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Miron G, Müller PM, Hohmann L, Oltmanns F, Holtkamp M, Meisel C, Chien C. Cortical Thickness Patterns of Cognitive Impairment Phenotypes in Drug-Resistant Temporal Lobe Epilepsy. Ann Neurol 2024; 95:984-997. [PMID: 38391006 DOI: 10.1002/ana.26893] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE In temporal lobe epilepsy (TLE), a taxonomy classifying patients into 3 cognitive phenotypes has been adopted: minimally, focally, or multidomain cognitively impaired (CI). We examined gray matter (GM) thickness patterns of cognitive phenotypes in drug-resistant TLE and assessed potential use for predicting postsurgical cognitive outcomes. METHODS TLE patients undergoing presurgical evaluation were categorized into cognitive phenotypes. Network edge weights and distances were calculated using type III analysis of variance F-statistics from comparisons of GM regions within each TLE cognitive phenotype and age- and sex-matched healthy participants. In resected patients, logistic regression models (LRMs) based on network analysis results were used for prediction of postsurgical cognitive outcome. RESULTS A total of 124 patients (63 females, mean age ± standard deviation [SD] = 36.0 ± 12.0 years) and 117 healthy controls (63 females, mean age ± SD = 36.1 ± 12.0 years) were analyzed. In the multidomain CI group (n = 66, 53.2%), 28 GM regions were significantly thinner compared to healthy controls. Focally impaired patients (n = 37, 29.8%) showed 13 regions, whereas minimally impaired patients (n = 21, 16.9%) had 2 significantly thinner GM regions. Regions affected in both multidomain and focally impaired patients included the anterior cingulate cortex, medial prefrontal cortex, medial temporal, and lateral temporal regions. In 69 (35 females, mean age ± SD = 33.6 ± 18.0 years) patients who underwent surgery, LRMs based on network-identified GM regions predicted postsurgical verbal memory worsening with a receiver operating curve area under the curve of 0.70 ± 0.15. INTERPRETATION A differential pattern of GM thickness can be found across different cognitive phenotypes in TLE. Including magnetic resonance imaging with clinical measures associated with cognitive profiles has potential in predicting postsurgical cognitive outcomes in drug-resistant TLE. ANN NEUROL 2024;95:984-997.
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Affiliation(s)
- Gadi Miron
- Computational Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epilepsy Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Paul Manuel Müller
- Computational Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Louisa Hohmann
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epilepsy Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Frank Oltmanns
- Epilepsy Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Epilepsy Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Christian Meisel
- Computational Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
| | - Claudia Chien
- Experimental Clinical and Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Neuroscience, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Peng Y, Bjelde A, Aceituno PV, Mittermaier FX, Planert H, Grosser S, Onken J, Faust K, Kalbhenn T, Simon M, Radbruch H, Fidzinski P, Schmitz D, Alle H, Holtkamp M, Vida I, Grewe BF, Geiger JRP. Directed and acyclic synaptic connectivity in the human layer 2-3 cortical microcircuit. Science 2024; 384:338-343. [PMID: 38635709 DOI: 10.1126/science.adg8828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
The computational capabilities of neuronal networks are fundamentally constrained by their specific connectivity. Previous studies of cortical connectivity have mostly been carried out in rodents; whether the principles established therein also apply to the evolutionarily expanded human cortex is unclear. We studied network properties within the human temporal cortex using samples obtained from brain surgery. We analyzed multineuron patch-clamp recordings in layer 2-3 pyramidal neurons and identified substantial differences compared with rodents. Reciprocity showed random distribution, synaptic strength was independent from connection probability, and connectivity of the supragranular temporal cortex followed a directed and mostly acyclic graph topology. Application of these principles in neuronal models increased dimensionality of network dynamics, suggesting a critical role for cortical computation.
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Affiliation(s)
- Yangfan Peng
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Antje Bjelde
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Pau Vilimelis Aceituno
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, 8057 Zürich, Switzerland
| | - Franz X Mittermaier
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Henrike Planert
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Sabine Grosser
- Institute for Integrative Neuroanatomy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Thilo Kalbhenn
- Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, 33617 Bielefeld, Germany
| | - Matthias Simon
- Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, 33617 Bielefeld, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Pawel Fidzinski
- Clinical Study Center, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117 Berlin, Germany
| | - Dietmar Schmitz
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117 Berlin, Germany
- Neuroscience Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Henrik Alle
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Imre Vida
- Institute for Integrative Neuroanatomy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Benjamin F Grewe
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, 8057 Zürich, Switzerland
| | - Jörg R P Geiger
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
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Doerrfuss JI, Hüsing T, Graf L, Ilyas-Feldmann M, Holtkamp M. Non-discontinuation of antiseizure medication in seizure-free epilepsy patients. Eur J Neurol 2024; 31:e16160. [PMID: 38015451 DOI: 10.1111/ene.16160] [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: 07/06/2023] [Revised: 10/03/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE In patients with epilepsy and sustained seizure freedom, guidelines recommend considering discontinuation of antiseizure medication (ASM) based on shared decision-making. This study aims to identify factors associated with non-discontinuation of ASM in seizure-free patients. METHODS Retrospective data from three sites of an academic outpatient clinic were analyzed. Adult patients with epilepsy who have been seizure-free for ≥24 months on ASM monotherapy were included. The primary end-point was non-discontinuation of ASM, defined as no discontinuation or no dose reduction of ≥25% at the last outpatient clinic visit in the ultimate seizure-free interval. Secondary end-points included frequency of discussion on discontinuation attempts between patients and physicians, adherence to ASM discontinuation decisions, and post-discontinuation seizure outcomes. RESULTS Out of 338 included patients, 81.7% did not discontinue ASM and did not reduce its dose, 11.5% discontinued ASM and 6.8% had a significant dose reduction. Factors independently associated with non-discontinuation of ASM were history of focal to bilateral or generalized tonic-clonic seizures (odds ratio [OR] 2.33, 95% confidence interval [CI] 1.08-5.06), history of breakthrough seizures (OR 3.32, 95% CI 1.10-10.04), history of failed attempts to discontinue or reduce the ASM dose (OR 4.67, 95% CI 1.03-21.11) and higher ASM load at the index visit (OR 6.10, 95% CI 2.09-17.78). Discontinuation attempts were made during the entire period of seizure freedom and were most commonly undertaken ≥10 years after the last seizure. CONCLUSIONS This study provides insights into factors associated with the shared decision-making process regarding ASM discontinuation in seizure-free patients and highlights the importance of considering individual patient characteristics and seizure history.
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Affiliation(s)
- Jakob I Doerrfuss
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
| | - Thea Hüsing
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
| | - Luise Graf
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
| | - Maria Ilyas-Feldmann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
| | - Martin Holtkamp
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
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Rifat A, Ossola B, Bürli RW, Dawson LA, Brice NL, Rowland A, Lizio M, Xu X, Page K, Fidzinski P, Onken J, Holtkamp M, Heppner FL, Geiger JRP, Madry C. Differential contribution of THIK-1 K + channels and P2X7 receptors to ATP-mediated neuroinflammation by human microglia. J Neuroinflammation 2024; 21:58. [PMID: 38409076 PMCID: PMC10895799 DOI: 10.1186/s12974-024-03042-6] [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: 11/16/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024] Open
Abstract
Neuroinflammation is highly influenced by microglia, particularly through activation of the NLRP3 inflammasome and subsequent release of IL-1β. Extracellular ATP is a strong activator of NLRP3 by inducing K+ efflux as a key signaling event, suggesting that K+-permeable ion channels could have high therapeutic potential. In microglia, these include ATP-gated THIK-1 K+ channels and P2X7 receptors, but their interactions and potential therapeutic role in the human brain are unknown. Using a novel specific inhibitor of THIK-1 in combination with patch-clamp electrophysiology in slices of human neocortex, we found that THIK-1 generated the main tonic K+ conductance in microglia that sets the resting membrane potential. Extracellular ATP stimulated K+ efflux in a concentration-dependent manner only via P2X7 and metabotropic potentiation of THIK-1. We further demonstrated that activation of P2X7 was mandatory for ATP-evoked IL-1β release, which was strongly suppressed by blocking THIK-1. Surprisingly, THIK-1 contributed only marginally to the total K+ conductance in the presence of ATP, which was dominated by P2X7. This suggests a previously unknown, K+-independent mechanism of THIK-1 for NLRP3 activation. Nuclear sequencing revealed almost selective expression of THIK-1 in human brain microglia, while P2X7 had a much broader expression. Thus, inhibition of THIK-1 could be an effective and, in contrast to P2X7, microglia-specific therapeutic strategy to contain neuroinflammation.
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Affiliation(s)
- Ali Rifat
- Institute of Neurophysiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernardino Ossola
- Cerevance Ltd, 418 Cambridge Science Park, Milton Road, Cambridge, CB4 0PZ, UK
| | - Roland W Bürli
- Cerevance Ltd, 418 Cambridge Science Park, Milton Road, Cambridge, CB4 0PZ, UK
| | - Lee A Dawson
- Cerevance Ltd, 418 Cambridge Science Park, Milton Road, Cambridge, CB4 0PZ, UK
| | - Nicola L Brice
- Cerevance Ltd, 418 Cambridge Science Park, Milton Road, Cambridge, CB4 0PZ, UK
| | - Anna Rowland
- Cerevance Ltd, 418 Cambridge Science Park, Milton Road, Cambridge, CB4 0PZ, UK
| | - Marina Lizio
- Cerevance Ltd, 418 Cambridge Science Park, Milton Road, Cambridge, CB4 0PZ, UK
| | - Xiao Xu
- Cerevance Ltd, 418 Cambridge Science Park, Milton Road, Cambridge, CB4 0PZ, UK
| | - Keith Page
- Cerevance Ltd, 418 Cambridge Science Park, Milton Road, Cambridge, CB4 0PZ, UK
| | - Pawel Fidzinski
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Neurocure Cluster of Excellence, Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Julia Onken
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Frank L Heppner
- Neurocure Cluster of Excellence, Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117, Berlin, Germany
| | - Jörg R P Geiger
- Institute of Neurophysiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Madry
- Institute of Neurophysiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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5
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Drexler R, Ricklefs FL, Ben-Haim S, Rada A, Wörmann F, Cloppenborg T, Bien CG, Simon M, Kalbhenn T, Colon A, Rijkers K, Schijns O, Borger V, Surges R, Vatter H, Rizzi M, de Curtis M, Didato G, Castelli N, Carpentier A, Mathon B, Yasuda CL, Cendes F, Chandra PS, Tripathi M, Clusmann H, Delev D, Guenot M, Haegelen C, Catenoix H, Lang J, Hamer H, Brandner S, Walther K, Hauptmann JS, Jeffree RL, Kegele J, Weinbrenner E, Naros G, Velz J, Krayenbühl N, Onken J, Schneider UC, Holtkamp M, Rössler K, Spyrantis A, Strzelczyk A, Rosenow F, Stodieck S, Alonso-Vanegas MA, Wellmer J, Wehner T, Dührsen L, Gempt J, Sauvigny T. Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases. Epilepsia 2024. [PMID: 38400789 DOI: 10.1111/epi.17923] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Benchmarking has been proposed to reflect surgical quality and represents the highest standard reference values for desirable results. We sought to determine benchmark outcomes in patients after surgery for drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS This retrospective multicenter study included patients who underwent MTLE surgery at 19 expert centers on five continents. Benchmarks were defined for 15 endpoints covering surgery and epilepsy outcome at discharge, 1 year after surgery, and the last available follow-up. Patients were risk-stratified by applying outcome-relevant comorbidities, and benchmarks were calculated for low-risk ("benchmark") cases. Respective measures were derived from the median value at each center, and the 75th percentile was considered the benchmark cutoff. RESULTS A total of 1119 patients with a mean age (range) of 36.7 (1-74) years and a male-to-female ratio of 1:1.1 were included. Most patients (59.2%) underwent anterior temporal lobe resection with amygdalohippocampectomy. The overall rate of complications or neurological deficits was 14.4%, with no in-hospital death. After risk stratification, 377 (33.7%) benchmark cases of 1119 patients were identified, representing 13.6%-72.9% of cases per center and leaving 742 patients in the high-risk cohort. Benchmark cutoffs for any complication, clinically apparent stroke, and reoperation rate at discharge were ≤24.6%, ≤.5%, and ≤3.9%, respectively. A favorable seizure outcome (defined as International League Against Epilepsy class I and II) was reached in 83.6% at 1 year and 79.0% at the last follow-up in benchmark cases, leading to benchmark cutoffs of ≥75.2% (1-year follow-up) and ≥69.5% (mean follow-up of 39.0 months). SIGNIFICANCE This study presents internationally applicable benchmark outcomes for the efficacy and safety of MTLE surgery. It may allow for comparison between centers, patient registries, and novel surgical and interventional techniques.
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Affiliation(s)
- Richard Drexler
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franz L Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California, San Diego, San Diego, California, USA
| | - Anna Rada
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Friedrich Wörmann
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Thomas Cloppenborg
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Matthias Simon
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
- Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, Bielefeld, Germany
| | - Thilo Kalbhenn
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
- Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, Bielefeld, Germany
| | - Albert Colon
- Department of Epileptology, Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands
- ACE Work Group Epilepsy Surgery Kempenhaeghe/Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Kim Rijkers
- ACE Work Group Epilepsy Surgery Kempenhaeghe/Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Neurosurgery, Academic Center for Epileptology UMC/Maastricht University Medical Center+, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Olaf Schijns
- ACE Work Group Epilepsy Surgery Kempenhaeghe/Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Neurosurgery, Academic Center for Epileptology UMC/Maastricht University Medical Center+, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Michele Rizzi
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco de Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nicoló Castelli
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Bertrand Mathon
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Poodipedi Sarat Chandra
- Department of Neurosurgery and Neurology, AIIMS, and MEG Resource Facility, New Delhi, India
| | - Manjari Tripathi
- Department of Neurosurgery and Neurology, AIIMS, and MEG Resource Facility, New Delhi, India
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Daniel Delev
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marc Guenot
- Department of Functional Neurosurgery, Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Claire Haegelen
- Department of Functional Neurosurgery, Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Hélène Catenoix
- Department of Neurology, Hospices Civils de Lyon, Lyon, France
| | - Johannes Lang
- Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hajo Hamer
- Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Brandner
- Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katrin Walther
- Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jason S Hauptmann
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Rosalind L Jeffree
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Josua Kegele
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Eliane Weinbrenner
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Georgios Naros
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Julia Velz
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Onken
- Institute for Diagnostics of Epilepsy, Epilepsy Center Berlin-Brandenburg, Berlin, Germany
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf C Schneider
- Department of Neurosurgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Martin Holtkamp
- Institute for Diagnostics of Epilepsy, Epilepsy Center Berlin-Brandenburg, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Andrea Spyrantis
- Department of Neurosurgery and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurosurgery and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurosurgery and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Stefan Stodieck
- Department of Neurology and Epileptology, Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany
| | - Mario A Alonso-Vanegas
- National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez", Mexico City, Mexico
| | - Jörg Wellmer
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Tim Wehner
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Gempt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hohmann L, Bien CG, Holtkamp M, Grewe P. German questionnaires assessing quality of life and psycho-social status in people with epilepsy: Reliable change and intercorrelations. Epilepsy Behav 2024; 150:109554. [PMID: 38041998 DOI: 10.1016/j.yebeh.2023.109554] [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: 08/21/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES People with epilepsy (PWE) not only suffer from seizures but also from various psycho-social issues containing facets such as social functioning, anxiety, depression or stigmatization, and consequently quality of life. (1) Assessing reliable change of these issues is crucial to evaluate their course and potential treatment effects. As most psycho-social self-report questionnaires have been validated in separate samples, their clinical-socio-demographic differences may limit the comparability and generalizability of the scales' internal consistency, which is important for the reliable change index (RCI). Using a co-normalized approach, we provide the internal consistency and RCIs for a large set of questionnaires targeting quality of life (QOLIE-31-P), depressive symptoms (NDDI-E), anxiety (GAD-7), seizure severity (LSSS), subjective antiseizure medication adverse events (LAEP), stigma, epilepsy-related fear, and restrictions in daily life (PESOS), and subjective cognition (FLei). As for some German versions of these measures, psychometric data is still missing, we also add important information for the German language area. (2) In addition, knowledge about intercorrelations of these constructs is needed to shape questionnaire usage and treatment approaches. We thus investigate associations of these scales and compare weighted and unweighted subscales of the QOLIE-31-P. METHODS In our prospective study, 202 adult in-patients of the Epilepsy-Center Berlin-Brandenburg with a reliable diagnosis of epilepsy filled out a set of self-report questionnaires between 03/2018 and 03/2021. We calculated Cronbach's α, RCIs, and bivariate intercorrelations and compared the respective correlations of weighted and unweighted scales of the QOLIE-31-P. RESULTS For most of the scales, good to excellent internal consistency was identified. Furthermore, we found intercorrelations in the expected directions with strong links between scales assessing similar constructs (e.g., QOLIE-31-P Cognition and FLei), but weak relationships between measures for different constructs (e.g., QOLIE-31-P Seizure worry and FLei). The QOLIE-31-P Total score was highly correlated with most of the other scales. Some differences regarding their correlational patterns for weighted and unweighted QOLIE-31-P scales were identified. CONCLUSIONS Psycho-social constructs share a large amount of common variance, but still can be separated from each other. The QOLIE-31-P Total score represents an adequate measure of general psycho-social burden.
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Affiliation(s)
- Louisa Hohmann
- Department of Neurology, Berlin-Brandenburg Epilepsy Center, Charité-Universitätsmedizin Berlin, corporate member of Free University and Humboldt University of Berlin, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany.
| | - Christian G Bien
- Department of Epileptology, Mara Hospital (Bethel Epilepsy Center), Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Martin Holtkamp
- Department of Neurology, Berlin-Brandenburg Epilepsy Center, Charité-Universitätsmedizin Berlin, corporate member of Free University and Humboldt University of Berlin, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany
| | - Philip Grewe
- Department of Epileptology, Mara Hospital (Bethel Epilepsy Center), Medical School OWL, Bielefeld University, Bielefeld, Germany; Neuropsychology and Epilepsy Research, Medical School OWL, Bielefeld University, Bielefeld, Germany
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Cerulli Irelli E, Gesche J, Schlabitz S, Fortunato F, Catania C, Morano A, Labate A, Vorderwülbecke BJ, Gambardella A, Baykan B, Holtkamp M, Di Bonaventura C, Beier CP. Epilepsy with generalized tonic-clonic seizures alone: Electroclinical features and prognostic patterns. Epilepsia 2024; 65:84-94. [PMID: 37872695 DOI: 10.1111/epi.17809] [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: 06/07/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE Epilepsy with generalized tonic-clonic seizures alone (GTCA) is a common but poorly characterized idiopathic generalized epilepsy (IGE) syndrome. Hence, we investigated electroclinical features, seizure outcome, and antiseizure medication (ASM) withdrawal in a large cohort of GTCA patients. METHODS In this multicenter retrospective study, GTCA patients defined according to the diagnostic criteria of the International League Against Epilepsy (2022) were included. We investigated prognostic patterns, drug resistance at the last visit, and ASM withdrawal, along with their prognostic factors. RESULTS We included 247 patients with a median (interquartile range [IQR]) age at onset of 17 years (13-22) and a median follow-up duration of 10 years (IQR = 5-20). Drug resistance at the last visit was observed in 40 (16.3%) patients, whereas the median latency to achieve 2-year remission was 24 months (IQR = 24-46.5) with a median number of 1 (IQR = 1-2) ASM. During the long-term follow-up (i.e., 202 patients followed ≥5-years after the first ASM trial), 69 (34.3%) patients displayed an early remission pattern and 36 (17.9%) patients displayed a late remission pattern, whereas 16 (8%) and 73 (36.3%) individuals had no-remission and relapsing-remitting patterns, respectively. Catamenial seizures and morning predominance of generalized tonic-clonic seizures (GTCS) independently predicted drug resistance at the last visit according to multivariable logistic regression. Treatment withdrawal was attempted in 63 (25.5%) patients, with 59 (93.7%) of them having at least a 12-month follow-up after ASM discontinuation. At the last visit, 49 (83%) of those patients had experienced GTCS recurrence. A longer duration of seizure freedom was the only factor predicting a higher chance of successful ASM withdrawal according to multivariable Cox regression. SIGNIFICANCE GTCA could be considered a relatively easily manageable IGE syndrome, with a low rate of drug resistance and a high prevalence of early response to treatment. Nevertheless, a considerable proportion of patients experience relapsing patterns of seizure control, highlighting the need for appropriate counseling and lifestyle recommendations.
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Affiliation(s)
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sophie Schlabitz
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Cecilia Catania
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Bernd J Vorderwülbecke
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Betül Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Martin Holtkamp
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Brandhoff F, Mayer T, Wienecke M, Kovacevic-Preradovic T, Holtkamp M, Breuer E. Generalized onset seizures with focal evolution (GOFE) - a largely unknown ictal variation in genetic generalized epilepsies. Seizure 2024; 114:40-43. [PMID: 38039806 DOI: 10.1016/j.seizure.2023.11.016] [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: 08/28/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE At onset of generalized seizures, focal electroclinical features are commonly seen, while generalized onset seizures with focal evolution (GOFE) are largely unknown bearing the risk of misclassification. METHODS In two German epilepsy-centers, patients with GOFE documented by video-EEG monitoring (VEM) between 2017 and 2022 were identified retrospectively. In addition to analysis of ictal electroclinical features, detailed epilepsy and family history, response to antiseizure medication (ASM), and findings from neuroimaging were considered. RESULTS We identified five patients with GOFE, three females, age 14 to 22 years. All patients developed genetic generalized epilepsy in childhood or adolescence, each presenting with two or three generalized seizure types. In each of the five patients, one GOFE was recorded by VEM. At onset, EEG seizure patterns were characterized by generalized spike-wave discharges at 2.5 to 3.5/sec for 9 to 16 s followed by focal evolution of the discharges. Interictally, all patients presented with generalized spike-wave discharges without focal abnormalities. Semiology at onset was behavioral arrest in two patients and generalized increase in tone in one, while two onsets were clinically inapparent. Semiological signs during focal evolution were variable, comprising head and body version, figure 4 sign, unilateral arm clonic activity, and staring with oral automatisms. In one case, focality involved both hemispheres successively. CONCLUSION Prominent focal semiological features in GOFE carry a high risk of misclassification as focal seizures and epilepsy and thus wrong choice of ASM. This calls for low-threshold VEM if any doubts of focal genesis of seizures exist.
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Affiliation(s)
- Frank Brandhoff
- Epilepsy-Center Kleinwachau, Wachauer Straße 30, 01454 Radeberg, Germany
| | - Thomas Mayer
- Epilepsy-Center Kleinwachau, Wachauer Straße 30, 01454 Radeberg, Germany
| | - Miriam Wienecke
- Epilepsy-Center Kleinwachau, Wachauer Straße 30, 01454 Radeberg, Germany
| | | | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Ev. Krankenhaus Königin Elisabeth Herzberge, Herzbergstr. 79, 10365 Berlin, Germany
| | - Eva Breuer
- Epilepsy-Center Berlin-Brandenburg, Ev. Krankenhaus Königin Elisabeth Herzberge, Herzbergstr. 79, 10365 Berlin, Germany.
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Doerrfuss JI, Holtkamp M, Vorderwülbecke BJ. The SeLECT 2.0 Score-Significance of Treatment With Antiseizure Medication. JAMA Neurol 2023; 80:1252. [PMID: 37747712 DOI: 10.1001/jamaneurol.2023.3371] [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: 09/26/2023]
Affiliation(s)
- Jakob I Doerrfuss
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
| | - Martin Holtkamp
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
| | - Bernd J Vorderwülbecke
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
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Doerrfuss JI, Hebel JM, Holtkamp M. Epileptogenicity of white matter lesions in cerebral small vessel disease: a systematic review and meta-analysis. J Neurol 2023; 270:4890-4902. [PMID: 37341807 PMCID: PMC10511556 DOI: 10.1007/s00415-023-11828-6] [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: 05/22/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The epileptogenic properties of white matter lesions (WML) in cerebral small vessel disease (CSVD) are not yet understood. The aim of our systematic review and meta-analysis was to estimate the association between the extent of WML in CSVD and epilepsy, analyze whether these WML are associated with an increased risk of seizure recurrence, and evaluate if treatment with anti-seizure medication (ASM) is justified in first-seizure patients with WML and no cortical lesions. METHODS Following a pre-registered study protocol (PROSPERO-ID CRD42023390665), we systematically searched Pubmed and Embase for relevant literature comparing WML load between patients with epilepsy and controls as well as studies on seizure recurrence risk and ASM therapy in the presence vs. absence of WML. We calculated pooled estimates using a random effects model. RESULTS Eleven studies comprising 2983 patients were included in our study. Presence of WML (OR 2.14, 95% CI 1.38-3.33) and presence of relevant WML as assessed by visual rating scales (OR 3.96, 95% CI 2.55-6.16) but not WML volume (OR 1.30, 95% CI 0.91-1.85) were significantly associated with seizures. These results stayed robust in sensitivity analyses restricted to studies on patients with late-onset seizures/epilepsy. Only two studies assessed the association between WML and risk of seizure recurrence with conflicting results. Currently, there are no studies on the efficacy of ASM therapy in the presence of WML in CSVD. CONCLUSIONS This meta-analysis suggests an association between presence of WML in CSVD and seizures. More research is needed addressing the association between WML and risk of seizure recurrence and ASM therapy focusing on a population of patients with a first unprovoked seizure.
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Affiliation(s)
- Jakob I Doerrfuss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Jonas M Hebel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Martin Holtkamp
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
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11
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Herzig-Nichtweiß J, Salih F, Berning S, Malter MP, Pelz JO, Lochner P, Wittstock M, Günther A, Alonso A, Fuhrer H, Schönenberger S, Petersen M, Kohle F, Müller A, Gawlitza A, Gubarev W, Holtkamp M, Vorderwülbecke BJ. Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study. Ann Intensive Care 2023; 13:85. [PMID: 37712992 PMCID: PMC10504169 DOI: 10.1186/s13613-023-01183-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Acute symptomatic epileptic seizures are frequently seen in neurocritical care. To prevent subsequent unprovoked seizures, long-term treatments with antiseizure medications are often initiated although supporting evidence is lacking. This study aimed at prospectively assessing the risk of unprovoked seizure relapse with respect to the use of antiseizure medications. It was hypothesized that after a first acute symptomatic seizure of structural etiology, the cumulative 12-month risk of unprovoked seizure relapse is ≤ 25%. METHODS Inclusion criteria were age ≥ 18 and acute symptomatic first-ever epileptic seizure; patients with status epilepticus were excluded. Using telephone and mail interviews, participants were followed for 12 months after the acute symptomatic first seizure. Primary endpoint was the occurrence and timing of a first unprovoked seizure relapse. In addition, neuro-intensivists in Germany were interviewed about their antiseizure treatment strategies through an anonymous online survey. RESULTS Eleven of 122 participants with structural etiology had an unprovoked seizure relapse, resulting in a cumulative 12-month risk of 10.7% (95%CI, 4.7%-16.7%). None of 19 participants with a non-structural etiology had a subsequent unprovoked seizure. Compared to structural etiology alone, combined infectious and structural etiology was independently associated with unprovoked seizure relapse (OR 11.1; 95%CI, 1.8-69.7). Median duration of antiseizure treatment was 3.4 months (IQR 0-9.3). Seven out of 11 participants had their unprovoked seizure relapse while taking antiseizure medication; longer treatment durations were not associated with decreased risk of unprovoked seizure relapse. Following the non-representative online survey, most neuro-intensivists consider 3 months or less of antiseizure medication to be adequate. CONCLUSIONS Even in case of structural etiology, acute symptomatic seizures bear a low risk of subsequent unprovoked seizures. There is still no evidence favoring long-term treatments with antiseizure medications. Hence, individual constellations with an increased risk of unprovoked seizure relapse should be identified, such as central nervous system infections causing structural brain damage. However, in the absence of high-risk features, antiseizure medications should be discontinued early to avoid overtreatment.
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Affiliation(s)
- Julia Herzig-Nichtweiß
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany
| | - Farid Salih
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany
| | - Sascha Berning
- Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
| | - Michael P Malter
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Johann O Pelz
- Department and Policlinic of Neurology, Leipzig University Medicine, Leipzig, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Medical Faculty, Saarland University Medical Center, Homburg a. d. Saar, Germany
| | - Matthias Wittstock
- Department and Policlinic of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Albrecht Günther
- Department of Neurology, University Hospital Jena, Jena, Germany
| | - Angelika Alonso
- Department of Neurology, Medical Faculty Mannheim, Ruprecht Karl University of Heidelberg, Mannheim, Germany
| | - Hannah Fuhrer
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
| | - Silvia Schönenberger
- Department of Neurology, Medical Faculty Heidelberg, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | | | - Felix Kohle
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Annekatrin Müller
- Department and Policlinic of Neurology, Leipzig University Medicine, Leipzig, Germany
| | - Alexander Gawlitza
- Department of Neurology, Medical Faculty, Saarland University Medical Center, Homburg a. d. Saar, Germany
| | - Waldemar Gubarev
- Department and Policlinic of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany
| | - Bernd J Vorderwülbecke
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany.
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Trinka E, Rocamora R, Chaves J, Koepp MJ, Rüegg S, Holtkamp M, Moreira J, Fonseca MM, Castilla-Fernández G, Ikedo F. Lipid profile with eslicarbazepine acetate and carbamazepine monotherapy in adult patients with newly diagnosed focal seizures: post hoc analysis of a phase III trial and open-label extension study. Ther Adv Neurol Disord 2023; 16:17562864231193530. [PMID: 37675038 PMCID: PMC10478566 DOI: 10.1177/17562864231193530] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/20/2023] [Indexed: 09/08/2023] Open
Abstract
Background Antiseizure medications can have negative effects on plasma lipid levels. Objectives To evaluate plasma lipid changes in patients with newly diagnosed focal epilepsy treated with eslicarbazepine acetate (ESL) or controlled-release carbamazepine (CBZ-CR) monotherapy during a phase III, randomized, double-blind (DB) trial and 2 years of ESL treatment in an open-label extension (OLE). Design Post hoc analysis of a phase III trial and OLE study. Methods Proportions of patients with elevated levels of total cholesterol and low-density lipoprotein (LDL) cholesterol were assessed at DB baseline, OLE baseline (last visit of DB trial), and end of OLE. Results A total of 184 patients received ESL monotherapy during the OLE: 96 received ESL monotherapy in the DB trial and 88 patients received CBZ-CR monotherapy. The proportions of patients with elevated total cholesterol and LDL cholesterol increased significantly during the DB trial in those treated with CBZ-CR monotherapy [total cholesterol, +14.9% (p < 0.001); LDL cholesterol, +11.5% (p = 0.012)] but decreased significantly after switching to ESL monotherapy in the OLE [total cholesterol, -15.3% (p = 0.008); LDL cholesterol, -11.1% (p = 0.021)]. No significant changes were observed in those treated with ESL monotherapy during the DB trial and OLE. At the end of the DB trial, between-group differences (ESL-CBZ-CR) in the proportions of patients with elevated total and LDL cholesterol were -13.6% (p = 0.037) and -12.3% (p = 0.061), respectively; at the end of the OLE, these between-group differences were -6.0% (p = 0.360) and -0.6% (p = 1.000), respectively. Conclusion A lower proportion of patients with newly diagnosed focal epilepsy had increased levels of total and LDL cholesterol, compared to baseline, following monotherapy with ESL versus CBZ-CR; after switching from CBZ-CR to ESL, the proportions of patients with increased levels decreased significantly. Registration ClinicalTrials.gov NCT01162460/NCT02484001; EudraCT 2009-011135-13/2015-001243-36.
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Affiliation(s)
- Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of the European Reference Centre EpiCARE, Ignaz Harrerstrasse 79, Salzburg A-5020, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Institute of Public Health, Medical Decision-Making and HTA, UMIT – Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Rodrigo Rocamora
- Hospital del Mar Medical Research Institute, Barcelona Spain
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Member of the European Reference Centre EpiCARE, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - João Chaves
- Department of Neurology, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mathias J. Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Stephan Rüegg
- Department of Neurology, Hospital of the University of Basel and University of Basel, Basel, Switzerland
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Fábio Ikedo
- Bial – Portela & Cª, S.A., Coronado, Portugal
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Miron G, Baag T, Götz K, Holtkamp M, Vorderwülbecke BJ. Integration of interictal EEG source localization in presurgical epilepsy evaluation - A single-center prospective study. Epilepsia Open 2023; 8:877-887. [PMID: 37170682 PMCID: PMC10472400 DOI: 10.1002/epi4.12754] [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: 02/14/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE To investigate cost in working hours for initial integration of interictal EEG source localization (ESL) into clinical practice of a tertiary epilepsy center, and to examine concordance of results obtained with three different ESL pipelines. METHODS This prospective study covered the first year of using ESL in the Epilepsy-Center Berlin-Brandenburg. Patients aged ≥14 years with drug-resistant focal epilepsy referred for noninvasive presurgical evaluation were included. Interictal ESL was based on low-density EEG and individual head models. Source maxima were obtained from two freely available software packages and one commercial provider. One physician and computer scientist documented their working hours for setting up and processing ESL. Additionally, a survey was conducted among epilepsy centers in Germany to assess the current role of ESL in presurgical evaluation. RESULTS Of 40 patients included, 22 (55%) had enough interictal spikes for ESL. The physician's working times decreased from median 4.7 hours [interquartile range 3.9-6.4] in the first third of cases to 2.0 hours [1.9-2.4] in the remaining two thirds; P < 0.01. In addition, computer scientist and physician spent a total of 35.5 and 33.0 working hours on setting up the digital infrastructure, and on training and testing. Sublobar agreement between all three pipelines was 20%, mean measurement of agreement (kappa) 0.13. Finally, the survey revealed that 53% of epilepsy centers in Germany currently use ESL for presurgical evaluation. SIGNIFICANCE This study provides information regarding expected effort and costs for integration of ESL into an epilepsy surgery program. Low result agreement across different ESL pipelines calls for further standardization.
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Affiliation(s)
- Gadi Miron
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
- Department of Neurology, Epilepsy‐Center Berlin‐BrandenburgCharité – Universitätsmedizin BerlinBerlinGermany
| | - Thomas Baag
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
| | - Kara Götz
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
- Department of Neurology, Epilepsy‐Center Berlin‐BrandenburgCharité – Universitätsmedizin BerlinBerlinGermany
| | - Martin Holtkamp
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
- Department of Neurology, Epilepsy‐Center Berlin‐BrandenburgCharité – Universitätsmedizin BerlinBerlinGermany
| | - Bernd J. Vorderwülbecke
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
- Department of Neurology, Epilepsy‐Center Berlin‐BrandenburgCharité – Universitätsmedizin BerlinBerlinGermany
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14
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Schulz P, Lütt A, Stöcker W, Teegen B, Holtkamp M, Prüss H. High frequency of cerebrospinal fluid autoantibodies in patients with seizures or epilepsies of unknown etiology. Front Neurol 2023; 14:1211812. [PMID: 37475738 PMCID: PMC10356105 DOI: 10.3389/fneur.2023.1211812] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/09/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction The increasing identification of specific autoantibodies against brain structures allows further refinement of the group of autoimmune-associated epilepsies and affects diagnostic and therapeutic algorithms. The early etiological allocation of a first seizure is particularly challenging, and the contribution of cerebrospinal fluid (CSF) analysis is not fully understood. Methods In this retrospective study with a mean of 7.8 years follow-up involving 39 well-characterized patients with the initial diagnosis of new-onset seizure or epilepsy of unknown etiology and 24 controls, we determined the frequency of autoantibodies to brain proteins in CSF/serum pairs using cell-based assays and unbiased immunofluorescence staining of unfixed murine brain sections. Results Autoantibodies were detected in the CSF of 30.8% of patients. Underlying antigens involved glial fibrillary acidic protein (GFAP) and N-methyl-D-aspartate (NMDA) receptors, but also a range of yet undetermined epitopes on neurons, glial and vascular cells. While antibody-positive patients had higher frequencies of cancer, they did not differ from antibody-negative patients with respect to seizure type, electroencephalography (EEG) and cranial magnetic resonance imaging (cMRI) findings, neuropsychiatric comorbidities or pre-existing autoimmune diseases. In 5.1% of patients with seizures or epilepsy of initially presumed unknown etiology, mostly CSF findings resulted in etiological reallocation as autoimmune-associated epilepy. Discussion These findings strengthen the potential role for routine CSF analysis. Further studies are needed to understand the autoantibody contribution to etiologically unclear epilepsies, including determining the antigenic targets of underlying autoantibodies.
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Affiliation(s)
- Paulina Schulz
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Alva Lütt
- Psychiatric University Hospital Charité at St. Hedwig Hospital, Berlin, Germany
- Department of Psychiatry and Neurosciences, CCM, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Bianca Teegen
- Institute for Experimental Immunology, Lübeck, Germany
| | - Martin Holtkamp
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
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15
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Hohmann L, Berger J, Kastell SU, Holtkamp M. Domain-specific relationships of subjective and objective cognition in epilepsy. Epilepsia 2023. [PMID: 37083235 DOI: 10.1111/epi.17624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/22/2023] [Revised: 04/06/2023] [Accepted: 04/20/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Many people with epilepsy report subjective cognitive impairment (SCI), i.e., problems with memory, attention or executive functions, reducing quality of life. Nevertheless, overlap with objective cognitive impairment (OCI) is often weak. One reason may be a domain-specific mismatch between subjective reports and objective tests. We aimed to evaluate relations between SCI and OCI of corresponding domains and to assess whether these differ between persons that over- or underestimate their performance. METHODS In this prospective, cross-sectional sample of 104 adult in-patients with epilepsy, we performed multiple regression analyses predicting SCI in the domains attention, memory and executive functions. We tested relationships with measures of psychomotor speed, short-term memory, verbal learning, verbal delayed recall, and word fluency while controlling for age, sex, seizure frequency, structural lesions, mono- vs. polytherapy and adverse events of antiseizure medication (ASM), depressive and anxiety symptoms, level of education, and employment status. Furthermore, we tested whether these relationships differed between realistic raters and over- and underestimators. RESULTS We found domain-specific relations for attention and executive functions for the full sample, explaining a small proportion of variance of SCI (General dominance index [GDI] 0.03 and 0.004), whereas ASM adverse events and psychological variables were more important predictors. When dividing the sample according to the concordance of SCI and OCI, we found high frequencies of both over- (23-46%) and underestimation (31-35%) depending on the domain. The explanatory power of OCI for SCI was stronger within the subgroups compared to the full sample, suggesting non-linear relationships and different underlying mechanisms for realistic raters, underestimators and overestimators. SIGNIFICANCE Domain-specific SCI and OCI are related, and both should be assessed with standardized instruments. These relationships differ between over- and underestimators as well as realistic raters. Based on the concordance of self-ratings and objective measures, tailored counseling and treatment should be offered.
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Affiliation(s)
- Louisa Hohmann
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Shirley-Uloma Kastell
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
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16
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Steinbart D, Yaakub SN, Steinbrenner M, Guldin LS, Holtkamp M, Keller SS, Weber B, Rüber T, Heckemann RA, Ilyas-Feldmann M, Hammers A. Automatic and manual segmentation of the piriform cortex: Method development and validation in patients with temporal lobe epilepsy and Alzheimer's disease. Hum Brain Mapp 2023; 44:3196-3209. [PMID: 37052063 PMCID: PMC10171523 DOI: 10.1002/hbm.26274] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 04/14/2023] Open
Abstract
The piriform cortex (PC) is located at the junction of the temporal and frontal lobes. It is involved physiologically in olfaction as well as memory and plays an important role in epilepsy. Its study at scale is held back by the absence of automatic segmentation methods on MRI. We devised a manual segmentation protocol for PC volumes, integrated those manually derived images into the Hammers Atlas Database (n = 30) and used an extensively validated method (multi-atlas propagation with enhanced registration, MAPER) for automatic PC segmentation. We applied automated PC volumetry to patients with unilateral temporal lobe epilepsy with hippocampal sclerosis (TLE; n = 174 including n = 58 controls) and to the Alzheimer's Disease Neuroimaging Initiative cohort (ADNI; n = 151, of whom with mild cognitive impairment (MCI), n = 71; Alzheimer's disease (AD), n = 33; controls, n = 47). In controls, mean PC volume was 485 mm3 on the right and 461 mm3 on the left. Automatic and manual segmentations overlapped with a Jaccard coefficient (intersection/union) of ~0.5 and a mean absolute volume difference of ~22 mm3 in healthy controls, ~0.40/ ~28 mm3 in patients with TLE, and ~ 0.34/~29 mm3 in patients with AD. In patients with TLE, PC atrophy lateralised to the side of hippocampal sclerosis (p < .001). In patients with MCI and AD, PC volumes were lower than those of controls bilaterally (p < .001). Overall, we have validated automatic PC volumetry in healthy controls and two types of pathology. The novel finding of early atrophy of PC at the stage of MCI possibly adds a novel biomarker. PC volumetry can now be applied at scale.
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Affiliation(s)
- David Steinbart
- Charité - Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität zu Berlin, Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, UK
| | - Siti N Yaakub
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, UK
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Mirja Steinbrenner
- Charité - Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität zu Berlin, Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Lynn S Guldin
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, UK
| | - Martin Holtkamp
- Charité - Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität zu Berlin, Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Bernd Weber
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Rolf A Heckemann
- Department of Medical Radiation Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Maria Ilyas-Feldmann
- Charité - Universitätsmedizin Berlin, Freie Universität and Humboldt-Universität zu Berlin, Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Alexander Hammers
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, London, UK
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17
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Steinbrenner M, Tito T, Dehnicke C, Holtkamp M. Predictors and reasons for epilepsy patients to decline surgery: a prospective study. J Neurol 2023; 270:2302-2307. [PMID: 36473975 PMCID: PMC10025225 DOI: 10.1007/s00415-022-11510-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/19/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients with drug-resistant focal epilepsy, resective surgery is the most successful treatment option to achieve seizure freedom. However, a surprisingly high rate of patients declines their physicians' recommendation to undergo removal of the seizure focus or-if necessary-further video-EEG monitoring (VEM). METHODS In this prospective study, consecutive patients in presurgical assessment with at least one scalp VEM between 2016 and 2018 were included. We assessed both epilepsy-related and psychosocial variables as well as decision-making of physicians and patients, including reasons for decline in the latter. RESULTS Out of 116 patients with a total of 165 VEM, 20 patients were eventually found to be ineligible for resection, 51 declined, and 45 agreed on recommendations for resection or further VEM diagnostics. Patients most frequently declined due to general fear of brain surgery (n = 30, 59%) and currently lower seizure frequency (n = 11, 22%). An independent predictor of patients' decline was less epilepsy-related fear (OR 0.43; p = 0.02) assessed in a standardised questionnaire. CONCLUSION Half of the patients potentially eligible for resective surgery decline the operation or further VEM procedures. Patients who decline are more fearful of brain surgery than of ongoing disabling seizures. More insight is needed to improve counselling of patients.
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Affiliation(s)
- Mirja Steinbrenner
- Department of Neurology and Experimental Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Tabea Tito
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Christoph Dehnicke
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology and Experimental Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
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18
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Hohmann L, Berger J, Kastell SU, Holtkamp M. Subjective cognition is linked to everyday functioning in epilepsy. Epilepsia Open 2023. [PMID: 36929747 DOI: 10.1002/epi4.12726] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE Many people with epilepsy (PWE) suffer from reduced everyday functioning such as unemployment, relationship difficulties, or lifestyle limitations. To identify whether subjective cognitive impairment (SCI) is a potential source of these impairments, associations with restrictions of daily life (RDL) and reduced daily activities (DA) were examined. METHODS In a prospective cross-sectional sample of 316 adult in-patients with epilepsy, multiple regression analyses were calculated predicting RDL and DA. The relationships between these two measures and SCI were controlled for age, sex, seizure frequency, presence of structural lesions, epilepsy duration, mono- vs polytherapy and adverse events of antiseizure medication (ASM), level of depressive and anxiety symptoms, education, and employment. We also checked for an interaction between depressive symptoms and SCI, to evaluate whether patients with more depressive symptoms are more vulnerable for unfavorable associations between SCI and RDL or DA, respectively. General dominance indices (GDIs) were calculated to compare predictors. RESULTS Substantial SCI was present in 46% of our sample. SCI was independently associated with RDL and DA. Comparison of relative predictor importance revealed that SCI accounted for 23% of the total variance of RDL (GDISCI = 0.12, R RDL 2 $$ {R}_{\mathrm{RDL}}^2 $$ = 50%) and 24% of the total variance of DA (GDISCI = 0.08, R DA 2 $$ {R}_{\mathrm{DA}}^2 $$ = 32%). SCI was among the two most important predictors in both models. PWE with more depressive symptoms had stronger associations between SCI and RDL or DA, respectively. SIGNIFICANCE Subjective cognitive impairment represents a frequent concern in PWE and may have detrimental consequences for their everyday life. PWE with depressive symptoms may be at greater risk of unfavorable relationships between SCI and everyday functioning. Exchange and collaboration between professionals offering psychotherapeutic, neuropsychological, and psychosocial interventions are crucial to address the patients' individual needs.
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Affiliation(s)
- Louisa Hohmann
- Department of Neurology, Berlin-Brandenburg Epilepsy Center, Charité - Universitätsmedizin Berlin, Corporate Member of Free University and Humboldt University of Berlin, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany
| | - Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany
| | - Shirley-Uloma Kastell
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology, Berlin-Brandenburg Epilepsy Center, Charité - Universitätsmedizin Berlin, Corporate Member of Free University and Humboldt University of Berlin, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany
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19
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Miron G, Müller PM, Holtkamp M, Meisel C. Prediction of epilepsy surgery outcome using foramen ovale EEG - A machine learning approach. Epilepsy Res 2023; 191:107111. [PMID: 36857943 DOI: 10.1016/j.eplepsyres.2023.107111] [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: 12/01/2022] [Revised: 01/20/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Patients with drug-resistant focal epilepsy may benefit from ablative or resective surgery. In presurgical work-up, intracranial EEG markers have been shown to be useful in identification of the seizure onset zone and prediction of post-surgical seizure freedom. However, in most cases, implantation of depth or subdural electrodes is performed, exposing patients to increased risks of complications. METHODS We analysed EEG data recorded from a minimally invasive approach utilizing foramen ovale (FO) and epidural peg electrodes using a supervised machine learning approach to predict post-surgical seizure freedom. Power-spectral EEG features were incorporated in a logistic regression model predicting one-year post-surgical seizure freedom. The prediction model was validated using repeated 5-fold cross-validation and compared to outcome prediction based on clinical and scalp EEG variables. RESULTS Forty-seven patients (26 patients with post-surgical 1-year seizure freedom) were included in the study, with 31 having FO and 27 patients having peg onset seizures. The area under the receiver-operating curve for post-surgical seizure freedom (Engel 1A) prediction in patients with FO onset seizures was 0.74 ± 0.23 using electrophysiology features, compared to 0.66 ± 0.22 for predictions based on clinical and scalp EEG variables (p < 0.001). The most important features for prediction were spectral power in the gamma and high gamma ranges. EEG data from peg electrodes was not informative in predicting post-surgical outcomes. CONCLUSION In this hypothesis-generating study, a data-driven approach based on EEG features derived from FO electrodes recordings outperformed the predictive ability based solely on clinical and scalp EEG variables. Pending validation in future studies, this method may provide valuable post-surgical prognostic information while minimizing risks of more invasive diagnostic approaches.
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Affiliation(s)
- Gadi Miron
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Paul Manuel Müller
- Computational Neurology, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Meisel
- Computational Neurology, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; Bernstein Center for Computational Neuroscience, Berlin, Germany; Center for Stroke Research Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
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20
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Hohmann L, Bien CG, Holtkamp M, Grewe P. How patients' psycho-social profiles contribute to decision-making in epilepsy surgery: A prospective study. Epilepsia 2023; 64:678-691. [PMID: 36598266 DOI: 10.1111/epi.17499] [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: 09/22/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Identifying factors associated with surgical decision-making is important to understand reasons for underutilization of epilepsy surgery. Neurologists' recommendations for surgery and patients' acceptance of these recommendations depend on clinical epilepsy variables, for example, lateralization and localization of seizure onset zones. Moreover, previous research shows associations with demographic factors, for example, age and sex. Here, we investigate the relevance of patients' psycho-social profile for surgical decision-making. METHODS We prospectively studied 296 patients from two large German epilepsy centers. Multiple logistic regression analyses were used to investigate variables linked to neurologists' recommendations for and patients' acceptance of surgery or intracranial video-electroencephalographic monitoring. Patients' psycho-social profiles were assessed via self-reports and controlled for various clinical-demographic variables. Model selection was performed using the Akaike information criterion. RESULTS As expected, models for neurologists' surgery recommendations primarily revealed clinical factors such as lateralization and localization of the seizure onset zone, load with antiseizure medication (ASM), and site of the epilepsy-center. For this outcome, employment was the only relevant psycho-social aspect (odds ratio [OR] = .38, 95% confidence interval [CI] = .13-1.11). In contrast, three of the five relevant predictors for patients' acceptance were psycho-social. Higher odds were found for those with more subjective ASM adverse events (OR = 1.04, 95% CI = .99-1.00), more subjective seizure severity (OR = 1.12, 95% CI = 1.01-1.24), and lower subjective cognitive impairment (OR = .98, 95% CI = .96-1.00). SIGNIFICANCE We demonstrated the relevance of the patients' psycho-social profile for decision-making in epilepsy surgery, particularly for patients' decisions. Thus, in addition to clinical-demographic variables, patients' individual psycho-social characteristics add to the understanding of surgical decision-making. From a clinical perspective, this calls for individually tailored counseling to assist patients in finding the optimal treatment option.
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Affiliation(s)
- Louisa Hohmann
- Department of Neurology, Berlin-Brandenburg Epilepsy Center, Charité-Universitätsmedizin Berlin, corporate member of Free University and Humboldt University of Berlin, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany
| | - Christian G Bien
- Department of Epileptology, Mara Hospital (Bethel Epilepsy Center), Medical School, Bielefeld University, Bielefeld, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany
| | - Philip Grewe
- Department of Epileptology, Mara Hospital (Bethel Epilepsy Center), Medical School, Bielefeld University, Bielefeld, Germany
- Clinical Neuropsychology and Epilepsy Research, Medical School, Bielefeld University, Bielefeld, Germany
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21
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Kühne F, Becker LL, Bast T, Bertsche A, Borggraefe I, Boßelmann CM, Fahrbach J, Hertzberg C, Herz NA, Hirsch M, Holtkamp M, Janello C, Kluger GJ, Kurlemann G, Lerche H, Makridis KL, von Podewils F, Pringsheim M, Schubert-Bast S, Schulz J, Schulze-Bonhage A, Steinbart D, Steinhoff BJ, Strzelczyk A, Syrbe S, De Vries H, Wagner C, Wagner J, Wilken B, Prager C, Klotz KA, Kaindl AM. Real-world data on cannabidiol treatment of various epilepsy subtypes: A retrospective, multicenter study. Epilepsia Open 2023. [PMID: 36693811 DOI: 10.1002/epi4.12699] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Cannabidiol (CBD) is approved for treatment of Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS), and tuberous sclerosis complex (TSC). Several studies suggest antiseizure effects also beyond these three epilepsy syndromes. METHODS In a retrospective multicenter study, we analyzed the efficacy and tolerability of CBD in patients with epilepsy at 16 epilepsy centers. RESULTS The study cohort comprised 311 patients with epilepsy with a median age of 11.3 (0-72) years (235 children and adolescents, 76 adults). Therapy with CBD was off-label in 91.3% of cases due to age, epilepsy subtype, lack of adjunct therapy with clobazam, and/or higher dose applied. CBD titration regimens were slower than recommended, with good tolerability of higher doses particularly in children. Of all patients, 36.9% experienced a reduction in seizure frequency of >50%, independent of their epilepsy subtype or clobazam co-medication. The median observation period was 15.8 months. About one third of all patients discontinued therapy within the observation period due to adverse effects or lack of efficacy. Adverse effects were reported frequently (46.9%). SIGNIFICANCE Our study highlights that CBD has an antiseizure effect comparable to other antiseizure medications with a positive safety profile independent of the epilepsy subtype. Comedication with clobazam was not associated with a better outcome. Higher doses to achieve seizure frequency reduction were safe, particularly in children. These findings call for further trials for an extended approval of CBD for other epilepsy subtypes and for children <2 years of age.
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Affiliation(s)
- Fabienne Kühne
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany
| | - Lena-Luise Becker
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany.,Charité - University Medicine, Institute of Cell- and Neurobiology, Berlin, Germany
| | | | - Astrid Bertsche
- Department of Pediatric Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Borggraefe
- Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Jörg Fahrbach
- Vivantes Hospital Neukölln, Socialpediatric Centre (DBZ), Berlin, Germany
| | | | - Nina A Herz
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany
| | - Martin Hirsch
- Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Martin Holtkamp
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Christine Janello
- Department of Pediatrics, Technical University of Munich, Munich, Germany
| | - Gerhard Josef Kluger
- Schön Klinik Vogtareuth, Center for Pediatric Neurology, Neurorehabilitation and Epileptology, PMU, Vogtareuth, Salzburg, Germany
| | - Gerhard Kurlemann
- Department of Pediatrics, Bonifatius Hospital Lingen, Lingen, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, University of Tübingen, Tübingen, Germany
| | - Konstantin L Makridis
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany.,Charité - University Medicine, Institute of Cell- and Neurobiology, Berlin, Germany
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | - Milka Pringsheim
- Schön Klinik Vogtareuth, Center for Pediatric Neurology, Neurorehabilitation and Epileptology, PMU, Vogtareuth, Salzburg, Germany.,Deparment for Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Munich, Germany
| | - Susanne Schubert-Bast
- University Hospital Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Frankfurt am Main, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | | | - David Steinbart
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork, Germany.,Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Adam Strzelczyk
- University Hospital Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Frankfurt am Main, Germany
| | - Steffen Syrbe
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Heike De Vries
- Department of Pediatric Neurology, University Medicine Jena, Jena, Germany
| | | | - Johanna Wagner
- Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Bernd Wilken
- Department of Neuropediatrics, Clinic Kassel, Kassel, Germany
| | - Christine Prager
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany
| | - Kerstin A Klotz
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany.,Charité - University Medicine, Institute of Cell- and Neurobiology, Berlin, Germany
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22
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Thorbecke R, Pfäfflin M, Bien CG, Hamer HM, Holtkamp M, Rating D, Schulze-Bonhage A, Straub HB, Strzelczyk A, May TW. Have attitudes toward epilepsy improved in Germany over the last 50 years? Epilepsy Behav 2023; 138:108982. [PMID: 36459812 DOI: 10.1016/j.yebeh.2022.108982] [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: 09/20/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In Germany, six previous representative surveys on attitudes toward epilepsy (AE) have been conducted between 1967 and 2008 using the four original Caveness questions (CQs) from 1949 to 1980. The aims of this study were (1) to investigate changes in AE over the time span of 50 years, including the current survey in 2018 (2) to investigate the first-time emotional reactions measured with the Scales of Attitudes toward People with Epilepsy (SAPE) (3) to identify predictors of AE. METHODS A representative face-to-face survey with CQ, in addition with the SAPE scales of Social Distance, Stereotypes, Personal Concerns, and Emotional Reactions was carried out in Germany in 2018. One thousand and twenty-six persons who ever had heard of epilepsy participated. Respondents who answered "don't know" in the CQs were subsequently asked to answer only yes/no. The analysis of trends from 1967 to 2018 was based on the pooled data of the surveys. The four CQs in the 2018 survey were included in the SAPE item pool and an exploratory principal axis factor analysis was performed. General linear models were performed to identify predictors. RESULTS For all four CQs, the trend of improved AE was significant over the past 50 years. In the 2018 survey, excluding the "don't know" answer option increased the proportion of negative responses for contact of one's own children with a person with epilepsy (PWE) from 6.9% to 11.4% and for the marriage of one's own children with a PWE from 13.9% to 23.8%. When encountering a PWE, 30.1% would feel insecure or uncomfortable and nearly 60% were concerned that the PWE might be injured in case of a seizure. Knowing what to do in case of a seizure, knowing that seizures can be treated successfully, personal contact with a PWE along with younger age, and higher education were found to be the strongest predictors for positive AE identified by multivariate analyses. Exploratory principal axis factor analysis revealed that three of the four CQs items loaded > 0.30 at the factors of Social Distance and Stereotypes of SAPE but none on the factors measuring emotional reactions. SIGNIFICANCE AE measured by CQs have markedly improved in Germany over the last 50 years. Germany is to our knowledge the only country with such a long-term trend investigation in AE. Negative AE may be underestimated by survey questions with "don't know" answer option. Emotional aspects of attitudes are underexposed resp. neglected in the CQs, which are used worldwide for measuring AE. Additional tools like SAPE can close this gap. The identified predictors may help to derive interventions against negative AE.
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Affiliation(s)
| | - Margarete Pfäfflin
- Protestant Hospital of Bethel Foundation, University Medical School OWL, Bielefeld University, Campus Bielefeld-Bethel, Germany
| | - Christian G Bien
- Society of Epilepsy Research, Epilepsy Center Bethel, Bielefeld, Germany; Dept. of Epileptology (Krankenhaus Mara), Bielefeld University, Campus Bielefeld-Bethel, Germany
| | - Hajo M Hamer
- Epilepsy Center, Dept. of Neurology, University Hospital Erlangen, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | | | - Andreas Schulze-Bonhage
- Epilepsy Center, University Medical Center - University of Freiburg, European Reference Network Epicare, Germany
| | - Hans-Beatus Straub
- Epilepsy Center Berlin-Brandenburg, Epilepsieklinik Tabor, Bernau, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Theodor W May
- Protestant Hospital of Bethel Foundation, University Medical School OWL, Bielefeld University, Campus Bielefeld-Bethel, Germany; University of Bielefeld, Bielefeld, Faculty of Psychology and Sports Science, Germany
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23
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Meisel C, Holtkamp M, Vock S. Ambulantes Langzeit-Video-EEG als neuer diagnostischer Ansatz in Deutschland: Ergebnisse einer Machbarkeitsstudie. Nervenarzt 2022:10.1007/s00115-022-01412-0. [DOI: 10.1007/s00115-022-01412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/23/2022]
Abstract
ZusammenfassungDas Langzeit-Video-EEG als Goldstandarddiagnostik bei Epilepsie und anderen Anfallsleiden ist in Deutschland derzeit nur in wenigen spezialisierten Zentren zur stationären Überwachung verfügbar. Diese begrenzten Überwachungskapazitäten und der damit verbundene hohe Zeit- und Arbeitsaufwand führen bundesweit zu einer erheblichen Wartezeit für diese wichtige Diagnostik. Neue, tragbare Sensortechnologien und automatisierte Datenanalysemethoden schaffen Möglichkeiten für Video-EEG-Langzeituntersuchungen nach dem Goldstandard im ambulanten Bereich, die dazu beitragen können, diese Barriere zu überwinden. Hier berichten wir über die Ergebnisse einer Machbarkeitsstudie an einem Zentrum, in der das ambulante Langzeit-Video-EEG (ALVEEG) als diagnostischer Weg in Deutschland eingeführt wurde. In dem neuen Diagnostikpfad soll der Einsatz innovativer, tragbarer Video-EEG-Monitoringsysteme zusammen mit einer durch künstliche Intelligenz unterstützten Datenanalyse den von Anfallsleiden betroffenen Patienten einen schnelleren, effizienteren und sektorübergreifenden Zugang zu einer Goldstandarddiagnostik in der häuslichen Umgebung ermöglichen. Die Diagnostik wurde von Patienten und Klinikern gut angenommen und könnte eine ergänzende Option zur stationären Überwachung darstellen, um die derzeitigen Engpässe in Diagnostik und Versorgung zu beseitigen.
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24
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Hebel JM, Holtkamp M. Epilepsy surgery in older patients – English Version. Z Epileptol 2022. [DOI: 10.1007/s10309-022-00481-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Holtkamp M, Krämer G. Antiepileptic pharmacotherapy in old age: evidence-based approach versus clinical routine – English Version. Z Epileptol 2022. [DOI: 10.1007/s10309-022-00492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Miron G, Müller PM, Holtkamp M. Diagnostic and prognostic value of EEG patterns recorded on foramen ovale and epidural peg electrodes. Clin Neurophysiol 2022; 143:107-115. [DOI: 10.1016/j.clinph.2022.08.027] [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: 07/04/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022]
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27
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Kastell SU, Hohmann L, Holtkamp M, Berger J. Psycho-socio-clinical profiles and quality of life in seizure disorders: A cross-sectional registry study. Epilepsy Behav 2022; 136:108916. [PMID: 36179607 DOI: 10.1016/j.yebeh.2022.108916] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This prospective study aimed at comparing quality of life (QoL) and psycho-socio-clinical profiles between patients with epilepsy, psychogenic nonepileptic seizures (PNES), and syncope. We also intended to identify predictors of QoL in these three seizure disorders. METHODS A total of 245 inpatients (epilepsy n = 182, PNES n = 50, syncope n = 13) from a tertiary epilepsy clinic were included. Information on QoL as well as on psychological, sociodemographic, and clinical profiles was retrieved using questionnaires and medical records. Group comparisons on QoL and psycho-socio-clinical profiles were performed via analyses of variance, chi-square tests, and related post hoc tests. Predictors of QoL in epilepsy and PNES were determined using general linear modeling, which was not possible for syncope due to a small sample size. RESULTS Patients with epilepsy, PNES, and syncope reported levels of QoL impairment that did not differ significantly between groups (p = 0.266). However, there were significant group differences regarding sex distribution (p < 0.001), seizure disorder duration (p = 0.004), seizure frequency (p = 0.019), current treatment with antiseizure medications (ASM) (p < 0.001), number of current ASM (p < 0.001), and adverse ASM events (p = 0.019). More depressive symptoms (p = 0.001), more adverse ASM events (p = 0.036), and unemployment (p = 0.046) (in this order) independently predicted a diminished QoL in epilepsy. For PNES, more depressive symptoms were the only independent predictor of lower QoL (p = 0.029). CONCLUSIONS Patients with epilepsy, PNES, and syncope experience similarly diminished QoL and show a general psycho-socio-clinical burden with a specific pattern for each seizure disorder diagnosis. Although clinical aspects play an undisputed role for QoL in epilepsy, the psychosocial aspects and consequences are equally, or for PNES probably even more, meaningful. A comprehensive approach to research and treatment of seizure disorders seems mandatory to increase QoL for these patients. More research on QoL in syncope is needed.
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Affiliation(s)
- Shirley-Uloma Kastell
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365 Berlin, Germany.
| | - Louisa Hohmann
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365 Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365 Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365 Berlin, Germany.
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28
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Stevelink R, Al-Toma D, Jansen FE, Lamberink HJ, Asadi-Pooya AA, Farazdaghi M, Cação G, Jayalakshmi S, Patil A, Özkara Ç, Aydın Ş, Gesche J, Beier CP, Stephen LJ, Brodie MJ, Unnithan G, Radhakrishnan A, Höfler J, Trinka E, Krause R, Irelli EC, Di Bonaventura C, Szaflarski JP, Hernández-Vanegas LE, Moya-Alfaro ML, Zhang Y, Zhou D, Pietrafusa N, Specchio N, Japaridze G, Beniczky S, Janmohamed M, Kwan P, Syvertsen M, Selmer KK, Vorderwülbecke BJ, Holtkamp M, Viswanathan LG, Sinha S, Baykan B, Altindag E, von Podewils F, Schulz J, Seneviratne U, Viloria-Alebesque A, Karakis I, D'Souza WJ, Sander JW, Koeleman BP, Otte WM, Braun KP. Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis. EClinicalMedicine 2022; 53:101732. [PMID: 36467455 PMCID: PMC9716332 DOI: 10.1016/j.eclinm.2022.101732] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. METHODS We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed - last updated on March 11, 2021 - including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). FINDINGS Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68-0·73). INTERPRETATION We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. FUNDING MING fonds.
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Affiliation(s)
- Remi Stevelink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Corresponding author. Department of Child Neurology, University Medical Center Utrecht, 3584 CX, Utrecht, Netherlands.
| | - Dania Al-Toma
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Floor E. Jansen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Herm J. Lamberink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
- Department of Neurology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
| | - Gonçalo Cação
- Department of Neurology, Unidade Local de Saude do Alto Minho, Estrada de Santa Luzia, Viana do Castelo, 4904-858, Portugal
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Anuja Patil
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Çiğdem Özkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Kocamustafapaşa caddesi, Istanbul, 34098, Turkey
| | - Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, University of Health Sciences, Belgrat Kapı yolu, Istanbul, 34020, Turkey
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Christoph P. Beier
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Linda J. Stephen
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin J. Brodie
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Gopeekrishnan Unnithan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Julia Höfler
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Hellbrunner Straße 34, Salzburg, 3100, Austria
- Department of Public Health, University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, 6060, Austria
| | - Roland Krause
- Bioinformatics Core Facility, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 6 Ave du Swing, Belvaux, 4367, Luxembourg
| | | | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Jerzy P. Szaflarski
- Departments of Neurology, Neurosurgery, and Neurobiology, UAB Epilepsy Center, University of Alabama at Birmingham Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35294, USA
| | - Laura E. Hernández-Vanegas
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Monica L. Moya-Alfaro
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Nicola Pietrafusa
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Nicola Specchio
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Giorgi Japaridze
- Department of Clinical Neurophysiology, Institute of Neurology and Neuropsychology, 83/11 Vazha-Pshavela Ave., Tbilisi, 186, Georgia
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Filadelfia, Visby Allé 5, Dianalund, 4293, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus, 8200, Denmark
| | - Mubeen Janmohamed
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Marte Syvertsen
- Department of Neurology, Vestre Viken Hospital Trust, Dronninggata 28, Drammen, 3004, Norway
| | - Kaja K. Selmer
- National Centre for Epilepsy & Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, G. F. Henriksens vei 29, Sandvika, 1337, Norway
| | - Bernd J. Vorderwülbecke
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Istanbul, 34390, Turkey
| | - Ebru Altindag
- Department of Neurology, Istanbul Florence Nightingale Hospital, Abide-i Hürriyet Cad, Istanbul, 34381, Turkey
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
- Department of Medicine, The School of Clinical Sciences at Monash Health, Monash University, Clayton Road, Melbourne, Victoria, 3168, Australia
| | - Alejandro Viloria-Alebesque
- Department of Neurology, Hospital General de la Defensa, Vía Ibérica 1, Zaragoza, 50009, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Avda. San Juan Bosco 13, Zaragoza, 50009, Spain
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Office 335, Atlanta, GA, 30303, USA
| | - Wendyl J. D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
| | - Josemir W. Sander
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 7, Heemstede, Netherlands
- UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Bobby P.C. Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Willem M. Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Kees P.J. Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
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Hohmann L, Berger J, Kastell SU, Holtkamp M. Perceived epilepsy-related stigma is linked to the socioeconomic status of the residence. Front Public Health 2022; 10:952585. [PMID: 36091545 PMCID: PMC9459334 DOI: 10.3389/fpubh.2022.952585] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/11/2022] [Indexed: 01/24/2023] Open
Abstract
Purpose Epilepsy is one of the most common neurological disorders with high costs for the healthcare systems and great suffering for patients. Beyond seizures, psychosocial comorbidities can have detrimental effects on the well-being of people with epilepsy. One source of social stress and reduced quality of life is epilepsy-related stigma that often occurs, e.g., due to public misconceptions or myths. Stigma has individual biological, psychological and social correlates. Moreover, environmental factors like living in remote areas are associated with stigma. However, little is known about the link between the social structure of the residence and stigma in epilepsy. Thus, we investigated the association between the structural socioeconomic status (SES) and perceived stigma in an urban epilepsy population. Methods This prospective, cross-sectional study examined 226 adult in-patients with epilepsy from Berlin. Multiple regression analyses were performed to check the relationship between structural SES and stigma controlling for individual-level demographic, clinical, psychological and social factors. Continuous social indices (SI) of the districts and neighborhoods ("SI district" and "SI neighborhood") of Berlin were used to measure different levels of structural SES. Non-linear relationships are tested by grouping the SI in quartiles. Results Both indicators of structural SES were independently linked to stigma (p = 0.002). For "SI district", we identified a non-linear relationship with patients from the most deprived quartile feeling less stigmatized compared to those in the second (p < 0.001) or least deprived quartile (p = 0.009). Furthermore, more restrictions of daily life (p < 0.001), unfavorable income (p = 0.009) and seizure freedom in the past 6 months (p = 0.05) were related to increased stigma. A lower "SI neighborhood" was associated with higher stigma (p = 0.002). Conclusion Strategies to reduce epilepsy-related stigma need to consider the sociostructural living environment on different regional levels. Unfavorable relations with the immediate living environment may be directly targeted in patient-centered interventions. Non-linear associations with the structural SES of broader regional levels should be considered in public education programs. Further research is needed to examine possible underlying mechanisms and gain insight into the generalizability of our findings to other populations.
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Affiliation(s)
- Louisa Hohmann
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany,Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany,*Correspondence: Louisa Hohmann
| | - Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Shirley-Uloma Kastell
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany,Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Bäuerle P, Schneider U, Holtkamp M, Gloveli T, Dugladze T. Outlines to Initiate Epilepsy Surgery in Low- and Middle-Income Countries. J Integr Neurosci 2022; 21:134. [DOI: 10.31083/j.jin2105134] [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: 03/23/2022] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 11/06/2022] Open
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Miron G, Dehnicke C, Meencke HJ, Onken J, Holtkamp M. Presurgical video-EEG monitoring with foramen ovale and epidural peg electrodes: a 25-year perspective. J Neurol 2022; 269:5474-5486. [PMID: 35705881 PMCID: PMC9468058 DOI: 10.1007/s00415-022-11208-6] [Citation(s) in RCA: 1] [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: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
Background Epilepsy surgery cases are becoming more complex and increasingly require invasive video-EEG monitoring (VEM) with intracranial subdural or intracerebral electrodes, exposing patients to substantial risks. We assessed the utility and safety of using foramen ovale (FO) and epidural peg electrodes (FOP) as a next step diagnostic approach following scalp VEM. Methods We analyzed clinical, electrophysiological, and imaging characteristics of 180 consecutive patients that underwent FOP VEM between 1996 and 2021. Multivariate logistic regression was used to assess predictors of clinical and electrophysiological outcomes. Results FOP VEM allowed for immediate resection recommendation in 36 patients (20.0%) and excluded this option in 85 (47.2%). Fifty-nine (32.8%) patients required additional invasive EEG investigations; however, only eight with bilateral recordings. FOP VEM identified the ictal onset in 137 patients, compared to 96 during prior scalp VEM, p = .004. Predictors for determination of ictal onset were temporal lobe epilepsy (OR 2.9, p = .03) and lesional imaging (OR 3.1, p = .01). Predictors for surgery recommendation were temporal lobe epilepsy (OR 6.8, p < .001), FO seizure onset (OR 6.1, p = .002), and unilateral interictal epileptic activity (OR 3.8, p = .02). One-year postsurgical seizure freedom (53.3% of patients) was predicted by FO ictal onset (OR 5.8, p = .01). Two patients experienced intracerebral bleeding without persisting neurologic sequelae. Conclusion FOP VEM adds clinically significant electrophysiological information leading to treatment decisions in two-thirds of cases with a good benefit–risk profile. Predictors identified for electrophysiological and clinical outcome can assist in optimally selecting patients for this safe diagnostic approach. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11208-6.
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Affiliation(s)
- Gadi Miron
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany.
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Christoph Dehnicke
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Heinz-Joachim Meencke
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Michail G, Senkowski D, Holtkamp M, Wächter B, Keil J. Early beta oscillations in multisensory association areas underlie crossmodal performance enhancement. Neuroimage 2022; 257:119307. [PMID: 35577024 DOI: 10.1016/j.neuroimage.2022.119307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/09/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022] Open
Abstract
The combination of signals from different sensory modalities can enhance perception and facilitate behavioral responses. While previous research described crossmodal influences in a wide range of tasks, it remains unclear how such influences drive performance enhancements. In particular, the neural mechanisms underlying performance-relevant crossmodal influences, as well as the latency and spatial profile of such influences are not well understood. Here, we examined data from high-density electroencephalography (N = 30) recordings to characterize the oscillatory signatures of crossmodal facilitation of response speed, as manifested in the speeding of visual responses by concurrent task-irrelevant auditory information. Using a data-driven analysis approach, we found that individual gains in response speed correlated with larger beta power difference (13-25 Hz) between the audiovisual and the visual condition, starting within 80 ms after stimulus onset in the secondary visual cortex and in multisensory association areas in the parietal cortex. In addition, we examined data from electrocorticography (ECoG) recordings in four epileptic patients in a comparable paradigm. These ECoG data revealed reduced beta power in audiovisual compared with visual trials in the superior temporal gyrus (STG). Collectively, our data suggest that the crossmodal facilitation of response speed is associated with reduced early beta power in multisensory association and secondary visual areas. The reduced early beta power may reflect an auditory-driven feedback signal to improve visual processing through attentional gating. These findings improve our understanding of the neural mechanisms underlying crossmodal response speed facilitation and highlight the critical role of beta oscillations in mediating behaviorally relevant multisensory processing.
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Affiliation(s)
- Georgios Michail
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany.
| | - Daniel Senkowski
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin 10365, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, Berlin 10117, Germany
| | - Bettina Wächter
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin 10365, Germany
| | - Julian Keil
- Biological Psychology, Christian-Albrechts-University Kiel, Kiel 24118, Germany
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May TW, Pfäfflin M, Bien CG, Hamer HM, Holtkamp M, Rating D, Schulze-Bonhage A, Straub HB, Strzelczyk A, Thorbecke R. Attitudes toward epilepsy assessed by the SAPE questionnaire in Germany - Comparison of its psychometric properties and results in a web-based vs. face-to-face survey. Epilepsy Behav 2022; 130:108665. [PMID: 35334259 DOI: 10.1016/j.yebeh.2022.108665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/30/2021] [Revised: 02/28/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aims of this study were (1) to investigate psychometric properties of a new questionnaire (SAPE, Scales of the Attitudes toward People with Epilepsy) that assesses attitudes toward people with epilepsy (PWE) (2) to compare the effects of mode of survey administration (web-based vs. face-to-face) on attitudes, and (3) to identify predictors of attitudes. METHODS A face-to-face and a web-based survey were performed in Germany. Weighting factors were used to achieve representative samples of the German population. Reliability and validity of the 6 scales of the SAPE (social distance, stereotypes, personal concerns, and emotional reactions differentiated by fear, anger, and pity) were evaluated and compared for both surveys. Epilepsy knowledge was also assessed. General linear models were performed to investigate predictors of attitudes toward PWE including the type of survey. RESULTS In total, 1001 participants of the web-based survey and 1026 participants of face-to-face survey were included. Psychometric analyses indicated satisfactory reliability and validity of the scales and differed only slightly between modes of survey. In both surveys, fears and concerns were more pronounced than stereotypes and social distance. However, mean values of two scales were slightly or moderately higher in the face-to-face survey indicating more negative attitudes toward PWE (p < 0.001). Fewer participants of the face-to-face survey reported personal experience with PWE, claiming to know what to do in case of a seizure and claiming to know that seizures can be treated successfully (p < 0.001). These variables proved to be important predictors of positive attitudes toward PWE, besides demographic factors (e.g. age < 65, female gender). When controlling for them, the differences remained significant only for the scales Social Distance (moderately) and Fear (slightly). SIGNIFICANCE In total, psychometric analyses show that web-based surveys using the SAPE may be an alternative to face-to-face surveys to assess attitudes toward PWE. This applies also to the scales Social Distance and Emotional Reactions that allow comparisons with other diseases, e.g. psychiatric disorders. Most scales differ only slightly between survey modes, except social distance. This indicates that single components of attitudes toward PWE may be dependent on the mode of survey or different characteristics of respondents.
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Affiliation(s)
- Theodor W May
- Protestant Hospital of Bethel Foundation, University Medical School OWL, Bielefeld University, Campus Bielefeld-Bethel, Germany; University of Bielefeld, Faculty of Psychology and Sports Science, Germany.
| | - Margarete Pfäfflin
- Protestant Hospital of Bethel Foundation, University Medical School OWL, Bielefeld University, Campus Bielefeld-Bethel, Germany
| | - Christian G Bien
- Dept. of Epileptology (Krankenhaus Mara), Bielefeld University, Campus Bielefeld-Bethel, Germany; Society of Epilepsy Research, Epilepsy Center Bethel, Bielefeld, Germany
| | - Hajo M Hamer
- Epilepsy Center, Dept. of Neurology, University Hospital Erlangen, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | | | - Andreas Schulze-Bonhage
- Epilepsy Center, University Medical Center - University of Freiburg, Germany; European Reference Network Epicare, Germany
| | - Hans-Beatus Straub
- Epilepsy Center Berlin-Brandenburg, Epilepsieklinik Tabor, Bernau, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
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Steinbrenner M, Duncan JS, Dickson J, Rathore C, Wächter B, Aygun N, Menon RN, Radhakrishnan A, Holtkamp M, Ilyas-Feldmann M. Utility of 18F-fluorodeoxyglucose positron emission tomography in presurgical evaluation of patients with epilepsy: A multicenter study. Epilepsia 2022; 63:1238-1252. [PMID: 35166379 DOI: 10.1111/epi.17194] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 10/11/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in presurgical assessment in patients with drug-resistant focal epilepsy (DRE) if magnetic resonance imaging (MRI) and scalp electroencephalography (EEG) do not localize the seizure onset zone or are discordant. METHODS In this multicenter, retrospective observational cohort study, we included consecutive patients with DRE who had undergone FDG-PET as part of their presurgical workup. We assessed the utility of FDG-PET, which was defined as contributing to the decision-making process to refer for resection or intracranial EEG (iEEG) or to conclude surgery was not feasible. RESULTS We included 951 patients in this study; 479 had temporal lobe epilepsy (TLE), 219 extratemporal epilepsy (ETLE), and 253 epilepsy of uncertain lobar origin. FDG-PET showed a distinct hypometabolism in 62% and was concordant with ictal EEG in 74% in TLE and in 56% in ETLE (p < .001). FDG-PET was useful in presurgical decision-making in 396 patients (47%) and most beneficial in TLE compared to ETLE (58% vs. 44%, p = .001). Overall, FDG-PET contributed to recommending resection in 78 cases (20%) and iEEG in 187 cases (47%); in 131 patients (33%), FDG-PET resulted in a conclusion that resection was not feasible. In TLE, seizure-freedom 1 year after surgery did not differ significantly (p = .48) between patients with negative MRI and EEG-PET concordance (n = 30, 65%) and those with positive MRI and concordant EEG (n = 46, 68%). In ETLE, half of patients with negative MRI and EEG-PET concordance and three quarters with positive MRI and concordant EEG were seizure-free postsurgery (n = 5 vs. n = 6, p = .28). SIGNIFICANCE This is the largest reported cohort of patients with DRE who received presurgical FDG-PET, showing that FDG-PET is a useful diagnostic tool. MRI-negative and MRI-positive cases with concordant FDG-PET results (with either EEG or MRI) had a comparable outcome after surgery. These findings confirm the significance of FDG-PET in presurgical epilepsy diagnostics.
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Affiliation(s)
- Mirja Steinbrenner
- Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK
| | - John Dickson
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah (SBKS) Medical College, Sumandeep Vidyapeeth, Vadodara, India
| | - Bettina Wächter
- Epilepsy Center Berlin-Brandenburg, Evangelische Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Nafi Aygun
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Martin Holtkamp
- Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Epilepsy Center Berlin-Brandenburg, Evangelische Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Maria Ilyas-Feldmann
- Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Göttert R, Fidzinski P, Kraus L, Schneider UC, Holtkamp M, Endres M, Gertz K, Kronenberg G. Lithium inhibits tryptophan catabolism via the inflammation-induced kynurenine pathway in human microglia. Glia 2021; 70:558-571. [PMID: 34862988 DOI: 10.1002/glia.24123] [Citation(s) in RCA: 10] [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: 01/27/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022]
Abstract
Despite its decades' long therapeutic use in psychiatry, the biological mechanisms underlying lithium's mood-stabilizing effects have remained largely elusive. Here, we investigated the effect of lithium on tryptophan breakdown via the kynurenine pathway using immortalized human microglia cells, primary human microglia isolated from surgical specimens, and microglia-like cells differentiated from human induced pluripotent stem cells. Interferon (IFN)-γ, but not lipopolysaccharide, was able to activate immortalized human microglia, inducing a robust increase in indoleamine-2,3-dioxygenase (IDO1) mRNA transcription, IDO1 protein expression, and activity. Further, chromatin immunoprecipitation verified enriched binding of both STAT1 and STAT3 to the IDO1 promoter. Lithium counteracted these effects, increasing inhibitory GSK3βS9 phosphorylation and reducing STAT1S727 and STAT3Y705 phosphorylation levels in IFN-γ treated cells. Studies in primary human microglia and hiPSC-derived microglia confirmed the anti-inflammatory effects of lithium, highlighting that IDO activity is reduced by GSK3 inhibitor SB-216763 and STAT inhibitor nifuroxazide via downregulation of P-STAT1S727 and P-STAT3Y705 . Primary human microglia differed from immortalized human microglia and hiPSC derived microglia-like cells in their strong sensitivity to LPS, resulting in robust upregulation of IDO1 and anti-inflammatory cytokine IL-10. While lithium again decreased IDO1 activity in primary cells, it further increased release of IL-10 in response to LPS. Taken together, our study demonstrates that lithium inhibits the inflammatory kynurenine pathway in the microglia compartment of the human brain.
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Affiliation(s)
- Ria Göttert
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Pawel Fidzinski
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Berlin, Germany.,NeuroCure Cluster of Excellence, Berlin, Germany
| | - Larissa Kraus
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Ulf Christoph Schneider
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Neurochirurgie, Berlin, Germany
| | - Martin Holtkamp
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Matthias Endres
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Berlin, Germany.,NeuroCure Cluster of Excellence, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Karen Gertz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Golo Kronenberg
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Berlin, Germany.,College of Life Sciences, University of Leicester, Leicester, UK.,Leicestershire Partnership National Health Service Trust, Leicester, UK.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
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Reinecke LCS, Doerrfuss JI, Kowski AB, Holtkamp M. Acute symptomatic seizures in the emergency room: predictors and characteristics. J Neurol 2021; 269:2707-2714. [PMID: 34727204 PMCID: PMC9021090 DOI: 10.1007/s00415-021-10871-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/06/2022]
Abstract
Background When treating patients with epileptic seizures in the emergency room (ER), it is of paramount importance to rapidly assess whether the seizure was acute symptomatic or unprovoked as the former points to a potentially life-threatening underlying condition. In this study, we seek to identify predictors and analyze characteristics of acute symptomatic seizures (ASS). Methods Data from patients presenting with seizures to highly frequented ERs of two sites of a university hospital were analyzed retrospectively. Seizures were classified as acute symptomatic or unprovoked according to definitions of the International League Against Epilepsy. Univariate and multivariate analysis were conducted to identify predictors; furthermore, characteristics of ASS were assessed. Results Finally, 695 patients were included, 24.5% presented with ASS. Variables independently associated with ASS comprised male sex (OR 3.173, 95% CI 1.972–5.104), no prior diagnosis of epilepsy (OR 11.235, 95% CI 7.195–17.537), and bilateral/generalized tonic–clonic seizure semiology (OR 2.982, 95% CI 1.172–7.588). Alcohol withdrawal was the most common cause of ASS (74.1%), with hemorrhagic stroke being the second most prevalent etiology. Neuroimaging was performed more often in patients with the final diagnosis of ASS than in those with unprovoked seizures (82.9% vs. 67.2%, p < 0.001). Patients with ASS were more likely to receive acute antiseizure medication in the ER (55.9% vs. 30.3%, p < 0.001). Conclusions In one quarter of patients presenting to the ER after an epileptic fit, the seizure had an acute symptomatic genesis. The independently associated variables may help to early identify ASS and initiate management of the underlying condition.
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Affiliation(s)
- Lili C S Reinecke
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jakob I Doerrfuss
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Alexander B Kowski
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
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Monni L, Kraus L, Dipper-Wawra M, Soares-da-Silva P, Maier N, Schmitz D, Holtkamp M, Fidzinski P. In vitro and in vivo anti-epileptic efficacy of eslicarbazepine acetate in a mouse model of KCNQ2-related self-limited epilepsy. Br J Pharmacol 2021; 179:84-102. [PMID: 34605012 DOI: 10.1111/bph.15689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/16/2021] [Revised: 08/26/2021] [Accepted: 09/08/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE The KCNQ2 gene encodes for the Kv 7.2 subunit of non-inactivating potassium channels. KCNQ2-related diseases range from autosomal dominant neonatal self-limited epilepsy, often caused by KCNQ2 haploinsufficiency, to severe encephalopathies caused by KCNQ2 missense variants. In vivo and in vitro effects of the sodium channel blocker eslicarbazepine acetate (ESL) and eslicarbazepine metabolite (S-Lic) in a mouse model of self-limited neonatal epilepsy as a first attempt to assess the utility of ESL in the KCNQ2 disease spectrum was investigated. EXPERIMENTAL APPROACH Effects of S-Lic on in vitro physiological and pathological hippocampal neuronal activity in slices from mice carrying a heterozygous deletion of Kcnq2 (Kcnq2+/- ) and Kcnq2+/+ mice were investigated. ESL in vivo efficacy was investigated in the 6-Hz psychomotor seizure model in both Kcnq2+/- and Kcnq2+/+ mice. KEY RESULTS S-Lic increased the amplitude and decreased the incidence of physiological sharp wave-ripples in a concentration-dependent manner and slightly decreased gamma oscillations frequency. 4-Aminopyridine-evoked seizure-like events were blocked at high S-Lic concentrations and substantially reduced in incidence at lower concentrations. These results were not different in Kcnq2+/+ and Kcnq2+/- mice, although the EC50 estimation implicated higher efficacy in Kcnq2+/- animals. In vivo, Kcnq2+/- mice had a lower seizure threshold than Kcnq2+/+ mice. In both genotypes, ESL dose-dependently displayed protection against seizures. CONCLUSIONS AND IMPLICATIONS S-Lic slightly modulates hippocampal oscillations and blocks epileptic activity in vitro and in vivo. Our results suggest that the increased excitability in Kcnq2+/- mice is effectively targeted by S-Lic high concentrations, presumably by blocking diverse sodium channel subtypes.
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Affiliation(s)
- Laura Monni
- Clinical and Experimental Epileptology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Centre, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Larissa Kraus
- Clinical and Experimental Epileptology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Life Sciences Institute, Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthias Dipper-Wawra
- Clinical and Experimental Epileptology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Patricio Soares-da-Silva
- Division of Research and Development, BIAL - Portela & CA S. A, da Siderurgia Nacional, São Mamede do Coronado, Portugal.,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University Porto, Porto, Portugal
| | - Nikolaus Maier
- Neuroscience Research Centre, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dietmar Schmitz
- Neuroscience Research Centre, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Holtkamp
- Clinical and Experimental Epileptology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Pawel Fidzinski
- Clinical and Experimental Epileptology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Centre, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
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Steinbart D, Gaus V, Kowski AB, Holtkamp M. Valproic acid use in fertile women with genetic generalized epilepsies. Acta Neurol Scand 2021; 144:288-295. [PMID: 33977526 DOI: 10.1111/ane.13446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/02/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In genetic generalized epilepsies (GGE), valproic acid (VPA) is the most efficacious compound. However, due to teratogenicity and increased risk for impaired cognitive development after intrauterine exposure, its use in women of fertile age is strictly regulated but sometimes unavoidable. METHODS All patients with GGE treated at the outpatient clinic of a tertiary epilepsy center with at least one visit between January 2015 and April 2020 were included in this retrospective study. The rate of women aged 18 to 49 years taking VPA was compared to that of men of the same age group and to women > 49 years. Furthermore, in each group, clinical variables associated with VPA use were sought. RESULTS Twenty-eight out of 125 women of fertile age (22%) were treated with VPA, compared to 28 out of 56 men ≤ 49 years (50%; p = .002) and to 22 out of 40 female patients > 49 years (55%; p < .001). VPA dose was lower in fertile women compared to men, with no difference in seizure freedom rates. In women ≤ 49 years, multivariate analysis demonstrated age as the only variable independently associated with VPA use (OR 1.095; 95% CI 1.036-1.159). In the other two groups, no associated variables were identified. CONCLUSIONS Despite warnings with respect to teratogenicity and impaired cognitive development with VPA, from 2015 to 2020, almost every fourth women of fertile age with GGE received this compound. Inevitably lower VPA doses in these women seem sufficient for favorable seizure freedom rates.
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Affiliation(s)
- David Steinbart
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
| | - Verena Gaus
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
| | - Alexander B. Kowski
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
| | - Martin Holtkamp
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
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Steinbart D, Steinbrenner M, Oltmanns F, Holtkamp M. P3. Significance of intracranial EEG parameters in prediction of seizure freedom. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.328] [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] [Indexed: 10/20/2022]
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Doerrfuss JI, Kowski AB, Holtkamp M. Etiology-specific response to antiseizure medication in focal epilepsy. Epilepsia 2021; 62:2133-2141. [PMID: 34328218 DOI: 10.1111/epi.17017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/22/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE In focal epilepsy, data on the etiology-specific response to antiseizure medication (ASM) are surprisingly sparse. In this study, we sought to reappraise whether seizure outcome of pharmacological treatment is linked to the underlying etiology. Furthermore, we assessed ASM load with respect to the cause of epilepsy. METHODS Data were retrospectively obtained from the electronic database of the three sites of an academic adult epilepsy outpatient clinic. For each patient, presumed cause of epilepsy was categorized into one of nine etiological groups. Individual drug loads were calculated according to the 2020 World Health Organization Center for Drug Statistics Methodology ATC/DDD Index. Univariate and multivariate analyses were conducted to explore the association between different etiologies and outcome regarding 12-month seizure freedom as well as ASM load. RESULTS A total of 591 patients with focal epilepsy were included in the final analysis. Ischemic stroke was the etiology with the highest rate of 12-month terminal seizure freedom (71.2%, 95% confidence interval [CI] = 57.9-82.2) and, considering all etiological groups, was an independent predictor of seizure freedom (odds ratio = 2.093, 95% CI = 1.039-4.216). The lowest rates of seizure freedom were observed in patients with hippocampal sclerosis (28.2%, 95% CI = 15.0-44.9) and malformation of cortical development (16.7%, 95% CI = 2.1-48.4). In patients with ischemic stroke, median ASM load (1.0, interquartile range [IQR] = .5-1.8) was significantly lower compared to that in patients with hippocampal sclerosis (median = 1.8, IQR = 1.2-3.0, p = .008) and brain tumors (median = 1.7, IQR = .7-3.2, p = .049). SIGNIFICANCE Response to treatment with ASM is highly etiology-specific and best in patients with epilepsy due to ischemic stroke. Interestingly, this most favorable treatment outcome can be achieved by the lowest ASM load considering all etiological groups. In focal epilepsy, etiology should be taken into account when counseling patients about their expected seizure outcome with pharmacological treatment and when tailoring initial ASM doses.
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Affiliation(s)
- Jakob I Doerrfuss
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander B Kowski
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
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Hardtstock F, Foskett N, Gille P, Joeres L, Molzan M, Wilson JC, Wilke T, Holtkamp M. Poststroke epilepsy incidence, risk factors and treatment: German claims analysis. Acta Neurol Scand 2021; 143:614-623. [PMID: 33626184 PMCID: PMC8248362 DOI: 10.1111/ane.13403] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 01/09/2023]
Abstract
Objectives To describe incidence, risk factors, and treatment of poststroke epilepsy (PSE) in Germany based on claims data. Methods Retrospective analysis of claims data from a German public sickness fund (AOK PLUS). Patients with acute stroke hospitalizations from January 01, 2011 and December 31, 2015 (index hospitalization) were followed for 12–72 months. Outcomes included incidence of PSE (patients with ≥2 seizure claims [during/after index hospitalization], or ≥1 seizure claim after index hospitalization), multivariate Cox‐regression analyses of time to seizure claim and death after index stroke hospitalization discharge, and antiepileptic drug (AED) treatment. Results Among 53 883 patients with stroke (mean follow‐up of 829.05 days [median 749]), 6054 (11.24%) had ≥1 seizure claim (mean age 73.95 years, 54.18% female). 2130 (35.18%) patients had a seizure claim during index hospitalization (indicative of acute symptomatic seizures). Estimated incidence of PSE (cases/1000 patient‐years) was 94.49 within 1 year. Risk of seizure claim following hospital discharge was higher in patients with hemorrhagic stroke (hazard ratio [HR] =1.13; p <.001) vs those with cerebral infarction. Seizure claim during index hospitalization was a risk factor for seizure claims after hospital discharge (HR =6.97; p <.001) and early death (HR =1.78; p <.001). In the first year of follow‐up, AEDs were prescribed in 73.75% of patients with seizure claims. Conclusions Incidence of PSE was in line with previous studies. Hemorrhagic stroke and seizure claim during index hospitalization were risk factors for seizure claims after hospital discharge. Most patients with seizure claims received AED treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Martin Holtkamp
- Department of Neurology, Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
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Ragot A, Luhmann HJ, Dipper-Wawra M, Heinemann U, Holtkamp M, Fidzinski P. Pathology-selective antiepileptic effects in the focal freeze-lesion rat model of malformation of cortical development. Exp Neurol 2021; 343:113776. [PMID: 34058228 DOI: 10.1016/j.expneurol.2021.113776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 01/29/2023]
Abstract
Malformations of cortical development (MCD) represent a group of rare diseases with severe clinical presentation as epileptic and pharmacoresistant encephalopathies. Morphological studies in tissue from MCD patients have revealed reduced GABAergic efficacy and increased intracellular chloride concentration in neuronal cells as important pathophysiological mechanisms in MCD. Also, in various animal models, alterations of GABAergic inhibition have been postulated as a predominant factor contributing to perilesional hyperexcitability. Along with this line, the NKCC1 inhibitor bumetanide has been postulated as a potential drug for treatment of epilepsy, mediating its antiepileptic effect by reduction of the intracellular chloride and increased inhibitory efficacy of GABAergic transmission. In the present study, we focused on the focal freeze-lesion model of MCD to compare antiepileptic drugs with distinct mechanisms of action, including NKCC1 inhibition by bumetanide. For this purpose, we combined electrophysiological and optical methods in slice preparations and assessed the properties of seizure like events (SLE) induced by 4-aminopyridine. In freeze-lesioned but not control slices, SLE onset was confined to the perilesional area, confirming that this region is hyperexcitable and likely triggers pathological activity. Bumetanide selectively reduced epileptic activity in lesion-containing slices but not in slices from sham-treated control rats. Moreover, bumetanide caused a shift in the SLE onset site away from the perilesional area. In contrast, effects of other antiepileptic drugs including carbamazepine, lacosamide, acezatolamide and zonisamide occurred mostly independently of the lesion and did not result in a shift of the onset region. Our work adds evidence for the functional relevance of chloride homeostasis in the pathophysiology of microgyrus formation as represented in the focal freeze-lesion model. Further studies in different MCD models and human tissue will be required to validate the effects across different MCD subtypes and species and to assess the translational value of our findings.
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Affiliation(s)
- Aliénor Ragot
- Charité - Universitätsmedizin Berlin, Clinical and Experimental Epileptology, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany
| | - Heiko J Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Matthias Dipper-Wawra
- Charité - Universitätsmedizin Berlin, Clinical and Experimental Epileptology, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany
| | - Uwe Heinemann
- Charité - Universitätsmedizin Berlin, Institute of Neurophysiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Martin Holtkamp
- Charité - Universitätsmedizin Berlin, Clinical and Experimental Epileptology, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Pawel Fidzinski
- Charité - Universitätsmedizin Berlin, Clinical and Experimental Epileptology, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany; Berlin Institute of Health at Charité -Universitätsmedizin Berlin, NeuroCure Clinical Research Center, Charitéplatz 1, 10117 Berlin, Germany.
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Sales F, Delanty N, Mecarelli O, Holtkamp M, McMurray R, Loureiro R, Fernandes H, Villanueva V. Predictors of seizure freedom, response and retention after 12 months of treatment with eslicarbazepine acetate: A post-hoc analysis of the Euro-Esli study. Epilepsy Res 2021; 174:106653. [PMID: 34049227 DOI: 10.1016/j.eplepsyres.2021.106653] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Eslicarbazepine acetate (ESL) is a once-daily antiseizure medication (ASM) that is approved in Europe and the USA for the treatment of focal-onset seizures. The Euro-Esli study, which included over 2000 patients, investigated the real-world effectiveness, safety and tolerability of ESL when used in everyday clinical practice in Europe. This post-hoc analysis of Euro-Esli employed univariate and multivariate binary logistic regression analyses to investigate the relationship between demographic and baseline characteristics (including epilepsy- and treatment-related factors) and the likelihood of seizure freedom, response and retention in adult patients with focal seizures after 12 months of ESL treatment in the real-world setting. Multivariate analysis revealed that the factors associated with seizure freedom and response at 12 months (N = 1054) were generally those characterising patients who were relatively early in their disease course and/or less refractory to treatment, such as older age at onset of epilepsy, absence of seizures at baseline and lower number of concomitant ASMs at baseline. Although it was not possible to construct a multivariate model to predict retention on ESL treatment at 12 months, when the univariate regression model was adjusted for age and epilepsy duration, the factors found to be significantly associated with retention at 12 months (N = 1559) comprised shorter duration of epilepsy, absence of any seizures at baseline, lower baseline seizure frequency (<5 vs. ≥ 5 seizures/month), lower number of previous ASMs, lower number of concomitant ASMs, and the absence of concomitant use of lamotrigine at baseline. These findings therefore identify baseline characteristics that are predictive of the effectiveness of ESL treatment in clinical practice, which may help clinicians choose appropriate ASM therapy for patients.
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Affiliation(s)
- Francisco Sales
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Norman Delanty
- Beaumont Hospital and School of Pharmacy and Biomolecular Sciences, FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Oriano Mecarelli
- Sapienza University, Policlinico Umberto I Hospital, Rome, Italy.
| | - Martin Holtkamp
- Epilepsy‑Center Berlin‑Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Rui Loureiro
- Bial - Portela & Cª, S.A., Coronado (S. Romão e S. Mamede), Portugal.
| | - Hélder Fernandes
- Bial - Portela & Cª, S.A., Coronado (S. Romão e S. Mamede), Portugal.
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Strzelczyk A, Knake S, Holtkamp M, Schulze-Bonhage A, Lemke J, von Spiczak S, Berkenfeld R, Rosenow F, Brandt C, Schmitt FC. Impfung zur Vorbeugung der COVID-19-Erkrankung sowie Impfpriorisierung bei Epilepsie. Z Epileptol 2021. [PMCID: PMC7848875 DOI: 10.1007/s10309-021-00404-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
ZusammenfassungDer Vorstand der Deutschen Gesellschaft für Epileptologie und die Kommission „Epilepsie und Synkopen“ der Deutschen Gesellschaft für Neurologie haben die aktuelle Datenlage zur Impfung zur Vorbeugung der Corona-Virus-Krankheit 2019 (COVID-19) sowie zur Impfpriorisierung bei Menschen mit Epilepsie gesichtet, diese zusammengefasst und geben die unten genannten Empfehlungen ab.
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Doerrfuss JI, Kowski AB, Holtkamp M, Thinius M, Leithner C, Storm C. Prognostic value of 'late' electroencephalography recordings in patients with cardiopulmonal resuscitation after cardiac arrest. J Neurol 2021; 268:4248-4257. [PMID: 33871711 PMCID: PMC8505381 DOI: 10.1007/s00415-021-10549-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022]
Abstract
Background Electroencephalography (EEG) significantly contributes to the neuroprognostication after resuscitation from cardiac arrest. Recent studies suggest that the prognostic value of EEG is highest for continuous recording within the first days after cardiac arrest. Early continuous EEG, however, is not available in all hospitals. In this observational study, we sought to evaluate the predictive value of a ‘late’ EEG recording 5–14 days after cardiac arrest without sedatives. Methods We retrospectively analyzed EEG data in consecutive adult patients treated at the medical intensive care units (ICU) of the Charité—Universitätsmedizin Berlin. Outcome was assessed as cerebral performance category (CPC) at discharge from ICU, with an unfavorable outcome being defined as CPC 4 and 5. Results In 187 patients, a ‘late’ EEG recording was performed. Of these patients, 127 were without continuous administration of sedative agents for at least 24 h before the EEG recording. In this patient group, a continuously suppressed background activity < 10 µV predicted an unfavorable outcome with a sensitivity of 31% (95% confidence interval (CI) 20–45) and a specificity of 99% (95% CI 91–100). In patients with suppressed background activity and generalized periodic discharges, sensitivity was 15% (95% CI 7–27) and specificity was 100% (95% CI 94–100). GPDs on unsuppressed background activity were associated with a sensitivity of 42% (95% CI 29–46) and a specificity of 92% (95% CI 82–97). Conclusions A ‘late’ EEG performed 5 to 14 days after resuscitation from cardiac arrest can aide in prognosticating functional outcome. A suppressed EEG background activity in this time period indicates poor outcome. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10549-y.
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Affiliation(s)
- Jakob I Doerrfuss
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Alexander B Kowski
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Thinius
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Leithner
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Storm
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Davids R, Kowski AB, Meencke H, Oltmanns F, Dehnicke C, Schneider UC, Holtkamp M. Surgery in intractable epilepsy-physicians' recommendations and patients' decisions. Acta Neurol Scand 2021; 143:421-429. [PMID: 33210727 DOI: 10.1111/ane.13377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/07/2020] [Revised: 10/29/2020] [Accepted: 11/14/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To identify demographic and clinical variables independently associated with patients' decisions against their physicians' recommendations for resective epilepsy surgery or further scalp video-EEG monitoring (sca-VEM), semi-invasive (sem-)VEM with foramen ovale and/or peg electrodes, and invasive (in-)VEM. METHODS Consecutive patients, who underwent presurgical assessment with at least one sca-VEM between 2010 and 2014, were included into this retrospective analysis. Multivariate analysis was used to identify independent variables associated with patients' decisions. RESULTS Within the study period, 352 patients underwent 544 VEM sessions comprising 451 sca-, 36 sem-, and 57 in-VEMs. Eventually, 96 patients were recommended resective surgery, and 106 were ineligible candidates; 149 patients denied further necessary VEMs; thus, no decision could be made. After sca- or additional sem-VEM, nine out of 51 eligible patients (17.6%) rejected resection. One hundred and ten patients were recommended in-VEM, 52 of those (47.2%) declined. Variables independently associated with rejection of in-VEM comprised intellectual disability (OR 4.721, 95% CI 1.047-21.284), extratemporal focal aware non-motor seizures ("aura") vs. no "aura" (OR 0.338, 95% CI 0.124-0.923), and unilateral or bilateral vs. no MRI lesion (OR 0.248, 95% CI 0.100-0.614 and 0.149, 95% CI 0.027-0.829, respectively). CONCLUSIONS During and after presurgical evaluation, patients with intractable focal epilepsy declined resections and intracranial EEGs, as recommended by their epileptologists, in almost 20% and 50% of cases. This calls for early and thorough counseling of patients on risks and benefits of epilepsy surgery. Future prospective studies should ask patients in depth for specific reasons why they decline their physicians' recommendations.
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Affiliation(s)
- Roman Davids
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg, Charité – Universitätsmedizin Berlin Berlin Germany
| | - Alexander B. Kowski
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg, Charité – Universitätsmedizin Berlin Berlin Germany
| | - Hans‐Joachim Meencke
- Institute for Diagnostics of Epilepsy Evangelisches Krankenhaus Königin Elisabeth Herzberge, Epilepsy‐Center Berlin‐Brandenburg Berlin Germany
| | - Frank Oltmanns
- Institute for Diagnostics of Epilepsy Evangelisches Krankenhaus Königin Elisabeth Herzberge, Epilepsy‐Center Berlin‐Brandenburg Berlin Germany
| | - Christoph Dehnicke
- Institute for Diagnostics of Epilepsy Evangelisches Krankenhaus Königin Elisabeth Herzberge, Epilepsy‐Center Berlin‐Brandenburg Berlin Germany
| | - Ulf C. Schneider
- Department of Neurosurgery Charité – Universitätsmedizin Berlin Berlin Germany
| | - Martin Holtkamp
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg, Charité – Universitätsmedizin Berlin Berlin Germany
- Institute for Diagnostics of Epilepsy Evangelisches Krankenhaus Königin Elisabeth Herzberge, Epilepsy‐Center Berlin‐Brandenburg Berlin Germany
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Schlabitz S, Monni L, Ragot A, Dipper-Wawra M, Onken J, Holtkamp M, Fidzinski P. Spatiotemporal Correlation of Epileptiform Activity and Gene Expression in vitro. Front Mol Neurosci 2021; 14:643763. [PMID: 33859552 PMCID: PMC8042243 DOI: 10.3389/fnmol.2021.643763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/18/2020] [Accepted: 03/03/2021] [Indexed: 11/14/2022] Open
Abstract
Epileptiform activity alters gene expression in the central nervous system, a phenomenon that has been studied extensively in animal models. Here, we asked whether also in vitro models of seizures are in principle suitable to investigate changes in gene expression due to epileptiform activity and tested this hypothesis mainly in rodent and additionally in some human brain slices. We focused on three genes relevant for seizures and epilepsy: FOS proto-oncogene (c-Fos), inducible cAMP early repressor (Icer) and mammalian target of rapamycin (mTor). Seizure-like events (SLEs) were induced by 4-aminopyridine (4-AP) in rat entorhinal-hippocampal slices and by 4-AP/8 mM potassium in human temporal lobe slices obtained from surgical treatment of epilepsy. SLEs were monitored simultaneously by extracellular field potentials and intrinsic optical signals (IOS) for 1–4 h, mRNA expression was quantified by real time PCR. In rat slices, both duration of SLE exposure and SLE onset region were associated with increased expression of c-Fos and Icer while no such association was shown for mTor expression. Similar to rat slices, c-FOS induction in human tissue was increased in slices with epileptiform activity. Our results indicate that irrespective of limitations imposed by ex vivo conditions, in vitro models represent a suitable tool to investigate gene expression. Our finding is of relevance for the investigation of human tissue that can only be performed ex vivo. Specifically, it presents an important prerequisite for future studies on transcriptome-wide and cell-specific changes in human tissue with the goal to reveal novel candidates involved in the pathophysiology of epilepsy and possibly other CNS pathologies.
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Affiliation(s)
- Sophie Schlabitz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology with Experimental Neurology, Clinical and Experimental Epileptology, Berlin, Germany
| | - Laura Monni
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology with Experimental Neurology, Clinical and Experimental Epileptology, Berlin, Germany
| | - Alienor Ragot
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology with Experimental Neurology, Clinical and Experimental Epileptology, Berlin, Germany
| | - Matthias Dipper-Wawra
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology with Experimental Neurology, Clinical and Experimental Epileptology, Berlin, Germany
| | - Julia Onken
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurosurgery, Berlin, Germany
| | - Martin Holtkamp
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology with Experimental Neurology, Clinical and Experimental Epileptology, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Pawel Fidzinski
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology with Experimental Neurology, Clinical and Experimental Epileptology, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Neuroscience Research Center, Berlin, Germany
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Thuberg D, Buentjen L, Holtkamp M, Voges J, Heinze HJ, Lee H, Kitay AY, Schmitt FC. Deep Brain Stimulation for Refractory Focal Epilepsy: Unraveling the Insertional Effect up to Five Months Without Stimulation. Neuromodulation 2021; 24:373-379. [PMID: 33577139 DOI: 10.1111/ner.13349] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/25/2019] [Revised: 10/29/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Following electrode implantation, a subgroup of patients treated with deep brain stimulation (DBS) for focal epilepsy exhibits a reduction of seizure frequency before stimulation is initiated. Microlesioning of the target structure has been postulated to be the cause of this "insertional" effect (IE). We examined the occurrence and duration of this IE in a group of patients with focal epilepsy following electrode implantation in the anterior nuclei of the thalamus (ANT) and/or nucleus accumbens (NAC) for DBS treatment. MATERIALS AND METHODS Changes in monthly seizure frequency compared to preoperative baseline were assessed one month (14 patients) and five months (four patients) after electrode implantation. A group analysis between patients with implantation of bilateral ANT-electrodes (four patients), NAC-electrodes (one patient) as well as ANT and NAC-electrodes (nine patients) was performed. RESULTS In this cohort, seizure frequency decreased one month after electrode implantation by 57.1 ± 30.1%, p ≤ 0.001 (compared to baseline). No significant difference within stimulation target subcohorts was found (p > 0.05). Out of the four patients without stimulation for five months following electrode insertion, three patients showed seizure frequency reduction lasting two to three months, while blinded to their stimulation status. CONCLUSION An IE might explain seizure frequency reduction in our cohort. This effect seems to be independent of the number of implanted electrodes and of the target itself. The time course of the blinded subgroup of epilepsy patients suggests a peak of the lesional effect at two to three months after electrode insertion.
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Affiliation(s)
- Dominik Thuberg
- Department of Neurology, University of Magdeburg, Magdeburg, Germany
| | - Lars Buentjen
- Department of Stereotactic Neurosurgery, University of Magdeburg, Magdeburg, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Voges
- Department of Stereotactic Neurosurgery, University of Magdeburg, Magdeburg, Germany.,Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, University of Magdeburg, Magdeburg, Germany.,Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
| | - Harim Lee
- Department of Neurology, University of Magdeburg, Magdeburg, Germany
| | - Ann-Yasmin Kitay
- Department of Neurology, University of Magdeburg, Magdeburg, Germany
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Steinbart D, Steinbrenner M, Oltmanns F, Holtkamp M. Prediction of seizure freedom after epilepsy surgery - Critical reappraisal of significance of intracranial EEG parameters. Clin Neurophysiol 2020; 131:2682-2690. [PMID: 33002730 DOI: 10.1016/j.clinph.2020.08.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To analyze the significance of intracranial electroencephalography (iEEG) parameters such as seizure onset patterns (SOP) and size of seizure onset zone (SOZ) with respect to prediction of seizure freedom after resective epilepsy surgery. METHODS All patients who underwent iEEG with subdural electrodes between January 2006 and December 2015 in our epilepsy-center were included. Various iEEG parameters were retrospectively analyzed regarding their predictive value to post-operative seizure freedom. Furthermore, associations of specific SOPs with underlying histopathology and brain regions of the SOZ were examined. RESULTS Eighty-one patients (34 female) with 324 seizures were assessed. Low-voltage fast activity (37%) and sharp activity <13 Hz (30%) were the most frequent SOPs. Focal SOZ (≤2 cm) was the only iEEG parameter independently associated with 1-year post-operative seizure freedom (OR 4.1, 95% CI 1.433-11.679). While no SOP was linked to specific histopathologies, some associations between SOPs and anatomical regions of SOZ were found. CONCLUSIONS A circumscribed SOZ, but no specific SOP was predictive for seizure freedom after epilepsy surgery. SIGNIFICANCE Intracranial EEG may be helpful to predict post-operative seizure freedom. Multicenter studies with larger numbers of patients are required to reliably assess the significance of specific SOPs for successful resective epilepsy surgery.
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Affiliation(s)
- David Steinbart
- Charité - Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany
| | - Mirja Steinbrenner
- Charité - Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany.
| | - Frank Oltmanns
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Martin Holtkamp
- Charité - Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
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50
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Pajkert A, Ploner CJ, Lehmann TN, Witte VA, Oltmanns F, Sommer W, Holtkamp M, Heekeren HR, Finke C. Early volumetric changes of hippocampus and medial prefrontal cortex following medial temporal lobe resection. Eur J Neurosci 2020; 52:4375-4384. [PMID: 32421911 DOI: 10.1111/ejn.14784] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 12/14/2022]
Abstract
Previous studies have shown that cognitive demands and physical exercise stimulate adult neurogenesis in the dentate gyrus and hippocampus. Recent observations in healthy humans and patients with mild cognitive impairment moreover suggest that training-induced increases in hippocampal volume may be associated with improved memory performance. The corresponding plasticity processes in hippocampal volume may occur on timescales of months to years. For patients with focal lesions in this region, previous functional imaging studies suggest that increased recruitment of the contralateral hippocampus and extratemporal regions may be an important part of the reorganization of episodic memory. However, it is currently unclear whether focal damage to the medial temporal lobe (MTL) induces gray matter (GM) volume changes in the intact contralateral hippocampus and in connected network regions on a shorter timescale. We therefore investigated whether unilateral resection of the MTL, including the hippocampus, induces measurable volumetric changes in the contralateral hippocampus and in the default mode network (DMN). We recruited 31 patients with unilateral left (N = 19) or right (N = 12) hippocampal sclerosis undergoing MTL resection for treatment of drug-resistant epilepsy. Structural MRI was acquired immediately before and 3 months after surgery. Longitudinal voxel-based morphometry (VBM) analysis revealed a significant increase of right hippocampal volume following resection of the left anterior MTL. Furthermore, this patient group showed GM volume increases in the DMN. These results demonstrate significant structural plasticity of the contralateral hippocampus, even in patients with a long-standing unilateral hippocampal dysfunction and structural reorganization processes extending to distant, but functionally connected brain regions.
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Affiliation(s)
- Anna Pajkert
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph J Ploner
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Veronica A Witte
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Werner Sommer
- Institut für Psychologie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
| | - Hauke R Heekeren
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.,Center for Cognitive Neuroscience Berlin, Freie Universität Berlin, Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind & Brain, Humboldt-Universität zu Berlin, Berlin, Germany
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