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Crespo Pimentel B, Kuchukhidze G, Heyduk M, Thomschewski A, Trinka E, Höfler J. Ictal Cotard delusion as a manifestation of nonconvulsive status epilepticus: A case report and commentary. Epileptic Disord 2024. [PMID: 38686977 DOI: 10.1002/epd2.20221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 05/02/2024]
Abstract
Psychosis of epileptic origin can present a wide range of cognitive and affective symptoms and is often underrecognized. Usually occurring in the inter- and postictal phase, epileptic psychosis is mostly related to temporal lobe epilepsy. Here, we describe the clinical presentation and diagnostic workup including routine EEG recording and brain MRI of a 63-year-old woman expressing isolated nihilistic delusions comprising belief of being dead and denial of self-existence. EEG showed an ictal pattern fulfilling the Salzburg criteria of nonconvulsive status epilepticus and brain MRI revealed extensive peri-ictal hyperperfusion. Delusional symptoms and EEG abnormalities subsided after acute antiseizure treatment. Our case illustrates how nihilistic delusions can occur as a direct clinical correlate of seizure activity, thereby expanding the spectrum of ictal neuropsychiatric phenomena in temporal lobe epilepsy and highlighting the need to consider an epileptic origin in patients presenting with psychotic symptoms.
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Affiliation(s)
- Bernardo Crespo Pimentel
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St. Peter, UK
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
| | - Marta Heyduk
- University Institute of Radiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
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Safdarian M, Trinka E, Rahimi-Movaghar V, Thomschewski A, Aali A, Abady GG, Abate SM, Abd-Allah F, Abedi A, Adane DE, Afzal S, Ahinkorah BO, Ahmad S, Ahmed H, Amanat N, Angappan D, Arabloo J, Aryannejad A, Athari SS, Atreya A, Azadnajafabad S, Azzam AY, Babamohamadi H, Banik PC, Bardhan M, Bashiri A, Berhie AY, Bhat AN, Brown J, Champs AP, Charalampous P, Chukwu IS, Coberly K, Dadras O, Yada DY, Dai X, Dandona L, Dandona R, Dessalegn FN, Desta AA, Dhingra S, Diao N, Diaz D, Dibas M, Dongarwar D, Dsouza HL, Ekholuenetale M, El Nahas N, Elhadi M, Eskandarieh S, Fagbamigbe AF, Fares J, Fatehizadeh A, Fereshtehnejad SM, Fischer F, Franklin RC, Garg T, Getachew M, Ghaffarpasand F, Gholamrezanezhad A, Gholizadeh Mesgarha M, Ghozy S, Golechha M, Goleij P, Graham SM, Gupta VK, Haagsma JA, Hamidi S, Harlianto NI, Harorani M, Hasanian M, Hassan A, Hassen MB, Hoveidaei AH, Iravanpour F, Irilouzadian R, Iwu CCD, Jacob L, Jaja CJ, Joseph N, Joshua CE, Jozwiak JJ, Kadashetti V, Kandel A, Kantar RS, Karaye IM, Karkhah S, Khader YS, Khan EA, Khan MJ, Khayat Kashani HR, Khonji MS, Khormali M, Kim G, Krishnamoorthy V, Kumaran SD, Malekpour MR, Meretoja TJ, Mesregah MK, Mestrovic T, Micheletti Gomide Nogueira de Sá AC, Miller TR, Mirahmadi A, Mirghaderi SP, Mirza M, Misganaw A, Misra S, Mohammad Y, Mohammadi E, Mokdad AH, Möller H, Momtazmanesh S, Moni MA, Mostafavi E, Mulita F, Naghavi M, Nassereldine H, Natto ZS, Nejati K, Nguyen HLT, Nguyen VT, Nogueira de Sá AT, Olagunju AT, Olufadewa II, Omotayo AO, Owolabi MO, Patil S, Pawar S, Pedersini P, Petcu IR, Polinder S, Pourbagher-Shahri AM, Qureshi MF, Raghav PR, Rahman M, Rahnavard N, Rajabpour-Sanati A, Rashidi MM, Rawaf S, Roberts NLS, Saddik B, Saeed U, Samadzadeh S, Samy AM, Sarveazad A, Seylani A, Shafie M, Shahbandi A, Sharew MMS, Sheikhi RA, Shetty PH, Yigit A, Shobeiri P, Shool S, Shorofi SA, Sibhat MM, Sinaei E, Singh P, Singh S, Solomon Y, Sotoudeh H, Tadesse BA, Umair M, Valadan Tahbaz S, Valdez PR, Venketasubramanian N, Vu LG, Wickramasinghe ND, Zare I, Yazdanpanah F, Wu AM, Zhang ZJ. Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2023; 22:1026-1047. [PMID: 37863591 PMCID: PMC10584692 DOI: 10.1016/s1474-4422(23)00287-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) is a major cause of health loss due to premature mortality and long-term disability. We aimed to report on the global, regional, and national incidence, prevalence, and years of life lived with disability (YLDs) for SCI from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS Using GBD 2019 data pooled in DisMod-MR 2.1, a Bayesian meta-regression tool, we systematically derived numbers and age-standardised rate changes with 95% uncertainty intervals (95% UIs) for the incidence, prevalence, and YLDs for SCI from 1990 to 2019 for the whole world, 21 GBD regions, and 204 countries and territories. We report trends based on age, sex, year, cause of injury, and level of injury. FINDINGS Globally, 20·6 million (95% UI 18·9 to 23·6) individuals were living with SCI in 2019. The incidence of SCI was 0·9 million (0·7 to 1·2) cases with an estimated 6·2 million (4·5 to 8·2) YLDs. SCI rates increased substantially from 1990 to 2019 for global prevalence (81·5%, 74·2 to 87·1), incidence (52·7%, 30·3 to 69·8), and YLDs (65·4%, 56·3 to 76·0). However, global age-standardised rates per 100 000 population showed small changes in prevalence (5·8%, 2·6 to 9·5), incidence (-6·1%, -17·2 to 1·5), and YLDs (-1·5%, -5·5 to 3·2). Data for 2019 shows that the incidence of SCI increases sharply until age 15-19 years, where it remains reasonably constant until 85 years of age and older. By contrast, prevalence and YLDs showed similar patterns to each other, with one peak at around age 45-54 years. The incidence, prevalence, and YLDs of SCI have consistently been higher in men than in women globally, with a slight and steady increase for both men and women from 1990 to 2019. Between 1990 and 2019, SCI at neck level was more common than SCI below neck level in terms of incidence (492 thousand [354 to 675] vs 417 thousand [290 to 585]), prevalence (10·8 million [9·5 to 13·9] vs 9·7 million [9·2 to 10·4]), and YLDs (4·2 million [3·0 to 5·8] vs 1·9 million [1·3 to 2·5]). Falls (477 thousand [327 to 683] cases) and road injuries (230 thousand [122 to 389] cases) were the two leading causes of SCI globally in 2019. INTERPRETATION Although age-standardised rates of incidence, prevalence, and YLDs for SCI changed only slightly, absolute counts increased substantially from 1990 to 2019. Geographical heterogeneity in demographic, spatial, and temporal patterns of SCI, at both the national and regional levels, should be considered by policy makers aiming to reduce the burden of SCI. FUNDING Bill & Melinda Gates Foundation.
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Tsalouchidou PE, Müller CJ, Belke M, Zahnert F, Menzler K, Trinka E, Knake S, Thomschewski A. Verbal memory depends on structural hippocampal subfield volume. Front Neurol 2023; 14:1209941. [PMID: 37900611 PMCID: PMC10613087 DOI: 10.3389/fneur.2023.1209941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/18/2023] [Indexed: 10/31/2023] Open
Abstract
Objective To investigate correlates in hippocampal subfield volume and verbal and visual memory function in patients with temporal lobe epilepsy (TLE), mild amnestic cognitive impairment (MCI) and heathy participants (HP). Methods 50 right-handed participants were included in this study; 11 patients with temporal lobe epilepsy (TLE), 18 patients with mild amnestic cognitive impairment (MCI) and 21 healthy participants (HP). Verbal memory performance was evaluated via the verbal memory test (VLMT) and visual memory performance via the diagnosticum for cerebral damage (DCM). Hippocampal subfield volumes of T1-weighted Magnetic Resonance Imaging (MRI) scans were computed with FreeSurfer version 7.1. Stepwise correlation analyses were performed between the left hippocampal subfield volumes and learning, free recall, consolidation and recognition performance scores of the VLMT as well as between right hippocampal subfield volumes and visual memory performance. Results The volume of the left subicular complex was highly correlated to learning performance (β = 0.284; p = 0.042) and free recall performance in the VLMT (β = 0.434; p = 0.001). The volume of the left CA3 subfield showed a significant correlation to the consolidation performance in the VLMT (β = 0.378; p = 0.006) and recognition performance in the VLMT (β = 0.290; p = 0.037). There was no significant correlation identified between the right hippocampal subfields and the visual memory performance. Conclusion The results of this study show verbal memory correlates with hippocampal subfields and support the role of left subiculum and left CA2/CA3 in verbal memory performance.
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Affiliation(s)
| | - Christina-Julia Müller
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Marcus Belke
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Frankfurt, Germany
| | - Felix Zahnert
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Katja Menzler
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Eugen Trinka
- Department of Neurology and Centre for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Frankfurt, Germany
| | - Aljoscha Thomschewski
- Department of Neurology and Centre for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
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Thomschewski A, Giovannini G, Gaspard N, Steinbrenner M, Wickström R, Jacobs J. Editorial: Advances in diagnosing and treating new-onset refractory status epilepticus (NORSE). Front Neurol 2023; 14:1270702. [PMID: 37712084 PMCID: PMC10499399 DOI: 10.3389/fneur.2023.1270702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Aljoscha Thomschewski
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giada Giovannini
- Unitá di Neurologia, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Nicolas Gaspard
- Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mirja Steinbrenner
- Clinic for Neurology With Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Ronny Wickström
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - Julia Jacobs
- Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
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Golaszewski S, Frey V, Thomschewski A, Sebastianelli L, Versace V, Saltuari L, Trinka E, Nardone R. Neural mechanisms underlying the Rubber Hand Illusion: A systematic review of related neurophysiological studies. Brain Behav 2021; 11:e02124. [PMID: 34288558 PMCID: PMC8413782 DOI: 10.1002/brb3.2124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/28/2021] [Accepted: 03/14/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Many researchers took advantage of the well-established rubber hand illusion (RHI) paradigm to explore the link between the sense of body ownership and the different brain structures and networks. Here, we aimed to review the studies that have investigated this phenomenon by means of neurophysiological techniques. METHODS The MEDLINE, accessed by Pubmed and EMBASE electronic databases, was searched using the medical subject headings: "Rubber hand illusion" AND "Transcranial magnetic stimulation (TMS)" OR "Evoked potentials (EP)" OR "Event related potentials (ERP)" OR "Electroencephalography (EEG)". RESULTS Transcranial magnetic stimulation studies revealed a significant excitability drop in primary motor cortex hand circuits accompanying the disembodiment of the real hand during the RHI experience and that the perceived ownership over the rubber hand is associated with normal parietal-motor communication. Moreover, TMS provided causal evidence that the extrastriate body area is involved in the RHI and subsequently in body representation, while neuromodulation of ventral premotor area and the inferior parietal lobe did not result in an enhancement of embodiment. EP and ERP studies suggest that pre-existing body representations may affect larger stages of tactile processing and support predictive coding models of the functional architecture of multisensory integration in bodily perceptual experience. High-frequency oscillations on EEG play a role in the integrative processing of stimuli across modalities, and EEG activity in γ band activity in the parietal area reflects the visuotactile integration process. EEG studies also revealed that RHI is associated with the neural circuits underlying motor control and that premotor areas play a crucial role in mediating illusory body ownership. CONCLUSION Neurophysiological studies shed new light on our understanding of the different aspects that contribute to the formation of a coherent self-awareness in humans.
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Affiliation(s)
- Stefan Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.,Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Vanessa Frey
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.,Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.,Centre for Cognitive Neuroscience Salzburg, Salzburg, Austria.,University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.,Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria.,Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
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Wutzl B, Golaszewski SM, Leibnitz K, Langthaler PB, Kunz AB, Leis S, Schwenker K, Thomschewski A, Bergmann J, Trinka E. Narrative Review: Quantitative EEG in Disorders of Consciousness. Brain Sci 2021; 11:brainsci11060697. [PMID: 34070647 PMCID: PMC8228474 DOI: 10.3390/brainsci11060697] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 03/15/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
In this narrative review, we focus on the role of quantitative EEG technology in the diagnosis and prognosis of patients with unresponsive wakefulness syndrome and minimally conscious state. This paper is divided into two main parts, i.e., diagnosis and prognosis, each consisting of three subsections, namely, (i) resting-state EEG, including spectral power, functional connectivity, dynamic functional connectivity, graph theory, microstates and nonlinear measurements, (ii) sleep patterns, including rapid eye movement (REM) sleep, slow-wave sleep and sleep spindles and (iii) evoked potentials, including the P300, mismatch negativity, the N100, the N400 late positive component and others. Finally, we summarize our findings and conclude that QEEG is a useful tool when it comes to defining the diagnosis and prognosis of DOC patients.
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Affiliation(s)
- Betty Wutzl
- Graduate School of Information Science and Technology, Osaka University, Suita 565-0871, Japan; (B.W.); (K.L.)
- Symbiotic Intelligent Systems Research Center, Osaka University, Suita 565-0871, Japan
| | - Stefan M. Golaszewski
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kenji Leibnitz
- Graduate School of Information Science and Technology, Osaka University, Suita 565-0871, Japan; (B.W.); (K.L.)
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita 565-0871, Japan
| | - Patrick B. Langthaler
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Department of Mathematics, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Alexander B. Kunz
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
| | - Stefan Leis
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Jürgen Bergmann
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-5-7255-34600
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Lachner-Piza D, Kunz L, Brandt A, Dümpelmann M, Thomschewski A, Schulze-Bonhage A. Effects of Spatial Memory Processing on Hippocampal Ripples. Front Neurol 2021; 12:620670. [PMID: 33746877 PMCID: PMC7973270 DOI: 10.3389/fneur.2021.620670] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Human High-Frequency-Oscillations (HFO) in the ripple band are oscillatory brain activity in the frequency range between 80 and 250 Hz. HFOs may comprise different subgroups that either play a role in physiologic or pathologic brain functions. An exact differentiation between physiologic and pathologic HFOs would help elucidate their relevance for cognitive and epileptogenic brain mechanisms, but the criteria for differentiating between physiologic and pathologic HFOs remain controversial. In particular, the separation of pathologic HFOs from physiologic HFOs could improve the identification of epileptogenic brain regions during the pre-surgical evaluation of epilepsy patients. In this study, we performed intracranial electroencephalography recordings from the hippocampus of epilepsy patients before, during, and after the patients completed a spatial navigation task. We isolated hippocampal ripples from the recordings and categorized the ripples into the putative pathologic group iesRipples, when they coincided with interictal spikes, and the putative physiologic group isolRipples, when they did not coincide with interictal spikes. We found that the occurrence of isolRipples significantly decreased during the task as compared to periods before and after the task. The rate of iesRipples was not modulated by the task. In patients who completed the spatial navigation task on two consecutive days, we furthermore examined the occurrence of ripples in the intervening night. We found that the rate of ripples that coincided with sleep spindles and were therefore putatively physiologic correlated with the performance improvement on the spatial navigation task, whereas the rate of all ripples did not show this relationship. Together, our results suggest that the differentiation of HFOs into putative physiologic and pathologic subgroups may help identify their role for spatial memory and memory consolidation processes. Conversely, excluding putative physiologic HFOs from putative pathologic HFOs may improve the HFO-based identification of epileptogenic brain regions in future studies.
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Affiliation(s)
- Daniel Lachner-Piza
- Epilepsy Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Lukas Kunz
- Epilepsy Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg im Breisgau, Germany
- Faculty of Biology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Armin Brandt
- Epilepsy Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Matthias Dümpelmann
- Epilepsy Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Andreas Schulze-Bonhage
- Epilepsy Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Thomschewski A, Trinka E, Jacobs J. Temporo-Frontal Coherences and High-Frequency iEEG Responses during Spatial Navigation in Patients with Drug-Resistant Epilepsy. Brain Sci 2021; 11:brainsci11020162. [PMID: 33530531 PMCID: PMC7911024 DOI: 10.3390/brainsci11020162] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 11/16/2022] Open
Abstract
The prefrontal cortex and hippocampus function in tight coordination during multiple cognitive processes. During spatial navigation, prefrontal neurons are linked to hippocampal theta oscillations, presumably in order to enhance communication. Hippocampal ripples have been suggested to reflect spatial memory processes. Whether prefrontal-hippocampal-interaction also takes place within the ripple band is unknown. This intracranial EEG study aimed to investigate whether ripple band coherences can also be used to show this communication. Twelve patients with epilepsy and intracranial EEG evaluation completed a virtual spatial navigation task. We calculated ordinary coherence between prefrontal and temporal electrodes during retrieval, re-encoding, and pre-task rest. Coherences were compared between the conditions via permutation testing. Additionally, ripples events were automatically detected and changes in occurrence rates were investigated excluding ripples on epileptic spikes. Ripple-band coherences yielded no general effect of the task on coherences across all patients. Furthermore, we did not find significant effects of task conditions on ripple rates. Subsequent analyses pointed to rather short periods of synchrony as opposed to general task-related changes in ripple-band coherence. Specifically designed tasks and adopted measures might be necessary in order to map these interactions in future studies.
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Affiliation(s)
- Aljoscha Thomschewski
- Affiliated Centre of the European Reference Network EpiCARE, Department of Neurology and Centre for Cognitive Neuroscience, Christian-Doppler Medical Centre, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria;
- Department of Psychology, Paris-Lodron University of Salzburg, Hellbrunnerstraße 34, 5020 Salzburg, Austria
- Correspondence:
| | - Eugen Trinka
- Affiliated Centre of the European Reference Network EpiCARE, Department of Neurology and Centre for Cognitive Neuroscience, Christian-Doppler Medical Centre, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020 Salzburg, Austria;
| | - Julia Jacobs
- Member of the European Reference Network EpiCARE, Epilepsy Center, Medical Center, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany;
- Department of Neuropediatrics and Muscle Disorders, University Hospital Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany
- Room 293, Alberta Children’s Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Heritage Medical Research Building, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada
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Thomschewski A, Gerner N, Langthaler PB, Trinka E, Bathke AC, Fell J, Höller Y. Automatic vs. Manual Detection of High Frequency Oscillations in Intracranial Recordings From the Human Temporal Lobe. Front Neurol 2020; 11:563577. [PMID: 33192999 PMCID: PMC7604344 DOI: 10.3389/fneur.2020.563577] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background: High frequency oscillations (HFOs) have attracted great interest among neuroscientists and epileptologists in recent years. Not only has their occurrence been linked to epileptogenesis, but also to physiologic processes, such as memory consolidation. There are at least two big challenges for HFO research. First, detection, when performed manually, is time consuming and prone to rater biases, but when performed automatically, it is biased by artifacts mimicking HFOs. Second, distinguishing physiologic from pathologic HFOs in patients with epilepsy is problematic. Here we automatically and manually detected HFOs in intracranial EEGs (iEEG) of patients with epilepsy, recorded during a visual memory task in order to assess the feasibility of the different detection approaches to identify task-related ripples, supporting the physiologic nature of HFOs in the temporal lobe. Methods: Ten patients with unclear seizure origin and bilaterally implanted macroelectrodes took part in a visual memory consolidation task. In addition to iEEG, scalp EEG, electrooculography (EOG), and facial electromyography (EMG) were recorded. iEEG channels contralateral to the suspected epileptogenic zone were inspected visually for HFOs. Furthermore, HFOs were marked automatically using an RMS detector and a Stockwell classifier. We compared the two detection approaches and assessed a possible link between task performance and HFO occurrence during encoding and retrieval trials. Results: HFO occurrence rates were significantly lower when events were marked manually. The automatic detection algorithm was greatly biased by filter-artifacts. Surprisingly, EOG artifacts as seen on scalp electrodes appeared to be linked to many HFOs in the iEEG. Occurrence rates could not be associated to memory performance, and we were not able to detect strictly defined "clear" ripples. Conclusion: Filtered graphoelements in the EEG are known to mimic HFOs and thus constitute a problem. So far, in invasive EEG recordings mostly technical artifacts and filtered epileptiform discharges have been considered as sources for these "false" HFOs. The data at hand suggests that even ocular artifacts might bias automatic detection in invasive recordings. Strict guidelines and standards for HFO detection are necessary in order to identify artifact-derived HFOs, especially in conditions when cognitive tasks might produce a high amount of artifacts.
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Affiliation(s)
- Aljoscha Thomschewski
- Department of Neurology, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria,Department of Mathematics, Paris-Lodron University of Salzburg, Salzburg, Austria,Department of Psychology, Paris-Lodron University of Salzburg, Salzburg, Austria,*Correspondence: Aljoscha Thomschewski
| | - Nathalie Gerner
- Department of Neurology, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Patrick B. Langthaler
- Department of Neurology, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria,Department of Mathematics, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Arne C. Bathke
- Department of Mathematics, Paris-Lodron University of Salzburg, Salzburg, Austria,Intelligent Data Analytics Lab Salzburg, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Jürgen Fell
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Yvonne Höller
- Faculty of Psychology, University of Akureyri, Akureyri, Iceland
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Gerner N, Thomschewski A, Marcu A, Trinka E, Höller Y. Pitfalls in Scalp High-Frequency Oscillation Detection From Long-Term EEG Monitoring. Front Neurol 2020; 11:432. [PMID: 32582002 PMCID: PMC7280487 DOI: 10.3389/fneur.2020.00432] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022] Open
Abstract
Aims: Intracranially recorded high-frequency oscillations (>80 Hz) are considered a candidate epilepsy biomarker. Recent studies claimed their detectability on the scalp surface. We aimed to investigate the applicability of high-frequency oscillation analysis to routine surface EEG obtained at an epilepsy monitoring unit. Methods: We retrospectively analyzed surface EEGs of 18 patients with focal epilepsy and six controls, recorded during sleep under maximal medication withdrawal. As a proof of principle, the occurrence of motor task-related events during wakefulness was analyzed in a subsample of six patients with seizure- or syncope-related motor symptoms. Ripples (80-250 Hz) and fast ripples (>250 Hz) were identified by semi-automatic detection. Using semi-parametric statistics, differences in spontaneous and task-related occurrence rates were examined within subjects and between diagnostic groups considering the factors diagnosis, brain region, ripple type, and task condition. Results: We detected high-frequency oscillations in 17 out of 18 patients and in four out of six controls. Results did not show statistically significant differences in the mean rates of event occurrences, neither regarding the laterality of the epileptic focus, nor with respect to active and inactive task conditions, or the moving hand laterality. Significant differences in general spontaneous incidence [WTS(1) = 9.594; p = 0.005] that indicated higher rates of fast ripples compared to ripples, notably in patients with epilepsy compared to the control group, may be explained by variations in data quality. Conclusion: The current analysis methods are prone to biases. A common agreement on a standard operating procedure is needed to ensure reliable and economic detection of high-frequency oscillations.
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Affiliation(s)
- Nathalie Gerner
- Department of Neurology, Christian-Doppler Medical Centre, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria,Department of Mathematics, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian-Doppler Medical Centre, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria,Department of Mathematics, Paris-Lodron University of Salzburg, Salzburg, Austria,*Correspondence: Aljoscha Thomschewski
| | - Adrian Marcu
- Department of Neurology, Christian-Doppler Medical Centre, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Yvonne Höller
- Department of Neurology, Christian-Doppler Medical Centre, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria,Department of Psychology, University of Akureyri, Akureyri, Iceland
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11
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Nardone R, Golaszewski S, Thomschewski A, Sebastianelli L, Versace V, Brigo F, Orioli A, Saltuari L, Höller Y, Trinka E. Disinhibition of sensory cortex in patients with amyotrophic lateral sclerosis. Neurosci Lett 2020; 722:134860. [DOI: 10.1016/j.neulet.2020.134860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/05/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
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12
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Zimmermann G, Bolter L, Sluka R, Höller Y, Bathke AC, Thomschewski A, Leis S, Lattanzi S, Brigo F, Trinka E. Sample sizes and statistical methods in interventional studies on individuals with spinal cord injury: A systematic review. J Evid Based Med 2019; 12:200-208. [PMID: 31231977 PMCID: PMC6771853 DOI: 10.1111/jebm.12356] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/12/2019] [Indexed: 12/13/2022]
Abstract
AIM Prevalence and incidence of spinal cord injury (SCI) are low. However, sample sizes have not been systematically examined yet, although this might represent useful information for study planning and power considerations. Therefore, our objective was to determine the median sample size in clinical trials on SCI individuals. Moreover, within small-sample size studies, statistical methods and awareness of potential problems regarding small samples were examined. METHODS We systematically reviewed all studies on human SCI individuals published between 2014 and 2015, where the effect of an intervention on one or more health-related outcomes was assessed by means of a hypothesis test. If at least one group had a size <20, the study was classified as a small sample size study. PubMed was searched for eligible studies; subsequently, data on sample sizes and statistical methods were extracted and summarized descriptively. RESULTS Out of 8897 studies 207 were included. Median total sample size was 18 (range 4-582). Small sample sizes were found in 167/207 (81%) studies, resulting limitations and implications for statistical analyses were mentioned in 109/167 (65%) studies. CONCLUSIONS Although most recent SCI trials have been conducted with small samples, the consequences on statistical analysis methods and the validity of the results are rarely acknowledged.
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Affiliation(s)
- Georg Zimmermann
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Spinal Cord Injury and Tissue Regeneration Centre SalzburgParacelsus Medical UniversitySalzburgAustria
- Department of MathematicsParis Lodron UniversitySalzburgAustria
| | | | - Ronny Sluka
- Department of PsychologyParis Lodron UniversitySalzburgAustria
| | - Yvonne Höller
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Arne C. Bathke
- Department of MathematicsParis Lodron UniversitySalzburgAustria
| | - Aljoscha Thomschewski
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Spinal Cord Injury and Tissue Regeneration Centre SalzburgParacelsus Medical UniversitySalzburgAustria
- Department of PsychologyParis Lodron UniversitySalzburgAustria
| | - Stefan Leis
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical MedicineMarche Polytechnic UniversityAnconaItaly
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
- Division of NeurologyFranz Tappeiner HospitalMeranoItaly
| | - Eugen Trinka
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Department of Public HealthHealth Services Research and Health Technology Assessment, UMITHall i. T.Austria
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13
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Thomschewski A, Hincapié AS, Frauscher B. Localization of the Epileptogenic Zone Using High Frequency Oscillations. Front Neurol 2019; 10:94. [PMID: 30804887 PMCID: PMC6378911 DOI: 10.3389/fneur.2019.00094] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [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: 11/08/2018] [Accepted: 01/23/2019] [Indexed: 01/22/2023] Open
Abstract
For patients with drug-resistant focal epilepsy, surgery is the therapy of choice in order to achieve seizure freedom. Epilepsy surgery foremost requires the identification of the epileptogenic zone (EZ), defined as the brain area indispensable for seizure generation. The current gold standard for identification of the EZ is the seizure-onset zone (SOZ). The fact, however that surgical outcomes are unfavorable in 40-50% of well-selected patients, suggests that the SOZ is a suboptimal biomarker of the EZ, and that new biomarkers resulting in better postsurgical outcomes are needed. Research of recent years suggested that high-frequency oscillations (HFOs) are a promising biomarker of the EZ, with a potential to improve surgical success in patients with drug-resistant epilepsy without the need to record seizures. Nonetheless, in order to establish HFOs as a clinical biomarker, the following issues need to be addressed. First, evidence on HFOs as a clinically relevant biomarker stems predominantly from retrospective assessments with visual marking, leading to problems of reproducibility and reliability. Prospective assessments of the use of HFOs for surgery planning using automatic detection of HFOs are needed in order to determine their clinical value. Second, disentangling physiologic from pathologic HFOs is still an unsolved issue. Considering the appearance and the topographic location of presumed physiologic HFOs could be immanent for the interpretation of HFO findings in a clinical context. Third, recording HFOs non-invasively via scalp electroencephalography (EEG) and magnetoencephalography (MEG) is highly desirable, as it would provide us with the possibility to translate the use of HFOs to the scalp in a large number of patients. This article reviews the literature regarding these three issues. The first part of the article focuses on the clinical value of invasively recorded HFOs in localizing the EZ, the detection of HFOs, as well as their separation from physiologic HFOs. The second part of the article focuses on the current state of the literature regarding non-invasively recorded HFOs with emphasis on findings and technical considerations regarding their localization.
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Affiliation(s)
- Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria,Department of Psychology, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Ana-Sofía Hincapié
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Birgit Frauscher
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada,*Correspondence: Birgit Frauscher
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14
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Höller Y, Thomschewski A, Uhl A, Bathke AC, Nardone R, Leis S, Trinka E, Höller P. HD-EEG Based Classification of Motor-Imagery Related Activity in Patients With Spinal Cord Injury. Front Neurol 2018; 9:955. [PMID: 30510537 PMCID: PMC6252382 DOI: 10.3389/fneur.2018.00955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/20/2017] [Accepted: 10/24/2018] [Indexed: 12/16/2022] Open
Abstract
Brain computer interfaces (BCIs) are thought to revolutionize rehabilitation after SCI, e.g., by controlling neuroprostheses, exoskeletons, functional electrical stimulation, or a combination of these components. However, most BCI research was performed in healthy volunteers and it is unknown whether these results can be translated to patients with spinal cord injury because of neuroplasticity. We sought to examine whether high-density EEG (HD-EEG) could improve the performance of motor-imagery classification in patients with SCI. We recorded HD-EEG with 256 channels in 22 healthy controls and 7 patients with 14 recordings (4 patients had more than one recording) in an event related design. Participants were instructed acoustically to either imagine, execute, or observe foot and hand movements, or to rest. We calculated Fast Fourier Transform (FFT) and full frequency directed transfer function (ffDTF) for each condition and classified conditions pairwise with support vector machines when using only 2 channels over the sensorimotor area, full 10-20 montage, high-density montage of the sensorimotor cortex, and full HD-montage. Classification accuracies were comparable between patients and controls, with an advantage for controls for classifications that involved the foot movement condition. Full montages led to better results for both groups (p < 0.001), and classification accuracies were higher for FFT than for ffDTF (p < 0.001), for which the feature vector might be too long. However, full-montage 10–20 montage was comparable to high-density configurations. Motor-imagery driven control of neuroprostheses or BCI systems may perform as well in patients as in healthy volunteers with adequate technical configuration. We suggest the use of a whole-head montage and analysis of a broad frequency range.
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Affiliation(s)
- Yvonne Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Andreas Uhl
- Department of Computer Sciences, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Arne C Bathke
- Department of Mathematics, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Stefan Leis
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Peter Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
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15
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Schmid E, Thomschewski A, Taylor A, Zimmermann G, Kirschner M, Kobulashvili T, Brigo F, Rados M, Helmstaedter C, Braun K, Trinka E. Diagnostic accuracy of functional magnetic resonance imaging, Wada test, magnetoencephalography, and functional transcranial Doppler sonography for memory and language outcome after epilepsy surgery: A systematic review. Epilepsia 2018; 59:2305-2317. [PMID: 30374948 DOI: 10.1111/epi.14588] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The European Union-funded E-PILEPSY project was launched to develop guidelines and recommendations for epilepsy surgery. In this systematic review, we aimed to assess the diagnostic accuracy of functional magnetic resonance imaging (fMRI), Wada test, magnetoencephalography (MEG), and functional transcranial Doppler sonography (fTCD) for memory and language decline after surgery. METHODS The literature search was conducted using PubMed, Embase, and CENTRAL. The diagnostic accuracy was expressed in terms of sensitivity and specificity for postoperative language or memory decline, as determined by pre- and postoperative neuropsychological assessments. If two or more estimates of sensitivity or specificity were extracted from a study, two meta-analyses were conducted, using the maximum ("best case") and the minimum ("worst case") of the extracted estimates, respectively. RESULTS Twenty-eight papers were eligible for data extraction and further analysis. All tests for heterogeneity were highly significant, indicating large between-study variability (P < 0.001). For memory outcomes, meta-analyses were conducted for Wada tests (n = 17) using both memory and language laterality quotients. In the best case, meta-analyses yielded a sensitivity estimate of 0.79 (95% confidence interval [CI] = 0.67-0.92) and a specificity estimate of 0.65 (95% CI = 0.47-0.83). For the worst case, meta-analyses yielded a sensitivity estimate of 0.65 (95% CI = 0.48-0.82) and a specificity estimate of 0.46 (95% CI = 0.28-0.65). The overall quality of evidence, which was assessed using Grading of Recommendations Assessment, Development, and Evaluation methodology, was rated as very low. Meta-analyses concerning diagnostic accuracy of fMRI, fTCD, and MEG were not feasible due to small numbers of studies (fMRI, n = 4; fTCD, n = 1; MEG, n = 0). This also applied to studies concerning language outcomes (Wada test, n = 6; fMRI, n = 2; fTCD, n = 1; MEG, n = 0). SIGNIFICANCE Meta-analyses could only be conducted in a few subgroups for the Wada test with low-quality evidence. Thus, more evidence from high-quality studies and improved data reporting are required. Moreover, the large between-study heterogeneity underlines the necessity for more homogeneous and thus comparable studies in future research.
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Affiliation(s)
- Elisabeth Schmid
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
| | - Alexandra Taylor
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Matea Rados
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | | | - Kees Braun
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
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16
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Rohracher A, Kalss G, Neuray C, Höfler J, Dobesberger J, Kuchukhidze G, Kreidenhuber R, Florea C, Thomschewski A, Novak HF, Pilz G, Leitinger M, Trinka E. Perampanel in patients with refractory and super-refractory status epilepticus in a neurological intensive care unit: A single-center audit of 30 patients. Epilepsia 2018; 59 Suppl 2:234-242. [PMID: 30043411 DOI: 10.1111/epi.14494] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 05/31/2018] [Indexed: 11/29/2022]
Abstract
In refractory status epilepticus (SE), γ-aminobutyric acidergic drugs become less effective and glutamate plays a major role in seizure perpetuation. Data on the efficacy of perampanel (PER) in treatment of refractory SE in humans are limited. Here, we present a single-center case series of patients with refractory SE who received PER orally in an intensive care unit. We retrospectively analyzed treatment response, outcome, and adverse effects of all patients with refractory SE in our Neurological Intensive Care Unit who received add-on PER between September 2012 and February 2018. Thirty patients with refractory SE (median = 72 years, range = 18-91, 77% women) were included. In 14 patients (47%), a high-dose approach was used, with a median initial dose of 24 mg (range = 16-32). In five patients (17%), SE could be terminated after PER administration (median dose = 6 mg, range = 6-20 mg, 2/5 patients in high-dose group). Clinical response was observed after a median of 24 hours (range = 8-48 hours), whereas electroencephalogram resolved after a median of 60 hours (range = 12-72 hours). Time to treatment response tended to be shorter in patients receiving high-dose PER (median clinical response = 16 hours vs 18 hours; electroencephalographic response = 24 hours vs 72 hours), but groups were too small for statistical analysis. Continuous cardiorespiratory monitoring showed no changes in cardiorespiratory function after "standard" and "high-dose" treatment. Elevated liver enzymes without clinical symptoms were observed after a median of 6 days in seven of 30 patients (23%; 57% high dose vs 43% standard dose), of whom six also received treatment with phenytoin (PHT). Outcome was unfavorable (death, persistent vegetative state) in 13 patients (43%; 39% high dose vs 61% standard dose), and good recovery (no significant disability, moderate disability) was achieved in nine patients (56% high dose vs 44% standard dose). Oral PER in loading doses up to 32 mg were well tolerated but could terminate SE only in a few patients (5/30; 17%). Long duration of SE, route of administration, and severe underlying brain dysfunction might be responsible for the modest result. An intravenous formulation is highly desired to explore the full clinical utility in the treatment of refractory SE.
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Affiliation(s)
- Alexandra Rohracher
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Caroline Neuray
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria.,Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Rudolf Kreidenhuber
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Cristina Florea
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | | | - Helmut F Novak
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Georg Pilz
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
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17
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Dobesberger J, Höfler J, Leitinger M, Kuchukhidze G, Zimmermann G, Thomschewski A, Unterberger I, Walser G, Kalss G, Rohracher A, Neuray C, Kobulashvili T, Höller Y, Trinka E. Personalized safety measures reduce the adverse event rate of long-term video EEG. Epilepsia Open 2018; 2:400-414. [PMID: 29588971 PMCID: PMC5862109 DOI: 10.1002/epi4.12078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Accepted: 07/17/2017] [Indexed: 11/07/2022] Open
Abstract
Objective Safety in epilepsy monitoring units (EMUs) has become an increasing concern because adverse events occur in up to 10% of patients undergoing long‐term video EEG in EMUs. The aim of this study was to assess the effectiveness of a specific safety protocol in an EMU. Methods We retrospectively assessed the adverse event rates in a group without (group 1, 84‐month period, Innsbruck, Austria) and a group with (group 2, 33‐month period, Salzburg, Austria) personalized safety measures utilizing a standardized protocol for long‐term epilepsy monitoring in high‐risk patients. Differences in adverse event rates during and after long‐term video EEG between the two groups were calculated and compared. Results In group 1, 44/507 (9%, 95% confidence interval [CI] 6.5–11.5%) patients experienced 53 adverse events: 20/507 (4%, 95% CI 2.6–6.0%) patients had psychiatric events, 15/507 (3%, 95% CI 1.8–4.8%) patients sustained a total of 19 injuries during seizures, and 10/507 (2%, 95% CI 1.1–3.6%) patients had 13 episodes of status epilepticus; one adverse event was treatment‐related (valproic acid–induced encephalopathy; 1/507, 0.2%, 95% CI 0.0–1.1%). By using the new safety protocol in group 2, the adverse event rate was only 5% (95% CI 3.4–7.6%; 30 adverse events in 26/491; 45% reduction; p = 0.036), in contrast. These events included 13 psychiatric complications in 13/491 (2%, 95% CI 1.6–4.5%, p = 0.252) patients, 12 seizure‐related injuries in 9/491 (2%, 95% CI 1.0–3.4%, p = 0.250) patients, and 5 episodes of status epilepticus in 4/491 (1%, 95% CI 0.3–2.1%, p = 0.120) patients. Significance Implementation of personalized safety measures in high‐risk patients resulted in a clinically relevant reduction of adverse events in the EMU. Safety protocols are a valid tool to reduce the occurrence of adverse events in EMUs.
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Affiliation(s)
- Judith Dobesberger
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Julia Höfler
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Markus Leitinger
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Giorgi Kuchukhidze
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria.,Department of Neurology Medical Innsbruck University Innsbruck Austria
| | - Georg Zimmermann
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Aljoscha Thomschewski
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria.,Department of Mathematics Paris Lodron University Salzburg Austria.,Spinal Cord Injury and Tissue Regeneration Center Paracelsus Medical University Salzburg Austria
| | - Iris Unterberger
- Department of Neurology Medical Innsbruck University Innsbruck Austria
| | - Gerald Walser
- Department of Neurology Medical Innsbruck University Innsbruck Austria
| | - Gudrun Kalss
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Alexandra Rohracher
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Caroline Neuray
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Teia Kobulashvili
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Yvonne Höller
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Eugen Trinka
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
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18
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Thomschewski A, Ströhlein A, Langthaler PB, Schmid E, Potthoff J, Höller P, Leis S, Trinka E, Höller Y. Imagine There Is No Plegia. Mental Motor Imagery Difficulties in Patients with Traumatic Spinal Cord Injury. Front Neurosci 2017; 11:689. [PMID: 29311771 PMCID: PMC5732245 DOI: 10.3389/fnins.2017.00689] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/23/2017] [Indexed: 12/30/2022] Open
Abstract
In rehabilitation of patients with spinal cord injury (SCI), imagination of movement is a candidate tool to promote long-term recovery or to control futuristic neuroprostheses. However, little is known about the ability of patients with spinal cord injury to perform this task. It is likely that without the ability to effectively perform the movement, the imagination of movement is also problematic. We therefore examined, whether patients with SCI experience increased difficulties in motor imagery (MI) compared to healthy controls. We examined 7 male patients with traumatic spinal cord injury (aged 23–70 years, median 53) and 20 healthy controls (aged 21–54 years, median 30). All patients had incomplete SCI, with AIS (ASIA Impairment Scale) grades of C or D. All had cervical lesions, except one who had a thoracic injury level. Duration after injury ranged from 3 to 314 months. We performed the Movement Imagery Questionnaire Revised as well as the Beck Depression Inventory in all participants. The self-assessed ability of patients to visually imagine movements ranged from 7 to 36 (Md = 30) and tended to be decreased in comparison to healthy controls (ranged 16–49, Md = 42.5; W = 326.5, p = 0.055). Also, the self-assessed ability of patients to kinesthetically imagine movements (range = 7–35, Md = 31) differed significantly from the control group (range = 23–49, Md = 41; W = 337.5, p = 0.0047). Two patients yielded tendencies for depressive mood and they also reported most problems with movement imagination. Statistical analysis however did not confirm a general relationship between depressive mood and increased difficulty in MI across both groups. Patients with spinal cord injury seem to experience difficulties in imagining movements compared to healthy controls. This result might not only have implications for training and rehabilitation programs, but also for applications like brain-computer interfaces used to control neuroprostheses, which are often based on the brain signals exhibited during the imagination of movements.
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Affiliation(s)
- Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Psychology, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Anja Ströhlein
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Patrick B Langthaler
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Mathematics, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Elisabeth Schmid
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Psychology, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Jonas Potthoff
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Peter Höller
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Stefan Leis
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
| | - Yvonne Höller
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris-Lodron University of Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience Salzburg, Salzburg, Austria
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19
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Verhoeven T, Coito A, Plomp G, Thomschewski A, Pittau F, Trinka E, Wiest R, Schaller K, Michel C, Seeck M, Dambre J, Vulliemoz S, van Mierlo P. Automated diagnosis of temporal lobe epilepsy in the absence of interictal spikes. Neuroimage Clin 2017. [PMID: 29527470 PMCID: PMC5842753 DOI: 10.1016/j.nicl.2017.09.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective To diagnose and lateralise temporal lobe epilepsy (TLE) by building a classification system that uses directed functional connectivity patterns estimated during EEG periods without visible pathological activity. Methods Resting-state high-density EEG recording data from 20 left TLE patients, 20 right TLE patients and 35 healthy controls was used. Epochs without interictal spikes were selected. The cortical source activity was obtained for 82 regions of interest and whole-brain directed functional connectivity was estimated in the theta, alpha and beta frequency bands. These connectivity values were then used to build a classification system based on two two-class Random Forests classifiers: TLE vs healthy controls and left vs right TLE. Feature selection and classifier training were done in a leave-one-out procedure to compute the mean classification accuracy. Results The diagnosis and lateralization classifiers achieved a high accuracy (90.7% and 90.0% respectively), sensitivity (95.0% and 90.0% respectively) and specificity (85.7% and 90.0% respectively). The most important features for diagnosis were the outflows from left and right medial temporal lobe, and for lateralization the right anterior cingulate cortex. The interaction between features was important to achieve correct classification. Significance This is the first study to automatically diagnose and lateralise TLE based on EEG. The high accuracy achieved demonstrates the potential of directed functional connectivity estimated from EEG periods without visible pathological activity for helping in the diagnosis and lateralization of TLE. Both classifiers for TLE diagnosis and lateralization achieved high accuracy (90%). Outflow from left and right hippocampus was the most important for diagnosis. Outflow from the right ACC was the most important for lateralization. The interaction between features is important for a correct classification.
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Affiliation(s)
- Thibault Verhoeven
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.
| | - Ana Coito
- Functional Brain Mapping Lab, Department of Basic Neuroscience, University of Geneva, Geneva, Switzerland
| | - Gijs Plomp
- Perceptual Networks Group, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Aljoscha Thomschewski
- Department of Neurology, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria
| | - Francesca Pittau
- Epilepsy Unit, Neurology Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Eugen Trinka
- Department of Neurology, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria
| | - Roland Wiest
- Institute for Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - Karl Schaller
- Neurosurgery Clinic, University Hospital Geneva, Geneva, Switzerland
| | - Christoph Michel
- Functional Brain Mapping Lab, Department of Basic Neuroscience, University of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- Epilepsy Unit, Neurology Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Joni Dambre
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Serge Vulliemoz
- Epilepsy Unit, Neurology Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Pieter van Mierlo
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium; Functional Brain Mapping Lab, Department of Basic Neuroscience, University of Geneva, Geneva, Switzerland
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20
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Coito A, Verhoeven T, Plomp G, Thomschewski A, Pittau F, Trinka E, Wiest R, Schaller K, Michel C, Seeck M, Dambre J, Vulliemoz S, Mierlo PV. P362 Automated diagnosis of temporal lobe epilepsy in the absence of interictal spikes. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Höller Y, Uhl A, Bathke A, Thomschewski A, Butz K, Nardone R, Fell J, Trinka E. Reliability of EEG Measures of Interaction: A Paradigm Shift Is Needed to Fight the Reproducibility Crisis. Front Hum Neurosci 2017; 11:441. [PMID: 28912704 PMCID: PMC5582168 DOI: 10.3389/fnhum.2017.00441] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 12/04/2022] Open
Abstract
Measures of interaction (connectivity) of the EEG are at the forefront of current neuroscientific research. Unfortunately, test-retest reliability can be very low, depending on the measure and its estimation, the EEG-frequency of interest, the length of the signal, and the population under investigation. In addition, artifacts can hamper the continuity of the EEG signal, and in some clinical situations it is impractical to exclude artifacts. We aimed to examine factors that moderate test-retest reliability of measures of interaction. The study involved 40 patients with a range of neurological diseases and memory impairments (age median: 60; range 21–76; 40% female; 22 mild cognitive impairment, 5 subjective cognitive complaints, 13 temporal lobe epilepsy), and 20 healthy controls (age median: 61.5; range 23–74; 70% female). We calculated 14 measures of interaction based on the multivariate autoregressive model from two EEG-recordings separated by 2 weeks. We characterized test-retest reliability by correlating the measures between the two EEG-recordings for variations of data length, data discontinuity, artifact exclusion, model order, and frequency over all combinations of channels and all frequencies, individually for each subject, yielding a correlation coefficient for each participant. Excluding artifacts had strong effects on reliability of some measures, such as classical, real valued coherence (~0.1 before, ~0.9 after artifact exclusion). Full frequency directed transfer function was highly reliable and robust against artifacts. Variation of data length decreased reliability in relation to poor adjustment of model order and signal length. Variation of discontinuity had no effect, but reliabilities were different between model orders, frequency ranges, and patient groups depending on the measure. Pathology did not interact with variation of signal length or discontinuity. Our results emphasize the importance of documenting reliability, which may vary considerably between measures of interaction. We recommend careful selection of measures of interaction in accordance with the properties of the data. When only short data segments are available and when the signal length varies strongly across subjects after exclusion of artifacts, reliability becomes an issue. Finally, measures which show high reliability irrespective of the presence of artifacts could be extremely useful in clinical situations when exclusion of artifacts is impractical.
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Affiliation(s)
- Yvonne Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical UniversitySalzburg, Austria
| | - Andreas Uhl
- Department of Computer Sciences, Paris Lodron UniversitySalzburg, Austria
| | - Arne Bathke
- Department of Mathematics, Paris Lodron UniversitySalzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria
| | - Kevin Butz
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria.,Department of Neurology, Franz Tappeiner HospitalMerano, Italy
| | - Jürgen Fell
- Department of Epileptology, University of BonnBonn, Germany
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria
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22
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Höller Y, Butz K, Thomschewski A, Schmid E, Uhl A, Bathke AC, Zimmermann G, Tomasi SO, Nardone R, Staffen W, Höller P, Leitinger M, Höfler J, Kalss G, Taylor AC, Kuchukhidze G, Trinka E. Reliability of EEG Interactions Differs between Measures and Is Specific for Neurological Diseases. Front Hum Neurosci 2017; 11:350. [PMID: 28725190 PMCID: PMC5496950 DOI: 10.3389/fnhum.2017.00350] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/07/2016] [Accepted: 06/20/2017] [Indexed: 11/21/2022] Open
Abstract
Alterations of interaction (connectivity) of the EEG reflect pathological processes in patients with neurologic disorders. Nevertheless, it is questionable whether these patterns are reliable over time in different measures of interaction and whether this reliability of the measures is the same across different patient populations. In order to address this topic we examined 22 patients with mild cognitive impairment, five patients with subjective cognitive complaints, six patients with right-lateralized temporal lobe epilepsy, seven patients with left lateralized temporal lobe epilepsy, and 20 healthy controls. We calculated 14 measures of interaction from two EEG-recordings separated by 2 weeks. In order to characterize test-retest reliability, we correlated these measures for each group and compared the correlations between measures and between groups. We found that both measures of interaction as well as groups differed from each other in terms of reliability. The strongest correlation coefficients were found for spectrum, coherence, and full frequency directed transfer function (average rho > 0.9). In the delta (2–4 Hz) range, reliability was lower for mild cognitive impairment compared to healthy controls and left lateralized temporal lobe epilepsy. In the beta (13–30 Hz), gamma (31–80 Hz), and high gamma (81–125 Hz) frequency ranges we found decreased reliability in subjective cognitive complaints compared to mild cognitive impairment. In the gamma and high gamma range we found increased reliability in left lateralized temporal lobe epilepsy patients compared to healthy controls. Our results emphasize the importance of documenting reliability of measures of interaction, which may vary considerably between measures, but also between patient populations. We suggest that studies claiming clinical usefulness of measures of interaction should provide information on the reliability of the results. In addition, differences between patient groups in reliability of interactions in the EEG indicate the potential of reliability to serve as a new biomarker for pathological memory decline as well as for epilepsy. While the brain concert of information flow is generally variable, high reliability, and thus, low variability may reflect abnormal firing patterns.
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Affiliation(s)
- Yvonne Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria
| | - Kevin Butz
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria
| | - Elisabeth Schmid
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria
| | - Andreas Uhl
- Department of Computer Sciences, Paris Lodron University of SalzburgSalzburg, Austria
| | - Arne C Bathke
- Department of Mathematics, Paris Lodron University of SalzburgSalzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria.,Department of Mathematics, Paris Lodron University of SalzburgSalzburg, Austria
| | - Santino O Tomasi
- Department of Neurosurgery, Christian Doppler Medical Centre, Paracelsus Medical University SalzburgSalzburg, Austria
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria.,Department of Neurology, Franz Tappeiner HospitalMerano, Italy
| | - Wolfgang Staffen
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria
| | - Peter Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria
| | - Markus Leitinger
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria
| | - Alexandra C Taylor
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University SalzburgSalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical UniversitySalzburg, Austria
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23
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Thomschewski A, Höller Y, Höller P, Leis S, Trinka E. High Amplitude EEG Motor Potential during Repetitive Foot Movement: Possible Use and Challenges for Futuristic BCIs That Restore Mobility after Spinal Cord Injury. Front Neurosci 2017; 11:362. [PMID: 28690497 PMCID: PMC5481367 DOI: 10.3389/fnins.2017.00362] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/09/2017] [Indexed: 11/23/2022] Open
Abstract
Recent advances in neuroprostheses provide us with promising ideas of how to improve the quality of life in people suffering from impaired motor functioning of upper and lower limbs. Especially for patients after spinal cord injury (SCI), futuristic devices that are controlled by thought via brain-computer interfaces (BCIs) might be of tremendous help in managing daily tasks and restoring at least some mobility. However, there are certain problems arising when trying to implement BCI technology especially in such a heterogenous patient group. A plethora of processes occurring after the injuries change the brain's structure as well as its functionality collectively referred to as neuroplasticity. These changes are very different between individuals, leading to an increasing interest to reveal the exact changes occurring after SCI. In this study we investigated event-related potentials (ERPs) derived from electroencephalography (EEG) signals recorded during the (attempted) execution and imagination of hand and foot movements in healthy subjects and patients with SCI. As ERPs and especially early components are of interest for BCI research we aimed to investigate differences between 22 healthy volunteers and 7 patients (mean age = 51.86, SD = 15.49) suffering from traumatic or non-traumatic SCI since 2–314 months (mean = 116,57, SD = 125,55). We aimed to explore differences in ERP responses as well as the general presence of component that might be of interest to further consider for incorporation into BCI research. In order to match the real-life situation of BCIs for controlling neuroprostheses, we worked on small trial numbers (<25), only. We obtained a focal potential over Pz in ten healthy participants but in none of the patients after lenient artifact rejection. The potential was characterized by a high amplitude, it correlated with the repeated movements (6 times in 6 s) and in nine subjects it significantly differed from a resting condition. Furthermore, there are strong arguments against possible confounding factors leading to the potential's appearance. This phenomenon, occurring when movements are repeatedly conducted, might represent a possible potential to be used in futuristic BCIs and further studies should try to investigate the replicability of its appearance.
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Affiliation(s)
- Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center SalzburgSalzburg, Austria.,Department of Psychology, Paris-Lodron University of SalzburgSalzburg, Austria
| | - Yvonne Höller
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Department of Psychology, Paris-Lodron University of SalzburgSalzburg, Austria.,Center for Cognitive Neuroscience SalzburgSalzburg, Austria
| | - Peter Höller
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center SalzburgSalzburg, Austria
| | - Stefan Leis
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center SalzburgSalzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center SalzburgSalzburg, Austria.,Center for Cognitive Neuroscience SalzburgSalzburg, Austria
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24
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Rohracher A, Kalss G, Leitinger M, Granbichler C, Deak I, Dobesberger J, Kuchukhidze G, Thomschewski A, Höfler J, Trinka E. Two-year real-world experience with perampanel in patients with refractory focal epilepsy: Austrian data. Ther Adv Neurol Disord 2016; 9:445-453. [PMID: 27800020 DOI: 10.1177/1756285616661115] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The aim of this study was to analyse registry data of seizure outcome and adverse events (AEs) for perampanel as add-on therapy in patients with focal epilepsy since its approval in 2012 for adjunctive treatment of focal epilepsy in patients ⩾12 years. METHOD A retrospective 2-year chart review of all patients receiving perampanel was carried out. RESULTS A total of 122 patients received perampanel [median treatment length: 20.1 (range: 3.4-26.8) months]; 71 (58%) remained on treatment at last follow up. Overall, 33 patients (27%) were seizure-free for ⩾3 months at last follow up; of these, eight were seizure free for ⩾3 times the longest interictal interval before perampanel therapy; 18 (15%) had reduced seizure frequency ⩾50%. A total of 58 (47%) had an AE and 34 (28%) withdrew from treatment because of AEs. AEs included dizziness (33%), fatigue (12%), psychiatric symptoms (8%), cognitive deficits (7%), speech problems (5%), nausea (4%) and gait problems (4%). AEs subsided in 17/18 patients (94%) following a 2 mg dose reduction. A total of 43 (35%) took a concomitant enzyme inducer. Patients not taking enzyme inducers were more likely to be seizure free (p = 0.002); there were no other between-group differences. CONCLUSIONS Perampanel was well tolerated and improved seizure control in 42% of patients (50- 100% reduction), with higher rates in those not receiving a concomitant enzyme inducer. AEs, particularly dizziness, were common but often disappeared with a slight dose reduction. The results are consistent with those from randomized controlled trials.
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Affiliation(s)
- Alexandra Rohracher
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Ignaz-Harrer-Straße 79, A-5020 Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Claudia Granbichler
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ildiko Deak
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
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Rohracher A, Reiter DP, Brigo F, Kalss G, Thomschewski A, Novak H, Zerbs A, Dobesberger J, Akhundova A, Höfler J, Kuchukhidze G, Leitinger M, Trinka E. Status epilepticus in the elderly-A retrospective study on 120 patients. Epilepsy Res 2016; 127:317-323. [PMID: 27694014 DOI: 10.1016/j.eplepsyres.2016.08.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 06/30/2016] [Accepted: 08/14/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Status epilepticus (SE) is one of the most common neurological emergencies with a high incidence in the elderly. Major determinants of prognosis are patients' age, duration of SE and underlying etiology. We aimed identifying differences in clinical presentation of SE, etiologies and outcome between patients (pts.) sixty years or older (≥60) and younger than sixty (<60) years (yrs). METHODS We retrospectively analyzed 120 patients (48 women) with SE admitted to the Neurological Intensive Care Unit (NICU), Department of Neurology, Paracelsus Medical University Salzburg, Austria between 1/2011 and 01/2013. KEY FINDINGS Median age was 69 years (range 14-90) (63% ≥60yrs). Generalized tonic clonic SE was the most common SE type, whereas non convulsive SE with and without coma tended to occur more frequently in the elderly (33% ≥60 yrs. vs. 20%<60 yrs, Chi2=3.511, p=0.061). Preexisting history of epilepsy was more common in the younger age group (64% vs 41% p=0.014). An acute symptomatic cause of SE was identified in 25% (31/120), with cerebrovascular diseases being more frequent in the elderly (47% vs. 11%; p<0.01). Duration of SE did not differ between the age groups (p=0.63). Mortality was higher in elderly patients (31% vs. 7%, p=0.028, Chi Square=5.18) and moderate disability in younger patients (42% vs 17%; p=0.005, Chi Square=7.83). After Bonferroni correction only the higher rate of cerebrovascular etiologies in the elderly was statistically significant. SIGNIFICANCE In the elder population, SE occurs more often in patients without preexisting epilepsy and is most frequently caused by cerebrovascular diseases. NCSE tends to be more frequent in the elderly and diagnosis is complicated by subtle clinical presentation. Even though comorbidities represent treatment limitations, in our sample no differences in choice of AED as well as dosage were observed between the age groups, reflecting a trend toward AEDs with more favorable adverse event profile in all patients. SE in older patients is associated with poorer outcome and higher mortality.
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Affiliation(s)
| | - Doris P Reiter
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Gudrun Kalss
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | | | - Helmut Novak
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Zerbs
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - Aynur Akhundova
- Department of Neurology, Medical University Azerbaijan, Baku, Azerbaijan
| | - Julia Höfler
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Leitinger
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria.
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Coito A, Plomp G, Abela E, Iannotti G, Thomschewski A, Höller Y, Trinka E, Wiest R, Seeck M, Michel C, Vulliemoz S. ID 316 – EEG resting-state directed connectivity in temporal lobe epilepsy vs healthy controls. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.286] [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: 10/22/2022]
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Coito A, Genetti M, Pittau F, Iannotti GR, Thomschewski A, Höller Y, Trinka E, Wiest R, Seeck M, Michel CM, Plomp G, Vulliemoz S. Altered directed functional connectivity in temporal lobe epilepsy in the absence of interictal spikes: A high density EEG study. Epilepsia 2016; 57:402-11. [DOI: 10.1111/epi.13308] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Ana Coito
- Functional Brain Mapping Lab; Department of Fundamental Neurosciences; University of Geneva; Geneva Switzerland
| | - Melanie Genetti
- Functional Brain Mapping Lab; Department of Fundamental Neurosciences; University of Geneva; Geneva Switzerland
| | - Francesca Pittau
- EEG and Epilepsy Unit; University Hospital of Geneva; Geneva Switzerland
| | - Giannina R. Iannotti
- Functional Brain Mapping Lab; Department of Fundamental Neurosciences; University of Geneva; Geneva Switzerland
| | - Aljoscha Thomschewski
- Department of Neurology; Paracelsus Medical University and Center for Cognitive Neuroscience; Salzburg Austria
| | - Yvonne Höller
- Department of Neurology; Paracelsus Medical University and Center for Cognitive Neuroscience; Salzburg Austria
| | - Eugen Trinka
- Department of Neurology; Paracelsus Medical University and Center for Cognitive Neuroscience; Salzburg Austria
| | - Roland Wiest
- Institute for Diagnostic and Interventional Neuroradiology; University of Bern; Bern Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit; University Hospital of Geneva; Geneva Switzerland
| | - Christoph M. Michel
- Functional Brain Mapping Lab; Department of Fundamental Neurosciences; University of Geneva; Geneva Switzerland
| | - Gijs Plomp
- Functional Brain Mapping Lab; Department of Fundamental Neurosciences; University of Geneva; Geneva Switzerland
- Department of Psychology; University of Fribourg; Fribourg Switzerland
| | - Serge Vulliemoz
- EEG and Epilepsy Unit; University Hospital of Geneva; Geneva Switzerland
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Höller Y, Kutil R, Klaffenböck L, Thomschewski A, Höller PM, Bathke AC, Jacobs J, Taylor AC, Nardone R, Trinka E. High-frequency oscillations in epilepsy and surgical outcome. A meta-analysis. Front Hum Neurosci 2015; 9:574. [PMID: 26539097 PMCID: PMC4611152 DOI: 10.3389/fnhum.2015.00574] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [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: 04/13/2015] [Accepted: 10/02/2015] [Indexed: 01/14/2023] Open
Abstract
High frequency oscillations (HFOs) are estimated as a potential marker for epileptogenicity. Current research strives for valid evidence that these HFOs could aid the delineation of the to-be resected area in patients with refractory epilepsy and improve surgical outcomes. In the present meta-analysis, we evaluated the relation between resection of regions from which HFOs can be detected and outcome after epilepsy surgery. We conducted a systematic review of all studies that related the resection of HFO-generating areas to postsurgical outcome. We related the outcome (seizure freedom) to resection ratio, that is, the ratio between the number of channels on which HFOs were detected and, among these, the number of channels that were inside the resected area. We compared the resection ratio between seizure free and not seizure free patients. In total, 11 studies were included. In 10 studies, ripples (80-200 Hz) were analyzed, and in 7 studies, fast ripples (>200 Hz) were studied. We found comparable differences (dif) and largely overlapping confidence intervals (CI) in resection ratios between outcome groups for ripples (dif = 0.18; CI: 0.10-0.27) and fast ripples (dif = 0.17; CI: 0.01-0.33). Subgroup analysis showed that automated detection (dif = 0.22; CI: 0.03-0.41) was comparable to visual detection (dif = 0.17; CI: 0.08-0.27). Considering frequency of HFOs (dif = 0.24; CI: 0.09-0.38) was related more strongly to outcome than considering each electrode that was showing HFOs (dif = 0.15; CI = 0.03-0.27). The effect sizes found in the meta-analysis are small but significant. Automated detection and application of a detection threshold in order to detect channels with a frequent occurrence of HFOs is important to yield a marker that could be useful in presurgical evaluation. In order to compare studies with different methodological approaches, detailed and standardized reporting is warranted.
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Affiliation(s)
- Yvonne Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University Salzburg, Austria
| | - Raoul Kutil
- Department of Mathematics, Paris Lodron University Salzburg, Austria
| | - Lukas Klaffenböck
- Department of Mathematics, Paris Lodron University Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University Salzburg, Austria
| | - Peter M Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University Salzburg, Austria
| | - Arne C Bathke
- Department of Mathematics, Paris Lodron University Salzburg, Austria
| | - Julia Jacobs
- Department of Neuropediatrics and Muscular Diseases and Epilepsy Center, University Medical Center Freiburg, Germany
| | - Alexandra C Taylor
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University Salzburg, Austria
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University Salzburg, Austria ; Department of Neurology, Franz Tappeiner Hospital Merano, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University Salzburg, Austria
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Nardone R, Höller Y, Taylor A, Thomschewski A, Orioli A, Frey V, Trinka E, Brigo F. Noninvasive Spinal Cord Stimulation: Technical Aspects and Therapeutic Applications. Neuromodulation 2015; 18:580-91; discussion 590-1. [DOI: 10.1111/ner.12332] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/23/2015] [Accepted: 06/03/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Raffaele Nardone
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Yvonne Höller
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Alexandra Taylor
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Aljoscha Thomschewski
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Andrea Orioli
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
| | - Vanessa Frey
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Eugen Trinka
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Francesco Brigo
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
- Department of Neurological and Movement Sciences. Section of Clinical Neurology; University of Verona; Verona Italy
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Rohracher A, Dobesberger J, Granbichler CA, Höfler J, Kuchukhidze G, Ortler M, Unterberger I, Walser G, Thomschewski A, Trinka E. The ILAE definition of drug resistant epilepsy and its clinical applicability compared with “older” established definitions. Journal of Epileptology 2015. [DOI: 10.1515/joepi-2015-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SUMMARY
Background. Early identification of potential epilepsy surgery candidates is essential to the treatment process.
Aim. To evaluate the clinical applicability of the ILAE definition of drug resistant epilepsy and its potential in identifying surgical candidates earlier compared to three established “older” definitions of drug resistant epilepsy.
Material and Methods. Retrospective analysis of 174 patients who underwent epilepsy surgery between 1998 and 2009. Clinical factors and course of disease were extracted from patients' charts. Drug resistant epilepsy was classified according to four definitions and the time until fulfillment of criteria compared.
Results. Mean time to fulfillment of criteria of drug resistant epilepsy ranged from 11.8 (standard deviation (SD) 9.8) to 15.6 years (SD 11.3). Time to drug resistance was significantly longer applying the only definition, requiring failure of three antiepileptic drugs (AEDs) (Canada definition), whereas time to fulfillment of all other definitions did not differ. Fifty percent of all patients experienced a seizure free period of ≥1 year prior to being classified as drug resistant, 13% entered another 1-year remission after fulfilling any criteria for drug resistance.
Conclusion. We conclude that the ILAE definition identifies drug resistant epilepsy, with similar latency like two of three formerly used definitions. It is an easy applicable tool to minimize the delay of referral to a specialized center. Intermittent remissions delay assessment of drug resistance for all definitions and 13% of patients enter a remission despite established drug resistance.
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Nardone R, Höller Y, Thomschewski A, Bathke AC, Ellis AR, Golaszewski SM, Brigo F, Trinka E. Assessment of corticospinal excitability after traumatic spinal cord injury using MEP recruitment curves: a preliminary TMS study. Spinal Cord 2015; 53:534-8. [PMID: 25665538 DOI: 10.1038/sc.2015.12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/30/2014] [Accepted: 01/08/2015] [Indexed: 12/20/2022]
Abstract
STUDY DESIGN Transcranial magnetic stimulation study. OBJECTIVES To further investigate the corticospinal excitability changes after spinal cord injury (SCI), as assessed by means of transcranial magnetic stimulation (TMS). SETTING Merano (Italy) and Salzburg (Austria). METHODS We studied resting motor threshold (RMT), motor evoked potential (MEP) amplitude and recruitment curve in five subjects with good recovery after traumatic incomplete cervical SCI. RESULTS RMT did not differ significantly between patients and controls, whereas the slope of MEP recruitment curve was significantly increased in the patients. CONCLUSION This abnormal finding may represent an adaptive response after SCI. The impaired ability of the motor cortex to generate proper voluntary movement may be compensated by increasing spinal excitability. The easily performed measurement of MEP recruitment curve may provide a useful additional tool to improve the assessment and monitoring of motor cortical function in subjects with SCI. Increasing our knowledge of the corticospinal excitability changes in the functional recovery after SCI may also support the development of effective therapeutic strategies.
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Affiliation(s)
- R Nardone
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria [2] Department of Neurology, Franz Tappeiner Hospital, Merano, Italy [3] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Y Höller
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - A Thomschewski
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - A C Bathke
- 1] Department of Mathematics, Paris Lodron University, Salzburg, Austria [2] Department of Statistics, University of Kentucky, Lexington, KY, USA
| | - A R Ellis
- Department of Statistics, University of Kentucky, Lexington, KY, USA
| | - S M Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria
| | - F Brigo
- 1] Department of Neurology, Franz Tappeiner Hospital, Merano, Italy [2] Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - E Trinka
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
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Nardone R, Höller Y, Thomschewski A, Brigo F, Orioli A, Höller P, Golaszewski S, Trinka E. rTMS modulates reciprocal inhibition in patients with traumatic spinal cord injury. Spinal Cord 2014; 52:831-5. [PMID: 25112970 DOI: 10.1038/sc.2014.136] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/20/2014] [Accepted: 07/13/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Randomized, double-blind, crossover, sham-controlled trial. OBJECTIVES Repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) leads to a significant reduction of spasticity in subjects with spinal cord injury (SCI), but the physiological basis of this effect is still not well understood. The purpose of this study was to evaluate the disynaptic reciprocal Ia inhibition of soleus motoneurons in SCI patients. SETTING Department of Neurology, Merano, Italy and TMS Laboratory, Paracelsus Medical University, Salzburg, Austria. METHODS Nine subjects with incomplete cervical or thoracic SCI received 5 days of daily sessions of real or sham rTMS applied over the contralateral M1. We compared the reciprocal inhibition, the Modified Ashworth Scale and the Spinal Cord Injury Assessment Tool for Spasticity at baseline, after the last session and 1 week later in the real rTMS and sham stimulation groups. RESULTS We found that real rTMS significantly reduced lower limb spasticity and restored the impaired excitability in the disynaptic reciprocal inhibitory pathway. CONCLUSIONS In a small proof-of-concept study, rTMS strengthened descending projections between the motor cortex and inhibitory spinal interneuronal circuits. This reversed a defect in reciprocal inhibition after SCI, and reduced leg spasticity.
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Affiliation(s)
- R Nardone
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Department of Neurology, Franz Tappeiner Hospital, Merano, Italy [3] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Y Höller
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - A Thomschewski
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - F Brigo
- 1] Department of Neurology, Franz Tappeiner Hospital, Merano, Italy [2] Department of Neurological, Neuropsychological, Morphological and Movement Sciences. Section of Clinical Neurology, University of Verona, Verona, Italy
| | - A Orioli
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - P Höller
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - S Golaszewski
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - E Trinka
- 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
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Höller Y, Butz K, Thomschewski A, Höller P, Trinka E. YIA3: Consistency over time of electroencephalographic connectivity measures in temporal lobe epilepsy. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50099-5] [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: 10/25/2022]
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Höller Y, Butz K, Thomschewski A, Hoeller P, Trinka E. P793: Consistency over time of electroencephalographic connectivity measures in temporal lobe epilepsy. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50832-2] [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: 11/25/2022]
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Butz K, Thomschewski A, Hoeller Y, Trinka E. LP29: Considering transcallosal coherence as a marker of consciousness. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Butz K, Thomschewski A, Höller Y, Trinka E. Connectivity as a marker for accurate diagnosis in Disorders of Consciousness (DOC). KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371241] [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: 10/25/2022]
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Nardone R, Höller Y, Leis S, Höller P, Thon N, Thomschewski A, Golaszewski S, Brigo F, Trinka E. Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: a review. J Spinal Cord Med 2014; 37:19-31. [PMID: 24090372 PMCID: PMC4066547 DOI: 10.1179/2045772313y.0000000140] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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] [Indexed: 01/20/2023] Open
Abstract
CONTEXT Past evidence has shown that invasive and non-invasive brain stimulation may be effective for relieving central pain. OBJECTIVE To perform a topical review of the literature on brain neurostimulation techniques in patients with chronic neuropathic pain due to traumatic spinal cord injury (SCI) and to assess the current evidence for their therapeutic efficacy. METHODS A MEDLINE search was performed using following terms: "Spinal cord injury", "Neuropathic pain", "Brain stimulation", "Deep brain stimulation" (DBS), "Motor cortex stimulation" (MCS), "Transcranial magnetic stimulation" (TMS), "Transcranial direct current stimulation" (tDCS), "Cranial electrotherapy stimulation" (CES). RESULTS Invasive neurostimulation therapies, in particular DBS and epidural MCS, have shown promise as treatments for neuropathic and phantom limb pain. However, the long-term efficacy of DBS is low, while MCS has a relatively higher potential with lesser complications that DBS. Among the non-invasive techniques, there is accumulating evidence that repetitive TMS can produce analgesic effects in healthy subjects undergoing laboratory-induced pain and in chronic pain conditions of various etiologies, at least partially and transiently. Another very safe technique of non-invasive brain stimulation - tDCS - applied over the sensory-motor cortex has been reported to decrease pain sensation and increase pain threshold in healthy subjects. CES has also proved to be effective in managing some types of pain, including neuropathic pain in subjects with SCI. CONCLUSION A number of studies have begun to use non-invasive neuromodulatory techniques therapeutically to relieve neuropathic pain and phantom phenomena in patients with SCI. However, further studies are warranted to corroborate the early findings and confirm different targets and stimulation paradigms. The utility of these protocols in combination with pharmacological approaches should also be explored.
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Affiliation(s)
- Raffaele Nardone
- Correspondence to: Raffaele Nardone, Department of Neurology, ‘F. Tappeiner’ Hospital, Meran/o, Via Rossini, 5, 39012 Meran/o (BZ), Italy.
| | | | - Stefan Leis
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
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Rohracher A, Huber D, Dobesberger J, Höfler J, Novak H, Thomschewski A, Zerbs A, Akhundova A, Trinka E. Status epilepticus in the elderly on a neurological intensive care unit. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Höller Y, Bergmann J, Kronbichler M, Crone JS, Schmid EV, Thomschewski A, Butz K, Schütze V, Höller P, Trinka E. Real movement vs. motor imagery in healthy subjects. Int J Psychophysiol 2012; 87:35-41. [PMID: 23123181 DOI: 10.1016/j.ijpsycho.2012.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 09/30/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
Motor imagery tasks are well established procedures in brain computer interfaces, but are also used in the assessment of patients with disorders of consciousness. For testing awareness in unresponsive patients it is necessary to know the natural variance of brain responses to motor imagery in healthy subjects. We examined 22 healthy subjects using EEG in three conditions: movement of both hands, imagery of the same movement, and an instruction to hold both hands still. Single-subject non-parametric statistics were applied to the fast-Fourier transformed data. Most effects were found in the α- and β-frequency ranges over central electrodes, that is, in the μ-rhythm. We found significant power changes in 18 subjects during movement and in 11 subjects during motor imagery. In 8 subjects these changes were consistent over both conditions. The significant power changes during movement were a decrease of μ-rhythm. There were 2 subjects with an increase and 9 subjects with a decrease of μ-rhythm during imagery. α and β are the most responsive frequency ranges, but there is a minor number of subjects who show a synchronization instead of the more common desynchronization during motor imagery. A (de)synchronization of μ-rhythm can be considered to be a normal response.
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Affiliation(s)
- Yvonne Höller
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria.
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Höller Y, Thomschewski A, Schmid EV, Höller P, Crone JS, Trinka E. Individual brain-frequency responses to self-selected music. Int J Psychophysiol 2012; 86:206-13. [PMID: 23000014 DOI: 10.1016/j.ijpsycho.2012.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 09/09/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
Abstract
Music is a stimulus which may give rise to a wide range of emotional and cognitive responses. Therefore, brain reactivity to music has become a focus of interest in cognitive neuroscience. It is possible that individual preference moderates the effectof music on the brain. In the present study we examined whether there are common effects of listening to music even if each subject in a sample chooses their own piece of music. We invited 18 subjects to bring along their favorite relaxing music, and their favourite stimulating music. Additionally, a condition with tactile stimulation on the foot and a baseline condition (rest) without stimulation were used. The tactile stimulation was chosen to provide a simple, non-auditory condition which would be identical for all subjects. The electroencephalogram was recorded for each of the 3 conditions and during rest. We found responses in the alpha range mainly on parietal and occipital sites that were significant compared to baseline in 13 subjects during relaxing music, 15 subjects during activating music, and 16 subjects during tactile stimulation. Most subjects showed an alpha desynchronization in a lower alpha range followed by a synchronization in an upper frequency range. However, some subjects showed an increase in this area, whereas others showed a decrease only. In addition, many subjects showed reactivity in the beta range. Beta activity was especially increased while listening to activating music and during tactile stimulation in most subjects. We found interindividual differences in the response patterns even though the stimuli provoked comparable subjective emotions (relaxation, activation), and even if the stimulus was the same for all subjects (somatosensory stimulation). We suggest that brain responsivity to music should be examined individually by considering individual characteristics.
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Affiliation(s)
- Yvonne Höller
- Department of Neurology, Christian-Doppler-Clinic, Paracelsus Medical University, Salzburg, Austria.
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