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Delazer L, Pressler N, Balestrini S, Xiao F, Clayton LM, Anders-Cannon J, Salvatierra R, Henry I, Sisodiya SM, Sander JW, Koepp MJ. COVID-19 response in a long-term care facility for people with epilepsy. Epilepsia Open 2024. [PMID: 38593277 DOI: 10.1002/epi4.12940] [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: 02/10/2024] [Revised: 03/09/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE To assess asymptomatic rates and severity of SARS-CoV-2 infection in people with epilepsy and their healthcare workers in a long-term care facility which had implemented weekly surveillance testing between April 2020 and June 2022. METHODS Questionnaires focused on objective and subjective COVID-19 symptoms for people with epilepsy residing in and their healthcare workers at the Chalfont Centre for Epilepsy in June 2022. Demographic information, comorbidities, and seizure frequency were gathered from medical records. We also collected responses on objective and subjective COVID-19 symptoms from healthcare workers who participated in a prospective study assessing the reaction to COVID-19 vaccinations (SAFER). RESULTS Fifty-five out of 89 (62%) residents tested positive at least once on weekly PCR testing for SARS-CoV-2 during the period of interest; 20 of those (37%) were asymptomatic. In comparison, of those 63 healthcare workers who tested positive at least once on weekly testing during the same period, only four (6%) were asymptomatic. Of the 159 healthcare workers who also participated in the SAFER study, 41 tested positive at least once, and seven (17%) were completely asymptomatic during infection with SARS-CoV-2. SIGNIFICANCE People with epilepsy living in a long-term care facility were more likely to present with asymptomatic SARS-CoV-2 infections than healthcare workers at the same facility. Despite possible bias in the reporting of subjective symptoms due to management-by-proxy, there is no evidence that vulnerable people living in an epilepsy long-term care facility showed reduced resilience towards infections. PLAIN LANGUAGE SUMMARY People with epilepsy living in care home facilities had a surprisingly high degree of asymptomatic infections with SARS-CoV-2. Very few residents had severe or fatal outcomes. This is in stark contrast to the widely reported bad outcomes for people without epilepsy in other care homes. People with epilepsy reported significantly less symptoms than their healthcare workers. No changes in seizure frequency during or after infection were observed.
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Affiliation(s)
- Luisa Delazer
- Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Department of Neurology, Epilepsy Center, Ludwig Maximilians University, Munich, Germany
| | - Noah Pressler
- University of Nottingham, Medical School, Nottingham, UK
| | - Simona Balestrini
- Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Neuroscience Department, Children's Hospital A. Meyer IRCSS, University of Florence, Florence, Italy
| | - Fenglai Xiao
- Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lisa M Clayton
- Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | | | | | - Ian Henry
- Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks, UK
| | - Sanjay M Sisodiya
- Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Josemir W Sander
- Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Matthias J Koepp
- Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks, UK
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
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Trimmel K, Vos SB, Binding L, Caciagli L, Xiao F, van Graan LA, Koepp MJ, Thompson PJ, Duncan JS. Naming fMRI-guided white matter language tract volumes influence naming decline after temporal lobe resection. J Neurol 2024:10.1007/s00415-024-12315-2. [PMID: 38583105 DOI: 10.1007/s00415-024-12315-2] [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: 12/16/2023] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE The aim of this study was to explore the relation of language functional MRI (fMRI)-guided tractography with postsurgical naming decline in people with temporal lobe epilepsy (TLE). METHODS Twenty patients with unilateral TLE (9 left) were studied with auditory and picture naming functional MRI tasks. Activation maxima in the left posterobasal temporal lobe were used as seed regions for whole-brain fibre tractography. Clinical naming performance was assessed preoperatively, 4 months, and 12 months following temporal lobe resection. Volumes of white matter language tracts in both hemispheres as well as tract volume laterality indices were explored as moderators of postoperative naming decline using Pearson correlations and multiple linear regression with other clinical variables. RESULTS Larger volumes of white matter language tracts derived from auditory and picture naming maxima in the hemisphere of subsequent surgery as well as stronger lateralization of picture naming tract volumes to the side of surgery correlated with greater language decline, which was independent of fMRI lateralization status. Multiple regression for picture naming tract volumes was associated with a significant decline of naming function with 100% sensitivity and 93% specificity at both short-term and long-term follow-up. INTERPRETATION Naming fMRI-guided white matter language tract volumes relate to postoperative naming decline after temporal lobe resection in people with TLE. This can assist stratification of surgical outcome and minimize risk of postoperative language deficits in TLE.
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Affiliation(s)
- Karin Trimmel
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.
| | - Sjoerd B Vos
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK
- Centre for Microscopy Characterisation and Analysis, University of Western Australia, Nedlands, Australia
| | - Lawrence Binding
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Lorenzo Caciagli
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fenglai Xiao
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Louis A van Graan
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Matthias J Koepp
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Pamela J Thompson
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - John S Duncan
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
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Devinsky O, Elder C, Sivathamboo S, Scheffer IE, Koepp MJ. Idiopathic Generalized Epilepsy: Misunderstandings, Challenges, and Opportunities. Neurology 2024; 102:e208076. [PMID: 38165295 DOI: 10.1212/wnl.0000000000208076] [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: 06/12/2023] [Accepted: 10/19/2023] [Indexed: 01/03/2024] Open
Abstract
The idiopathic generalized epilepsies (IGE) make up a fifth of all epilepsies, but <1% of epilepsy research. This skew reflects misperceptions: diagnosis is straightforward, pathophysiology is understood, seizures are easily controlled, epilepsy is outgrown, morbidity and mortality are low, and surgical interventions are impossible. Emerging evidence reveals that patients with IGE may go undiagnosed or misdiagnosed with focal epilepsy if EEG or semiology have asymmetric or focal features. Genetic, electrophysiologic, and neuroimaging studies provide insights into pathophysiology, including overlaps and differences from focal epilepsies. IGE can begin in adulthood and patients have chronic and drug-resistant seizures. Neuromodulatory interventions for drug-resistant IGE are emerging. Rates of psychiatric and other comorbidities, including sudden unexpected death in epilepsy, parallel those in focal epilepsy. IGE is an understudied spectrum for which our diagnostic sensitivity and specificity, scientific understanding, and therapies remain inadequate.
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Affiliation(s)
- Orrin Devinsky
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Christopher Elder
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Shobi Sivathamboo
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Ingrid E Scheffer
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Matthias J Koepp
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
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Xiao F, Caciagli L, Wandschneider B, Sone D, Young AL, Vos SB, Winston GP, Zhang Y, Liu W, An D, Kanber B, Zhou D, Sander JW, Thom M, Duncan JS, Alexander DC, Galovic M, Koepp MJ. Identification of different MRI atrophy progression trajectories in epilepsy by subtype and stage inference. Brain 2023; 146:4702-4716. [PMID: 37807084 PMCID: PMC10629797 DOI: 10.1093/brain/awad284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/24/2023] [Revised: 06/30/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Artificial intelligence (AI)-based tools are widely employed, but their use for diagnosis and prognosis of neurological disorders is still evolving. Here we analyse a cross-sectional multicentre structural MRI dataset of 696 people with epilepsy and 118 control subjects. We use an innovative machine-learning algorithm, Subtype and Stage Inference, to develop a novel data-driven disease taxonomy, whereby epilepsy subtypes correspond to distinct patterns of spatiotemporal progression of brain atrophy.In a discovery cohort of 814 individuals, we identify two subtypes common to focal and idiopathic generalized epilepsies, characterized by progression of grey matter atrophy driven by the cortex or the basal ganglia. A third subtype, only detected in focal epilepsies, was characterized by hippocampal atrophy. We corroborate external validity via an independent cohort of 254 people and confirm that the basal ganglia subtype is associated with the most severe epilepsy.Our findings suggest fundamental processes underlying the progression of epilepsy-related brain atrophy. We deliver a novel MRI- and AI-guided epilepsy taxonomy, which could be used for individualized prognostics and targeted therapeutics.
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Affiliation(s)
- Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
| | - Daichi Sone
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, 105-8461, Japan
| | - Alexandra L Young
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Sjoerd B Vos
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
- Centre for Microscopy, Characterisation, and Analysis, University of Western Australia, Perth, WA 6009, Australia
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, K7L 3N6, Canada
- Centre for Neuroscience Studies, Queen’s University, Kingston, K7L 3N6, Canada
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wenyu Liu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Dongmei An
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Baris Kanber
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
- Stichting Epilepsie Instellingen Nederland – (SEIN), Heemstede, 2103SW, The Netherlands
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, CH-8091, Switzerland
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
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Caciagli L, Ratcliffe C, Xiao F, van Graan LA, Trimmel K, Vollmar C, Centeno M, Duncan JS, Thompson PJ, Baxendale S, Koepp MJ, Wandschneider B. Cognitive phenotype of juvenile absence epilepsy: An investigation of patients and unaffected siblings. Epilepsia 2023; 64:2792-2805. [PMID: 37475704 PMCID: PMC10952612 DOI: 10.1111/epi.17719] [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: 11/24/2022] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The cognitive profile of juvenile absence epilepsy (JAE) remains largely uncharacterized. This study aimed to: (1) elucidate the neuropsychological profile of JAE; (2) identify familial cognitive traits by investigating unaffected JAE siblings; (3) establish the clinical meaningfulness of JAE-associated cognitive traits; (4) determine whether cognitive traits across the idiopathic generalized epilepsy (IGE) spectrum are shared or syndrome-specific, by comparing JAE to juvenile myoclonic epilepsy (JME); and (5) identify relationships between cognitive abilities and clinical characteristics. METHODS We investigated 123 participants-23 patients with JAE, 16 unaffected siblings of JAE patients, 45 healthy controls, and 39 patients with JME-who underwent a comprehensive neuropsychological test battery including measures within four cognitive domains: attention/psychomotor speed, language, memory, and executive function. We correlated clinical measures with cognitive performance data to decode effects of age at onset and duration of epilepsy. RESULTS Cognitive performance in individuals with JAE was reduced compared to controls across attention/psychomotor speed, language, and executive function domains; those with ongoing seizures additionally showed lower memory scores. Patients with JAE and their unaffected siblings had similar language impairment compared to controls. Individuals with JME had worse response inhibition than those with JAE. Across all patients, those with older age at onset had better attention/psychomotor speed performance. SIGNIFICANCE JAE is associated with wide-ranging cognitive difficulties that encompass domains reliant on frontal lobe processing, including language, attention, and executive function. JAE siblings share impairment with patients on linguistic measures, indicative of a familial trait. Executive function subdomains may be differentially affected across the IGE spectrum. Cognitive abilities are detrimentally modulated by an early age at seizure onset.
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Affiliation(s)
- Lorenzo Caciagli
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of Neurology, Inselspital, Sleep‐Wake‐Epilepsy‐Center, Bern University HospitalUniversity of BernBernSwitzerland
| | - Corey Ratcliffe
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative BiologyUniversity of LiverpoolLiverpoolUK
- Department of Neuroimaging and Interventional RadiologyNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Fenglai Xiao
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Louis A. van Graan
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Karin Trimmel
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Christian Vollmar
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of NeurologyLudwig‐Maximilians‐UniversitätMunichGermany
| | - Maria Centeno
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Epilepsy Unit, Department of NeurologyHospital Clínic de BarcelonaBarcelonaSpain
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Pamela J. Thompson
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Sallie Baxendale
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Matthias J. Koepp
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Britta Wandschneider
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
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Koepp MJ, Trinka E, Mah Y, Bentes C, Knake S, Gigli GL, Serratosa JM, Zelano J, Magalhães LM, Pereira A, Moreira J, Soares‐da‐Silva P. Antiepileptogenesis after stroke-trials and tribulations: Methodological challenges and recruitment results of a Phase II study with eslicarbazepine acetate. Epilepsia Open 2023; 8:1190-1201. [PMID: 36944588 PMCID: PMC10472381 DOI: 10.1002/epi4.12735] [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: 01/04/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
There is currently no evidence to support the use of antiseizure medications to prevent unprovoked seizures following stroke. Experimental animal models suggested a potential antiepileptogenic effect for eslicarbazepine acetate (ESL), and a Phase II, multicenter, randomized, double-blind, placebo-controlled study was designed to test this hypothesis and assess whether ESL treatment for 1 month can prevent unprovoked seizures following stroke. We outline the design and status of this antiepileptogenesis study, and discuss the challenges encountered in its execution to date. Patients at high risk of developing unprovoked seizures after acute intracerebral hemorrhage or acute ischemic stroke were randomized to receive ESL 800 mg/d or placebo, initiated within 120 hours after primary stroke occurrence. Treatment continued until Day 30, then tapered off. Patients could receive all necessary therapies for stroke treatment according to clinical practice guidelines and standard of care, and are being followed up for 18 months. The primary efficacy endpoint is the occurrence of a first unprovoked seizure within 6 months after randomization ("failure rate"). Secondary efficacy assessments include the occurrence of a first unprovoked seizure during 12 months after randomization and during the entire study; functional outcomes (Barthel Index original 10-item version; National Institutes of Health Stroke Scale); post-stroke depression (Patient Health Questionnaire-9; PHQ-9); and overall survival. Safety assessments include the evaluation of treatment-emergent adverse events; laboratory parameters; vital signs; electrocardiogram; suicidal ideation and behavior (PHQ-9 question 9). The protocol aimed to randomize approximately 200 patients (1:1), recruited from 21 sites in seven European countries and Israel. Despite the challenges encountered, particularly during the COVID-19 pandemic, the study progressed and included a remarkable number of patients, with 129 screened and 125 randomized. Recruitment was stopped after 30 months, the first patient entered in May 2019, and the study is ongoing and following up on patients according to the Clinical Trial Protocol.
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Affiliation(s)
- Matthias J. Koepp
- UCL Queen Square Institute of NeurologyLondonUK
- National Hospital for Neurology and NeurosurgeryLondonUK
| | - Eugen Trinka
- Department of NeurologyChristian‐Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARESalzburgAustria
- Neuroscience Institute, Christian‐Doppler University HospitalParacelsus Medical University, Centre for Cognitive NeuroscienceSalzburgAustria
- Institute of Public Health, Medical Decision‐Making and HTAUMIT – Private University for Health SciencesMedical Informatics and TechnologyHall in TyrolAustria
| | - Yee‐Haur Mah
- King's College Hospital NHS Foundation TrustLondonUK
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Carla Bentes
- Reference Centre for Refractory Epilepsies (Member of EpiCARE)Hospital de Santa Maria‐CHULNLisbonPortugal
- Department of Neuroscience and Mental Health (Neurology)Hospital de Santa Maria‐CHULNLisbonPortugal
- Centro de Estudos Egas MonizFaculdade de Medicina da Universidade de LisboaLisbonPortugal
| | - Susanne Knake
- Department of Neurology, Epilepsy Centre HessenPhilipps‐University MarburgMarburgGermany
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Medicine (DAME)University of UdineUdineItaly
| | - José M. Serratosa
- Department of Neurology and Laboratory of Neurology, Fundación Instituto de Investigación Sanitaria‐Fundación Jiménez DíazAutónoma UniversityMadridSpain
- Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER)MadridSpain
| | - Johan Zelano
- Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Wallenberg Centre for Molecular and Translational MedicineUniversity of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | | | | | | | - Patrício Soares‐da‐Silva
- Bial—Portela & Cª, S.A.CoronadoPortugal
- Department of BiomedicinePharmacology and Therapeutics Unit, Faculty of MedicineUniversity PortoPortoPortugal
- MedInUP—Center for Drug Discovery and Innovative MedicinesUniversity PortoPortoPortugal
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Sinka L, Abraira L, Imbach LL, Zieglgänsberger D, Santamarina E, Álvarez-Sabín J, Ferreira-Atuesta C, Katan M, Scherrer N, Bicciato G, Terziev R, Simmen C, Schubert KM, Elshahabi A, Baumann CR, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Winklehner M, von Oertzen TJ, Wagner JN, Gigli GL, Serafini A, Nilo A, Janes F, Merlino G, Valente M, Zafra-Sierra MP, Bayona-Ortiz H, Conrad J, Evers S, Lochner P, Roell F, Brigo F, Bentes C, Peralta AR, Pinho e Melo T, Keezer MR, Duncan JS, Sander JW, Tettenborn B, Koepp MJ, Galovic M. Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model. JAMA Neurol 2023; 80:605-613. [PMID: 37036702 PMCID: PMC10087089 DOI: 10.1001/jamaneurol.2023.0611] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 08/13/2022] [Accepted: 12/16/2022] [Indexed: 04/11/2023]
Abstract
Importance Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. Objective To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. Design, Setting, and Participants This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. Exposures Type of acute symptomatic seizure. Main Outcomes and Measures All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). Results A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. Conclusions and Relevance In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up.
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Affiliation(s)
- Lucia Sinka
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Laura Abraira
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | | | | | - Estevo Santamarina
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - José Álvarez-Sabín
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Carolina Ferreira-Atuesta
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Mira Katan
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Natalie Scherrer
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Giulio Bicciato
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Cyril Simmen
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Kai Michael Schubert
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Adham Elshahabi
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christian R. Baumann
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nico Döhler
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
- Specialist Clinic for Neurorehabilitation, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | | | - Ansgar Felbecker
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Philip Siebel
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Michael Winklehner
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Tim J. von Oertzen
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Judith N. Wagner
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Gian Luigi Gigli
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Anna Serafini
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Francesco Janes
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Giovanni Merlino
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Mariarosaria Valente
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - María Paula Zafra-Sierra
- Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
| | - Hernan Bayona-Ortiz
- Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
| | - Julian Conrad
- Department of Neurology, University of Muenster, Muenster, Germany
- Department of Neurology and German Center for Vertigo and Balance Disorders-IFB-LMU, Ludwig Maximilians University of Munich, Munich, Germany
| | - Stefan Evers
- Department of Neurology, University of Muenster, Muenster, Germany
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Frauke Roell
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Carla Bentes
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Rita Peralta
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Teresa Pinho e Melo
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mark R. Keezer
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
- Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - John S. Duncan
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Josemir W. Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Barbara Tettenborn
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Matthias J. Koepp
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
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8
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Platzbecker K, Müller-Fielitz H, Foraita R, Koepp MJ, Voss A, Pflock R, Linder R, Pigeot I, Schink T, Schwaninger M. In atrial fibrillation epilepsy risk differs between oral anticoagulants: active comparator, nested case-control study. Europace 2023; 25:euad087. [PMID: 37013704 PMCID: PMC10228540 DOI: 10.1093/europace/euad087] [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: 12/18/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is a risk factor for brain infarction, which can lead to epilepsy. We aimed to investigate whether treatment of AF with direct oral anticoagulants (DOACs) affects the risk of epilepsy in comparison to treatment with the vitamin K antagonist phenprocoumon (PPC). METHODS AND RESULTS We performed an active comparator, nested case-control study based on the German Pharmacoepidemiological Research Database that includes claims data from statutory health insurance providers of about 25 million persons since 2004. In 2011-17, 227 707 AF patients initiated treatment with a DOAC or PPC, of which 1828 cases developed epilepsy on current treatment with an oral anticoagulant. They were matched to 19 084 controls without epilepsy. Patients with DOAC treatment for AF had an overall higher risk of epilepsy with an odds ratio of 1.39, 95% CI (1.24; 1.55) compared to current PPC treatment. Cases had higher baseline CHA2DS2-VASc scores and more frequently a history of stroke than controls. After excluding patients with ischaemic stroke prior to the diagnosis of epilepsy, the risk of epilepsy was still higher on DOACs than on PPC. In contrast, within a cohort of patients with venous thromboembolism, the risk of epilepsy on treatment with DOACs was less elevated [adjusted odds ratio 1.15, 95% CI (0.98; 1.34)]. CONCLUSION In patients with AF initiating oral anticoagulation, treatment with a DOAC was associated with an increased risk of epilepsy compared to the vitamin K antagonist PPC. Covert brain infarction may explain the observed elevated risk of epilepsy.
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Affiliation(s)
- Katharina Platzbecker
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Helge Müller-Fielitz
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Ronja Foraita
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, Queen Square, Box 29, London WC1N 3BG, United Kingdom
| | - Annemarie Voss
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - René Pflock
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Roland Linder
- Techniker Krankenkasse, Bramfelder Straße 140, 22305 Hamburg, Germany
| | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bibliothekstraße 5, 28334 Bremen, Germany
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Markus Schwaninger
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel, Germany
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9
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Xiao F, Caciagli L, Wandschneider B, Fleury M, Binding L, Giampiccolo D, Hill A, Galovic M, Foong J, Zhou D, Sander JW, Duncan JS, Koepp MJ. Verbal fluency functional magnetic resonance imaging detects anti-seizure effects and affective side effects of perampanel in people with focal epilepsy. Epilepsia 2023; 64:e9-e15. [PMID: 36524702 PMCID: PMC10107311 DOI: 10.1111/epi.17493] [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: 10/10/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Perampanel, a noncompetitive antagonist of the postsynaptic a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic (AMPA) receptor, is effective for controlling focal to bilateral tonic-clonic seizures but is also known to increase feelings of anger. Using statistical parametric mapping-derived measures of activation and task-modulated functional connectivity (psychophysiologic interaction), we investigated 14 people with focal epilepsy who had verbal fluency functional magnetic resonance imaging (fMRI) twice, before and after the add-on treatment of perampanel. For comparison, we included 28 people with epilepsy, propensity-matched for clinical characteristics, who had two scans but no change in anti-seizure medication (ASM) regimen in-between. After commencing perampanel, individuals had higher task-related activations in left orbitofrontal cortex (OFC), fewer task-related activations in the subcortical regions including the left thalamus and left caudate, and lower task-related thalamocaudate and caudate-subtantial nigra connectivity. Decreased task-related connectivity is observed between the left OFC and precuneus and left medial frontal lobe. Our results highlight the brain regions associated with the beneficiary therapeutic effects on focal to bilateral tonic-clonic seizures (thalamus and caudate) but also the undesired affective side effects of perampanel with increased anger and aggression (OFC).
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Affiliation(s)
- Fenglai Xiao
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Lorenzo Caciagli
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Britta Wandschneider
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Department of Neurology, The Royal London Hospital, London, UK
| | - Marine Fleury
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Lawrence Binding
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Davide Giampiccolo
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Andrea Hill
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Marian Galovic
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Jaqueline Foong
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
- Stichting Epilepsie Instellingen Nederland - (SEIN), Heemstede, The Netherlands
| | - John S Duncan
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Matthias J Koepp
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
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10
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Galovic M, Al-Diwani A, Vivekananda U, Walker MC, Irani SR, Koepp MJ. In Vivo N-Methyl-d-Aspartate Receptor (NMDAR) Density as Assessed Using Positron Emission Tomography During Recovery From NMDAR-Antibody Encephalitis. JAMA Neurol 2023; 80:211-213. [PMID: 36469313 PMCID: PMC9857588 DOI: 10.1001/jamaneurol.2022.4352] [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: 07/06/2022] [Accepted: 09/09/2022] [Indexed: 12/12/2022]
Abstract
This case-control study uses a radiotracer and positron emission tomography to assess N-methyl-d-aspartate receptor (NMDAR) density changes during recovery from NMDAR-antibody encephalitis.
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Affiliation(s)
- Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Adam Al-Diwani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Umesh Vivekananda
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Matthew C. Walker
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sarosh R. Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Matthias J. Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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11
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Sone D, Galovic M, Myers J, Leonhardt G, Rabiner I, Duncan JS, Koepp MJ, Foong J. Contribution of the μ-opioid receptor system to affective disorders in temporal lobe epilepsy: A bidirectional relationship? Epilepsia 2023; 64:420-429. [PMID: 36377838 PMCID: PMC10107876 DOI: 10.1111/epi.17463] [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: 07/29/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Affective disorders are frequent comorbidities of temporal lobe epilepsy (TLE). The endogenous opioid system has been implicated in both epilepsy and affective disorders, and may play a significant role in their bidirectional relationship. In this cross-sectional study, we investigated the association between μ-opioid receptor binding and affective disorders in patients with TLE. METHODS Nine patients with TLE and depression/anxiety underwent 11 C-carfentanil positron emission tomography (CFN PET) and neuropsychiatric assessment, including the Hospital Anxiety and Depression Scale and the Positive and Negative Affect Schedule. The normalized CFN PET scans were compared with those of 26 age-matched healthy controls. Correlation analyses with affective symptoms were performed by region of interest-based analysis focusing on the limbic circuit and orbitofrontal cortex. RESULTS We observed widely reduced CFN binding potential (BP) in bilateral frontal lobes and striata in patients with TLE compared to healthy controls. In the TLE group, more severe anxiety and negative affect were associated with decreased CFN BP in the posterior cingulate gyrus. SIGNIFICANCE In patients with TLE, interictally reduced binding in the opioid system was associated with higher levels of anxiety and negative affect. We speculate that seizure-related agonist-driven desensitization and downregulation of opioid receptors could be a potential underlying pathomechanism.
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Affiliation(s)
- Daichi Sone
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Jim Myers
- Faculty of Medicine, Imperial College London, London, UK
| | - Georg Leonhardt
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
- Department of Neurosurgery, Carl Gustav Carus University Hospitals, Dresden, Germany
| | | | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Jacqueline Foong
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
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12
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Caciagli L, Paquola C, He X, Vollmar C, Centeno M, Wandschneider B, Braun U, Trimmel K, Vos SB, Sidhu MK, Thompson PJ, Baxendale S, Winston GP, Duncan JS, Bassett DS, Koepp MJ, Bernhardt BC. 31 Disorganization of language and working memory networks in frontal versus temporal lobe epilepsy. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-bnpa.31] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives/AimsCognitive impairment is a common comorbidity of epilepsy, and can be more burdensome than seizures themselves. Temporal and frontal lobe epilepsy (TLE, FLE) are accompanied by multi-domain cognitive impairment. While the underlying neural substrates have been extensively investigated in TLE, functional imaging studies in FLE are scarce. Here, we aimed to: (i) investigate systems-level neural processes accounting for cognitive dysfunction in FLE; (ii) directly compare FLE and TLE patients, establishing commonalities and differences; and (iii) decode the potential influence of clinical characteristics on cognitive network architecture.MethodsWe capitalized on a large, single-centre sample of 172 adult participants (56 with FLE, 64 with TLE, 52 with controls) who were investigated via: (i) an extensive neuropsychological test battery that included attention, psychomotor speed, language, working memory, executive function, and episodic memory tests; and (ii) four functional MRI tasks probing expressive language (verbal fluency, verb generation) and working memory (verbal and visuo-spatial). Patient groups were comparable in age of epilepsy onset, disease duration, and antiseizure medication load. We mapped task-related brain activation and deactivation using a novel multiscale approach, and tracked reorganization in FLE and TLE. We complemented voxel-based maps with profiling of task effects across established motifs of functional brain organization: (i) canonical resting-state functional networks, and (ii) the principal functional connectivity gradient, that encodes a continuous transition from lower-level (sensory) to higher-order (transmodal) brain areas.ResultsWe find that cognitive impairment in FLE is accompanied by broadly reduced activation across frontoparietal attentional and executive networks, and reduced default-mode network deactivation, indicating large-scale disorganization of task-related recruitment, particularly during working memory. Patterns of dysfunction in FLE and TLE are broadly similar, but some traits are syndrome-specific: impaired task-related deactivation of the default-mode network is more prominent in FLE, while impaired recruitment of posterior language areas is more marked in TLE. More severe epilepsy, as tracked by age at onset, epilepsy duration, seizure frequency, time since last seizure, and propensity for focal-to-bilateral tonic-clonic seizures, relates to more marked cognitive network disorganization both in FLE and TLE.ConclusionsOur study elucidates neural processes underlying cognitive impairment in the most common focal epilepsies, identifies frontoparietal executive alterations as a shared biological signature, irrespective of seizure focus localization, and shows that temporal lobe language alterations are TLE-specific. The highlighted systems-level behaviour may be amenable to future remediation strategies, including neurostimulation.
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13
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Hansen JY, Shafiei G, Markello RD, Smart K, Cox SML, Nørgaard M, Beliveau V, Wu Y, Gallezot JD, Aumont É, Servaes S, Scala SG, DuBois JM, Wainstein G, Bezgin G, Funck T, Schmitz TW, Spreng RN, Galovic M, Koepp MJ, Duncan JS, Coles JP, Fryer TD, Aigbirhio FI, McGinnity CJ, Hammers A, Soucy JP, Baillet S, Guimond S, Hietala J, Bedard MA, Leyton M, Kobayashi E, Rosa-Neto P, Ganz M, Knudsen GM, Palomero-Gallagher N, Shine JM, Carson RE, Tuominen L, Dagher A, Misic B. Mapping neurotransmitter systems to the structural and functional organization of the human neocortex. Nat Neurosci 2022; 25:1569-1581. [PMID: 36303070 PMCID: PMC9630096 DOI: 10.1038/s41593-022-01186-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 09/20/2022] [Indexed: 01/13/2023]
Abstract
Neurotransmitter receptors support the propagation of signals in the human brain. How receptor systems are situated within macro-scale neuroanatomy and how they shape emergent function remain poorly understood, and there exists no comprehensive atlas of receptors. Here we collate positron emission tomography data from more than 1,200 healthy individuals to construct a whole-brain three-dimensional normative atlas of 19 receptors and transporters across nine different neurotransmitter systems. We found that receptor profiles align with structural connectivity and mediate function, including neurophysiological oscillatory dynamics and resting-state hemodynamic functional connectivity. Using the Neurosynth cognitive atlas, we uncovered a topographic gradient of overlapping receptor distributions that separates extrinsic and intrinsic psychological processes. Finally, we found both expected and novel associations between receptor distributions and cortical abnormality patterns across 13 disorders. We replicated all findings in an independently collected autoradiography dataset. This work demonstrates how chemoarchitecture shapes brain structure and function, providing a new direction for studying multi-scale brain organization.
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Affiliation(s)
- Justine Y Hansen
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Golia Shafiei
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Ross D Markello
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Kelly Smart
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Sylvia M L Cox
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Martin Nørgaard
- Department of Psychology, Center for Reproducible Neuroscience, Stanford University, Stanford, CA, USA
- Neurobiology Research Unit, Cimbi & OpenNeuroPET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Vincent Beliveau
- Neurobiology Research Unit, Cimbi & OpenNeuroPET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Yanjun Wu
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jean-Dominique Gallezot
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Étienne Aumont
- Cognitive Pharmacology Research Unit, UQAM, Montréal, QC, Canada
| | - Stijn Servaes
- McGill University Research Centre for Studies in Aging, Douglas Hospital, McGill University, Montréal, QC, Canada
| | | | | | | | - Gleb Bezgin
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Hospital, McGill University, Montréal, QC, Canada
| | - Thomas Funck
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
| | - Taylor W Schmitz
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - R Nathan Spreng
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont Saint Peter, UK
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont Saint Peter, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont Saint Peter, UK
| | - Jonathan P Coles
- Department of Medicine, Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Colm J McGinnity
- King's College London and Guy's and St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Alexander Hammers
- King's College London and Guy's and St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Jean-Paul Soucy
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Sylvain Baillet
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Synthia Guimond
- Department of Psychiatry, Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
- Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Marc-André Bedard
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
- Cognitive Pharmacology Research Unit, UQAM, Montréal, QC, Canada
| | - Marco Leyton
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Eliane Kobayashi
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Pedro Rosa-Neto
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
- McGill University Research Centre for Studies in Aging, Douglas Hospital, McGill University, Montréal, QC, Canada
| | - Melanie Ganz
- Neurobiology Research Unit, Cimbi & OpenNeuroPET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Cimbi & OpenNeuroPET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicola Palomero-Gallagher
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
- C. and O. Vogt Institute for Brain Research, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - James M Shine
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Richard E Carson
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Lauri Tuominen
- Department of Psychiatry, Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Alain Dagher
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Bratislav Misic
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada.
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14
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Fleury M, Buck S, Binding LP, Caciagli L, Vos SB, Winston GP, Thompson P, Koepp MJ, Duncan JS, Sidhu MK. Episodic memory network connectivity in temporal lobe epilepsy. Epilepsia 2022; 63:2597-2622. [PMID: 35848050 PMCID: PMC9804196 DOI: 10.1111/epi.17370] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Temporal lobe epilepsy (TLE) affects brain networks and is associated with impairment of episodic memory. Temporal and extratemporal reorganization of memory functions is described in functional magnetic resonance imaging (fMRI) studies. Functional reorganizations have been shown at the local activation level, but network-level alterations have been underinvestigated. We aim to investigate the functional anatomy of memory networks using memory fMRI and determine how this relates to memory function in TLE. METHODS Ninety patients with unilateral TLE (43 left) and 29 controls performed a memory-encoding fMRI paradigm of faces and words with subsequent out-of-scanner recognition test. Subsequent memory event-related contrasts of words and faces remembered were generated. Psychophysiological interaction analysis investigated task-associated changes in functional connectivity seeding from the mesial temporal lobes (MTLs). Correlations between changes in functional connectivity and clinical memory scores, epilepsy duration, age at epilepsy onset, and seizure frequency were investigated, and between connectivity supportive of better memory and disease burden. Connectivity differences between controls and TLE, and between TLE with and without hippocampal sclerosis, were explored using these confounds as regressors of no interest. RESULTS Compared to controls, TLE patients showed widespread decreased connectivity between bilateral MTLs and frontal lobes, and increased local connectivity between the anterior MTLs bilaterally. Increased intrinsic connectivity within the bilateral MTLs correlated with better out-of-scanner memory performance in both left and right TLE. Longer epilepsy duration and higher seizure frequency were associated with decreased connectivity between bilateral MTLs and left/right orbitofrontal cortex (OFC) and insula, connections supportive of memory functions. TLE due to hippocampal sclerosis was associated with greater connectivity disruption within the MTL and extratemporally. SIGNIFICANCE Connectivity analyses showed that TLE is associated with temporal and extratemporal memory network reorganization. Increased bilateral functional connectivity within the MTL and connectivity to OFC and insula are efficient, and are disrupted by greater disease burden.
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Affiliation(s)
- Marine Fleury
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Sarah Buck
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Lawrence P. Binding
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of Computer Science, Centre for Medical Image ComputingUniversity College LondonLondonUK
| | - Lorenzo Caciagli
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sjoerd B. Vos
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Neuroradiological Academic Unit, University College London Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Division of Neurology, Department of MedicineQueen's UniversityKingstonOntarioCanada
| | - Pamela J. Thompson
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Matthias J. Koepp
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Meneka K. Sidhu
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
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15
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Green SF, Hare N, Kassam M, Rugg-Gunn F, Koepp MJ, Sander JW, Rajakulendran S. Retention of brivaracetam in adults with drug-resistant epilepsy at a single tertiary care center. Epilepsy Behav 2022; 135:108868. [PMID: 35985166 DOI: 10.1016/j.yebeh.2022.108868] [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: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Brivaracetam (BRV) is licensed as an adjunctive treatment for focal epilepsy. We describe our clinical experience with BRV at a large UK tertiary center. METHODS Adults initiated on BRV between July 2015 and July 2020 were followed up until they discontinued BRV or September 2021. Data on epilepsy syndrome, duration, seizure types, concomitant and previous antiseizure medication (ASM) use, BRV dosing, efficacy, and side effects were recorded. Efficacy was categorized as temporary (minimum three months) or ongoing (at last follow-up) seizure freedom, ≥50% seizure reduction, or other benefits (e.g., no convulsions or daytime seizures). Brivaracetam retention was estimated using Kaplan-Meier survival analysis. RESULTS Two-hundred people were treated with BRV, of whom 81% had focal epilepsy. The mean (interquartile range [IQR]) follow-up time was 707 (688) days, and the dose range was 50-600 mg daily. The mean (IQR) of the previous number of used ASMs was 6.9 (6.0), and concomitant use was 2.2 (1.0). One-hundred and eighty-eight people (94%) had previously discontinued levetiracetam (LEV), mainly due to side effects. 13/200 (6.5%) were seizure free for a minimum of six months during treatment, and 46/200 (23%) had a ≥50% reduction in seizure frequency for six months or more. Retention rates were 83% at six months, 71% at 12 months, and 57% at 36 months. Brivaracetam was mostly discontinued due to side effects (38/75, 51%) or lack of efficacy (28/75, 37%). Concomitant use of carbamazepine significantly increased the hazard ratio of discontinuing BRV due to side effects (p = 0.006). The most commonly reported side effects were low mood (20.5%), fatigue (18%) and aggressive behavior (8.5%). These side effects were less prevalent than when the same individuals took LEV (low mood, 59%; aggressive behavior, 43%). Intellectual disability was a risk factor for behavioral side effects (p = 0.004), and a pre-existing mood disorder significantly increased the likelihood of further episodes of low mood (p = 0.019). CONCLUSIONS Brivaracetam was effective at a broad range of doses in managing drug-resistant epilepsy across various phenotypes, but less effective than LEV in those who switched due to poor tolerability on LEV. There were no new tolerability issues, but 77% of the individuals experiencing side effects on BRV also experienced similar side effects on LEV.
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Affiliation(s)
- Sebastian F Green
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Nisha Hare
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Mehreen Kassam
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - Fergus Rugg-Gunn
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - Matthias J Koepp
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
| | - Sanjeev Rajakulendran
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
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16
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Iqbal S, Leon-Rojas JE, Galovic M, Vos SB, Hammers A, de Tisi J, Koepp MJ, Duncan JS. Volumetric analysis of the piriform cortex in temporal lobe epilepsy. Epilepsy Res 2022; 185:106971. [PMID: 35810570 PMCID: PMC10510027 DOI: 10.1016/j.eplepsyres.2022.106971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/13/2022] [Accepted: 06/22/2022] [Indexed: 11/03/2022]
Abstract
The piriform cortex, at the confluence of the temporal and frontal lobes, generates seizures in response to chemical convulsants and electrical stimulation. Resection of more than 50% of the piriform cortex in anterior temporal lobe resection for refractory temporal lobe epilepsy (TLE) was associated with a 16-fold higher chance of seizure freedom. The objectives of the current study were to implement a robust protocol to measure piriform cortex volumes and to quantify the correlation of these volumes with clinical characteristics of TLE. Sixty individuals with unilateral TLE (33 left) and 20 healthy controls had volumetric analysis of left and right piriform cortex and hippocampi. A protocol for segmenting and measuring the volumes of the piriform cortices was implemented, with good inter-rater and test-retest reliability. The right piriform cortex volume was consistently larger than the left piriform cortex in both healthy controls and patients with TLE. In controls, the mean volume of the right piriform cortex was 17.7% larger than the left, and the right piriform cortex extended a mean of 6 mm (Range: -4 to 12) more anteriorly than the left. This asymmetry was also seen in left and right TLE. In TLE patients overall, the piriform cortices were not significantly smaller than in controls. Hippocampal sclerosis was associated with decreased ipsilateral and contralateral piriform cortex volumes. The piriform cortex volumes, both ipsilateral and contralateral to the epileptic temporal lobe, were smaller with a longer duration of epilepsy. There was no significant association between piriform cortex volumes and the frequency of focal seizures with impaired awareness or the number of anti-seizure medications taken. Implementation of robust segmentation will enable consistent neurosurgical resection in anterior temporal lobe surgery for refractory TLE..
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Affiliation(s)
- Sabahat Iqbal
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom; Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Jose E Leon-Rojas
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom; Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, United Kingdom; Facultad de Ciencias Médicas de la Salud y de la Vida, Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Marian Galovic
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom; Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, United Kingdom; Department of Neurology, Zurich University Hospital, Zurich, Switzerland
| | - Sjoerd B Vos
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom; Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, United Kingdom; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, Kings College, London, United Kingdom; Kings College London & Guys and St Thomas' PET Centre at St. Thomas' Hospital, United Kingdom
| | - Jane de Tisi
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Matthias J Koepp
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom; Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - John S Duncan
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom; Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, United Kingdom.
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17
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Bialer M, Johannessen SI, Koepp MJ, Levy RH, Perucca E, Perucca P, Tomson T, White HS. Progress report on new antiepileptic drugs: A summary of the Sixteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XVI): II. Drugs in more advanced clinical development. Epilepsia 2022; 63:2883-2910. [PMID: 35950617 DOI: 10.1111/epi.17376] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 05/29/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Abstract
The Sixteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XVI) was held in Madrid, Spain on May 22-25, 2022 and was attended by 157 delegates from 26 countries representing basic and clinical science, regulatory agencies, and pharmaceutical industries. One day of the conference was dedicated to sessions presenting and discussing investigational compounds under development for the treatment of seizures and epilepsy. The current progress report summarizes recent findings and current knowledge for seven of these compounds in more advanced clinical development for which either novel preclinical or patient data are available. These compounds include bumetanide and its derivatives, darigabat, ganaxolone, lorcaserin, soticlestat, STK-001, and XEN1101. Of these, ganaxolone was approved by the US Food and Drug Administration in March 2022 for the treatment of seizures associated with cyclin-dependent kinase-like 5 deficiency disorder in patients 2 years of age and older.
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Affiliation(s)
- Meir Bialer
- Institute for Drug Research, Faculty of Medicine, School of Pharmacy, and David R. Bloom Center for Pharmacy, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Svein I Johannessen
- National Center for Epilepsy, Sandvika, Norway.,Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - René H Levy
- Department of Pharmaceutics and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Emilio Perucca
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Piero Perucca
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
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18
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Bialer M, Johannessen SI, Koepp MJ, Levy RH, Perucca E, Perucca P, Tomson T, White HS. Progress report on new antiepileptic drugs: A summary of the Sixteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XVI): I. Drugs in preclinical and early clinical development. Epilepsia 2022; 63:2865-2882. [PMID: 35946083 DOI: 10.1111/epi.17373] [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: 05/29/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
The Eilat Conferences have provided a forum for discussion of novel treatments of epilepsy among basic and clinical scientists, clinicians, and representatives from regulatory agencies as well as from the pharmaceutical industry for 3 decades. Initially with a focus on pharmacological treatments, the Eilat Conferences now also include sessions dedicated to devices for treatment and monitoring. The Sixteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XVI) was held in Madrid, Spain, on May 22-25, 2022 and was attended by 157 delegates from 26 countries. As in previous Eilat Conferences, the core of EILAT XVI consisted of a sequence of sessions where compounds under development were presented and discussed. This progress report summarizes preclinical and, when available, phase 1 clinical data on five different investigational compounds in preclinical or early clinical development, namely GAO-3-02, GRT-X, NBI-921352 (formerly XEN901), OV329, and XEN496 (a pediatric granular formulation of retigabine/ezogabine). Overall, the data presented in this report illustrate novel strategies for developing antiseizure medications, including an interest in novel molecular targets, and a trend to pursue potential new treatments for rare and previously neglected severe epilepsy syndromes.
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Affiliation(s)
- Meir Bialer
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine and David R. Bloom Center for Pharmacy, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Svein I Johannessen
- National Center for Epilepsy, Sandvika, Norway.,Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - René H Levy
- Department of Pharmaceutics and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Emilio Perucca
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Piero Perucca
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
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19
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Caciagli L, Paquola C, He X, Vollmar C, Centeno M, Wandschneider B, Braun U, Trimmel K, Vos SB, Sidhu MK, Thompson PJ, Baxendale S, Winston GP, Duncan JS, Bassett DS, Koepp MJ, Bernhardt BC. Disorganization of language and working memory systems in frontal versus temporal lobe epilepsy. Brain 2022; 146:935-953. [PMID: 35511160 PMCID: PMC9976988 DOI: 10.1093/brain/awac150] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 02/06/2023] Open
Abstract
Cognitive impairment is a common comorbidity of epilepsy and adversely impacts people with both frontal lobe (FLE) and temporal lobe (TLE) epilepsy. While its neural substrates have been investigated extensively in TLE, functional imaging studies in FLE are scarce. In this study, we profiled the neural processes underlying cognitive impairment in FLE and directly compared FLE and TLE to establish commonalities and differences. We investigated 172 adult participants (56 with FLE, 64 with TLE and 52 controls) using neuropsychological tests and four functional MRI tasks probing expressive language (verbal fluency, verb generation) and working memory (verbal and visuo-spatial). Patient groups were comparable in disease duration and anti-seizure medication load. We devised a multiscale approach to map brain activation and deactivation during cognition and track reorganization in FLE and TLE. Voxel-based analyses were complemented with profiling of task effects across established motifs of functional brain organization: (i) canonical resting-state functional systems; and (ii) the principal functional connectivity gradient, which encodes a continuous transition of regional connectivity profiles, anchoring lower-level sensory and transmodal brain areas at the opposite ends of a spectrum. We show that cognitive impairment in FLE is associated with reduced activation across attentional and executive systems, as well as reduced deactivation of the default mode system, indicative of a large-scale disorganization of task-related recruitment. The imaging signatures of dysfunction in FLE are broadly similar to those in TLE, but some patterns are syndrome-specific: altered default-mode deactivation is more prominent in FLE, while impaired recruitment of posterior language areas during a task with semantic demands is more marked in TLE. Functional abnormalities in FLE and TLE appear overall modulated by disease load. On balance, our study elucidates neural processes underlying language and working memory impairment in FLE, identifies shared and syndrome-specific alterations in the two most common focal epilepsies and sheds light on system behaviour that may be amenable to future remediation strategies.
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Affiliation(s)
- Lorenzo Caciagli
- Correspondence to: Lorenzo Caciagli, MD, PhD Department of Bioengineering University of Pennsylvania, 240 Skirkanich Hall 210 South 33rd Street, Philadelphia, PA 19104, USA E-mail: ;
| | - Casey Paquola
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Quebec H3A 2B4, Canada
| | - Xiaosong He
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Christian Vollmar
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Neurology, Ludwig-Maximilians-Universität, 81377 Munich, Germany
| | - Maria Centeno
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Epilepsy Unit, Hospital Clínic de Barcelona, IDIBAPS, 08036 Barcelona, Spain
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Urs Braun
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karin Trimmel
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Centre for Medical Image Computing, University College London, London, UK,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Meneka K Sidhu
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Pamela J Thompson
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Medicine, Division of Neurology, Queen’s University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Dani S Bassett
- Correspondence may also be addressed to: Dani S. Bassett, PhD E-mail:
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Xiao F, Caciagli L, Wandschneider B, Joshi B, Vos SB, Hill A, Galovic M, Long L, Sone D, Trimmel K, Sander JW, Zhou D, Thompson PJ, Baxendale S, Duncan JS, Koepp MJ. Effect of Anti-seizure Medications on Functional Anatomy of Language: A Perspective From Language Functional Magnetic Resonance Imaging. Front Neurosci 2022; 15:787272. [PMID: 35280343 PMCID: PMC8908426 DOI: 10.3389/fnins.2021.787272] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background In epilepsy, cognitive difficulties are common, partly a consequence of anti-seizure medications (ASM), and cognitive side-effects are often considered to be more disabling than seizures and significantly affect quality of life. Functional MRI during verbal fluency tasks demonstrated impaired frontal activation patterns and failed default mode network deactivation in people taking ASM with unfavourable cognitive profiles. The cognitive effect of ASMs given at different dosages in monotherapy, or in different combinations, remains to be determined. Methods Here, we compared the effects of different drug loads on verbal fluency functional MRI (fMRI) in people (i) taking dual therapy of ASMs either considered to be associated with moderate (levetiracetam, lamotrigine, lacosamide, carbamazepine/oxcarbazepine, eslicarbazepine, valproic acid; n = 119, 56 females) or severe (topiramate, zonisamide) side-effects; n = 119, 56 females), (ii) taking moderate ASMs in either mono-, dual- or triple-therapy (60 subjects in each group), or (iii) taking different dosages of ASMs with moderate side-effect profiles (n = 180). “Drug load” was defined as a composite value of numbers and dosages of medications, normalised to account for the highest and lowest dose of each specific prescribed medication. Results In people taking “moderate” ASMs (n = 119), we observed higher verbal-fluency related to left inferior frontal gyrus and right inferior parietal fMRI activations than in people taking “severe” ASMs (n = 119). Irrespective of the specific ASM, people on monotherapy (n = 60), showed greater frontal activations than people taking two (n = 60), or three ASMs (n = 60). People on two ASMs showed less default mode (precuneus) deactivation than those on monotherapy. In people treated with “moderate” ASMs (n = 180), increased drug load correlated with reduced activation of language-related regions and the right piriform cortex. Conclusion Our study delineates the effects of polytherapy and high doses of ASMs when given in monotherapy on the functional anatomy of language. Irrespective of the cognitive profile of individual ASMs, each additional ASM results in additional alterations of cognitive activation patterns. Selection of ASMs with moderate cognitive side effects, and low doses of ASMs when given in polytherapy, could reduce the cognitive effect.
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Affiliation(s)
- Fenglai Xiao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
- Department of Neurology, The Royal London Hospital, London, United Kingdom
| | - Bhavini Joshi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
| | - Sjoerd B. Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
- UCL Centre for Medical Image Computing, London, United Kingdom
- Department of Neuroradiology, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Andrea Hill
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zürich, Zurich, Switzerland
| | - Lili Long
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Daichi Sone
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
| | - Karin Trimmel
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Josemir W. Sander
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
- Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Pamela J. Thompson
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
| | - Matthias J. Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
- *Correspondence: Matthias J. Koepp,
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21
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Rajakulendran S, Belluzzo M, Novy J, Sisodiya SM, Koepp MJ, Duncan JS, Sander JW. Late-life terminal seizure freedom in drug-resistant epilepsy: "Burned-out epilepsy". J Neurol Sci 2021; 431:120043. [PMID: 34753039 DOI: 10.1016/j.jns.2021.120043] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023]
Abstract
The course of established epilepsy in late life is not fully known. One key question is whether the resolution of an epileptic diathesis is a natural outcome in some people with long-standing epilepsy. We investigated this with a view to generating a hypothesis. We retrospectively explored whether terminal seizure-freedom occurs in older people with previous drug-resistant epilepsy at the Chalfont Centre for Epilepsy over twenty years. Of the 226 people followed for a median period of 52 years, 39 (17%) achieved late-life terminal seizure-freedom of at least two years before death, which occurred at a median age of 68 years with a median duration of 7 years. Multivariate analysis suggests that a high initial seizure frequency was a negative predictor (p < 0.0005). Our findings indicate that the 'natural' course of long-standing epilepsy in some people is one of terminal seizure freedom. We also consider the concept of "remission" in epilepsy, its definition challenges, and the evolving terminology used to describe the state of seizure freedom. The intersection of ageing and seizure freedom is an essential avenue of future investigation, especially in light of current demographic trends. Gaining mechanistic insights into this phenomenon may help broaden our understanding of the neurobiology of epilepsy and potentially provide targets for therapeutic intervention.
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Affiliation(s)
- S Rajakulendran
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - M Belluzzo
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Department of Clinical Neurosciences, Neurology Unit, Santa Maria della Misericordia Hospital, Udine 33100, Italy
| | - J Novy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital (Vaud University Hospital Center) and University of Lausanne, Lausanne, Switzerland
| | - S M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - M J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - J S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - J W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, Heemstede 2103SW, Netherlands; Department of Neurology, West China Hospital & Institute of Brain Science & Brain-inspired Technology, Sichuan University, Chengdu 610041, China.
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22
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Sone D, Ahmad M, Thompson PJ, Baxendale S, Vos SB, Xiao F, de Tisi J, McEvoy AW, Miserocchi A, Duncan JS, Koepp MJ, Galovic M. Optimal Surgical Extent for Memory and Seizure Outcome in Temporal Lobe Epilepsy. Ann Neurol 2021; 91:131-144. [PMID: 34741484 PMCID: PMC8916104 DOI: 10.1002/ana.26266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Postoperative memory decline is an important consequence of anterior temporal lobe resection (ATLR) for temporal lobe epilepsy (TLE), and the extent of resection may be a modifiable factor. This study aimed to define optimal resection margins for cognitive outcome while maintaining a high rate of postoperative seizure freedom. METHODS This cohort study evaluated the resection extent on postoperative structural MRI using automated voxel-based methods and manual measurements in 142 consecutive patients with unilateral drug refractory TLE (74 left, 68 right TLE) who underwent standard ATLR. RESULTS Voxel-wise analyses revealed that postsurgical verbal memory decline correlated with resections of the posterior hippocampus and inferior temporal gyrus, whereas larger resections of the fusiform gyrus were associated with worsening of visual memory in left TLE. Limiting the posterior extent of left hippocampal resection to 55% reduced the odds of significant postoperative verbal memory decline by a factor of 8.1 (95% CI 1.5-44.4, p = 0.02). Seizure freedom was not related to posterior resection extent, but to the piriform cortex removal after left ATLR. In right TLE, variability of the posterior extent of resection was not associated with verbal and visual memory decline or seizures after surgery. INTERPRETATION The extent of surgical resection is an independent and modifiable risk factor for cognitive decline and seizures after left ATLR. Adapting the posterior extent of left ATLR might optimize postoperative outcome, with reduced risk of memory impairment while maintaining comparable seizure-freedom rates. The current, more lenient, approach might be appropriate for right ATLR. ANN NEUROL 2021.
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Affiliation(s)
- Daichi Sone
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Maria Ahmad
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Pamela J Thompson
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, UK.,Centre for Medical Image Computing (CMIC), University College London, London, UK.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, UK
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, UK
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, UK
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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23
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Trimmel K, Vos SB, Caciagli L, Xiao F, van Graan LA, Winston GP, Koepp MJ, Thompson PJ, Duncan JS. Decoupling of functional and structural language networks in temporal lobe epilepsy. Epilepsia 2021; 62:2941-2954. [PMID: 34642939 PMCID: PMC8776336 DOI: 10.1111/epi.17098] [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: 04/09/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 12/01/2022]
Abstract
Objective To identify functional and structural alterations in language networks of people with temporal lobe epilepsy (TLE), who frequently present with naming and word‐finding difficulties. Methods Fifty‐five patients with unilateral TLE (29 left) and 16 controls were studied with auditory and picture naming functional magnetic resonance imaging (fMRI) tasks. Activation maxima in the left posterobasal temporal lobe were used as seed regions for whole‐brain functional connectivity analyses (psychophysiological interaction). White matter language pathways were investigated using diffusion tensor imaging and neurite orientation dispersion and density imaging metrics extracted along fiber bundles starting from fMRI‐guided seeds. Regression analyses were performed to investigate the correlation of functional connectivity with diffusion MRI metrics. Results In the whole group of patients and controls, weaker functional connectivity from the left posterobasal temporal lobe (1) to the bilateral anterior temporal lobe, precentral gyrus, and lingual gyrus during auditory naming and (2) to the bilateral occipital cortex and right fusiform gyrus during picture naming was associated with decreased neurite orientation dispersion and higher free water fraction of white matter tracts. Compared to controls, TLE patients exhibited fewer structural connections and an impaired coupling of functional and structural metrics. Significance TLE is associated with an impairment and decoupling of functional and structural language networks. White matter damage, as evidenced by diffusion abnormalities, may contribute to impaired functional connectivity and language dysfunction in TLE.
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Affiliation(s)
- Karin Trimmel
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sjoerd B Vos
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.,Centre for Medical Image Computing, University College London, London, UK.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lorenzo Caciagli
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
| | - Fenglai Xiao
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.,Department of Neurology, West China of Sichuan University, Chengdu, China
| | | | - Gavin P Winston
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.,Division of Neurology, Department of Medicine, Queen's University, Kingston, Canada
| | - Matthias J Koepp
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
| | - Pamela J Thompson
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
| | - John S Duncan
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
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Ferreira‐Atuesta C, Döhler N, Erdélyi‐Canavese B, Felbecker A, Siebel P, Scherrer N, Bicciato G, Schweizer J, Sinka L, Imbach LL, Katan M, Abraira L, Santamarina E, Álvarez‐Sabín J, Winklehner M, von Oertzen TJ, Wagner JN, Gigli GL, Serafini A, Janes F, Merlino G, Valente M, Gregoraci G, Conrad J, Evers S, Lochner P, Roell F, Brigo F, Bentes C, Peralta AR, Melo TPE, Keezer MR, Duncan JS, Sander JW, Tettenborn B, Koepp MJ, Galovic M. Seizures after Ischemic Stroke: A Matched Multicenter Study. Ann Neurol 2021; 90:808-820. [PMID: 34505305 PMCID: PMC9292028 DOI: 10.1002/ana.26212] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/30/2023]
Abstract
Objective The purpose of this study was to identify risk factors for acute symptomatic seizures and post‐stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. Methods We assessed the risk factors for post‐stroke seizures using logistic or Cox regression in a multicenter study, including adults from 8 European referral centers with neuroimaging‐confirmed ischemic stroke. We compared the risk of post‐stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. Results In the overall cohort of 4,229 participants (mean age 71 years, 57% men), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and strokes caused by large‐artery atherosclerosis. Strokes caused by small‐vessel occlusion carried a small risk of acute symptomatic seizures. 6% developed post‐stroke epilepsy. Risk factors for post‐stroke epilepsy were acute symptomatic seizures, more severe strokes, infarcts involving the cerebral cortex, and strokes caused by large‐artery atherosclerosis. Electroencephalography findings within 7 days of stroke onset were not independently associated with the risk of post‐stroke epilepsy. There was no association between reperfusion treatments in general or only intravenous thrombolysis or mechanical thrombectomy with the time to post‐stroke epilepsy or the risk of acute symptomatic seizures. Interpretation Post‐stroke seizures are related to stroke severity, etiology, and location, whereas an early electroencephalogram was not predictive of epilepsy. We did not find an association of reperfusion treatment with risks of acute symptomatic seizures or post‐stroke epilepsy. ANN NEUROL 2021;90:808–820
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Affiliation(s)
- Carolina Ferreira‐Atuesta
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Nico Döhler
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
- Specialist Clinic for Neurorehabilitation, Kliniken BeelitzBeelitz‐HeilstättenGermany
| | | | - Ansgar Felbecker
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Philip Siebel
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Natalie Scherrer
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Giulio Bicciato
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Juliane Schweizer
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Lucia Sinka
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Lukas L. Imbach
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Mira Katan
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
- Neuroscience Center ZurichUniversity of ZurichZurichSwitzerland
| | - Laura Abraira
- Epilepsy Unit, Department of NeurologyVall d'Hebron Hospital UniversitariBarcelonaSpain
- Universitat Autonoma de BarcelonaBellaterraSpain
| | - Estevo Santamarina
- Epilepsy Unit, Department of NeurologyVall d'Hebron Hospital UniversitariBarcelonaSpain
- Universitat Autonoma de BarcelonaBellaterraSpain
| | - José Álvarez‐Sabín
- Epilepsy Unit, Department of NeurologyVall d'Hebron Hospital UniversitariBarcelonaSpain
- Universitat Autonoma de BarcelonaBellaterraSpain
| | - Michael Winklehner
- Department of Neurology 1Kepler UniversitätsklinikumLinzAustria
- Division of Neuropathology and Neurochemistry, Department of NeurologyMedical University of ViennaViennaAustria
| | | | | | - Gian Luigi Gigli
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Anna Serafini
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Francesco Janes
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Giovanni Merlino
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Mariarosaria Valente
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | | | - Julian Conrad
- Department of NeurologyUniversity of MuensterMuensterGermany
- Department of Neurology and German Center for Vertigo and Balance Disorders‐IFB‐LMULudwig Maximilians University of MunichMunichGermany
| | - Stefan Evers
- Department of NeurologyUniversity of MuensterMuensterGermany
- Department of NeurologyKrankenhaus LindenbrunnCoppenbrüggeGermany
| | | | - Frauke Roell
- Department of NeurologySaarland University Medical CenterHomburgGermany
| | - Francesco Brigo
- Division of NeurologyHospital of Merano‐Meran (SABES‐ASDAA)MeranoItaly
| | - Carla Bentes
- Department of Neurosciences and Mental Health (Neurology)Hospital de Santa Maria‐CHLN, Faculdade de Medicina, Universidade de LisboaLisboaPortugal
| | - Ana Rita Peralta
- Department of Neurosciences and Mental Health (Neurology)Hospital de Santa Maria‐CHLN, Faculdade de Medicina, Universidade de LisboaLisboaPortugal
| | - Teresa Pinho e Melo
- Department of Neurosciences and Mental Health (Neurology)Hospital de Santa Maria‐CHLN, Faculdade de Medicina, Universidade de LisboaLisboaPortugal
| | - Mark R. Keezer
- Stichting Epilepsie Instellingen Nederland – (SEIN)HeemstedeThe Netherlands
- Centre Hospitalier de l'Université de MontréalMontrealQuebecCanada
| | - John S. Duncan
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
| | - Josemir W. Sander
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Stichting Epilepsie Instellingen Nederland – (SEIN)HeemstedeThe Netherlands
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
- Department of Neurology, West of China HospitalChengduChina
| | | | - Matthias J. Koepp
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
| | - Marian Galovic
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
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Clayton LM, Balestrini S, Cross JH, Wilson G, Eldred C, Evans H, Koepp MJ, Sisodiya SM. The impact of SARS-CoV-2 vaccination in Dravet syndrome: A UK survey. Epilepsy Behav 2021; 124:108258. [PMID: 34536735 PMCID: PMC8379095 DOI: 10.1016/j.yebeh.2021.108258] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/25/2021] [Accepted: 08/02/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to the urgent need for accelerated vaccine development. Approved vaccines have proved to be safe and well tolerated across millions of people in the general population. Dravet syndrome (DS) is a severe, early onset, developmental and epileptic encephalopathy. Vaccination is a precipitating factor for seizures. While there is no evidence that vaccine-precipitated seizures lead to adverse outcomes in people with DS, fear surrounding vaccination can remain for caregivers of people with DS, in some cases resulting in rejection of recommended vaccinations, leaving individuals more vulnerable to the relevant infections. A greater understanding of the safety profile of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in this vulnerable group will help provide guidance for caregivers and clinicians when considering vaccination. METHODS A cross-sectional survey regarding COVID-19 and SARS-CoV-2 vaccine, in people with DS, was conducted by Dravet Syndrome UK (DSUK). Concomitantly, a review of individuals with DS who had recently received the SARS-CoV-2 vaccine, and who are resident at the Chalfont Centre for Epilepsy (CCE), or attend epilepsy clinics at the National Hospital for Neurology and Neurosurgery (NHNN), was undertaken. RESULTS Thirty-eight people completed the DSUK survey. Thirty-seven percent of caregivers reported being concerned about someone with DS receiving the SARS-CoV-2 vaccine; with some reporting that they would decline a vaccine when offered. Seventy-seven percent had not received any advice from a healthcare professional about the SARS-CoV-2 vaccination. 18/38 were eligible for SARS-CoV-2 vaccination, of whom nine had received their first vaccine dose. Combining the results of the DSUK survey and the review of individuals monitored at CCE or NHNN, fifteen people with DS had received their first dose of the SARS-CoV-2 vaccine. 11/15 (73%) reported at least one side effect, the most common being fatigue (6/15; 40%) and fever (6/15; 40%). Three individuals (20%) reported an increase in seizure frequency after the first vaccine dose. No increase in seizure frequency or duration was reported after the second dose. CONCLUSION Overall, these results suggest that SARS-CoV-2 vaccines are safe and well tolerated in individuals with DS, as they are in most people without DS. In most people with DS, SARS-CoV-2 vaccine does not appear to be associated with an increase in the frequency or duration of seizures, even in those who develop fever post-vaccination. Many caregivers are concerned about a person with DS receiving a SARS-CoV-2 vaccine, with some reporting that they would decline a SARS-CoV-2 vaccine when offered. It is crucial that healthcare professionals are proactive in providing accurate information regarding the risks and benefits of vaccination in this population, given the potential for serious outcomes from infection.
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Affiliation(s)
- Lisa M Clayton
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St. Peter, Buckinghamshire SL9 0RJ, UK.
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St. Peter, Buckinghamshire SL9 0RJ, UK; Neuroscience Department, Meyer Children Hospital, Viale Gaetano Pieraccini, 2450139 Florence, Italy.
| | - J Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; Young Epilepsy, Piers Lane, Lingfield RH7 6PW, UK.
| | - Galia Wilson
- Dravet Syndrome UK (DSUK), Registered Charity Number 1128289, Member of Dravet Syndrome European Federation (DSEF), PO Box 756, Chesterfield S43 9EB, UK.
| | - Claire Eldred
- Dravet Syndrome UK (DSUK), Registered Charity Number 1128289, Member of Dravet Syndrome European Federation (DSEF), PO Box 756, Chesterfield S43 9EB, UK.
| | - Helen Evans
- Dravet Syndrome UK (DSUK), Registered Charity Number 1128289, Member of Dravet Syndrome European Federation (DSEF), PO Box 756, Chesterfield S43 9EB, UK.
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St. Peter, Buckinghamshire SL9 0RJ, UK.
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St. Peter, Buckinghamshire SL9 0RJ, UK.
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Leon-Rojas JE, Iqbal S, Vos SB, Rodionov R, Miserocchi A, McEvoy AW, Vakharia VN, Mancini L, Galovic M, Sparks RE, Ourselin S, Cardoso JM, Koepp MJ, Duncan JS. Resection of the piriform cortex for temporal lobe epilepsy: a Novel approach on imaging segmentation and surgical application. Br J Neurosurg 2021:1-6. [PMID: 34406102 DOI: 10.1080/02688697.2021.1966385] [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: 04/16/2021] [Revised: 07/09/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The piriform cortex (PC) occupies both banks of the endorhinal sulcus and has an important role in the pathophysiology of temporal lobe epilepsy (TLE). A recent study showed that resection of more than 50% of PC increased the odds of becoming seizure free by a factor of 16. OBJECTIVE We report the feasibility of manual segmentation of PC and application of the Geodesic Information Flows (GIF) algorithm to automated segmentation, to guide resection. METHODS Manual segmentation of PC was performed by two blinded independent examiners in 60 patients with TLE (55% Left TLE, 52% female) with a median age of 35 years (IQR, 29-47 years) and 20 controls (60% Women) with a median age of 39.5 years (IQR, 31-49). The GIF algorithm was used to create an automated pipeline for parcellating PC which was used to guide excision as part of temporal lobe resection for TLE. RESULTS Right PC was larger in patients and controls. Parcellation of PC was used to guide anterior temporal lobe resection, with subsequent seizure freedom and no visual field or language deficit. CONCLUSION Reliable segmentation of PC is feasible and can be applied prospectively to guide neurosurgical resection that increases the chances of a good outcome from temporal lobe resection for TLE.
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Affiliation(s)
- Jose E Leon-Rojas
- NeurALL Research Group, Medical School, Universidad Internacional del Ecuador, Quito, Ecuador
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Sabahat Iqbal
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Sjoerd B Vos
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK
| | - Roman Rodionov
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Anna Miserocchi
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Andrew W McEvoy
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Vejay N Vakharia
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Laura Mancini
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Marian Galovic
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Neurology, Zurich University Hospital, Zurich, Switzerland
| | - Rachel E Sparks
- School of Biomedical Engineering and Imaging Sciences, Kings College, St Thomas Hospital, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, Kings College, St Thomas Hospital, London, UK
| | - Jorge M Cardoso
- School of Biomedical Engineering and Imaging Sciences, Kings College, St Thomas Hospital, London, UK
| | - Matthias J Koepp
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - John S Duncan
- UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, and Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
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Galovic M, Erlandsson K, Fryer TD, Hong YT, Manavaki R, Sari H, Chetcuti S, Thomas BA, Fisher M, Sephton S, Canales R, Russell JJ, Sander K, Årstad E, Aigbirhio FI, Groves AM, Duncan JS, Thielemans K, Hutton BF, Coles JP, Koepp MJ. Validation of a combined image derived input function and venous sampling approach for the quantification of [ 18F]GE-179 PET binding in the brain. Neuroimage 2021; 237:118194. [PMID: 34023451 DOI: 10.1016/j.neuroimage.2021.118194] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/20/2020] [Revised: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
Blood-based kinetic analysis of PET data relies on an accurate estimate of the arterial plasma input function (PIF). An alternative to invasive measurements from arterial sampling is an image-derived input function (IDIF). However, an IDIF provides the whole blood radioactivity concentration, rather than the required free tracer radioactivity concentration in plasma. To estimate the tracer PIF, we corrected an IDIF from the carotid artery with estimates of plasma parent fraction (PF) and plasma-to-whole blood (PWB) ratio obtained from five venous samples. We compared the combined IDIF+venous approach to gold standard data from arterial sampling in 10 healthy volunteers undergoing [18F]GE-179 brain PET imaging of the NMDA receptor. Arterial and venous PF and PWB ratio estimates determined from 7 patients with traumatic brain injury (TBI) were also compared to assess the potential effect of medication. There was high agreement between areas under the curves of the estimates of PF (r = 0.99, p<0.001), PWB ratio (r = 0.93, p<0.001), and the PIF (r = 0.92, p<0.001) as well as total distribution volume (VT) in 11 regions across the brain (r = 0.95, p<0.001). IDIF+venous VT had a mean bias of -1.7% and a comparable regional coefficient of variation (arterial: 21.3 ± 2.5%, IDIF+venous: 21.5 ± 2.0%). Simplification of the IDIF+venous method to use only one venous sample provided less accurate VT estimates (mean bias 9.9%; r = 0.71, p<0.001). A version of the method that avoids the need for blood sampling by combining the IDIF with population-based PF and PWB ratio estimates systematically underestimated VT (mean bias -20.9%), and produced VT estimates with a poor correlation to those obtained using arterial data (r = 0.45, p<0.001). Arterial and venous blood data from 7 TBI patients showed high correlations for PF (r = 0.92, p = 0.003) and PWB ratio (r = 0.93, p = 0.003). In conclusion, the IDIF+venous method with five venous samples provides a viable alternative to arterial sampling for quantification of [18F]GE-179 VT.
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Affiliation(s)
- Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; MRI Unit, Chalfont Centre for Epilepsy, UK
| | - Kjell Erlandsson
- Institute of Nuclear Medicine, University College London, London, UK
| | - Tim D Fryer
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Roido Manavaki
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Hasan Sari
- Institute of Nuclear Medicine, University College London, London, UK; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Sarah Chetcuti
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Benjamin A Thomas
- Institute of Nuclear Medicine, University College London, London, UK
| | - Martin Fisher
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Selena Sephton
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Roberto Canales
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Joseph J Russell
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Kerstin Sander
- Centre for Radiopharmaceutical Chemistry, University College London, London, UK
| | - Erik Årstad
- Centre for Radiopharmaceutical Chemistry, University College London, London, UK
| | - Franklin I Aigbirhio
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; MRI Unit, Chalfont Centre for Epilepsy, UK
| | - Kris Thielemans
- Institute of Nuclear Medicine, University College London, London, UK
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, London, UK
| | - Jonathan P Coles
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; MRI Unit, Chalfont Centre for Epilepsy, UK.
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28
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Galovic M, Ferreira-Atuesta C, Abraira L, Döhler N, Sinka L, Brigo F, Bentes C, Zelano J, Koepp MJ. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management. Drugs Aging 2021; 38:285-299. [PMID: 33619704 PMCID: PMC8007525 DOI: 10.1007/s40266-021-00837-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 12/14/2022]
Abstract
Stroke is the leading cause of seizures and epilepsy in older adults. Patients who have larger and more severe strokes involving the cortex, are younger, and have acute symptomatic seizures and intracerebral haemorrhage are at highest risk of developing post-stroke epilepsy. Prognostic models, including the SeLECT and CAVE scores, help gauge the risk of epileptogenesis. Early electroencephalogram and blood-based biomarkers can provide information additional to the clinical risk factors of post-stroke epilepsy. The management of acute versus remote symptomatic seizures after stroke is markedly different. The choice of an ideal antiseizure medication should not only rely on efficacy but also consider adverse effects, altered pharmacodynamics in older adults, and the influence on the underlying vascular co-morbidity. Drug-drug interactions, particularly those between antiseizure medications and anticoagulants or antiplatelets, also influence treatment decisions. In this review, we describe the epidemiology, risk factors, biomarkers, and management of seizures after an ischaemic or haemorrhagic stroke. We discuss the special considerations required for the treatment of post-stroke epilepsy due to the age, co-morbidities, co-medication, and vulnerability of stroke survivors.
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Affiliation(s)
- Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
| | - Carolina Ferreira-Atuesta
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Laura Abraira
- Epilepsy Unit, Department of Neurology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Nico Döhler
- Specialist Clinic for Neurorehabilitation, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | - Lucia Sinka
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Francesco Brigo
- Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy
| | - Carla Bentes
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Lisboa, Portugal
| | - Johan Zelano
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
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29
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Balestrini S, Koepp MJ, Gandhi S, Rickman HM, Shin GY, Houlihan CF, Anders-Cannon J, Silvennoinen K, Xiao F, Zagaglia S, Hudgell K, Ziomek M, Haimes P, Sampson A, Parker A, Helen Cross J, Pardington R, Nastouli E, Swanton C, Sander JW, Sisodiya SM. Clinical outcomes of COVID-19 in long-term care facilities for people with epilepsy. Epilepsy Behav 2021; 115:107602. [PMID: 33279440 PMCID: PMC7643621 DOI: 10.1016/j.yebeh.2020.107602] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 01/12/2023]
Abstract
In this cohort study, we aim to compare outcomes from coronavirus disease 2019 (COVID-19) in people with severe epilepsy and other co-morbidities living in long-term care facilities which all implemented early preventative measures, but different levels of surveillance. During 25-week observation period (16 March-6 September 2020), we included 404 residents (118 children), and 1643 caregivers. We compare strategies for infection prevention, control, and containment, and related outcomes, across four UK long-term care facilities. Strategies included early on-site enhancement of preventative and infection control measures, early identification and isolation of symptomatic cases, contact tracing, mass surveillance of asymptomatic cases and contacts. We measured infection rate among vulnerable people living in the facilities and their caregivers, with asymptomatic and symptomatic cases, including fatality rate. We report 38 individuals (17 residents) who tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive, with outbreaks amongst residents in two facilities. At Chalfont Centre for Epilepsy (CCE), 10/98 residents tested positive: two symptomatic (one died), eight asymptomatic on weekly enhanced surveillance; 2/275 caregivers tested positive: one symptomatic, one asymptomatic. At St Elizabeth's (STE), 7/146 residents tested positive: four symptomatic (one died), one positive during hospital admission for symptoms unrelated to COVID-19, two asymptomatic on one-off testing of all 146 residents; 106/601 symptomatic caregivers were tested, 13 positive. In addition, during two cycles of systematically testing all asymptomatic carers, four tested positive. At The Meath (TM), 8/80 residents were symptomatic but none tested; 26/250 caregivers were tested, two positive. At Young Epilepsy (YE), 8/80 children were tested, all negative; 22/517 caregivers were tested, one positive. Infection outbreaks in long-term care facilities for vulnerable people with epilepsy can be quickly contained, but only if asymptomatic individuals are identified through enhanced surveillance at resident and caregiver level. We observed a low rate of morbidity and mortality, which confirmed that preventative measures with isolation of suspected and confirmed COVID-19 residents can reduce resident-to-resident and resident-to-caregiver transmission. Children and young adults appear to have lower infection rates. Even in people with epilepsy and multiple co-morbidities, we observed a high percentage of asymptomatic people suggesting that epilepsy-related factors (anti-seizure medications and seizures) do not necessarily lead to poor outcomes.
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Affiliation(s)
- Simona Balestrini
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy (CCE), Chalfont St Peter, Bucks SL9 0RJ, UK
| | - Matthias J Koepp
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy (CCE), Chalfont St Peter, Bucks SL9 0RJ, UK.
| | - Sonia Gandhi
- The Francis Crick Institute, London NW1 1AT, UK; UCL Cancer Institute, London WC1E 6DD, UK; Department of Virology, University College London Hospitals, NHS Foundation Trust, London NW1 2PG, UK
| | - Hannah M Rickman
- Department of Virology, University College London Hospitals, NHS Foundation Trust, London NW1 2PG, UK
| | - Gee Yen Shin
- Department of Virology, University College London Hospitals, NHS Foundation Trust, London NW1 2PG, UK
| | - Catherine F Houlihan
- Department of Virology, University College London Hospitals, NHS Foundation Trust, London NW1 2PG, UK
| | | | - Katri Silvennoinen
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Fenglai Xiao
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Sara Zagaglia
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | | | | | - Paul Haimes
- St. Elizabeth (STE), Much Hadham, Herts SG106EW, UK
| | - Adam Sampson
- St. Elizabeth (STE), Much Hadham, Herts SG106EW, UK
| | - Annie Parker
- The Meath (TM), Westbrook Road, Godalming GU7 2QH, UK
| | - J Helen Cross
- Great Ormond Street Hospital (GOSH) and UCL Institute of Child Health, WC1N 1EH, UK; Young Epilepsy (YE), Surrey RH7 6PW, UK
| | | | - Eleni Nastouli
- Department of Virology, University College London Hospitals, NHS Foundation Trust, London NW1 2PG, UK; Department of Population, Policy and Practice, UCL GOS Institute of Child Health, London WC1N 1EH, UK
| | - Charles Swanton
- The Francis Crick Institute, London NW1 1AT, UK; UCL Cancer Institute, London WC1E 6DD, UK; Department of Virology, University College London Hospitals, NHS Foundation Trust, London NW1 2PG, UK
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy (CCE), Chalfont St Peter, Bucks SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
| | - Sanjay M Sisodiya
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy (CCE), Chalfont St Peter, Bucks SL9 0RJ, UK
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30
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McGinnity CJ, Riaño Barros DA, Hinz R, Myers JF, Yaakub SN, Thyssen C, Heckemann RA, de Tisi J, Duncan JS, Sander JW, Lingford-Hughes A, Koepp MJ, Hammers A. Αlpha 5 subunit-containing GABA A receptors in temporal lobe epilepsy with normal MRI. Brain Commun 2021; 3:fcaa190. [PMID: 33501420 PMCID: PMC7811756 DOI: 10.1093/braincomms/fcaa190] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 09/06/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
GABAA receptors containing the α5 subunit mediate tonic inhibition and are widely expressed in the limbic system. In animals, activation of α5-containing receptors impairs hippocampus-dependent memory. Temporal lobe epilepsy is associated with memory impairments related to neuron loss and other changes. The less selective PET ligand [11C]flumazenil has revealed reductions in GABAA receptors. The hypothesis that α5 subunit receptor alterations are present in temporal lobe epilepsy and could contribute to impaired memory is untested. We compared α5 subunit availability between individuals with temporal lobe epilepsy and normal structural MRI ('MRI-negative') and healthy controls, and interrogated the relationship between α5 subunit availability and episodic memory performance, in a cross-sectional study. Twenty-three healthy male controls (median ± interquartile age 49 ± 13 years) and 11 individuals with MRI-negative temporal lobe epilepsy (seven males; 40 ± 8) had a 90-min PET scan after bolus injection of [11C]Ro15-4513, with arterial blood sampling and metabolite correction. All those with epilepsy and six controls completed the Adult Memory and Information Processing Battery on the scanning day. 'Bandpass' exponential spectral analyses were used to calculate volumes of distribution separately for the fast component [V F; dominated by signal from α1 (α2, α3)-containing receptors] and the slow component (V S; dominated by signal from α5-containing receptors). We made voxel-by-voxel comparisons between: the epilepsy and control groups; each individual case versus the controls. We obtained parametric maps of V F and V S measures from a single bolus injection of [11C]Ro15-4513. The epilepsy group had higher V S in anterior medial and lateral aspects of the temporal lobes, the anterior cingulate gyri, the presumed area tempestas (piriform cortex) and the insulae, in addition to increases of ∼24% and ∼26% in the ipsilateral and contralateral hippocampal areas (P < 0.004). This was associated with reduced V F:V S ratios within the same areas (P < 0.009). Comparisons of V S for each individual with epilepsy versus controls did not consistently lateralize the epileptogenic lobe. Memory scores were significantly lower in the epilepsy group than in controls (mean ± standard deviation -0.4 ± 1.0 versus 0.7 ± 0.3; P = 0.02). In individuals with epilepsy, hippocampal V S did not correlate with memory performance on the Adult Memory and Information Processing Battery. They had reduced V F in the hippocampal area, which was significant ipsilaterally (P = 0.03), as expected from [11C]flumazenil studies. We found increased tonic inhibitory neurotransmission in our cohort of MRI-negative temporal lobe epilepsy who also had co-morbid memory impairments. Our findings are consistent with a subunit shift from α1/2/3 to α5 in MRI-negative temporal lobe epilepsy.
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Affiliation(s)
- Colm J McGinnity
- Centre for Neuroscience, Department of Medicine, Imperial College London, London W12 0NN, UK
- MRC Clinical Sciences Centre, Hammersmith Hospital, London W12 0NN, UK
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Daniela A Riaño Barros
- Centre for Neuroscience, Department of Medicine, Imperial College London, London W12 0NN, UK
- MRC Clinical Sciences Centre, Hammersmith Hospital, London W12 0NN, UK
| | - Rainer Hinz
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester M20 3LJ, UK
| | - James F Myers
- Centre for Neuroscience, Department of Medicine, Imperial College London, London W12 0NN, UK
| | - Siti N Yaakub
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Charlotte Thyssen
- Medical Image and Signal Processing (MEDISIP), Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, 9000 Ghent, Belgium
| | - Rolf A Heckemann
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Jane de Tisi
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - John S Duncan
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103SW, The Netherlands
| | - Anne Lingford-Hughes
- Neuropsychopharmacology Unit, Centre for Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London W12 0NN, UK
| | - Matthias J Koepp
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - Alexander Hammers
- Centre for Neuroscience, Department of Medicine, Imperial College London, London W12 0NN, UK
- MRC Clinical Sciences Centre, Hammersmith Hospital, London W12 0NN, UK
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EH, UK
- Neurodis Foundation, CERMEP, Imagerie du Vivant, 69003 Lyon, France
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Galovic M, de Tisi J, McEvoy AW, Miserocchi A, Vos SB, Borzi G, Cueva Rosillo J, Vuong KA, Nachev P, Duncan JS, Koepp MJ. Resective surgery prevents progressive cortical thinning in temporal lobe epilepsy. Brain 2020; 143:3262-3272. [PMID: 33179036 PMCID: PMC7719024 DOI: 10.1093/brain/awaa284] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/16/2020] [Revised: 05/25/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Focal epilepsy in adults is associated with progressive atrophy of the cortex at a rate more than double that of normal ageing. We aimed to determine whether successful epilepsy surgery interrupts progressive cortical thinning. In this longitudinal case-control neuroimaging study, we included subjects with unilateral temporal lobe epilepsy (TLE) before (n = 29) or after (n = 56) anterior temporal lobe resection and healthy volunteers (n = 124) comparable regarding age and sex. We measured cortical thickness on paired structural MRI scans in all participants and compared progressive thinning between groups using linear mixed effects models. Compared to ageing-related cortical thinning in healthy subjects, we found progressive cortical atrophy on vertex-wise analysis in TLE before surgery that was bilateral and localized beyond the ipsilateral temporal lobe. In these regions, we observed accelerated annualized thinning in left (left TLE 0.0192 ± 0.0014 versus healthy volunteers 0.0032 ± 0.0013 mm/year, P < 0.0001) and right (right TLE 0.0198 ± 0.0016 versus healthy volunteers 0.0037 ± 0.0016 mm/year, P < 0.0001) presurgical TLE cases. Cortical thinning in these areas was reduced after surgical resection of the left (0.0074 ± 0.0016 mm/year, P = 0.0006) or right (0.0052 ± 0.0020 mm/year, P = 0.0006) anterior temporal lobe. Directly comparing the post- versus presurgical TLE groups on vertex-wise analysis, the areas of postoperatively reduced thinning were in both hemispheres, particularly, but not exclusively, in regions that were affected preoperatively. Participants who remained completely seizure-free after surgery had no more progressive thinning than that observed during normal ageing. Those with postoperative seizures had small areas of continued accelerated thinning after surgery. Thus, successful epilepsy surgery prevents progressive cortical atrophy that is observed in TLE and may be potentially neuroprotective. This effect was more pronounced in those who remained seizure-free after temporal lobe resection, normalizing the rate of atrophy to that of normal ageing. These results provide evidence of epilepsy surgery preventing further cerebral damage and provide incentives for offering early surgery in refractory TLE.
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Affiliation(s)
- Marian Galovic
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Giuseppe Borzi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Institute of Neurology, University of Catanzaro, Italy
- Neurology Unit, Ospedale Civile San’Agostino Estense, Azienda Ospedaliero-Universitaria Modena, Modena Italy
| | - Juana Cueva Rosillo
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Khue Anh Vuong
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Parashkev Nachev
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
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Bialer M, Johannessen SI, Koepp MJ, Levy RH, Perucca E, Perucca P, Tomson T, White HS. Progress report on new antiepileptic drugs: A summary of the Fifteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XV). I. Drugs in preclinical and early clinical development. Epilepsia 2020; 61:2340-2364. [DOI: 10.1111/epi.16725] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Meir Bialer
- Faculty of Medicine School of Pharmacy and David R. Bloom Center for Pharmacy Institute for Drug Research Hebrew University of Jerusalem Jerusalem Israel
| | - Svein I. Johannessen
- National Center for Epilepsy Sandvika Norway
- Department of Pharmacology Oslo University Hospital Oslo Norway
| | - Matthias J. Koepp
- Department of Clinical and Experimental Epilepsy UCL Institute of Neurology London UK
| | - René H. Levy
- Department of Pharmaceutics and Neurological Surgery University of Washington Seattle WA USA
| | - Emilio Perucca
- Department of Internal Medicine and Therapeutics University of Pavia Pavia Italy
- IRCCS Mondino Foundation (member of the ERN EpiCARE) Pavia Italy
| | - Piero Perucca
- Department of Neuroscience Central Clinical School Monash University Melbourne Victoria Australia
- Departments of Medicine and Neurology Royal Melbourne Hospital University of Melbourne Melbourne Victoria Australia
- Department of Neurology Alfred Health Melbourne Victoria Australia
| | - Torbjörn Tomson
- Department of Clinical Neuroscience Karolinska Institute Stockholm Sweden
| | - H. Steve White
- Department of Pharmacy School of Pharmacy University of Washington Seattle WA USA
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33
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Bialer M, Johannessen SI, Koepp MJ, Levy RH, Perucca E, Perucca P, Tomson T, White HS. Progress report on new antiepileptic drugs: A summary of the Fifteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XV). II. Drugs in more advanced clinical development. Epilepsia 2020; 61:2365-2385. [PMID: 33165915 DOI: 10.1111/epi.16726] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
The Fifteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XV) was held as a fully virtual conference from July 27 to July 30, 2020 for the sessions on drugs, and on August 3, 2020 for the sessions on devices. A total of 534 delegates from 63 countries attended lectures and interactive discussions, representing a broad range of disciplines from basic science, clinical research, and clinical care. This progress report provides summaries of recent findings on investigational compounds for which preclinical data as well as data from patient studies were presented. The report includes the following five compounds: anakinra, cenobamate, CVL-865, fenfluramine, and ganaxolone, all with novel modes of action compared to more established antiepileptic drugs. Some of these compounds demonstrated promising results in placebo-controlled phase 3 trials, and two have recently received approval from the US Food and Drug Administration (FDA). These include cenobamate, which was approved by the FDA on November 21, 2019 for the treatment of partial onset (focal) seizures in adults, and fenfluramine oral solution, which was approved by the FDA on June 25, 2020 for the treatment of seizures associated with Dravet syndrome in patients 2 years and older.
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Affiliation(s)
- Meir Bialer
- Faculty of Medicine, School of Pharmacy and David R. Bloom Center for Pharmacy, Institute for Drug Research, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Svein I Johannessen
- National Center for Epilepsy, Sandvika, Norway.,Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - René H Levy
- Department of Pharmaceutics and Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Emilio Perucca
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
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Caciagli L, Allen LA, He X, Trimmel K, Vos SB, Centeno M, Galovic M, Sidhu MK, Thompson PJ, Bassett DS, Winston GP, Duncan JS, Koepp MJ, Sperling MR. Thalamus and focal to bilateral seizures: A multiscale cognitive imaging study. Neurology 2020; 95:e2427-e2441. [PMID: 32847951 PMCID: PMC7682917 DOI: 10.1212/wnl.0000000000010645] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/01/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the functional correlates of recurrent secondarily generalized seizures in temporal lobe epilepsy (TLE) using task-based fMRI as a framework to test for epilepsy-specific network rearrangements. Because the thalamus modulates propagation of temporal lobe onset seizures and promotes cortical synchronization during cognition, we hypothesized that occurrence of secondarily generalized seizures, i.e., focal to bilateral tonic-clonic seizures (FBTCS), would relate to thalamic dysfunction, altered connectivity, and whole-brain network centrality. METHODS FBTCS occur in a third of patients with TLE and are a major determinant of disease severity. In this cross-sectional study, we analyzed 113 patients with drug-resistant TLE (55 left/58 right), who performed a verbal fluency fMRI task that elicited robust thalamic activation. Thirty-three patients (29%) had experienced at least one FBTCS in the year preceding the investigation. We compared patients with TLE-FBTCS to those without FBTCS via a multiscale approach, entailing analysis of statistical parametric mapping (SPM) 12-derived measures of activation, task-modulated thalamic functional connectivity (psychophysiologic interaction), and graph-theoretical metrics of centrality. RESULTS Individuals with TLE-FBTCS had less task-related activation of bilateral thalamus, with left-sided emphasis, and left hippocampus than those without FBTCS. In TLE-FBTCS, we also found greater task-related thalamotemporal and thalamomotor connectivity, and higher thalamic degree and betweenness centrality. Receiver operating characteristic curves, based on a combined thalamic functional marker, accurately discriminated individuals with and without FBTCS. CONCLUSIONS In TLE-FBTCS, impaired task-related thalamic recruitment coexists with enhanced thalamotemporal connectivity and whole-brain thalamic network embedding. Altered thalamic functional profiles are proposed as imaging biomarkers of active secondary generalization.
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Affiliation(s)
- Lorenzo Caciagli
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA.
| | - Luke A Allen
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Xiaosong He
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Karin Trimmel
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Sjoerd B Vos
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Maria Centeno
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Marian Galovic
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Meneka K Sidhu
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Pamela J Thompson
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Danielle S Bassett
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Gavin P Winston
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - John S Duncan
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Matthias J Koepp
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
| | - Michael R Sperling
- From the Department of Clinical and Experimental Epilepsy (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.) and Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (L.C., L.A.A., K.T., S.B.V., M.C., M.G., M.K.S., P.J.T., G.P.W., J.S.D., M.J.K.), Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK; Departments of Bioengineering (L.C., X.H., D.S.B.), Physics and Astronomy (D.S.B.), Electrical and Systems Engineering (D.S.B.), Neurology (D.S.B.), and Psychiatry (D.S.B.), University of Pennsylvania, Philadelphia; Department of Neurology (K.T.), Medical University of Vienna, Austria; Centre for Medical Image Computing (S.B.V.), University College London, UK; Department of Neurology (M.G.), University Hospital Zurich, Switzerland; Santa Fe Institute (D.S.B.), NM; Department of Medicine, Division of Neurology (G.P.W.), Queen's University, Kingston, Canada; and Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA
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Trimmel K, Caciagli L, Xiao F, van Graan LA, Koepp MJ, Thompson PJ, Duncan JS. Impaired naming performance in temporal lobe epilepsy: language fMRI responses are modulated by disease characteristics. J Neurol 2020; 268:147-160. [PMID: 32747979 PMCID: PMC7815622 DOI: 10.1007/s00415-020-10116-x] [Citation(s) in RCA: 5] [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: 05/12/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate alterations of language networks and their relation to impaired naming performance in temporal lobe epilepsy (TLE) using functional MRI. METHODS Seventy-two adult TLE patients (41 left) and 36 controls were studied with overt auditory and picture naming fMRI tasks to assess temporal lobe language areas, and a covert verbal fluency task to probe frontal lobe language regions. Correlation of fMRI activation with clinical naming scores, and alteration of language network patterns in relation to epilepsy duration, age at onset and seizure frequency, were investigated with whole-brain multiple regression analyses. RESULTS Auditory and picture naming fMRI activated the left posterior temporal lobe, and stronger activation correlated with better clinical naming scores. Verbal fluency MRI mainly activated frontal lobe regions. In left and right TLE, a later age of epilepsy onset related to stronger temporal lobe activations, while earlier age of onset was associated with impaired deactivation of extratemporal regions. In left TLE patients, longer disease duration and higher seizure frequency were associated with reduced deactivation. Frontal lobe language networks were unaffected by disease characteristics. CONCLUSIONS While frontal lobe language regions appear spared, temporal lobe language areas are susceptible to dysfunction and reorganisation, particularly in left TLE. Early onset and long duration of epilepsy, and high seizure frequency, were associated with compromised activation and deactivation patterns of task-associated regions, which might account for impaired naming performance in individuals with TLE.
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Affiliation(s)
- Karin Trimmel
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, UK. .,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK. .,Department of Neurology, Medical University of Vienna, 1090, Vienna, Austria.
| | - Lorenzo Caciagli
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, UK.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Fenglai Xiao
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, UK.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Louis A van Graan
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, UK.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Matthias J Koepp
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, UK.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Pamela J Thompson
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, UK.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - John S Duncan
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, UK.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
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36
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Caciagli L, Wandschneider B, Centeno M, Vollmar C, Vos SB, Trimmel K, Long L, Xiao F, Lowe AJ, Sidhu MK, Thompson PJ, Winston GP, Duncan JS, Koepp MJ. Motor hyperactivation during cognitive tasks: An endophenotype of juvenile myoclonic epilepsy. Epilepsia 2020; 61:1438-1452. [PMID: 32584424 PMCID: PMC7681252 DOI: 10.1111/epi.16575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/10/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Juvenile myoclonic epilepsy (JME) is the most common genetic generalized epilepsy syndrome. Myoclonus may relate to motor system hyperexcitability and can be provoked by cognitive activities. To aid genetic mapping in complex neuropsychiatric disorders, recent research has utilized imaging intermediate phenotypes (endophenotypes). Here, we aimed to (a) characterize activation profiles of the motor system during different cognitive tasks in patients with JME and their unaffected siblings, and (b) validate those as endophenotypes of JME. METHODS This prospective cross-sectional investigation included 32 patients with JME, 12 unaffected siblings, and 26 controls, comparable for age, sex, handedness, language laterality, neuropsychological performance, and anxiety and depression scores. We investigated patterns of motor system activation during episodic memory encoding and verb generation functional magnetic resonance imaging (fMRI) tasks. RESULTS During both tasks, patients and unaffected siblings showed increased activation of motor system areas compared to controls. Effects were more prominent during memory encoding, which entailed hand motion via joystick responses. Subgroup analyses identified stronger activation of the motor cortex in JME patients with ongoing seizures compared to seizure-free patients. Receiver-operating characteristic curves, based on measures of motor activation, accurately discriminated both patients with JME and their siblings from healthy controls (area under the curve: 0.75 and 0.77, for JME and a combined patient-sibling group against controls, respectively; P < .005). SIGNIFICANCE Motor system hyperactivation represents a cognitive, domain-independent endophenotype of JME. We propose measures of motor system activation as quantitative traits for future genetic imaging studies in this syndrome.
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Affiliation(s)
- Lorenzo Caciagli
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Britta Wandschneider
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Maria Centeno
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Epilepsy UnitHospital Clínic de BarcelonaBarcelonaSpain
| | - Christian Vollmar
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyLudwig‐Maximilians‐UniversitätMunichGermany
| | - Sjoerd B. Vos
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Centre for Medical Image ComputingUniversity College LondonLondonUK
- Neuroradiological Academic UnitUCL Queen Square Institute of NeurologyLondonUK
| | - Karin Trimmel
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Lili Long
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyXiangya Hospital of Central South UniversityChangshaChina
| | - Fenglai Xiao
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduChina
| | - Alexander J. Lowe
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Meneka K. Sidhu
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Pamela J. Thompson
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyQueen's UniversityKingstonONCanada
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Matthias J. Koepp
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
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37
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Postma TS, Cury C, Baxendale S, Thompson PJ, Cano-López I, de Tisi J, Burdett JL, Sidhu MK, Caciagli L, Winston GP, Vos SB, Thom M, Duncan JS, Koepp MJ, Galovic M. Hippocampal Shape Is Associated with Memory Deficits in Temporal Lobe Epilepsy. Ann Neurol 2020; 88:170-182. [PMID: 32379905 PMCID: PMC8432153 DOI: 10.1002/ana.25762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/29/2022]
Abstract
Objective Cognitive problems, especially disturbances in episodic memory, and hippocampal sclerosis are common in temporal lobe epilepsy (TLE), but little is known about the relationship of hippocampal morphology with memory. We aimed to relate hippocampal surface‐shape patterns to verbal and visual learning. Methods We analyzed hippocampal surface shapes on high‐resolution magnetic resonance images and the Adult Memory and Information Processing Battery in 145 unilateral refractory TLE patients undergoing epilepsy surgery, a validation set of 55 unilateral refractory TLE patients, and 39 age‐ and sex‐matched healthy volunteers. Results Both left TLE (LTLE) and right TLE (RTLE) patients had lower verbal (LTLE 44 ± 11; RTLE 45 ± 10) and visual learning (LTLE 34 ± 8, RTLE 30 ± 8) scores than healthy controls (verbal 58 ± 8, visual 39 ± 6; p < 0.001). Verbal learning was more impaired the greater the atrophy of the left superolateral hippocampal head. In contrast, visual memory was worse with greater bilateral inferomedial hippocampal atrophy. Postsurgical verbal memory decline was more common in LTLE than in RTLE (reliable change index in LTLE 27% vs RTLE 7%, p = 0.006), whereas there were no differences in postsurgical visual memory decline between those groups. Preoperative atrophy of the left hippocampal tail predicted postsurgical verbal memory decline. Interpretation Memory deficits in TLE are associated with specific morphological alterations of the hippocampus, which could help stratify TLE patients into those at high versus low risk of presurgical or postsurgical memory deficits. This knowledge could improve planning and prognosis of selective epilepsy surgery and neuropsychological counseling in TLE. ANN NEUROL 2020 ANN NEUROL 2020;88:170–182
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Affiliation(s)
- Tjardo S Postma
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom.,GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Claire Cury
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,University of Rennes, Inria, Inserm, CNRS, IRISA UMR 6074, Empenn team ERL U 1228, F-35000, Rennes, France.,Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Pamela J Thompson
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Irene Cano-López
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,Valencian International University, Valencia, Spain
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Jane L Burdett
- MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Meneka K Sidhu
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom.,Department of Medicine, Division of Neurology, Queen's University, Kingston, Canada
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom.,Department of Medicine, Division of Neurology, Queen's University, Kingston, Canada
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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38
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Ratcliffe C, Wandschneider B, Baxendale S, Thompson P, Koepp MJ, Caciagli L. Cognitive Function in Genetic Generalized Epilepsies: Insights From Neuropsychology and Neuroimaging. Front Neurol 2020; 11:144. [PMID: 32210904 PMCID: PMC7076110 DOI: 10.3389/fneur.2020.00144] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
Abstract
Genetic generalized epilepsies (GGE), previously called idiopathic generalized epilepsies, constitute about 20% of all epilepsies, and include childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic-clonic seizures alone (CAE, JAE, JME, and GGE-GTCS, respectively). GGE are characterized by high heritability, likely underlain by polygenetic mechanisms, which may relate to atypical neurodevelopmental trajectories. Age of onset ranges from pre-school years, for CAE, to early adulthood for GGE-GTCS. Traditionally, GGE have been considered benign, a belief contrary to evidence from neuropsychology studies conducted over the last two decades. In JME, deficits in executive and social functioning are common findings and relate to impaired frontal lobe function. Studies using neuropsychological measures and cognitive imaging paradigms provide evidence for hyperconnectivity between prefrontal and motor cortices, aberrant fronto-thalamo-cortical connectivity, and reduced fronto-cortical and subcortical gray matter volumes, which are associated with altered cognitive performance. Recent research has also identified associations between abnormal hippocampal morphometry and fronto-temporal activation during episodic memory. Longitudinal studies on individuals with newly diagnosed JME have observed cortical dysmaturation, which is paralleled by delayed cognitive development compared to the patients' peers. Comorbidities and cognitive deficits observed in other GGE subtypes, such as visuo-spatial and language deficits in both CAE and JAE, have also been correlated with atypical neurodevelopment. Although it remains unclear whether cognitive impairment profiles differ amongst GGE subtypes, effects may become more pronounced with disease duration, particularly in absence epilepsies. Finally, there is substantial evidence that patients with JME and their unaffected siblings share patterns of cognitive deficits, which is indicative of an underlying genetic etiology (endophenotype), independent of seizures and anti-epileptic medication.
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Affiliation(s)
- Corey Ratcliffe
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Pamela Thompson
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Matthias J. Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
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Flaus A, Riaño Barros DA, Hinz R, Myers JF, Lingford-Hughes A, Koepp MJ, Hammers A, McGinnity CJ. Decreased GABA-A Receptor Binding in Association With β-Lactam Antibiotic Use. Clin Nucl Med 2019; 44:981-982. [PMID: 31689281 DOI: 10.1097/rlu.0000000000002811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
β-Lactam antibiotics are proconvulsive. In laboratory animals, this effect seems to be predominantly mediated through inhibition of GABA-A receptors, but it has not been demonstrated in humans in vivo. We report images of a [C]Ro15-4513 PET from a 40-year-old man who had completed a 1-week course of flucloxacillin before it. Relative to healthy controls, the participant had significantly lower mean gray matter binding. These novel data suggest that, in humans, the proconvulsive effect of β-lactam antibiotics is mediated via either competition for the same benzodiazepine-binding site as [C]Ro15-4513 or downregulation of GABA-A receptor expression.
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Affiliation(s)
- Anthime Flaus
- From the Department of Nuclear Medicine, University Hospital, Saint-Etienne, France
- School of Biomedical Engineering & Imaging Sciences, King's College London, and Guy's and St Thomas' PET Centre, St Thomas' Hospital
| | - Daniela Alexandra Riaño Barros
- Centre for Neuroscience, Department of Medicine, Imperial College London
- MRC Clinical Sciences Centre Hammersmith Hospital, London
| | - Rainer Hinz
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester
| | - James F Myers
- Centre for Neuroscience, Department of Medicine, Imperial College London
| | | | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London
- Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, and Guy's and St Thomas' PET Centre, St Thomas' Hospital
- Centre for Neuroscience, Department of Medicine, Imperial College London
- MRC Clinical Sciences Centre Hammersmith Hospital, London
- Neurodis Foundation, CERMEP, Imagerie du Vivant, Lyon, France
| | - Colm Joseph McGinnity
- School of Biomedical Engineering & Imaging Sciences, King's College London, and Guy's and St Thomas' PET Centre, St Thomas' Hospital
- Centre for Neuroscience, Department of Medicine, Imperial College London
- MRC Clinical Sciences Centre Hammersmith Hospital, London
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40
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Abstract
Pharmacological treatment with antiepileptic medications (AEDs) in epilepsy is associated with a variety of neurocognitive side effects. However, the mechanisms underlying these side effects, and why certain brain anatomies are more affected still remain poorly understood. Advanced functional magnetic resonance imaging (fMRI) methods, such as pharmaco-fMRI, can investigate medication-related effects on brain activities using task and resting state fMRI and showing reproducible activation and deactivation patterns. This methodological approach has been used successfully to complement neuropsychological studies of AEDs. Here we review pharmaco-fMRI studies in people with epilepsy targeting the most-widely prescribed AEDs. Pharmco-fMRI has advanced our understanding of the impact of AEDs on specific brain networks and thus may provide potential biomarkers to move beyond the current “trial and error” approach when commencing anti-epileptic medication.
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Affiliation(s)
- Fenglai Xiao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom.,MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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41
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Trimmel K, van Graan LA, Gonzálvez GG, Haag A, Caciagli L, Vos SB, Bonelli S, Sidhu M, Thompson PJ, Koepp MJ, Duncan JS. Naming fMRI predicts the effect of temporal lobe resection on language decline. Ann Clin Transl Neurol 2019; 6:2186-2196. [PMID: 31578819 PMCID: PMC6856622 DOI: 10.1002/acn3.50911] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To develop language functional MRI (fMRI) methods that accurately predict postsurgical naming decline in temporal lobe epilepsy (TLE). METHODS Forty-six patients with TLE (25 left) and 19 controls underwent two overt fMRI paradigms (auditory naming and picture naming, both with active baseline conditions) and one covert task (verbal fluency). Clinical naming performance was assessed preoperatively and 4 months following anterior temporal lobe resection. Preoperative fMRI activations were correlated with postoperative naming decline. Individual laterality indices (LI) were calculated for temporal (auditory and picture naming) and frontal regions (verbal fluency) and were considered as predictors of naming decline in multiple regression models, along with other clinical variables (age at onset of seizures, preoperative naming scores, hippocampal volume, age). RESULTS In left TLE patients, activation of the left posterior inferior temporal gyrus during auditory naming and activation of left fusiform gyrus during picture naming were related to greater postoperative naming decline. Activation LI were the best individual predictors of naming decline in a multivariate regression model. For picture naming, an LI of higher than 0.34 gave 100% sensitivity and 92% specificity (positive predictive value (PPV) 91.6%). For auditory naming, a temporal lobe LI higher than 0.18 identified all patients with a clinically significant naming decline with 100% sensitivity and 58% specificity (PPV: 58.3%). No effect was seen for verbal fluency. INTERPRETATION Auditory and picture naming fMRI are clinically applicable to predict postoperative naming decline after left temporal lobe resection in individual patients, with picture naming being more specific.
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Affiliation(s)
- Karin Trimmel
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom.,Department of Neurology, Medical University of Vienna, A-1090, Vienna, Austria
| | - Louis A van Graan
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - Gloria G Gonzálvez
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - Anja Haag
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - Lorenzo Caciagli
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - Sjoerd B Vos
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom.,Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Silvia Bonelli
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom.,Department of Neurology, Medical University of Vienna, A-1090, Vienna, Austria
| | - Meneka Sidhu
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - Pamela J Thompson
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - Matthias J Koepp
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - John S Duncan
- Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0LR, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
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Galovic M, van Dooren VQH, Postma TS, Vos SB, Caciagli L, Borzì G, Cueva Rosillo J, Vuong KA, de Tisi J, Nachev P, Duncan JS, Koepp MJ. Progressive Cortical Thinning in Patients With Focal Epilepsy. JAMA Neurol 2019; 76:1230-1239. [PMID: 31260004 DOI: 10.1001/jamaneurol.2019.1708] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance It is controversial whether epilepsy is a static or progressive disease. Evidence of progressive gray matter loss in epilepsy would support early diagnosis, rapid treatment, and early referral for surgical interventions. Objective To demonstrate progressive cortical thinning in patients with focal epilepsy distinct from cortical thinning associated with normal aging. Design, Setting, and Participants A case-control neuroimaging study was conducted from August 3, 2004, to January 26, 2016, among 190 patients with focal epilepsy at a tertiary epilepsy referral center (epilepsy data) and 3 independent comparison cohorts matched for age and sex (healthy volunteer data; n = 141). Exposures Two or more high-resolution T1-weighted magnetic resonance imaging scans at least 6 months apart (mean [SD] interval, 2.5 [1.6] years). Main Outcomes and Measures Global and vertexwise rate of progressive cortical thinning. Results A total of 190 people with focal epilepsy (99 women and 91 men; mean [SD] age, 36 [11] years; 396 magnetic resonance imaging scans) were compared with 141 healthy volunteers (76 women and 65 men; mean [SD] age, 35 [17] years; 282 magnetic resonance imaging scans). Widespread highly significant progressive cortical thinning exceeding normal aging effects, mainly involving the bilateral temporal lobes, medial parietal and occipital cortices, pericentral gyri, and opercula, was seen in 146 individuals with epilepsy (76.8%; 95% CI, 58%-95%). The mean (SD) annualized rate of global cortical thinning in patients with epilepsy was twice the rate of age-associated thinning observed in healthy volunteers (0.024 [0.061] vs 0.011 [0.029] mm/y; P = .01). Progression was most pronounced in adults older than 55 years and during the first 5 years after the onset of seizures. Areas of accelerated cortical thinning were detected in patients with early onset of epilepsy and in patients with hippocampal sclerosis. Accelerated thinning was not associated with seizure frequency, history of generalized seizures, or antiepileptic drug load and did not differ between patients with or without ongoing seizures. Progressive atrophy in temporal (n = 101) and frontal (n = 28) lobe epilepsy was most pronounced ipsilaterally to the epileptic focus but also affected a widespread area extending beyond the focus and commonly affected the contralateral hemisphere. For patients with temporal lobe epilepsy, accelerated cortical thinning was observed within areas structurally connected with the ipsilateral hippocampus. Conclusions and Relevance Widespread progressive cortical thinning exceeding that seen with normal aging may occur in patients with focal epilepsy. These findings appear to highlight the need to develop epilepsy disease-modifying treatments to disrupt or slow ongoing atrophy. Longitudinal cortical thickness measurements may have the potential to serve as biomarkers for such studies.
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Affiliation(s)
- Marian Galovic
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom.,Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland.,Department of Neurology, University Hospital Zurich, Switzerland
| | - Victor Q H van Dooren
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Tjardo S Postma
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom.,Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Giuseppe Borzì
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,Institute of Neurology, University of Catanzaro, Catanzaro, Italy
| | - Juana Cueva Rosillo
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Khue Anh Vuong
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Parashkev Nachev
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom.,Magnetic Resonance Imaging Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
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Wandschneider B, Hong SJ, Bernhardt BC, Fadaie F, Vollmar C, Koepp MJ, Bernasconi N, Bernasconi A. Developmental MRI markers cosegregate juvenile patients with myoclonic epilepsy and their healthy siblings. Neurology 2019; 93:e1272-e1280. [PMID: 31467252 PMCID: PMC7011863 DOI: 10.1212/wnl.0000000000008173] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 06/07/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE MRI studies of genetic generalized epilepsies have mainly described group-level changes between patients and healthy controls. To determine the endophenotypic potential of structural MRI in juvenile myoclonic epilepsy (JME), we examined MRI-based cortical morphologic markers in patients and their healthy siblings. METHODS In this prospective, cross-sectional study, we obtained 3T MRI in patients with JME, siblings, and controls. We mapped sulco-gyral complexity and surface area, morphologic markers of brain development, and cortical thickness. Furthermore, we calculated mean geodesic distance, a surrogate marker of cortico-cortical connectivity. RESULTS Compared to controls, patients and siblings showed increased folding complexity and surface area in prefrontal and cingulate cortices. In these regions, they also displayed abnormally increased geodesic distance, suggesting network isolation and decreased efficiency, with strongest effects for limbic, fronto-parietal, and dorsal-attention networks. In areas of findings overlap, we observed strong patient-sibling correlations. Conversely, neocortical thinning was present in patients only and related to disease duration. Patients showed subtle impairment in mental flexibility, a frontal lobe function test, as well as deficits in naming and design learning. Siblings' performance fell between patients and controls. CONCLUSION MRI markers of brain development and connectivity are likely heritable and may thus serve as endophenotypes. The topography of morphologic anomalies and their abnormal structural network integration likely explains cognitive impairments in patients with JME and their siblings. By contrast, cortical atrophy likely represents a marker of disease.
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Affiliation(s)
- Britta Wandschneider
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Seok-Jun Hong
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Boris C Bernhardt
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Fatemeh Fadaie
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Christian Vollmar
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Matthias J Koepp
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Neda Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada.
| | - Andrea Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada.
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Caciagli L, Wandschneider B, Xiao F, Vollmar C, Centeno M, Vos SB, Trimmel K, Sidhu MK, Thompson PJ, Winston GP, Duncan JS, Koepp MJ. Abnormal hippocampal structure and function in juvenile myoclonic epilepsy and unaffected siblings. Brain 2019; 142:2670-2687. [PMID: 31365054 PMCID: PMC6776114 DOI: 10.1093/brain/awz215] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 06/20/2018] [Revised: 04/09/2019] [Accepted: 05/27/2019] [Indexed: 02/05/2023] Open
Abstract
Juvenile myoclonic epilepsy is the most common genetic generalized epilepsy syndrome, characterized by a complex polygenetic aetiology. Structural and functional MRI studies demonstrated mesial or lateral frontal cortical derangements and impaired fronto-cortico-subcortical connectivity in patients and their unaffected siblings. The presence of hippocampal abnormalities and associated memory deficits is controversial, and functional MRI studies in juvenile myoclonic epilepsy have not tested hippocampal activation. In this observational study, we implemented multi-modal MRI and neuropsychological data to investigate hippocampal structure and function in 37 patients with juvenile myoclonic epilepsy, 16 unaffected siblings and 20 healthy controls, comparable for age, gender, handedness and hemispheric dominance as assessed with language laterality indices. Automated hippocampal volumetry was complemented by validated qualitative and quantitative morphological criteria to detect hippocampal malrotation, assumed to represent a neurodevelopmental marker. Neuropsychological measures of verbal and visuo-spatial learning and an event-related verbal and visual memory functional MRI paradigm addressed mesiotemporal function. We detected a reduction of mean left hippocampal volume in patients and their siblings compared with controls (P < 0.01). Unilateral or bilateral hippocampal malrotation was identified in 51% of patients and 50% of siblings, against 15% of controls (P < 0.05). For bilateral hippocampi, quantitative markers of verticalization had significantly larger values in patients and siblings compared with controls (P < 0.05). In the patient subgroup, there was no relationship between structural measures and age at disease onset or degree of seizure control. No overt impairment of verbal and visual memory was identified with neuropsychological tests. Functional mapping highlighted atypical patterns of hippocampal activation, pointing to abnormal recruitment during verbal encoding in patients and their siblings [P < 0.05, familywise error (FWE)-corrected]. Subgroup analyses indicated distinct profiles of hypoactivation along the hippocampal long axis in juvenile myoclonic epilepsy patients with and without malrotation; patients with malrotation also exhibited reduced frontal recruitment for verbal memory, and more pronounced left posterior hippocampal involvement for visual memory. Linear models across the entire study cohort indicated significant associations between morphological markers of hippocampal positioning and hippocampal activation for verbal items (all P < 0.05, FWE-corrected). We demonstrate abnormalities of hippocampal volume, shape and positioning in patients with juvenile myoclonic epilepsy and their siblings, which are associated with reorganization of function and imply an underlying neurodevelopmental mechanism with expression during the prenatal stage. Co-segregation of abnormal hippocampal morphology in patients and their siblings is suggestive of a genetic imaging phenotype, independent of disease activity, and can be construed as a novel endophenotype of juvenile myoclonic epilepsy.
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Affiliation(s)
- Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Christian Vollmar
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Neurology, Ludwig-Maximilians-Universität, Marchioninistrasse 15, Munich, Germany
| | - Maria Centeno
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Karin Trimmel
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Meneka K Sidhu
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Pamela J Thompson
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
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Galovic M, Baudracco I, Wright-Goff E, Pillajo G, Nachev P, Wandschneider B, Woermann F, Thompson P, Baxendale S, McEvoy AW, Nowell M, Mancini M, Vos SB, Winston GP, Sparks R, Prados F, Miserocchi A, de Tisi J, Van Graan LA, Rodionov R, Wu C, Alizadeh M, Kozlowski L, Sharan AD, Kini LG, Davis KA, Litt B, Ourselin S, Moshé SL, Sander JWA, Löscher W, Duncan JS, Koepp MJ. Association of Piriform Cortex Resection With Surgical Outcomes in Patients With Temporal Lobe Epilepsy. JAMA Neurol 2019; 76:690-700. [PMID: 30855662 PMCID: PMC6490233 DOI: 10.1001/jamaneurol.2019.0204] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 10/08/2018] [Accepted: 12/21/2018] [Indexed: 12/23/2022]
Abstract
Importance A functional area associated with the piriform cortex, termed area tempestas, has been implicated in animal studies as having a crucial role in modulating seizures, but similar evidence is limited in humans. Objective To assess whether removal of the piriform cortex is associated with postoperative seizure freedom in patients with temporal lobe epilepsy (TLE) as a proof-of-concept for the relevance of this area in human TLE. Design, Setting, and Participants This cohort study used voxel-based morphometry and volumetry to assess differences in structural magnetic resonance imaging (MRI) scans in consecutive patients with TLE who underwent epilepsy surgery in a single center from January 1, 2005, through December 31, 2013. Participants underwent presurgical and postsurgical structural MRI and had at least 2 years of postoperative follow-up (median, 5 years; range, 2-11 years). Patients with MRI of insufficient quality were excluded. Findings were validated in 2 independent cohorts from tertiary epilepsy surgery centers. Study follow-up was completed on September 23, 2016, and data were analyzed from September 24, 2016, through April 24, 2018. Exposures Standard anterior temporal lobe resection. Main Outcomes and Measures Long-term postoperative seizure freedom. Results In total, 107 patients with unilateral TLE (left-sided in 68; 63.6% women; median age, 37 years [interquartile range {IQR}, 30-45 years]) were included in the derivation cohort. Reduced postsurgical gray matter volumes were found in the ipsilateral piriform cortex in the postoperative seizure-free group (n = 46) compared with the non-seizure-free group (n = 61). A larger proportion of the piriform cortex was resected in the seizure-free compared with the non-seizure-free groups (median, 83% [IQR, 64%-91%] vs 52% [IQR, 32%-70%]; P < .001). The results were seen in left- and right-sided TLE and after adjusting for clinical variables, presurgical gray matter alterations, presurgical hippocampal volumes, and the proportion of white matter tract disconnection. Findings were externally validated in 2 independent cohorts (31 patients; left-sided TLE in 14; 54.8% women; median age, 41 years [IQR, 31-46 years]). The resected proportion of the piriform cortex was individually associated with seizure outcome after surgery (derivation cohort area under the curve, 0.80 [P < .001]; external validation cohorts area under the curve, 0.89 [P < .001]). Removal of at least half of the piriform cortex increased the odds of becoming seizure free by a factor of 16 (95% CI, 5-47; P < .001). Other mesiotemporal structures (ie, hippocampus, amygdala, and entorhinal cortex) and the overall resection volume were not associated with outcomes. Conclusions and Relevance These results support the importance of resecting the piriform cortex in neurosurgical treatment of TLE and suggest that this area has a key role in seizure generation.
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Affiliation(s)
- Marian Galovic
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
- Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Irene Baudracco
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Evan Wright-Goff
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Galo Pillajo
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Imaging, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
- Division of Neuroanatomy, Facultad de Medicina, Universidad Internacional del Ecuador, Quito
| | - Parashkev Nachev
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Britta Wandschneider
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Friedrich Woermann
- Magnetic Resonance Imaging Unit, Klinik Mara, Bethel Epilepsy Centre, Bielefeld, Germany
| | - Pamela Thompson
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Sallie Baxendale
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Institute of Cognitive Neuroscience, UCL, London, United Kingdom
| | - Andrew W. McEvoy
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Mark Nowell
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Matteo Mancini
- Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, UCL, London, United Kingdom
| | - Sjoerd B. Vos
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
- Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, UCL, London, United Kingdom
| | - Gavin P. Winston
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Rachel Sparks
- Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, UCL, London, United Kingdom
- School of Biomedical Engineering and Image Sciences, Kings College London, London, United Kingdom
| | - Ferran Prados
- Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, United Kingdom
| | - Anna Miserocchi
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jane de Tisi
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Louis André Van Graan
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Roman Rodionov
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Chengyuan Wu
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mahdi Alizadeh
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lauren Kozlowski
- medical student at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ashwini D. Sharan
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lohith G. Kini
- Center for Neuroengineering and Therapeutics, Department of Bioengineering, University of Pennsylvania, Philadelphia
| | - Kathryn A. Davis
- Center for Neuroengineering and Therapeutics, Department of Bioengineering, University of Pennsylvania, Philadelphia
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
| | - Brian Litt
- Center for Neuroengineering and Therapeutics, Department of Bioengineering, University of Pennsylvania, Philadelphia
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, UCL, London, United Kingdom
- School of Biomedical Engineering and Image Sciences, Kings College London, London, United Kingdom
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Solomon L. Moshé
- Laboratory of Developmental Epilepsy, Saul R. Korey Department of Neurology, Montefiore/Einstein Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
- Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
- Department of Pediatrics, Montefiore/Einstein Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Josemir W. A. Sander
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine, Hannover, Germany
- Center for Systems Neuroscience, University of Veterinary Medicine, Hannover, Germany
| | - John S. Duncan
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
| | - Matthias J. Koepp
- UK National Institute for Health Research, University College London (UCL) Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, United Kingdom
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46
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Bernasconi A, Cendes F, Theodore WH, Gill RS, Koepp MJ, Hogan RE, Jackson GD, Federico P, Labate A, Vaudano AE, Blümcke I, Ryvlin P, Bernasconi N. Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: A consensus report from the International League Against Epilepsy Neuroimaging Task Force. Epilepsia 2019; 60:1054-1068. [PMID: 31135062 DOI: 10.1111/epi.15612] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [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: 05/11/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/01/2023]
Abstract
Structural magnetic resonance imaging (MRI) is of fundamental importance to the diagnosis and treatment of epilepsy, particularly when surgery is being considered. Despite previous recommendations and guidelines, practices for the use of MRI are variable worldwide and may not harness the full potential of recent technological advances for the benefit of people with epilepsy. The International League Against Epilepsy Diagnostic Methods Commission has thus charged the 2013-2017 Neuroimaging Task Force to develop a set of recommendations addressing the following questions: (1) Who should have an MRI? (2) What are the minimum requirements for an MRI epilepsy protocol? (3) How should magnetic resonance (MR) images be evaluated? (4) How to optimize lesion detection? These recommendations target clinicians in established epilepsy centers and neurologists in general/district hospitals. They endorse routine structural imaging in new onset generalized and focal epilepsy alike and describe the range of situations when detailed assessment is indicated. The Neuroimaging Task Force identified a set of sequences, with three-dimensional acquisitions at its core, the harmonized neuroimaging of epilepsy structural sequences-HARNESS-MRI protocol. As these sequences are available on most MR scanners, the HARNESS-MRI protocol is generalizable, regardless of the clinical setting and country. The Neuroimaging Task Force also endorses the use of computer-aided image postprocessing methods to provide an objective account of an individual's brain anatomy and pathology. By discussing the breadth and depth of scope of MRI, this report emphasizes the unique role of this noninvasive investigation in the care of people with epilepsy.
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Affiliation(s)
- Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - William H Theodore
- Clinical Epilepsy Section, National Institutes of Health, Bethesda, Maryland
| | - Ravnoor S Gill
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Robert Edward Hogan
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Paolo Federico
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Angelo Labate
- Institute of Neurology, University of Catanzaro, Catanzaro, Italy
| | - Anna Elisabetta Vaudano
- Neurology Unit, Azienda Ospedaliero Universitaria, University of Modena and Reggio Emilia, Modena, Italy
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Philippe Ryvlin
- Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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47
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Bialer M, Johannessen SI, Koepp MJ, Levy RH, Perucca E, Tomson T, White HS. Progress report on new antiepileptic drugs: A summary of the Fourteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XIV). II. Drugs in more advanced clinical development. Epilepsia 2019; 59:1842-1866. [PMID: 30368788 DOI: 10.1111/epi.14555] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 07/01/2018] [Revised: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 12/24/2022]
Abstract
The Fourteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XIV) took place in Madrid, Spain, on May 13-16, 2018 and was attended by 168 delegates from 28 countries. The conference provided a forum for professionals involved in basic science, clinical research, regulatory affairs, and clinical care to meet and discuss the latest advances related to discovery and development of drugs and devices aimed at improving the management of people with epilepsy. This progress report provides a summary of findings on investigational compounds for which data from both preclinical studies and studies in patients were presented. The compounds reviewed include anakinra, cannabidiol, cannabidivarin, fenfluramine, ganaxolone, medium-chain fatty acids, padsevonil, and the valproic derivatives valnoctamide and sec-butylpropylacetamide. On June 25, 2018, the US Food and Drug Administration approved a standardized formulation of cannabidiol oral solution for the treatment of seizures associated with Lennox-Gastaut syndrome and Dravet syndrome in patients 2 years and older. The report shows that there continues to be a steady flow of potential antiepileptic drugs progressing to clinical development. Many of these compounds show innovative mechanisms of action, and some have already been tested in placebo-controlled randomized controlled trials, with promising efficacy and safety results.
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Affiliation(s)
- Meir Bialer
- Faculty of Medicine, School of Pharmacy and David R. Bloom Center for Pharmacy, Institute for Drug Research, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Svein I Johannessen
- National Center for Epilepsy, Sandvika, Norway.,Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - René H Levy
- Department of Pharmaceutics and Neurological Surgery, University of Washington, Seattle, Washington
| | - Emilio Perucca
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington
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Bialer M, Johannessen SI, Koepp MJ, Levy RH, Perucca E, Tomson T, White HS. A summary of data presented at the XIV conference on new antiepileptic drug and devices (EILAT XIV). Epilepsy Res 2019; 153:66-67. [PMID: 30910314 DOI: 10.1016/j.eplepsyres.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 11/27/2022]
Abstract
The Fourteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XIV) took place in Madrid, Spain from May 13th to 16th 2018. Again, presentations on new medical devices and neuromodulation and discussions on device-related regulatory aspects were included in the programme. The virtual special issue on "neuromodulation" summarises the presentations focusing firstly, on the pre-clinical developments and the difficulties of clinical trial designs for neuromodulatory therapies, including vagus nerve stimulation (VNS) and Brain-Responsive Neurostimulation (RNS), and the use of transcutaneous vagus nerve stimulation (tVNS) as a potential screening tool for determining the efficacy of neuromodulatory treatments in individual patients; secondly, on wearable devices for seizure monitoring through indices of peripheral sympathetic nervous activity, the use of such devices in combination with biofeedback for the treatment of epilepsy, and its potential for improving epilepsy specialist services, particularly in remote areas.
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Affiliation(s)
- Meir Bialer
- Institute for Drug Research, School of Pharmacy and David R. Bloom Centre for Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Svein I Johannessen
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway; Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - René H Levy
- Department of Pharmaceutics, University of Washington, Seattle, WA, USA; Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Emilio Perucca
- Division of Clinical and Experimental Pharmacology, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
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Galovic M, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Conrad J, Evers S, Winklehner M, von Oertzen TJ, Haring HP, Serafini A, Gregoraci G, Valente M, Janes F, Gigli GL, Keezer MR, Duncan JS, Sander JW, Koepp MJ, Tettenborn B. Prediction of late seizures after ischaemic stroke with a novel prognostic model (the SeLECT score): a multivariable prediction model development and validation study. Lancet Neurol 2019; 17:143-152. [PMID: 29413315 DOI: 10.1016/s1474-4422(17)30404-0] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke is one of the leading causes of acquired epilepsy in adults. An instrument to predict whether people are at high risk of developing post-stroke seizures is not available. We aimed to develop and validate a prognostic model of late (>7 days) seizures after ischaemic stroke. METHODS In this multivariable prediction model development and validation study, we developed the SeLECT score based on five clinical predictors in 1200 participants who had an ischaemic stroke in Switzerland using backward elimination of a multivariable Cox proportional hazards model. We externally validated this score in 1169 participants from three independent international cohorts in Austria, Germany, and Italy, and assessed its performance with the concordance statistic and calibration plots. FINDINGS Data were complete for 99·2% of the predictors (99·2% for Switzerland, 100% for Austria, 97% for Germany, and 99·7% for Italy) and 100% of the outcome parameters. Overall, the risk of late seizures was 4% (95% CI 4-5) 1 year after stroke and 8% (6-9) 5 years after stroke. The final model included five variables and was named SeLECT on the basis of the first letters of the included parameters (severity of stroke, large-artery atherosclerotic aetiology, early seizures, cortical involvement, and territory of middle cerebral artery involvement). The lowest SeLECT value (0 points) was associated with a 0·7% (95% CI 0·4-1·0) risk of late seizures within 1 year after stroke (1·3% [95% CI 0·7-1·8] within 5 years), whereas the highest value (9 points) predicted a 63% (42-77) risk of late seizures within 1 year (83% [62-93] within 5 years). The model had an overall concordance statistic of 0·77 (95% CI 0·71-0·82) in the validation cohorts. Calibration plots indicated high agreement of predicted and observed outcomes. INTERPRETATION This easily applied instrument was shown to be a good predictor of the risk of late seizures after stroke in three external validation cohorts and is freely available as a smartphone app. The SeLECT score has the potential to identify individuals at high risk of seizures and is a step towards more personalised medicine. It can inform the selection of an enriched population for antiepileptogenic treatment trials and will guide the recruitment for biomarker studies of epileptogenesis. FUNDING None.
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Affiliation(s)
- Marian Galovic
- Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland; Department of Clinical and Experimental Epilepsy, National Institute for Health Research University College London Hospitals Biomedical Research Centre, Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Nico Döhler
- Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Ansgar Felbecker
- Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Philip Siebel
- Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Julian Conrad
- Department of Neurology, University of Münster, Münster, Germany; Department of Neurology and German Center for Vertigo and Balance Disorders-IFB-LMU, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefan Evers
- Department of Neurology, University of Münster, Münster, Germany; Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
| | - Michael Winklehner
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Tim J von Oertzen
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Hans-Peter Haring
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Anna Serafini
- Dipartimento di Aerea Medica (DAME), University of Udine, Udine, Italy
| | - Giorgia Gregoraci
- Dipartimento di Aerea Medica (DAME), University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Dipartimento di Aerea Medica (DAME), University of Udine, Udine, Italy; Neurology Unit, University of Udine Academic Hospital, Udine, Italy
| | - Francesco Janes
- Neurology Unit, University of Udine Academic Hospital, Udine, Italy
| | - Gian Luigi Gigli
- Dipartimento di Aerea Medica (DAME), University of Udine, Udine, Italy; Neurology Unit, University of Udine Academic Hospital, Udine, Italy
| | - Mark R Keezer
- Department of Clinical and Experimental Epilepsy, National Institute for Health Research University College London Hospitals Biomedical Research Centre, Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK; Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, QC, Canada; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, National Institute for Health Research University College London Hospitals Biomedical Research Centre, Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, National Institute for Health Research University College London Hospitals Biomedical Research Centre, Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, National Institute for Health Research University College London Hospitals Biomedical Research Centre, Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Barbara Tettenborn
- Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland.
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50
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McGinnity CJ, Årstad E, Beck K, Brooks DJ, Coles JP, Duncan JS, Galovic M, Hinz R, Hirani E, Howes OD, Jones PA, Koepp MJ, Luo F, Riaño Barros DA, Singh N, Trigg W, Hammers A. Comment on " In Vivo [ 18F]GE-179 Brain Signal Does Not Show NMDA-Specific Modulation with Drug Challenges in Rodents and Nonhuman Primates". ACS Chem Neurosci 2019; 10:768-772. [PMID: 30346706 DOI: 10.1021/acschemneuro.8b00246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Schoenberger and colleagues ( Schoenberger et al. ( 2018 ) ACS Chem. Neurosci. 9 , 298 - 305 ) recently reported attempts to demonstrate specific binding of the positron emission tomography (PET) radiotracer, [18F]GE-179, to NMDA receptors in both rats and Rhesus macaques. GE-179 did not work as expected in animal models; however, we disagree with the authors' conclusion that "the [18F]GE-179 signal seems to be largely nonspecific". It is extremely challenging to demonstrate specific binding for the use-dependent NMDA receptor intrachannel ligands such as [18F]GE-179 in animals via traditional blocking, due to its low availability of target sites ( Bmax'). Schoenberger and colleagues anesthetized rats and Rhesus monkeys using isoflurane, which has an inhibitory effect on NMDA receptor function and thus would be expected to further reduce the Bmax'. The extent of glutamate release achieved in the provocation experiments is uncertain, as is whether a significant increase in NMDA receptor channel opening can be expected under anesthesia. Prior data suggest that the uptake of disubstituted arylguanidine-based ligands such as GE-179 can be reduced by phencyclidine binding site antagonists, if injection is performed in the absence of ketamine and isoflurane anesthesia, e.g., with GE-179's antecedent, CNS 5161 ( Biegon et al. ( 2007 ) Synapse 61 , 577 - 586 ), and with GMOM ( van der Doef et al. ( 2016 ) J. Cereb. Blood Flow Metab. 36 , 1111 - 1121 ). However, the extent of nonspecific uptake remains uncertain.
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Affiliation(s)
- Colm J. McGinnity
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, United Kingdom
- King’s
College London & Guy’s and St Thomas’ PET Centre,
St Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Erik Årstad
- Institute of Nuclear Medicine and Department of Chemistry, University College London, London NW1 2BU, United Kingdom
| | - Katherine Beck
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, United Kingdom
| | - David J. Brooks
- Department of Nuclear Medicine, Aarhus University, Aarhus 8200, Denmark
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
| | - Jonathan P. Coles
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
- Epilepsy Society, Gerrards Cross SL9 0RJ, United Kingdom
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
- Epilepsy Society, Gerrards Cross SL9 0RJ, United Kingdom
- Department of Neurology, Kantonsspital St Gallen, 9007 St. Gallen, Switzerland
| | - Rainer Hinz
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester M20 3LJ, United Kingdom
| | - Ella Hirani
- GE Healthcare Ltd, Amersham HP7 9LL, United Kingdom
| | - Oliver D. Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, United Kingdom
| | | | - Matthias J. Koepp
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
- Epilepsy Society, Gerrards Cross SL9 0RJ, United Kingdom
| | - Feng Luo
- GE Healthcare Ltd, Amersham HP7 9LL, United Kingdom
| | - Daniela A. Riaño Barros
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, London BR3 3BX, United Kingdom
| | - Nisha Singh
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, United Kingdom
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, United Kingdom
| | | | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, United Kingdom
- King’s
College London & Guy’s and St Thomas’ PET Centre,
St Thomas’ Hospital, London SE1 7EH, United Kingdom
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