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Hanin A, Chollet C, Demeret S, Di Meglio L, Castelli F, Navarro V. Metabolomic changes in adults with status epilepticus: A human case-control study. Epilepsia 2024; 65:929-943. [PMID: 38339978 DOI: 10.1111/epi.17899] [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: 10/26/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Status epilepticus (SE) is a life-threatening prolonged epileptic seizure that affects ~40 per 100 000 people yearly worldwide. The persistence of seizures may lead to excitotoxic processes, neuronal loss, and neuroinflammation, resulting in long-term neurocognitive and functional disabilities. A better understanding of the pathophysiological mechanisms underlying SE consequences is crucial for improving SE management and preventing secondary neuronal injury. METHODS We conducted a comprehensive untargeted metabolomic analysis, using liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS), on plasma and cerebrospinal fluid (CSF) samples from 78 adult patients with SE and 107 control patients without SE, including 29 with CSF for both groups. The metabolomic fingerprints were compared between patients with SE and controls. Metabolites with differences in relative abundances that could not be attributed to treatment or nutrition provided in the intensive care unit were isolated. Enrichment analysis was performed on these metabolites to identify the most affected pathways. RESULTS We identified 76 metabolites in the plasma and 37 in the CSF that exhibited differential expression in patients with SE compared to controls. The enrichment analysis revealed that metabolic dysregulations in patients with SE affected primarily amino acid metabolism (including glutamate, alanine, tryptophan, glycine, and serine metabolism), pyrimidine metabolism, and lipid homeostasis. Specifically, patients with SE had elevated levels of pyruvate, quinolinic acid, and keto butyric acid levels, along with lower levels of arginine, N-acetylaspartylglutamate (NAAG), tryptophan, uracil, and uridine. The tryptophan kynurenine pathway was identified as the most significantly altered in SE, resulting in the overproduction of quinolinic acid, an N-methyl-d-aspartate (NMDA) receptor agonist with pro-inflammatory properties. SIGNIFICANCE This study has identified several pathways that may play pivotal roles in SE consequences, such as the tryptophan kynurenine pathway. These findings offer novel perspectives for the development of neuroprotective therapeutics.
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Affiliation(s)
- Aurélie Hanin
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtrière, Paris, France
- AP-HP, Epilepsy Unit and Clinical Neurophysiology Department, DMU Neurosciences, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Céline Chollet
- Université Paris Saclay, CEA, INRAE, Médicaments et Technologies pour la Santé (MTS), MetaboHUB, Gif-sur-Yvette, France
| | - Sophie Demeret
- AP-HP, Neuro-Intensive Care Unit, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Lucas Di Meglio
- AP-HP, Neuro-Intensive Care Unit, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Florence Castelli
- Université Paris Saclay, CEA, INRAE, Médicaments et Technologies pour la Santé (MTS), MetaboHUB, Gif-sur-Yvette, France
| | - Vincent Navarro
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtrière, Paris, France
- AP-HP, Epilepsy Unit and Clinical Neurophysiology Department, DMU Neurosciences, Hôpital de la Pitié-Salpêtrière, Paris, France
- Center of Reference for Rare Epilepsies, Epicare, Hôpital de la Pitié-Salpêtrière, Paris, France
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Seidel Malkinson T, Bayle DJ, Kaufmann BC, Liu J, Bourgeois A, Lehongre K, Fernandez-Vidal S, Navarro V, Lambrecq V, Adam C, Margulies DS, Sitt JD, Bartolomeo P. Intracortical recordings reveal vision-to-action cortical gradients driving human exogenous attention. Nat Commun 2024; 15:2586. [PMID: 38531880 DOI: 10.1038/s41467-024-46013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/09/2024] [Indexed: 03/28/2024] Open
Abstract
Exogenous attention, the process that makes external salient stimuli pop-out of a visual scene, is essential for survival. How attention-capturing events modulate human brain processing remains unclear. Here we show how the psychological construct of exogenous attention gradually emerges over large-scale gradients in the human cortex, by analyzing activity from 1,403 intracortical contacts implanted in 28 individuals, while they performed an exogenous attention task. The timing, location and task-relevance of attentional events defined a spatiotemporal gradient of three neural clusters, which mapped onto cortical gradients and presented a hierarchy of timescales. Visual attributes modulated neural activity at one end of the gradient, while at the other end it reflected the upcoming response timing, with attentional effects occurring at the intersection of visual and response signals. These findings challenge multi-step models of attention, and suggest that frontoparietal networks, which process sequential stimuli as separate events sharing the same location, drive exogenous attention phenomena such as inhibition of return.
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Affiliation(s)
- Tal Seidel Malkinson
- Sorbonne Université, Inserm UMRS 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France.
- Université de Lorraine, CNRS, IMoPA, F-54000, Nancy, France.
| | - Dimitri J Bayle
- Licae Lab, Université Paris Ouest-La Défense, 92000, Nanterre, France
| | - Brigitte C Kaufmann
- Sorbonne Université, Inserm UMRS 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Jianghao Liu
- Sorbonne Université, Inserm UMRS 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
- Dassault Systèmes, Vélizy-Villacoublay, France
| | - Alexia Bourgeois
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, 1206, Geneva, Switzerland
| | - Katia Lehongre
- CENIR - Centre de Neuro-Imagerie de Recherche, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Sara Fernandez-Vidal
- CENIR - Centre de Neuro-Imagerie de Recherche, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Inserm UMRS 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
- AP-HP, Epilepsy and EEG Units, Pitié-Salpêtrière Hospital, 75013, Paris, France
- Reference center of rare epilepsies, EpiCare, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Virginie Lambrecq
- Sorbonne Université, Inserm UMRS 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
- AP-HP, Epilepsy and EEG Units, Pitié-Salpêtrière Hospital, 75013, Paris, France
- Reference center of rare epilepsies, EpiCare, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Claude Adam
- Sorbonne Université, Inserm UMRS 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
- AP-HP, Epilepsy and EEG Units, Pitié-Salpêtrière Hospital, 75013, Paris, France
- Reference center of rare epilepsies, EpiCare, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Daniel S Margulies
- Laboratoire INCC, équipe Perception, Action, Cognition, Université de Paris, 75005, Paris, France
| | - Jacobo D Sitt
- Sorbonne Université, Inserm UMRS 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Paolo Bartolomeo
- Sorbonne Université, Inserm UMRS 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
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De Falco E, Solcà M, Bernasconi F, Babo-Rebelo M, Young N, Sammartino F, Tallon-Baudry C, Navarro V, Rezai AR, Krishna V, Blanke O. Single neurons in the thalamus and subthalamic nucleus process cardiac and respiratory signals in humans. Proc Natl Acad Sci U S A 2024; 121:e2316365121. [PMID: 38451949 PMCID: PMC10945861 DOI: 10.1073/pnas.2316365121] [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: 09/27/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
Visceral signals are constantly processed by our central nervous system, enable homeostatic regulation, and influence perception, emotion, and cognition. While visceral processes at the cortical level have been extensively studied using non-invasive imaging techniques, very few studies have investigated how this information is processed at the single neuron level, both in humans and animals. Subcortical regions, relaying signals from peripheral interoceptors to cortical structures, are particularly understudied and how visceral information is processed in thalamic and subthalamic structures remains largely unknown. Here, we took advantage of intraoperative microelectrode recordings in patients undergoing surgery for deep brain stimulation (DBS) to investigate the activity of single neurons related to cardiac and respiratory functions in three subcortical regions: ventral intermedius nucleus (Vim) and ventral caudalis nucleus (Vc) of the thalamus, and subthalamic nucleus (STN). We report that the activity of a large portion of the recorded neurons (about 70%) was modulated by either the heartbeat, the cardiac inter-beat interval, or the respiration. These cardiac and respiratory response patterns varied largely across neurons both in terms of timing and their kind of modulation. A substantial proportion of these visceral neurons (30%) was responsive to more than one of the tested signals, underlining specialization and integration of cardiac and respiratory signals in STN and thalamic neurons. By extensively describing single unit activity related to cardiorespiratory function in thalamic and subthalamic neurons, our results highlight the major role of these subcortical regions in the processing of visceral signals.
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Affiliation(s)
- Emanuela De Falco
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
- Department of Neuroscience, Rockefeller Neuroscience Institute–West Virginia University, Morgantown, WV26505
| | - Marco Solcà
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
- Department of Psychiatry, University Hospital Geneva, Geneva1205, Switzerland
| | - Fosco Bernasconi
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
| | - Mariana Babo-Rebelo
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
| | - Nicole Young
- Medical Department, SpecialtyCare, Brentwood, TN37027
| | - Francesco Sammartino
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH43210
| | - Catherine Tallon-Baudry
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d’Etudes Cognitives, École normale supérieure-Paris Sciences et Lettres University, Inserm, Paris75005, France
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm, CNRS, Assistance Publique - Hôpitaux de Paris, Epilepsy Unit, Hôpital de la Pitié-Salpêtrière, Paris75013, France
| | - Ali R. Rezai
- Department of Neurosurgery, Rockefeller Neuroscience Institute—West Virginia University, Morgantown, WV26505
| | - Vibhor Krishna
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Durham, NC27516
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, School of Life Sciences, Neuro-X Institute and Brain Mind Institute, École Polytechnique Fédérale de Lausanne, Lausanne1015, Switzerland
- Department of Clinical Neurosciences, University Hospital Geneva, Geneva1205, Switzerland
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Wirth T, Roze E, Delvallée C, Trouillard O, Drouot N, Damier P, Boulay C, Bourgninaud M, Jegatheesan P, Sangare A, Forlani S, Gaymard B, Hervochon R, Navarro V, Calmels N, Schalk A, Tranchant C, Piton A, Méneret A, Anheim M. Rare Missense Variants in KCNJ10 Are Associated with Paroxysmal Kinesigenic Dyskinesia. Mov Disord 2024. [PMID: 38436103 DOI: 10.1002/mds.29752] [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: 10/18/2023] [Revised: 01/03/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Although the group of paroxysmal kinesigenic dyskinesia (PKD) genes is expanding, the molecular cause remains elusive in more than 50% of cases. OBJECTIVE The aim is to identify the missing genetic causes of PKD. METHODS Phenotypic characterization, whole exome sequencing and association test were performed among 53 PKD cases. RESULTS We identified four causative variants in KCNJ10, already associated with EAST syndrome (epilepsy, cerebellar ataxia, sensorineural hearing impairment and renal tubulopathy). Homozygous p.(Ile209Thr) variant was found in two brothers from a single autosomal recessive PKD family, whereas heterozygous p.(Cys294Tyr) and p.(Thr178Ile) variants were found in six patients from two autosomal dominant PKD families. Heterozygous p.(Arg180His) variant was identified in one additional sporadic PKD case. Compared to the Genome Aggregation Database v2.1.1, our PKD cohort was significantly enriched in both rare heterozygous (odds ratio, 21.6; P = 9.7 × 10-8 ) and rare homozygous (odds ratio, 2047; P = 1.65 × 10-6 ) missense variants in KCNJ10. CONCLUSIONS We demonstrated that both rare monoallelic and biallelic missense variants in KCNJ10 are associated with PKD. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thomas Wirth
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Département de Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Emmanuel Roze
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Institut du Cerveau, Sorbonne Université, INSERM-U1127/CNRS-UMR7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Clarisse Delvallée
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Département de Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Oriane Trouillard
- Institut du Cerveau, Sorbonne Université, INSERM-U1127/CNRS-UMR7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nathalie Drouot
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | | | - Clotilde Boulay
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marine Bourgninaud
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Institut du Cerveau, Sorbonne Université, INSERM-U1127/CNRS-UMR7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Prasanthi Jegatheesan
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Institut du Cerveau, Sorbonne Université, INSERM-U1127/CNRS-UMR7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Aude Sangare
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Institut du Cerveau, Sorbonne Université, INSERM-U1127/CNRS-UMR7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sylvie Forlani
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Institut du Cerveau, Sorbonne Université, INSERM-U1127/CNRS-UMR7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Bertrand Gaymard
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Institut du Cerveau, Sorbonne Université, INSERM-U1127/CNRS-UMR7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Remi Hervochon
- Service d'Oto-Rhino-Laryngologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Vincent Navarro
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Institut du Cerveau, Sorbonne Université, INSERM-U1127/CNRS-UMR7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nadège Calmels
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
- Laboratoire de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Audrey Schalk
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
- Laboratoire de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Département de Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Amélie Piton
- Département de Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
- Laboratoire de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aurélie Méneret
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Institut du Cerveau, Sorbonne Université, INSERM-U1127/CNRS-UMR7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Département de Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
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Serrano C, Rothschild S, Villacampa G, Heinrich MC, George S, Blay JY, Sicklick JK, Schwartz GK, Rastogi S, Jones RL, Rutkowski P, Somaiah N, Navarro V, Evans D, Trent JC. Novel trial designs for patients with gastrointestinal stromal tumor. ESMO Open 2024; 9:102218. [PMID: 38194880 PMCID: PMC10837772 DOI: 10.1016/j.esmoop.2023.102218] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- C Serrano
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona; Sarcoma Translational Research Program, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | | | - G Villacampa
- Oncology Data Science, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; The Institute of Cancer Research, London, UK
| | - M C Heinrich
- Portland VA Health Care System and Knight Cancer Institute, Oregon Health & Science University, Portland
| | - S George
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - J-Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon, France
| | - J K Sicklick
- Department of Surgery, Division of Surgical Oncology, University of California San Diego, San Diego; Department of Pharmacology, University of California San Diego, San Diego
| | - G K Schwartz
- Case Comprehensive Cancer Center, Cleveland, USA
| | - S Rastogi
- Department of Medical Oncology, AIIMS, New Delhi, India
| | - R L Jones
- The Royal Marsden NHS Foundation Trust, London; Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - N Somaiah
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - V Navarro
- Oncology Data Science, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - D Evans
- The Life Raft Group, Wayne, USA
| | - J C Trent
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, USA
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Dusanter C, Houot M, Mere M, Denos M, Samson S, Herlin B, Navarro V, Dupont S. Cognitive effect of antiseizure medications in medial temporal lobe epilepsy. Eur J Neurol 2023; 30:3692-3702. [PMID: 37650365 DOI: 10.1111/ene.16050] [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: 06/08/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND PURPOSE The specific effects of antiseizure medications (ASMs) on cognition are a rich field of study, with many ongoing questions. The aim of this study was to evaluate these effects in a homogeneous group of patients with epilepsy to guide clinicians to choose the most appropriate medications. METHODS We retrospectively identified 287 refractory patients with medial temporal lobe epilepsy associated with hippocampal sclerosis. Scores measuring general cognition (global, verbal and performance IQ), working memory, episodic memory, executive functions, and language abilities were correlated with ASM type, number, dosage and generation (old vs. new). We also assessed non-modifiable factors affecting cognition, such as demographics and epilepsy-related factors. RESULTS Key parameters were total number of ASMs and specific medications, especially topiramate (TPM) and sodium valproate (VPA). Four cognitive profiles of the ASMs were identified: (i) drugs with an overall detrimental effect on cognition (TPM, VPA); (ii) drugs with negative effects on specific areas: verbal memory and language skills (carbamazepine), and language functions (zonisamide); (iii) drugs affecting a single function in a specific and limited area: visual denomination (oxcarbazepine, lacosamide); and (iv) drugs without documented cognitive side effects. Non-modifiable factors such as age at testing, age at seizure onset, and history of febrile seizures also influenced cognition and were notably influenced by total number of ASMs. CONCLUSION We conclude that ASMs significantly impact cognition. Key parameters were total number of ASMs and specific medications, especially TPM and VPA. These results should lead to a reduction in the number of drugs received and the avoidance of medications with unfavorable cognitive profiles.
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Affiliation(s)
- Cedric Dusanter
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marion Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital, Paris, France
| | - Marie Mere
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marisa Denos
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Séverine Samson
- Univ. Lille, ULR 4072 - PSITEC - Psychologie: Interactions Temps Émotions Cognition, Lille, France
| | - Bastien Herlin
- CEA Neurospin, Unité Mixte de Recherche BAOBAB (Building Large Instruments for Neuroimaging: From Population Imaging to Ultra-High Magnetic Fields), Paris, France
| | - Vincent Navarro
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Sorbonne, Paris, France
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France
| | - Sophie Dupont
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Sorbonne, Paris, France
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France
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Cousyn L, Leclercq D, Ta MC, Gilbert F, Di Meglio L, Marois C, Haddad A, Mathon B, Eyries M, Navarro V. Late-Onset Status Epilepticus Associated With Isolated Leptomeningeal Angioma and Sturge-Weber Syndrome-Related GNA11 Pathogenic Variation. Neurology 2023; 101:1021-1022. [PMID: 37813580 PMCID: PMC10727224 DOI: 10.1212/wnl.0000000000207839] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/04/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
- Louis Cousyn
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
| | - Delphine Leclercq
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Minh Chau Ta
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - François Gilbert
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Lucas Di Meglio
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Clémence Marois
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Andrei Haddad
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Bertrand Mathon
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Mélanie Eyries
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Navarro
- From the Epilepsy Unit, Department of Neurology (L.C., F.G., V.N.), AP-HP, Pitié-Salpêtrière Hospital; Sorbonne Université (L.C., L.D.M., B.M., M.E., V.N.); Paris Brain Institute (ICM) (L.C., V.N.), Sorbonne Université, CNRS UMR 7225-Inserm U1127; Department of Neuroradiology (D.L.), Department of Neuropathology (M.C.T.), Neuro-intensive Care Unit, Department of Neurology (L.D.M., C.M., A.H.); and Departments Neurosurgery (B.M), and Genetics (M.E.), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
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Cousyn L, Dono F, Navarro V, Chavez M. Can heart rate variability identify a high-risk state of upcoming seizure? Epilepsy Res 2023; 197:107232. [PMID: 37783038 DOI: 10.1016/j.eplepsyres.2023.107232] [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: 05/23/2023] [Revised: 08/10/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
Heart rate variability (HRV) is an accessible and convenient means to assess the sympathetic/parasympathetic balance. Autonomic dysfunctions may reflect a pro-ictal state and occur before the seizure onset. Previous studies have reported HRV-based models to identify preictal states in continuous electrocardiogram (EKG) monitoring. Here, we evaluated the ability of HRV metrics extracted from daily single resting-state periods to estimate the risk of upcoming seizure(s) using probabilistic forecasts. Daily standardized 10-min vigilance-controlled EKG periods were recorded in 15 patients with drug-resistant focal epilepsy who underwent intracerebral electroencephalography (EEG). Analyses of a total of 156 periods, based on machine learning approaches, suggested that HRV features can identify preictal states with a median AUC of 0.75 [0.68;0.99]. Pseudoprospective daily forecasts yielded a median Brier score of 0.3 [0.18;0.48]. About 60% of preictal days were correctly forecasted, while false positive predictions were noticed in 24% of interictal days. Daily resting HRV seems to capture information on autonomic variations that may reflect a pro-ictal state. The method could be embedded in an ambulatory clinical seizure prediction device, but additional modalities (prodromes, EEG-based features, etc.) should be associated to improve its performance.
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Affiliation(s)
- Louis Cousyn
- Paris Brain Institute (Inserm, CNRS, Sorbonne Université), Paris, France; AP-HP, Department of Neurology, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France.
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti -Pescara, Chieti, Italy
| | - Vincent Navarro
- Paris Brain Institute (Inserm, CNRS, Sorbonne Université), Paris, France; AP-HP, Department of Neurology, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Mario Chavez
- CNRS UMR-7225, Pitié-Salpêtrière Hospital, Paris, France
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Collomb-Clerc A, Gueguen MCM, Minotti L, Kahane P, Navarro V, Bartolomei F, Carron R, Regis J, Chabardès S, Palminteri S, Bastin J. Human thalamic low-frequency oscillations correlate with expected value and outcomes during reinforcement learning. Nat Commun 2023; 14:6534. [PMID: 37848435 PMCID: PMC10582006 DOI: 10.1038/s41467-023-42380-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/09/2023] [Indexed: 10/19/2023] Open
Abstract
Reinforcement-based adaptive decision-making is believed to recruit fronto-striatal circuits. A critical node of the fronto-striatal circuit is the thalamus. However, direct evidence of its involvement in human reinforcement learning is lacking. We address this gap by analyzing intra-thalamic electrophysiological recordings from eight participants while they performed a reinforcement learning task. We found that in both the anterior thalamus (ATN) and dorsomedial thalamus (DMTN), low frequency oscillations (LFO, 4-12 Hz) correlated positively with expected value estimated from computational modeling during reward-based learning (after outcome delivery) or punishment-based learning (during the choice process). Furthermore, LFO recorded from ATN/DMTN were also negatively correlated with outcomes so that both components of reward prediction errors were signaled in the human thalamus. The observed differences in the prediction signals between rewarding and punishing conditions shed light on the neural mechanisms underlying action inhibition in punishment avoidance learning. Our results provide insight into the role of thalamus in reinforcement-based decision-making in humans.
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Affiliation(s)
- Antoine Collomb-Clerc
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000, Grenoble, France
| | - Maëlle C M Gueguen
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000, Grenoble, France
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, NJ, USA
| | - Lorella Minotti
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000, Grenoble, France
- Neurology Department, University Hospital of Grenoble, Grenoble, France
| | - Philippe Kahane
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000, Grenoble, France
- Neurology Department, University Hospital of Grenoble, Grenoble, France
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Fabrice Bartolomei
- Timone University Hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, University Hospital of Marseille, Marseille, France
- Aix Marseille University, Inserm, Institut de Neurosciences des Systèmes, Marseille, France
| | - Romain Carron
- Aix Marseille University, Inserm, Institut de Neurosciences des Systèmes, Marseille, France
- Timone University Hospital, Department of functional and stereotactic neurosurgery, University Hospital of Marseille, Marseille, France
| | - Jean Regis
- Neurosurgery Department, University Hospital of Marseille, Marseille, France
| | - Stephan Chabardès
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000, Grenoble, France
- Neurosurgery Department, University Hospital of Grenoble, Grenoble, France
| | - Stefano Palminteri
- Laboratoire de Neurosciences Cognitives Computationnelles, Département d'Etudes Cognitives, ENS, PSL, INSERM, Paris, France
| | - Julien Bastin
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000, Grenoble, France.
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Serrand C, Faucanié M, Jaussent A, Crespel A, Denuelle M, Bartolomei F, Vercueil L, Derambure P, Tyvaert L, Marchal C, Landre E, Szurhaj W, Mura T, Navarro V, Rheims S, Picot MC. How valid are proxy assessment of mental health and sleep comorbidities of patients with epilepsy using standardized questionnaires? Seizure 2023; 111:151-157. [PMID: 37634353 DOI: 10.1016/j.seizure.2023.08.011] [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: 04/26/2023] [Revised: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND The study aimed to determine the level of agreement between patients with epilepsy and their proxies when assessing psychiatric comorbidities, sleep disorders, and medication adherence using standardized questionnaires. METHODS This agreement study is an ancillary analysis of the PRERIES study, a matched case-control study exploring SUDEP risk factors. Controls aged 15 years and older, with active epilepsy or in remission for less than 5 years were recruited between 01/01/2011 and 03/31/2019. An interview was carried out by a trained psychologist on both the patient and a proxy-respondent. During these independent interviews, the following comorbidities were explored: psychiatric comorbidities using the MINI, the STAI- Y2 and NDDI-E scales, sleep disorders with the SDQ-SA and Epworth scales and medication adherence. Level of agreement between patient and their proxy was estimated using Gwet's AC1&2. RESULTS Among the 107 patient-proxy dyads recruited, proxy respondents were mainly family members (65.4%) or spouses (30.8%). Exploration of present major depression showed excellent agreement at 0.81 [0.65;0.97], as well as exploration of dysthymia at 0.96 [0.61;1]. Suicidal risk evaluation had a lesser agreement at 0.77 [0.60;0.94]. Agreement on anxiety was moderate 0.5 [0.38;0.62]. For sleep disorder, SDQ-SA presented a better agreement than the Epworth questionnaire with respectively 0.73 [0.51;0.95] and 0.45 [0.26;0.63]. For medication adherence, the overall agreement rate was excellent (0.90 [0.78;1]). CONCLUSION Exploration of potential risk factors through families can give valuable and relatively robust information, especially if the respondent lives with the patient, and should be retrieved, when possible, in usual clinical setting.
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Affiliation(s)
- Chris Serrand
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nîmes, Univ. Montpellier, Nîmes, France; CESP, Villejuif Paris, France
| | | | | | | | | | | | | | | | | | | | | | - William Szurhaj
- Clinical Neurophysiology Department, CHU Amiens, UR 7516, CHIMERE, University of Picardie Jules Verne, Amiens, France
| | - Thibault Mura
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nîmes, Univ. Montpellier, Nîmes, France
| | - Vincent Navarro
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epilepsy Unit, Paris Brain Institute, ICM, Reference Center for Rare epilepsies, 75013, Paris, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
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Lerond J, Mathon B, Scopin M, Nichelli L, Guégan J, Bertholle C, Izac B, Andrieu M, Gareau T, Donneger F, Mohand Oumoussa B, Letourneur F, Tran S, Bertrand M, Le Roux I, Touat M, Dupont S, Poncer JC, Navarro V, Bielle F. Hippocampal and neocortical BRAF mutant non-expansive lesions in focal epilepsies. Neuropathol Appl Neurobiol 2023; 49:e12937. [PMID: 37740653 DOI: 10.1111/nan.12937] [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: 07/21/2022] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Mesial Temporal Lobe Epilepsy-associated Hippocampal Sclerosis (MTLE-HS) is a syndrome associated with various aetiologies. We previously identified CD34-positive extravascular stellate cells (CD34+ cells) possibly related to BRAFV600E oncogenic variant in a subset of MTLE-HS. We aimed to identify the BRAFV600E oncogenic variants and characterise the CD34+ cells. METHODS We analysed BRAFV600E oncogenic variant by digital droplet Polymerase Chain Reaction in 53 MTLE-HS samples (25 with CD34+ cells) and nine non-expansive neocortical lesions resected during epilepsy surgery (five with CD34+ cells). Ex vivo multi-electrode array recording, immunolabelling, methylation microarray and single nuclei RNAseq were performed on BRAFwildtype MTLE-HS and BRAFV600E mutant non-expansive lesion of hippocampus and/or neocortex. RESULTS We identified a BRAFV600E oncogenic variant in five MTLE-HS samples with CD34+ cells (19%) and in five neocortical samples with CD34+ cells (100%). Single nuclei RNAseq of resected samples revealed two unique clusters of abnormal cells (including CD34+ cells) associated with senescence and oligodendrocyte development in both hippocampal and neocortical BRAFV600E mutant samples. The co-expression of the oncogene-induced senescence marker p16INK4A and the outer subventricular zone radial glia progenitor marker HOPX in CD34+ cells was confirmed by multiplex immunostaining. Pseudotime analysis showed that abnormal cells share a common lineage from progenitors to myelinating oligodendrocytes. Epilepsy surgery led to seizure freedom in eight of the 10 patients with BRAF mutant lesions. INTERPRETATION BRAFV600E underlies a subset of MTLE-HS and epileptogenic non-expansive neocortical focal lesions. Detection of the oncogenic variant may help diagnosis and open perspectives for targeted therapies.
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Affiliation(s)
- Julie Lerond
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Sorbonne Université, Paris, France
| | - Bertrand Mathon
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Department of Neurosurgery, Sorbonne Université, Paris, France
| | - Mélina Scopin
- Institut du Fer à Moulin, Inserm, Sorbonne Université, Paris, France
| | - Lucia Nichelli
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Department of Neuroradiology, Sorbonne Université, Paris, France
| | - Justine Guégan
- Institut du Cerveau-Paris Brain Institute-ICM-Data Analysis Core platform, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Céline Bertholle
- CNRS, INSERM, Institut Cochin, Université Paris Cité, Paris, France
| | - Brigitte Izac
- CNRS, INSERM, Institut Cochin, Université Paris Cité, Paris, France
| | - Muriel Andrieu
- CNRS, INSERM, Institut Cochin, Université Paris Cité, Paris, France
| | - Thomas Gareau
- Institut du Cerveau-Paris Brain Institute-ICM-Data Analysis Core platform, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Florian Donneger
- Institut du Fer à Moulin, Inserm, Sorbonne Université, Paris, France
| | - Badreddine Mohand Oumoussa
- Inserm, UMS Production et Analyse des données en Sciences de la vie et en Santé, PASS, Plateforme Post-génomique de la Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Suzanne Tran
- AP-HP, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Department of Neuropathology, Sorbonne Université, Paris, France
| | - Mathilde Bertrand
- Institut du Cerveau-Paris Brain Institute-ICM-Data Analysis Core platform, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Isabelle Le Roux
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Sorbonne Université, Paris, France
| | - Mehdi Touat
- AP-HP, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Department of Neurology 2-Mazarin, Sorbonne Université, Paris, France
| | - Sophie Dupont
- IAP-HP, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière, Rehabilitation Unit, Sorbonne Université, Paris, France
| | | | - Vincent Navarro
- AP-HP, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Epilepsy Unit, Department of Neurology and EEG Unit, Department of Clinical Neurophysiology, Reference Center for Rare Epilepsies, Sorbonne Université, Paris, France
| | - Franck Bielle
- AP-HP, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Department of Neuropathology, Sorbonne Université, Paris, France
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Onconeurotek, Paris, France
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12
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Ralls AM, Leong K, Clayton J, Fuelling P, Mercer C, Navarro V, Menezes PL. The Role of Lithium-Ion Batteries in the Growing Trend of Electric Vehicles. Materials (Basel) 2023; 16:6063. [PMID: 37687758 PMCID: PMC10488475 DOI: 10.3390/ma16176063] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023]
Abstract
Within the automotive field, there has been an increasing amount of global attention toward the usability of combustion-independent electric vehicles (EVs). Once considered an overly ambitious and costly venture, the popularity and practicality of EVs have been gradually increasing due to the usage of Li-ion batteries (LIBs). Although the topic of LIBs has been extensively covered, there has not yet been a review that covers the current advancements of LIBs from economic, industrial, and technical perspectives. Specific overviews on aspects such as international policy changes, the implementation of cloud-based systems with deep learning capabilities, and advanced EV-based LIB electrode materials are discussed. Recommendations to address the current challenges in the EV-based LIB market are discussed. Furthermore, suggestions for short-term, medium-term, and long-term goals that the LIB-EV industry should follow are provided to ensure its success in the near future. Based on this literature review, it can be suggested that EV-based LIBs will continue to be a hot topic in the years to come and that there is still a large amount of room for their overall advancement.
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Affiliation(s)
| | | | | | | | | | | | - Pradeep L. Menezes
- Department of Mechanical Engineering, University of Nevada, Reno, NV 89557, USA; (A.M.R.); (K.L.)
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13
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Liu J, Bayle DJ, Spagna A, Sitt JD, Bourgeois A, Lehongre K, Fernandez-Vidal S, Adam C, Lambrecq V, Navarro V, Seidel Malkinson T, Bartolomeo P. Fronto-parietal networks shape human conscious report through attention gain and reorienting. Commun Biol 2023; 6:730. [PMID: 37454150 PMCID: PMC10349830 DOI: 10.1038/s42003-023-05108-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
How do attention and consciousness interact in the human brain? Rival theories of consciousness disagree on the role of fronto-parietal attentional networks in conscious perception. We recorded neural activity from 727 intracerebral contacts in 13 epileptic patients, while they detected near-threshold targets preceded by attentional cues. Clustering revealed three neural patterns: first, attention-enhanced conscious report accompanied sustained right-hemisphere fronto-temporal activity in networks connected by the superior longitudinal fasciculus (SLF) II-III, and late accumulation of activity (>300 ms post-target) in bilateral dorso-prefrontal and right-hemisphere orbitofrontal cortex (SLF I-III). Second, attentional reorienting affected conscious report through early, sustained activity in a right-hemisphere network (SLF III). Third, conscious report accompanied left-hemisphere dorsolateral-prefrontal activity. Task modeling with recurrent neural networks revealed multiple clusters matching the identified brain clusters, elucidating the causal relationship between clusters in conscious perception of near-threshold targets. Thus, distinct, hemisphere-asymmetric fronto-parietal networks support attentional gain and reorienting in shaping human conscious experience.
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Affiliation(s)
- Jianghao Liu
- Sorbonne Université, Inserm, CNRS, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France.
- Dassault Systèmes, Vélizy-Villacoublay, France.
| | | | - Alfredo Spagna
- Sorbonne Université, Inserm, CNRS, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
- Department of Psychology, Columbia University in the City of New York, New York, NY, 10027, USA
| | - Jacobo D Sitt
- Sorbonne Université, Inserm, CNRS, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Alexia Bourgeois
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, 1206, Geneva, Switzerland
| | - Katia Lehongre
- CENIR - Centre de Neuro-Imagerie de Recherche, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Sara Fernandez-Vidal
- CENIR - Centre de Neuro-Imagerie de Recherche, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
| | - Claude Adam
- Epilepsy Unit, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Virginie Lambrecq
- Sorbonne Université, Inserm, CNRS, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
- Epilepsy Unit, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
- Clinical Neurophysiology Department, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Inserm, CNRS, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France
- Epilepsy Unit, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
- Clinical Neurophysiology Department, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Tal Seidel Malkinson
- Sorbonne Université, Inserm, CNRS, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France.
- CNRS, CRAN, Université de Lorraine, F-54000, Nancy, France.
| | - Paolo Bartolomeo
- Sorbonne Université, Inserm, CNRS, Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, 75013, Paris, France.
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Hanin A, Cespedes J, Pulluru Y, Gopaul M, Aronica E, Decampo D, Helbig I, Howe CL, Huttner A, Koh S, Navarro V, Taraschenko O, Vezzani A, Wilson MR, Xian J, Gaspard N, Hirsch LJ. Review and standard operating procedures for collection of biospecimens and analysis of biomarkers in new onset refractory status epilepticus. Epilepsia 2023; 64:1444-1457. [PMID: 37039049 PMCID: PMC10756682 DOI: 10.1111/epi.17600] [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: 01/06/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
New onset refractory status epilepticus (NORSE), including its subtype with a preceding febrile illness known as febrile infection-related epilepsy syndrome (FIRES), is one of the most severe forms of status epilepticus. The exact causes of NORSE are currently unknown, and there is so far no disease-specific therapy. Identifying the underlying pathophysiology and discovering specific biomarkers, whether immunologic, infectious, genetic, or other, may help physicians in the management of patients with NORSE. A broad spectrum of biomarkers has been proposed for status epilepticus patients, some of which were evaluated for patients with NORSE. Nonetheless, none has been validated, due to significant variabilities in study cohorts, collected biospecimens, applied analytical methods, and defined outcome endpoints, and to small sample sizes. The NORSE Institute established an open NORSE/FIRES biorepository for health-related data and biological samples allowing the collection of biospecimens worldwide, promoting multicenter research and sharing of data and specimens. Here, we suggest standard operating procedures for biospecimen collection and biobanking in this rare condition. We also propose criteria for the appropriate use of previously collected biospecimens. We predict that the widespread use of standardized procedures will reduce heterogeneity, facilitate the future identification of validated biomarkers for NORSE, and provide a better understanding of the pathophysiology and best clinical management for these patients.
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Affiliation(s)
- Aurélie Hanin
- Department of Neurology and Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
- Sorbonne Université, Institut du Cerveau ICM, Paris Brain Institute, Inserm, CNRS, Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Epilepsy Unit and Department of Clinical Neurophysiology, Paris, France
| | - Jorge Cespedes
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Universidad Autonoma de Centro America, School of Medicine, San Jose, Costa Rica
| | - Yashwanth Pulluru
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Nebraska Medical Center, Omaha, Nebraska, USA
| | - Margaret Gopaul
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Danielle Decampo
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles L. Howe
- Division of Experimental Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anita Huttner
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sookyong Koh
- Department of Pediatrics, Children’s Hospital Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | - Vincent Navarro
- Sorbonne Université, Institut du Cerveau ICM, Paris Brain Institute, Inserm, CNRS, Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Epilepsy Unit and Department of Clinical Neurophysiology, Paris, France
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Annamaria Vezzani
- Department of Acute Brain Injury, Istituto di Recerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michael R. Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, California, San Francisco, USA
| | - Julie Xian
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nicolas Gaspard
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Lawrence J. Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
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15
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Mathon B, Navarro V, Lecas S, Roussel D, Charpier S, Carpentier A. Safety Profile of Low-Intensity Pulsed Ultrasound-Induced Blood-Brain Barrier Opening in Non-epileptic Mice and in a Mouse Model of Mesial Temporal Lobe Epilepsy. Ultrasound Med Biol 2023; 49:1327-1336. [PMID: 36878831 DOI: 10.1016/j.ultrasmedbio.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE It is unknown whether ultrasound-induced blood-brain barrier (BBB) disruption can promote epileptogenesis and how BBB integrity changes over time after sonication. METHODS To gain more insight into the safety profile of ultrasound (US)-induced BBB opening, we determined BBB permeability as well as histological modifications in C57BL/6 adult control mice and in the kainate (KA) model for mesial temporal lobe epilepsy in mice after sonication with low-intensity pulsed ultrasound (LIPU). Microglial and astroglial changes in ipsilateral hippocampus were examined at different time points following BBB disruption by respectively analyzing Iba1 and glial fibrillary acidic protein immunoreactivity. Using intracerebral EEG recordings, we further studied the possible electrophysiological repercussions of a repeated disrupted BBB for seizure generation in nine non-epileptic mice. RESULTS LIPU-induced BBB opening led to transient albumin extravasation and reversible mild astrogliosis, but not to microglial activation in the hippocampus of non-epileptic mice. In KA mice, the transient albumin extravasation into the hippocampus mediated by LIPU-induced BBB opening did not aggravate inflammatory processes and histologic changes that characterize the hippocampal sclerosis. Three LIPU-induced BBB opening did not induce epileptogenicity in non-epileptic mice implanted with depth EEG electrodes. CONCLUSION Our experiments in mice provide persuasive evidence of the safety of LIPU-induced BBB opening as a therapeutic modality for neurological diseases.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, Paris, France; Paris Brain Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne University, Paris, France; Sorbonne University, GRC 23, Brain Machine Interface, APHP, La Pitié-Salpêtrière Hospital, Paris, France; Advanced Surgical Research Technology Lab, Sorbonne University, Paris, France.
| | - Vincent Navarro
- Paris Brain Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne University, Paris, France; Epileptology Unit, Department of Neurology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, Paris, France
| | - Sarah Lecas
- Paris Brain Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne University, Paris, France
| | - Delphine Roussel
- Paris Brain Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne University, Paris, France
| | - Stéphane Charpier
- Paris Brain Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne University, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, GRC 23, Brain Machine Interface, APHP, La Pitié-Salpêtrière Hospital, Paris, France; Advanced Surgical Research Technology Lab, Sorbonne University, Paris, France
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16
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Axelrod V, Rozier C, Sohier E, Lehongre K, Adam C, Lambrecq V, Navarro V, Naccache L. Intracranial study in humans: Neural spectral changes during watching comedy movie of Charlie Chaplin. Neuropsychologia 2023; 185:108558. [PMID: 37061128 DOI: 10.1016/j.neuropsychologia.2023.108558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
Humor plays a prominent role in our lives. Thus, understanding the cognitive and neural mechanisms of humor is particularly important. Previous studies that investigated neural substrates of humor used functional MRI and to a lesser extent EEG. In the present study, we conducted intracranial recording in human patients, enabling us to obtain the signal with high temporal precision from within specific brain locations. Our analysis focused on the temporal lobe and the surrounding areas, the temporal lobe was most densely covered in our recording. Thirteen patients watched a fragment of a Charlie Chaplin movie. An independent group of healthy participants rated the same movie fragment, helping us to identify the most funny and the least funny frames of the movie. We compared neural activity occurring during the most funny and least funny frames across frequencies in the range of 1-170 Hz. The most funny compared to least funny parts of the movie were associated with activity modulation in the broadband high-gamma (70-170 Hz; mostly activation) and to a lesser extent gamma band (40-69Hz; activation) and low frequencies (1-12 Hz, delta, theta, alpha bands; mostly deactivation). With regard to regional specificity, we found three types of brain areas: (I) temporal pole, middle and inferior temporal gyrus (both anterior and posterior) in which there was both activation in the high-gamma/gamma bands and deactivation in low frequencies; (II) ventral part of the temporal lobe such as the fusiform gyrus, in which there was mostly deactivation the low frequencies; (III) posterior temporal cortex and its environment, such as the middle occipital and the temporo-parietal junction, in which there was activation in the high-gamma/gamma band. Overall, our results suggest that humor appreciation might be achieved by neural activity across the frequency spectrum.
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Affiliation(s)
- Vadim Axelrod
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, 52900, Israel.
| | - Camille Rozier
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Elisa Sohier
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Katia Lehongre
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Claude Adam
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Virginie Lambrecq
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; AP-HP, EEG Unit, Neurophysiology Department, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; AP-HP, EEG Unit, Neurophysiology Department, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France; AP-HP, Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France
| | - Lionel Naccache
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurophysiology, 47-83 boulevard de l'Hôpital, Paris 75013, France
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17
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Saint Amour di Chanaz L, Pérez-Bellido A, Wu X, Lonzano-Soldevilla D, Pacheco-Estefan D, Lehongre K, Conde-Blanco E, Roldan P, Adam C, Lambrecq V, Frazzini V, Donaire A, Carreño M, Navarro V, Valero-Cabré A, Fuentemilla L. Gamma amplitude is coupled to opposed hippocampal theta-phase states during the encoding and retrieval of episodic memories in humans. Curr Biol 2023; 33:1836-1843.e6. [PMID: 37060906 DOI: 10.1016/j.cub.2023.03.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/05/2023] [Accepted: 03/24/2023] [Indexed: 04/17/2023]
Abstract
Computational models and in vivo studies in rodents suggest that the emergence of gamma activity (40-140 Hz) during memory encoding and retrieval is coupled to opposed-phase states of the underlying hippocampal theta rhythm (4-9 Hz).1,2,3,4,5,6,7,8,9,10 However, direct evidence for whether human hippocampal gamma-modulated oscillatory activity in memory processes is coupled to opposed-phase states of the ongoing theta rhythm remains elusive. Here, we recorded local field potentials (LFPs) directly from the hippocampus of 10 patients with epilepsy, using depth electrodes. We used a memory encoding and retrieval task whereby trial unique sequences of pictures depicting real-life episodes were presented, and 24 h later, participants were asked to recall them upon the appearance of the first picture of the encoded episodic sequence. We found theta-to-gamma cross-frequency coupling that was specific to the hippocampus during both the encoding and retrieval of episodic memories. We also revealed that gamma was coupled to opposing theta phases during both encoding and recall processes. Additionally, we observed that the degree of theta-gamma phase opposition between encoding and recall was associated with participants' memory performance, so gamma power was modulated by theta phase for both remembered and forgotten trials, although only for remembered trials the dominant theta phase was different for encoding and recall trials. The current results offer direct empirical evidence in support of hippocampal theta-gamma phase opposition models in human long-term memory and provide fundamental insights into mechanistic predictions derived from computational and animal work, thereby contributing to establishing similarities and differences across species.
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Affiliation(s)
- Ludovico Saint Amour di Chanaz
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Pg Vall Hebrón 171, 08035 Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Pg Vall Hebrón 171, 08035 Barcelona, Spain
| | - Alexis Pérez-Bellido
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Pg Vall Hebrón 171, 08035 Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Pg Vall Hebrón 171, 08035 Barcelona, Spain
| | - Xiongbo Wu
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Pg Vall Hebrón 171, 08035 Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Pg Vall Hebrón 171, 08035 Barcelona, Spain; Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Diego Lonzano-Soldevilla
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politécnica de Madrid, Crta. M40, Km. 38, Pozuelo de Alarcón, Madrid 28223, Spain
| | - Daniel Pacheco-Estefan
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, 44801 Bochum, Germany
| | - Katia Lehongre
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| | - Estefanía Conde-Blanco
- Epilepsy Program, Neurology Department, Hospital Clínic de Barcelona, EpiCARE: European Reference Network for Epilepsy, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Pedro Roldan
- Epilepsy Program, Neurology Department, Hospital Clínic de Barcelona, EpiCARE: European Reference Network for Epilepsy, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Claude Adam
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| | - Virginie Lambrecq
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France; AP-HP, Département de Neurophysiologie, Hôpital PitiéSalpêtrière, DMU Neurosciences, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| | - Valerio Frazzini
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France; AP-HP, Département de Neurophysiologie, Hôpital PitiéSalpêtrière, DMU Neurosciences, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| | - Antonio Donaire
- Epilepsy Program, Neurology Department, Hospital Clínic de Barcelona, EpiCARE: European Reference Network for Epilepsy, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Mar Carreño
- Epilepsy Program, Neurology Department, Hospital Clínic de Barcelona, EpiCARE: European Reference Network for Epilepsy, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France; AP-HP, Département de Neurophysiologie, Hôpital PitiéSalpêtrière, DMU Neurosciences, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France; AP-HP, Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| | - Antoni Valero-Cabré
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France; Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB team, CNRS UMR 7225, INSERM U1127, Paris, France; Faculty of Health and Science, Cognitive Neurolab, Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Avinguda del Tibidabo, 39-43, 08035 Barcelona, Spain; Laboratory for Cerebral Dynamics Plasticity and Rehabilitation, Boston University School of Medicine, 72 E Concord Street, Boston, MA 02118, USA
| | - Lluís Fuentemilla
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Pg Vall Hebrón 171, 08035 Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Pg Vall Hebrón 171, 08035 Barcelona, Spain; Institute for Biomedical Research of Bellvitge, C/ Feixa Llarga, s/n - Pavelló de Govern -Edifici Modular, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
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18
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Vellieux G, Apartis E, Degos V, Fossati P, Navarro V. Effectiveness of electroconvulsive therapy in Lance-Adams syndrome. Brain Stimul 2023; 16:647-649. [PMID: 36935000 DOI: 10.1016/j.brs.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/13/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Affiliation(s)
- Geoffroy Vellieux
- Paris Brain Institute, ICM, Inserm, CNRS, Sorbonne Université, F-75013, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuelle Apartis
- Paris Brain Institute, ICM, Inserm, CNRS, Sorbonne Université, F-75013, Paris, France; AP-HP, Neurophysiology Department, Saint-Antoine Hospital, Paris, France
| | - Vincent Degos
- AP-HP, Neurosurgical Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France; Clinical Research Group 29, Sorbonne Université, Paris, France
| | - Philippe Fossati
- Paris Brain Institute, ICM, Inserm, CNRS, Sorbonne Université, F-75013, Paris, France; AP-HP, Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Navarro
- Paris Brain Institute, ICM, Inserm, CNRS, Sorbonne Université, F-75013, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France.
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19
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Hanin A, Cespedes J, Dorgham K, Pulluru Y, Gopaul M, Gorochov G, Hafler DA, Navarro V, Gaspard N, Hirsch LJ. Cytokines in New-Onset Refractory Status Epilepticus Predict Outcomes. Ann Neurol 2023. [PMID: 36871188 DOI: 10.1002/ana.26627] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The objective of this study was to investigate inflammation using cerebrospinal fluid (CSF) and serum cytokines/chemokines in patients with new-onset refractory status epilepticus (NORSE) to better understand the pathophysiology of NORSE and its consequences. METHODS Patients with NORSE (n = 61, including n = 51 cryptogenic), including its subtype with prior fever known as febrile infection-related epilepsy syndrome (FIRES), were compared with patients with other refractory status epilepticus (RSE; n = 37), and control patients without SE (n = 52). We measured 12 cytokines/chemokines in serum or CSF samples using multiplexed fluorescent bead-based immunoassay detection. Cytokine levels were compared between patients with and without SE, and between the 51 patients with cryptogenic NORSE (cNORSE) and the 47 patients with a known-etiology RSE (NORSE n = 10, other RSE n = 37), and correlated with outcomes. RESULTS A significant increase of IL-6, TNF-α, CXCL8/IL-8, CCL2, MIP-1α, and IL-12p70 pro-inflammatory cytokines/chemokines was observed in patients with SE compared with patients without SE, in serum and CSF. Serum innate immunity pro-inflammatory cytokines/chemokines (CXCL8, CCL2, and MIP-1α) were significantly higher in patients with cNORSE compared to non-cryptogenic RSE. Patients with NORSE with elevated innate immunity serum and CSF cytokine/chemokine levels had worse outcomes at discharge and at several months after the SE ended. INTERPRETATION We identified significant differences in innate immunity serum and CSF cytokine/chemokine profiles between patients with cNORSE and non-cryptogenic RSE. The elevation of innate immunity pro-inflammatory cytokines in patients with NORSE correlated with worse short- and long-term outcomes. These findings highlight the involvement of innate immunity-related inflammation, including peripherally, and possibly of neutrophil-related immunity in cNORSE pathogenesis and suggest the importance of utilizing specific anti-inflammatory interventions. ANN NEUROL 2023.
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Affiliation(s)
- Aurélie Hanin
- Department of Neurology and Immunobiology, Yale University School of Medicine, New Haven, CT, United States.,Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France.,Department of Clinical Neurophysiology, Epilepsy Unit, DMU Neurosciences 6, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Jorge Cespedes
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.,Universidad Autonoma de Centro America, School of Medicine, San Jose, Costa Rica
| | - Karim Dorgham
- Department of Immunology, Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Yashwanth Pulluru
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.,Division of Epilepsy, Nebraska Medical Center, Omaha, NE, United States
| | - Margaret Gopaul
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Guy Gorochov
- Department of Immunology, Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - David A Hafler
- Department of Neurology and Immunobiology, Yale University School of Medicine, New Haven, CT, United States
| | - Vincent Navarro
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France.,Department of Clinical Neurophysiology, Epilepsy Unit, DMU Neurosciences 6, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France.,Center of Reference for Rare Epilepsies, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Nicolas Gaspard
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.,Department of Neurology, Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
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Baudin P, Roussel D, Mahon S, Charpier S, Navarro V. In Vivo Injection of Anti-LGI1 Antibodies into the Rodent M1 Cortex and Hippocampus Is Ineffective in Inducing Seizures. eNeuro 2023; 10:ENEURO.0267-22.2023. [PMID: 36849262 PMCID: PMC10012326 DOI: 10.1523/eneuro.0267-22.2023] [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: 07/01/2022] [Revised: 12/22/2022] [Accepted: 02/02/2023] [Indexed: 03/01/2023] Open
Abstract
Autoimmune encephalitis (AIE) associated with antibodies directed against the leucine-rich glioma inactivated 1 (LGI1) protein is the second most common AIE and is responsible for deleterious neocortical and limbic epileptic seizures. Previous studies demonstrated a pathogenic role of anti-LGI1 antibodies via alterations in the expression and function of Kv1 channels and AMPA receptors. However, the causal link between antibodies and epileptic seizures has never been demonstrated. Here, we attempted to determine the role of human anti-LGI1 autoantibodies in the genesis of seizures by analyzing the impact of their intracerebral injection in rodents. Acute and chronic injections were performed in rats and mice in the hippocampus and primary motor cortex, the two main brain regions affected by the disease. Acute infusion of CSF or serum IgG of anti-LGI1 AIE patients did not lead to the emergence of epileptic activities, as assessed by multisite electrophysiological recordings over a 10 h period after injection. A chronic 14 d injection, coupled with continuous video-EEG monitoring, was not more effective. Overall, these results demonstrate that acute and chronic injections of CSF or purified IgG from LGI1 patients are not able to generate epileptic activity by themselves in the different animal models tested.
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Affiliation(s)
- Paul Baudin
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtriére, 75013 Paris, France
| | - Delphine Roussel
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtriére, 75013 Paris, France
| | - Séverine Mahon
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtriére, 75013 Paris, France
| | - Stéphane Charpier
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtriére, 75013 Paris, France
| | - Vincent Navarro
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtriére, 75013 Paris, France
- AP-HP, Hôpital de la Pitié-Salpêtriére, DMU Neurosciences 6, Epilepsy Unit and Clinical Neurophysiology Department, 75013 Paris, France
- Center of Reference for Rare Epilepsies, APHP, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France
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21
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Hanin A, Roussel D, Lecas S, Baudin P, Navarro V. Repurposing of cholesterol-lowering agents in status epilepticus: A neuroprotective effect of simvastatin. Epilepsy Behav 2023; 141:109133. [PMID: 36813661 DOI: 10.1016/j.yebeh.2023.109133] [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: 10/11/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
The increase of cholesterol synthesis after a status epilepticus may lead to excitotoxic processes, neuronal loss and favor the appearance of spontaneous epileptic seizures. Lowering cholesterol content could be a neuroprotective strategy. Here, we evaluated the protective effect of simvastatin administrated daily for 14 days, after the induction of a status epilepticus by intrahippocampal injection of kainic acid in mice. The results were compared to those obtained from mice showing a kainic acid-induced status epilepticus, treated daily with a saline solution, and from mice injected with a control phosphate-buffered solution without any status epilepticus. We first assessed the antiseizure effects of simvastatin by performing video-electroencephalographic recordings during the first three hours after kainic acid injection and continuously between the fifteenth and the thirty-first days. Mice treated with simvastatin had significantly fewer generalized seizures during the first three hours without a significant effect on generalized seizures after two weeks. There was a trend for fewer hippocampal electrographic seizures after two weeks. Secondly, we evaluated the neuroprotective and anti-inflammatory effects of simvastatin by measuring the fluorescence of neuronal and astrocyte markers on the thirtieth day after status onset. We found that simvastatin reduced CA1 reactive astrocytosis, demonstrated by a significant 37% decrease in GFAP-positive cells, and that simvastatin prevented the neuronal loss in CA1, demonstrated by a significant 42% increase in the NeuN-positive cells, as compared to the findings in mice with kainic acid-induced status epilepticus treated by a saline solution. Our study confirms the interest of cholesterol-lowering agents, and in particular simvastatin, in status epilepticus and paves the way for a clinical pilot study to prevent neurological sequelae after status epilepticus. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Aurélie Hanin
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France; AP-HP, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Epilepsy Unit and Clinical Neurophysiology Department, 47 Boulevard de l'Hôpital, 75013 Paris, France; Department of Neurology and Immunobiology, Yale University School of Medicine, 06511 New Haven, CT, USA.
| | - Delphine Roussel
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France
| | - Sarah Lecas
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France
| | - Paul Baudin
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France
| | - Vincent Navarro
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France; AP-HP, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Epilepsy Unit and Clinical Neurophysiology Department, 47 Boulevard de l'Hôpital, 75013 Paris, France; Centre de référence Epilepsies rares, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France
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22
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Bergeret S, Birzu C, Meneret P, Giron A, Demeret S, Marois C, Cousyn L, Rozenblum L, Laurenge A, Alentorn A, Navarro V, Psimaras D, Kas A. Brain Metabolic Alterations in Seropositive Autoimmune Encephalitis: An 18F-FDG PET Study. Biomedicines 2023; 11:biomedicines11020506. [PMID: 36831042 PMCID: PMC9953044 DOI: 10.3390/biomedicines11020506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Autoimmune encephalitis (AE) diagnosis and follow-up remain challenging. Brain 18F-fluoro-deoxy-glucose positron emission tomography (FDG PET) has shown promising results in AE. Our aim was to investigate FDG PET alterations in AE, according to antibody subtype. METHODS We retrospectively included patients with available FDG PET and seropositive AE diagnosed in our center between 2015 and 2020. Brain PET Z-score maps (relative to age matched controls) were analyzed, considering metabolic changes significant if |Z-score| ≥ 2. RESULTS Forty-six patients were included (49.4 yrs [18; 81]): 13 with GAD autoantibodies, 11 with anti-LGI1, 9 with NMDAR, 5 with CASPR2, and 8 with other antibodies. Brain PET was abnormal in 98% of patients versus 53% for MRI. The most frequent abnormalities were medial temporal lobe (MTL) and/or striatum hypermetabolism (52% and 43% respectively), cortical hypometabolism (78%), and cerebellum abnormalities (70%). LGI1 AE tended to have more frequent MTL hypermetabolism. NMDAR AE was prone to widespread cortical hypometabolism. Fewer abnormalities were observed in GAD AE. Striatum hypermetabolism was more frequent in patients treated for less than 1 month (p = 0.014), suggesting a relation to disease activity. CONCLUSION FDG PET could serve as an imaging biomarker for early diagnosis and follow-up in AE.
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Affiliation(s)
- Sébastien Bergeret
- Sorbonne University, AP-HP, Pitié Salpêtrière-Charles Foix Hospital Group, Nuclear Medicine Department, 75013 Paris, France
| | - Cristina Birzu
- Paris Brain Institute, ICM, Sorbonne University, AP-HP, UMR S 1127, INSERM, Pitié Salpêtrière-Charles Foix Hospital Group, Service de Neurologie 2-Mazarin, 75013 Paris, France
| | - Pierre Meneret
- Nuclear Medicine Department, Eugène Marquis Centre, INSERM, LTSI-UMR 1099, 35000 Rennes, France
| | - Alain Giron
- Laboratoire d’Imagerie Biomédicale, LIB, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - Sophie Demeret
- Sorbonne University, AP-HP, Pitié Salpêtrière-Charles Foix Hospital Group, Neurology Department, Neurological Intensive Care Unit, 75013 Paris, France
| | - Clemence Marois
- Sorbonne University, AP-HP, Pitié Salpêtrière-Charles Foix Hospital Group, Neurology Department, Neurological Intensive Care Unit, 75013 Paris, France
| | - Louis Cousyn
- Sorbonne University, AP-HP, Pitié-Salpêtrière-Charles Foix Hospital Group, Epilepsy Unit, Paris Brain Institute, ICM, Reference Center for Rare Epilepsies, 75013 Paris, France
| | - Laura Rozenblum
- Sorbonne University, AP-HP, Pitié Salpêtrière-Charles Foix Hospital Group, Nuclear Medicine Department, 75013 Paris, France
| | - Alice Laurenge
- Paris Brain Institute, ICM, Sorbonne University, AP-HP, UMR S 1127, INSERM, Pitié Salpêtrière-Charles Foix Hospital Group, Service de Neurologie 2-Mazarin, 75013 Paris, France
| | - Agusti Alentorn
- Paris Brain Institute, ICM, Sorbonne University, AP-HP, UMR S 1127, INSERM, Pitié Salpêtrière-Charles Foix Hospital Group, Service de Neurologie 2-Mazarin, 75013 Paris, France
| | - Vincent Navarro
- Sorbonne University, AP-HP, Pitié-Salpêtrière-Charles Foix Hospital Group, Epilepsy Unit, Paris Brain Institute, ICM, Reference Center for Rare Epilepsies, 75013 Paris, France
| | - Dimitri Psimaras
- Paris Brain Institute, ICM, Sorbonne University, AP-HP, UMR S 1127, INSERM, Pitié Salpêtrière-Charles Foix Hospital Group, Service de Neurologie 2-Mazarin, 75013 Paris, France
| | - Aurélie Kas
- Sorbonne University, Laboratoire d’Imagerie Biomédicale, LIB, CNRS, INSERM, AP-HP, Pitié Salpêtrière-Charles Foix Hospital Group, Nuclear Medicine Department, 75013 Paris, France
- Correspondence:
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23
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Cousyn L, Messaoud RB, Lehongre K, Frazzini V, Lambrecq V, Adam C, Mathon B, Navarro V, Chavez M. Daily resting-state intracranial EEG connectivity for seizure risk forecasts. Epilepsia 2023; 64:e23-e29. [PMID: 36481871 DOI: 10.1111/epi.17480] [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: 05/10/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Forecasting seizure risk aims to detect proictal states in which seizures would be more likely to occur. Classical seizure prediction models are trained over long-term electroencephalographic (EEG) recordings to detect specific preictal changes for each seizure, independently of those induced by shifts in states of vigilance. A daily single measure-during a vigilance-controlled period-to estimate the risk of upcoming seizure(s) would be more convenient. Here, we evaluated whether intracranial EEG connectivity (phase-locking value), estimated from daily vigilance-controlled resting-state recordings, could allow distinguishing interictal (no seizure) from preictal (seizure within the next 24 h) states. We also assessed its relevance for daily forecasts of seizure risk using machine learning models. Connectivity in the theta band was found to provide the best prediction performances (area under the curve ≥ .7 in 80% of patients), with accurate daily and prospective probabilistic forecasts (mean Brier score and Brier skill score of .13 and .72, respectively). More efficient ambulatory clinical application could be considered using mobile EEG or chronic implanted devices.
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Affiliation(s)
- Louis Cousyn
- Department of Neurology, Epilepsy Unit, Public Hospital Network of Paris, Pitié-Salpêtrière Hospital, Paris, France
- Paris Brain Institute, ICM (INSERM-U1127, CNRS-UMR7225), Paris, France
- Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University, Paris, France
| | - Rémy Ben Messaoud
- Paris Brain Institute, ICM (INSERM-U1127, CNRS-UMR7225), Paris, France
- INRIA, ARAMIS Project-Team, Paris, France
| | - Katia Lehongre
- Paris Brain Institute, ICM (INSERM-U1127, CNRS-UMR7225), Paris, France
| | - Valerio Frazzini
- Department of Neurology, Epilepsy Unit, Public Hospital Network of Paris, Pitié-Salpêtrière Hospital, Paris, France
- Paris Brain Institute, ICM (INSERM-U1127, CNRS-UMR7225), Paris, France
- Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University, Paris, France
| | - Virginie Lambrecq
- Department of Neurology, Epilepsy Unit, Public Hospital Network of Paris, Pitié-Salpêtrière Hospital, Paris, France
- Paris Brain Institute, ICM (INSERM-U1127, CNRS-UMR7225), Paris, France
- Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University, Paris, France
| | - Claude Adam
- Department of Neurology, Epilepsy Unit, Public Hospital Network of Paris, Pitié-Salpêtrière Hospital, Paris, France
- Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France
| | - Bertrand Mathon
- Paris Brain Institute, ICM (INSERM-U1127, CNRS-UMR7225), Paris, France
- Sorbonne University, Paris, France
- Department of Neurosurgery, Public Hospital Network of Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Navarro
- Department of Neurology, Epilepsy Unit, Public Hospital Network of Paris, Pitié-Salpêtrière Hospital, Paris, France
- Paris Brain Institute, ICM (INSERM-U1127, CNRS-UMR7225), Paris, France
- Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University, Paris, France
| | - Mario Chavez
- Paris Brain Institute, ICM (INSERM-U1127, CNRS-UMR7225), Paris, France
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24
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Sharshar T, Porcher R, Asfar P, Grimaldi L, Jabot J, Argaud L, Lebert C, Bollaert PE, Harlay ML, Chillet P, Maury E, Santoli F, Blanc P, Sonneville R, Vu DC, Rohaut B, Mazeraud A, Alvarez JC, Navarro V, Clair B, Outin H, Azabou E, Beloncle F, Ben-Hadj O, Blanc P, Bollaert PE, Bolgert F, Bouadma L, Chillet P, Clair B, Corne P, Clere-Jehl R, Cour M, Crespel A, Déiler V, Dellamonica J, Demeret S, Harley ML, Henry-Lagarrigue M, Jabot J, Heming N, Hernu R, Kouatchet A, Lebert C, Lerolle N, Maury E, Letrou S, Mazeraud A, Mercat A, Mortaza S, Mourvillier B, Outin H, Paugham-Burtz C, Pierrot M, Provent M, Rohaut B, De La Salle S, Santoli F, Schenk M, Siami S, Souday V, Sharshar T, Sonneville R, Timsit JF, Thuong M, Weiss N. Valproic acid as adjuvant treatment for convulsive status epilepticus: a randomised clinical trial. Crit Care 2023; 27:8. [PMID: 36624526 PMCID: PMC9830759 DOI: 10.1186/s13054-022-04292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Generalised convulsive status epilepticus (GCSE) is a medical emergency. Guidelines recommend a stepwise strategy of benzodiazepines followed by a second-line anti-seizure medicine (ASM). However, GCSE is uncontrolled in 20-40% patients and is associated with protracted hospitalisation, disability, and mortality. The objective was to determine whether valproic acid (VPA) as complementary treatment to the stepwise strategy improves the outcomes of patients with de novo established GCSE. METHODS This was a multicentre, double-blind, randomised controlled trial in 244 adults admitted to intensive care units for GCSE in 16 French hospitals between 2013 and 2018. Patients received standard care of benzodiazepine and a second-line ASM (except VPA). Intervention patients received a 30 mg/kg VPA loading dose, then a 1 mg/kg/h 12 h infusion, whilst the placebo group received an identical intravenous administration of 0.9% saline as a bolus and continuous infusion. Primary outcome was proportion of patients discharged from hospital by day 15. The secondary outcomes were seizure control, adverse events, and cognition at day 90. RESULTS A total of 126 (52%) and 118 (48%) patients were included in the VPA and placebo groups. 224 (93%) and 227 (93%) received a first-line and a second-line ASM before VPA or placebo infusion. There was no between-group difference for patients hospital-discharged at day 15 [VPA, 77 (61%) versus placebo, 72 (61%), adjusted relative risk 1.04; 95% confidence interval (0.89-1.19); p = 0.58]. There were no between-group differences for secondary outcomes. CONCLUSIONS VPA added to the recommended strategy for adult GCSE is well tolerated but did not increase the proportion of patients hospital-discharged by day 15. TRIAL REGISTRATION NO NCT01791868 (ClinicalTrials.gov registry), registered: 15 February 2012.
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Affiliation(s)
- Tarek Sharshar
- grid.508487.60000 0004 7885 7602Neuro-Intensive Care Medicine, Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France
| | - Raphaël Porcher
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France ,grid.411394.a0000 0001 2191 1995Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | - Pierre Asfar
- grid.411147.60000 0004 0472 0283Department of Medical Intensive Care, University Hospital, Angers, France
| | - Lamiae Grimaldi
- grid.50550.350000 0001 2175 4109Clinical Research Unit, Assistance Publique - Hôpitaux de Paris University Paris-Saclay. Faculty of medicine, University of Versailles Saint-Quentin en Yvelines. Inserm U1018 Team Anti-infective evasion and pharmacoepidemiology, Boulogne-Billancourt, France
| | - Julien Jabot
- Medical-Surgical Intensive Care Unit, CHU Felix-Guyon, Saint-Denis, La Réunion, France
| | - Laurent Argaud
- grid.412180.e0000 0001 2198 4166Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Christine Lebert
- grid.477015.00000 0004 1772 6836Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Pierre-Edouard Bollaert
- grid.29172.3f0000 0001 2194 6418CHRU-Nancy, Service de Médecine Intensive Réanimation, Université de Lorraine, 54000 Nancy, France
| | - Marie Line Harlay
- grid.412201.40000 0004 0593 6932Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Patrick Chillet
- Service de Médecine Intensive - Réanimation, Centre hospitalier Léon Bourgeois, Châlons en Champagne, France
| | - Eric Maury
- grid.462844.80000 0001 2308 1657Service de Médecine Intensive et Réanimation Hôpital Saint-Antoine, Paris-Sorbonne Université, Paris, France
| | - Francois Santoli
- grid.414308.a0000 0004 0594 0368Médecine Intensive—Réanimation, Centre Hospitalier Robert Ballanger, Aulnay sous Bois, France
| | - Pascal Blanc
- grid.440383.80000 0004 1765 1969Réanimation Médico Chirurgicale, Centre Hospitalier René Dubos, Pontoise, France
| | - Romain Sonneville
- Université de Paris Cité, INSERM UMR1137, Paris, France ,grid.411119.d0000 0000 8588 831XAPHP Nord, Médecine Intensive – Réanimation, Hôpital Bichat—Claude Bernard, Paris, France
| | - Dinh Chuyen Vu
- General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Benjamin Rohaut
- grid.462844.80000 0001 2308 1657Department of Neurology, Neuro-ICU & Brain institute - ICM, Pitié-Salpêtrière Hospital APHP, Sorbonne Université, Paris, France
| | - Aurelien Mazeraud
- grid.508487.60000 0004 7885 7602Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Perception and Memory Unit, Neurosciences Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Jean-Claude Alvarez
- grid.12832.3a0000 0001 2323 0229Department of Pharmacology and Toxicology, Inserm U-1173, Raymond Poincare Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, 104 Boulevard Raymond Poincare, 92380 Garches, France
| | - Vincent Navarro
- grid.425274.20000 0004 0620 5939AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Sorbonne Université, and Paris Brain Institute, Paris, France
| | - Bernard Clair
- grid.12832.3a0000 0001 2323 0229General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Hervé Outin
- grid.418056.e0000 0004 1765 2558Intensive Care Unit Centre Hospitalier Intercommunal, Poissy/Saint-Germain-en-Laye, France
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25
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Serrand C, Rheims S, Faucanié M, Crespel A, Dinkelacker V, Szurhaj W, Biraben A, Bartolomei F, de Grissac N, Landré E, Denuelle M, Vercueil L, Marchal C, Maillard L, Derambure P, Dupont S, Navarro V, Mura T, Jaussent A, Macioce V, Ryvlin P, Picot MC. Stratifying sudden death risk in adults with drug-resistant focal epilepsy: The SUDEP-CARE score. Eur J Neurol 2023; 30:22-31. [PMID: 36094672 PMCID: PMC10087018 DOI: 10.1111/ene.15566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/22/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE A clinical risk score for sudden unexpected death in epilepsy (SUDEP) in patients with drug-resistant focal epilepsy could help improve prevention. METHODS A case-control study was conducted including (i) definite or probable SUDEP cases collected by the French National Sentinel Mortality Epilepsy Network and (ii) control patients from the French national research database of epilepsy monitoring units. Patients with drug-resistant focal epilepsy were eligible. Multiple logistic regressions were performed. After sensitivity analysis and internal validation, a simplified risk score was developed from the selected variables. RESULTS Sixty-two SUDEP cases and 620 controls were included. Of 21 potential predictors explored, seven were ultimately selected, including generalized seizure frequency (>1/month vs. <1/year: adjusted odds ratio [AOR] 2.6, 95% confidence interval [CI] 1.25-5.41), nocturnal or sleep-related seizures (AOR 4.49, 95% CI 2.68-7.53), current or past depression (AOR 2.0, 95% CI 1.19-3.34) or the ability to alert someone of an oncoming seizure (AOR 0.57, 95% CI 0.33-0.98). After internal validation, a clinically usable score ranging from -1 to 8 was developed, with high discrimination capabilities (area under the receiver operating curve 0.85, 95% CI 0.80-0.90). The threshold of 3 has good sensitivity (82.3%, 95% CI 72.7-91.8), whilst keeping a good specificity (82.7%, 95% CI 79.8-85.7). CONCLUSIONS These results outline the importance of generalized and nocturnal seizures on the occurrence of SUDEP, and show a protective role in the ability to alert someone of an oncoming seizure. The SUDEP-CARE score is promising and will need external validation. Further work, including paraclinical explorations, could improve this risk score.
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Affiliation(s)
- Chris Serrand
- University Hospital of Montpellier, Montpellier, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sophie Dupont
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Navarro
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France.,Paris Brain Institute, ICM, INSERM, CNRS, Paris, France
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Nguyen-Michel VH, Houot M, Delorme C, Sangaré A, Gales A, Frazzini V, Hanin A, Aissani D, Trân T, Oquendo B, Ketz F, Lafuente-Lafuente C, Oasi C, Kinugawa K, Ouvrard G, Ursu R, Degos B, Rohaut B, Demeret S, Lambrecq V, Navarro V, Fournier E, Corvol JC, Borden A. Older patients with COVID-19 and neuropsychiatric conditions: A study of risk factors for mortality. Brain Behav 2022; 12:e2787. [PMID: 36355411 PMCID: PMC9759137 DOI: 10.1002/brb3.2787] [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: 02/27/2022] [Revised: 09/05/2022] [Accepted: 09/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about risk factors for mortality in older patients with COVID-19 and neuropsychiatric conditions. METHODS We conducted a multicentric retrospective observational study at Assistance Publique-Hôpitaux de Paris. We selected inpatients aged 70 years or older, with COVID-19 and preexisting neuropsychiatric comorbidities and/or new neuropsychiatric manifestations. We examined demographics, comorbidities, functional status, and presentation including neuropsychiatric symptoms and disorders, as well as paraclinical data. Cox survival analysis was conducted to determine risk factors for mortality at 40 days after the first symptoms of COVID-19. RESULTS Out of 191 patients included (median age 80 [interquartile range 74-87]), 135 (71%) had neuropsychiatric comorbidities including cognitive impairment (39%), cerebrovascular disease (22%), Parkinsonism (6%), and brain tumors (6%). A total of 152 (79%) patients presented new-onset neuropsychiatric manifestations including sensory symptoms (6%), motor deficit (11%), behavioral (18%) and cognitive (23%) disturbances, gait impairment (11%), and impaired consciousness (18%). The mortality rate at 40 days was 19.4%. A history of brain tumor or Parkinsonism or the occurrence of impaired consciousness were neurological factors associated with a higher risk of mortality. A lower Activities of Daily Living score (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58-0.82), a neutrophil-to-lymphocyte ratio ≥ 9.9 (HR 5.69, 95% CI 2.69-12.0), and thrombocytopenia (HR 5.70, 95% CI 2.75-11.8) independently increased the risk of mortality (all p < .001). CONCLUSION Understanding mortality risk factors in older inpatients with COVID-19 and neuropsychiatric conditions may be helpful to neurologists and geriatricians who manage these patients in clinical practice.
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Affiliation(s)
- Vi-Huong Nguyen-Michel
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France
| | - Marion Houot
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Institut de la Mémoire et de la maladie d'Alzheimer, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Center of Excellence of Neurodegenerative Disease (CoEN), Paris, France
| | - Cécile Delorme
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Aude Sangaré
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Ana Gales
- Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Sleep Disorders Unit, Paris, France
| | - Valerio Frazzini
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Aurélie Hanin
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Djamal Aissani
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Department of Radiology, Paris, France
| | - Thanh Trân
- Pierre Bérégovoy Hospital, Neurological Unit, Nevers, France
| | - Bruno Oquendo
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | - Flora Ketz
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | | | - Christel Oasi
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | - Kiyoka Kinugawa
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, CNRS, UMR 8256 Biological Adaption and Aging, Paris, France
| | - Gaëlle Ouvrard
- Sorbonne Université, AP-HP, Rothschild Hospital, Neurological Rehabilitation Unit, Paris, France
| | - Renata Ursu
- Université de Paris, AP-HP Nord, Saint-Louis Hospital, Neurological Unit, Paris, France
| | - Bertrand Degos
- Sorbonne Université Paris Nord, AP-HP, Avicenne Hospital, Department of Neurology, Bobigny, France
| | - Benjamin Rohaut
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Neurological Intensive Care Unit, Paris, France
| | - Sophie Demeret
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Neurological Intensive Care Unit, Paris, France
| | - Virginie Lambrecq
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Vincent Navarro
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Emmanuel Fournier
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Alaina Borden
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France
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Axelrod V, Rozier C, Lehongre K, Adam C, Lambrecq V, Navarro V, Naccache L. Neural modulations in the auditory cortex during internal and external attention tasks: A single-patient intracranial recording study. Cortex 2022; 157:211-230. [PMID: 36335821 DOI: 10.1016/j.cortex.2022.09.011] [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: 10/31/2021] [Revised: 05/12/2022] [Accepted: 09/27/2022] [Indexed: 12/15/2022]
Abstract
Brain sensory processing is not passive, but is rather modulated by our internal state. Different research methods such as non-invasive imaging methods and intracranial recording of the local field potential (LFP) have been used to study to what extent sensory processing and the auditory cortex in particular are modulated by selective attention. However, at the level of the single- or multi-units the selective attention in humans has not been tested. In addition, most previous research on selective attention has explored externally-oriented attention, but attention can be also directed inward (i.e., internal attention), like spontaneous self-generated thoughts and mind-wandering. In the present study we had a rare opportunity to record multi-unit activity (MUA) in the auditory cortex of a patient. To complement, we also analyzed the LFP signal of the macro-contact in the auditory cortex. Our experiment consisted of two conditions with periodic beeping sounds. The participants were asked either to count the beeps (i.e., an "external attention" condition) or to recall the events of the previous day (i.e., an "internal attention" condition). We found that the four out of seven recorded units in the auditory cortex showed increased firing rates in "external attention" compared to "internal attention" condition. The beginning of this attentional modulation varied across multi-units between 30-50 msec and 130-150 msec from stimulus onset, a result that is compatible with an early selection view. The LFP evoked potential and induced high gamma activity both showed attentional modulation starting at about 70-80 msec. As the control, for the same experiment we recorded MUA activity in the amygdala and hippocampus of two additional patients. No major attentional modulation was found in the control regions. Overall, we believe that our results provide new empirical information and support for existing theoretical views on selective attention and spontaneous self-generated cognition.
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Affiliation(s)
- Vadim Axelrod
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel.
| | - Camille Rozier
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute, ICM, INSERM U1127, CNRS UMR 7225, Paris, France
| | - Katia Lehongre
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute, ICM, INSERM U1127, CNRS UMR 7225, Paris, France; Centre de NeuroImagerie de Recherche-CENIR, Paris Brain Institute, UMRS 1127, CNRS UMR 7225, Pitié-Salpêtriere Hospital, Paris, France
| | - Claude Adam
- AP-HP, GH Pitie-Salpêtrière-Charles Foix, Epilepsy Unit, Neurology Department, Paris, France
| | - Virginie Lambrecq
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute, ICM, INSERM U1127, CNRS UMR 7225, Paris, France; AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurophysiology, Paris, France; Sorbonne Université, UMR S1127, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute, ICM, INSERM U1127, CNRS UMR 7225, Paris, France; AP-HP, GH Pitie-Salpêtrière-Charles Foix, Epilepsy Unit, Neurology Department, Paris, France; Sorbonne Université, UMR S1127, Paris, France
| | - Lionel Naccache
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute, ICM, INSERM U1127, CNRS UMR 7225, Paris, France; AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurophysiology, Paris, France
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Frazzini V, Whitmarsh S, Lehongre K, Yger P, Lemarechal JD, Mathon B, Adam C, Hasboun D, Lambrecq V, Navarro V. Human periventricular nodular heterotopia shows several interictal epileptic patterns and hyperexcitability of neuronal firing. Front Neurol 2022; 13:1022768. [PMID: 36438938 PMCID: PMC9695411 DOI: 10.3389/fneur.2022.1022768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
Periventricular nodular heterotopia (PNH) is a malformation of cortical development that frequently causes drug-resistant epilepsy. The epileptogenicity of ectopic neurons in PNH as well as their role in generating interictal and ictal activity is still a matter of debate. We report the first in vivo microelectrode recording of heterotopic neurons in humans. Highly consistent interictal patterns (IPs) were identified within the nodules: (1) Periodic Discharges PLUS Fast activity (PD+F), (2) Sporadic discharges PLUS Fast activity (SD+F), and (3) epileptic spikes (ES). Neuronal firing rates were significantly modulated during all IPs, suggesting that multiple IPs were generated by the same local neuronal populations. Furthermore, firing rates closely followed IP morphologies. Among the different IPs, the SD+F pattern was found only in the three nodules that were actively involved in seizure generation but was never observed in the nodule that did not take part in ictal discharges. On the contrary, PD+F and ES were identified in all nodules. Units that were modulated during the IPs were also found to participate in seizures, increasing their firing rate at seizure onset and maintaining an elevated rate during the seizures. Together, nodules in PNH are highly epileptogenic and show several IPs that provide promising pathognomonic signatures of PNH. Furthermore, our results show that PNH nodules may well initiate seizures.
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Affiliation(s)
- Valerio Frazzini
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stephen Whitmarsh
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Katia Lehongre
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Pierre Yger
- Institut de la Vision, INSERM UMRS 968, UPMC UM 80, Paris, France
| | - Jean-Didier Lemarechal
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
- Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille, France
| | - Bertrand Mathon
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
- AP-HP, Pitié Salpêtrière Hospital, Department of Neurosurgery, Paris, France
| | - Claude Adam
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
| | - Dominique Hasboun
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
- AP-HP, Pitié Salpêtrière Hospital, Department de Neuroradiology, Paris, France
| | - Virginie Lambrecq
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Vincent Navarro
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
- *Correspondence: Vincent Navarro
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Marmolejo Castaneda D, Morales-Barrera R, Suarez C, Lozano F, López Molina C, Gonzalez M, Mateo J, Carrion A, Mast R, Roche S, Semidey M, Navarro V, Serrano C, Valverde C, Trilla E, De Torres I, Raventos C, Carles J. Impact of maximal transurethral resection of bladder tumor before neoadjuvant chemotherapy for muscle-invasive bladder cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02579-4] [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: 11/11/2022] Open
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30
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Salazar R, Tafuto S, Krogh M, Teule A, Garcia-Carbonero R, Klumpen H, Cremer B, Sevilla I, Eriksson B, Tabaksblat E, Metges JP, Reed N, Schrader J, Navarro V, Valentí V, Hernando J, Colao A, Vestermark L, Carnaghi C, Capdevila J. LBA45 Randomized open label phase III study comparing the efficacy and safety of everolimus followed by chemotherapy (CT) with streptozotocin (STZ)-5FU upon progression or the reverse sequence, in advanced progressive panNETs: The SEQTOR study (GETNE 1206). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.044] [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: 11/28/2022] Open
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31
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Cedres S, Cruellas M, Assaf J, Iranzo P, Callejo A, Pardo N, Navarro A, Martinez-Marti A, Carbonell C, Frigola J, Amat R, Gonzalo J, Navarro V, Dienstmann R, Balmaña J, Felip E. EP07.01-023 Family History of Cancer in a Series of Malignant Pleural Mesothelioma (MPM) Patients (P). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.555] [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: 11/27/2022]
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Cedres S, Romero L, Assaf J, Iranzo P, Callejo A, Pardo N, Navarro A, Martinez-Marti A, Molina G, Garcia-Illescas D, Sanchez L, Rosado J, Carbonell C, Frigola J, Amat R, Gonzalo J, Navarro V, Dienstmann R, Felip E. EP07.01-022 Analysis of Second Surgery for Recurrence in Malignant Pleural Mesothelioma (MPM) Patients (P). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.554] [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]
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Ros Montana F, Navarro V, Comas R, Garcia Rodriguez A, Gomez D, Saoudi Gonzalez N, Vicente P, Cuadra J, Paez D, Alonso V, Hernandez Martinez A, López Valbuena D, Baraibar Argota I, Salvà Ballabrera F, Tabernero J, Elez Fernandez M. 374P Influence of sex on safety and efficacy in BRAF-V600E mutated metastatic colorectal cancer (mCRC) treated with encorafenib-cetuximab +/-binimetinib (E-C+/-B). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.512] [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: 11/26/2022] Open
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Mirallas O, Marmolejo Castaneda D, Illescas D, Gómez-Puerto D, Berché R, Calvo A, Vieito Villar M, Lorini L, Navarro V, Assaf Pastrana J, Saavedra O, Alonso G, Aguilar Izquierdo S, Bescós C, Lorente J, Giralt J, Dienstmann R, Garralda E, Felip E, Brana I. 686P Next generation sequencing (NGS) helps predict response to immunotherapy (IO) in recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients (pts). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.810] [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: 11/30/2022] Open
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Nadal E, Cantero A, Ortega A, Dómine M, Barba A, Blasco A, García J, Mosquera J, Vázquez S, Rodríguez D, López-Castro R, Juan-Vidal O, Sánchez A, Paz-Ares L, Hernández A, Iranzo P, Diz P, Provencio M, Simó M, Navarro V, Bruna J. EP08.01-029 NIVIPI-BRAIN, A Phase II Study of Nivolumab plus Ipilimumab Combined with Chemotherapy for Patients with NSCLC and Synchronous Brain Metastases. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.601] [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: 11/16/2022]
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Fouad A, Azizollahi H, Le Douget JE, Lejeune FX, Valderrama M, Mayor L, Navarro V, Le Van Quyen M. Interictal epileptiform discharges show distinct spatiotemporal and morphological patterns across wake and sleep. Brain Commun 2022; 4:fcac183. [PMID: 36483575 PMCID: PMC9724782 DOI: 10.1093/braincomms/fcac183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/26/2021] [Revised: 03/24/2022] [Accepted: 07/15/2022] [Indexed: 03/19/2024] Open
Abstract
Presurgical evaluation of mesial temporal and neocortical focal pharmacoresistant epilepsy patients using intracranial EEG recordings has led to the generation of extensive data on interictal epileptiform discharges, located within or remotely from seizure onset zones. In this study, we used this data to investigate how interictal epileptiform discharges are modulated and how their spatial distribution changes during wake and sleep and analysed the relationship between these discharge events and seizure onset zones. Preoperative evaluation data from 11 adult patients with focal pharmacoresistant epilepsy were extracted from the Epilepsiae database. Interictal epileptiform discharges were automatically detected during wakefulness and over several hours of continuous seizure-free sleep (total duration of EEG recordings:106.7 h; mean per patient: 9.7 h), and analysed across four brain areas (mesial temporal, lateral neocortical, basal cortical and the temporal pole). Sleep stages were classified manually from scalp EEG. Discharge events were characterized according to their rate and morphology (amplitude, sharpness and duration). Eight patients had a seizure onset zone over mesial areas and three patients over lateral neocortical areas. Overall, discharge rates varied across brain areas during wakefulness and sleep [wake/sleep stages × brain areas interaction; Wald χ 2(df = 6) = 31.1, P < 0.0001]. N2-N3 non-rapid eye movement sleep increased interictal epileptiform discharges in mesial areas compared with wakefulness and rapid eye movement sleep (P < 0.0001), and to other areas (P < 0.0001 for all comparisons). This mesial pattern was observed both within and outside of seizure onset zones. During wakefulness, the rate of interictal epileptiform discharges was significantly higher than during N2-N3 non-rapid eye movement sleep (P = 0.04), and rapid eye movement sleep (P = 0.01) in lateral neocortical areas (referred to as lateral neocortical pattern), a finding that was more pronounced in seizures onset zones (P = 0.004). The morphological characteristics of the discharge events were modulated during wakefulness and sleep stages across brain areas. The effect of seizure onset zones on discharge morphology was conditioned by brain area and was particularly marked in temporal pole areas. Our analysis of discharge patterns in relation to cerebral localization, vigilance state and the anatomical affiliation of seizure onset zones revealed the global and local aspects of the complex relationship between interictal discharges, sleep and seizure onset zones. This novel approach may lead to a better understanding of cognitive decline and responses to therapy, as well as to adaptation of surgical interventions for epileptic patients.
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Affiliation(s)
- Amal Fouad
- Bioelectrics Lab, Paris Brain Institute (ICM Institut du Cerveau), (UMRS 1127, CNRS UMR 7225), Pitié-Salpêtriere Hospital, 75013 Paris, France
- Department of Neurology, Faculty of medicine, Ain-Shams University, Cairo, Egypt
| | - Hamed Azizollahi
- Bioelectrics Lab, Paris Brain Institute (ICM Institut du Cerveau), (UMRS 1127, CNRS UMR 7225), Pitié-Salpêtriere Hospital, 75013 Paris, France
- Bioserenity, Paris Brain Institute (ICM Institut du Cerveau), 75013 Paris, France
| | - Jean-Eudes Le Douget
- Bioelectrics Lab, Paris Brain Institute (ICM Institut du Cerveau), (UMRS 1127, CNRS UMR 7225), Pitié-Salpêtriere Hospital, 75013 Paris, France
- Bioserenity, Paris Brain Institute (ICM Institut du Cerveau), 75013 Paris, France
| | - François-Xavier Lejeune
- Sorbonne University, Paris, France
- Paris Brain Institute (ICM Institut du Cerveau), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, 75013 Paris, France
- Paris Brain Institute's Data and Analysis Core (ICM Institut du Cerveau), University Hospital Pitié-Salpêtrière, 75013 Paris, France
| | - Mario Valderrama
- Department of Biomedical Engineering, University of los Andes, Bogotá, Colombia
| | | | - Vincent Navarro
- Sorbonne University, Paris, France
- Paris Brain Institute (ICM Institut du Cerveau), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, 75013 Paris, France
- Epileptology Unit, AP-HP Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Michel Le Van Quyen
- Bioelectrics Lab, Paris Brain Institute (ICM Institut du Cerveau), (UMRS 1127, CNRS UMR 7225), Pitié-Salpêtriere Hospital, 75013 Paris, France
- Sorbonne University, Paris, France
- Laboratoire D’Imagerie Biomédicale, (INSERM U1146, UMR7371, CNRS), Sorbonne University, Paris, France
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Guery D, Cousyn L, Navarro V, Picard G, Rogemond V, Bani-Sadr A, Shor N, Joubert B, Muñiz-Castrillo S, Honnorat J, Rheims S. Long-term evolution and prognostic factors of epilepsy in limbic encephalitis with LGI1 antibodies. J Neurol 2022; 269:5061-5069. [PMID: 35595970 DOI: 10.1007/s00415-022-11162-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To characterize the evolution of epilepsy in patients with leucine-rich glioma inactivated 1 antibody-associated (LGI1ab) limbic encephalitis, including factors associated with drug-resistant epilepsy (DRE). METHODS Retrospective analysis of patients with LGI1 encephalitis managed at two tertiary epilepsy centers between 2005 and 2019 and whose samples were confirmed by the French Reference Center of Paraneoplastic Neurological Syndromes. Raw clinical, biological, EEG, and MRI data were reviewed. Two endpoints were defined: (i) Epilepsy remission: patients seizure free and in whom anti-seizure medications (ASM) have been stopped for at least 1 year at the last follow-up visit (ii) DRE: patients with persistent seizures at the last follow-up despite at least two ASM used at efficacious daily dose. RESULTS 39 patients with LGI1 encephalitis were included with a median follow-up duration of 42 months (range 13-169). All of them reported seizures at the acute phase, with faciobrachial dystonic seizures (FBDS) in 23 (59%) and other focal seizures in 38 (97%), including 4 patients (10%) with de novo status epilepticus. At the last follow-up visit, 11 patients (28%) achieved epilepsy remission. Among the 28 patients with persistent epilepsy, eight (29%) fulfilled criteria of DRE. The only factor significantly associated with epilepsy remission was the time from clinical onset of the encephalitis to initiation of the first immunomodulatory treatment, with longer delay in patients with persistent epilepsy (7.5 ± 8.9 vs 2.4 ± 1.7 months, p = 0.006). Evolution to DRE was only driven by MRI evolution. Eight of the 15 patients (53%) who developed hippocampal atrophy (p = 0.007) also suffered from drug-resistant seizures at the last follow-up. SIGNIFICANCE In patients with LGI1 encephalitis, rapid initiation of immunomodulatory treatment favors long-term epilepsy remission. Evolution to DRE might primarily reflect the anatomical lesion of limbic structures. Determining what modalities of immune treatment may alter these outcomes requires prospective studies with long-term follow-up.
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Affiliation(s)
- Déborah Guery
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Louis Cousyn
- Epileptology Unit, Assistance Publique-Hôpitaux de Paris Groupe Hospitalier Pitié-Salpêtrière and Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC University Paris 06), Paris, France
| | - Vincent Navarro
- Epileptology Unit, Assistance Publique-Hôpitaux de Paris Groupe Hospitalier Pitié-Salpêtrière and Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC University Paris 06), Paris, France
| | - Géraldine Picard
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France
| | - Véronique Rogemond
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, Université de Lyon, Hospices Civils de Lyon, Lyon, France
| | - Natalia Shor
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Bastien Joubert
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.,MELIS UMR Inserm 1314/ CNRS 5284, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Sergio Muñiz-Castrillo
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.,MELIS UMR Inserm 1314/ CNRS 5284, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Jérome Honnorat
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.,MELIS UMR Inserm 1314/ CNRS 5284, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France. .,Lyon's Neurosciences Research Center, INSERM U1028CNRSUMR 5292, University Claude Bernard Lyon 1, Lyon, France. .,University Claude Bernard Lyon 1, Lyon, France.
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Cerrolaza M, Sanagustin P, Navarro V, Escuin C, Lanuza A, Flamarique S, Campos A, Lanzuela M, Ibañez R, Tejedor M. PO-1436 Radical radiotherapy for non-melanoma skin cancer: orthovoltage vs. electronic brachytherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03400-4] [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: 10/18/2022]
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Cerrolaza M, Mendez A, Puertas M, Navarro V, Escuin C, Lanuza A, García C, García B, Villa D, Tejedor M. PO-1412 Long-term PRQoL outcomes analysis of low-dose-rate brachytherapy prostate cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cerrolaza M, Mendez A, Miranda A, Navarro V, Escuin C, Campos A, Flamarique S, Gascon M, Lozares S, Ibañez R. PO-1339 Long- term outcomes after electronic brachytherapy in the adjuvant treatment of endometrial cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03303-5] [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: 11/26/2022]
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Nadjar Y, Levy P, Nguyen-Michel VH, Luyt CE, Puybasset L, Navarro V. Prognostic value of electroencephalographic paroxysms in post-anoxic coma: A new regularity EEG-based score. Neurophysiol Clin 2022; 52:223-231. [PMID: 35490145 DOI: 10.1016/j.neucli.2022.03.007] [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: 02/25/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Several electroencephalographic (EEG) features -mainly the reactivity of background activity-have been suggested as reliable predictors of outcome for patients with post-anoxic coma (PAC). However, EEG in PAC often contains abundant EEG paroxysms (EP) that may hinder the detection of background EEG activity. We aimed to identify the features, among the different paroxysmal and non-paroxysmal EEG patterns, that may predict the outcome of patients with PAC. METHODS We retrospectively reviewed the clinical and EEG characteristics of 67 patients with PAC and selected those with abundant EP. We classified EP according to several features and assessed their prognostic value for survival at 15 days. We calculated a global regularity score, as the sum of the value (1 if regular, 0 if not) attributed to each of 4 features of EP (duration, morphology, amplitude, and frequency). RESULTS The 35 patient-group with abundant EP showed a higher mortality than the group without abundant EP. Among 12 features of EP, four regularity features (regularity of EP duration, morphology, amplitude, and global regularity score) had a poor prognostic value. A global regularity score ≥ 3 showed a positive predictive value of 100 % for a poor outcome and a negative predictive value of 54 %, with good interrater consistency (Cohen's kappa = .63). CONCLUSIONS The presence of EP and their regularity features in PAC patients are strongly associated with poor outcome. We propose a global regularity score, easily derived from visual EEG inspection, that may be a reliable prognostic tool for these patients. Prospective and larger studies are needed to confirm these findings.
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Affiliation(s)
- Yann Nadjar
- AP-HP, Epileptology Unit and Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, DMU Neuroscience, Paris 75013, France
| | - Pierre Levy
- AP-HP, Public Health Departement and Clinical Neurophysiology Unit, Tenon Hospital, Paris, France
| | - Vi-Huong Nguyen-Michel
- AP-HP, Epileptology Unit and Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, DMU Neuroscience, Paris 75013, France
| | - Charles-Edouard Luyt
- AP-HP, Medical Intensive Care Department, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France
| | - Louis Puybasset
- AP-HP, Neurosurgical Intensive Care Department, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France
| | - Vincent Navarro
- AP-HP, Epileptology Unit and Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, DMU Neuroscience, Paris 75013, France; Sorbonne Université, Paris, France; Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Paris Brain Institute, ICM, INSERM, CNRS, sorbonne Université, Paris, France.
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Lehongre K, Lambrecq V, Whitmarsh S, Frazzini V, Cousyn L, Soleil D, Fernandez-Vidal S, Mathon B, Houot M, Lemarechal JD, Clemenceau S, Hasboun D, Adam C, Navarro V. Long-term deep intracerebral microelectrode recordings in patients with drug-resistant epilepsy: proposed guidelines based on 10-year experience. Neuroimage 2022; 254:119116. [PMID: 35318150 DOI: 10.1016/j.neuroimage.2022.119116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/23/2022] [Accepted: 03/15/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Human neuronal activity, recorded in vivo from microelectrodes, may offer valuable insights into physiological mechanisms underlying human cognition and pathophysiological mechanisms of brain diseases, in particular epilepsy. Continuous and long-term recordings are necessary to monitor non predictable pathological and physiological activities like seizures or sleep. Because of their high impedance, microelectrodes are more sensitive to noise than macroelectrodes. Low noise levels are crucial to detect action potentials from background noise, and to further isolate single neuron activities. Therefore, long-term recordings of multi-unit activity remains a challenge. We shared here our experience with microelectrode recordings and our efforts to reduce noise levels in order to improve signal quality. We also provided detailed technical guidelines for the connection, recording, imaging and signal analysis of microelectrode recordings. RESULTS During the last 10 years, we implanted 122 bundles of Behnke-Fried hybrid macro-microelectrodes, in 56 patients with pharmacoresistant focal epilepsy. Microbundles were implanted in the temporal lobe (74%), as well as frontal (15%), parietal (6%) and occipital (5%) lobes. Low noise levels depended on our technical setup. The noise reduction was mainly obtained after electrical insulation of the patient's recording room and the use of a reinforced microelectrode model, reaching median root mean square values of 5.8 µV. Seventy percent of the bundles could record multi-units activities (MUA), on around 3 out of 8 wires per bundle and for an average of 12 days. Seizures were recorded by microelectrodes in 91% of patients, when recorded continuously, and MUA were recorded during seizures for 75 % of the patients after the insulation of the room. Technical guidelines are proposed for (i) electrode tails manipulation and protection during surgical bandage and connection to both clinical and research amplifiers, (ii) electrical insulation of the patient's recording room and shielding, (iii) data acquisition and storage, and (iv) single-units activities analysis. CONCLUSIONS We progressively improved our recording setup and are now able to record (i) microelectrode signals with low noise level up to 3 weeks duration, and (ii) MUA from an increased number of wires . We built a step by step procedure from electrode trajectory planning to recordings. All these delicate steps are essential for continuous long-term recording of units in order to advance in our understanding of both the pathophysiology of ictogenesis and the neuronal coding of cognitive and physiological functions.
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Affiliation(s)
- Katia Lehongre
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France
| | - Virginie Lambrecq
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Département de Neurophysiologie, Hôpital Pitié-Salpêtrière, DMU Neurosciences, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Stephen Whitmarsh
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France
| | - Valerio Frazzini
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Département de Neurophysiologie, Hôpital Pitié-Salpêtrière, DMU Neurosciences, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Louis Cousyn
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Daniel Soleil
- Bureau d'Etudes CEMS, 801 Route d'Eyguieres, 13 560 Senas, France
| | - Sara Fernandez-Vidal
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France
| | - Bertrand Mathon
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Service de Neurochirurgie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marion Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.; Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital Paris, France
| | - Jean-Didier Lemarechal
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille, France
| | | | - Dominique Hasboun
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Service de Neuroradiologie, Pitié-Salpêtrière Hospital, Paris, France
| | - Claude Adam
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Département de Neurophysiologie, Hôpital Pitié-Salpêtrière, DMU Neurosciences, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France; AP-HP, Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France.
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Frazzini V, Mathon B, Donneger F, Cousyn L, Hanin A, Nguyen-Michel VH, Adam C, Lambrecq V, Dupont S, Poncer JC, Bielle F, Navarro V. Epilepsy related to focal neuronal lipofuscinosis: extra-frontal localization, EEG signatures and GABA involvement. J Neurol 2022; 269:4102-4109. [DOI: 10.1007/s00415-022-11024-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 12/21/2022]
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Axelrod V, Rozier C, Malkinson TS, Lehongre K, Adam C, Lambrecq V, Navarro V, Naccache L. Face-selective multi-unit activity in the proximity of the FFA modulated by facial expression stimuli. Neuropsychologia 2022; 170:108228. [DOI: 10.1016/j.neuropsychologia.2022.108228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 02/13/2022] [Accepted: 03/23/2022] [Indexed: 01/02/2023]
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Hanin A, Denis JA, Frazzini V, Cousyn L, Imbert-Bismut F, Rucheton B, Bonnefont-Rousselot D, Marois C, Lambrecq V, Demeret S, Navarro V. Neuron Specific Enolase, S100-beta protein and progranulin as diagnostic biomarkers of status epilepticus. J Neurol 2022; 269:3752-3760. [PMID: 35190890 DOI: 10.1007/s00415-022-11004-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
Status epilepticus (SE) is a life-threatening prolonged epileptic seizure. A rapid diagnosis is fundamental to initiate antiepileptic treatment and to prevent the development of neurological sequels. Several serum and cerebrospinal fluid biomarkers have been proposed to help in the diagnosis of SE. Nevertheless, previous studies were conducted on too small patient cohorts, precluding the utilization of interesting biomarkers for the SE diagnosis. Here, we aimed to assess the ability of Neuron Specific Enolase (NSE), S100-beta protein (S100B) and progranulin to help in the diagnosis of SE in a large cohort of patients (36 control patients, 56 patients with pharmacoresistant epilepsy and 82 SE patients). Blood NSE, S100B and progranulin levels were higher in SE patients when compared with control patients or patients with pharmacoresistant epilepsy. Both NSE and progranulin levels were higher in cerebrospinal fluid from SE patients when compared with control patients. The receiver-operating characteristics curves revealed good accuracy at detecting SE for serum S100B (AUC 0.748) and plasma progranulin (AUC 0.756). The performances were lower for serum NSE (AUC 0.624). Eighty-four percent of patients with serum S100B levels above 0.09 ng/mL presented with a SE, whereas 90% of patients without SE had serum S100B levels lower than 0.09 ng/mL. Serum S100B levels were not significantly different according to SE etiology, SE semiology or SE refractoriness. Our results confirm that NSE, S100B and progranulin levels are increased after SE. We suggest that serum S100B levels might be added to clinical evaluation and electroencephalogram to identify difficult-to-diagnose form of SE.
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Affiliation(s)
- Aurélie Hanin
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.,AP-HP, Epilepsy Unit and Clinical Neurophysiology Department, DMU Neurosciences, Pitié-Salpêtrière Hospital, Paris, France
| | - Jérôme Alexandre Denis
- Sorbonne Université, Paris, France.,AP-HP, Endocrine and Oncological Biochemistry Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Valerio Frazzini
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.,AP-HP, Epilepsy Unit and Clinical Neurophysiology Department, DMU Neurosciences, Pitié-Salpêtrière Hospital, Paris, France
| | - Louis Cousyn
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.,AP-HP, Epilepsy Unit and Clinical Neurophysiology Department, DMU Neurosciences, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Benoit Rucheton
- AP-HP, Metabolic Biochemistry Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Dominique Bonnefont-Rousselot
- AP-HP, Metabolic Biochemistry Department, Pitié-Salpêtrière Hospital, Paris, France.,UTCBS, CNRS, INSERM, Université de Paris, Paris, France
| | - Clémence Marois
- AP-HP, Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Virginie Lambrecq
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.,AP-HP, Epilepsy Unit and Clinical Neurophysiology Department, DMU Neurosciences, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne Université, Paris, France
| | - Sophie Demeret
- AP-HP, Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France. .,AP-HP, Epilepsy Unit and Clinical Neurophysiology Department, DMU Neurosciences, Pitié-Salpêtrière Hospital, Paris, France. .,Sorbonne Université, Paris, France. .,AP-HP, Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France.
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Ekmen A, Meneret A, Valabregue R, Beranger B, Worbe Y, Lamy JC, Mehdi S, Herve A, Adanyeguh I, Temiz G, Damier P, Gras D, Roubertie A, Piard J, Navarro V, Mutez E, Riant F, Welniarz Q, Vidailhet M, Lehericy S, Meunier S, Gallea C, Roze E. Cerebellum Dysfunction in Patients With PRRT2-Related Paroxysmal Dyskinesia. Neurology 2022; 98:e1077-e1089. [DOI: 10.1212/wnl.0000000000200060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives:The main culprit gene for paroxysmal kinesigenic dyskinesia, characterized by brief and recurrent attacks of involuntary movements, is PRRT2. The location of the primary dysfunction associated with paroxysmal dyskinesia remains a matter of debate and may vary depending on the etiology. While striatal dysfunction has often been implicated in these patients, evidence from preclinical models indicate that the cerebellum could also play a role. We aimed to investigate the role of the cerebellum in the pathogenesis of PRRT2-related dyskinesia in humans.Methods:We enrolled 22 consecutive right-handed patients with paroxysmal kinesigenic dyskinesia with a pathogenic variant of PRRT2, and their matched controls. Participants underwent a multi-modal neuroimaging protocol. We recorded anatomic and diffusion-weighted MRI, as well as resting-state functional MRI during which we tested the after-effects of sham and repetitive transcranial magnetic stimulation applied to the cerebellum on endogenous brain activity. We quantified: (i) the structural integrity of gray matter using voxel-based morphometry; (ii) the structural integrity of white matter using fixel-based analysis; (iii) the strength and direction of functional cerebellar connections using spectral dynamic causal modeling.Results:PRRT2 patients had: (i) decreased gray matter volume in the cerebellar lobule VI and in the medial prefrontal cortex; (ii) microstructural alterations of white matter in the cerebellum and along the tracts connecting the cerebellum to the striatum and the cortical motor areas; (iii) dysfunction of cerebellar motor pathways to the striatum and the cortical motor areas, as well as abnormal communication between the associative cerebellum (Crus I) and the medial prefrontal cortex. Cerebellar stimulation modulated communication within the motor and associative cerebellar networks, and tended to restore this communication to the level observed in healthy controls.Discussion:Patients with PRRT2-related dyskinesia have converging structural alterations of the motor cerebellum and related pathways with a dysfunction of cerebellar output towards the cerebello-thalamo-striato-cortical network. We hypothesize that abnormal cerebellar output is the primary dysfunction in patients with a PRRT2 pathogenic variant, resulting in striatal dysregulation and paroxysmal dyskinesia. More broadly, striatal dysfunction in paroxysmal dyskinesia might be secondary to aberrant cerebellar output transmitted by thalamic relays in certain disorders.Clinical trial number:NCT03481491 (https://ichgcp.net/clinical-trials-registry/NCT03481491)
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Mathon B, Favreau M, Degos V, Amelot A, Le Joncour A, Weiss N, Rohaut B, Le Guennec L, Boch AL, Carpentier A, Bielle F, Mokhtari K, Idbaih A, Touat M, Combes A, Demoule A, Shotar E, Navarro V, Raux M, Demeret S, Pineton De Chambrun M. Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield. Crit Care Med 2022; 50:e516-e525. [PMID: 34995211 DOI: 10.1097/ccm.0000000000005439] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Brain biopsy is a useful surgical procedure in the management of patients with suspected neoplastic lesions. Its role in neurologic diseases of unknown etiology remains controversial, especially in ICU patients. This study was undertaken to determine the feasibility, safety, and the diagnostic yield of brain biopsy in critically ill patients with neurologic diseases of unknown etiology. We also aimed to compare these endpoints to those of non-ICU patients who underwent a brain biopsy in the same clinical context. DESIGN Monocenter, retrospective, observational cohort study. SETTING A French tertiary center. PATIENTS All adult patients with neurologic diseases of unknown etiology under mechanical ventilation undergoing in-ICU brain biopsy between January 2008 and October 2020 were compared with a cohort of non-ICU patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among the 2,207 brain-biopsied patients during the study period, 234 biopsies were performed for neurologic diseases of unknown etiology, including 29 who were mechanically ventilated and 205 who were not ICU patients. Specific histological diagnosis and final diagnosis rates were 62.1% and 75.9%, respectively, leading to therapeutic management modification in 62.1% of cases. Meningitis on prebiopsy cerebrospinal fluid analysis was the sole predictor of obtaining a final diagnosis (2.3 [1.4-3.8]; p = 0.02). ICU patients who experienced therapeutic management modification after the biopsy had longer survival (p = 0.03). The grade 1 to 4 (mild to severe) complication rates were: 24.1%, 3.5%, 0%, and 6.9%, respectively. Biopsy-related mortality was significantly higher in ICU patients compared with non-ICU patients (6.9% vs 0%; p = 0.02). Hematological malignancy was associated with biopsy-related mortality (1.5 [1.01-2.6]; p = 0.04). CONCLUSIONS Brain biopsy in critically ill patients with neurologic disease of unknown etiology is associated with high diagnostic yield, therapeutic modifications and postbiopsy survival advantage. Safety profile seems acceptable in most patients. The benefit/risk ratio of brain biopsy in this population should be carefully weighted.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, AP-HP, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France. Paris Brain Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, UMRS 1127, Paris, France. Department of Neurosurgical Anesthesiology and Critical Care, AP-HP, Sorbonne University, La Pitié Salpêtrière Hospital, Paris, France. Department of Internal Medicine and Clinical Immunology, AP-HP, Sorbonne University, La Pitié Salpêtrière Hospital, Paris, France. Department of Neurology, Neuro-ICU, AP-HP, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France. Brain Liver Pitié-Salpêtrière Study Group, INSERM UMR S 938, Centre de Recherche Saint-Antoine, Sorbonne University, Paris, France. Department of Neuropathology, AP-HP, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France. Department of Neurology, Sorbonne University, DMU Neurosciences, AP-HP, La Pitié-Salpêtrière Hospital, Paris, France. Intensive Care Medicine Department, AP-HP, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France. Intensive Care Medicine Department (R3S Department), AP-HP, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France. INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France. Department of Neuroradiology, AP-HP, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France. Department of Neurology, Epileptology Unit, AP-HP, Sorbonne University, La Pitié Salpêtrière Hospital, Paris, France. Department of Anesthesiology and Critical Care, AP-HP, Sorbonne University, La Pitié Salpêtrière Hospital, Paris, France. Department of Internal Medicine 2, AP-HP, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France. INSERM, UMRS 1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
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Abstract
Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy. First descriptions of TLE date back in time and detailed portraits of epileptic seizures of temporal origin can be found in early medical reports as well as in the works of various artists and dramatists. Depending on the seizure onset zone, several subtypes of TLE have been identified, each one associated with peculiar ictal semiology. TLE can result from multiple etiological causes, ranging from genetic to lesional ones. While the diagnosis of TLE relies on detailed analysis of clinical as well as electroencephalographic (EEG) features, the lesions responsible for seizure generation can be highlighted by multiple brain imaging modalities or, in selected cases, by genetic investigations. TLE is the most common cause of refractory epilepsy and despite the great advances in diagnostic tools, no lesion is found in around one-third of patients. Surgical treatment is a safe and effective option, requiring presurgical investigations to accurately identify the seizure onset zone (SOZ). In selected cases, presurgical investigations need intracerebral investigations (such as stereoelectroencephalography) or dedicated metabolic imaging techniques (interictal PET and ictal SPECT) to correctly identify the brain structures to be removed.
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Affiliation(s)
- Valerio Frazzini
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Louis Cousyn
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Vincent Navarro
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France.
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Bacq A, Roussel D, Bonduelle T, Zagaglia S, Maletic M, Ribierre T, Adle‐Biassette H, Marchal C, Jennesson M, An I, Picard F, Navarro V, Sisodiya SM, Baulac S. Cardiac Investigations in Sudden Unexpected Death in DEPDC5-Related Epilepsy. Ann Neurol 2022; 91:101-116. [PMID: 34693554 PMCID: PMC9299146 DOI: 10.1002/ana.26256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/13/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Germline loss-of-function mutations in DEPDC5, and in its binding partners (NPRL2/3) of the mammalian target of rapamycin (mTOR) repressor GATOR1 complex, cause focal epilepsies and increase the risk of sudden unexpected death in epilepsy (SUDEP). Here, we asked whether DEPDC5 haploinsufficiency predisposes to primary cardiac defects that could contribute to SUDEP and therefore impact the clinical management of patients at high risk of SUDEP. METHODS Clinical cardiac investigations were performed in 16 patients with pathogenic variants in DEPDC5, NPRL2, or NPRL3. Two novel Depdc5 mouse strains, a human HA-tagged Depdc5 strain and a Depdc5 heterozygous knockout with a neuron-specific deletion of the second allele (Depdc5c/- ), were generated to investigate the role of Depdc5 in SUDEP and cardiac activity during seizures. RESULTS Holter, echocardiographic, and electrocardiographic (ECG) examinations provided no evidence for altered clinical cardiac function in the patient cohort, of whom 3 DEPDC5 patients succumbed to SUDEP and 6 had a family history of SUDEP. There was no cardiac injury at autopsy in a postmortem DEPDC5 SUDEP case. The HA-tagged Depdc5 mouse revealed expression of Depdc5 in the brain, heart, and lungs. Simultaneous electroencephalographic-ECG records on Depdc5c/- mice showed that spontaneous epileptic seizures resulting in a SUDEP-like event are not preceded by cardiac arrhythmia. INTERPRETATION Mouse and human data show neither structural nor functional cardiac damage that might underlie a primary contribution to SUDEP in the spectrum of DEPDC5-related epilepsies. ANN NEUROL 2022;91:101-116.
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Affiliation(s)
- Alexandre Bacq
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, AP‐HP, Pitié‐Salpêtrière HospitalParisFrance
| | - Delphine Roussel
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, AP‐HP, Pitié‐Salpêtrière HospitalParisFrance
| | - Thomas Bonduelle
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, AP‐HP, Pitié‐Salpêtrière HospitalParisFrance
- Epilepsy and Neurology Department, Bordeaux University Hospital CenterBordeauxFrance
| | - Sara Zagaglia
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyBucksUK
| | - Marina Maletic
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, AP‐HP, Pitié‐Salpêtrière HospitalParisFrance
| | - Théo Ribierre
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, AP‐HP, Pitié‐Salpêtrière HospitalParisFrance
| | - Homa Adle‐Biassette
- Pathological Anatomy Department, University of Paris, AP‐HP, Lariboisière Hospital, DMU, DREAM, UMR 1141, INSERMParisFrance
| | - Cécile Marchal
- Epilepsy and Neurology Department, Bordeaux University Hospital CenterBordeauxFrance
| | - Mélanie Jennesson
- Department of PediatricsAmerican Memorial Hospital, Reims University Hospital CenterReimsFrance
| | - Isabelle An
- Epileptology Unit and Reference Center of Rare Epilepsies, Pitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | - Fabienne Picard
- EEG and Epilepsy Unit, Department of Clinical NeurosciencesUniversity Hospitals and Faculty of Medicine of GenevaGenevaSwitzerland
| | - Vincent Navarro
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, AP‐HP, Pitié‐Salpêtrière HospitalParisFrance
- Epileptology Unit and Reference Center of Rare Epilepsies, Pitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUniversity College London Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyBucksUK
| | - Stéphanie Baulac
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, AP‐HP, Pitié‐Salpêtrière HospitalParisFrance
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Miceli G, Bartolomeo P, Navarro V. Preface. Handb Clin Neurol 2022; 187:xi-xii. [PMID: 35964996 DOI: 10.1016/b978-0-12-823493-8.09997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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