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Fearns N, Wagner M, Borggräfe I, Kunz M, Rémi J, Vollmar C. Good Outcome of Resective Epilepsy Surgery in a 1-Year-Old Child with Drug-Resistant Focal Epilepsy with a Novel Pathogenic COL4A1 Mutation. Neuropediatrics 2024. [PMID: 38167978 DOI: 10.1055/a-2236-7066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Pathogenic variants in COL4A1, encoding the α chain of type IV collagen, have been associated with cerebrovascular pathology as well as malformations of cortical development, thereby causing structural epilepsy. This case illustrates successful resective epilepsy surgery in a 12-month-old girl with left occipital focal cortical dysplasia (FCD) associated with a heterozygous splice-donor variant in COL4A1. She presented with drug-resistant focal epilepsy with daily seizures from the age of 2 months, refractory to several combinations of antiseizure medications, as well as mild right-sided hemiparesis and developmental delay. All presurgical diagnostic modalities, including ictal and interictal electroencephalography, magnetic resonance imaging, and ictal fluorodeoxyglucose positron emission tomography, showed congruent findings, pointing toward one single left occipital epileptogenic zone (EZ). We performed a left occipital lobectomy, using intraoperative electrocorticography to confirm the boundaries of the EZ. After surgery, the patient has remained seizure free, and both cognitive and motor developments have improved. Histopathology of the resected brain tissue showed FCD type Ia. Resective epilepsy surgery can have a very good outcome, also in patients with genetic mutations in COL4A1, constituting a less invasive option than the previously used more radical surgical procedures such as hemispherectomy.
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Affiliation(s)
- Nicholas Fearns
- Department of Neurology, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Matias Wagner
- Institute of Human Genetics, University Hospital rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- Institute of Neurogenomics, Helmholtz Center Munich, Munich, Germany
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Ingo Borggräfe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Jan Rémi
- Department of Neurology, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
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Schmidlechner T, Zaddach M, Heinen F, Cornell S, Ramantani G, Rémi J, Vollmar C, Kunz M, Borggraefe I. IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis. J Neurol 2024; 271:177-187. [PMID: 37770569 PMCID: PMC10770207 DOI: 10.1007/s00415-023-12002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE This systematic review aimed to assess the intellectual outcome of children who underwent surgery for epilepsy. METHODS A systematic review of electronic databases was conducted on December 3, 2021, for PubMed and January 11, 2022, for Web of Science. The review was conducted according to the PRISMA guidelines. The included studies reported on intelligence quotient (IQ) or developmental quotient (DQ) before and after epilepsy surgery in children. Studies were included, if the patients had medically intractable epilepsy and if the study reported mainly on curative surgical procedures. We conducted a random-effects meta-analysis to determine the mean change of IQ/DQ. RESULTS Fifty-seven studies reporting on a total of 2593 patients met the inclusion criteria. The mean age at surgery was 9.2 years (± 3.44; range 2.4 months-19.81 years). Thirty-eight studies showed IQ/DQ improvement on a group level, 8 yielded stable IQ/DQ, and 19 showed deterioration. Pooled analysis revealed a significant mean gain in FSIQ of + 2.52 FSIQ points (95% CI 1.12-3.91). The pooled mean difference in DQ was + 1.47 (95% CI - 6.5 to 9.5). The pooled mean difference in IQ/DQ was 0.73 (95% CI - 4.8 to 6.2). Mean FSIQ gain was significantly higher in patients who reached seizure freedom (+ 5.58 ± 8.27) than in patients who did not (+ 0.23 ± 5.65). It was also significantly higher in patients who stopped ASM after surgery (+ 6.37 ± 3.80) than in patients who did not (+ 2.01 ± 2.41). Controlled studies showed a better outcome in the surgery group compared to the non-surgery group. There was no correlation between FSIQ change and age at surgery, epilepsy duration to surgery, and preoperative FSIQ. SIGNIFICANCE The present review indicates that there is a mean gain in FSIQ and DQ in children with medically intractable epilepsy after surgery. The mean gain of 2.52 FSIQ points reflects more likely sustainability of intellectual function rather than improvement after surgery. Seizure-free and ASM-free patients reach higher FSIQ gains. More research is needed to evaluate individual changes after specific surgery types and their effect on long-term follow-up.
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Affiliation(s)
- Tristan Schmidlechner
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Malin Zaddach
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Sonia Cornell
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Jan Rémi
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany.
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
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Schuler FAF, Ribó M, Dequatre‐Ponchelle N, Rémi J, Dobrocky T, Goeldlin MB, Gralla J, Kaesmacher J, Meinel TR, Mordasini P, Seiffge DJ, Fischer U, Arnold M, Kägi G, Jung S. Geographical Requirements for the Applicability of the Results of the RACECAT Study to Other Stroke Networks. J Am Heart Assoc 2023; 12:e029965. [PMID: 37830330 PMCID: PMC10757535 DOI: 10.1161/jaha.123.029965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/11/2023] [Indexed: 10/14/2023]
Abstract
Background The RACECAT (Transfer to the Closest Local Stroke Center vs Direct Transfer to Endovascular Stroke Center of Acute Stroke Patients With Suspected Large Vessel Occlusion in the Catalan Territory) trial was the first randomized trial addressing the prehospital triage of acute stroke patients based on the distribution of thrombolysis centers and intervention centers in Catalonia, Spain. The study compared the drip-and-ship with the mothership paradigm in regions where a local thrombolysis center can be reached faster than the nearest intervention center (equipoise region). The present study aims to determine the population-based applicability of the results of the RACECAT study to 4 stroke networks with a different degree of clustering of the intervention centers (clustered, dispersed). Methods and Results Stroke networks were compared with regard to transport time saved for thrombolysis (under the drip-and-ship approach) and transport time saved for endovascular therapy (under the mothership approach). Population-based transport times were modeled with a local instance of an openrouteservice server using open data from OpenStreetMap.The fraction of the population in the equipoise region differed substantially between clustered networks (Catalonia, 63.4%; France North, 87.7%) and dispersed networks (Southwest Bavaria, 40.1%; Switzerland, 40.0%). Transport time savings for thrombolysis under the drip-and-ship approach were more marked in clustered networks (Catalonia, 29 minutes; France North, 27 minutes) than in dispersed networks (Southwest Bavaria and Switzerland, both 18 minutes). Conclusions Infrastructure differences between stroke networks may hamper the applicability of the results of the RACECAT study to other stroke networks with a different distribution of intervention centers. Stroke networks should assess the population densities and hospital type/distribution in the temporal domain before applying prehospital triage algorithms to their specific setting.
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Affiliation(s)
- Florian A. F. Schuler
- Department of NeurologyInselspital, Bern University Hospital, University of BernSwitzerland
| | - Marc Ribó
- Stroke Unit, Department of NeurologyVall d’Hebron University HospitalBarcelonaSpain
| | | | - Jan Rémi
- Department of NeurologyUniversity Hospital, Ludwig‐Maximilians‐UniversityMunichGermany
| | - Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Martina B. Goeldlin
- Department of NeurologyInselspital, Bern University Hospital, University of BernSwitzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Thomas R. Meinel
- Department of NeurologyInselspital, Bern University Hospital, University of BernSwitzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalUniversity of BernSwitzerland
- Network RadiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - David J. Seiffge
- Department of NeurologyInselspital, Bern University Hospital, University of BernSwitzerland
| | - Urs Fischer
- Department of NeurologyInselspital, Bern University Hospital, University of BernSwitzerland
- Department of NeurologyUniversity Hospital Basel, University of BaselSwitzerland
| | - Marcel Arnold
- Department of NeurologyInselspital, Bern University Hospital, University of BernSwitzerland
| | - Georg Kägi
- Department of NeurologyInselspital, Bern University Hospital, University of BernSwitzerland
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Simon Jung
- Department of NeurologyInselspital, Bern University Hospital, University of BernSwitzerland
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Schließer P, Struebing FL, Northoff BH, Kurz A, Rémi J, Holdt L, Höglinger GU, Herms J, Koeglsperger T. Detection of a Parkinson's Disease-Specific MicroRNA Signature in Nasal and Oral Swabs. Mov Disord 2023; 38:1706-1715. [PMID: 37382573 DOI: 10.1002/mds.29515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Biomaterials from oral and nasal swabs provide, in theory, a potential resource for biomarker development. However, their diagnostic value has not yet been investigated in the context of Parkinson's disease (PD) and associated conditions. OBJECTIVE We have previously identified a PD-specific microRNA (miRNA) signature in gut biopsies. In this work, we aimed to investigate the expression of miRNAs in routine buccal (oral) and nasal swabs obtained from cases with idiopathic PD and isolated rapid eye movement sleep behavior disorder (iRBD), a prodromal symptom that often precedes α-synucleinopathies. We aimed to address their value as a diagnostic biomarker for PD and their mechanistic contribution to PD onset and progression. METHODS Healthy control cases (n = 28), cases with PD (n = 29), and cases with iRBD (n = 8) were prospectively recruited to undergo routine buccal and nasal swabs. Total RNA was extracted from the swab material, and the expression of a predefined set of miRNAs was quantified by quantitative real-time polymerase chain reaction. RESULTS Statistical analysis revealed a significantly increased expression of hsa-miR-1260a in cases who had PD. Interestingly, hsa-miR-1260a expression levels correlated with diseases severity, as well as olfactory function, in the PD and iRBD cohorts. Mechanistically, hsa-miR-1260a segregated to Golgi-associated cellular processes with a potential role in mucosal plasma cells. Predicted hsa-miR-1260a target gene expression was reduced in iRBD and PD groups. CONCLUSIONS Our work demonstrates oral and nasal swabs as a valuable biomarker pool in PD and associated neurodegenerative conditions. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Patricia Schließer
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Felix L Struebing
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig Maximilian University, Munich, Germany
| | - Bernd H Northoff
- Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Kurz
- Department of Gynaecology and Obstetrics, Klinikum Landsberg am Lech, Landsberg, Germany
| | - Jan Rémi
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Günter U Höglinger
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases e.V. (DZNE) Munich, Munich, Germany
| | - Jochen Herms
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig Maximilian University, Munich, Germany
| | - Thomas Koeglsperger
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases, Munich, Germany
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Fearns N, Birk D, Bartkiewicz J, Rémi J, Noachtar S, Vollmar C. Quantitative analysis of the morphometric analysis program MAP in patients with truly MRI-negative focal epilepsy. Epilepsy Res 2023; 192:107133. [PMID: 37001290 DOI: 10.1016/j.eplepsyres.2023.107133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE In the presurgical evaluation of epilepsy, identifying the epileptogenic zone is challenging if magnetic resonance imaging (MRI) is negative. Several studies have shown the benefit of using a morphometric analysis program (MAP) on T1-weighted MRI scans to detect subtle lesions. MAP can guide a focused re-evaluation of MRI to ultimately identify structural lesions that were previously overlooked. Data on patients where this additional review after MAP analysis did not reveal any lesions is limited. Here we evaluate the diagnostic yield of MAP in a large group of truly MRI-negative patients. METHODS We identified 68 patients with MRI-negative focal epilepsy and clear localization of the epileptogenic zone by intracranial EEG or postoperative seizure freedom. High resolution 3D T1 data of patients and 73 healthy controls were acquired on a 3 T scanner. Morphometric analysis was performed with MAP software, creating five z-score maps, reflecting different structural properties of the brain and a patient's deviation from the control population, and a neural network-based focal cortical dysplasia probability map. Ten brain regions were specified to quantify whether MAP findings were located in the correct region. Receiver operating characteristic (ROC) analyses were performed to identify the optimal thresholds for each map. RESULTS MAP-guided visual re-evaluation of the original MRI revealed overlooked lesions in three patients. The remaining 65 truly MRI-negative patients were included in the statistical analysis. At the optimal thresholds, maximum sensitivity was 84 %, with 35 % specificity. Balanced accuracy (arithmetic mean of sensitivity and specificity) of the respective maps ranged from 51 % to 60 %, creating three to six times more false positive than true positive findings. CONCLUSION This study confirms that MAP is useful in detecting previously overlooked subtle structural lesions. However, in truly MRI-negative patients, the additional diagnostic yield is very limited.
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Rémi J. [First epileptic seizure]. MMW Fortschr Med 2023; 165:53-54. [PMID: 37081356 DOI: 10.1007/s15006-023-2522-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Jan Rémi
- Epilepsie-Zentrum, Neurologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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Halford JJ, Brinkmann BH, Clunie DA, Gotman J, Beniczky S, Rampp S, Rémi J, Husain A, Andrew Ehrenberg J, Winkler S. Continued progress in DICOM neurophysiology standardization. Clin Neurophysiol 2023; 147:11-13. [PMID: 36610358 DOI: 10.1016/j.clinph.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - Benjamin H Brinkmann
- Departments of Biomedical Engineering and Neurology, Mayo Clinic, Rochester, MN, USA.
| | | | - Jean Gotman
- Montreal Neurologic Institute and Hospital, McGill University, Quebec, Canada.
| | - Sándor Beniczky
- Departments of Clinical Neurophysiology, Aarhus University Hospital, Aarhus and Danish Epilepsy Centre, Dianalund, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Germany and Department of Neurosurgery, University Hospital Halle (Saale), Germany.
| | - Jan Rémi
- Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Aatif Husain
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.
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8
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Mueller F, Fabritius MP, Stueckelschweiger L, Kiesl S, Moench S, Tiedt S, Rémi J, Kellert L, Herzberg M, Küpper C, Dimitriadis K, Ricke J, Puhr-Westerheide D, Liebig T, Kunz WG, Reidler P. CT after interhospital transfer in acute ischemic stroke: Imaging findings and impact of prior intravenous contrast administration. Front Neurol 2022; 13:1023147. [PMID: 36570440 PMCID: PMC9767970 DOI: 10.3389/fneur.2022.1023147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Large vessel occlusion (LVO) stroke patients routinely undergo interhospital transfer to endovascular thrombectomy capable centers. Imaging is often repeated with residual intravenous (IV) iodine contrast at post-transfer assessment. We determined imaging findings and the impact of residual contrast on secondary imaging. Anterior circulation LVO stroke patients were selected out of a consecutive cohort. Directly admitted patients were contrast naïve, and transferred patients had previously received IV iodine contrast for stroke assessment at the referring hospital. Two independent readers rated the visibility of residual contrast on non-contrast computed tomography (CT) after transfer and assessed the hyperdense vessel sign. Multivariate linear regression analysis was used to investigate the association of the Alberta Stroke Program Early CT score (ASPECTS) with prior contrast administration, time from symptom onset (TFSO), and CTP ischemic core volume in both directly admitted and transferred patients. Results We included 161 patients, with 62 (39%) transferred and 99 (62%) directly admitted patients. Compared between these groups, transferred patients had a longer TFSO-to-imaging at our institution (median: 212 vs. 75 min, p < 0.001) and lower ASPECTS (median: 8 vs. 9, p < 0.001). Regression analysis presented an independent association of ASPECTS with prior contrast administration (β = -0.25, p = 0.004) but not with TFSO (β = -0.03, p = 0.65). Intergroup comparison between transferred and directly admitted patients pointed toward a stronger association between ASPECTS and CTP ischemic core volume in transferred patients (β = -0.39 vs. β = -0.58, p = 0.06). Detectability of the hyperdense vessel sign was substantially lower after transfer (66 vs. 10%, p < 0.001). Conclusion Imaging alterations due to residual IV contrast are frequent in clinical practice and render the hyperdense vessel sign largely indetectable. Larger studies are needed to clarify the influence on the association between ASPECTS and ischemic core.
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Affiliation(s)
- Franziska Mueller
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Sophia Kiesl
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Moench
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research, LMU Munich, Munich, Germany
| | - Jan Rémi
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Lars Kellert
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Moriz Herzberg
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Clemens Küpper
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Konstantinos Dimitriadis
- Institute for Stroke and Dementia Research, LMU Munich, Munich, Germany,Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Thomas Liebig
- Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany,*Correspondence: Paul Reidler
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Wiegand TLT, Rémi J, Dimitriadis K. Electroencephalography in delirium assessment: a scoping review. BMC Neurol 2022; 22:86. [PMID: 35277128 PMCID: PMC8915483 DOI: 10.1186/s12883-022-02557-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/13/2022] [Indexed: 01/03/2023] Open
Abstract
Background Delirium is a common disorder affecting around 31% of patients in the intensive care unit (ICU). Delirium assessment scores such as the Confusion Assessment Method (CAM) are time-consuming, they cannot differentiate between different types of delirium and their etiologies, and they may have low sensitivities in the clinical setting. While today, electroencephalography (EEG) is increasingly being applied to delirious patients in the ICU, a lack of clear cut EEG signs, leads to inconsistent assessments. Methods We therefore conducted a scoping review on EEG findings in delirium. One thousand two hundred thirty-six articles identified through database search on PubMed and Embase were reviewed. Finally, 33 original articles were included in the synthesis. Results EEG seems to offer manifold possibilities in diagnosing delirium. All 33 studies showed a certain degree of qualitative or quantitative EEG alterations in delirium. Thus, normal routine (rEEG) and continuous EEG (cEEG) make presence of delirium very unlikely. All 33 studies used different research protocols to at least some extent. These include differences in time points, duration, conditions, and recording methods of EEG, as well as different patient populations, and diagnostic methods for delirium. Thus, a quantitative synthesis and common recommendations are so far elusive. Conclusion Future studies should compare the different methods of EEG recording and evaluation to identify robust parameters for everyday use. Evidence for quantitative bi-electrode delirium detection based on increased relative delta power and decreased beta power is growing and should be further pursued. Additionally, EEG studies on the evolution of a delirium including patient outcomes are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02557-w.
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Leitner MA, Hubert G, Paternoster L, Leitner M, Rémi J, Trumm C, Haberl R, Hubert N. Abstract TP158: High Mortality In In-Hospital-Stroke Patients After Interhospital Transfer For Endovascular Therapy. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are only few studies examining In-Hospital-Stroke- (IHS) patients with a large vessel occlusion and subsequent transfer to a comprehensive stroke center for endovascular therapy (EVT). However, this patient group is highly relevant given the substantial amount of IHS, the ongoing trend towards a more frequent use of EVT and the lack of EVT capacities in rural hospitals. Furthermore, these patients are particularly vulnerable, as IHS is associated with higher rates of pre-existing conditions and worse clinical outcomes. We retrospectively analyzed prospectively collected data of patients receiving EVT after interhospital transfer from 15 rural hospitals of the Telemedical Stroke Network in Southeast Bavaria, Germany (
TEMPiS
) between 02-2018 and 07-2020. Baseline characteristics, treatment times and outcomes were compared between IHS- and Out-of-Hospital-Stroke- (OHS) patients. Primary endpoint was mRS after 3 months. A total of 49 IHS-patients and 274 OHS-patients received EVT after interhospital transfer. IHS-patients had a higher prevalence of atrial fibrillation (55.3% vs. 35.9%, p= 0.012), diabetes (36.2% vs. 21.1%, p= 0.024) and use of oral anticoagulants (44.7% vs. 20.8%, p< 0.001). Severity of stroke was similar in both groups. Treatment times from symptom onset to first brain imaging, therapy decision or groin puncture were significantly shorter for IHS-patients. IHS-patients displayed significantly worse outcomes: 59.2% of them died within 3 months compared to only 28.5% of OHS-patients (p< 0.001). Additionally, they were less likely to achieve moderate outcomes (mRS 0-3) 3 months after stroke (20.4% vs. 39.8%, p= 0.010). A logistic regression analysis revealed that - after controlling for possible confounding variables such as severity of stroke, premorbid state, pre-existing conditions, age and gender - IHS was significantly associated with a higher chance of death (adjusted OR: 3.99 (95%-CI: 1.84-8.92), p< 0.001). The mortality rate of IHS-patients who underwent EVT after interhospital transfer was substantially higher than that of OHS-patients. Thus, this patient group may not benefit from this therapeutic approach. In future studies alternative approaches that circumvent interhospital transfer should be explored.
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Affiliation(s)
| | | | | | | | - Jan Rémi
- Neurology, LMU München, Munich, Germany
| | | | - Roman Haberl
- Neurology, München Klinik Harlaching, Munich, Germany
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Borggraefe I, Rémi J. Normvarianten im kindlichen EEG: Pitfalls in der Praxis. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1528-2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungNormvarianten sind nicht obligat auftretenden EEG-Veränderung. Die Kenntnis von Normvarianten ist wichtig, da sie sonst als pathologische Veränderungen fehlinterpretiert werden können. Daraus können klinisch falsche diagnostische und therapeutische Schlussfolgerungen entstehen. Die vorliegende Übersicht dient einer Zusammenfassung und Erläuterung der im Kindes- und Jugendalter auftretenden Normvarianten.
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Affiliation(s)
- Ingo Borggraefe
- Abteilung für Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, Dr. von Haunersches Kinderspital, LMU Klinikum München, München
- Interdiszipilnäres Epilepsiezentrum, LMU Klinikum München, München
| | - Jan Rémi
- Klinik für Neurologie, LMU Klinikum München, München
- Interdiszipilnäres Epilepsiezentrum, LMU Klinikum München, München
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12
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Seethaler M, Lauseker M, Ernst K, Rémi J, Vollmar C, Noachtar S, Kaufmann E. Hemispheric differences in the duration of focal onset seizures. Acta Neurol Scand 2021; 143:248-255. [PMID: 33011970 DOI: 10.1111/ane.13356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess hemispheric differences in the duration of focal onset seizures and its association with clinical and demographic factors. METHODS A retrospective analysis was performed on adult patients with drug-resistant unifocal epilepsy, who underwent intracranial EEG recording between 01/2006 and 06/2016. Seizure duration was determined based on the subdural and/or stereo-EEG (sEEG) recordings. Hemispheric differences in seizure duration were statistically evaluated with regard to clinical and demographic data. RESULTS In total, 69 patients and 654 focal onset seizures were included. The duration of seizures with left-hemispheric onset (n = 297) was by trend longer (91.88 ± 93.92 s) than of right-hemispheric seizures (n = 357; 71.03 ± 68.53 s; p = .193). Significant hemispheric differences in seizures duration were found in temporal lobe seizures (n = 225; p = .013), especially those with automotor manifestation (n = 156; p = .045). A prolonged duration was also found for left-hemispheric onset seizures with secondary generalized commencing during waking state (n = 225; p = .034), but not during sleep. A similar hemispheric difference in seizure duration was found in female patients (p = .040), but not in men. CONCLUSIONS Hemispheric differences in seizure duration were revealed with significantly longer durations in case of left-hemispheric seizure onset. The observed differences in seizure duration might result from brain asymmetry and add new aspects to the understanding of seizure propagation and termination.
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Affiliation(s)
- Magdalena Seethaler
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
- Department of Psychiatry and Psychotherapy Charité University Medicine and St. Hedwig Hospital Berlin Germany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and Epidemiology LMU Munich Munich Germany
| | - Katharina Ernst
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Jan Rémi
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Christian Vollmar
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Elisabeth Kaufmann
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
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13
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Rémi J, Noachtar S. Übersetzung der Standardisierten Terminologie für EEG
bei Intensivstationspatienten der American Clinical Neurophysiological Society:
Version 2012 (Hirsch et al. American Clinical Neurophysiology Society’s
Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol
2013; 30: 1–27). KLIN NEUROPHYSIOL 2020. [DOI: 10.1055/a-1304-8038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung2012 erarbeitete eine EEG-Expertengruppe der American Clinical Neurophysiology
Society (ACNS) eine standardisierte Terminologie für EEG Muster, die bei
kritisch kranken Patienten häufig sind. Bis dahin existierte keine
einheitlich akzeptierte Nomenklatur für diese EEG Muster, wie zum
Beispiel periodische Entladungen, fluktuierende rhythmische Muster und
Kombinationen der beiden. Dabei bestand auch kein Konsens welche Muster mit
welchem neuronalen Schaden korrelieren, welche Muster behandelt werden
müssen oder wie aggressiv die Behandlung erfolgen sollte. Um diese
Fragen anzugehen entwickelte diese Gruppe eine standardisierte Terminologie
zunächst für den wissenschaftlichen Einsatz. Ziel war es die
Kommunikation zu erleichtern, indem Begriffe mit klinischer Konnotation
vermieden wurden und um damit multizentrische Forschung zu erleichtern.
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Affiliation(s)
- J. Rémi
- Neurologische Klinik und Poliklinik, Klinikum Großhadern der
Ludwig-Maximilians-Universität München
| | - S. Noachtar
- Neurologische Klinik und Poliklinik, Klinikum Großhadern der
Ludwig-Maximilians-Universität München
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14
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Rémi J, Shen S, Tacke M, Probst P, Gerstl L, Peraud A, Kunz M, Vollmar C, Noachtar S, Borggraefe I. Congruence and Discrepancy of Interictal and Ictal EEG With MRI Lesions in Pediatric Epilepsies. Clin EEG Neurosci 2020; 51:412-419. [PMID: 32420750 PMCID: PMC7457449 DOI: 10.1177/1550059420921712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To evaluate the congruence or discrepancy of the localization of magnetic resonance imaging (MRI) lesions with interictal epileptiform discharges (IEDs) or epileptic seizure patterns (ESPs) in surface EEG in lesional pediatric epilepsy patients. Methods. We retrospectively analyzed presurgical MRI and video-EEG monitoring findings of patients up to age 18 years. Localization of MRI lesions were compared with ictal and interictal noninvasive EEG findings of patients with frontal, temporal, parietal, or occipital lesions. Results. A total of 71 patients were included. Localization of ESPs showed better congruence with MRI in patients with frontal lesions (n = 21, 77.5%) than in patients with temporal lesions (n = 24; 40.7%) (P = .009). No significant IED distribution differences between MRI localizations could be found. Conclusions. MRI lesions and EEG findings are rarely fully congruent. Congruence of MRI lesions and ESPs was highest in children with frontal lesions. This is in contrast to adults, in whom temporal lesions showed the highest congruency with the EEG localization of ESP. Lesional pediatric patients should be acknowledged as surgical candidates despite incongruent findings of interictal and ictal surface EEG.
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Affiliation(s)
- Jan Rémi
- Department of Neurology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany.,Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany
| | - Sophie Shen
- Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
| | - Moritz Tacke
- Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
| | - Philipp Probst
- Department of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany
| | - Lucia Gerstl
- Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
| | - Aurelia Peraud
- Department of Neurosurgery, Pediatric Section, University of Ulm, Ulm, Germany
| | - Mathias Kunz
- Department of Neurosurgery, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany.,Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany
| | - Soheyl Noachtar
- Department of Neurology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany.,Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany
| | - Ingo Borggraefe
- Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany.,Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
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15
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Nobili L, de Weerd A, Rubboli G, Beniczky S, Derry C, Eriksson S, Halasz P, Högl B, Santamaria J, Khatami R, Ryvlin P, Rémi J, Tinuper P, Bassetti C, Manni R, Koutroumanidis M, Vignatelli L. Standard procedures for the diagnostic pathway of sleep-related epilepsies and comorbid sleep disorders: A European Academy of Neurology, European Sleep Research Society and International League against Epilepsy-Europe consensus review. J Sleep Res 2020; 29:e13184. [PMID: 32959468 DOI: 10.1111/jsr.13184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Some epilepsy syndromes (sleep-related epilepsies [SRE]) have a strong link with sleep. Comorbid sleep disorders are common in patients with SRE and can exert a negative impact on seizure control and quality of life. PURPOSES To define the standard procedures for the diagnostic pathway of patients with possible SRE (scenario 1) and the general management of patients with SRE and comorbidity with sleep disorders (scenario 2). METHODS The project was conducted under the auspices of the European Academy of Neurology (EAN), the European Sleep Research Society (ESRS) and the International League against Epilepsy (ILAE) Europe. The framework of the document entailed the following phases: conception of the clinical scenarios; literature review; statements regarding the standard procedures. For literature search a step-wise approach starting from systematic reviews to primary studies was applied. Published studies were identified from the National Library of Medicine's MEDLINE database and Cochrane Library. RESULTS Scenario 1: despite a low quality of evidence, recommendations on anamnestic evaluation, tools for capturing the event at home or in the laboratory are provided for specific SRE. Scenario 2: Early diagnosis and treatment of sleep disorders (especially respiratory disorders) in patients with SRE are likely to be beneficial for seizures control. CONCLUSIONS Definitive procedures for evaluating patients with SRE are lacking. We provide advice that could be of help for standardising and improving the diagnostic approach of specific SRE. The importance of identifying and treating specific sleep disorders for the management and outcome of patients with SRE is underlined.
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Affiliation(s)
- Lino Nobili
- Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy.,Department of Neuroscience - Rehabilitation-Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Guido Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Sofia Eriksson
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK
| | - Peter Halasz
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Multidisciplinary Sleep Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Ramin Khatami
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Barmelweid Academy, Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid, Barmelweid, Switzerland
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jan Rémi
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - Claudio Bassetti
- Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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16
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Nobili L, de Weerd A, Rubboli G, Beniczky S, Derry C, Eriksson S, Halasz P, Högl B, Santamaria J, Khatami R, Ryvlin P, Rémi J, Tinuper P, Bassetti C, Manni R, Koutroumanidis M, Vignatelli L. Standard procedures for the diagnostic pathway of sleep-related epilepsies and comorbid sleep disorders: an EAN, ESRS and ILAE-Europe consensus review. Eur J Neurol 2020; 28:15-32. [PMID: 32959446 DOI: 10.1111/ene.14468] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/01/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Some epilepsy syndromes (sleep-related epilepsies, SREs) have a strong link with sleep. Comorbid sleep disorders are common in patients with SRE and can exert a negative impact on seizure control and quality of life. Our purpose was to define the standard procedures for the diagnostic pathway of patients with possible SRE (scenario 1) and the general management of patients with SRE and comorbidity with sleep disorders (scenario 2). METHODS The project was conducted under the auspices of the European Academy of Neurology, the European Sleep Research Society and the International League Against Epilepsy Europe. The framework entailed the following phases: conception of the clinical scenarios; literature review; statements regarding the standard procedures. For the literature search a stepwise approach starting from systematic reviews to primary studies was applied. Published studies were identified from the National Library of Medicine's MEDLINE database and Cochrane Library. RESULTS Scenario 1: Despite a low quality of evidence, recommendations on anamnestic evaluation and tools for capturing the event at home or in the laboratory are provided for specific SREs. Scenario 2: Early diagnosis and treatment of sleep disorders (especially respiratory disorders) in patients with SRE are likely to be beneficial for seizure control. CONCLUSIONS Definitive procedures for evaluating patients with SRE are lacking. Advice is provided that could be of help for standardizing and improving the diagnostic approach of specific SREs. The importance of identifying and treating specific sleep disorders for the management and outcome of patients with SRE is underlined.
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Affiliation(s)
- L Nobili
- Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy.,Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genoa, Italy
| | - A de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, The Netherlands
| | - G Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - S Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - C Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - S Eriksson
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK
| | - P Halasz
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - B Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Santamaria
- Multidisciplinary Sleep Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - R Khatami
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Barmelweid Academy, Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid AG, Barmelweid, Switzerland
| | - P Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - J Rémi
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - P Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - C Bassetti
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
| | - R Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - M Koutroumanidis
- Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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17
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Reidler P, Stueckelschweiger L, Puhr-Westerheide D, Feil K, Kellert L, Dimitriadis K, Tiedt S, Herzberg M, Rémi J, Liebig T, Fabritius MP, Kunz WG. Performance of Automated Attenuation Measurements at Identifying Large Vessel Occlusion Stroke on CT Angiography. Clin Neuroradiol 2020; 31:763-772. [PMID: 32939563 PMCID: PMC8463515 DOI: 10.1007/s00062-020-00956-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Computed tomography angiography (CTA) is routinely used to detect large-vessel occlusion (LVO) in patients with suspected acute ischemic stroke; however, visual analysis is time consuming and prone to error. To evaluate solutions to support imaging triage, we tested performance of automated analysis of CTA source images (CTASI) at identifying patients with LVO. METHODS Stroke patients with LVO were selected from a prospectively acquired cohort. A control group was selected from consecutive patients with clinically suspected stroke without signs of ischemia on CT perfusion (CTP) or infarct on follow-up. Software-based automated segmentation and Hounsfield unit (HU) measurements were performed on CTASI for all regions of the Alberta Stroke Program Early CT score (ASPECTS). We derived different parameters from raw measurements and analyzed their performance to identify patients with LVO using receiver operating characteristic curve analysis. RESULTS The retrospective analysis included 145 patients, 79 patients with LVO stroke and 66 patients without stroke. The parameters hemispheric asymmetry ratio (AR), ratio between highest and lowest regional AR and M2-territory AR produced area under the curve (AUC) values from 0.95-0.97 (all p < 0.001) for detecting presence of LVO in the total population. Resulting sensitivity (sens)/specificity (spec) defined by the Youden index were 0.87/0.97-0.99. Maximum sens/spec defined by the specificity threshold ≥0.70 were 0.91-0.96/0.77-0.83. Performance in a small number of patients with isolated M2 occlusion was lower (AUC: 0.72-0.85). CONCLUSION Automated attenuation measurements on CTASI identify proximal LVO stroke patients with high sensitivity and specificity. This technique can aid in accurate and timely patient selection for thrombectomy, especially in primary stroke centers without CTP capacity.
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Affiliation(s)
- Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Lena Stueckelschweiger
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Daniel Puhr-Westerheide
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Katharina Feil
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Lars Kellert
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Konstantinos Dimitriadis
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Stroke and Dementia Research, LMU Munich, Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research, LMU Munich, Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - Moriz Herzberg
- Department of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jan Rémi
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias P Fabritius
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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18
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Feil K, Rémi J, Küpper C, Herzberg M, Dorn F, Kunz WG, Reidler P, Levin J, Hüttemann K, Tiedt S, Heidger W, Müller K, Thunstedt DC, Dabitz R, Müller R, Pfefferkorn T, Hamann GF, Liebig T, Dieterich M, Kellert L. Inter-hospital transfer for mechanical thrombectomy within the supraregional stroke network NEVAS. J Neurol 2020; 268:623-631. [PMID: 32889616 PMCID: PMC7880976 DOI: 10.1007/s00415-020-10165-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
Background Telemedicine stroke networks are mandatory to provide inter-hospital transfer for mechanical thrombectomy (MT). However, studies on patient selection in daily practice are sparse. Methods Here, we analyzed consecutive patients from 01/2014 to 12/2018 within the supraregional stroke network “Neurovascular Network of Southwest Bavaria” (NEVAS) in terms of diagnoses after consultation, inter-hospital transfer and predictors for performing MT. Degree of disability was rated by the modified Rankin Scale (mRS), good outcome was defined as mRS ≤ 2. Successful reperfusion was assumed when the modified thrombolysis in cerebral infarction (mTICI) was 2b-3. Results Of 5722 telemedicine consultations, in 14.1% inter-hospital transfer was performed, mostly because of large vessel occlusion (LVO) stroke. A total of n = 350 patients with LVO were shipped via NEVAS to our center for MT. While n = 52 recanalized spontaneously, MT-treatment was performed in n = 178 patients. MT-treated patients had more severe strokes according to the median National institute of health stroke scale (NIHSS) (16 vs. 13, p < 0.001), were more often treated with intravenous thrombolysis (64.5% vs. 51.7%, p = 0.026) and arrived significantly earlier in our center (184.5 versus 228.0 min, p < 0.001). Good outcome (27.5% vs. 30.8%, p = 0.35) and mortality (32.6% versus 23.5%, p = 0.79) were comparable in MT-treated versus no-MT-treated patients. In patients with middle cerebral artery occlusion in the M1 segment or carotid artery occlusion good outcome was twice as often in the MT-group (21.8% vs. 12.8%, p = 0.184). Independent predictors for performing MT were higher NIHSS (OR 1.096), higher ASPECTS (OR 1.28), and earlier time window (OR 0.99). Conclusion Within a telemedicine network stroke care can successfully be organized as only a minority of patients has to be transferred. Our data provide clinical evidence that all MT-eligible patients should be shipped with the fastest transportation modality as possible.
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Affiliation(s)
- Katharina Feil
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilian University (LMU), Munich, Germany
| | - Jan Rémi
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Clemens Küpper
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Moriz Herzberg
- Institute of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Franziska Dorn
- Institute of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Paul Reidler
- Department of Radiology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Katrin Hüttemann
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research, Ludwig Maximilian University (LMU), Munich, Germany
| | - Wanja Heidger
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Katharina Müller
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Dennis C Thunstedt
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Rainer Dabitz
- Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Robert Müller
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | | | - Gerhard F Hamann
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilian University (LMU), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.
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Affiliation(s)
- Jan Rémi
- Klinikum Großhadern d. LMU München, Marchioninistr. 15, 81377, München, Germany.
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20
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Reidler P, Puhr-Westerheide D, Rotkopf L, Fabritius MP, Feil K, Kellert L, Tiedt S, Rémi J, Liebig T, Kunz WG. Cerebral attenuation on single-phase CT angiography source images: Automated ischemia detection and morphologic outcome prediction after thrombectomy in patients with ischemic stroke. PLoS One 2020; 15:e0236956. [PMID: 32790766 PMCID: PMC7425881 DOI: 10.1371/journal.pone.0236956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives Stroke triage using CT perfusion (CTP) or MRI gained importance after successful application in recent trials on late-window thrombectomy but is often unavailable and time-consuming. We tested the clinical value of software-based analysis of cerebral attenuation on Single-phase CT angiography source images (CTASI) as CTP surrogate in stroke patients. Methods Software-based automated segmentation and Hounsfield unit (HU) measurements for all regions of the Alberta Stroke Program Early CT Score (ASPECTS) on CTASI were performed in patients with large vessel occlusion stroke who underwent thrombectomy. To normalize values, we calculated relative HU (rHU) as ratio of affected to unaffected hemisphere. Ischemic regions, regional ischemic core and final infarction were determined on simultaneously acquired CTP and follow-up imaging as ground truth. Receiver operating characteristics analysis was performed to calculate the area-under-the-curve (AUC). Resulting cut-off values were used for comparison with visual analysis and to calculate an 11-point automated CTASI ASPECTS. Results Seventy-nine patients were included. rHU values enabled significant classification of ischemic involvement on CTP in all ten regions of the ASPECTS (each p<0.001, except M4-cortex p = 0.002). Classification of ischemic core and prediction of final infarction had best results in subcortical regions but produced lower AUC values with significant classification for all regions except M1, M3 and M5. Relative total hemispheric attenuation provided strong linear correlation with CTP total ischemic volume. Automated classification of regional ischemia on CTASI was significantly more accurate in most regions and provided better agreement with CTP cerebral blood flow ASPECTS than visual assessment. Conclusions Automated attenuation measurements on CTASI provide excellent performance in detecting acute ischemia as identified on CTP with improved accuracy compared to visual analysis. However, value for the approximation of ischemic core and morphologic outcome in large vessel occlusion stroke after thrombectomy was regionally dependent and limited. This technique has the potential to facilitate stroke imaging as sensitive surrogate for CTP-based ischemia.
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Affiliation(s)
- Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- * E-mail:
| | | | - Lukas Rotkopf
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Katharina Feil
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU Munich, Munich, Germany
| | - Lars Kellert
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research, LMU Munich, Munich, Germany
| | - Jan Rémi
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Kaufmann E, Seethaler M, Lauseker M, Fan M, Vollmar C, Noachtar S, Rémi J. Who seizes longest? Impact of clinical and demographic factors. Epilepsia 2020; 61:1376-1385. [DOI: 10.1111/epi.16577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Elisabeth Kaufmann
- Department of Neurology Epilepsy Center University HospitalLudwig Maximilian University of Munich Munich Germany
| | - Magdalena Seethaler
- Department of Neurology Epilepsy Center University HospitalLudwig Maximilian University of Munich Munich Germany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and Epidemiology Ludwig Maximilian University of Munich Munich Germany
| | - Min Fan
- Institute for Medical Information Processing, Biometry, and Epidemiology Ludwig Maximilian University of Munich Munich Germany
| | - Christian Vollmar
- Department of Neurology Epilepsy Center University HospitalLudwig Maximilian University of Munich Munich Germany
| | - Soheyl Noachtar
- Department of Neurology Epilepsy Center University HospitalLudwig Maximilian University of Munich Munich Germany
| | - Jan Rémi
- Department of Neurology Epilepsy Center University HospitalLudwig Maximilian University of Munich Munich Germany
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Palmini A, Akamatsu N, Bast T, Bauer S, Baumgartner C, Benbadis S, Bermeo-Ovalle A, Beyenburg S, Bleasel A, Bozorgi A, Brázdil M, Carreño M, Delanty N, Devereaux M, Duncan JS, Fernandez-Baca Vaca G, García Losarcos N, Ghanma L, Gil-Nagel A, Hamer H, Holthausen H, Omidi SJ, Kahane P, Kalamangalam G, Kanner A, Knake S, Kovac S, Kraemer G, Kurlemann G, Lacuey N, Landazuri P, Hui Lim S, LoRusso G, Luders H, Mani J, Matsumoto R, Miller J, Noachtar S, O'Dwyer R, Park J, Reif PS, Rémi J, Rosenow F, Sakamoto A, Schubert-Bast S, Schuele S, Shahid A, Steinhoff JB, Strzelczyk A, Szabó CÁ, Tandon N, Terada K, Toledo M, van Emde Boas W, Walker M, Widdess-Walsh P. From theory to practice: Critical points in the 2017 ILAE classification of epileptic seizures and epilepsies. Epilepsia 2020; 61:350-353. [PMID: 32073153 DOI: 10.1111/epi.16426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- André Palmini
- Department of Clinical Neurosciences, School of Medicine, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Porto Alegre Epilepsy Surgery Program, Hospital São Lucas, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Naoki Akamatsu
- Department of Neurology, School of Medicine, International University of Health and Welfare, Fukuoka, Japan
| | - Thomas Bast
- Epilepsy Center Kork, Kehl, Germany.,Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Center for Personalized Translational Epilepsy Research (CePTER), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing With Neurological Center Rosenhuegel, Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Selim Benbadis
- University of South Florida and Tampa General Hospital, Tampa, Florida
| | - Adriana Bermeo-Ovalle
- Department of Neurological Sciences, Section of Epilepsy, Rush University Medical Center, Chicago, Illinois
| | - Stefan Beyenburg
- Department of Neurosciences, Neurology Department, Luxembourg Hospital Center, Luxembourg City, Luxembourg
| | - Andrew Bleasel
- Westmead Clinical School, University of Sydney, Wentworthville, New South Wales, Australia
| | | | - Milan Brázdil
- Brno Epilepsy Center, Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Mar Carreño
- Epilepsy Unit, Hospital Clinic, Barcelona, Spain
| | - Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Michael Devereaux
- Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - John S Duncan
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Guadalupe Fernandez-Baca Vaca
- Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Naiara García Losarcos
- Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Lauren Ghanma
- Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Hajo Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Hans Holthausen
- Epilepsy Center Vogtareuth, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Shirin J Omidi
- Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Philippe Kahane
- Neurology Department, Grenoble University Hospital, Grenoble, France
| | - Giri Kalamangalam
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Andrés Kanner
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Susanne Knake
- Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Stjepana Kovac
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | | | | | - Nuria Lacuey
- Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Patrick Landazuri
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Shih Hui Lim
- National Neuroscience Institute, Duke-National University of Singapore Medical School, Singapore
| | - Giorgio LoRusso
- "Claudio Munari" Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Hans Luders
- Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jayanti Mani
- Department of Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jonathan Miller
- Functional and Restorative Neurosurgery Center, Department of Neurological Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig Maximilian University, Munich, Germany
| | - Rebecca O'Dwyer
- Epilepsy Section, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Jun Park
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Center for Personalized Translational Epilepsy Research (CePTER), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Center for Personalized Translational Epilepsy Research (CePTER), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan Rémi
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Center for Personalized Translational Epilepsy Research (CePTER), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Americo Sakamoto
- Department of Neurology, University of São Paulo at Ribeirão Preto, Ribeirão Preto, Brazil
| | - Susanne Schubert-Bast
- Epilepsy Center, Department of Neuropediatrics and Epilepsy Center Frankfurt Rhine-Main, University Children's Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Stephan Schuele
- Epilepsy Section, Neurological Testing Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Asim Shahid
- Epilepsy Center, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - J Bernhard Steinhoff
- Epilepsy Center Kork, Kehl, Germany.,Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Adam Strzelczyk
- Department of Neurology, University of São Paulo at Ribeirão Preto, Ribeirão Preto, Brazil
| | | | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School, Texas Institute of Restorative Neurotechnologies, UT Health AND Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Kiyohito Terada
- Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Manuel Toledo
- Epilepsy Unit, Vall d´Hebron University Hospital, Barcelona, Spain
| | - Walter van Emde Boas
- Formerly Director of Department of Electroencephalography and Epilepsy Monitoring Unit, Stichting Epilepsie Instellingen Nederland, Heemstede and Zwolle, the Netherlands
| | - Matthew Walker
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Peter Widdess-Walsh
- "Claudio Munari" Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Affiliation(s)
- Jan Rémi
- *Neurologische Klinik und Poliklinik, LMU München
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Sykora M, Kellert L, Michel P, Eskandari A, Feil K, Rémi J, Ferrari J, Krebs S, Lang W, Serles W, Siarnik P, Turcani P, Kovacik M, Bender B, Mengel A, Poli K, Poli S. Thrombolysis in Stroke With Unknown Onset Based on Non-Contrast Computerized Tomography (TRUST CT). J Am Heart Assoc 2020; 9:e014265. [PMID: 32067594 PMCID: PMC7070213 DOI: 10.1161/jaha.119.014265] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intravenous thrombolysis (IVT) in wake‐up stroke (WUS) or stroke with unknown onset (SUO) has been recently proven to be safe and effective using advanced neuroimaging (magnetic resonance imaging or computerized tomography‐perfusion) for patient selection. However, in most of the thrombolyzing centers advanced neuroimaging is not instantly available. We hypothesize that pragmatic non‐contrast computed tomography‐based IVT in WUS/SUO may be feasible and safe. Methods and Results TRUST‐CT (Thrombolysis in Stroke With Unknown Onset Based on Non‐Contrast Computerized Tomography) is an international multicenter registry‐based study. WUS/SUO patients undergoing non‐contrast computed tomography‐based IVT with National Institute of Health Stroke Scale ≥4 and initial Alberta Stroke Program Early Computerized Tomography score ≥7 were included and compared with propensity score matched non‐thrombolyzed WUS/SUO controls. Primary end point was the incidence of symptomatic intracranial hemorrhage; secondary end points included 24‐hour National Institute of Health Stroke Scale improvement of ≥4 and modified Rankin Scale at 90 days. One hundred and seventeen WUS/SUO patients treated with non‐contrast computed tomography‐based IVT were included. As compared with 112 controls, the median admission National Institute of Health Stroke Scale was 10 and the median Alberta Stroke Program Early Computerized Tomography score was 10 in both groups. Four (3.4%) IVT patients and one control patient (0.9%) suffered symptomatic intracranial hemorrhage (adjusted odds ratio 7.9, 95% CI 0.65–96, P=0.1). A decrease of ≥4 National Institute of Health Stroke Scale points was observed in 67 (57.3%) of IVT patients as compared with 25 (22.3%) in controls (adjusted odds ratio 5.8, CI 3.0–11.2, P<0.001). A months, 39 (33.3%) IVT patients reached a modified Rankin Scale score of 0 or 1 versus 23 (20.5%) controls (adjusted odds ratio 1.94, CI 1.0–3.76, P=0.05). Conclusions Non‐contrast computed tomography‐based thrombolysis in WUS/SUO seems feasible and safe and may be effective. Randomized prospective comparisons are warranted. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT03634748.
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Affiliation(s)
- Marek Sykora
- Department of Neurology St. John's Hospital Medical faculty Sigmund Freud University Vienna Austria
| | - Lars Kellert
- Department of Neurology Ludwig Maximilians University Munich Germany
| | - Patrik Michel
- Stroke Center, Neurology Service Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
| | - Ashraf Eskandari
- Stroke Center, Neurology Service Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
| | - Katharina Feil
- Department of Neurology Ludwig Maximilians University Munich Germany.,German Center for Vertigo and Balance Disorders Ludwig Maximilians University Munich Germany
| | - Jan Rémi
- Department of Neurology Ludwig Maximilians University Munich Germany
| | - Julia Ferrari
- Department of Neurology St. John's Hospital Medical faculty Sigmund Freud University Vienna Austria
| | - Stefan Krebs
- Department of Neurology St. John's Hospital Medical faculty Sigmund Freud University Vienna Austria
| | - Wilfried Lang
- Department of Neurology St. John's Hospital Medical faculty Sigmund Freud University Vienna Austria
| | | | - Pavel Siarnik
- Department of Neurology Comenius University Bratislava Slovakia
| | - Peter Turcani
- Department of Neurology Comenius University Bratislava Slovakia
| | - Michal Kovacik
- Department of Neurology General Hospital Liptovsky Mikulas Slovakia
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology University Hospital Tübingen Germany
| | - Annerose Mengel
- Department of Neurology with Focus on Neurovascular Diseases and Neurooncology and Hertie Institute for Clinical Brain Research University Hospital Tübingen Germany
| | - Khouloud Poli
- Department of Neurology with Focus on Neurovascular Diseases and Neurooncology and Hertie Institute for Clinical Brain Research University Hospital Tübingen Germany
| | - Sven Poli
- Department of Neurology with Focus on Neurovascular Diseases and Neurooncology and Hertie Institute for Clinical Brain Research University Hospital Tübingen Germany
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Feil K, Rémi J, Küpper C, Herzberg M, Dorn F, Kunz WG, Rotkopf LT, Heinrich J, Müller K, Laub C, Levin J, Hüttemann K, Dabitz R, Müller R, Wollenweber FA, Pfefferkorn T, Hamann GF, Liebig T, Dieterich M, Kellert L. Drip and ship for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria. Neurology 2019; 94:e453-e463. [DOI: 10.1212/wnl.0000000000008753] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/23/2019] [Indexed: 01/07/2023] Open
Abstract
ObjectiveTo determine feasibility and safety of stroke care organization within our Neurovascular Network of Southwest Bavaria (NEVAS) in a rural area with distances of up to 100 kilometers, we compared patients who underwent mechanical thrombectomy (MT) in large vessel occlusion admitted directly to our center (direct to center [DTC]) to patients who were transferred for MT via NEVAS (drip and ship [DS]).MethodsThis is a retrospective analysis of prospectively collected data of all MT patients between January 2015 and May 2018. Successful recanalization was defined as a thrombolysis in cerebral infarction score of 2b-3. Symptomatic intracerebral hemorrhage (sICH) was defined according to European Cooperative Acute Stroke Study 3. Modified Rankin Scale (mRS) score of 0–2 at 3 months indicated good outcome.ResultsMT was performed in 410 patients: 221 DTC and 189 DS. Median NIH Stroke Scale (NIHSS) score was 16 and premorbid mRS score was 0. Thrombolysis was applied in 62.2% with the same time from symptom onset in both groups (94.5 vs 95 minutes). Successful recanalization (79.3% vs 77.8%) and NIHSS score reduction from admission to discharge (16–7 vs 17–6) were comparable. Time delay from onset to revascularization was 96 minutes in DS (212 vs 308 minutes, p = 0.001). At follow-up, DTC patients had a trend to better outcome (33.5% vs 24.3%, p = 0.056). Neither sICH (6.3% vs 5.9%, p = 0.840) nor mortality (31.2% vs 34.4%, p = 0.387) differed between the groups.ConclusionDS patients benefit from MT without relevant safety concerns, but with a trend to unfavorable outcome compared to DTC patients. These results suggest that DS is suitable to provide MT in rural areas where DTC is not possible.
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Rémi J, Pollmächer T, Spiegelhalder K, Trenkwalder C, Young P. Sleep-Related Disorders in Neurology and Psychiatry. Dtsch Arztebl Int 2019; 116:681-688. [PMID: 31709972 PMCID: PMC6865193 DOI: 10.3238/arztebl.2019.0681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/07/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sleep-related disorders are a group of illnesses with marked effects on patients' quality of life and functional ability. Their diagnosis and treatment is a matter of common interest to multiple medical disciplines. METHODS This review is based on relevant publications retrieved by a selective search in PubMed (Medline) and on the guide- lines of the German Society for Sleep Medicine, the German Neurological Society, and the German Association for Psychiatry, Psychotherapy and Psychosomatics. RESULTS A pragmatic classification of sleep disorders by their three chief complaints-insomnia, daytime somnolence, and sleep-associated motor phenomena-enables tentative diagnoses that are often highly accurate. Some of these disorders can be treated by primary care physicians, while others call for referral to a neurologist or psychiatrist with special experience in sleep medicine. For patients suffering from insomnia as a primary sleep disorder, rather than a symptom of another disease, meta-analyses have shown the efficacy of cognitive behavioral therapy, with high average effect sizes. These patients, like those suffering from secondary sleep disorders, can also benefit from drug treatment for a limited time. Studies have shown marked improvement of sleep latency and sleep duration from short-term treatment with benzodiazepines and Z-drugs (non- benzodiazepine agonists such as zolpidem and zopiclone), but not without a risk of tolerance and dependence. For sleep disorders with the other two main manifestations, specific drug therapy has been found to be beneficial. CONCLUSION Sleep disorders in neurology and psychiatry are a heterogeneous group of disorders with diverse manifestations. Their proper diagnosis and treatment can help prevent secondary diseases and the worsening of concomitant conditions. Care structures for the treatment of sleep disorders should be further developed.
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Affiliation(s)
- Jan Rémi
- Department of Neurology, Medical Center of the Ludwig-Maximilians–University of Munich (LMU), Germany
| | | | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Medical Faculty, University of Freiburg, Germany
| | - Claudia Trenkwalder
- Center of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany and Department of Neurosurgery, University Medical Center Göttingen, Germany
| | - Peter Young
- Specialized Clinic for Therapies in Neurology, Medical Park Reithofpark, Bad Feilnbach, Germany
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Rémi J, Loesch-Biffar AM, Mehrkens J, Thon N, Seelos K, Pfister HW. Stenotrophomonas maltophilia brain abscesses after implantation of motor cortex stimulator. J Neurol Sci 2019; 400:32-33. [DOI: 10.1016/j.jns.2019.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 11/25/2022]
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Hartl E, Seethaler M, Lauseker M, Rémi J, Vollmar C, Noachtar S. Impact of withdrawal of antiepileptic medication on the duration of focal onset seizures. Seizure 2019; 67:40-44. [DOI: 10.1016/j.seizure.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/11/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022] Open
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Rémi J, Bubeck C, Hartl E, Tezer FI, Noachtar S. Sleep spindle reduction precedes seizures by several epochs. Clin Neurophysiol 2018; 129:1624-1625. [DOI: 10.1016/j.clinph.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/16/2018] [Accepted: 05/04/2018] [Indexed: 11/16/2022]
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Hartl E, Knoche T, Choupina H, Rémi J, Vollmar C, Cunha J, Noachtar S. Quantitative and qualitative analysis of ictal vocalization in focal epilepsy syndromes. Seizure 2018; 60:178-183. [DOI: 10.1016/j.seizure.2018.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022] Open
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Vollmar C, Stredl I, Heinig M, Noachtar S, Rémi J. Unilateral temporal interictal epileptiform discharges correctly predict the epileptogenic zone in lesional temporal lobe epilepsy. Epilepsia 2018; 59:1577-1582. [PMID: 30009572 DOI: 10.1111/epi.14514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 06/19/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the necessity of recording ictal electroencephalography (EEG) in patients with temporal lobe epilepsy (TLE) considered for resective surgery who have unilateral temporal interictal epileptiform discharges (IEDs) and concordant ipsitemporal magnetic resonance imaging (MRI) pathology. To calculate the necessary number of recorded EEG seizure patterns (ESPs) to achieve adequate lateralization probability. METHODS In a retrospective analysis, the localization and lateralization of interictal and ictal EEG of 304 patients with lesional TLE were analyzed. The probability of further contralateral ESPs was calculated based on a total of 1967 recorded ESPs, using Bayes' theorem. RESULTS Two hundred seventy-one patients had unilateral TLE, and in 98% of them (265 of 271), IEDs were recorded during video-EEG monitoring. Purely unilateral temporal IEDs were present in 61% (166 of 271 patients). Ipsilateral temporal MRI pathology was found in 83% (138 of 166). Ictal EEG was concordant with the clinical side of TLE in 99% (136 of 138) of these patients. Two patients had discordant ictal EEG with both ipsilateral and contralateral ESPs. Epilepsy surgery with resection in the lesioned temporal lobe was still performed, and both patients remain seizure-free. Probability calculations demonstrate that at least 6 recorded unilateral ESPs result in a >95% probability for a concordance of >0.9 of any further ESPs. SIGNIFICANCE The combination of purely unilateral temporal IED with ipsitemporal MRI pathology is sufficient to identify the epileptogenic zone, and the recording of ictal ESP did not add any surgically relevant information in these 138 patients. Rarely, discordant ESPs might be recorded, but the surgical outcome remains excellent after surgery on the lesioned side.
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Affiliation(s)
- Christian Vollmar
- Epilepsy Center, Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Iris Stredl
- Epilepsy Center, Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Heinig
- Institute of Computational Biology, Helmholtz Center for Environmental Health, Munich, Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Jan Rémi
- Epilepsy Center, Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Baysal-Kirac L, Feddersen B, Einhellig M, Rémi J, Noachtar S. Does semiology of status epilepticus have an impact on treatment response and outcome? Epilepsy Behav 2018; 83:81-86. [PMID: 29660507 DOI: 10.1016/j.yebeh.2018.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study investigated whether there is an association between semiology of status epilepticus (SE) and response to treatment and outcome. METHOD Two hundred ninety-eight consecutive adult patients (160 females, 138 males) with SE at the University of Munich Hospital were prospectively enrolled. Mean age was 63.2±17.5 (18-97) years. Patient demographics, SE semiology and electroencephalography (EEG) findings, etiology, duration of SE, treatment, and outcome measures were investigated. Status epilepticus semiology was classified according to a semiological status classification. Patient's short-term outcome was determined by Glasgow Outcome Scale (GOS). RESULTS The most frequent SE type was nonconvulsive SE (NCSE) (39.2%), mostly associated with cerebrovascular etiology (46.6%). A potentially fatal etiology was found in 34.8% of the patients. More than half (60.7%) of the patients had poor short-term outcome (GOS≤3) with an overall mortality of 12.4%. SE was refractory to treatment in 21.5% of the patients. Older age, potentially fatal etiology, systemic infections, NCSE in coma, refractory SE, treatment with anesthetics, long SE duration (>24h), low Glasgow Coma Scale (GCS) (≤8) at onset, and high Status Epilepticus Severity Score (STESS-3) (≥3) were associated with poor short-term outcome and death (p<0.05). Potentially fatal etiology and low GCS were the strongest predictors of poor outcome (Exp [b]: 4.74 and 4.10 respectively, p<0.05). CONCLUSION Status epilepticus semiology has no independent association with outcome, but potentially fatal etiology and low GCS were strong predictive factors for poor short-term outcome of SE.
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Affiliation(s)
- Leyla Baysal-Kirac
- Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany
| | - Berend Feddersen
- Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany
| | - Marion Einhellig
- Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany
| | - Jan Rémi
- Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany.
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Franco AC, Kremmyda O, Rémi J, Noachtar S. Positive interictal epileptiform discharges in adults: A case series of a rare phenomenon. Clin Neurophysiol 2018; 129:952-955. [PMID: 29554576 DOI: 10.1016/j.clinph.2018.01.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/30/2017] [Accepted: 01/24/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Positive interictal epileptiform discharges (IEDs) are rarely recorded from surface EEG, due to the orientation of the cortex and its neurons. Their frequency and significance in adults is unknown, and has only been studied as a phenomenon of the neonatal period and childhood. We aimed to evaluate the frequency and characteristics of positive epileptiform discharges in a large cohort of patients. METHODS We retrospectively reviewed 24,178 reports from 18,060 patients of non-invasively recorded EEGs for various indications. RESULTS Positive IEDs were recorded in six patients (eight EEGs - 0.033%), all of which had epileptic seizures. Brain surgery was the most common reason for recording positive and not negative IEDs. Cortical malformation was the most probable etiology in the remaining patients. CONCLUSIONS Positive IEDs seem to be of lower frequency in adults than in children and are highly associated with epilepsy. They appear more often, but not exclusively, in adult patients with skull defects. SIGNIFICANCE This is the first adult series reported. Positive IEDs must be identified for the correct diagnosis and clearly differentiated from normal variants.
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Affiliation(s)
- Ana Catarina Franco
- Epilepsy Center, Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Olympia Kremmyda
- Epilepsy Center, Department of Neurology, Ludwig Maximilians University, Munich, Germany.
| | - Jan Rémi
- Epilepsy Center, Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Rémi J, Bötzel K. [Parasomnia and paroxysmal dyskinesia]. Nervenarzt 2017; 88:1141-1146. [PMID: 28831514 DOI: 10.1007/s00115-017-0400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Short involuntary paroxysmal movements or behavioral patterns are an important differential diagnosis to epileptic seizures, especially when occurring for the first time. Typically, these attacks are not witnessed by medically trained personnel and the patient anamnesis or observations by a third party are often not specific enough to differentiate between epileptic seizures and the differential diagnoses. This review presents the epidemiology, the clinical presentation, the necessary diagnostic steps and the differential diagnostic approach to parasomnias and dyskinesias. The focus is on the clinical aspects, and therapeutic principles are also briefly described.
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Affiliation(s)
- J Rémi
- Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland.
| | - K Bötzel
- Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland
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Tacke M, Neubauer BA, Gerstl L, Roser T, Rémi J, Borggraefe I. [Epilepsy-new diagnostic tools, old drugs? : Therapeutic consequences of epilepsy genetics]. Nervenarzt 2017; 88:1385-1394. [PMID: 28932874 DOI: 10.1007/s00115-017-0427-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent advances in the field of epilepsy genetics have led to an increased fraction of patients with epilepsies where the etiology of the disease could be identified. Nevertheless, there is some criticism regarding the use of epilepsy genetics because in many cases the identification of a pathogenetic mutation does not lead to an adaptation of therapy or to an improved prognosis. In addition, the interpretation of genetic results might be complicated due to the considerable numbers of variants of unclear significance. OBJECTIVE This publication presents the arguments in favour of a broad use of genetic investigations for children with epilepsies. Several diseases where a genetic diagnosis does in fact have direct therapeutic consequences are mentioned. In addition, the indirect impact of an established etiology, encompassing the avoidance of unnecessary diagnostic measures, possibility of genetic counselling, and the easing of the psychologic burden for the caregivers, should not be underestimated. CONCLUSION The arguments in favour of broad genetic diagnostics prevail notwithstanding the lack of relevant new developments regarding the therapy.
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Affiliation(s)
- M Tacke
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Sektion für Pädiatrische Epileptologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - B A Neubauer
- Abteilung für Neuropädiatrie, Sozialpädiatrie und Epileptologie, Universitätskinderklinik, Universität Gießen-Marburg, Gießen, Deutschland
| | - L Gerstl
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Sektion für Pädiatrische Epileptologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - T Roser
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Sektion für Pädiatrische Epileptologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - J Rémi
- Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Campus Großhadern, Klinikum der Universität München, München, Deutschland.,Interdisziplinäres Epilepsiezentrum am Campus Großhadern und im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, München, Deutschland
| | - I Borggraefe
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Sektion für Pädiatrische Epileptologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland. .,Interdisziplinäres Epilepsiezentrum am Campus Großhadern und im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, München, Deutschland.
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Rémi J. [Wild dreams and injured bed partners - The REM-sleep-behavior disorder as a precursor of neurodegenerative disorders]. MMW Fortschr Med 2017; 159:58-59. [PMID: 28900980 DOI: 10.1007/s15006-017-0011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Jan Rémi
- Neurologische Klinik, Klinikum der Universität - Großhadern, Marchioninistr. 15, D-81377, München, Deutschland.
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Franco AC, Noachtar S, Rémi J. Ictal ipsilateral sweating in focal epilepsy. Seizure 2017; 50:4-5. [DOI: 10.1016/j.seizure.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 11/26/2022] Open
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Abstract
BACKGROUND Periodic discharges (PDs) are well established as either periodic lateralized epileptiform discharges (LPDs) or generalized discharges. However, PDs in the midline can currently not be adequately classified as they are not generalized and not lateralized. AIMS OF THE STUDY To propose a modification of the current LPD classification. METHODS We here present a paradigmatic case series of three adult patients with midline LPDs. RESULTS In our patients, ictal electroencephalography (EEG) recordings revealed periodic epileptiform discharges in the midline region. All three patients were non-lesional. CONCLUSION We, thus, suggest to include periodic localized non-lateralized epileptiform discharges into the term LPDs (in addition to periodic lateralized epileptiform discharges), as they can also be recorded as localized EEG phenomenon in the midline region.
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Affiliation(s)
- E. Hartl
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
| | - J. Rémi
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
| | - C. Stoyke
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
| | - S. Noachtar
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
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Loesch AM, Steger H, Losher C, Hartl E, Rémi J, Vollmar C, Noachtar S. Seizure-associated aphasia has good lateralizing but poor localizing significance. Epilepsia 2017; 58:1551-1555. [DOI: 10.1111/epi.13835] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Anna Mira Loesch
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
| | - Hannah Steger
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
| | - Claudia Losher
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
| | - Elisabeth Hartl
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
| | - Jan Rémi
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
| | - Christian Vollmar
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
| | - Soheyl Noachtar
- Department of Neurology; Epilepsy Center; University of Munich; Munich Germany
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Hartl E, Angel J, Rémi J, Schankin CJ, Noachtar S. Visual Auras in Epilepsy and Migraine - An Analysis of Clinical Characteristics. Headache 2017; 57:908-916. [DOI: 10.1111/head.13113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/12/2017] [Accepted: 03/12/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Elisabeth Hartl
- Department of Neurology, Epilepsy Center; University of Munich; Munich Germany
| | - Jose Angel
- Department of Neurology; University of Regensburg; Regensburg Germany
| | - Jan Rémi
- Department of Neurology, Epilepsy Center; University of Munich; Munich Germany
| | - Christoph J. Schankin
- Department of Neurology, Inselspital; Bern University Hospital, University of Bern; Switzerland
| | - Soheyl Noachtar
- Department of Neurology, Epilepsy Center; University of Munich; Munich Germany
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Rémi J, Noachtar S. [Not Available]. MMW Fortschr Med 2017; 159:52. [PMID: 28321725 DOI: 10.1007/s15006-017-9390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Jan Rémi
- Epilepsie-Zentrum, Neurologische Klinik und Poliklinik, Klinikum der Universität München, Marchioninistraße 15, D-81377, München, Deutschland.
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Borggraefe I, Catarino CB, Rémi J, Vollmar C, Peraud A, Winkler PA, Noachtar S. Lateralization of cortical negative motor areas. Clin Neurophysiol 2016; 127:3314-21. [DOI: 10.1016/j.clinph.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/26/2016] [Accepted: 08/03/2016] [Indexed: 11/28/2022]
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Hartl E, Rémi J, Vollmar C, Goc J, Loesch AM, Rominger A, Noachtar S. PET imaging in extratemporal epilepsy requires consideration of electroclinical findings. Epilepsy Res 2016; 125:72-6. [DOI: 10.1016/j.eplepsyres.2016.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/19/2016] [Accepted: 05/25/2016] [Indexed: 11/27/2022]
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Rémi C, Rémi J, Bausewein C. Pharmacological Management of Bronchorrhea in Malignant Disease: A Systematic Literature Review. J Pain Symptom Manage 2016; 51:916-25. [PMID: 26979624 DOI: 10.1016/j.jpainsymman.2015.12.335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/14/2015] [Accepted: 12/23/2015] [Indexed: 11/20/2022]
Abstract
CONTEXT Malignant respiratory tract tumors can lead to massive fluid production, known as bronchorrhea. This symptom can be very distressing itself, and it can lead to or aggravate other symptoms such as dyspnea and cough. Pharmacological treatment options have been reported in the literature. However, no systematic evaluation of their effectiveness has been conducted so far. OBJECTIVES To systematically identify, appraise, and evaluate the effectiveness of symptomatic pharmacological treatment of bronchorrhea in malignant disease in palliative care. METHODS A systematic literature review in Medline, Embase, and the Cochrane Database, as well as citation tracking, hand searches of selected journals, and reference lists of retrieved articles, was performed. For the purpose of this review, only symptomatic treatments were considered. RESULTS No controlled clinical studies could be identified. Twenty of 48 retrieved references were analyzed in detail. These 20 case reports and case series dealt with the symptomatic pharmacological management of bronchorrhea in malignant disease; the other 28 had to be excluded for various reasons. The majority of patients suffered from bronchioloalveolar carcinoma. Reported treatments comprise corticosteroids, macrolide antibiotics, inhaled indomethacin, octreotide, and tyrosine-kinase inhibitors. For some drugs, significant clinical impact on distressing symptoms associated with bronchorrhea was reported. CONCLUSION There are only very limited data on the pharmacological management of bronchorrhea in malignant disease. Because of the distressing nature of the symptom, a pragmatic management strategy is essential. This can include promising treatment options reported in the literature but should also take into account availability, individual tolerability, and costs. Further research is needed.
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Affiliation(s)
- Constanze Rémi
- Pharmacy, Munich University Hospital, LMU Munich, Munich, Germany; Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany.
| | - Jan Rémi
- Department of Neurology, Munich University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
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Kirac LB, Vollmar C, Rémi J, Loesch AM, Noachtar S. Notch filter artefact mimicking high frequency oscillation in epilepsy. Clin Neurophysiol 2016; 127:979-981. [DOI: 10.1016/j.clinph.2015.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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Abstract
Phenytoin is an established drug in the treatment of acute repetitive seizures and status epilepticus. One of its main advantages over benzodiazepines is the less sedative effect. However, the possibility of cardiovascular adverse effects with the intravenous use of phenytoin cause a reluctance to its usage, and this has lead to a search for safer anticonvulsant drugs. In this study, we aimed to review the studies which evaluated the safety of phenytoin with respect to cardiovascular adverse effects. The original clinical trials and case reports listed in PUBMED in English language between the years of 1946-2014 were evaluated. As the key words, "phenytoin, diphenylhydantoin, epilepsy, seizure, cardiac toxicity, asystole, arrhythmia, respiratory arrest, hypotension, death" were used. Thirty-two clinical trials and ten case reports were identified. In the case reports, a rapid infusion rate (>50 mg/min) of phenytoin appeared as the major cause of increased mortality. In contrast, no serious cardiovascular adverse effects leading to death were met in the clinical trials which applied the recommended infusion rate and dosages. An infusion rate of 50 mg/min was reported to be safe for young patients. For old patients and patients with a cardiovascular co-morbidity, a slower infusion rate was recommended with a careful follow-up of heart rhythm and blood pressure. No cardiovascular adverse effect was reported in oral phenytoin overdoses except one case with a very high serum phenytoin level and hypoalbuminemia. Phenytoin is an effective and well tolerated drug in the treatment of epilepsy. Intravenous phenytoin is safe when given at recommended infusion rates and doses.
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Affiliation(s)
- B Guldiken
- Department of Neurology, Epilepsy Center, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.,Neurology Department, Trakya University Medical Faculty, Edirne, Turkey
| | - J Rémi
- Department of Neurology, Epilepsy Center, University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Soheyl Noachtar
- Department of Neurology, Epilepsy Center, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Affiliation(s)
- Berend Feddersen
- Department of Palliative Medicine, Klinikum Innenstadt, University of Munich, Munich, Germany2Epilepsy Center, Department of Neurology, Klinikum Großhadern, University of Munich, Munich, Germany
| | - Christian Vollmar
- Epilepsy Center, Department of Neurology, Klinikum Großhadern, University of Munich, Munich, Germany
| | - Jan Rémi
- Epilepsy Center, Department of Neurology, Klinikum Großhadern, University of Munich, Munich, Germany
| | - Thomas Stephan
- Graduate School of Systemic Neuroscience, University of Munich, Planegg-Martinsried, Germany
| | - Virginia L. Flanagin
- Graduate School of Systemic Neuroscience, University of Munich, Planegg-Martinsried, Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, Klinikum Großhadern, University of Munich, Munich, Germany
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Affiliation(s)
- Elisabeth Hartl
- Epilepsy Center; Department of Neurology; University of Munich; Munich Germany
| | - Jan Rémi
- Epilepsy Center; Department of Neurology; University of Munich; Munich Germany
| | - Soheyl Noachtar
- Epilepsy Center; Department of Neurology; University of Munich; Munich Germany
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Baysal-Kirac L, Rémi J, Loesch AM, Hartl E, Vollmar C, Noachtar S. Eye movements differ between ictal ipsilateral and contralateral head turning. Epilepsy Res 2015; 114:73-7. [PMID: 26088888 DOI: 10.1016/j.eplepsyres.2015.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/07/2015] [Accepted: 03/28/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE This study evaluated the relation of head and eye movements during ictal ipsilateral and contralateral head turning in patients with focal epilepsies with regard to lateralization of the epileptogenic zone. METHODS We reviewed our database and identified patients with ictal head turning ipsilateral and contralateral to the seizure onset as defined by ictal EEG. Twenty-seven seizures of 19 consecutive patients with ipsilateral and 40 seizures of 32 patients with contralateral head turning were investigated. Twenty-four patients had temporal lobe epilepsy (TLE), and 27 patients had extratemporal or multifocal epilepsy. KEY FINDINGS Eye movement in the same direction preceded contralateral head turning in 90% (36 of 40 seizures) of the seizures, but this was the case in only 33% (9 of 27 seizures) of the ipsilateral ictal head turning. In contrary, head turning preceded the eye movements in 67% (18 of 27 seizures) of the ipsilateral ictal head turning and in only 10% of the contralateral head turning (p < 0.001). The results were similar in TLE and FLE. SIGNIFICANCE The sequence of head and eye movements is different in ictal ipsilateral and contralateral head turning movements which likely reflects different spread patterns of epileptic activity associated with activation of different generators. The analysis of eye movements adds to the lateralization of ictal head movements.
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Affiliation(s)
- Leyla Baysal-Kirac
- Epilepsy Center, Department of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Jan Rémi
- Epilepsy Center, Department of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Anna Mira Loesch
- Epilepsy Center, Department of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Elisabeth Hartl
- Epilepsy Center, Department of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christian Vollmar
- Epilepsy Center, Department of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
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