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Bruno F, Mo F, Meletti S, Belcastro V, Quadri S, Napolitano M, Bello L, Dainese F, Scarpelli M, Florindo I, Mascia A, Pauletto G, Pellerino A, Giovannini G, Polosa M, Sessa M, Conti Nibali M, Di Gennaro G, Gigli G, Cavallieri F, Pisanello A, Rudà R. OS02.6.A Lacosamide in monotherapy in brain tumour-related epilepsy (BTRE): results from an Italian multicentre retrospective study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Lacosamide (LCM) is a third-generation anti-seizure medication (ASM) approved for focal onset epilepsy in patients aged ≥4 years. Previous studies have reported an efficacy of LCM as add-on treatment in brain tumour-related epilepsy (BTRE). To date, there are no studies in the literature focusing on lacosamide used in monotherapy to treat BTRE. In our retrospective study we investigated efficacy and tolerability of LCM in monotherapy in a multicentre national cohort of primary brain tumour patients.
Patients and Methods
Adult patients who were treated with LCM in monotherapy were collected from 12 Italian Centres (either mainly involved in neuro-oncology or in epileptology). Main inclusion criteria were diagnosis of primary brain tumour; at least two focal-onset seizures in the disease course; LCM used either as primary or secondary monotherapy after withdrawal of previous ASMs. For each patient, we evaluated seizure freedom at 3 and 6 months (primary endpoints), side effects and drop-out rate (secondary endpoints).
Results
We collected 132 patients. The majority of patients had a diagnosis of diffuse gliomas, being those with lower-grade glioma 66 (50.0%) and those with glioblastoma 33 (25.0%). Overall, LCM led to seizure-freedom in 64.4% of patients at 3 months and 55% at 6 months. Patients who used two or more ASMs before LCM had a worse seizure control than patients in monotherapy with LCM as first choice.In 14 patients, we observed seizure control despite tumour progression on magnetic resonance (MRI). Multivariate analysis showed that gross-total resection at diagnosis and use of steroids were significantly associated with higher seizure freedom rate at 6 months. Side effects were mainly mild (grade 1-2 according to the CTCAE classification), and the drop-out rate was low (1.5%). The main side effects were dizziness and somnolence.
Conclusion
This is the first study on the role of LCM in monotherapy in BTRE. The study has shown a good efficacy and tolerability of LCM with more than a half of patients becoming seizure-free at 6 months and with a very low rate of drop-out. Further studies are needed to confirm these preliminary data in a prospective manner, adding quality of life and neurocognitive functions as endpoints.
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Affiliation(s)
- F Bruno
- University and City of Health and Science, Turin, Italy , Turin , Italy
| | - F Mo
- University and City of Health and Science, Turin, Italy , Turin , Italy
| | - S Meletti
- Division of Neurology, Modena University Hospital, Modena, Italy , Modena , Italy
- Center for Neuroscience and Neurotechnology, Department of Biomedical, Metabolic and Neural Sciences; University of Modena and Reggio Emilia, Italy , Modena and Reggio Emilia , Italy
| | - V Belcastro
- Division of Neurology, Maggiore Hospital, Lodi, Italy , Lodi , Italy
| | - S Quadri
- Division of Neurology, ASST Papa Giovanni XXIII of Bergamo, Italy , Bergamo , Italy
| | - M Napolitano
- Division of Neurology and Stroke Unit, Hospital A. Cardarelli, Napoli, Italy , Naples , Italy
| | - L Bello
- Division of Neurosurgical Oncology, Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Italy , Milan , Italy
| | - F Dainese
- Epilepsy Centre, Division of Neurology, Hospital of Venezia, Italy , Venice , Italy
| | - M Scarpelli
- Division of Neurology, Department of Neuroscience, AOUI Verona, Verona, Italy , Verona , Italy
| | - I Florindo
- Division of Neurology, Hospital of Parma, Italy , Parma , Italy
| | - A Mascia
- IRCCS Neuromed, Pozzilli, Italy , Pozzilli , Italy
| | - G Pauletto
- Neurology Unit, Department of Neuroscience, “S. Maria della Misericordia” University Hospital, Udine, Italy , Udine , Italy
| | - A Pellerino
- University and City of Health and Science, Turin, Italy , Turin , Italy
| | - G Giovannini
- Division of Neurology, Modena University Hospital, Modena, Italy , Modena , Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy , Modena and Reggio Emilia , Italy
| | - M Polosa
- Division of Neurosurgery, ASST Lariana, Como, Italy , Como , Italy
| | - M Sessa
- Division of Neurology, ASST Papa Giovanni XXIII of Bergamo, Italy , Bergamo , Italy
| | - M Conti Nibali
- Division of Neurosurgical Oncology, Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Italy , Milan , Italy
| | - G Di Gennaro
- IRCCS Neuromed, Pozzilli, Italy , Pozzilli , Italy
| | - G Gigli
- Department of Medicine (DAME), University of Udine, Udine, Italy , Udine , Italy
- Clinical Neurology Unit, “S. Maria della Misericordia” University Hospital, Udine, Italy , Udine , Italy
| | - F Cavallieri
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy , Modena and Reggio Emilia , Italy
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy , Reggio Emilia , Italy
| | - A Pisanello
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy , Reggio Emilia , Italy
| | - R Rudà
- University and City of Health and Science, Turin, Italy , Turin , Italy
- Dept. of Neurology, Castelfranco and Treviso Hospitals, Italy , Treviso , Italy
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Mascia A. SP-0203 Translating FLASH into the clinic: Treatment planning and preparing for clinical trials. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mo F, Meletti S, Belcastro V, Quadri S, Napolitano M, Bello L, Dainese F, Scarpelli M, Florindo I, Mascia A, Pauletto G, Bruno F, Pellerino A, Giovannini G, Polosa M, Sessa M, Conti Nibali M, Di Gennaro G, Gigli GL, Pisanello A, Cavallieri F, Rudà R. Lacosamide in monotherapy in BTRE (brain tumor-related epilepsy): results from an Italian multicenter retrospective study. J Neurooncol 2022; 157:551-559. [DOI: 10.1007/s11060-022-03998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
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Lattanzi S, Ascoli M, Canafoglia L, Canevini MP, Casciato S, Cerulli Irelli E, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Manfredi Basili L, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongiorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Donato F, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Teresa Faedda M, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gasparini S, Gazzina S, Teresa Giallonardo A, Sean Giorgi F, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Kiferle L, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Meletti S, Milano C, Nilo A, Orlando B, Paladin F, Grazia Pascarella M, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Rosa Pisani L, Placidi F, Pollicino P, Porcella V, Puligheddu M, Quadri S, Paolo Quarato P, Quintas R, Renna R, Rum A, Michele Salamone E, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Elisabetta Vaudano A, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Sustained seizure freedom with adjunctive brivaracetam in patients with focal‐onset seizures. Epilepsia 2022; 63:e42-e50. [PMID: 35278335 PMCID: PMC9311068 DOI: 10.1111/epi.17223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic Department of Experimental and Clinical Medicine Marche Polytechnic University Ancona Italy
| | - Michele Ascoli
- Department of Medical and Surgical Sciences Magna Græcia University of Catanzaro Catanzaro Italy
| | - Laura Canafoglia
- Department of Epileptology Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Maria Paola Canevini
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
- Department of Health Sciences Università degli Studi Milan Italy
| | | | | | - Valentina Chiesa
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center Spedali Civili Brescia Italy
| | - Giuseppe Didato
- Epilepsy Unit Fondazione IRCCS Istituto Neurologico "Carlo Besta" Milan Italy
| | | | - Giovanni Falcicchio
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Martina Fanella
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Massimo Gangitano
- Department of Biomedicine Neuroscience, and advanced Diagnostic (BIND) University of Palermo Palermo Italy
| | - Angela La Neve
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Oriano Mecarelli
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Elisa Montalenti
- Epilepsy Center AOU Città della Salute e della Scienza di Torino Turin Italy
| | - Alessandra Morano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Federico Piazza
- Rita Levi Montalcini Department of Neurosciences University of Turin Turin Italy
| | - Chiara Pizzanelli
- Department of Clinical and Experimental Medicine Neurological Clinic University of Pisa Pisa, Pisa Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | | | - Eleonora Rosati
- Department Neurology 2 Careggi University Hospital Florence Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Centre Niguarda Hospital Milan Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Irelli EC, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Ferlazzo E, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Ascoli M, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Basili LM, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Faedda MT, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gazzina S, Giallonardo AT, Giorgi FS, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Milano C, Meletti S, Nilo A, Orlando B, Paladin F, Pascarella MG, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Pisani LR, Placidi F, Pollicino P, Porcella V, Pradella S, Puligheddu M, Quadri S, Quarato PP, Quintas R, Renna R, Rizzo GR, Rum A, Salamone EM, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Vaudano AE, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Brivaracetam as add-on treatment in patients with post-stroke epilepsy: real-world data from the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST). Seizure 2022; 97:37-42. [DOI: 10.1016/j.seizure.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
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Lee N, Lourenco A, Thomas R, Romano F, Palmans H, Lee E, Mascia A, Amos R, Subiel A. FLASH Modalities Track (Oral Presentations) DEVELOPMENT AND TEST OF A SMALL PORTABLE GRAPHITE CALORIMETER FOR USE IN ULTRA-HIGH DOSE RATE PARTICLE BEAMS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Casciato S, Quarato PP, Gialluisi A, D'Aniello A, Mascia A, Grammaldo LG, Di Gennaro G. Lacosamide as first add-on or conversion monotherapy: A retrospective real-life study. Epilepsy Behav 2021; 122:108128. [PMID: 34229159 DOI: 10.1016/j.yebeh.2021.108128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Lacosamide (LCM), the R-enantiomer of 2-acetamido-N-benzyl-3-methoxypropionamide, is a newer approved antiseizure medication characterized by a novel pharmacodynamic and favorable pharmacokinetic profile that was approved as adjunctive treatment for adults with focal onset and focal to bilateral tonic-clonic seizures in 2008, and recently also for monotherapy. The aim of this study was to evaluate the effectiveness and tolerability of LCM as first add-on or conversion monotherapy in adult subjects with focal epilepsy. METHODS We retrospectively included all adult patients who received LCM as first add-on regimen or as substitution monotherapy at least 12 months before starting the chart review, with a historical baseline of 6 months prior to day of the first administration of LCM. The choice of treatment was made independently by the epilepstologists, according to routine clinical practice. Clinical data were obtained at 3, 6, and 12 months after subjects started LCM and then analyzed to assess retention rate, seizure freedom, and adverse events (AE). RESULTS A total of 101 patients (58 men) with a mean age of 44 years and a median epilepsy duration of 6.6 years (range 1-53) were included in the study. At 12 months 72 patients retained LCM, 54 (75%) of them were seizure free, 44 (81.5%) in monotherapy and 10 (18.5%) in add-on LCM treatment. Among all subjects, 31 (57.4%) were free from seizure under LCM monotherapy throughout the entire observation period. Thirty one out of 72 (43%) PwE who retained LCM at 12 months, were free from seizures throughout the entire observation period. The maintenance median dosage of LCM was 200 mg/day. Ten (10%) subjects reported mild to moderate AE, most commonly drowsiness and dizziness. No serious AE were documented. CONCLUSIONS This real-life study confirms that LCM is an effective and well tolerated treatment option as first add-on or conversion monotherapy for focal seizures.
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Mascia A, Casciato S, De Risi M, Quarato PP, Morace R, D'Aniello A, Grammaldo LG, Pavone L, Picardi A, Esposito V, Di Gennaro G. Bilateral epileptogenesis in temporal lobe epilepsy due to unilateral hippocampal sclerosis: A case series. Clin Neurol Neurosurg 2021; 208:106868. [PMID: 34388593 DOI: 10.1016/j.clineuro.2021.106868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Bitemporal epilepsy (biTLE), a potential cause of failure in TLE surgery, is rarely associated with unilateral HS and could be suggested by not lateralizing ictal scalp EEG/interictal PET-FDG findings. We evaluated the proportion of biTLE in a population of drug-resistant TLE-HS subjects who underwent intracranial investigation for lateralizing purpose. METHODS We retrospectively included all consecutive refractory TLE-HS patients and not lateralizing ictal scalp EEG/interictal PET-FDG findings, investigated by intracranial bilateral longitudinal hippocampal electrodes. Demographic characteristics, electroclinical findings and seizure outcome were evaluated. RESULTS We identified 14 subjects (7 males; mean age 39.5 years; mean age at disease onset 14.4 years), 7 of them had biTLE diagnosed after intracranial investigations. In the remaining 7 with unilateral epileptogenesis (uniTLE) anterior temporal lobectomy was performed (6/7 were in Engel class I). Preoperative neuropsychological assessment differentiated biTLE from uniTLE, as it was normal in six uniTLE patients but only in one with biTLE (p < 0.05). CONCLUSIONS Not lateralizing ictal scalp EEG and functional imaging findings in TLEHS should alert about the possibility of a true biTLE also in presence of unilateral findings at MRI. Intracranial investigations with bilateral longitudinal hippocampal electrodes can localize the EZ with a good risk-benefit profile. Consistently with the warning on memory functions in TLE patients explored by using longitudinal hippocampal electrodes, further studies are needed to better define the optimal investigation strategy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Angelo Picardi
- Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Vincenzo Esposito
- IRCCS NEUROMED, Pozzilli, Isernia, Italy; Department of Neurosurgery, "Sapienza" University, Rome, Italy
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Casciato S, Quarato PP, Mascia A, D'Aniello A, Grammaldo LG, Di Gennaro G. Seizures induced by micturition: A rare form of reflex epilepsy. Epilepsy Behav Rep 2021; 16:100460. [PMID: 34159309 PMCID: PMC8202341 DOI: 10.1016/j.ebr.2021.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022] Open
Abstract
•Micturition-induced seizures are a rare form of reflex epilepsy.•Video-EEG monitoring is crucial for diagnosis.•Symptomatogenic zone involves mesial fronto-parietal cortex.
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Casciato S, Morace R, Quarato PP, Mascia A, D'Aniello A, Grammaldo LG, Esposito V, Di Gennaro G. Very long-term seizure outcome in frontal lobe epilepsy surgery. Epilepsy Behav 2021; 117:107848. [PMID: 33621814 DOI: 10.1016/j.yebeh.2021.107848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | - Vincenzo Esposito
- IRCCS NEUROMED, Pozzilli (IS), Italy; Department of Human Neuroscience, "Sapienza" University of Rome, Italy
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Palomba NP, Martinello K, Cocozza G, Casciato S, Mascia A, Di Gennaro G, Morace R, Esposito V, Wulff H, Limatola C, Fucile S. ATP-evoked intracellular Ca 2+ transients shape the ionic permeability of human microglia from epileptic temporal cortex. J Neuroinflammation 2021; 18:44. [PMID: 33588880 PMCID: PMC7883449 DOI: 10.1186/s12974-021-02096-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/02/2021] [Indexed: 12/18/2022] Open
Abstract
Background Intracellular Ca2+ modulates several microglial activities, such as proliferation, migration, phagocytosis, and inflammatory mediator secretion. Extracellular ATP, the levels of which significantly change during epileptic seizures, activates specific receptors leading to an increase of intracellular free Ca2+ concentration ([Ca2+]i). Here, we aimed to functionally characterize human microglia obtained from cortices of subjects with temporal lobe epilepsy, focusing on the Ca2+-mediated response triggered by purinergic signaling. Methods Fura-2 based fluorescence microscopy was used to measure [Ca2+]i in primary cultures of human microglial cells obtained from surgical specimens. The perforated patch-clamp technique, which preserves the cytoplasmic milieu, was used to measure ATP-evoked Ca2+-dependent whole-cell currents. Results In human microglia extracellular ATP evoked [Ca2+]i increases depend on Ca2+ entry from the extracellular space and on Ca2+ mobilization from intracellular compartments. Extracellular ATP also induced a transient fivefold potentiation of the total transmembrane current, which was completely abolished when [Ca2+]i increases were prevented by removing external Ca2+ and using an intracellular Ca2+ chelator. TRAM-34, a selective KCa3.1 blocker, significantly reduced the ATP-induced current potentiation but did not abolish it. The removal of external Cl− in the presence of TRAM-34 further lowered the ATP-evoked effect. A direct comparison between the ATP-evoked mean current potentiation and mean Ca2+ transient amplitude revealed a linear correlation. Treatment of microglial cells with LPS for 48 h did not prevent the ATP-induced Ca2+ mobilization but completely abolished the ATP-mediated current potentiation. The absence of the Ca2+-evoked K+ current led to a less sustained ATP-evoked Ca2+ entry, as shown by the faster Ca2+ transient kinetics observed in LPS-treated microglia. Conclusions Our study confirms a functional role for KCa3.1 channels in human microglia, linking ATP-evoked Ca2+ transients to changes in membrane conductance, with an inflammation-dependent mechanism, and suggests that during brain inflammation the KCa3.1-mediated microglial response to purinergic signaling may be reduced. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02096-0.
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Affiliation(s)
| | | | | | | | | | | | | | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza Rome University, Rome, Italy
| | - Heike Wulff
- Department of Pharmacology, University of California, Davis, CA, USA
| | - Cristina Limatola
- IRCCS Neuromed, Pozzilli, IS, Italy.,Department of Physiology and Pharmacology "V. Erspamer", Sapienza Rome University, Rome, Italy
| | - Sergio Fucile
- IRCCS Neuromed, Pozzilli, IS, Italy.,Department of Physiology and Pharmacology "V. Erspamer", Sapienza Rome University, Rome, Italy
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Markoula S, Liampas A, Rubboli G, Duncan J, Velis DN, Schulze-Bonhage A, Guekht A, Bartholomeyczik K, Tisi JD, Gras A, Lossius MI, Villani F, Staack AM, Hospes A, Baaijen JC, van Straaten ECW, Ronner HE, Casciato S, D'Aniello A, Mascia A, Santos SF, Bentes C, Aledo-Serrano Á, Gil-Nagel A, Dimova P, Hećimović H, Özkara Ç, Malmgren K, Papacostas S, Kelemen A, Reuber M, Trinka E, Ryvlin P. A European questionnaire survey on epilepsy monitoring units' current practice for postoperative psychogenic nonepileptic seizures' detection. Epilepsy Behav 2020; 112:107355. [PMID: 32745960 DOI: 10.1016/j.yebeh.2020.107355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In cases undergoing epilepsy surgery, postoperative psychogenic nonepileptic seizures (PNES) may be underdiagnosed complicating the assessment of postsurgical seizures' outcome and the clinical management. We conducted a survey to investigate the current practices in the European epilepsy monitoring units (EMUs) and the data that EMUs could provide to retrospectively detect cases with postoperative PNES and to assess the feasibility of a subsequent postoperative PNES research project for cases with postoperative PNES. METHODS We developed and distributed a questionnaire survey to 57 EMUs. Questions addressed the number of patients undergoing epilepsy surgery, the performance of systematic preoperative and postoperative psychiatric evaluation, the recording of sexual or other abuse, the follow-up period of patients undergoing epilepsy surgery, the performance of video-electroencephalogram (EEG) and postoperative psychiatric assessment in suspected postoperative cases with PNES, the existence of electronic databases to allow extraction of cases with postoperative PNES, the data that these bases could provide, and EMUs' interest to participate in a retrospective postoperative PNES project. RESULTS Twenty EMUs completed the questionnaire sheet. The number of patients operated every year/per center is 26.7 ( ± 19.1), and systematic preoperative and postoperative psychiatric evaluation is performed in 75% and 50% of the EMUs accordingly. Sexual or other abuse is systematically recorded in one-third of the centers, and the mean follow-up period after epilepsy surgery is 10.5 ± 7.5 years. In suspected postoperative PNES, video-EEG is performed in 85% and psychiatric assessment in 95% of the centers. An electronic database to allow extraction of patients with PNES after epilepsy surgery is used in 75% of the EMUs, and all EMUs that sent the sheet completed expressed their interest to participate in a retrospective postoperative PNES project. CONCLUSION Postoperative PNES is an underestimated and not well-studied entity. This is a European survey to assess the type of data that the EMUs surgical cohorts could provide to retrospectively detect postoperative PNES. In cases with suspected PNES, most EMUs perform video-EEG and psychiatric assessment, and most EMUs use an electronic database to allow extraction of patients developing PNES.
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Affiliation(s)
- Sofia Markoula
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
| | - Andreas Liampas
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece.
| | - Guido Rubboli
- Adult Department, Danish Epilepsy Center, Epilepsihospitalet, Dianalund, Denmark
| | - John Duncan
- UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, London, United Kingdom
| | - Demetrios N Velis
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | | | - Alla Guekht
- Moscow Research and Clinical Center for Neuriopsychiatry, Russian National Research Medical University, Moscow, Russia
| | | | - Jane de Tisi
- UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, London, United Kingdom
| | - Adrien Gras
- Psychiatry Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Flavio Villani
- Division of Clinical Epileptology and Experimental Neurophysiology, "Carlo Besta" Neurological Institute Foundation, Milan, Italy
| | | | - Annette Hospes
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Johannes C Baaijen
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Elisabeth C W van Straaten
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Hanneke E Ronner
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS NEUROMED, Pozzilli, Italy
| | | | | | - Susana Ferrao Santos
- Refractory Epilepsy Centre at Cliniquesuniversitaires Saint-Luc, University Hospital, Brussels, Belgium
| | - Carla Bentes
- EEG/Sleep Laboratory, Department of Neurosciences, Hospital de Santa Maria - CHLN, University Hospital, Lisbon, Portugal
| | - Ángel Aledo-Serrano
- Department of Neurology, Hospital Ruber Internacional & Hospital La Luz, Madrid, Spain
| | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional & Hospital La Luz, Madrid, Spain
| | - Petia Dimova
- Epilepsy Surgery Center, Department of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Hrvoje Hećimović
- Epilepsy Center, Department of Neurology, University Hospital, Zagreb, Croatia
| | - Çiğdem Özkara
- Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg University, Göteborg, Sweden
| | - Savvas Papacostas
- Department of Neurology Clinic B, The Cyprus Institute of Neurology & Genetics, Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Anna Kelemen
- National Institute of Psychiatry and Neurology, Department of Neurology, University of Pécs, Budapest, Hungary
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Eugen Trinka
- Paracelsus Medical University Salzburg, Department of Neurology, Christian Doppler University Hospital, Salzburg, Austria
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Casciato S, Mascia A, D'Aniello A, Quarato PP, Grammaldo LG, Scoppetta C, Aloj F, Paolini S, Di Gennaro G. A case of epilepsia partialis continua of abdominal muscles after brain tumor surgery. Eur Rev Med Pharmacol Sci 2020; 23:3001-3004. [PMID: 31002150 DOI: 10.26355/eurrev_201904_17581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Epilepsia partialis continua (EPC) is a rare form of focal motor status epilepticus characterized by continuous muscular twitches or jerks involving a limited part of the body, usually facial region and distal limb. Although the cerebrovascular disease is known to be one of the most common causes of this condition, other reported cases with predominant abdominal involvement have different aetiologies, including, tumors, focal cortical dysplasia, and central nervous system infections. No cases of epilepsia partialis continua of the abdominal wall occurred after brain surgery have been previously reported. We describe the clinical, electrophysiological, and neuroimaging findings in an adult patient presenting with persistent unilateral abdominal myoclonus configuring an EPC as the evolution of a super-refractory hemibody convulsive status epilepticus, occurred after brain tumor surgery.
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Maschio M, Maialetti A, Mocellini C, Domina E, Pauletto G, Costa C, Mascia A, Romoli M, Giannarelli D. Effect of Brivaracetam on Efficacy and Tolerability in Patients With Brain Tumor-Related Epilepsy: A Retrospective Multicenter Study. Front Neurol 2020; 11:813. [PMID: 32973649 PMCID: PMC7466736 DOI: 10.3389/fneur.2020.00813] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Epilepsy is a common symptom of brain tumors and is often pharmacoresistent. Among new antiseizure medications (ASMs) Brivaracetam (BRV) has been approved as adjunctive treatment for focal seizures and it was tested in non-oncological patient populations. This is the first study that retrospectively explored efficacy and tolerability of BRV as add-on therapy in brain tumor-related epilepsy (BTRE) patients. Materials and Methods: We reviewed the medical records of 33 BTRE patients from six Italian epilepsy centers; charts included tumor history, diagnosis of BTRE, BRV added as first or second add-on for uncontrolled seizures and/or adverse events (AEs) of the previous ASMs, at least 1-month follow-up, seizure frequency, and AEs assessment. Results: Thirty-three patients (19 males, mean age: 57.6 years; 14 females, mean age: 42.4 years): 11 low grade gliomas, five high grade gliomas, six meningiomas, 10 glioblastomas, one primary cerebral lymphoma. Fourteen patients had focal aware seizures, nine focal unaware, seven focal to bilateral tonic-clonic seizures, three patients presented more than one seizure type: focal unaware with focal to bilateral tonic clonic seizures (two patients) and focal aware and unaware seizures (one patient). Mean seizure frequency in the month preceding BRV introduction: 7.0; at last follow-up: 2.0 (p = 0.001). Seven patients (21.2%) reported AEs (anxiety, agitation, fatigue, vertigo) and three of them (9.0%) required drug withdrawal due to psychiatric adverse events (PAEs). Three other patients withdrew BRV: one for scarce compliance (3.0%), two for uncontrolled seizures (6.0%). Conclusion: Our results showed that BRV could be a new therapeutic option effective in reducing seizures in BTRE patients, taking into account the incidence of PAEs in this particular population. Future and larger prospective studies are needed.
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Affiliation(s)
- Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neurology, Regina Elena National Cancer Institute IRCCS IFO, Rome, Italy
| | - Andrea Maialetti
- Center for Tumor-Related Epilepsy, UOSD Neurology, Regina Elena National Cancer Institute IRCCS IFO, Rome, Italy
| | | | | | - Giada Pauletto
- Neurology Unit, Azienda Sanitaria Universitaria, ASUFC, Udine, Italy
| | - Cinzia Costa
- Clinic of Neurology, Ospedale SM Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | | | - Michele Romoli
- Clinic of Neurology, Ospedale SM Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | - Diana Giannarelli
- Biostatistic Unit, Regina Elena National Cancer Institute IRCCS IFO, Rome, Italy
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15
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Cerulli Irelli E, Cocchi E, Morano A, Casciato S, Fanella M, Albini M, Fisco G, Barone FA, Orlando B, Mascia A, Manfredi M, Fattouch J, Giallonardo AT, Di Gennaro G, Di Bonaventura C. Valproate impact and sex-dependent seizure remission in patients with idiopathic generalized epilepsy. J Neurol Sci 2020; 415:116940. [DOI: 10.1016/j.jns.2020.116940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
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Casciato S, Mascia A, Quarato PP, D'Aniello A, Scoppetta C, Di Gennaro G. Subacute cerebellar ataxia as presenting symptom of systemic lupus erythematosus. Eur Rev Med Pharmacol Sci 2019; 22:7401-7403. [PMID: 30468487 DOI: 10.26355/eurrev_201811_16279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Neuropsychiatric manifestations are commonly observed in systemic lupus erythematosus (SLE) patients. In particular, neurological involvement is known to be more common in patients with positive anticardiolipin antibodies and lupus anticoagulants. Nevertheless, cerebellar ataxia has rarely been reported, especially as the first clinical manifestation of this systemic autoimmune disorder. Cerebral vascular infarction or ischemia, vasogenic oedema and antibody-mediated cerebral vasculopathy or vasculitic process have been supposed as possible aetiologies of acute cerebellar ataxia related to SLE. We report the clinical and radiological features of a woman who developed a rapidly progressive cerebellar syndrome as first sign of SLE; no other cause explaining her cerebellar ataxia was found. The patient improved after high-dose steroids. The appearance of a cerebellar syndrome with unknown aetiology with associated features of possible systemic autoimmune dysfunction, should be taken into account in clinical practice for appropriate diagnostic workup in order to provide effective therapeutic options.
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Mula M, Zaccara G, Galimberti CA, Ferrò B, Canevini MP, Mascia A, Mecarelli O, Michelucci R, Pisani LR, Specchio LM, Striano S, Perucca E. Validated outcome of treatment changes according to International League Against Epilepsy criteria in adults with drug-resistant focal epilepsy. Epilepsia 2019; 60:1114-1123. [PMID: 30866058 PMCID: PMC6850288 DOI: 10.1111/epi.14685] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/28/2022]
Abstract
Objective Although many studies have attempted to describe treatment outcomes in patients with drug‐resistant epilepsy, results are often limited by the adoption of nonhomogeneous criteria and different definitions of seizure freedom. We sought to evaluate treatment outcomes with a newly administered antiepileptic drug (AED) in a large population of adults with drug‐resistant focal epilepsy according to the International League Against Epilepsy (ILAE) outcome criteria. Methods This is a multicenter, observational, prospective study of 1053 patients with focal epilepsy diagnosed as drug‐resistant by the investigators. Patients were assessed at baseline and 6, 12, and 18 months, for up to a maximum of 34 months after introducing another AED into their treatment regimen. Drug resistance status and treatment outcomes were rated according to ILAE criteria by the investigators and by at least two independent members of an external expert panel (EP). Results A seizure‐free outcome after a newly administered AED according to ILAE criteria ranged from 11.8% after two failed drugs to 2.6% for more than six failures. Significantly fewer patients were rated by the EP as having a “treatment failure” as compared to the judgment of the investigator (46.7% vs 62.9%, P < 0.001), because many more patients were rated as “undetermined outcome” (45.6% vs 27.7%, P < 0.001); 19.3% of the recruited patients were not considered drug‐resistant by the EP. Significance This study validates the use of ILAE treatment outcome criteria in a real‐life setting, providing validated estimates of seizure freedom in patients with drug‐resistant focal epilepsy in relation to the number of previously failed AEDs. Fewer than one in 10 patients achieved seizure freedom on a newly introduced AED over the study period. Pseudo drug resistance could be identified in one of five cases.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London and Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals National Health Service Foundation Trust, London, UK
| | | | | | | | - Maria Paola Canevini
- Department of Health Sciences, University of Milan, Epilepsy Center, San Paolo Hospital, Milan, Italy
| | | | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Roberto Michelucci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia Ospedale Bellaria, Bologna, Italy
| | - Laura Rosa Pisani
- Neurology Unit, Cutrona-Zodda Hospital, Barcellona Pozzo di Gotto, Italy
| | | | - Salvatore Striano
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, School of Medicine, Federico II Epilepsy Center, University of Naples, Naples, Italy
| | - Emilio Perucca
- Clinical Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia and Clinical Trial Center, IRCCS Mondino Foundation, Pavia, Italy
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Morace R, Casciato S, Quarato PP, Mascia A, D'Aniello A, Grammaldo LG, De Risi M, Di Gennaro G, Esposito V. Long-term seizure outcome in frontal lobe epilepsy surgery. Epilepsy Behav 2019; 90:93-98. [PMID: 30522059 DOI: 10.1016/j.yebeh.2018.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/19/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to report long-term seizure outcome in patients who underwent frontal lobe epilepsy (FLE) surgery. METHOD This retrospective study included 44 consecutive subjects who underwent resective surgery for intractable FLE at IRCCS NEUROMED (period 2001-2014), followed up for at least 2 years (mean: 8.7 years). All patients underwent noninvasive presurgical evaluation and/or invasive electroencephalography (EEG) monitoring when nonconcordant data were obtained or epileptogenic zone was hypothesized to be close to the eloquent cortex. Electroclinical, neuroimaging, surgical data, and histology were compared to seizure outcome. RESULTS Mean epilepsy duration was 19 years; mean age at surgery was 31.6 years. Preoperative magnetic resonance imaging (MRI) showed a frontal lesion in 86.4 % of cases. Scalp video-electroencephalography (VEEG) monitoring detected a focal ictal onset in 90% of cases. Twenty-seven patients (61.4%) underwent invasive recordings. Resections involved dorsolateral (47.7%), medial (9%), orbital (13.6%), and rolandic (13.6%) region. Lobectomy within functional boundaries was performed in the remaining 7 cases (16%). Transient and permanent neurological deficits were observed in 2 and 3 cases, respectively. Histology revealed focal cortical dysplasia (45.5%), World Health Organization (WHO) I-II grade tumors (15.9%), gliosis (22.7%), vascular malformations (4.5%), Rasmussen encephalitis (6.8%), and normal tissue (4.5%). At last observation 68.1% of patients were in Engel's class I, 11.4% in class II, 9% in class III, and 11.4% in class IV. A favorable outcome was associated with focal ictal scalp EEG onset (p = 0.0357). CONCLUSION Surgery is a safe treatment option in drug-resistant FLE with a satisfying long-term outcome. These data highlight the importance of an appropriate selection of potential surgical candidates.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Vincenzo Esposito
- IRCCS "NEUROMED", Pozzilli, IS, Italy; Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
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Casciato S, Morano A, Fattouch J, Fanella M, Avorio F, Albini M, Basili LM, Cerulli Irelli E, Viganò A, De Risi M, Grammaldo LG, D'Aniello A, Mascia A, Manfredi M, Quarato P, Giallonardo AT, Di Gennaro G, Di Bonaventura C. Factors underlying the development of chronic temporal lobe epilepsy in autoimmune encephalitis. J Neurol Sci 2018; 396:102-107. [PMID: 30447604 DOI: 10.1016/j.jns.2018.10.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Limbic encephalitis (LE) is an autoimmune condition characterized by amnestic syndrome, psychiatric features and seizures. Early diagnosis and prompt treatment are crucial to avoid long-term sequelae, including psycho-cognitive deficits and persisting seizures. The aim of our study was to analyze the characteristics of 33 LE patients in order to identify possible prognostic factors associated with the development of chronic epilepsy. METHODS This is a retrospective cohort study including adult patients diagnosed with LE in the period 2010-2017 and followed up for ≥12 months. Demographics, seizure semiology, EEG pattern, MRI features, CSF/serum findings were reviewed. RESULTS All 33 LE patients (19 M/14F, mean age 61.2 years) presented seizures. Thirty subjects had memory deficits; 22 presented behavioural/mood disorders. Serum and/or CSF auto-antibodies were detected in 12 patients. In 31 subjects brain MRI at onset showed typical alterations involving temporal lobes. All patients received immunotherapy. At follow-up, 13/33 had developed chronic epilepsy; predisposing factors included delay in diagnosis (p = .009), low seizure frequency at onset (p = .02), absence of amnestic syndrome (p = .02) and absence/rarity of inter-ictal epileptic discharges on EEG (p = .06). CONCLUSIONS LE with paucisymptomatic electro-clinical presentation seemed to be associated to chronic epilepsy more than LE presenting with definite and severe "limbic syndrome".
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Affiliation(s)
| | - Alessandra Morano
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Federica Avorio
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Luca Manfredi Basili
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Emanuele Cerulli Irelli
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Alessandro Viganò
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | | | | | | | | | - Mario Manfredi
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | | | - Anna Teresa Giallonardo
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy.
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Delaney A, Dong L, Mascia A, Zou W, Zhang Y, Yin L, Hrbacek J, Lomax A, Slotman B, Dahele M, Verbakel W. OC-0304: Using a single knowledge-based proton planning model to create automated plans for different centers. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Martinello K, Sciaccaluga M, Morace R, Mascia A, Arcella A, Esposito V, Fucile S. Loss of constitutive functional γ-aminobutyric acid type A-B receptor crosstalk in layer 5 pyramidal neurons of human epileptic temporal cortex. Epilepsia 2017; 59:449-459. [PMID: 29283181 DOI: 10.1111/epi.13991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE γ-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter in adult central nervous system, and profound alterations of GABA receptor functions are linked to temporal lobe epilepsy (TLE). Here we describe the functional relationships between GABA receptors type B (GABAB R) and type A (GABAA R) in human temporal cortex and how TLE affects this aspect of GABAergic signaling. METHODS Miniature inhibitory postsynaptic currents (mIPSCs) were recorded by patch-clamp techniques from human L5 pyramidal neurons in slices from temporal cortex tissue obtained from surgery. RESULTS We describe a constitutive functional crosstalk between GABAB Rs and GABAA Rs in human temporal layer 5 pyramidal neurons, which is lost in epileptic tissues. The activation of GABAB Rs by baclofen, in addition to the expected reduction of mIPSC frequency, produced, in cortex of nonepileptic patients, the prolongation of mIPSC rise and decay times, thus increasing the inhibitory net charge associated with a single synaptic event. Block of K+ channels did not prevent the increase of decay time and charge. Protein kinase A (PKA) blocker KT5720 and pertussis toxin inhibited the action of baclofen, whereas 8Br-cAMP mimicked the GABAB R action. The same GABAB R-mediated modulation of GABAA Rs was observed in pyramidal neurons of rat temporal cortex, with both PKA and PKC involved in the process. In cortices from TLE patients and epileptic rats, baclofen lost its ability to modulate mIPSCs. SIGNIFICANCE Our results highlight the association of TLE with functional changes of GABAergic signaling that may be related to seizure propagation, and suggest that the selective activation of a definite subset of nonpresynaptic GABAB Rs may be therapeutically useful in TLE.
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Affiliation(s)
| | | | | | | | | | - Vincenzo Esposito
- Neuromed IRCCS, Pozzilli, Italy.,Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Sergio Fucile
- Neuromed IRCCS, Pozzilli, Italy.,Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
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Casciato S, D'Aniello A, Mascia A, Quarato PP, De Risi M, Grammaldo LG, Esposito V, Zoccarato M, Di Gennaro G. Possible autoantibody-negative limbic encephalitis after anterior temporal lobectomy for hippocampal sclerosis. Int J Neurosci 2017; 128:464-466. [PMID: 29053037 DOI: 10.1080/00207454.2017.1394852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Amnestic syndromes are acknowledged to be associated to bilateral hippocampal damage. MATERIALS AND METHODS We briefly report the case of a young man who underwent anterior left temporal lobectomy for a medically refractory temporal lobe epilepsy due to hippocampal sclerosis with an excellent seizure and neuropsychological outcome. Approximately 10 years later, he presented with a subacute severe global amnesia and neuroimaging findings of a damage involving the contralateral mesial temporal lobe structures. RESULTS A diagnosis of a possible autoimmune encephalitis was made. CONCLUSIONS Due to its peculiarities (compared with other cases of bilateral temporal lesions, the damage occurred on two distinct occasions), this case might contribute to shed light on the issue of the possible contralateral reorganization of memory processes subserved by the mesial temporal lobe structures chronically involved in epileptogenesis.
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Affiliation(s)
| | | | | | | | | | | | - Vincenzo Esposito
- a IRCCS NEUROMED Pozzilli (IS) , Italy.,b Department of Neurosurgery , "Sapienza" University of Rome , Rome , Italy
| | - Marco Zoccarato
- c Department of Neurology , Ospedale S.Antonio , Padua , Italy
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Casciato S, Gambardella S, Mascia A, Quarato PP, D'Aniello A, Ackurina Y, Albano V, Fornai F, Scala S, Di Gennaro G. Severe and rapidly-progressive Lafora disease associated with NHLRC1 mutation: a case report. Int J Neurosci 2017; 127:1150-1153. [DOI: 10.1080/00207454.2017.1337012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | - Yana Ackurina
- Functional Diagnostic Department, Kazakh-Russian Medical National University, Almaty, Kazakhstan
| | | | - Francesco Fornai
- IRCCS “NEUROMED”, Pozzilli (IS), Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Morace R, Di Gennaro G, Quarato PP, D'Aniello A, Mascia A, Grammaldo L, De Risi M, Sparano A, Di Cola F, De Angelis M, Esposito V. Vagal Nerve Stimulation for Drug-Resistant Epilepsy: Adverse Events and Outcome in a Series of Patients with Long-Term Follow-Up. Acta Neurochir Suppl 2017; 124:49-52. [PMID: 28120052 DOI: 10.1007/978-3-319-39546-3_8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Vagal nerve stimulation (VNS) is a palliative treatment option for drug-resistant epilepsy. The aim of this study was to describe the clinical and demographic features of selected patients scheduled for VNS and to evaluate the long-term efficacy of VNS in seizure control. MATERIALS AND METHODS Between 2006 and 2013, 32 consecutive epileptic patients (14 male and 18 female) were enrolled at our Institute for VNS implantation. In all cases resective surgery had previously been excluded by the use of a noninvasive presurgical study protocol. Mean age was 32 years (range 18-50), and mean epilepsy duration 23 years (range 11-39). All subjects were followed-up for at least 2 years (mean 6 years, range 2-9) after VNS implantation. Patients were considered responders when a reduction of seizures of more than 50 % was reported. RESULTS All patients had complex partial seizures, in 81 % of the patients with secondary generalization and in 56 % with drop attacks. Neurological examination revealed focal deficits in 19 % of the patients. Brain magnetic resonance imaging (MRI) was positive in 47 % of the patients. No surgical complications were observed in this series. Three patients were lost to follow-up. Twelve patients were classified as responders. Among the others, 1 patient experienced side effects (snoring and groaning during sleep) and the device was removed. CONCLUSIONS Our data confirm that VNS is a safe procedure and a valid palliative treatment option for drug-resistant epileptic patients not suitable for resective surgery.
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Affiliation(s)
- R Morace
- I.R.C.C.S. Neuromed, Pozzilli, Italy.
| | | | | | | | - A Mascia
- I.R.C.C.S. Neuromed, Pozzilli, Italy
| | | | - M De Risi
- I.R.C.C.S. Neuromed, Pozzilli, Italy
| | - A Sparano
- I.R.C.C.S. Neuromed, Pozzilli, Italy
| | - F Di Cola
- I.R.C.C.S. Neuromed, Pozzilli, Italy
| | - M De Angelis
- I.R.C.C.S. Neuromed, Pozzilli, Italy.,Department of Neuroscience and Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - V Esposito
- I.R.C.C.S. Neuromed, Pozzilli, Italy.,Department of Neurology and Psychiatry, University of Rome "Sapienza", Rome, Italy
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25
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Lewis L, Sudhoff M, Meier T, Wolf E, Mascia A, Lamba M, Kharofa J. Comparison of Dose to Positron Emission Tomography–Derived Active Bone Marrow and Total Bone in Predicting Leukopenia in Anal Cancer Patients. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Platt M, Platt M, Lamba M, Mascia A, Huang K. SU-F-J-206: Systematic Evaluation of the Minimum Detectable Shift Using a Range- Finding Camera. Med Phys 2016. [DOI: 10.1118/1.4956114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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27
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Di Gennaro G, D'Aniello A, De Risi M, Grillea G, Quarato PP, Mascia A, Grammaldo LG, Casciato S, Morace R, Esposito V, Picardi A. Temporal pole abnormalities in temporal lobe epilepsy with hippocampal sclerosis: Clinical significance and seizure outcome after surgery. Seizure 2015; 32:84-91. [PMID: 26552570 DOI: 10.1016/j.seizure.2015.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/16/2015] [Accepted: 09/20/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the clinical significance of temporal pole abnormalities (temporopolar blurring, TB, and temporopolar atrophy, TA) in patients with temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS) with a long post-surgical follow-up. METHODS We studied 60 consecutive patients with TLE-HS and 1.5 preoperative MRI scans who underwent surgery and were followed up for at least 5 years (mean follow-up 7.3 years). Based on findings of pre-surgical MRI, patients were classified according to the presence of TB or TA. Groups were compared on demographic, clinical, neuropsychological data, and seizure outcome. RESULTS TB was found in 37 (62%) patients, while TA was found in 35 (58%) patients, always ipsilateral to HS, with a high degree of overlap (83%) between TB and TA (p<0.001). Patients with TB did not differ from those without TB with regard to history of febrile convulsions, GTCSs, age of epilepsy onset, side of surgery, seizure frequency, seizure outcome, and neuropsychological outcome. On the other hand, they were significantly older, had a longer duration of epilepsy, and displayed lower preoperative scores on several neuropsychological tests. Similar findings were observed for TA. Multivariate analysis corroborated the association between temporopolar abnormalities and age at onset, age at surgery (for TB only), and lower preoperative scores on some neuropsychological tests. CONCLUSIONS Temporopolar abnormalities are frequent in patients with TLE-HS. Our data support the hypothesis that TB and TA are caused by seizure-related damages. These abnormalities did not influence seizure outcome, even after a long-term post-surgical follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | - Sara Casciato
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | | | - Vincenzo Esposito
- IRCCS "NEUROMED", Pozzilli, IS, Italy; Department of Neurosurgery, Sapienza University of Rome, Italy
| | - Angelo Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
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Mascia A, Quarato PP, D'Aniello A, Di Gennaro G. Psychogenic nonepileptic seizures mimicking gelastic seizures: A description of two cases. Epilepsy Behav Case Rep 2015; 4:67-9. [PMID: 27195218 PMCID: PMC4543217 DOI: 10.1016/j.ebcr.2015.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/30/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are sudden, involuntary seizure-like attacks that, unlike epileptic seizures, are not related to electrographic ictal discharges and are psychological in nature. Psychogenic nonepileptic seizures presenting symptoms mimic a wide array of nervous system dysfunctions, as they involve changes in behavior, motor activity, sensation, cognitive, and autonomic functions. Spontaneous paroxysms of laughing resembling gelastic seizure have only exceptionally been reported as main symptom of PNES. Here, we describe the cases of two patients with a prolonged history of laughter attacks mistaken for epilepsy and unresponsive to AED treatment. Brain MRI and interictal EEG were unremarkable. Video-EEG monitoring allowed us to document the spontaneous and suggestion-induced habitual episodes that were then diagnosed as PNES.
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29
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Casciato S, Di Bonaventura C, Giallonardo AT, Fattouch J, Quarato PP, Mascia A, D'Aniello A, Romigi A, Esposito V, Di Gennaro G. Epilepsy surgery in adult-onset Rasmussen's encephalitis: case series and review of the literature. Neurosurg Rev 2015; 38:463-70; discussion 470-1. [PMID: 25877887 DOI: 10.1007/s10143-015-0623-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/01/2014] [Accepted: 11/16/2014] [Indexed: 11/29/2022]
Abstract
Rasmussen's encephalitis (RE) is a rare immune-mediated condition characterized by drug-resistant focal epilepsy, progressive neurological, and cognitive deficits associated to unilateral hemispheric atrophy. The onset is typically reported in childhood, although adult cases (A-RE) have been described. While surgical strategies in childhood RE are well defined, little is known about usefulness of epilepsy surgery in A-RE patients. We describe clinical features, surgical approach, and outcome of five A-RE patients who underwent epilepsy surgery, and we review the literature with regard to surgical A-RE cases. We retrospectively studied five A-RE patients aged 21-38 years (mean age 22.8 years) who were followed after surgery for a period ranging from to 1 to 6 years. Demographic, electroclinical, and neuroimaging data were systematically reviewed. Four out of five subjects underwent invasive EEG monitoring to define epileptogenic zone. Epilepsy outcome was defined according to Engel's classification. Surgery consisted of frontal corticectomy in three patients, temporal lobectomy in one, combined temporal lobectomy plus insular, and frontobasal corticectomy in the remaining case. No permanent neurological deficits were observed after surgery. At the last follow-up observation, one patient was seizure-free, two subjects experienced rare disabling seizures, another had moderate seizure reduction, and one had no clinical improvement. Our experience, although limited to few cases, suggests that resective surgery in A-RE may play a role in the context of multidisciplinary therapeutical approach of this severe condition. Since the lack of specific data about surgical options, this topic seems to deserve further investigations and more targeted studies.
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Affiliation(s)
- Sara Casciato
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
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Di Gennaro G, Casciato S, Quarato PP, Mascia A, D’Aniello A, Grammaldo LG, De Risi M, Meldolesi GN, Romigi A, Esposito V, Picardi A. Acute postoperative seizures and long-term seizure outcome after surgery for hippocampal sclerosis. Seizure 2015; 24:59-62. [DOI: 10.1016/j.seizure.2014.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/31/2014] [Accepted: 08/19/2014] [Indexed: 11/25/2022] Open
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31
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Di Gennaro G, Casciato S, D’Aniello A, De Risi M, Quarato PP, Mascia A, Grammaldo LG, Meldolesi GN, Esposito V, Picardi A. Serial postoperative awake and sleep EEG and long-term seizure outcome after anterior temporal lobectomy for hippocampal sclerosis. Epilepsy Res 2014; 108:945-52. [DOI: 10.1016/j.eplepsyres.2014.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 03/02/2014] [Accepted: 03/16/2014] [Indexed: 11/25/2022]
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32
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Zhang Y, Giebeler A, Mascia A, Piskulich F, Perles L, Lepage R, Dong L. SU-D-BRE-03: Dosimetric Impact of In-Air Spot Size Variations for Commissioning a Room-Matched Beam Model for Pencil Beam Scanning Proton Therapy. Med Phys 2014. [DOI: 10.1118/1.4887874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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33
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Perles L, Mascia A, Piskulich F, Lepage R, Zhang Y, Giebeler A, Dong L. SU-D-BRE-04: Evaluating the Dose Accuracy of a 2D Ion Chamber Array in High Dose Rate Pencil Beam Scanning Proton Beam. Med Phys 2014. [DOI: 10.1118/1.4887875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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34
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Piskulich F, Zhang Y, Perles L, Mascia A, Lepage R, Giebeler A, Dong L. SU-E-CAMPUS-T-06: Initial Experience of Patient-Specific QA Using a Pencil Beam Scanning Proton Therapy System. Med Phys 2014. [DOI: 10.1118/1.4889013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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35
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Roseti C, Fucile S, Lauro C, Martinello K, Bertollini C, Esposito V, Mascia A, Catalano M, Aronica E, Limatola C, Palma E. Fractalkine/CX3CL1 modulates GABAA currents in human temporal lobe epilepsy. Epilepsia 2013; 54:1834-44. [PMID: 24032743 DOI: 10.1111/epi.12354] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The chemokine fractalkine/CX3CL1 and its receptor CX3CR1 are widely expressed in the central nervous system (CNS). Recent evidence showed that CX3CL1 participates in inflammatory responses that are common features of CNS disorders, such as epilepsy. Mesial temporal lobe epilepsy (MTLE) is the prevalent form of focal epilepsy in adults, and hippocampal sclerosis (HS) represents the most common underlying pathologic abnormality, as demonstrated at autopsy and postresection studies. Relevant features of MTLE are a characteristic pattern of neuronal loss, as are astrogliosis and microglia activation. Several factors affect epileptogenesis in patients with MTLE, including a lack of γ-aminobutyric acid (GABA)ergic inhibitory efficacy. Therefore, experiments were designed to investigate whether, in MTLE brain tissues, CX3CL1 may influence GABAA receptor (GABAA R) mediated transmission, with a particular focus on the action of CX3CL1 on the use-dependent decrease (rundown) of the GABA-evoked currents (IGABA ), a feature underlying the reduction of GABAergic function in epileptic tissue. METHODS Patch-clamp recordings were obtained from cortical pyramidal neurons in slices from six MTLE patients after surgery. Alternatively, the cell membranes from epileptic brain tissues of 17 MTLE patients or from surgical samples and autopsies of nonepileptic patients were microtransplanted into Xenopus oocytes, and IGABA were recorded using the standard two-microelectrode voltage-clamp technique. Immunohistochemical staining and double-labeling studies were carried out on the same brain tissues to analyze CX3CR1 expression. KEY FINDINGS In native pyramidal neurons from cortical slices of patients with MTLE, CX3CL1 reduced IGABA rundown and affected the recovery of IGABA amplitude from rundown. These same effects were confirmed in oocytes injected with cortical and hippocampal MTLE membranes, whereas CX3CL1 did not influence IGABA in oocytes injected with nonepileptic tissues. Consistent with a specific effect of CX3CL1 on tissues from patients with MTLE, CX3CR1 immunoreactivity was higher in MTLE sclerotic hippocampi than in control tissues, with a prominent expression in activated microglial cells. SIGNIFICANCE These findings indicate a role for CX3CL1 in MTLE, supporting recent evidence on the relevance of brain inflammation in human epilepsies. Our data demonstrate that in MTLE tissues the reduced GABAergic function can be modulated by CX3CL1. The increased CX3CR1 expression in microglia and the modulation by CX3CL1 of GABAergic currents in human epileptic brain suggests new therapeutic approaches for drug-resistant epilepsies based on the evidence that the propagation of seizures can be influenced by inflammatory processes.
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36
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Casciato S, Di Bonaventura C, Fattouch J, Lapenta L, Di Gennaro G, Quarato PP, Mascia A, Esposito V, Berardelli A, Giallonardo AT. Extrarolandic electroclinical findings in the evolution of adult-onset Rasmussen's encephalitis. Epilepsy Behav 2013; 28:467-73. [PMID: 23892576 DOI: 10.1016/j.yebeh.2013.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/23/2013] [Accepted: 05/24/2013] [Indexed: 11/26/2022]
Abstract
Rasmussen's encephalitis (RE) is a rare immunomediated disorder characterized by unilateral hemispheric atrophy, drug-resistant focal epilepsy, and progressive neurological deficits. Its onset typically occurs in childhood, though it has also been reported in adult age (A-RE) with atypical clinical features. The aim of this study was to describe the electroclinical features in a group of seven patients with A-RE. We retrospectively studied seven women aged 23-43years (mean: 32.1years) with a diagnosis of RE according to commonly accepted diagnostic criteria. All the patients were clinically evaluated and underwent prolonged video-EEG monitoring, laboratory investigations, and high-resolution MRI follow-up. All the patients displayed an ictal electroclinical pattern whose evolution varied. We identified an early phase characterized by polymorphic ictal electroclinical manifestations (temporal semiology in five cases, frontal in one, and parietal in the remaining case) and a late phase clinically characterized by viscerosensitive phenomena followed by somatosensitive signs, experiential symptoms, and motor signs in all the cases. In the late phase, the ictal EEG pattern was characterized by monomorphic, pseudorhythmic, repetitive slow-wave theta activity over the frontal and central regions, with ipsilateral propagation and/or secondary spreading to contralateral perisylvian structures. Patients were treated with a combination of AEDs and immunotherapy (steroids and IVIg); epilepsy surgery was performed in 3 cases. Our results show that A-RE is characterized by early and late clinical- and EEG-different features which may reflect a progressive involvement of a specific "extrarolandic" network in the advanced phase of the disease and may suggest that the electroclinical expression of RE varies according to the different stages of the pathological process.
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Affiliation(s)
- Sara Casciato
- Epilepsy Unit, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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37
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Di Gennaro G, D’Aniello A, De Risi M, Quarato PP, Mascia A, Grammaldo LG, Meldolesi GN, Esposito V, Fabi E, Picardi A. Prognostic significance of acute postoperative seizures in extra-temporal lobe epilepsy surgery. Clin Neurophysiol 2013; 124:1536-40. [DOI: 10.1016/j.clinph.2013.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
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38
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Di Gennaro G, De Risi M, Quarato PP, Sparano A, Mascia A, Grammaldo LG, Meldolesi GN, Esposito V, Picardi A. Prognostic significance of serial postoperative EEG in extratemporal lobe epilepsy surgery. Clin Neurophysiol 2012; 123:2346-51. [DOI: 10.1016/j.clinph.2012.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/09/2012] [Accepted: 05/22/2012] [Indexed: 01/04/2023]
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39
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Matthiesen C, Singh H, Mascia A, Simpson H, Higby C, Ortega H, Keole S, Bogardus C, Ahmad S, De La Fuente Herman T. A Comparative and Dosimetric Analysis Regarding the Practical Use of 3D Conformal, IMRT, VMAT, and Proton Therapy for the Treatment of Early-Stage T1/T2 Glottic Laryngeal Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Ding X, Zheng Y, Mascia A, Hsi W, Kang Y, Ramirez E, Zeidan O, Foster R, Gao M, Laub S, Pankuch M, Schreuder N, Harris B. SU-E-T-301: A Novel Daily QA Device for Proton Therapy. Med Phys 2012; 39:3772-3773. [DOI: 10.1118/1.4735387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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41
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Hsi W, Kang Y, Ding X, Iannello J, Mascia A, Schreuder N, Smith J, Zeidan O, Zheng Y. MO-A-213AB-03: Commissioning of a Clinical Chair for Patients Treated in the Seated Position Using an Inclined Beam Line Treatment Room. Med Phys 2012; 39:3859. [DOI: 10.1118/1.4735755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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42
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Zheng Y, Ding X, Mascia A, Hsi W, Kang Y, Ramirez E, Zeidan O, Schreuder N. SU-E-T-202: Comprehensive Quality Assurance Procedures for Uniform Scanning Proton Therapy Machines. Med Phys 2012; 39:3749. [PMID: 28517814 DOI: 10.1118/1.4735262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Quality assurance (QA) is essential in safe and accurate delivery of radiation therapy. However, QA in proton therapy is challenging due to complicated and often facility-specific beam delivery systems and limited beam time for QA. The purpose of this study is to develop an efficient and comprehensive QA procedure for a multi-room proton therapy center using uniform scanning beams. METHODS Our proton therapy center is comprised of a 230 MeV cyclotron, one fixed beam room, two inclined beam rooms, and one gantry room. Uniform scanning is employed exclusively in all treatment rooms. A rfDaily QA3 (Sun Nuclear Inc., Melbourne, Florida) together with home-made devices is used for daily QA. Parallel plane chambers, a multi-layer ionization chamber array (Zebra, IBA dosimetry, Schwarzenbruck, German), and an IC profiler (Sun Nuclear Inc., Melbourne, Florida) are used to QA the characteristics of the uniform scanning beams, including output, range, modulation width, flatness, symmetry, and penumbra, for both monthly and annual QA. QA procedures and acceptance criteria were developed, taking into account the likelihood and potential risk of failure, as well as the available equipment, personnel and other resources. RESULTS QA procedures and tolerances were developed for daily, monthly and annual QA at our proton therapy center. Daily QA is performed by radiation therapists, and can be completed within 30 minutes for all rooms. Monthly QA and annual QA are performed by physicists, taking about 4 hours and a weekend respectively. Trend analysis was performed for various machine characteristics, such as machine output, range, flatness, and symmetry. CONCLUSION QA standards are desired in Radiation Oncology, but not many standards are developed and available for proton therapy. In the mean time, facility-specific QA procedures should be developed based on the equipment failure modes and available resources.
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Affiliation(s)
- Y Zheng
- ProCure Proton Therapy Center, Oklahoma City, OK.,ProCure Treatment Centers, Bloomington, IN
| | - X Ding
- ProCure Proton Therapy Center, Oklahoma City, OK.,ProCure Treatment Centers, Bloomington, IN
| | - A Mascia
- ProCure Proton Therapy Center, Oklahoma City, OK.,ProCure Treatment Centers, Bloomington, IN
| | - W Hsi
- ProCure Proton Therapy Center, Oklahoma City, OK.,ProCure Treatment Centers, Bloomington, IN
| | - Y Kang
- ProCure Proton Therapy Center, Oklahoma City, OK.,ProCure Treatment Centers, Bloomington, IN
| | - E Ramirez
- ProCure Proton Therapy Center, Oklahoma City, OK.,ProCure Treatment Centers, Bloomington, IN
| | - O Zeidan
- ProCure Proton Therapy Center, Oklahoma City, OK.,ProCure Treatment Centers, Bloomington, IN
| | - N Schreuder
- ProCure Proton Therapy Center, Oklahoma City, OK.,ProCure Treatment Centers, Bloomington, IN
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Hsi W, Kang Y, Ding X, Mascia A, Ramirez E, Zheng Y, Zeidan O. SU-E-J-76: Clinical Use of a Real-Time Surface Image-Guided Positioning and Tracking System in Proton Therapy. Med Phys 2012; 39:3670. [DOI: 10.1118/1.4734911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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44
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Rains M, Mascia A, Ramirez E, Zheng Y, Ding X, Neuenschwander D, Harris B. SU-E-T-127: Feasibility Study for Using a 2D Array Detector for All Beam Measurements in Monthly Quality Assurance Procedure for a Uniform Scanning Proton Therapy System. Med Phys 2012; 39:3732. [PMID: 28517158 DOI: 10.1118/1.4735185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To develop a more efficient monthly quality assurance (QA) process by utilizing one detector with multiple setups instead of multiple detectors with multiple setups. METHOD The Sun Nuclear IC Profiler was used to measure machine output, transverse profiles, and depth-dose profiles. The IC Profiler contains 251 ionization chambers aligned in the X, Y, and diagonal axes, and was designed to measure machine output and transverse profiles. In order to measure depth-doses, a Lucite compensator with an angled surface was fabricated. To test the capability of the detector, a proton beam of 10.5 cm range in water was used. The distal edge coincided with the overall water equivalent depth upstream of the detector on central axis. The measurement was repeated with an additional 1.0 mm of solid water placed in front of the detector. The measured profiles from both measurements were compared to quantify the IC Profiler response for a small range change. RESULTS The IC Profiler performs within vendor specification for measuring machine output and transverse profiles. When measuring depth-doses with an angled compensator, the IC profiler measures a change in profile along central axis of 17.0% for a 1.0mm range change. Based on overall reproducibility of the beam delivery system, the IC profiler is capable of detecting 0.3 mm range shift. Therefore, the sensivity of the IC profiler response is suffficient to detect sub millimeter changes in delivered range. CONCLUSION The Sun Nuclear IC Profiler is capable of measuring machine output, transverse profiles, and depth-dose profile constancy with a high degree of accuracy and precision. Using a single detector for all beam measurements increases the overall QA efficiency by reducing multiple detector overhead while not sacrificing the accuracy and precision of the measurements.
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Affiliation(s)
- M Rains
- ProCure Proton Therapy Center, Oklahoma City, Oklahoma.,Southern Nazarene University, Bethany, Oklahoma.,ProCure Treatment Centers, Bloomington, Indianna
| | - A Mascia
- ProCure Proton Therapy Center, Oklahoma City, Oklahoma.,Southern Nazarene University, Bethany, Oklahoma.,ProCure Treatment Centers, Bloomington, Indianna
| | - E Ramirez
- ProCure Proton Therapy Center, Oklahoma City, Oklahoma.,Southern Nazarene University, Bethany, Oklahoma.,ProCure Treatment Centers, Bloomington, Indianna
| | - Y Zheng
- ProCure Proton Therapy Center, Oklahoma City, Oklahoma.,Southern Nazarene University, Bethany, Oklahoma.,ProCure Treatment Centers, Bloomington, Indianna
| | - X Ding
- ProCure Proton Therapy Center, Oklahoma City, Oklahoma.,Southern Nazarene University, Bethany, Oklahoma.,ProCure Treatment Centers, Bloomington, Indianna
| | - D Neuenschwander
- ProCure Proton Therapy Center, Oklahoma City, Oklahoma.,Southern Nazarene University, Bethany, Oklahoma.,ProCure Treatment Centers, Bloomington, Indianna
| | - B Harris
- ProCure Proton Therapy Center, Oklahoma City, Oklahoma.,Southern Nazarene University, Bethany, Oklahoma.,ProCure Treatment Centers, Bloomington, Indianna
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Morace R, Di Gennaro G, Picardi A, Quarato PP, Sparano A, Mascia A, Meldolesi GN, Grammaldo LG, De Risi M, Esposito V. Surgery after intracranial investigation with subdural electrodes in patients with drug-resistant focal epilepsy: outcome and complications. Neurosurg Rev 2012; 35:519-26; discussion 526. [DOI: 10.1007/s10143-012-0382-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 11/20/2011] [Indexed: 10/28/2022]
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Di Gennaro G, Picardi A, Sparano A, Mascia A, Meldolesi GN, Grammaldo LG, Esposito V, Quarato PP. Seizure clusters and adverse events during pre-surgical video-EEG monitoring with a slow anti-epileptic drug (AED) taper. Clin Neurophysiol 2012; 123:486-8. [DOI: 10.1016/j.clinph.2011.08.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 08/12/2011] [Accepted: 08/16/2011] [Indexed: 11/24/2022]
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Keole S, Zeidan O, Mascia A, Vargas C, Prabhu K, Larson G, Nordhues E, Gaston R, Taylor J. Initial Toxicities of Prostate Cancer Patients Treated with Uniform Scanning Proton Therapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Kang Y, Zeidan O, Schenkenfelder P, Hsi W, Zheng Y, Mascia A, Ding X, Larson G, Prabhu K, Keole S. SU-E-T-358: Dosimetric Effects of Beam Angle Arrangements in Lung Proton Therapy. Med Phys 2011. [DOI: 10.1118/1.3612312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Zheng Y, Hsi W, Harris B, Ding X, Jesseph R, Mascia A, Okoth B, Wagner A, Schreuder A. SU-GG-T-472: Output Modeling for a Contemporary Proton Therapy Center. Med Phys 2010. [DOI: 10.1118/1.3468870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Roseti C, Martinello K, Fucile S, Piccari V, Mascia A, Di Gennaro G, Quarato PP, Manfredi M, Esposito V, Cantore G, Arcella A, Simonato M, Fredholm BB, Limatola C, Miledi R, Eusebi F. Adenosine receptor antagonists alter the stability of human epileptic GABAA receptors. Proc Natl Acad Sci U S A 2008; 105:15118-23. [PMID: 18809912 PMCID: PMC2567502 DOI: 10.1073/pnas.0807277105] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Indexed: 12/26/2022] Open
Abstract
We examined how the endogenous anticonvulsant adenosine might influence gamma-aminobutyric acid type A (GABA(A)) receptor stability and which adenosine receptors (ARs) were involved. Upon repetitive activation (GABA 500 microM), GABA(A) receptors, microtransplanted into Xenopus oocytes from neurosurgically resected epileptic human nervous tissues, exhibited an obvious GABA(A)-current (I(GABA)) run-down, which was consistently and significantly reduced by treatment with the nonselective adenosine receptor antagonist CGS15943 (100 nM) or with adenosine deaminase (ADA) (1 units/ml), that inactivates adenosine. It was also found that selective antagonists of A2B (MRS1706, 10 nM) or A3 (MRS1334, 30 nM) receptors reduced I(GABA) run-down, whereas treatment with the specific A1 receptor antagonist DPCPX (10 nM) was ineffective. The selective A2A receptor antagonist SCH58261 (10 nM) reduced or potentiated I(GABA) run-down in approximately 40% and approximately 20% of tested oocytes, respectively. The ADA-resistant, AR agonist 2-chloroadenosine (2-CA) (10 microM) potentiated I(GABA) run-down but only in approximately 20% of tested oocytes. CGS15943 administration again decreased I(GABA) run-down in patch-clamped neurons from either human or rat neocortex slices. I(GABA) run-down in pyramidal neurons was equivalent in A1 receptor-deficient and wt neurons but much larger in neurons from A2A receptor-deficient mice, indicating that, in mouse cortex, GABA(A)-receptor stability is tonically influenced by A2A but not by A1 receptors. I(GABA) run-down from wt mice was not affected by 2-CA, suggesting maximal ARs activity by endogenous adenosine. Our findings strongly suggest that cortical A2-A3 receptors alter the stability of GABA(A) receptors, which could offer therapeutic opportunities.
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Affiliation(s)
- Cristina Roseti
- *Istituto Pasteur–Fondazione Cenci Bolognetti and Dipartimento di Fisiologia Umana e Farmacologia, Centro di Eccellenza di Biologia e Medicina Molecolare, Università di Roma “La Sapienza”, Piazzale A. Moro 5, I-00185 Rome, Italy
| | | | - Sergio Fucile
- *Istituto Pasteur–Fondazione Cenci Bolognetti and Dipartimento di Fisiologia Umana e Farmacologia, Centro di Eccellenza di Biologia e Medicina Molecolare, Università di Roma “La Sapienza”, Piazzale A. Moro 5, I-00185 Rome, Italy
- Neuromed I.R.C.C.S., Via Atinese 18, I-86077 Isernia, Italy
| | - Vanessa Piccari
- *Istituto Pasteur–Fondazione Cenci Bolognetti and Dipartimento di Fisiologia Umana e Farmacologia, Centro di Eccellenza di Biologia e Medicina Molecolare, Università di Roma “La Sapienza”, Piazzale A. Moro 5, I-00185 Rome, Italy
- Neuromed I.R.C.C.S., Via Atinese 18, I-86077 Isernia, Italy
| | | | | | | | - Mario Manfredi
- Neuromed I.R.C.C.S., Via Atinese 18, I-86077 Isernia, Italy
| | | | | | | | - Michele Simonato
- Department of Clinical and Experimental Medicine, Section of Pharmacology, Neuroscience Center, University of Ferrara and National Institute of Neuroscience, I-44100 Ferrara, Italy
| | - Bertil B. Fredholm
- Department of Physiology and Pharmacology, Karolinska Institutet, S-171 77 Stockholm, Sweden
| | - Cristina Limatola
- *Istituto Pasteur–Fondazione Cenci Bolognetti and Dipartimento di Fisiologia Umana e Farmacologia, Centro di Eccellenza di Biologia e Medicina Molecolare, Università di Roma “La Sapienza”, Piazzale A. Moro 5, I-00185 Rome, Italy
- Neuromed I.R.C.C.S., Via Atinese 18, I-86077 Isernia, Italy
| | - Ricardo Miledi
- **Instituto de Neurobiología, Campus UNAM-Juriquilla, Universidad Nacional Autónoma de México, AP1-1141 Querétaro, Mexico; and
- Department of Neurobiology and Behavior, University of California, Irvine, CA 92697-4550
| | - Fabrizio Eusebi
- *Istituto Pasteur–Fondazione Cenci Bolognetti and Dipartimento di Fisiologia Umana e Farmacologia, Centro di Eccellenza di Biologia e Medicina Molecolare, Università di Roma “La Sapienza”, Piazzale A. Moro 5, I-00185 Rome, Italy
- Neuromed I.R.C.C.S., Via Atinese 18, I-86077 Isernia, Italy
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