognition that in some individuals, certain comorbidities may have preexisted, and may have contributed to their developing epilepsy. Many mechanisms are capable of interconnecting different dysfunctions that manifest as distinct disorders, often diagnosed and managed by different specialists. We review the human data from the perspective of epidemiology as well as insights gathered from neurodiagnostic and endocrine studies. Animal studies are reviewed to refine our mechanistic understanding of the connections, because they permit the narrowing of variables, which is not possible when studying humans.
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Affiliation(s)
- Andrey Mazarati
- Department of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California 90095-1752
| | - Raman Sankar
- Department of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California 90095-1752 Department of Neurology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California 90095-1752
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26
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Keller SS. Brain atrophy in seizure-free temporal lobe epilepsy: Implications for predicting pharmacoresistance. Epilepsia 2016; 57:855-6. [PMID: 27160802 DOI: 10.1111/epi.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Simon S Keller
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom. .,Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom. .,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
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27
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Alvim MKM, Coan AC, Yasuda CL, Morita ME, Cendes F. In response: Brain atrophy in seizure-free temporal lobe epilepsy: Implications for predicting pharmacoresistance. Epilepsia 2016; 57:856-7. [DOI: 10.1111/epi.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Marina K. M. Alvim
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
| | - Ana C. Coan
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
| | - Clarissa L. Yasuda
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
| | - Marcia E. Morita
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas; Campinas SP Brazil
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Alvim MKM, Coan AC, Campos BM, Yasuda CL, Oliveira MC, Morita ME, Cendes F. Progression of gray matter atrophy in seizure-free patients with temporal lobe epilepsy. Epilepsia 2016; 57:621-9. [PMID: 26865066 DOI: 10.1111/epi.13334] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To investigate the presence and progression of gray matter (GM) reduction in seizure-free patients with temporal lobe epilepsy (TLE). METHODS We enrolled 39 consecutive TLE patients, seizure-free for at least 2 years--20 with magnetic resonance imaging (MRI) signs of hippocampal sclerosis (TLE-HS), 19 with normal MRI (TLE-NL), and 74 healthy controls. For longitudinal analysis, we included individuals who had a second MRI with minimum interval of 18 months: 21 patients (10 TLE-HS, 11 TLE-NL) and 11 controls. Three-dimensional (3D) T1 -weighted images acquired in 3 Tesla MRI were analyzed with voxel-based morphometry (VBM). The images of patients with right-sided interictal epileptogenic zone (EZ) were right-left flipped, as well as a comparable proportion of controls. Cross-sectional analysis: The patients' images from each group were compared to controls to investigate differences in GM volumes. Longitudinal analysis: The first and second images were compared in each group to look for decreased GM volume. RESULTS Cross-sectional analysis: Patients with TLE-HS had diffuse GM atrophy, including hippocampus and parahippocampal gyrus, insula, frontal, and occipital lobes ipsilateral to EZ, bilateral thalamus and contralateral orbitofrontal gyrus, and caudate. In contrast, TLE-NL group did not present significant differences compared to controls. Longitudinal analysis: TLE-HS presented progressive GM reduction in ipsilateral insula and occipital lobe, contralateral motor area, and bilateral temporal and frontal lobes. TLE-NL had GM progression in ipsilateral hypothalamus and parietal lobe, contralateral cerebellum, and bilateral temporal lobe. Controls did not show changes in GM volume between MRIs. SIGNIFICANCE Diffuse extrahippocampal GM atrophy is present in seizure-free patients with TLE-HS. In addition, there is progressive GM atrophy in patients with and without HS. These results demonstrate that not only ongoing seizures are involved in the progression of GM atrophy. An underlying pathologic mechanism could be responsible for progressive brain volume loss in TLE patients even in seizure-free periods.
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Affiliation(s)
- Marina K M Alvim
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Ana C Coan
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Brunno M Campos
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Clarissa L Yasuda
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Mariana C Oliveira
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Marcia E Morita
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, Neuroimaging Laboratory, State University of Campinas, Campinas, São Paulo, Brazil
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29
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Pan S, Wang F, Wang J, Li X, Liu X. Factors influencing the duration of generalized tonic–clonic seizure. Seizure 2016; 34:44-7. [DOI: 10.1016/j.seizure.2015.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022] Open
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30
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Cacabelos R, Torrellas C. Epigenetics of Aging and Alzheimer's Disease: Implications for Pharmacogenomics and Drug Response. Int J Mol Sci 2015; 16:30483-543. [PMID: 26703582 PMCID: PMC4691177 DOI: 10.3390/ijms161226236] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/16/2015] [Accepted: 12/08/2015] [Indexed: 02/07/2023] Open
Abstract
Epigenetic variability (DNA methylation/demethylation, histone modifications, microRNA regulation) is common in physiological and pathological conditions. Epigenetic alterations are present in different tissues along the aging process and in neurodegenerative disorders, such as Alzheimer’s disease (AD). Epigenetics affect life span and longevity. AD-related genes exhibit epigenetic changes, indicating that epigenetics might exert a pathogenic role in dementia. Epigenetic modifications are reversible and can potentially be targeted by pharmacological intervention. Epigenetic drugs may be useful for the treatment of major problems of health (e.g., cancer, cardiovascular disorders, brain disorders). The efficacy and safety of these and other medications depend upon the efficiency of the pharmacogenetic process in which different clusters of genes (pathogenic, mechanistic, metabolic, transporter, pleiotropic) are involved. Most of these genes are also under the influence of the epigenetic machinery. The information available on the pharmacoepigenomics of most drugs is very limited; however, growing evidence indicates that epigenetic changes are determinant in the pathogenesis of many medical conditions and in drug response and drug resistance. Consequently, pharmacoepigenetic studies should be incorporated in drug development and personalized treatments.
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Affiliation(s)
- Ramón Cacabelos
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, 15165-Bergondo, Corunna, Spain.
- Chair of Genomic Medicine, Camilo José Cela University, 28692-Madrid, Spain.
| | - Clara Torrellas
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, 15165-Bergondo, Corunna, Spain.
- Chair of Genomic Medicine, Camilo José Cela University, 28692-Madrid, Spain.
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31
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Moreira-Filho CA, Bando SY, Bertonha FB, Iamashita P, Silva FN, Costa LDF, Silva AV, Castro LHM, Wen HT. Community structure analysis of transcriptional networks reveals distinct molecular pathways for early- and late-onset temporal lobe epilepsy with childhood febrile seizures. PLoS One 2015; 10:e0128174. [PMID: 26011637 PMCID: PMC4444281 DOI: 10.1371/journal.pone.0128174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/24/2015] [Indexed: 12/21/2022] Open
Abstract
Age at epilepsy onset has a broad impact on brain plasticity and epilepsy pathomechanisms. Prolonged febrile seizures in early childhood (FS) constitute an initial precipitating insult (IPI) commonly associated with mesial temporal lobe epilepsy (MTLE). FS-MTLE patients may have early disease onset, i.e. just after the IPI, in early childhood, or late-onset, ranging from mid-adolescence to early adult life. The mechanisms governing early (E) or late (L) disease onset are largely unknown. In order to unveil the molecular pathways underlying E and L subtypes of FS-MTLE we investigated global gene expression in hippocampal CA3 explants of FS-MTLE patients submitted to hippocampectomy. Gene coexpression networks (GCNs) were obtained for the E and L patient groups. A network-based approach for GCN analysis was employed allowing: i) the visualization and analysis of differentially expressed (DE) and complete (CO) - all valid GO annotated transcripts - GCNs for the E and L groups; ii) the study of interactions between all the system's constituents based on community detection and coarse-grained community structure methods. We found that the E-DE communities with strongest connection weights harbor highly connected genes mainly related to neural excitability and febrile seizures, whereas in L-DE communities these genes are not only involved in network excitability but also playing roles in other epilepsy-related processes. Inversely, in E-CO the strongly connected communities are related to compensatory pathways (seizure inhibition, neuronal survival and responses to stress conditions) while in L-CO these communities harbor several genes related to pro-epileptic effects, seizure-related mechanisms and vulnerability to epilepsy. These results fit the concept, based on fMRI and behavioral studies, that early onset epilepsies, although impacting more severely the hippocampus, are associated to compensatory mechanisms, while in late MTLE development the brain is less able to generate adaptive mechanisms, what has implications for epilepsy management and drug discovery.
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Affiliation(s)
| | - Silvia Yumi Bando
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Fernanda Bernardi Bertonha
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Priscila Iamashita
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | | | | | | | - Luiz Henrique Martins Castro
- Department of Neurology, FMUSP, São Paulo, SP, Brazil
- Clinical Neurology Division, Hospital das Clínicas, FMUSP, São Paulo, SP, Brazil
| | - Hung-Tzu Wen
- Epilepsy Surgery Group, Hospital das Clínicas, FMUSP, São Paulo, SP, Brazil
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32
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Wagner J, Weber B, Elger CE. Early and chronic gray matter volume changes in limbic encephalitis revealed by voxel-based morphometry. Epilepsia 2015; 56:754-61. [DOI: 10.1111/epi.12968] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Jan Wagner
- Department of Epileptology; University of Bonn; Bonn Germany
- Department of NeuroCognition/Imaging; Life & Brain Center; Bonn Germany
| | - Bernd Weber
- Department of Epileptology; University of Bonn; Bonn Germany
- Department of NeuroCognition/Imaging; Life & Brain Center; Bonn Germany
- Center for Economics and Neuroscience; University of Bonn; Bonn Germany
| | - Christian E. Elger
- Department of Epileptology; University of Bonn; Bonn Germany
- Department of NeuroCognition/Imaging; Life & Brain Center; Bonn Germany
- Center for Economics and Neuroscience; University of Bonn; Bonn Germany
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33
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Kanner AM. Is depression associated with an increased risk of treatment-resistant epilepsy? Research strategies to investigate this question. Epilepsy Behav 2014; 38:3-7. [PMID: 25260238 DOI: 10.1016/j.yebeh.2014.06.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/24/2014] [Indexed: 11/18/2022]
Abstract
Persons with epilepsy (PWE) have a higher risk of developing depressive disorders (DDs), and people with primary DD have an increased risk of developing epilepsy. Furthermore, a lifetime history of DD has been associated with a worse response of the seizure disorder to pharmacotherapy and epilepsy surgery. The first part of this article reviews the literature of this problem with the intention of highlighting the neurobiologic pathogenic mechanisms operant in DD with a potential to facilitate the epileptogenic process and/or cortical hyperexcitability in humans and experimental animal studies of depression. They include the following: (i) a hyperactive hypothalamic-pituitary-adrenal axis and the associated structural and functional abnormalities of limbic structures, (ii) increased glutamatergic activity and decreased GABAergic and serotonergic activity, and (iii) immunologic disturbances. In the second part of this article, we suggest research strategies to test the hypothesis of whether depression worsens the course of epilepsy and identify the pathogenic mechanisms operant in this process.
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Affiliation(s)
- Andres M Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, USA.
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34
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Park KM, Shin KJ, Ha SY, Park J, Kim SE, Kim SE. Response to antiepileptic drugs in partial epilepsy with structural lesions on MRI. Clin Neurol Neurosurg 2014; 123:64-8. [DOI: 10.1016/j.clineuro.2014.04.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 03/21/2014] [Accepted: 04/30/2014] [Indexed: 11/26/2022]
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35
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Laxer KD, Trinka E, Hirsch LJ, Cendes F, Langfitt J, Delanty N, Resnick T, Benbadis SR. The consequences of refractory epilepsy and its treatment. Epilepsy Behav 2014; 37:59-70. [PMID: 24980390 DOI: 10.1016/j.yebeh.2014.05.031] [Citation(s) in RCA: 431] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 12/12/2022]
Abstract
Seizures in some 30% to 40% of patients with epilepsy fail to respond to antiepileptic drugs or other treatments. While much has been made of the risks of new drug therapies, not enough attention has been given to the risks of uncontrolled and progressive epilepsy. This critical review summarizes known risks associated with refractory epilepsy, provides practical clinical recommendations, and indicates areas for future research. Eight international epilepsy experts from Europe, the United States, and South America met on May 4, 2013, to present, review, and discuss relevant concepts, data, and literature on the consequences of refractory epilepsy. While patients with refractory epilepsy represent the minority of the population with epilepsy, they require the overwhelming majority of time, effort, and focus from treating physicians. They also represent the greatest economic and psychosocial burdens. Diagnostic procedures and medical/surgical treatments are not without risks. Overlooked, however, is that these risks are usually smaller than the risks of long-term, uncontrolled seizures. Refractory epilepsy may be progressive, carrying risks of structural damage to the brain and nervous system, comorbidities (osteoporosis, fractures), and increased mortality (from suicide, accidents, sudden unexpected death in epilepsy, pneumonia, vascular disease), as well as psychological (depression, anxiety), educational, social (stigma, driving), and vocational consequences. Adding to this burden is neuropsychiatric impairment caused by underlying epileptogenic processes ("essential comorbidities"), which appears to be independent of the effects of ongoing seizures themselves. Tolerating persistent seizures or chronic medicinal adverse effects has risks and consequences that often outweigh risks of seemingly "more aggressive" treatments. Future research should focus not only on controlling seizures but also on preventing these consequences.
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Affiliation(s)
- Kenneth D Laxer
- Sutter Pacific Epilepsy Program, California Pacific Medical Center, San Francisco, CA, USA.
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Lawrence J Hirsch
- Division of Epilepsy and EEG, Department of Neurology, Yale Comprehensive Epilepsy Center, New Haven, CT, USA
| | - Fernando Cendes
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - John Langfitt
- Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA; Department Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA; Strong Epilepsy Center, University of Rochester School of Medicine, Rochester, NY, USA
| | - Norman Delanty
- Epilepsy Service and National Epilepsy Surgery Programme, Beaumont Hospital, Dublin, Ireland
| | - Trevor Resnick
- Comprehensive Epilepsy Program, Miami Children's Hospital, Miami, FL, USA
| | - Selim R Benbadis
- Comprehensive Epilepsy Program, University of South Florida, Tampa, FL, USA
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36
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Cendes F, Sakamoto AC, Spreafico R, Bingaman W, Becker AJ. Epilepsies associated with hippocampal sclerosis. Acta Neuropathol 2014; 128:21-37. [PMID: 24823761 DOI: 10.1007/s00401-014-1292-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 01/22/2023]
Abstract
Hippocampal sclerosis (HS) is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy (MTLE). Hippocampal specimens of pharmacoresistant MTLE patients that underwent epilepsy surgery for seizure control reveal the characteristic pattern of segmental neuronal cell loss and concomitant astrogliosis. However, classification issues of hippocampal lesion patterns have been a matter of intense debate. International consensus classification has only recently provided significant progress for comparisons of neurosurgical and clinic-pathological series between different centers. The respective four-tiered classification system of the International League Against Epilepsy subdivides HS into three types and includes a term of "gliosis only, no-HS". Future studies will be necessary to investigate whether each of these subtypes of HS may be related to different etiological factors or with postoperative memory and seizure outcome. Molecular studies have provided potential deeper insights into the pathogenesis of HS and MTLE on the basis of epilepsy-surgical hippocampal specimens and corresponding animal models. These include channelopathies, activation of NMDA receptors, and other conditions related to Ca(2+) influx into neurons, the imbalance of Ca(2+)-binding proteins, acquired channelopathies that increase neuronal excitability, paraneoplastic and non-paraneoplastic inflammatory events, and epigenetic regulation promoting or facilitating hippocampal epileptogenesis. Genetic predisposition for HS is clearly suggested by the high incidence of family history in patients with HS, and by familial MTLE with HS. So far, it is clear that HS is multifactorial and there is no individual pathogenic factor either necessary or sufficient to generate this intriguing histopathological condition. The obvious variety of pathogenetic combinations underlying HS may explain the multitude of clinical presentations, different responses to clinical and surgical treatment. We believe that the stratification of neuropathological patterns can help to characterize specific clinic-pathological entities and predict the postsurgical seizure control in an improved fashion.
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Lee SK. Treatment strategy for the patient with hippocampal sclerosis who failed to the first antiepileptic drug. J Epilepsy Res 2014; 4:1-6. [PMID: 24977123 PMCID: PMC4066627 DOI: 10.14581/jer.14001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 05/15/2014] [Indexed: 11/03/2022] Open
Abstract
Despite many epilepsy patients respond to antiepileptic drugs (AED) successfully, more than 30% of patients continue to have seizures on multiple AEDs. The refractory epilepsy increases the risk of cognitive deterioration, psychosocial dysfunction, and sudden unexpected death of epilepsy patients (SUDEP). It is important to identify refractory epilepsy early and make the goal of epilepsy treatment as the prevention of decline in social, vocational, and cognitive performances and minimizing the risk of accident or SUDEP. The syndrome of medial temporal lobe epilepsy with hippocampal sclerosis (MTLE with HS) is often resistant to AEDs, and surgically remediable. Initially well-controlled seizures often become intractable to AEDs. There are progressive behavioral changes including increasing memory deficit. Surgical outcome is also worse with longer duration of epilepsy or increasing age at surgery, which suggests that MTLE is a progressive disorder. Some emphasized the ultimate intractability of MTLE in which intractability of MTLE could be evident only after some years following initial diagnosis. However, when patients considered to have intractable epilepsy were followed up for a long period of time, many of them experienced seizure-free state. Some studies clearly demonstrated the wax and wane courses of treatment response in epilepsy. Late remission could be achieved up to in a half of patients. Thus intractable state is not a static condition but a fluctuating one and initial refractoriness does not necessarily mean the final intractability. Even though the chance of seizure remission with AEDs is not high for MTLE, some of them do well respond to drugs. It is even possible to withdraw AEDs for a few patients. Though epilepsy surgery is very effective method to treat MTLE, considering the fluctuation courses of intractability and the possibility of delayed remission, at least two adequate AEDs could be applied to the patients before surgery. However, medical intractability becomes evident by definition, it is not reasonable to delay epilepsy surgery.
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Affiliation(s)
- Sang Kun Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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38
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Pacagnella D, Lopes TM, Morita ME, Yasuda CL, Cappabianco FAM, Bergo F, Balthazar MLF, Coan AC, Cendes F. Memory impairment is not necessarily related to seizure frequency in mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsia 2014; 55:1197-204. [DOI: 10.1111/epi.12691] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Denise Pacagnella
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Tatila M. Lopes
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Marcia E. Morita
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Clarissa L. Yasuda
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Fabio A. M. Cappabianco
- Department of Science and Technology; Federal University of Sao Paulo; São José dos Campos SP Brazil
| | - Felipe Bergo
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | | | - Ana C. Coan
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
| | - Fernando Cendes
- Department of Neurology; University of Campinas; Campinas Sao Paulo Brazil
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39
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Park KM, Hur Y, Kim HY, Ji KH, Hwang TG, Shin KJ, Ha SY, Park J, Kim SE. Initial response to antiepileptic drugs in patients with newly diagnosed epilepsy. J Clin Neurosci 2014; 21:923-6. [DOI: 10.1016/j.jocn.2013.10.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/14/2013] [Accepted: 10/27/2013] [Indexed: 12/18/2022]
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40
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Abstract
The last decade has witnessed a significant shift on our understanding of the relationship between psychiatric disorders and epilepsy. While traditionally psychiatric disorders were considered as a complication of the underlying seizure disorder, new epidemiologic data, supported by clinical and experimental research, have suggested the existence of a bidirectional relation between the two types of conditions: not only are patients with epilepsy at greater risk of experiencing a psychiatric disorder, but patients with primary psychiatric disorders are at greater risk of developing epilepsy. Do these data suggest that some of the pathogenic mechanisms operant in psychiatric comorbidities play a role in epileptogenesis? The aim of this article is to review the epidemiologic data that demonstrate that primary psychiatric disorders are more frequent in people who develop epilepsy, before the onset of the seizure disorder than among controls. The next question looks at the available data of pathogenic mechanisms of primary mood disorders and their potential for facilitating the development and/or exacerbation in the severity of epileptic seizures. Finally, we review data derived from experimental studies in animal models of depression and epilepsy that support a potential role of pathogenic mechanisms of mood disorders in the development of epileptic seizures and epileptogenesis. The data presented in this article do not yet establish conclusive evidence of a pathogenic role of psychiatric comorbidities in epileptogenesis, but raise important research questions that need to be investigated in experimental, clinical, and population-based epidemiologic research studies.
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Affiliation(s)
- Andres M Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW, 14th Street, Room 1324, Miami, FL, 33136, USA,
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41
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Coan AC, Campos BM, Yasuda CL, Kubota BY, Bergo FPG, Guerreiro CAM, Cendes F. Frequent seizures are associated with a network of gray matter atrophy in temporal lobe epilepsy with or without hippocampal sclerosis. PLoS One 2014; 9:e85843. [PMID: 24475055 PMCID: PMC3903486 DOI: 10.1371/journal.pone.0085843] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/02/2013] [Indexed: 11/23/2022] Open
Abstract
Objective Patients with temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS) have diffuse subtle gray matter (GM) atrophy detectable by MRI quantification analyses. However, it is not clear whether the etiology and seizure frequency are associated with this atrophy. We aimed to evaluate the occurrence of GM atrophy and the influence of seizure frequency in patients with TLE and either normal MRI (TLE-NL) or MRI signs of HS (TLE-HS). Methods We evaluated a group of 172 consecutive patients with unilateral TLE-HS or TLE-NL as defined by hippocampal volumetry and signal quantification (122 TLE-HS and 50 TLE-NL) plus a group of 82 healthy individuals. Voxel-based morphometry was performed with VBM8/SPM8 in 3T MRIs. Patients with up to three complex partial seizures and no generalized tonic-clonic seizures in the previous year were considered to have infrequent seizures. Those who did not fulfill these criteria were considered to have frequent seizures. Results Patients with TLE-HS had more pronounced GM atrophy, including the ipsilateral mesial temporal structures, temporal lobe, bilateral thalami and pre/post-central gyri. Patients with TLE-NL had more subtle GM atrophy, including the ipsilateral orbitofrontal cortex, bilateral thalami and pre/post-central gyri. Both TLE-HS and TLE-NL showed increased GM volume in the contralateral pons. TLE-HS patients with frequent seizures had more pronounced GM atrophy in extra-temporal regions than TLE-HS with infrequent seizures. Patients with TLE-NL and infrequent seizures had no detectable GM atrophy. In both TLE-HS and TLE-NL, the duration of epilepsy correlated with GM atrophy in extra-hippocampal regions. Conclusion Although a diffuse network GM atrophy occurs in both TLE-HS and TLE-NL, this is strikingly more evident in TLE-HS and in patients with frequent seizures. These findings suggest that neocortical atrophy in TLE is related to the ongoing seizures and epilepsy duration, while thalamic atrophy is more probably related to the original epileptogenic process.
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Affiliation(s)
- Ana C. Coan
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Brunno M. Campos
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Clarissa L. Yasuda
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Bruno Y. Kubota
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Felipe PG. Bergo
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Carlos AM. Guerreiro
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas, SP, Brazil
- * E-mail:
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Coan AC, Cendes F. Understanding the spectrum of temporal lobe epilepsy: contributions for the development of individualized therapies. Expert Rev Neurother 2014; 13:1383-94. [DOI: 10.1586/14737175.2013.857604] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Coan AC, Cendes F. Multimodal neuroimaging: potential biomarkers for response to antiepileptic drugs? Epilepsia 2013; 54 Suppl 2:67-70. [PMID: 23646975 DOI: 10.1111/epi.12188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neuroimaging techniques in epilepsy are used widely for definition of the epileptogenic lesion and surgical decision. However, its applications extend to the knowledge of epileptic mechanisms and include the identification of prognostic features that can help our decisions on the appropriate type of treatment on an individual basis. Structural neuroimaging may be able to identify patients more likely to respond to antiepileptic drug (AED) treatment and also patients who are better candidates for earlier surgical treatment. In the past decades, quantitative analyses have also improved our knowledge about epileptogenic lesions and networks as well as the following prognoses: seizure control, cognitive outcome, and comorbidities. New advanced neuroimaging techniques such as functional magnetic resonance imaging (MRI) and the development biotracers that could be associated with inflammation and specific genetic patterns will add further knowledge to the development of epilepsy treatments.
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Affiliation(s)
- Ana C Coan
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, SP, Brazil
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Coan AC, Cendes F. Epilepsy as progressive disorders: what is the evidence that can guide our clinical decisions and how can neuroimaging help? Epilepsy Behav 2013; 26:313-21. [PMID: 23127969 DOI: 10.1016/j.yebeh.2012.09.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 09/16/2012] [Indexed: 10/27/2022]
Abstract
There is evidence that some types of epilepsy progress over time, and an important part of this knowledge has derived from neuroimaging studies. Different authors have demonstrated structural damage more pronounced in individuals with a longer duration of epilepsy, and others have been able to quantify this progression over time. However, others have failed to demonstrate progression possibly due to the heterogeneity of individuals evaluated. Currently, temporal lobe epilepsy associated with hippocampal sclerosis is regarded as a progressive disorder. Conversely, for other types of epilepsy, the evidence is not so clear. The causes of this damage progression are also unknown although there is consistent evidence that seizure is one of the mechanisms. The conflicting data about epilepsy progression can be a challenge for clinical decisions for an individual patient. Studies with homogenous groups and longer follow-up are necessary for appropriate conclusions about the real burden of damage progression in epilepsies, and neuroimaging will be essential in this context.
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Affiliation(s)
- Ana C Coan
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, SP, Brazil
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Kanner AM. Can neurobiological pathogenic mechanisms of depression facilitate the development of seizure disorders? Lancet Neurol 2012; 11:1093-102. [DOI: 10.1016/s1474-4422(12)70201-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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White Matter Atrophy in Patients with Mesial Temporal Lobe Epilepsy: Voxel-Based Morphometry Analysis of T1- and T2-Weighted MR Images. Radiol Res Pract 2012; 2012:481378. [PMID: 23150823 PMCID: PMC3488412 DOI: 10.1155/2012/481378] [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: 04/10/2012] [Accepted: 09/05/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction. Mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis is highly refractory to clinical treatment. MRI voxel-based morphometry (VBM) of T1-weighted images has revealed a widespread pattern of gray matter (GM) and white matter (WM) atrophy in MTLE. Few studies have investigated the role of T2-weighted images in revealing WM atrophy using VBM. Objectives. To compare the results of WM atrophy between T1- and T2-weighted images through VBM. Methods. We selected 28 patients with left and 27 with right MTLE and 60 normal controls. We analyzed T1- and T2- weighted images with SPM8, using VBM/DARTEL algorithm to extract maps of GM and WM. The second level of SPM was used to investigate areas of WM atrophy among groups. Results. Both acquisitions showed bilateral widespread WM atrophy. T1-weighted images showed higher sensibility to detect areas of WM atrophy in both groups of MTLE. T2-weighted images also showed areas of WM atrophy in a more restricted pattern, but still bilateral and with a large area of superposition with T1-weighted images. Conclusions. In MTLE, T1-weighted images are more sensitive to detect subtle WM abnormalities using VBM, compared to T2 images, although both present a good superposition of statistical maps.
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Gomez-Ibañez A, Gasca-Salas C, Urrestarazu E, Viteri C. Clinical phenotypes within non-surgical patients with mesial temporal lobe epilepsy caused by hippocampal sclerosis based on response to antiepileptic drugs. Seizure 2012; 22:20-3. [PMID: 23041032 DOI: 10.1016/j.seizure.2012.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/10/2012] [Accepted: 09/14/2012] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate evolution and elucidate clinical phenotypes related to prognosis of patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) treated exclusively with antiepileptic drugs (AED). METHODS Forty-seven out of 68 MTLE-HS patients treated between January 2005 and June 2010 were retrospectively studied for demographic, clinical and outcome data. The population was divided into drug-responder and drug-resistant patients; the latter was divided, according to the duration of the seizure-free periods along their evolution, into patients with at least one seizure-free period longer than one year and those with shorter periods. Variables were compared between drug-responders vs drug-resistants and drug-resistants with long seizure-free periods vs drug-resistants without it. RESULTS There were 7 (15%) drug-responders, 39 (83%) drug-resistants and 1 patient (2%) with an undetermined response. Eighteen (46%) drug-resistant individuals had seizure-free periods longer than one year, with mean duration of 46 months (3.8 years). Since no factor was statistically associated with long seizure-free period within drug-resistants, we can clinically distinguish two phenotypes: women with left HS and late onset of seizures, with poor prognosis, and men with right HS and earlier appearance of seizures, attaining a better outcome. Twenty out of 47 (42.5%) patients followed an intermittent pattern of epilepsy. CONCLUSIONS Non-surgical MTLE-HS drug-resistant patients can achieve long seizure-free periods with AED, but relapses are common. Female gender, left or bilateral lesion and later onset of seizures seem to be bad prognosis factors within MTLE-HS drug-resistant patients.
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Affiliation(s)
- Asier Gomez-Ibañez
- Department of Neurology and Neurosurgery, Clinica Universidad de Navarra, Pamplona, Spain.
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Yasuda CL, Cendes F. Neuroimaging for the prediction of response to medical and surgical treatment in epilepsy. ACTA ACUST UNITED AC 2012; 6:295-308. [PMID: 23480740 DOI: 10.1517/17530059.2012.683408] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Approximately 30% of patients with epilepsy do not respond to adequate medication and are candidates for surgical treatment. Outcome predictors can improve the selection of more suitable treatment options for each patient. Therefore, the authors aimed to review the role of neuroimaging studies in predicting outcomes for both clinical and surgical treatment of epilepsy. AREAS COVERED This review analyzes studies that investigated different neuroimaging techniques as predictors of clinical and surgical treatment outcome in epilepsy. Studies involving both structural (i.e., T1-weighted images and diffusion tensor images) and functional MRI (fMRI) were identified, as well as other modalities such as spectroscopy, PET, SPECT and MEG. The authors also evaluated the importance of fMRI in predicting memory outcome after surgical resections in temporal lobe epilepsy. EXPERT OPINION The identification of reliable biomarkers to predict response to medical and surgical treatments are much needed in order to provide more adequate patient counseling about prognosis and treatment options individually. Different neuroimaging techniques may provide combined measurements that potentially may become these biomarkers in the near future.
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Affiliation(s)
- Clarissa Lin Yasuda
- University of Campinas/UNICAMP, Department of Neurology, Neuroimaging Laboratory , Cidade Universitária Zeferino Vaz, Rua Tessália Vieira de Camargo, 126. Cx postal 6111, Campinas, SP. CEP 13083-970 , Brazil
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Kanner AM, Schachter SC, Barry JJ, Hesdorffer DC, Mula M, Trimble M, Hermann B, Ettinger AE, Dunn D, Caplan R, Ryvlin P, Gilliam F, LaFrance WC. Depression and epilepsy: epidemiologic and neurobiologic perspectives that may explain their high comorbid occurrence. Epilepsy Behav 2012; 24:156-68. [PMID: 22632406 DOI: 10.1016/j.yebeh.2012.01.007] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2012] [Indexed: 12/25/2022]
Abstract
Depression is the most frequent psychiatric comorbidity in people with epilepsy (PWE) with lifetime prevalence rates ranging between 30 and 35%. Multifactorial variables play a pathogenic role in the high comorbid occurrence of these two disorders. These variables were critically examined during an international symposium held in Chicago in September 2010, the results of which are presented in two companion manuscripts. The first manuscript summarizes new epidemiologic data highlighting the bidirectional relation between depression and epilepsy and related methodological issues in studying this relationship. An examination of the neurobiologic aspects of primary mood disorders, mood disorders in PWE and pathogenic mechanisms of epilepsy derived from studies in animal models and humans is allowing a better understanding of the complex relation between the two conditions. In the first manuscript, we review data from animal models of epilepsy in which equivalent symptoms of depression and anxiety disorders develop and, conversely, animal models of depression in which the kindling process is facilitated. Data from structural and functional neuroimaging studies in humans provide a further understanding of potential common pathogenic mechanisms operant in depression and epilepsy that may explain their high comorbidity. The negative impact of depression on the control of seizure disorders has been documented in various studies. In this manuscript, these data are reviewed and potential mechanisms explaining this phenomenon are proposed.
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Affiliation(s)
- Andres M Kanner
- Department of Neurological Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Baldaçara L, Jackowski AP, Schoedl A, Pupo M, Andreoli SB, Mello MF, Lacerda ALT, Mari JJ, Bressan RA. Reduced cerebellar left hemisphere and vermal volume in adults with PTSD from a community sample. J Psychiatr Res 2011; 45:1627-33. [PMID: 21824628 DOI: 10.1016/j.jpsychires.2011.07.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/14/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Traumatic events exposure is a necessary condition for developing posttraumatic stress disorder (PTSD), but not all individuals exposed to the same trauma will develop PTSD. Human studies have suggested that the cerebellum is involved in human fear perception, anticipation, and recollection. In this context, the current study evaluated whether cerebellar volume is associated with PTSD. METHODS Eighty-four victims of violence, 42 who fulfilled the DSM-IV-TR criteria for PTSD and 42 resilient controls, were identified through an epidemiologic survey conducted in the city of São Paulo. Subjects were evaluated using the Clinician-Administered PTSD Scale (CAPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Early Trauma Inventory (ETI). All subjects underwent a magnetic resonance imaging (MRI) scan to evaluate their cerebellar hemispheres and vermis. RESULTS PTSD subjects had relative smaller left hemisphere (p = 0.04) and vermis (p < 0.01) volumes persisted after controlling for gender, age, and brain volume. In PTSD group, left cerebellar hemisphere volume correlated negatively with PTSD (p = 0.01) and depressive symptoms (p = 0.04). Vermal volume correlated negatively with PTSD symptoms (p < 0.01), early traumatic life events (p < 0.01), depressive symptoms (p = 0.04) and anxiety (p = 0.01). CONCLUSION The cerebellum is involved in emotion modulation, and our results suggest that cerebellar volumetric reduction is associated with mood, anxiety and PTSD symptoms. Early traumatic life experiences are related to vermal volume reduction and may be a risk factor for future PTSD development.
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Affiliation(s)
- Leonardo Baldaçara
- Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo (UNIFESP), Brazil.
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