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Chu PC, Yu HY, Fisher RS, Liu HL. Neuromodulatory Focused Ultrasound for Epilepsy: Are Animal Models Useful? ACS Chem Neurosci 2024; 15:1728-1731. [PMID: 38634833 PMCID: PMC11066834 DOI: 10.1021/acschemneuro.4c00198] [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: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Ultrasound neuromodulation is a potential alternative therapy for suppressing epileptic discharges. Recently, several human clinical trials have reported promising results from repeated focused ultrasound (FUS) treatments for temporal lobe epilepsy. In this Viewpoint, we highlight the valuable guidance of preclinical validation methods for choosing the optimal FUS parameters, thus ensuring consistency with the outcomes of clinical trials and leading human trials to the safest and most effective approaches.
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Affiliation(s)
- Po-Chun Chu
- Department
of Electrical Engineering, National Taiwan
University, Taipei
City 10617, Taiwan
| | - Hsiang-Yu Yu
- Department
of Neurology, Taipei Veteran General Hospital, Taipei City 11217, Taiwan
- School of
Medicine, National Yang Ming Chiao Tung
University, Taipei City 112304, Taiwan
| | - Robert S. Fisher
- Department
of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California 94305, United States
| | - Hao-Li Liu
- Department
of Electrical Engineering, National Taiwan
University, Taipei
City 10617, Taiwan
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Ma Z, Xu Y, Baier G, Liu Y, Li B, Zhang L. Dynamical modulation of hypersynchronous seizure onset with transcranial magneto-acoustic stimulation in a hippocampal computational model. Chaos 2024; 34:043107. [PMID: 38558041 DOI: 10.1063/5.0181510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
Hypersynchronous (HYP) seizure onset is one of the frequently observed seizure-onset patterns in temporal lobe epileptic animals and patients, often accompanied by hippocampal sclerosis. However, the exact mechanisms and ion dynamics of the transition to HYP seizures remain unclear. Transcranial magneto-acoustic stimulation (TMAS) has recently been proposed as a novel non-invasive brain therapy method to modulate neurological disorders. Therefore, we propose a biophysical computational hippocampal network model to explore the evolution of HYP seizure caused by changes in crucial physiological parameters and design an effective TMAS strategy to modulate HYP seizure onset. We find that the cooperative effects of abnormal glial uptake strength of potassium and excessive bath potassium concentration could produce multiple discharge patterns and result in transitions from the normal state to the HYP seizure state and ultimately to the depolarization block state. Moreover, we find that the pyramidal neuron and the PV+ interneuron in HYP seizure-onset state exhibit saddle-node-on-invariant-circle/saddle homoclinic (SH) and saddle-node/SH at onset/offset bifurcation pairs, respectively. Furthermore, the response of neuronal activities to TMAS of different ultrasonic waveforms revealed that lower sine wave stimulation can increase the latency of HYP seizures and even completely suppress seizures. More importantly, we propose an ultrasonic parameter area that not only effectively regulates epileptic rhythms but also is within the safety limits of ultrasound neuromodulation therapy. Our results may offer a more comprehensive understanding of the mechanisms of HYP seizure and provide a theoretical basis for the application of TMAS in treating specific types of seizures.
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Affiliation(s)
- Zhiyuan Ma
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing 100124, China
| | - Yuejuan Xu
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing 100124, China
| | - Gerold Baier
- Cell and Developmental Biology, Faculty of Life Sciences, University College London, London WC1E 6BT, United Kingdom
| | - Youjun Liu
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing 100124, China
| | - Bao Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing 100124, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing 100124, China
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Cho S, Lee HJ, Lee SH, Kim KM, Chu MK, Kim J, Heo K. Long-term outcome of treatment-naïve patients with mesial temporal lobe epilepsy with hippocampal sclerosis: A retrospective study in a single center. Seizure 2024; 117:36-43. [PMID: 38308907 DOI: 10.1016/j.seizure.2024.01.018] [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: 11/24/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024] Open
Abstract
PURPOSE This study aimed to describe long-term treatment outcomes of treatment-naïve patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). METHODS A retrospective review was conducted of treatment-naïve patients with MTLE-HS who visited the Yonsei Epilepsy Clinic from April 2000 to April 2022 and were followed up for at least 2 years. Seizure freedom (SF) was defined as no seizures or auras only for >1 year, and complete SF was defined as no seizures including auras for >1 year. RESULTS Eighty-four treatment-naïve patients with MTLE-HS with a median follow-up of 122 months were included. Except for one patient who underwent early surgical treatment, of the remaining 83 patients, 31 (37.3 %) achieved SF and remained in remission, 38 (45.8 %) had fluctuations in seizure control, and 14 (16.9 %) never achieved SF. Additionally, 18 (21.7 %) patients achieved complete SF and remained in remission, 42 (50.6 %) showed fluctuations, and 23 (27.7 %) never achieved complete SF. Fifty-three (63.9 %) patients achieved SF and 34 (41.0 %) achieved complete SF at their last visit. Older age at epilepsy onset, male sex, low pretreatment seizure density, history of central nervous system infection before age 5, absence of aura, and fewer antiseizure medications in the final regimen were associated with favorable outcome. Of the 84 patients, 11 (13.1 %) underwent temporal lobectomy. CONCLUSIONS Medical treatment outcomes in treatment-naïve MTLE-HS were relatively better than previously reported outcomes in MTLE-HS, although frequent fluctuations in seizure control were observed.
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Affiliation(s)
- Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Jeong Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Sue Hyun Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Kleis P, Paschen E, Häussler U, Haas CA. Low frequency stimulation for seizure suppression: Identification of optimal targets in the entorhinal-hippocampal circuit. Brain Stimul 2024; 17:395-404. [PMID: 38531502 DOI: 10.1016/j.brs.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS) is a common form of drug-resistant focal epilepsy in adults. Treatment for pharmacoresistant patients remains a challenge, with deep brain stimulation (DBS) showing promise for alleviating intractable seizures. This study explores the efficacy of low frequency stimulation (LFS) on specific neuronal targets within the entorhinal-hippocampal circuit in a mouse model of MTLE. OBJECTIVE Our previous research demonstrated that LFS of the medial perforant path (MPP) fibers in the sclerotic hippocampus reduced seizures in epileptic mice. Here, we aimed to identify the critical neuronal population responsible for this antiepileptic effect by optogenetically stimulating presynaptic and postsynaptic compartments of the MPP-dentate granule cell (DGC) synapse at 1 Hz. We hypothesize that specific targets for LFS can differentially influence seizure activity depending on the cellular identity and location within or outside the seizure focus. METHODS We utilized the intrahippocampal kainate (ihKA) mouse model of MTLE and targeted specific neural populations using optogenetic stimulation. We recorded intracranial neuronal activity from freely moving chronically epileptic mice with and without optogenetic LFS up to 3 h. RESULTS We found that LFS of MPP fibers in the sclerotic hippocampus effectively suppressed epileptiform activity while stimulating principal cells in the MEC had no impact. Targeting DGCs in the sclerotic septal or non-sclerotic temporal hippocampus with LFS did not reduce seizure numbers but shortened the epileptiform bursts. CONCLUSION Presynaptic stimulation of the MPP-DGC synapse within the sclerotic hippocampus is critical for seizure suppression via LFS.
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Affiliation(s)
- Piret Kleis
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Enya Paschen
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Ute Häussler
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany
| | - Carola A Haas
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany.
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Zhou Q, Zhang N, Wang M, Zhao Q, Zhu S, Kang H. Adenosine kinase gene modified mesenchymal stem cell transplantation retards seizure severity and associated cognitive impairment in a temporal lobe epilepsy rat model. Epilepsy Res 2024; 200:107303. [PMID: 38306957 DOI: 10.1016/j.eplepsyres.2024.107303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/05/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE Temporal lobe epilepsy (TLE) has a high risk of developing drug resistant and cognitive comorbidities. Adenosine has potential anticonvulsant effects as an inhibitory neurotransmitter, but drugs targeting its receptors and metabolic enzyme has inevitable side effects. Therefore, we investigated adenosine augmentation therapy for seizure control and cognitive comorbidities in TLE animals. METHODS Using lentiviral vectors coexpressing miRNA inhibiting the expression of adenosine kinase (ADK), we produced ADK--rMSC (ADK knockdown rat mesenchymal stem cell). ADK--rMSC and LV-con-rMSC (rMSC transduced by randomized scrambled control sequence) were transplanted into the hippocampus of TLE rat respectively. ADK-+DPCPX group was transplanted with ADK--rMSC and intraperitoneally injected with DPCPX (adenosine A1 receptor antagonist). Seizure behavior, EEG, CA1 pyramidal neuron apoptosis, and behavior in Morris water maze and novel object recognition test were studied RESULTS: Adenosine concentration in the supernatants of 105 ADK--rMSCs was 13.8 ng/ml but not detectable in LV-con-rMSCs. ADK--rMSC (n = 11) transplantation decreased spontaneous recurrent seizure (SRS) duration compared to LV-con-rMSC (n = 11, P < 0.05). CA1 neuron apoptosis was decreased in ADK--rMSC (n = 3, P < 0.05). ADK--rMSC (n = 11) improved the Morris water maze performance of TLE rats compared to LV-con-rMSC (n = 11, escape latency, P < 0.01; entries in target quadrant, P < 0.05). The effect of ADK--rMSC on neuron apoptosis and spatial memory were counteracted by DPCPX. However, ADK--rMSC didn't improve the performance in novel object recognition test. CONCLUSION Adenosine augmentation-based ADK--rMSC transplantation is a promising therapeutic candidate for TLE and related cognitive comorbidities.
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Affiliation(s)
- Qing Zhou
- Department of Neurology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Na Zhang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang 330006, People's Republic of China
| | - Man Wang
- Department of Neurology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Qin Zhao
- Department of Neurology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Huicong Kang
- Department of Neurology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China.
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Pan L, Wang J, Wu W, Wang Y, Zhu Y, Song Y. Transcutaneous auricular vagus nerve stimulation improves working memory in temporal lobe epilepsy: A randomized double-blind study. CNS Neurosci Ther 2024; 30:e14395. [PMID: 37553557 PMCID: PMC10848055 DOI: 10.1111/cns.14395] [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: 03/10/2023] [Revised: 06/08/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
AIMS This study investigated the impact of transcutaneous auricular vagus nerve stimulation (taVNS) on working memory (WM) in refractory temporal lobe epilepsy (rTLE) and the underlying mechanisms. METHODS In this randomized double-blind study, 28 rTLE patients were subjected to an active or sham taVNS (a/s-taVNS) protocol for 20 weeks (a-taVNS group, n = 19; s-ta VNS group, n = 9). Patients performed visual WM tasks during stimulation and neural oscillations were simultaneously recorded by 19-channel electroencephalography. RESULTS Compared with the baseline state, reaction time was significantly shorter after 20 weeks of taVNS in the a-taVNS group (p = 0.010), whereas no difference was observed in the s-taVNS group (p > 0.05). The power spectral density (PSD) of the theta frequency band in the Fz channel decreased significantly after a-taVNS during WM-encoding (p = 0.020), maintenance (p = 0.038), and retrieval (p = 0.039) phases, but not in the s-taVNS group (all p > 0.05). CONCLUSION Neural oscillations during WM were altered by taVNS and WM performance was improved. Alterations in frontal midline theta oscillations may be a marker for the effect of taVNS on cognitive regulation.
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Affiliation(s)
- Liping Pan
- General Medicine DepartmentTianjin Medical University General HospitalTianjinChina
| | - Jiajing Wang
- Department of Intensive Care Medicine, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Medical UniversityTianjinChina
| | - Wenjuan Wu
- Department of NeurologyThe First Affiliated Hospital of Henan University of Science and TechnologyLuoyangChina
| | | | | | - Yijun Song
- Department of Intensive Care Medicine, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
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Paschen E, Kleis P, Vieira DM, Heining K, Boehler C, Egert U, Häussler U, Haas CA. On-demand low-frequency stimulation for seizure control: efficacy and behavioural implications. Brain 2024; 147:505-520. [PMID: 37675644 DOI: 10.1093/brain/awad299] [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: 03/20/2023] [Revised: 07/24/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
Mesial temporal lobe epilepsy (MTLE), the most common form of focal epilepsy in adults, is often refractory to medication and associated with hippocampal sclerosis. Deep brain stimulation represents an alternative treatment option for drug-resistant patients who are ineligible for resective brain surgery. In clinical practice, closed-loop stimulation at high frequencies is applied to interrupt ongoing seizures, yet has (i) a high incidence of false detections; (ii) the drawback of delayed seizure-suppressive intervention; and (iii) limited success in sclerotic tissue. As an alternative, low-frequency stimulation (LFS) has been explored recently in patients with focal epilepsies. In preclinical epilepsy models, hippocampal LFS successfully prevented seizures when applied continuously. Since it would be advantageous to reduce the stimulation load, we developed a protocol for on-demand LFS. Given the importance of the hippocampus for navigation and memory, we investigated potential consequences of LFS on hippocampal function. To this end, we used the intrahippocampal kainate mouse model, which recapitulates the key features of MTLE, including spontaneous seizure activity and hippocampal sclerosis. Specifically, our online detection algorithm monitored epileptiform activity in hippocampal local field potential recordings and identified short epileptiform bursts preceding focal seizure clusters, triggering hippocampal LFS to stabilize the network state. To probe behavioural performance, we tested the acute influence of LFS on anxiety-like behaviour in the light-dark box test, spatial and non-spatial memory in the object location memory and novel object recognition test, as well as spatial navigation and long-term memory in the Barnes maze. On-demand LFS was almost as effective as continuous LFS in preventing focal seizure clusters but with a significantly lower stimulation load. When we compared the behavioural performance of chronically epileptic mice to healthy controls, we found that both groups were equally mobile, but epileptic mice displayed an increased anxiety level, altered spatial learning strategy and impaired memory performance. Most importantly, with the application of hippocampal LFS before behavioural training and test sessions, we could rule out deleterious effects on cognition and even show an alleviation of deficits in long-term memory recall in chronically epileptic mice. Taken together, our findings may provide a promising alternative to current therapies, overcoming some of their major limitations, and inspire further investigation of LFS for seizure control in focal epilepsy syndromes.
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Affiliation(s)
- Enya Paschen
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
- Faculty of Biology, University of Freiburg, Freiburg 79104, Germany
| | - Piret Kleis
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
- Faculty of Biology, University of Freiburg, Freiburg 79104, Germany
| | - Diego M Vieira
- Biomicrotechnology, Department of Microsystems Engineering-IMTEK, Faculty of Engineering, University of Freiburg, Freiburg 79108, Germany
| | - Katharina Heining
- Department of Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden
| | - Christian Boehler
- Department of Microsystems Engineering (IMTEK), Bioelectronic Microtechnology (BEMT), University of Freiburg, Freiburg 79108, Germany
| | - Ulrich Egert
- Biomicrotechnology, Department of Microsystems Engineering-IMTEK, Faculty of Engineering, University of Freiburg, Freiburg 79108, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Freiburg 79110, Germany
| | - Ute Häussler
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Freiburg 79110, Germany
| | - Carola A Haas
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Freiburg 79110, Germany
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Che LQ, Qu ZZ, Xie T, Zhang YG, Yuan DJ, Li Q, Jia LJ, Wang WP. Effect of low‑frequency repetitive transcranial magnetic stimulation on cognitive function in rats with medial temporal lobe epilepsy. Acta Neurobiol Exp (Wars) 2023; 83:395-403. [PMID: 38224282 DOI: 10.55782/ane-2023-2471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Indexed: 01/16/2024]
Abstract
Epilepsy, especially the medial temporal lobe epilepsy (TLE), can result in cognitive impairment. Low‑frequency repetitive magnetic stimulation (rTMS) has been verified to suppress neural excitability and reduce seizures. Given its potential in modifying cortical activity, we aimed to investigate its impact on cognitive function in the context of epilepsy, a condition where the use of rTMS has not been extensively explored. However, the influence on cognitive function has not yet been investigated. Therefore, this study aimed to investigate the effects of low‑frequency rTMS on cognitive improvement in epileptic rats. Rats used in this study were randomly divided into five groups: the sham group, the epilepsy group, and three epilepsy groups treated with rTMS at different frequencies. Each group underwent the Morris water maze test to investigate hippocampus‑dependent episodic memory, to evaluate their cognitive performance. Further assessments included patch clamp and western blot techniques to estimate the synaptic function in the hippocampus. Comparison between groups showed that low‑frequency rTMS significantly reduced spontaneous recurrent seizures and improved spatial learning and memory impairment in epileptic rats. Additionally, rTMS remodeled the synaptic plasticity affected by seizures and notably enhanced the expression of AMPAR and synaptophysin. Low‑frequency rTMS can antagonize the cognitive impairment caused by TLE, and promote synaptic connections.
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Affiliation(s)
- Li-Qin Che
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Zhen-Zhen Qu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Tao Xie
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Yan-Ge Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Dong-Juan Yuan
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Qing Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Li-Jing Jia
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Wei-Ping Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
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Metto AC, Telgkamp P, McLane-Svoboda AK, Gilad AA, Pelled G. Closed-loop neurostimulation via expression of magnetogenetics-sensitive protein in inhibitory neurons leads to reduction of seizure activity in a rat model of epilepsy. Brain Res 2023; 1820:148591. [PMID: 37748572 DOI: 10.1016/j.brainres.2023.148591] [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: 08/04/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
On-demand neurostimulation has shown success in epilepsy patients with pharmacoresistant seizures. Seizures produce magnetic fields that can be recorded using magnetoencephalography. We developed a new closed-loop approach to control seizure activity based on magnetogenetics using the electromagnetic perceptive gene (EPG) that encodes a protein that responds to magnetic fields. The EPG transgene was expressed in inhibitory interneurons under the hDlx promoter and kainic acid was used to induce acute seizures. In vivo electrophysiological signals were recorded. We found that hDlx EPG rats exhibited a significant delay in the onset of first seizure (1142.72 ± 186.35 s) compared to controls (644.03 ± 15.06 s) and significantly less seizures (4.11 ± 1.03) compared to controls (8.33 ± 1.58). These preliminary findings suggest that on-demand activation of EPG expressed in inhibitory interneurons suppresses seizure activity, and magnetogenetics via EPG may be an effective strategy to alleviate seizure severity in a closed-loop, and cell-specific fashion.
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Affiliation(s)
- Abigael C Metto
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI, United States
| | - Petra Telgkamp
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Autumn K McLane-Svoboda
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI, United States
| | - Assaf A Gilad
- Department of Chemical Engineering and Materials Science, Michigan State University, East Lansing, MI, United States; Department of Radiology, Michigan State University, East Lansing, MI, United States; Neuroscience Program, Michigan State University, East Lansing, MI, United States
| | - Galit Pelled
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States; Department of Radiology, Michigan State University, East Lansing, MI, United States; Neuroscience Program, Michigan State University, East Lansing, MI, United States.
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10
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Boileau C, Deforges S, Peret A, Scavarda D, Bartolomei F, Giles A, Partouche N, Gautron J, Viotti J, Janowitz H, Penchet G, Marchal C, Lagarde S, Trebuchon A, Villeneuve N, Rumi J, Marissal T, Khazipov R, Khalilov I, Martineau F, Maréchal M, Lepine A, Milh M, Figarella-Branger D, Dougy E, Tong S, Appay R, Baudouin S, Mercer A, Smith JB, Danos O, Porter R, Mulle C, Crépel V. GluK2 Is a Target for Gene Therapy in Drug-Resistant Temporal Lobe Epilepsy. Ann Neurol 2023; 94:745-761. [PMID: 37341588 DOI: 10.1002/ana.26723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Temporal lobe epilepsy (TLE) is characterized by recurrent seizures generated in the limbic system, particularly in the hippocampus. In TLE, recurrent mossy fiber sprouting from dentate gyrus granule cells (DGCs) crea an aberrant epileptogenic network between DGCs which operates via ectopically expressed GluK2/GluK5-containing kainate receptors (KARs). TLE patients are often resistant to anti-seizure medications and suffer significant comorbidities; hence, there is an urgent need for novel therapies. Previously, we have shown that GluK2 knockout mice are protected from seizures. This study aims at providing evidence that downregulating KARs in the hippocampus using gene therapy reduces chronic epileptic discharges in TLE. METHODS We combined molecular biology and electrophysiology in rodent models of TLE and in hippocampal slices surgically resected from patients with drug-resistant TLE. RESULTS Here, we confirmed the translational potential of KAR suppression using a non-selective KAR antagonist that markedly attenuated interictal-like epileptiform discharges (IEDs) in TLE patient-derived hippocampal slices. An adeno-associated virus (AAV) serotype-9 vector expressing anti-grik2 miRNA was engineered to specifically downregulate GluK2 expression. Direct delivery of AAV9-anti grik2 miRNA into the hippocampus of TLE mice led to a marked reduction in seizure activity. Transduction of TLE patient hippocampal slices reduced levels of GluK2 protein and, most importantly, significantly reduced IEDs. INTERPRETATION Our gene silencing strategy to knock down aberrant GluK2 expression demonstrates inhibition of chronic seizure in a mouse TLE model and IEDs in cultured slices derived from TLE patients. These results provide proof-of-concept for a gene therapy approach targeting GluK2 KARs for drug-resistant TLE patients. ANN NEUROL 2023;94:745-761.
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Affiliation(s)
| | - Severine Deforges
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience IINS, UMR 5297, Bordeaux, France
| | | | - Didier Scavarda
- APHM, INSERM, Aix Marseille Univ, INS, Timone Hospital, Pediatric Neurosurgery, Marseille, France
| | - Fabrice Bartolomei
- APHM, INSERM, Aix Marseille Univ, INS, Timone Hospital, Epileptology Department, Marseille, France
| | | | - Nicolas Partouche
- Aix-Marseille Univ. INSERM, Marseille, France
- Corlieve Therapeutics SAS, uniQure NV, Paris, France
| | - Justine Gautron
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience IINS, UMR 5297, Bordeaux, France
- Corlieve Therapeutics SAS, uniQure NV, Paris, France
| | - Julio Viotti
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience IINS, UMR 5297, Bordeaux, France
| | | | | | - Cécile Marchal
- Pellegrin Hospital, Neurosurgery Department, Bordeaux, France
| | - Stanislas Lagarde
- APHM, INSERM, Aix Marseille Univ, INS, Timone Hospital, Epileptology Department, Marseille, France
| | - Agnès Trebuchon
- APHM, INSERM, Aix Marseille Univ, INS, Timone Hospital, Epileptology Department, Marseille, France
| | - Nathalie Villeneuve
- APHM, INSERM, Aix Marseille Univ, INS, Timone Hospital, Epileptology Department, Marseille, France
| | - Julie Rumi
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience IINS, UMR 5297, Bordeaux, France
| | | | | | | | | | - Marine Maréchal
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience IINS, UMR 5297, Bordeaux, France
| | - Anne Lepine
- APHM, INSERM, Aix Marseille Univ, INS, Timone Hospital, Epileptology Department, Marseille, France
| | - Mathieu Milh
- APHM, INSERM, Aix Marseille Univ, INS, Timone Hospital, Epileptology Department, Marseille, France
| | - Dominique Figarella-Branger
- APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Aix-Marseille Univ, Marseille, France
| | - Etienne Dougy
- APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Aix-Marseille Univ, Marseille, France
| | - Soutsakhone Tong
- APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Aix-Marseille Univ, Marseille, France
| | - Romain Appay
- APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Aix-Marseille Univ, Marseille, France
| | | | | | | | | | | | - Christophe Mulle
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience IINS, UMR 5297, Bordeaux, France
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Doerr JM, Juenemann M, Hakel L, Schmidt L, Menzler K, Krause K, Linka L, Skoluda N, Nater UM, Knake S. Effect of transcutaneous vagus nerve stimulation on stress-reactive neuroendocrine measures in a sample of persons with temporal lobe epilepsy. Epilepsia Open 2023; 8:1013-1020. [PMID: 37310988 PMCID: PMC10472404 DOI: 10.1002/epi4.12774] [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: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE Dysregulation of stress-reactive neuroendocrine measures, as well as subjective stress, have been found to worsen epilepsy. Transcutaneous vagus nerve stimulation (tVNS) is a relatively new treatment option for epilepsy. We were interested in its effect on the activity of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) as well as subjective stress and tiredness in patients with temporal lobe epilepsy (TLE). METHODS Twenty patients (age 44 ± 11 years, 13 women) were enrolled in the study. They were free of seizures for more than 1 year. All took part in two sessions with 4 h of stimulation (tVNS vs. sham) in a randomized order. Saliva samples and subjective stress and tiredness levels were measured at five time points each session (before and after stimulation and three time points every hour in between). Data were analyzed using repeated measures analysis of variance as well as paired t-tests. RESULTS There was a dampened salivary cortisol (sCort) decrease during tVNS (time × condition effect: F[2.38, 38.15] = 6.50, P = 0.002, partial η2 = 0.29). Furthermore, we detected a dampened increase in salivary flow rate during tVNS (time × condition effect: F[3.28, 55.67] = 2.82, P = 0.043, partial η2 = 0.14). There was neither a difference in overall sCort or salivary alpha-amylase (sAA) levels nor in subjective stress or tiredness levels between conditions. sAA levels at the last measurement point were slightly higher during tVNS (t(19) = 2.26, P = 0.035, d = 0.51), but this effect failed to reach significance when controlled for multiple comparisons. SIGNIFICANCE Our results partially support that tVNS influences the regulation of stress-reactive neuroendocrine systems (namely the HPA axis and ANS) in epilepsy. More research with larger samples is needed on the difference between short-term and repeated long-term stimulation.
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Affiliation(s)
- Johanna M. Doerr
- Department of NeurologyUniversity Hospital Gießen and MarburgGießenGermany
| | - Martin Juenemann
- Department of NeurologyUniversity Hospital Gießen and MarburgGießenGermany
| | - Lukas Hakel
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Laura Schmidt
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Katja Menzler
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Kristina Krause
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Louise Linka
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Urs M. Nater
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Susanne Knake
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
- Center for Mind, Brain and Behavior (CMBB)Philipps‐University MarburgMarburgGermany
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12
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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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13
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Hyder SK, Ghosh A, Forcelli PA. Optogenetic activation of the superior colliculus attenuates spontaneous seizures in the pilocarpine model of temporal lobe epilepsy. Epilepsia 2023; 64:524-535. [PMID: 36448878 PMCID: PMC10907897 DOI: 10.1111/epi.17469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/04/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Decades of studies have indicated that activation of the deep and intermediate layers of the superior colliculus can suppress seizures in a wide range of experimental models of epilepsy. However, prior studies have not examined efficacy against spontaneous limbic seizures. The present study aimed to address this gap through chronic optogenetic activation of the superior colliculus in the pilocarpine model of temporal lobe epilepsy. METHODS Sprague Dawley rats underwent pilocarpine-induced status epilepticus and were maintained until the onset of spontaneous seizures. Virus coding for channelrhodopsin-2 was injected into the deep and intermediate layers of the superior colliculus, and animals were implanted with head-mounted light-emitting diodes at the same site. Rats were stimulated with either 5- or 100-Hz light delivery. Seizure number, seizure duration, 24-h seizure burden, and behavioral seizure severity were monitored. RESULTS Both 5- and 100-Hz optogenetic stimulation of the deep and intermediate layers of the superior colliculus reduced daily seizure number and total seizure burden in all animals in the active vector group. Stimulation did not affect either seizure duration or behavioral seizure severity. Stimulation was without effect in opsin-negative control animals. SIGNIFICANCE Activation of the deep and intermediate layers of the superior colliculus reduces both the number of seizures and total daily seizure burden in the pilocarpine model of temporal lobe epilepsy. These novel data demonstrating an effect against chronic experimental seizures complement a long history of studies documenting the antiseizure efficacy of superior colliculus activation in a range of acute seizure models.
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Affiliation(s)
- Safwan K. Hyder
- Department of Pharmacology & Physiology, Georgetown University, Washington DC, USA
| | - Anjik Ghosh
- Department of Pharmacology & Physiology, Georgetown University, Washington DC, USA
| | - Patrick A. Forcelli
- Department of Pharmacology & Physiology, Georgetown University, Washington DC, USA
- Department of Neuroscience, Georgetown University, Washington DC, USA
- Interdisciplinary Program in Neuroscience, Georgetown University, Washington DC, USA
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14
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Yang JC, Bullinger KL, Dickey AS, Karakis I, Alwaki A, Cabaniss BT, Winkel D, Rodriguez-Ruiz A, Willie JT, Gross RE. Anterior nucleus of the thalamus deep brain stimulation vs temporal lobe responsive neurostimulation for temporal lobe epilepsy. Epilepsia 2022; 63:2290-2300. [PMID: 35704344 PMCID: PMC9675907 DOI: 10.1111/epi.17331] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/02/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Based on the promising results of randomized controlled trials, deep brain stimulation (DBS) and responsive neurostimulation (RNS) are used increasingly in the treatment of patients with drug-resistant epilepsy. Drug-resistant temporal lobe epilepsy (TLE) is an indication for either DBS of the anterior nucleus of the thalamus (ANT) or temporal lobe (TL) RNS, but there are no studies that directly compare the seizure benefits and adverse effects associated with these therapies in this patient population. We, therefore, examined all patients who underwent ANT-DBS or TL-RNS for drug-resistant TLE at our center. METHODS We performed a retrospective review of patients who were treated with either ANT-DBS or TL-RNS for drug-resistant TLE with at least 12 months of follow-up. Along with the clinical characteristics of each patient's epilepsy, seizure frequency was recorded throughout each patient's postoperative clinical course. RESULTS Twenty-six patients underwent ANT-DBS implantation and 32 patients underwent TL-RNS for drug-resistant TLE. The epilepsy characteristics of both groups were similar. Patients who underwent ANT-DBS demonstrated a median seizure reduction of 58% at 12-15 months, compared to a median seizure reduction of 70% at 12-15 months in patients treated with TL-RNS (p > .05). The responder rate (percentage of patients with a 50% decrease or more in seizure frequency) was 54% for ANT-DBS and 56% for TL-RNS (p > .05). The incidence of complications and stimulation-related side effects did not significantly differ between therapies. SIGNIFICANCE We demonstrate in our single-center experience that patients with drug-resistant TLE benefit similarly from either ANT-DBS or TL-RNS. Selection of either ANT-DBS or TL-RNS may, therefore, depend more heavily on patient and provider preference, as each has unique capabilities and configurations. Future studies will consider subgroup analyses to determine if specific patients have greater seizure frequency reduction from one form of neuromodulation strategy over another.
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Affiliation(s)
- Jimmy C. Yang
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katie L. Bullinger
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adam S. Dickey
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abdulrahman Alwaki
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian T. Cabaniss
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel Winkel
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jon T. Willie
- Departments of Neurosurgery, Neurology, and Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert E. Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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15
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Charlebois CM, Anderson DN, Johnson KA, Philip BJ, Davis TS, Newman BJ, Peters AY, Arain AM, Dorval AD, Rolston JD, Butson CR. Patient-specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy. Epilepsia 2022; 63:2037-2055. [PMID: 35560062 DOI: 10.1111/epi.17298] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Responsive neurostimulation is an effective therapy for patients with refractory mesial temporal lobe epilepsy. However, clinical outcomes are variable, few patients become seizure-free, and the optimal stimulation location is currently undefined. The aim of this study was to quantify responsive neurostimulation in the mesial temporal lobe, identify stimulation-dependent networks associated with seizure reduction, and determine if stimulation location or stimulation-dependent networks inform outcomes. METHODS We modeled patient-specific volumes of tissue activated and created probabilistic stimulation maps of local regions of stimulation across a retrospective cohort of 22 patients with mesial temporal lobe epilepsy. We then mapped the network stimulation effects by seeding tractography from the volume of tissue activated with both patient-specific and normative diffusion-weighted imaging. We identified networks associated with seizure reduction across patients using the patient-specific tractography maps and then predicted seizure reduction across the cohort. RESULTS Patient-specific stimulation-dependent connectivity was correlated with responsive neurostimulation effectiveness after cross-validation (p = .03); however, normative connectivity derived from healthy subjects was not (p = .44). Increased connectivity from the volume of tissue activated to the medial prefrontal cortex, cingulate cortex, and precuneus was associated with greater seizure reduction. SIGNIFICANCE Overall, our results suggest that the therapeutic effect of responsive neurostimulation may be mediated by specific networks connected to the volume of tissue activated. In addition, patient-specific tractography was required to identify structural networks correlated with outcomes. It is therefore likely that altered connectivity in patients with epilepsy may be associated with the therapeutic effect and that utilizing patient-specific imaging could be important for future studies. The structural networks identified here may be utilized to target stimulation in the mesial temporal lobe and to improve seizure reduction for patients treated with responsive neurostimulation.
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Affiliation(s)
- Chantel M Charlebois
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Daria Nesterovich Anderson
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, Utah, USA
| | - Kara A Johnson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Brian J Philip
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Tyler S Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Blake J Newman
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Angela Y Peters
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Amir M Arain
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Alan D Dorval
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - John D Rolston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Christopher R Butson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, Gainesville, Florida, USA
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
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16
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Koubeissi MZ, Joshi S, Eid A, Emami M, Jaafar N, Syed T, Foreman PJ, Sheth A, Amdur R, Bou Nasif M, Puente AN, Aly R, Chen H, Becker A, Gholipour T, Makke Y, Elmashad A, Gagnon L, Durand DM, Gaillard WD, Shields DC. Low-frequency stimulation of a fiber tract in bilateral temporal lobe epilepsy. Epilepsy Behav 2022; 130:108667. [PMID: 35344808 DOI: 10.1016/j.yebeh.2022.108667] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Pharmacoresistant bilateral mesial temporal lobe epilepsy often implies poor resective surgical candidacy. Low-frequency stimulation of a fiber tract connected to bilateral hippocampi, the fornicodorsocommissural tract, has been shown to be safe and efficacious in reducing seizures in a previous short-term study. Here, we report a single-blinded, within-subject control, long-term deep-brain stimulation trial of low-frequency stimulation of the fornicodorsocommissural tract in bilateral mesial temporal lobe epilepsy. Outcomes of interest included safety with respect to verbal memory scores and reduction of seizure frequency. METHODS Our enrollment goal was 16 adult subjects to be randomized to 2-Hz or 5-Hz low-frequency stimulation of the fornicodorsocommissural tract starting at 2 mA. The study design consisted of four two-month blocks of stimulation with a 50%-duty cycle, alternating with two-month blocks of no stimulation. RESULTS We terminated the study after enrollment of five subjects due to slow accrual. Fornicodorsocommissural tract stimulation elicited bilateral hippocampal evoked responses in all subjects. Three subjects underwent implantation of pulse generators and long-term low-frequency stimulation with mean monthly seizures of 3.14 ± 2.67 (median 3.0 [IQR 1-4.0]) during stimulation-off blocks, compared with 0.96 ± 1.23 (median 1.0 [IQR 0-1.0]) during stimulation-on blocks (p = 0.0005) during the blinded phase. Generalized Estimating Equations showed that low-frequency stimulation reduced monthly seizure-frequency by 0.71 per mA (p < 0.001). Verbal memory scores were stable with no psychiatric complications or other adverse events. SIGNIFICANCE The results demonstrate feasibility of stimulating both hippocampi using a single deep-brain stimulation electrode in the fornicodorsocommissural tract, efficacy of low-frequency stimulation in reducing seizures, and safety as regards verbal memory.
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Affiliation(s)
- Mohamad Z Koubeissi
- Department of Neurology, The George Washington University, Washington, DC 20052, USA.
| | - Sweta Joshi
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Alexandra Eid
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Mehrdad Emami
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Nadim Jaafar
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | | | - Perry J Foreman
- Department of Neurology, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Anumeha Sheth
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Richard Amdur
- Department of Surgery, George Washington University School of Medicine, Washington, DC 20052, USA
| | - Mei Bou Nasif
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Antonio N Puente
- Department of Psychiatry, George Washington University School of Medicine, Washington, DC 20052, USA
| | - Radwa Aly
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Hai Chen
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Andrew Becker
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Taha Gholipour
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Yamane Makke
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Ahmed Elmashad
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Linda Gagnon
- Department of Neurology, The George Washington University, Washington, DC 20052, USA
| | - Dominique M Durand
- Neural Engineering Center, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - William D Gaillard
- Center for Neuroscience and Behavioral Health, Children's National Hospital, Washington, DC 20010, USA
| | - Donald C Shields
- Department of Neurosurgery, The George Washington University, Washington, DC 20052, USA
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17
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Velasco AL, Saucedo-Alvarado PE, Alejandre-Sánchez M, Guzmán-Jiménez DE, González-Garcia I, Velasco F. New Horizons in Temporal Lobe Seizure Control. J Clin Neurophysiol 2021; 38:478-484. [PMID: 34261115 DOI: 10.1097/wnp.0000000000000715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY In patients with mesial temporal lobe epilepsy, high-frequency, low-amplitude electrical stimulation (ES) was applied during 3 weeks through contacts of intracranial electrodes that defined the epileptogenic zone. This subacute ES induced cessation of spontaneous seizures, decreased the number of EEG interictal spikes, caused a 10-fold increase in threshold to induce postdischarges, and showed a profound decrease in regional blood flow of the stimulated area in SPECT studies. Autoradiography analysis of surgical specimens from these patients demonstrated increased expression of benzodiazepine receptors and in gamma-aminobutyric acid content, particularly in the parahippocampal cortex. These observations provided evidence of a gamma-aminobutyric acid-mediated antiepileptic effect induced by ES. Several reports of long-term hippocampal ES through internalized neurostimulators have confirmed the antiepileptic effect on mesial temporal lobe-initiated seizures, with preservation of neuropsychological performance, in particular memory functions. The experience of the authors is that the response is optimal in patients without hippocampal sclerosis evidenced by MRI, whereas it is less significant and delayed in patients with hippocampal sclerosis. Other studies reported the best result stimulating through the contacts in the subiculum, the transition between the hippocampus and parahippocampal cortex, that usually escapes to the hippocampal sclerosis. Currently, the effect of ES directed at the subiculum and the parahippocampal cortex in patients with hippocampal sclerosis is under investigation.
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Affiliation(s)
- Ana L Velasco
- Unit for Stereotactic and Functional Neurosurgery, Epilepsy Clinic, Hospital General de México, Mexico City, Mexico
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18
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Wang S, Zhao M, Li T, Zhang C, Zhou J, Wang M, Wang X, Ma K, Luan G, Guan Y. Long-term efficacy and cognitive effects of bilateral hippocampal deep brain stimulation in patients with drug-resistant temporal lobe epilepsy. Neurol Sci 2020; 42:225-233. [PMID: 32632633 DOI: 10.1007/s10072-020-04554-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/02/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Temporal lobe epilepsy patients treated with hippocampal deep brain stimulation (Hip-DBS) have rarely been reported before. Preoperative and postoperative cognitive function is seldom analyzed. METHODS Seven patients with drug-resistant temporal lobe epilepsy were included in this study. Bilateral Hip-DBS was performed in these patients. The stimulator was activated 1 month after the implantation. Then, the patients returned for further adjustments 4 months after the surgery and reprogramming every year. The seizure frequency, Wechsler Adult Intelligence Scale-IV, and Wechsler memory scale-IV were assessed blindly as the outcomes at each follow-up. RESULTS After a mean 48-month follow-up, the mean seizure frequency significantly decreased (p = 0.011, paired t test; decrease of 78.1%). One patient (14.3%) was seizure-free by the last follow-up; six of seven (85.7%) patients had reductions in seizure frequency of at least 50%; one patient (14.3%) who did not comply with the antiepileptic drug instructions had a less than 50% reduction in seizure frequency. In addition, there were no significant decreases in intelligence or verbal and visual memory from baseline to the last follow-up (p = 0.736, paired t test; p = 0.380, paired t test, respectively). CONCLUSION Hip-DBS could provide acceptable long-term efficacy and safety. For patients with drug-resistant temporal lobe epilepsy who are not suitable for resective surgery, Hip-DBS could become a potential therapeutic option.
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Meng Zhao
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Tianfu Li
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing, 100093, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, 100093, China
| | - Chunsheng Zhang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Jian Zhou
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Mengyang Wang
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Xiongfei Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Kaiqiang Ma
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Guoming Luan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing, 100093, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China.
- Beijing Key Laboratory of Epilepsy, Beijing, 100093, China.
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, 100093, China.
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Brinker ST, Preiswerk F, White PJ, Mariano TY, McDannold NJ, Bubrick EJ. Focused Ultrasound Platform for Investigating Therapeutic Neuromodulation Across the Human Hippocampus. Ultrasound Med Biol 2020; 46:1270-1274. [PMID: 32088061 PMCID: PMC7239323 DOI: 10.1016/j.ultrasmedbio.2020.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 05/25/2023]
Abstract
Pulsed low-intensity focused ultrasound (PLIFUS) has shown promise in inducing neuromodulation in several animal and human studies. Therefore, it is of clinical interest to develop experimental platforms to test repetitive PLIFUS as a therapeutic modality in humans with neurologic disorders. In the study described here, our aim was to develop a laboratory-built experimental device platform intended to deliver repetitive PLIFUS across the hippocampus in seizure onset zones of patients with drug-resistant temporal lobe epilepsy. The system uses neuronavigation targeting over multiple therapeutic sessions. PLIFUS (548 kHz) was emitted across multiple hippocampal targets in a human subject with temporal lobe epilepsy using a mechanically steered piezoelectric transducer. Stimulation was delivered up to 2.25 W/cm2 spatial peak temporal average intensity (free-field equivalent), with 36%-50% duty cycle, 500-ms sonications and 7-s inter-stimulation intervals lasting 140 s per target and repeated for multiple sessions. A first-in-human PLIFUS course of treatment was successfully delivered using the device platform with no adverse events.
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Affiliation(s)
- Spencer T Brinker
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank Preiswerk
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip J White
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Physics, Simmons College, Boston, Massachusetts, USA
| | - Timothy Y Mariano
- Center for Neurorestoration and Neurotechnology, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA; Butler Hospital, Providence, Rhode Island, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathan J McDannold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ellen J Bubrick
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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20
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Agostinho AS, Mietzsch M, Zangrandi L, Kmiec I, Mutti A, Kraus L, Fidzinski P, Schneider UC, Holtkamp M, Heilbronn R, Schwarzer C. Dynorphin-based "release on demand" gene therapy for drug-resistant temporal lobe epilepsy. EMBO Mol Med 2019; 11:e9963. [PMID: 31486590 PMCID: PMC6783645 DOI: 10.15252/emmm.201809963] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 11/13/2022] Open
Abstract
Focal epilepsy represents one of the most common chronic CNS diseases. The high incidence of drug resistance, devastating comorbidities, and insufficient responsiveness to surgery pose unmet medical challenges. In the quest of novel, disease-modifying treatment strategies of neuropeptides represent promising candidates. Here, we provide the "proof of concept" that gene therapy by adeno-associated virus (AAV) vector transduction of preprodynorphin into the epileptogenic focus of well-accepted mouse and rat models for temporal lobe epilepsy leads to suppression of seizures over months. The debilitating long-term decline of spatial learning and memory is prevented. In human hippocampal slices obtained from epilepsy surgery, dynorphins suppressed seizure-like activity, suggestive of a high potential for clinical translation. AAV-delivered preprodynorphin expression is focally and neuronally restricted and release is dependent on high-frequency stimulation, as it occurs at the onset of seizures. The novel format of "release on demand" dynorphin delivery is viewed as a key to prevent habituation and to minimize the risk of adverse effects, leading to long-term suppression of seizures and of their devastating sequel.
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Affiliation(s)
| | - Mario Mietzsch
- Institute of VirologyCampus Benjamin Franklin, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Luca Zangrandi
- Department of PharmacologyMedical University of InnsbruckInnsbruckAustria
| | - Iwona Kmiec
- Department of PharmacologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Mutti
- Department of PharmacologyMedical University of InnsbruckInnsbruckAustria
| | - Larissa Kraus
- Department of NeurologyCharité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health, Epilepsy‐Center Berlin‐BrandenburgBerlinGermany
- Berlin Institute of Health (BIH)BerlinGermany
| | - Pawel Fidzinski
- Department of NeurologyCharité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health, Epilepsy‐Center Berlin‐BrandenburgBerlinGermany
| | - Ulf C Schneider
- Department of NeurosurgeryCharité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Martin Holtkamp
- Department of NeurologyCharité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health, Epilepsy‐Center Berlin‐BrandenburgBerlinGermany
- Berlin Institute of Health (BIH)BerlinGermany
| | - Regine Heilbronn
- Institute of VirologyCampus Benjamin Franklin, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Berlin Institute of Health (BIH)BerlinGermany
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21
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Li K, Vakharia VN, Sparks R, França LGS, Granados A, McEvoy AW, Miserocchi A, Wang M, Ourselin S, Duncan JS. Optimizing Trajectories for Cranial Laser Interstitial Thermal Therapy Using Computer-Assisted Planning: A Machine Learning Approach. Neurotherapeutics 2019; 16:182-191. [PMID: 30520003 PMCID: PMC6361073 DOI: 10.1007/s13311-018-00693-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Laser interstitial thermal therapy (LITT) is an alternative to open surgery for drug-resistant focal mesial temporal lobe epilepsy (MTLE). Studies suggest maximal ablation of the mesial hippocampal head and amygdalohippocampal complex (AHC) improves seizure freedom rates while better neuropsychological outcomes are associated with sparing of the parahippocampal gyrus (PHG). Optimal trajectories avoid sulci and CSF cavities and maximize distance from vasculature. Computer-assisted planning (CAP) improves these metrics, but the combination of entry and target zones has yet to be determined to maximize ablation of the AHC while sparing the PHG. We apply a machine learning approach to predict entry and target parameters and utilize these for CAP. Ten patients with hippocampal sclerosis were identified from a prospectively managed database. CAP LITT trajectories were generated using entry regions that include the inferior occipital, middle occipital, inferior temporal, and middle temporal gyri. Target points were varied by sequential AHC erosions and transformations of the centroid of the amygdala. A total of 7600 trajectories were generated, and ablation volumes of the AHC and PHG were calculated. Two machine learning approaches (random forest and linear regression) were investigated to predict composite ablation scores and determine entry and target point combinations that maximize ablation of the AHC while sparing the PHG. Random forest and linear regression predictions had a high correlation with the calculated values in the test set (ρ = 0.7) for both methods. Maximal composite ablation scores were associated with entry points around the junction of the inferior occipital, middle occipital, and middle temporal gyri. The optimal target point was the anteromesial amygdala. These parameters were then used with CAP to generate clinically feasible trajectories that optimize safety metrics. Machine learning techniques accurately predict composite ablation score. Prospective studies are required to determine if this improves seizure-free outcome while reducing neuropsychological morbidity following LITT for MTLE.
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Affiliation(s)
- Kuo Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, 33 Queen Square, London, WC1E 6BT, UK
| | - Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, 33 Queen Square, London, WC1E 6BT, UK.
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Rachel Sparks
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
| | - Lucas G S França
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, 33 Queen Square, London, WC1E 6BT, UK
| | - Alejandro Granados
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, 33 Queen Square, London, WC1E 6BT, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, 33 Queen Square, London, WC1E 6BT, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Maode Wang
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, 33 Queen Square, London, WC1E 6BT, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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22
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Ashmaig O, Connolly M, Gross RE, Mahmoudi B. Bayesian Optimization of Asynchronous Distributed Microelectrode Theta Stimulation and Spatial Memory. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:2683-2686. [PMID: 30440959 DOI: 10.1109/embc.2018.8512801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is a great need for an electrical stimulation therapy to treat medication-resistant, surgically ineligible epileptic patients that successfully reduces seizure incidence with minimal side effects. Critical to advancing such therapies will be identifying the trade-offs between therapeutic efficacy and side effects. One novel treatment developed in the tetanus toxin rat model of mesial temporal lobe epilepsy, asynchronous distributed microelectrode stimulation (ADMETS) in the hippocampus has been shown to significantly reduce seizure frequency. However, our results have demonstrated that ADMETS has a negative effect on spatial memory that scales with the amplitude of stimulation. Given the high dimensional space of possible stimulation parameters, it is difficult to construct a mapping from variations in stimulation to behavioral effect. In this project, we present a novel, principled approach using closed-loop Bayesian optimization to tune stimulation that successfully maximize a desired objective - performance on a spatial memory assay.
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23
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Curot J, Valton L, Denuelle M, Vignal JP, Maillard L, Pariente J, Trébuchon A, Bartolomei F, Barbeau EJ. Déjà-rêvé: Prior dreams induced by direct electrical brain stimulation. Brain Stimul 2018; 11:875-885. [PMID: 29530448 PMCID: PMC6028740 DOI: 10.1016/j.brs.2018.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/09/2018] [Accepted: 02/22/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Epileptic patients sometimes report experiential phenomena related to a previous dream they had during seizures or electrical brain stimulation (EBS). This has been alluded to in the literature as "déjà-rêvé" ("already dreamed"). However, there is no neuroscientific evidence to support its existence and this concept is commonly mixed up with déjà-vu. We hypothesized that déjà-rêvé would be a specific entity, i.e., different from other experiential phenomena reported in epileptic patients, induced by EBS of specific brain areas. METHODS We collected all experiential phenomena related to dreams induced by electrical brain stimulations (EBS) in our epileptic patients (2003-2015) and in a review of the literature. The content of these déjà-rêvé and the location of EBS were analyzed. RESULTS We collected 7 déjà-rêvé in our database and 35 from the literature, which corresponds to an estimated prevalence of 0.3‰ of all EBS-inducing déjà-rêvé. Déjà-rêvé is a generic term for three distinct entities: it can be the recollection of a specific dream ("episodic-like"), reminiscence of a vague dream ("familiarity-like") or experiences in which the subject feels like they are dreaming (literally "a dreamy state"). EBS-inducing "episodic-like" and "familiarity-like" déjà-rêvé were mostly located in the medial temporal lobes. "Dreamy states" were induced by less specific EBS areas although still related to the temporal lobes. CONCLUSIONS This study demonstrates that déjà-rêvé is a heterogeneous entity that is different from déjà-vu, the historical "dreamy state" definition and other experiential phenomena. This may be relevant for clinical practice as it points to temporal lobe dysfunction and could be valuable for studying the neural substrates of dreams.
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Affiliation(s)
- Jonathan Curot
- Toulouse University Hospital, Department of Neurology, Toulouse, FR 31059, France; Centre de Recherche Cerveau et Cognition, CNRS, UMR5549, FR 31052, France.
| | - Luc Valton
- Toulouse University Hospital, Department of Neurology, Toulouse, FR 31059, France; Centre de Recherche Cerveau et Cognition, CNRS, UMR5549, FR 31052, France
| | - Marie Denuelle
- Toulouse University Hospital, Department of Neurology, Toulouse, FR 31059, France
| | | | - Louis Maillard
- Nancy University & CNRS, CRAN, UMR 7039, FR 54516, France; University Hospital of Nancy, Neurology Department Nancy, FR 54035, France
| | - Jérémie Pariente
- Toulouse University Hospital, Department of Neurology, Toulouse, FR 31059, France; INSERM, U1214, TONIC, Toulouse Mind and Brain Institute, FR 31024, France
| | - Agnès Trébuchon
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, FR 13005, France; AP-HM, Hôpital de la Timone, Service de Neurophysiologie Clinique, Marseille, FR 13005, France
| | - Fabrice Bartolomei
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, FR 13005, France; AP-HM, Hôpital de la Timone, Service de Neurophysiologie Clinique, Marseille, FR 13005, France
| | - Emmanuel J Barbeau
- Centre de Recherche Cerveau et Cognition, CNRS, UMR5549, FR 31052, France
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24
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Vakharia VN, Sparks R, Li K, O'Keeffe AG, Miserocchi A, McEvoy AW, Sperling MR, Sharan A, Ourselin S, Duncan JS, Wu C. Automated trajectory planning for laser interstitial thermal therapy in mesial temporal lobe epilepsy. Epilepsia 2018; 59:814-824. [PMID: 29528488 PMCID: PMC5901027 DOI: 10.1111/epi.14034] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Surgical resection of the mesial temporal structures brings seizure remission in 65% of individuals with drug-resistant mesial temporal lobe epilepsy (MTLE). Laser interstitial thermal therapy (LiTT) is a novel therapy that may provide a minimally invasive means of ablating the mesial temporal structures with similar outcomes, while minimizing damage to the neocortex. Systematic trajectory planning helps ensure safety and optimal seizure freedom through adequate ablation of the amygdalohippocampal complex (AHC). Previous studies have highlighted the relationship between the residual unablated mesial hippocampal head and failure to achieve seizure freedom. We aim to implement computer-assisted planning (CAP) to improve the ablation volume and safety of LiTT trajectories. METHODS Twenty-five patients who had previously undergone LiTT for MTLE were studied retrospectively. The EpiNav platform was used to automatically generate an optimal ablation trajectory, which was compared with the previous manually planned and implemented trajectory. Expected ablation volumes and safety profiles of each trajectory were modeled. The implemented laser trajectory and achieved ablation of mesial temporal lobe structures were quantified and correlated with seizure outcome. RESULTS CAP automatically generated feasible trajectories with reduced overall risk metrics (P < .001) and intracerebral length (P = .007). There was a significant correlation between the actual and retrospective CAP-anticipated ablation volumes, supporting a 15 mm diameter ablation zone model (P < .001). CAP trajectories would have provided significantly greater ablation of the amygdala (P = .0004) and AHC (P = .008), resulting in less residual unablated mesial hippocampal head (P = .001), and reduced ablation of the parahippocampal gyrus (P = .02). SIGNIFICANCE Compared to manually planned trajectories CAP provides a better safety profile, with potentially improved seizure-free outcome and reduced neuropsychological deficits, following LiTT for MTLE.
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Affiliation(s)
- Vejay N. Vakharia
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
- Epilepsy Society MRI UnitChalfont St PeterUK
| | - Rachel Sparks
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
| | - Kuo Li
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
- The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | | | - Anna Miserocchi
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Andrew W. McEvoy
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Michael R. Sperling
- Department of Neurology, Vickie and Jack Farber Institute for NeuroscienceJefferson Comprehensive Epilepsy CenterThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ashwini Sharan
- Division of Epilepsy and Neuromodulation NeurosurgeryVickie and Jack Farber Institute for NeuroscienceThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Sebastien Ourselin
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
- Epilepsy Society MRI UnitChalfont St PeterUK
| | - Chengyuan Wu
- Division of Epilepsy and Neuromodulation NeurosurgeryVickie and Jack Farber Institute for NeuroscienceThomas Jefferson UniversityPhiladelphiaPAUSA
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Qiao LN, Yang HL, Tan LH, Yang JJ, Gao QL, Zhou SH, Zhang YC, Yang YS. [Transcutaneous Electrostimulation of Auricular Otopoints Reduces Epileptic Attack Possibly by Suppressing Hippocampal Gliocyte Proliferation and Regulating IL-6 and IL-10 Expression in Chronic Temporal Lobe Epilepsy Rats]. Zhen Ci Yan Jiu 2017; 42:189-196. [PMID: 29071973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To observe the effect of transcutaneous otopoint electrostimulaiton (TCOES) on seizure frequency, immunoreactivity of hippocampal gliocytes and expression of proinflammatory cytokine interleukin-6(IL-6) and anti-inflammatory cytokine IL-10 in chronic temporal lobe epilepsy (CTLE) rats, so as to investigate its antiepileptic mechanism. METHODS Thirty-six SD rats were randomly divided into control, model and TCOES groups (n=12 in each group). The CTLE model was established by intraperitoneal injection (i.p.i.) of lithium chloride (127.2 mg/kg), scopolamine (1 mg/kg, 20 h after the 1st injection) and pilocarpine (10 mg/kg, 30 min after scopolamine injection). Rats of the control group were treated by i.p.i. of normal saline. TCOES (1 mA, 20 Hz) was applied to bilateral otopoint "Heart"-"Lung"-"Subcortex" region for 20 min, once daily for 6 weeks. The epileptic attack was observed by a video monitoring system. The numbers of ionized calcium-binding adapter molecule-1 (Iba 1)-labeled microgliacytes and glial fibrillary acidic protein (GFAP)-labeled astrocytes in the CA 1 and CA 3 regions of hippocampus were counted under light microscope after immunostaining, and the expression levels of hippocampal IL-6 and IL-10 proteins and genes were determined by immunofluorescence and quantitative real-time PCR, respectively. RESULTS After TCOES intervention, the seizure frequency was significantly decreased in comparison with pre-treatment(P<0.05), modeling-induced dramatic increase of the numbers of microgliacytes and astrocytes,IL-6 immunoactivity in the hippocampal CA 1 and CA 3 regions, and IL-6 mRNA expression in the hippocampus were significantly suppressed (P<0.05), and hippo-campal IL-10 immunoactivity and mRNA expression were considerably up-regulated in comparison with the model group (P<0.05). CONCLUSIONS TCOES intervention has an antiepileptic effect in CTLE rats, which may be associated with its effects in suppressing gliocyte proliferation, suppressing the expression of proinflammatory cytokine IL-6, and up-regulaiting the expression of anti-inflammatory cytokine IL-10 in the hippocampus.
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Affiliation(s)
- Li-Na Qiao
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Hai-Long Yang
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China; School of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan 250014
| | - Lian-Hong Tan
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jiao-Jiao Yang
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China; School of Acupuncture and Massage, Changchun University of Traditional Chinese Medicine, Changchun 130117
| | - Qiao-Ling Gao
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China; School of Acupuncture and Massage, Changchun University of Traditional Chinese Medicine, Changchun 130117
| | - Sheng-Hong Zhou
- Shandong Academy of Traditional Chinese Medicine, Jinan 250014
| | - Yong-Chen Zhang
- School of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan 250014
| | - Yong-Sheng Yang
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
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Grau-López L, Jiménez M, Ciurans J, Cáceres C, Becerra JL. Importance of neuropsychological and clinical features to predict seizure control in medically treated patients with mesial temporal epilepsy and hippocampal sclerosis. Epilepsy Behav 2017; 69:121-125. [PMID: 28242475 DOI: 10.1016/j.yebeh.2017.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE It is not yet understood why seizures in certain patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS) develop resistance to antiepileptic drugs (AEDs) while others achieve good seizure control with this treatment. We analyzed clinical and neuropsychological features associated with seizure control in patients with MTLE-HS who had not undergone resective surgery. METHODS We enrolled 40 patients with medically treated MTLE-HS and retrospectively collected the following data from prospective databases: sex, febrile seizures, central nervous system infection, history of head trauma, cognitive impairment, psychiatric disturbances, history of status epilepticus, age at onset of epilepsy, aura, seizure type and frequency, electroencephalography abnormalities, HS side, AEDs, global cognitive status, and neuropsychological functions such as cognitive processing speed, attention and executive functions, verbal and visual memory, language, and visuospatial ability. These factors were compared between patients who achieved seizure control (no seizures or a >50% reduction in seizure frequency) with AED treatment and those who continued with poor seizure control (increase or no change in frequency or <50% reduction) after starting treatment. RESULTS The factors associated with poor seizure control in the multivariate analysis were >2seizures per month before treatment (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.2-4.8, p=0.04), moderate or severe cognitive impairment (OR 2.1, 95% CI 1.8-7.6, p=0.02), and impairment of >2 neuropsychological functions (OR 2.88, 95% CI 2-6.6, p=0.04). No associations were observed between poor seizure control and specific neuropsychological function impairment. CONCLUSIONS Poor seizure control in MTLE-HS is associated with moderate-severe cognitive impairment but not with a specific profile of impairment. Recognizing poor prognostic features such as a high frequency of monthly seizures prior to starting AED treatment could help to identify patients with medically intractable MTLE-HS who may be good candidates for early epilepsy surgery.
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Affiliation(s)
- Laia Grau-López
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain.
| | - Marta Jiménez
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Jordi Ciurans
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Cynthia Cáceres
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Juan Luis Becerra
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain
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27
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Yang HL, Qiao LN, Tan LH, Yang JJ, Chen Z, Zhang YC, Yang YS. [Effects of Transcutaneous Electrostimulation of Auricular Points on Behavior and Hippocampal IL-1 β and TNF-α Expression in Temporal Lobe Epilepsy Rats]. Zhen Ci Yan Jiu 2016; 41:283-290. [PMID: 29071921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To observe the effect of transcutaneous otopoint electrostimulation (TCOES) on behavior and expression of hippocampal interleukin-1 β (IL-1 β) and tumor necrosis factor-α (TNF-α) expression in lithium-pilocarpine induced chronic spontaneous temporal lobe epilepsy (TLE) rats, so as to investigate its antiepileptic mechanism. METHODS Thirty-six SD rats were randomly divided into control, model and TCOES groups (n=12 in each group). The epilepsy model was established by intraperitoneal injection of lithium chloride (127.2 mg/kg), scopolamine(1 mg/kg, 20 h after the 1st injection) and pilocarpine (10 mg/kg, 30 min after scopolamine injection). Rats of the control group were treated by injection of normal saline(i.p.i.). Transcutaneous electrostimulation (1 mA, 20 Hz) was applied to bilateral otopoints "Heart" "Lung" and "Subcortex" for 20 min, once daily for 6 weeks except the weekends. The behavior reactions were observed by a video monitoring system. The expression of IL-1 β and TNF-α proteins and genes in the hippocampus were determined by immunofluorescence and quantitative real-time PCR, separately. RESULTS Behavioral observation showed that after TCOES intervention, the frequency of epilepsy attack was significantly decreased in comparison with pre-treatment (P<0.05). Immunofluorescence and real-time PCR showed that compared with the control group, the immunoactivity of IL-1 β and TNF-α in both hippocampal CA 1 and CA 3 regions and hippocampal IL-1 β and TNF-α gene expression were obviously increased in the model group (P<0.05, P<0.01). Following TCOES, the increased hippocampal IL-1 β and TNF-α and IL-1 β mRNA and TNF-α mRNA expression levels were all suppressed (P<0.05, P<0.01). CONCLUSIONS TCOES intervention has an antiepileptogenic effect in temporal lobe epilepsy rats, which may be related to its effects in down-regulating expression of proinflammatory cytokine IL-1 β and TNF-α in the hippocampus.
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Affiliation(s)
- Hai-Long Yang
- Institute of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan 250014, China; Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700
| | - Li-Na Qiao
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700
| | - Lian-Hong Tan
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700
| | - Jiao-Jiao Yang
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700; Changchun University of Traditional Chinese Medicine, Changchun 130117
| | - Zhong Chen
- Shandong Provincial Mental Health Center, Jinan 250014
| | - Yong-Chen Zhang
- Institute of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan 250014, China
| | - Yong-Sheng Yang
- Lab of Biochemistry and Molecular Biology, Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700.
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Upadhya D, Hattiangady B, Shetty GA, Zanirati G, Kodali M, Shetty AK. Neural Stem Cell or Human Induced Pluripotent Stem Cell-Derived GABA-ergic Progenitor Cell Grafting in an Animal Model of Chronic Temporal Lobe Epilepsy. Curr Protoc Stem Cell Biol 2016; 38:2D.7.1-2D.7.47. [PMID: 27532817 PMCID: PMC5313261 DOI: 10.1002/cpsc.9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Grafting of neural stem cells (NSCs) or GABA-ergic progenitor cells (GPCs) into the hippocampus could offer an alternative therapy to hippocampal resection in patients with drug-resistant chronic epilepsy, which afflicts >30% of temporal lobe epilepsy (TLE) cases. Multipotent, self-renewing NSCs could be expanded from multiple regions of the developing and adult brain, human embryonic stem cells (hESCs), and human induced pluripotent stem cells (hiPSCs). On the other hand, GPCs could be generated from the medial and lateral ganglionic eminences of the embryonic brain and from hESCs and hiPSCs. To provide comprehensive methodologies involved in testing the efficacy of transplantation of NSCs and GPCs in a rat model of chronic TLE, NSCs derived from the rat medial ganglionic eminence (MGE) and MGE-like GPCs derived from hiPSCs are taken as examples in this unit. The topics comprise description of the required materials, reagents and equipment, methods for obtaining rat MGE-NSCs and hiPSC-derived MGE-like GPCs in culture, generation of chronically epileptic rats, intrahippocampal grafting procedure, post-grafting evaluation of the effects of grafts on spontaneous recurrent seizures and cognitive and mood impairments, analyses of the yield and the fate of graft-derived cells, and the effects of grafts on the host hippocampus. © 2016 by John Wiley & Sons, Inc.
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Affiliation(s)
- Dinesh Upadhya
- Institute for Regenerative Medicine, Texas A&M University Health Science Center College of Medicine, Temple, Texas
- Research Service, Olin E. Teague Veterans' Medical Center, Central Texas Veterans Health Care System, Temple, Texas
- Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas
| | - Bharathi Hattiangady
- Institute for Regenerative Medicine, Texas A&M University Health Science Center College of Medicine, Temple, Texas
- Research Service, Olin E. Teague Veterans' Medical Center, Central Texas Veterans Health Care System, Temple, Texas
- Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas
| | - Geetha A Shetty
- Institute for Regenerative Medicine, Texas A&M University Health Science Center College of Medicine, Temple, Texas
- Research Service, Olin E. Teague Veterans' Medical Center, Central Texas Veterans Health Care System, Temple, Texas
- Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas
| | - Gabriele Zanirati
- Institute for Regenerative Medicine, Texas A&M University Health Science Center College of Medicine, Temple, Texas
- Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas
| | - Maheedhar Kodali
- Institute for Regenerative Medicine, Texas A&M University Health Science Center College of Medicine, Temple, Texas
- Research Service, Olin E. Teague Veterans' Medical Center, Central Texas Veterans Health Care System, Temple, Texas
- Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas
| | - Ashok K Shetty
- Institute for Regenerative Medicine, Texas A&M University Health Science Center College of Medicine, Temple, Texas
- Research Service, Olin E. Teague Veterans' Medical Center, Central Texas Veterans Health Care System, Temple, Texas
- Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas
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Liu A, Bryant A, Jefferson A, Friedman D, Minhas P, Barnard S, Barr W, Thesen T, O'Connor M, Shafi M, Herman S, Devinsky O, Pascual-Leone A, Schachter S. Exploring the efficacy of a 5-day course of transcranial direct current stimulation (TDCS) on depression and memory function in patients with well-controlled temporal lobe epilepsy. Epilepsy Behav 2016; 55:11-20. [PMID: 26720704 DOI: 10.1016/j.yebeh.2015.10.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/17/2015] [Accepted: 10/18/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depression and memory dysfunction significantly impact the quality of life of patients with epilepsy. Current therapies for these cognitive and psychiatric comorbidities are limited. We explored the efficacy and safety of transcranial direct current stimulation (TDCS) for treating depression and memory dysfunction in patients with temporal lobe epilepsy (TLE). METHODS Thirty-seven (37) adults with well-controlled TLE were enrolled in a double-blinded, sham-controlled, randomized, parallel-group study of 5 days of fixed-dose (2 mA, 20 min) TDCS. Subjects were randomized to receive either real or sham TDCS, both delivered over the left dorsolateral prefrontal cortex. Patients received neuropsychological testing and a 20-minute scalp EEG at baseline immediately after the TDCS course and at 2- and 4-week follow-up. RESULTS There was improvement in depression scores immediately after real TDCS, but not sham TDCS, as measured by changes in the Beck Depression Inventory (BDI change: -1.68 vs. 1.27, p<0.05) and NDDI-E (-0.83 vs. 0.9091, p=0.05). There was no difference between the groups at the 2- or 4-week follow-up. There was no effect on delayed or working memory performance. Transcranial direct current stimulation was well-tolerated and did not increase seizure frequency or interictal discharge frequency. Transcranial direct current stimulation induced an increase in delta frequency band power over the frontal region and delta, alpha, and theta band power in the occipital region after real stimulation compared to sham stimulation, although the difference did not reach statistical significance. DISCUSSION This study provides evidence for the use of TDCS as a safe and well-tolerated nonpharmacologic approach to improving depressive symptoms in patients with well-controlled TLE. However, there were no changes in memory function immediately following or persisting after a stimulation course. Further studies may determine optimal stimulation parameters for maximal mood benefit.
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Affiliation(s)
- Anli Liu
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA; Berenson Allen Center for Non-invasive Brain Stimulation, Division of Cognitive Neurology, USA.
| | - Andrew Bryant
- NYU Comprehensive Epilepsy Center, USA; NYU Graduate School of Psychology, USA
| | - Ashlie Jefferson
- NYU Comprehensive Epilepsy Center, USA; NYU Graduate School of Psychology, USA
| | - Daniel Friedman
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Preet Minhas
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Sarah Barnard
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - William Barr
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Thomas Thesen
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Margaret O'Connor
- Beth Israel Deaconess Medical Center, USA; Harvard Medical School, USA
| | - Mouhsin Shafi
- Beth Israel Deaconess Medical Center, USA; Berenson Allen Center for Non-invasive Brain Stimulation, Division of Cognitive Neurology, USA; Harvard Medical School, USA
| | - Susan Herman
- Beth Israel Deaconess Medical Center, USA; Harvard Medical School, USA
| | - Orrin Devinsky
- NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA
| | - Alvaro Pascual-Leone
- Beth Israel Deaconess Medical Center, USA; Berenson Allen Center for Non-invasive Brain Stimulation, Division of Cognitive Neurology, USA; Harvard Medical School, USA
| | - Steven Schachter
- Beth Israel Deaconess Medical Center, USA; Harvard Medical School, USA
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Park GY, Lee EM, Seo MS, Seo YJ, Oh JS, Son WC, Kim KS, Kim JS, Kang JK, Kang KS. Preserved Hippocampal Glucose Metabolism on 18F-FDG PET after Transplantation of Human Umbilical Cord Blood-derived Mesenchymal Stem Cells in Chronic Epileptic Rats. J Korean Med Sci 2015; 30:1232-40. [PMID: 26339161 PMCID: PMC4553668 DOI: 10.3346/jkms.2015.30.9.1232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 05/18/2015] [Indexed: 11/20/2022] Open
Abstract
Human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) may be a promising modality for treating medial temporal lobe epilepsy. (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a noninvasive method for monitoring in vivo glucose metabolism. We evaluated the efficacy of hUCB-MSCs transplantation in chronic epileptic rats using FDG-PET. Rats with recurrent seizures were randomly assigned into three groups: the stem cell treatment (SCT) group received hUCB-MSCs transplantation into the right hippocampus, the sham control (ShC) group received same procedure with saline, and the positive control (PC) group consisted of treatment-negative epileptic rats. Normal rats received hUCB-MSCs transplantation acted as the negative control (NC). FDG-PET was performed at pre-treatment baseline and 1- and 8-week posttreatment. Hippocampal volume was evaluated and histological examination was done. In the SCT group, bilateral hippocampi at 8-week after transplantation showed significantly higher glucose metabolism (0.990 ± 0.032) than the ShC (0.873 ± 0.087; P < 0.001) and PC groups (0.858 ± 0.093; P < 0.001). Histological examination resulted that the transplanted hUCB-MSCs survived in the ipsilateral hippocampus and migrated to the contralateral hippocampus but did not differentiate. In spite of successful engraftment, seizure frequency among the groups was not significantly different. Transplanted hUCB-MSCs can engraft and migrate, thereby partially restoring bilateral hippocampal glucose metabolism. The results suggest encouraging effect of hUCB-MSCs on restoring epileptic networks.
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Affiliation(s)
- Ga Young Park
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- The Asan Institute for Life Science, Seoul, Korea
| | - Eun Mi Lee
- Department of Neurology, Ulsan University Hospital, Ulsan, Korea
| | - Min-Soo Seo
- Adult Stem Cell Research, College of Veterinary Medicine, Seoul National University, Seoul, Korea
| | - Yoo-Jin Seo
- Adult Stem Cell Research, College of Veterinary Medicine, Seoul National University, Seoul, Korea
| | - Jungsu S. Oh
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo-Chan Son
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki Soo Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joong Koo Kang
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung-Sun Kang
- Adult Stem Cell Research, College of Veterinary Medicine, Seoul National University, Seoul, Korea
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Hakimova H, Kim S, Chu K, Lee SK, Jeong B, Jeon D. Ultrasound stimulation inhibits recurrent seizures and improves behavioral outcome in an experimental model of mesial temporal lobe epilepsy. Epilepsy Behav 2015; 49:26-32. [PMID: 25940106 DOI: 10.1016/j.yebeh.2015.04.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 02/06/2023]
Abstract
Current therapies for epilepsy consist mostly of pharmacological agents or invasive surgery. Recently, ultrasound (US) stimulation has been considered a promising tool for the noninvasive treatment of brain diseases, including epilepsy. However, in temporal lobe epilepsy (TLE), a common form of epilepsy, neurophysiological and functional outcomes following US stimulation are not well defined. To address this, we developed a paradigm of transcranial pulsed US stimulation to efficiently suppress seizure activity in the initial/acute period in a kainate (KA)-induced mouse model of mesial TLE. Pulsed US stimulation inhibited acute seizure activity and either delayed the onset of or suppressed status epilepticus (SE). Kainate-treated mice that had received US stimulation in the initial period exhibited fewer spontaneous recurrent seizures (SRSs) and improved performance in behavioral tasks assessing sociability and depression in the chronic period of epilepsy. Our results demonstrate that US stimulation in the acute period of epilepsy can inhibit SRSs and improve behavioral outcomes in a mouse model of mesial TLE. The present study suggests that noninvasive transcranial pulsed US stimulation may be feasible as an adjuvant therapy in patients with epilepsy. This article is part of a Special Issue entitled "Status Epilepticus".
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Affiliation(s)
- Hilola Hakimova
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sangwoo Kim
- Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Seoul, Republic of Korea
| | - Kon Chu
- Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Seoul, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Seoul, Republic of Korea
| | - Bumseok Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
| | - Daejong Jeon
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea; Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital (SNUH), Seoul, Republic of Korea.
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Abstract
During the last 20 years, it has been well established that a finely tuned, continuous crosstalk between neurons and astrocytes not only critically modulates physiological brain functions but also underlies many neurological diseases. In particular, this novel way of interpreting brain activity is markedly influencing our current knowledge of epilepsy, prompting a re-evaluation of old findings and guiding novel experimentation. Here, we review recent studies that have unraveled novel and unique contributions of astrocytes to the generation and spread of convulsive and nonconvulsive seizures and epileptiform activity. The emerging scenario advocates an overall framework in which a dynamic and reciprocal interplay among astrocytic and neuronal ensembles is fundamental for a fuller understanding of epilepsy. In turn, this offers novel astrocytic targets for the development of those really novel chemical entities for the control of convulsive and nonconvulsive seizures that have been acknowledged as a key priority in the management of epilepsy.
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Affiliation(s)
- Vincenzo Crunelli
- Neuroscience Division, School of Biosciences, Cardiff University, Cardiff, UK
| | - Giorgio Carmignoto
- Centro Nazionale della Ricerca, Neuroscience Institute and Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Christian Steinhäuser
- Institute of Cellular Neurosciences, Medical Faculty, University of Bonn, Bonn, Germany
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Sergeeva TV, Gurchin AF, Koroleva NY, Arkhipova NB, Chugunova AA, Danilenko LA. [Combined therapy of pleomorphic xanthoastrocytoma with sympathetic temporal epilepsy diagnosed in the first trimester of pregnancy]. Vestn Khir Im I I Grek 2015; 174:79-81. [PMID: 26983266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Young D, Fong DM, Lawlor PA, Wu A, Mouravlev A, McRae M, Glass M, Dragunow M, During MJ. Adenosine kinase, glutamine synthetase and EAAT2 as gene therapy targets for temporal lobe epilepsy. Gene Ther 2014; 21:1029-40. [PMID: 25231174 PMCID: PMC4257851 DOI: 10.1038/gt.2014.82] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/15/2014] [Accepted: 08/06/2014] [Indexed: 12/19/2022]
Abstract
Astrocytes are an attractive cell target for gene therapy, but the validation of new therapeutic candidates is needed. We determined whether adeno-associated viral (AAV) vector-mediated overexpression of glutamine synthetase (GS) or excitatory amino-acid transporter 2 (EAAT2), or expression of microRNA targeting adenosine kinase (miR-ADK) in hippocampal astrocytes in the rat brain could modulate susceptibility to kainate-induced seizures and neuronal cell loss. Transgene expression was found predominantly in astrocytes following direct injection of glial-targeting AAV9 vectors by 3 weeks postinjection. ADK expression in miR-ADK vector-injected rats was reduced by 94-96% and was associated with an ~50% reduction in the duration of kainate-induced seizures and greater protection of dentate hilar neurons but not CA3 neurons compared with miR-control vector-injected rats. In contrast, infusion of AAV-GS and EAAT2 vectors did not afford any protection against seizures or neuronal damage as the level of transcriptional activity of the glial fibrillary acidic promoter was too low to drive any significant increase in transgenic GS or EAAT2 relative to the high endogenous levels of these proteins. Our findings support ADK as a prime therapeutic target for gene therapy of temporal lobe epilepsy and suggest that alternative approaches including the use of stronger glial promoters are needed to increase transgenic GS and EAAT2 expression to levels that may be required to affect seizure induction and propagation.
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Affiliation(s)
- Deborah Young
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
- Department of Molecular Medicine & Pathology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Dahna M. Fong
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Patricia A. Lawlor
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Angela Wu
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Alexandre Mouravlev
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Michelle McRae
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Michelle Glass
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Michael Dragunow
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Matthew J. During
- Department of Molecular Medicine & Pathology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Department of Molecular Virology, Immunology and Medical Genetics, Neuroscience and Neurological Surgery, Ohio State University, Columbus, Ohio, USA
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Heerey A, Nash P, Hennessy M. The ictal bradycardia syndrome: persistence of seizures despite cardiac pacemaker implantation. Ir Med J 2014; 107:80-81. [PMID: 24757892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Ictal bradycardic syndrome (IBS), a rare manifestation of temporal lobe epilepsy is both difficult to diagnose and treat. Our case study of a 24 year old with persistent and unexplained syncope highlights the typical presentation, investigation and treatment of IBS.
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Zhang L, Liang S, Zhang G, Liu Z, Lv H, Fang F, Wang Y, Zhang S, Kang X. Seizure control of current shunt on rats with temporal lobe epilepsy and neocortical epilepsy. PLoS One 2014; 9:e86477. [PMID: 24497949 PMCID: PMC3907408 DOI: 10.1371/journal.pone.0086477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine the effects of current shunt on rats with temporal lobe epilepsy and neocortex epilepsy. Experimental Design A kainic acid (KA)-induced model of temporal lobe seizure and a penicillin-induced model of neocortical partial seizure were used in this study. Rats of each model were randomly allocated into two groups: control and model groups. The model group was further divided into the KA or penicillin group, sham conduction group and conduction group. The current shunt was realized through the implantation of a customized conduction electrode. After surgery, electroencephalogram (EEG) was recorded for two hours for each rat under anesthesia. Subsequently, the rats were video monitored for 72 h to detect the occurrence of behavioral seizures upon awakening. The average number and duration of seizures on EEG and the number of behavioral seizures were measured. Results In KA model, the number of total EEG seizures in conduction group (9.57±2.46) was significantly less than that in sham conduction group (15.13±3.45) (p<0.01). The duration of EEG seizures in conduction group (26.13±7.81 s) was significantly shorter than that in sham conduction group (34.17±7.25 s) (p = 0.001). A significant reduction of behavioral seizures was observed in the conduction group compared with KA (p = 0.000) and sham conduction groups (p = 0.000). In penicillin model, there was a 61% reduction in total EEG seizures in conduction group compared with sham conduction group (p<0.01), and the duration of EEG seizures in conduction group (6.29±2.64 s) was significantly shorter than that in the sham conduction group (12.07±3.81 s) (p = 0.002). A significant reduction of behavioral seizures was observed in conduction group compared with penicillin (p<0.01) and sham conduction groups (p<0.01). Conclusion Current shunt effectively reduces the onset and severity of seizures. Current shunt therapy could be an effective alternative minimally invasive approach for temporal lobe epilepsy and neocortex epilepsy.
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Affiliation(s)
- Limin Zhang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Capital Epilepsy Therapy Center, First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shuli Liang
- Department of Neurosurgery, Capital Epilepsy Therapy Center, First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
- * E-mail: (SL); (XK)
| | - Guojun Zhang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhizhong Liu
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Lv
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Fang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yajie Wang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shaohui Zhang
- Department of Neurosurgery, Capital Epilepsy Therapy Center, First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xixiong Kang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail: (SL); (XK)
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Goodarzi P, Aghayan HR, Soleimani M, Norouzi-Javidan A, Mohamadi-Jahani F, Jahangiri S, Emami-Razavi SH, Larijani B, Arjmand B. Stem cell therapy for treatment of epilepsy. Acta Med Iran 2014; 52:651-655. [PMID: 25325201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/17/2013] [Indexed: 06/04/2023] Open
Abstract
Epilepsy as one of the most common neurological disorders affects more than 50 million people worldwide with a higher prevalence rate in low-income countries. Excessive electrical discharges in neurons following neural cell damage or loss cause recurrent seizures. One of the most common and difficult to treat types of epilepsy is temporal lobe epilepsy (TLE) which results from hippocampal sclerosis. Nowadays, similar to other diseases, epilepsy also is a candidate for treatment with different types of stem cells. Various stem cell types were used for treatment of epilepsy in basic and experimental researches. Two major roles of stem cell therapy in epilepsy are prophylaxis against chronic epilepsy and amelioration cognitive function after the occurrence of TLE. Several animal studies have supported the use of these cells for treating drug-resistant TLE. Although stem cell therapy seems like a promising approach for treatment of epilepsy in the future however, there are some serious safety and ethical concerns that are needed to be eliminated before clinical application.
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Affiliation(s)
- Parisa Goodarzi
- Brain and Spinal Cord Injury Research Center, Cellule Fanavaran Knowledge-Based Organization, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamid Reza Aghayan
- Brain and Spinal Cord Injury Research Center, Cellule Fanavaran Knowledge-Based Organization, Tehran University of Medical Sciences, Tehran, Iran. AND Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Masoud Soleimani
- Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Hematology, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran.
| | - Abbas Norouzi-Javidan
- Brain and Spinal Cord Injury Research Center, Cellule Fanavaran Knowledge-Based Organization, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Sharareh Jahangiri
- Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Hasan Emami-Razavi
- Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Babak Arjmand
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Bleekers R. Photocopy for your patients. Miserable, manic or misdiagnosed? Afr J Psychiatry (Johannesbg) 2013; 16:306. [PMID: 24051571] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Hunt RF, Girskis KM, Rubenstein JL, Alvarez-Buylla A, Baraban SC. GABA progenitors grafted into the adult epileptic brain control seizures and abnormal behavior. Nat Neurosci 2013; 16:692-7. [PMID: 23644485 PMCID: PMC3665733 DOI: 10.1038/nn.3392] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/26/2013] [Indexed: 01/16/2023]
Abstract
Impaired GABA-mediated neurotransmission has been implicated in many neurologic diseases, including epilepsy, intellectual disability and psychiatric disorders. We found that inhibitory neuron transplantation into the hippocampus of adult mice with confirmed epilepsy at the time of grafting markedly reduced the occurrence of electrographic seizures and restored behavioral deficits in spatial learning, hyperactivity and the aggressive response to handling. In the recipient brain, GABA progenitors migrated up to 1,500 μm from the injection site, expressed genes and proteins characteristic for interneurons, differentiated into functional inhibitory neurons and received excitatory synaptic input. In contrast with hippocampus, cell grafts into basolateral amygdala rescued the hyperactivity deficit, but did not alter seizure activity or other abnormal behaviors. Our results highlight a critical role for interneurons in epilepsy and suggest that interneuron cell transplantation is a powerful approach to halting seizures and rescuing accompanying deficits in severely epileptic mice.
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Affiliation(s)
- Robert F Hunt
- Epilepsy Research Laboratory, University of California, San Francisco, California, USA.
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Bondallaz P, Boëx C, Rossetti AO, Foletti G, Spinelli L, Vulliemoz S, Seeck M, Pollo C. Electrode location and clinical outcome in hippocampal electrical stimulation for mesial temporal lobe epilepsy. Seizure 2013; 22:390-5. [PMID: 23540624 DOI: 10.1016/j.seizure.2013.02.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To study the clinical outcome in hippocampal deep brain stimulation (DBS) for the treatment of patients with refractory mesial temporal lobe epilepsy (MTLE) according to the electrode location. METHODS Eight MTLE patients implanted in the hippocampus and stimulated with high-frequency DBS were included in this study. Five underwent invasive recordings with depth electrodes to localize ictal onset zone prior to chronic DBS. Position of the active contacts of the electrode was calculated on postoperative imaging. The distances to the ictal onset zone were measured as well as atlas-based hippocampus structures impacted by stimulation were identified. Both were correlated with seizure frequency reduction. RESULTS The distances between active electrode location and estimated ictal onset zone were 11±4.3 or 9.1±2.3mm for patients with a >50% or <50% reduction in seizure frequency. In patients (N=6) showing a >50% seizure frequency reduction, 100% had the active contacts located <3mm from the subiculum (p<0.05). The 2 non-responders patients were stimulated on contacts located >3mm to the subiculum. CONCLUSION Decrease of epileptogenic activity induced by hippocampal DBS in refractory MTLE: (1) seems not directly associated with the vicinity of active electrode to the ictal focus determined by invasive recordings; (2) might be obtained through the neuromodulation of the subiculum.
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Affiliation(s)
- Percy Bondallaz
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
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41
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Tellez-Zenteno JF, Ladino LD. [Temporal epilepsy: clinical, diagnostic and therapeutic aspects]. Rev Neurol 2013; 56:229-242. [PMID: 23400651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Epilepsy is a common neurological disease with significant public health impact. Temporal lobe epilepsy (TLE) is one of the most frequent and complex epilepsies. AIM To review the most important aspects of clinical diagnosis, the use of diagnostic tests, and medical and surgical treatment of TLE. DEVELOPMENT TLE is a well described type of epilepsy. Approximately 40% of patients with TLE develop drug resistant epilepsy. Nowadays, new diagnosis tools have been added for the assessment of patients with TLE that could be candidates for epilepsy surgery. However semiology remains the starting point for the disease understanding and every localizing and lateralizing sign is relevant to understand the potential onset and dissemination of seizures. The combination of tests and semiology is important to decide which cases require intracranial electrodes. The prognosis of epilepsy surgery in TLE is very good and between 60 to 70% of patients rendered seizure free after surgery. CONCLUSIONS The approach to patients with TLE is complex and requires a multidisciplinary team of trained specialists.
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Miltiadous P, Kouroupi G, Stamatakis A, Koutsoudaki PN, Matsas R, Stylianopoulou F. Subventricular zone-derived neural stem cell grafts protect against hippocampal degeneration and restore cognitive function in the mouse following intrahippocampal kainic acid administration. Stem Cells Transl Med 2013; 2:185-98. [PMID: 23417642 DOI: 10.5966/sctm.2012-0074] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is a major neurological disease, often associated with cognitive decline. Since approximately 30% of patients are resistant to antiepileptic drugs, TLE is being considered as a possible clinical target for alternative stem cell-based therapies. Given that insulin-like growth factor I (IGF-I) is neuroprotective following a number of experimental insults to the nervous system, we investigated the therapeutic potential of neural stem/precursor cells (NSCs) transduced, or not, with a lentiviral vector for overexpression of IGF-I after transplantation in a mouse model of kainic acid (KA)-induced hippocampal degeneration, which represents an animal model of TLE. Exposure of mice to the Morris water maze task revealed that unilateral intrahippocampal NSC transplantation significantly prevented the KA-induced cognitive decline. Moreover, NSC grafting protected against neurodegeneration at the cellular level, reduced astrogliosis, and maintained endogenous granule cell proliferation at normal levels. In some cases, as in the reduction of hippocampal cell loss and the reversal of the characteristic KA-induced granule cell dispersal, the beneficial effects of transplanted NSCs were manifested earlier and were more pronounced when these were transduced to express IGF-I. However, differences became less pronounced by 2 months postgrafting, since similar amounts of IGF-I were detected in the hippocampi of both groups of mice that received cell transplants. Grafted NSCs survived, migrated, and differentiated into neurons-including glutamatergic cells-and not glia, in the host hippocampus. Our results demonstrate that transplantation of IGF-I producing NSCs is neuroprotective and restores cognitive function following KA-induced hippocampal degeneration.
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MESH Headings
- Animals
- Astrocytes/metabolism
- Astrocytes/pathology
- Behavior, Animal
- Cell Movement
- Cell Proliferation
- Cell Survival
- Cognition
- Disease Models, Animal
- Epilepsy, Temporal Lobe/chemically induced
- Epilepsy, Temporal Lobe/genetics
- Epilepsy, Temporal Lobe/metabolism
- Epilepsy, Temporal Lobe/pathology
- Epilepsy, Temporal Lobe/physiopathology
- Epilepsy, Temporal Lobe/psychology
- Epilepsy, Temporal Lobe/therapy
- Genetic Therapy/methods
- Genetic Vectors
- Glutamic Acid/metabolism
- Green Fluorescent Proteins/biosynthesis
- Green Fluorescent Proteins/genetics
- Hippocampus/metabolism
- Hippocampus/pathology
- Hippocampus/physiopathology
- Hippocampus/surgery
- Insulin-Like Growth Factor I/biosynthesis
- Insulin-Like Growth Factor I/genetics
- Kainic Acid
- Lentivirus/genetics
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Nerve Degeneration
- Neural Stem Cells/metabolism
- Neural Stem Cells/transplantation
- Neurogenesis
- Neurons/metabolism
- Neurons/pathology
- Spheroids, Cellular
- Time Factors
- Transduction, Genetic
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Migliorelli C, Romero S, Alonso JF, Nowak R, Russi A, Mananas MA. Reduction of metallic interference in MEG signals using AMUSE. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:5970-5973. [PMID: 24111099 DOI: 10.1109/embc.2013.6610912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Magnetoencephalography is a technique that can noninvasively measure the brain signal. There are many advantages of using this technique rather than similar procedures such as the EEG for the evaluation of medical diseases. However, one of its main problems is its high sensitivity to sources causing metallic distortion of the signal, and the removal of this type of artifacts remains unsolved. In this study a technique for reducing metallic interference was presented. This algorithm was based on AMUSE, a second order blind source separation method, and a procedure for choosing the artifactual independent components was also presented. The results showed that the elimination of these artifacts would be possible by means of the application of this AMUSE-based interference reduction procedure.
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Mandzia J, Andrade D, Burneo JG, Jenkins ME. Critically appraised topic. Temporal lobe epilepsy and hippocampal stimulation. Can J Neurol Sci 2012; 39:830-832. [PMID: 23041406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Jennifer Mandzia
- Department of Clinical Neurological Sciences, University of Western Ontario, 339 Windermere Rd, London, Ontario, N6A 5A5, Canada
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45
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Tsai CY, Chan JYH, Hsu KS, Chang AYW, Chan SHH. Brain-derived neurotrophic factor ameliorates brain stem cardiovascular dysregulation during experimental temporal lobe status epilepticus. PLoS One 2012; 7:e33527. [PMID: 22442695 PMCID: PMC3307740 DOI: 10.1371/journal.pone.0033527] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/14/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Status epilepticus (SE) is an acute, prolonged epileptic crisis with a mortality rate of 20-30%; the underlying mechanism is not completely understood. We assessed the hypothesis that brain stem cardiovascular dysregulation occurs during SE because of oxidative stress in rostral ventrolateral medulla (RVLM), a key nucleus of the baroreflex loop; to be ameliorated by brain-derived neurotrophic factor (BDNF) via an antioxidant action. METHODOLOGY/PRINCIPAL FINDINGS In a clinically relevant experimental model of temporal lobe SE (TLSE) using Sprague-Dawley rats, sustained hippocampal seizure activity was accompanied by progressive hypotension that was preceded by a reduction in baroreflex-mediated sympathetic vasomotor tone; heart rate and baroreflex-mediated cardiac responses remained unaltered. Biochemical experiments further showed concurrent augmentation of superoxide anion, phosphorylated p47(phox) subunit of NADPH oxidase and mRNA or protein levels of BDNF, tropomyosin receptor kinase B (TrkB), angiotensin AT1 receptor subtype (AT1R), nitric oxide synthase II (NOS II) or peroxynitrite in RVLM. Whereas pretreatment by microinjection bilaterally into RVLM of a superoxide dismutase mimetic (tempol), a specific antagonist of NADPH oxidase (apocynin) or an AT1R antagonist (losartan) blunted significantly the augmented superoxide anion or phosphorylated p47(phox) subunit in RVLM, hypotension and the reduced baroreflex-mediated sympathetic vasomotor tone during experimental TLSE, pretreatment with a recombinant human TrkB-Fc fusion protein or an antisense bdnf oligonucleotide significantly potentiated all those events, alongside peroxynitrite. However, none of the pretreatments affected the insignificant changes in heart rate and baroreflex-mediated cardiac responses. CONCLUSIONS/SIGNIFICANCE We conclude that formation of peroxynitrite by a reaction between superoxide anion generated by NADPH oxidase in RVLM on activation by AT1R and NOS II-derived NO leads to a reduction in baroreflex-mediated sympathetic vasomotor tone during experimental TLSE; to be ameliorated by the upregulated BDNF/TrkB signaling via inhibition of p47(phox) phosphorylation. This information offers a new vista in devising therapeutic strategy towards minimizing mortality associated with TLSE.
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MESH Headings
- Acetophenones/pharmacology
- Animals
- Antioxidants/metabolism
- Brain Stem
- Brain-Derived Neurotrophic Factor
- Cardiovascular System/metabolism
- Cardiovascular System/physiopathology
- Cyclic N-Oxides/pharmacology
- Enzyme Inhibitors/pharmacology
- Epilepsy, Temporal Lobe/metabolism
- Epilepsy, Temporal Lobe/pathology
- Epilepsy, Temporal Lobe/physiopathology
- Epilepsy, Temporal Lobe/therapy
- Humans
- Losartan/pharmacology
- NADPH Oxidases/antagonists & inhibitors
- NADPH Oxidases/metabolism
- Nitric Oxide Synthase Type II/metabolism
- Oxidative Stress/drug effects
- Peroxynitrous Acid/metabolism
- Phosphorylation/drug effects
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Receptor, Angiotensin, Type 1/metabolism
- Receptor, trkB/antagonists & inhibitors
- Receptor, trkB/metabolism
- Spin Labels
- Status Epilepticus/metabolism
- Status Epilepticus/pathology
- Status Epilepticus/physiopathology
- Status Epilepticus/therapy
- Superoxides/metabolism
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Affiliation(s)
- Ching-Yi Tsai
- Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
| | - Julie Y. H. Chan
- Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
| | - Kuei-sen Hsu
- Department of Pharmacology, National Cheng Kung University, Tainan, Taiwan, Republic of China
| | - Alice Y. W. Chang
- Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
- * E-mail: (AYWC); (SHHC)
| | - Samuel H. H. Chan
- Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
- * E-mail: (AYWC); (SHHC)
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Nishimoto T, Iida K, Kagawa K, Watanabe Y, Kiura Y, Hashizume A, Sugiyama K, Kurisu K. Late recurrence of intractable epilepsy associated with MRI-occult pilocytic astrocytoma in the temporal lobe nine years after initial removal: a case report with surgical and late-seizure recurrence observations. Hiroshima J Med Sci 2011; 60:45-49. [PMID: 21970188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 28-year-old male who presented a relapse of intractable epilepsy consisting of complex partial seizures with occasional secondary generalizations at the age of 26, had undergone removal of a left mesial temporal lobe tumor at another hospital at 18 years old. Pathological examination at that time revealed a low-grade astrocytoma, and the tumor was further treated by complementary adjuvant irradiation therapy. Magnetic resonance imaging (MRI) findings on admission portrayed a post-operative cavity anterior to the atrophied hippocampus on the left side with hyperintense in fluid-attenuated inversion recovery (FLAIR) images. There were no enhanced lesions in T1-weighted gadolinium images. As it was diagnosed as left mesial temporal lobe epilepsy with preoperative evaluations, the patient underwent left anterior temporal lobe resection (TLR). Intraoperative findings revealed that a small lump of grey tissue was attached to the anteromesial side of the sclerotic hippocampus. We surgically removed this and the tissue was a pilocytic astrocytoma. The patient has since remained seizure-free for 2.5 years. Seizure outcomes at postoperative 1-2 years are highly predictive of long-term outcomes after TLR for temporal lobe epilepsy (TLE). Late-seizure recurrence (> postoperative 2 years) with an initially successful outcome rarely occurs in TLR patients. This case report suggests that recurrence of even benign pilocytic astrocytomas may occur when seizure recurs in long-term follow-up.
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Affiliation(s)
- Takeshi Nishimoto
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734 - 8551, Japan.
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Spencer D, Gwinn R, Salinsky M, O'Malley JP. Laterality and temporal distribution of seizures in patients with bitemporal independent seizures during a trial of responsive neurostimulation. Epilepsy Res 2011; 93:221-5. [PMID: 21256715 DOI: 10.1016/j.eplepsyres.2010.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/14/2010] [Accepted: 12/21/2010] [Indexed: 11/17/2022]
Abstract
We describe seizure laterality and temporal seizure patterns in six subjects with bilateral temporal lobe epilepsy (bTLE) implanted with bilateral hippocampal depth electrodes and the NeuroPace RNS™ system over 84 consecutive days. Seizures were disproportionate in laterality in three subjects and disproportionate in time for two subjects. Clustering of seizures did not clearly affect laterality. Some but not all subjects with bTLE displayed nonrandom temporal or lateral clustering of seizures.
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Affiliation(s)
- David Spencer
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. CR120, Portland, OR 97239, United States.
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48
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Gallego JM, Sancho FJ, Vidueira S, Ortiz L, Gómez-Pinedo U, Barcia JA. Injection of embryonic median ganglionic eminence cells or fibroblasts within the amygdala in rats kindled from the piriform cortex. Seizure 2010; 19:461-6. [PMID: 20675157 DOI: 10.1016/j.seizure.2010.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 04/13/2010] [Accepted: 06/04/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracerebral infusion of anticonvulsant agent secreting cells has proven to raise the threshold for seizure generation in epileptogenic areas. Median ganglionic eminence (MGE) is the main embryonic region where future GABAergic cells originate. Here we report the results of intraamygdaline grafting of MGE cells versus fibroblasts in a piriform cortex kindling model of epilepsy in the rat. MATERIAL AND METHODS Rats were implanted with an electrode in the left piriform cortex and subjected to infusion at the left basolateral amygdala of cells obtained from the MGE of embryos or fibroblasts. Some of the donor cells were obtained from transgenic rats expressing the green fluorescent protein (GFP). Seizure and neurologic behavior were recorded, and inmunohistochemical and ultrastructural studies were carried out. RESULTS Cells obtained from the embryonic MGE elevated both the afterdischarge and the seizure threshold progressively, being significant 3 weeks after their injection. On the contrary, fibroblasts injected into the amygdala raised the seizure thresholds the first week, the effect weaning during the following weeks. Fibroblasts and MGE cells were shown at the injected amygdala. No behavioral side effects were recorded in either experimental group. CONCLUSION MGE cells implanted at the amygdala may control the focal component of temporolimbic seizures. This effect may be mediated by local release of GABA.
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Affiliation(s)
- José M Gallego
- Servicio de Neurocirugía, Hospital General Universitario de Valencia, Spain
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Abstract
Voltage-gated potassium channels are widely expressed throughout the entire nervous system. These channels play a critical role in establishing the resting membrane potential and generation of neuronal action potentials. There is mounting evidence that autoantibodies reactive to neuronal cell surface antigens, such as voltage-gated potassium channels, play a pathogenic role in a wide spectrum of central and peripheral nervous system disorders. We report a case of new-onset drug-refractory seizure disorder associated with the presence of high levels of serum anti-voltage-gated potassium channel antibodies that responded only to immunotherapy. As demonstrated by this case report, anti-voltage-gated potassium channel antibody associated drug-refractory seizure disorder, although rare, should be considered in patients with unexplained adult-onset seizure activity. Once the diagnosis has been established the initiation of immunotherapy should be undertaken without delay.
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Affiliation(s)
- Ramon F Barajas
- Department of Radiology, Neuroradiology Section, University of California, San Francisco, California 94143-1207, USA
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50
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Schulze-Bonhage A, Dennig D, Wagner K, Cordeiro JG, Carius A, Fauser S, Trippel M. Seizure control resulting from intrahippocampal depth electrode insertion. J Neurol Neurosurg Psychiatry 2010; 81:352-3. [PMID: 20185477 DOI: 10.1136/jnnp.2009.180075] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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