1
|
Del Gaudio N, Ferrao Santos S, Raftopoulos C. Modified Vertical Parasagittal Sub-Insular Hemispherotomy-Case Series and Technical Note. Brain Sci 2023; 13:1395. [PMID: 37891764 PMCID: PMC10605112 DOI: 10.3390/brainsci13101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Hemispherotomy is the generally accepted treatment for hemispheric drug-resistant epilepsy (DRE). Lateral or vertical approaches are performed according to the surgeon's preference. Multiple technical variations have been proposed since Delalande first described his vertical technique. We propose a sub-insular variation of the vertical parasagittal hemispherotomy (VPH) and describe our case series of patients operated on using this procedure. (2) Methods: Data from a continuous series of patients with hemispheric DRE who were operated on by the senior author (CR) using the modified sub-insular VPH technique were analyzed retrospectively. Pre-operative demographic and epilepsy characteristics, functional outcome, and surgical complications were extracted from medical charts. (3) Results: Twenty-five patients were operated on between August 2008 and August 2023; 23 have at least 3 months of follow-up. Of this group, 20 (86.9%) patients are seizure-free. Only two patients developed postoperative hydrocephalus (8.7%). All patients who were able to walk autonomously preoperatively and 20 (86.9%) of those with follow-up were able to walk without assistance. A total of 17 (74%) patients were able to perform adapted social activities at the latest follow-up. (4) Conclusions: Modified sub-insular VPH is a successful surgical technique for hemispheric DRE with seizure freedom rates similar to the largest series reported in the literature. Compared to other series, patients who were operated on with our modified technique had a lower rate of postoperative hydrocephalus and excellent long-term motor and cognitive outcomes.
Collapse
Affiliation(s)
- Nicole Del Gaudio
- Neurosurgery Department, University Hospital Saint Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200 Brussels, Belgium;
| | - Susana Ferrao Santos
- Neurology Department, University Hospital Saint Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200 Brussels, Belgium;
| | | |
Collapse
|
2
|
Santalucia R, Carapancea E, Vespa S, Germany Morrison E, Ghasemi Baroumand A, Vrielynck P, Fierain A, Joris V, Raftopoulos C, Duprez T, Ferrao Santos S, van Mierlo P, El Tahry R. Clinical added value of interictal automated electrical source imaging in the presurgical evaluation of MRI-negative epilepsy: A real-life experience in 29 consecutive patients. Epilepsy Behav 2023; 143:109229. [PMID: 37148703 DOI: 10.1016/j.yebeh.2023.109229] [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: 02/06/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE During the presurgical evaluation, manual electrical source imaging (ESI) provides clinically useful information in one-third of the patients but it is time-consuming and requires specific expertise. This prospective study aims to assess the clinical added value of a fully automated ESI analysis in a cohort of patients with MRI-negative epilepsy and describe its diagnostic performance, by evaluating sublobar concordance with stereo-electroencephalography (SEEG) results and surgical resection and outcome. METHODS All consecutive patients referred to the Center for Refractory Epilepsy (CRE) of St-Luc University Hospital (Brussels, Belgium) for presurgical evaluation between 15/01/2019 and 31/12/2020 meeting the inclusion criteria, were recruited to the study. Interictal ESI was realized on low-density long-term EEG monitoring (LD-ESI) and, whenever available, high-density EEG (HD-ESI), using a fully automated analysis (Epilog PreOp, Epilog NV, Ghent, Belgium). The multidisciplinary team (MDT) was asked to formulate hypotheses about the epileptogenic zone (EZ) location at sublobar level and make a decision on further management for each patient at two distinct moments: i) blinded to ESI and ii) after the presentation and clinical interpretation of ESI. Results leading to a change in clinical management were considered contributive. Patients were followed up to assess whether these changes lead to concordant results on stereo-EEG (SEEG) or successful epilepsy surgery. RESULTS Data from all included 29 patients were analyzed. ESI led to a change in the management plan in 12/29 patients (41%). In 9/12 (75%), modifications were related to a change in the plan of the invasive recording. In 8/9 patients, invasive recording was performed. In 6/8 (75%), the intracranial EEG recording confirmed the localization of the ESI at a sublobar level. So far, 5/12 patients, for whom the management plan was changed after ESI, were operated on and have at least one-year postoperative follow-up. In all cases, the EZ identified by ESI was included in the resection zone. Among these patients, 4/5 (80%) are seizure-free (ILAE 1) and one patient experienced a seizure reduction of more than 50% (ILAE 4). CONCLUSIONS In this single-center prospective study, we demonstrated the added value of automated ESI in the presurgical evaluation of MRI-negative cases, especially in helping to plan the implantation of depth electrodes for SEEG, provided that ESI results are integrated into the whole multimodal evaluation and clinically interpreted.
Collapse
Affiliation(s)
- Roberto Santalucia
- Cliniques Universitaires Saint-Luc, Paediatric Neurology Unit, Brussels, Belgium; Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Centre Hospitalier Neurologique William Lennox (CHNWL), Clinical Neurophysiology, Ottignies, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium.
| | - Evelina Carapancea
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Simone Vespa
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Enrique Germany Morrison
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Amir Ghasemi Baroumand
- Medical Image and Signal Processing, Ghent University, Ghent, Belgium; Epilog NV, Ghent, Belgium
| | - Pascal Vrielynck
- Centre Hospitalier Neurologique William Lennox (CHNWL), Clinical Neurophysiology, Ottignies, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium
| | - Alexane Fierain
- Centre Hospitalier Neurologique William Lennox (CHNWL), Clinical Neurophysiology, Ottignies, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium
| | - Vincent Joris
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurosurgery Unit, Brussels, Belgium
| | - Christian Raftopoulos
- Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurosurgery Unit, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Medical Imaging Department, Neuroradiology Unit, Belgium
| | - Susana Ferrao Santos
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium
| | - Pieter van Mierlo
- Medical Image and Signal Processing, Ghent University, Ghent, Belgium; Epilog NV, Ghent, Belgium
| | - Riëm El Tahry
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium; WELBIO Department, WEL Research Institute, Avenue Pasteur 6, 1300 Wavre, Belgium
| |
Collapse
|
3
|
Baltus C, El M’Kaddem B, Ferrao Santos S, Ribeiro Vaz JG, Raftopoulos C. Second surgery after vertical paramedian hemispherotomy for epilepsy recurrence. Heliyon 2023; 9:e14326. [PMID: 36950565 PMCID: PMC10025104 DOI: 10.1016/j.heliyon.2023.e14326] [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: 05/18/2022] [Revised: 02/02/2023] [Accepted: 03/01/2023] [Indexed: 03/13/2023] Open
Abstract
Background Vertical Paramedian Hemispherotomy (VPH) is considered an effective surgical treatment for drug-resistant epilepsy with 80% of patients experiencing seizure freedom or worthwhile improvement. Identifying persistent connective tracts is challenging in failed VPH. Methods We reviewed our series of consecutive patients undergoing VPH for hemispheric drug-resistant epilepsy and included cases with recurrent epileptic seizures undergoing second surgery with at least 6 months of postoperative follow-up. The cases were extensively assessed to propose a targeted complementary resection. Results Two children suffering from seizure recurrence following hemispherotomy leading to second surgery were included. After complete assessment, persisting amygdala residue was suspected responsible for the epilepsy recurrence in both patients. Complementary resection of the amygdala residue led to seizure freedom for both patients (Engel IA/ILAE Class 1) without complication. Different diagnostic tools are used to assess patients after failed hemispherotomy including routine EEG, prolonged video EEG, MRI (particularly DTI sequences), SPECT or PET scans and clinical evaluation. These tools allow to rule out epileptic foci in the contralateral hemisphere and to localize a potentially persisting epileptogenic zone. Assessment of these patients should be as systematic and integrated as the initial workup. Although our two patients suffered from Rasmussen's encephalitis, seizure recurrence after VPH has been described in other pathologies. Conclusion Lying deep and medially in the surgical corridor of VPH, the amygdala can be incompletely resected and cause recurrent epilepsy. Complementary selective resection of the amygdala residue may safely lead to success in epilepsy control.
Collapse
Affiliation(s)
- Cedric Baltus
- Department of Neurosurgery, University Hospital St-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
| | - Bouchra El M’Kaddem
- Department of Pediatric Neurology, University Hospital St-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
| | - Susana Ferrao Santos
- Refractory Epilepsy Center, University Hospital St-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
| | - José Géraldo Ribeiro Vaz
- Department of Neurosurgery, University Hospital St-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
| | - Christian Raftopoulos
- Department of Neurosurgery, University Hospital St-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
- Corresponding author.
| |
Collapse
|
4
|
Costa E, Joris V, Vaz G, Santos SF, El-Tahry R, Duprez T, Raftopoulos C. The trans superior temporal gyrus approach for selective amygdalohippocamptectomy. World Neurosurg 2021; 159:e244-e251. [PMID: 34923179 DOI: 10.1016/j.wneu.2021.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Different surgical approaches have been described for selective amygdalohippocampectomy (SeAH) in patients with pharmacoresistant temporal lobe epilepsy (TLE). We report the results of the innovative trans-superior temporal gyrus (trans-STG) approach in a monocentric patients' series. METHODS We reviewed the patients' characteristics, post-operative outcomes, and complications in a series of 8 consecutive TLE patients operated on using the trans-STG approach and recruited between November 2015 and April 2017. RESULTS Over a mean 2,5-year follow-up period, 7/8 patients (87,5%) remained seizure-free (Engel 1). Only one (12,5%) was not cured (Engel 3) without clear explanation for treatment failure. Mean operative time was 237 minutes, representing a shortage of 80 minutes when compared to our historic trans-sylvian approach. No peri-operative death was recorded nor visual field defect/visual acuity impairment due to the approach. One patient suffered from a left posterior thalamo-capsular stroke. CONCLUSION Trans-STG approach is feasible, fast, and safefor SeAH in drug refractory TLE patients. This approach allows preservation of the optic radiation but cuts part of the uncinate fasciculus and potentially the anterior aspect of the anterior bundle of the midlle longitudinal fasciculus.
Collapse
Affiliation(s)
- Emmanuel Costa
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Joris
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Geraldo Vaz
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Susana Ferrao Santos
- Department of Neurology, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Riëm El-Tahry
- Department of Neurology, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology and Medical Imaging, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Christian Raftopoulos
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium.
| |
Collapse
|
5
|
Vespa S, Heyse J, Stumpp L, Liberati G, Santos SF, Rooijakkers H, Nonclercq A, Mouraux A, van Mierlo P, El Tahry R. Vagus Nerve Stimulation elicits sleep EEG desynchronization and network changes in responder patients in epilepsy. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
6
|
Iachim E, Vespa S, Baroumand AG, Danthine V, Vrielynck P, de Tourtchaninoff M, Fierain A, Ribeiro Vaz JG, Raftopoulos C, Ferrao Santos S, van Mierlo P, El Tahry R. Automated electrical source imaging with scalp EEG to define the insular irritative zone: Comparison with simultaneous intracranial EEG. Clin Neurophysiol 2021; 132:2965-2978. [PMID: 34715421 DOI: 10.1016/j.clinph.2021.09.004] [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: 04/07/2021] [Revised: 08/13/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the accuracy of automatedinterictallow-density electrical source imaging (LD-ESI) to define the insular irritative zone (IZ) by comparing the simultaneous interictal ESI localization with the SEEG interictal activity. METHODS Long-term simultaneous scalp electroencephalography (EEG) and stereo-EEG (SEEG) with at least one depth electrode exploring the operculo-insular region(s) were analyzed. Automated interictal ESI was performed on the scalp EEG using standardized low-resolution brain electromagnetic tomography (sLORETA) and individual head models. A two-step analysis was performed: i) sublobar concordance betweencluster-based ESI localization and SEEG-based IZ; ii) time-locked ESI-/SEEG analysis. Diagnostic accuracy values were calculated using SEEG as reference standard. Subgroup analysis wascarried out, based onthe involvement of insular contacts in the seizure onset and patterns of insular interictal activity. RESULTS Thirty patients were included in the study. ESI showed an overall accuracy of 53% (C.I. 29-76%). Sensitivity and specificity were calculated as 53% (C.I. 29-76%), 55% (C.I. 23-83%) respectively. Higher accuracy was found in patients with frequent and dominant interictal insular spikes. CONCLUSIONS LD-ESI defines with good accuracy the insular implication in the IZ, which is not possible with classical interictalscalpEEG interpretation. SIGNIFICANCE Automated LD-ESI may be a valuable additional tool to characterize the epileptogenic zone in epilepsies with suspected insular involvement.
Collapse
Affiliation(s)
- Evelina Iachim
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Simone Vespa
- Institute of Neuroscience (IoNS), Université Catholique de Louvain, Brussels, Belgium.
| | - Amir G Baroumand
- Medical Image and Signal Processing Group (MEDISIP), Department of Electronics and Information Systems, Ghent University, Ghent, Belgium; Epilog NV, Ghent, Belgium
| | - Venethia Danthine
- Institute of Neuroscience (IoNS), Université Catholique de Louvain, Brussels, Belgium
| | - Pascal Vrielynck
- Epileptology and Clinical Neurophysiology, Centre Neurologique William Lennox, Ottignies, Belgium
| | - Marianne de Tourtchaninoff
- Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alexane Fierain
- Epileptology and Clinical Neurophysiology, Centre Neurologique William Lennox, Ottignies, Belgium
| | - Jose Geraldo Ribeiro Vaz
- Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Susana Ferrao Santos
- Institute of Neuroscience (IoNS), Université Catholique de Louvain, Brussels, Belgium; Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pieter van Mierlo
- Medical Image and Signal Processing Group (MEDISIP), Department of Electronics and Information Systems, Ghent University, Ghent, Belgium; Epilog NV, Ghent, Belgium
| | - Riëm El Tahry
- Institute of Neuroscience (IoNS), Université Catholique de Louvain, Brussels, Belgium; Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
7
|
Vespa S, Heyse J, Stumpp L, Liberati G, Ferrao Santos S, Rooijakkers H, Nonclercq A, Mouraux A, van Mierlo P, El Tahry R. Vagus Nerve Stimulation Elicits Sleep EEG Desynchronization and Network Changes in Responder Patients in Epilepsy. Neurotherapeutics 2021; 18:2623-2638. [PMID: 34668148 PMCID: PMC8804116 DOI: 10.1007/s13311-021-01124-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
Neural desynchronization was shown as a key mechanism of vagus nerve stimulation (VNS) action in epilepsy, and EEG synchronization measures are explored as possible response biomarkers. Since brain functional organization in sleep shows different synchrony and network properties compared to wakefulness, we aimed to explore the effects of acute VNS on EEG-derived measures in the two different states of vigilance. EEG epochs were retrospectively analyzed from twenty-four VNS-treated epileptic patients (11 responders, 13 non-responders) in calm wakefulness and stage N2 sleep. Weighted Phase Lag Index (wPLI) was computed as connectivity measure of synchronization, for VNS OFF and VNS ON conditions. Global efficiency (GE) was computed as a network measure of integration. Ratios OFF/ON were obtained as desynchronization/de-integration index. Values were compared between responders and non-responders, and between EEG states. ROC curve and area-under-the-curve (AUC) analysis was performed for response classification. In responders, stronger VNS-induced theta desynchronization (p < 0.05) and decreased GE (p < 0.05) were found in sleep, but not in wakefulness. Theta sleep wPLI Ratio OFF/ON yielded an AUC of 0.825, and 79% accuracy as a response biomarker if a cut-off value is set at 1.05. Considering all patients, the VNS-induced GE decrease was significantly more important in sleep compared to awake EEG state (p < 0.01). In conclusion, stronger sleep EEG desynchronization in theta band distinguishes responders to VNS therapy from non-responders. VNS-induced reduction of network integration occurs significantly more in sleep than in wakefulness.
Collapse
Affiliation(s)
- Simone Vespa
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium.
| | - Jolan Heyse
- Medical Image and Signal Processing Group (MEDISIP), Ghent University, Ghent, Belgium
| | - Lars Stumpp
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
| | - Giulia Liberati
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
| | - Susana Ferrao Santos
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
- Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Herbert Rooijakkers
- Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Antoine Nonclercq
- Bio, Electro and Mechanical Systems (BEAMS), Université Libre de Bruxelles, Brussels, Belgium
| | - André Mouraux
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
| | - Pieter van Mierlo
- Medical Image and Signal Processing Group (MEDISIP), Ghent University, Ghent, Belgium
| | - Riëm El Tahry
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
- Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
8
|
Cornet MC, Morabito V, Lederer D, Glass HC, Ferrao Santos S, Numis AL, Ferriero DM, Sands TT, Cilio MR. Neonatal presentation of genetic epilepsies: Early differentiation from acute provoked seizures. Epilepsia 2021; 62:1907-1920. [PMID: 34153113 DOI: 10.1111/epi.16957] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Although most seizures in neonates are due to acute brain injury, some represent the first sign of neonatal onset genetic epilepsies. Delay in recognition and lack of expert assessment of neonates with epilepsy may result in worse developmental outcomes. As in older children and adults, seizure semiology in neonates is an essential determinant in diagnosis. We aimed to establish whether seizure type at presentation in neonates can suggest a genetic etiology. METHODS We retrospectively analyzed the clinical and electroencephalographic (EEG) characteristics of seizures in neonates admitted in two Level IV neonatal intensive care units, diagnosed with genetic epilepsy, for whom a video-EEG recording at presentation was available for review, and compared them on a 1:2 ratio with neonates with seizures due to stroke or hypoxic-ischemic encephalopathy. RESULTS Twenty neonates with genetic epilepsy were identified and compared to 40 neonates with acute provoked seizures. Genetic epilepsies were associated with pathogenic variants in KCNQ2 (n = 12), KCNQ3 (n = 2), SCN2A (n = 2), KCNT1 (n = 1), PRRT2 (n = 1), and BRAT1 (n = 2). All neonates with genetic epilepsy had seizures with clinical correlates that were either tonic (18/20) or myoclonic (2/20). In contrast, 17 of 40 (42%) neonates with acute provoked seizures had electrographic only seizures, and the majority of the remainder had clonic seizures. Time to first seizure was longer in neonates with genetic epilepsies (median = 60 h of life) compared to neonates with acute provoked seizures (median = 15 h of life, p < .001). Sodium channel-blocking antiseizure medications were effective in 13 of 14 (92%) neonates with tonic seizures who were trialed at onset or during the course of the epilepsy. SIGNIFICANCE Seizure semiology is an easily accessible sign of genetic epilepsies in neonates. Early identification of the seizure type can prompt appropriate workup and treatment. Tonic seizures are associated with channelopathies and are often controlled by sodium channel-blocking antiseizure medications.
Collapse
Affiliation(s)
- Marie-Coralie Cornet
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Valeria Morabito
- Department of Pediatrics, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | | | - Hannah C Glass
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.,Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Susana Ferrao Santos
- Department of Neurology, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Adam L Numis
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Donna M Ferriero
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.,Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Tristan T Sands
- Department of Neurology, Columbia University, New York, New York, USA
| | - Maria Roberta Cilio
- Department of Pediatrics, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| |
Collapse
|
9
|
Boon P, Ferrao Santos S, Jansen AC, Lagae L, Legros B, Weckhuysen S. Recommendations for the treatment of epilepsy in adult and pediatric patients in Belgium: 2020 update. Acta Neurol Belg 2021; 121:241-257. [PMID: 33048338 PMCID: PMC7937601 DOI: 10.1007/s13760-020-01488-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022]
Abstract
To guide health care professionals in Belgium in selecting the appropriate antiepileptic drugs (AEDs) for their epilepsy patients, a group of Belgian epilepsy experts developed recommendations for AED treatment in adults and children (initial recommendations in 2008, updated in 2012). As new drugs have become available, others have been withdrawn, new indications have been approved and recommendations for pregnant women have changed, a new update was pertinent. A group of Belgian epilepsy experts (partly overlapping with the group in charge of the 2008/2012 recommendations) evaluated the most recent international guidelines and relevant literature for their applicability to the Belgian situation (registration status, reimbursement, clinical practice) and updated the recommendations for initial monotherapy in adults and children and add-on treatment in adults. Recommendations for add-on treatment in children were also included (not covered in the 2008/2012 publications). Like the 2008/2012 publications, the current update also covers other important aspects related to the management of epilepsy, including the importance of early referral in drug-resistant epilepsy, pharmacokinetic properties and tolerability of AEDs, comorbidities, specific considerations in elderly and pregnant patients, generic substitution and the rapidly evolving field of precision medicine.
Collapse
Affiliation(s)
- Paul Boon
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Ghent, Belgium.
| | | | - Anna C Jansen
- Pediatric Neurology Unit, Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieven Lagae
- Reference Center for Refractory Epilepsy, Pediatric Neurology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - Benjamin Legros
- Department of Neurology, Reference Center for the Treatment of Refractory Epilepsy, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sarah Weckhuysen
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
- VIB-Center for Molecular Neurology, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
10
|
Liberati G, Mulders D, Algoet M, van den Broeke EN, Santos SF, Ribeiro Vaz JG, Raftopoulos C, Mouraux A. Insular responses to transient painful and non-painful thermal and mechanical spinothalamic stimuli recorded using intracerebral EEG. Sci Rep 2020; 10:22319. [PMID: 33339884 PMCID: PMC7749115 DOI: 10.1038/s41598-020-79371-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/04/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
Brief thermo-nociceptive stimuli elicit low-frequency phase-locked local field potentials (LFPs) and high-frequency gamma-band oscillations (GBOs) in the human insula. Although neither of these responses constitute a direct correlate of pain perception, previous findings suggest that insular GBOs may be strongly related to the activation of the spinothalamic system and/or to the processing of thermal information. To disentangle these different features of the stimulation, we compared the insular responses to brief painful thermonociceptive stimuli, non-painful cool stimuli, mechano-nociceptive stimuli, and innocuous vibrotactile stimuli, recorded using intracerebral electroencephalograpic activity in 7 epileptic patients (9 depth electrodes, 58 insular contacts). All four types of stimuli elicited consistent low-frequency phase-locked LFPs throughout the insula, possibly reflecting supramodal activity. The latencies of thermo-nociceptive and cool low-frequency phase-locked LFPs were shorter in the posterior insula compared to the anterior insula, suggesting a similar processing of thermal input initiating in the posterior insula, regardless of whether the input produces pain and regardless of thermal modality. In contrast, only thermo-nociceptive stimuli elicited an enhancement of insular GBOs, suggesting that these activities are not simply related to the activation of the spinothalamic system or to the conveyance of thermal information.
Collapse
Affiliation(s)
- Giulia Liberati
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
| | - Dounia Mulders
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Maxime Algoet
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | | | | | | | - André Mouraux
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
11
|
Markoula S, Liampas A, Rubboli G, Duncan J, Velis DN, Schulze-Bonhage A, Guekht A, Bartholomeyczik K, Tisi JD, Gras A, Lossius MI, Villani F, Staack AM, Hospes A, Baaijen JC, van Straaten ECW, Ronner HE, Casciato S, D'Aniello A, Mascia A, Santos SF, Bentes C, Aledo-Serrano Á, Gil-Nagel A, Dimova P, Hećimović H, Özkara Ç, Malmgren K, Papacostas S, Kelemen A, Reuber M, Trinka E, Ryvlin P. A European questionnaire survey on epilepsy monitoring units' current practice for postoperative psychogenic nonepileptic seizures' detection. Epilepsy Behav 2020; 112:107355. [PMID: 32745960 DOI: 10.1016/j.yebeh.2020.107355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In cases undergoing epilepsy surgery, postoperative psychogenic nonepileptic seizures (PNES) may be underdiagnosed complicating the assessment of postsurgical seizures' outcome and the clinical management. We conducted a survey to investigate the current practices in the European epilepsy monitoring units (EMUs) and the data that EMUs could provide to retrospectively detect cases with postoperative PNES and to assess the feasibility of a subsequent postoperative PNES research project for cases with postoperative PNES. METHODS We developed and distributed a questionnaire survey to 57 EMUs. Questions addressed the number of patients undergoing epilepsy surgery, the performance of systematic preoperative and postoperative psychiatric evaluation, the recording of sexual or other abuse, the follow-up period of patients undergoing epilepsy surgery, the performance of video-electroencephalogram (EEG) and postoperative psychiatric assessment in suspected postoperative cases with PNES, the existence of electronic databases to allow extraction of cases with postoperative PNES, the data that these bases could provide, and EMUs' interest to participate in a retrospective postoperative PNES project. RESULTS Twenty EMUs completed the questionnaire sheet. The number of patients operated every year/per center is 26.7 ( ± 19.1), and systematic preoperative and postoperative psychiatric evaluation is performed in 75% and 50% of the EMUs accordingly. Sexual or other abuse is systematically recorded in one-third of the centers, and the mean follow-up period after epilepsy surgery is 10.5 ± 7.5 years. In suspected postoperative PNES, video-EEG is performed in 85% and psychiatric assessment in 95% of the centers. An electronic database to allow extraction of patients with PNES after epilepsy surgery is used in 75% of the EMUs, and all EMUs that sent the sheet completed expressed their interest to participate in a retrospective postoperative PNES project. CONCLUSION Postoperative PNES is an underestimated and not well-studied entity. This is a European survey to assess the type of data that the EMUs surgical cohorts could provide to retrospectively detect postoperative PNES. In cases with suspected PNES, most EMUs perform video-EEG and psychiatric assessment, and most EMUs use an electronic database to allow extraction of patients developing PNES.
Collapse
Affiliation(s)
- Sofia Markoula
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
| | - Andreas Liampas
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece.
| | - Guido Rubboli
- Adult Department, Danish Epilepsy Center, Epilepsihospitalet, Dianalund, Denmark
| | - John Duncan
- UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, London, United Kingdom
| | - Demetrios N Velis
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | | | - Alla Guekht
- Moscow Research and Clinical Center for Neuriopsychiatry, Russian National Research Medical University, Moscow, Russia
| | | | - Jane de Tisi
- UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, London, United Kingdom
| | - Adrien Gras
- Psychiatry Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Flavio Villani
- Division of Clinical Epileptology and Experimental Neurophysiology, "Carlo Besta" Neurological Institute Foundation, Milan, Italy
| | | | - Annette Hospes
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Johannes C Baaijen
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Elisabeth C W van Straaten
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Hanneke E Ronner
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS NEUROMED, Pozzilli, Italy
| | | | | | - Susana Ferrao Santos
- Refractory Epilepsy Centre at Cliniquesuniversitaires Saint-Luc, University Hospital, Brussels, Belgium
| | - Carla Bentes
- EEG/Sleep Laboratory, Department of Neurosciences, Hospital de Santa Maria - CHLN, University Hospital, Lisbon, Portugal
| | - Ángel Aledo-Serrano
- Department of Neurology, Hospital Ruber Internacional & Hospital La Luz, Madrid, Spain
| | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional & Hospital La Luz, Madrid, Spain
| | - Petia Dimova
- Epilepsy Surgery Center, Department of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Hrvoje Hećimović
- Epilepsy Center, Department of Neurology, University Hospital, Zagreb, Croatia
| | - Çiğdem Özkara
- Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg University, Göteborg, Sweden
| | - Savvas Papacostas
- Department of Neurology Clinic B, The Cyprus Institute of Neurology & Genetics, Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Anna Kelemen
- National Institute of Psychiatry and Neurology, Department of Neurology, University of Pécs, Budapest, Hungary
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Eugen Trinka
- Paracelsus Medical University Salzburg, Department of Neurology, Christian Doppler University Hospital, Salzburg, Austria
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| |
Collapse
|
12
|
Vespa S, Baroumand AG, Ferrao Santos S, Vrielynck P, de Tourtchaninoff M, Feys O, Strobbe G, Raftopoulos C, van Mierlo P, El Tahry R. Ictal EEG source imaging and connectivity to localize the seizure onset zone in extratemporal lobe epilepsy. Seizure 2020; 78:18-30. [DOI: 10.1016/j.seizure.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 12/16/2022] Open
|
13
|
Vespa S, Stumpp L, Bouckaert C, Delbeke J, Smets H, Cury J, Ferrao Santos S, Rooijakkers H, Nonclercq A, Raedt R, Vonck K, El Tahry R. Vagus Nerve Stimulation-Induced Laryngeal Motor Evoked Potentials: A Possible Biomarker of Effective Nerve Activation. Front Neurosci 2019; 13:880. [PMID: 31507360 PMCID: PMC6718640 DOI: 10.3389/fnins.2019.00880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/21/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Vagus nerve stimulation (VNS) therapy is associated with laryngeal muscle activation and induces voice modifications, well-known side effects of the therapy resulting from co-activation of the recurrent laryngeal nerve. In this study, we describe the non-invasive transcutaneous recording of laryngeal motor evoked potentials (LMEPs), which could serve as a biomarker of effective nerve activation and individual titration in patients with drug-resistant epilepsy. We recruited drug-resistant epileptic patients treated for at least 6 months with a VNS. Trains of 600-1200 VNS pulses were delivered with increasing current outputs. We placed six skin electrodes on the ventral surface of the neck, in order to record LMEPs whenever the laryngeal muscular threshold was reached. We studied the internal consistency and the variability of LMEP recordings, and compared different methods for amplitude calculation. Recruitment curves were built based on the stimulus-response relationship. We also determined the electrical axis of the LMEPs dipole in order to define the optimal electrode placement for LMEPs recording in a clinical setting. LMEPs were successfully recorded in 11/11 patients. The LMEPs threshold ranged from 0.25 to 1 mA (median 0.50 mA), and onset latency was between 5.37 and 8.77 ms. The signal-to-noise ratio was outstanding in 10/11 patients. In these cases, excellent reliability (Intraclass correlation coefficient, ICC > 0.90 across three different amplitude measurements) was achieved with 10 sample averages. Moreover, our recordings showed very good internal consistency (Cronbach's alpha > 0.95 for 10 epochs). Area-under-the-curve and peak-to-peak measurement proved to be complementary methods for amplitude calculation. Finally, we determined that an optimal derivation requires only two recording electrodes, aligned on a horizontal axis around the laryngeal prominence. In conclusion, we describe here an optimal methodology for the recording of VNS-induced motor evoked responses from the larynx. Although further clinical validation is still necessary, LMEPs might be useful as a non-invasive marker of effective nerve activation, and as an aid for the clinician to perform a more rational titration of VNS parameters.
Collapse
Affiliation(s)
- Simone Vespa
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Lars Stumpp
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Jean Delbeke
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Hugo Smets
- Bio, Electro And Mechanical Systems, Université Libre de Bruxelles, Brussels, Belgium
| | - Joaquin Cury
- Bio, Electro And Mechanical Systems, Université Libre de Bruxelles, Brussels, Belgium
| | - Susana Ferrao Santos
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Centre for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Herbert Rooijakkers
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Antoine Nonclercq
- Bio, Electro And Mechanical Systems, Université Libre de Bruxelles, Brussels, Belgium
| | - Robrecht Raedt
- 4Brain, Institute for Neurosciences, Ghent University, Ghent, Belgium
| | - Kristl Vonck
- 4Brain, Institute for Neurosciences, Ghent University, Ghent, Belgium.,Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University, Ghent, Belgium
| | - Riëm El Tahry
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Centre for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
14
|
Finet P, Santos LP, El Tahry R, Santos SF, Vaz GR, Raftopoulos C. Clinical Outcome of Radiating Multiple Subpial Transections Alone for Drug Resistant Epilepsy After More Than 5 Years Follow-Up. World Neurosurg 2019; 126:e1155-e1159. [DOI: 10.1016/j.wneu.2019.02.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
|
15
|
Liberati G, Algoet M, Santos SF, Ribeiro-Vaz JG, Raftopoulos C, Mouraux A. Tonic thermonociceptive stimulation selectively modulates ongoing neural oscillations in the human posterior insula: Evidence from intracerebral EEG. Neuroimage 2018; 188:70-83. [PMID: 30529399 DOI: 10.1016/j.neuroimage.2018.11.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 01/18/2023] Open
Abstract
The human insula is an important target for spinothalamic input, but there is still no consensus on its role in pain perception and nociception. In this study, we show that the human insula exhibits activity preferential for sustained thermonociception. Using intracerebral EEG recorded from the insula of 8 patients (2 females) undergoing a presurgical evaluation of focal epilepsy (53 contacts: 27 anterior, 26 posterior), we "frequency-tagged" the insular activity elicited by sustained thermonociceptive and vibrotactile stimuli, by periodically modulating stimulation intensity at a fixed frequency of 0.2 Hz during 75 s. Both types of stimuli elicited an insular response at the frequency of stimulation (0.2 Hz) and its harmonics, whose magnitude was significantly greater in the posterior insula compared to the anterior insula. Compared to vibrotactile stimulation, thermonociceptive stimulation exerted a markedly greater 0.2 Hz modulation of ongoing theta-band (4-8 Hz) and alpha-band (8-12 Hz) oscillations. These modulations were also more prominent in the posterior insula compared to the anterior insula. The identification of oscillatory activities preferential for thermonociception could lead to new insights into the physiological mechanisms of nociception and pain perception in humans.
Collapse
Affiliation(s)
- Giulia Liberati
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium.
| | - Maxime Algoet
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium
| | | | | | | | - André Mouraux
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium
| |
Collapse
|
16
|
Liberati G, Klöcker A, Algoet M, Mulders D, Maia Safronova M, Ferrao Santos S, Ribeiro Vaz JG, Raftopoulos C, Mouraux A. Gamma-Band Oscillations Preferential for Nociception can be Recorded in the Human Insula. Cereb Cortex 2018; 28:3650-3664. [PMID: 29028955 PMCID: PMC6366557 DOI: 10.1093/cercor/bhx237] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 04/14/2017] [Indexed: 12/17/2022] Open
Abstract
Transient nociceptive stimuli elicit robust phase-locked local field potentials (LFPs) in the human insula. However, these responses are not preferential for nociception, as they are also elicited by transient non-nociceptive vibrotactile, auditory, and visual stimuli. Here, we investigated whether another feature of insular activity, namely gamma-band oscillations (GBOs), is preferentially observed in response to nociceptive stimuli. Although nociception-evoked GBOs have never been explored in the insula, previous scalp electroencephalography and magnetoencephalography studies suggest that nociceptive stimuli elicit GBOs in other areas such as the primary somatosensory and prefrontal cortices, and that this activity could be closely related to pain perception. Furthermore, tracing studies showed that the insula is a primary target of spinothalamic input. Using depth electrodes implanted in 9 patients investigated for epilepsy, we acquired insular responses to brief thermonociceptive stimuli and similarly arousing non-nociceptive vibrotactile, auditory, and visual stimuli (59 insular sites). As compared with non-nociceptive stimuli, nociceptive stimuli elicited a markedly stronger enhancement of GBOs (150-300 ms poststimulus) at all insular sites, suggesting that this feature of insular activity is preferential for thermonociception. Although this activity was also present in temporal and frontal regions, its magnitude was significantly greater in the insula as compared with these other regions.
Collapse
Affiliation(s)
- Giulia Liberati
- Institute of Neuroscience, Université catholique de Louvain,
1200 Brussels, Belgium
| | - Anne Klöcker
- Institute of Neuroscience, Université catholique de Louvain,
1200 Brussels, Belgium
| | - Maxime Algoet
- Institute of Neuroscience, Université catholique de Louvain,
1200 Brussels, Belgium
| | - Dounia Mulders
- Institute of Neuroscience, Université catholique de Louvain,
1200 Brussels, Belgium
| | - Marta Maia Safronova
- Department of Radiology, Neuroradiology Clinic, Erasme Hospital,
1070 Brussels, Belgium
| | | | | | | | - André Mouraux
- Institute of Neuroscience, Université catholique de Louvain,
1200 Brussels, Belgium
| |
Collapse
|
17
|
Liberati G, Algoet M, Klöcker A, Ferrao Santos S, Ribeiro-Vaz JG, Raftopoulos C, Mouraux A. Habituation of phase-locked local field potentials and gamma-band oscillations recorded from the human insula. Sci Rep 2018; 8:8265. [PMID: 29844373 PMCID: PMC5974133 DOI: 10.1038/s41598-018-26604-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 03/05/2018] [Accepted: 05/15/2018] [Indexed: 01/18/2023] Open
Abstract
Salient nociceptive and non-nociceptive stimuli elicit low-frequency local field potentials (LFPs) in the human insula. Nociceptive stimuli also elicit insular gamma-band oscillations (GBOs), possibly preferential for thermonociception, which have been suggested to reflect the intensity of perceived pain. To shed light on the functional significance of these two responses, we investigated whether they would be modulated by stimulation intensity and temporal expectation - two factors contributing to stimulus saliency. Insular activity was recorded from 8 depth electrodes (41 contacts) implanted in the left insula of 6 patients investigated for epilepsy. Thermonociceptive, vibrotactile, and auditory stimuli were delivered using two intensities. To investigate the effects of temporal expectation, the stimuli were delivered in trains of three identical stimuli (S1-S2-S3) separated by a constant 1-s interval. Stimulation intensity affected intensity of perception, the magnitude of low-frequency LFPs, and the magnitude of nociceptive GBOs. Stimulus repetition did not affect perception. In contrast, both low-frequency LFPs and nociceptive GBOs showed a marked habituation of the responses to S2 and S3 as compared to S1 and, hence, a dissociation with intensity of perception. Most importantly, although insular nociceptive GBOs appear to be preferential for thermonociception, they cannot be considered as a correlate of perceived pain.
Collapse
Affiliation(s)
- Giulia Liberati
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium.
| | - Maxime Algoet
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium
| | - Anne Klöcker
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium
| | | | | | | | - André Mouraux
- Institute of Neuroscience, Université catholique de Louvain, 1200, Brussels, Belgium
| |
Collapse
|
18
|
Liberati G, Algoet M, Ferrao Santos S, Ribeiro-Vaz JG, Raftopoulos C, Mouraux A. Thermonociceptive stimuli preferentially modulate theta and alpha oscillations in the human posterior insula: evidence from intracerebral recordings. Front Neurosci 2018. [DOI: 10.3389/conf.fnins.2018.95.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
19
|
Murariu AME, Lejeune N, Ferrao Santos S. Étude de l’épilepsie dans une population de patients en éveil de coma. Neurophysiol Clin 2017. [DOI: 10.1016/j.neucli.2017.05.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
20
|
Liberati G, Algoet M, Van Den Broeke E, Ferrao Santos S, Ribeiro Vaz JG, Raftopoulos C, Mouraux A. Nociceptive gamma-band oscillations recorded from the human insula are related to the activation of the spinothalamic tract. Front Neurosci 2017. [DOI: 10.3389/conf.fnins.2017.94.00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
21
|
Liberati G, Colon E, Algoet M, Ferrao Santos S, Ribeiro Vaz JG, Raftopoulos C, Mouraux A. Frequency tagging insular activity related to tonic heat pain: evidence from intracerebral recordings. Front Neurosci 2017. [DOI: 10.3389/conf.fnins.2017.94.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Dillien P, Ferrao Santos S, van Pesch V, Suin V, Lamoral S, Hantson P. New-Onset Refractory Status Epilepticus: More Investigations, More Questions. Case Rep Neurol 2016; 8:127-33. [PMID: 27462243 PMCID: PMC4939680 DOI: 10.1159/000447295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/30/2016] [Indexed: 11/21/2022] Open
Abstract
A 27-year-old previously healthy woman was admitted to the hospital with recurrent seizures. Status epilepticus developed that became refractory to third-line therapy with propofol and barbiturates. The patient had a very extensive diagnostic workup including autoimmune, viral and genetic investigations. A tentative immune therapy was proposed with high doses of steroids and plasma exchanges. Our patient had an inherited heterozygous single nucleotide variant in the sequence c.1280A>G [p.Lys427Arg] of the SMC3 gene that was insufficient to explain the seizures. Surprisingly, IgM antibodies against Japanese encephalitis virus were positive on the serum drawn 11 days after symptom onset, as detected by ELISA and the immunofluorescence antibody (IFA) technique. IgG antibodies were also positive using the IFA technique, but not with ELISA. The same investigations as well as the detection of the viral genome by the q-RT-PCR technique were negative on cerebrospinal fluid. Despite the suspicion of a viral infection, we concluded that our patient had a new-onset refractory status epilepticus of cryptogenic origin. Termination of the status epilepticus was obtained after 47 days, with a possible benefit from the introduction of ketamine.
Collapse
Affiliation(s)
- Philippe Dillien
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Susana Ferrao Santos
- Department of Neurology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium; Laboratory of Neurophysiology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium; Laboratory of Neurophysiology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Vanessa Suin
- Viral Diseases Unit, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Sophie Lamoral
- Viral Diseases Unit, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
23
|
Conceição LDHCS, Belo GO, Souza MM, Santos SF, Cerqueira-Silva CBM, Corrêa RX. Confirmation of cross-fertilization using molecular markers in ornamental passion flower hybrids. Genet Mol Res 2011; 10:47-52. [PMID: 21264815 DOI: 10.4238/vol10-1gmr894] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Several interspecific Passiflora hybrids are produced in the northern hemisphere for the ornamental plant market. In Brazil, production of passion flower hybrids is limited to the introgression of genes into the main cultivated species, yellow passion fruit, to be used as rootstocks. Confirmation of hybridization in the initial developmental stage is important for breeding perennial and sub-perennial plants, such as passion flowers, reducing time and costs in plant stock maintenance. In order to obtain F₁ hybrids with ornamental potential, four species of Passiflora (P. alata, P. gardneri, P. gibertii, and P. watsoniana) from the Active Germplasm Bank at UESC were hybridized. Flower buds, in pre-anthesis, of the genitors were previously protected, and the female buds were emasculated. To confirm hybridization, the genomic DNA of the genitor species and the supposed hybrids was extracted and RAPD primers were used to obtain molecular markers and select passion flower interspecific hybrids. Eight primers were used to confirm hybrids derived from P. gardneri with P. alata, P. watsoniana with P. alata, P. watsoniana with P. gardneri, and P. gardneri with P. gibertii; 75, 50, 45, and 46% of the informative bands, respectively, confirmed the hybrid nature of these plants. The RAPD technique was effective in the early identification of hybrids; this will be useful for development of hybrid Passiflora progeny.
Collapse
|
24
|
Abstract
UNLABELLED Recent reports have drawn attention to dysfunctions of intrinsic neuronal excitability and network activity in Alzheimer disease (AD). Here we review the possible causes of these basic dysfunctions and implications for AD, based on in vitro and in vivo findings. We then review the current therapeutic approaches particularly linked to the issue of neuronal excitability in AD. CONCLUSION AD is a complex, neurodegenerative disorder. Hippocampal synaptic dysfunction is an early feature of the degenerative process that is clearly linked to memory impairment, the first and major symptom of AD. A growing body of evidence points toward a dysfunction of neuronal networks. Intrinsic neuronal excitability, mainly through profound dysregulation of calcium homeostasis, appears to be largely affected. Consequently, neuronal communication is disturbed. Such cellular defects might underlie cognitive manifestations like fluctuations in cognitive impairment and might also explain several observations obtained with EEG, MEG, MRI, or PET studies, leading to the concept of a disconnection syndrome in AD.
Collapse
Affiliation(s)
- Susana Ferrao Santos
- Université catholique de Louvain, Institute of Neuroscience, B-1200 Brussels, Belgium.
| | | | | |
Collapse
|
25
|
Santos SF, Tasiaux B, Sindic C, Octave JN. Inhibition of neuronal calcium oscillations by cell surface APP phosphorylated on T668. Neurobiol Aging 2010; 32:2308-13. [PMID: 20122754 DOI: 10.1016/j.neurobiolaging.2010.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 01/05/2010] [Accepted: 01/14/2010] [Indexed: 11/15/2022]
Abstract
Adenoviral expression of human APP (hAPP), but not of hAPP deleted from its C-terminal intracellular domain, in rat cortical neurons abolishes spontaneous synchronous calcium oscillations. The intracellular domain of APP695 contains several residues that can be phosphorylated. Contrary to non-neuronal cells, a very high phosphorylation of APP on T668 is observed in neurons, which is mediated by JNK, GSK3 and Cdk5 protein kinases. JNK activity, modulated by GSK3, enhances the traffic of phosphorylated APP to nerve terminals, contrary to Cdk5. Here we show that inhibition of GSK3 and JNK restores calcium oscillations in an hAPP expressing neuronal network, whereas inhibition of Cdk5 does not. Expression of mutant hAPPT668A does not inhibit calcium oscillations, and the proportion of hAPPT668A at the plasma membrane is reduced by more than 50%. Altogether, these results indicate that the intracellular domain of APP is needed to inhibit neuronal calcium oscillations because GSK3/JNK phosphorylation of T668 controls APP trafficking at the plasma membrane.
Collapse
Affiliation(s)
- Susana Ferrao Santos
- Université catholique de Louvain, Institute of Neuroscience, B-1200 Brussels, Belgium
| | | | | | | |
Collapse
|
26
|
Santos SF, Morel N, Gailly P, Sindic C, Octave JN. P4‐191: APP‐mediated increase of L‐type calcium currents leads to inhibition of calcium oscillations in a neuronal network. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.04.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
27
|
Pierrot N, Santos SF, Feyt C, Morel M, Brion JP, Octave JN. Calcium-mediated transient phosphorylation of tau and amyloid precursor protein followed by intraneuronal amyloid-beta accumulation. J Biol Chem 2006; 281:39907-14. [PMID: 17085446 DOI: 10.1074/jbc.m606015200] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Intraneuronal accumulation of hyperphosphorylated protein tau in paired helical filaments together with amyloid-beta peptide (Abeta) deposits confirm the clinical diagnosis of Alzheimer disease. A common cellular mechanism leading to the production of these potent toxins remains elusive. Here we show that, in cultured neurons, membrane depolarization induced a calcium-mediated transient phosphorylation of both microtubule-associated protein tau and amyloid precursor protein (APP), followed by a dephosphorylation of these proteins. Phosphorylation was mediated by glycogen synthase kinase 3 and cyclin-dependent kinase 5 protein kinases, while calcineurin was responsible for dephosphorylation. Following the transient phosphorylation of APP, intraneuronal Abeta accumulated and induced neurotoxicity. Phosphorylation of APP on Thr-668 was indispensable for intraneuronal accumulation of Abeta. Our data demonstrate that an increase in cytosolic calcium concentration induces modifications of neuronal metabolism of APP and tau, similar to those found in Alzheimer disease.
Collapse
Affiliation(s)
- Nathalie Pierrot
- Laboratory of Experimental Pharmacology, Université Catholique de Louvain, 1200 Brussels, Belgium
| | | | | | | | | | | |
Collapse
|
28
|
Peixoto AJ, Santos SF, Mendes RB, Crowley ST, Maldonado R, Orias M, Mansoor GA, White WB. Reproducibility of ambulatory blood pressure monitoring in hemodialysis patients. Am J Kidney Dis 2000; 36:983-90. [PMID: 11054355 DOI: 10.1053/ajkd.2000.19100] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) has been increasingly used in hemodialysis (HD) practice and research; however, no study has evaluated the reproducibility of ABPM in this population. To address this question, we performed 48-hour interdialytic ABPM on 21 HD patients (mean age, 53 +/- 16 years; 7 women) on two different occasions 68 +/- 34 days (range, 30 to 154 days) apart. To qualify for the protocol, patients had to be at the same dry weight and on the same vasoactive drug regimen at both monitoring periods. BP was analyzed according to three different methods: isolated pre-HD and post-HD values, average pre-HD and post-HD values for the five HD sessions surrounding each monitoring period, and 48-hour interdialytic ABPM. Reproducibility was determined by analysis of the SD of the differences (SDD) between the two monitoring periods and the coefficient of variation of each method of BP determination. Our results show better reproducibility of ABPM (SDD, 10.6/6.6 mm Hg; coefficient of variation, 7.5%/8.1%) compared with isolated pre-HD BP (SDD, 24.4/11.3 mm Hg; coefficient of variation, 16.7%/14.1%) or post-HD BP (SDD, 16.8/14.5 mm Hg; coefficient of variation, 11.7%/17.8%), and averaged pre-HD BP (SDD, 14.7/7.2 mm Hg; coefficient of variation, 10.1%/9.1%) or post-HD BP (SDD, 12.4/8.7 mm Hg; coefficient of variation, 8.9%/11.1%). The reproducibility of the decrease in BP during sleep was poor, with up to 43% of the subjects changing dipping category within or between interdialytic periods. We conclude that ABPM is the most accurate method to study BP in HD patients over time. However, variability is significant, and there is poor reproducibility of the nocturnal decline in BP.
Collapse
Affiliation(s)
- A J Peixoto
- Sections of General Internal Medicine and Nephrology, Yale University School of Medicine, West Haven, CT, USA.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Borges G, Bonilha L, Santos SF, Carelli EF, Fernandes YB, Ramina R, Zanardi V, Menezes JR, Nogueira RJ. Thrombosis of the internal carotid artery secondary to soft palate injury in children and childhood. Report of two cases. Pediatr Neurosurg 2000; 32:150-3. [PMID: 10867563 DOI: 10.1159/000028921] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Trauma to the soft palate is a uncommon event during childhood. Stroke following intraoral trauma is also rare, but has been well documented by the current literature as a potentially serious complication. In this article, we report 2 cases of posttraumatic internal carotid artery thrombosis depicted by imaging studies. We discuss pathogenesis, and the literature is reviewed.
Collapse
Affiliation(s)
- G Borges
- Department of Neurology and Neurosurgery, Faculty of Medical Sciences, UNICAMP, Campinas, SP, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Santos SF, Vieira LM, Moura RS. Effect of high-salt intake on blood pressure and vascular reactivity of diabetic rats. Braz J Med Biol Res 1995; 28:889-94. [PMID: 8555991] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The etiopathogenesis of diabetes mellitus (DM)-associated hypertension is not known. Sodium and an increased vascular reactivity to vasopressor agents have been implicated in the pathogenesis of this disease in humans. The aim of the present study was to experimentally evaluate the possible role of salt intake and changes in vascular reactivity in the pathogenesis of DM-associated hypertension. Male Wistar rats, weighing 180 to 200 g, rendered diabetic by streptozotocin (65 mg/kg) and maintained moderately hyperglycemic with insulin were submitted to high-salt intake (tap water replaced with 1.0% NaCl) for 8 weeks (D+salt rats, N = 8). Mean arterial pressure and reactivity of the isolated aorta to norepinephrine and angiotensin II were then determined. Diabetic rats on normal-salt intake (group D+nl, N = 6) or normal-salt intake (group non-D+nl, N = 8) were used as controls. Mean blood pressure was significantly higher in D+salt rats (123 +/- 3 mmHg) compared with the D+nl (113 +/- 3 mmHg), non-D+salt (111 +/- 2 mmHg) and non-D+nl (105 +/- 2 mmHg) groups. Mean blood pressure was also significantly higher in diabetic rats on normal-salt intake compared with control rats on normal-salt intake. Vascular reactivity of the aorta to norepinephrine was increased only in diabetic rats on high-salt intake. No modification in reactivity was detected with regard to the reactivity to angiotensin II. We conclude that high-salt intake increases blood pressure in diabetic rats and that increased aorta vascular reactivity to norepinephrine might be involved in the blood pressure alteration.
Collapse
Affiliation(s)
- S F Santos
- Disciplinas de Nefrologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Brasil
| | | | | |
Collapse
|
31
|
Maues MG, Santos SF, Filho HP, Lugon JR, Cruz VP, Sampaio JC, Ruzany F. Thyroid hormone losses in CAPD. ARCH ESP UROL 1995; 15:266-9. [PMID: 7578506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M G Maues
- Universidade Federal do Para, Rio de Janeiro, Brazil
| | | | | | | | | | | | | |
Collapse
|