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Zupcic SG, Zupcic M, Duzel V, Simurina T, Sakic L, Grubjesic I, Tonković D, Udovic IS, Ferreri VM. The potential role of micro-RNA-211 in the pathogenesis of sleep-related hypermotor epilepsy. Med Hypotheses 2020; 143:110115. [PMID: 32763656 DOI: 10.1016/j.mehy.2020.110115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022]
Abstract
Sleep-related hypermotor epilepsy (SHE) is a rare epileptic syndrome characterized by epileptic seizures which occur during the non-rapid eye movement (NREM) stage of sleep. It manifests with hypermotor semiology resembling violent limb movements and an asymmetric tonic-dystonic posture. The genes which are responsible for the autosomal dominant form of SHE (ADSHE) and whose function is to code the sub-unit of the neuronal acetylcholine receptor are well known. Considering that ADSHE is a prototype of SHE, it is thought that the dysfunction of the cortico-subcortical cholinergic network, which regulates the cycle of sleep, has a key role in the epileptogenesis of this syndrome. Namely, studies to date, have shown that the hypercholinergic activity is sufficient for the development of epileptic seizures, even though the exact mechanism remains to be elucidated. NREM parasomnias are sleep disorders that are the most difficult to differentiate from SHE due to a similar clinical presentation. Considering the clinical similarities, NREM occurrence and probable genetic connection, it is considered that fundamentally, both of these conditions share a common pathophysiological mechanism i.e. cholinergic dysfunction. The main difference between SHE and NREM parasomnias are the genuine epileptic seizures that are responsible for the semiology in SHE. These genuine seizures are not present in NREM parasomnias. Why this is so, remains to be elucidated. Considering that animal studies have shown that dynamic changes and the decreased levels of microRNA-211 contribute to epileptic seizures and to changes in cholinergic pathways, our hypothesis is that epileptic seizures and the development of epileptogenesis in SHE are a consequence of cholinergic dysfunction and decreased levels of microRNA-211 as opposed to NREM parasomnias where there is a stable level of microRNA-211, preventing epileptogenesis despite the cholinergic system dysfunction.
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Affiliation(s)
- Sandra Graf Zupcic
- Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia.
| | - Miroslav Zupcic
- University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia
| | - Viktor Duzel
- Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom
| | - Tatjana Simurina
- J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; Department of Health Studies, University of Zadar, General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia
| | - Livija Sakic
- J. J. Strossmayer University, Faculty of Dental Medicine and Health, Osijek, Croatia; University Hospital "Sveti Duh", Clinic of Anesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia
| | - Igor Grubjesic
- Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia
| | - Dinko Tonković
- School of Medicine, University of Zagreb, Croatia; Clinical Hospital Centre Zagreb, Clinic of Anesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia
| | - Ingrid Sutic Udovic
- University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia
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Zupcic SG, Zupcic M, Duzel V, Šimurina T, Milošević M, Basic S, Vuletic V, Kapural L. Effect of clonidine on the cutaneous silent period during spinal anesthesia. World J Clin Cases 2018; 6:1136-1145. [PMID: 30613672 PMCID: PMC6306629 DOI: 10.12998/wjcc.v6.i16.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/17/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the effect of clonidine on the cutaneous silent period (CSP) during spinal anesthesia.
METHODS A total of 67 adult patients were included in this randomized, prospective, single-center, double-blind trial. They did not have neurological disorders and were scheduled for inguinal hernia repair surgery. This trial was registered on ClinicalTrials.gov (NTC03121261). The patients were randomized into two groups with regards to the intrathecally administered solution: (1) 15 mg of 0.5% levobupivacaine with 50 µg of 0.015% clonidine, or (2) 15 mg of 0.5% levobupivacaine alone. There were 34 patients in the levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group. CSP and its latency were measured four times: prior to the subarachnoid block (SAB), after motor block regression to the 0 level of the Bromage scale, with ongoing sensory blockade, and both 6 and 24 h after SAB.
RESULTS Only data from 30 patients in each group were analyzed. There were no significant differences between the groups investigated preoperatively and after 24 h. The CSP of the L group at the time point when the Bromage scale was 0 was 44.8 ± 8.1 ms, while in the LC group it measured 40.2 ± 3.8 ms (P = 0.007). The latency in the L group at the time point when the Bromage scale was 0 was 130.3 ± 10.2 ms, and in the LC group it was 144.7 ± 8.3 ms (P < 0.001). The CSP of the L group after 6 h was 59.6 ± 9.8 ms, while in the LC group it was 44.5 ± 5.0 ms (P < 0.001). The latency in the L group after 6 h was 110.4 ± 10.6 ms, while in LC group it was 132.3 ± 9.7 ms (P < 0.001).
CONCLUSION Intrathecal addition of clonidine to levobupivacaine for SAB in comparison with levobupivacaine alone results in a diminished inhibitory tonus and shortened CSP.
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Affiliation(s)
- Sandra Graf Zupcic
- Clinic of Neurology, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
| | - Miroslav Zupcic
- Faculty of Medicine, J. J. Strossmayer University, Osijek 31000, Croatia
- Clinic of Anesthesiology and Intensive Care Medicine, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Viktor Duzel
- Department of Anaesthesia, Barking, Havering and Redbridge University Hospitals NHS Trust, London RM7 0AG, United Kingdom
| | - Tatjana Šimurina
- Faculty of Medicine, J. J. Strossmayer University, Osijek 31000, Croatia
- Department of Health Studies University of Zadar, Zadar 23000, Croatia
- Department of Anesthesiology and Intensive Care Medicine, General Hospital Zadar, Zadar 23000, Croatia
| | - Milan Milošević
- University of Zagreb, School of Medicine, Andrija Stampar School of Public Health WHO Collaborative Centre for Occupational Health, Zagreb 10000, Croatia
| | - Silvio Basic
- Faculty of Medicine, J. J. Strossmayer University, Osijek 31000, Croatia
- Department of Neurology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
| | - Vladimira Vuletic
- Clinic of Neurology, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Leonardo Kapural
- Center for Clinical Research, Winston Salem, NC 27103, United States
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