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Jordán Z, Szabó JP, Sákovics A, Kelemen A, Halász L, Erőss L, Fabó D. Epileptiform discharges in the anterior thalamus of epilepsy patients. iScience 2024; 27:109582. [PMID: 38726366 PMCID: PMC11079473 DOI: 10.1016/j.isci.2024.109582] [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: 04/19/2023] [Revised: 07/25/2023] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
Anterior thalamus (ANT) deep-brain stimulation (DBS) is an approved therapy for drug resistant epilepsy. We aimed to identify interictal epileptiform discharges (IED) in the ANT and to investigate their relationship with surface IEDs. Fifteen patients were monitored for two consecutive nights with externalized thalamic leads to analyze the intrathalamic epileptiform activities (TIED). Forty-six % of all contacts were located within the ANT. We found that all the responders had TIEDs within the ANT, while this held true only for 44% of the non-responders. The overall response rate (RR) at 1-year follow-up was 40%, while it was 44% in bilateral ANT hit patients and 45% in epileptic focus side hit. However, in case of TIEDs present in the focus side the RR reached as high as 71%. TIED activity may prove the pathophysiological connection to the seizure focus, and stimulation of this area might have a better suppressing effect on seizures.
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Affiliation(s)
- Zsófia Jordán
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
| | - Johanna-Petra Szabó
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- János Szentágothai Neuroscience Program, School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
- Lendület Laboratory of Systems Neuroscience, Institute of Experimental Medicine, 1083 Budapest, Hungary
| | - Anna Sákovics
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- János Szentágothai Neuroscience Program, School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Anna Kelemen
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary
| | - László Halász
- Functional Neurosurgery Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
| | - Loránd Erőss
- Functional Neurosurgery Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
| | - Dániel Fabó
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- Department of Neurology, University of Szeged, 6720 Szeged, Hungary
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Szalárdy O, Simor P, Ujma PP, Jordán Z, Halász L, Erőss L, Fabó D, Bódizs R. Temporal association between sleep spindles and ripples in the human anterior and mediodorsal thalamus. Eur J Neurosci 2024; 59:641-661. [PMID: 38221670 DOI: 10.1111/ejn.16240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
Sleep spindles are major oscillatory components of Non-Rapid Eye Movement (NREM) sleep, reflecting hyperpolarization-rebound sequences of thalamocortical neurons. Reports suggest a link between sleep spindles and several forms of high-frequency oscillations which are considered as expressions of pathological off-line neural plasticity in the central nervous system. Here we investigated the relationship between thalamic sleep spindles and ripples in the anterior and mediodorsal nuclei (ANT and MD) of epilepsy patients. Whole-night LFP from the ANT and MD were co-registered with scalp EEG/polysomnography by using externalized leads in 15 epilepsy patients undergoing a Deep Brain Stimulation protocol. Slow (~12 Hz) and fast (~14 Hz) sleep spindles were present in the human ANT and MD and roughly, 20% of them were associated with ripples. Ripple-associated thalamic sleep spindles were characterized by longer duration and exceeded pure spindles in terms of spindle power as indicated by time-frequency analysis. Furthermore, ripple amplitude was modulated by the phase of sleep spindles within both thalamic nuclei. No signs of pathological processes were correlated with measures of ripple and spindle association, furthermore, the density of ripple-associated sleep spindles in the ANT showed a positive correlation with verbal comprehension. Our findings indicate the involvement of the human thalamus in coalescent spindle-ripple oscillations of NREM sleep.
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Affiliation(s)
- Orsolya Szalárdy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Institute of Cognitive Neuroscience and Psychology, Budapest, Hungary
| | - Péter Simor
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN, Center for Research in Cognition and Neurosciences and UNI-ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Zsófia Jordán
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - László Halász
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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Hadady L, Sperling MR, Alcala-Zermeno JL, French JA, Dugan P, Jehi L, Fabó D, Klivényi P, Rubboli G, Beniczky S. Prediction tools and risk stratification in epilepsy surgery. Epilepsia 2024; 65:414-421. [PMID: 38060351 DOI: 10.1111/epi.17851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE This study was undertaken to conduct external validation of previously published epilepsy surgery prediction tools using a large independent multicenter dataset and to assess whether these tools can stratify patients for being operated on and for becoming free of disabling seizures (International League Against Epilepsy stage 1 and 2). METHODS We analyzed a dataset of 1562 patients, not used for tool development. We applied two scales: Epilepsy Surgery Grading Scale (ESGS) and Seizure Freedom Score (SFS); and two versions of Epilepsy Surgery Nomogram (ESN): the original version and the modified version, which included electroencephalographic data. For the ESNs, we used calibration curves and concordance indexes. We stratified the patients into three tiers for assessing the chances of attaining freedom from disabling seizures after surgery: high (ESGS = 1, SFS = 3-4, ESNs > 70%), moderate (ESGS = 2, SFS = 2, ESNs = 40%-70%), and low (ESGS = 2, SFS = 0-1, ESNs < 40%). We compared the three tiers as stratified by these tools, concerning the proportion of patients who were operated on, and for the proportion of patients who became free of disabling seizures. RESULTS The concordance indexes for the various versions of the nomograms were between .56 and .69. Both scales (ESGS, SFS) and nomograms accurately stratified the patients for becoming free of disabling seizures, with significant differences among the three tiers (p < .05). In addition, ESGS and the modified ESN accurately stratified the patients for having been offered surgery, with significant difference among the three tiers (p < .05). SIGNIFICANCE ESGS and the modified ESN (at thresholds of 40% and 70%) stratify patients undergoing presurgical evaluation into three tiers, with high, moderate, and low chance for favorable outcome, with significant differences between the groups concerning having surgery and becoming free of disabling seizures. Stratifying patients for epilepsy surgery has the potential to help select the optimal candidates in underprivileged areas and better allocate resources in developed countries.
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Affiliation(s)
- Levente Hadady
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Michael R Sperling
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Juan Luis Alcala-Zermeno
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jacqueline A French
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Patricia Dugan
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Computational Life Sciences, Cleveland, Ohio, USA
| | - Dániel Fabó
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Guido Rubboli
- Department of Neurology, Danish Epilepsy Center, Dianalund, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sándor Beniczky
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark
- Department of Clinical Medicine, Aarhus University and Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
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Hadady L, Klivényi P, Fabó D, Beniczky S. Real-world user experience with seizure detection wearable devices in the home environment. Epilepsia 2023; 64 Suppl 4:S72-S77. [PMID: 35195898 DOI: 10.1111/epi.17189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate direct user experience with wearable seizure detection devices in the home environment. METHODS A structured online questionnaire was completed by 242 users (175 caregivers and 67 persons with epilepsy), most of the patients (87.19%) having tonic-clonic seizures. RESULTS The vast majority of the users were overall satisfied with the wearable device, considered that using the device was easy, and agreed that the use of the device improved their quality of life (median = 6 on 7-point Likert scale). A high retention rate (84.58%) and a long median usage time (14 months) were reported. In the home environment, most users (75.85%) experienced seizure detection sensitivity similar (≥95%) to what was previously reported in validation studies in epilepsy monitoring units. The experienced false alarm rate was relatively low (0-0.43 per day). Due to the alarms, almost one third of persons with epilepsy (PWEs; 30.00%) experienced decrease in the number of seizure-related injuries, and almost two thirds of PWEs (65.41%) experienced improvement in the accuracy of seizure diaries. Nonvalidated devices had significantly lower retention rate, overall satisfaction, perceived sensitivity, and improvement in quality of life, as compared with validated devices. SIGNIFICANCE Our results demonstrate the feasibility and usefulness of automated seizure detection in the home environment.
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Affiliation(s)
- Levente Hadady
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Dániel Fabó
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Sándor Beniczky
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Epilepsy Center, Dianalund, Denmark
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Bod R, Tóth K, Essam N, Tóth EZ, Erõss L, Entz L, Bagó AG, Fabó D, Ulbert I, Wittner L. Synaptic alterations and neuronal firing in human epileptic neocortical excitatory networks. Front Synaptic Neurosci 2023; 15:1233569. [PMID: 37635750 PMCID: PMC10450510 DOI: 10.3389/fnsyn.2023.1233569] [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: 06/02/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Epilepsy is a prevalent neurological condition, with underlying neuronal mechanisms involving hyperexcitability and hypersynchrony. Imbalance between excitatory and inhibitory circuits, as well as histological reorganization are relatively well-documented in animal models or even in the human hippocampus, but less is known about human neocortical epileptic activity. Our knowledge about changes in the excitatory signaling is especially scarce, compared to that about the inhibitory cell population. This study investigated the firing properties of single neurons in the human neocortex in vitro, during pharmacological blockade of glutamate receptors, and additionally evaluated anatomical changes in the excitatory circuit in tissue samples from epileptic and non-epileptic patients. Both epileptic and non-epileptic tissues exhibited spontaneous population activity (SPA), NMDA receptor antagonization reduced SPA recurrence only in epileptic tissue, whereas further blockade of AMPA/kainate receptors reversibly abolished SPA emergence regardless of epilepsy. Firing rates did not significantly change in excitatory principal cells and inhibitory interneurons during pharmacological experiments. Granular layer (L4) neurons showed an increased firing rate in epileptic compared to non-epileptic tissue. The burstiness of neurons remained unchanged, except for that of inhibitory cells in epileptic recordings, which decreased during blockade of glutamate receptors. Crosscorrelograms computed from single neuron discharge revealed both mono- and polysynaptic connections, particularly involving intrinsically bursting principal cells. Histological investigations found similar densities of SMI-32-immunopositive long-range projecting pyramidal cells in both groups, and shorter excitatory synaptic active zones with a higher proportion of perforated synapses in the epileptic group. These findings provide insights into epileptic modifications from the perspective of the excitatory system and highlight discrete alterations in firing patterns and synaptic structure. Our data suggest that NMDA-dependent glutamatergic signaling, as well as the excitatory synaptic machinery are perturbed in epilepsy, which might contribute to epileptic activity in the human neocortex.
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Affiliation(s)
- Réka Bod
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Eötvös Loránd Research Network, Budapest, Hungary
- Semmelweis University Doctoral School, Budapest, Hungary
| | - Kinga Tóth
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Eötvös Loránd Research Network, Budapest, Hungary
| | - Nour Essam
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Eötvös Loránd Research Network, Budapest, Hungary
| | - Estilla Zsófia Tóth
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Eötvös Loránd Research Network, Budapest, Hungary
- Semmelweis University Doctoral School, Budapest, Hungary
| | - Loránd Erõss
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - László Entz
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Attila G. Bagó
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - István Ulbert
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Eötvös Loránd Research Network, Budapest, Hungary
- Semmelweis University Doctoral School, Budapest, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary
| | - Lucia Wittner
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Eötvös Loránd Research Network, Budapest, Hungary
- Semmelweis University Doctoral School, Budapest, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
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Lőrincz K, Bóné B, Karádi K, Kis-Jakab G, Tóth N, Halász L, Erőss L, Balás I, Faludi B, Jordán Z, Chadaide Z, Gyimesi C, Fabó D, Janszky J. Effects of anterior thalamic nucleus DBS on interictal heart rate variability in patients with refractory epilepsy. Clin Neurophysiol 2023; 147:17-30. [PMID: 36630886 DOI: 10.1016/j.clinph.2022.11.020] [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: 08/14/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Heart rate variability (HRV) changes were investigated by several studies after resective epilepsy surgery/vagus nerve stimulation. We examined anterior thalamic nucleus (ANT)-deep brain stimulation (DBS) effects on HRV parameters. METHODS We retrospectively analyzed 30 drug-resistant epilepsy patients' medical record data and collected electrocardiographic epochs recorded during video- electroencephalography monitoring sessions while awake and during N1- or N2-stage sleep pre-DBS implantation surgery, post-surgery but pre-stimulation, and after stimulation began. RESULTS The mean square root of the mean squared differences between successive RR intervals and RR interval standard deviation values differed significantly (p < 0.05) among time-points, showing increased HRV post-surgery. High (0.15-0.4 Hz) and very low frequency (<0.04 Hz) increased, while low frequency (0.04-0.15 Hz) and the LF/HF ratio while awake decreased, suggesting improved autonomic regulation post-surgery. Change of effect size was larger in patients where both activated contacts were located in the ANT than in those where only one or none of the contacts hit the ANT. CONCLUSIONS In patients with drug-resistant epilepsy, ANT-DBS might positively influence autonomic regulation, as reflected by increased HRV. SIGNIFICANCE To gain a more comprehensive outcome estimation after DBS implantation, we suggest including HRV measures with seizure count in the post-surgery follow-up protocol.
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Affiliation(s)
- Katalin Lőrincz
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler str. 3, 72076 Tübingen, Germany.
| | - Beáta Bóné
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Kázmér Karádi
- Department of Behavioral Sciences, Medical School, University of Pecs, Szigeti u.12, H-7624 Pecs, Hungary
| | - Greta Kis-Jakab
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Ret u. 2., H-7623 Pecs, Hungary
| | - Natália Tóth
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - László Halász
- Department of Functional Neurosurgery, National Institute of Neurosciences, Amerikai ut 57, H-1345 Budapest, Hungary
| | - Loránd Erőss
- Department of Functional Neurosurgery, National Institute of Neurosciences, Amerikai ut 57, H-1345 Budapest, Hungary
| | - István Balás
- Department of Neurosurgery, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Béla Faludi
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Zsófia Jordán
- Department of Neurology, National Institute of Neurosciences, Amerikai ut 57., H-1345 Budapest, Hungary
| | - Zoltan Chadaide
- University of Szeged Albert Szentgyörgyi Medical School, Tisza Lajos krt.109, 6725 Szeged, Hungary
| | - Csilla Gyimesi
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary
| | - Dániel Fabó
- Department of Neurology, National Institute of Neurosciences, Amerikai ut 57., H-1345 Budapest, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pecs, Ret u. 2, H-7623 Pecs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Ret u. 2., H-7623 Pecs, Hungary
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Szabó JP, Hajnal B, Sákovics A, Erőss L, Fabó D. Spectral analysis of after-discharges elicited by intracranial 50 Hz stimulation of epileptic patients. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.632] [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: 02/17/2023] Open
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Ujma PP, Dresler M, Simor P, Fabó D, Ulbert I, Erőss L, Bódizs R. The sleep EEG envelope is a novel, neuronal firing-based human biomarker. Sci Rep 2022; 12:18836. [PMID: 36336717 PMCID: PMC9637727 DOI: 10.1038/s41598-022-22255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/12/2022] [Indexed: 11/08/2022] Open
Abstract
Sleep EEG reflects voltage differences relative to a reference, while its spectrum reflects its composition of various frequencies. In contrast, the envelope of the sleep EEG reflects the instantaneous amplitude of oscillations, while its spectrum reflects the rhythmicity of the occurrence of these oscillations. The sleep EEG spectrum is known to relate to demographic, psychological and clinical characteristics, but the envelope spectrum has been rarely studied. In study 1, we demonstrate in human invasive data from cortex-penetrating microelectrodes and subdural grids that the sleep EEG envelope spectrum reflects neuronal firing. In study 2, we demonstrate that the scalp EEG envelope spectrum is stable within individuals. A multivariate learning algorithm could predict age (r = 0.6) and sex (r = 0.5) from the EEG envelope spectrum. With age, oscillations shifted from a 4-5 s rhythm to faster rhythms. Our results demonstrate that the sleep envelope spectrum is a promising biomarker of demographic and disease-related phenotypes.
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Affiliation(s)
- Péter P Ujma
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary.
- National Institute of Clinical Neuroscience, Budapest, Hungary.
| | - Martin Dresler
- Radboud University Medical Center, Donders Institute, Nijmegen, The Netherlands
| | - Péter Simor
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN - Center for Research in Cognition and Neurosciences and UNI - ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Dániel Fabó
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - István Ulbert
- Department of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary
- Research Centre for Natural Sciences, Institute for Cognitive Neuroscience and Psychology, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- National Institute of Clinical Neuroscience, Budapest, Hungary
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Szabó JP, Fabó D, Pető N, Sákovics A, Bódizs R. Role of anterior thalamic circuitry during sleep. Epilepsy Res 2022; 186:106999. [DOI: 10.1016/j.eplepsyres.2022.106999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/22/2022] [Accepted: 08/10/2022] [Indexed: 12/01/2022]
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Sákovics A, Csukly G, Borbély C, Virág M, Kelemen A, Bódizs R, Erőss L, Fabó D. Prolongation of cortical sleep spindles during hippocampal interictal epileptiform discharges in epilepsy patients. Epilepsia 2022; 63:2256-2268. [PMID: 35723195 PMCID: PMC9796153 DOI: 10.1111/epi.17337] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Memory deficits are frequent among patients with epilepsies affecting the temporal lobe. Hippocampal interictal epileptic discharges (hIEDs), the presumed epileptic exaggeration of sharp wave-ripples (SWRs), are known to contribute to memory dysfunction, but the potential underlying mechanism is unknown. The precise temporal coordination between hippocampal SWRs and corticothalamic spindles during sleep is critical for memory consolidation. Moreover, previous investigation indicated that hIEDs induce neocortical spindlelike oscillation. In the present study, we aimed to assess the influence of hIEDs on neocortical spindles. METHODS We analyzed the spindle characteristics (duration, amplitude, frequency) of 21 epilepsy patients implanted with foramen ovale (FO) electrodes during a whole night sleep. Scalp sleep spindles were categorized based on their temporal relationship to hIEDs detected on the FO electrodes. Three groups were created: (1) spindles coinciding with hIEDs, (2) spindles "induced" by hIEDs, and (3) spindles without hIED co-occurrence. RESULTS We found that spindles co-occurring with hIEDs had altered characteristics in all measured properties, lasted longer by 126 ± 48 ms (mean ± SD), and had higher amplitude by 3.4 ± 3.2 μV, and their frequency range shifted toward the higher frequencies within the 13-15-Hz range. Also, hIED-induced spindles had identical oscillatory properties to spindles without any temporal relationships with hIEDs. In more than half of our subjects, clear temporal coherence was revealed between hIEDs and spindles, but the direction of the coupling was patient-specific. SIGNIFICANCE We investigated the effect of hippocampal IEDs on neocortical spindle activity and found spindle alterations in cases of spindle-hIED co-occurrence, but not in cases of hIED-initiated spindles. We propose that this is a marker of a pathologic process, where IEDs may have direct effect on spindle generation. It could mark a potential mechanism whereby IEDs disrupt memory processes, and also provide a potential therapeutic target to treat memory disturbances in epilepsy.
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Affiliation(s)
- Anna Sákovics
- Department of NeurologyNational Institute of Mental Health, Neurology, and NeurosurgeryBudapestHungary,School of PhDSemmelweis UniversityBudapestHungary
| | - Gábor Csukly
- Department of Psychiatry and PsychotherapySemmelweis UniversityBudapestHungary
| | - Csaba Borbély
- Department of NeurologyNational Institute of Mental Health, Neurology, and NeurosurgeryBudapestHungary
| | - Márta Virág
- Department of NeurologyNational Institute of Mental Health, Neurology, and NeurosurgeryBudapestHungary
| | - Anna Kelemen
- Department of NeurologyNational Institute of Mental Health, Neurology, and NeurosurgeryBudapestHungary,András Pető FacultySemmelweis UniversityBudapestHungary
| | - Róbert Bódizs
- Department of NeurologyNational Institute of Mental Health, Neurology, and NeurosurgeryBudapestHungary,Institute of Behavioral SciencesSemmelweis UniversityBudapestHungary
| | - Loránd Erőss
- Department of Functional NeurosurgeryNational Institute of Mental Health, Neurology, and NeurosurgeryBudapestHungary
| | - Dániel Fabó
- Department of NeurologyNational Institute of Mental Health, Neurology, and NeurosurgeryBudapestHungary
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Ujma PP, Szalárdy O, Fabó D, Erőss L, Bódizs R. Thalamic activity during scalp slow waves in humans. Neuroimage 2022; 257:119325. [PMID: 35605767 DOI: 10.1016/j.neuroimage.2022.119325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022] Open
Abstract
Slow waves are major pacemakers of NREM sleep oscillations. While slow waves themselves are mainly generated by cortical neurons, it is not clear what role thalamic activity plays in the generation of some oscillations grouped by slow waves, and to what extent thalamic activity during slow waves is itself driven by corticothalamic inputs. To address this question, we simultaneously recorded both scalp EEG and local field potentials from six thalamic nuclei (bilateral anterior, mediodorsal and ventral anterior) in fifteen epileptic patients (age-range: 17-64 years, 7 females) undergoing Deep Brain Stimulation Protocol and assessed the temporal evolution of thalamic activity relative to scalp slow waves using time-frequency analysis. We found that thalamic activity in all six nuclei during scalp slow waves is highly similar to what is observed on the scalp itself. Slow wave downstates are characterized by delta, theta and alpha activity and followed by beta, high sigma and low sigma activity during subsequent upstates. Gamma activity in the thalamus is not significantly grouped by slow waves. Theta and alpha activity appeared first on the scalp, but sigma activity appeared first in the thalamus. These effects were largely independent from the scalp region in which SWs were detected and the precise identity of thalamic nuclei. Our results suggest that while small thalamocortical neuron assemblies may initiate cortical oscillations, especially in the sleep spindle range, the large-scale neuronal activity in the thalamus which is detected by field potentials is principally driven by global cortical activity, and thus it is highly similar to what is observed on the scalp.
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Affiliation(s)
- Péter P Ujma
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary; National Institute of Clinical Neuroscience, Budapest, Hungary.
| | - Orsolya Szalárdy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary; National Institute of Clinical Neuroscience, Budapest, Hungary
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12
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Hofer KT, Kandrács Á, Tóth K, Hajnal B, Bokodi V, Tóth EZ, Erőss L, Entz L, Bagó AG, Fabó D, Ulbert I, Wittner L. Bursting of excitatory cells is linked to interictal epileptic discharge generation in humans. Sci Rep 2022; 12:6280. [PMID: 35428851 PMCID: PMC9012754 DOI: 10.1038/s41598-022-10319-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Knowledge about the activity of single neurons is essential in understanding the mechanisms of synchrony generation, and particularly interesting if related to pathological conditions. The generation of interictal spikes—the hypersynchronous events between seizures—is linked to hyperexcitability and to bursting behaviour of neurons in animal models. To explore its cellular mechanisms in humans we investigated the activity of clustered single neurons in a human in vitro model generating both physiological and epileptiform synchronous events. We show that non-epileptic synchronous events resulted from the finely balanced firing of excitatory and inhibitory cells, which was shifted towards an enhanced excitability in epileptic tissue. In contrast, interictal-like spikes were characterised by an asymmetric overall neuronal discharge initiated by excitatory neurons with the presumptive leading role of bursting pyramidal cells, and possibly terminated by inhibitory interneurons. We found that the overall burstiness of human neocortical neurons is not necessarily related to epilepsy, but the bursting behaviour of excitatory cells comprising both intrinsic and synaptically driven bursting is clearly linked to the generation of epileptiform synchrony.
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Affiliation(s)
- Katharina T Hofer
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Eötvös Loránd Research Network, Magyar tudósok körútja 2., 1117, Budapest, Hungary.,Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, 1083, Budapest, Hungary.,Department of Neurobiology, School of Medicine and Institute for Medical Research Israel-Canada, The Hebrew University, 91120, Jerusalem, Israel
| | - Ágnes Kandrács
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Eötvös Loránd Research Network, Magyar tudósok körútja 2., 1117, Budapest, Hungary.,Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, 1083, Budapest, Hungary
| | - Kinga Tóth
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Eötvös Loránd Research Network, Magyar tudósok körútja 2., 1117, Budapest, Hungary
| | - Boglárka Hajnal
- National Institute of Mental Health, Neurology and Neurosurgery, 1143, Budapest, Hungary.,Semmelweis University Doctoral School, 1026, Budapest, Hungary
| | - Virág Bokodi
- National Institute of Mental Health, Neurology and Neurosurgery, 1143, Budapest, Hungary
| | - Estilla Zsófia Tóth
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Eötvös Loránd Research Network, Magyar tudósok körútja 2., 1117, Budapest, Hungary.,Semmelweis University Doctoral School, 1026, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Mental Health, Neurology and Neurosurgery, 1143, Budapest, Hungary
| | - László Entz
- National Institute of Mental Health, Neurology and Neurosurgery, 1143, Budapest, Hungary
| | - Attila G Bagó
- National Institute of Mental Health, Neurology and Neurosurgery, 1143, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Mental Health, Neurology and Neurosurgery, 1143, Budapest, Hungary
| | - István Ulbert
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Eötvös Loránd Research Network, Magyar tudósok körútja 2., 1117, Budapest, Hungary.,Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, 1083, Budapest, Hungary.,National Institute of Mental Health, Neurology and Neurosurgery, 1143, Budapest, Hungary
| | - Lucia Wittner
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Eötvös Loránd Research Network, Magyar tudósok körútja 2., 1117, Budapest, Hungary. .,Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, 1083, Budapest, Hungary. .,National Institute of Mental Health, Neurology and Neurosurgery, 1143, Budapest, Hungary.
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13
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Benkő Z, Stippinger M, Rehus R, Bencze A, Fabó D, Hajnal B, Eröss LG, Telcs A, Somogyvári Z. Manifold-adaptive dimension estimation revisited. PeerJ Comput Sci 2022; 8:e790. [PMID: 35111907 PMCID: PMC8771813 DOI: 10.7717/peerj-cs.790] [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: 02/08/2021] [Accepted: 11/01/2021] [Indexed: 06/14/2023]
Abstract
Data dimensionality informs us about data complexity and sets limit on the structure of successful signal processing pipelines. In this work we revisit and improve the manifold adaptive Farahmand-Szepesvári-Audibert (FSA) dimension estimator, making it one of the best nearest neighbor-based dimension estimators available. We compute the probability density function of local FSA estimates, if the local manifold density is uniform. Based on the probability density function, we propose to use the median of local estimates as a basic global measure of intrinsic dimensionality, and we demonstrate the advantages of this asymptotically unbiased estimator over the previously proposed statistics: the mode and the mean. Additionally, from the probability density function, we derive the maximum likelihood formula for global intrinsic dimensionality, if i.i.d. holds. We tackle edge and finite-sample effects with an exponential correction formula, calibrated on hypercube datasets. We compare the performance of the corrected median-FSA estimator with kNN estimators: maximum likelihood (Levina-Bickel), the 2NN and two implementations of DANCo (R and MATLAB). We show that corrected median-FSA estimator beats the maximum likelihood estimator and it is on equal footing with DANCo for standard synthetic benchmarks according to mean percentage error and error rate metrics. With the median-FSA algorithm, we reveal diverse changes in the neural dynamics while resting state and during epileptic seizures. We identify brain areas with lower-dimensional dynamics that are possible causal sources and candidates for being seizure onset zones.
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Affiliation(s)
- Zsigmond Benkő
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Marcell Stippinger
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
| | - Roberta Rehus
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
| | - Attila Bencze
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
| | - Dániel Fabó
- Epilepsy Center, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Boglárka Hajnal
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
- Epilepsy Center, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Loránd G. Eröss
- Department of Functional Neurosurgery, National Institute of Clinical Neurosciences, Budapest, Hungary
- Faculty of Information Technology and Bionics, Péter Pázmány Catholic University, Budapest, Hungary
| | - András Telcs
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
- Department of Computer Science and Information Theory, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Budapest, Hungary
- Department of Quantitative Methods, Faculty of Business and Economics,, University of Pannonia, Veszprém, Hungary
| | - Zoltán Somogyvári
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
- Neuromicrosystems ltd., Budapest, Hungary
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14
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Hadady L, Klivényi P, Perucca E, Rampp S, Fabó D, Bereczki C, Rubboli G, Asadi-Pooya AA, Sperling MR, Beniczky S. Web-based decision support system for patient-tailored selection of antiseizure medication in adolescents and adults: An external validation study. Eur J Neurol 2021; 29:382-389. [PMID: 34741372 DOI: 10.1111/ene.15168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Antiseizure medications (ASMs) should be tailored to individual characteristics, including seizure type, age, sex, comorbidities, comedications, drug allergies, and childbearing potential. We previously developed a web-based algorithm for patient-tailored ASM selection to assist health care professionals in prescribing medication using a decision support application (https://epipick.org). In this validation study, we used an independent dataset to assess whether ASMs recommended by the algorithm are associated with better outcomes than ASMs considered less desirable by the algorithm. METHODS Four hundred twenty-five consecutive patients with newly diagnosed epilepsy were followed for at least 1 year after starting an ASM chosen by their physician. Patient characteristics were fed into the algorithm, blinded to the physician's ASM choices and outcome. The algorithm recommended ASMs, ranked in hierarchical groups, with Group 1 ASMs labeled as the best option for that patient. We evaluated retention rates, seizure freedom rates, and adverse effects leading to treatment discontinuation. Survival analysis contrasted outcomes between patients who received favored drugs and those who received lower ranked drugs. Propensity score matching corrected for possible imbalances between the groups. RESULTS Antiseizure medications classified by the algorithm as best options had a higher retention rate (79.4% vs. 67.2%, p = 0.005), higher seizure freedom rate (76.0% vs. 61.6%, p = 0.002), and lower rate of discontinuation due to adverse effects (12.0% vs. 29.2%, p < 0.001) than ASMs ranked as less desirable by the algorithm. CONCLUSIONS Use of the freely available decision support system is associated with improved outcomes. This drug selection application can provide valuable assistance to health care professionals prescribing medication for individuals with epilepsy.
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Affiliation(s)
- Levente Hadady
- Department of Neurology, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Emilio Perucca
- Division of Clinical and Experimental Pharmacology, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.,Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Dániel Fabó
- Department of Neurology, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Csaba Bereczki
- Department of Pediatrics, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Guido Rubboli
- Department of Neurology, Danish Epilepsy Center (Member of the European Reference Network EpiCARE), Dianalund, University of Copenhagen, Copenhagen, Denmark
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center (Member of the European Reference Network EpiCARE), Aarhus University Hospital, Dianalund, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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15
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Tóth M, Barsi P, Tóth Z, Borbély K, Lückl J, Emri M, Repa I, Janszky J, Dóczi T, Horváth Z, Halász P, Juhos V, Gyimesi C, Bóné B, Kuperczkó D, Horváth R, Nagy F, Kelemen A, Jordán Z, Újvári Á, Hagiwara K, Isnard J, Pál E, Fekésházy A, Fabó D, Vajda Z. The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy. BMC Neurol 2021; 21:363. [PMID: 34537017 PMCID: PMC8449490 DOI: 10.1186/s12883-021-02352-z] [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: 10/28/2020] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background When MRI fails to detect a potentially epileptogenic lesion, the chance of a favorable outcome after epilepsy surgery becomes significantly lower (from 60 to 90% to 20–65%). Hybrid FDG-PET/MRI may provide additional information for identifying the epileptogenic zone. We aimed to investigate the possible effect of the introduction of hybrid FDG-PET/MRI into the algorithm of the decision-making in both lesional and non-lesional drug-resistant epileptic patients. Methods In a prospective study of patients suffering from drug-resistant focal epilepsy, 30 nonlesional and 30 lesional cases with discordant presurgical results were evaluated using hybrid FDG-PET/MRI. Results The hybrid imaging revealed morphological lesion in 18 patients and glucose hypometabolism in 29 patients within the nonlesional group. In the MRI positive group, 4 patients were found to be nonlesional, and in 9 patients at least one more epileptogenic lesion was discovered, while in another 17 cases the original lesion was confirmed by means of hybrid FDG-PET/MRI. As to the therapeutic decision-making, these results helped to indicate resective surgery instead of intracranial EEG (iEEG) monitoring in 2 cases, to avoid any further invasive diagnostic procedures in 7 patients, and to refer 21 patients for iEEG in the nonlesional group. Hybrid FDG-PET/MRI has also significantly changed the original therapeutic plans in the lesional group. Prior to the hybrid imaging, a resective surgery was considered in 3 patients, and iEEG was planned in 27 patients. However, 3 patients became eligible for resective surgery, 6 patients proved to be inoperable instead of iEEG, and 18 cases remained candidates for iEEG due to the hybrid FDG-PET/MRI. Two patients remained candidates for resective surgery and one patient became not eligible for any further invasive intervention. Conclusions The results of hybrid FDG-PET/MRI significantly altered the original plans in 19 of 60 cases. The introduction of hybrid FDG-PET/MRI into the presurgical evaluation process had a potential modifying effect on clinical decision-making. Trial registration Trial registry: Scientific Research Ethics Committee of the Medical Research Council of Hungary. Trial registration number: 008899/2016/OTIG. Date of registration: 08 February 2016.
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Affiliation(s)
- Márton Tóth
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary.
| | - Péter Barsi
- Department of Medical Imaging, Semmelweis University, Balassa út 6, Budapest, H-1083, Hungary
| | - Zoltán Tóth
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Katalin Borbély
- PET/CT Ambulance, National Institute of Oncology, Ráth György u.7-9, Budapest, H-1122, Hungary
| | - János Lückl
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Miklós Emri
- MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Imre Repa
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary.,MTA-PTE Clinical Neuroscience MRI Research Group, Ifjúság u. 20, Pécs, H-7624, Hungary
| | - Tamás Dóczi
- MTA-PTE Clinical Neuroscience MRI Research Group, Ifjúság u. 20, Pécs, H-7624, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Zsolt Horváth
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Péter Halász
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Vera Juhos
- Epihope Non-Profit Kft, Szilágyi Erzsébet fasor 17-21, Budapest, 1026, Hungary
| | - Csilla Gyimesi
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Beáta Bóné
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Diána Kuperczkó
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Réka Horváth
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Sándor u. 40, Guba, H-7400, Hungary
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Zsófia Jordán
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Ákos Újvári
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Koichi Hagiwara
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, 3-6-45, Momochihama, Sawara-ku, Fukuoka, 814-0001, Japan
| | - Jean Isnard
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, 59 Boulevard Pinel, 69500, Lyon, France
| | - Endre Pál
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Attila Fekésházy
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Zsolt Vajda
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
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16
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Simor P, Szalárdy O, Gombos F, Ujma PP, Jordán Z, Halász L, Erőss L, Fabó D, Bódizs R. REM Sleep Microstates in the Human Anterior Thalamus. J Neurosci 2021; 41:5677-5686. [PMID: 33863786 PMCID: PMC8244978 DOI: 10.1523/jneurosci.1899-20.2021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/24/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
Rapid eye movement (REM) sleep is an elusive neural state that is associated with a variety of functions from physiological regulatory mechanisms to complex cognitive processing. REM periods consist of the alternation of phasic and tonic REM microstates that differ in spontaneous and evoked neural activity. Although previous studies indicate, that cortical and thalamocortical activity differs across phasic and tonic microstates, the characterization of neural activity, particularly in subcortical structures that are critical in the initiation and maintenance of REM sleep is still limited in humans. Here, we examined electric activity patterns of the anterior nuclei of the thalamus as well as their functional connectivity with scalp EEG recordings during REM microstates and wakefulness in a group of epilepsy patients (N = 12, 7 females). Anterothalamic local field potentials (LFPs) showed increased high-α and β frequency power in tonic compared with phasic REM, emerging as an intermediate state between phasic REM and wakefulness. Moreover, we observed increased thalamocortical synchronization in phasic compared with tonic REM sleep, especially in the slow and fast frequency ranges. Wake-like activity in tonic REM sleep may index the regulation of arousal and vigilance facilitating environmental alertness. On the other hand, increased thalamocortical synchronization may reflect the intrinsic activity of frontolimbic networks supporting emotional and memory processes during phasic REM sleep. In sum, our findings highlight that the heterogeneity of phasic and tonic REM sleep is not limited to cortical activity, but is also manifested by anterothalamic LFPs and thalamocortical synchronization.SIGNIFICANCE STATEMENT REM sleep is a heterogeneous sleep state that features the alternation of two microstates, phasic and tonic rapid eye movement (REM). These states differ in sensory processing, awakening thresholds, and cortical activity. Nevertheless, the characterization of these microstates, particularly in subcortical structures is still limited in humans. We had the unique opportunity to examine electric activity patterns of the anterior nuclei of the thalamus (ANTs) as well as their functional connectivity with scalp EEG recordings during REM microstates and wakefulness. Our findings show that the heterogeneity of phasic and tonic REM sleep is not limited to cortical activity, but is also manifested in the level of the thalamus and thalamocortical networks.
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Affiliation(s)
- Péter Simor
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest 1064, Hungary
- Institute of Behavioural Sciences, Semmelweis University, Budapest 1089, Hungary
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN, Center for Research in Cognition and Neurosciences and UNI-ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels 1050, Belgium
| | - Orsolya Szalárdy
- Institute of Behavioural Sciences, Semmelweis University, Budapest 1089, Hungary
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest 1117, Hungary
| | - Ferenc Gombos
- MTA-PPKE, Hungarian Academy of Sciences, Pázmány Péter Catholic University, Adolescent Development Research Group, Budapest 1088, Hungary
| | - Péter Przemyslaw Ujma
- Institute of Behavioural Sciences, Semmelweis University, Budapest 1089, Hungary
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - Zsófia Jordán
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - László Halász
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, Budapest 1089, Hungary
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest 1117, Hungary
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17
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Jordán Z, Horváth B, Hajnal B, Halász L, Ujvári Á, Fogarasi A, Halász P, Kelemen A, Erőss L, Fabó D. Changes of the outcomes of epilepsy surgery within 10 years in the National Institute of Clinical Neurosciences, Hungary. Orv Hetil 2021; 162:219-226. [PMID: 33550274 DOI: 10.1556/650.2021.31991] [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: 07/17/2020] [Accepted: 08/23/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés és célkitűzés: A terápiarezisztens fokális epilepsziák sebészeti kezelése elterjedten használt kezelési lehetőség. Célunk az epilepsziasebészet-hatékonyság változásának vizsgálata egy évtizednyi távlatból a budapesti centrumban. Módszerek: Az Országos Klinikai Idegtudományi Intézetben reszektív epilepsziasebészeti beavatkozásokon átesett fokális epilepsziás betegek adatai kerültek feldolgozásra. A vizsgált 10 év beteganyagát két periódusra osztottuk a műtét időpontja szerint (2006-2010 és 2011-2016). Vizsgálati szempontjaink: demográfiai adatok, az epilepszia kezdete és típusa, mágnesesrezonancia-lelet, preoperatív rohamfrekvencia, műtéttípus és szövettani lelet. Az epileptológiai kimenetelt az Engel-klasszifikáció alapján értékeltük. Eredmények: Epilepsziasebészeti beavatkozás 187 betegen történt, akik közül 137-nél került sor reszekciós műtétre. A betegek 65%-ában temporalis, 18%-ában frontalis, míg 7%-ában olyan multilobaris epilepszia igazolódott, mely a temporalis vagy a frontalis lebenyt érintette. Teljes rohammentességet (Engel I/A) az 1. évben 68%-ban, a 2. évben 64%-ban, míg az 5. évben 63%-ban mértünk. A két intervallum összehasonlításakor az 1 éves rohammentesség aránya 60%-ról (temporalis: 67%, extratemporalis: 50%) 73%-ra (temporalis: 79%, extratemporalis: 62%) javult a második periódusban. Az etiológia szempontjából a hippocampalis sclerosis aránya 28%-ról 14%-ra csökkent, a fokális corticalis dysplasiák aránya 22%-ról 31%-ra növekedett. Következtetés: A sebészeti kezelés fokális epilepsziák esetén - alapos előzetes kivizsgálást követően - általában biztonságos és a legnagyobb arányban sikeres beavatkozás. A legkedvezőbb kimenetel temporalis lokalizációban érhető el. A hatékonyság az évek során egyre javuló tendenciát mutatott az egyre nehezebb sebészeti esetek ellenére. Ez magyarázható a sebészeti technikák fejlődésével, illetve a jobb, műtét előtti elektrofiziológiai és képalkotó technikákkal, amelyek bevezetésével pontosabb lokalizáció adható. Orv Hetil. 2021; 162(6): 219-226. SUMMARY INTRODUCTION AND OBJECTIVE The surgical treatment of medically intractable focal epilepsies is a well established practice. Our aim was to examine the efficacy of epilepsy surgery within a decade long period in our centre in Budapest. METHODS Data of drug-resistant patients with resective epilepsy surgery in the National Institute of Clinical Neurosciences were evaluated. The examined 10-year period was divided based on the year of the operation in two parts (2006-2010 and 2011-2016). The following data were collected: demography, beginning and type of epilepsy, magnetic resonance, preoperative seizure frequency, type of surgery and histology. Epileptological outcome was based on modified Engel's classification. RESULTS Out of 187 surgeries, we identified 137 patients with resective intervention: 65% temporal lobe, 18% frontal, and 7% multilobar epilepsy. Seizure-freedom (Engel I/A) was 68% in the first postoperative year, 64% in the second, and 63% in the fifth year. In the first period, 1-year seizure freedom was 60% (temporal: 67% extratemporal: 50%), while in the second period it was 73% (temporal 79%, extratemporal 62%). Hippocampal sclerosis ratio dropped from 28% to 14%, while focal cortical dysplasia ratio increased from 22% to 31%. CONCLUSION Surgical treatment in focal epilepsy - after thorough presurgical evaluation - is generally safe and successful. The most favorable outcome is in temporal localization. The efficacy tended to improve over time despite of the more challenging cases. This can be explained with the development of surgical techniques and improvement of presurgical localization. Orv Hetil. 2021; 162(6): 219-226.
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Affiliation(s)
- Zsófia Jordán
- 1 Országos Klinikai Idegtudományi Intézet, Neurológia Osztály, Epilepszia Centrum, Budapest, Amerikai út 57., 1145
| | - Boglárka Horváth
- 1 Országos Klinikai Idegtudományi Intézet, Neurológia Osztály, Epilepszia Centrum, Budapest, Amerikai út 57., 1145
| | - Boglárka Hajnal
- 1 Országos Klinikai Idegtudományi Intézet, Neurológia Osztály, Epilepszia Centrum, Budapest, Amerikai út 57., 1145
| | - László Halász
- 2 Országos Klinikai Idegtudományi Intézet, Funkcionális Idegsebészeti Osztály, Budapest
| | - Ákos Ujvári
- 1 Országos Klinikai Idegtudományi Intézet, Neurológia Osztály, Epilepszia Centrum, Budapest, Amerikai út 57., 1145
| | | | - Péter Halász
- 1 Országos Klinikai Idegtudományi Intézet, Neurológia Osztály, Epilepszia Centrum, Budapest, Amerikai út 57., 1145
| | - Anna Kelemen
- 1 Országos Klinikai Idegtudományi Intézet, Neurológia Osztály, Epilepszia Centrum, Budapest, Amerikai út 57., 1145
| | - Loránd Erőss
- 2 Országos Klinikai Idegtudományi Intézet, Funkcionális Idegsebészeti Osztály, Budapest
| | - Dániel Fabó
- 1 Országos Klinikai Idegtudományi Intézet, Neurológia Osztály, Epilepszia Centrum, Budapest, Amerikai út 57., 1145
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Kovács S, Tóth M, Janszky J, Dóczi T, Fabó D, Boncz I, Botz L, Zemplényi A. Cost-effectiveness analysis of invasive EEG monitoring in drug-resistant epilepsy. Epilepsy Behav 2021; 114:107488. [PMID: 33257296 DOI: 10.1016/j.yebeh.2020.107488] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Our aim was to determine the cost-effectiveness of two intracranial electroencephalography (iEEG) interventions: 1) stereoelectroencephalography (SEEG) and 2) placement of subdural grid electrodes (SDGs) both followed by resective surgery in patients with drug-resistant, partial-onset epilepsy, compared with medical management (MM) in Hungary from payer's perspective. METHODS The incremental health gains and costs of iEEG interventions have been determined with a combination of a decision tree and prevalence Markov process model over a 30-year time horizon in a cost-utility analysis (CUA). To address the effect of parameter uncertainty on the incremental cost-effectiveness ratio (ICER), deterministic and probabilistic sensitivity analyses were performed. RESULTS Our results showed that both SEEG and SDG interventions represent a more expensive but more effective strategy than MM representing the current standard of care. The total discounted cost of SEEG and SDG were € 32,760 and € 25,028 representing € 18,108 and € 10,375 additional cost compared with MM, respectively. However, they provide an additional 3.931 (in SEEG group) and 3.444 quality-adjusted life years (QALYs; in SDG group), correspondingly. Thus, the ICER of SEEG is € 4607 per QALY gain, while the ICER for SDG is € 3013 per QALY gain, compared with MM. At a cost-effectiveness threshold of € 41,058 per QALY in Hungary, both subtypes of iEEG interventions are cost-effective and provide good value for money. SIGNIFICANCE Because of the high cost of implanting electrodes and monitoring, the invasive EEG for patients with refractory epilepsy is currently not available in the Hungarian national healthcare system. Our study demonstrated that these procedures in Hungary are cost-effective compared with the MM. As a result, the introduction of iEEG interventions to the reimbursement list of the National Health Insurance Fund Administration was initiated.
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Affiliation(s)
- Sándor Kovács
- University of Pécs, Centre for Health Technology Assessment, Pécs, Rákóczi u. 2., H-7623, Hungary; University of Pécs, Faculty of Pharmacy, Division of Pharmacoeconomics, Department of Pharmaceutics, Pécs, Rákóczi u. 2., H-7623, Hungary.
| | - Márton Tóth
- University of Pécs, Medical School, Department of Neurology, Pécs, Rét u. 2., H-7623, Hungary
| | - József Janszky
- University of Pécs, Medical School, Department of Neurology, Pécs, Rét u. 2., H-7623, Hungary; MTA-PTE Clinical Neuroscience MRI Research Group, Pécs, Ifjúság u. 20., H-7624, Hungary
| | - Tamás Dóczi
- MTA-PTE Clinical Neuroscience MRI Research Group, Pécs, Ifjúság u. 20., H-7624, Hungary; University of Pécs, Medical School, Department of Neurosurgery, Pécs, Rét u. 2., H-7623, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Budapest, Amerikai u. 57., H-1145, Hungary
| | - Imre Boncz
- University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, Pécs, Mária u. 5-7., H-7621, Hungary
| | - Lajos Botz
- University of Pécs, Faculty of Pharmacy, Department of Pharmaceutics and Central Clinical Pharmacy, Pécs, Honvéd u. 3., H-7624, Hungary
| | - Antal Zemplényi
- University of Pécs, Centre for Health Technology Assessment, Pécs, Rákóczi u. 2., H-7623, Hungary; University of Pécs, Faculty of Pharmacy, Division of Pharmacoeconomics, Department of Pharmaceutics, Pécs, Rákóczi u. 2., H-7623, Hungary
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Gerencsér L, Perczel G, Erőss L, Fabó D, Vágó Z. Hawkes processes: some key ideas, links to neuroscience and system identification. Communications in Information and Systems 2021. [DOI: 10.4310/cis.2021.v21.n3.a4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- László Gerencsér
- Institute for Computer Science and Control (SZTAKI), Eötvös Loránd Research Network (ELKH), Budapest, Hungary; and Széchenyi István University, Győr, Hungary
| | - György Perczel
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University (PPKE ITK), Budapest, Hungary; and Széchenyi István University, Győr, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neurosciences (OKITI), Budapest, Hungary; and Faculty of Information Technology and Bionics, Pázmány Péter Catholic University (PPKE ITK), Budapest, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences (OKITI), Budapest, Hungary; and Faculty of Information Technology and Bionics, Pázmány Péter Catholic University (PPKE ITK), Budapest, Hungary
| | - Zsuzsanna Vágó
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University (PPKE ITK), Budapest, Hungary; and Széchenyi István University, Győr, Hungary
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Ujma PP, Hajnal B, Bódizs R, Gombos F, Erőss L, Wittner L, Halgren E, Cash SS, Ulbert I, Fabó D. The laminar profile of sleep spindles in humans. Neuroimage 2020; 226:117587. [PMID: 33249216 PMCID: PMC9113200 DOI: 10.1016/j.neuroimage.2020.117587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/05/2020] [Accepted: 11/18/2020] [Indexed: 11/17/2022] Open
Abstract
Sleep spindles are functionally important NREM sleep EEG oscillations which are generated in thalamocortical, corticothalamic and possibly cortico-cortical circuits. Previous hypotheses suggested that slow and fast spindles or spindles with various spatial extent may be generated in different circuits with various cortical laminar innervation patterns. We used NREM sleep EEG data recorded from four human epileptic patients undergoing presurgical electrophysiological monitoring with subdural electrocorticographic grids (ECoG) and implanted laminar microelectrodes penetrating the cortex (IME). The position of IMEs within cortical layers was confirmed using postsurgical histological reconstructions. Many spindles detected on the IME occurred only in one layer and were absent from the ECoG, but with increasing amplitude simultaneous detection in other layers and on the ECoG became more likely. ECoG spindles were in contrast usually accompanied by IME spindles. Neither IME nor ECoG spindle cortical profiles were strongly associated with sleep spindle frequency or globality. Multiple-unit and single-unit activity during spindles, however, was heterogeneous across spindle types, but also across layers and patients. Our results indicate that extremely local spindles may occur in any cortical layer, but co-occurrence at other locations becomes likelier with increasing amplitude and the relatively large spindles detected on ECoG channels have a stereotypical laminar profile. We found no compelling evidence that different spindle types are associated with different laminar profiles, suggesting that they are generated in cortical and thalamic circuits with similar cortical innervation patterns. Local neuronal activity is a stronger candidate mechanism for driving functional differences between spindles subtypes.
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Affiliation(s)
- Péter P Ujma
- Institute of Behavioural Sciences, Semmelweis University, 1089 Budapest, Hungary; Epilepsy Centrum, Dept. of Neurology, National Institute of Clinical Neurosciences, 1145 Budapest, Hungary
| | - Boglárka Hajnal
- Epilepsy Centrum, Dept. of Neurology, National Institute of Clinical Neurosciences, 1145 Budapest, Hungary; School of P.h.D. studies, Semmelweis University, 1085 Budapest, Hungary
| | - Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, 1089 Budapest, Hungary; Epilepsy Centrum, Dept. of Neurology, National Institute of Clinical Neurosciences, 1145 Budapest, Hungary
| | - Ferenc Gombos
- Department of General Psychology, Pázmány Péter Catholic University, 1088 Budapest, Hungary; MTA-PPKE Adolescent Development Research Group, Hungarian Academy of Sciences, 1088 Budapest, Hungary
| | - Loránd Erőss
- Epilepsy Centrum, Dept. of Neurology, National Institute of Clinical Neurosciences, 1145 Budapest, Hungary
| | - Lucia Wittner
- Epilepsy Centrum, Dept. of Neurology, National Institute of Clinical Neurosciences, 1145 Budapest, Hungary; Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Eötvös Loránd Research Network 1117 Budapest, Hungary; Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, 1088 Budapest, Hungary
| | - Eric Halgren
- Departments of Radiology and Neurosciences, University of California, 92093 San Diego CA, USA
| | - Sydney S Cash
- Center for Neurotechnology and Neurorecovery (CNTR), Department of Neurology, Massachusetts General Hospital, 02114 Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, 02115 MA, USA
| | - István Ulbert
- Epilepsy Centrum, Dept. of Neurology, National Institute of Clinical Neurosciences, 1145 Budapest, Hungary; Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Eötvös Loránd Research Network 1117 Budapest, Hungary; Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, 1088 Budapest, Hungary
| | - Dániel Fabó
- Epilepsy Centrum, Dept. of Neurology, National Institute of Clinical Neurosciences, 1145 Budapest, Hungary
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Tóth E, Bokodi V, Somogyvári Z, Maglóczky Z, Wittner L, Ulbert I, Erőss L, Fabó D. Laminar distribution of electrically evoked hippocampal short latency ripple activity highlights the importance of the subiculum in vivo in human epilepsy, an intraoperative study. Epilepsy Res 2020; 169:106509. [PMID: 33310654 DOI: 10.1016/j.eplepsyres.2020.106509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/04/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The goal of this study was to define the pathology and anesthesia dependency of single pulse electrical stimulation (SPES) dependent high-frequency oscillations (HFOs, ripples, fast ripples) in the hippocampal formation. METHODS Laminar profile of electrically evoked short latency (<100 ms) high-frequency oscillations (80-500 Hz) was examined in the hippocampus of therapy-resistant epileptic patients (6 female, 2 male) in vivo, under general anesthesia. RESULTS Parahippocampal SPES evoked HFOs in all recorded hippocampal subregions (Cornu Ammonis 2-3, dentate gyrus, and subiculum) were not uniform, rather the combination of ripples, fast ripples, sharp transients, and multiple unit activities. Mild and severe hippocampal sclerosis (HS) differed in the probability to evoke fast ripples: it decreased with the severity of sclerosis in CA2-3 but increased in the subiculum. Modulation in the ripple spectrum was observed only in the subiculum with increased fast HFO rate and frequency in severe HS. Inhalational anesthetics (isoflurane) suppressed the chance to evoke HFOs compared to propofol. CONCLUSION The presence of early HFOs in the dentate gyrus and early fast HFOs (>250 Hz) in the other subregions indicate the pathological nature of these evoked oscillations. Subiculum was found to be active producing HFOs in parallel with the cell loss in the hippocampus proper, which emphasize the role of this region in the generation of epileptic activity.
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Affiliation(s)
- Emília Tóth
- Epilepsy Centrum, Dept of Neurology, National Institute of Clinical Neurosciences, Budapest, 1145, Hungary; Department of Neurology, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA (present affiliation)
| | - Virág Bokodi
- Epilepsy Centrum, Dept of Neurology, National Institute of Clinical Neurosciences, Budapest, 1145, Hungary; Pázmány Péter Catholic University, Faculty of Information Technology and Bionics, Budapest, 1083, Hungary
| | - Zoltán Somogyvári
- Department of Computational Sciences, Wigner Research Centre, Eötvös Loránd Research Network, Budapest, 1121, Hungary
| | - Zsófia Maglóczky
- Department of Cellular and Network Neurobiology, Institute of Experimental Medicine, Eötvös Loránd Research Network, Budapest, 1083, Hungary; Human Brain Research Laboratory, Institute of Experimental Medicine, Eötvös Loránd Research Network, Budapest, 1083, Hungary
| | - Lucia Wittner
- Epilepsy Centrum, Dept of Neurology, National Institute of Clinical Neurosciences, Budapest, 1145, Hungary; Pázmány Péter Catholic University, Faculty of Information Technology and Bionics, Budapest, 1083, Hungary; Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Eötvös Loránd Research Network, Budapest, 1117, Hungary
| | - István Ulbert
- Epilepsy Centrum, Dept of Neurology, National Institute of Clinical Neurosciences, Budapest, 1145, Hungary; Pázmány Péter Catholic University, Faculty of Information Technology and Bionics, Budapest, 1083, Hungary; Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Eötvös Loránd Research Network, Budapest, 1117, Hungary
| | - Loránd Erőss
- Pázmány Péter Catholic University, Faculty of Information Technology and Bionics, Budapest, 1083, Hungary; Department of Functional Neurosurgery, National Institute of Clinical Neurosciences, Budapest, 1145, Hungary
| | - Dániel Fabó
- Epilepsy Centrum, Dept of Neurology, National Institute of Clinical Neurosciences, Budapest, 1145, Hungary.
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Fabó D, Horváth Z, Klivényi P, Kamondi A. Changes in epilepsy care during the first medical emergency period of COVID-19 pandemic in Hungary: A questionnaire survey. Orv Hetil 2020; 161:1939-1943. [PMID: 33190124 DOI: 10.1556/650.2020.32003] [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: 07/24/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: A COVID-19-járvány világszerte hónapokra átalakította a járóbeteg-ellátás működését is. Magyarországon a 2020. március 11-től 2020. június 17-ig fennálló egészségügyi veszélyhelyzeti rendelkezések szabták meg az új kereteket. Célkitűzés: Az első veszélyhelyzeti periódus második felében, 2020. április 22. és 2020. május 5. között mértük fel az epilepsziaellátásban részt vevő orvosok véleményét, hogy milyen mértékben változott a betegek ellátása, és hogyan élték meg a változásokat személyesen. Módszer: Internetes kérdőíves véleményfelmérés történt, a Magyar Epilepszia Liga 2020. április 16-17-re tervezett, de a COVID-19-járvány miatt elhalasztott XV. kongresszusára regisztrált neurológusok között. Kilenc egyszeres vagy többszörös feleletválasztós kérdés és 'szabad kommentár' mezők álltak rendelkezésre. Eredmények: A megkeresett 116 neurológus közül 33-an válaszoltak (28%), összesen 30 kommentár került rögzítésre. 73%-uk szerint a változások komoly nehézséget okoztak, 15%-uk gondolta, hogy ennek súlyos következményei lesznek. Új betegek fogadása 53%-ban leállt, 25%-ban nagy nehézségekbe ütközött. A gondozott betegek problémáit 49%-ban a távvizit lehetőségeivel élve meg tudták oldani, de 24%-ban ez nem sikerült. A beteg távollétében lebonyolított vizitek 68%-a dokumentált telefonbeszélgetések formájában zajlott. Az orvosok kétharmada veszélyeztetve érezte magát, hogy elkapja a vírust, ebből 40% úgy érezte, nem kap elegendő védelmet, 6% (2 fő) kapta el a fertőzést. Következtetés: A COVID-19-járvány a leginkább az új szakvélemények kiadását érintette, de a gondozási feladatokat sem mindig lehetett megfelelően megoldani. A károkat jelentősen enyhítette az ellátószemélyzet rugalmassága. A telefonvizitek, szükség esetén, az epileptológiában pótolhatják a személyes orvos-beteg találkozásokat. A járvány visszatérésének veszélye miatt a távvizit-alkalmazások technikai fejlesztése és ezek dokumentálási kérdéseinek megoldása fontos. A járványidőszakban a személyzet védelmére nagy figyelmet kell fordítani a fertőződés elkerülése és az orvosok biztonságérzetének fokozása érdekében. Orv Hetil. 2020; 161(46): 1939-1943. SUMMARY INTRODUCTION COVID-19 pandemic has transformed the operation of outpatient care worldwide for months. The new framework was set in Hungary by the health emergency regulations that existed from 11. 03. 2020 to 17. 06. 2020. OBJECTIVE In the second half of the emergency period, between 22. 04. 2020 and 05. 05. 2020, we surveyed the opinion of physicians involved in epilepsy care about the extent to which patient care had changed and how they experienced the changes in person. METHOD An internet questionnaire survey was conducted among neurologists registered for the annual congress of the Hungarian Chapter of the International League Against Epilepsy. Nine single- or multiple-choice questions and 'free comment' fields were available. RESULTS Of 116 neurologists contacted, 33 responded (28%), and a total of 30 comments were recorded. 73% said the changes caused a serious difficulty, 15% thought it would have serious consequences. Reception of new patients was stopped in 53%, and 25% encountered great difficulties. In 49%, the problems of the cared patients could be solved using remote visits, but 24% could not solve them properly. 68% of outpatient visits took the form of documented telephone conversations. Two-thirds of doctors feared catching the virus, 40% of whom felt they were not getting enough protection. 6% caught the infection. CONCLUSION The COVID-19 pandemic has mostly affected the issuance of new expert opinions, but care tasks have not always been adequately addressed. The damage was significantly mitigated by the flexibility of the care staff. Telephone visits, if necessary, can replace personal doctor-patient encounters in epileptology. The technical development of remote visit applications and their documentation issues are important. During the pandemic period, great care must be taken to protect staff in order to avoid infection and increase the sense of safety of doctors. Orv Hetil. 2020; 161(46): 1939-1943.
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Affiliation(s)
- Dániel Fabó
- 1 Neurológiai Osztály, Országos Klinikai Idegtudományi Intézet, Budapest, Amerikai út 57., 1145.,2 Általános Orvostudományi Kar, Neurológiai Klinika, Szegedi Tudományegyetem, Szeged
| | - Zoltán Horváth
- 2 Általános Orvostudományi Kar, Neurológiai Klinika, Szegedi Tudományegyetem, Szeged
| | - Péter Klivényi
- 2 Általános Orvostudományi Kar, Neurológiai Klinika, Szegedi Tudományegyetem, Szeged
| | - Anita Kamondi
- 1 Neurológiai Osztály, Országos Klinikai Idegtudományi Intézet, Budapest, Amerikai út 57., 1145
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Papp A, Horváth A, Fabó D, Kamondi A, Szűcs A. Sleep changes and epileptiform discharges in Parkinson's and Alzheimer's disease: 24-hour EEG study. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kaufmann E, Bartolomei F, Boon P, Chabardes S, Colon AJ, Eross L, Fabó D, Gonçalves-Ferreira A, Imbach LL, Van Paesschen W, Peltola J, Rego R, Theys T, Voges B. European Expert Opinion on ANT-DBS therapy for patients with drug-resistant epilepsy (a Delphi consensus). Seizure 2020; 81:201-209. [PMID: 32861153 DOI: 10.1016/j.seizure.2020.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/23/2020] [Accepted: 08/13/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Although deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) represents an established third-line therapy for patients with drug-resistant focal epilepsy, guiding reports on practical treatment principles remain scarce. METHODS An Expert Panel (EP) of 10 European neurologists and 4 neurosurgeons was assembled to share their experience with ANT-DBS therapy. The process included a review of the current literature, which served as a basis for an online survey completed by the EP prior to and following a face-to-face meeting (Delphi method). An agreement level of ≥71 % was considered as consensus. RESULTS Out of 86 reviewed studies, 46 (53 %) were selected to extract information on the most reported criteria for patient selection, management, and outcome. The Delphi process yielded EP consensus on 4 parameters for selection of good candidates and patient management as well as 7 reasons of concern for this therapy. Since it was not possible to give strict device programming advice due to low levels of evidence, the experts shared their clinical practice: all of them start with monopolar stimulation, 79 % using the cycling mode. Most (93 %) EP members set the initial stimulation frequency and pulse width according to the SANTE parameters, while there is more variability in the amplitudes used. Further agreement was achieved on a list of 7 patient outcome parameters to be monitored during the follow-up. CONCLUSIONS Although current evidence is too low for definite practical guidelines, this EP report could support the selection and management of patients with ANT-DBS.
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Affiliation(s)
- Elisabeth Kaufmann
- Epilepsy Center, Department of Neurology, University Hospital, LMU Munich, Munich, Germany.
| | - Fabrice Bartolomei
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France; APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Paul Boon
- Reference Center for Refractory Epilepsy, Ghent University Hospital Belgium - Academic Center for Epileptology, Heeze-Maastricht, the Netherlands
| | - Stéphan Chabardes
- Department of Neurosurgery-Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Department of Neurosurgery, Grenoble Alpes University Hospital, Grenoble, France; Grenoble Institute of Neurosciences GIN-INSERM U1216/CEA/UGA, Grenoble, France; Grenoble Alpes University, Grenoble, France
| | - Albert J Colon
- Academic Centre for Epileptology, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands; Academic Centre for Epileptology, Kempenhaeghe, Heeze, the Netherlands
| | - Loránd Eross
- Faculty of Information Technology and Bionics, Péter Pázmány Catholic University, Budapest, Hungary; Department of Functional Neurosurgery, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Dániel Fabó
- Epilepsy Centrum, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Antonio Gonçalves-Ferreira
- Department of Neurosurgery, University Hospital Santa Maria, Faculdade Medicina Lisboa, Lisbon, Portugal
| | - Lukas L Imbach
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wim Van Paesschen
- Department of Neurology, UZ Leuven, Leuven, Belgium; Laboratory for Epilepsy Research, KU Leuven, Leuven, Belgium
| | - Jukka Peltola
- Department of Neurology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Ricardo Rego
- Department of Neurophysiology, Hospital De São João, Porto, Portugal
| | - Tom Theys
- Laboratory for Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Berthold Voges
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany
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File B, Nánási T, Tóth E, Bokodi V, Tóth B, Hajnal B, Kardos Z, Entz L, Erőss L, Ulbert I, Fabó D. Reorganization of Large-Scale Functional Networks During Low-Frequency Electrical Stimulation of the Cortical Surface. Int J Neural Syst 2019; 30:1950022. [DOI: 10.1142/s0129065719500229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the functional network reorganization caused by low-frequency electrical stimulation (LFES) of human brain cortical surface. Intracranial EEG data from subdural grid positions were analyzed in 16 pre-surgery epileptic patients. LFES was performed by injecting current pulses (10[Formula: see text]mA, 0.2[Formula: see text]ms pulse width, 0.5[Formula: see text]Hz, 25 trials) into all adjacent electrode contacts. Dynamic functional connectivity analysis was carried out on two frequency bands (low: 1–4[Formula: see text]Hz; high: 10–40[Formula: see text]Hz) to investigate the early, high frequency and late, low frequency responses elicited by the stimulation. The centralization increased in early compared to late responses, suggesting a more prominent role of direct neural links between primarily activated areas and distant brain regions. Injecting the current into the seizure onset zone (SOZ) evoked a more integrated functional topology during the early (N1) period of the response, whereas during the late (N2) period — regardless of the stimulation site — the connectedness of the SOZ was elevated compared to the non-SOZ tissue. The abnormal behavior of the epileptic sub-network during both part of the responses supports the idea of the pathogenic role of impaired inhibition and excitation mechanisms in epilepsy.
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Affiliation(s)
- Bálint File
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, H-1083, Hungary
- Computational Neuroscience Group, Wigner Research Centre for Physics, HAS, Budapest, H-1121, Hungary
| | - Tibor Nánási
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, H-1083, Hungary
- Institute of Cognitive Neuroscience and Psychology, RCNS, HAS, Budapest, H-1117, Hungary
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, H-1085, Hungary
| | - Emília Tóth
- Department of Neurology, University of Alabama at Birmingham, AL 35233, USA
| | - Virág Bokodi
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, H-1083, Hungary
- Department of Functional Neurosurgery, National Institute of Clinical Neurosciences, Budapest, H-1145, Hungary
| | - Brigitta Tóth
- Institute of Cognitive Neuroscience and Psychology, RCNS, HAS, Budapest, H-1117, Hungary
| | - Boglárka Hajnal
- Juhász Pál Epilepsy Centrum, National Institute of Clinical Neuroscience, Budapest, H-1145, Hungary
| | - Zsófia Kardos
- Institute of Cognitive Neuroscience and Psychology, RCNS, HAS, Budapest, H-1117, Hungary
| | - László Entz
- Department of Functional Neurosurgery, National Institute of Clinical Neurosciences, Budapest, H-1145, Hungary
| | - Loránd Erőss
- Department of Functional Neurosurgery, National Institute of Clinical Neurosciences, Budapest, H-1145, Hungary
| | - István Ulbert
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, H-1083, Hungary
- Institute of Cognitive Neuroscience and Psychology, RCNS, HAS, Budapest, H-1117, Hungary
| | - Dániel Fabó
- Juhász Pál Epilepsy Centrum, National Institute of Clinical Neuroscience, Budapest, H-1145, Hungary
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Gyebnár G, Klimaj Z, Entz L, Fabó D, Rudas G, Barsi P, Kozák LR. Personalized microstructural evaluation using a Mahalanobis-distance based outlier detection strategy on epilepsy patients' DTI data - Theory, simulations and example cases. PLoS One 2019; 14:e0222720. [PMID: 31545838 PMCID: PMC6756533 DOI: 10.1371/journal.pone.0222720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/05/2019] [Indexed: 11/19/2022] Open
Abstract
Quantitative MRI methods have recently gained extensive interest and are seeing substantial developments; however, their application in single patient vs control group comparisons is often limited by inherent statistical difficulties. One such application is detecting malformations of cortical development (MCDs) behind drug resistant epilepsies, a task that, especially when based solely on conventional MR images, may represent a serious challenge. We aimed to develop a novel straightforward voxel-wise evaluation method based on the Mahalanobis-distance, combining quantitative MRI data into a multidimensional parameter space and detecting lesion voxels as outliers. Simulations with standard multivariate Gaussian distribution and resampled DTI-eigenvalue data of 45 healthy control subjects determined the optimal critical value, cluster size threshold, and the expectable lesion detection performance through ROC-analyses. To reduce the effect of false positives emanating from registration artefacts and gyrification differences, an automatic classification method was applied, fine-tuned using a leave-one-out strategy based on diffusion and T1-weighted data of the controls. DWI processing, including thorough corrections and robust tensor fitting was performed with ExploreDTI, spatial coregistration was achieved with the DARTEL tools of SPM12. Additional to simulations, clusters of outlying diffusion profile, concordant with neuroradiological evaluation and independent calculations with the MAP07 toolbox were identified in 12 cases of a 13 patient example population with various types of MCDs. The multidimensional approach proved sufficiently sensitive in pinpointing regions of abnormal tissue microstructure using DTI data both in simulations and in the heterogeneous example population. Inherent limitations posed by registration artefacts, age-related differences, and the different or mixed pathologies limit the generalization of specificity estimation. Nevertheless, the proposed statistical method may aid the everyday examination of individual subjects, ever so more upon extending the framework with quantitative information from other modalities, e.g. susceptibility mapping, relaxometry, or perfusion.
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Affiliation(s)
- Gyula Gyebnár
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Zoltán Klimaj
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - László Entz
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Gábor Rudas
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - Péter Barsi
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - Lajos R. Kozák
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
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Kandrács Á, Hofer KT, Tóth K, Tóth EZ, Entz L, Bagó AG, Erőss L, Jordán Z, Nagy G, Fabó D, Ulbert I, Wittner L. Presence of synchrony-generating hubs in the human epileptic neocortex. J Physiol 2019; 597:5639-5670. [PMID: 31523807 DOI: 10.1113/jp278499] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/06/2019] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS •Initiation of pathological synchronous events such as epileptic spikes and seizures is linked to the hyperexcitability of the neuronal network in both humans and animals. •In the present study, we show that epileptiform interictal-like spikes and seizures emerged in human neocortical slices by blocking GABAA receptors, following the disappearance of the spontaneously occurring synchronous population activity. •Large variability of temporally and spatially simple and complex spikes was generated by tissue from epileptic patients, whereas only simple events appeared in samples from non-epileptic patients. •Physiological population activity was associated with a moderate level of principal cell and interneuron firing, with a slight dominance of excitatory neuronal activity, whereas epileptiform events were mainly initiated by the synchronous and intense discharge of inhibitory cells. •These results help us to understand the role of excitatory and inhibitory neurons in synchrony-generating mechanisms, in both epileptic and non-epileptic conditions. ABSTRACT Understanding the role of different neuron types in synchrony generation is crucial for developing new therapies aiming to prevent hypersynchronous events such as epileptic seizures. Paroxysmal activity was linked to hyperexcitability and to bursting behaviour of pyramidal cells in animals. Human data suggested a leading role of either principal cells or interneurons, depending on the seizure morphology. In the present study, we aimed to uncover the role of excitatory and inhibitory processes in synchrony generation by analysing the activity of clustered single neurons during physiological and epileptiform synchronies in human neocortical slices. Spontaneous population activity was detected with a 24-channel laminar microelectrode in tissue derived from patients with or without preoperative clinical manifestations of epilepsy. This population activity disappeared by blocking GABAA receptors, and several variations of spatially and temporally simple or complex interictal-like spikes emerged in epileptic tissue, whereas peritumoural slices generated only simple spikes. Around one-half of the clustered neurons participated with an elevated firing rate in physiological synchronies with a slight dominance of excitatory cells. By contrast, more than 90% of the neurons contributed to interictal-like spikes and seizures, and an intense and synchronous discharge of inhibitory neurons was associated with the start of these events. Intrinsically bursting principal cells fired later than other neurons. Our data suggest that a balanced excitation and inhibition characterized physiological synchronies, whereas disinhibition-induced epileptiform events were initiated mainly by non-synaptically synchronized inhibitory neurons. Our results further highlight the differences between humans and animal models, and between in vivo and (pharmacologically manipulated) in vitro conditions.
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Affiliation(s)
- Ágnes Kandrács
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary.,Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary
| | - Katharina T Hofer
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary.,Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary
| | - Kinga Tóth
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Estilla Z Tóth
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - László Entz
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Attila G Bagó
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Zsófia Jordán
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Gábor Nagy
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - István Ulbert
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary.,Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary.,National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Lucia Wittner
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary.,Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary.,National Institute of Clinical Neuroscience, Budapest, Hungary
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Benkő Z, Stippinger M, Zlatnicki Á, Fabó D, Sólyom A, Erőss L, Yolchuyeva S, Telcs A, Somogyvári Z. Inferring causal relations between neurophysiological signals with dimensional causality. IBRO Rep 2019. [DOI: 10.1016/j.ibror.2019.07.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hajnal B, Entz L, Tóth E, Ulbert I, Fabó D, Erőss L. P10-S The neocortical neural correlates of electrically evoked cortical potentials in humans. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.550] [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: 10/26/2022]
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30
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Györfi O, Újvári Á, Hajnal B, Fabó D, Halász L, Eröss L, Kelemen A. P07-T Presurgical investigation of sexual behaviour of an epileptic patient. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.370] [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: 11/17/2022]
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Halász P, Ujma PP, Fabó D, Bódizs R, Szűcs A. Epilepsy as a derailment of sleep plastic functions may cause chronic cognitive impairment - A theoretical review. Sleep Med Rev 2019; 45:31-41. [PMID: 30878843 DOI: 10.1016/j.smrv.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/31/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
We report on a peculiar way of chronic cognitive impairment associated with interictal epileptic activity during NREM sleep. We review three major groups of epilepsy: mesiotemporal epilepsy (MTLE) involving the epileptic derailment of the hippocampal declarative memory system; childhood developmental epileptic encephalopathies; and the spectrum disorders of the perisylvian communication network with the centrotemporal spike phenomenon, overarching child- and adulthood epilepsies, totaling up the majority of epilepsies in childhood. We outline high impact research-lines on the cognitive harm of epilepsy; causing specific or global cognitive decline through its interference with sleep plastic functions. We highlight the key role of interictal activity in the development of cognitive impairment and the fact that we are unarmed against this harm, antiepileptic pharmaco-therapy being ineffective against the interictal process marked by spikes and high frequency oscillations.
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Affiliation(s)
- Péter Halász
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary.
| | - Péter Przemyslaw Ujma
- Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Róbert Bódizs
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary; Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Anna Szűcs
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary; Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
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Halász P, Bódizs R, Ujma PP, Fabó D, Szűcs A. Strong relationship between NREM sleep, epilepsy and plastic functions - A conceptual review on the neurophysiology background. Epilepsy Res 2019; 150:95-105. [PMID: 30712997 DOI: 10.1016/j.eplepsyres.2018.11.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/08/2018] [Accepted: 11/15/2018] [Indexed: 12/15/2022]
Abstract
The aim of this review is to summarize and discuss the strong bond between NREM sleep and epilepsy underlain by the shared link and effect on brain plasticity. Beyond the seizure occurrence rate, sleep relatedness may manifest in the enhancement of interictal epileptic discharges (spikes and pathological ripples). The number of the discharges as well as their propagation increase during NREM sleep, unmasking the epileptic network that is hidden during wakefulness. The interictal epileptic discharges associate with different sleep constituents (sleep slow waves, spindling and high frequency oscillations); known to play essential role in memory and learning. We highlight three major groups of epilepsies, in which sleep-related plastic functions suffer an epileptic derailment. In absence epilepsy mainly involving the thalamo-cortical system, sleep spindles transform to generalized spike-wave activity. In mesio-temporal epilepsy affecting the hippocampal declarative memory system, the sharp wave ripples derail to dysfunctional epileptic oscillations (spikes and pathological ripples). Idiopathic childhood epilepsies affecting the perisylvian network may progress to catastrophic status electricus during NREM sleep. In these major epilepsies, NREM sleep has a pivotal role in the development and course of the disorder. Epilepsy is born in-, and exhibits its pathological properties during NREM sleep. Interictal discharges are important causative agents in this process.
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Affiliation(s)
- Péter Halász
- National Institute of Clinical Neuroscience, Amerikai út 57. Budapest, H-1145, Hungary.
| | - Róbert Bódizs
- Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Péter Przemyslaw Ujma
- Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neuroscience, Amerikai út 57. Budapest, H-1145, Hungary
| | - Anna Szűcs
- National Institute of Clinical Neuroscience, Amerikai út 57. Budapest, H-1145, Hungary
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Sampson AL, Lainscsek C, Gonzalez CE, Ulbert I, Devinsky O, Fabó D, Madsen JR, Halgren E, Cash SS, Sejnowski TJ. Delay differential analysis for dynamical sleep spindle detection. J Neurosci Methods 2019; 316:12-21. [PMID: 30707917 DOI: 10.1016/j.jneumeth.2019.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/04/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sleep spindles are involved in memory consolidation and other cognitive functions. Numerous automated methods for detection of spindles have been proposed; most of these rely on spectral analysis in some form. However, none of these approaches are ideal, and novel approaches to the problem could provide additional insights. NEW METHOD Here, we apply delay differential analysis (DDA), a time-domain technique based on nonlinear dynamics to detect sleep spindles in human intracranial sleep data, including laminar electrode, stereoelectroencephalogram (sEEG), and electrocorticogram (ECoG) recordings. RESULTS We show that this approach is computationally fast, generalizable, requires minimal preprocessing, and provides excellent agreement with human scoring. COMPARISON WITH EXISTING METHODS We compared the method with established methods on a set of intracranial recordings and this method provided the highest agreement with human expert scoring when evaluated with F1 score while being the second-fastest to run. We also compared the results on the DREAMS surface EEG data, where the method produced a higher average F1 score than all other tested methods except the automated detections published with the DREAMS data. Further, in addition to being a fast and reliable method for spindle detection, DDA also provides a novel characterization of spindle activity based on nonlinear dynamical content of the data. CONCLUSIONS This additional, non-frequency-based perspective could prove particularly useful for certain atypical spindles, or identifying spindles of different types.
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Affiliation(s)
- Aaron L Sampson
- Computational Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA 92037, USA; Neurosciences Graduate Program, University of California San Diego, La Jolla, CA 92093, USA.
| | - Claudia Lainscsek
- Computational Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA 92037, USA; Institute for Neural Computation, University of California San Diego, La Jolla, CA 92093, USA
| | - Christopher E Gonzalez
- Computational Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA 92037, USA; Neurosciences Graduate Program, University of California San Diego, La Jolla, CA 92093, USA
| | - István Ulbert
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Magyar tudósok körútja 2, H-1117 Budapest, Hungary; Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, H-1083 Budapest, Hungary
| | - Orrin Devinsky
- New York University Comprehensive Epilepsy Center, New York, NY 10016, USA
| | - Dániel Fabó
- Epilepsy Centrum, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Joseph R Madsen
- Departments of Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Eric Halgren
- Departments of Radiology and Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA 02114, USA
| | - Terrence J Sejnowski
- Computational Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA 92037, USA; Institute for Neural Computation, University of California San Diego, La Jolla, CA 92093, USA; Division of Biological Sciences, University of California San Diego, La Jolla, CA 92093, USA
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Manhalter N, Györfi O, Boros E, Bokor M, Fazekas F, Dénes Z, Fabó D, Kamondi A, Erőss L. Case report of a woman with anti amphiphysin positive stiff person syndrome. Ideggyogy Sz 2019; 70:213-216. [PMID: 29870637 DOI: 10.18071/isz.70.0213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stiff person syndrome is a rare neuroimmunological disease, characterized by severe, involuntary stiffness with superimposed painful muscle spasms, which are worsened by external stimuli. The classical form is associated with high levels of antibodies against glutamic acid decarboxylase. One of the variant forms is associated with antibodies against amphiphysin. This entity is a paraneoplastic syndrome, caused primarily by breast cancer, secondarily by lung cancer. Symptomatic therapy of anti amphiphysin positive stiff person syndrome includes treatment with benzodiazepines and baclofen (including intrathecal baclofen therapy). The effect of immunological therapies is controversial. Treatment of the underlying cancer may be very effective. In this report, we describe a 68 year old female presenting with an unusally rapidly developing anti amphiphysin positive stiff person syndrome, which was associated with breast cancer. Her painful spasms abolished after intrathecal baclofen treatment was initiated. Her condition improved spontaneously and significantly after cancer treatment, which enabled to start her complex rehabilitation and the simultaneous dose reduction of the intrathecal baclofen. The bedridden patient improved to using a rollator walker and the baclofen pump could be removed 18 monthes after breast surgery. This highlights the importance of cancer screening and treatment in anti amphiphysin positive stiff person syndrome cases.
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Affiliation(s)
- Nóra Manhalter
- Neurological Rehabilitation Center Rosenhügel, Vienna, Austria
| | - Orsolya Györfi
- Department of Neurology, National Institut of Psychiatry and Addictology Nyírô Gyula, Budapest, Hungary
| | - Erzsébet Boros
- National Institute for Medical Rehabilitation, Budapest, Hungary
| | - Magdolna Bokor
- Department of Neurology, National Institut of Psychiatry and Addictology Nyírô Gyula, Budapest, Hungary
| | - Ferenc Fazekas
- Department of Neurology, Hungarian Military Hospital, Budapest, Hungary
| | - Zoltán Dénes
- National Institute for Medical Rehabilitation, Budapest, Hungary
| | - Dániel Fabó
- Department of Neurology, National Institut of Clinical Neuroscience, Budapest, Hungary
| | - Anita Kamondi
- Department of Neurology, National Institut of Clinical Neuroscience, Budapest, Hungary
| | - Loránd Erőss
- Department of Functional Neurosurgery, National Institut of Clinical Neuroscience, Budapest, Hungary
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Ujma PP, Halász P, Simor P, Fabó D, Ferri R. Increased cortical involvement and synchronization during CAP A1 slow waves. Brain Struct Funct 2018; 223:3531-3542. [PMID: 29951916 DOI: 10.1007/s00429-018-1703-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/20/2018] [Indexed: 12/25/2022]
Abstract
Slow waves recorded with EEG in NREM sleep are indicative of the strength and spatial extent of synchronized firing in neuronal assemblies of the cerebral cortex. Slow waves often appear in the A1 part of the cyclic alternating patterns (CAP), which correlate with a number of behavioral and biological parameters, but their physiological significance is not adequately known. We automatically detected slow waves from the scalp recordings of 37 healthy patients, visually identified CAP A1 events and compared slow waves during CAP A1 with those during NCAP. For each slow wave, we computed the amplitude, slopes, frequency, synchronization (synchronization likelihood) between specific cortical areas, as well as the location of origin and scalp propagation of individual waves. CAP A1 slow waves were characterized by greater spatial extent and amplitude, steeper slopes and greater cortical synchronization, but a similar prominence in frontal areas and similar propagation patterns to other areas on the scalp. Our results indicate that CAP A1 represents a period of highly synchronous neuronal firing over large areas of the cortical mantle. This feature may contribute to the role CAP A1 plays in both normal synaptic homeostasis and in the generation of epileptiform phenomena in epileptic patients.
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Affiliation(s)
- Péter Przemyslaw Ujma
- Institute of Clinical Neuroscience, "Juhász Pál" Epilepsy Centrum, Amerikai út 57, Budapest, 1145, Hungary.
- Institute of Behavioural Sciences, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary.
| | - Péter Halász
- Institute of Clinical Neuroscience, "Juhász Pál" Epilepsy Centrum, Amerikai út 57, Budapest, 1145, Hungary
| | - Péter Simor
- Institute of Psychology, ELTE, Eötvos Loránd University, Kazinczy utca 23-27, Budapest, 1075, Hungary
| | - Dániel Fabó
- Institute of Clinical Neuroscience, "Juhász Pál" Epilepsy Centrum, Amerikai út 57, Budapest, 1145, Hungary
| | - Raffaele Ferri
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 91018, Troina, Italy
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Kováts D, Császár-Nagy N, Juhos V, Sallay V, Békés J, Fabó D, Kelemen A, Kurimay T. [Assessment of health related quality of life among epileptic patients in the context of coping strategies and subjective disease perception]. Ideggyogy Sz 2018; 71:184-196. [PMID: 29889461 DOI: 10.18071/isz.71.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background and purpose Psychosocial condition and life quality of epileptic patients are greatly determined by the existence of the disease-related comorbid disorders, like depression, anxiety, and the subjective disease perception, as well as the neuropsychological consequences of the seizures.It has been examined in patients living with epilepsy how subjective disease perception and coping strategies influence life quality, comorbid depression and the condition of anxiety. Methods Study patients were asked to fill in a self-completion questionnaire, which examined their psychosocial condition (HADS, Beck Depression Scale), life quality (Qolie-31), coping strategies (FKV-LIS), and subjective disease perception (IPQ-R), as well as sociodemographic and disease variables. The subjects of the study: the data of epileptic patients between the age of 18 to 70 was recorded. Patients were selected from the adult outpatients of a national centre, a regional hospital and two private health care centres located in Budapest. Results Based on the multiple regression analysis. Beck's depression (b coefficient=-0.351, t=-4.703, p<0.001**). Depressive coping strategy (FKV Dep) (b coefficient = -0.235, t=-3.123, p=0.002**). Subjective health perception (b coefficient =0.232. t=3.643, p<0.001**). Sex (women; b coefficient =-0.162, t=-3.008, p=0.003**). IPQ consequences (b coefficient =-0.161, t=-2.572, p=0.012*). Active coping strategy (FKV Act; b coefficient =0.146, t=2.572, p=0.012*). Type of seizure (b coefficient =-0.138, t=-2.527, p=0.013*), and Sleep quality (b coefficient =-0.125, t=-1.995, p=0.049) explain some 75.6% of the variance of life quality's total score (model3: F=33.333, p<0.001**. adjusted R2=0.733). Conclusion Among the factors of the subjective disease perception (IPQ-R), the physical, mental and social consequences play the most important role. Similarly, the impact of negative emotional representation, as well as the erratic nature of the seizures are decisive. Emotional representation, cyclicity and disease coherence have an important role in coping with disease-related negative emotions.
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Affiliation(s)
| | | | - Vera Juhos
- Felnôtt és Gyermek Epilepszia Rendelés, Budapest
| | | | - Judit Békés
- Juhász Pál Epilepszia Centrum, Országos Klinikai Idegtudományi Intézet, Budapest
| | - Dániel Fabó
- Országos Klinikai Idegtudományi Intézet, Budapest
| | - Anna Kelemen
- Országos Klinikai Idegtudományi Intézet, Budapest
| | - Tamás Kurimay
- Szent János Kórház és Észak-budai Egyesített Kórházak, Budapest
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Abstract
Neurophysiological methods are gaining ground in the diagnosis and therapy of cerebrovascular disease. While the role of the EEG (electroencephalography) in the diagnosis of post-stroke epilepsy is constant, quantitative EEG para-meters, as new indicators of early efficiency after thrombolysis or in prognosis of patient's condition have proved their effectiveness in several clinical studies. In intensive care units, continuous EEG monitoring of critically ill patients became part of neurointenzive care protocols. SSEP (somatosesnsory evoked potencial) and EEG performed during carotid endarterectomy, are early indicative intraoperativ neuromonitoring methods of poor outcome. Neurorehabilitation is a newly discovered area of neurophysiology. Clinical studies have demonstrated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the rehabilitation of stroke patients. Brain computer interface mark the onset of modern rehabi-litation, where the function deficit is replaced by robotic tehnology.
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Affiliation(s)
- Ildikó Nagy
- Szentendre Város Egészségügyi Intézményei, Neurofiziológiai Laboratórium, Szentendre
| | - Dániel Fabó
- Juhász Pál Epilepszia Centrum, Neurológiai Osztály, Országos Klinikai Idegtudományi Intézet, Budapest
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Tóth K, Hofer KT, Kandrács Á, Entz L, Bagó A, Erőss L, Jordán Z, Nagy G, Sólyom A, Fabó D, Ulbert I, Wittner L. Hyperexcitability of the network contributes to synchronization processes in the human epileptic neocortex. J Physiol 2017; 596:317-342. [PMID: 29178354 DOI: 10.1113/jp275413] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/15/2017] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Hyperexcitability and hypersynchrony of neuronal networks are thought to be linked to the generation of epileptic activity in both humans and animal models. Here we show that human epileptic postoperative neocortical tissue is able to generate two different types of synchronies in vitro. Epileptiform bursts occurred only in slices derived from epileptic patients and were hypersynchronous events characterized by high levels of excitability. Spontaneous population activity emerged in both epileptic and non-epileptic tissue, with a significantly lower degree of excitability and synchrony, and could not be linked to epilepsy. These results help us to understand better the role of excitatory and inhibitory neuronal circuits in the generation of population events, and to define the subtle border between physiological and pathological synchronies. ABSTRACT Interictal activity is a hallmark of epilepsy diagnostics and is linked to neuronal hypersynchrony. Little is known about perturbations in human epileptic neocortical microcircuits, and their role in generating pathological synchronies. To explore hyperexcitability of the human epileptic network, and its contribution to convulsive activity, we investigated an in vitro model of synchronous burst activity spontaneously occurring in postoperative tissue slices derived from patients with or without preoperative clinical and electrographic manifestations of epileptic activity. Human neocortical slices generated two types of synchronies. Interictal-like discharges (classified as epileptiform events) emerged only in epileptic samples, and were hypersynchronous bursts characterized by considerably elevated levels of excitation. Synchronous population activity was initiated in both epileptic and non-epileptic tissue, with a significantly lower degree of excitability and synchrony, and could not be linked to epilepsy. However, in pharmacoresistant epileptic tissue, a higher percentage of slices exhibited population activity, with higher local field potential gradient amplitudes. More intracellularly recorded neurons received depolarizing synaptic potentials, discharging more reliably during the events. Light and electron microscopic examinations showed slightly lower neuron densities and higher densities of excitatory synapses in the human epileptic neocortex. Our data suggest that human neocortical microcircuits retain their functionality and plasticity in vitro, and can generate two significantly different synchronies. We propose that population bursts might not be pathological events while interictal-like discharges may reflect the epileptogenicity of the human cortex. Our results show that hyperexcitability characterizes the human epileptic neocortical network, and that it is closely related to the emergence of synchronies.
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Affiliation(s)
- Kinga Tóth
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, 1117, Budapest, Hungary.,Institute of Experimental Medicine, Hungarian Academy of Sciences, 1083, Budapest, Hungary
| | - Katharina T Hofer
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, 1117, Budapest, Hungary.,Department of Information Technology, Pázmány Péter Catholic University, 1083, Budapest, Hungary
| | - Ágnes Kandrács
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, 1117, Budapest, Hungary.,Department of Information Technology, Pázmány Péter Catholic University, 1083, Budapest, Hungary
| | - László Entz
- National Institute of Clinical Neuroscience, 1145, Budapest, Hungary
| | - Attila Bagó
- National Institute of Clinical Neuroscience, 1145, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neuroscience, 1145, Budapest, Hungary
| | - Zsófia Jordán
- National Institute of Clinical Neuroscience, 1145, Budapest, Hungary
| | - Gábor Nagy
- National Institute of Clinical Neuroscience, 1145, Budapest, Hungary
| | - András Sólyom
- National Institute of Clinical Neuroscience, 1145, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neuroscience, 1145, Budapest, Hungary
| | - István Ulbert
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, 1117, Budapest, Hungary.,Department of Information Technology, Pázmány Péter Catholic University, 1083, Budapest, Hungary.,National Institute of Clinical Neuroscience, 1145, Budapest, Hungary
| | - Lucia Wittner
- Institute of Cognitive Neuroscience and Psychology, Research Center for Natural Sciences, Hungarian Academy of Sciences, 1117, Budapest, Hungary.,Institute of Experimental Medicine, Hungarian Academy of Sciences, 1083, Budapest, Hungary.,National Institute of Clinical Neuroscience, 1145, Budapest, Hungary
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Horváth A, Szűcs A, Barcs G, Fabó D, Kelemen A, Halász P, Erőss L, Kamondi A. Interictal Epileptiform Activity in the Foramen Ovale Electrodes of a Frontotemporal Dementia Patient. J Alzheimers Dis Rep 2017; 1:89-96. [PMID: 30480231 PMCID: PMC6159658 DOI: 10.3233/adr-170020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Frontotemporal dementia (FTD) is a frequent cause of cognitive decline. While epilepsy is an important comorbidity of Alzheimer’s disease, we lack studies on its presence in FTD. We report on an FTD patient with transient, short-term changes of behavior and cognitive performance suggesting non-convulsive epilepsy. Video-EEG recording with foramen ovale (FO) electrodes revealed mesio-temporal epileptiform potentials, undetectable by scalp leads. We also found beta spindles in the FO electrodes, not described in the literature. We conclude that video-EEG monitoring with FO electrodes might usefully complement the assessment of dementia-associated epilepsy opening new perspectives in dementia-research.
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Affiliation(s)
- András Horváth
- National Institute of Clinical Neurosciences, Budapest, Hungary.,Semmelweis University School of PhD Studies, János Szentágothai Doctoral School of Neurosciences, Budapest, Hungary.,Department of Anatomy Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Anna Szűcs
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Gábor Barcs
- National Institute of Clinical Neurosciences, Budapest, Hungary.,Semmelweis University School of PhD Studies, János Szentágothai Doctoral School of Neurosciences, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Péter Halász
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Anita Kamondi
- National Institute of Clinical Neurosciences, Budapest, Hungary.,Department of Neurology, Semmelweis University, Budapest, Hungary
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40
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Somogyvári Z, Hajnal B, Halász P, Erőss L, Fabó D. P372 Inference of intra and inter hippocampal directed causal relationships based on foramen ovale recordings. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.380] [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: 11/29/2022]
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41
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File B, Tóth E, Bokodi V, Keczer Z, Entz L, Ulbert I, Fabó D. P243 Functional connectivity analysis of cortico-cortical evoked potentials. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.251] [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: 11/29/2022]
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42
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Perczel G, Erőss L, Fabó D, Gerencsér L, Vágó Z. P371 Simulation and estimation of Hawkes processes for modeling EEG data to forecast epileptic seizures. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.379] [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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43
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Erőss L, Halász L, Kozák LR, Barsi P, Fabó D, Entz L. S196 New approach to presurgical evaluation in epilepsy surgery. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.204] [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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44
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Bokodi V, Tóth E, Somogyvári Z, Maglóczky Z, Entz L, Erőss L, Ulbert I, Fabó D. P308 Cross-frequency coupling in the human epileptic hippocampus. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Kováts D, Császár N, Haller J, Juhos V, Sallay V, Békés J, Kelemen A, Fabó D, Rásonyi G, Folyovich A, Kurimay T. Factors affecting quality of life in Hungarian adults with epilepsy: A comparison of four psychiatric instruments. Epilepsy Behav 2017; 74:45-58. [PMID: 28686907 DOI: 10.1016/j.yebeh.2017.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/30/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We investigated the impact of 19 factors on life quality in Hungarian patients with epilepsy. Wellbeing was evaluated by several inventories to investigate the impact of factors in more detail. METHODS A cross-sectional study was performed in 170 patients. Wellbeing was evaluated with the WHO-5 Well-being Index (WHOQOL-5), Diener Satisfaction with Life Scale (SwLS), and the Quality of Life in Epilepsy-31 Questionnaire (Qolie-31). We investigated their association with demographic characteristics, general health status, epilepsy, and its treatment. The impact of these factors on illness perception (Illness Perception Questionnaire, IPQ) was also studied. RESULTS The four measures correlated highly significantly. In addition, the predictive power of factors was comparable with the four inventories as evaluated by Multiple Regression. Factors explained 52%, 41%, 63% and 46% in the variance of WHOQOL-5, SwLS, Qolie-31, and IPQ scores, respectively. However, associations with particular factors were instrument-specific. The WHOQOL-5 was associated with factors indicative of general health. SwLS scores were associated with health-related and several demographic factors. Neither showed associations with epilepsy-related factors. All four categories of factors were associated with Qolie-31 and IPQ scores. Factors had an additive impact on IPQ, but not on Qolie-31. SIGNIFICANCE Our findings reveal interactions between the method of life quality assessment and the factors that are identified as influencing life quality. This appears to be the first study that analyses the factors that influence illness perception in epilepsy patients, and suggests that the IPQ may become a valuable tool in epilepsy research.
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Affiliation(s)
| | - Noémi Császár
- Károli Gáspár University, Faculty of Humanities, Institute of Psychology, Budapest, Hungary
| | - József Haller
- National University of Public Service, Budapest, Hungary; Institute of Experimental Medicine, Budapest, Hungary
| | - Vera Juhos
- Pediatric and Adult Epilepsy-Neurology Centre, Budapest, Hungary
| | - Viola Sallay
- University of Szeged, Department of Clinical and Health Psychology, Institute of Psychology, Szeged, Hungary
| | - Judit Békés
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - György Rásonyi
- National Institute of Clinical Neurosciences, Budapest, Hungary; Neurocenter, Rigshospitalet, Copenhagen University, Denmark
| | - András Folyovich
- Szent János Hospital of the Municipality of Budapest, United Hospitals of North Buda, Department of Neurology, Budapest, Hungary
| | - Tamás Kurimay
- Szent János Hospital of the Municipality of Budapest, United Hospitals of North Buda, Department of Psychiatry and Psychiatric Rehabilitation, Budapest, Hungary
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Gorka E, Fabó D, Gézsi A, Czirbesz K, Fedorcsák I, Liszkay G. Dabrafenib Therapy in 30 Patients with Melanoma Metastatic to the Brain: a Single-centre Controlled Retrospective Study in Hungary. Pathol Oncol Res 2017; 24:401-406. [PMID: 28567600 DOI: 10.1007/s12253-017-0256-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/23/2017] [Indexed: 01/01/2023]
Abstract
Dabrafenib is a potent BRAF inhibitor, which showed intracranial tumor activity. The purpose of our retrospective analysis was to evaluate the efficacy of dabrafenib for patients with melanoma brain metastasis (BM). We studied 30 BRAF mutant melanoma patients with BM, who received dabrafenib after local control of the brain between 2014 and 2017. Eastern Cooperative Oncology Group Performance Status (ECOG) was 0-2. The control arm consisted of 204 melanoma patients from our institutional melanoma database with BM and ECOG 0-2 treated with local therapies and/or chemotherapy, between 2003 and 2015. We found the intracranial disease control rate (DCR) was 83% including four (13%) complete remissions (CR), nine (30%) partial remissions (PR) and twelve (40%) stable diseases (SD) in contrast to five (17%) progressive diseases (PD). With a median follow-up of 14 months, median progression-free survival (PFS) and overall survival (OS) were 5.5 months, and 8.8 months, respectively. If calculated from BM onset, the OS turned to be 11.8 months on the dabrafenib arm, while it was only 6.0 months in the control arm (HR = 0.45, p = 0.0014). Higher risk of progression was observed with increasing ECOG (HR =4.06, p = 0.00027) and if more than 2 extracranial organs were involved (HR = 3.4, p = 0.0077). Elevated lactate dehydrogenase (LDH) was non-significantly associated with worse clinical outcome. Remarkable intracranial activity of dabrafenib in real practice was confirmed by our analysis.
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Affiliation(s)
- Eszter Gorka
- Dermatooncology Department, National Institute of Oncology, Ráth György str. 7-9, Budapest, H-1122, Hungary.
| | - Dániel Fabó
- Epilepsy Centrum, Department of Neurology, National Institute of Clinical Neurosciences, Amerikai str. 57, Budapest, H-1145, Hungary
| | - András Gézsi
- Department of Genetics, Cell- and Immunbiology, Semmelweis University, Nagyvárad sq. 4, Budapest, H-1084, Hungary
| | - Kata Czirbesz
- Dermatooncology Department, National Institute of Oncology, Ráth György str. 7-9, Budapest, H-1122, Hungary
| | - Imre Fedorcsák
- Epilepsy Centrum, Department of Neurology, National Institute of Clinical Neurosciences, Amerikai str. 57, Budapest, H-1145, Hungary
| | - Gabriella Liszkay
- Dermatooncology Department, National Institute of Oncology, Ráth György str. 7-9, Budapest, H-1122, Hungary
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Balogh A, Anwar A, Kelemen A, Erőss L, Fabó D. The role of the insula in the parieto-frontomedial epileptic network. Clues from successful surgical treatment. Ideggyogy Sz 2017; 70:203-208. [PMID: 29870635 DOI: 10.18071/isz.70.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We present a case of MRI negative SMA seizure with the seizure onset zone in the secondary leg area on the superior bank of the Sylvian fissure, localized with multiscale electro-clinical and neuroradiological examinations. The 34-year-old female patient's intractable epilepsy started at age 14. She had diffuse pain aura in her left leg followed by tonic posturing with fully preserved consciousness suggesting parieto-fronto-medial seizure propagation. Her daily nocturnal SMA seizures became drug-resistant. Multiple 3T MRI images and neuropsychological evaluations were normal. Interictal PET detected a right parietal and insular FDG hypometabolism. The seizure onset zone and the symptomatogenic zone were localized by invasive electrophysiology. The insular deep electrode showed the propagation of ictal activity with an onset in the secondary sensory leg area through the insula to the fronto-medial surface. Eighteen spontaneous seizures, electrical cortical stimulation and cortical mapping confirmed the designated area of the resection, which was later proved macroscopically abnormal during surgery. The histological and immunohistological workup confirmed focal cortical dysplasia (IIb type). Postoperative postprocessing morphometry of the preoperative MRI study confirmed the lesion in the right inferior parietal lobe. The patient remained seizure free after surgery for more than 4 years, and medication free for the last two years. Our results concluded that the insula has a "relay" or "node" function in the parieto-opercular-fronto-medial epileptic network. The insular functional connectivity predisposed frontal propagation of the epileptic activity in the connectome of her epilepsy. The three-way insular structural connectivity has determining function on the seizure propagation.
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Affiliation(s)
- Attila Balogh
- Capital and Regional Center of Epilepsy, Department of Neurology, St Stephen Hospital, Budapest
| | - Aimen Anwar
- Capital and Regional Center of Epilepsy, Department of Neurology, St Stephen Hospital, Budapest
| | - Anna Kelemen
- National Institute of Clinical Neuroscience, Budapest
| | - Lóránd Erőss
- National Institute of Clinical Neuroscience, Budapest
| | - Dániel Fabó
- National Institute of Clinical Neuroscience, Budapest
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48
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Halász L, Kis D, Entz L, Tamás G, Klivényi P, Fabó D, Barzó P, Ero˝ss L. EP 77. Target identification in deep brain stimulation for Parkinson’s disease: The role of probabilistic tractography. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Tamás G, Kelemen A, Albert D, Rózsa I, Csibri E, Entz L, Fabó D, Halász L, Rudas G, Barsi P, Golopencza P, Eröss L. EP 8. Motor outcome of the bilateral subthalamic stimulation in Parkinson’s disease, one-year follow-up results from the Neuromodulation Centre in Budapest. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.202] [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: 10/21/2022]
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50
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Gorka E, Fabó D, Gézsi A, Czirbesz K, Liszkay G. Distance from Primary Tumor Is the Strongest Predictor for Early Onset of Brain Metastases in Melanoma. Anticancer Res 2016; 36:3065-3069. [PMID: 27272828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/11/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM The frequency of brain metastasis (BM) is up to 45-50% in patients with advanced melanoma. Our aim was to identify the risk factors for the early occurrence of BM. PATIENTS AND METHODS A total of 333 patients with BM were identified from our database of 2,972 patients with melanoma between 2003-2015. RESULTS The median elapsed time to BM (TTBM) was significantly associated with Breslow thickness, ulceration, location, and patient age. Head and neck location was the strongest predictor for early BM development [hazard ratio (HR)=1.81, 95% confidence interval (CI)=1.05-3.12; p=0.031) followed by Breslow thickness >2 mm (HR=1.53, 95% CI=1.04-2.23; p=0.027). Body part-specific median TTBM was 51.5, 43, 38.5, 32, 35, 36.5, 35.5 and 19 months in leg-foot, thigh, abdomen-pelvic, chest-back, lower arm-hand, upper arm-shoulder, face-neck and scalp regions, respectively. CONCLUSION We suggest brain magnetic resonance imaging follow-up in the high-risk patient group of patients with melanoma in the head and neck region, especially for those with primary melanoma over Breslow 2 mm located in the scalp.
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Affiliation(s)
- Eszter Gorka
- Department of Dermato-oncology, National Institute of Oncology, Budapest, Hungary
| | - Dániel Fabó
- Epilepsy Centre, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - András Gézsi
- Department of Genetics, Cell and Immunbiology, Semmelweis University, Budapest, Hungary
| | - Kata Czirbesz
- Department of Dermato-oncology, National Institute of Oncology, Budapest, Hungary
| | - Gabriella Liszkay
- Department of Dermato-oncology, National Institute of Oncology, Budapest, Hungary
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